self dosing

[babshappy]

well after a few months of back and forth with Dr.s ,I'm am now cleared to do my own self dosing...I feel somewhat liberated as I dont have to go to the lab every week/month..So I'm going to try for a year and see how I feel about it...and how my pocketbook feels about it..It's probably going to cost me an extra 50.00 a month to self monitor ,as opposed to nothing if I just went to the labs.. Does anyone have any advise or cautions or?????

thanks

 

[Freddie]

When in doubt ask questions, someone here should be able to help you, or use this:
http://www.pace-med-apps.com/CoumCalc.htm

 

[Bina]

Babs, will you be self testing and self dosing?
You really can't go wrong with your Coaguchek XS. It has excellent quality check processes before every test.
My home testing supplies are no more expensive than going to the lab and paying for gas and parking.
Enjoy !

 

[pellicle]

well after a few months of back and forth with Dr.s ,I'm am now cleared to do my own self dosing...I feel somewhat liberated as I dont have to go to the lab every week/month..

do a little dance ...

So I'm going to try for a year and see how I feel about it...and how my pocketbook feels about it..It's probably going to cost me an extra 50.00 a month to self monitor ,as opposed to nothing if I just went to the labs.. Does anyone have any advise or cautions or?????

* measure once a week. Try to make it the same day
* start a spread sheet, document carefully what dose you take and if you think you missed one
* at the end of week then test and review your dose
* make adjustments subtle, say no more than 10% change. If the INR is at great variance from our target range then you may need to make a larger adjustment. Be careful. In these cases test again in about 3 days to see where its heading.
* be aware of the lag time in dose change and adjustments. I have put some threads up here with data from hospital visits where I was off the warfarin dose and put up the Lab vein drawn INR data for view.
* be consistent in measurement.

* if you get a Coaguchek XS, be cautious of "milking" the finger for blood, and follow the 15second rule for producing the blood drop: NB don't take more than 15 seconds to get the blood drop from lancing to placing on the test strip sample area. Personally I find that a light tourniquet of cotton or dental floss on the first joint of the finger helps me to get a good blood sample with a smaller incision in about 4 seconds.

 

[Protimenow]

I completely agree with Pellicle's advice. A spreadsheet is a useful tool -- not only does it help you demonstrate to the doctors who prescribe your warfarin that you're on top of things, it's also good to refer to should you even have any questions about medical history. I have been maintaining an INR Diary for four years - ever since my first successful self-test. I also record any activities, diet changes, medication changes, etc. that may have some impact on the INR.

I don't know where you get the $50/month figure. Once you own your meter, strips are roughly $5 each -- weekly testing will probably cost around $20 each month. And, as was already said, you can easily spend that much for gas and parking when you go to a lab.

Personally, I like to test weekly. If I change my dose or make other changes in my medications, lifestyle, etc., I may test a bit more frequently.

As has already been said - any dosing changes should be done slowly and conservatively. You won't see the effects of changes right away.

Being able to self-test is empowering and liberating.

 

[babshappy]

great advice, i will be self testing and self dosing on coaguchek xs machine, the strips cost 50.00 for 6, I plan to check every week, I made an error in calculating how much it would cost..

 

[dtread]

Babshappy, not sure how it works in Canada. But in the U.S.A. if you are over 65 years old or otherwise eligible for Medicare the INR testers, strips, etc are considered Durable Medical Equipment (DME) by Medicare and are covered under Medicare (similar to Diabetes testers). In fact, INR testers are very similar in functionality to Diabetes testers, although the two testers test for quite different things. So, not sure why medical health care providers/insurers in the U.S.A. do not typically cover the INR testers for the patients that need them, as they do for patients that have need for diabetes testers, particularly when they are considered DME by Medicare. If someone knows the answer to that please chime in. I suspect it is related to the cost (which translates to profit by the medical health care providers/insurers).

 

[babshappy]

so far the Inr testers and strips are not covered on my health insurance, but I think as of 2012 they are tax deductible...it does not cost me to go to the lab and have my Inr tested , I have chosen to try and self manage my inr and dosing as an act of liberation. It seems to me that especially in Vancouver that this is not common...so therefore the insurance company does'nt recognize that self dosing is a viable way of managing your Inr.
It was like pulling teeth to get to where I am..so I am stuck for now to pay for my test strips and anything else involving self testing.

 

[Protimenow]

I JUST got a Coaguchek XS (I received it last Wednesday). I also got some test strips on eBay -- I paid $31.95, including shipping, for 6. I don't know how much it will cost to ship to Canada, and I'm not sure about the exchange rate, but you may be able to do better than $5 a test. Two tubes of 24 will probably cost less, and should last you for most of a year.

As was already said, make small adjustments, and keep your history on a spreadsheet so that you can refer to history if you have any questions about what you're doing/what you've done.

 

[babshappy]

thanks good advice boy they sure getcha one way or another

 

[Herb M]

I go to a lab to have my blood drawn.It is fullly covered by medicare. I get the results by calling the lab within a few hours after the draw. The lab also sends the results to my physician. I get a call from on of the physicians's medical assistanst within a few days with information about what the physician says I should do about my dose. I listen, but I do whatever I think is apprpriate when I am out of range. My decision what to do is much better than what the physician says.

Those taking Coumadin/Warfarin should learn to self-dose rather than relying on the recommendation of a physician, which is commonly wrong.

 

[pellicle]

strange multiple poste appears

 

[pellicle]

the strips cost 50.00 for 6, I plan to check every week, I made an error in calculating how much it would cost..

say what?

I pay $135 for 24 strips which is $5.60 or so a test. I buy them in 24's as its not like I'm going to be going off warfarin...

 

[Protimenow]

Herb:
Unless you live across the street or next door to the lab, you may be better off (in terms of time and hassle getting to the lab) if you test at home -- even if your insurance pays for the lab test.

As far as trusting the doctors (or other so-called 'professionals') to give dosing instructions, I'm with you -- I've encountered an anticoagulation 'clinic' that is perfectly happy with testing monthly and forbade me from doing my own testing (like that's going to happen), and I've encountered a doctor who assumed that it's okay to double my dose one day a week (as long as my weekly total went up 10%).

I'm confident that I'm better off self managing -- as long as the meter that I'm using is reliable and accurate. (Last year, I had a situation with a meter that reported high, and I had a minor TIA as a result. A clinic, given the same numbers, wouldn't have managed me any differently).

Right now, I'm a bit obsessive about getting an accurate device - or at least knowing that I am actually in range. I probably won't have blood draws for a while (until I FINALLY get a job with insurance), but I have a few meters that I'm using to try to determine which is the most accurate.

Your approach - taking lab results and doing your own management - is probably a pretty good one. Self testing weekly with your own meter (once you confirm its degree of error or its accuracy) makes it a bit easier.

 

[pellicle]

Hi

I've encountered an anticoagulation 'clinic' that is perfectly happy with testing monthly and forbade me from doing my own testing (like that's going to happen)

I assume you were a naughty boy and did it anyway ;-)

did they offer any spanking?

, and I've encountered a doctor who assumed that it's okay to double my dose one day a week (as long as my weekly total went up 10%).

I've often wondered about this tendency to report dose by week ... like seem crazy to me. Its like daily dose 'evens itself out' which isn't what I see. Keeping dose consistent from day to day is an important factor AFAIK.

 

[Protimenow]

Yes, I was definitely naughty, and did my own tests. The only real value that the clinic provided me with was the ability to have a monthly blood draw to which I was able to compare my meter's results.

The idea of 'weekly total dose' doesn't make a lot of sense to me, either. If a person should be taking 49 mg/week, the extreme would be to take 49 mg on a Sunday, and nothing until the next Sunday. Ridiculous, I know. But so is increasing a dose (perhaps taking a double dose) one day a week, and expecting the spike in INR to last for an entire week. I've always advocated for the SAME dose if at all possible. (There were times, years ago, when I would alternate between 5 mg on even numbered days and 7.5 mg on odd numbered days. This seemed to keep my INR pretty stable, although I probably had a slightly different INR depending on the day of the month the test was made). This may have been almost as effective as taking 6 mg for six days and 7 mg on the seventh day. (In order to get 6, I would have had to take a 5 and a 1 or a 4 and 1/2 of a second 4 -- it would have been a bit of a hassle and the difference in INR consistency probably wouldn't have justified the hassle).

I'm pretty confident that with the experience that many of us at this forum have with dosing management - and the availability of dosing calculators - plus the fact that it's OUR lives that we're dealing with, many of us are doing better than we would if we trusted the management to doctors or clinics. (Although I'm not advocating NOT using doctors or clinics, this may be something that some people may consider)

 

[Herb M]

Protimenow,

I live 2 blocks away from the hospitals lab. My INR is fairly stable, so I only get tested every 4 or 5 weeks. If I am consideraby e out of range (greater than 5-0), I go for a blood draw sooner. If the out of range is less than 5.0, I will cut a dose in half for one day and maybe eat more greens. Folling the physicians advice is often life threatening. I have been doing this for 24 years and I am more experienced than most doctors. I sometimes refer to the dosing chart to verify my decision.

 

[Protimenow]

If you're 'considerably out of range' on a test taken five weeks after the last test, how do you know that you weren't out of range during the five weeks that elapsed between tests?
How do you know that 'extra greens' a a half dose will bring you in range but not drop you BELOW range?
Can you tell if, after the greens and reduced dose you resume your prior dosing that your INR doesn't again shoot up out of range?

I used to think that I could 'feel' when my INR was out of range. I was lucky - I didn't have any dangerous bleeds and I didn't have a stroke (well, actually, I may have had one years ago that resolved on its own, come to think of it).

I personally DO NOT THINK that testing every month or every five weeks is good management. Personally, I no longer believe that even if an INR is consistent on those 'snapshot' days, that this gives you any idea what your INR is between tests.

Many monitor makers suggest weekly testing - and this isn't just to sell more strips. It's because it gives you a more accurate ides of where your INR actually IS during the previous few days.

Personally, I am most comfortable with a test every week.

It's not just about convenience. It's about well being. It's about protecting myself from a stroke or from issues that may occur when I'm too high above my range.

The old medical protocols that say 4 weeks - or even 8 weeks between tests is okay is doing us all a disservice. It's probably related to the once high costs of testing and the lack of suitable alternatives (meters and strips that a lab can use or that patients can use at home). There are many papers that clearly conclude that self-testing, weekly, keeps patients in range a lot more than monthly testing in a lab.

I know what my decision has been about testing frequency. I discount doctor's advice about monthly testing. For my own protection, I test weekly. This is something that you may think about considering.

 

[pellicle]

Herb

For those of us that are on tight budgets I reckon that self testing is the best way. As I have said (and is the recent experience of others) you can get a coaguchek for $500 in good condition used, and the strips cost about $5.60 each when buying online in 24 packs.

I can say that my own INR though stable does undergo variance based on things like health. When I got sick my INR was trending up, and I adjusted the dose. When I got better the INR trended down and I adjusted the dose open again.

Even the lab that used to monitor me would weekly test me when my INR varied for one reason or another.

Ask yourself this. If you had a TIA how much would you pay to have not had it? $300 bucks? Cos that's a year of weekly testing.

Heck even if you stretch it out to fortnightly (if you find yourself stable) its better than monthly

 

[Protimenow]

I don't know if I'm breaking any rules by mentioning this. I just bought 60 Coaguchek XS strips on eBay for $191.70. This is ten boxes of 6 strips. Apparently, part of the seal at the top of the box was messed up, so they couldn't be sold as perfect. Last week, when I got my XS, I bought a box of 6 strips and from what I can tell, they work just fine.

I don't work with this seller. I have no relationship to this seller, other than having bought some strips from him (or her). Once you have your meter, and if these strips are available, you should be able to cut your cost per week of tests (one each week) to less than $3.50.

Of course, if you choose to use eBay, or not, it's entirely up to you. I'm just reporting what I chose to do.

(I'm still probably going to use Coag-Sense for occasional testing and comparison with the XS. I've got a year's supply of InRatio strips that I'll probably try to sell on eBay -- I think that the XS is easier to use and more accurate. I won't know for sure without a blood draw, and I don't know if/when I'll have another of those).