My talk with the Coumadin Clinic

[twinmaker]

Ross, I'm not sure if I should keep adding on to my thread on home testing, but I started a new one about talking with the Coumadin nurse this morning. I tested last night and my INR was 2.4. I had agreed last week to call the Coumadin nurse at the cardio's office with my results. This was the first time that I talked with her. Went through my whole story with her. She started in with the protocol of the office and how they don't allow ANY of their patients to home test but...they were making an exception for me since my cardio consented to it. Also asked me if I had ever been taught about my diet and things high in Vit. K,...blah, blah, blah. I told her what dosage change I made last night after testing and she then asks me if I had tested today to see if it helped. HELLO!!!! This is when I knew I was in trouble. I told her I wouldn't see a result of the change for about three days and she said, "not necessarily". Then she went into the legal aspect of why they have to determine my dose, blah, blah, blah. She said she could get me on one dose and I would be able to stay on that same dose forever. I told her that my hematologist at Johns Hopkins could never do that (and after 15 years of trying)! I agreed that I don't like to change my dose over minor variations in my INR but with my current INR at 2.4 I wasn't about to let it sit there. I told her I wanted to be on the high side. After she told me that she had been managing Coumadin for many years, I told her that I knew my body better than anyone else. In essence, we agreed that she and I would confer on the proper dosage and I would get my venous draws every three months. Of course, I told myself that if I'm not comfortable with what she is doing, I will just take matters into my own hands...in other words, what they don't know won't hurt them.

After this phone call, my husband said, "find a new cardio." The problem is with our insurance coverage. I can see whomever I want, but if they're not in our network, then we have to pay 30% versus 15% of the bill. Of course, I'm not sure if I could even find another cardio that would allow me to home test and dose myself. Should I call around and ask other practices what they would allow me to do?

OK, I'm now going to try to calm down enough so I can eat my lunch...and OH! "watch out for that dreaded vitamin K and all those veges, and melons, and blah, blah, blah! LINDA P.S. Thanks for letting me vent.

 

[Ross]

Linda if she can give you a dose and see a change overnight, pigs can fly, hell has frozen over, more pygmies have moved into the new rainforest, etc.

HOGWASH! She hasn't learned much has she? You probably know more about the whole thing then she could ever hope too. If you don't know, ask us, If I don't know, Al Lodwick does, so I'd say we have your back. They have no way to legally say no to anyone regarding home testing. They may not want the responsiblity, but they cannot deny it either. Sounds like a profit shop to me.

I'm with your husband, call around and see what you can find. This place surely doesn't know what it's about. Now go have some Spinich.

Pharmacodynamics and Dosing Considerations

Anticoagulant Activity. The anticoagulant activity of warfarin depends on the clearance of functional clotting factors from the systemic circulation after administration of the dose. The clearance of these clotting factors is determined by their half-lives. The earliest changes in the International Normalized Ratio (INR) are typically noted 24 to 36 hours after a dose of warfarin is administered. These changes are due to the clearance of functional factor VII, which is the vitamin K*dependent clotting factor with the shortest half-life (six hours). However, the early changes in the INR are deceptive because they do not actually affect the body's physiologic ability to halt clot expansion or form new thromboses.

Overnight she can see a result difference, yeah sure she can!

 

[Karlynn]

Linda,
Wow, I was feeling my blood pressure beginning to rise as I read your post. Did this nurse know how long you've been on Coumadin? Yet she's so sure she knows more than you.

They are so worried about liability. But they are also so sure that they avoid liability by controling your testing and dosing. With the lack of knowledge that this nurse displayed, their liability lies more in their management than in there non-management of your Coumadin, but they are too errogant to realize this. This "clinic" is the very reason that I say the worst thing about having to take Coumadin is dealing with "professionals" who think they know the drug but don't have a clue.

Best wishes in finding a new doctor that will work with you and give you credit for our intelligence and your years of experience with Coumadin.

 

[Nan]

Oh My Goodness, yes indeedy you need to find a new cardio! Boy that kind of ineptitude makes me so angry, not just for you, but for all the other patients being monitored there. Scary, scary stuff.

Hope you can find a practice with more enlightened and educated people. And if you get the chart from Al you can figure out how to dose yourself in any case.

Take care and good luck in your search.

 

[Sagebrush]

agree with hubby

agree with hubby

Linda, I also agree with your hubby about finding a new cardio. I have a new cardio well another cardio...main cardio is at the Mayo and local cardio in town because I was having rythum problems recently. My local cardio doesn't have a problem with my home testing and I can't imagine why they are making such a big deal out of it expecially since you have been home testing so long.

Go to your insurance webi site to determine a cardio that is in network.

Good luck in finding a new dr.

 

[Cris N]

I find this discussion quite interesting. My cardio, or rather his incompetent nurse, seem to know nothing about anticoagulation therapy. It's my PCP who's actually got the brains to realize I'm capable of managing this aspect of my health care. Have you found/talked with a new PCP?(A young one perhaps who's come away from medical school/internship/residency with a respect for these 'new-fangled' contraptions. Or better yet, one who's been educated to realize that people can and should take an active role in their health care.

Jeez... some of these medical people drive me crazy!

 

[twinmaker]

Cris, I'm pretty new to the Charlotte area. My cardio is a very young guy with good credentials. He didn't seem at all concerned about me home testing and dosing myself. It was the nursing staff/coumadin nurses that started this ball rolling (downhill) when I called in for a new script for my Coumadin. Since the doc is relatively new in this huge practice, I think he's having to do what they are telling him. There are probably 20 doctors in this practice and I'm sure he's not at the top of the totem pole. I haven't gotten my new internist but will have to shortly. I'm overdue for my six month check with one of them. LINDA

 

[Annilou]

Variable INR

Variable INR

Has anyone else had quite a difference in reading from their machine compared to a veinipuncture done at the clinic or hospital? The first time I did the home testing, my reading w/ the machine came back 2.3 and the reading from the lab was 3.09. I'm supposed to be between 3-4 . So I added .7 to all my readings from that box of strips and it seemed to work quite well. The highest reading I got during the month and a half that I was out of touch added up to a 4. I got back and went in for a veinipuncture and it matched their 3.2. Now I'm totally confused. Is there supposed to be this degree of variability in the test results?

 

[QAS David]

Finding a new cardio

Finding a new cardio

Linda:
I am the outside sales rep for QAS and might be able to help
you locate a new cardiologist since I work with so many across
the country.

I will provide you with my numbers and you can contact me at
any time.
cell: 407-325-6554
email [email protected]

Sincerely
David Vaughn

 

[twinmaker]

Thanks David. I've only seen this doc a couple of times...today being the second. I may need some names from you if I decide to look elsewhere. Thanks for offering. LINDA