Has the online calculator gone down?

[watson524]

Hi all,

I was going to use the link I've always used to calculate mom's dosage:
http://www.pace-med-apps.com/CoumCalc.htm

And I'm getting the error below.

Not Authorized to View This Page [CFN #0004]

Is the site gone?

thanks!

 

[pellicle]

interesting ... I've not used that one, what does it do (assuming it remains down before you answer).

Does it do anything like this one?
http://www.warfarindosing.org/Source/Home.aspx

also ... what's to calculate?

Do you have records of your doses and INR so far?

Does my blog post here (http://cjeastwd.blogspot.com/2014/09/managing-my-inr.html) help?

 

[watson524]

It would tell how much to add per week/day to get into a certain range depending on if it was the initial dose or ongoing dosing. This is for my mom who has been on warfarin for 30+ years. Her doctor and I have a fundamental disagreement on how to dose (i.e. if she gets say a 1.7 reading when her range should be 2 - 3, he says take a double dose one day and re-test in 3 weeks) so I handle the dosing myself. Her last test came up as 1.82 which, tho not far out of range, my guess is she could stand another day of the week with +1mg (she takes 4mg on Sun, Tu, Thurs, Sat and 5mg on Mon, Wed, Fri - I wanted to confirm using the calculator like I always have. I can't go from previous doses/INRs because in the past 4mg / day was enough to keep her in range but as she's aged and other factors come into play with non-related health issues, we've had to play with things a bit. Your warfarindosing.org doesn't work because it's for existing patients of that service.

 

[pellicle]

ok

myself I just take the same dose each day (until I reevaluate at weeks end) but your alternated dose is not bad either, because the alternation is not big. I would have thought with a history of the data that the dose was sort of obvious. I can not recommend the montly or 3 weekly testing especially since you say there is variations ... seems just like closing your eyes for 10 seconds regularly while driving (because nothing usually happens).

My INR is never the same either, but I manage to be in range 93% of the time following my heuristic method of looking and seeing what it was and making small changes as required. If my INR is sinking then I increase the dose a wee bit, if its rising then I decrease it a wee bit. It hardly seems like rocket science (even clinics seem to do it). Then again I measure weekly and so keep on top of things.

if it was me and her INR was rising I'd drop a few of the 5's back to 4 in that alternation routine and if it was raising I'd make some of the 5's back to 4.

seems intuitively obvious. Like if your car is going faster you ease off the accellerator and if you're going slower push a bit harder. Don't slam it down or back right off ...

Anyway I hope that calculator comes up for you

PS and its not MY warfarindosing ... I do everything myself ... I just suggested it because I didn't know what the one you use did

 

[watson524]

Yeah for YEARS she did 4mg / day. Then things started getting a bit whacky with some hospital/rehab stays in the last 2 years and I got it good and level with the 4/5 alternating vs messing with splitting a 1mg pill. Unfortunately, I don't have a long history of data and even in reviewing what I have, since the 4mg / day kept it in range before, it doesn't really help as much. A 3 or 4 week testing routine is because her stupid doctor will not hear reason that home testing is just as good AND it gets reported to him so it's not like we're going rogue. Don't even get me started on that mess. Over 3 - 4 weeks, her variation hasn't been more than 0.3 which really, isn't much but since she's been a bit on the low side the last 3 tests (1.82 - 2.01) I was hoping to get the INR up just a bit more to get it more into the range.

I saw your graphs and tables and now that I'm collecting the data, I'll be right there with you (I'm a data geek myself and love a good line chart). I think I'm going to just give her an extra 1mg 1 day so 4 days with 5mg and 3 days with 4mg and see how we make out. 1mg on 31mg total / week now is definitely within the +/- 10% window that's recommended for changes in any given week.

 

[pellicle]

I so wish I didn't keep reading this sort of thing

... A 3 or 4 week testing routine is because her stupid doctor will not hear reason that home testing is just as good AND it gets reported to him so it's not like we're going rogue. Don't even get me started on that mess.

have you thought of just buying a Coaguchek XS on ebay and testing yourself weekly ... I think your approach of 4 then 5 is good and you seem to have a methodical approach. I'd just (meaning if it was me, cos I'm me) measure myself weekly (not mention it) and adjust dose as I saw fit (meaning probably not much) and sleep well at night knowing that my mum hadn't drifted towards bleed or clot areas.

I think it becomes more important to manage with care as people are increasing in age, as Stroke or Bleed event are more likely then anyway ...

Best Wishes

 

[watson524]

Going totally rogue, no, I actually hadn't. Her GP does her warfarin dosing (the cardiologist is aware but doesn't manage the actual dosing tho does NOT object to home testing and sees no issue with it). Her GP has been her GP for years and she's not interested in changing from him. Tho even tho his groups labs were bought by a lab that uses finger sticks in their labs AND his group is now part of them, he still disagrees. I guess I thought it had to go through medicare to get the tester and then buy the strips, I didn't realize the machines themselves were available on ebay.

It's something I'll look into. Is there anything I should know about particular machines? I think Dick (user here) uses the XS as well. I know there was another one I had heard about when I looked into it a few years ago to get through insurance but don't know if one is "better" than the other.

 

[pellicle]

Hi

well not totally rogue ... more like 'covert rogue'

...
It's something I'll look into. Is there anything I should know about particular machines? I think Dick (user here) uses the XS as well. I know there was another one I had heard about when I looked into it a few years ago to get through insurance but don't know if one is "better" than the other.

To me they're pretty much of a muchness. I myself use a Coaguchek XS as I was given it by ATS after my surgery. Some here are fond of their Allere. Myself I think its hard to go wrong with either of them. Strips on eBay seem well priced for the XS units. (I buy mine online here in Australia).

Here is an eBay auction within the USA

http://www.ebay.com/itm/Good-Coaguc...897583?hash=item23655495ef:g:7WcAAOSwyjBW7Anm

and

http://www.ebay.com/itm/NIB-ROCHE-CO...UAAOxy9tpR9AKZ

thats a higher price than I've followed some though to ... I'd say under $400 is doable

 

[watson524]

I'll have to take a look and see what's what. I'd be hesitant for a non new in sealed box one because of the method of sample collection and possible contamination (unless I'm missing something)

 

[pellicle]

Hi

I'll have to take a look and see what's what. I'd be hesitant for a non new in sealed box one because of the method of sample collection and possible contamination (unless I'm missing something)

perhaps only the actuality of the situation. ... you see the strips are separate things to the machine. So essentially the machine is just a machine. The strips are where its all at and are always sold sealed in a bottle (but you know ... you have to open that bottle to use them right? As I buy 24 strips then that bottle has been opened for about 5 months before the last strip is used...)

Then there is the fact that my machine is over 3 years old. Has been dragged about the countryside in my backpack, gone over seas a few times, taken INR readings in England, Ireland, Finland and Australia ... I don't open a new unit and unbox it every time I make an INR test.

So IFF you were worried that it was broken (and its electronic, so it either works fine or its buggered) buy some strips, test yourself, test your mum and see if you are near 1 (un-anticoagulated) and if your mum is close to what you got at the lab.

If its no good return it. But if it turns on, takes a reading and presents results the its good to go.

They're just like CD players ... only not as complex ... the real stuff is on the CD not the player

 

[watson524]

But what actually pricks the finger? I figured that was part of the machine too, assuming you just don't stab yourself with a straight pin

 

[Freddie]

Yes, the on-line calculator has been down for a few days. At one time someone contacted the owner of the site to remind them to renew.

 

[watson524]

Yes, the on-line calculator has been down for a few days. At one time someone contacted the owner of the site to remind them to renew.

Hopefully they do. Unless someone has a suitable alternative they can tell me about?

 

[Freddie]

I too use the XS. Like a diabetic you use a lancet to "poke" your finger and place the blood drop onto the strip. If your having problems with the "old" GP accepting a home monitor go to your cardiologist to get a prescription for a monitor, that's exactly what I did......it took two years for my GP to except it and no longer complains how they don'y like it.

 

[Freddie]

Hopefully they do. Unless someone has a suitable alternative they can tell me about?

I really do wish I had an alternative to share - I miss that on-line calculator.

 

[pellicle]

But what actually pricks the finger? I figured that was part of the machine too, assuming you just don't stab yourself with a straight pin

as Freddie mentioned you do with a small device which is almost exactly what diabetics use ... I guess that means you haven't watched what they do at the place your mum goes to

Here's a clip I've made (which is on my blog post on INR management)



(I often feel like "why do I bother" when I go to the trouble to give answer questions and give information which many seem to fail to read or even watch.)

 

[watson524]

Ok I thought the lancet was part of or came with the device. As for watching where my mom goes... I do, but they use a needle to draw the blood. Only one lab around here (in the network that bought out our gp's lab) used the finger prick and they closed. That's another reason I want her to switch. She has rolling veins and 30+ years of doing this at least monthly well... She tells them right where to put the needle in and if they don't listen forget it.

I hadn't thought about the cardiologist rx'ing a machine. I thought that would mean it'd have to report to a doctor vs just being used by us and not telling anyone and then I'd still have the gp issue since results would go to him. Unless we agree that ok she'll still go to the lab once a month so we can compare results until he sees they're similar and gets his panties out of the bunch they're in.

 

[pellicle]

Hi

Ok I thought the lancet was part of or came with the device.

it does ... but they're about $10 at the chemists too ... if the machine you buy doesn't come with one. Myself even if it did, I'd probably dump that and buy a new one. Get #20 guage lancelets, but if you're doing the rubber band trick (from my video) then you'll get a good sample with smaller pinpricks.

As for watching where my mom goes... I do, but they use a needle to draw the blood.

my mistake, I thought you said in an earlier post they were doing finger sticks

...Tho even tho his groups labs were bought by a lab that uses finger sticks in their labs AND his group is now part of them,...

and you're bang on about blood draws... they have zero regard on the sustainablility of your veins to the (often mal) treatment of the staff drawing blood. I'm only 52 and already people say to me "oh, you have got some scar tissue there" when sucking a vein with a needle

...Unless we agree that ok she'll still go to the lab once a month so we can compare results until he sees they're similar and gets his panties out of the bunch they're in.

well I'm sure (from what you've written) that you would love to change Dr, but as that's not going to happen, perhaps the monthly draw could just go on? I mean I do a compare to lab needle draw about every 6 months just to be sure. The difference is usually 0.1 or 0.2 INR points ... perhaps one or two months of that would be enough to change even his mind.

and sorry if I got my panties in a twist before. I just get frustrated easily I guess.

 

[watson524]

I think the monthly draw would have to go on. And tho my mother (78) has developed some communication issues, she reads them the riot act if they won't use a pediatric needle and put it right where she tells them.

No worries about your panties

I guess now I need to look into how it would work if we got a machine with a factors rx and the reporting of tests vs just buying one outright. I sort of feel like she's paid into insurance for years, let them pay something out

 

[Warrick]

Hi this calculator is quite easy to follow and you don't need to sign up to anything, and I think is more accurate than a doctor guessing a dose every month,

as from what I've seen so far doctors do dosing off the cuff rather than having some sort of reasoning deduced from data

http://www.globalrph.com/warf-maint.htm

So far I've found warfarin dosing is a bit of an art but becomes easier once you start have some records and data to follow, then it becomes just another thing, ( and help from fellow members... thanks)
I do weekly testing both myself with a coaguchek and at a hospital lab which also use a coaguchek meter

My INR so far has alternated a fair bit , and I can see that if I did monthly testing I could be a long way out in between which is a worry

My father is also on warfarin with a mechanical AVR and has only done monthly testing with an arm blood draw, and he's done that for 30+ years and his veins aren't flash,
he's also had a clot (14 years ago) due to doctor dosing incompetence. But it has worked for him

I had a blood draw (first since surgery) 2 weeks ago for a cholesterol test and I thought OMG thank the stars for finger prick testing