ProTime Microcoagulation Machine

[Blanche]

I'm writing for Albert. Folks here helped us so very much in March when we were considering the ProTime machine. It is great. Thank you all. Now, we are asking your help. The machine was ordered through Al's Cardiologist, but in April the protime regulation was turned over to his internist. At first, he was supportive and agreed to have us use the machine instead of the labs. Then, Al had another stroke (TIA) on May l6. Now, the internist is reversed and suggests that we send it back!!! He's concerned because the lab and the machine are always a few tenths of a point off. We really need to use this machine. There is a very good possibility that a low INR contributed to the TIA. We were not testing then. The QAS people are helping us by sending info to the dr. But, come this Thursday, it will be Al and I who have to plead the case to the doctor. If anyone here would be willing to relate their experiences with the Machine, we could use those experiences as a testimonials to support our case. If you wish, we will not reveal information about you. However, with your permission, we'd like to copy your response for the doctor. He criticized us by saying, "you don't even know anyone who uses the machine." And, he also said he didn't know of anyone in Arizona who used the machine. Well, we know better.
Although our biggest concern now is protime regulation to avoid further strokes, Albert had a mitral valve replaced with a St. Jude valve in October, l990. Any help you can give will be greatly appreciated. It was his third stroke. Many thanks, Blanche

 

[Sierra Bob]

Hi Blanche---I had my aortic valve replaced with a St. Jude Silzone mechanical valve in April, 1999. I purchased the ProTime Microcoagulation System last March. It has only been tested twice with the lab, but in both cases it was exactly the same reading. My primary physician whom monitors my protime is of the opinion that the PT M S is probably more accurate than the lab, as there is no lag time between drawing the blood and running the test. In fact he even considered getting one for himself. Even if there is a slight diffrerence, I don't see what the problem would be. My cardiologist gives me a full INR unit spread (3.5 to 4.5) so I don't have to adjust the Coumadin so often. (I'm not a bleeder, so he wants it high.) I will see my cardiologist this coming Thursday for a echogram and INR test. I can let you know the results of the test and comparison, if you so desire. You can certainly use this reply in ant way that is a benefit to you.

Regards and good luck, Sierra Bob

 

[Sierra Bob]

Blanche--- Sorry about the typos. I didn't read it before posting. That should have been an echogram and you can use it in any way that is a benefit to you. Sierra Bob

 

[Christina]

Protime Machine..

Protime Machine..

This machine can save your life. You can check your protime anytime you want to, and won't be dependent upon a lab. You are also saving your veins, and that will save you future health problems.
My doctor was not to keen on it either, but I told him if I get another blood clot (I had two AVR's last year, the second one was because of low INR) and the AVR needs to be done again, it'll be my chest on the table, not yours. So, I bought the machine.
I could not get him to say that this machine was medically necessary, and I did not get it paid for by my Inusrance company, but so be it. It still is worth it.
I went on vacation and did not have to worry about getting to a strange lab. I checked my INR myself. It is such peace of mind by having this machine.
Yes, the range will always be about .2 points off compared to the lab either up or down, but the lab isn't perfect, we all know that.
I keep my INR high, around 3, and that's how I want it. I want to be in charge of my health, and if I need help I'll call the doctor.
I call the doctor every two weeks and let them know where I am, and they call me back with a change in Coumadin, if any. But since I don't speak with them that often I adjust my Coumadin myself. Can't wait for them to call me back whenever they get around doing that.
I wish you luck, and take care.

 

[Marty]

Hi Blanche, the national authority in this area is Dr. Jack Ansell in
Boston. He answers his E-mail faithfully. I suggest you present your problem to him at [email protected]. You may also refer your doctor to him. I am a doctor myself (radiologist) had a mitral
valve replacement with a mechanical St.Jude 9/17/98 and use the Coaguchek to monitor my INR's. When I had a similar question to yours, Dr. Ansell gave me a detailed answer which in effect said the Coaguchek had just as good a chance of being right than did the central lab. Please feel free to contact me personally at [email protected]. Marty Thomas Mclean VA.

 

[Gillian (in UK)]

Blanche - I am not on coudamin so have nothing to add - but I just wanted to say, having read all the replies - aren't we fortunate to have found such a great bunch of people with so much information there for us.

THANK YOU HANK

 

[strayze]

There's plenty of peer-reviewed articles in the medical literature about the tight control achieved with home monitoring. I don't have my hands on such literature at this instant moment, but the research was done in Europe and US. The control is vastly superior to anything I've ever experienced (which I won't go into now- - only to say that in my part of Maryland it's hard to find a doc willing to do anticoagulation monitoring at all).

To do a search I'd try http//www.nlm.nih.gov and check into grateful med or pubmed (not the search engine for the nonprofessionals) and then type in some descriptors. I would use "home" and "anticoagulation" for starters. If using the drug name in your search, use the generic or chemical name "warfarin" I don't use the quote marks or the "and" in my searches.

One can also find a few references in the manufacturers websites. Try the name of the instrument you have "protime", or "avosure". With those references, if not hypertexted, one can go back to pubmed and follow directions about searching the authors, or use the words in the title.

In about an hour you should have a good-sized handfull of references to give your providers.

For some reason providers are leery of something they've had no experience with- - it's human nature. They like to have buddies in their field who've had experience.

 

[Blanche]

Many, many thanks

Many, many thanks

Sierra Bob, Phil, Christina, Maxtar, Gillian (in UK), Stayze:

Thank you one and all. I am overwhelmed with the responses and with the speed in which you replied. Your support means more than I can say. Your experiences speak louder than the research to me. But, I will continue to search for more articles.
And, I will follow all the leads, email and internet, that you have suggested.

We are in a bit of a quandry today. Al tested 2.9 at the lab yesterday and 4.1 on the ProTime. (He had his recent stroke at 2.4.) If we used the lab figures, the dose would increase. If the ProTime machine figures were used, the dose would decrease. The doctor returns from vacation tomorrow. I'll bet this discrepancy will really get his undies in a twist. I must say that the doctor, one of the busiest in Mesa, has always given us all the time needed, has been open to all of our questions and suggestions, and has always been concerned about Al's health and my well-being. (He isn't my dr.). I know he would like to accommodate us, but he's relying on the lab that he uses every day and has used for 10 years. He's been Al's internist since his valve replacement in 1990. We'll just have to pursuade him and I think I can do that without putting this into a win-lose situation. And, your testimonials will be of great help. You all have made a great difference to us today. With kind regards, Blanche

 

[RobThatsMe]

Hi Blanche,

I have a ProTime and use it when ever I feel that I need to check. The doctor also want me to check on a 2 week basis, and call the results in to him. My levels have been within my range most of the time. when it is out of range, I call and tell him. I also suggest the course of action I would take, and he either agrees or suggests a different doasage than the one I suggested.

My doctor likes the machine. In fact, he wants one for his office. He has many elderly patients that need to be checked, and also, in many cases they need to adjust their Coumadin ASAP. Sending it out to the lab takes a day, sometimes 2. So, if he had the machine, he could test them and adjust while they are they for the visit.
Does your doctor know that the ProTime does 3 self checks to calibrate, then samples twice to average and compare against the calibrated result? Lance at QAS can provide more detail.

Also, when I showed him my machine, we did a test. He took my blood sample the usual way, and then I used the ProTime Unit. The results were within .1 ( 1 tenth of each other). The ProTime unit lieved up to what it advertises. The manual says that it comes within 1/10th of a venus draw. Mine did. We took and compared both ways. Also, when we did the comparison, we made sure that it was done at the same time, or within 10 minutes of each other. Please feel free to contact me if I can be of further help at [email protected]

Good Luck,

Rob

 

[arlice]

ProTime unit

ProTime unit

Blanche,

Have you checked the expiration date on your test cuvettes? Or could they have been exposed to heat or freezing? Those things could affect the results of a test. If none of those things have happened then you should call QAS as soon as possible and explain the problem to them.

Is there anyone in your area who also has the ProTime unit? Maybe you could get together and do a test on both units to see if you get the same results. QAS also suggests that you take the unit to the lab and do one at the same time as they do a draw and then compare the results. If everything checks out on the ProTime then go to another lab (if you have any energy left) and have a test to see what results you get. It is possible, I suppose, that the doctor's lab could be wrong.

We have not had the problems of monitoring anticoagulation in the Kansas City area. The cardiologist's office has done that using nurses. We always got the results the same day. Otherwise it has no meaning at all. Might as well not have one done. They do tend to move the dosage around but my husband just tries to keep it as close to the same every day as possible.

Arlice

 

[RobThatsMe]

Heat and Coumadin INR to Janie

Heat and Coumadin INR to Janie

Hi Janie,

Hot weather can cause your INR to become "LOWER". In hot weather, your body sweats.. metabolism rate is higher.. Thus burning off more coumadin.

You can find this information out yourself at the following web site.

http://neuro-oas.mgh.harvard.edu/stopstroke/coumadin_aspirin.html

This site is provided Through the Massachusetts General Hospital

Go to the Coumadin Drug Interactions.

Personally, My INR target range is 2.0 to 2.5 I also take a 325 mg aspirin everyday with my Coumadin. It is a presecription coated aspirin. Both my heart surgeon and cardiologist agree with this regiment. MY heart surgeon also sent me the latest reports and studies regarding target levels for Mechanical heart valve patients, and the report also included the target range for those of us that take both Coumadin and Aspirin. I should try and scan it into my computer so that I Can share that with everyone on here.

Hope that bump on the head gets better soon,

Rob

 

[Hank]

Hey Janie - Be Careful!

Hey Janie - Be Careful!

You should be careful when getting soused on sunshine. Its effects have been know to be intoxicating. I should know, I live in sun central.

Yes, I agree, 2.0 is WAY too low.

Like I said, 4.0 is my friend.

I hope you heal without too much discomfort. If you weren't drinking then, I'll bet you wanna now! Heals the pain you know!

 

[LUVMyBirman]

Janie re: falling

Janie re: falling

Janie!!!!

Are you ok???? Just read your post. I felt like picking up the phone and calling you. Did not want to wake anyone at this hour.

About the INR. Most of the time I get in "the heat" my INR has spiked. Recently in FL in dropped to 2.3. My diet had not drastically changed. The only thing I ate that was new were Scallops. Have not had them since surgery.

Guess it can go either way when it's really hot. Since the weather has changed my INR has been unstable, mostly too high.

Please email me back. Want to make sure you are ok. If you hit your head pretty hard you should call your doctor. This is nothing to mess around with!

Take care

 

[Blanche]

Quickly running out of hope

Quickly running out of hope

RobThatsMe, Arlice, and all the folks who have tried to help, I fear that the problems are becoming impossible. I thank you for the information and great suggestions. The doctor has stated that he now must rely on the lab he uses. The differences between the machine and the lab are too broad. Al was testing every two days. The last two comparisons were 1.2 off (lab 2.9 and machine 4.1) We also had recent readings that were .8, and .9 difference. To complicate matters, although the machine is usually higher, there was one time when the readings were .5 off and the lab was higher. I've checked all that I can. The exp date of the cuvette is 1/02. They are kept in the fridge, so heat and frost are not a problem. The nurse at QAS wants us go to a lab that will test within one hour and use our machine there too. Sounds good, but the labs here don't draw on the same premises where the tests are run. The only option is to go to outpatient care at a hospital. The dr. suggested 3 tests and wrote orders for same. At outpatient, we would bear the cost of about $750. per draw. QAS believes that the time between the draw and the test run could be at issue. But, how do I question a lab that services a large hospital and many private physicians? QAS sent a packet last week to us and the dr. Perhaps when that arrives there will be some possibilities. The dr is willing to accommodate us and I have not diven up yet. Hearing the success stories from you good people makes me know that there has to be a way.

 

[Bob Gleason]

PT machine

PT machine

Although I don't use it as much as I should, I would advise Blanche to get into a routine of using it and making more comparisons to the cardio's readings. Do the testing at the same times to see if the PT is in sinc with what the cardio's unit says.

 

[strayze]

Hi Janie,

You've had 2 wake up calls. Lounger balance, and INR! It's a slippery slope. Please be careful.

Thanks Rob for the reference.

STRAYZE

 

[RobThatsMe]

Blanche $750 / draw/// No Way!!!

Blanche $750 / draw/// No Way!!!

Hi Blanche,

Prior to procuring my Protime Unit, I went to the outpatient lab at the hospital here in Nashville, TN

The total cost for the draw and lab was $64.00

Also, I wanted to ask if you are comparing "PT" or "INR" readings?

The "PT" readings can differ depending on the testing medium used. QAS informed of this, and I checked to be sure of the hospitals lab settings. Since INR is a universal standard, the INR numbers should be the same now matter what settings are used.


I think you should check things out at the hospital. $750.00 for someone to draw blood and run a simple test is outragous!

Good Luck,

Rob

 

[DickV]

INR Machines

INR Machines

I have a machine and I am of the opinion that lab testing is not all that accurate depending on many factors. I discovered that Lab Corp, who is contracted to do my bloodwork put of my Cardiologist's office, does not even test in the same town. I live in Houston and they test in Austin, @ 150 miles away. Who the hell knows that that blood goes through en-route. I believe the transit, weather variations and the time element alone could have some effect on the results.

I have just started testing and while the Dr. and I will compare findings for 3 months, my dr. is already using mine in which to base the dosage.

 

[arlice]

lab fees

lab fees

Wow! I can't believe those lab fees. And to think that I complained when our hospital lab charged $26 for a protime. And we get the results the same day - often within 2 hours. The reason I complained about $26 was because another lab (which is not as conveniently located) only charges about $15 for the same test. Plus Blue Cross pays for a good percentage of it. Even when we have traveled and had to get a protime in NC or Hawaii or wherever, the cost was never as high as $64. Having blood drawn at the doctor's office is always more expensive (I think) and takes longer to get results because it's sent out to someplace like LabOne in the Kansas City area or Lab Corp in Texas. Those places are ok for specialized tests but a protime should be much cheaper if you go to a hospital lab and they fax or call the results to the doctor almost immediately. I am of the opinion that protime results are practically worthless if you don't get the results before your next dose of coumadin is due.

Arlice

 

[strayze]

Yesterday, June 25, Health Care Finance Administration (HCFA) announced that the May 11, 2001 due date for a decision on home monitor, has been extended to July 9 2001.

( Let's hope that we'll not be seeing a similar announcement on August 16 for extension of July 9 date to August 29. )

This decision would affect Medicare reimbursement of CoaguCheck, Protime, and Avosure monitors, already approved for patient use by FDA.

STRAYZE