My PCP's an idiot when it comes to INR

[KristyW]

Time to vent...sorry.

I've about had it up to "here" with my PCP!!! I swear I know 10x more about warfarin regulation (thanks to Al Lodwick and this wonderful site) than he does!!

My INR bottomed out because I changed my diet pretty drastically AND I started exercising every day for at least 1/2 hour. I've managed to lose about 25 lbs since Mid-March by eating lots of veggies, lean meat, lowfat dairy, fresh fruit & whole grains. I digress. Since, this happened (INR bottoming out), my PCP dinked with my dosage 2g a week. I finally put my foot down and told him what I was going to do to get my INR out of the basement by increasing my dose 10-15%. He wasn't happy, but what was he going to do?

I went back for my 1st test after that about 3 weeks ago and my INR was 2.1, in range but too low for my taste. He said come back in a month, I said how about 2 weeks..we agreed on 3. I went in on Tuesday this week and my INR came back (a day later) at 3.6. My PCP went nuts. He said your range is 2.0-3.0 according to the lab (Since when does the lab get to make that call?), and we need to reduce your dose!! I told him..NO WAY! I'll just have 7 V8/week instead of 5/week. This was a major battle for me.

Supposedly, my insurance (Pacificare - Pa see if I care) won't pay for me to have my INR monitored at my Cardiologists office where they use a Coaguchek nor will they pay for a home monitoring machine. Even if I had my own machine, I'd still have these fights. I don't know what to do, but thanks for letting me vent

 

[Karlynn]

Knowlege is power and some doctors just don't like relinquishing any part of their power.

Good for you for standing your ground.

 

[Ross]

Kristy I went throught the same deal. I have no veins left for their sticking pleasure and I'm sick and tired of needle probing. My Doc was the same way and it got to the point that I just didn't care anymore, I was taking control of the ship and the hell with what he said. Everytime I turned around, get tested. Your too high, your to low, adjust adjust adjust, test test test. Were talking changing doses for mere .1 overs or unders!

I had charted all my dosages and results and concluded that I needed to use 42.5 mg per week. So I did my math, divided it up, took it like that and since then, I've only had to make minor changes on occasion. I float between 42.5 and 40.0 per week. I no longer do a darn thing in changing dosages if I'm anywhere from 2.0 to 4.0 INR. Now I general hit 3.0 to 3.5 every week.

Sometimes you just have to take over and do it for yourself.

 

[ALCapshaw2]

Ross - What did your Doc say about your results (vs. his?)

'AL'

Kristy - That's a bummer when your insurance won't cover 'proper' monitoring. What if your PCP throws up his hands and gives you a 'referal' to the Cardio or some Coumadin Clinic? There's gotta be a better way! Good luck.

'AL'

 

[Ross]

What did my Doctor say? How about nothing and side stepped the issue completely.

 

[KristyW]

Al - I'm thinking about it. Actually, I'm thinking about moving to a different Dr in the same practice. My current PCP is probably late 50s, but there's a nice woman about mid 30s who treated me when I had a kidney stone. She and I had a good rapport. I really should interview her and see about her philosophies regarding coumadin/warfarin management.

Ross - The crazy thing is I had figured out my dose about 2 weeks before my PCP "agreed" to it. It just made me so mad that when I was at 1.4, 1.8, 1.9 he just added maybe 1/2 a pill per week & then said come back in a month, but the minute I went "over" he tried to do a big adjustment & come back in a week..::: shaking head:::

The thing that really threw me was when the Dr. said "The lab says that your range should be 2.0 to 3.0." YIKES!! Now there's this mysterious entity who had never met me telling my Dr what my INR range is. I swear that Pa-see-if-I-care and Quest Labratories are owned by the same people!

Sorry for venting again. It just makes me mad

 

[ALCapshaw2]

Kristy -

How about copying / printing off the appropriate sections from www.warfarinfo.com and / or buying AL's Book and Dosing Tables. See if you can find the AHA recommendations for INR and print them as well. Should be on their website. Sounds like the younger lady doc might be worth an interview. Good Luck.

'AL'