Home Monitoring

[KristaDeAnn]

When I saw my GP on Friday I asked him about the possibility of eventually Home Testing for Coumadin. He told me that it would be a couple of years before he would even consider someone for home testing. Does this seem excessive? I know I have a lot to learn about INS and Coumadin since I am not on it yet, but I will be soon enough. Two years just seems like a lifetime to be tied to his office for testing. Any info would be appreciated.

 

[jeffp]

That does seem kinda odd. I just saw my cardio today (7 weeks out) and suggested home testing. He thought it would be great and started on the paperwork for the insurance. He did say that the insurance has a policy of 3 months of lab testing first, but 2 years...why? It costs them more in the long run, and is a real pain (in more ways than one) for you. Does your GP just want to make the few bucks for the lab testing? Its just not worth the bother to him financially to do it this way. Just sounds weird.

 

[ALCapshaw2]

Does your GP use vein draws to test INR or one of the modern 'finger stick' testers?

If he uses vein draws, you may want to see if there is a Coumadin Clinic nearby that uses the finger stick testers.

Also talk with your Cardiologist about home testing. Some allow their patients to test and make dose adjustments. Others allow them to test but want them to call in their results for the Doctor to review and advise on dosing changes.

'AL Capshaw'

 

[KMB]

Krista
That is very strange - my surgeon said that he would want a home test started right away. After hearing about Teddy getting his right away in the hospital, I am going to ask if that can be the case for me tomorrow at my pre-op appointment.

 

[Ross]

A couple of years is way out of line! It boils down to cutting into your physicians profits and whether or not he's willing to accept responsibility for your testing. There is no reason why it couldn't happen tomorrow.

 

[RobThatsMe]

Hi,

I started testing shorty after my surgery, and throughout the 5 years all of the doctors I see think it is great that I home test. I provide them with a spreadsheet of all my readings, and notes on my adjustments. They are impressed that my readings never go far out of range. I tell them that this is due to my ability to home test weekly and quickly adjust before readings get too far out of line.

Good luck... perhaps you need to seek out a doctor that is more open to home testing.

Rob

 

[Patrick]

No mad rush to test!

No mad rush to test!

When I saw my GP on Friday I asked him about the possibility of eventually Home Testing for Coumadin. He told me that it would be a couple of years before he would even consider someone for home testing. Does this seem excessive? I know I have a lot to learn about INS and Coumadin since I am not on it yet, but I will be soon enough. Two years just seems like a lifetime to be tied to his office for testing. Any info would be appreciated.

Perhaps there is no mad rush to worry about self-testing just now, especially when you are only working up to your op? There will be lots of time after your op to move your Doc forward with your wishes. It was about three months after my AVR when I started self testing but this is very new technology in Ireland. There is very little self-testing going on in Dublin. For months after starting to self test I still went to my GP for INR testing but used the opportunity to run my Coaguchek-S against a hospital lab on the same blood samples. Lots of interesting data from that actually but that is for another day. You may find as I did that attending your Doc for testing will offer you the opportunity to discuss things that may be nagging at you and the support a good GP can offer you during the first few months post op is irreplaceable. He may just want to keep an eye on you and be sure you are going to do well.
Best of luck with the op.

 

[catwoman]

Krista:

Sometimes physicians are against home testing because they say they would be responsible for any problems a patient encounters. I've read that in various posts here at vr.com.

HOWEVER, studies show that warfarin patients who home-test stay in range more of the time than patients who go to a lab or their doctor's office. Why? Because the machine is there at home and is more convenient. Most, if not all, are on warfarin indefinitely.

My PCP has 2 other patients who home-test. He has often said he's very glad I have my own machine, because if I have to take an Rx that interacts with warfarin, I can stay on top of it instead of having to come to his office and be tested there. His office is near downtown Fort Worth, not far from my office, but I would have to make up at least 1 hour weekly to go in for testing, since he has advised me to test weekly. Since I have begun home-testing, I have never been lower than 2.5. My range is 2.5-3.5, but I prefer to be 3.0-4.0.
He also allows me to adjust my warfarin dose. I purchased one of Al Lodwick's dosing charts (see www.warfarinfo.com).

Do some internet research about studies on home-testing and show it to your doctor. You may need to get one of your other doctors (a cardiologist, for example) to agree to allow you to home-test.

 

[KristaDeAnn]

I wonder if part of his hesitation is because he is so young, and I wouldnt be surprised if I am his first official Heart Patient. (I swear he looks like he is 12 years old) I just still feel so young that someone that looks as "young" as him couldnt possibly be a doctor yet.. Heh heh..

I wanted to ask all of you first so I wouldnt look like an idiot if I didnt know what I was talking about...but now Im going to talk to my Cardiologist when I go in for my pre-op on the 26th. Dr. Bansal is just the BEST!! I loved him the moment I met him.

He was the one that was on "my side" and said "I can keep riding my horses as long as I do so with a lot of extra caution and with protective gear and stay out of the "RODEO"...(Ive never been in the "Rodeo" anyway I did barrel race a long time ago, but not recently he was just kidding with me about that part!! ) While Dr. Nan Wang (my very "stern and serious" surgeon that never "kids" about anything) said "Ah...well....we dont want you even riding horses on coumadin" Without so much as thought about what that meant to me. I went ahead and forgave him for that since I havent had my surgery yet.

My GP said his office uses a finger prick, they test right then and there, and there is no co-pay involved, I dont even have to make an appointment. I just think he is leaning to the overly-cautious side possibly??? I will see what my cardiologist says. Can he recommend home testing for me?? Do they have the authority to do that??? I hope so because 2 years seems like a long "sentence" to be chained to a clinic. This all came up because of what I read on Teddy's post, he gets home testing right off the bat!! Im jealous!!

Thank you for you responses there is so much I dont know about all of this.. you guys are great!!!!

 

[geebee]

Your cardio can certainly sign the form for home testing. You just need to make sure he can follow-up with you as to results. It would be much easier for you if your GP was on board as well. Perhaps your cardio can discuss it with him (do doctors talk to each other these days?). OR you might just want to have your cardio follow the INR - my cardio handles my INR not my GP.

You should not have to wait 2 years to start home testing. Your GP is just not well informed. Maybe you will be the one to bring him into the 21st century

Good luck.

 

[Ross]

Sorry, if he approves it for you, that's money his office isn't going to get, so he's in no hurry to slit his own throat.

 

[ALCapshaw2]

Home Testing is less of an issue than Home DOSING. I can see how a doctor might want to keep an eye on your dosing until he feels you fully understand how your body reacts to Coumadin and changes in diet, medication, activity level, etc.

Since your Doc has a finger stick tester and no appointment is necessary, I'd cut him some slack. That is a GREAT arrangement, assuming you don't have far to drive.

IF your INR proves to be fairly stable, then he may be more willing to let you home test and call in your numbers to see how that goes for a while. Then you may want to pursue home dosing with the aid of a Dosing Guide such as the one sold by Al Lodwick.

FWIW, I have my own machine but still use my Coumadin Clinic because of an insurance change that requires I go through my company's home state office which does NOT cover Home Testing instruments or supplies. I know, I need to mount (another) crusade to get home testing approved in that state. Another hassle that I've been reluctant to begin.

FWIW, I was the 'test case' to get home testing approved in my state of residence. The secret was finding someone in the insurance company who had a clue about anti-coagulation testing. Once that person pointed me in the right direction, approval came along on a couple of months. So far, I've been unsuccessful in finding anyone who knows anything about anti-coagulation in the company's home state office.

'AL Capshaw'

 

[KristaDeAnn]

Thank you for the information, I appreciate it. I will talk to my cardiologist at my pre-op next week just to see what his opinion is as far as home monitoring/dosing.

Maybe I will get lucky like Liza and wake up with a REPAIR... Gosh wouldnt that just wonderful!!!!!!

 

[Dave S]

I was talking to my surgon about home testing, he told me he would like me to waite 6 mths first to get stablized, then he would be all for it.

 

[Ross]

I was talking to my surgon about home testing, he told me he would like me to waite 6 mths first to get stablized, then he would be all for it.

That sounds most reasonable to me.

 

[EVELYN]

Krista

Two years is absolutely absurd!!! I think we waited about 2 months before we started home testing.....yep, I'm pretty sure of it. Tyce had his surgery 6/26/02 and by the beginning of September we had our first machine. Our cardio was great with it and still is.

Home testing is absolutely wonderful.....you're not tied to an office, can travel whenever you want to and don't have to worry. For us it was the only way to go. We do still check with the cardio's office on occasion, though, just to make sure both machines are happy with each other.

Go for it, girl, and be persistent!!!

Evelyn

 

[catwoman]

I was talking to my surgon about home testing, he told me he would like me to waite 6 mths first to get stablized, then he would be all for it.

I was stabilized by 3 months.

A friend took 6 months to get stabilized -- because his cardiologist didn't understand warfarin. He was always have his dosage adjusted, being retested within just a few days. It was getting near the end of the year and he wanted to be able to get a home-test machine to take advantage of insurance paying 100% for it since he'd already met his deductible and insurance was picking up 100% at that point. He had to switch his warfarin management to his PCP, who got it stabilized within 4 weeks...

However, he still doesn't have a home-test machine and he does live a fair ways out from his PCP.