What to do?

[lance]

It's the same old song. Spouse discharged from hospital after receiving a stent. Cardiologist advised 2 mg warfarin a day. On day 7 INR 1.1 on XS. I increased warfarin to 6 mg per day resulting in a reading of 1.9 XS, and I again increased increased dose for 9 mg one day followed by 6 mg for 6 days resulting in 2.4 XS and 2.4 comparison vein draw.

Husband has been attending a cardiac rehab clinic and yesterday the lecture given by a pharmacist on drug use included warfarin. Luckily/unluckily I wasn't there.

According to the "pharmacist" home monitors are illegal in Canada, we must have obtained ours from the US, they are dangerously inaccurate and are "out" by 2.0 to 3.0 when compared to lab testing. Luckily he knew better and a heated discussion ensued. Pharmacist became defensive when opposing information presented. When he stated that doctors frequently give bad advice pharmacist requested the name of one. So the name of the doctor advising 2 mg a day was given and she then asked who/where was managing husband's INR. When advised I was and the INR is now in range she didn't respond. Husband advised her to consult with the Roche representative and stated I was hospital trained.

Then she handed out a sheet listing the Vit.K content of foods warning to watch intake. She had never heard the expression "dose the diet" and advised to beware of high Vit. K intake. She did not advise him to use an electric razer for once knowing what she was talking about.

When faced with this situation from a Cardiac Care Clinic affiliated with a hospital performing cardiac surgery how does one combat this situation? Obviously something has to be done. PCP not associated with this particular hospital.

 

[Cooker]

Sounds like you did what you could...stood up and told the true story....sad but there seem to be more uneducated than educated warfarin "professionals"

 

[lance]

How about informing the hospital

How about informing the hospital

Thanks Cooker and Bouncer I thought about warfarininfo.com too and ISMAAP and a few others. I wasn't present at the incident and am considering notifying the hospital the "pharmacist" is associated with as well as the official organization pharmacists belong to.
For at least a year Health Canada has approved pharmacists, when properly trained to take the blood test with a home monitor and manage the dosing or report the results to a doctor's office and/or train clients to use home monitors.

I'm still fuming.

 

[Bina]

Sandra, I would have wacked that pharmacist in the Head, and then reported him!
I was trained by a pharmacist who is certified in home monitors for ACT, it was in June of 2007 and I'm in Ontario.
You could even call a rep from Roche and see if they have any plans for a more widespread system of education.

 

[Blanche]

THere are none so blind as those who will not see

THere are none so blind as those who will not see

Sandra, I am so sorry that you must contend with this type of misinformation, especially when it comes from from a medical professional who should know better.

My dear one has been home testing since March 2001. It was very hard to convince his internist, whom he wanted to monitor his prothrombin time, that the monitor was safe. Four years later that very doctor started a Coumadin Clinic in his office. Medical personnel are way behind this kind of monitoring so those of us who need anticoagulation management have to educate ourselves and sometimes become our own monitors. That's what we do now.

I have been hearing a lot of misinformation coming from Canada. Things like, it is illegal for patients to monitor their own anticoagulation or have their own machines. Dang, it, this is exactly the same thing I heard here in Arizona, USA in 2001.

"There are none so blind as those who refuse to see." All we can do is deal with it the best we can. I wish there was some way to conduct a study in Canada to determine which hospitals use point-of-care testing in their labs or emergency rooms.

That was the turning-point for my doctors here in Arizona. I compiled a list of hospitals, emergency rooms, urgent care offices, and doctors offices that had their own monitors for use with their patients. Our doctor changed his tune. Still there are docs here that don't accept that contention.

Sure is hard being a Pioneer, isn't it?

Wishing you and yours well.

Blanche

 

[lance]

I'm still fuming, however ................

I'm still fuming, however ................

the hospital has been contacted and so has the College of Pharmacists. I related what happened. I wasn't at the training session so was unable to speak with the "pharmacist".

Thanks Bina and Blanche for your kind words.

I think I'll phone the Cardiac Rehab Centre. My husband is seeing our PCP (the one that said I was capable of monitoring INR) and he will also inform him. Our PCP does not have status at St. Mary's just that place in Hamilton.

Something needs to be don.

Cheers

 

[Bina]

No, it is not at all "illegal" to home monitor ACT in Canada.
And yes, it can be a challenge to find information and get it started.
If not for VR.Com I would have never had a clue that this was possible. It is a guarded secret, LOL>>
We seem to have more of a problem in the communication and co-operation between the provinces regarding what is acceptable under Health Canada guidelines.