Working with the Cardiologist

[Dotty]

I just got my Protime Microcoagulation System last week. This is an ITC product. I did my first test on Sunday and got a 2.5 INR Result. My target is 2.8-3.5. I spoke with my cardiologist yesterday. He has no other patients doing home testing so is uncomfortable with this. The literature said that there is an acceptable variance of 0.6 but in my case that could be 1.9 to 3.l. The 1.9 is not acceptable and he fears that I could have a stroke. I did discuss with him that labs have a variance too depending upon equipment, reagents, personnel and time that it takes to run the test. He rejected that as not true. What can I do to get him comfortable with home testing and using this machine. I got the machine from Home Care Medical. My insurance company denied QAS as a provider and I had me go to the Home Care Medical people. Again, I am the first patient they have had to have this home testing so they will take no responsibility for teaching and following up. I did call ITC and spoke with a technician. She will send me their research which I can share with my MD. I am just frustrated because I have tried for 2 1/2 years to get this approved by the insurance company and now feel that I have to maybe change MD in order to do home monitoring. In all other ways, I like him very much.

 

[Debbrn]

Dear Dotty,

Maybe your Doc will feel for confortable if you do three tests at the lab over a period of time and use your home tester at the same time and compare the results. If you get similar results maybe he will be comfortable with you doing home testing.

Debbie

 

[Karlynn]

The variance is one of the reasons most of us like to keep our INR on the higher side of our range.

Was this doctor the one that gave you the 2.8 - 3.5 range? With the varience possible in ALL tests, whether done in the lab or at home, the 2.8 is a bit silly and suggests that, if he is the one that set your range, he isn't as knowledgable about Coumadin as you would like.

I'd like him to go to a lab and get his INR tested on all the machines they have and have them all come out exactly the same.

I'm not so sure about getting lab tests and comparing them. If they are different (which they will be) and the doctor seems to think lab tests are spot-on perfect, then that will just make him distrust the home unit even more.

You are a pioneer for this doctor apparently.

 

[Natanni]

We will be the first as well...

We will be the first as well...

Hi Dotty

Nathan will be getting his INRatio sometime next week. He is only 2 wks post op, and our GP has never heard of home INR monitoring either but is willing to work with us on it. Our coumadin clinic uses the Protime 3, and our approach is going to be testing with our clinic for the first 3 months (basically while his INR settles down, we hope) so we can get an idea of where both machines stand, and go from there.

 

[Marty]

I just got my Protime Microcoagulation System last week. This is an ITC product. I did my first test on Sunday and got a 2.5 INR Result. My target is 2.8-3.5. I spoke with my cardiologist yesterday. He has no other patients doing home testing so is uncomfortable with this. The literature said that there is an acceptable variance of 0.6 but in my case that could be 1.9 to 3.l. The 1.9 is not acceptable and he fears that I could have a stroke. I did discuss with him that labs have a variance too depending upon equipment, reagents, personnel and time that it takes to run the test. He rejected that as not true. What can I do to get him comfortable with home testing and using this machine. I got the machine from Home Care Medical. My insurance company denied QAS as a provider and I had me go to the Home Care Medical people. Again, I am the first patient they have had to have this home testing so they will take no responsibility for teaching and following up. I did call ITC and spoke with a technician. She will send me their research which I can share with my MD. I am just frustrated because I have tried for 2 1/2 years to get this approved by the insurance company and now feel that I have to maybe change MD in order to do home monitoring. In all other ways, I like him very much.

Who was the doctor that wrote the prescription for your ProTime? Maybe you can work with that doctor.

 

[Ross]

Dotty this Physician sounds like one that no matter how much postive information, support, or feedback you give, he'll be undetered in his thinking.
What Karlynn says is true. I called my own PCP out about it and he won't play. He was citing the same reasons your Card is. When I told him to do two tests in his own lab and the INR was the same, then I'd believe his lab was accurate. Fact of the matter is, it's not going to happen. Each and every time you test, it's going be different. Well let me rephrase that, if you do get two results the same, you hit a rarity.

PCP said they aren't accurate enough, so I asked him if that was the case, then why did my Cardio's office use them in their clinic. You'd of thought I hit a nerve or something!

 

[Dotty]

Who was the doctor that wrote the prescription for your ProTime? Maybe you can work with that doctor.

The cardiologist wrote the prescription. I don't think he ever thought I would be approved for it!!! or he was just appeasing me. I filled out the paperwork and he just signed it!! I am not giving up and will try to educate him and work with him as best as I can.

 

[lance]

home m monitoring, "professional training"/UAW

home m monitoring, "professional training"/UAW

Our insurance (through the autoworkers) didn't cover home monitoring so I paid for everything. During recent contract negotiations the representative for Daimler Chrysler--didn't want to pay--said the best advice they could give me was to throw the unit away because they were so unreliable I was putting myself at risk. This from an American organization where so many patients home test unlike Canada where very few do. No wonder your MD is suspicious of their value.

Being trained by "professionals" at a hospital earlier this year made all the difference to my PCP. Could you be trained in a similar fashion? Maybe then he would be confident with your using one.

 

[Dotty]

Our insurance (through the autoworkers) didn't cover home monitoring so I paid for everything. During recent contract negotiations the representative for Daimler Chrysler--didn't want to pay--said the best advice they could give me was to throw the unit away because they were so unreliable I was putting myself at risk. This from an American organization where so many patients home test unlike Canada where very few do. No wonder your MD is suspicious of their value.

Being trained by "professionals" at a hospital earlier this year made all the difference to my PCP. Could you be trained in a similar fashion? Maybe then he would be confident with your using one.

I am a professional and very capable of doing these tests. In fact, I have already done two without any problem. My cardiologist is very concerned about the reliability of the machine. I have the microcoagulation system with the curvettes so I am very confident in the results. Somehow I have not pursuaded him of that. I did contact QAS and they will contact him to see if they can answer his concerns better than I did.

 

[catwoman]

Dotty:

Some doctors do use the ProTime 3, some may have an INRatio and others (probably the majority) have a CoaguCheck. My guess is whoever got on the bandwagon first and used the best marketing strategy is who holds the market with professionals.

A year ago I took my ProTime 3 w/ me to San Antonio to demonstrate it to another Coumadin patient. Someone else saw me w/ it and said that she's an RN and that the PCP she works for uses a ProTime 3 (or whatever it's professional version is called).

When a physician has no other Coumadin patients doing home-testing, there's always some hesitancy on their part at allowing a patient to home test.
There's an awful lot of diabetics out there and they all test themselves every day, several times and adjust their insulin according to test results, exercise, etc. I realize that Coumadin and insulin are 2 different animals, but ...

 

[Dotty]

Dotty:

Some doctors do use the ProTime 3, some may have an INRatio and others (probably the majority) have a CoaguCheck. My guess is whoever got on the bandwagon first and used the best marketing strategy is who holds the market with professionals.

A year ago I took my ProTime 3 w/ me to San Antonio to demonstrate it to another Coumadin patient. Someone else saw me w/ it and said that she's an RN and that the PCP she works for uses a ProTime 3 (or whatever it's professional version is called).

When a physician has no other Coumadin patients doing home-testing, there's always some hesitancy on their part at allowing a patient to home test.
There's an awful lot of diabetics out there and they all test themselves every day, several times and adjust their insulin according to test results, exercise, etc. I realize that Coumadin and insulin are 2 different animals, but ...

Marsha...you are correct. I have the Protime 3 and I do know physician clinics do use it and rely on the results. High or low INRs can have serious consequences whereas glucose out of range a bit will not have serious consequences. It is only if they don't test and let their glucose get way out of control. Thanks for your help. It is amazing how frustrating this is for me. I have wanted so much to be independent and free of going to the clinics for testing. I waste several hours doing that and with working full time plus it is very difficult to do on a regular basis. I also test at a variety of clinics because the cardiologist I see is part of a huge medical group (300 MDs) and they have clinics all over this areas...so I go to the place that is most convenient on the day I have to test. Also, some clinics have nicer personnel. The last thing I want to cope with are lab people who are not patient friendly!!! My health has been very rocky...I have had two open hearts in 11 months with numerous cardioversions in between, two pacemakers, severe heart failure and now an ICD. So to get just a piece of independence is worth so much to me.

 

[bvdr]

I think I was so very very fortunate regarding home INR testing. Within 5 minutes of having learned of my need of valve replacement I was also told by my PCP that I should go mechanical and that being on warfarin for the rest of my life wouldn't be that big of deal since I would hometest. I really went home with my head spinning but I never had to battle about getting my protime unit. Who was going to pay for what was another story but not whether I should have one or not. I also would rather be on the high side than the low side of my INR range.

I don't think cardiologists usually manage anticoagulation therapy and maybe he is wondering what he got himself into, particularily since he has never done this before. Did he manage your warfarin before you got the machine?

 

[ccrawford]

Dotty - I may be out in left field, but I have another idea that may appeal to you. I happen to self test and self dose, but my cardiologist was very supportive (he's my son-in-law) and I was determined to gain his total confidence. Given this, I read everything I could about anti coagulation, memorized the dosing charts, got familiar with the drug interaction web sites, learned about the half life of coumadin, etc, etc. While i cannot recite the entire mechanism of the couaguation cascade, I am probably as well informed about coagulation as some docs. My suggestion is that you take an overkill approach and learn as much as you can. In a given time period, your doc will realize you "get it" and will trust your opinion. Hope this helps, Chris