POC not reading INRs correctly

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Hi again Protimenow, CBC has been done and is in normal ranges. It's one of the things we did a couple weeks back to see if hematocrit level was ok. That was when either you or Pellicle had suggested it earlier. All results were normal or close to it. So that's ruled out, along with a host of other factors. I contacted a Dr's office here who has a CoagSense machine, but he won't do just a test (even when the company offered to reimburse him the strips). But, I think I've figured out how to get around it. I'm pretty sure I can get my AC clinic to put me in for a second opinion referral. Then I'll go to the new clinic and try the CoagSense one. If that falls through, I will be contacting you about arranging maybe renting one of your machines (Protimes or otherwise) to check them out. Want to exhaust ALL other avenues first though since we live on opposite sides of the country. No one, except you, has replied to my thread offering use of a CS machine on this side of the US. I have someone who's offered trial on an INRatio but have feeling, since it uses same process as others, that it won't read any better. I'm going to talk to pharmacist at AC clinic tomorrow about referral. They've been very cooperative so far so think they'll be willing. Wish Dr. office was more cooperative and not making me jump through so many hoops for a 15 sec fingerstick test, but I can also see possible liability issues for them that might interfere with their willingness to help off the record. I'll be in touch via PM if I decide to arrange something with you on shipping machines possibly back and forth across the country. I don't want to commit to buying anything until I know if it would work on me but certainly willing to pay for shipping, strips, and other expenses. Let's wait and cross that air bridge if we need to. Thanks for offers though! Linda
 
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The Clot Thickens..... An update on my POC fun. I finally got to meet with NewMitral who lives in my area and offered testing on his two machines. We met last Sat. Both his machines (An CoaguCheck XS and a INRatio) had me registering at 3.5 and 3.1 respectively. So we thought, Ah Ha, must be the alcohol (since he doesn't use any but my lab does.) Unfortunately, Monday's follow up testing at the lab didn't bear this out. I had the lab tech do the POC test WITHOUT alcohol. The test registered a 4.3 , subsequent lab vein draw 15 min. later showed 2.9. 2 hours later NewMitral and I tried on his machine and got 4.1. SOOOO, it's not the alcohol and the machines are still not reading me right. My lab clinician is now looking into seeing if they even can do a second opinion referral to have me go test on the Coag-Sense machine at a local AC clinic and see if that machine does any better since it uses a different method for processing the blood sample. I know this thread probably will pertain to NO ONE else, as my situation seems pretty darn unique. But I've learned a lot from posting it and really appreciate everyone's input. Hopefully it will help others if only in helping them to know how testing should be done in the clinics and what to watch for if there are problems with readings. ProtimeNow, If you happen to see this... There is still a good chance that my current lab will NOT be able to get me a second opinion consult with the off base clinic. If this happens, I may be contacting you about doing the stupid thing of paying you to mail me your Coag-Sense machine for me to test on and possibly buy (if you're offering still) IF it works any better. I'll let you know in a week or two. I will be on vacation this coming week and my clinic's Dr. is on vacation next week, so it won't be until we are all back in town before I can persue things. But the clinician was concerned that since they are a referral service, they are not authorized to further refer me to someone else. My situation is soooo unique, no one seems to be able to figure out a way to deal with it. All are willing to help, just can't figure out how to legally do so. Anyway, Thanks all for letting me vent about this and for offering thoughts and advice. Linda
 
At one time I thought my POC (INRatio 2) was not giving me the right readings either. So I decided I'd use my husband as a guinea pig and tested him. The INR reading was 1.1 which is the normal range for someone NOT on anticoagulants.

So, if you can find someone who wouldn't mind a little poke and donating a drop of blood, try verifying your machine that way? Just an idea.....
 
njean;n845154 said:
At one time I thought my POC (INRatio 2) was not giving me the right readings either. So I decided I'd use my husband as a guinea pig and tested him. The INR reading was 1.1 which is the normal range for someone NOT on anticoagulants.

So, if you can find someone who wouldn't mind a little poke and donating a drop of blood, try verifying your machine that way? Just an idea.....

Sorry about my post. Just realized after taking the time to re-read your posts, you don't have a home monitor so my advice wouldn't apply.

Hope your issues get resolved soon!
 
Linda: I just sent you something about your hospital perhaps using a Hemochron Junior - a meter that is used in Operating Rooms (and at my anticoagulation clinic), and that your clinic may not be aware of/or that they have access to it. Perhaps a referral INSIDE the hospital to a department where the do routine blood testing (including clotting times) may be fruitful. I hope your situation resolves soon. (In spite of the apparent uniqueness of your issues with POC machines, there are undoubtedly others with the same situation -- it would be helpful to know WHY there's the issue -- and also if changing meters would actually help.
(I just had a different thought -- what if the POCs are correct and the lab has some odd issue with YOUR blood -- perhaps the reagents don't work properly or who knows what? Is there a possibility of having your blood tested by two different labs? Is it possible that whoever draws your blood puts it into the wrong tube? Maybe your meters are okay and the LAB has a problem)
 
One more thought -- a few years ago, I was taking Quercetin, and it seemed to confound the meter - the readings weren't correct. Are you taking Quercetin or something that contains Quercetin?
 
Protimenow;n845179 said:
Linda: ....... I hope your situation resolves soon. (In spite of the apparent uniqueness of your issues with POC machines, there are undoubtedly others with the same situation -- it would be helpful to know WHY there's the issue -- and also if changing meters would actually help. (I just had a different thought -- what if the POCs are correct and the lab has some odd issue with YOUR blood -- perhaps the reagents don't work properly or who knows what? Is there a possibility of having your blood tested by two different labs? Is it possible that whoever draws your blood puts it into the wrong tube? Maybe your meters are okay and the LAB has a problem)
ProTime, first, the lab and AC Clinic are in the same facility and routinely check machines correlation with each other's equipment. This was particularly researched at the beginning to make sure there was not a technical issue causing the off readings. Given that my lab draws are pretty much always in the right range and where expected, AND that we got the same results when New Mitral and I tested on his machines, I'd say the issue is not the lab. I have virtually NO access to personnel in the lab, so have no idea about reagents, etc... I actually did a different lab for testing once. I was at Bethesda Med Center (military hospital where the Presidents and Generals go) for an appointment and had my blood tested there since it was convenient -- result: same issue with INR. We are currently waiting on the insurance reply to Health Care Services, folks who run Coag-sense home monitoring programs to see about testing me on the CoagSense machines. But they'll only do this as a full set up or purchase outright and not as a trial run just to see if the machine will even work. She couldn't give me a definite answer if I bought the machine outright, would they take it back if the system doesn't work for me. She kept saying it's under warranty and I kept pointing out warranty is for defective equipment not issues with the patient causing the problem. I'd be worried about buying it and then them not taking it back if it doesn't read me right. She wants to try the insurance thing first and then discuss issue with her supervisor if I have to outright buy it. I'm pretty sure insurance won't cover since the clinic has a contract with Alere already. So, ProTime, don't be surprised if I'm contacting you PM soon about trying out and maybe buying your machine, despite the idiocy of mailing them across the country. At least you're not in Australia like Pellicle. BTW not taking Quercertin or any other ODD drugs. No herbal supplements. On LoPressor, Protonix, Warfarin (of course), Voltarin. Been on them the whole time. So unfortunately, can't rule that out. But thanks for the continued brainstorming! :)
 
Well , shock of shocks.... Tricare WILL cover the Coag-sense home monitoring program even when clinic already has a contract with Alere. I'll use them initially just to see if the machine works any better than the CoaguChecks at the clinic. It is a pretty redundant system where I call in results to them and they contact my clinic who then contacts me with any med changes..... Sheesh! But, it let's me try a machine without buying it first. If machine works then I'll look into purchasing in the future. Cross fingers, even if a crazy system, I'd like to be avoiding weekly blood draws! More soon, Linda
 
Linda: It's great to hear about the Coag-Sense. It's really pretty easy to use -- see if they'll give you the NEW transfer tubes (these are small capillary tubes that draw the blood into the tube, when the blood is in the tube, you position the tip over the test strip, cover the hole with you finger, then just squeeze to deposit the blood. I've been using mine for a couple years and am very pleased with it.

The thing with anticoagulation clinics IS a bit weird. They seem to believe that all patients are completely unable to check or manage their INRs, although some don't care if it's a month or more since THEY had a test run. I had to go to my clinic today (they see me every three months), and wondered why I should even bother -- I manage my dosing, I manage my testing. The answer from the clinic was a) we WANT to manage your INR and b) we write the prescriptions for your warfarin.

As long as it's covered, I may continue going, but they're really not providing me with any real value.

Let me know if you need any help running your first test with the Coag-Sense. (When I ran my first test, the CEO of the company talked me through it).

If you're like me, the INR reported by the Coag-Sense may be just slightly below the lab results. Comparing the two will, of course, give you a better sense of the reliability of the meter and how the meter's results compare to a blood draw.

Again -- if you have questions about using it, PM me and I'll be happy to walk you through it. (One thing to remember -- you'll need about 12 mm of blood - not a lot, but one that I've had most success with using Unistik Extra or Tenderlette lancing devices).
 
Update, not much to report. POCs STILL not working. My faithful lab guy blew the first vein today and had to stick me twice. In 5 months of testing weekly, it's only the second time he had to stick me twice. Most the other techs took at least two sticks to get my blood. Insurance has said yes to CoagSense home monitor and ACC clinic turned in paperwork to monitoring company but I've not heard back from them. Very curious if CS machine will work and wish we could get things going faster to give it the try. Well, I'll update again when I hear from CS about my training appointment. Linda
 
Linda:

That's great news. CoaguSense has some new tubes that make it very easy to collect and transfer the blood.
I am anxious to see how lab results compare to Coag-Sense results.
In my testing, I found the Coag-Sense to be slightly below the lab, and about .5 or .6 below the CoaguChek XS. It'll be interesting to see what your Coag-Sense gives you.

(The Coag-Sense and CoaguChek XS are both pretty easy to learn and use--just be sure that, for either, you get a lancing device or lancet designed to go deeply enough to get a large enough drop of blood. It's no big deal, really, but it sure helps to get a good test every time....and it won't blow out your veins, either).
 
ARGHHH... That probably gives a hint where I'm going with this post. Talked late yesterday afternoon with the folks at the CoagSense monitoring company. I got tired of waiting to hear from them. It turns out, my insurance denied the request for coverage AND NO ONE at the company bothered to call me to let me know. I got a pass off story that the person I have been working with all along, only one I was ever out in contact with, wasn't in the insurance side of the company, so she never followed up to call me and let me know it was denied. Her final answer was to go back to the head of CoagSense and talk with him about taking the machine back if I buy one and it turns out to also not work on me. Well, I already did that at the start if the whole thing..... The answer was, just subtract the differential between the vein draws and our machine and use that as your number!

My answer is NO WAY! The differential between the two methods has never been the same, it ranges between 1.5-3 points difference. I'm NOT going to just pick some average number as the differential and count that as a safe bet as to what my INR really is. Clotting and other detrimental outcomes is too much to risk on random values assumptions.

So, I'm back to square one. A possible machine that MAY read my INRs right but no way to test the issue. Close to being able to test, but not able to take that last step. As crazy as it sounds I think I'm to the point of engaging in a conversation with Protimenow about his machines. Protimenow, I'll be sending you a PM and hope it comes through the disfunctional website's system.

This all has been SOOOO frustrating. I keep thinking it should be a simple issue and it keeps not being one.

Well, thanks for letting me vent. Now to reach out and see if Protimenow and I can work out logistics....
Linda
 
Protimenow, I just sent you a PM but I've no idea if it came through. It's not showing up in my sent box. If you didn't get it, let me know via this thread and I'll try a different way. I may have to just go out on a limb and post my email address up publicly. But I would like to get in direct contact with you. Thanks, Linda
 
Aggie85 -- I didn't receive a PM or a mesage at my e-mail address that said that I had a message waiting.
I agree that the method you're being told to use isn't worth betting your life on. If I had strips for my Protime meter(s), I'd be happy to send you one of those meters so that you can try one of THEM. I don't know if it's worth buying a batch of strips (they call them 'cuvettes') just for a couple tests -- but the ProTime may also work for you. We can explore the possibility of a Coag-Sense, with a couple strips, as an alternative, if we can somehow send messages through this system. Please try to PM me again, and I'll see if I can send you something.
I don't want to see ANYONE who needs accurate testing have to do without -- the risks are too damned high.
 
Aggie: I tried sending you a PM, and it appears as if I can't send or receive because this system puts what I think is a somewhat ridiculous limit on how many PMs can be held in the outbox and the inbox. My boxes are full, so I can't send or receive any messages.
I don't want to violate any rules (if any) set for users of this forum by giving you my e-mail address. If I DID release the address, I doubt that I'll be getting a lot of irrelevant messages, but I won't give that information out.

Suffice it to say that most people call me Mark. Also, it might be helpful to know that one of my domain names is the same as my name here, plus .COM.

I'm sorry to hear that Coagusense dropped the ball on your order and on the insurance issues. I haven't checked on the price of the Coag-Sense meter on eBay. It would sure be good if you can find a meter that works with your blood chemistry and gives results that are near those of the lab -- or are ALWAYS a predictable distance from the lab results.
 
Protimenow, I tried your suggestion in your second email but maybe I missed an obvious clue, but the domain name hint didn't work. Probably barely internet savvy me missed something. LOL I'm going to go out on a limb here out of desperation and post my email here since the PM system isn't working. I feel fairly safe that no one here is going to harass me and I already get a TON of junk mail on that address that a few more won't even be noticed. If I get in trouble I'll beg forgiveness on the grounds that "improvements" have made it impossible for members to communicate. THANKS!
 
firstly I can't emphasize how fast you should get that email off this site ... unless you want to start getting more spam than you can poke a stick at ...

Aggie85;n848340 said:
Protimenow, I tried your suggestion in your second email but maybe I missed an obvious clue, but the domain name hint didn't wor

so if I may, gmail would be an example of a domain ... so -> gmail dot com (or to be succinct gmail.com)

so his name was given

thus it would be name@[B]domain[/B].com

he mentioned that his domain was related to his site username ... which appears to be protimenow
 
Thanks guys. My plan had been to remove the email as soon as I'd gotten something from ProTimenow to know that he's seen it. I'll try the domain name route and assume ProtimeNow has seen mine as well. I've contacted my insurance company to see why the denial but was told they have 24-48 hours to let me know. I've still not heard back from them. Anyway, I'll sign off here to see if I can locate Protimenow via email. Linda
 
Ok, time for another update. Protimenow and i have been in contact and I've gotten one of his CoagSense machines to test out on. So far, results are still puzzling. Monday I did three INR tests, all within an hour or so of each other. Lab Vein draw came in at 3.2. CoaguCheck showed 4.6 and CoagSense had 4.2. The CS was closer to the lab value but still signifcantly higher. BUMMER. I was really hoping the different testing mechanism of the CS would make the difference.

Protimenow in our privte conversation wondered if I'd had done lab testing at any other facilities and what were the results? He's thinking that maybe the problem is the lab results and not the macihines. I think Pellicle mentioned something similiar somewhere in this long thread. To answer both of them, yes I have been tested in different facilities and had the same pattern of results. The lab vein draws have been done at three different military hospitals while the POC machines have either been at the one ACC clinic or using NewMitral's machines (INRatio and CCxs.) Both times i had the labs drawn at a different hospital, I've been able to do a POC test fairly soon aftewards (either at my regular clinic or the one time, was on NewMitral's machine. A reminder, my ACC clinic uses CCxs machines. The labs have consistently, across facilities and numerous visits shown INRs at one value and the POC machines way above. Those not in the US military may not realize this, one oddity with the military is they don't all get their supplies and equipment from the same places. Each branch has it's own procurement systems and uses different suppliers. So the machines at a Navy hospital could be different than those at an Army hospital. Heck, it's only been within the last couple years that their computer records could talk to each other. We used to have to hand carry our records from one military facility to another if appointments were at different places. I know Bathesda Naval uses INRatio (well had until the recent difficulty) while the Army hospital I go to, uses the CoaguChecks. So lab testing machines and reagents very likely aren't the same across the three facilities I've used. Yet the results have been consistent. (labs in range, POCs high)

Protimenow also figured that there aren't many people in my facility who get tested both ways and that maybe the problem is the lab reagents and they just don't know it. I've looked into this already as well because I wondered the same thing and asked. Actually, it's standard procedure for ALL new patients to the ACC clinic to be tested with both vein and POC samples for the first intake visit. Just to get baselines. Also, with ANY patient in the ACC clinic who's POC shows higher than 4.0 they do two things. They first restest with a new fingerstick and if the second test also shows above 4.0 the Pt. is then sent to the lab for a vein check. It was both of these factors which started the whole thing with me. On my initial intake, my POC showed a level 5.2 (or something like that) but since I was going to the lab anyway for an initial verification level they didn't adjust my dosage until the lab results came in. I'd have to go back to the start of this thread to see the level, but it was within range and way lower than the POC. So, while not numerous (other than the new patients) there would indeed be at least a few pts. tested both ways within the facility. The pharmacists have checked these pts. records and I'm the only one showing this disparity between results problem.

What I haven't done to this point is do the two different blood samples (vein and finger) ON THE SAME MACHINE. I will be making arrangements to do this. This will at least maybe answer if the issue is a skin being pricked issue vs veinous blood. It would once and for all verify that the issue is vein vs finger and not machines and reagents causing the different readings. This might take some time to set up because while the two (lab and ACC are at the same hospital they are not set up to share samples (ie, me or someone transport vein draw sample or finger sample between the two areas.) I think the lab will be easiest but I'll have to make special arrangements and I need to see if their machine can process both sample types.

I've seen it discussed here, but can't remember, can the CoaguCheck do both sample types?

The other question that's come up is whether to use the lab results as the gold standard of what my INR is or the machines? Labs have been consistent (except once when I had a 6.0 INR via vein blood) (unfortunately, we had NOT gotten a POC sample that day to see what it would have shown.) BUT the POCs have been consistent as well (if running consistently high.) My inclination is to go with the lab results; I'd rather base on lab and accidentally be too high than base on POC and be accidentally too low. The real reason to keep persuing this is two fold to try saving my veins. I'm a very difficult stick (it took the phlebotomy guys 6 tries the other day to draw my blood.) Also, the ACC clinic keeps trying to extend my checks out to 10 days to 2 weeks. I'd really rather stay on weekly for safety sake. So far, there's always been a reason to go ahead and draw it at about the 1 week point, but they keep trying to get me to extend it. if having to get vein stuck for the rest of my life, I'll probably have to go ahead and extend out to longer times between tests just to save my skin and veins. Maybe as I get more comfortable with my coumadin management, I'll get more comfortable with extended checks but not yet. Also traveling would be more limited. But thankfully if I'm using a US military facility anywhere in the world both my standing orders and lab results are available so I could go when and wherever I need a test. Also, I'm now bloody curious as to WHY this is going on!

I just wish there was someone out there in a research position who deals with lots of people on Warfarin who could give me a definitive answer as to why i'm getting such wide range results between the two methods and better yet, what I could do differently to get the POCs to work. My clinic keeps thinking its a platelet, Antibody skin thing (even when I have NO other signs of such issues). And, from what I've read online, the APA problem causes the POCs to read values as false low, not false high. Why would I be the only person on the earth (maybe a slight exaggeration) who has this problem between the lab vein and finger sample tests???

Thanks to all of you guys out there who keep brainstorming for ideas as to what might be going on or what else to eliminate as a cause!
SPECIAL THANKS to Protimenow for sending me his spare machine and testing supplies!!!! Wish they'd worked!

Linda
 
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