How to choose a good doctor to manage your INR?
- Thread starter Naomi
- Start date
Help Support Valve Replacement Forums:
You may be surprised and lucky like I am. My small town family doc is great with INR.
Many Cardios maintain INR clinics (they are good profit centers) and they are very good. They do hundreds of INR tests and generally know how to manage it. The only downside I had with these clinics is the waiting time and the nurses do not like to compromize on dosing changes for small INR "out of range" tests....but then, I'm old and can be difficult.
My INR is now handled by my family PCP....and me. Like I posted elsewhere, if and when they become comfortable that the patient can be trusted, most are not hard to deal with. That is my experience, but it was not that way 15+ years ago.
Really, this stuff is not that difficult....like the ad says "even a caveman can do it"
ALCapshaw2
Well-known member
I wrote a post in your other thread (the 'difficult choice' one) addressing this issue.
'AL C'
'AL C'
How about a cavewoman? That's hilarious!
What should I ask my doc? How many patients they manage? Should I just try to find an INR clinic? I would want to do self testing and have a bit of control over my dosage so would I just need to wait until I'm stable-ish before I can do that? Or is there like a "waiting period" before they trust you enough to let you do that? I am pretty trustworthy! Just hate going to the doctor...
What should I ask my doc? How many patients they manage? Should I just try to find an INR clinic? I would want to do self testing and have a bit of control over my dosage so would I just need to wait until I'm stable-ish before I can do that? Or is there like a "waiting period" before they trust you enough to let you do that? I am pretty trustworthy! Just hate going to the doctor...
Hi Naomi,
Do you have a cardiologist now? After surgery, you're usually released by the surgeon fairly soon to the care of your cardiologist. I wouldn't worry too much about it now. You don't have to find an INR clinic, if there's one in your area your doc may refer you, or he/she may prefer to mange it. You will have at least several follow-up visits with your cardiologist in the months after surgery. INR testing doesn't require a doctor visit. You can either get the blood work done at doctor's office or a lab, and doctor's office will call you and let you know results, so there's no need for extra doctor visits.
I've only had one bump with my INR management when I first came home from the hospital and I got help and info needed from here. I've been stable since December. I freely eat whatever veggies and or salad I want. Other than taking an extra pill and about 10 minutes once a month to get the blood drawn, nothing else has changed for me. And, as Dick said, it's not difficult.
Do you have a cardiologist now? After surgery, you're usually released by the surgeon fairly soon to the care of your cardiologist. I wouldn't worry too much about it now. You don't have to find an INR clinic, if there's one in your area your doc may refer you, or he/she may prefer to mange it. You will have at least several follow-up visits with your cardiologist in the months after surgery. INR testing doesn't require a doctor visit. You can either get the blood work done at doctor's office or a lab, and doctor's office will call you and let you know results, so there's no need for extra doctor visits.
I've only had one bump with my INR management when I first came home from the hospital and I got help and info needed from here. I've been stable since December. I freely eat whatever veggies and or salad I want. Other than taking an extra pill and about 10 minutes once a month to get the blood drawn, nothing else has changed for me. And, as Dick said, it's not difficult.
Last edited:
Naomi, sure a Cavewoman can do it....and probably even better. Hows' that for correcting a macho statement.
My experience with INR clinics is they are knowledgeable...or you could give your PCP a try. The "warning bell" is if they make large and frequent changes unless you are way out of range. It might take a little while to "get a feel" that the doc knows how to manage you. If you stay on a "roller-coaster", they don't know what they are doing and it will be time to find someone else.
Home testing will be your answer, but you will need to have a reasonably stable INR before starting home testing. It is also a good idea to have someone else test you for a couple months in order for you to learn some of the ins and outs. Most insurance plans and Medicare require three months of doctor/clinic testing prior to self-testing if you try to get them to help pay for home testing.
Luana, Yes I have a cardiologist now and feel like we have a good "relationship". I actually haven't seen my family practice doctor in a couple years...I almost never get sick and I go to the Gyn for my yearly checkups.... so I guess what I'm saying is I would trust my cardiologist to take care of it but not my GP. It's good to know it's just going to the lab in and out. I can handle that. My kids will just have to learn to like the lab since they come with me everywhere unless they are at school. Eventually the home testing sounds like a perfect fit for me...
Dick you sound like a man who knows his place!
Thanks for your input!
Dick you sound like a man who knows his place!
Thanks for your input!
Ross
Well-known member
Pose some questions to them like. What would you do for an INR of 4.0, figuring your range wouldl be 2.5 to 3.5? If the answer is hold a dose. Walk away. No, run away.
There are many tell tale signs that you have either a great manager or a poor manager. If they test you more then 2 times a week and change doses just as often, run away.
If they tell you to stay away from high content vit k food items, ie leafy greens, run away.
If they tell you can't live an active lifestyle, run away.
I'm sure I'll think of many others.
Here is a link to a pretty good education on Warfarin, how to dose it, adjust it and what alot of what interacts with it. Read it as part of your deciding process. It's a little outdated, but for the most part, it's pretty spot on:
http://www.aafp.org/afp/990201ap/635.html
There are many tell tale signs that you have either a great manager or a poor manager. If they test you more then 2 times a week and change doses just as often, run away.
If they tell you to stay away from high content vit k food items, ie leafy greens, run away.
If they tell you can't live an active lifestyle, run away.
I'm sure I'll think of many others.
Here is a link to a pretty good education on Warfarin, how to dose it, adjust it and what alot of what interacts with it. Read it as part of your deciding process. It's a little outdated, but for the most part, it's pretty spot on:
http://www.aafp.org/afp/990201ap/635.html
Naomi,
Most likely it will be cardiologist who will start out with your INR; however, it could easily turn into your family doc.
Ross' questions are really good. How many warfarin users the doc manages means nothing if their INRs are all over the darn place, so how many are managed is a moot point. It's not like a surgeon who you want to have lots of experience.
Most likely it will be cardiologist who will start out with your INR; however, it could easily turn into your family doc.
Ross' questions are really good. How many warfarin users the doc manages means nothing if their INRs are all over the darn place, so how many are managed is a moot point. It's not like a surgeon who you want to have lots of experience.
Ross
Well-known member
I know when I first started, my doctor insisted on me using his coumadin clinic. When I first started, they were testing me everyday, changing my dose just as often and my INR was all over the place. Al Lodwick was here at the time and after a while, I simply listened to what he had to say, and within 2 weeks time, I had stablizied my own INR. I quit going to that clinic too. I talked to my cardio about finding another, since this was vein sticking all the time and he told me they had one that used fingersticks and got me started there. Low and behold, who's the nurse in his clinic.....The very same one I left at the other, however, she had now been enlightened by Al Lodwicks publications and actually had some of his things in her rack. Never had a problem after that. Al insists that he learned from us, but he has no idea of how much he actually taught us. I'm very happy to have gotten to meet him, have dinner with him, and be taught by him.
Luana, Yes I have a cardiologist now and feel like we have a good "relationship". I actually haven't seen my family practice doctor in a couple years...I almost never get sick and I go to the Gyn for my yearly checkups.... so I guess what I'm saying is I would trust my cardiologist to take care of it but not my GP. It's good to know it's just going to the lab in and out. I can handle that. My kids will just have to learn to like the lab since they come with me everywhere unless they are at school. Eventually the home testing sounds like a perfect fit for me...
Dick you sound like a man who knows his place!
Naomi:
When I was in my 20s, I went to my GYN for almost everything.
When I was had a hysterectomy at 34, I decided to get a good primary care physician. I haven't seen an OB/GYN since 1985.
I've had the same PCP now for 26 years and he's part of a large practice that has a Coumadin clinic. I only see my cardio once or twice a year (my annual checkup is Friday, July 23). My PCP writes my warfarin Rxes, has signed paperwork for both of my INR testers, etc. He did my PAP tests, all blood work, etc. His practice uses a different type of algorithm chart for warfarin dosing than what I use; I have given him a copy of mine so he knows what I'm basing my dosage changes on.
You might also want to check out the list of anticoagulation clinics at www.acforum.org. That website has some good links, too.
Good healthcare first, of course.
But, if it matters to you also, check what your insurance will cover too. I was only on ACT for three months post-op but my cardio wasn't local so I was having the blood tests at my nearby family doctor's office. A conflict quickly arose, I suppose based on who was managing my INR, and who would be reimbursed for it. It soon became a hassle for me to have to travel from my rural home to a nearby town to the closest hospital to get my checks done. And now, my family doctor's office gets so little reimbursement from my medical insurance that they won't do blood draws for them anymore anyway. So, back to that hospital for any blood draws. Really a hassle.
But, if it matters to you also, check what your insurance will cover too. I was only on ACT for three months post-op but my cardio wasn't local so I was having the blood tests at my nearby family doctor's office. A conflict quickly arose, I suppose based on who was managing my INR, and who would be reimbursed for it. It soon became a hassle for me to have to travel from my rural home to a nearby town to the closest hospital to get my checks done. And now, my family doctor's office gets so little reimbursement from my medical insurance that they won't do blood draws for them anymore anyway. So, back to that hospital for any blood draws. Really a hassle.
Ross
Well-known member
Another reason why those on anticoagulation need to grab the bull by the horns. You can be lead around or you can take charge.
