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PROTIME RULES!!!!!

PROTIME RULES!!!!!

Hi Christina

We had absolutely no trouble with the machine, finger stick or figuring it out. Will go on Monday to double check with the cardio and get signed off......it TRULY IS A DREAM!!! I was anEMT for many years, so I guess figuring out machines is my second nature, and as long as I'm not getting my finger stuck, I'll do it all day long (just kidding)!!! Can't wait to compare it to cardios office! I know 2.1 and 2.0 are too low for Tyce if they are the correct readings....no salad or wine for him today! You're right, trust your own machine! We just want to see how much of a difference there is between the cardio's machine and ours. His office has a coaguchek, so they do all their work there, too....no sending out to labs.....Coaguchek gave him the machine, but he has to buy supplies from them, and with the way they use tenderletts and cuvettes, it was a smart move for Coaguchek!!! I was very surprised when you mentioned an arm stick, because we've never experienced that.

Bonny just emailed me and thought Tyce's dosage was too low.....I think so too, but we'll definitely find out on Monday....will let you all know.

Thanks for all your support. PROTIME IS DEFINITELY KEWL!!!!

Chat soon.

Evelyn
 
PROTIME TESTS

PROTIME TESTS

WHAT A WONDERFUL COMPANY QAS IS!!! ON FRIDAY WHEN WE RECEIVED OUR MACHINE, WE ALSO GOT A CALL FROM LISA, THE NURSE WHO WAS READY TO TRAIN US ON THE MACHINE. I CALLED HER BACK FRIDAY EVENING, LEFT A VOICEMAIL MESSAGE THAT WE WOULD BE AVAILABLE ANYTIME, BUT FIGURED SINCE THE CO. WAS CLOSED FOR THE WEEKEND, MONDAY WAS GOOD FOR HER. SHE RETURNED OUR CALL ON SUNDAY.....HER DAY OF REST.....BECAUSE SHE SAID SHE WOULD BE BUSY ON MONDAY AND WANTED TO GET US GOING ON THE MACHINE. WOW!!! HOW MANY TIMES HAS THAT HAPPENED TO YOU LATELY???? FOR US, BASICALLY NEVER!

ANYWAY, SHE ANSWERED ALL OF OUR QUESTIONS, ESPECIALLY ABOUT THE 2.0 READINGS FROM THIS MACHINE AND THE 3.2 READING FROM THE COAGUCHEK IN THE DR.S OFFICE AND BASICALLY SHE SAID TO CHECK THE ISI NUMBER AND COMPARE SAME.....WHICH WE WILL DO WHEN WE GO TODAY TO GET SIGNED OFF.

QAS IS LUCKY TO HAVE HER! SHE DEFINITELY KNOWS HER STUFF.
NEEDLESS TO SAY, IT WAS A VERY PLEASANT EXPERIENCE.

ONE THING SHE DID MENTION FOR ALL OF YOU OUT THERE WHO HAVE THE MACHINE WAS THAT THE TENDERLETTES SHOULD ALSO BE REFRIGERATED, ALONG WITH THE CUVETTES, BECAUSE THEY HAVE A DROP OF SOMETHING OR OTHER IN THEM AND SHOULDN'T BE LEFT OUT. SO, THEY'RE SNUG IN OUR REFRIG ALONG WITH THE CUVETTES.

EVELYN
 
Tenderletts do not need refrigeration

Tenderletts do not need refrigeration

Evelyn:
The nurse's enthusiasm exceeded her information base. I spoke with QAS this morning and there is no drop of anything in the Tenderlettes. They do not require refrigeration. We are on our 5th box of supplies and have never refrigerated the tenderlettes. I'm sure that someone from QAS will be on soon to verify this.

I'm always happy to see someone get a machine. My husband had his valve replaced in l990. For ten years, there were no problems. Then, at Christmas time in 2000, there was a giant problem that changed our lives. If we had been monitoring at home, that problem would not have happened. Since receiving the monitor his INR has been in range about 90% of the time. Point of care testing is important for many reasons, not the least of which is that it relieves stress and brings peace of mind.

Kind regards,
Blanche
 
Hi Blanche

Thanks for the info. That was what I thought before she said anything, but....oh well, they're in the refrig anyway and it shouldn't hurt them.

Quick question.....how often do you test? My game plan is to test 3x week for now till we're pretty sure he's fine and stable, and then 2x weekly from then on.....Just trying to get a handle on what everyone does.

Thanks for the info.

Evelyn
 
Evelyn

Evelyn

There are others here who have more experience and more authority than I do. I'm sure you will receive much information from them. This is what we do and why. Albert tests once per week, which under normal circumstances is sufficient. I think others will tell you too that 3 times per week is ineffective and it is too much. If you start changing dosages three times a week, you'll be a a rollercoaster with no end. Coumadin/warfarin stays in the body for a very long time, so you need to give the body time between doses. This is a quote from the American Heart Association's "Guide to Anticoagulant Therapy Part 2: Oral Anticoagulants" (page 2 of 20)

"It (coumadin) is rapidly absorbed from the gastronintestinal tract, reaches maximal blood concentrations in health volunteers in 90 minutes, and has a has a half-life of 36 to 42 hours."

What that means. roughly, is that 36 to 42 hours after a dose is taken , 1/2 of that dose is still circulating in the body, doing it's anticoagulation job. As I understand it, in order for things to level out, you have to give the body 3-4 days after a change of dosage to level out. I'll try to find the web site for the article for you.

As I said, Al tests every week (his target is 3.0 to 4.0 because of a stroke) and his current dose is 6.5. This dose has been the same for about 7 weeks now. When his dose is increased or decreased, it is done by adding or subtracting .5. We don't worry about a salad here or a green vegetable there. For me a world without vegetables is no world for me. Al has vegetables and or salad every day. His doctor wants him to drink 1-2 glasses of red wine everyday, doctors orders. Generally it's one glass, sometimes two. He has had no large swings in INR because of diet or wine. Again, I'm no expert, but I would wager that any small effects of vegetables or wine clear the system in a short time.

I'm so glad things are goind well for both of you. I remember your very first post here.
 
Hi Evelyn,

I'm so glad you found ProTime as easy to use as I did, and I, too cannot say enough good things about QAS. You're right...such service these days is SO very rare!!!!

My Cuvettes and Tenderletts are all in my " KEWL Pro-Time" drawer in frig.(right under my candy drawer..HeeHee) I just find it easier to keep them together.

I test once a week. I also test aprox. the same time of day each time..usually in the aftenoon. I take my meds in the evening. I have no trouble getting the 'drops'in the funnel..Maybe by the afternoon the body is well hydrated...I don't know....But I feel it's good to be consistant in time of testing..???

Blanche made perfect sense to me...I'm certainly no expert either.but I agree 3xweek seems excessive and not of value, for all of the reasons she stated.

Carry on...it sounds like you've mastered the technique with no problem!!!

Zip *~*
 
TESTING FREQUENCY

TESTING FREQUENCY

My personal rule of thumb is to test 3 or 4 days after making *any* change in medication, either Coumadin OR anything that may interact with Coumadin (which I suspect includes most medications).

IF I drop below an INR of 1.8 or above 5.0 (or developed any bleeding / excessive bruising), then I might be tempted to check in two days but would go back to a 3 or 4 day wait as soon as the numbers were within safe limits.

For dosing recommendations, I still refer to my Coumadin Clinic. It is best NOT to make large changes or skip a dose unless recommended by a Coumadin knowledgable nurse or doctor.

The more stable your numbers, the longer you can go between tests.
Personally, I think I will still test at least once every two weeks, even with stable numbers, just for my own peace of mind.

'AL'
 
Hey, Zip and Al

Hey, Zip and Al

Zipper: The engineer I sleep with (40th anniversary this month) made an interesting comment about refigerating the tenderletts. He said, "What about that little plastic or rubber ring that sits on the cuvette? You don't want to refigerate rubber or plastic. It has to be pliable to make a good contact." I never noticed it, but under the little "funnel" on the tenderlett that holds the blood is a rubber or plastic ring that makes contact. I guess this is another question for QAS.

Al: Your responses set me thinking. So many people are worried about the higher end of the range. While it is true that best case is not to exceed your range, it does happen. You are right. No panic is necessary. Al hit 5.2 twice. They had him skip coumadin for three days, and he was down to 1.6. Never again. I don't care to live with another stroke. I understand that 5.0 can cause problems, but it is not emergency time. I would say anyone.....Never, never, never stop coumadin unless told to do so by your doctor. And do so only after your doctor has explained in detail why....Al's been told, and others have too, to stop coumadin for dental work, high INR, even a colonoscopy. And, each time it was unnessary....and even life threatening. As much as I love the front line troops, the nurses, I would never stop coumadin on a nurse's say so.

The second important point your made was that during unusual circumstances, one might want to test more frequently than 3-4 days. We have done this to gage the reaction and the direction of the INR to problems....antibiotics, certain drugs, hospitalization where vitamin K was administered. Sometimes you need to know that the INR is going in the right direction. Finally, as you said, drastic changes can bring drastic results.
 
Thanks Al and Blanche !

Thanks Al and Blanche !

Ya know, Blanche, that is a good point...I never thought of that!!! I think I'll take them (Tenderletts) out of Frig....hmmm..yes I'd like to hear from QAS on this. The guy I sleep with (lol..28 yrs) is a Contractor and hasn't paid any attention to my 'ProTime drawer'...only my 'candy drawer'..LOL!

Yes, Al made several good points also...certainly I would/have tested on a 3/4 day basis if there's been ANY changes in medications or even health problems due to lack of consistant diet. We are so fortunate to have each other to share all this!!!! I learn something everyday here!!!!

Zipper *~*
 
You guys are the best.......thanks for the advice. When we were at the cardio today getting signed off the machine, Tyce's pt was 2.5 and the cardio's machine was 3.2 (Coaguchek) Our Protime machine has an ISI of 1 and the Coaguchek has an ISI of 2.....so we just used the conversion scale in the back of the booklet and realized that we are in normal range. The cardio's lab tech made a copy of our conversion scale to keep for all of her patients who home check.

After reading your posts, I feel much more confident about how often to home check. That is good because at least Tyce won't feel like a pin cushion!!! I think we'll do a check next week because he's got a dental appt. on Monday and has to go on amoxicillin for the cleaning....so I'll check on Wed. or Thursday. Our cardio is great, we can just fax in the results and they'll call us with any changes, etc.

I agree, Blanche, a day without veges is like a day without sunshine for me, especially this time of year!! Yes, I too remember my first post....pretty much of a basket case, huh???

Zipper, you're absolutely right.....I can't imagine how I would have gotten through Tyce's surgery and everything else without this list!!!

Thanks, Al....I will remember to test Tyce 3-4 days after making any med. change......

Evelyn
 
PROTIME vs. COAGUCHEK

PROTIME vs. COAGUCHEK

I'm beginning to see a trend here, that INR measured on Protime Units is 0.6 to 1.0 LOWER than INR measured on Coaguchek Units. QAS suggested using an arm draw as the standard of comparison. I'm beginning to think this is a good idea. Any volunteers?

As a side note, my old reliable veins that NO ONE ever misses have had 3 (out of 4) dry draws since my surgery and going on Coumadin. Similarly, I have had a few dry sticks for IV's since surgery. Not quite sure what is going on here. My PCP did note that I was anemic following surgery and estimated my blood loss at 4 to 5 units.

'AL'
 
Hi Al.....I'll ask Tyce if he'd like to volunteer for an arm draw, but somehow I don't think so...... I'm having such fun with the unit that I'd test him every day just because, but he's having none of that either.

I'm not quite sure what the ISI stands for, but if you have your protime unit, there's a chart in the back of the operators manual that gives the conversions in PT. Our cardio did say that the coaguchek's ISI is 2.0 which makes up for the difference.

Evelyn
 
I think there is a misunderstanding here. It's been my understanding that if you receive an INR reading (International Normalized Ratio), you are getting a number that has already been corrected for the different ISI reagents used during the test. The INR was adopted to allow a direct comparison between readings from different labs or machines. The ISI is the relative sensitivity of the coagulation reagent used in each test. By knowing the ISI of the reagent and how long the blood takes to coagulate (Prothombin Time), the INR, which is a calculated index, can be calculated. It should not matter if the Coagucheck uses an ISI of 2.0 while Protime uses and ISI of 1.0 since these numbers are converted to INR. At least this is my understanding and explains why the PT is not used except for calculating the INR.
 
Testing Frequency

Testing Frequency

Hi All:

Are you guys getting your ProTime cuvettes at some discount house? At $10 a pop, testing more than once a week can start to drain the wallet! I have been testing once a week and am trying to get my insurance to pick up the tab on that. I know I should not put a price on my health. I just wish the test was cheaper ($5/test).

Greg T.
 
Hi,

KRISONRON I believe you are correct. The INR is the international standard, and the ISI should not matter if comparing INR results.

ISI does matter if comparing PT results.

Perhaps someone can shed more light on this topic.

GREG.. I test once a week too, at the $10 / test cost. That equals $40 / month which is still less than the lab charged for one test.

My insurance company covers 80% of the cost, so my net out of pocket is only $2.00 per test. My insurance company still saves money as compared to me going to the lab.

Rob
 
Last edited:
Evelyn

Evelyn

THERE IS NO CONVERSION CHART FOR COMPARING DIFFERENT INRs. The chart that you are referencing at the back of the manual, which is for professional use should not be used to compare INRs from different machines. I'm sure someone from QAS will be on to explain this better than I can.

The chart you referenced deals with:

PT/ Protime (prothrombin time), which is the time in seconds it takes for plasma to clot.

ISI/ International Sensitivity Index, which denotes the sensitivity of the reagent (I think of the reagent as the chemicals used) with ranges from 1.0 to 3.0, with 1.0 being the most sensitive.

INR/ International Normalized Ratio, which calculation that takes into consideration Protime (clot time) and ISI (sensitivity) to provide a standard value. INR is a standard way of reporting after considering the variables and variability in PT and ISI.

Once you have an INR from a point-of-care monitor or a lab, there is nothing you can to to that value (number) and there is nothing that you should do. The chart you reference is not for that purpose. I know how very frustrating it is to take tests on different machines and get different numbers and I have posted several times on Albert's experiences over a 6 month period.

I would guess that it highly unlikely that you will ever get two tests on two machines, or with two labs, or a lab and a machine to agree consistently. And, there is no valid, reliable way to account for those differences. NONE. If you are multiplying the INR you got from your machine by the PT(time in seconds for plasma to clot) with an ISI of a certain value, you get a number that mean nothing. However, if you use that number to make decisions about anticoagulation therapy (coumadin dosage) you could be an trouble. The chart you reference is NOT a conversion chart. It merely shows relationships between data that is intended for professionals.

Now, I hope someone else, who can explain this better than I can will come to the rescue here. In the meantime, you must call your cardiologist and stop the cardio lab person from sharing the chart with others and from claiming that it is a chart for converting INR. The cardiologist will understand the chart. I guarantee you that the lab person did not. This scares me more than fear itself.

I know I am coming on strong here, and should I have offended any one, I do sincerely apologize. In my past life I was a researcher, although not a medical one. I am experienced in handling data. I can not stress how serious the potential consequences could be if someone tries to convert an INR and medical decisions are made on that basis.
 
INR-ISI -Batteries-Power converter

INR-ISI -Batteries-Power converter

First batteries are rechargable not replaceable by the patient. This procedure must be done at the factory, it comes with a complete update and at this time costs $350.00 & another full year warrenty.
Second power converter is the plug you get with the instrument. If you are planning to use only in Europe then I suggest you tell us that at time of purchase because we can trade out the US cord and put in a European one at only $55.00 more. Otherwise the power for Europe converter is $80.00.
Tests should be taken as often as Dr. orders or if results are out of range.( more if you can afford)
Blanche,Robthatsme,& Kirsonron are very much correct. The machine has already done the calculation when displaying the INR.
Evelyn, the chart you refer to on page 36, please read page 34 first. This section can even mess up professionals at times. Last week I had a Coagclinic want to send back 3 machines that they just recieved because the PT seconds were not correlating like the old machines. When I did this demo at their site 2 years ago the Coumadin Nurse wanted to have results similiar to what they had been experiencing with their labs,who had ISI of 2.2. With me was the ITC Rep. & together we adjusted their machine with the plug that only Professional Monitor's get. This chart is only to show what PT second are to ISI. Nothing to do with INR. Any way the Nurse who had been there has since left. I tried to tell new person that they have to make the adjustment on their new monitors, and everything fell back into place after they did.
 
Thanks Woody..

Thanks Woody..

Hi Woody,

Thanks for filling in the blanks. Glad to hear that we had it right!

Also, I agree with Blanche, someone needs to contact that lab person and stop them from using that calculation sheet. Would hate to see a repeat of the incident that occured in PA. Lab results in error and using bad data to prescribe wrong doses of Coumadin.

Still so glad I purchased my ProTime unit almost 2 years ago. I could not even put a price on the "peace of mind" it has and still does provide. Home Testing is the way to go, along with the knowledge of how to use it, which the folks at QAS have helped provide.

Rob
 
Lab results in error...

Lab results in error...

Hi Rob

I kind-of remember that story. I live in PA. Do you remember where in PA that took place? Where might I be able to find it on-line?

Thanks,
Greg T
 
Hi Guys....I will contact the cardio's office first thing tomorrow. Thank you all for setting me straight. We do plan to test once weekly and then fax the results into the cardio.

Evelyn
 
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