My experience is a bit differenet. First off I was told that even if I get an elevated reading I am NEVER to accept a HOLD dose order. Even if all I took was 1mg I was never to hold it. The first thing that should have been done was to lower your dose slightly when the steroids began. I do not know your target but many have a target of 4.0 so you can imagine that 4.3 was a bit over-reacting. Although yes it increased bleeding risk a dose stop was just poor management.
IF IT WERE me I would do what I know has worked best for my body and when you get to level let them know what dose is working. BUT not EVERYONE feels comfortable in that or has figured out their own rhythm yet.

Good luck and tuch this one under your cap of knowledge for the next time you need steroids or antibiotics.

oops I now see your range but the point is still valid.

I am trying to switch to a Coagucheck but it is an insurance nightmare right now. My Dr. prescribed one through Roche Labs, which apparently has some kind of value-added service where one turns in the results to them, and they work with the PCP and the patient in some way for the dosing part.
Something about it seemed fishy, given that self-dosing is off limits, there is no face to face, and neither they nor the PCP appear to avail themselves like a clinic would; though the clinic is dangerously only once a month.
The whole thing is on hold now since the arrangement would be expensively out-of-network with the insurance company. Given that diabetics now have over half a dozen cheap off-the-shelf glucose testers to choose from at any drugstore, and they have been trusted to take control over their own monitoring for decades, somehow we should be empowered to manage the hazards of our own condition and get timely action.

BeeCute,

When the Coumadin Clinic was using he Coagucheck on me post op, I learned that when the INR is high 3.8 or up, that the machine was not as reliable. A PT/INR test (blood draw) confirm this. Turned out when it said it was 3.8 then I was really 3.0. Might be the same problem your having (or not).

Just wanted to throw that out as a possibility. From everything I've seen, read, and discussed before audiences of patients, everyone loves them and there are a lot of medical studies showing they can be as reliable if not better then lab testing (exception of high INR). Dr. Jack Answell did a whole show on Discovery Health (check it out on-line) about anticoagulation management and discussed the issue of Home INR testing in a positive way. I know Jack and he is firmly behind the process.

Regards,
Tom in Connecticut

When I check my INR I call the company who issued my monitor. If I am out of range they immediately forward my call to my primary care physician who then regulates my dose. However my Primary care physician is also the one who has always done my dosing. The company QAS also immediately faxes a copy of my PT/INR to my doctor. I am going to bet it all depends on who actually does your dosing. Since I live at end of the earth Idaho we don't have things like Coumadin Clinics, just doctors offices so that's why I get put in touch with the doctor who does my dosing. My machine is the inratio 2 which is the newest of the monitoring devices and i love it. Even here in the hospital the doctor has me do my INR so she can find out what my INR is while she is standing here instead of having to wait for the lab to get the results back.
Hope things start to work out for you soon
Hugs
Ferr

When I switched Dr.'s, my new Dr. asked me if I thought I could do it myself-as I was complaining that the old Dr. made too drastic of changes and had me on a roller coaster most of the time constantly changing my dose and poking the crap out of me too. I have been doing it myself for the past 6 months and have bounced around a little bit -but within the 2-3 range-a couple times over 3.0 -but as long as I am between 2 and 3.5, I am on my own. You will get the hang of it.
If they told you to take a lower dose for a week, and you are pretty sure it will not get you in safe range, then take it for a day or 2 and check your level, and if it isn't coming up, then call. That way the Dr. won't think you are being pushy without a good reason. My old Dr. had some sort of control problem. Blessings, Teri

Hi Beecute,
I'm in the UK and attend a local warfarin clinic so have no experience of the home monitoring. I just wanted to add that I had an INR test a few weeks ago which was just a little high at 3.1. I only take 3mg and 4mg alternate days and was told to reduce the dose to 3mg each day. I checked my record book to find that 6 months ago the same thing happened and my INR dropped from 3.2 to 1,6 in 2 weeks! As I was just about to go on a 7 hour flight I really didn't want to be so low again and risk more clots. I phoned the hospital who agreed with me and decided to leave my dose as it was until I returned from holiday. My INR this week was 2.3 so I dread to think what it would have gone down to if I had just accepted their instructions.
I suppose what I'm trying to say is that I think we each know ourselves better than the doctors at times - and so you should insist that they listen to you if you think that they are wrong !!!Good luck - Sandi x

Thanks for all of your replies.
I was going to a coumadin clinic that used the same type of Coaguchek that I am now using at home.
Now, instead of actually going to the clinic, I just call in the results and talk to someone on the phone there.
I really think the clinic manages my coumadin well in general.
It's just a matter of getting used to this phone communication...

BethAnneS, the reason I had to HOLD doses is that my normal does is very low. Since I metabolize it slowly, I only take 1.5mg of coumadin a day. I know I am unusual like that.

Flipperclot, I think your advice is good. I'm going to follow the coumadin clinic's advice until Monday, test again and call again. That's the advantage of having a home monitor.

RetiredNavy, I really think home monitoring is the way to go and am excited about my own Coaguchek. I hope this discussion doesn't confuse anyone about that. I recommend it. I find it easy to check and so nice to know the results.
I just want better communication when I call in my results.
That's just a local issue with the specific nurse that I talked to this week.
I'm sure it will get worked out.

Just another thought that I did not see expressed on any of the replies is this:

My Drs have told me that it will take 72 hrs to see a change in your INR after making a dosage change. I did actually get that advice from more than one Dr, which seems to be one of the few things they have agreed upon.

So I look back at when the dosage change was made and not get too excited about the INR being a "true" reflection of that change for at least 3 days. I hope that made sense. That is of course also taking into consideration all other factors that effect the way your body is processing the coumadin - ie like your steriods and other meds, your food intake etc... Like one of my Drs told me, "You are always chasing warfarin. Only you know what you have done such as, recent activity level, what you have eaten or taken, that may change your INR today. But remember the lag time"

Thanks. That makes sense.

I also wonder if the nurse knows something about the half-life of steroids...perhaps they will still be in my system and interacting w/coumadin even though I quit taking them a few days ago.

UPDATE:
I took Teri's advice and took it before the week was up.
I had dropped even lower to 1.3. Yikes!
I talked to a different medical professional this time.
I told her I wanted to go back to my regular dose that worked for me for months.
She said that was good and is having me call back in a week.

I think I will have this figured out soon.
I think part of it is learning to be assertive on the phone about what I know about my body and my dosing.