Posts Tagged ‘CBC’

Not on MY life!!!

October 9, 2008

This is unreal.

My hospital is not going to be doing the prothrombin test anymore: That’s the test of the Warfarin level in my blood that gives me my INR number. And it isn’t really their fault — their accreditation agency told them to stop offering the test. Apparently, if your Hemocrit is above 55%, they have to hand-calculate the results to determine the correct INR. The hand calculation means they can not guarantee the accuracy of the results, and so they ordered the hospital lab not to offer that test anymore.

I’m not mad at the lab techs. They are some of the nicest people I’ve met, and always bend over backwards to help me out or to hurry up the process if I ever need a test rushed. And they can still do the CBC test for me. But I’d really like to talk to someone from the accreditation agency. if you aren’t offering this test to people with a Hemocrit over 55%, what about the patients in the hospital? And if you suddenly can’t speak for the accuracy of the results, then what about all my previous results? I’ve had that test done once a month for SIX YEARS; are those results suddenly no good?

But like I said, I’m not mad at the hospital lab. I’m not mad at the accreditation agency, though if I sat down and asked them some questions, I’d probably be steaming before we were through. You are about to meet the people I am really mad at.

Before I even knew there was a problem, my doctors and nurses in Atlanta learned about it and were trying to work out the problem. One of my Nurses Googled my area and found this group of doctors, who have an office about half a mile from the hospital. She called them, explained the situation, and asked if they would be willing to do the prothrombin test for me.

Now don’t let the fancy name fool you. They aren’t a state agency, what they are is a group of 24 cardiologists who, along with their Nurses and Nurse Practitioners, work at five offices spread throughout the middle part of the state.  So my Nurse asks if they are set up to do a prothrombin test on a patient with a Hemocrit above 55%.

Certainly! came the answer.

Can you do it for a local patient of ours, and forward the results?

Absolutely not.

Before they will do a lab test for me, I would have to transfer all of my cardiac care to them. Look down their list of doctors — there is not a Pediatric Cardiologist in the entire group, much less an Adult Congenital Heart Specialist. But they are arrogant enough to demand that I leave the doctors and nurses that I trust, and who specialize in care for my heart, before they would stick a needle in my arm.

I’ll answer them with the same answer they gave my nurse: Absolutely not.

South Carolina has the highest death rate from heart disease in the country. Heart disease – the problems you have when you age, nasty stuff builds up in your arteries, and you have heart problems because of that. If you have a heart attack followed by a bypass, these are the guys for you. Congenital Heart Defects are pretty consistent throughout the population: 1 in every 125 people have a CHD; slightly more in some areas; slightly less in others. The composition of their staff shows that they are not interested in dealing with Congenital Heart Defects; I guess it just isn’t a “growth industry.”

And that is why I am miffed. They have offices in the larger cities, but they also have some offices in smaller areas. It would be the perfect situation for them to hire a Pediatric Cardiologist and move him/her between these smaller offices, providing good health care to sick kids (and adults) in the rural parts of the state. But it seems that they are chasing the dollar bill. Maybe that heart on their sign should be green, not red.

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If it’s Thursday, it must be Blood Day

August 20, 2008

Tomorrow, as usual, I’m heading to town. I usually get groceries on Thursdays. And while I’m in town, I’ll swing by my local hospital and have my blood checked.

It can be a pain in the neck, (the arm, actually) but if you have a CHD, you come to think of it as “one of those things.” Into every life a little blood work will fall. My local hospital is a small, 130 bed facility, that can’t handle my heart problems. Don’t get me wrong, they are good at what they do. But 90% of the stuff they see is broken legs, infections, and requests for blood work. If I have a serious enough problem to require hospitalization, I probably won’t be a patient here.

The nurses all know me; they are a fun group of people. So I’ll be greeted by name when I walk into the lab. My usual tests are a CBC – Complete Blood Count, in which the level of nearly everything you can think of is measured. Red blood cells, white blood cells, hemoglobin, and a dozen other readings are measured. If something goes wrong in your body, it will usually show itself by changes in your blood chemistry, so this is why I have this test.

I also have a test the Lab techs refer to as “protime” — at least, that is what it sounds like. I’m take a blood thinning drug, and it is monitored monthly. If the Anticoagulation Center that my ACHD doc works with determines that I need to either increase or lower my dose of blood thinner, they will call me before the day is out. I have no idea why it is called a protime test, but if being a pro means getting a needle shoved up your arm, I’ll gladly remain an amateur! As i said, it is usually a monthly test, but lately I’ve been getting that checked every two weeks. I’m changing an unrelated medication, and the change causes the protime numbers to do weird things.

The results of a protime test are reported as the INR number. INR stands for International Normalization Ratio. In the past there was no set standard for reporting the results, a test at one lab may result in a score of 75, while a test at another may score a 2.6. So they put their heads together at the World Heath Organization and decided on a standard, the INR number.

Before they stick you the Lab Tech will ask you for your name and your birthday and compare it to the form the computer just printed for them. Occasionally I refuse, saying that I tell them this every time I come in but no one has sent me a birthday card yet. You can get away with that if the Lab isn’t too busy and you have a smile on your face. Occasionally on holidays I’ll throw another answer out there (“Paul Revere, July 4, 1776!”) but when the lab tech offered to bend me over the table and take the sample from my… hip, I figured I had just about worn that joke out.

When you have a Congenital Heart Defect, it’s not really the big things that bother you. It’s understood that I might need surgery in the future, but until then, what can I do? I exercise and try to stay in decent shape; and I’ll deal with that when (and if) the time comes. I’ve found that it’s the little things that really bug me. These blood tests take about half an hour, at the most. And I work it into my usual schedule so I don’t have to make a special trip. But it is just the idea of it… I’ll be doing this once a month forever. You always have to get that blood checked. You always watch your sodium and your liquids.

If you let it get to you it gets depressing. So you look at it as a step in accomplishing your goals. If I want to stick around long enough to meet that perfect woman, I’ll get that blood test. If I want to have the house and the picket fence, I’ll turn down that awesome dessert.

I do what I have to do to defeat the evil that is inside of me.