My mother's local cardio doesn't support home testing.

[watson524]

Mom had her follow up with the local cardio today.

She asked about a hospital/clinic in the area that does finger prick vs vein draw and also home testing (she's not sold on home testing herself but WOULD go to a place that does a finger prick) and he said that no place in the area does a finger prick because the equipment is more expensive and then she says to me "and he said for the home testing..." and I cut her off and said "what he thinks it's not accurate??" and she said "that's what he said". I told her I "know" lots of nice people here that would absolutely disagree. She is going to ask her GP though since he's the one that manages her INR levels and changes dosages the few times it's been needed. I suspect she'll get the same answer and I won't push it since she doesn't seem too keen on home testing and 28 years of going to the clinic has worked out ok but I wish somewhere local had a finger prick vs the vein draw.

 

[Protimenow]

The cardio I used to use didn't want to bother with anything not directly related to the heart. He didn't want to get involved in anticoagulation management -- this was something that a GP would manage.

Your mom's GP is probably the right one to talk to about testing using meters versus lab blood draws. I wouldn't trust the cardiologist's statement that there are no clinics in the area that use meters -- he or she probably hasn't checked on this for years (if ever) and it's a conclusion made without research. When you or your mom finds a lab that does testing with a meter, she'll see how much easier it is (yes - I realize that sitting in a chair while someone tries to find an artery in your arm isn't all that difficult either - but she'll appreciate the simple incision and quick results you can get from a meter). Some people aren't great candidates for home testing and home management, but there should be clinics that can do the testing using meters.

Also -- although I'm not on Medicare, others have indicated that Medicare will cover costs of a meter and strips. There are at least two companies - Alere and Philips - that provide meter and supplies, and notify your doctor after you report test values to them. The copay is relatively low, but the charge to Medicare isn't -- but Alere and Philips are experienced in working with doctors and may be able to get your mother's GP to write a prescription for home testing - if this is something your mother wants to do.

(If you mom's been seeing the same cardio for 28 years, it may make sense for her to find one who is probably more up to date with current cardiology and not stuck in the 70s.)

 

[watson524]

This is so frustrating! I called another local hospital that my mom volunteers in and talked to their lab. They don't use a finger prick. I asked why (nicely) and the woman said "well they're just not as accurate as a blood draw". Oh ok.... (SEETHING under my breath!). Then I called another group (Geisinger's local office) and the very nice, cheery woman said "no mam, we use a finger prick, why go through a blood draw?". So I thought awesome, sign my mom up.... nope, have to be a patient of a doctor in the group......... BAH! I called a Rehab place that came up as a clinic on the website and the woman there said they use vein draws but only because of it not just being a clinic and subject to other regulations and mentioned the place that I called that does finger stick but only for their own. She mentioned a lot of home health places do it for the doctors when they visit and understood my frustration with the "old" mentality so she had me leave a voicemail with a colleague who has more contacts on the off chance he'd know of a place so we'll see where that gets me.

It's just so frustrating when you know there's alternatives and people say "no".

 

[Duffey]

People who deal with ACT will jump on me for this, but honestly, a major reason I went nonmechanical is due to issues with testing INR. I just didn't want to deal with the medical idiocracy that I read about in so many anticoagulation posts.
I know my reply doesn't help your mother's circumstances, but at least you know that I understand your frustration.

 

[watson524]

Heh... and this is idiocracry before she even has a valve replacement! LOL!

 

[kfay]

I would pursue getting a home monitor since you seem to be able to be so involved in her care (she doesn't seem to really be interested in doing it herself, but if you are willing to help her with it, it could be a good thing and once you get started and she sees how easy it is, she might start doing it herself). So, I would approach her GP like you mentioned, and if he isn't up for it, which he might not be since there is some financial incentive to keep her coming in for vein draws, I might even consider calling her cardio at the CC and asking him to write the script for it and just explain that none of your local Dr's believe in it. Sorry you are having such a hard time with all of this. I can't imagine having to have vein draws for 20+ years like she has!

 

[watson524]

Oh no... that I couldn't do. She's very independent, only semi retired, fully "with it" etc.... she'd never let me do it at home for her since she doesn't view the vein draw as a big deal really but as soon as her possible valve replacement came up and I started reading here and heard a finger prick could be used she was like "what? I have to look into that" and so now that we're back and no valve replacement is happening in the short term, I'm starting to ask more questions... but yeah, she'd never let me just get her the monitor (I don't think they'd even allow it because she's fully able to make her own decisions - I'm just the investigator basically).

 

[Protimenow]

By all means, encourage her to look into the use of meters for INR testing. She can certainly check this forum. She can also check the clinical papers available on the sites operated by the major meter manufacturers -- Hemosense (also Alere now does the Hemosense InRatio meter), Roche (Roche makes the CoaguChek XS), or Protime (ITC) - which makes the ProTime meters. These sites have results of clinical research that indicates a small range of differences from blood draws, and also will show that patients who do their own testing are WiTHIN RANGE more of the time than people who come in to labs for testing. Your mother may even be convinced that self-testing is a better way to go -- and if she gets a result that is too high, or that she doesn't trust - she can still have the blood draw. Armed with this information, she may even be able to convince her GP and Cardiologist that there's great sense in going the self-test route.

(As far as problems with 'inaccuracy', there's the option to confirm high values with a blood draw -- but values within range can usually be trusted. Even if the values are .1-.4 higher (or lower) than a blood draw, if these 'incorrect' values still fall within range after assumed adjustment, what's wrong with that? If you wear a watch that is always 10 minutes fast, you learn to adjust the time -- it could be the same thing with a meter)

Again - I suspect that once your mom looks into it, she'll come around and agree that self testing is easier, less expensive (unless her medicare pays 100%), and a good alternative to blood draws.

 

[ALCapshaw2]

Medicare will pay for home testing IF there is a Doctor willing to write the prescription for the instrument and testing supplies AND willing to receive calls from Alere to report the INR reading and then provide dosing instructions. It will probably take another 10 or 20 years for the USA to catch up with the European countries which whole heartedly embrace home testing.

There is (was) a website where you could find links to Anticoagulation Clinics (www.acforum.com) but their website seems to be outdated.... At least I was not able to get to the links when I tried (on my outdated computer / operating system).

EDIT - website correction - see www.acforum.org to find local anticoagulation clinics

 

[watson524]

Hi again,

This topic is definitely on the discussion list for my mom's appointment with her GP this week. Al - that website is actually where I went to find a few (including the one that does the finger prick but only for patients of doctors in their group).

Right now my mom pays nothing for her testing but it sounds like there may be a co-pay with Medicare (unless her BCBS supplemental picked that up?)

I do have a question on what you said about having to call Alere.... it's not just you and your doctor involved in this? Does medicare only allow certain kinds of meters?

thanks!

 

[normofthenorth]

There is (was) a website where you could find links to Anticoagulation Clinics (www.acforum.com) but their website seems to be outdated.... At least I was not able to get to the links when I tried (on my outdated computer / operating system).

Al, I'm getting a list of local clinics in my neck of the woods from www.acforum.org . Maybe they switched from COM to ORG?

 

[ALCapshaw2]

Here is the contact information for Alere Home Monitoring (www.coagnow.com)

Alere Home Monitoring
6465 National Drive
Livermore, California 94550-8808

Customer Service 7:00 a.m. — 5:00 p.m., PST
PHONE: 1-877-COAGNOW (1-877-262-4669)
FAX: 1-925-606-6978

Their website lists 3 different fingerstick monitors they sell which should all be covered by Medicare.
See their website or call them to ask about how to go about reporting INR and getting dosing feedback.

Anticoagulation Clinic Locations can be found at www.acforum.org (I previously erroneously posted it as .com)

 

[watson524]

Thanks Al! I wasn't thinking that there would be anyone other than my mom's GP and us involved in the home monitoring but it's worth checking into. I suppose there's also the option of buying outright too.

 

[Philip B]

Help?

Help?

Watson,

Maybe I'm missing something, but it seems like you're going through a lot of stress despite your mother appearing to be okay with what she's been doing. A vein draw is a perfectly legitimate way to check INR... if one doesn't mind getting stuck with the needle.

-Philip (one of those who's not okay with getting stuck)

 

[watson524]

She was ok with it because we didn't know until we thought she was to have surgery that there were any other options. Once she found out that a finger stick was an option, it's definitely something she wants to look into. Especially given how her veins are (small and they tend to "roll")... if the one tech that is really good isn't there, she ends up with multiple jabs or someone driving a race car with the needle when they're in there and then is all black and blue after. Just didn't know there were other options.

 

[ALCapshaw2]

Another option to avoid 'rolling veins' is to use the veins in the hands, especially if they are 'prominent'.
With a tiny needle (such as the Butterfly), it's more like a Mosquito Bite vs. a Bee Sting.

Digging Around to 'stab' a Rolling Vein? OUCH !

I'll take the Butterfly in the hands anyday!

Fortunately, I don't have to do either as long as the INR from my clinic's Finger Stick instrument is between 2.0 and 4.5

 

[Protimenow]

Another advantage to having your own monitor and strips is the flexibility you have to do a test when you may have missed a dose, or changed diet, or done something else that you are concerned may effect the INR. It's a lot better than having to wait a week or two (or whatever, depending on your doctor's whims), so you can quickly address concerns. If you're using Alere, you may get some static about testing too much (but, since they're reimbursed for each test anyway, they may not mind), but you'll have peace of mind that going to the lab on the doctor's schedule may not provide. (I guess that if you told the doctor that you were concerned that you may have done something to effect your INR, you'll probably be okayed to go for a test, but it's so much more convenient when you have the meter).

I saw that Alere gives you the option of three different meters -- these are probably the CoaguChek XS, the InRatio 2 and the Protime 3. Not being on Medicare or using Alere, I can't confirm this, but these seem to be the three current models from three leading meter manufacturers. Now that Alere seems to be making the InRatio machines, this will probably be their first recommendation - and it's a good machine.

What Alere seems to be doing is providing you with the meter and strips, reminding you when you should be testing, and reporting to your doctor the test results that you call in to an Alere phone line.

For myself, I own my own meter(s) and buy the strips myself, because I have no insurance. This may be an option for you, too -- again, I don't know how Medicare will take care of reimbursing the cost of meter and strips.

 

[Philip B]

Rolling Veins?

Rolling Veins?

My veins are rather large and don't roll. Despite this, the lab techs at the small mountain hospital in the community I was living in couldn't manage to get a clean hit on a vein to save their lives. Often it would take them six tries. I'll take a finger prick anytime over that kind of torture.

-Philip

 

[normofthenorth]

My local lab, in my PCP/GP's clinic, has been very good at hitting my vein the first try -- in fact, I don't think anybody (two clinics and many nurses in the Hospital) has missed my vein for a blood draw. (That's as OPPOSED to the FIVE tries it took to get a good Arterial line in my forearm when I was going in for my OHS -- Yee-Yikes! )

But I'd still rather get the finger stick instead, and get my INR results right away. So far I've tracked down two clinics in Toronto that use the finger stick. Neither is close to my house, though one is close to where I'll be doing Cardio Rehab some time soon, so that may work. I plan to phone them and ask them if they know of a finger stick INR clinic closer to where I live. . .

Toronto's a very well-serviced and advanced city for hospitals and world-class cardiac clinics etc., but it may be a bit on the conservative side of average. E.g., it's a tough place to find a surgeon who wants to do robotic or minimally invasive HVR. That same conservatism may mean that the vast majority of INR testing is still done with a venous blood draw. . . (At least they're GOOD at it! )

 

[Protimenow]

Norm:
If you prefer the finger stick, and aren't having much success finding a local clinic that uses the meters for testing -- why don't you get your own meter and supplies? I realize that there may be financial reasons not to, but you're probably also paying something for the test (I am not very familiar with Canadian medical services) and, even if free, there's the cost and inconvenience of traveling to and from the clinics for testing. Personally, I've been able to get meters on eBay - and the meters work just fine. (My ProTime 3, which I'll probably retire in favor of an InRatio I just got) matched a hospital lab when I made the comparison. I'm confident in the accuracy of my InRatio and my ProTime meters - and it didn't really bother me much that I didn't get them from an authorized dealer.

I suggest that you AT LEAST look into getting your own meter and supplies so you can take better control of your INR (or at least can test on a schedule approved by your MD and not have to travel far to get the testing done).

I don't mean to be too far off the subject of this thread -- but I'm a strong proponent of self testing - if you're capable of doing it. (One thing to consider, relative to this thread -- if your doctor's mind is not open enough to consider self testing (in spite of papers that indicate better results for self testing than for lab testing), how current is this doctor on other cardiology issues?)