mdINR service

[balloonshark]

Unfortunately I don't have Excel. I also need a spreadsheet to track my rechargeable batteries hehe.

I was able to find a simple chart but I'll have to improvise if I need to make a comment. The .pdf can be found at this link and is labeled "INR Results Chart for Heart Valve Patients: the same chart as above, with a different goal range for patients with heart valve replacements." http://www.azcert.org/consumers/warfarinpatients.cfm

 

[Protimenow]

There are printable charts at a few locations. A commercially available product, MyINR, is used by a person I know, and she likes it (but it's a commercial product - $29.95). You can download OpenOffice (www.openoffice.org), which is free, Microsoft Office compatible, and includes a spreadsheet. I'd be happy to send you the fields I use for my INR tracking spreadsheet - but they're pretty obvious. I think OpenOffice will allow you to choose which applications to install -- so you may be able to only install their spreadsheet, if that's all you need.

There may even be a Mac version of OpenOffice, if that's what you're using.

I think it's probably best to be able to enter your results into a computer (and print them out occasionally, or back them up). This way, if you ever have to send results to a new doctor, you've got everything ready to go.

(I've got records from the day I started self-testing -- it may be useful some time in the future to track why I had a recent blip in my INR and what I'm doing to resolve it).

 

[lance]

Good morning Shark,
Along with "tweaking/small changing" you warfarin dose I'd eat a healthy well-balanced diet including a similar amount of "greens" every day and then dose that diet. I'm much too lazy to document Vit. K intake.
AND
Also I'd order new strips when I had 3 left because you never know when a strip will be wasted and you don't want to run out delaying a test.
Cheers and happy sticking.

 

[Protimenow]

Personally, I don't document my Vitamin K intake, either - I just TRY to be careful and consistent. It's not all that easy to document, anyway, because it may be a bit difficult to figure out how large a portion of which green you take, and how much Vitamin K that particular meal provides, etc. If you get it in a vitamin or supplement, that may be slightly different -- but there are those pesky greens to be concerned with.

The idea of ordering new strips when you're down to three is a really good one -- especially if you're testing often,or you run into a situation like I recently did where you have to test every few days.

 

[ShezaGirlie]

Wasting Medicare dollars...

Wasting Medicare dollars...

Hi Shark and welcome! Since I'm on the Medicare scheme of INR testing, just thought I'd chime in.

I just called Alere Home Monitoring who I get my lease machine (CoaguChek XS) and supplies from and found out the following info/charges on only 12 strips!

Billed to Medicare = $795.00 (12 strips)
Approved by Medicare = $476.31 of which Medicare pays 80% to Alere
Deductible = $75.13 which is the Medicare deductible payable by me
Adjusted by Alere = $381.06 which is the 80% medicare allows paid to Alere
Balance = $155.36 payable by me since I do not meet my Supplement Deductible and won't.

Per test cost:
Medicare pays = $31.76
I pay = $12.95
TOTAL COST = $44.71 that Alere gets paid for machine lease and strip test.

I am also charged a monitoring fee by the INR lab in my cardio's office, but haven't figured that one out yet. Talk about confusing..

Another choice I have is to buy my own meter which is possible for about $600 and buy my strips directly from Alere. I was quoted $102.00 for a box of 12 or $8.50 per strip and no red tape. This looks very favorable to me versus running Medicare into the ground. I am on a bi-weekly scheme of testing at my request as I thought the once-a-week was overkill and my cardio agreed. I have self-tested since Dec of 1999 without all this high-priced Medicare monitoring. Yes, this is just one more reason Medicare is in such dire financial straits..:mad2: Hopefully, that will change!

Shark - once you've become fairly stable, you should ask your cardio to change from the weekly testing to bi-weekly and it shouldn't be a problem. Goodluck!

 

[Protimenow]

The Medicare option seems absolutely crazy. This is $795 JUST FOR THE STRIPS? YOU have to pay $12.95 PER TEST? (Plus your doctor's monitoring fee). I'm not on Medicare yet (if I was, I'd have used it this past week).

I have my own InRatio meter. I buy my own strips. A box of 48 strips on eBay costs around $200 -- they may have a shorter expiration date than a brand new box, so you may have good reason to test weekly. (According to some on the board, the InRatio strips are still good for up to a year after they expire -- in my experience, this is correct). Medical suppliers also charge less than Alere does for the strips, from what I've seen.

I was testing weekly until last week, when I thought I might push my testing intervals out to two weeks -- but then decided that ten days between tests would have been enough. I'm glad I didn't wait the full two weeks -- my INR, for some reason I'm not entirely sure of, dropped from 3.1 ten days earlier, to 1.1. I increased my dose of warfarin, and have been testing almost daily to see if it's starting to rise. What this means is that I'm burning through strips more rapidly than usual. It's good to have extras - but not for $13 a strip. (Of course, if I had Medicare, I'd have probably gone to a doctor and had him or her help manage my INR, and the strips used would have been the ones at the doctor's office or the blood draw at the lab). My point here is that I don't agree that weekly testing is overkill. My INR had been in range, pretty stable, and I had no clue that my INR dropped. If I had waited the extra four days for testing, I wouldn't have known my INR was low, or made any dosage increases to deal with it.

(And I still believe that anyone on warfarin who is able to do a self test SHOULD be able to get a meter and strips. It's empowering, and it allows them to monitor without having to go to a doctor office or lab or other inconvenient place)

 

[Cooker]

The Medicare option seems absolutely crazy. This is $795 JUST FOR THE STRIPS? YOU have to pay $12.95 PER TEST? (Plus your doctor's monitoring fee). I'm not on Medicare yet (if I was, I'd have used it this past week).

I have my own InRatio meter. I buy my own strips. A box of 48 strips on eBay costs around $200 -- they may have a shorter expiration date than a brand new box, so you may have good reason to test weekly. (According to some on the board, the InRatio strips are still good for up to a year after they expire -- in my experience, this is correct). Medical suppliers also charge less than Alere does for the strips, from what I've seen.

I was testing weekly until last week, when I thought I might push my testing intervals out to two weeks -- but then decided that ten days between tests would have been enough. I'm glad I didn't wait the full two weeks -- my INR, for some reason I'm not entirely sure of, dropped from 3.1 ten days earlier, to 1.1. I increased my dose of warfarin, and have been testing almost daily to see if it's starting to rise. What this means is that I'm burning through strips more rapidly than usual. It's good to have extras - but not for $13 a strip. (Of course, if I had Medicare, I'd have probably gone to a doctor and had him or her help manage my INR, and the strips used would have been the ones at the doctor's office or the blood draw at the lab). My point here is that I don't agree that weekly testing is overkill. My INR had been in range, pretty stable, and I had no clue that my INR dropped. If I had waited the extra four days for testing, I wouldn't have known my INR was low, or made any dosage increases to deal with it.

(And I still believe that anyone on warfarin who is able to do a self test SHOULD be able to get a meter and strips. It's empowering, and it allows them to monitor without having to go to a doctor office or lab or other inconvenient place)

Blah Blah Blah ... many ways to test ... your way is not for everyone....I test at the cardio once a month and have had no issues .... I'm always in range but I don't demand that my range is +/- a decimal or two ... if I'm between 2 and 4 I'm happy ... people can drive themselves crazy being obsessive about warfrin management and make life on anticoagulation miserable

 

[Protimenow]

I didn't say that everyone SHOULD self-test, I just said that anyone who wants to - and can - should be able to. If going to a lab and getting a blood draw works for you, I wouldn't advise against it.

Personally, I don't obsess over a point or two -- I've been a bit concerned with a 1.1 - way below range - for the past week -- as anyone taking warfarin should understand. In the past, if I dropped below 2, I'd usually give it a few days to get back (and test in a week), and if I was a bit above range, I did the same. With Warfarin - it's not like stopping on a dime -- it's more like stopping in a football field with faulty brakes.

I still don't see a problem with weekly testing -- if you've got the resources to do this (at a lab or on your own machine). If an anomaly should turn up, it's better to know and correct for it sooner, rather than later.

 

[balloonshark]

Protimenow and lance,

I've heard of open office but never gave it a try. I was put off by the large file size. I also can't remember if it needs .NET framework which I avoid lol. I may need to investigate it though as this is the 2nd time this month where a spreadsheet program would come in handy. As far as keeping track of vitamin K intake I think all I would need to do is write down what I ate the night before I test. If my INR was whacky I could give my doctor a possible reason.

ShezaGirlie,

Thanks for posting the costs of your service. I can't believe how much they charge and how much you need to pay. Perhaps that is why I couldn't get any amounts from mdINR. It seems the government doesn't need to cut spending, they just need to "fix" spending.

At any rate this service should be a good thing for me. The only time I have been getting my INR checked is when I have a doctors appt. every 6 months. This is mainly because of my anxiety. Home testing is perfect for me and my "situation". Luckily for me my INR has always been fairly stable.

 

[Protimenow]

I don't think Open Office requires .NET. Although it's a large download, you can choose which application you install. An installation of just the spreadsheet shouldn't be too large.

Testing your INR every six months is not a good idea. Although your INR may have been about the same each time you tested it, who knows about some variations BETWEEN tests? I've heard of someone who was banned from this forum because he went without testing for a few years, and reasoned that his INR was stable, so he didn't need to test frequently. This person, apparently, didn't have a meter and couldn't afford a lab test or doctor. The argument that an INR is stable just because tests weeks or months apart are roughly the same doesn't take into account probable variations that occur between tests.

My INR has been stable for months - staying in range on the same dose for the long period. I started another thread when my INR surprisingly plunged to 1.1. If I was testing every six months, I probably would have missed this.

For myself, I have my own meter. I thought I would test every 10 days or every two weeks, to conserve strips, but I am convinced that weekly testing is probably safer and is a better way to keep track of my INR. I don't freak out over minor peaks or valleys and usually maintain a steady dosage. The weekly test is just to assure myself that nothing strange is happening to my INR.

If you have access to a meter, it's certainly a good idea to use it -- I don't think weekly tests are too frequent, even with a stable INR. With weekly testing, if something strange DOES happen to your INR, you (and your doctor) can deal with it sooner, rather than later.

 

[balloonshark]

Just to be clear I wasn't suggesting that anyone including myself test only every 6 months. At a minimum we should test every month or at least that was what I always did in the past for years and years. I just haven't been getting it done because I have anxiety and spend 99% of my time at home. I also don't like the idea of going to a doctor's office when I'm healthy and taking the chance of getting a disease. Every time I get sick it affects the level of meds in my blood and I can feel a change in my depression and anxiety. I also understand that my thinking is a bit irrational but that's just where I am in life right now but I'm moving forward with every day.

They said that I have to test once a week so that is what I will do. I will ask my regular doc in Dec. if he wants me to continue weekly or go to bi-weekly test.