Coumadin

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Patricia Choate

Hi everyone. It has been awhile since I have posted.....father was very ill and died in January (But that it a whole other story)
I had my mitral valve replaced in October 1999 and I am still having problems with my Coumadin doasge. So every two weeks I go to the lab and they draw blood. That is the problem....every time it is a little more painful. Yesterday they had to stick me once in each arm and then back to the first arm to get a sample.( I was actually in tears.) Today I am bruised and sore on both arms. I asked if they could draw the blood from my wrist or anywhere else and the lab tech said no. I just don't know what to do. I have reached the point where I considered refusing to have the lab test me and instead getting my own machine, but my cardiologist refuses to write me a prescription for the machine unless I agree to still have the lab test every two weeks. If that is the case, why get my own machine? I mainly needed to vent all this but if anyone has any suggestions, please, let me know.
 
Hi Patricia, sorry to hear about your father. That sort of thing is bound to give you some mixed feelings.

I'm about the same as you when it comes to being sick and tired of all the needle poking. My veins have had just about all they can take. They're testing me once every 3 weeks now. Last time it took 4 different attempts, 2 in each arm (Darn girl missed and was probing muscle tissue and that really hurts!), to get the blood. I don't know what the reasoning is behind why they won't try another location. We'll have to wait for someone else that might be able to tell us.

What is going on with your dosage? Is your diet consistant? Some drug(s) interfering with your metabolism? How about if you post some more information like, your dosage, how often they test you after a dosage change etc,.

My Doctor(s) won't give me a prescription for a machine either. They site inaccuracy of the units which I think is a whole bunch of hogwash. Since we both have to put up with needle sticks, why don't you insist that they use a "Butterfly Needle"? It is the smallest (23 1/4 gauge?) and induces the least amount of pain. I can tolerate a good bit of probing with it, but they love to try to use the darn 22 gauge and those things have me sore and bruised too! They may not even offer to use the smaller one, but INSIST ON IT! They have them! ;)
 
Hi Patricia,

I would like to share some of my thoughts on your issue.

If you are on Coumadin, and have to get tested every 2 weeks for the rest of your life, your arms will continue to build up scar tissue on the veins everytime they stick you. It is for this reason that I wanted to obtain my own testing unit for home use. Some folks have so much scar tissue on the veins of their arms, that they have to have the lab stick them in other places, since they can no longer get a good draw from the arm.

I would seek out another cardiologist. My doctor has been very supportive, and impressed that I have taken such a proactive approach to my health care management. I submit my results to him every time I vist, ( 6 month intervals), and I also call him if my INR ever gets too high or low. I test every week, and due to this, I can easily manage my INR if it is swinging too much in either direction. My doctor has even recommended this unit to other patients. Do yourself a favor, interview, ( YES.. interview other doctors.. find one that is more proactive in patient health care management).

Again, if you are going to have to go to the lab every 2 weeks for the rest of your life, things will only get harder. Prescription or no prescription... you should try and obtain a home testing unit.

Your doctor cannot make you go to the lab every 2 weeks. Tell him you want the home testing unit, and that you will calibrate it against the lab every 6 months. Also, tell him that you will provide him with the weekly results of your tests.


Good luck,

Rob
 
Bad veins,finger stick monitor

Bad veins,finger stick monitor

Patricia, I'm old, lousy veins, etc. I had mitral valve replacement with a mechanical St. Jude September 1998. On my first post op visit my cardiologist prescribed a Coaguchek for me. I havn't been to a central lab since January 1999. Early on I found a slight discrepancy when I compared the results of my Coaguchek with the central lab. However I consulted with Dr. Jack Ansell the ultimate clotting guru in Boston and he reassured me that the results of the Coaguchek had just as much chance of being right as those from the central hospital lab. Now I wonder where you found such an ignorant cardiologist. There is a massive literature on this subject if he would take the time to check it out. I'm an M.D. (radiologist) myself and I know from the inside that we have some doctors who if not stupid are certainly negligent. I know you have some competent MD's in the "valley" and my advice is start to look for one.
 
Down with paternalistic doctors

Down with paternalistic doctors

Hi, Patricia!

I'm with the others on this. Your doc is being not only paternalistic, but incredibly controlling by requiring the bi-weekly sticks AND refusing to consider the home machines.

I know it's frightening to change cardiologists; mine MOVED 3 weeks after I had my surgery; so my post-surgical check up was a new doctor. I felt totally abandoned and at a loss. I was fortunate in that my new cardiologist is great - a specialist in women's heart problems and wants me to be knowledgeable and empowered (I hate that word, but it fits here). My cardiac surgeon told me that the only way to go is a home testing unit once we get the levels set. I feel really fortunate to have helpful and supportive medical people.

So there are lots of them out there - go find one.

And what's with the sticking only in the arm? I have only one arm that can be used due to lymph node removal in my right arm; they take blood from any vein available (few and far between); hand, wrist, whatever; and yes, they do have to use butterfly (scalp) needles. And tell the lab you want their BEST phlebotomist and carry on until you get him/her (I did; it worked. A person only gets 2 chances then I call for another until I find one I like. Don't think of it as a popularity contest; demand the best and no students). And they can use the fine veins because they only need 5 ccs for protime/inr testing. SO THERE!!! Now you're armed (no pun intended).

If you're demanding and know what they can do and what they SHOULD be doing, they'll do everything they can to get you out of there - namely, successful sticks as fast as possible.

The other suggestion - is there a coumadin clinic near you? Seems that would be a great help.

Good luck - from a needle phobic (I thought that chemotherapy was my worst nightmare come to pass; now I have coumadin to contend with. ARGH)
 
Hi Patricia,
First let me say I am sorry to hear about your father passing on.
I have been on Coumadin since July 0f '96.
I get tested once and only once each month.
They have used the same arm and the same vein all this time with no problems.
I don't understand why your doc insists on every two weeks.
That is painful and I guess could start to get expensive as well.
I would have to go along with Ross on this one and ask if there is something you could do to be more consistent and get away from all these tests each month.
It could be that your doctor is just covering his/her behind.
 
Ross Y suggested that I post a little more information about my INR and Coumadin dosage. My INR is supposed to be 2.5-3.5. My diet is fairly consistent and I take no medications or supplements without my doctor's approval. My usual Coumadin dose is 5mg every day except Wednesday when I take 7.5mg. My INR is never too far from the target range.......3.6-change in dosage-recheck 10 days.....2.4-change in dosage-recheck 10 days.....2.6-no change in dosage-recheck 10 days....3.0-no change-recheck 10 days...2.2-change in dose-recheck in 10 days and yesterday's came back at 3.6-no change in dose, but recheck in 10 days.
My husband suggested that I drink a lot of water before I get my bloodwork as that might hydrate me and make the blood draw easier. Anyone have thoughts on that?
 
They are checking you way too much. If your INR was 3.6 they shouldn't change anything. It sounds like your in your ideal therapeutic range, so the only thing I'd do is watch very closely, my vitamin K intake. Make sure it is consistent. (Don't get mad, I have a hard time with this too!) Looking at the numbers you have posted, they really don't need to test you more then once a month. Changing dosages for very minor fluctuation is crazy.

I have a new coumadin clinic nurse where I go and she tried to get me to do the same things as yours. I told her straight out NOPE. I don't suggest everyone do this, but I've charted my INR testing for a long long time, and I'm certainly in my therapeutic range at 7.5 mg everyday. I was at 3.6 and she wanted me to drop 10% and recheck in 5 days. NOT GONNA DO IT! I didn't do it either. My retest figure was 3.3. If I'd dropped 10%, I'd be in the less then 2.5 area.

I think you and I both need to find ourselves a doctor that will get us the prescriptions for the machine. I'm still chipping away at my doc about it. Maybe if he gets tired of my bombardment of statistics, he'll give in?

I don't think drinking water is going to do anything to make you easier to stick. They plain don't need to be testing you that darn much.
 
Patricia

Patricia

I'm with Ross, why are they checking you so often, you are within range most of the time, and no additional meds, and no change in diet, to me you seem to be doing good.

I've been tested everyweek since surgery (5 months post-op), I've been, for the most part under the therapuetic dose, I take 62.5 mg a week sometimes more, alternating between 7.5 & 10. mg a day, my doctor can't wait to let me go every 2 weeks and then hopefully once a month and maybe longer.

The butterflies are great, I've used them on pt especially Cancer pt, and children, they are thinner and shorter, and the vacumn from the vial isn't as strong so even thin veins can be used. The suggestion of water from hubby isn't nonsense, if you go fasting or dehydrated it is hard to draw the blood, the veins tend to hide until re-hydration. It can't hurt to try.

Terry40
 
Hi Patricia-

My deepest sympathies on the passing of your dad.

My husband has been on Coumadin for 25 years, plus he has many other medical problems which require loads of bloodwork. He has only one good arm, but they use the other in emergencies.

The biggest determining factor in his blood draws is the experience of the phlebotomist. Expenienced ones, no problem, not so good ones, problems. Ask for the best one available. It'll help in the long run.

The good ones, never have a problem finding the vein, even with all kinds of scar tissue in his arm. The others couldn't find a vein if it came up and hit them on the nose.

Right now, he is getting tested every week because he is on some new medication which interferes with his INR.
 
Patricia,

As an experienced RN and vein poker, I will tell you, they can use a number of veins. I have used hands, wrists, wherever need be to get the job done. No sense in wearing out those antecubital veins and scarring them up. I like using a syringe but it should be a 21 gauge for the INR- or they can use a butterfly.

Like everyone else said, make sure you are getting an experienced and great phlebotomist. If insurance pays for it, I would get the Protime machine. Then you can check at home when you want to. Good luck!

wife of Nascarfan
 
My cardiologist clinic has a coumadin nurse. She must use a different process than you guys are going through. I just get a finger stick, she collects the blood in a small tube, puts it on a strip in a measuring device and we're done. I assume the device is something like the protime or cougacheck or whatever they are called. I'll look a little closer next time.

Is the procedure that I'm having different than the ones y'all are having that require a vein withdrawal?
 
You will NEVER, NEVER,NEVER, EVER, EVER, get your INR regulated with the cardiologist that you have.

You will NEVER, NEVER,NEVER, EVER, EVER, get your INR regulated with the cardiologist that you have.

You will NEVER, NEVER,NEVER, EVER, EVER, get your INR regulated with the cardiologist that you have.

You will NEVER, NEVER,NEVER, EVER, EVER, get your INR regulated with the cardiologist that you have.


DO I MAKE MYSELF CLEAR????????????????????????????

Anybody who changes the warfarin dose for an INR of 2.4 or 3.6 knows no more about warfarin that does a puppy who thinks he can catch his tail.

Some day the internet will be replaced by something that we can't even dream of yet. The last message posted as the internet fades away will probably be you, venting over your doctor not being able to get your warfarin dose stabilized. Unless you change doctors!!!!!!!!!!!!!!!!!!!

I have probably done about 16,000 fingerstick tests, so I think I can claim to have warfarin fairly well figured out.
 
Hello Patricia,

Sorry you are having such problems.

If I were in your place, I would start looking for another Coumadin Clinic (one that uses a finger stick machine such as the Coaguchek or ProTime) and give serious consideration to finding another Cardiologist.

In the mean time, I would INSIST they use a Butterfly needle (they have them, they are just more expensive and take a little longer to collect the blood but are virtually painless and can be used ANYWHERE, i.e. hands, wrist, arms etc.)

Sometimes you have to vote with your feet. I changed Coumadin clinics because I did not have confidence in the young and relatively inexperienced nurses at the first one I was sent to.

'AL Capshaw'
 
Hi Patricia,

I think the bigger picture here, (As Allodwick so elequently pointed out), Is not the "Sticking", It is the fact that your doctor or nurse or nurses aid, does not know how to manage and regulate Coumadin for their patients. The game they are playing with you is dangerous.

As I said in my earlier post. Seek out a new doctor. Interveiw them, and select one that you feel meets your health care management standards and expectations.

Rob
 
I'm dreaming of fingersticks

I'm dreaming of fingersticks

Oh, you folks who only have to do fingersticks. . . from those of us who have scarred and bruised veins and hands sacrificed to PT/INR levels . . . we salute you. And envy you. And would kidnap your coumadin clinics or phlebotomists or anyone providing you with such a service in a NY minute!!! I just can't stand it.
 
I don't know why, but Joe's PCP, who handles his Coumadin, has Joe go to the lab, even though he has a fingerstick unit in his office.

I guess it just depends on the patient. Maybe it's because Joe has to have so much other bloodwork and it's easier to piggy-back them on. Or maybe it has a lot to do with his multiple medical problems.
 
Hi Patricia

Hi Patricia

I just read all your past threads. You posted..June 20, 2001 Your INR was out of range.. Coming up 2 years and you still cannot get it in range:confused: :confused: :confused: Repeating Al..who is an expert. Change Cardiologist. change Card. change Card..Mission, Texas? How far are you from a larger town? Every 2 weeks for a lab draw?:eek: :eek: :eek: How in the world, can you ever have a normal life.:eek: :eek: Change Card. change Card..You are giving me and Al an heart attack:D :D 3 and a half years is enough wasting on that clown:p :p :p :p Life is so simple after Mech. valves..if you have a good coumadin Doctor. :) Bonnie
 
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