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Home testing questions

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slipkid

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After months of trying to get one (very very long stories) I now finally have a home testing unit (INRatio2).

Some things have come up that have me confused regarding home monitoring.

(1) I thought one of the main points of home testing was to enable more frequent testing (weekly) with less hassle (traveling to lab, waiting for results).

With the key being that WEEKLY testing with instant results (at home) provides a better picture of one's INR & allows for tighter warfarin management in response to issues than testing every 2 weeks, or just monthly, etc. Is this not the case? Is WEEKLY testing any kind of a standard or recommendation????

I ask this because now, after my first 2 home tests, to my complete surprise, my GP told me to "test every two weeks". My cardiologist was the one who originally brought up home testing to me & said he wanted to get me testing weekly via a home program with Alere (however I can't use Alere because of very entangled insurance issues). All the things I've read on-line researching this say "weekly" home testing with lab testing monthly or so to double-check things. The info at Alere mentions "weekly" testing. The company my GP set me up with (RCS) specifically mentions "weekly testing", and they even told me when I first got enrolled that I had to call in every week, and that if I didn't, I would be non-compliant and have to return the equipment (?).

Yet my GP now is telling me to reduce testing to every 2 weeks. I discussed this with him further & told him that I thought the whole point of home monitoring was so we could do weekly testing, and that since cost is not currently an issue I would like to continue doing that, plus since I am enrolled in a service which appears to require me to test weekly or have to return the unit & he said "OK" but he made a point to say that he had many patients with home units doing testing only every 2 weeks or once a month etc and that him being the Dr. the service should do what he wants not the other way around.

So what gives with this? Is WEEKLY home testing the standard (& my Dr. misinformed) or is my Dr. correct, and "weekly" is just overkill perhaps invented by the monitoring companies to make more $$/sell more supplies??


(2) I was trained in the use of the InRatio2 by a rep from RCS, but several things about what she showed me might be wrong, at least from what I have been reading lately (which I only stumbled onto by accident btw).

The trainer told me to wash my fingers in warm water (OK on that) but also to rub the fingertips to get the blood flowing before doing the finger prick. However, I just read that you should NOT rub your finger before doing a test, that this will affect the INR reading. TRUE OR FALSE?


(3) The trainer also showed me that instead of pricking a finger, squeezing some blood out, then placing that finger onto the meter (which is how it was done by the visiting nurses I had when I first got out of the hospital) to instead prick the finger (she insisted I use my thumb btw, not a finger), to squeeze/milk a big drop of blood out, then use a capillary tube to suck the blood up, then put the tube over the meter and squeeze the blood out of the tube. To not try to place the finger (actually thumb in this case) on the strip, that it was better/easier to use the tube.

But everything I've been reading on-line only mentions doing the prick then putting the finger onto the test strip/device. I haven't seen anything that mentions using these tube things. It seems to me that the use of the tubes introduces an extra delay that could affect clotting time (??). YES/NO???


Note that both of my last home tests yielded the exact same result (2.5) but that I also did a veinous puncture lab test about one hour before the last test, and the result of that lab was a "PT" of "2.35" (I think that is actually the INR, but the INR field was blank as reported by that lab and "2.35" was listed as "PT" which makes no sense actually).
 

Protimenow

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If your INR is 'stable' (the same results a few times in a row), believe it or not, some labs/doctors are happy with testing every two MONTHS.
The thing about weekly testing is not just a way to sell more strips -- research shows that in some cases, a person with a low INR (in my case, around 1.7 or so) can throw a clot (have a stroke or transient ischemic attack (TIA) in less than a week. It's happened. It's documented.

Although it's not entirely likely that a person who has had a pretty consistent INR will suddenly wind up with an unsafe low INR, it DOES happen. The cost of a few extra strips each month is certainly less than the cost of hospitalization, or worse, for the rare case where an INR DOES drop and a person has a stroke or TIA. Personally, I try to remember to test once a week, and I strongly suggest to all on this forum that weekly testing be performed just in case there's a drop in INR that can pose risks. The INR drops CAN, AND DO happen -- eating a lot of leafy greens when you don't normally do so; adding a supplement that contains a lot of Vitamin K, or other things can cause unexpected drops in INR.

I haven't mentioned the situation with high INRs, and they pose their own risks.

As far as I'm concerned, weekly testing is the best way to be certain that your INR has not been out of range for more than a week.

---

The use of a capillary tube isn't necessarily a bad thing, as long as you place the drop on the strip fairly quickly. I use a Coag-Sense meter, and the place where you place the blood makes it difficult to transfer a drop from your finger. In this case, I incise my finger, let a drop form (not by 'milking' the finger, but by making sure that I had a good pool of blood before incising the finger) and then dropping it onto the strip.

In the case of the InRatio and CoaguChek XS meters, a drop of blood that you can get by dropping it onto the strip is fine. It may be slightly easier to use the capillary tube, because it may be easier to 'aim' the blood directly onto the strip. I've done it both ways -- but for the InRatio and CoaguChek XS, it didn't seem that the capillary tubes made it much easier.

I am concerned, however, that you've got an InRatio. In my experience, the results were higher, or much higher, than the lab results. Further, with a recent recall of InRatio strips, it seems as if the supply of ANY strips has either dried up or just become much more limited. This may change some time down the road, and if your provider can furnish you with strips, you may be okay, but, personally, I would be more comfortable with either the CoaguChek XS or the Coag-Sense than I would be with the InRatio.

---

So -- weekly testing is the best way of knowing that your INR hasn't been out of range for a week or more. It's okay to move blood into your fungertip/thumbtip -- just don't milk the finger to get more blood AFTER you make the incision. And make sure that you use the first drop, and put it on the strip within fifteen seconds of making the incision.

---

Congratulations on being abile to self test.
 

pellicle

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Hi

After months of trying to get one (very very long stories) I now finally have a home testing unit (INRatio2).
woo hooo!

Some things have come up that have me confused regarding home monitoring.
ok ...

(1) I thought one of the main points of home testing was to enable more frequent testing (weekly) with less hassle (traveling to lab, waiting for results).
it is ...

With the key being that WEEKLY testing with instant results (at home) provides a better picture of one's INR & allows for tighter warfarin management in response to issues than testing every 2 weeks

correct

however you're assuming that
1) medical people actually are up to speed with this (when in fact you're ahead of them on the curve
2) they know what they are doing
3) they have algorithms or experts who know how to deal with the data (well, even the monthly data). To be honest the medical profession is quite behind the 8 ball on most of the new views of this (and by new I mean within the last 10 years)

I ask this because now, after my first 2 home tests, to my complete surprise, my GP told me to "test every two weeks".
his mind id caught in the era of vein draws ... fogive him, its just his job, you on the other hand ... well its your health.

All the things I've read on-line researching this say "weekly" home testing with lab testing monthly or so to double-check things.
its the new way, but it takes time for the old codgers to die out and get out of the system. That includes their thinking.

Yet my GP now is telling me to reduce testing to every 2 weeks.
you can see why I do my own dosing ....

So what gives with this? Is WEEKLY home testing the standard
there are no 'standards' ... I thought metric was the standard, but Americans still use inches and Fahrenheit ... because its so much clearer that three eighths is bigger than five sixteenths compared looking at 10mm vs 8mm

"standards" are wonderful ... everyone has their own.


The trainer told me to wash my fingers in warm water (OK on that) but also
recall that trainers are picked because they know nothing about the subject and have their head filled with "jargon" and told to follow a prodecure ... it may even be a good procedure.


However, I just read that you should NOT rub your finger before doing a test, that this will affect the INR reading. TRUE OR FALSE?
my observations and the readings of the manuals (as they change iterations) and the observations reported by others is that it makes little difference. I prefer my rubber band method but equally people will get hysterical about that.

But everything I've been reading on-line only mentions doing the prick then putting the finger onto the test strip/device. I haven't seen anything that mentions using these tube things.
you'll find its in the manual for Coaguchek XS (as is vein draw) for the same strips. Its because perhaps some people are so immobilised that thats the easiest way to get the sample

It seems to me that the use of the tubes introduces an extra delay that could affect clotting time (??). YES/NO???
clearly to a logical mind (as you've concluded logically) this demonstrates that many of the "common truths" about this are not true, although are common.

"2.35" was listed as "PT" which makes no sense actually).
this is because even INR (International Normalised Ratio) is itself new, and the older measurement was Prothrombin Time. From Wikipedia

The result (in seconds) for a prothrombin time performed on a normal individual will vary according to the type of analytical system employed. This is due to the variations between different batches of manufacturer's tissue factor used in the reagent to perform the test. The INR was devised to standardize the results. Each manufacturer assigns an ISI value (International Sensitivity Index) for any tissue factor they manufacture. The ISI value indicates how a particular batch of tissue factor compares to an international reference tissue factor. The ISI is usually between 1.0 and 2.0. The INR is the ratio of a patient's prothrombin time to a normal (control) sample, raised to the power of the ISI value for the analytical system being used.
 

pellicle

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slipkid;n846628 said:
Thanks a lot for your comments.

I have an INRatio2. I thought those were better than the older INRatio machines. Yes/No?
define better?

I use a Coaguchek XS, at least the strips are well priced and available. That has to count for something :)
 

slipkid

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pellicle;n846631 said:
define better?
I read something - somewhere - thread either on this forum or elsewhere (I 4get where) - someone was saying that the "old" InRatio devices were not recommended for use anymore but that the "new" model InRatio2 were OK (?).
 

slipkid

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pellicle;n846630 said:
however you're assuming that
1) medical people actually are up to speed with this (when in fact you're ahead of them on the curve
Hi Pellicle. Thanks for your comments.

Here's the thing - very depressing to say but true - I have reached the point of no return as far as trying to stay on top of things when I keep getting wrong, conflicting, misinformation, disinformation, confusion amongst one Dr office even amongst their own people, one to the next - I could write 20 pages of issues if I had the time - I definitely do not assume the doctors know anything at this point, let alone even know enough about my OWN case without getting it wrong or confusing me with a different patient.

You would not believe some of the stuff I went through just last week....sigh...actually I will relay one "quick story" - and this is with a Dr. I actually like:

When I finally got a home unit thanks to my GP - whereas the cardiologist sat on the signup form with RCS for over 6 weeks because "he only works with Alere and was not comfortably with signing up with any other service until he had time to investigate it" (which means never) - as part of this my warfarin management transferred from the cardiologist to the GP - a doctor I am much more impressed with and confident in than the cardiologist. It was he who expressed doubts that my cardiologist was managing my warfarin dosage correctly but that is a different story. Thanks also to the GP who now after roughly 5-6 weeks of results of around 1.7 to 1.8 (and during this time even being told to delay testing to 2 weeks then a month), I am now at 2.5 last 2 tests (at least according to the InRatio2), which I feel is safer.

My first home test, gave a result of 1.8. I called it in to RCS who then notifed my Dr. Within 35 minutes my GP's office called me, the assistant said they got the results and they are still too low and the Dr. wants to up my dosage again. She then put the Dr. on and he told me what the new dosage should be etc. Great! Couldn't ask for a better system IMO, very nice respond time and advice.

But then, 4 days later, I get a voicemail from the assistant saying "we just got your INR result from your home test of 4 days ago and this is too long to go without getting the results. From now on we need you to not only call RCS but to also call us every time personally". Plus she even mentioned that I was on a "35mg weekly dose" even though I was on 44 mg! WTF??? I called her back and attempted to explain to her that they already got my results last week and even called me to adjust the dose, but she argued & insisted that was not the case. Went around in circles trying to prove to her that they DID already deal with this. Eventually I had to go into the Dr. office to discuss this confusion as well as other confusion regarding something else that also came up. It appears to me that their office has a hard time managing faxes & juggling patients, in addition to how they log patient information which they then refer back to later. I had similar experiences (even worse though) with the cardiologist's office where confusion/wrong information ruled the day almost every time I spoke with them. I did have a good conversation with the Dr. about all this and was satisfied at the end of the day they will try harder, but then the next thing I hear is a voicemail telling me to "test again in 2 weeks" I was back to "what are they talking about???? I am enrolled in a service that actually REQUIRES me to test every week". Sigh.


I really don't have the energy to keep on top of all this anymore. I feel completely beat down trying to deal with all this, it is just never ending...you have no idea....
 

pellicle

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Hi

Hi Pellicle. Thanks for your comments.
no problems ... hope any of it helped.


Here's the thing - very depressing to say but true - I have reached the point of no return as far as trying to stay on top of things when I keep getting wrong, conflicting, misinformation, disinformation, confusion amongst one Dr office even amongst their own people, one to the next
well I advise you the following:
You have to dig through lots of soil to find a gem. The thing is to learn to recognise a gem and to recognise the soil.

When you find soil simply discard it. Do not try to analyze why its not a gem, or what sort of soil it is, just discard it.

Do not listen too much to the dribblings of just Doctors who while quite capable of understanding don't because they do not apply their brain to the problem. Why they don't apply their brain is answered by a myriad of reasons.

When you know what is right then that's all there is to know (unless you're doing acaademic research).

What is needed to know is quite simple:
- what your INR is (in round about terms)
- what you need to do to your dose to keep it within that range

not much when you look at it that way is it?

You also know that your INR is not a rock steady metric like your height, and unlike other metrics (like your weight) changes much more rapidly (like have you ever seen anyone double their weight in a month? - While uncommon it is possible under some circumstances INR can do that if things change (and they do).

So you know that more frequent sampling is the way to go to stay on top of the changes.

You would not believe some of the stuff I went through just last week

it may surprise you to know that I'm a heart valve patient, I (and many others here on VR) have been through the mill and had to fight for what's right with INR too. Even (and perhaps especially) in Hospitals.


I really don't have the energy to keep on top of all this anymore.
Then don't. It seems to me you are taking a high anxiety approach to this (to my eyes it seems like the Giraffe character in Madagasga). Its not rewarding and will not yeild fruit. You must take the sit back and watch approach. Gather data and know that you won't burst into a mess like a scene from that old movie "Scanners"

I feel completely beat down trying to deal with all this, it is just never ending...you have no idea....
Well, let me see ... how about within 6 months I find my father has cancer, his partner dies suddenly, he gives up and dies, we had barely cleaned up after his funeral when my wife dies (also from a tumor {which was unknown till her death}), just after her funeral my the infection which had been smouldering wound breaks out and I have to go to hospital twice to have chunks cut out. Sound like a roller coaster to you? So I then have to deal with all the estates, the banks, the battling relatives all by my effing self while I'm carrying a VAC pump for the dressing and a electric pump pumping stuff into a PIC line.

Ohh ... and my motorbike broke down and I had to pull it apart and replace the alternator stator.

http://cjeastwd.blogspot.com/2012/08...l-my-love.html
http://cjeastwd.blogspot.com/2012/09...or-stator.html
http://cjeastwd.blogspot.com/2012/11...r-surgery.html
http://cjeastwd.blogspot.com/2012/11...s-stage-1.html
http://cjeastwd.blogspot.com/2013/02...ough-love.html

my VR surgery was November 2011, so yes, you can see that I was in getting my chest bone scraped clean (the first time) exactly a year after my VR surgery. So putting it back to Nov 2011 I had the OHS and recovery on top of the above.

I also gave up my job (well how could I work? I have not worked in paid employment for a while now)

With totally no one to support me as they're now all dead, its been tough.

so perhaps I have some sort of inkling .. clearly I don't know the details, but I know that life can be tough.

My point here is not to play cards and see who wins, but to reenforce that on this forum, people really do have an idea (unlike non VR people who of course don't know about how beaten down you can feel after surgery).

Please try to accept (it only became obvious to me recently) how much surgery and all the other stuff that goes along with it can effect your cognitive and emotional state. Just give it time and take it one step at a time.

The thing with survival is this: don't try to do more than you can. Rest when you're tired and realise that you just have to make one step every day. If you manage two then great, but just try for one.

Don't make things worse in your mind and work with what you know.

Chin up, don't let it get you down (and yes, it is all in the mind) rant and vent here and people will either listen or assist as needed (or wished for by you)

Best Wishes
 

slipkid

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Oh man, I am so sorry for your loss(es)....what you've been through. Makes my current struggles seem miniscule in comparison.

I've been some very tough times in the past but somehow survived in the end. This latest health stuff has me very down because I've not had to deal with much like this I guess. Prior to this I've only been to a doctor maybe 4-5 times in the last 10 years, but now it just seems endless. Had no idea how hard it is just dealing with being sick/ill health/managing doctors/etc.

Misery does not love company though afaiac, so sorry to vent some of my hassles in light of above. We (humans) get very wrapped up in our miseries and forget how it could be so much worse. Not much comfort on the one hand but....yeah....chin up (to anybody that reads this). Life is not ez though, that is for sure....
 

VTT_AVR

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Hi slipkid

I too found it a real struggle when there was so much conflicting information from so called experts who all consider themselves to be 100% correct, even when they are advice is in conflict with other experts. I also feel for myself at least, that I was desperate to hear certainties when there has been so much turmoil around my conditions.Unfortunately around warfarin and INR there are not definitive answers that suit everyone.

The principles pellicle outlined around your INR management are in my opinion totally correct. Your INR will vary and you need to test at frequency that will ensure you see these changes and take action to keep in range as much as possible.

It's very difficult to accept that you have all this stuff to deal with, I sure know that I underestimated the emotional impact of being mostly "healthy" person changed into to being "sick" and the effort required with that and all the other associated stuff. It is exhausting and you often feel like the old you is MIA. You will feel tired and like me, you may even beat yourself up a bit for not recovering quickly enough ie not on your schedule, and sometimes it all just feels like its too much. But trust everyone here that is normal to feel that way, that you will in time feel much better, in fact your old self again, but it does take time, so go gently on yourself, recovery is something you can not rush. One step at time, one day at a time, (with plenty of rest in between) you are getting better all the time.

It's more than OK to vent. Your frustration with the doctors is proof that you want to get things right for yourself which you should be proud of.

The angst is in the mind, you will get through it as you have you can in the past. Your 100% correct it is not easy, but have faith that you can overcome it. The people on this forum are proof that you can and further to that they are willing you on to do so.

Keep at it
 

big_L

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Reading your troubles with the cardio and the INR, makes me doubly glad that I backed off and decided to just buy my meter and strips out of pocket. When I first approached the insurance and Roche about the meter/strips, I got all the detailed BS about what I would and wouldn't do that scared me off. All I wanted was to check the result myself at home.
 

pellicle

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Hi

My point is not to makemeasurements and comparisons but to nidentify that challenges happen, we front up to them and life goes on

Complaining about it helps sometimes thougj

slipkid;n846694 said:
Oh man, I am so sorry for your loss(es)....what you've been through. Makes my current struggles seem minuscule
.... Life is not ez though, that is for sure....
 

Protimenow

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I just re-read this string. One of your questions appear to have been missed. It was the question of 'milking' the finger.

This applies to squeezing the blood from the finger AFTER you make the incision. Doing this is supposed to bring up plasma and other fluids that WILL change the result. The meters are designed to test the blood at the incision site - and this includes clotting factors that can be diluted by the interstitial fluids that you 'milk' through the finger.

In fact, some meters are designed to use that 'first' drop. Others (ProTime and Hemochron) specifically state that the first drop should be taken away (rubbed on a paper towel or gauze square) so that the other fluids (the stuff that you milk from the finger) are testted. These other meters can test blood from a blood draw (lacking the clotting factors in the skin).

With proper preparation and the right lancet (and technique), there should be no need to 'milk' the finger. Personally, I've had good success using Unistik 3 Extra and Tenderlette incision devices (and something called Bullseye) that are designed for INR testing. A 21 gauge lancet and a device set at or near maximum depth also work fine. (I have a LOT of 21 gauge lancets --PM me if you can use a box or two).

I go to an anticoagulation clinic, but primarily just to get my prescription for Warfarin. This clinic doesn't provide me with anything that I can't do for myself (plus, I can test more frequently to be certain that my INR STAYS in range).
 

slipkid

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Protimenow;n847073 said:
I just re-read this string. One of your questions appear to have been missed. It was the question of 'milking' the finger.

This applies to squeezing the blood from the finger AFTER you make the incision. Doing this is supposed to bring up plasma and other fluids that WILL change the result. The meters are designed to test the blood at the incision site - and this includes clotting factors that can be diluted by the interstitial fluids that you 'milk' through the finger.

In fact, some meters are designed to use that 'first' drop. Others (ProTime and Hemochron) specifically state that the first drop should be taken away (rubbed on a paper towel or gauze square) so that the other fluids (the stuff that you milk from the finger) are testted. These other meters can test blood from a blood draw (lacking the clotting factors in the skin).

With proper preparation and the right lancet (and technique), there should be no need to 'milk' the finger. Personally, I've had good success using Unistik 3 Extra and Tenderlette incision devices (and something called Bullseye) that are designed for INR testing. A 21 gauge lancet and a device set at or near maximum depth also work fine. (I have a LOT of 21 gauge lancets --PM me if you can use a box or two).

I go to an anticoagulation clinic, but primarily just to get my prescription for Warfarin. This clinic doesn't provide me with anything that I can't do for myself (plus, I can test more frequently to be certain that my INR STAYS in range).
Wow, thanks. This is yet one more thing that blows my mind, in relation to apparently being given WRONG information/directions/followup/etc from various health care providers.

The woman who came out to TRAIN me on how to use the INR unit STRESSED multiple times to MILK the finger to get more blood out - after the first drop had appeared. I felt like I was a cow. This same method was also done to me by two different home nurses (although one of them really screwed things up repeatedly, in multiple ways, which is yet another long story).
 

Aggie85

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How are you doing Slipkd? Haven't heard from you in a while. Did you finally get everything worked out and figure out who to trust with your care? Just thinking about you and hope you're doing well! ..... On a separate note, you and I were exchanging notes on a different thread, which I think is now lost due to inactivity, about tattoos. I've given up on the idea. A couple weeks ago the local news radio station told of a recall of tattoo inks because they had bacteria in the ink and were causing infections. Its one thing to check out a parlor to see if clean and sterile, quite a different thing when the ink itself can cause infections. DO NOT need endocarditis on top of all else, so am skipping the tattoo idea. Still haven't ordered my medical ID either. 😚 Linda
 

slipkid

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Aggie85;n847980 said:
How are you doing Slipkd? Haven't heard from you in a while. Did you finally get everything worked out and figure out who to trust with your care? Just thinking about you and hope you're doing well! ..... On a separate note, you and I were exchanging notes on a different thread, which I think is now lost due to inactivity, about tattoos. I've given up on the idea. A couple weeks ago the local news radio station told of a recall of tattoo inks because they had bacteria in the ink and were causing infections. Its one thing to check out a parlor to see if clean and sterile, quite a different thing when the ink itself can cause infections. DO NOT need endocarditis on top of all else, so am skipping the tattoo idea. Still haven't ordered my medical ID either. 😚 Linda
Hi.

There was a thread I tried to answer a couple days ago (last week I think) - might have been a post from you, I forget - but the forum went down when I tried to post it! Have not been back up here since...and been very busy....just got back to work this week....it is killing me but that is another issue....God I feel awful...

I think I finally have a handle on my INR. At the current dose (46mg/week) I have been solid 2.1 to 2.5 about 3 times in a row. This is under the GP's care. If it stays solid then I won't feel as bad come Jan 1st 2015 & I give back the home unit etc and go to monthly vein draws (I don't think I can afford to keep the unit/supplies once my insurance clock resets).

Skip your tattoo (just my opinion). Not worth the risk/hassle in my view. I have a nice alert dongle on my keychain, plus another one that I wear on a shoe at work. Interestingly, returning to work, I found out that one of my coworkers has an aortic mechanical valve too! He got his 12 years ago. He's been doing fine, doesn't wear any kind of medical alert thing at all, and only gets his INR tested once a month. We have a "zipper club" at work now. Three members (me with double bypass + aortic valve, Larry with aortic valve, and Pete with triple bypass). I knew Pete had a triple bypass already but I had no idea Larry had anything at all!

Be well.
 

pellicle

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Hi

perhaps I don't understand the nuances of life in the USA, but ...
slipkid;n847983 said:
.. I give back the home unit etc and go to monthly vein draws (I don't think I can afford to keep the unit/supplies once my insurance clock resets).
as the strips cost about $140 for 24 (IE $5.84 per test) why not just buy your own? (and a machine isn't that dear either)
 

Protimenow

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Location
California
I'm with Pellicle -- if you had your own machine (and he's right -- you can buy one fairly reasonably and the strips aren't too expensive - you would be able to test weekly (a frequency that I am most comfortable with). Monthly testing really doesn't make much sense to me when you consider that if your INR drops below 2 for more than a week, you can have a stroke (I learned the hard way). I don't want to trivialize the cost of machine or testing -- IF you can afford both, you should STRONGLY CONSIDER doing it at your own expense if insurance won't cover it. You can probably deduct the cost of the machine and supplies as a medical expense, so some of the costs may even come back to you.
 

Aggie85

Well-known member
Joined
Jun 6, 2014
Messages
167
Location
Woodbridge, Va. USA
That's my plan to whenever I find a machine that works for me. Updated the other thread the other day about waiting to get set up to see if CoagSense works for me. I don't want to buy it until I know it will work. But if it works, I'm going to buy my own. I think the whole process of test, call in to monitoring company, wait for my clinic to call me or contact me via the monitoring company is six steps too many. I want to test myself and talk directly with my ACT clinic. They feel the same way. Said they use the company because they are required to if I go the insurance route, but are happy to work with me directly if I go the buy it myself route. It's worth it to me to have access to the machine and strips WHENEVER I want to test. I also still don't feel comfortable going more than 7-10 days between testing. No way will I feel comfortable with once a month. And that's speaking as someone who so far HAS to do vein blood draws for each week's test.

Slipkd, Guess you missed that part of my last reply saying I WAS NOT going to go the tattoo route. Too risky. 😳 glad to hear from you, hopefully slowly getting back to a regular work routine will help with everything else. Take heart, I'm just recently getting back to feeling like I can handle daily "work" routines as well and have only been lightly dabbling in my glass studio. No big cuts from glass yet! Gave myself two doozies of bruises at rehab yesterday though. Ran both legs into the handles on two NuStep machines that were side by side and I'd misjudged the distance between them.
 
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