Paulc and someone else mentioned coumadin on another discussion so I thought I would pass this information on. Possibly it will be of help to some of you.
Claude was on coumadin from 1991 until he passed on in 2009. His PT/INR levels could never be kept constant, so we were at the Lab sometimes weekly. As he got worse, it got harder and harder to get him there.
A friend who's husband was on coumadin. sent me a link to www.coaguchek.com. Her husband's cardiologist prescribed it for him. It's a machine very similar to the glucose testing one. You put a drop of blood on a test strip and you get the PT/INR figure within a minute. It's the same type machine Claude's cardiologist used the same machine in his office. His PCP looked into it one time but wasn't sure the $6000 cost would pay for itself.
I contacted the company, got the information and gave it to his cardiologist. He prescribed it and Medicare and our supplemental insurance paid for it and the test strips. The company sent someone to train me on using it. It certainly made his last year easier on both of us.
I understand insurance will pay for the machine.My DH and I are both on bloodthiners.I've ask for it but the Dr. has to prescribe it and mine won't do that for whatever reason.
Yes rebud73086*, that is what we have. I think the doctor has to give a reason for having a home testing machine since it, and the strips, are very expensive. At the time L was getting weekly tests so it possibly made sense for the insurance company economically. I am sure that her pulmonologist noted dementia in part of the reasoning for the machine.
Were you ever given a reason for the variation in his PT/INR levels? It is a mystery to the pulmonologist. There is some problem with variation in diet (I have to remember to serve the same amount of veggies rich in vitamin K every week) but it seems to go beyond that. Plus a change in any medication that processes in the liver will affect the PT/INR levels.
The company we use, Alere, provides excellent support. If you ever have a test strip failure you are to call them and they do a great job of helping you over the phone. And before we ever started using the tester they sent someone to our home to train us.
The test strips are at least $20 per strip. For some reason our insurance company contracted to buy the strips at a higher price but over a year it doesn't affect what we pay so I don't wonder why they negotiated such a bad deal.
DH's cardiologist used to do the tests - and DH had them weekly, sometimes more often. Then the doctor joined a large practice, and they don't do the tests anymore. One of the office people suggested we order the machine and do it ourselves. I asked the pharmacy about the strips and told it was in the $340 range for a package. The machine and strips would be covered by our insurance, but I am not sure I want to do it.
DH already does glucose testing, insulin shots and an MS shot at home. And I know with the Coumadin test, the finger cannot touch the strip -- with his spasms, that is not easy to control. For us, it's easier for him to go to the hospital lab - they bill our insurance $70 a visit.
DH's PT/INR levels often jump out of the 2-3 point range. The cardiologist accuses him of eating green veggies - and I have to assure him, DH does not like most things on that chart, particularly broccoli!!! The fluctuations have to be caused by something else.
Lloyd is on blood thinners. We went last week to see the doctor who specifically handles that aspect of Lloyd's health. We are going every 6 months now. The doctor said Lloyd has progressed to a point where it is just too much for me to get him there monthly. Of course his levels are consistently good, only bad if there has been a medical crisis. Comfort is now the key and as long as he is in no pain, we don't delve into other health problems.
DH likes the trips to the hospital blood lab, it gives him something to do. So that's another reason I haven't gotten the machine to test it at home. His aide takes him to the hospital, then they eat breakfast or lunch in the cafeteria. People know him by name, and that makes him happy, to have people greet him.
His cardiologist is very conservative, and if his blood is anything more or less than 2.5 - smack in the middle of normal - the doctor won't let him go more than a couple days without a test. Funny, but when the cardiologist is out of town, the doctors covering for him will allow DH to go a full week between tests!
As Claude had a heart valve replacement, the cardiologist wanted his INR to be in the 3.0-3.5 range it was a real hassle to keep it in that range. They never really did figure out why it fluctuated so much.
One thing they think could have contributed to it was the difference between the brand name and generic. The warfarin is the same in both but each manufacturer can use different fillers in the manufacturing process. Our insurance required we use their mail order pharmacy, and each time they reordered their supply, they went with the cheapest cost. The doctor would order the brand name coumadin and they would send us the generic. Then the INR would fluctuate, sometimes dramatically. The light finally dawned and the doctor would order "brand specific coumadin". The insurance company didn't like it, but had to dispense the brand name by law at least here in Texas. Like Paul said, the liver metabolizes things differently, and evidently the fillers in the generic didn't work for him.
The company we used was great. They sent someone to train me in how to use the machine and if a strip was defective or if I screwed up in getting the sample, they would replace the strips at no cost and immediately.
The last six months before he passed, both of us were in wheelchairs. It helped my daughter tremendously to have one less trip in transporting both of us and the wheelchairs.
In terms of grrn veggies, it is important to have around the same amount every week. I make sure that we have broccoli 2 days before testing and then a smaller amount the day before.
We have generic warfarin and it hasn't been a problem. But we have the same generic all of the time. If the different generics were changed with each prescription that would be a problem.
DH hates green veggies! Well, he'll eat peas and green beans, occasionally.
What about cranberry juice?
We get generic too and it has not been a problem.
Last year when he was admitted to the hospital for coumadin toxicity, his blood was 7.3 or so - went higher before they brought it down. No idea what caused it. One doc thought the steroids they were transfusing for the MS exacerbation.
L's blood once hit 6.0. This was before we had the home tester. The doctor was quick to call us as soon as he saw the results. He just ordered her to have lots and lots of broccoli or spinach and to stop the Warfarin and to test again the next day. The cause was her having a lot of Tylenol with Codeine for severe pain. The problem is that Tylenol will compete with warfarin for liver function, slowing down the breakdown of warfarin, resulting in a hirer INR (and too little clotting ability).
The reason why prodoxin (sp?) hasn't been approved yet in the US for some cases, such as L's, is because they don't yet have a protocol for quickly increasing the clotting factor if there is a problem, warfarin is easy to deal with in those cases. Her pulmonologist says that he would start putting his patients on prodoxin 6 months after it is approved to ensure that these protocols are in place, but after I said that her neurologist would love her to be on prodoxin to eliminate the drug interactions, the pulmonologist said he would get her on it earlier rather than later, that in her case it was worth the risk. Plus eliminating weekly/biweekly testing would be a plus. Considering the cost of L's blood testing I am sure the insurance company would agree.
Are you talking about Pradaxa? DH's cardiologist did not want to prescribe that for him. We discussed it with another doctor in the group, but he was not in favor of it either.
When DH's blood went up past 7, they hospitalized him and eventually gave him a shot of vitamin K.
I think several of his meds compete for liver function. He is on meds for diabetes, MS and heart.
Interesting about the Tylenol with codeine - DH has had that on occasion.
Claude was allergic to codeine and Tylenol upset his stomach. He could take hydrocordone (Norco) even tho it is a derivitive of codeine. He had extreme degenerative disc disease and arthritis in his lower spine. We tried the pain patch but it wouldn't stick to his skin. The Excelon patch wouldn't stick either.
L's pulmonologist said the problem wasn't the codeine, it was the Tylenol. Just too much in one day. Normally it isn't a problem.
Ms. Magic, yes, Pradaxa. There are some deaths associated with it and the protocols for dealing with too high a level aren't there yet. Those are the negatives. The positives are less testing and fewer drug interactions. For me, and L agrees, the positives outweigh the negatives in her case. But it hasn't been approved yet for her condition. As the pulmonologist said, Pradaxa isn't the wonder drug that everyone thought it would be. Not the first time for warfarin alternatives.
Ms.Magic, as long as you are able to get him out to the Lab fairly easily, go for it. It gets both of you out of the house. Unfortunately, we had reached the point where it was extremely difficult so the machine was a godsend to us.
At least y'all know it's out there if you need it.
We are told that anywhere between 2 and 3 are OK, but a doctor might want to keep tabs on it if there is a change from 2.9 to 2.2 or anything that might be considered a wide swing. I suspect it depends on the doctor and the patient.
Yes, between 2 and 3 is good ... but his doctor is so conservative about things, he wouldn't be happy with 2.5!!!
When his Dr. is out of town and someone else in the practice takes over, they let DH go a week without testing as long as he is in the 2-3 point range. But as soon as Dr. Conservative comes back, it's every couple days.
Paul, you are right, he wants to keep tabs if there seems to be a trend - say it goes from 2.2 to 2.9 in a couple days ... then he decreases the dosage to get it back down to the lower 2's again.
This cardiologist also sends him back for more labs if he doesn't like the results of a blood test for other things - liver function, cholesterol, etc. He want the lab to do a retest to make sure there was no error.
Redbud, I am out of the house, LOL, at work daily!
But DH likes to get out with his aides, Mon-Fri, so the testing is not a bad thing. Actually, when he was bedridden last year, the cardiologist sent home healthcare to DH to test his blood.
I am sure I could manage a testing machine, should we get one, but right now it's just too much to deal with. His spasticity would make it very challenging, more so than blood sugar testing or his shots.
Do these doctors understand that your husband has dementia and this frequent testing has a cost in terms of quality of life (both for your husband and for you)? Of course a blood clot can cause a stroke and lower the quality of life, so I'm not saying that they don't have valid concerns, but may they be overdoing it?
If you already find blood sugar testing challenging I would say skip the home INR testing, I think it requires more blood and I've goofed it up enough times.
His cardiologist and neurologist have different opinions on some meds - she wanted him to take something to give him energy, because MS causes such fatigue, but the cardiologist said no. So we chose not to give it to him, as it would affect his heart.
As far as the blood testing - he does enjoy the trips to the lab with the aide, so I have no problem with that. I just wish we could make them once a week, not every three days or so.
The blood sugar testing is much easier than the INR testing at home. With the blood sugar, you can touch the strips to the skin. WIth the INR testing, you have to hold the strip over the bubble of blood and wait for it to adhere to the strip - and can't come in contact with the skin. Because of his MS and spasms, that is far more difficult to do.
For us, right now, the testing at the hospital is best. I just wish it would be once a week, is all.
The only time his testing affects my quality of life is when the doctor orders it for a Saturday! After getting up daily at 5 a.m. for work, I want to sleep in!!!