I am so upset!!

[Mileena46]

As most of you know I have no medical insurance. I was paying my doctor $10 for INR testing which wasn't bad. I went in today and my INR was 4.7. It's been this high before but the nurse informed me that from now on if it's not right you MUST see the doctor. He has been just looking at it and telling the nurses to tell me what to do......now I have to see him so HE can tell me what to do....which isn't a bad thing really...but it cost $50! The same as any other appointment with him and I am almost ALWAYS above my 3.5!! Then to make matters worse....if you are off, you have to come back in one week and get re-tested and HOPE you aren't out or its another $50! At this rate I will be paying $200 a month (possibly) just to get my INR tested!

This really sucks as funds are pretty strained at my house anyway!! Have you guys ever heard of this nonsense??? AND today he told me to skip a dose and you KNOW I am not going to do that!!

Mileena

 

[KristyW]

Mileena,

Call and ask to speak with the Dr. directly. No nurses, no billing office. Explain your situation to him. It's possible that he'll relent. Can't hurt to ask. The worst he can say is "no", and that is no worse than if you didn't ask.

 

[dick0236]

This really sucks as funds are pretty strained at my house anyway!! Have you guys ever heard of this nonsense??? AND today he told me to skip a dose and you KNOW I am not going to do that!!

Mileena

I would have no trouble skipping a dose with a 4.7. If you are hesitent about this, skip half a dose for two days and retest in a week.

 

[Ross]

Refresh my memory. What is your weekly dose? I remember you having control problems, but I don't remember what we thought it might be.

 

[Mileena46]

Hi Ross,

I am on 6mg 5 days and 7mg 2 days. He wants me to skip today and reduce to 5 mg a day for 2 wks and retest.

Mileena

 

[Bina]

With an INR of 4.7 taking one half dose would be good enough for me, then reduce your weekly dose as a permanent solution.

 

[Mileena46]

Thx Bina. I think that is what I will do. 3mg tonight and then 5 for the remainder of the week.


Mileena

 

[Ross]

Thx Bina. I think that is what I will do. 3mg tonight and then 5 for the remainder of the week.


Mileena

His plan sounds reasonable, but I would test in one week, not two. My question is, are they having you change doses every time you test?

 

[westie]

alternative

alternative

hi mileena

if getting stuck paying $200 per month for inr testing is inevitable, it maybe to your advantage to start home testing. i know the machine and test strips are not cheap but if you put it on your credit card and paid it off over a couple of years, you would come out it better off financially plus there are many other benefits of home testing. yes, it still is not cheap but at least you would have the expense tied down to a fixed monthly amount you can budget for.

you say your inr is always wrong; perhaps this is more a case of your doctor and nurses always being wrong...................

 

[Ross]

you say your inr is always wrong; perhaps this is more a case of your doctor and nurses always being wrong...................

This is almost always the problem if someone is not stable after more then 2 months.

 

[nngbwh]

I don't blame you for being mad. Doesn't sound fair and right.

 

[Jkm7]

I hope you'll consider speaking directly with your doctor about this new policy. Perhaps you can work something out with him/her.

 

[arnie2498]

Hi Mileena46.
you don't have medical insurance.are you employ?if not seeinto this http://findahealthcenter.hrsa.gov/
perhaps they can help you.

 

[Mileena46]

I did look this up arnie and I called the local clinic to set up testing for my PT Time next week. I know I will have to see the doctor there on occasion, but I am hoping it won't be everytime I am one point high or low and also hoping it won't be $50! It is based on my income so it shouldn't be. Thanks for the advice on that. We will see how this goes.... I also intend to talk to the doctor once I return for a regular visit, but I am finished with them checking my INR!

Mileena

 

[Ross]

Mileena are you following their orders or are you attempting to dose yourself?

 

[ALCapshaw2]

Mileena -

If you don't already have a copy of AL Lodwick's Dosing Guide I strongly encourage you to purchase one from his website www.warfarinfo.com (see publications). It is the best $5 you will spend on INR management!

I can't help but think that your Doctor is over-reacting to slightly high INR readings by telling you to HOLD one dose for an INR of 4.7 AND to reduce your daily dose as well.

Personally, I NEVER Hold a dose for an INR under 5.0 and prefer to cut my dose by 1/2 (split the tablet) for ONE night and retest in 1 week. If that doesn't bring it back in range, then tweek my weekly dose by a SMALL amount (typically 5%).

I'm wondering what kind of test you had that gave the 4.7 INR (Fingerstick or Vein Draw?)
My Coumadin Clinic (at The Heart Center in HSV) found that their fingerstick machines sometimes read excessively high for INR's that were on the high side of the target range when compared with Lab Draws at their on-site lab. (e.g. I recall a 4.7 fingerstick coming back 3.8 from the Lab. CRNP suggested Half Dose for ONE night and follow-up in 2 weeks with NO reduction in the subsequent weekly dose).

Is this new clinic a dedicated Anti-Coagulation Clinic?
Or, if not, do they do a fairly high volume of anticoatulation testing?
Usually, the more they do, the better they are at managing their patients.

'AL C'