Boy, I am really hacked off!!

[Icarus]

Hi to All,
It's been quite a while since I've posted anything but now I guess I'm just furious and wanted to vent. Hopefully Lance is monitoring this forum as it's mainly a question to him, but I'm interested in anyone's experience.
Problem: I've been self monitoring since around 2000. I got my test equipment from QAS (I believe I was Lance's first customer and I still have a copy of his CoagCheck vs. Protime Boo/Yay list). When I got the equipment I really let out a sigh of relief because that meant that I didn't have to go to my doctor for blood tests. My Cardiologist just said keep it between 2.5 & 3.5.
I got phone certified by a nurse from QAS at first and I kept in touch with the Cardiologist office to learn how to make corrections. Between that and Al Lodwick, I got really good at managing my INR.
9 years later: I'm now in Florida with a new Cardiologist. Great doctor, the problem is his group contains a coumadin clinic. The Doctor signed my letter of necessity (understanding that I will self-test and make adjustments as needed), it got faxed in and was promptly recalled by the nurse in the coumadin clinic.
According to the Nurse, all patients going to their office who are on coumadin, must go through them. I have to prove I know how to use my Protime then let them know every test so they can adjust my dosage.
Needless to say I'm crazed at the thought of getting back on that medical merry-go-round.
Question to Lance: Was this the way it was meant to be? If I have to do that, I could go to my primary once a month for a blood test. What was the need for that great, life normalizing machine?
I'd also like to know if anyone else is going through anything like this. Am I making too much of this situation and that I should bite the bullet, swallow my ego and go to, IMHO, Nurse Ratchet?
Regards,
Rich

P.S. (to Lance) You have a great staff.

 

[ALCapshaw2]

Your Problem is NOT with Lance or QAS,
it is with your New Cardiologist and his Staff.

From your writeup, it appears that the Cardio is OK with your Home Testing / Dosing.

TELL HIM that his Coumadin Clinic Nurse 'over-rode' his approval and told you that you MUST use their Clinic to monitor and dose your anti-coagulation.

IF he concurs with this policy, it's time to go Shopping for another CARDIOLOGIST.

Hopefully he will 'straighten out' Nurse Ratchet.

Good Luck !

 

[Ross]

Your Problem is NOT with Lance or QAS,
it is with your New Cardiologist and his Staff.

From your writeup, it appears that the Cardio is OK with your Home Testing / Dosing.

TELL HIM that his Coumadin Clinic Nurse 'over-rode' his approval and told you that you MUST use their Clinic to monitor and dose your anti-coagulation.

IF he concurs with this policy, it's time to go Shopping for another CARDIOLOGIST.

Hopefully he will 'straighten out' Nurse Ratchet.

Good Luck !

Precisely. That set up is totally removing the idea of home testing. I think you need to speak directly to the Cardiologist, who is the one that gives the orders.

 

[Jkm7]

Revenue, revenue, revenue.

 

[COLLEEN S]

Jkm,
So true, so true, so true!

 

[terodac]

Sometimes Nurses seem to over shoot there mouths! I would go over her head and ask your doctor about this, sometimes I get different answers from everybody in his office. The lab knows everything, the NP know everything, then you start 2nd guessing yourself. Just shoot right over her head and call the doctor.

 

[Icarus]

Follow-Up

Follow-Up

Hi,
I did follow up with a call to my Cardiologist. I got a call back from his PA and she also told me that their hands were bound and they can do nothing but follow the rules - anyone using home testing MUST go through the Coumadin clinic for follow-up and advice on how to maintain INR levels. They did not want to make exceptions for anyone.
Thinking back on the whole situation, I remember the first question I asked the Dr. - "Do you have any problem with me doing home testing?". He replied "Absolutely No Problem" and I still at this point believe he was OK with it. Being he's fairly new within his group of Cardiologists, he had no idea of all the groups rules.
I like this Dr., he's interested and talkative and you don't feel you have 3 minutes to explain any problem or limited on your questions. So I'll stay with him.
I finally got a prescription from my Primary Dr. If that didn't happen, I would really be up a tree.
Boy, those poor insurance companies. First they have to pay for home test kits then they have to pay (I'm pretty sure they're getting billed for this) for INR consultation.
Rich

 

[Marty]

My wife ran into the same problem with her cardio group. Her cardiologist is fine with self dosing and self testing. The ACT nurse however says they are medico legally responsible and must keep records. OK, now I test Alice every four weeks, she is very stable at 2.5-3.0. She calls in the INR and the nurse records it and tells her to stay on the same dose. Every body's happy.

 

[tobagotwo]

This is exactly the kind of lame, patronizing, self-serving, bureaucratic manure that makes some of us shudder at the thought of ACT. It's not the warfarin: it's the crap and smug semipro medical staffers that go with it.

I doubt very much that their argument of "responsibility" would actually hold water if tested. Millions of diabetics would descend on the 50 state houses if that were the case with insulin, milligram-for-milligram a much more dangerous drug. Problem is, someone has to have time and money to go after these self-important twits.

You have my sincere sympathies for this Big Brother (Big Sister?) grab of your personal freedom by the Clinic Queen. I couldn't agree with your outrage more.

Best wishes,

 

[Marty]

Bob, You have a point, but the "clinic queen" told Alice to call in -or find another group! Sometimes you just have to knuckle under.

 

[dick0236]

I finally got a prescription from my Primary Dr. If that didn't happen, I would really be up a tree.

I think you will find that your PCP can manage your INR as well as a cardios pro-time clinic, especially since you have been on ACT for a long time. I tried my cardios pro-time clinic a couple years ago....found it to be crowded, slow and unnessisarily costly. PCPs seem to be a little more willing to allow home testing since their insurance allowance is barely break-even. Mine gets $11.99 per test and I have no copay. My PCP wishes I would go back to home testing (I did it for about 6 months) but I cannot justify the personal expense of home testing especially since my PCP is minutes away and I like the nursing staff. Besides, the continuity of contact I have with the office comes in handy when I need services for the "sniffles"

 

[tobagotwo]

Rich had already said that he decided to do what they require for the sake of seeing the cardiologist who he feel suits him best. That's reasonable, because there is no other choice. Good cardios are hard to find. I'm not trying to talk him out of that.

However, that doesn't mean that I can't see this type of peremptory behaviour as outrageous. I do. We're worried about government control over us in medical issues. Too late: here it is already from the private sector.

Best wishes,

 

[evelyn2]

I am a registered nurse who was going to the coumadin clinic at the hospital where I worked. Last spring I started home testing after much coercion with my cardio and an appeal to the coumadin clinic. The only way I could self test was to have the coumadin clinic attest that they would continue to monitor my result. Hence, I call in my result every 4 - 6 weeks and come in to the clinic every 6 months. I didn't feel they had to know that I got Al Lodwick's algorithm chart and have been self managing my coumadin for almost a year now. Everybody is happy and I have a backup if something goes wrong.

 

[Ross]

I am a registered nurse who was going to the coumadin clinic at the hospital where I worked. Last spring I started home testing after much coercion with my cardio and an appeal to the coumadin clinic. The only way I could self test was to have the coumadin clinic attest that they would continue to monitor my result. Hence, I call in my result every 4 - 6 weeks and come in to the clinic every 6 months. I didn't feel they had to know that I got Al Lodwick's algorithm chart and have been self managing my coumadin for almost a year now. Everybody is happy and I have a backup if something goes wrong.

I had been using QAS's call in service for a long time, but have since just deal straight with the cardiologist. He knows that I have a much higher understanding of how the drug works then most of the people he's encountered. Get this. His nursing staff asked me about my opinion of the Coumadin Cookbook. I told them straight up, it's fine for recipes, but don't have a patient using it to try to control their vit k intake like the book suggests. Tell them to eat a normal diet as they always have and not to suddenly binge on something high in vit k and all will be well.

 

[evelyn2]

That's so true Ross. One of the best things I learned from this site is to feel free to the eat as you want and adjust the coumadin. More reason to home test. Whether it is your PCP, cardio, or clininc, they should be able to determine if you are able to self monitor and even self manage your dosage.
I have successfully dosed my coumadin completely on my own. I think if you want to self monitor that should be clue enough that you are capable and realize the importance of keeping your INR stable.
Especially with all the knowledgable people on this site who can help others because they have been monitoring and managing their dosage for a long time.