What is the best way to handle ......................

[lance]

I've been monitoring my spouse's INR for over a year and all is well. He's well within his range. Our PCP suggested this arrangement. Head nurse hmmm how to put it is not so tolerant.
POC monitoring is otherwise unknown in our rural, farming area.
When/if spouse is hospitalized for anything his INR will be checked.
For all successfully monitoring your own INR how has this info been received by ER/hospital staff and unfamiliar doctors?
A recent experience of my own POC testing was met with skepticism and suspicion. ER doctor aghast when told.

 

[netmiff]

In a word, no problem - this is long but it does cover a lot, I hope!

As you know, I recently moved to a small town; there are no certified trainers in the area, and I believe I am the only home-monitor, although this smaller area does seem a little more advanced in certain medical areas than my larger old one - they rely fairly heavily on nurse practitioners here, and I don't think I ever met one before. However, there are NO cardiologists - so that is maybe why there is no home monitoring.

Anyway, within a month of moving, I broke my arm. I went to ER on the Sunday when I did it, and they referred me to the ortho clinic on the Tuesday, where I met my ortho surgeon, and surgery was arranged for the Friday. He told me no more aspirin (I take a baby one daily) or coumadin, and I was referred to CCAC (our government's home health care provider/co-ordinator, for all non-Ontarions) for heparin needles - they made arrangements with a community clinic (which we never had in Niagara, either) to go and get my shots done there daily (our Canadian heparin is good for 24 hours, go figure); my main point of contact was a nurse practitioner, who got so excited about my monitor, I thought she was going to move into my spare bedroom until I had to test, just to see it being done! One of the things she did was refer me to a nurse practitioner (yeah, told you so!) who runs the anti-coagulation service from emergency - when she has time. So, I went and met with her, and had a nice long chat/meeting/appointment. She had heard of it, was aware it was accurate etc., but had never met anyone doing it. I told her I prefer to run a little high, told her about here, and she gave me a pat on the back, and said carry on! she calls me about every other month to see how I am doing, and that's about it.

My ortho surgeon was WONDERFUL! He had never heard of home monitoring, and is a man of few words (but a very nice person and very unflappable, and he did a good job pinning my wrist, which is what really counts in an ortho surgeon ). He kept me in overnight for IV antibiotics (for my mechanical heart valve) without any prompting. My discharge notes said heparin needles daily until my INR was at 2 - I didn't argue that one, I pick my fights! - a prescription for heparin, a bag of needles and alcohol swabs and NO chit for hospital/lab INR testing. Nurses on the floor showed me and my DH how to do the needles (I couldn't, with right arm in a cast) and we did the needles at home after that, until my INR was close to 2.5.

Any questions or if you want more info, PM or e-mail me - in case this isn't enough!

 

[Bina]

I live in a farming town also, and was concerned about my doc accepting the new technology. When I brought the Coaguchek pamphlet to show my GP, I had a pleasant surprise and he only asked that I do a comparison test with a lab occasionally. Of course the monitor is made by Roche Diagnostics in Europe and not "monitors-R-us" in Timbuktu.

 

[lance]

Fantastic experience ................

Fantastic experience ................

In a word, no problem - this is long but it does cover a lot, I hope!

As you know, I recently moved to a small town; there are no certified trainers in the area, and I believe I am the only home-monitor, although this smaller area does seem a little more advanced in certain medical areas than my larger old one - they rely fairly heavily on nurse practitioners here, and I don't think I ever met one before. However, there are NO cardiologists - so that is maybe why there is no home monitoring.

Anyway, within a month of moving, I broke my arm. I went to ER on the Sunday when I did it, and they referred me to the ortho clinic on the Tuesday, where I met my ortho surgeon, and surgery was arranged for the Friday. He told me no more aspirin (I take a baby one daily) or coumadin, and I was referred to CCAC (our government's home health care provider/co-ordinator, for all non-Ontarions) for heparin needles - they made arrangements with a community clinic (which we never had in Niagara, either) to go and get my shots done there daily (our Canadian heparin is good for 24 hours, go figure); my main point of contact was a nurse practitioner, who got so excited about my monitor, I thought she was going to move into my spare bedroom until I had to test, just to see it being done! One of the things she did was refer me to a nurse practitioner (yeah, told you so!) who runs the anti-coagulation service from emergency - when she has time. So, I went and met with her, and had a nice long chat/meeting/appointment. She had heard of it, was aware it was accurate etc., but had never met anyone doing it. I told her I prefer to run a little high, told her about here, and she gave me a pat on the back, and said carry on! she calls me about every other month to see how I am doing, and that's about it.

My ortho surgeon was WONDERFUL! He had never heard of home monitoring, and is a man of few words (but a very nice person and very unflappable, and he did a good job pinning my wrist, which is what really counts in an ortho surgeon ). He kept me in overnight for IV antibiotics (for my mechanical heart valve) without any prompting. My discharge notes said heparin needles daily until my INR was at 2 - I didn't argue that one, I pick my fights! - a prescription for heparin, a bag of needles and alcohol swabs and NO chit for hospital/lab INR testing. Nurses on the floor showed me and my DH how to do the needles (I couldn't, with right arm in a cast) and we did the needles at home after that, until my INR was close to 2.5.

Any questions or if you want more info, PM or e-mail me - in case this isn't enough!

Hi Jeannette
This is the first I've heard of CCAC's. The Lovenox I used was every 12 hours. When you were on heparin prior to your INR level advancing to 2.5 were you going to the lab? I didn't think the XS would test properly if heparin present. My PCP teaches Family Medicine at Hamilton and I hope he's promoting POC. I should have said POC testing not POC monitoring in my original post.
Wonderful to learn of your positive experiences. AND just where is the "Classic car capital of Canada? It's a new one on me.
Sandra

 

[netmiff]

CCACs are Community Care Access Centres, and they co-ordinate all the home health care, provide referrals to other agencies and that kind of thing.

My heparin was called "inohep" I think; I will look and double-check next time I am upstairs; it was a completely different name on the prescription, so I might be able to give you that one too. I was a bit skeptical about the 24-hour dosing, so I checked their website.

No, I wasn't going to a lab, I home tested, immediately before my shot was due, and it worked fine.

The "Classis Car Capital of Canada" is Chatham, about half-way between London and Windsor. We have a classic car museum, showroom and sales place; apparently Jay Leno and other collectors are frequent visitors.

 

[westie]

out of town

out of town

.
ha, i also live in a small rural town which would have to be the rabid (as in rabies) gossip capital of the world. how does the local medical/health centre cope with my self testing? they do not! i never go near them and as far as i know, they and the local gossips know nothing about my ohs.

i attend the sea side medical practice 80 kms from home where my business is located. that has never caused a problem, even on my 3rd day at home when i needed to see my doctor because i did not feel so good. (heart beating too quick)

my suspicion is my tiny rural towns medical centre would not be up with the play on home testing; their speciality is gossip, no kidding!

 

[Karlynn]

I'm a little confused at your question? PCP thinks it's fine - head nurse doesn't. PCP trumps head nurse. If it's the PCP's head nurse - sometimes those nurses start to think they run the show.

 

[lance]

I'm a little confused at your question? PCP thinks it's fine - head nurse doesn't. PCP trumps head nurse. If it's the PCP's head nurse - sometimes those nurses start to think they run the show.

Thanks Karlynn. I'm not concerned about the head nurse. PCP has already advised hubby to pay attention to what I advise when his nurse and I disagree. It's terrible when he admits a patient knows more than the pro.
My problem is what will/could happen when/if hubby is hospitalized and hospital personnel learn a layperson is dosing warfarin. I had a hard enough time telling one ER doc that I use POC monitor.
I'm probably tilting at windmills. Sooner or later this situation will be real.

 

[Philip B]

Mixed...

Mixed...

It would be nice if all ER doctors were hugely receptive to home INR test results, but that's not been my experience. When I landed in two different ER's following my hit & run accident in late June, both ER doctors listened politely to my test results (I had tested earlier in the day) and then ordered their own lab tests.

The results in the first ER confirmed my home test results. I was then transferred to a different ER at a hospital 45 miles away and the lab tests ordered there came back much higher than those from my home test earlier in the day.

While I have no memory of what transpired in either ER, my wife tells me that the second ER doctor and I had a heated arguement over the accuracy of the lab tests done there. Evidently, I simply kept telling him their lab tests were wrong and ordered him to run another test. She also tells me that the doctor was extremely angry about my refusal to accept his lab's initial results. When an additonal test was ordered, the results confirmed my home testing results from earlier in the day.

I really can't blame either ER doctor for wanting to rely on their lab tests. After all, they were dealing with someone who had just been knocked off his bicycle and bounced off the front end of some kind of motor vehicle. I had a TBI and was pretty broken and beat-up.

-Philip

 

[Cris N]

I guess you could always remind the ER docs or anyone else that it's really no different - and not really any more complicated - than a diabetic performing test and adjusting insulin.

 

[netmiff]

the needles I used were :

INNOHEP, also called TINZAPARIN; made by Leo laboratories in Thornhill, Ontario. Instructions on the bottle say "inject subcutaneously 1xday"

I still have 4 x 2ml sealed bottles, good until 9/2011