Frequency of Tests?

[Perrster]

Al,

Are there any general guidelines for the frequency of an INR test? I scored a "perfect" 2.9 on my last test in late December. My future Coumadin Clinic appointments have always been set for roughly 30 days (after a good score) and 2 weeks (after an unsatisfactory score and subsequent adjustment of Coumadin).

Do we go by an unwritten rule of thumb that says we always have to test every 30 days if our score is good? As long as a person is feeling fine and doesn't go on a lettuce-eating binge or do something real whacky with his diet, could their test frequency be extended?

I once didn't test for 2 months because the hospital lab I was going to employed very bad vampires so I avoided it as long as possible!

My point is, I'm still here to talk about it and now have another situation that may force me to go back to those bad bats! My lovely Coumadin nurse's last day is today. I was seeing her diligently for a whole year and nobody knows my veins better than her!

Basically, I'm thinking of delaying my 30-day "due date" to about 45 days so I can see my one and only favorite clinic nurse again at her new job. Am I breaking the law?

I am also going to benefit from her new employer (a local Cardiologist and Director of the Cath lab at the hospital) so I'm waiting my records to be transferred.

Thanks in advance for your thoughts.

 

[RobThatsMe]

Hi Perry,

I know how you feel about staying with the nurse that you feel is most knowledgable. I just found out that the nurse that I have been working with to adjust my levels, just left to be a stay at home mom. Well, the new nurse proceeds to tell me that she has only been adjusting the doctors' patients Coumadin levels for 2 weeks. I am so glad I have gained the confedence to adjust mine on my own. Thanks to my home testing unit.

It does take 3 days for an adjustment to your dose to stablize within you system. I surely would want to test more frequently than every 2 months. Alot can happen within that time, diet changes, exercise level changes, colds, etc. As you know, anything and everything can effect our INR levels. I test every 2 weeks if I have been within range for the prior few tests. But, I test weekly if my levels have been bouncing.

I am sure Al will provide his thoughts on this as well.

Have a great weekend!

Rob

 

[Nancy]

Hi Perry-

Joe has always gone in on a monthly basis, unless his Coumadin is a little out of whack, then it's every 2 weeks and has even been every week. Too many things both known and maybe even unknown can influence the INR. It's too tricky to let it go too long.

So be a good boy now.

 

[hensylee]

Now Perry, you know better than that. Nuff said

God bless, anyway

 

[Guest]

I have stretched out the time between tests to 6 weeks for people who have not had their warfarin dose changed in the past 6 months. I have even gone to 2 months for people who have not had a change in over one year. But...
One of the most interesting aspects of warfarin management is that the more routine your life is, the easier warfarin is to manage. I saw a lady today who is a high functioning Down's Syndrome person. She eats the same thing every day, carries out the same duties every day and is able to take the bus to get to her appointments. I have not changed her warfarin dose in over 2 years and her INR has not been up or down by more than 0.3 units in that time.
At the other end of the spectrum - homeless. Never any routine. They rarely return for the first follow-up appointment and I can't recall one who ever came back for the third visit.

 

[Perrster]

Thanks Al

Thanks Al

Once again, I appreciate your thorough reply.

I think I'll be ok stretching my next test to 35 or 45 days so I can see the good nurse, but I'm surely not planning to make a habit of it!

Interesting factoids about routines.

 

[Herb M]

My INR usually does not fluctuate very much so I usually get tested about every 6 weeks. For the few times my INR was out of acceptable range, I tested in one or two weeks after a change in doseage and then at 4 weeks before going back to the 6 week interval.

 

[McCln]

Perry

Perry

You should know by now that you should stay in routine unless there has been a change in your numbers. Please go despite they being vampires. You know that when people refuse to go to doctor's, what happens? They get sick and then have to go to doctor. The same thing here, and you are an example to others who are still quit new, like me. You are telling me to not take good care of myself, by neglicting my coumadin check every month. Shame on you. I am doing quite well, but when one does not take care of him/herself, I have to say something. Please keep up the coumadin checks. You will be glad you did.


Caroline
Aortic valve replacement
09-13-01
St jude's valve

 

[Perrster]

I'm Sorry

I'm Sorry

I know, I know.

I appreciate the lecture. Really! I won't let you down.

I've been thinking I may have to just bite the (silver) bullet and go see a bad vampire.

My next Protime test is not actually scheduled until the 30th so I still have time to work this thing out. My former clinic nurse starts her new job on the 28th. I'm hoping I can get on the Cardiologist's new patient list by then and get in to see her, even before I see him! (I wouldn't have had a follow-up appointment with my old Cardiologist until June). I've already requested my records transfer and faxxing a letter today explaining the scenario to the doc.

I'm hoping her new boss (and my new Cardiologist) would allow her to take a 5-minute break (for me!?) from her orientation.

Thanks again.

 

[RobThatsMe]

Hi Perry,

Hey..Perry.... Here's an idea! Take a gettaway weekend mini-vacation .....get a cheap plane ride to Nashville, and use my ProTime Unit.

Hope you have a good week!

Rob

 

[Lorraine]

Perry..., Perry...., Perry...!

I know how you feel about the INR checks. But come on now. We don't want to set a bad example for all the newcomers, now do we? I understand about wanting your favorite vampire to take care of you, but you should be checked, especially if you don't have a home unit to check yourself. At my cardio's office they use the Coagucheck machine, thank goodness. Nothing is simpilier than that little prick to my finger. Doesn't leave bruises, I don't have a sore arm when they had to chase my veins around, I love it. THe best is, it doesn't matter which nurse takes my protime. When they are going to a vein, then I can understand you wanting to prolong the agony if the wrong person is there to do it. Did you ever ask the nurses at your clinic, why they don't a Coagucheck or Protime unit for testing there? I know it's available in our area. I like it because I know the results right then, and I'm not playing phone tag with the nurse to find out what my instructions are. Just thought I'd add my two cents.

 

[Perrster]

Rob, the thought seriously did cross my mind!!! Oddly enough the clinic I went to for a year does have a Coagucheck machine. Don't know why they didn't start me on it last year?

Are the readings any different once you "convert" to Coagucheck from the standard needle approach?

I appreciate all of your concerns and yes, even being lectured!

I'm still on my Protime schedule for January and now just waiting for my new Cardiologist office to give me an appointment. I will discuss Coagu-checking once I'm in there. Makes sense as I've grown pretty tired of the bruises and especially vampire "miss-hits." Count dracula wouldn't stand for it!

Thanks again.

 

[RobThatsMe]

Hi Perry,

When I tested my unit against the blood draw and lab results they were within .1 1/10th of each other. That is good enough for me!

I took my unit to the lab, they drew my sample, then I tested with my unit right there. so the tests were within minutes of each other.

Hey, if you are gonna be testing the rest of your life, get away from the needles.. they scar your veins, and each time it gets more difficult for the lab tecs to find a good spot to draw from.

Rob

 

[LUVMyBirman]

Perry...
Listen to Rob. Dump the vampires as soon as you can. Since my veins are basically non-exsistant.....the finger prick route works best. The only good vein I had is still calcified after almost three years. They could only get me in one location while in for surgery.

At this point..... I would recommend waiting on the new Coaguchek to be released to the general public again. In the meantime... see if you can demo a Protime so you can make the best choice.

PS. I emailed you regarding ORD.

 

[Guest]

This is changing the subject but it was so astounding that I just have to share it.

One of my patients is a diabetic. She got the stomach flu and couldn't eat or keep much down. But she faithfully kept taking her warfarin and insulin. She was admitted over the weekend.

INR = 12.6
Blood Sugar = 18

Not a misprint. She did not bleed but was unconscious from the low blood sugar when her daughter found her.

Can you imagine an INR almost equal to the blood sugar???!!!

Moral of the story, if you get sick and can't eat, you should call the person managing your warfarin and see about reducing the dose.

 

[LUVMyBirman]

It's unfortunate that I experienced similar cirumstances. Ended up with an INR of 14. Needed transfusing with frozen packed cells. Initially tested at a 4.0 was told to continue. This was two weeks post op with an obvious pretty fresh surgical site. I was none the wiser. Following directions provided by my cardioligist. Progressed into cardiac tamponade and CHF...back to surgery. Why? because of pure negligence. And not on my part.

A lesson well learned, the hard way

 

[Perrster]

45 days between Protimes

45 days between Protimes

In spite of all the good advice I received from everyone on this subject, I did wait out the 45 days. I kept a positive attitude that this wasn't going to kill me and lookie here...

Last test: December 19. Results = 2.9
January 31 test = 3.5 Results phoned to me this morning (by my not-so- long-lost nurse buddy!)

Sure it went up a bit, but a lot of things have contibuted to it with the holidays in between tests, vacation in Florida, and a root canal just a week ago (with Amoxicillin in me, of course). She advised me to flip-flop one-day's worth of Coumadin and go back to my regularly scheduled program and see her again in 30 days. Phew!

It was worth the wait also because she is acquiring a Protime machine. Yippee!

Rain, your form works great!

Thank you all very much and have a great February already!

 

[RobThatsMe]

Hi Perry,

My only concern would have been .... " Just how did it go during that period? " Perhaps it was higher , and was on it's way back down.

I am a firm believer in testing once a week, if you have a home testing unit. I may go every 2 weeks, if my levels have been stable over the last few tests.

Home testing has proven to help folks stay well within their recommended ranges.

Go Patriots!!


Rob

 

[LUVMyBirman]

Hey Perry

Now this is cause for celebration!

I still would have a beef with that nurse though. You are within range. 3.5 is wonderful.... Especially with dual valves. Why is she messing with you?

Believe me....I have been there, done that! Never been better all by my lonesome. Can you get into home monitoring? Like Rob stated.....testing once a week will give you tighter control.

 

[McCln]

Perry

Perry

Despite what Gina said, don't have a beef with your nurse friend. She told you that you were okay for thirty days. My PT was down and just got back to normal. It is okay to be betweem 2.5 and 3.5. You don't want it higher than 3.5 or lower than 2.5. You are doing quite well. Keep up the good work.


Caroline
09-13-01
aortic valve replacement
St. Jude's valve