Home monitoring for coumadin. I have a mechanical heart valve

[Sheenas7]

Good morning everyone. I went yesterday and the nurse in my cardiologist’s office did my inr and showed me what I needed to do. I couldn’t get the blood on the strip correctly. I would stick myself on the side but each time I approached the strip, she said I was going under. Can I just plop the drop in the middle? Or approach the side from the top? Any tips are welcome. I was 2.5.
i will try again in a week from home. I saw the video on line. They gave me a dvd but it’s not working on my TV set. Is it different than the one on line? I wasted 3 strips yesterday. Are they good about sending new supplies? And last question what do you clean it with? I looked on line for the recommended wipes and could not find them on amazon. Thank you for your help.

 

[LondonAndy]

My INR nurse suggested that, once you have gently massaged the finger to get a reasonable size drop of blood, lift the meter with your other hand and hold it against the drop such that the test strip is angled down a bit, away from the finger, and touch the test strip to the drop. This way the strip breaks the surface tension of the droplet and, being angled, gravity helps the droplet to run across the strip at the clear part.

I suspect that we all waste a few strips at the start, and every so often I still waste the odd one, usually where I didn't get enough blood.

If you keep the meter in the carry case that comes with it, you will hardly ever need to clean it. And when I do need to, I wipe it with a soft, moist fine cloth. Nothing fancy.

 

[Sheenas7]

My INR nurse suggested that, once you have gently massaged the finger to get a reasonable size drop of blood, lift the meter with your other hand and hold it against the drop such that the test strip is angled down a bit, away from the finger, and touch the test strip to the drop. This way the strip breaks the surface tension of the droplet and, being angled, gravity helps the droplet to run across the strip at the clear part.

I suspect that we all waste a few strips at the start, and every so often I still waste the odd one, usually where I didn't get enough blood.

If you keep the meter in the carry case that comes with it, you will hardly ever need to clean it. And when I do need to, I wipe it with a soft, moist fine cloth. Nothing fancy.

Thank you. I spoke to patient services help and they told me to touch blood to clear center of the clear window and hold until i hear a beep or see the blue circle, being careful not to touch with finger but just with blood. I will also try that next time.

 

[caro]

Roche recommends the “super sani cloth” to clean the meter and lancing device. I’ve botched a lot of test strips. I’m just starting to get the hang of it after a few weeks. When you need more, call the number for Roche that the nurse gave you and they should send you more in a week. Glad you have your meter!!

 

[Sheenas7]

I haven’t tried again. Since I tested Friday I am waiting a week to try again. Do you practice at home and not report? Or do you wait to when it’s time again?

 

[dick0236]

I haven’t tried again. Since I tested Friday I am waiting a week to try again. Do you practice at home and not report? Or do you wait to when it’s time again?

Infrequently I test midweek if I am curious about my INR and don't call it in. As you get started testing your INR , begin a simple spreadsheet for a good record of your trending INR. Mine is pretty simple 'cause I remain a novice around computers.....my column headings are:

date INR dosage notes

My PCP is really impressed with my spreadsheet w/graph.

 

[Sheenas7]

Hi my name is Sheena. I would like your advise on what is the best home monitoring. I live in northern virginia and my doctor is in chevy chase Maryland. With the coronavirus I would like to have a home monitor in case I should need to home test. I am 70 years old female and my valve surgery was in Cleveland Clinic in 2001.
Thank you. Advise for ease of use, test strips, accuracy and whether medicare covers it. I have medicare and Cigna as my secondary.
Thank you
Sheena

Hi Sheenas7! I have had the Coaguchek Vantus for two weeks now. I really like it so far. A nurse delivered it to my house, taught me how to use it and had me test myself. Last week was the first time I tested by myself. I went through a few tests before finally getting a result. I found that if I tilted the Vantus back a little after the test, it got a reading. I also have Cigna. They require at least 2 tests a month in order to keep your meter. I'll be testing every week.

Hi Caro
I tested by myself for the first time today. First time I didn’t have enough blood. Second time I did. I spoke w patient help and they are sending me a new Softclix. It isn’t working well we think.
I applied blood to clear center of the clear window like nurse told me to try. Was glad it worked on the second try. I like once a week too. My doctor favors every 2 weeks or even 3 bit I’m not comfortable with that so I think I’ll stick to once a week for now. I do vary at times and not sure why.
Best wishes to all. Sheena

 

[caro]

Hi Caro
I tested by myself for the first time today. First time I didn’t have enough blood. Second time I did. I spoke w patient help and they are sending me a new Softclix. It isn’t working well we think.
I applied blood to clear center of the clear window like nurse told me to try. Was glad it worked on the second try. I like once a week too. My doctor favors every 2 weeks or even 3 bit I’m not comfortable with that so I think I’ll stick to once a week for now. I do vary at times and not sure why.
Best wishes to all. Sheena

That is great to hear! I think it took me four or five attempts for my first one. The floss and rubber band tricks mentioned on this thread have really helped me. Such a relief having a meter at home- especially right now! Wishing you the best!

 

[tom in MO]

Hi Caro
I tested by myself for the first time today. First time I didn’t have enough blood. Second time I did. I spoke w patient help and they are sending me a new Softclix. It isn’t working well we think.
I applied blood to clear center of the clear window like nurse told me to try. Was glad it worked on the second try. I like once a week too. My doctor favors every 2 weeks or even 3 bit I’m not comfortable with that so I think I’ll stick to once a week for now. I do vary at times and not sure why.
Best wishes to all. Sheena

I soak my hand in hot water for a few minutes and dry it off when the meter starts its 180 second count does. I have a softclix, but don't use it as designed. I take off the top and stab it in the full 2mm, twice right next to each other.

Some INR variations have reasons, such as antibiotics or gorging on kale However most variations are not within the ken of man. Many if not most of us settle down to a routine dose, but then one day your INR starts changing.

 

[Protimenow]

Tom: I suspect that you may not be using the right lancets - for INR testing, you need 21 gauge. The lancets used for blood sugar testing are just too damned small.

I recently returned to using a lancing device (the 'Bayer' device works well) and I hope that the SoftClix works well for you. My lancing device uses a setting of 4 in order to make a large enough incision.

Now that I'll be taking Plavix for about a year, I'll see if I may need less preparation before incising.

Tom - no matter which meter you use, you should get the drop of blood onto the strip within 15 seconds of incising your finger. I don't know how much longer it takes you to lance it twice - but you'll probaby have to shorten the time between your second incision and putting the blood on the strip. And, again, if you're not using 21 gauge, you're probably just making things harder for yourself.

FWIW - I've been using the single use preloaded lancing devices. They're not expensive, and do the job. I have a few hundred, and like them, but I've grown to like the lancing device and lancets perhaps even more than the single use devices.

 

[dick0236]

In the past, I used various "pen" type lancets that sometimes did not produce a good droplet. A few years ago, my service provider, Coaguchek Patient Services sent me a box of single use "T" shaped lancets 1.8 mm depth, 23 gauge/0.63 mm. Rather than producing a tine "hole" the lancet slices a tiny 0.63mm cut (similar to a cut with an exacto knife or razor blade (doesn't hurt). Now I very seldom do not get a good droplet of blood.

FYI:
lancet manufacturer - Coaguchek
Ref #04348150001

 

[Sheenas7]

Hi my name is Sheena. I would like your advise on what is the best home monitoring. I live in northern virginia and my doctor is in chevy chase Maryland. With the coronavirus I would like to have a home monitor in case I should need to home test. I am 70 years old female and my valve surgery was in Cleveland Clinic in 2001.
Thank you. Advise for ease of use, test strips, accuracy and whether medicare covers it. I have medicare and Cigna as my secondary.
Thank you
Sheena

 

[Sheenas7]

Hi Caro
I tested by myself for the first time today. First time I didn’t have enough blood. Second time I did. I spoke w patient help and they are sending me a new Softclix. It isn’t working well we think.
I applied blood to clear center of the clear window like nurse told me to try. Was glad it worked on the second try. I like once a week too. My doctor favors every 2 weeks or even 3 bit I’m not comfortable with that so I think I’ll stick to once a week for now. I do vary at times and not sure why.
Best wishes to all. Sheena

Hi Caro
My doctor’s office only wants me to test every other week. So only every 2 weeks. Is that unusual? Even when I was going to his office for the test he wanted me to wait at least 2 weeks. He says I’m stable enough but I have had some high results. Once in January 21 this year 4.9 and again in March 23 I was 4.7.
They had to of course adjust me.
Anyone here with this situation? Any suggestions?
Thank you

 

[Protimenow]

Every other week is not often enough -- although some sources are comfortable with 4-6 weeks if your INR is stable. According to a study from Duke Clinic, it can take as few as 10 days if undercogulated to develop a clot that could cause a stroke.

Meter manufacturers recommend weekly tests - and this isn't only so they can sell more strips. If I recall, some countries say that weekly testing is best practice. I just got out of the hospital and the video that they showed about anticoagulatoin said that for people with stable INRs, the time between tests can be up to 6 weeks. Ridiculous.

My suggestion is to test weekly. If your doctor won't do it, and you can afford it, get a meter and self-test (meters are often affordable on EBay). If you're on Medicare, I know that some people have gotten meters through Medicare.

Bottom line -- I don't agree that testing every two weeks is adequate to keep you safe. Although your INR may not vary much from between tests every two weeks, it's probably not worth the risk, just in case something strange may lower your INR.

 

[caro]

I agree. Roche is fine with weekly testing and insurance will cover it. My clinic recommended weekly at first and then once every several weeks but I’d rather test weekly.

 

[Protimenow]

I'm glad to hear it.

My new HMO keeps pushing me to use an anticoagulation clinic. My fear is that I'd know more than them, probably wouldn't take any advice, and may quickly alienate them. If they use CoaguChek XS meters, I'll be able to compare results to my CoagSense. It may be worth the hassle -- if they can stand this know it all.

 

[Sheenas7]

I think I’ll test again in one week. If I’m in range I just won’t report it to Roche who then reports to my doctor. If I’m out of range then of course I would report. My doctor makes me feel like I’m overreacting. I have been going to that office since I was 19 years old! My first open heart surgery was when I was just seven years old. I developed complete heart block and have had a pacemaker since age 23. I now have Medtronic ‘s wireless pacemaker. There was no more arteries available.I am now 70. My favorite doctor retired after talking care of me for 48 years. My second open heart surgery was in 2001. Mechanical heart valve and the Cosgrove ring in another valve at Cleveland Clinic. I live in Virginia. They also caused me a tiny VSD in trying to repair valve which couldn’t be done. So my new doctor at the same office is not very empathetic.
Thank you for your comments. It helps me decide

 

[Sheenas7]

Does this plan sound good. I have some extra strips I received for practice.

 

[tom in MO]

Some people on this board believe in weekly testing. Others believe in less frequent testing. For my doctor's practice the minimum frequency is monthly the maximum is weekly. Whatever frequency you decide to test at, you should make sure it is supported by your insurance company and your doctor's prescription. My cardio's nurse helps me out on these types of things.

My insurance company requires a prescription for test supplies. Eight years ago when I started testing, my prescription was for biweekly testing. I was given strips for that frequency. I could get extras if I needed it in case the doctor ordered extra tests or if I ruined a few. My INR was not settling down and I had trouble wasting strips, I was concerned about not having enough. I talked to the nurse and she had the prescription changed to weekly testing. I get 12 strips and cannot get a full order until 12 weeks has passed. I can get lancets whenever I need them. They also supply a book to keep track of test results and strip information.

I personally test every 2-3 weeks when stable, and weekly when unstable. This works for me.

If I were you, I'd report my test results so your doctor knows your INR history if it starts to change. My doctor recently let me self-monitor so I only report results to him if I'm out of whack and need help. I'd also question the doctor or their nurse as to what frequency of testing is prescribed. I would suggest the prescription be weekly even if you test biweekly. It's nice to have a buffer and be prepared if your INR changes.

 

[Protimenow]

This does not come down to a matter of 'belief' - it's a matter of fact. According to a paper written by the Duke Clinic, if your INR is below 2 for as few as ten days, you're at risk of a stroke.

Best practice in some countries is weekly testing; the meter makers also prescribe weekly testing - and this isn't only to sell more strips.

There's science behind the need for weekly testing - not a belief that you can test every other week, every month, perhaps every few years. Go by science - not by beliefs.

This is the last I'll write about this for now - I don't want to get into a string of debates about this.