Managing Anti-Coagulation Therapy While Overseas

[ThomasAw]

Hi,
I am from Malaysia. I am a Malaysian Chinese staying in Kuala Lumpur, the capital of Malaysia. I had a St Jude Mechanical AVR on the 14th February 2008 & I will forever remember the date because it is Valentine Day. I had it done at our National Heart Institute. I am on 2.5mg Warfarin.

I came to this website while I was surfing for information on heart surgery & I must say that this is such a wonderful website.

Anyone got any experiences on how to manage his/her anti-coagulation therapy while staying for a few months in a far away country. I am sure the food consumption will be different.

I plan to visit my sister in the US for a few months & am wondering how to go about in managing my anti-coagulation therapy there.

Thank You Very Much.

 

[Cooker]

Hi Thomas and welcome to the zoo.....If you don't have your own tester and test strips the I guess you would need to find a clinic....when are you going?....Is your INR stable?...If the food is not going to be that much different then there should not be much of an issue.

 

[Jkm7]

I'm sure others more knowledgable than me will be along to help. I just want to say welcome and wonder if you might not speak with your cardiologist and/or surgeon for their input.

 

[njean]

Hi,
I am from Malaysia. I am a Malaysian Chinese staying in Kuala Lumpur, the capital of Malaysia. I had a St Jude Mechanical AVR on the 14th February 2008 & I will forever remember the date because it is Valentine Day. I had it done at our National Heart Institute. I am on 2.5mg Warfarin.

I came to this website while I was surfing for information on heart surgery & I must say that this is such a wonderful website.

Anyone got any experiences on how to manage his/her anti-coagulation therapy while staying for a few months in a far away country. I am sure the food consumption will be different.

I plan to visit my sister in the US for a few months & am wondering how to go about in managing my anti-coagulation therapy there.

Thank You Very Much.

First of all, welcome to the forum! You have come to the right place for your questions and/or concerns.

Where are you getting tested in Malaysia! Are you going to a clinic at the institute? If it were me, I would get a letter from the doctor or clinic explaining that you need to have your anticoagulation managed on a weekly or however often you were being tested there. When you get to the US, take this letter to a nearby hospital & seek help there. That's where I would start. Hopefully, someone else on this forum will come along & give you more advice but that is where I would start. Best of luck to you & enjoy your stay in the USA!

P.S. I think it would be a good idea too, for you to get a "condensed" copy of your medical file/records to bring with you as well.

 

[Jan]

Hi Thomas

I live in the Uk but usually holiday in the USA, but only for 4 or 5 weeks
my INR is pretty stable so I test before I leave and them as soon as I get home and that suits me, but I realise not everyone would be happy doing that.

One trip I took a letter with me from my GP and went to a local clinic in Nevada they told me they would take a blood sample and do the INR but they couldn't give me the results they would only give them to my GP in England, well it was weekend and with the time difference and us moving on that was no use too me,so I never bothered, I figured what they were charging me for the test $100 I was entitled to have my results, no way they said.

So a home testing unit may be the answer for you, then you can telephone your results to whoever manages you INR and then alter your dose.

I always take a good supply of warfarin with me so I have them to hand and I do have an INR record/dosage card thay I carry with me at all times

If my INR goes high I usually develop bruises on my legs so in a case like that I would just turn up at a hospital and ask for an INR test ( hopefully my Insurance would cover that cost ) then phone my warfarin nurse in the UK for what dose too take

As I say the above suits me but would not suit others

cheers

Jan

 

[ThomasAw]

Hi Thomas and welcome to the zoo.....If you don't have your own tester and test strips the I guess you would need to find a clinic....when are you going?....Is your INR stable?...If the food is not going to be that much different then there should not be much of an issue.

Thanks cooker. My INR is not stable yet. Most probably will be going year end or next year.

 

[ThomasAw]

First of all, welcome to the forum! You have come to the right place for your questions and/or concerns.

Where are you getting tested in Malaysia! Are you going to a clinic at the institute? If it were me, I would get a letter from the doctor or clinic explaining that you need to have your anticoagulation managed on a weekly or however often you were being tested there. When you get to the US, take this letter to a nearby hospital & seek help there. That's where I would start. Hopefully, someone else on this forum will come along & give you more advice but that is where I would start. Best of luck to you & enjoy your stay in the USA!

P.S. I think it would be a good idea too, for you to get a "condensed" copy of your medical file/records to bring with you as well.

Thanks for the advice. Presently I go to the institute 2 week once for the INR testing.

Normally how much the hospital in the US charge for INR testing? I will have to pay myself as I think my insurance will not cover for it.

Thanks a lot.

 

[ThomasAw]

Hi Thomas

I live in the Uk but usually holiday in the USA, but only for 4 or 5 weeks
my INR is pretty stable so I test before I leave and them as soon as I get home and that suits me, but I realise not everyone would be happy doing that.

One trip I took a letter with me from my GP and went to a local clinic in Nevada they told me they would take a blood sample and do the INR but they couldn't give me the results they would only give them to my GP in England, well it was weekend and with the time difference and us moving on that was no use too me,so I never bothered, I figured what they were charging me for the test $100 I was entitled to have my results, no way they said.

So a home testing unit may be the answer for you, then you can telephone your results to whoever manages you INR and then alter your dose.

I always take a good supply of warfarin with me so I have them to hand and I do have an INR record/dosage card thay I carry with me at all times

If my INR goes high I usually develop bruises on my legs so in a case like that I would just turn up at a hospital and ask for an INR test ( hopefully my Insurance would cover that cost ) then phone my warfarin nurse in the UK for what dose too take

As I say the above suits me but would not suit others

cheers

Jan

Thanks for the advice. I think home testing in Malaysia is expensive. Almost all go to the hospital for their INR testing. Maybe I can get my INR to be stable for monthly testing, visit the US & come back a month time for the INR to be done back home. Or maybe even up to 2/3 month stable. I have friend here who is stable enough to go for quarterly testing.

Thanks a lot

 

[Jkm7]

With advance notice such as you have, couldn't your local testing hospital or clinic assist you in this issue. Can't they locate a hospital or clinic where they could pre-arrange for you to call, get an appointment, get tested and have them give you the results. That clinic certainly should be able to adjust your dose if needed eliminating the need for you to call your local coumadin manager. It seems it should be possible for pre-arrangements/connection to be made for you.

Perhaps I am just wishing professionals would do that to assist their patients......in a perfect world.

 

[ALCapshaw2]

With advance notice such as you have, couldn't your local testing hospital or clinic assist you in this issue. Can't they locate a hospital or clinic where they could pre-arrange for you to call, get an appointment, get tested and have them give you the results. That clinic certainly should be able to adjust your dose if needed eliminating the need for you to call your local coumadin manager. It seems it should be possible for pre-arrangements/connection to be made for you.

Perhaps I am just wishing professionals would do that to assist their patients......in a perfect world.

This is where things can get "sticky".

It's called LIABILITY and nobody wants to take it on!

 

[ThomasAw]

With advance notice such as you have, couldn't your local testing hospital or clinic assist you in this issue. Can't they locate a hospital or clinic where they could pre-arrange for you to call, get an appointment, get tested and have them give you the results. That clinic certainly should be able to adjust your dose if needed eliminating the need for you to call your local coumadin manager. It seems it should be possible for pre-arrangements/connection to be made for you.

Perhaps I am just wishing professionals would do that to assist their patients......in a perfect world.

Jkm7,
You hit the jackpot man! I think it is a perfect solution when traveling to any country in the world provided that country has hospitals that does INR testing. If that is the case I can travel to any country in the world after prearranging my ACT management with that particular country's hospital. With this kind of prearrangement I think I don't have to worry at all. I am a retiree & like traveling. With my condition it will be perfect scenario.

This give me an idea. I will be going to do my testing this coming Wednesday & will ask the hospital whether they can have this kind of prearrangement when traveling overseas.

Thank You Very Much

 

[Jkm7]

Thomas.....

I so hope this works for you. Please let us know.

I will suggest you look into cruising if that appeals to you. We cruise very often and I know that the cruise ships infirmiry will do INR tests for their guests. Cruise lines such as Holland America Line which does a 108 days world cruise every year (and many other lengthy cruises of 60+ days) know their doctors/nurses have to do this for guests and they do it. It enables many people who otherwise could not sail to be able to have the 'cruise of a lifetime'.

Good luck. Let us know.

 

[witzkeyman]

you have it tough. I served overseas myself. I always thought about what it would be like if I had the mechanical valve overseas. I was at a remote-like site which didn't have a hospital, and the nearest base was 100 miles away. the best advice I could say is demand a machine to test your INR.

 

[ThomasAw]

Thomas.....

I so hope this works for you. Please let us know.

I will suggest you look into cruising if that appeals to you. We cruise very often and I know that the cruise ships infirmiry will do INR tests for their guests. Cruise lines such as Holland America Line which does a 108 days world cruise every year (and many other lengthy cruises of 60+ days) know their doctors/nurses have to do this for guests and they do it. It enables many people who otherwise could not sail to be able to have the 'cruise of a lifetime'.

Good luck. Let us know.

JKm7,

My INR was 2.0 today & I forgot to ask the hospital. My next testing is in one week's time & I will definitely remmember to ask. Sorry

 

[ThomasAw]

you have it tough. I served overseas myself. I always thought about what it would be like if I had the mechanical valve overseas. I was at a remote-like site which didn't have a hospital, and the nearest base was 100 miles away. the best advice I could say is demand a machine to test your INR.

It's tough man! We mechanical valve men are handicapped by having to do INR testing wherever we may be.

If we have our own machine, that means we have to adjust the dosage ourselves when we are unable to contact our doctor. And we must have ample stock of warfarin!

Thanks

 

[ThomasAw]

It's tough man! We mechanical valve men are handicapped by having to do INR testing wherever we may be.

If we have our own machine, that means we have to adjust the dosage ourselves when we are unable to contact our doctor. And we must have ample stock of warfarin!

Thanks

I am not sure I am able to buy my own machine here. Testing is all done in the hosptials. Maybe I can purchase one from overseas, US or Europe.

Thanks

 

[ThomasAw]

My INR today was 2.8 (2.5-3.0). The hospital does not prearrange for INR testing for me when going overseas. I have to arrange it myself.

Thanks

 

[ThomasAw]

Any US clinic that will not give you your results is in violation of the law. When they do the test, the create a record of it, and you are entitled to a copy of any record on you that they have in their possession. You may have to either rant and rave a bit (I hope not) or sweet-talk them to get them to understand this and act accordingly, but once they do that test, they HAVE to share the results with you. Now, the hitch comes in the timing and the form of the release of the information. They do not necessarily have to give it to you in the exact form that you request or as quickly as you might like.

For instance, when I have had to test on a holiday eve, and my doctor's office was going to be closed for the next few days and I did not want to wait that long for the results, my local lab agreed to let me wait around for about an hour while they ran the test, and then they had me sign a form and they handed me the report with the INR on it. Yes, I did have to explain to (remind, that is) them that I was entitled to the results, and I did have to explain to them that if my INR was out of range and they refused to tell me that, that I would hold them accountable for making me go through a long holiday weekend that way. I was nice about it -- but firm. I would have preferred that they let me go on my way as soon as they drew the blood and then let them call me on my cell phone or leave a message on my home phone with the results. But they were having to do something they really didn't want to do, so I "gave" a little also.

Thanks for the advice Oaktree. When I visit the US I will know what to expect.

Thanks

 

[geebee]

When I used to travel before getting my own monitor, I carried prescriptions for all my meds and for INR testing. You should be able to find a hospital that will honor the testing prescription. The only issue might be to whom they want to provide the results.

 

[ThomasAw]

Oh, yeah, if your home clinic is not going to help you make arrangements to bring enough warfarin with you to last for the trip, then you will definitely have to have a US doctor -- and the US doctor
might or might not be willing to cooperate with self-testing.

If you want to say where your sister lives, there might be a vr.com member who lives in that area who could refer you to a good doctor.

Thank you very much Oaktree . Your advice is very much appreciated.

Thanks