Self-monitoring INR from the start

[Amy]

Where do you find these images

 

[pellicle]

Where do you find these images

some are mine, most are googled : almost all get some help in photoshop
call it a hobby

 

[Warrick]

Here in kiwi land its common knowledge every Aussie has a sheep suit in their wardrobe...

 

[pellicle]

Here in kiwi land its common knowledge every Aussie has a sheep suit in their wardrobe...

I do ... does that arouse you?

 

[Warrick]

You can start to test and manage your INR from the get go, I was lucky enough to get my meter free from the NZ valve importer for St Jude, I did my first self test in week 3 post op I think it was.
My last dose recomendation from a medical person I had I think was around week 10, with Pellicles guidance starting out I got the gist of it all enough to go it alone.
I did get tested regularly via a lab using a coaguchek the first 6 months or so until I became really confidant and trusted my results. Would be near a year since I last went to the lab and I test weekly for around $7 a test with
95.9% in range since the start of 2019, once you know what dose increase or decrease does what to your INR it really is just test and adjust as needed. When you get some time and confidance under your belt a little bit of self dosing experimentation makes you an expert on yourself, more than any lab or gp.

 

[Meanjellybean]

some are mine, most are googled : almost all get some help in photoshop
call it a hobby
View attachment 887643

Yea, im stealing that image!! Too good..

 

[Amy]

I did get tested regularly via a lab using a coaguchek

The clinic I’ll go to mentioned they just do a fingerstick to test INR (I assume probably with a coaguchek). Considering what you all have said here in other threads regarding the occasional innaccuracy of labs, is there then no necessity of ever having a blood draw sent to a lab, then?

 

[Unicusp]

Depending on your insurance plan, you may not need to use an INR management service (e.g. BioTel Heart)......................

Sorry if I struck a nerve here. Was not my intention. Yes, I am and always have been a "do it yourselfer". In the beginning it was due to lack of funds. Then slowly due to wanting to ensure that the job gets done right. Yep, still change my own oil too! I have many horror stories there when you entrust someone to do it for you.
It appears that you have very good insurance coverage. Mine has zero coverage for out-of-network medical devices & equipment.
Does the service actually call your wife if she forgets to call in a result? How quickly? That's great if they do. I'm still waiting 2 weeks now for them to call me back with a quote and to potentially get the service started.
As for the personal training, due to Covid they offer it via Zoom etc.. To me that's the same as watching one of the many YouTube video's available.
One can also download all of the manuals directly from the meter manufacturer site. I did.
In the meantime, I received my new Coag-Sense PT meter yesterday (from eBay). Ran the high and low control tests, updated the software, and ran my first test. Very easy. First test was good at 2.3
I'm happy. Thanks!

 

[Unicusp]

Welcome to Arkansas.

Hello. Upon discharge, the Cleveland Clinic will send specific orders to your PCP. They will specify testing once per week with targeted INR range. If desired, and your insurance covers it, there are Quest locations in Arkansas. You will have a standing order there, and the PCP will tell you when to go. For me here, it takes 5 to 10 minutes to go in and get the blood draw. If done early in the morning, the results are available that same afternoon. Very quick & easy. I'm still doing this along with (now) comparison to my self test results. Don't worry. It will all work out.

 

[Amy]

How do you know what kind of lancets to use? I can’t find anything about it online.

 

[Unicusp]

How do you know what kind of lancets to use? I can’t find anything about it online.

You want 21G & 1.8mm depth. From the Wilburn site:

 

[Amy]

Are these good to use?
It says 23 gauge but not the depth levels.

https://www.ebay.com/itm/Safe-T-Pro...427484&hash=item3b5279025f:g:veoAAOSw0axfuyhY

 

[MdaPA]

Sorry if I struck a nerve here. Was not my intention.

No, you didn't strike a nerve and hope I didn't come across that way. Just wanted to share what I know and clarify some things.

It appears that you have very good insurance coverage. Mine has zero coverage for out-of-network medical devices & equipment.

My wife has an employer PPO plan (has both in- and out-of-network benefits) but is only using in-network benefits for the service. Each plan is different so you need to really read the explanation of benefits to understand what your coverage and costs are (i.e. don't trust what someone tells you).

Does the service actually call your wife if she forgets to call in a result? How quickly?

Never tested this out. She calls in her results religiously (often before her finger even stops bleeding!).

I'm still waiting 2 weeks now for them to call me back with a quote and to potentially get the service started.

They may require you go through your insurance and/or your doctor needs to send in a script/form.

In the meantime, I received my new Coag-Sense PT meter yesterday (from eBay).

Good, looks like you got your own meter so you don't need the service.

 

[ATHENS1964]

You want 21G & 1.8mm depth. From the Wilburn site:
View attachment 887644

I use 21g. 1.8 or 2.4 also I use the roche lancets 50pc from 6 euros

 

[Amy]

Oh, whoops, I need 21 gauge, not 23. Sigh. It’s morning. Thank you.

 

[Amy]

Like these?
https://www.ebay.com/itm/McKesson-P...jVfbhhV:sc:ShippingMethodStandard!72002!US!-1Or these fufu ones with a hot pink button?
https://www.ebay.com/itm/McKesson-S...-BfWNdi:sc:ShippingMethodStandard!72002!US!-1Would you use these, @ATHENS1964?

 

[ATHENS1964]

See the following links

https://vitrexmedical.com/products/vitrex-lancets/vitrex-sterilance-lite-iii-2/
Also if you use the roche device as inrange it include a softclix .
https://www.rochediabetescareme.com/en/lancing-devices/softclix

 

[Unicusp]

Like these?
https://www.ebay.com/itm/McKesson-P...jVfbhhV:sc:ShippingMethodStandard!72002!US!-1Or these fufu ones with a hot pink button?
https://www.ebay.com/itm/McKesson-S...-BfWNdi:sc:ShippingMethodStandard!72002!US!-1Would you use these, @ATHENS1964?

Amy - Did you see my post above regarding the lancets from Wilburn?

 

[BluesCards]

I also pushed to self test as soon as possible after my surgery in July 2019. With On-X, and everything I had read on here ahead of time, I wanted to be tested weekly. That was a lot of trips to the lab and wasted time. I was offered home monitoring through my insurance, and after looking at the cost, decided it would be cheaper to buy my own. My cardio agreed to sign the script and I ordered through Wilburn medical. Got the Coagusense package which includes the meter, 1 year of transfer tubes, 1 year of strips and two years of lancets. Very easy to order, and I started self testing in September 2019, I month earlier then insurance would allow. I have since re-ordered strips twice and lancets just recently. I do at least two lab draw/home monitor comparisons a year. I email my cardio every week, and he is happy with how stable I have been. I will continue to do my weekly pokes and self adjust as needed.

 

[tom in MO]

Superman, thank you for your two cents. You’re right, and I know, and constantly remind myself not to ‘fight the lab too soon’. But... but.... the lab I FINALLY was able to make an appointment at, for the week after surgery - - the woman who ‘runs’ it said they have hundreds of mechanical valve patients they test (which in itself I’m skeptical about) and that they ALL only need to test (either at home or coming in to the lab) once every * two to four weeks * as long as they’re stable. I said, “you mean every week, right? For mechanical valve patients at least?” She got a TONE and reiterated that testing that often wasn’t necessary for any of her patients.....

Hmm.

Guess I have another reason to get my own INR monitor like NOW. lol

She was right. Most people don't need to test weekly. Two weeks is best for most, longer than 4 weeks and my cardio's practice doesn't want you as a warfarin patient.

Think about it from the nurse's perspective, if people came in every week instead of every 2 weeks, they would need to have twice as much resources for no medical reason...other than to relieve patient anxiety. You will not die of a blood clot or bleed out testing every 2 weeks.

Each insurance company has its own rules, each cardio has their own treatment beliefs and each person is different. I was tested about every 3 days after hospital release, then once a week, then every 2 weeks. The insurance company let me get a home monitor after ~4 months. My advice is let your cardio handle the testing, evaluation and dosing after surgery. It takes awhile to stabilize. You can figure out home testing while recuperating