The patient regularly argues about the results and the indicated Coumadin dose. She argues both with the doctor and with me, her caregiver, who has been doing this testing with her for more years than the doctor. Also, the Dr frequently does not get back to us with the new dose. Home testing is weekly, but the patient wants the test more often because she's sure the medication dose is wrong. So maybe my question is really about what to do when the patient stops trusting the doctor and the caregiver.

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This would have impressed my husband who was an engineer and still had a need-to-know even with dementia. Whether it would comfort your lady is a guess for you to make.

The target for INR value is either 2.5 or 3.0 (depending on the reason wafarin is being taken). In each case, the acceptable range is plus or minus .5. (2.0 to 3.0) or (2.5 to 3.5).

What I would do for my husband is make a simple graph with INR values up the side and weeks across the bottom. I would shade in the band that represents the target range. Then put a dot at the INR reading for each week. It would be very obvious how often the numbers were out of range, and if they were usually high or low. This would give my husband a lot more confidence in the tests! I would do this on the computer, but it would be simple to do on graph paper also.

By the way, because he fell fairly often, eventually it was decided that the risk of a brain bleed outweighed the benefit of the blood thinner, and he was taken off them. It is always a risk/benefit trade off, isn't it? There is no perfect drug.
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Jeanne, thank you so much! As I understand it, Medicare pays for home testing only if it's done weekly. When we used to do it at a lab, the doctor would call in the afternoon, adjust the dose, not tell us the result, and say to go back in 4-5 weeks. No stress!

Today's she demanding that I retest tomorrow morning, although I tested yesterday. I told her that that will NOT be beneficial, it won't give us useful information. And, whatever it says, she's going to want to change the dose again based on that. At the same time, she refuses to look at or understand that I keep a book of every result and dose, going back years. I can see her trends. But now I believe that stress is effecting the results as well.

When home testing began, an RN came out to do the training. The company's been bought out, but perhaps the new company could send someone out...

I'm going to share with her what you said about 96 hours being needed to learn if we've made the correct adjustment. Thanks again!
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"You are right, dear lady. The dose may be wrong. It is very hard to get the dose exactly right for each patient. And that is why we test so often. The complete effect of the drug doesn't happen for up to 96 hours, so testing more often than once a week doesn't really give better results."

If she had dementia I'd ask if it might be worthwhile to take it more often and just not call it in. But if she is of relatively sound mind, I'd try agreeing with her premise -- the dose may need adjustment -- but explain why the testing is done the way it is.

When she argues the the test results are wrong, why would she want the test done more often? If she doesn't trust the doctor, what is the point in asking his opinion more often? Could it be that she is no longer the sharpest crayon in the box?

When the result is significantly different from the previous week, could you play detective with her and try to figure out (guess) why it changed?

Wow, once a week is certainly often. Are her results that unstable? Does the doctor not call back when there is no change to the dose? At our clinic the INR monitoring is done by a nurse with specialized training. Since that is 100% of her job, she is reliable in getting back to you.

I'm sorry you are dealing with this dear lady's mistrust and misunderstandings. At least you don't have to drag her to a clinic once a week!
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