Medical question re INR testing and warfarin on the Camino

[Ant]

In many ways I've been on my own personal "camino" for the last year struggling with health problems. I have a window of opportunity to do the camino (something I've wanted to do for more than 30 years but never had the luxury of 6-7 weeks spare time).

One of the side effects of all the drugs and treatment I've been on is that I am at risk of blood clots (already had two bad attacks) so need to get my blood coagulation levels (INR) checked every couple of weeks and adjust the daily medication (warfarin) amounts accordingly. It is a very simple process. We suspect that the exercise, change of diet, etc, etc will affect the INR levels. So I think I have two options:

Pre-arrange to be tested with local doctors surgeries in Spain (here in the UK it is all done by the nurse). Only takes about 5 mins, then ring my local doctor's surgery with the reading and adjust the warfarin amounts accordingly OR
Buy a portable INR reader and learn to do the process myself, ring through with the reading and be told what warfarin to take if a change is needed. These readers appear to cost about £350 plus weigh about 1K (machine, charger, cable etc)

My advantage is I am bi-lingual English and Spanish so won't have any comms problems in Spain. I would be interested to hear if anyone has any experience of this along the way or any other ideas or tips. I'm planning on starting on 2nd of May 2014.

 

[marjm007]

Buen Camino! I start May 2nd also. I wish I could help with medical advice but I have no knowledge or wisdom to share. See you soon.

 

[RENSHAW]

Perhaps change your thread title - to something including ' Warfarin INR tests on the Camino' , this way you may get some direct advice for a pilgrim who has had the same problem . My bet is that you would have to visit a hospital in a large city along the way each time your 14 day period is due. Logrono , Burgos , Leon. Have your test done and return the next morning for the result.

 

[RENSHAW]

Also the ideal time to take a day off and explore.

 

[PANO]

You may not want to take any chances and luckily you speak Spanish. Why don't you google doctors in towns along the Camino, and call them up on Skype or fax/mail them your medical brief? Set-up a schedule with them; also ask for recommendations, doctors usually know their colleagues in the next towns. The fact that you have 10-12 days in between check-ups gives you plenty of choices and alternatives. Spain has a highly developed medical care system and you will have no problems of getting attended along the Camino. Even tiny villages have a first-aid assistance which can get you to a doctor or a hospital nearby. Carry a smartphone and download one of the many "emergency" apps, e.g. "emergencyAssistence" in iTunes for iPhone. These apps are GPS guided and give you numbers to call nearby your location.

Like most of us in a certain age, I need to take my daily doses of pills to control blood-pressure, cholesterol, etc. My physician was surprised to find that all my parameters were in the green zone on my return from the Camino last year, in spite that I had stopped taking my medicines after a week on my way. Wish you the same experience, while you'll have piece of mind with the suggested preps. And remember: you are never alone on the Camino and it will provide what you need.

 

[ManyMiles2Go]

I also had a blood clot years ago. Not sure of your severity, but with mine, after about 6 months, they got my level to where they wanted it to be and took me off my medication. I now only take a daily aspirin to keep my blood "thinned" out. There were certain foods I was to avoid while on the medication (leafy green vegetables, liver, etc.), but you should not have a problem with controlling your diet on the Camino. The only problem I still have is that when I do a lot of exercising (walking), my leg where my clot was still swells slightly. As you can imagine, it was slightly swelled the entire Camino. I think the beer/wine helped keep my blood thinned out too Hope you have a great Camino and make sure you listen to your doctor!!

 

[JohnnieWalker]

Hola Ant - I take it that you will be carrying a European Health Card. This only entitles you to emergency health care and I think that even if you persuaded doctors along the way to take the blood and send it to the lab you will be charged both for the consultation and the cost of the lab analysis. It may well prove cost effective in the long term for you to invest in your own monitoring device.

John

 

[JohnnieWalker]

Ant - the previous post notwithstanding I've been looking at the website of the Rosaleda - the private clinic in Santiago. They do anticoagulant testing and I am certain there will be similar private facilities in the big towns: Pamplona, Leon, Burgos. I can enquire about the cost and timescale if you like:

El laboratorio de La Rosaleda realiza también la prueba del Sintrom digital que permite, con un pequeño pinchazo en un dedo, obtener los resultados de cada paciente en cuanto a su tratamiento. Unha forma rápida, individualizada y eficaz de llevar el seguimiento de quienes están sometidos a este tratamiento.
En España hay unas 600.000 personas tratadas con anticoagulantes orales debido, en gran parte, al aumento de la esperanza de vida y a que las nuevas tecnologías, como los estudios genéticos y de biología molecular, identifican a pacientes de riesgo.
Se deben realizar análisis periódicos de sangre para controlar su tiempo de coagulación ya que si es muy corto se pueden producir trombosis y si se alarga demasiado existe riesgo de hemorragias. http://www.hospitalrosaleda.com/

 

[grayland]

John,
Is there a way to find a list of these private clinics along the way? It would be good to have that information before it is needed.
Interesting that the private clinic (Rosaleda) in Santiago (that you kindly took me to) was a much cheaper option then the public system..for non-EU members.
They also are much quicker and efficient.

 

[JohnnieWalker]

Interesting question - I am not aware of a list but having one is a very good idea. I'll phone the Rosealeda and ask what their equivalents are along the Camino Frances. From the office we can call the Tourist Offices in the cities and get the information. APOC and the other Amigos and Confraternities could circulate it to members.

You are absolutely right about the charges and not just for non EU members. UK citizens for example visiting Spain are only entitled to emergency treatment which is why medical insurance is so important. Despite the anecdotes of pilgrims being treated free of charge this tends to be for minor issues and in Spain they are really tightening up on providing free health care for foreigners.

Good idea about the list. We'll get on to it.

John

 

[Ant]

Thanks for all the comments and suggestions in the thread here - very helpful. I do appreciate that the European Health card is for emergency treatment only. I was expecting to pay for an INR test so I was going to search for a list of private clinics from here. I can then weigh up the risk/benefits of self testing with a portable machine or booking appointments in some of the bigger towns with a clinic, along the way.

 

[t2andreo]

Interesting question - I am not aware of a list but having one is a very good idea. I'll phone the Rosealeda and ask what their equivalents are along the Camino Frances. From the office we can call the Tourist Offices in the cities and get the information. APOC and the other Amigos and Confraternities could circulate it to members.

You are absolutely right about the charges and not just for non EU members. UK citizens for example visiting Spain are only entitled to emergency treatment which is why medical insurance is so important. Despite the anecdotes of pilgrims being treated free of charge this tends to be for minor issues and in Spain they are really tightening up on providing free health care for foreigners.

Good idea about the list. We'll get on to it.

John

May I interject one suggestion? If John is able to obtain or develop a list of medical providers who can provide diabetic testing and or support along the way, perhaps this could be made available as a resource on this forum or through the Pilgrim Office. Something catchy like: Information for Diabetics on the Camino (Frances). The various helpful tips that have been vetted by diabetics, as well as resources available to them along the way would be helpful.

I know Philip Wren would have sought such a list and would have endorsed it. He was a Type I who wore an insulin pump. As you may know, he succumbed to his illness, or complications related to his long term struggle last May 1 at Logrono, while on his 11th Camino.

Just thinkin...

 

[Roger Hogstrom]

I take warfarin and walked last year. The easyest way was private labs , 6 euros and I got the results after 30 minutes. Touristoffices helped me to find labs and make a list. For this years walk Camino de Levante I´m buying a portebal INR reader, 200 grams including everything.

Roger

 

[Roger Hogstrom]

Hi Ant

Iwalked 2012 and 2013 and checked my INR as I wrote before. Both years I got home after 3 weeks and my levels was high not low. My doctor said that vegetables and walking alot makes INR lower and wine makes it high. My levels should be between 2.0 and 3.0 and after 3 weeks I had 3.8.
If you want to do tests try also Centro de Salud in bigger places they do tests and of cource hospitals.
For me it feels safer to have the possibility to do tests with a testingdevice of my own and send the results to my doctor in Sweden via SMS. By the way the device kosts 650 Euros in sweden

Roger

 

[Ant]

Hi there Roger,

Thanks for the advice and I'm leaning towards buying a portable device, self testing and communicating with my doctor re the results. I've looked online and spoken to the Coaguchek customer service (https://shop.coaguchek.com/) and they have one for £299 and it weighs in at 250 grams. The one at the clinic that the nurse uses must be really old and clunky as it and the charger were at least 1 kilo. My target level is 2.3 and I've had two attacks of blood clots twice and the first was life threatening and I was hospitalised for 2 weeks so I need to be careful. We suspect the extra exercise and change of diet will change things but just don't know if that will be up or down. Unluckily, my INR is not very stable and jumps around a lot.

 

[Roger Hogstrom]

Your INR will probably be up if you like me take 2-3 glasses of wine a day. By the way Coaguchek is the device I´m buying. I have to take a course next week and learn to use it and it cost like I wrote 650 euros here in Sweden.