surprised (home monitoring)

[Bina]

I was tested DAILY for 16 days after surgery.

 

[realkarl]

Sorry, didn't mean to start a big discussion with my numbers. I will of course not say anything at all about my INR dosing, but being an inquiring mind, I was really just keeping my mind busy speculating what they'd do next

 

[R&N Brown]

Hello Karl,

You sound like you're doing pretty well for 5 days out, everyday gets a little better from here on out. I wish you a speedy and uneventful recovery.

I'm with Bina, They tested my INR every morning and used its determination in cutting me loose. They wanted me to be a minimum of 2.0 before discharge but let me go after six days and registering a 1.6. (I wined a lot and went for the window more then once!) A nurse visited my home everyday after discharge for a week to make sure I was somewhat stabilized.

I attended the clinic for the first four months and then I was started on home testing.

Karl, are you going to be involved in the On-X Study?

The reason I home test is because I'm in the study.

Rob

 

[realkarl]

No, I chose On-X for its technical advantages. My hospital is not part of the study.

 

[R&N Brown]

Hello Karl,

Your only concern right now should be resting, getting a little nourshment and walking. Are you home yet?

Don't rush.

Rob

 

[Cozycat]

Karl, if your surgery was July 21st, then they probably will test you daily for a number of days...and it may bounce around a bit. I had surgery in Feb. 09 and was in the hosp. for 10 days....and they tested daily until I was released, then had to go to the lab twice a week for about 4 weeks, then once a week for a while and am finally up to once every 14-15 days. My numbers seem to want to stick on the low end, 2.4, 2.5, 2.65 but it's being worked on. Since I have an HMO it may be a challenge getting to home monitor so soon but think I can make it work later. I'm on Medicare and know they cover the cost so don't know why the HMO won't loosen up a bit. $$$$$$ my guess.

Midge

 

[Ross]

Karl testing you everyday is over kill and will set you up to teeter totter or roller coaster. They need to leave you on one steady dose for a full week. 3mg would be my guess. I know you don't want to really get involved in the numbers thing, but dude, your on Coumadin now and you need to know. Testing more then 2 times a week shows they don't know what they're doing. It takes 3 days for your first dose to reach it's peak concentration.

How they can all deny not knowing about home INR testing is utterly ridiculous. This too, shows they have not done their homework. Give them this link and tell them that they get CME credit just for watching the darn thing:

http://discoveryhealthcme.discovery.com/beyond/miniPlayer.html?playerId=1225901422

A simple search of google for inr home testing yields all these results, so how can they deny knowledge of it?

Results 1 - 50 of about 409,000 for inr home testing.

http://www.google.com/search?q=inr+...-us&ie=UTF-8&oe=UTF-8&startIndex=&startPage=1

Either it's greed on their part or you need to run far far away from these people and find someone with knowledge in your area.

 

[realkarl]

Ross: what you say makes sense. Based on overheard nurse conversation, they are terribly paranoid about keeping the INR levels within range at all times (maybe while in the hospital - lawsuits?). They mentioned how my health co-op who outsources these heart surgeries to them kept calling to check up on another patient who had gone too high. I don't really know, but your suggestion has been noted for the next time a doctor comes by. I am suffering from slight information overload though, all the other levels they measure and medicines they give to get them in range, and I am still pretty weak, 6 days after my surgery

 

[Bina]

Maybe they fear that prevalent home monitoring would shutter all the Coumadin clinics making money for the hospitals or whoever runs them.

This morning another woman (hospital pharmacy rep - Virginia Mason) came to talk about coumadin. I asked her as well, and she had never heard of it. She knew about home glucose monitoring though

My coumadin data so far:

Date Dose Taken INR
7/22 5mg 1800 1.3
7/23 1mg 1900 1.6
7/24 3mg 1730 2.0
7/25 3mg 1715 3.0

My target range: 2.0-3.0
They will probably reduce my next dose

Karl, your hospital is absolutely correct in testing you every day, they all do.
Once you have been in range for 3 days in a row, they should let you go for a few days until your next test.
Then, if you are still in range, you will be tested weekly.

 

[dick0236]

Karl testing you everyday is over kill and will set you up to teeter totter or roller coaster. They need to leave you on one steady dose for a full week. 3mg would be my guess. I know you don't want to really get involved in the numbers thing, but dude, your on Coumadin now and you need to know. Testing more then 2 times a week shows they don't know what they're doing. It takes 3 days for your first dose to reach it's peak concentration.

How they can all deny not knowing about home INR testing is utterly ridiculous. This too, shows they have not done their homework. Give them this link and tell them that they get CME credit just for watching the darn thing:

http://discoveryhealthcme.discovery.com/beyond/miniPlayer.html?playerId=1225901422

A simple search of google for inr home testing yields all these results, so how can they deny knowledge of it?

Results 1 - 50 of about 409,000 for inr home testing.

http://www.google.com/search?q=inr+...-us&ie=UTF-8&oe=UTF-8&startIndex=&startPage=1

Either it's greed on their part or you need to run far far away from these people and find someone with knowledge in your area.

Ross, thank you for posting these links. They should be posted on the walls of every hospital, doctors office, and protime clinic.....now, if we can only get the insurers to cooperate!!!!

 

[Ross]

Karl, your hospital is absolutely correct in testing you every day, they all do.

Sure they all do, but if it's strictly for INR, it's just to add more lab expense to the bill.

 

[Bina]

Sure they all do, but if it's strictly for INR, it's just to add more lab expense to the bill.

Well, since we pay for nothing, that doesn't apply here.
But they do want us to be able to go home, and testing every day WHILE IN HOSPITAL AND UNDER RANGE is the only way to go.
Believe me, I could have lived without all those stabbings and that dang heparin IV drip.

 

[Ross]

Ross: what you say makes sense. Based on overheard nurse conversation, they are terribly paranoid about keeping the INR levels within range at all times (maybe while in the hospital - lawsuits?). They mentioned how my health co-op who outsources these heart surgeries to them kept calling to check up on another patient who had gone too high. I don't really know, but your suggestion has been noted for the next time a doctor comes by. I am suffering from slight information overload though, all the other levels they measure and medicines they give to get them in range, and I am still pretty weak, 6 days after my surgery

Karl so long as you don't freak out over your INR, things will be fine. INR is not a constant. It goes up and down all the time. The key is to find the dose that keeps you in range, then it's minor tweakage +/- 5 or 10% to keep you there. Eat like you always have. Do not fall for the, "Stay away from foods high in vitamin k" deal.

As your activity increases, so will your dose of Coumadin. More blood is filtered through the liver with more activity. Other meds can have an effect too, so it's important to know what all your taking as well.

Most all of us are happy with and INR between 2 and 4.

 

[Ross]

Well, since we pay for nothing, that doesn't apply here.
But they do want us to be able to go home, and testing every day WHILE IN HOSPITAL AND UNDER RANGE is the only way to go.
Believe me, I could have lived without all those stabbings and that dang heparin IV drip.

Hon just because you don't pay for it, doesn't mean that isn't why they do it.

 

[Bina]

I know for a fact that my daily INR readings affected the timing/duration of the Heparin IV in my arm.
Some days it was on for 4 hours, other days it was on for 6 hours, etc.
If they DIDN"T test me daily, I could say that they were cutting corners and trying to save some $$.

 

[Ross]

I know for a fact that my daily INR readings affected the timing/duration of the Heparin IV in my arm.
Some days it was on for 4 hours, other days it was on for 6 hours, etc.
If they DIDN"T test me daily, I could say that they were cutting corners and trying to save some $$.

Umm no, they were doing it because of the Heparin, not because of the INR. There supposed to draw every 6 hours and adjust the Heparin as needed.

 

[COLLEEN S]

And do these great people have their own coumadin clinic? If they do, they dont want to lose clients, like Ross said...they are pulling your chain.
Tell them (if you intend to self tes) that you are serious about wanting to test yourself, and that you intend to get a monitor and self test and that you want a cardio who will go along. Some will balk, others will agree to it, and others will enthusiastically support you. I had the former 2 and found the last one after some searching. Now I'm self testing and will not go back. You can find what you are looking for.
Also, I went thru QAS....and my insurance..., who was billed $2240, I had a copay of 25% of that (577.00). QAS gives 1K off if you self pay. I took me 12 weeks to get it and have someone come and train me. Best of wishes.