Numbers don't match

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Main part of my reply.

Main part of my reply.

Karlynn you fail to understand me on several levels. You also appear to have difficulty accepting advice for what it is, simply helpful advice based on reproducible results. There are many points I want to address and will post twice the first is the most relevant point for Joe Cool.

Point 1 You wrote:
I stand by my assertion for Joe Cool that, without the ……….concurrently, the easiest way to set his mind at ease is to check his machine on a person or people who do not use Coumadin.

Please Karlynn read this carefully as you are offering a lot of advice to lots of people whom at times can be vulnerable and nervous.

If Joe’s INR was reading low in his range a “normal” INR test would be very useful in checking the accuracy of his monitor. Unfortunately Joe’s INR was reading high therefore it would be of no value to him.
If Joe had run a normal INR and then believed his monitor was working correctly he could have changed his dose and put himself at risk of dropping below his therapeutic range. This is exactly what I am trying to get across to you.

However if Joe had been dual testing over a period of time and had worked out the relative value of both systems he would have no difficulty. Joe’s single dual test as he stated was, self-test 3.4 versus hospital test 2.6. No need to change dose!

Now Karlynn, what exactly is your difficulty with my logic on this? Can you see how your advice that you stand over so fervently could get him into trouble?

Point 2 You wrote:
Patrick, I think all you need to do is ……………..the next time they still waited a week to call her with her INR and dose.

Hospital turn around time??? I accept totally your point but fail to understand why you choose to introduce this now as it is irrelevant to Joe’s discussion points. If your cardiologist had been raising hell about the accuracy of the lab result, this would have been relevant.

Point 3 You wrote:
I'm not assuming you are naive. Most people do not have the ability to oversee their hospital testing. It sounds like you may be in a position to do this.

I am not in a position to oversee my hospital testing. I pay to have my blood taken at my GP surgery and the testing is done independently in a large Dublin based general hospital.

Point 4 You wrote:
Nor do most people have the time to extensively oversee and monitor their testing as you do.

My self-testing takes less than five minutes from getting my monitor out to putting it away again. I then write my result in a book. I fail to see what you talking about?


Point 5 You wrote:
A few recent papers……….that those who home test and even self dose…………………needed continual comparison with lab tests.

I am well aware of this opinion Karlynn and I am a passionate supporter of self-testing and when medically appropriate self-dosing. The trust-worthiness of monitors is not in question, it is all about getting to know YOUR OWN monitor and calibrating it. I am not aware of any home monitor manufacturers who claim the reagents used in their testing systems are exactly those which are used in routine hospital testing systems, hence the discrepancy in results. Therefore because of this discrepancy some calibration is necessary, this is a very fundamental but important point!

Point 6 You wrote:
Twice a year comparison with labs has been sufficient enough for both machines that I've had.

You are a very fortunate woman but I think even you might be surprised if you dual tested a bit more.

Patrick
 
Dear GeeBee

Dear GeeBee

As a scientist it really bothers me if machines are inaccurate or they fail to deliver the assistance for which they are designed.

I take no alcohol and eat sensibly but still manage to go out of range for no apparent reason. I am almost always on 8mg per day and yet I can go as low as 2.1 and as high as 5. I usually only need to adjust my dose for about three days and I am back in range again for another month or two. Mind you, having said that, it was during one of my three-day highs that I had my brain hemorrhage so that does galvanize my attention.

This can be frustrating but my ability to believe my monitor prevents me getting into trouble. I suppose I see all this as scientific fun also, but I wish there were not such dire consequences in getting it wrong.

Patrick
 
Hi all,
Just chiming in with my "for what it's worth" on the topic. I think Patrick has made some valid points. Referring to post #17 of this thread, his point #2 "Get to know your own monitor and learn how to trust both systems working in tandem. Learn for example that 2.3 on your monitor could = 2.2 in the hospital, that 3.5 can = 2.7, that 4 can = 3.1, that 5 can = 4 etc. etc. It will be specific for you, your monitor and your lab results."; I've found that the variance/error tends to be geometric rather than arithmetic. It runs about 20% above the lab result with my current batch and I get a parallel test with each batch of strips. I also parallel test the end of one lot of strips with the beginning of the new lot just to get an idea what to expect from the upcoming box.
The common belief that if a normal person tests 0.8 to 1.2 then the machine is spot on can lead to a false sense of comfort. Almost all measurements increase in absolute error along with an increase in the magnitude of the reading. I can measure to within a few 1/10's of a mm over about 10-20 cm, but wouldn't expect the same precision in absolutes over 10 meters (but I would expect about the same precision in parts per hundred though).
The home testing units are aimed toward a market where the expected results are in the 2-4 range and it would make sense to aim for the minimum error in the target range. Lab tests are geared around normal results and would have some increased error out of that range. The INR is by its nature imprecise and relies on the exponential ISI factor of the reagent. Small variations in ISI calibration/calculation (or the use/storage/age/temperature of the test reagents) leads to much larger (exponentially so) errors from the "real" result.
As a physician myself, I've come to look at unexpected lab results (in all tests, not just INR) well outside the normal range with some suspicion. Very frequently, if I need to take some significant corrective action because of the result; I'll get a retest (much to the patient's dismay) and have found more than half the time the second test comes back normal. How many normal results are really abnormal? I couldn't venture a guess, but without any reason to doubt them, it's the best we have to go by. (It is an unusual occurrence that lab results come back unexpectedly off - usually we're looking for how much off the suspected disease has pushed the system away from normal.
I don't think Patrick is trying to push an argument; my feeling is that he's just looking at it from more of an engineering/logical standpoint.
Personally, I compensate my home test results to dose to get within the OK range as per the lab tests as that's how the studies derived the INR ranges to minimize (alas, not eliminate) the risk of stroke/hemorrhage. If I can stay there as much as possible, I'm doing the best I can. That's all any of us can do. Let?s stop making ourselves crazy over the difference between a 2.8 and a 3.3.
(I think this is my longest post to date!) :) I also just noticed the spell checker - either it's new, or I've not been posting much (or my typing is awful :eek: ).
 
Thank you Jeff, for getting it!

Thank you Jeff, for getting it!

I am probably a bit passionate about the relative security we get by having home testing available to us but I want to keep it real and as accurate as possible. I adjust my dose as little as possible and as seldom as possible because I know my monitor. I probably do test too often by some standards but that is just a bit of healthy paranoia left over after my brain bleed. What the hell it is only money and if I don?t spend it on test strips it will be only here when I am gone.
Thanks again
Patrick
 
For Patrick

For Patrick

Senator Johnson is now off the ventilator, tracheostomy tube out, and in physical therapy and speech therapy. Post 1/20/07 Doctors think he is making good progress. I hope he does as well as you did Patrick.
 
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