INR Ups and downs

[Gnusgal]

I got a 5.0 on Sunday, despite the countless veggies I consumed last week. I finally gave in and went down on my dosage. I just hate doing that... I'll test again tomorrow.

 

[Guest]

I just sent an article off to the publisher today. We did over 11,000 checks with CoaguChek and our major bleeding rate and clotting rate were equal to or better than other published articles. The accuracy is not that big of an issue, you just have to manage people so they do not get above 5.0 or below about 1.8 very often or for very long.

Tyce's 3.7 and 4.0 would be handled the same way in my clinic - no change or take 1/2 the usual dose for one day depending on what the person taking the warfarin feels comfortable with. I let the people make a lot more of the decisions now after 6 years of experience because I know that it doesn't make much difference but if the person taking the warfarin feels comfortable then they are happy.

My idea of an adrenalin rush is to give somebody a 15% dose change and see what happens in a week.

 

[Sherry]

Hi, Bonnie,
Actually, you would think I'd be normal after six years, but beginning the end of last summer (2002), my nurse has never been able to stabilize me. I dip really low and then when she orders extra mgs., I tend to go excessively high. (not the case last week) The only thing that I wonder about constantly is the effect of stress on the numbers. I'm a high school teacher, grad student, and former coach so my stress level was through the roof this past school year. Anyway, I mentioned the home testing to my nurse who then broached it with my doc who basically said "No way!!" I would give anything to have my own system. How did you get your doc to order it for you?

 

[Ross]

Sherry my PCP kept telling me no to home testing, saying that they are not accurate enough. I saw my Cardiologist last week and about fell of the exam table when he said he'd prescribe it and agreed with me. I guess what really threw me is the fact that I didn't have to have a knock down drag out fight with him.

All I can say is keep checking with all your doctors until someone agrees. The next problem is overcoming the insurance obstacle. I fully expect for them to deny mine, but I'm going to try anyway.

 

[Sherry]

Hi, Ross. I may broach this with my g.p. today when I go in with my son for his sports physical. Maybe he would agree since the cardio wouldn't. I did call my insurance last summer, and she said they would cover a good percentage of the cost. I guess the things that bother me the most (and everyone else on the board, I'm sure) has to do with the $15 co-pay that I have to pay each time I get it tested (frequently over the past year) plus when the three regional Coagucheck nurses are out on Fridays, there is no place other than a regular lab that can do it. Plus they won't give you your numbers (since the patient is "too ignorant" to interpret them...) Well, sorry for the rant, but after six years, I'm fed up. I will keep trying to talk someone into writing me a script for the machine. Do you think my veterinarian could do it?

 

[Granbonny]

Hi sherry

Hi sherry

Ross will write you a scrip. That's really how he got his. I found out about Protime first month on VR..Asked my clinical nurse to ask my Card. She called back and he said sure. Send me the paperwork to sign. that easy.. I call my INR in to her every 3 weeks and she calls me back in 30 min..saying. Great.continue what you are doing. Make a list of reasons you must have one. Late getting home from school..afterschool parents meetings.. Lab closed..ect. Discuss with PCP..sounds like your Card has never bothered to look in to home testing.Bonnie

 

[JimL]

I vote for the veterinarian.

I can't believe they won't give you the numbers, Sherry. That's ridiculous! I started self-dosing a couple weeks after surgery, because I recognized that my surgeon was prescribing the wrong amount of coumadin.

I go each Friday for a fingerstick, and after I see the number on the Coaguchek, I tell her what I'm going to take the next week. I look at the expression on her face, and then adjust what I'm going to take up or down a little. It works for me!

When I have to have a veinous draw, it's a real pain, not only because of the needle, but because the results take an hour instead of two minutes with the fingerstick. But if I wait around for an hour, or come back in an hour, and sign some form, the lab will give me a full print-out, which somewhere amongst all the other information lists my INR.

 

[Guest]

Sherry, I hope you get the home test unit, but if not, have you looked into the University of Southern Indiana in Evansville?

 

[Sherry]

Hello, All. Thanks for all the great responses and encouragement. (I love this forum!!) Bonnie, you're right about my cardio not looking into it. According to him, no one has even asked about it before. (hmmmm) However, today I saw my young general practitioner (who is an incredible doc) when my son was getting his physical. He said that he would order it, and for me to start the process when I was ready. Said that if he had a valve, he would definitely own one himself.
Jim, my coagucheck nurse does give me my numbers and is very receptive to my own suggestions for modifications; it's the people in the standard labs that I've had to see on vacation and around here on Fridays (when everyone else is out of the office) that won't give me my numbers. I'm not kidding; I almost came to blows with some lab person last Friday who really blew me off and told me I couldn't be given the numbers. Turns out that I was extremely low (1.9 again) and didn't find out until Monday. Al, I know that U.S.I. offers some training courses on anticoagulation therapy for nurses. Would I be able to get in on that training if I am ever able to get my own machine?

 

[Guest]

Sherry,

Look at www.acforum.org and click on clinic locations. These are people who manage warfarin they might be able to give you some help.

I also have a set of guidelines available for people who want to dose their own warfarin. Look at my website http://www.warfarinfo.com/publications.htm

 

[Sherry]

Thanks so much for this wonderful info. I'm going to spend some time this week researching before I return to teaching next week. Now that my g.p. has given me a positive answer, I'm pretty hopeful that I may be a home tester within the year.

 

[ccrawford]

Sherry - I'm a home tester, and I'm sure my cardio would be glad to write the script - actually its a couple of pages of paperwork but not too bad. I think I read in one of your posts that you INR test near your work. The OVHC has a great Coumadin clinic headed by Angie Wooten, and they'll give you your numbers without any fuss. I always give the ladies a hard time when I come in and they reciprocate big time so we have fun. I email my home results to OVHC just so they have a running record on their system, and it works pretty well. I also do my own dosing, but let them know these changes too. It took me a couple of months to get my machine - I suspect this could be reduced if you ran your own gauntlet with the insurance co. Chris