Who calls the shots?

[Dexter Bob]

I am trying to get ahead of the powercurve on my impending anticoag. therapy (AVR 1-7-2010).

Both the Cardio and Surgeon feel home monitoring is great (after they establish your needed levels). My GP however is against it and wants me in his groups Anticoagulation Clinic. They want testing every four weeks.

I am pretty sure my insurance would pay the freight on home monitoring as they do for home diabetic testing.

So my question is who takes the lead on my monitoring??

Bob

 

[Bina]

Bob, you may just want to wait and see how it goes.
After OHS it took me 2-3 weeks to be stable with my INR and then my regular GP doc handled me with testing once monthly for the next 18 months. After that time, I had learned enough here on VR that I suggested home monitoring and my GP was fine with it; he saw that I was reporting regularly and feeling more relaxed with my INR.
Almost immediately I was self dosing as well as self testing, what a blessing it is.
(your police dog is stunning)

 

[ShezaGirlie]

Hi Bob and welcome. I'd say that YOU call the shots since you're the paying customer. For quick and efficient results: I downloaded the Patient Information Sheet from QAS website, filled it out and faxed it to Brandi at 407-902-2780 and she took it from there. Several of us on here went through Brandi and she gets the job done..!!

Here's the form: http://www.qualityassuredservices.co...oche_rxlmn.pdf

And here's her contact information:
Brandi L. Thrailkill
Quality Assured Service, Inc.
Customer Service/Special Accounts
70 South Keller Road
Orlando, FL 32810
1.800.298.4515 ext: 2823
407.902.2780 - fax
[email protected]

And I agree, your 'pal' is a beaut. His name Dexter..??
__________________

 

[RobNDenver]

Well, surgeon will be pretty much out of your case within 3 months or so post surgery. My cardiologist manages my INR and was happy to hear that I wanted to test at home, instead of driving to the lab, getting stuck, waiting for results . . aaargh!

So that's what I do. QAS squared it up with my cardio and I am rocking. PCP has notihing to do with it. When I had a sinus infection recently I took antibiotics prescribed by the PCP, tested a little more frequently and adjusted my dosage accordingly. I send an email to my cardiologist's nurse and she and I work it out.

Sounds like your PCP wants to earn a little extra every month.

 

[Lynlw]

Who is writing your scripts for the coumadin? Since your card is for home testing would he take care of everything, writing scripts ect? IF so then it wouldn't matter what your GP likes.

 

[Philip B]

Calling Shots?

Calling Shots?

I love these questions. You're in charge!

You can have your cardiologist write you the script for home monitoring equipment. Mine did this for me and also writes scripts whenever I decide to change test strip vendors.

Others' opinions may vary, but I don't see my GP for anything related to my valve replacement surgery. I see my GP for other kinds of health related issues. I consult with my cardiologist every six months.

Again, there are probably those with differing opinions out there (and that's okay), but I firmly believe one should look at the medical professionals we deal with as consultants. In other words, I consult with my cardiologist or GP when I have a concern and make decisions based upon their advice. There have been times when I disagreed with the advice a doctor gave me and chose not to follow that advice.

You don't need your GP's permission to home test. If you want to do it, you should do it. If your GP wants to hassle you about it, find a different GP.

Personally, I test my INR weekly. The weekly tests allow me to monitor and adjust to changes more easily. I wouldn't be comfortable doing monthly tests; I frequently adjust dosages to stay within my range. Every few months I send my cardiologist a list of my INR test results so he has information about how things are going. These results are usually the subject of a short discussion when I do my check-up visits with him.

You get to make choices; take charge!

-Philip

 

[Blanche]

I agree with Philip.

The person who regulates your anticoagulation is the person who is in charge. It can be a GP, Cardiologist, but the Surgeon does not usually do that. Since you are having difficulties with your GP, I wonder if he has other reasons for wanting to monitor your anticoagulation. $$$$$$$$$?

Albert and I had a bit of a different problem with home monitoring. In March 2001 when he got his monitor, the Cardio was great, but many of his 17 partners had differing ideas on how to manage anticoagulation. It did get confusing. So, we asked our Internist to do the monitoring. At first it was tough, but finally it worked...and the Internist now has his own anticoagulation clinic. And, the two of us have been monitoring our own anticoagulation since 2003 and 2005.

There are varing opinions on the length of time between tests. Albert and I test weekly.
We do what works for us.....and since we paid for our own monitor and pay for our strips, we get to do what pleases us.

It really does get very easy after a while. I wish you the best.

Blanche

 

[Ross]

My PCP was against it, so my Cardiologist prescribed it for me. Poop on PCP.

In the end, it's YOU who calls the shots.

 

[Cris N]

There's some printed material on the various websites - like QAS - that you can give your PCP. Chances are he doesn't really know what a good thing this is for the patient. I was lucky with my PCP, I approached him, ready to throw all the stuff his way, but he was agreeable right off.

 

[ALCapshaw2]

EXCELLENT Responses from ALL above.

BRAVO !

Go for it Bob !

'AL Capshaw'

 

[westie]

weekly not 4 weekly

weekly not 4 weekly

My GP however is against it and wants me in his groups Anticoagulation Clinic. They want testing every four weeks.

I Bob

it is simple bob, you call the shots, it your life.

personally, i do not think 4 weekly testing is sufficent; a lot can go wrong in that time.

i self test and self dose weekly, any variations are picked up very quickly before they become a problem; i am convinced weekly self testing is the way to go.

if your doc is dead against self testing etc, it probably indicates his thinking is still in the dark ages; maybe you need a new doc?

is his anticoagualtion clinic some sort of cash cow?

.

 

[Cris N]

I want to add one thing to my earlier comment that boosts my PCP's forward thinking a little bit more. The medical group that he's part of has an ACT clinic of their own (very good by the way)!

 

[Marty]

Self testing only way to go

Self testing only way to go

My cardiologist prescribed a coaguchek for me on my first post op visit two weeks after surgery- and this was eleven years ago , when this was a fairly new technique. Prior to getting my monitor it was awful, getting results, etc.
Recently my wife was diagnosed with afib,sick sinus syndrome unresponsive to any medical treatment and he put a pacemaker in her. She is now on warfarin. He was delighted to have me test and and dose her. He said home testing is the best thing available to the warfarin paient. You don't have to drive into a busy hospital parking garage and pay $5.00, wait in the lab, get stuck in the arm by a big needle, and then wait for God knows how long to get the results and dose advice. For those patients of his who self test but don't self dose; the patients call in the monitor result to his nurse who will set the new dose if indicated.He does ask we keep good records, graphs,spread sheets, etc., just in case something unusual occurs. I don't approve of doctors who don't approve of self testing! Evidence based medicine has proven that patients who use home monitors stay in range better than those that don't! Ask your cardiologist if he will prescribe for your monitor and stay in charge of your warfarin dose. Bob,tell your GP, nothing personal, and you can use him for everything else.

 

[COLLEEN S]

Dexter Bob,
Welcome! I agree with the ones who say "you" are in charge. I self test and self monitor my coumadin, along with the cardio I have now after searching for one that would advocate self testing. I have to drive 2 hours to see her, but that's ok with me if it s 2 x a year. I take my INR reading here at home and phone it in. Just went for stress test for breathing issues and the shortness of breath I get isnt from my heart.
I went thru QAS for my monitor and insurance. Glad I did! Best of wishes to you as you navigate the maze!

 

[EVELYN]

Hi Bob
We were very lucky as my husband's cardio and our pcp both agreed with his doing home testing once his INR was stable. His cardio prescribed both the machine and does his coumadin scripts. Basically we manage our own and test once weekly, although he is there if we need to ask any questions. We test weekly and I definitely suggest that is the way to go.

Evelyn