just venting!!

[Nan]

Hi all,

I just got a pro-time monitor, was trained how to use it on Saturday and IT is working fine. The thing that is really frustrating me is that my INR was 1.9.

That is low for me, I'm usually at 3 where it should be (between 2.5 and 3.5). My cardio says that it is fine and I know it isn't.

My PCP's office, who will be checking the monitor with me on Wednsday, say that since I wasn't scheduled for a test yet that I shouldn't worry about it!!!! My PCP will probably think differently, but we'll see.

Oh me on my. They don't really seem to know what they are doing!

Thanks for listening!

 

[Ross]

Sounds to me like you should run from that place, not walk. 1.9 is not fine and you should bring it up into range. When you did the training on the phone, what was your INR result then or is this it?

 

[Nancy]

Let's see, does that mean if you hide your eyes, the thing doesn't exist??? Just because it's not test time doesn't mean that your INR isn't going to fluctuate. Agree with Ross, if you have discovered this problem, then they should be addressing it.

The problem exists, you know it, and now they know it. Ostriches don't fare too well. They leave their fannies up in the air. Pretty vulnerable.

Press the issue.

 

[Karlynn]

When I got my Pro-time monitor, I had the same experience. I think I was at 2.1. I called my cardio's office and she had me bring the monitor in right away (an hour drive into the city - kind of a pain) and they tested me with their machine and then again w/ mine. It was me, not the machine.

The chances are much greater that you are low, not tht the monitor is malfunctioning. They test it pretty heavily before sending them out.

 

[Ross]

Nan did you get the ITC Protime unit or one of the others and if so, which one?

When you take your unit in to test, let me know what they are testing against please. Also if you feel that test that you did is wrong, don't hesitate to test once more. I've had a time now that I tested way high and upon retest, was right in range and much more like it. What I'm saying is, if it seems too low or too high for what it should be, retest for safety sake.

 

[Nan]

Thanks for your responses and support!! Yes, I got the ITC Pro Time monitor. And the 1.9 was on Saturday with the instruction. I am sorely tempted to adjust the dosage upward by 10% myself as I know that is what should be done, but am afraid to do so.....

I think my PCP (who was managing my coumadin prior to my going to cardio ) will react differently. I went to the cardio's "coumadin clinic" as a self -pay because they had a coagucheck monitor and I didn't have to have a venous draw..my veins are in terrible shape. Insurance wouldn't pay for me to continue with the cardio, but would pay for 80% of the Pro-TIme! Go figure!!

I will see my PCP Wednesday. It is really to demonstrate that I can use the monitor (Per QAS) and I don't believe that they are also going to have me do a venous draw as a check, but one never knows...

If she doesn't change it then, I may take action. At the very least I will ask why.

I really am having trouble believing that my cardio was OK with this. He has been so careful in the past. I know he is annoyed with me as I did not follow through with surgery to replace/fix/have aortic root replacement for the St. Jude's which is too small. This was a while ago, however. I wonder if he has just given up on me.

Well, anyhow, onward with life!

Thanks again, guys.

 

[Ross]

Nan if you truly believe that figure to be unusually low for you, retest and see. If it's still low, I wouldn't hesitate to bump up 10% over the week, just be sure to let the Doctor know you did and why you did it.

I'm sorry, I get aggravated at these "Professionals" that blow you off or really don't know what they're doing, but act as though they're God.

Of course, I'm not a doctor or the doctor, but that's what I would do!

 

[Nan]

Hi Ross, and thanks. I will be testing on Weds......and if they don't up the dose, I will up it myself.....I agree with you about the docs and/or their staffs who don't seem to know what they are doing, but think they are the end all and be all for everything.

Actually, I may test tomorrow am ....think I will. They said not to test in the evening before or after taking the coumadin as it will give a false result. So I need to wait til morning.

 

[Ross]

Actually, I may test tomorrow am ....think I will. They said not to test in the evening before or after taking the coumadin as it will give a false result. So I need to wait til morning.

O.K. would anyone like to explain this one to me?

 

[bvdr]

Nan,

I don't believe that it makes any difference how close to taking your coumadin you test. The INR is not a measurement of your coumadin level, so fresh coumadin floating around in your blood shouldn't affect anything.

I think the answer you were give is deplorable! l.9 is too low and regardless if it was your testing date or not makes no difference. I have permisssion to self dose as needed and I think you would benefit by that as well. The idea of self-testing is to test more often and hopefully have better control. I love my Pro-time unit and you probably will too.

 

[Guest]

The answer that testing close to when you took the warfarin proves beyond a reasonable doubt that they do not understand how warfarin works.

Warfarin is so long and slow acting that it does not matter when you measure it.

If you want to order a set of my algorithms and do your own dose adjusting you can fine the form at http://warfarinfo.com/publications.htm
the cost is $4.95. It goes through PayPal, so I never see your credit card number.

Several of the people on here have purchased them. If anyone wants to write and tell Nan whether they were helpful please do so.

 

[Nan]

Update

Update

Hi and thanks everyone for your support. I tested this morning and the INR was 2.4!!! I am a much happier person today.

I will try to get the OK from my PCP to test as needed.

And thanks Al for the info, I will probably get the algorithym (sp.?) from your site.

By the way, it was the training nurse from QAS who who said not to test before or after taking the Coumadin!!

 

[Guest]

The reason that it does not matter about when you test warfarin is this. You are not testing the warfarin level. You are testing the suppression of the production of the vitamin K dependent clotting factors. If you were testing the warfarin level, it would matter when you took the dose. Since suppression of the production of the clotting factors takes several days, it does not matter when you test.

The actual warfarin level in your body does not play a direct role in the amount of suppression of the production of clotting factors. People who take 10 mg of warfarin daily have a higher level of warfarin in their blood right after a dose then do people who take 1 mg, yet they can have the same INR.

QAS needs to get the nurse straight on this. If the nurse got it from the manufacturer's literature then the manufacturer needs to correct their information.

I have done in excess of 20,000 finger stick tests and I can assure you that it makes absolutely no difference.

 

[Nan]

Thanks again Al for the very comprehensive info about how the coumadin works and why it doesn't matter when one tests. And I ordered your form too...thanks for making it available to us!

Ross, I will mention this to the nurse when she next calls me and see if we can help her/them understand that the timing in testing does not matter!

Well, I am now going to be late for work! But worth it!

Have a good day everyone.

 

[QAS Lance]

Here is a post from our professional services department at QAS:





Lance
What the training nurse probably had reference to is the fact that a test of coumadin would not indeed show any difference in the INR reading prior or after the taking the drug because as you know coumadin is a very slow acting drug (half life a day and a half). If the tester is expecting a results taken immediately before to those taken immediately after to be of substantial difference they would of course be disappointed to find that there was none. There seems to be a misunderstanding on the part of the nurse or a miscommunication but we have taken steps here in the office to correct the situation. Be assured that QAS seeks at all times to be a source of information that is correct and beneficial to our customers.
Regards
Professional Services

 

[Ross]

Thank you for clearing that up Lance, it's most appreciated.

 

[Guest]

Thanks Lance. We know that you guys always strive for the best service.

We also know that we don't always say what we thought we said. Quite often we do not translate into our own brains what the speaker thought was said.

It is a constant battle just to keep myself on the straight and narrow.