Unexpected and Question

[Gnusgal]

Okay, I know I should have expected it, but I didn't. I have now stuck myself for my ProTime three times. The first being me just trying it out, the second on the phone with the QAS nurse, and the third right after because I got an error. I now have little circle bruises on the tips of my fingers. I expected them to be sore, but I've never gotten visible bruises from finger sticks before. Guess it just goes with my other bruises (though none can compare to the DARK purple one on my upper arm).

Anyway, my INR earlier this week when I checked it (Monday, I think) was 2.4, yesterday it was 2.5. So I'm consistant, but the question is, how close is it to the lab??? I'm thinking my INR at the lab will be a bit higher, but I'm not sure how much. So here's a question, once you find out how the ProTime compares to the lab, do you adjust in your head what your "actual" INR is, or do you just go by what the ProTime says??? I suppose I'll talk to my card about it tonight when she calls to tell me my lab results. I plan to take my machine with me today and do a comparison.

I had also planned on going to talk to the rehab people about starting a program (I have a prescription from my card now), but I'm not sure I'll have time, since I told the QAS nurse to call me tonight at 6:30. I had her call early so I could go out tonight, but that may be too soon to be back from the rehab place... I'll let you know what I do.

Thanks for everything,

 

[Gnusgal]

Yikes!

Yikes!

Okay, I just got to work, and now my nose is bleeding! I never get nose bleeds. If my INR was 2.5 last night (which is my bottom limit) then why would my nose bleed??? I'll be calling my card later today, but I needed to "yikes" a bit.

Thanks,

 

[Creed3]

Niki!
I can't really answer your question about the ProTime machine. I am just now starting to look into getting one, so I have alot of questions too.
I too have just recently started to get nose bleeds. Pardon me for asking, but is it just when you blow or wipe your nose or was it running out of your nose? My nose bleeds were just when I wipe or blow my nose. I never used to get nose bleeds. I had my INR checked and I too was at 2.6 and 2.3, right where I should be. Confusing isn't it. Why the bleeds then? Well, I would definately check with your doc. Let us know how things go.

Take Care!
Creed/Gail

 

[Christina]

Nikki, just trust your machine!

Nikki, just trust your machine!

Nikki,

Who cares how close it is to the lab!You have so many variances there. Just trust YOUR machine otherwise it'll drive you crazy and your doctor will give you a hard time as well. I want to remind you that most doctors don't like hometesting because that is taking money out of their pocket.
I have been home testing since Janaury 2001 and have seen the inside of a lab in 15 months. I hope I can keep it this way. My doctor doesn't mind either, and I don't ask too many questions becasuse he might change his mind. What you have to go by is HOW you are doing. Are you eating about the same amount of vitamin K per day?
Little nose bleeds happen and often is because of dryness and not because of INR. With an INR of 2.3 -2.4 it is highly unlikely that the nosebleed is as a result of your high INR.
Again, TRUST YOUR MACHINE.

Christina
AVR's 8/7/00 & 8/18/00
Tucson, AZ

 

[Blanche]

Nikki:
I agree with Christina. You must trust the method that you choose. There is no way to "adjust" INR results from the lab and from your machine. We spent 6 months comparing lab results and Protime monitor results and there is no way to compare them. I believe the monitor is more accurate because there are so many variables to be accounted for in lab tests. We once sent samples to two labs from the same draw and got different INR values. Another time the lab reported 8.2. A second lab result done STAT one day later resulted in an INR of 3.8.

Christina is also right about freaking out the doctor. We have a doctor who is so agreeable, accessible, and caring that I love him more than the piggie loves the mud. Yet, he is still concerned about home testing. After l9 months, he still gets a bee in his bonnet from time to time. Home testing has been done in other countries for years. Currently there is a study being done in Germany with 70,000 people. In the US home testing does not have a long track record and most doctors do not have the experience base to be confident....and many are just not adequately informed. The most important issue is for you to be comfortable with the method you choose.

As for nose bleeds, at this time of the year I get them frequently. I convinced that mine come from allergy medications that dry me out too much. Happens alot in spring and fall for me and I don't take blood thinners. Good luch and best wishes.
Blanche

 

[LUVMyBirman]

Christina has some very sound advice. Take it! You should have a lab draw every six months to make sure things are in check. There will be a variance. You could visit three different labs in a day and obtain varying results. It's not down to an science..... so I have finally come to the conclusion NOT to expect perfection.

In reference to your question about the nose bleeds. I have been getting a little when blowing my nose first thing in the AM. Normal INR. You have to remember, most of us have just turned the heat on for the winter. That's when it started for me. We do have humidifiers on our furnace.....need to check to be certain they are working. I did not have this problem living in Tennessee. Drier climate up north.

 

[Michele]

Bruises/Lab results

Bruises/Lab results

Dear Gnusgal,
Please call us at 1-800-298-4515 we would be more than happy to send you samples of Tenderlett Juniors to see if they work better for you than the Tenderletts. You do the finger stick with the juniors and still use the collection cup on the Tenderletts to collect your blood and snap into your machine. We also would be happy to discuss variances with you from the lab. You might get two different readings even from the two top labs in the country just by different ISI, time of day, things you ate - you just need to trust one method.

 

[EVELYN]

Hi Niki

We have been exactly where you are now as far as the differences between Protime and lab/coagucheck. After many calls to Protime, we finally got some answers from a wonderfully nice gal who told us that the difference between the Protime and Coaguchek was about .6666. There is also a plug that your cardio can request to change the Protime's ISI of 1 and the Coagucheck's ISI of 3 to put them in line. We had planned to do that, but now we just add .6 on and go from there. I think Christina's words of advice were the best, JUST TRUST YOUR MACHINE. I do make a habit of faxing in Tyce's results to the cardio every few weeks or whenever he is not within 2.5 to 3.5. They return my call and we adjust meds or eat salads or have an extra glass of wine---whatever works. We love our machine. Just got back from Virginia, had it with us, checked the INR and just continued on. The peace of mind is absolutely worth it. Good luck with it. As far as the nosebleeds go, check with your cardio. Evelyn

 

[Ross]

Okay, I just got to work, and now my nose is bleeding! I never get nose bleeds.

1. Stop picking your nose.
2. You just got to work and your anxious. Your blood pressure just shot up and the inside of your nasal passages are dried out.
Guess what-Perfect scenario for a nose bleed!

The question is, did it stop in a relatively short amount of time or was it one of those bleeds that make you wonder if you shouldn't head for the hospital?

I know I had one not long ago that didn't want to stop (INR was 4.4 at the time). I packed my head full of gauze and Kleenex and it stopped about 2 hours later. My problem is this oxygen drying my sinuses out. I have a water bottle added to the system, but I don't think it does much of anything to relieve the dryness.

 

[Granbonny]

Hi Niki

Hi Niki

Are you using the same finger..switch off..bruise will be gone in a day...Nose bleed has nothing to do with INR..It would be on HIGH side. You bleed when your blood gets thin..HIGH INR ( I think HELP Al.. I asked you before..but don't you have a gym at your school..walk after school is out..ect..Why go home, back out to Rehab, home again..I never went to Rehab..Just Walk...We have several cute water fountains around inside our house. Keeps moisture inside...Plus drowns out my clicking Bonnie

 

[Johnny Stephens]

I haven't had a nosebleed for several hours now. Seriously, my numbers are in the 3.5 -4 range, I get the pink hanky all the time. Only a couple of out and out nosebleeds in six months, but then, it's nice and moist up here in Seattle

 

[Nancy]

Here's some info. that saved Joe from having to go to the ER when he had a mammoth nosebleed. He's got a "bleeder" in his nose that opens up on occasion. Of course, if it doesn't stop and you are losing a lot of blood, you must go and get it taken care of.

http://www.doctorhoffman.com/epistaxis.htm

 

[Blanche]

You may have misunderstood

You may have misunderstood

Evelyn:

There is nothing that one should do to an INR. There are no conversions and there are no formulaes. You are, once again, giving dangerous advice to people here. I think you misunderstood. What do you do with the .6? That is 60%. So, if an INR is 2.5 on Protime, you adjust by 60% or 6666%? The plug you talk about is for professionals, meaning trained, professional medical personal including doctors. My husband's INR is currently 4.1 on the protime. Should I multiply it by .6666? That would mean that he is at 2.7.One is in range and the other is not. If we followed your advice, and it is misguided, we would find ourselves in the same position that the people were in pennsylvania when lab results had errors and people died.

Stick to what you know. As I wrote in the past, there is nothing, nothing, nothing that one does to an INR.l There are no accepted conversions, there is nothing to do but read the results on the monitor. To advocate anything else is misguided and dangerous.

Evelyn, You are one of my favorite people here and I so enjoy youand your posts...and I remember the first one. Stick to what you know.

 

[Gnusgal]

Home now

Home now

Alright, I'm home from work (finally!) and can finally sit down to the computer. My nose bleed just freaked me out a bit, because it was different from the "dry weather" nose bleeds of my past. But it stopped after a little while. Wasn't flowing or anything, just discovered it when I sneezed. I'm not too worried, and did not get a chance to talk to my card today (though she should be calling some time this weekend to give me my INR results from the lab, and I'll talk to her then).

As for the ProTime, I did three tests today. One right after my blood draw that read 2.0, which seemed way off to me, so I decided to do it again right then (I brought two of everything just in case something went wrong) and got an air bubble. So I had to wait until I got home (about an hour later) and do one once the cuvette was out of the fridge long enough. That one (with the QAS nurse on the phone with me) went fine and read 2.6. I'm much more tempted to believe this one, since it is close to the number I got last night (2.5). I don't understand why it would read 2.0??? Did I do something wrong? Anyway, I'm still working on figuring this thing out.

As for my finger bruises, yes I'm changing fingers. but after doing six sticks in one week (because of training and errors) I'm running out of places to go.

-----------------

My card just called with my INR results! I had a 2.9 from the blood draw. So we are going to compare the lab and ProTime again next Friday, but she doesn't have a problem with the difference, since they are both within range. I know you guys are always talking about your docs who don't like home testing, but my card was actually the first to suggest it to me when I got started on coumadin. She's great. I don't think I'll ever be able to move out of this city, because I don't want to have to find another card. She's the best!

Anyway, thanks for all your responses. You really are a great bunch of people!

 

[Gnusgal]

oops. Sorry Bonnie

oops. Sorry Bonnie

I didn't mean to not answer your question, but got distracted when my card called. The school I teach at probably has some equipment, but I have never used any of it myself (I've never been able to exercise much- never even took a PE course) and I would feel uncomfortable going in and using it while my students were around (and the 7th grade athletics is in the morning, 8th in the afternoon). My card decided rehab would be a good idea because of the problem I may be having with my paracardium. And I think it would be good if I can find out what is going on that is making me so short of breath. I know that just going out and DOING something would be helpful, but I have to be honest and say that once I'm home there is little hope of getting me active, because I'm SO tired by the end of the day, and there are no street lights where I live. I think rehab would be a motivator and help me to actually see results. I've had other OH surgeries, and managed to do fine without rehab, because I started doing more on my own. But that was back in college when I actually had time to take naps durring the day, and then go to a pool to swim. I'm hoping to not be in rehab all that long, just until I can feel comfortable with what I should be doing and then I will probably look into going to the gym at the local college (where my husband attends). But first I want to feel comfortable with what I'm doing and not put myself at risk. Besides, the rehab place is MUCH closer to home than the college, or my school.

Oh, and I don't intend to go home, then to rehab, then back. I probably wouldn't go if I did. I intend to go straight to rehab from work. You're right on that one.

Thanks for the suggestions!

 

[EVELYN]

Hello Blanche

The last time people on this list questioned the INR and comparisons with Coagucheck and Protime, I contacted Protime and spoke with a lovely gal named Lakeesha at extension 274---actually both my husband and I spoke with her. We queried her about the difference between the two machines and her answer to both of us (after much debate within the office) was to ADD .666 to the protime INR and it should equal the difference between that and the Coagucheck machine; meaning if the Protime tests 2.0, the Coagucheck will test 2.6. We also did a check of the two machines at our cardio's office from the same blood draw and the difference between the 2 machines was exactly .6---Protime being lower than the Coagucheck.

She also told us about the plug that our cardio could request to bring our Protime and the Coagucheck machine that our cardio uses in line with each other. All your cardio has to do is write a letter to Protime and they will send the plug---you then bring your machine to the office and they will adjust same--no additional fees involved. We were both very satisfied with her answers and decided NOT to have our cardio request the plug because we knew, based on Protime's advice, not my conversions, that the difference was very easy to figure out.

I do not feel I am giving erroneous information, Blanche. The reason we contacted Protime for a second time was specifically to question the differences between the two machines. What I have stated above is EXACTLY what they told us, almost verbatim, as I wrote it down in shorthand on the file folder we keep all the Protime information in.

Evelyn

 

[Christine]

hi niki,

i just tested at home on both the 3 and 5 channel couvetts.. my numbers from the lab vrs the 3 channel were not even consistantly off, so QAS sent me some 5's yesterday.. today i did them back to back and got the same results.. even though my doc goes by the lab results..he knows i have this machine and was just waiting until it's more in line.. but i'm beginning to believe what the others say.. i'm not going to get a consistant reading between the lab and at home.. seeing the same result on both channels kinda reinforced my confindence with the machine.. but i go back to labcorp in plano this week and i'll test both couvetts again then.. i might go across the street to hospital area and get it drawn by another lab (one my GP not Card uses) at some point in time to compare.. but since my draw is not stat, and with labcorp i believe the all the tests are performed at medical city (their main office) the time lasp might be the culprit also.. (i'm going to call them to confirm their testing facility)

sorry, but i forgot.. do you go to a coumadin clinic or lab... also, you mentioned your husband goes to college... just out of couriousity (sp? - mind freeze there) which college does he go to.. my boyfriend works at UTD (central energy plant) and i've been thinking about going to back to school to get my second degree in either radiology or sonagraphy/echocardiography at the dallas community colleges - we're also looking at moving into the collin county area (townhome/house to rent) in the spring, so i'm debating that issue as well.. dallas vrs collin county rates for community colleges..

anyway, hang in there.. i promise you the brusing will and does go away.. but they are correct when everyone says to stick yourself in the upper middle area of the tip of your finger.. more fleshy, easier to get blood and it doesn't hurt as much..

chris

 

[Ross]

they are correct when everyone says to stick yourself in the upper middle area of the tip of your finger.. more fleshy, easier to get blood and it doesn't hurt as much..

Yeah, what she said. Stick it, poke it, jab it, have fun with it.

I'm just jealous that I'm still getting 24 gauge (23 1/2 ?) needles poked in my arms and I hate it!

 

[Gnusgal]

Chris--
I go to a lab (Lab Corp IN the Plano Hospital) and get arm sticks. My card wants me to go to the lab at least one more time, to check the difference between the lab and ProTime, but she's confident that I won't have to go very often after that. Yeah! You're right about Lab Corp, they do send the blood to the main hospital to get the results. I have all kinds of problems with them. I have standing orders for them to be stat, but on more than one occasion it has not been done right away.

As for my husband, he goes to CCCC (Collin County Community College), and is currently on a track to go into nursing, but will most likely change to radiology or sonography (isn't that a coincidence?). We live in a duplex very near the hospital (about 5 minutes away). We could be neighbors! The street we live on is all duplexes and there is always at least one with a For Lease sign outside. It's a nice area. My husband attends classes at the Frisco campus, which is only 15 or so minutes from here, but I know the nursing classes are at the McKinney campus, which would be just a bit further. Don't know where the sonogorphy and radiology courses are held. But all of the campuses are not too terribly far from us.

Everyone--
Anyway, thanks for the words of wisdom everyone. When I think about it, the difference between the ProTime and lab draw was very small (only .3 off) and I think I'll be comfortable with that. And I figure, once I'm only sticking myself once a week, instead of six, my fingers will forgive me.

 

[KIRSONRON]

I'd like to reinforce what Blanche said - INR is a normalized ratio that once calculated, allows a direct comparison between readings, regardless of the variation between the ISI of the reagents used for the testing. I believe that any difference between ISI reagents shows up as a change in clotting time. By knowing the clotting time and the ISI of the reagents, the INR can be calculated. Therefore, INR is INR - regardless of any difference in methods or reagents used for the test. The INR was developed to allow a direct comparison of readings regardless of which lab did the testing or any differences in their reagents. If you are given an INR reading, it has been corrected already for any differences in methodology. Don't mathmatically correct this number or you will get yourself in real trouble.