New to INR Home Testing

[TLB123]

Hi
I have just starte home testing (3 weeks). I have been testing at home, and once a week in my Dr.'s office just to make sure the meter is accurate. This was my cardio's idea. I understand his concern, but now I am getting corncerned he is going to have me cancel the home testing because the results have been off. Two weeks ago I was at 3.3 at home, and 4.4 in the doctor's office. Today I am at 2.0 at home, and 2.5 in the doctor's office.
It was at 3.9 one day and then 4.4 three days later.

Has anyone else had this problem when they started testing(inr/pt all over the place)? Did your cardio have you test in the office or lab for a while before they let you do it just at home? I'm just curious, because this is still so new to me. I really like the idea of home testing, but I think my cardio is going to cancel it because the machines are off. I am the ONLY ONE in this office that is doing this.
Thanks
Tara

 

[Karlynn]

It is very possible that your INR was 3.9 one day and 4.4 3 days later. The first test comparing your machine with the doctor's test was pretty wide. The question of who's was more accurate wasn't answered.

How does your doctor test? If it's a lab draw he needs to realize that there are many factors that can affect the INR reading such as reagents, timeliness of the test etc.

The fastest way to see how accurate your machine is would be to test someone who isn't taking Coumadin. If they are around 1.0 - you know your machine is not malfunctioning.

Are you the first person your doctor has home testing? Many doctors can be very skeptical and have their patients jumping through hoops to prove to them that their machines are accurate.

Do not back down - do not let the doctor take away your machine. There are articles on VR somewhere (don't have time to search) that speak specifically how home testing (point of care) is becoming the safest way to manage INR.

 

[Ross]

You cannot compare apples to oranges and the same goes with meter testing vs lab draws. You doctor should know that too. It's not uncommon, I'm beginning to think its a large conspiracy to keep people going to their labs and collecting whatever money they can.

you need to direct your doctor to this link: http://discoveryhealthcme.discovery.com/anticoagulation/anticoagulation.html

 

[TLB123]

It
How does your doctor test? If it's a lab draw he needs to realize that there are many factors that can affect the INR reading such as reagents, timeliness of the test etc.


Are you the first person your doctor has home testing? Many doctors can be very skeptical and have their patients jumping through hoops to prove to them that their machines are accurate.

Do not back down - do not let the doctor take away your machine. There are articles on VR somewhere (don't have time to search) that speak specifically how home testing (point of care) is becoming the safest way to manage INR.

Karylynn,
To answer your first question. I am tested with a finger stick at his office. I don't know the name of the machine they use. There was one time we tested side by side and it was 3.1 office machine, and 3.0 my machine. This is why I am upset with the other results.

To answer the second question. I am the first and only patient doing this right now. None of the nurses or medical assistants in his office had even heard of it until me. I am still learning and trying to teach them. I wish Raytel would have given a little more training or education.

He has already told me he wanted to cancel it after the first time I tested. I had to convince him to give me more time. It scares me just thinking about how out of range I could have been, and not knowing about it because I was only tested every 5 weeks at times. As long as I was in range that one time I went to the office I didn't have to return for another 5 weeks or so. Even with going to the office and testing at home these last three weeks I have been out of range each time we tested. Scares me!!
I will argue, fuss and fight to keep home testing. It will be tough because he is very stubborn.
Thanks
Tara

 

[cirrider]

"The Doctor Works For You"

"The Doctor Works For You"

A wise surgeon once reminded me "the Doctor works for you". You can fire him any time you choose and find a better qualified one.

 

[Magic8Ball]

Hold on, he wants to cancel you using a machine at home but he tests with a machine in his office?

If you were having a needle draw and a lab test by comparison i'd somehow understand his position but not if he's just using an 'industry strength' version of the same equipment.

As for your comparisons, the test where you drew at the same time and got within .1 of your doctors machine should be the key.

The only time you can get a comparison even remotely close is to test the two machines within 5 minutes....and they will only ever be exactly the same by pure co-incidence but they should be close.

To be worried about different values on different machines days appart is not a valid worry.

To say today at home you are 2.0 and at the doc's you are 2.5 that is acceptable to me. You should only really consider any test like this to be .2 +- what it acutally is so you could be 2.3 and both machines reporting slightly different. How far is your doc's from your home, did you drink anything between the first and second test, eat anything, go to the loo.....test yourself at 7am and then test again on your same machine at 1pm and there will be a difference.

Its early days for you and we are all over cautious in the early days, it will settle down over time but please, unless the test is done within 5 minutes of each other the differences can't be discussed as a problem.

Stick with it, i haven't tested at a lab for nearly 8 months and i've been between 2.0 and 3.5 during that time testing nearly weekly.

 

[Karlynn]

You are in the early stages of learning your way around your own warfarin management, but your doctor is not giving you any credit if he thinks there's any difference between you testing on his machine at his office and testing on your machine at home. (It's like telling you that you can operate a TV remote control in his office, but don't have the ability to do it safely at home.) I agree - if he continues on that path I'd find a new doctor. Being someone who will take warfarin for the rest of your life, home testing is in your best interest and will keep you safest for many reasons and you need a doctor who supports that.

I really don't casually tell people to change doctors but I would never allow any doctor to take home testing away from me. First and foremost it tells me that they have not done their work and kept up to date with current studies that are important for my life.

 

[Ross]

There was one time we tested side by side and it was 3.1 office machine, and 3.0 my machine.

There is no significant difference here. NONE. Virtually the same. If this Doctor understood Coumadin, he wouldn't be issuing such garbage from his mouth. Find a new Doctor.

You can test back to back with the same machine and get up to a .5 difference in the tests. If his is so superior, dare him to run two tests back to back then explain why they arent same results.

 

[TLB123]

Being someone who will take warfarin for the rest of your life, home testing is in your best interest and will keep you safest for many reasons and you need a doctor who supports that.

I really don't casually tell people to change doctors but I would never allow any doctor to take home testing away from me. First and foremost it tells me that they have not done their work and kept up to date with current studies that are important for my life.

I agree with you, all of you. I will be on coumadin for the rest of my life, and I have a pretty hectic schedule. I work two jobs and go to school.

I know because I am the only patient in this office doing the home testing makes it a challenge for me. I work in a hospital and haven't heard or come across anyone that is home testing. I have thought about changing cardiologist, and if I do it will be someone out of Mass general which is where I had my surgery. I guess I will wait to see what happens next week. I'll test again in the office and at home. I 'll bring my machine in again and do it side by side.
Thanks!!

 

[njean]

Tara,

When I bought my first home testing machine, I would conduct the test at home & then I would go to the coumadin clinic to have them draw me to compare. The lab's reports always differed from my machine. This was almost all the time & without fail, their tests always showed my INR readings lower than my home readings. So, they would adjust my coumadin according to their readings! This went on for months & I was getting so stressed out about it because I was not feeling well & the coumadin doctor would actually start yelling at me & would ask me what my diet consisted of & kept telling me that my machine was no good & that I should return it to the vendor. Well, I did return it & they sent me a new machine & guess what, the INR's readings still differed! Finally, I could not take it anymore & I sent that machine back as well, & went with a different vendor & bought another machine (QAS).

The same thing started happening; the lab's readings & my readings never matched. So, I took my new machine down with me to the lab one day & said, okay lets test. The lab conducted a finger stick on their machine & then I did a finger stick on my machine (different finger). Well guess what? Their machine read 2.3 & mine read 3.0! So, then they decided to do a vein draw & the vein draw came back at 3.1! Then they did another finger stick & it came back 2.6. It turns out their equipment needed to be re-calibrated & I was sent a letter of apology from the hospital administrator!

So, as the others have mentioned, do not let the doctor discourage you from home testing. There is a good chance that their equipment may be at fault so, I would do as Karlynn mentioned, test someone not on coumadin & if their reading comes back as 1.0 or in the vicinity, then your machine is correct!

And, I have been on coumadin for 33 years if that accounts for anything!
Take care & good luck!