My mother's local cardio doesn't support home testing.

[watson524]

Well, I went to the GP with my mom today to talk about various things since her canceled MV replacement, among them was a clinic in the area that might do a finger prick or home testing. He said he absolutely doesn't believe it's as accurate and won't support it. I was very disappointed but my mother isn't discouraged and said she was ok with continue the vein draws and ultimately, it has to be her decision. It's unfortunate that more doctors aren't opened to "new fangled methods" but I think in my mind, this is one of those pick my battle things in my mind and pushing my mother any further wasn't warranted in the grand scheme of things since I was more concerned with her not having the stress test (that's another thread).

thanks for everyone's input, I definitely do appreciate you all taking the time to write and provide feedback.

 

[Protimenow]

Yes, it makes sense to pick your battles carefully. If your mom doesn't mind the occasional botched blood draw, and likes her doctor, it probably makes sense to keep the status quo.

Just for arguments' sake -- blood draws aren't always accurate, either, because the blood can be mishandled, the lab's reagents can be slightly inaccurate, etc. With a meter - if the reported values are high, a blood draw is often used to validate the high readings. At the low ranges, the meters are reportedly quite close to the lab values. I know that many doctors have no problem with meters -- even if they're inaccurate, they're probably reliable (meaning that a reading of blood with a specific INR will almost always give the same number on the meter even if the meter is wrong) -- and that they can help provide an indication of a problem when the user's blood is out of range. For INRs, EXACT ACCURACY isn't always critical - our INRs probably vary slightly at different times of the day anyway -- just knowing whether you're within range should be enough for most people -- and if you're out of range, confirming a high INR with a blood draw is very frequently advised.

 

[ALCapshaw2]

Expanding on Protimenow's post,

YES, some of the Finger-Stick Instruments tend to read overly High at the Higher Ranges.

MY Coumadin Clinic (3000 patients 4 CRNP's) accepts the Finger-Stick Readings on their Coaguchek XS instruments between 2.0 and 4.5 with NO or SMALL changes to dosing.
Any INR reading above 4.5 triggers a Lab Draw for confirmation.
They Rarely (almost never) recommend Holding a Dose for INR's in the 5 range.

'AL Capshaw'

 

[lance]

My local lab, in my PCP/GP's clinic, has been very good at hitting my vein the first try -- in fact, I don't think anybody (two clinics and many nurses in the Hospital) has missed my vein for a blood draw. (That's as OPPOSED to the FIVE tries it took to get a good Arterial line in my forearm when I was going in for my OHS -- Yee-Yikes! )

But I'd still rather get the finger stick instead, and get my INR results right away. So far I've tracked down two clinics in Toronto that use the finger stick. Neither is close to my house, though one is close to where I'll be doing Cardio Rehab some time soon, so that may work. I plan to phone them and ask them if they know of a finger stick INR clinic closer to where I live. . .

Toronto's a very well-serviced and advanced city for hospitals and world-class cardiac clinics etc., but it may be a bit on the conservative side of average. E.g., it's a tough place to find a surgeon who wants to do robotic or minimally invasive HVR. That same conservatism may mean that the vast majority of INR testing is still done with a venous blood draw. . . (At least they're GOOD at it! )

Hi Norm
Lucky you- You had your surgery at Tor.Gen'l. How does it feel to be a Munkee?
Anyway I live 2 hours north and west of Toronto and guess what? Staff at UHN taught me to use both monitors and manage my INR. I send my INR result via e-mail. It's worked for years--even when I was in England and I haven't been back to the clinic in years.

 

[clement]

I am having the same issue in Portland, OR. I cannot find a single ACT clinic that does finger prick instead of vein draw.

I am willing to start a long journey/battle to make it happen.
The US seems like a moron compared to Europe where home testing/finger testing is so much more common.

Cheers,
Clement

 

[ALCapshaw2]

I am having the same issue in Portland, OR. I cannot find a single ACT clinic that does finger prick instead of vein draw.

I am willing to start a long journey/battle to make it happen.
The US seems like a moron compared to Europe where home testing/finger testing is so much more common.

Cheers,
Clement

Clement -

Another alternatiave you may want to investigate is to see if your Cardio or Primary Care Physician will write a prescription for a Home Test Instrument. One of them will then need to agree to be your anti-coagulation manager. Some of our members who home test have been able to persuade their Doctors that they are fully capable of also Self Dosing and they merely provide their Doctor with a list or spread sheet documenting their INR's and dosing pattern. It's worth a try!

'AL Capshaw'

 

[Protimenow]

Clement: Before I finally got my meter (I bought it on eBay), I did a search for a clinic that uses the meters. The ones I found were at Permanente - and if you weren't on their health plan, their services were unavailable. I'm in the Los Angeles area - so I kind of expected a good selection of anticoagulation clinics that used the meters.

In addition to what Al suggested, it may help to convince your primary care physician that you are able to do self dosing (or at least self-testing), if you bring a copy of a spreadsheet you've prepared so you can keep track of date, time, weekly dose, and comments (but no data yet), to show that you're prepared to start keeping track of this data once you get your meter. (My spreadsheet goes back to my first self-test -- and it's available to the doctor prescribing my warfarin whener he requests it). You might bring a copy of a dosing chart - Al Lodwick's or another one - that shows the doctor that you've also got a chart that you can use to help you manage your INR. (I wouldn't be surprised if the doctor takes a copy - for his or her office to use - once you show the chart).

Good luck in your dealings with your docs.

 

[Lily]

Mom had her follow up with the local cardio today.

She asked about a hospital/clinic in the area that does finger prick vs vein draw and also home testing (she's not sold on home testing herself but WOULD go to a place that does a finger prick) and he said that no place in the area does a finger prick because the equipment is more expensive and then she says to me "and he said for the home testing..." and I cut her off and said "what he thinks it's not accurate??" and she said "that's what he said". I told her I "know" lots of nice people here that would absolutely disagree. She is going to ask her GP though since he's the one that manages her INR levels and changes dosages the few times it's been needed. I suspect she'll get the same answer and I won't push it since she doesn't seem too keen on home testing and 28 years of going to the clinic has worked out ok but I wish somewhere local had a finger prick vs the vein draw.

My happily limited and temporary post-op experience with anticoagulation therapy was complicated in this way: My cardio is 3 hours away and my family doctor is 10 minutes away. My ACT draws were at the local doctor's but the cardio wanted to manage it. If the cardio managed it, the local doctor couldn't get properly reimbursed for the draw. So their staff fought between themselves and the end result was that I eventually had to drag myself down to the nearest hospital clinic in the nearest town, more than a half hour away, and have very expensive draws done there. That hospital is dirty and sloppy and it sometimes took days to get my results and a call-back from the cardio's office. And to top it off, despite my best and most careful efforts, my INR would not get into range.

I once posted a study that explained how expensive being on ACT was for many insured people, though a former member rudely shouted down the information; I don't know if that study might be in the archives or not.

If a doctor will approve home testing and a patient is competent to followup on it, that sure seems the way to go, if a person has to be on Coumadin/Warfarin.

 

[normofthenorth]

Hi Norm
Lucky you- You had your surgery at Tor.Gen'l. How does it feel to be a Munkee?
Anyway I live 2 hours north and west of Toronto and guess what? Staff at UHN taught me to use both monitors and manage my INR. I send my INR result via e-mail. It's worked for years--even when I was in England and I haven't been back to the clinic in years.

Lance, this is FASCINATING! Was it TGH/Munk that set you up with the monitors, or another part of UHN?

So far, my research has only turned up two big medical centers in Toronto -- Sunnybrook and St. Josephs -- that do the finger-stick INR tests, and one pharmacist at a clinic I'm not a member of. Neither of the big medical centers is especially handy, so I'll have my vein stabbed again today. It seems backwards to me.

Mind you, the fact that I should be coming off the ACT in another 6 weeks makes me much less energetic in searching out alternatives. . .

 

[Protimenow]

Just a thought, Norm, if you've got a lot of time on your hands. You might try phoning cardiologists - and possibly Family or General practitioners to see if a) they know of and can refer you to a clinic or lab that uses the finger stick method for testing or b) if they may be able to do it for you without your having to change doctors just to get the test. In this time when a lot of medicine is still pretty Byzantine, you might be able to find someone a bit closer who can help you out - or give you a USEFUL referral. (One other thought -- perhaps someone else in the Toronto area- a member of this forum - can send you a private e-mail offering to help you out with a test or two (or more). I don't think this can be thought of as practicing medicine if they don't give you any advice either way - helping you run a test shouldn't be thought of as little more than putting a thermometer in your mouth or a hand to your forehead. And if YOU run the test yourself, using someone else's meter, then even THAT objection should go away.)

 

[catwoman]

I am having the same issue in Portland, OR. I cannot find a single ACT clinic that does finger prick instead of vein draw.

I am willing to start a long journey/battle to make it happen.
The US seems like a moron compared to Europe where home testing/finger testing is so much more common.

Cheers,
Clement

Did you check locations listed at www.acforum.org?

Here's what I found at that website. I don't know which locations are near Portland; I travel quite a bit and have been in the Portland area, but I'm not extremely familiar with all of it.

BTW, my cardio's practice has a Coumadin clinic that is listed at www.acforum.org, and they do use CoaguCheks there. I already had my own unit, so I do my own testing.

Oregon

Sky Lakes Medical Center
Phone: 541-274-3770
2865 Daggett Avenue
Klamath Falls, OR 97601

St Charles Anticoagulation Clinic
Phone: 541-706-3780
2100 NE Wyatt Ct
Bend OR 97701

Portland Clinic
Phone: 503-646-0161
15950 SW Milikan Way, Beaverton, OR 97006

BEND ORTHOPEDIC & FRACTURE CLINIC, P.C.
Phone: (541)383-7332
2600 N.E. NEFF ROAD, BEND, OR 97702

BEND MEMORIAL CLINIC
Phone: (541)382-4900
1501 N.E. MEDICAL CENTER DRIVE, BEND, OR 97701

CORVALLIS CLINIC
Phone: (541)754-1256
3680 NW SAMARITAN DRIVE, CORVALLIS, OR 97330

SAMARITAN ANTICOAGULATION SERVICES
Phone: (541)757-5185
3517 NW SAMARITAN DRIVE, CORVALLIS, OR 97330

SOUTH LANE MEDICAL GROUP
Phone: (541)942-5505
1345 BIRCH AVE, COTTAGE GROVE, OR 97424

OAKWAY INTERNAL MEDICINE
Phone: (503)687-4905
495 OAKWAY ROAD, EUGENE, OR 97401

Peacehealth Anticoagulation Clinic
Phone: 541-687-6385
1162 Willamette Street, Eugene, OR 97401

SACRED HEART MEDICAL CENTER
Phone: (503)686-7162
1255 HILYARD ST., EUGENE, OR 97401

PeaceHealth Anticoagulation Clinic
Phone: (541)997-1335
PHMG Siuslaw Region, 380 E. 9th St., Florence, OR 97439

Legacy Mt. Hood Medical Center Anticoagulation Clinic
Phone: (503) 674-1229
24700 SE Stark , Gresham, OR 97030

PHYSICIANS MEDICAL CENTER
Phone: (503)472-6161
420 EAST 5TH STREET, MCMINNVILLE, OR 97128

Medford Clinic - Cardiology Dept.
Phone: (800)888-2778
555 Black Oak Drive, Medford, OR 97504

Providence Medical Group
Phone: 541-732-500
1111 Crater Lake Ave., Medford, OR 97502

PROVIDENCE MILWAUKIE ANTICOAGULATION CLINIC
Phone: (503)513-8343
10150 SE 32ND AVENUE, MILWAUKIE, OR 97222

Portland Cardiovascular Institute
Phone: (503)229-8003
2222 NW Love Joy, Suite 505, Portland, OR 97210

Vibra Specialty Hospital
Phone: (503) 257-5603
10300 North East Hancock Street, Portland, OR 97220

Legacy Emanuel Hospital
Phone: (503) 413-2078
2801 North Gantenbein Avenue, Portland, OR 97227

OHSU Anticoagulation Clinic
Phone: 503-494-7631
3181 SW Sam Jackson Park Rd , portland , OR 97239

Providence Portland Medical Center
Phone: 503-215-2284
4805 NE Glisan, Portland, OR 97213

Kaiser Permanente - ACC
Phone: (503)249-6777
5055 N. Greeley Ave., Portland, OR 97217

Anticoagulation Care Management Program At Kaiser Permanente
Phone: (503)331-6269
3225 North Interstate Ave., Portland, OR 97227

Legacy Good Samaritan Anticoagulation Clinic
Phone: (503)413-8165
1130 NW 22nd Avenue, Suite 150, Portland, OR 97210

PSVMC Anitcoagulation Clinic
Phone: (503)216-7923
9205 SW Barnes Road, Portland, OR 97225

Columbia Cardiology
Phone: 503-297-6234
9427 SW Barnes Rd. Suite 498, Portland, OR 97225

Portland VA Medical Center
Phone: 503-220-8262
3710 SW US Veterans Hospital Road, Portland, OR 97239

REDMOND INTERNAL MEDICINE
Phone: (541)504-7626
213 NW LARCH, REDMOND, OR 97756

SALEM CLINIC
Phone: (503)375-7462
2020 CAPITOL STREET, NE, SALEM, OR 97303

Salem Hospital Ambulatory Parenteral and Enteral Service
Phone: 503-561-5719
875 Oak Street, Salem, OR 97301

Legacy Clinic St. Helens Anticoagulation Clinic
Phone: 503-366-5519
500 N Columbia River Hwy, St. Helens, OR 97051

Legacy Clinic Tigard-King City Anticoagulation Clinic
Phone: 503-620-0721
15298 SW Royalty Parkway, Tigard, OR 97224

Legacy Meridian Park Hospital
Phone: (503) 692-7794
19300 SW 65th Avenue, Tualatin, OR 97062

Dept. of Veterans Affairs
Phone: 541-826-2111
8495 Crater Lake Hwy, White City, OR 97524

Silverton Hospital
342 Fairview St
Silverton OR 97381
Phone: 503-873-1670

 

[normofthenorth]

I phoned a bunch of local clinics from acforum.org, but they mostly use blood draws, so it was a time killer. What HELPED was a phone call to the CoaguCheck (Roche) rep! Yesterday afternoon, my sweetie and I both walked to my local medical clinic -- me for an INR blood draw, she for a flu shot. While she was waiting for me (getting prescriptions renewed), she looked through a rack of brochures, and there was one about INR monitoring "at home or at the pharmacy"!! So she grabbed it for me, and I phoned the 800 # (probably just canadian) and left a message.
This morning, the Roche rep called back and gave me a bunch of phone numbers -- TWO of which are for people at TGH, my own hospital! It's also a short bike ride away, if the snow ever clears up enough that I return to bicycling. Also one subway stop and maybe a 1-mile walk. . . Not quite as handy as my clinic, but maybe worth it for the convenience, less pain, and instant results. . .

 

[Bina]

Norm, that is exactly what I did. Called Roche office in Quebec and they sent me the brochure to show my doc.
2 weeks later I had the training and monitor in my possesion. Happy Happy ever since.

 

[clement]

Hello Catwoman,

Thank you for the data.

Actually, I need to correct my statements:
My cardiologist office has already started the process to provide me with home monitoring. I was told that it takes 4 weeks to get one. Paid or not by my health insurance.

However, in the meantime, I still need vein draw for inr testing since one one ACT clinic offers finger prick and new patients are on a waiting list.

Clement

 

[normofthenorth]

If I expected to stay on ACT forever, I probably would have already started the process to get a home monitor -- or bought one on eBay, since that's my style! But I'm expecting/hoping to say goodbye to it in another ~6 weeks.

 

[ALCapshaw2]

Hello Catwoman,

Thank you for the data.

Actually, I need to correct my statements:
My cardiologist office has already started the process to provide me with home monitoring. I was told that it takes 4 weeks to get one. Paid or not by my health insurance.

However, in the meantime, I still need vein draw for inr testing since one one ACT clinic offers finger prick and new patients are on a waiting list.

Clement

Ask the Tech to use a Butterfly Needle. It's more like a mosquito bite than a bee sting.
One tech I know is so good I don't even feel the Butterfly Needle (in my hand no less!)

 

[normofthenorth]

Norm, that is exactly what I did. Called Roche office in Quebec and they sent me the brochure to show my doc.
2 weeks later I had the training and monitor in my possesion. Happy Happy ever since.

Bina, I now know even more than I did a couple of days ago! The Roche rep was apparently wrong. I've spoken to a number of people on her list, who are supposed to offer coagucheck finger-prick INR testing to patients. Several of the contacts sell the machines but don't offer the service. (One doesn't even sell the machines!) And the nearest pharmacy on the list? The guy there said "I'd LOVE to offer that service! I got the training, I know exactly how to do it, but it's against the law in Ontario for a pharmacist to prick your finger, so I can't do it!" (My wife asked me to ask him if I could prick my own finger, then have him test the blood. I haven't done that.)

The nice woman who runs the anti-coagulation clinic at TGH helps set patients up with their own Coaguchek machines, but doesn't USE one. She made it sound like a Herculean task to try to change the hospital from vein draws to finger-pricks, even if it ends up cheaper. And the only real advantages are to the patients. . .

Meanwhile, my own INR is still a bit too low (2.3 vs. 2.5-3.0) two readings in a row (Thursday and Mon/yesterday), so I've got to boost my own dose a smidge -- a bit of a challenge with my new 5mg pills!

Meanwhile, my GP/PCP Doctor just told me that she's been warned that cutting a pill into smaller pieces than the "break here" scoring marks might NOT divide the active ingredients proportionally! I guess I can believe that's true with some fancy time-release capsule or multi-layer tablet. But for a simple tablet like my cheap genetic Warfarin, I cannot believe that anybody would go to the trouble and expense to make the distribution of Warfarin and the distribution of fillers/binders/"glue" DIFFERENT -- oh, yeah, AND simultaneously make sure that the distribution is identical across the "break here" scoring marks! (She said THAT distribution is guaranteed, as long as you break the pill on the scoring mark.) SURELY they just mix the active ingredients into the fillers/binders/"glue" in a huge vat, then feed it all into the pill-making machine, and mold a gazillion pills into the right shape (including the "break here" scoring marks).

Has anybody else heard this claim? Sounds to me like a drug-company's mythical pitch for more premiums for small-dose pills. . .

 

[Bina]

Bina, I now know even more than I did a couple of days ago! The Roche rep was apparently wrong. I've spoken to a number of people on her list, who are supposed to offer coagucheck finger-prick INR testing to patients. Several of the contacts sell the machines but don't offer the service. (One doesn't even sell the machines!) And the nearest pharmacy on the list? The guy there said "I'd LOVE to offer that service! I got the training, I know exactly how to do it, but it's against the law in Ontario for a pharmacist to prick your finger, so I can't do it!" (My wife asked me to ask him if I could prick my own finger, then have him test the blood. I haven't done that.)

The nice woman who runs the anti-coagulation clinic at TGH helps set patients up with their own Coaguchek machines, but doesn't USE one. She made it sound like a Herculean task to try to change the hospital from vein draws to finger-pricks, even if it ends up cheaper. And the only real advantages are to the patients. . .

Meanwhile, my own INR is still a bit too low (2.3 vs. 2.5-3.0) two readings in a row (Thursday and Mon/yesterday), so I've got to boost my own dose a smidge -- a bit of a challenge with my new 5mg pills!

Meanwhile, my GP/PCP Doctor just told me that she's been warned that cutting a pill into smaller pieces than the "break here" scoring marks might NOT divide the active ingredients proportionally! I guess I can believe that's true with some fancy time-release capsule or multi-layer tablet. But for a simple tablet like my cheap genetic Warfarin, I cannot believe that anybody would go to the trouble and expense to make the distribution of Warfarin and the distribution of fillers/binders/"glue" DIFFERENT -- oh, yeah, AND simultaneously make sure that the distribution is identical across the "break here" scoring marks! (She said THAT distribution is guaranteed, as long as you break the pill on the scoring mark.) SURELY they just mix the active ingredients into the fillers/binders/"glue" in a huge vat, then feed it all into the pill-making machine, and mold a gazillion pills into the right shape (including the "break here" scoring marks).

Has anybody else heard this claim? Sounds to me like a drug-company's mythical pitch for more premiums for small-dose pills. . .

I don't know of any finger stick clinics in my farming area of Eastern Ontario, that's why I bought my own machine.
There was no way that my arm veins would hold out for the next 30 years, and the monitor was a meazly $500.
Regarding pill splitting; I would only use halves, anything smaller is just easier and more accurate with another dosage.
I have a bottle of 2 mg and a bottle of 3 mg.

 

[ALCapshaw2]

Hey Norm -

Get your Doc to give you an Rx for some 1 mg tablets to make adjustments.

 

[normofthenorth]

My new Doc is terrific, but she makes very quick decisions, and they're mostly based on the here-and-now rather than the what-if. So after my prescription for twice-weekly INR lab tests ran out, she gave me a prescription for one test every TWO weeks -- because my last two tests had been in-range(!). (Ironically, that was last Thursday, and last Friday, she told me to get tested again on Monday! ) And since I'd been in-range on 5mg/day (2.5 2mg pills/day), she wrote me a prescription for 5mg pills, since that would mean I'd have to swallow fewer pills -- IFF everything goes according to plan, which it NEVER does for long!! This woman was obviously not raised to believe that Murphy was an optimist!

I still have 1.5 2mg pills left over. And I'm a (and I HAVE a) good little pill cutter, and I'm not concerned about my accuracy quartering the new pills, if it comes to that. (Since most experts tell you that your 3-day or 7-day Warfarin dose is way more important than any 1 day's dose, I don't see why pill cutting is so frowned on, unless you're consistently under-dosing by throwing away the "cutting crumbs".) If I have to juggle my dose a lot before I (let's hope) kick the ACT habit, I'll get some smaller tablets. If I don't get to kick the Warfarin habit on March 1, I'll change a lot of things. . .

Bina, the only places I've found in the Big Smoke of TO that do finger-prick INR tests are Sunnybrook and St. Joseph's Hospitals. Maybe some day the pharmacists will be allowed to stick a finger, or to let a client do so!