Ship MD and Coumadin Check

My husband is on coumadin and I'm wondering if the ship's doctor has the equipment to do level checks during a cruise.

Thanks in advance for your help. (Hopefully he will be stabilized by the cruise and not need 2x week checks!)

My husband is on coumadin and I'm wondering if the ship's doctor has the equipment to do level checks during a cruise.

 

Thanks in advance for your help. (Hopefully he will be stabilized by the cruise and not need 2x week checks!)

Things have a way of changing, so even if someone posts and said it worked for them, I highly recommend you contact NCL special needs services and ask them to check with the ship and confirm that they can do this, rather than just assuming it will still be ok. You can find the email address on NCL website.

My husband is on coumadin and I'm wondering if the ship's doctor has the equipment to do level checks during a cruise.

 

Thanks in advance for your help. (Hopefully he will be stabilized by the cruise and not need 2x week checks!)

If he is going to be on Coumadin for an extended period of time, there is a fingerstick INR monitor that you can get (usually) your insurance company to cover for you, so that you can do your own monitoring. My daughter will be on Coumadin for sometime between six months and the rest of her life, depending on the results of her upcoming hematology consultation for her DVT (clots). It is as simple as doing blood sugar monitoring (a finger stick and putting blood on the monitor strip).

The big problem is getting the updated Coumadin orders. I doubt that the ship's physician would be wanting to do Coumadin management. That leaves calling your PCP ashore every time the INR is done (most docs that I work with will NOT let patients self manage, all they can do is do the finger stick INR's at home so as to avoid Anticoagulation Clinic visits twice a week, but still have to check in with the doc every time you do one to get your updated Coumadin orders).

My husband is on coumadin and I'm wondering if the ship's doctor has the equipment to do level checks during a cruise.

 

Thanks in advance for your help. (Hopefully he will be stabilized by the cruise and not need 2x week checks!)

I would contact the ship directly. My guess is, probably not, but I could be wrong. i too hope he gets stableized. It didn't take too long for my husbend to get his correct. Thank God he is no longer on it and hasn't been for years. For him it was a pretty short lived love/hate affair with the drug.

Nita

Thanks everyone. I will contact NCL and see what they say.

VNAs travel with portable INR devices. I'm not exactly sure of the cost of them but it's a fingerstick test that is done and takes about two minutes to read and the results are right there. However, you'd better have a sliding scale setup for what to do if the INR is too high or too low. I do hope that the INR is regulated better by the cruise to only need the one test during the (week long voyage?). I don't think insurance would cover such an expensive device for one week unless it was something you rented from somewhere.

I would definitely contact NCL's medical department for special requests and here is their email: accessdesk@ncl.com

I would follow up with NCL directly though. I didn't see one out on the tour I had of one of the ship's medical centers but that doesn't mean anything either! :)

PS.. If you have to do the fingerstick test and bring your own unit. Please please for the safety of all involved bring a sharps container and if need be dispose of it with the medical staff onboard.

My impression from reading other posts is that the ships medical center will not perform follow-up type care. They are there for illnesses and injuries that occur after boarding.

We had a similar situation prior to one of our cruises. What we did is found labs in the city where we were embarking/disembarking ahead of time, and picked which one we wanted to go to that was in our insurance network. We arranged to have our doctor send the order to that lab to have the blood drawn and tested there, and the results sent back to the regular physician. Then the new Coumadin prescription was ready at the pharmacy when we got home. It all worked out very smoothly and kept the doctor happy even though it shifted the testing (and starting the new prescription) by just a couple days.

I was on the Dawn in Nov and did see someone getting his INR checked. They can run several blood tests there. You may need orders from MD regarding parameters and dose accordingly. I would still call NCL to be sure

Also you may want to check with your doctor, there is a new drug out that can replace Coumadin, the only difference is that you take 2 pills a day instead of one...and monitering is required...I believe the name of the new drug is Pradaxa...google it..now knowing what the reason for the Coumadin it may not fit your situation...but it doesn;t hurt to ask...

You are such fantastic people! Thank you so much for all your information and help.:)

Also you may want to check with your doctor, there is a new drug out that can replace Coumadin, the only difference is that you take 2 pills a day instead of one...and monitering is required...I believe the name of the new drug is Pradaxa...google it..now knowing what the reason for the Coumadin it may not fit your situation...but it doesn;t hurt to ask...

This drug is only approved for a select group of a-fib patient's. As a pharmacist, I still believe there is still very limited data available for this drug. The drug manufacturer also will tell you that this drug was not designed to replace Coumadin. Also, there is no antidote should a Pradaxa overdose occur. You simply just internally/externally bleed until the drug leaves your system. I say, stay on the Coumadin! Plus it's WAY cheaper!

This drug is only approved for a select group of a-fib patient's. As a pharmacist, I still believe there is still very limited data available for this drug. The drug manufacturer also will tell you that this drug was not designed to replace Coumadin. Also, there is no antidote should a Pradaxa overdose occur. You simply just internally/externally bleed until the drug leaves your system. I say, stay on the Coumadin! Plus it's WAY cheaper!

Good to know thanks...I only heard of it the other day...I wonder if there is no antidote, why it doesn;t require monitering...I doctor suggested it to a friend of mine and you are right he has a-fib...I wonder why a doc would suggest it instead of Coumadin...

My apologies to the OP -

We were on a family cruise with my parents. My mother was injured by a sliding door aboard ship. She is in her mid eighties and takes this drug. She spent several nights in the medical clinic and the doctor requested she have a CAT scan. This took place at the community city hospital in San Juan. She was given clearance to sail and we returned to the ship. The doctor was not happy with the result and was very concerned. Next port St Thomas the doctor requested she go to the hospital because of her EKG results. We were again transported to the hospital in St Thomas to the ER. The doctor checked her and cleared to sail before I could complete the paperwork. Back to the ship with papers for the doctor who was not happy to see us to say the least. We sailed to St Marteen our next port leaving the USA and sea days ahead back to Miami. The medical staff was excellent and took great care of my mother aboard the ship. They had the most up to date equipment and great staff. But understand there are limitations at sea. Some advise for all that have medical history and their families. Buy a thumb drive and go to your doctors and get the most up to date test results with contact information for your doctors before you cruise. EKG's, INR, Bloodwork, Medications and dosages and anything else you can think of. This will provide the doctor with history and a baseline for you. I took two shore excursions that were not on the list, spent two days at hospitals and did not know from minute to minute if I was going to be back aboard the before it sailed. Some free advice for all of my friends on CC.

My impression from reading other posts is that the ships medical center will not perform follow-up type care. They are there for illnesses and injuries that occur after boarding.

 

We had a similar situation prior to one of our cruises. What we did is found labs in the city where we were embarking/disembarking ahead of time, and picked which one we wanted to go to that was in our insurance network. We arranged to have our doctor send the order to that lab to have the blood drawn and tested there, and the results sent back to the regular physician. Then the new Coumadin prescription was ready at the pharmacy when we got home. It all worked out very smoothly and kept the doctor happy even though it shifted the testing (and starting the new prescription) by just a couple days.

This looks like the best idea. One thing I would recommend would be to get a supplementary prescription for 1 mg. tablets, so that if your doc orders a temporary change of dosage, you can easily do it without the need to fill new prescriptions enroute.