Frequency of Tests?

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Perry,

I agree with Gina. You and I both have dual valves and when I'm at 3.5 I'm happy. Even my nurse doesn't isn't alarmed. It's just when I jump up to 5.0 and then down to 1.4 within three days that they are concerned. That I think, was caused because they had me hold for two days after the 5.0 reading and then take 7.5mg that Sunday. Well that Friday I had started on antibiotics after they told me to hold the Coumadin. They said antibiotics usually make the PT go higher. It had gone the opposite way instead. So then they had me do 7.5mg for three days and on the 4th day take 10mg. My last reading was 2.8 on January 18th. I go for my INR tomorrow.

I'm perfecting happy if it's between 3.0 and 3.5 with having the dual valves. You were lucky everything turned out okay. I'm still working on getting a home unit just to be able to monitor myself and see where I stand. I agree with the rest that have home units, it definitely would give us peace of mind.

Have A Great SuperBowl Sunday!
 
When someone instructs a person with an INR of 5.0 (who is not bleeding) to hold warfarin for two days, they are displaying their ignorance about how warfarin behaves. The INR should decrease by half every 48 hours. Then 3 to 4 days later you are still below the desired range. To require a 2-day hold, the INR should always be above 6. I wish you would all challenge the person who gives you instructions to explain their line of reasoning. They will not be able to give a clear answer because they only know the hocus-pocus method of warfarin management.

About the only exception will be when someone is a very slow metabolizer of warfarin. This is characterized by having a weekly dose of less than 15 mg.
 
Hi Allodwick,

I agree with you. I'm still in the learning stages of when my INR readings fluctuates. I want to trust in what the nurses tell me but they aren't living in my body. As everyone here as indicated that has their own machine, at least weekly self testing gives you better control. The next time I go to 5.0 INR I will ask them to justify why they want me to hold, because it didn't work out for the best last time. I had to go for three readings within that week. Thanks for your input and I will point the 6.0 figure out to the nurses as really being high. At 5.0 I wasn't bleeding. Then by having me hold, the INR dropped to a 1.4INR so they obviousely went too extreme. I will share this information. Thanks again!
 
Hey Lorraine....

The same thing happened to me on numerous occasions. They even admitted me to the hospital once....hooked me up to the good old Heparin for two days. A little extreme, when I could have been sent home on Lovenox.

Anyway....try to get your doctor to agree to cut your dose in half for one day when you get too high. Then, resume your regular dosing schedule. If you were riding high for the prior few tests... do the half one day theory and decrease by 1/2 mg for the next week. Test again and see where you are at in week.

It works for me. It is my understanding that if you take anything over 5mg per day.... you are considered a fast metabolized of the Coumadin.
 
Keep preaching this to everyone who will listen. You two have it right on the money.
 
In Coumadin Clinicians I Trust

In Coumadin Clinicians I Trust

Lorraine, I think I'd go nuts trying to keep so many different doses of your Coumdain straight, not to mention purchasing all of them. I hope you get yourself stabilized soon.

While I'm becoming a believer in the self-testing machines, I currently have to place my trust in the hands of my Coumadin Clinic nurse. It's encouraging to know that she is advocating (to the team of ten Cardiologists' where she works) to purchase a Protime machine. I told her I'd be first in line to try it. My vr.com self-testing buddies are very encouraging.

In the meantime, the usual rules apply by staying consistent with my diet and meds. Darned Amoxicillin is always a culprit, isn't it?

Allodwick, I know some of the people here test themselves every week. Is this really necessary? None of my heart care professionals has ever suggested that I should test more than once a month (unless I'm off course, of course!). Is weekly self-testing therefore more of a lifestyle decision than clinical?

Gina, the string you started last week about St. Jude was encouraging too. How come none of us were involved in that test that lasted for 20 years?

Onward and upward.

Cheers!
 
Probably the biggest reason that I do not have people tested more often is that it is inconvenient. Most can't leave work an hour or two early one day per week to get the test done.

It appears that the more time spent in your target range the less likely you are to have a unwanted event.

I'm not entirely sure that testing every week prevents enough adverse events to amke it worth a person's time to take off work one day every week. But, when you can test at home for very minimal expenditure of time, it is probably worth the time and effort.
 
Cost?

Cost?

Sounds logical to me.

Curious what the weekly cost is for y'all self-testers? I remember Hank's demonstration in Nashville, but forgot the discussion on the price of the test strips.

My hospital (Coumadin Clinic) charges $53.50, however I pay $0.00 because of insurance coverage.

I'm kind of envisioning eventually going into my Cardio's office to use the Protime system like a walk-up computer in the library. I doubt they will keep it that simple.

Have a nice week.
 
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Hi Perry and others,

Perry, glad it worked out for you. I also tested at 2.9 on my last INR. But anyways - once I went 8 weeks between tests. It was so regular for so long, it had not changed in a year and I was confident. The test at 8 weeks was fine but my Doctor was very mad at me and gave me down the road. I received a nice lecture from him and have not went over 6 weeks since. I generally go every 4 weeks and don't give a second thought to it in between.
You have to figure what works for you, testing every day, every week, every other week BUT don't wait 8 weeks. LOL.

Tammy
 
Happy Monday Perry.....

My Coaguchek strips come in a box of 15 @ 90.00 per box. I run one set of controls upon opening a new box. Controls use two strips. This then gives me 13 weeks of tests out of one box.

This is the real kicker....my copay is $15 per visit. The insurance paid for my unit...but WILL NOT pay for the strips.
They will pay for me to have my protime drawn at the doctors office at 90.00 a pop in an unlimited fashion.
Hummmmm 12 tests for $90 or one for $90??? Have ceased my battel as it will be short lived. Changing insurance and I have already checked with the new company....no go. It is defiantly worth the expense to me.

If you can wait it out....I hear Coaguchek will be selling in the US again. Would advise comparing to the Protime and make your decision based on the demos. They are both great units.

Have not taken mine for an air journey since 9/11. May bring it in March for you to give it a whirl.
 
Talked to Roche,

Talked to Roche,

I got a call from Roche telling me that they will not be selling the S in this country since it has not been put though FDA approval as yet. They will sell the old Coaguchek soon. I have this unit and it has worked perfectly for over three years. Have no qualms about taking it instead of the S. Medicare is going slow. They still have not paid for any monitors. Will they ever pay for strips? Roche doesn't know and neither do I. My past experience says- keep making claims. One day you may get reimbirsed.
 
Hi Marty

Thank you for the updated Coaguchek information.

Upon watching a friend of mine test her blood sugar..... was envying her tiny little unit. Feature of interest being the strip. It has an indentation on the side and just grabs the sample. No holding over the target as we do with the Coaguchek. Which is not a big deal. Just thought I would mention there are better ways to design.

Wonder if Roche could handle this without changing the integrity of the original unit?
 
What my doctors office has at cardios office is the Coagucheck. It seems comparable to the Protime unit. I went for my INR today and it was 4.4. I had 5 beers while watching the SuperBowl last night at a party. I mentioned that to the nurse too, since I know that has a tendency to raise my INR. I think a couple of good salads would bring it back in range myself. I'm waiting for the doctors office to call and tell me my instructions and I'll take it from there. I already mentioned to the nurse that I didn't think they should hold my dosage for two days like they did the last time. I said look where that reading went in three days. From a 5.0 to 1.4. So I'll see what they say, and I'll argue the point again about not doing such a drastic change. I'll let you all know what happens. Take care!
 
coumadin levels

coumadin levels

I swear, once I think I have it figured out and the levels stay pretty consistant- boom - I went in this morning and my levels went from 3.7 to 4.3 with absolutely no changes in diet or activity. My pharmacist at the coagulation clinic was iffy about the 3.7 but did not change my dosing but did have me come a week sooner than usual. I am baffled. I even ate 2 small salads this past week since my reading was on the high side last time. My husband did have surgery for a clogged carotid artery this past week. Do you suppose the stress had anything to do with the rise in INR? I am lost in the sauce!:confused:
 
Hi Cookie,

I consistantly eat some greens or something green every day. I refuse to give it up. I love my salads and chinese vegies.
If I leave out the green stuff my INR will go high. If I eat too much green stuff which I also have done, my INR will be down. Last time when I ate a cup of spinach my INR went down to 2.6. My doctor still did not adjust my dosage and let me continue taking the 20mg a day that I have been on now for quite some time. I think I understand it quite well now, and am not as scared anymore. I test every two weeks now, but if the numbers are either too high or too low he'll tell me to check again in two days, and call him again. It all depends on the numbers.
Like Perry, would I test only once a month? Never, too scary! I need to know my numbers often otherwise I am always wondering.
I don't know if stress has anything to do with INR levels. I suppose it does as everything interferes with Coumadin.

Take Care,

Christina
Aortic Stenosis
AVR's 8/7/00 & 8/18/00
St.Jude's Mechanical
 
Good for you Lorraine. You tell them! It's gets to that point, I know all too well. Stick to your guns. It's just getting those nurses to agree.

Cookie.......Hope your husband is doing well. When my husband went through all of his medical concerns recently.......my INR went down. My activity level was up. All the running to and from the hospital. Lots of walking. I really did not eat much of anything. Didn't feel like it. I know this may sound strange.....but maybe you have eaten less and have been to wrapped up in things to calculate. Not eating can raise your INR.
 
Gina M.
Thanks for wishng my husband well. He is doing great - in fact he has to stay home for 2 weeks and we are on week #2 and he can go back to work anytime! LOL I love him but..............
As for not eating when he was in the hospital, very little stops me from eating! I have this hand to mouth disease! I have gained 40# since my surgery. Thank goodness I'm 5'11"! I'm not liking where I am right now. Oh well - where are those chocolate chip cookies!
 
Cookie....You are too funny:D What is it with us 'tall people' and valve replacement??? 5-10' myself. And yes, thank goodness we have places to 'hide it'!

Noticed your mention of weight gain since surgery. Yep, up 30 for me. Ahhhh. Did not start right away. After starting beta blocker. Are you taking one? Trying to get off. Hopefully soon!
 
Isn't it great that chocolate doesn't interact with warfarin the way vegetables do?
 
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