Just went on Coumadin - looking for a good electric razor

[Protimenow]

Absolutely right on most counts. I can't speak for Pellicle, but personally, I hope that the discussions on any of these forums are less 'amongst ourselves' than they are for public consumption.

There are research papers that show that patients who self-test have INRs that are in range a lot more of the time than those who don't. It only makes sense.

Personally, I worry a lot more when my INR is at the lower end of my range than I do about slightly more risk of bruising if it's at the higher end. When I've shaved, I've used a blade. And, as others (including myself) have said, the nicks are really no big deal.

 

[chaconne]

Once the legal system realizes that MONTHLY testing is ineffective, and that it may be argued that if a person had been tested WEEKLY, the causes of stroke or hemorrhage would be reduced because changes in INR can be caught in time to help, the medical community will HAVE to pay attention, and move to weekly testing.

To play a little Devil's advocate:

I've been self testing for 3-4 months now. I've noticed that my INR fluctuates up and down, in and out of range (2.5-3.5) but seems to spend the most time around 3.0. Every few tests (weekly), I might get a value of 2.2 or 3.7, but if I wait a few days and re-test. It goes back into range. The 3 tests I've been able to compare with the lab show an agreement within +-0.2 and have been in range.

On other words, the INR tests seem to be "noisy", but the average value is in range. Therefore I wouldn't want to make knee-jerk adjustments to my dosing since this may throw my average value out of range. Is it possible that this is what clinics are practicing by testing only monthy? Once they are convinced that the average value is stable. They back off and test less often, avoiding knee jerk reactions to noisy samples and making it more convenient for the patient.

 

[tom in MO]

I would hazard a guess that the reason much INR management is through services is due to the nature of private insurance and the way medicine is practiced.

In my insurance paradigm, the INR home testing service is the equivalent to a laboratory, that's why they report the value to the doctor...just like a laboratory.

By law in the US, prescription drug dosages must be provided by an authorized person, e.g. doctor, nurse practioner, physicians assistant, etc. They doctor provides the dosage, since they are theprescriber of the warfarin. To save money and provide better care, doctors pool their resources in a "coumadin clinic" so a nurse practitioner supervised by a doctor who is a "coumadin expert" provide the updated dosage. This way every cardiologist doesn't have to answer 5 calls a day about an updated dosage and your dosage is supervised by someone who is an "expert" in warfarin.

 

[Jkm7]

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Get yourself a meter. Test weekly. I hope that your MD is comfortable with self-testing. Shave (or don't shave) with whatever device you are most comfortable using (but be careful).

I'm sure that others here will agree with the absolute value of self-testing. I'm sure that many would agree with the benefit of weekly testing (versus monthly or less frequent testing).

I don't need to 'get myself a meter' as I don't take coumadin. I have a tissue valve.
I asked a question of Canon as his post really interested me.

If you are so dissatisfied at the clinic where you have your INR tested, it's too bad you can't find a different place that would be more satisfactory for you.

 

[Protimenow]

If you don't take Warfarin, of course you don't need a meter.

As far as Chaconne's post -- the reason for weekly testing is not so that you can have a 'knee jerk' reaction to the INRs as much as it is to be able to determine when your INR may be TOO high or TOO low. A snapshot every month or every six weeks doesn't tell you what may have happened to your INR between tests. With a 40 hour half life in the body, testing weekly is a better way to gauge what is actually happening with your INR. THAT'S WHY I BELIEVE THAT WEEKLY TESTING IS A BETTER OPTION THAN MONTHLY TESTING.

I have had times when my INR was below 2.0 -- a monthly test wouldn't have shown this. I tested a few days later, and if it was back in range, I did nothing. If it was still below 2.0, I bumped up my dose a slight amount (not a knee jerk response, but a correction). A monthly test wouldn't have shown this.

JKM7 - I can't quite understand the apparent angry tone of your reply. I think that I would be dissatisfied with ANY clinic that believes that testing every 4-6 weeks is appropriate; that prohibits self-testing; and that appears to be leaning towards a potentially dangerous new range. The only thing that I'm using the clinic for is prescription refills and monthly blood draws. I've been managing my dosing for years, using my own meter and common sense (and, at one time, dosing calculators), and I believe that I'm doing better than these 'clinics' can do for me. (I had one clinic botch a blood draw, come up with a crazy INR value then make a LARGE, ONCE A WEEK change that would have potentially caused hemorrhaging for a couple days, then dropped me to the lower limit of my range on other days -- just because they are MDs or Nurse Practitioners doesn't mean they KNOW how to manage patient dosing).

I doubt that I would be all that happy with ANY Anticoagulation Clinic, unless they supported weekly testing, were conservative about dosage changes, supported home testing (not necessarily - if they had a meter that they trust and knew how to use it, and were located nearby, this may also work), and had a really strong idea of WHAT THE HELL they are doing.

 

[chaconne]

I have had times when my INR was below 2.0 -- a monthly test wouldn't have shown this. I tested a few days later, and if it was back in range, I did nothing. If it was still below 2.0, I bumped up my dose a slight amount (not a knee jerk response, but a correction). A monthly test wouldn't have shown this.

Yes, this is the key: confirming with a follow up test soon after and/or a few days later. For me, more information is better than less.

 

[pellicle]

Hi

I've been self testing for 3-4 months now. I've noticed that my INR fluctuates up and down, in and out of range (2.5-3.5) but seems to spend the most time around 3.0. Every few tests (weekly), I might get a value of 2.2 or 3.7, but if I wait a few days and re-test. It goes back into range. The 3 tests I've been able to compare with the lab show an agreement within +-0.2 and have been in range.

Which is what drives me nuts with the lab testing I was in. They want me back for a blood draw again AND fool with my dose

Therefore I wouldn't want to make knee-jerk adjustments to my dosing since this may throw my average value out of range.

We have learned this in a short time, so you would think the clinics would too

 

[Protimenow]

Unfortunately, I think that many of the clinics are tied (hog-tied?) to ancient rules and thinking about anti-coagulation management. That's how it is with my clinic. Even IF they agree that weekly testing may be better than monthly; or that no change is better than knee jerk reaction; if their protocol doesn't allow them to do these things, they won't. If the clinics were able to be kept current, with modern understanding of the subject (and, frankly, knowing what many of us who take our lives into our own hands by doing self-testing and self-management), the clinics may do a better job. Clinicians may learn, but they can't do a damned thing with knowledge unless the people who they work for say that it's okay.

 

[yotphix]

If I might be so bold as to respond to the topic of the original post, I'd like to add to the apparent consensus that there is not really any good reason not to shave with a blade while on Coumadin. It actually never occurred to me to worry about it. It's also very hard to tell whether I bleed more or not, when the odd nick happens. Those little nicks on the thin skin of a chin always did bleed forever, and they still do today, though I suppose it is probably more now.
In truth, while I do seem to take longer to stop bleeding, what I notice more, is that I also seem to take longer to scab over, and to scar up. I don't know why that would be, but the effect seems quite pronounced.

 

[Jimjam]

Just went on Coumadin - looking for a good electric razor

I grew a beard for my time on Coumadin. Understand your cautiousness.

 

[marc_kowal]

I bought a decent wet/dry electric razor after my surgery but I still use a disposable razor more often then the electric one. Knicks and cuts do bleed a little bit longer for me, but it doesn't discourage me from using a blade the next time.

 

[TheGymGuy]

no need for electric razor. use a switch blade if you like. just make sure to have something handy to apply pressure so small cuts for 20-30 seconds. I tried electric and it just did not cut it for me (pun intended). Went back to regular Gilete Mach-3 blades and all is fine and dandy.

 

[Protimenow]

'Knicks and cuts'? We can tell what part of the country YOU are from.

IN my experience with a razor, most nicks just take a bit of pressure -- or none at all -- and they close up pretty quickly. OTOH -- so far, I've not had a deep enough, or large enough, cut with my razors to warrant much extra attention.

 

[marc_kowal]

"'Knicks and cuts'? We can tell what part of the country YOU are from. "



Hah, that was an honest typo. I can't stand basketball. I'm more baseball and football.