Lab tests VS home testing

[Blanche]

Tomorrow the rubber meets the road and the fate of home testing in my house may well hinge on the results of one comparison of INR results from a stat lab test and our ProTime monitor. Those of you who know me know that my frustrations seldom spill out in print. Tonight is an exception. I am so frustrated right now, I just want to break something.

Al tested today at home and his result was INR=4.7. An hour later, he tested again and got a result of INR=4.6. I also tested and got an INR result of 0.8, which would be expected since I do not take Coumadin. Last week, he tested at 4.2 and the week before at 3.9. Doctor said to stay on same dose. Al did have antibiotic therapy twice this month for dental surgery, which means that he probably isn't producing much Vitamin K because the bacteria in his intestines have been severely diminished. None the less, I would think that an INR of 4.7 would be given immediate attention. Nope!!

The doctor replied to my email. He instructed Al to have a stat test at the lab tommorow and to do a "Home" test tomorrow. (Those were his quotation marks around home.) It just seems that no matter what we do, our doctor will not be moved to accept home testing. For the past three years, Al has tested weekly and more often when there were problems with hospitalizations or antibiotic therapy. Still, after three years, the doctor requires him to do a lab test every fourth week for "QA." I went along with this nonsense because I know that it is vital for Al, who had a stroke while on Coumadin to maintain an INR in the 3.0 to 4.0 range. I thought I had him convinced to let us use home testing exclusively.

I recently sent the doctor an executive summary of information on home testing. His response was, "You have made an excellent case, young lady."
He also mentioned that in his new office (he's moving) he was planning to set up an anticoag clinic of "some sort." Yet, when the push comes to shove, his gold standard is still the d@#$ lab test. Well, I am not young and I am not a lady. I am a 62 year-old, salty old woman. The only thing young about me is my spirit. This doctor is the very best, most competent, most available and approachable doctor that I have ever encountered. We will be his patients until he retires or we expire...unless he fires us!!! And, tomorrow, I plan to give him good reason to do so.

Thank you for listening. If anyone has had problems with lab tests, I would appreciate that information. Right now I am going to go break something and I have my eye on a very big, ugly vase.

Kind regards,

Blanche

 

[Ross]

I got into it with my PCP. He feels the same way about the lab, so I took all of my INR tracking sheets and plopped them in front of his eyeballs. I asked him to explain to me the WIDE VARATIONS in the INR numbers and multiple dose changes chasing it while going to the lab and all of it came to a dead halt with fingerstick testing.

I mean something isn't right when they have you at 60mg one week and test you out at 4.9 and with in 4 weeks time they have you back at 60mg and they test you at 1.8! (Weekly testing here) This was it for me. I quit asking my PCP and went straight for the Cardio. The difference is on paper, why does the PCP want to dispute it? I don't need to tell you how many variables come into play with the lab test results. After seeing the proper drawing procedure, I can count numerous times where the technician drawing the blood didn't follow procedure, so I can only imagine what's going on in the lab.

 

[EVELYN]

Hi Blanche

I'm so sorry to read that you're having such problems with home testing.....again. As you well know, I've been there and can empathize with you. Tyce is now using the Coaguchek machine and so far we have been right on target with the cardio's clinic that we use. There are definitely more controls to run, and it's a bit different, but I do like it and feel more confident with it. I think in the two years he was using the other machine we only agreed with the coumadin clinic once, which was ok. This machine iseems right on the money, and as long as they're happy, we're happy.

Please let me know how things go---I'm definitely thinking of you and know how you feel. Hope the vase made it.

Evelyn

 

[Guest]

Blanche, I seldom get very upset about a 4.7. My rule is to stay under 5.0.

 

[Lisa in Katy]

My cardiologist's office told me that the CoaguChek tends to inflate the high readings. I'm not sure exactly where "high" starts in their definition, but I know when I tested at 6.9, they said that it probably wasn't actually that high, but it was definitely high. I also don't worry about 4 point anything, but I prefer to be on the high side.

 

[Blanche]

Al's stat test at the lab on monday was INR = 3.2. Home test that day was INR = 3.4. That shows me that there are no problems with the home monitor. The doctor wanted a comparison. Other than the lab results, I have heard nothing from him. The issue here was that we wanted to test at home 100% of the time. At this time, the dr. requires that we do a lab test once a month for "QA." This has been going on for three years. I am royally tweeked because we had results of a high INR, 4.7 on the ProTime, but had to wait until the next day for a lab test (QA) before his dose could be adjusted. But, I am not done. This is one more piece of data that I will use in my continuing effects to end the redundant practice of lab testing when we have a home monitor that was designed for home testing all of the time.

Ross: I thank you for your post about lab draws. I'll add this to my list of reasons why the labs have more opportunity for error than the home monitors.

Al: I feel like I have you, my anticoagulation specialist, in my pocket at all times. Without the info that you post here and your book, I would have been worried about 4.7. It didn't bother either of us. We just wanted to get down to business right away, which, of course, is the beauty of home testing.

Lisa: Thanks for reminding me about the lack of precision of the high INRs. I did not think of that before your post. You are right. I think it has something to do with the way p/t results are standardized using the INR equation. Since there is an exponent in the equation, the resulting INRl tends to lose power at the higher levels.

Evelyn: You were ever gentle on my mind when this came up. I remember your problems which resulted in your having to change monitors. I kept thinking.....here we do again. And, the vase got a stay of execution.

Thanks to all. We'll just keep on keeping on. Appreciate your support.

Blanche

 

[tommy]

Blanche,

Glad to hear Al is back in range.

My concern about the lab test where I am is that the vials get transported later in the day 20 miles to a lab in Dallas. Then the results are faxed to the doctor the next day. How many of these factors are variables that could be a problem?

Transported Later in the day 20 miles Next day results

I did a triple test one day (home, lab, coumadin clinic). The lab was the "odd man out".

If you must test at a lab, can you use a lab at a hospital that does on-site analysis? That reduces a bunch of variables.

Keep throwing salt on this "wound". Does insurance pay for both sets of tests?

By the way, I beg to differ about your use of the word "old". Okay, so you are 62, and you may be salty, and your body may not be considered young, but you are not old. My definition of old is "ten years older than you are now". That way, we never get there . Glad to hear the vase is still with us. Is it old?

 

[Blanche]

Tom:

Our lab operates in much the same manner as yours does. I recently wrote about it in another post.

http://www.valvereplacement.com/forums/showthread.php?p=75009#post75009

To make matters worse, our doctor's office has been experiencing "staff reorganization" for the past year and the results to us have been delayed as much as 5 days. Everytime that we don't receive the result the next day, I email the doctor, so he is aware. Our hospitals do not do routine p/t tests. They refer them to the lab sites located in the buildings next to the hospitals. At those lab sites, they merely draw the blood and ship it out in the manner I described in my previous post. The hospital will do a stat p/t test, if ordered by the doctor. He sees no reason to do this on a regular basis.

Medicare has paid for all of Al's p/t lab tests. We paid for the ProTime machine three years ago and must pay 100% for the supplies. It is my understanding that Medicare will not pay for hometesting and lab tests too. It's only been within the last year or so that Medicare has covered home testing.
Now that we see what a mess they can make out of the simplest things, we have decided not to involve them in the home testing.

Tom, I like being a salty old woman. I get to wear purple with a red hat which doesn't go and spend my pension check on brandy and summer gloves and sit on the pavement when I'm tired.....(From a poem titled, "Warning,"by Jenny Joseph).....The vase is about as "young" as I am.

Regards,

Blanche, who is singing, "You make me feel so young......."

 

[tommy]

Blanche,

Okay, okay, you're a salty ___ woman (I would never say that!). Thanks for the reference to the previous post. Sounds familiar.

My cardio's "coumadin nurse" position turns over every few months. Fortunately, it is a dedicated position albeit twice a week at my location. At least she doesn't have other stuff to do except draw blood all day (no wonder the turnover). Each new nurse seems to be well trained and slides in from another office. Only once did I get a rookie. She lasted a little over a month.

 

[Christina]

Home testing is the best way for me.

Home testing is the best way for me.

Blanche,
I had the exact same frustrating problems with the labs here in Tucson 3 1/2 years ago and that's the reason I purchased my Protime. Also had to buy it out of pocket and still have to pay 100% of all the supplies. No problem, I rather do this than be stuck going to the stinking labs where there is lots more opportunity for errors. And the patient usually ends up losing.
I've gone to the doctor's office once for a comparison and to demonstrate that I was capable of doing my own testing. That difference was .2 that day and he was fine with that. I haven't gone back. It only causes more stress and frustration for me, because if the lab is off more than a little bit with the Protime that day the doctor might decide he no longer trusts the Protime. I want to avoid these hassles at all cost.
He's pretty good about my doing the home testing and doesn't freak if my INR at times is over 4. He says NOT to go over 5. (how do you do that? I have a few times, but don't call him for this because I know he'll instruct me to hold for 48 hours and there is no way I am going to obey those orders. Just in case I test very, very high one week (which hasn't happened yet) I always have some vitamin K drops on hand. You got to be prepared.

Better safe than sorry..

 

[LUVMyBirman]

The control is so tight on my Coaguchek that it is within .1 of the lab. Trust that unit all the way. It is my understanding that anything over 6.0 can give you a false positive.

 

[Raquel]

Hello. My husband heard me talking about this machine and we both are very interested. Can any of you give me a phone nuber or address so I can find more info on it? He was getting the blood drawn at home, but it stopped this week so we have to start with the labs Thanks Raquel

 

[Guest]

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