My second visit to hospital

[PeteGS]

I'm looking for some feedback on coumadin, INR levels and Insurance issues.

My experience is as follows:

I had my surgery on December 6th to replace my BAV with a mechanical valve.
I left the hospital 4 days later on a safe INR level (target range 2.5-3.5). My dosage of Coumadin had been set at 5mg per day and I was also on Amiodarone (200mg). I had lots of pains from the surgery mainly in my back and ribs but otherwise felt reasonable.
Over the next couple of days I seemed to gain strength and felt like I was getting better. I had a home nurse visit who took blood 2 days after release and my INR was at 2.5.
I was then told by my cardiologist that I had to organize my future testing with the anti-coagulation clinic. I rang them and unfortunately I hold one of four insurance cards that they do not accept. My cardiologist explained the benefits of the clinic and how they can generate automatic coumadin levels following a finger prick. (I'm not sure if this is exactly correct but would welcome feedback).
After this setback I was left to my own devices to organize testing but I had a couple of home nurse visits to go and an appointment with my surgeon coming up on the 29th which required bloodwork to be drawn 5-7 days prior to the appointment. So I didn't overly concern myself.
I found out that my insurance allows me to use Labcorp whom draw blood and send off the results to an external party to verify my levels. This party would be my primary care physician. I felt a little frustrated and confused upon finding out about having to use Labcorp when the anti-coagulation clinic sounded much better. (I would welcome feedback on anybody who uses labcorp through their insurance).
My next home nurse visit was 3 days after my first blood test and this time to my surprise I had no blood drawn and was told that things were ok and all the signs were good. I continued with my Coumadin dosage of 5mg.
I started having sleeping problems and felt tired and pained for the next 3 days. I put all my discomfort down to lack of sleep and the fact that my surgery had been so recent. Unfortunately the next home nurse visit which was 5 days later and one day before I would give blood for my doctors visit, I felt aweful and was ordered to the emergency room. My INR was 9 and I required a procedure to remove excess fluid from my heart. (I was told that this was potentially life threatening and I was actually in a lot of pain and very weak at the time). I was told that my dosage was probably too high and the Amiodarone helped to push up my INR levels.
I spent 5 days over Christmas in hospital, my family had to cancel a vacation and my wife is still extremely upset about it all. So instead of ho-ho-ho it was wo-wo-wo.
At the hospital, I was injected with Vitamin K, taken off the Amiodarone and my INR levels reduced drastically to 1.5. I was put on a dosage of 5mg and an IV drip (heperon ???) to thin my blood. The day before release I was given 10mg of Coumadin which I felt was too high and I left the hospital yesterday with and INR of 2.5 and with orders to continue on 5mg per day until my blood work could be evaluated. One doctor mentioned that Coumadin takes upto 48 hours to take action in the body. Can anybody verify this? I'm just worried that my levels could shoot up again given that I received 10mg some 48 hours ago.
Today I had a blood test with labcorp and I was told my results may not be available for upto 2 days. Quite frankly I feel that this is not good enough and I am extremely frustrated.
I'd appreciate all the feedback on what I can expect and what my options are as I feel my doctors haven't expained this properly.
One frustrating issue is that I have been told for now that I can not self test. I think that this would be the easiest option particularly if fully explained to me. Also for the time being my cardiologist has agreed to be the external party to evaluate the INR levels but in the future it will probably be my PCP. Does anybody have this arrangement?
Peter

 

[Georgia]

Pete, Pete, Pete - what a mess.

First, two days is unacceptable for inr results. Period. No matter what, you have to make better arrangements than that.

No one wants to monitor coumadin levels; the cardiologists get to pass you off to your pcp; and they have to take care of it regardless of how little they know or how little they want to.

A coumadin clinic is by far the best arrangement (well, maybe home testing is the best). But without insurance for it, I don't know how much it'd cost you.

I haven't had personal experience with amiarodone (knock wood); but from previous postings it seems to be one of the meds that REALLY causes havoc with inr levels. And you need to keep in mind that when you go off amiarodone, the levels will be screwed up again until it gets totally out of your system (many months).

Please visit www.warfarinfo.com for all the information available on coumadin. And understand that immediately post-surgically is the worst time for keeping your inr in range.

Good luck, and feel free to ask any questions you have. I'm sure others with more experience than I will be along.

 

[geebee]

First off - sorry to hear of your setback. Things like this can be very frustrating but at least they determined problems and got them fixed.

That being said, if you go back on the same dosage that caused you to have an INR of 9, you will end up back in the same place unless there was some other reason for the INR of 9.

2 days for a test result is plain old BS. With a history of high INR, you should get results within hours not days. Even without INR problems, a test result should still come to you the same day.

I think getting with a clinic would be your safest bet even if you have to fork out the money initially. Fight with your insurance company. Give them the costs of your hospital stay and indicate it might have been prevented with proper INR management. Your life hangs in the balance.

Best of luck.

 

[Ross]

When you are first discharged, your INR is all over the place no matter what. This being the case, they should have tested at 3 days out, and every week there after. Throw in the Amiodarone and that's problems waiting to happen unmonitored.

YOU must have your INR result the same day as it's drawn, anything less is NO GOOD TO YOU OR ANYONE TAKING CARE OF YOU EITHER.

I would advise you to find a Coumadin Clinic that knows what they are doing. How they responded to you is ok, but you should never have been in that predicament to start with. There are clinics that use fingerstick testing and others cling to the veinous draws.

It takes up to 3 days for a dose to show in your blood test on Coumadin.

 

[catwoman]

Pete:

Having to wait for your results makes those results meaningless. Your clotting factors no doubt will have changed by the time you get results back 24, 48 or more hours after a test. Your INR could be lower or higher by then.

Have you checked with your primary physician (PCP)? Some family practitioners do have a PT/INR test machine in their clinics. Mine does, and is able to give instant results. I have my own machine (ProTime 3) and have my results instantly too.

I'm sure that Al Lodwick will be dropping in on this thread and can supply the link to the anti-coagulation forum's website, or perhaps he may have the name of someone in your area.

You may want to check your insurance for coverage of Durable Medical Equipment to see if you could get your own home testing machine.

 

[Guest]

The major problem is with your insurance. Your doctor already acknowledged that a warfarin clinic is the best option. Labcorp is your insurance's cheapest option. Unfortunately it already cost them more for your second hospitalization that they will save over several years. Look at www.acforum.org and click on clinic locations. Be sure to call before you go in to make sure that they are still in operation. Then call the customer service number on your insurance card and be persistent in getting someone with the authority to sign off on your using the clinic.

 

[Blanche]

Pete:
If this drastic approach doesn't work for you, just disregard it!!!

You are a young person and will have to deal with Coumadin for a very long time. Your first experiences have been very negative. But, then, things are always more scarey in the beginning because you have no past experiences to fall back upon. This is my suggestion, forget about your insurance for just a bit! Go to the Coumadin clinic and pay the bill yourself. Call them and ask the cost. I suspect it will be much less than you expect. THe clinic will give you a result immediately. This can then be the basis of your treatment. In the meantime, you will be able to explore other options, and there are many. But, you will be safe, protected, and assured that you have what you need to keep your INR levels where they need to be until you have made other arrangements. Sometimes we have to spend money to save......money, time, trips to the ER.......

Hope these thoughts help you in some way. What ever you do, I sincerely hope that you find some peace and know that things will get much, much better. Having this problem at this time of year is the pits.

Blanche

 

[imhayley]

lots in common

lots in common

Hi Pete! Your story is very similar to mine and I also was re-hospitalized with high INR"s (11.9) right after going home and this was due to lack of blood tests. I have NO insurance and had to go to labcorp every day for a week then every other day and so on. I was able to get a self tester (INratio) and now I do the test when my coumiden clinic tells me to (they are inside the cardiology office itself actually not a seperate clinic) and I call in the results to them and they give me my dosing schedule over the phone based on the INR number I report. I can only say for me that I find it easier to either....go to labcorp and have them call in your results to the coumiden clinic and then wait for them to call back with doseing schedule or since you have insurance I think they might just pay for the Inratio machine. Then you can just prick your finger (instead of giving up an entire vile) and test yourself. This is so scary for me so Im sure its got you a bit nervous. All I can say is ask ask ask as there are so many awesome people in here who have wonderful feedback and they have helped me more than my own doctors have when it comes to information and a caring ear. Good luck to you and hope you feel better soon.
Cheers!
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[JimL]

Peter, What everyone has said here is correct: You need your INR results within two minutes (by finger stick) or an hour (veinous draw). I was frustrated very soon after surgery with waiting all day for a doctor's office to get around to calling me back with the results of an INR test.

I go to a coumadin clinic in my local hospital, and I go every week because it is convenient and cheap. After we meet our deductible (which we will do regardless of how often I go to the coumadin clinic), the visits are free to me. The insurance pays some and the hospital writes off the rest.

Recently, however, the hospital has changed their billing policy. Specifically, they used to charge $40 for a finger stick test, and they now charge four times that much. It seems a brazen attempt to get more money out of the insurance companies. But, the coumadin clinic nurse told me that they will work with people and charge them the old rate if they have to pay out of pocket.

I mention all of this in order to encourage you to go to a coumadin clinic for a finger stick test, and to talk to them about pricing. Let us know how things work out for you.

 

[PeteGS]

Update

Update

I'm trying to get on top of this but things haven't been easy.
As I said, I was released on Monday with an INR of 2.5.
Using Labcorp on Tuesday, I had my blood drawn and was to call in to get the results today from my cardiologist. In the meantime, I contacted my employer who has contacted group insurance to look for a solution. I'm pushing to get permission to use the anti coagulation clinics or home testing.

Unfortunately, my results from Tuesdays blood work have kind of disappeared and I was asked to go back to Labcorp at 4pm (they close at 5pm) for another drawing. I found a different Labcorp to go to this time and my cardiologist faxed them with a STAT request. This means that my results will either be available tonight or tomorrow morning. I don't know why they couldn't have requested this in the first place ?

Anyway, I really want to self test and will speak to my surgeon tomorrow about it. I don't know much about it and would love it if the process would be self autonomous as relying on others has been a difficult process.

Thanks for all the feed back.

Peter

 

[Guest]

There is a strong resemblance there.

The lost test is a perfect example of why you need to self test. If your INR was critically out of range, you could have needed another hospitalization by now. Your insurance company needs seems to be in the recto-cranial inversion position.