Blood Clots And Vaccines
I had a little bit of trouble with my Roche Coaguchek INR meter yesterday and had to phone Roche.
I indicated that I would soon be having my second AstraZeneca jab and measuring my INR before and after as a medical experiment.
I was then told that all vaccines can cause blood clots. That can’t be right?
But Roche should know!
Roche To The Rescue?
This article on the BBC is entitled Covid Antibody Test A ‘Positive Development’.
This is the introductory paragraph.
A test to find out whether people have been infected with coronavirus in the past has been approved by health officials in England.
After false starts with dodgy and unreliable Chinese tests, this certainly is a positive development.
Personally, I trust Roche and their technology, as I regularly use one of their Coaguchek devices to test my INR.
Is There An Interaction Between Bisacodyl And Warfarin Or INR Self-Testing?
I am on long term Warfarin and since 2012, I have self-tested my INR using a Roche Coaguchek device.
I have had no problems and for perhaps the last five years, I have been on a regular daily dose of four mg.
I should say, I’m a trained Control Engineer and if you can keep any inputs, like drug dose, constant, you should get a stable system.
Recently, I have been suffering from severe constipation and my GP has prescribed bisacodyl. I have taken it perhaps five time before bed and it works well
On Friday, I was feeling constipated, so I took one of the bisacodyl tablets before bed.
On Saturday, I tested my INR using a strip from a newly-arrived box direct from Roche and found it was a rather extraordinary 5.2.
I had never seen a result higher than 3.2 before and put it down to one of the following reasons.
- The box of new strips was faulty. I have had dodgy ones before in the past, but not recently.
- There is an interaction between bisocodyl and warfarin. There are no reports on respected sites on the Internet.
- There is an interaction between bisocodyl and the Coaguchek testing process. There are no reports on respected sites on the Internet.
- I inadvertently took the wrong dose of warfarin.
I took a dose of two mg. yesterday and this morning I tested myself again twice.
- With a strip from the new box, found a reading of 5.3.
- With a strip from an old box, I found a reading of 5.
I shall test myself daily until I sort this out.
Keep Taking The Medicine
On Sunday, I usually fill up my daily pill-boxes.
I use my old Coaguchek strip containers, which each box having the pills for one day.
Eleven White Boxes
If I find that I can’t get seven sets of pills, like last Sunday, I know it is time to get my boots out and go to Boots for some more.
The great advantage of individual boxes, is that when I go away, I just take an appropriate number of boxes – two more than the nights I’m away.
Counting out the pills has been a lot easier, since my doctor decided that one pill wasn’t needed any more.
So now, I just put 4 mg. of Warfarin (one blue and one brown), a statin, two other drugs and two vitamin pills in for each day.
I check my own INR and have used 4 mg. a day, for a couple of years now and it tends to hover around the 2.5 level, that I need.
I test myself bi-weekly and only if it is below 2.2 or above 2.8, do I take any action.
Usually, I just stick to the 4 mg. and retest the next day. Very often, it has bounced back, as it was probably something I ate or drunk. Or it could be the weather, as the INR can rise in sun or fall, when you get back to miserable weather.
Some doctors may not like that I choose my own level of drug, but setting the level, is just the sort of problem for which I have a B. Eng degree in |Control Engineering from Liverpool University.
Some of the regimes, I’ve had from doctors and their systems, are pretty complicated and I suspect quite a few patients get confused.
My INR For January 2014
As January is now finished, I can show a graph of my daily INR tests for January 2014.
My INR For January 2014
The average INR for the month was 2.6 with a standard deviation of 0.2. This is well within the range of 2 to 3 and just above the target of 2.5.
I’m using a simple algorithm of 4 mg. normally, with 3 mg. if the INR is above or equal to 2.8 and 5 mg, if it is below or equal to 2.2.
It would be interesting to see if the results with the switch limits set to 2.1 and 2.9, or if a little bit of integral control were to be introduced. As with all control systems, getting everything stable always needs a bit of fine tuning.
Five Months Of Daily INR Testing
I’ve now been testing my INR using my Coaguchek device for five months now.
INR August-November 2013
I’ve missed very few days.
Nothing worries me about the results, but suppose you were testing every two weeks or so, you might start to get the impression your INR results were not what they should be.
I’ve now got enough data to start doing some serious analysis.
The NHS And Disruptive Innovation
I’m a great fan of disruptive innovation. It summed up in Wikipedia as follows.
A disruptive innovation is an innovation that helps create a new market and value network, and eventually goes on to disrupt an existing market and value network (over a few years or decades), displacing an earlier technology.
In some ways the classic disruptive innovation is iTunes, where Apple changed the music industry totally.
I, of course, would be a fan, because my first great success was Artemis, which took the project management industry out of the domain of large mainframe computers and cumbersome management structures into a computer that fitted under a desk.
But I have given this post, the title I have, as the NHS and other health systems is coming under pressure from disruptive innovation.
My other big innvation success was also disruptive innovation.
I was one of the backers of the technology that led to Respimat, a metered-dose inhaler.
That device seems to be too disruptive, as despite many years of development, I don’t think it is in general use.
It doesn’t use any batteries, compressed gases, nasty chemicals and is affordable to be throwaway. But despite their HCFC propellants, the incumbents in the healthcare industry, have not given market share.
But I have the satisfaction, that because of my scientific knowledge and practical experience, I spotted that the guys I backed could do something special. At least too, when I sold my share, I was well rewarded.
I do feel though that the NHS doesn’t do things in the same way as perhaps John Lewis would, when it comes to handling new methods of working.
As an example I was talking to my excellent GP about how having my cholesterol results on my blog, helped the doctors in Hong Kong when I had my stroke. I said it would be great if all our medical records were searchable on line. We were also discussing a small operation I had on my nose ten years ago and wondering if it should be done again to stop the nose bleeds I sometimes get.
We then both said that computerisation had been an expensive farce, but we were both agreed it would be a good thing, especially if like me you travel a lot. He did say Google launched something called Google Health, but that has now been discontinued. Read about it here.
So did the general conservatism of health professionals and a lot of the general public kill the project. Google don’t have many failures.
Reading about it, it seems that it would have been something I would have used.
If I look too at my Coaguchek, that is classic disruptive innovation. I don’t know how many use the device in the UK, but I suspect it’s not a large proportion of those who could benefit from such a device.
I suspect though that in a few years this device and its probably simpler successors will be as accepted as the monitors used by diabetics.
Small personal patient used technology like this will become more common. After all, we now have a population, who love their gadgets and what better gadget is there, than one that helps you improve your health.
The NHS is going to have to get used to new technology and especially where that technology shows substantial cost savings. But a lot of it, will mean changes in methods and management structures.
Disruptive innovation will improve the NHS, but it will be an NHS with a different number and type of hospitals, and staff not always deployed as they are now.
My INR For September 2013
As September is now finished, I can show a graph of my daily INR tests for September 2013.
My INR For September 2013
The average INR for the month was 2.4 with a standard deviation of 0.2. This is well within the range of 2 to 3 and just below the target of 2.5.
Note the drop in INR starting at the 19th. This was when the weather started to get colder and fresher. The lowest value of 1.9 on the 27th was after a particularly cold night.
Compare this graph with previous results for August 2013.
Some Can Do Customer Service
i returned back today from some shopping and found the tickets I ordered yesterday from Ipswich Town on the mat. And then after I’d been in for a few minutes, a courier delivered some Coagucheck strips from Roche, that I’d ordered from their web site on Sunday.
I’d also had a good shop, getting the cord trousers, I wanted for the winter, to replace the ones of the same make, I bought over twenty years ago. They’re still the same size.
A Coaguchek Failure
I get on well with my Coaguchek, but I did have a failure in Sweden.
The batteries chose to run out and I then had to reset the device.
Unfortunately, it is not an easy process to do without the manual, which I deliberately had not taken.
An ideal device would have a quick setup, where it took defaults for everything. After all, you always write down all your results and don’t rely on things like the date set into the device.
Everything should be simple and intuitive. It isn’t and the manual is needed too often. It also just gives you error numbers, rather than a proper error message.
The outcome was that I missed one of daily tests. Not important for me, as I just took the average Warfarin dose of 4 mg.
The Anonymous Widower 