Healthier Lifestyle Suggestions (Article)

[Homeskillet]

Can you cite a source that says that testing every two weeks is a best practice? A stroke can occur in as few as ten days if the INR is too low (according to a Duke University Clinic's report). I believe that in the U.K. and much of Europe, the accepted practice, and the way that patients are able to maintain their INRs is to test weekly.

And you said 'my INR strip provider will send you a few extra strips .' Why whould your provider send me strips?

The anticoagulation clinics often use outdated protocols for managing INR. These are the same people who advocate for testing monthly or even every other month if a patient's INR is stable.

Once weekly testing is safer than every two weeks.

Exactly! What he said.

 

[tom in MO]

Ummm, since I was the one dealing directly with her—and witnessed her clear stubbornness & patronizing way despite how many studies I referenced—I think I would far more able to ascertain her character than you.

You actually make my very point above. They often rely on outdated information/methods and do not emphasize continuing education. I now have an EXCELLENT NPR at the Coumadin clinic—who completely agrees with my situation with a mitral mechanical valve.

Opinions are like feet—everyone has them and most of them stink.

Dingbat: a stupid or eccentric person.

I find that attitude is everything. If you want good care from someone who you disagree with, communicating to them that you believe they are stupid may get you worse care. Your nurse recommending 2-week testing (not an opinion but a clinical consensus judgement by experts) was neither stupid or eccentric. It is one "standard of care," obviously not yours.

 

[Protimenow]

Referring to people as dingbats is A LOT DIFFERENT from actually calling them dingbats to their faces. The clinic wasn't identified, the workers weren't identified, and I have doubts that these people ever heard of this site (unless Homeskillet told them about it). Making a reference about them to a forum like this should result in no change in the standard of care received from them. They have no idea that this was posted. Suggesting that HomeSkillet somehow insulted them is far off target. (Although, as general advice, it makes sense not to insult a caregiver -- resentment - whether conscious or unconscious - can cause lower quality care).

I've had issues with an anticoagulation clinic that wanted to schedule me for as much as two months between testing. I told them that it doesn't make sense. I didn't call them names. What they told me was that, as nurse practitioners, they must follow specific guidelines and protocols. Their hands were tied. In such a case, it makes no sense to argue with them or to call them names.

OTOH - I just got off the phone with probably the stupidest MRI scheduler that I've ever encountered. After taking fifteen minutes for a call that should have taken three or four, I though I had an appointment scheduled. After completing the call, he called me back and asked if I can take a picture of my valve. I told him that it was in my chest. He repeated that he needed a picture of my valve. I again told him that it's in my chest. After he requested it again, I'd had enough. Now THAT was a dingbat.

 

[Protimenow]

I have no personal opinions on best practice for testing frequency. I only base my thoughts on best practice on recommendations that I've seen from reputable groups, and from a paper from the Duke Clinic that said that there's a possibilty of a stroke in as few as ten days for prosthetic valve patients with INRs below 2.0. I've gone two weeks or longer without testing, but I knew that the last test had my INR in the high 2s or low 3s, so my probable risk, with continued dosing unchanged, was pretty low.

Still, I feel safest with weekly testing - and there ARE papers that support this.

So - this isn't my opinion talking.