Canada

[Fundy]

First post here. Bicuspid Valve. Barely severe stenosis. Blood pressure always good. No symptoms yet. Well none that could be attributed to heart valve I guess.

I''ve got quite a few questions naturally.

I've read quite a bit of the posts here.

I guess a few questions that stick out in my mind are first; regarding Canadians.

What aspects are different...such as choice of surgeons. I seen on Adam Pick's site that someone from Canada has chosen surgeon, commenting on it's not easy to do in Canada. So wondering, is it easier than thought. I'm guessing an address move would be necessary maybe.

Costs?...doesn't seem to be an issue. But maybe there is regarding blood clot check equipment later for example. Or maybe there is costs I should be aware of that I don't know of.

Valve choice?...Is it a choice here or more prescribed?

More in general questions.

I'm not getting the impression that tobacco, alcohol, sugar, or salt are much in terms of factors; although I've seemed mentioned a few times elsewhere that low sodium diets are recommended for aortic stenosis people. Any thoughts on how any of those matter at all?

Also, family doctor and cardiologist both never mention recommending that other first degree relatives be checked regularly for similar condition. I have other connective tissue items, as did dad that died pre-60 from heart failure.
Is this normal?

That's it for now.

 

[Bina]

Greetings to a Maritimer !
When my cardiac issues developed I was living in Quebec, then when I moved to Eastern Ontario I kept my Montreal cardio and he referred me to a Montreal Hospital to meet a surgeon. Fortunately I booked in with the chief of surgery and never regretted it.
I was free to choose tissue or mechanical valve.
I had to sign a form for being "out of province" so that the hospital could be reimbursed from the government, my cost was zero.
Post op blood lab work if done in a hospital is free of cost.
PreSurgery I had no diet restrictions since my BP was great, but I had a very healthy diet anyways.
Still not sure if my 25 year old daughter will show up with any valve issue, seems good so far.

 

[Philip B]

Questions

Questions

Good questions for those with experience and expertise with the Canadian Health Care System. My son, daughter-in-law, and grandkids moved to Ontario last year and have had very positive experiences with the health care system.

I don't know exactly how the connective tissue disorder stuff works. Based on my family history over the last three generations, I seem to be the only one who was blessed with a bicuspid aortic valve and defective tissue which resulted in the development of an aortic aneuryism. If it's a genetic thing, it skipped a multitude of generations in my family.

Diet recommendation stuff seems to vary. During my hospital stay following surgery, the dietary staff attempted to put me on some kind of special cardiac diet. I couldn't tolerate it. Having my sense of taste screwed-up probably didn't help. The staff put me back on regular food pretty quickly.

My cardiologist has never suggested any restrictions on food, alcohol, or salt intake. I've never told him that on rare occasions I enjoy a cigar.

-Philip

 

[Freddie]

Does this mean your in the Bay of Fundy?
Welcome to the forums.

Living in Saskatchewan I did not have a choice in surgeons or Cardio, but I've come to learn both are at the top of their field and come highly recommended.

As far as valve choice, my surgeon basically said he "didn't think I would want to have this type of surgery again". So if a repair could be done, it would be a repair if not and due to my age "a mechanical valve would be used".

As for costs.....none! Zippo. The home monitor is the only thing one has to buy and it's your choice to get one or not. Although you may be the lucky few where your doctor may highly recommends it. But time will tell on that subject.

 

[Cris N]

Hi and welcome to the forum. I can't help you with the Canada question or the BAV issue. I can offer some thoughts on tobacco, alcohol, sugar, or salt. If you're smoking cigarettes, you should stop If you drink a lot of alcohol, you should cut down If you eat a lot of sugar, you should see a dentist If you use a lot of salt you probably should get used to a low(er) sodium diet - as least until you're through recovery. Obviously your doctor maywant to chime in on those products depending on your overall history.

At any rate, you've come to a good place. Glad to have you aboard.

 

[netmiff]

First post here. Bicuspid Valve. Barely severe stenosis. Blood pressure always good. No symptoms yet. Well none that could be attributed to heart valve I guess.
What do you mean "none that could be attributed to heart valve"??

Bicuspid valves are congenital - you are born with them. I had one. My surgeon recommended (when asked) that it would be a good idea for close family members to get checked.

I''ve got quite a few questions naturally.

I've read quite a bit of the posts here.

I guess a few questions that stick out in my mind are first; regarding Canadians.

What aspects are different...such as choice of surgeons. I seen on Adam Pick's site that someone from Canada has chosen surgeon, commenting on it's not easy to do in Canada. So wondering, is it easier than thought. I'm guessing an address move would be necessary maybe.

Here in Ontario, all you need is to be referred by a physician. They can refer you to anyone you, or they, want. If you don't like/trust the first guy, go back and referred to someone else. My cardio asked me if I had anyone in mind, when I said no, he asked me what qualities etc. I would like in a surgeon (apart from the obvious one of being good at his job ) and I got what I wanted.

Costs?...doesn't seem to be an issue. But maybe there is regarding blood clot check equipment later for example. Or maybe there is costs I should be aware of that I don't know of.


All hospital costs should be paid for by your provincial health care, unless you request an upgrade to a private room or whatever.
I have a Coaguchek from Roche (Google Roche Canada); I think they are around $500 now; lab testing is free . .and even though I paid every penny out my own pocket, it is worth it ! !

Valve choice?...Is it a choice here or more prescribed?
I pretty well knew beforehand that I wanted mechanical; I had not been terribly mis-informed about anti-coagulation as some have been. That being said, I was probably more ignorant about the whole thing than anti-warfarin or pro-warfarin My big question is that bleeding strokes occur frequently on my mother's side, and that was a concern. Talk it over with your cardio/surgeon. My surgeon asked me what I wanted, and said he would recommend mechanical, too. We did not get into makes and models (like saying to a used-car salesman, I want a car !).

More in general questions.

I'm not getting the impression that tobacco, alcohol, sugar, or salt are much in terms of factors; although I've seemed mentioned a few times elsewhere that low sodium diets are recommended for aortic stenosis people. Any thoughts on how any of those matter at all?
I was and am a smoker (30+ years at this point). Everyone I have ever met in the medical wanted me to quit, and to lose weight. Weight I did not manage, but had got down to about 2 cigarettes a day before surgery. I have never eaten much sodium, have never had high cholesterol or any other thing. Bicuspid valves are a malformation, not a disease;it is more like having club feet than, say, diabetes. The thing is though, they really don't want to have to do a re-do, and if you can avoid bypass in the future, they would rather go the prevent route than have to fix.

Also, family doctor and cardiologist both never mention recommending that other first degree relatives be checked regularly for similar condition. I have other connective tissue items, as did dad that died pre-60 from heart failure.
Is this normal?

OOOOps, I jumped the gun on that one - sorry

That's it for now.

Hope that helps, and doesn't confuse you even more! It is difficult even for me as a Canadian to answer some of this, as our health care is actually provincial.

 

[netmiff]

Good questions for those with experience and expertise with the Canadian Health Care System. My son, daughter-in-law, and grandkids moved to Ontario last year and have had very positive experiences with the health care system.

Glad to hear it - I too am very happy with our health system. If you don't mind sharing, where are they?

I don't know exactly how the connective tissue disorder stuff works. Based on my family history over the last three generations, I seem to be the only one who was blessed with a bicuspid aortic valve and defective tissue which resulted in the development of an aortic aneuryism. If it's a genetic thing, it skipped a multitude of generations in my family.

Philip, I think aneurysms are actually formed, in our cases, by the pressure of the blood trying to pump through the teeny weeny opening left in the aortic valve - think of a river cutting into a bank on a corner . .

Diet recommendation stuff seems to vary. During my hospital stay following surgery, the dietary staff attempted to put me on some kind of special cardiac diet. I couldn't tolerate it. Having my sense of taste screwed-up probably didn't help. The staff put me back on regular food pretty quickly.

Could the special diet have been because you were in a cardiac unit, and bypass surgery is waaaaayyyyy more common that valve replacement?? I know it was with me - every tray they sent up to cardiac was special diet.

My cardiologist has never suggested any restrictions on food, alcohol, or salt intake. I've never told him that on rare occasions I enjoy a cigar.

-Philip

xxxxxxxxxxxxxxxxxx

 

[Philip B]

Response

Response

Hi Jeanette,

My response was posted in an effort to lend a perspective to questions Fundy had posted...but since you offered some insight and questons concerning my reponse...

Our kids now live in Waterloo, Ontario, and work for one of the colleges there. They really like it there. They're doing the Canadian citizenship thing.

From what my surgeon and cardiologist told me about my aneuryism, it wasn't simply formed by increased pressure flowing through a constricted valve opening. The tissue in my aorta was actually defective. The inside of my lower aorta was potmarked and had a number of cyst like structures. The tissue caused turbid blood flow. It was pretty nasty looking. Both doctors commented that this kind of tissue is commonly found with aortic aneuryisms associated with bicuspid valves.

At the time of my surgery, my well-worn valve wasn't constricting blood flow excessively. This isn't to say your observation about the contributions blood flow through a restricted aortic valve can make in some patients with respect to aneuryism formation isn't true for some.

My bicuspid aortic valve and the defective tissue which resulted in my aortic aneuryism were genetic because I was born with the problems. As noted in my earlier post, I've not a clue about how the genetic stuff works because there is no obvious history of these kinds of issues in my family. In my family, the issues I encountered were definately outside of the norm.

Yes indeed, I'm sure that the hospital folks attempted to put me on a cardiac diet because I was in the intensive cardiac care unit following heart surgery. My point was that the diet was not necessary for me and the staff changed their tactics when they realized it wasn't a good fit for me. Changes in diet or for that matter, lifestyle, are not automatic just because someone has OHS. Other than taking coumadin and checking my INR weekly, my diet and overall lifestyle haven't changed since or because of surgery.

-Philip

 

[Mentu]

Fundy, I checked the weather and was a little surprised to see your temps warmer than here in Oklahoma. Tonight it will be -8° C but with only 3"-4" of snow left. Welcome to VR where I hope you will find help in getting answers to your questions. Welcome, aboard.

 

[Bryan B]

I'm not getting the impression that tobacco, alcohol, sugar, or salt are much in terms of factors; although I've seemed mentioned a few times elsewhere that low sodium diets are recommended for aortic stenosis people. Any thoughts on how any of those matter at all?
I was and am a smoker (30+ years at this point). Everyone I have ever met in the medical wanted me to quit, and to lose weight. Weight I did not manage, but had got down to about 2 cigarettes a day before surgery. I have never eaten much sodium, have never had high cholesterol or any other thing. Bicuspid valves are a malformation, not a disease;it is more like having club feet than, say, diabetes. The thing is though, they really don't want to have to do a re-do, and if you can avoid bypass in the future, they would rather go the prevent route than have to fix.

I have to disagree with this statement. Any malformation of the human body is considered a disease. I know that the word "disease" means "acquired" to many people but the fact is that congenital malformations are also considered diseases. I was born with a congenital VSD (hole in my heart). I had heart disease from the day I was born. The fact that Fundy has a malformed aortic valve means that Fundy has HEART DISEASE. I guess that if you have a bicuspid valve that is never diagnosed and/or never needs intervention then you might be able to rationalize that it's not a disease but it is. Once it is diagnosed and needs some type of intervention because of symptoms it then becomes more of a life threatening disease. Everyone here who has had heart valve surgery or any other type of ongoing treatment for heart related issues has heart disease and always will no matter how permanent their repair may seem.

I understand what you are trying to say netmiff and in some ways I kind of agree with you that if you have an anatomical malformation that never causes you any life altering problems it would seem that calling it a disease seems to be an overstatement, but it isn't.

Here is the definition of disease from a medical dictionary:

disease /dis·ease/ (dĭ-zēz´) any deviation from or interruption of the normal structure or function of any body part, organ, or system that is manifested by a characteristic set of symptoms and signs and whose etiology, pathology, and prognosis may be known or unknown.

http://medical-dictionary.thefreedictionary.com/disease

 

[netmiff]

Philip and Bryan, I stand corrected with no hard feelings!

Philip : I hadn't found this forum before my surgery, and did not know what questions to ask. I didn't even freak out when he said aortic aneurysm (and casually said that he would "just tuck that back in while I am in there), although I would now!

I seem to by the only one in my family, too, with a bicuspid valve, although a significant number of my fathers' close male relatives died of "heart attacks" many years ago, in their early sixties. I have since wondered if it was undiagnosed valve issues (HA! not disease, issues lol)

Bryan, you were right, I was simply trying to differentiate between a deviation in the normal structure and a deviation in the function - I personally feel that there is a big difference there. Maybe just because I do not want to be labelled as having heart disease; I had a problem, got it fixed . . and moved on. Maybe the difference between having a slow leak in a tire and a total unexpected blow-out - you get the slow leak fixed, and although you may check it a bit more than the others, you keep on driving. I'll leave what could happen with a blow-out up to your imaginations.

Sorry if I have confused or led anyone astray, and thanks for straightening me out.

 

[Mentu]

Greetings, Fundy

Greetings, Fundy

I thought I would send you a note about your question about the family. My surgeon asked me a number of questions about my family and in the course of searching for answers I learned a lot. The first surprise was that one of my maternal Uncles had not one but two valve replacements. An Uncle and Nephew with the same type of valve problem was certainly suspicious. I then learned that my maternal Grandfather had a severe heart murmur and suffered from fatigue throughout his adult life. No one in my family had ever told me about either of these things until I started asking. My surgeon thinks the probability of a genetic link is very high. So, after talking with my Uncle, I spoke with each of my cousins to alert them to the importance of following up any indication of heart murmur since that is often the first indication of a potential problem. As you probably know, even people with BAV usually do not develop serious problems. There is no need to alarm your family but I think they do need to be aware of the possibility.

I will now get off my soap box.

Let us know if we can help with your other questions.

Larry
Tulsa, OK

 

[Fundy]

Thanks for your responses.

I've got far more useful info via patients for health problems than I have from visiting docs. I've got a long idiot family doc rant but it'd take forever to be thorough. So I'll finish with a short rant on it.

I'll only add a bit though as I can't understand what I'm saying when I type it, so I doubt anyone else can either. But I'm sure if i had just remained complacent to going through whatever the system led me through I would die from heart failure within ten years. As my family doctor almost had me convinced I had no heart or lung problems even after an ER doc said I did. I mean why would he tell me so five times and seem frustrated whenever I suggested he had to be wrong. I'm thinking many others would have relented to his thoughts just as I almost did.

But first, if I'm reading your responses correct; valve choice and surgeon choice in Canada seems like it definitely can be up to me somehow, in someway if necessary. Even though it may take some effort. Definitely nice to know that it can be done if need be.

On costs, I'm wondering still about supplementary coverage via Medavie Blue Cross. For example, they do allow for some medical equipment reimbursement. Would blood check device and ongoing supplies be a part of it. Also, my plan says semi-private room reimbursement. How do they reimburse if I choose private if available. Do they cover semi-private amount or nothing in that case.

I would love to find a diet plan that extends initial 5-10 year replacement guestimate to something like 50-100 years. I'm still guessing low sodium diet wouldn't help that much if any, from the responses given anyway. How much would a low sodium diet help. I think i'm probably low sodium anyway. at least I never put table salt onto my cigarettes.

As far as symptoms and idiot doctor rant. I did have SOB, dizziness, night sweats, and chest pains. But I'm almost certain nothing is heart related or concerned. Well, other than brown outs. I'm not sure about those. But cardiologist assures me heart is functioning well in spite of stenosis and I have other explanations for all symptoms. Except brown outs which I no longer have but also had when I was 10-12. And then there is the exploding head syndrome thing. That's kind of cool once you find out it does happen but no one knows why it happens but appears to be harmless. At least nothing indicating stroke or brain tumours anyway. Anyone else have these?

On to short story of rant. Probably just garbled nothing to anyone reading it. Still pisses me off that I had to educate myself to come up with own solutions. Pisses me off big time that doc I trusted to find solution basically lied about some results which may have killed me eventually.

I first learned of murmur in April 2007 after finally giving in on health problems and going to ER doc then him again at walk-in clinic. Long freaking rant available from me, including new family doc insisting that echo was negative and I had no heart murmur or lung problems apparently as ER doc said.

Five appointments with new doc in four months and still the same story from him that all my problems were mental and I'd need psychologist and anti-depressants.

Finally I insisted on seeing the test paperwork(even after he filed paperwork with my work health insurance saying all testing negative), he only had the bloodwork (which was OK) from ER doc request and bone scan as per him(mild scoliosis and DVT consistent with CT scan from ER doc)(which new doc still said was totally negative even).

Anyway, echo report had moderate to severe stenosis from a bicuspid valve, and lung tests had the DVT and bullous emphysema. By the time cardiologist got request a year had passed and I needed another echo before appointment. She then had me do MRI and a stress echo. Which had stenosis progress to barely severe but heart working extremely well and shouldn't be causing me problems, especially the chronic pain in muscles. She says hard to guess accurately at time to replacement but she could say five years probably, but it could end up being ten.

Mentu, as you mention having no knowledge of family history readily but upon investigation it probably is there. I too have similar findings. Had a Dad die at 58 of a sudden heart failure three weeks after a mild stroke. He had flat feet such as me, hypermobility in thumbs and he was 6ft 118lbs when first married. He mentioned to methat all old family photos had the old guys with two canes and figured flat feet was frequent family problem. His mom died less than two months after him from massive heart failure while being moved upstairs to CCU in hospital while I waited to see her. She was unconscuos earlier that morning from a faint and apparent heart attack. She was gone within minutes after the last attack first happening right in CCU. She had mentioned years before that many men on her side had died early of heart failure. She also had faints that left her temporarily not knowing who she was sometimes and other times just no recollection of past few hours, such as being somewhere and not knowing suddenly where she was or how she got there.

To me, seems like a lot of Marfan-like characteristics. Myself, I was born tongue-tied, hernia at 2 yrs, flat feet, mild scoliosis, arm span to height ratio of 1.06, crowded teeth, odd protruding bump in sternum, emphysema, tennis ball size indent in back of skull, and chronic tight muscles.

But back to idiotic family doc rant....connective tissue still not a concern to him at al. Definitely a waste of my time seeing him. Chiropractor help and diet restrictions I've made myself including refraining from pop, chocolate, coffee, junk food, while adding almonds, salads and good clean water have worked. I went from 4500mg of tylenol daily, celebrex , clonozapam, cipralex, and muscle relaxants just to tolerate living, to no drugs at all. Doc felt I was being silly being concerned that Tylenol was too much, as 4500 daily was fine. I could go on forever ranting and wondering why? Enough for now.

Anyone have thoughts on DVT though. Should I just forget about it. What else could I do about it. Should I ask for test to confirm its gone and not occurring again?

 

[Philip B]

Choices

Choices

It'd be nice if the choices we make in life came with guarantees. How many people have we met who focus on healthy eating habits and still encounter serious illnesses despite their efforts to make healthy choices? On the flip side, most of us probably know people who eat a steady diet of junk, engage in all kinds of unhealthy habits, and live their lives without ever encountering a serious illness.

The night before my AVR surgery I took my wife to a pancake house for dinner. While she was eating, I observed four obese people gorging themselves at a nearby table and commented that life wasn't fair. When my wife asked me why, I motioned to the nearby table and commented that none of those people would probably ever deal with heart disease, but despite my efforts to watch my weight and maintain a decent fitness level I would have heart surgery in the morning. Of course, I don't know who those people were and whether or not any of them will ever deal with heart problems. Who knows, maybe all of them had heart attacks before the end of the week.

My grandfather was a chain smoker most of his life and passed away at age 95 without ever having a bout with cancer. Both of my parents have had cancer despite eating healthy and avoiding the use of products linked to cancer.

Hopefully, the choices we make will result in lengthy, healthy lives for all of us despite the occasional challenges we encounter. If one believes a low sodium diet will result in longer life expectancy, it may be worth a try.

I think my concept of life not being fair was wrong. Life is simply what it is and it often contains challenges that help us grow. Dealing with congenital heart disease undoubtedly changed my perspective on a lot of things. Good people don't face challenges for no reason; often challenges just make good people better.

-Philip

 

[Maryka]

Hi!
I was diagnosed as Marfan in the early 90s when my odd anneurysm was discovered in my ascending aorta and no heart murmers were found. Later I was demoted to "Marfan-like". I have lots of those Marfan characteristics you mentioned. These days you must have "one from two of three menus" ha ha! Besides the skeletal and heart stuff you mentioned, you need to have either detached eye lenses (or certain other rare eye issues) OR a special pouching out of your tissues at the base of your spine. HOWEVER I know people who had aneurysms only who died or almost died because of dissections.

Over 15 years ago I got to chat with Marfan actor Vincent Schiaveli. He got his heart valve and aneurysm surgery and eventually moved to Italy where he wrote cookbooks. Then he died, not of the Marfan symptoms, but of lung cancer because he continued to smoke. Something to think about.

 

[Bina]

My situation was one that I could not "request" a certain room, they did have some semi-privates for special cases, and a couple of private ones mainly for better quarantine control.
Mentionning that I had extra insurance for such luxuries made no diff.
So, I promised that I was a going to be a "problem" patient, and that they may want to make sure I had a quiet room.
My first couple of nights I was alone in my room, and thereafter I had to share with another patient.
HA, no group room for me.

 

[Fundy]

Just wondering if you had genetic testing after the diagnosis. and that was why you were movd to marfan-like.

Anyway, I believe the lung cancer maybe should be considered due to the Marfan's as from what I've read about most connective-tissue disorders they all mention predisposition to lung diseases such as cancer or emphysema. I'm guessing having CTD or not is why some get problems from smoking while others can smoke until 100 years of age and no problems.

Also, seems that most diagnosis requirements have a first degree relative confirmed of that disorder then you get an extra checkmark type of thing. My brother and I certainly have somethings and Dad did as well, dying at 58 from heart failure of some type. So I'm almost certain there is some type of genetic CTD of sometype. What exatly, I may never know and don't really see much benefit of knowing actually now that I'm seeing a cardiologist probably regularly for life anyway.

I don't think having a named disoorder would really help me for anything anyway, as major concerns are heart,eye,lung, and dural ectasia. Although I'm not really sure of what I would be concerned with regards to dura stuff. But heart concerns, I now know I've got barely severe aortic stenosis; so I'm guessing I'm going to have a cardiologist monitoring my valves and aorta for rest of life. Lungs, well I've got emphysema already and no that I shouldn't be smoking and that I should be doing deep breathing exercises at least a few times a day. So I guess the big thing for me there is to quit smoking.

Eyes, well I don't need a referral to get eye tests. So that's my own fault if something springs up there. Although I've been meaning to get tested. Actually been meaning to for at least twenty years; after a driving test examiner strongly suggested I do. Basically for several minutes a was completely blind in one eye because I couldn't pick out any of the dots. Finally after a bit I said, wait i see it. Retested the eye and basically perfect vision. He figured there must be something up with the eye, to have perfect vision sometime and sometime no vision.

As far as dural ecstasia, I'm not even sure about the concerns there. Other than I know there are concerns and also I should be concerned with chiropractic adjustments. Which I have monthly. But guess I've chosen to be unconcerned as long as the adjustments are helping.

I'm not sure having a family doctor knowledgeable about CTD would be of any benefit for me though. Unnamed or named, either way heart stuff is getting looked at regularly. I should have eyes checked but there's no history that eye know of where someone has a lens dislocate suddenly or anything.

 

[olefin]

although I've seemed mentioned a few times elsewhere that low sodium diets are recommended for aortic stenosis people. Any thoughts on how any of those matter at all?

I asked about diet when I was first diagnosed with aortic stenosis. My cardiologist said what I eat had nothing to do with progression of the stenosis. For many years I had tried to control eating to to keep my weight normal. He told me to continue to eat as I had. And I did for the next 10 years. In fact, still eat what I want. I had quit smoking 23 years before stenosis.

 

[wcasey5]

Hi Fundy

I just got back from Nova Scotia, and I visited friends in Wolfville, as well as family in Halifax and Cape Breton. I got caught in the snowstorm in New Brunswick and Conneticut on my way home.

Doctor and Valve choice: So some homework and choose the surgeon you want. Tell your family doctor, or whoever is going to refer you, who you want and it shouldn't be a problem. Valve choice is completely up to you, if you choose mechanical, do some homework here on the type of valve you want, St. Judes, on-x or whatever. Again, it shouldn't be a problem.

MY parents have a neighbor that just went through this procedure, he was kinda pushed toward a mechanical valve because of his age, but choose a pig valve, but could have gotten any he wanted. I don't know the name of his surgeon, but I do know he had to travel to Halifax to get the procedure. From speaking with him, it was a very similar experience that I had here in Baltimore, except the cost for him was zero. Everything else was pretty much the same, and within the same time frame.

Re embursed for Semi Private Room: Exactly like it sounds, you pay the hospital for a room, either private or semi private, and the insurance sends you a cheque for the difference between a ward and a semi private room. When my wife gave birth to our children in the 90's, the difference was about $100 per night. Who knows what it is now.

Home INR monitoring: My dad has tried to get an INR machine with no luck. But he hasn't tried very hard, check with your insurance.

Good luck!