Self-monitoring INR from the start

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Chuck C

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For all you nerds out there on Warfarin - have you read this? - Warfarin: The Definitive Guide — tl;dr pharmacy
Thanks Amy.
I note # 2 - wish that I was aware of this before going on amiodarone:

"Amiodarone (Cordarone/Nexterone) - This antiarrhythmic medication is even more infamous than sulfamethoxazole/trimethoprim for interacting with warfarin!"

" Consider a pre-emptive 30-50% reduction in warfarin dose with amiodarone initiation. "

This is good advice backed up by the literature. In three days my INR went from 3.1 to 9.7 after going on amiodarone. It had the effect of approximately doubling my warfarin dose.
 
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pellicle

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This is good advice backed up by the literature. In three days my INR went from 3.1 to 9.7 after going on amiodarone. It had the effect of approximately doubling my warfarin dose.
stuff that "jamms up the disposal hole in the bucket" is indeed an issue

Cytochrome P450 is important, so I'll just say Grapefruit juice and leave my first INR blog post sitting over here.
 
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Protimenow

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The only thing about buying used is there are blood products from previous user on machine. I went with new machine instead ,bought from wilbourn medical. It just showed up today. Payed 900 bucks for the kit. Insurance wanted to charge 3k to rent machine. Will see how it works out. I saw a used one just for machine was 180 bucks on eBay. I don’t need to get HepC or other virus like HIV, I have managed to avoid that working in medical field all of my life. YMMV
Not true. The meters don't actually draw blood products into the meter.

CoaguChek XS does an electronic test on the blood inside the strip - the strip doesn't come ANYWHERE NEAR the inside of the meter.

Coag-Sense may be a bit riskier - a wheel inside the strip turns - a clot makes the wheel stop turning. An optical sensor detects when the blood has clotted. But, again, no blood gets into the meter.

And - FWIW - even if blood products DO get into the meter (they don't), how is this putting you at ANY risk? You have no physical contact with what's inside the meter.
 

Protimenow

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Thanks Amy.
I note # 2 - wish that I was aware of this before going on amiodarone:

"Amiodarone (Cordarone/Nexterone) - This antiarrhythmic medication is even more infamous than sulfamethoxazole/trimethoprim for interacting with warfarin!"

" Consider a pre-emptive 30-50% reduction in warfarin dose with amiodarone initiation. "

This is good advice backed up by the literature. In three days my INR went from 3.1 to 9.7 after going on amiodarone. It had the effect of approximately doubling my warfarin dose.
And to think that, when I was having serious arrhythmias, my cardiologist started me on that NASTY STUFF (amiodarone).
 

Protimenow

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With only one exception, only one of my meters was acquired new.

And, FWIW, how do you know if a 'new' meter hasn't also been exposed to blood products? During manufacturing, quality control checks are probably made before the product is prepared for shipping. What do you think they use to do quality control tests?

Fear of blood products in the meters - ridiculous as it sounds - shouldn't be an issue for new, or old, meters.
 

Protimenow

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I didn’t see that a new machine was sold on eBay. I just know that the possibility of infection from a used machine maybe infinitesimally small to get an infection; but it’s not non-existent which is my entire point. If it’s new and cheap rock on , I missed out on it. Happy with what I got 50 test strips/controls/capillary tubes/coag sense meter/finger stick cartridges.
I see new Coag-Sense machines on eBay quite frequently. I would have ABSOLUTELY NO FEAR of a used Coag-Sense meter, as long as it comes with some kind of guarantee.
These things (Coag-Sense and CoaguChek XS) are made to do thousands of tests - they go into clinics and labs, so they HAVE to work , accurately, every time (and have QC tests that run before the strip is read). USED machines probably have very long lives left in them.
 

Chuck C

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And to think that, when I was having serious arrhythmias, my cardiologist started me on that NASTY STUFF (amiodarone).
It is indeed very nasty stuff. It wreaks havoc on your liver and drastically increases cancer rates for those on it long term. I'm very glad that I was only on it for one month, which does not correlate with long term damage or cancer risk.
 

Protimenow

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It is indeed very nasty stuff. It wreaks havoc on your liver and drastically increases cancer rates for those on it long term. I'm very glad that I was only on it for one month, which does not correlate with long term damage or cancer risk.
I was released from the hospital early last April, with an expensive prescription for 180 mg time release Amiodarone. It cost something like $130 or so - after deductible.

The crap turned my intestinal contents into concrete - another trip to the E.R. eventually resolved that issue, but I still had my nasty arrhythmias. And I wound up with a bottle of useless, iodine-based, medication that I couldn't use.
 

Chuck C

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I was released from the hospital early last April, with an expensive prescription for 180 mg time release Amiodarone. It cost something like $130 or so - after deductible.

The crap turned my intestinal contents into concrete - another trip to the E.R. eventually resolved that issue, but I still had my nasty arrhythmias. And I wound up with a bottle of useless, iodine-based, medication that I couldn't use.
Wow! 180mg is not even a very high dose. I was on 400mg/day week one, then 200mg for 2 weeks, then down to 100mg. Other than sending my INR to 9.7, which could have been prevented with property guidance, I can't speak to any side effects, but I did get a urine sample result that suggested that I may have high liver enzyme, which I suspect that the amiodarone was at least partially responsible for, if not totally responsible for.
The good news is that I have not had any afib since my release from the hospital, and this may have had to do with the amiodarone doing its job. Perhaps a necessary evil for a short time, but glad to be off of it.
 

Protimenow

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When I complained about problems with the sustained release, they dropped me to a smaller, 'baby dose', which was still more than I could handle.
The 'hospitalist' decided, without consulting my cardiologist, to give me some other prescriptions when I was released. These only caused problems, too.

It's a shame when the 'hospitalist' - by definition, a generalist - decides he or she knows better than a specialist and prescribes stuff that wasn't already written by the specialist.

A shame -- maybe even malpractice.
 

vitdoc

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Hospitalists are physicians generally trained in Internal Medicine and have an extra interest or training in critical care. They have replaced physicians making call on their patients in hospitals. Depending on their training they are usually very aware of the issues with many of the drugs that are used in critical patients.
So altering medication a bit is not unusual. Generally patients are instructed to check back with their routine physicians after discharge for follow up.
Malpractice usually starts with demonstrating some harm that was caused by something done or not done by a physician. No harm no foul no malpractice.
Even having a high INR in the face of amniodarone use is not malpractice unless something happened that injured the patient due to the high INR. So finding it and correcting it without harm is not going to get a malpractice verdict.
 

Protimenow

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Sorry that I used that word.

Still, prescribing Sotolol in addition to Amiodarone (when the Cardiologist DIDN'T prescribe Sotolol) seems rather questionable to me.
If the cardiologist thought that I needed it, wouldn't HE have prescribed it already?
 

tom in MO

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Malpractice is improper, illegal, or negligent professional activity or treatment, especially by a medical practitioner, lawyer, or public official. Harm is not needed to be called malpractice. However, if no harm, one cannot collect damages.
 

Protimenow

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Yes, the M was malpractice - I've retracted that term - it was too strong.

OTOH - even though there was no intention of doing harm, would IGNORING the orders of the physician that I was seeing, and replacing (or supplementing) them with another drug STILL suggest a lack of due diligence?

Wouldn't adding Sotolol to medications that the specialist DID prescribe be something of an overstep and, perhaps, disregarding the completeness of the specialist's prescriptions?

Isn't it possible that the hospitalist would have prescribed a medication that either added to or reduced the medications that the specialist prescribed? (For example, if I was prescribed a medication that reduces blood pressure, then the hospitalist adds another medication that further reduced blood pressure (without consulting the specialist.)

I was unable to take the stuff that the hospitalist prescribed, and after talking to the specialist (who didn't prescribe) was told to discontinue it. Why did the hospitalist prescribe it if the specialist didn't want me to take it (and didn't prescribe it)?
 

BillDaThrill

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Hi all, so looks like many use/like the Coaguchek XS. Anyone familiar with the newer Vantus (4 buttons, bluetooth) model? Is it advanced from the previous 2 button model?
 

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