Self testers in Australia...

[Elcarim]

I'm a warfarin lifer, been on it 18 years so far for an mechanical aortic valve. I looked into self testing years ago but the cost was prohibitive at the time and I assumed nothing had changed. The CoaguChek machine was about $1500 with no rebates available. But reading posts on here it seems there are several Aussies self testing. I would like to raise it with my GP, as I know the outcomes are better with more regular testing.

As it is, I go in for my INR, see the GP straight after, and she accepts my suggestions on what to do with my dose. I have a bit of a formula and so far so good. But sometimes this means I am in there every week or fortnight. Fortunately she bulk bills me if I'm just in for an INR review.

How would I go about self testing? Do I need to see the GP in order to change my dose? Presumably I would still go in every month or so for prescriptions, etc? I'd like a bit of info before I present the idea to her. I guess I'd have to learn how to prick my own finger? Is testing at home basically the same procedure has having a finger prick INR with the in-house pathology nurse? Anything else I need to consider?

Thanks for your time

 

[pellicle]

Hi

New machine is under $500

https://www.medshop.com.au/products/coaguchek-reg-inrange-system
Buy the machine and some strips and self test

http://cjeastwd.blogspot.com/2023/03/roche-coaguchek-xs.html
Pm me if you want to chat about this, I'm in Queensland

Best wishes

 

[LondonAndy]

Not sure if you have seen this document, which I regularly post. Whilst admittedly based on a study/recommendation for self-testing by a UK national medical body, the National Institute of Clinical Excellence, I initially prepared the document to give to my doctor when I wanted to get my own meter and self-test. It turns out he didn't need any convincing - he could see the benefits (for both the patient and the health service, in clinic testing and lower incidence of adverse events).

In the UK I test weekly, and send the result in week 6 to by INR nurse. Twice a year I go to the clinic to do an INR test on my machine and theirs to check mine is still accurate. This happened last week, and my machine's result was identical to theirs. Officially they manage my dose, but in reality I do it in response to minor changes, or if I know the cause. But it is nice to have professional medical support to call on if needed for something more significant.

 

[Chuck C]

Hi Elcarim.

How would I go about self testing? Do I need to see the GP in order to change my dose? Presumably I would still go in every month or so for prescriptions, etc? I'd like a bit of info before I present the idea to her. I guess I'd have to learn how to prick my own finger? Is testing at home basically the same procedure has having a finger prick INR with the in-house pathology nurse? Anything else I need to consider?

It would be a good move to self test. I'm in the US, so there will likely be some differences in how it works over here, and even here, it could vary depending on one's GP or cardiologist. I've heard that there is a guy on this forum from Australia who knows about INR management, and he could probably really give good suggestions. Some say he even wrote a book on INR management

When I first received my Coaguchek xs device, I used the Coumadin Clinic. I'd report my results to them through their portal and they would tell me the dosage to take. Usually I had my own ideas about dosage. For example, if they had me alternating between 3 and 4mg, I might suggest that I just take 3.5mg daily instead and they always agreed to my own plan. Then I started self adjusting and just informing them. For example, I might tell them that I was drifting towards the low end of my range, so I adjusted my dosage from 3.5mg to 3.75mg and now it is centered again. They would reply something like "Sounds good. Maintain the same dosage of 3.75mg and report back results in 2 weeks" Then, I found out that they were charging my insurance company $500 each time I reported my INR results to them. This made no sense to me, as I was doing my own thing by then and just keeping them in the loop.

I sent my Excell spreadsheet for the past 4 months to my cardiologist through the portal and told him that I would like to stop using the Coumadin Clinic. He was fine with this. When I needed him to renew my presciption, I would just send him my data and tell him what dosage I would like and he always worked with me. At my next appointment with him, I printed my INR data and brought it to my appointment. He laughed and made a comment about wishing all of his patients tracked their INR like this- I was in range over 95% of the time. He said that I could keep sending him my data if I wanted, but that he trusted me and it was no longer needed. Currently, I'm taking 6.5mg/day. To achieve this I use one 6mg tablet, then half of a 1mg tablet. When my script runs out, I just send him a message through the portal, give a little note about my current dosage and he reloads me for another year of prescriptions. My first cardiologist, prior to surgery, was not this patient friendly, so I switched to one who treated me like an adult.

As far as finger pricking and technique, that guy from AU has actually posted videos on exactly how to do it. Just be careful, because he is just a random internet person. Indeed, aren't we all

 

[LondonAndy]

How would I go about self testing? Do I need to see the GP in order to change my dose? Presumably I would still go in every month or so for prescriptions, etc? I'd like a bit of info before I present the idea to her. I guess I'd have to learn how to prick my own finger? Is testing at home basically the same procedure has having a finger prick INR with the in-house pathology nurse? Anything else I need to consider?

Thanks for your time

In addition to the comments in my previous post, and @Chuck C and @pellicle's comments, there are also a number of videos on YouTube.

 

[Joseph]

I'm a warfarin lifer, been on it 18 years so far for an mechanical aortic valve. I looked into self testing years ago but the cost was prohibitive at the time and I assumed nothing had changed. The CoaguChek machine was about $1500 with no rebates available. But reading posts on here it seems there are several Aussies self testing. I would like to raise it with my GP, as I know the outcomes are better with more regular testing.

As it is, I go in for my INR, see the GP straight after, and she accepts my suggestions on what to do with my dose. I have a bit of a formula and so far so good. But sometimes this means I am in there every week or fortnight. Fortunately she bulk bills me if I'm just in for an INR review.

How would I go about self testing? Do I need to see the GP in order to change my dose? Presumably I would still go in every month or so for prescriptions, etc? I'd like a bit of info before I present the idea to her. I guess I'd have to learn how to prick my own finger? Is testing at home basically the same procedure has having a finger prick INR with the in-house pathology nurse? Anything else I need to consider?

Thanks for your time

American here who recently began self-testing (with the invaluable assistance of @pellicle, @Protimenow, and @Chuck C) and my only regret is not doing it sooner. My GP had no issue with me performing the testing and reporting results every 4-6 weeks. Like others, I can adjust my dosage as-needed and pretty much know when changes are warranted. As @pellicle responded, equipment is "reasonably" priced (reasonable by screwy US healthcare standards) and I picked up a bundle of an INRange, lancets, case, and 48 strips (expiring 12/2024) for ~$700USD. Discuss with your GP, obviously, but I for one have no regrets taking control of my own healthcare.

 

[Elcarim]

Hi

New machine is under $500

https://www.medshop.com.au/products/coaguchek-reg-inrange-system
Buy the machine and some strips and self test

http://cjeastwd.blogspot.com/2023/03/roche-coaguchek-xs.html
Pm me if you want to chat about this, I'm in Queensland

Best wishes

Haha, just reading the blog post you linked and got to the bit about doing the task accurately and in the same manner every time 'just like you were making pottery mugs for sale', and it just so happens that I am a potter who makes and sells mugs, so that gave me a chuckle.

Thank you for this info, I will use it as a starting point and go back and watch the videos later.

 

[Protimenow]

American here who recently began self-testing (with the invaluable assistance of @pellicle, @Protimenow, and @Chuck C) and my only regret is not doing it sooner. My GP had no issue with me performing the testing and reporting results every 4-6 weeks. Like others, I can adjust my dosage as-needed and pretty much know when changes are warranted. As @pellicle responded, equipment is "reasonably" priced (reasonable by screwy US healthcare standards) and I picked up a bundle of an INRange, lancets, case, and 48 strips (expiring 12/2024) for ~$700USD. Discuss with your GP, obviously, but I for one have no regrets taking control of my own healthcare.

I hope you're not suggesting that you test every 4-6 weeks -- only that you report it to your doctor every 4-6 weeks. As you've undoubtedly been told a few times, and seen on this site, it's best not to let more than a week or so pass between tests (but I have to admit that I occasionally run as long as two weeks between tests). It may only take about ten days with an INR that's too low to have a stroke (it took about two weeks under 2.0 - I trusted a meter that the FDA had removed because of inaccuracies) - the meter said 2.6. The hospital said 1.7. (BTW - my testing of meters, comparing them to each other and to the labs, revealed that the CoaguChek was the most consistent (and often higher than labs), and the Coag-Sense was also consistent (and often below the labs and CoaguChek. I used to average the two meter results and get even closer to lab results. Recently I found that Coag-Sense results are too low and have stopped using and recommending it).

It sounds like you got a good deal on your meter and strips. It also looks like you may run out of strips (if you test weekly) before they all expire.

And thanks for including me on the list of those whose posts have helped you.

 

[Joseph]

I hope you're not suggesting that you test every 4-6 weeks -- only that you report it to your doctor every 4-6 weeks. As you've undoubtedly been told a few times, and seen on this site, it's best not to let more than a week or so pass between tests (but I have to admit that I occasionally run as long as two weeks between tests). It may only take about ten days with an INR that's too low to have a stroke (it took about two weeks under 2.0 - I trusted a meter that the FDA had removed because of inaccuracies) - the meter said 2.6. The hospital said 1.7. (BTW - my testing of meters, comparing them to each other and to the labs, revealed that the CoaguChek was the most consistent (and often higher than labs), and the Coag-Sense was also consistent (and often below the labs and CoaguChek. I used to average the two meter results and get even closer to lab results. Recently I found that Coag-Sense results are too low and have stopped using and recommending it).

It sounds like you got a good deal on your meter and strips. It also looks like you may run out of strips (if you test weekly) before they all expire.

And thanks for including me on the list of those whose posts have helped you.

Me fail English? That's unpossible!

Thanks for responding, I'm so used to belting out responses on meaningless forums that I forget that things said on this site could have serious consequences. We certainly do not want any confusion or misunderstanding in guiding new self-testers.

I test weekly, sometimes twice if I've had an out-of-range reading, and report those results to my GP every 4-6 weeks.

 

[pellicle]

Being Australian I can attempt to claim my dialect of English isn't proper.

Thanks for responding, I'm so used to belting out responses on meaningless forums that I forget that things said on this site could have serious consequences. We certainly do not want any confusion or misunderstanding in guiding new self-testers.

agreed, although generally the issue is overblown I would not want to encouarge anyone to (say) hover on 1.5 because On-X said it was ok and then hear about them having a stroke that meant they couldn't work in their profession.

I am sure I get things wrong, but I'm pretty sure I do due diligence on what flows from my keyboard more than some posters here.

 

[Protimenow]

I is perty kareful here, too. I usually reread what I've written at least once before pressing the Post reply button.

Thanks for the clarification, Joseph.

And I completely agree about the minimum for those with On-X valves. An INR of 2.0 or 2.5 (or even low 3s) isn't that much different - although much safer - than the 1.5 that On-X claims is safe.