Home monitoring for coumadin. I have a mechanical heart valve

[Protimenow]

If I recall correctly, Oxycodone is Codeine plus Acetaminophen. If you take this, you're still getting acetaminophen.

 

[ScribeWithALancet]

If I recall correctly, Oxycodone is Codeine plus Acetaminophen. If you take this, you're still getting acetaminophen.

They used to give me Percocet which is Oxycodone (5 mg) plus Tylenol (325 mg). After my valve surgery 16 years ago, my internist switched me to separate doses of Oxycodone and Tylenol so she could precisely control the doses of each that I was receiving. She wanted to reach the maximum of Tylenol before begining the taper off the Oxycodone and then work on the tapering of the Tylenol. She could not reach the maximum dose of Tylenol with the Percocet because of the 325 mg of Tylenol in each pill.
They gave me generics for the Percocet.
Drug Balancing and interactions are way too complex for mere mortal doctors which is why we have pharmacists as well. ; - )

Walk in His Peace,
Scribe With a Lancet

 

[Sheenas7]

Thank you everyone for your comments. I asked my cardiologist and he told me not to take more than 1500 total in one day and less is better he added. Also told me to go to weekly testing while taking Tylenol. I’m better today. Thank you again. So great to have this group.

 

[Protimenow]

Scribe - you're right. I should have followed the news better and realized that this country is in a terrible situation with deaths related to Oxycodone. It's the pure **** that is ruining lives all over the country (and, perhaps, the world?).

The sly weasel (codeine and acetamophen) disguises itself in many different names - Percot, Norco, and others.

A few years ago, I broke my left wrist. The doctors kept pushing Norco (codeine and acetaminophen), I was asked if I wanted it so many times that I got the sense that they thought I had broken my wrist in order to get drugs. (And, in honesty, perhaps others in the hospital system actually DID do this type of thing to get drugs).

I've been prescribed this stuff a few times - once for post-sinus surgery. I didn't (and don't) like the way it makes me feel after it wears off, and it didn't (for me) help much with the pain.

It's always good to have a reliable, well-informed, pharmacist who you could turn to for advice.

 

[ATHENS1964]

has anyone used the following monitor. ?
https://www.microvisk.com/

 

[Protimenow]

I'm kind of put off by the company's described product as a 'viscometer.' It sounds like they're testing the thickness of the blood - rather than the clotting time.

The test method looks more mechanical than electronic - there appears to be an oscillating piece of 'metal?' that stops moving when a clot develops. This isn't much different than the spinning wheel on Coag-Sense meters, or the 'tilt-table' that may be used by labs.

Being in the United States, this isn't available until it's FDA approved.

And, as far as using this meter - my answer is that I haven't, but, no doubt, somebody has.

 

[David Robbins]

Thank you so much. I will see how it goes. I don’t think I would be comfortable self dosing if out of range. But it may be good to have this option instead of having to drive to my doctor’s office. He uses this method. Thank you again

I self test and my doctor has provided a plan to change dosing if out of range. He also gave my 2.5mg tablets since the adjustments can be made by units/day. Ask your doctor about this.

 

[RAS]

I've used CoaguChek XS for several years and now have a CoaguCheck Vantas. Both are very easy to use and sufficiently accurate when compared to lab draws. I had an INRatio meter for many years, which was less accurate.

I've read about the Coag-Sense meter and by all accounts it is even more accurate than CoaguChek. I doubt it will be enough difference to affect your ability to stay in range. You can't go wrong either way.
It may come down to ease of use and/or cost or simply personal preference.

Your vendor should be able to provide the cost comparison. Others on this forum can probably speak to the ease of use. In reading about the Coag-Sense, they use a "transfer tube" It appears similar to what I used initially with my InRatio meter. I didn't like using that and eventually stopped using the tubes and transferred the drop of blood directly from finger to test strip.

 

[Protimenow]

I'm now testing both meters - Coag-Sense and CoaguChek XS, against each other and against the labs.

Recently, I've had issues with the Coag-Sense appearing to give results that are far enough below the XS and the labs to be somewhat troubling -- although this meter appears to be working fine for many others. Perhaps there are factors in my blood that let me form a clot faster, and that aren't detected by the XS or the labs. Perhaps the meter is wrong.

I don't know.

When I was in the hospital a few days ago, my INR was lowered (by skipping doses) so that I could get an ablation. I'm testing daily with the XS and the Coag-Sense to see when the difference happens.

FWIW - the business with the transfer tubes really isn't that big a deal. Touch the tube to the droplet of blood, wait a few seconds for the tube to draw it in, position the tip of the tube into the well of the strip, and push the plunger.

The XS may be a little easier - just touch the drop of blood to the side of the strip, or the middle, and the strip draws the blood into the strip. If there isn't enough blood, you won't get a result and have wasted a strip.

In theory, the Coag-Sense should be more accurate, because it detects the formation of a physical clot, rather than testing for impedance and applying a formula that produces INR and prothrombin time (whch the XS does).

 

[ScribeWithALancet]

I've used CoaguChek XS for several years and now have a CoaguCheck Vantas. Both are very easy to use and sufficiently accurate when compared to lab draws. I had an INRatio meter for many years, which was less accurate.

I've read about the Coag-Sense meter and by all accounts it is even more accurate than CoaguChek. I doubt it will be enough difference to affect your ability to stay in range. You can't go wrong either way.
It may come down to ease of use and/or cost or simply personal preference.

Your vendor should be able to provide the cost comparison. Others on this forum can probably speak to the ease of use. In reading about the Coag-Sense, they use a "transfer tube" It appears similar to what I used initially with my InRatio meter. I didn't like using that and eventually stopped using the tubes and transferred the drop of blood directly from finger to test strip.

I use the Coag-Sense (2nd generation). There have been a number of times when the poke did not produce an adequate quantity of blood. I lost the transfer tube but did not lose the more expensive test strip. I have my wife use the transfer tube and hand it to me. It is an additional step but having her watching me makes me more careful. She also reminds me when I forget something else.
That said, most of the early medical studies showing that INR test meters helped patients stay in range were done with at least one arm of the study using the CoagUChek. The best study I saw in this area showed that if one used regression analysis both the CoagUChek and the Coag-Sense could be strongly correlated to a single laboratory INR test site that did not change its reagent or machine.(+-0.2) The author of the study said that the lab changed reagents in the middle of the study and it broke the correlation. He had to reanalyze the data in the second half of the study to re-establish the regression analysis and correlation. It is statistics 101 (if you change variables in a regression analysis, it breaks the regression). Since many labs do change reagents and machines or even send samples out, you may not be so lucky.
I have been very lucky, my Coag-Sense walked with my laboratory readings perfectly. So, my doctor said Do not to visit the lab again until the epidemic is LONG over.
Walk in His Peace, and six feet away,
Scribe With a Lancet
PS best wishes to Protime Now on a quick and thorough recovery.

 

[Protimenow]

Thanks, Scribe.

You've confused me a bit. I don't know what you mean by 'lost the transfer tube.' Each set of strips comes with 54(?) transfer tubes - one tube per strip. The transfer tubes are for one-time use. I don't know how your wife can keep the transfer tube and reuse it. Is this what you're saying?

If so, you can get the transfer tubes online - the best deal that I've seen is on eBay, where yu can buy strips AND transfer tubes in the same bundle. The price is good, Coagusense has confirmed that these are legitimate strips, OK for use, although I have no idea how the hell this liquidator got them.

If you still need transfer tubes, I have extras - and if I'm able to package and mail them, I would be happy to send you a batch.

I'm testing with both meters daily, watching my INR go from near 1.1, up to about 3. (It was reduced when I had my ablation - after three days of taking warfarin, I'm expecting to see a significant change from yesterday when day three of dosing kicks in).

There are well documented methods for getting a large enough drop of blood. With the transfer tubes that came with your strips, I've found that if you leave the tube on the drop of blood, it eventually fills to the white line on the tube - this may take a few seconds, but it DOES get to that spot. Sometimes you may have to squeeze the finger a bit (but don't milk it) to get a large enough drop. Wapping your finger with dental floss or thread below the knuckle can also concentrate blood in the fingertip, so that you get a large enough drop.

Let me know, by private message, if I can help with using your Coag-Sense meter (although I'm sure that your pretty much an expert by now).

 

[ScribeWithALancet]

Thanks, Scribe.

You've confused me a bit. I don't know what you mean by 'lost the transfer tube.' Each set of strips comes with 54(?) transfer tubes - one tube per strip. The transfer tubes are for one-time use. I don't know how your wife can keep the transfer tube and reuse it. Is this what you're saying?

If so, you can get the transfer tubes online - the best deal that I've seen is on eBay, where yu can buy strips AND transfer tubes in the same bundle. The price is good, Coagusense has confirmed that these are legitimate strips, OK for use, although I have no idea how the hell this liquidator got them.

If you still need transfer tubes, I have extras - and if I'm able to package and mail them, I would be happy to send you a batch.

I'm testing with both meters daily, watching my INR go from near 1.1, up to about 3. (It was reduced when I had my ablation - after three days of taking warfarin, I'm expecting to see a significant change from yesterday when day three of dosing kicks in).

There are well documented methods for getting a large enough drop of blood. With the transfer tubes that came with your strips, I've found that if you leave the tube on the drop of blood, it eventually fills to the white line on the tube - this may take a few seconds, but it DOES get to that spot. Sometimes you may have to squeeze the finger a bit (but don't milk it) to get a large enough drop. Wapping your finger with dental floss or thread below the knuckle can also concentrate blood in the fingertip, so that you get a large enough drop.

Let me know, by private message, if I can help with using your Coag-Sense meter (although I'm sure that your pretty much an expert by now).

Whoops, poor English phrasing. By "lost the transfer tube" I meant lost the use of that particular transfer tube that we partially filled with blood. Once it is partially used, I assume that it is no longer usable and switch to a new one and poke a different finger.
We generally have good success by using the Thermaphore hand and forearm heating pad.
I just poke myself in the wrong spot on the digit every so often and get less blood. Lately (its taken 7 months now) we have been having more success on the first poke. Every month or so, I forget a step and still poke myself and have to start over. However, overall, the system is working well. You have answered most of my questions on the Coag-Sense by your other posts. We are praying for you and your family.
Get well and stay that way : - )
Walk in His Peace,
Scribe With a Lancet

 

[Protimenow]

Thanks.

Holter monitor today to see what's going on.

I've also wound up with too small a blood drop. I try different areas on my fingertip, and different fingers. I'm testing with to meters daily to see where the results diverge. My INR was brought low for my procedure last week, and it's slowly creeping back up. I've increased my dose twice just to be back in range. Once I'm in range, I can slightly tweak dosage (if I've overshot slightly), to get back in range. So - two sticks (or more) each day, for a while. I've found that lancig closer to the side of the fintertip seems to produce a good drop, and the lancing doesn't seem to 'hurt' as much.

 

[ScribeWithALancet]

I pulled a muscle and need something for pain. I understand we can only take Tylenol. Does it change INR a lot? Thank you

A quick note on my usage of tylenol. When I take 1 or two 8 hour tylenol, it may boost my INR by about 0.2 to 0.5.
However, at one time I had been told that it did not affect my INR. During this time, I had some kidney stone pain that lasted about a week. I was taking 4 to 6 pills a day. After a week, my inr had jumped from 3 to about 4.5 and I got a couple hematomas. So if you have to take the Tylenol persistently, it may affect you more intensely then if you only take it for a day. To quote others on this site, "your meter is your friend". : - )
Walk in His Peace, and six feet away, : - )
Scribe with a Stylus.

 

[Protimenow]

I don't take Tylenol. It never worked for me.

Doctors used to recommend it because, in theory, it doesn't affect INR. This, apparently, is nonsense. Plus, if you take acetamophen (Tylenol) consistently, for more than a few days (actually, I think the figure is ten days), you can damage your liver.

Doctors avoided NSAIDS (Aspirin, ibuprofen. and others) because they make the platelets less 'sticky' and may cause clotting times to increase beyond what Warfarin does. Meters don't detect this.

I take Plavix, which is supposed to have more effect on platelets than an NSAID. I haven't encountered any issues with it (aside from, perhaps, a bit more bruising if I bang into something). As I understand it, you CAN take an NSAID for pain - just don't overdo it - and don't take it for more than a day or two.

Personally, if I have pain that actually needs something to reduce it, I go for the NSAID.

 

[ScribeWithALancet]

I don't take Tylenol. It never worked for me.

Doctors used to recommend it because, in theory, it doesn't affect INR. This, apparently, is nonsense. Plus, if you take acetamophen (Tylenol) consistently, for more than a few days (actually, I think the figure is ten days), you can damage your liver.

Doctors avoided NSAIDS (Aspirin, ibuprofen. and others) because they make the platelets less 'sticky' and may cause clotting times to increase beyond what Warfarin does. Meters don't detect this.

I take Plavix, which is supposed to have more effect on platelets than an NSAID. I haven't encountered any issues with it (aside from, perhaps, a bit more bruising if I bang into something). As I understand it, you CAN take an NSAID for pain - just don't overdo it - and don't take it for more than a day or two.

Personally, if I have pain that actually needs something to reduce it, I go for the NSAID.

It never worked for me either (except in huge doses). At least, before last summer. It now seems to work for moderate muscle pain for me. Who knows what was different. It worked so well that I ended up with 3 hematomas last summer. Then again, none of the NSAIDS worked for me either.
Who knows what makes pain killers really tick?
They make me take one baby aspirin a day for the anti-platelet bit. No one seems to know of a practical (read low cost) test to show how well it works. I wish Coag-Sense could make a separate test strip for that. They said that a full aspirin was no better then a baby aspirin but had a lot more long term side effects, when I asked.
Walk in His Peace, and have a good recovery,
Scribe With a Lancet

 

[Warrick]

If I take Tylenol ( we call it Paracetamol here) for 3-4 days it definately raises my INR, but as a one off dose for say a headache theres no effect on my INR. Last time I took paracetamol was for pain after a filling and it definately took the edge off.

 

[David Robbins]

A quick note on my usage of tylenol. When I take 1 or two 8 hour tylenol, it may boost my INR by about 0.2 to 0.5.
However, at one time I had been told that it did not affect my INR. During this time, I had some kidney stone pain that lasted about a week. I was taking 4 to 6 pills a day. After a week, my inr had jumped from 3 to about 4.5 and I got a couple hematomas. So if you have to take the Tylenol persistently, it may affect you more intensely then if you only take it for a day. To quote others on this site, "your meter is your friend". : - )
Walk in His Peace, and six feet away, : - )
Scribe with a Stylus.

My cardiologist initially recommended until I told her I previously had a stroke and subsequent brain surgery during which they clamped off a blood vessel with a clip. She then retracted her recommendation. As my new cardiologist I was somewhat disappointed to assume she didn’t review my medical history

 

[Protimenow]

Your cardiologist recommended WHAT? The recent postings were about noth Tylenol and Aspirin.

 

[David Robbins]

Your cardiologist recommended WHAT? The recent postings were about noth Tylenol and Aspirin.

My cardiologist advised me not to take Tylenol with Warfarin because I had a clip on a blood vessel in my brain. She told me it may thin my blood excessively and could cause a brain bleed