Did This Get Lost In The Covids?
In October 2019, I wrote Asthma Carbon Footprint ‘As Big As Eating Meat’ and it made me think, when I just read it.
I would normally follow up a post like this, but I don’t remember doing anything like that.
The Wikipedia entry for the COVID-19 pandemic in England, starts with this paragraph.
The COVID-19 pandemic was first confirmed to have spread to England with two cases among Chinese nationals staying in a hotel in York on 31 January 2020.
It looks to me, that like everybody else in England, I had the Covids on my mind.
Is Respimat A Zero-Carbon Inhaler?
Just to be sure, I asked Google AI, the question in the title of this section and received this reply.
The Respimat soft mist inhaler is considered to have virtually no associated carbon emissions from its operation because it does not contain the high global warming potential (GWP) hydrofluorocarbon (HFC) propellants found in metered-dose inhalers (pMDIs).
While it has a substantially lower carbon footprint than traditional pMDIs, it is not strictly “zero-carbon” when considering its entire life cycle, which includes manufacturing, materials (stainless steel, aluminium, polymers), and end-of-life disposal. These factors contribute a small product carbon footprint (PCF).
According to Google AI, a reusable version is available.
A reusable Respimat device has been introduced, which further reduces the carbon footprint by up to 71% over six months compared to the disposable version because the device itself is kept longer, reducing manufacturing impacts.
Google AI says this about NHS guidance.
Health bodies like the NHS encourage the use of lower-carbon inhalers like the Respimat or dry powder inhalers (DPIs) as part of their net-zero targets, provided they are clinically appropriate for the patient.
But it does seem that Respimat devices are helping to cut global warming.
What Is The Patient Experience Of Respimat?
Google AI gave this answer to my question.
Patient experience with the Respimat inhaler is generally very positive, with high satisfaction for its ease of use, handling, and the “soft mist” it produces, leading to high continuation rates in studies; patients find it easier than many older devices and report good effectiveness, though common side effects like dry mouth, cough, and sore throat can occur.
Key Aspects of Patient Experience
- High Satisfaction: Over 85-90% of patients report being satisfied or very satisfied with the Respimat’s handling and the ease of inhaling the mist.
- Preference Over Other Devices: Many patients prefer Respimat over traditional metered-dose inhalers (pMDIs) or dry powder inhalers (DPIs), finding it easier to use and more effective.
- Soft Mist Technology: Patients appreciate the gentle, slow-moving mist, which helps deliver medication effectively and feels different from a typical puff.
- Good Adherence: High satisfaction often translates to continued use, with physicians reporting high patient adherence and continuation rates after studies end.
- Improved Technique: While initial use might need guidance, pharmacist-led interventions show significant improvements in patients’ inhalation technique over time.
That doesn’t look bad to me!
Could Immunotherapy Drugs Be Delivered By An Inhaler?
We always felt the device could deliver other drugs.
Google AI gave this answer to my question.
Yes, immunotherapy drugs could potentially be delivered by an inhaler, and this approach is a promising area of active research and development, particularly for treating lung cancer and respiratory diseases like asthma.
Rationale and Research
- Targeted Treatment: Inhaled delivery allows for high concentrations of the drug to be delivered directly to the lungs, which is particularly beneficial for treating lung-specific conditions like lung cancer or severe asthma. This localized approach aims to maximize the therapeutic effect where needed.
- Reduced Side Effects: By concentrating the medication in the lungs and minimizing its systemic absorption into the bloodstream, researchers hope to significantly reduce the severe side effects (e.g., systemic toxicity, autoimmune reactions) commonly associated with traditional intravenous or oral administration of some immunotherapies and chemotherapies.
- Patient Convenience: Inhalation is a non-invasive administration route, which is more convenient and comfortable for patients compared to injections or intravenous infusions, potentially allowing for self-administration and improving patient compliance.
The Soft Mist Technology could surely be a help!
Was Osborne Reynolds The Greatest Fluid Dynamicist?
I have to ask Google AI this question, as some of the discussions that led to creation of Respimat, took place in my house at Debach, where Osborne Reynolds had lived.
Google AI gave this answer to my question.
Osborne Reynolds is considered one of the most influential and foundational contributors to the field of fluid dynamics, though naming a single person the “greatest” is subjective. His work fundamentally shaped modern engineering and physics and remains central to the study of fluid flow today.
Key Contributions to Fluid Dynamics
Reynolds’ most significant achievements include:
- The Reynolds Number: He identified a crucial dimensionless parameter (now named the Reynolds number) that determines whether fluid flow is laminar (smooth and orderly) or turbulent (chaotic and eddying). This number is a foundational concept used across all engineering and physical sciences.
- The Theory of Turbulence: In an 1895 paper, he established the standard mathematical framework used in the study of turbulence, introducing what is known as the Reynolds-averaged Navier–Stokes equations.
- Experimental Validation: His elegant, yet simple, dye experiments visually demonstrated the transition between flow regimes, providing clear empirical evidence for his theories.
- Theory of Lubrication: He developed the Reynolds equation in 1886, which still underpins the analysis of hydrodynamic lubrication in modern bearings.
- Heat Transfer and Similitude: His research into heat transfer between solids and fluids led to significant improvements in boiler and condenser designs, and his work on hydraulic similitude enables engineers to use scaled-down models (e.g., in wind tunnels for aircraft design) to predict the performance of full-scale machines.
How Many Good Ideas Did The Covids Delay?
It could be that the roll-out of Respimat for was delayed by the Covids!
But it wouldn’t have been the only idea to have been delayed in that way!
My Family And Lunchtime Naps
Consider.
- My father was a great one for a lunchtime nap of perhaps thirty minutes after his sandwiches and a cup of tea in his print works in Wood Green.
- I can still see him sitting there on a wartime Utility dining-chair fast asleep.
- As my paternal grandfather was a professional alcoholic, I suspect he slept a lot. But whether he took naps, I do not know.
- I’ve always been prone to fall asleep, but as I’ve got older, I seem to do it more often.
- My middle son, also had a nap after Christmas Lunch last year. But was that just coincidence.
These are questions, that I’ve asked Google AI.
Are There Any Medical Benefits Of The Spanish Siesta?
Google AI said.
Yes, there are potential medical benefits associated with the Spanish siesta, which is a short afternoon nap. Studies suggest that siestas can improve cognitive function, mood, and cardiovascular health. A well-timed and appropriately short siesta can help reduce stress, improve memory consolidation, and even lower blood pressure.
That seems fairly positive.
Will A Spanish Siesta Help Atrial Fibrillation?
I ask this question, as I have atrial fibrillation and I was told, it caused my stroke.
Google AI said.
Spanish siesta, or daytime napping, is not a guaranteed or recommended treatment for atrial fibrillation (AFib). While some studies suggest a link between napping and AFib risk, the relationship is complex and depends on nap duration and individual factors. Short naps (15-30 minutes) may be associated with a lower risk, while longer naps could potentially increase the risk, especially in those with hypertension.
As I don’t have hypertension, it could be positive for me!
Does Atrial Fibrilation Run In Families?
Google AI said.
Yes, atrial fibrillation (AFib) can run in families, meaning it can be inherited. While many cases of AFib are linked to lifestyle factors, age, and other medical conditions, a significant portion of individuals with AFib, especially those with no clear cause, have a family history of the condition. Studies suggest that up to 30% of people with AFib of unknown cause have a family history of the condition.
As my father’s medical history seems fairly similar to mine, I wouldn’t be surprised if he had had it.
Is there A Connection Between Atrial Fibrilation And Coeliac Disease?
Google AI said.
Yes, there is an association between atrial fibrillation (AF) and celiac disease (CD), with studies indicating an increased risk of AF in individuals with CD. This connection is thought to be linked to the inflammatory nature of both conditions.
I have both and I suspect my father did too. We both had a serious stroke at around sixty.
My father had a second, which killed him a few years later. Modern pharmaceuticals have probably kept me alive.
Deadly ‘Climate Change’ Fungus Targeted In Drug Project
The title of this post, is the same as that of this article in The Times.
This is the sub-heading.
Dundee University team leading fight against Candida auris, a type of yeast that causes severe illness and spreads easily among hospital and care home patients.
These are the first two paragraphs.
A rapidly growing deadly fungus, thought to have emerged in humans due to climate change, is one of the targets of a £17.9 million drug project.
Candida auris is a type of yeast that can cause severe illness and spreads easily among patients in healthcare facilities. It was first seen in Japan in 2009 and has spread worldwide, with outbreaks in hospitals in the UK, South Africa, India and parts of North and South America.
These are points from the rest of a must-read article.
- The first cases in the UK were recorded in 2014 and numbers have been rising yearly since 2020.
- Found particularly in hospitals and care homes.
- Many infections occur when medical devices such as catheters or ventilators are fitted to patients.
- I’ve had my fill of catheters, when I had my stroke in Hong Kong.
- Immunocompromised people are most at risk.
I may be coeliac, but I tend to believe my immune system is like a platoon of SAS soldiers on steroids. It certainly gave the AstraZeneca viral vector Covid-19 vaccine a good kicking. But it welcomed the second dose, like a long-lost friend.
I asked Google if there was any interaction and got this reply.
While Candida auris is a serious fungal infection, it is not directly linked to celiac disease. However, Candida albicans, another type of yeast, has been implicated in the development or exacerbation of celiac disease through mechanisms like cross-reactivity and molecular mimicry.
I shall act responsibly and hope for the best.
But.
- Research at the University of Padua has shown, that diagnosed coeliacs sticking to their gluten-free diet, don’t get serious doses of Covid-19.
- Research at the University of Nottingham has shown, that diagnosed coeliacs sticking to their gluten-free diet, have a lower cancer rate, than the general population.
- I’ve very rarely had colds, flu and other infection, since my diagnosis as a coeliac and going gluten-free in 1997.
- I’ve never had Covid-19.
A Floridian restauranteur once called me one of the Devil’s children, as I was a coeliac. If that is true, she certainly looks after her own!
Alzheimer’s Expert Was Treated Like A Heretic Until Now
The title of this post, is the same as that of this article in The Times.
This is the sub-heading.
For decades Professor Ruth Itzhaki believed there was a link between Alzheimer’s and the virus that causes shingles, and has just been vindicated
These two paragraphs outline an amazing story.
Ruth Itzhaki does not, she says, refer to it as her time “in the wilderness”. When she reflects on the decades investigating — often almost alone — whether Alzheimer’s could be triggered by viruses, she prefers a different term. “I’d call it, ‘repeated burning as a heretic at the stake’. ” For much of her career she was treated “contemptuously”.
Today, as yet another study finds that the shingles vaccine appears to cut dementia risk, that has changed. At a stage in life when most researchers are retired, Itzhaki, an emeritus professor at Manchester University, finds herself reviewing studies from around the world. She is treated with contempt no more. But, she says, it has not been fun. “I just have to stop myself from being bitter.”
Sad to say, it is not an unusual story.
This was the comment, I appended to the Times web site.
There was a wonderful BBC Panorama about a Glasgow Veterinary professor, who believed the messenger of the body was an oxide of nitrogen, at least twenty years ago.
He was ostrasised for being a heretic.
Eventually, he was proved to be right.
I might have exposed how a simple treatment for stroke is ignored in the UK.
I was found to be coeliac at fifty and Addenbrooke’s hospital said that I should have B12 injections every three months.
In my sixties, I had a serious stroke and if I lived in the States, I would have been given B12 injections to aid my recovery. But that simple treatment is not used here, as it is considered American quackery.
However, several doctors have said, I have made a remarkable recovery. Was that because of the B12 injections, I still have?
More research needs to be done and I’ll travel anywhere to help any doctor, who is doing serious research.
It could just be, that as a London Mongrel, I have more survival genes, than a small field of Japanese Knotweed.
I should add, that as the date of my next B12 injection approaches, I can almost feel, the various parts of my body fighting for what little I have left.
But what do I know? I’m just a slightly crazy engineer/scientist and mathematician, with no medical training, who has been given an unusual body to investigate.
Are Too Many Pharmaceuticals Round And White?
Last week one of the nine pills I take was changed from a small plain cream pill to one that was white, slightly larger with a slash on it.
I now take nine pills daily of which five are white and round, with two having slashes on them.
It didn’t cause any confusion with the dispensing, as I made sure I only pre-loaded a week’s drug containers. But, when I went to fill up Tuesday’s and Wednesday’s containers for this week, I couldn’t find the new drugs, as I’d confused them with the other drug with a slash and put them in the wrong drawer of the cabinet, where I store the drugs.
I put the confusion down to two many similar white drugs.
As a child, I used to build radios and amplifiers, so to avoid mistakes electricians and engineers started to use colour-coded wires, for all the different signals.
It became important, as some voltages used in high-power amplifiers could kill you. As Keith Relf of the Yardbirds was!
But then white drugs are cheap, just like grey cables.
First Commercial-Scale Seaweed Farm Between Wind Turbines Fully Operational In Netherlands
The title of this post, is the same as that of this article on offshoreWIND.biz.
This is the sub-heading.
The world’s first commercial-scale seaweed farm within the Hollandse Kust Zuid offshore wind farm in the Netherlands is fully operational.
These initial three paragraphs fill out the details.
According to the non-profit organisation North Sea Farmers (NSF), the final deployment step was completed one week ago by deploying the seeded substrate.
North Sea Farm 1, initiated by NSF with funding from Amazon’s Right Now Climate Fund, is a floating farm located in the open space between wind turbines where seaweed production can be tested and improved.
The seaweed farm is located within the Hollandse Kust Zuid wind farm, nearly 22 kilometres off the coast of Scheveningen. The 1.5 GW project is owned by Vattenfall, BASF, and Allianz.
I find this an interesting concept.
I can remember reading in the Meccano Magazine in the 1950s, about the production of alginates from seaweed in Scotland.
Surprisingly, Wikipedia has very little on alginates, except for this illuminating Wikipedia entry for alginic acid.
This is the opening paragraph.
Alginic acid, also called algin, is a naturally occurring, edible polysaccharide found in brown algae. It is hydrophilic and forms a viscous gum when hydrated. When the alginic acid binds with sodium and calcium ions, the resulting salts are known as alginates. Its colour ranges from white to yellowish-brown. It is sold in filamentous, granular, or powdered forms.
But it does appear that the Scottish production of alginates is very much of the past. Unless someone else can enlighten me!
Perhaps Scottish seaweed farming can be revived to produce alginates, which appear to have a surprising number of uses, as this section of the Wikipedia entry shows.
Alginates do appear to be remarkably useful.
These are a few uses.
- As of 2022 alginate had become one of the most preferred materials as an abundant natural biopolymer.
- Sodium alginate is mixed with soybean protein to make meat analogue.
- They are an ingredient of Gaviscon and other pharmaceuticals.
- Sodium alginate is used as an impression-making material in dentistry, prosthetics, lifecasting, and for creating positives for small-scale casting.
- Sodium alginate is used in reactive dye printing and as a thickener for reactive dyes in textile screen-printing.
- Calcium alginate is used in different types of medical products, including skin wound dressings to promote healing,
Alginates seem to have some rather useful properties.
Four years ago, I tripped over in my bedroom, which I wrote about in An Accident In My Bedroom. I wonder if the Royal London Hospital used calcium alginate skin dressings to restore my hand to its current condition.
Paul Daniels would have said, “It’s magic!”
In the future these dressings may be produced from UK-produced seaweed.
Gluten-Free Egg Sandwiches From Boots
This morning, I had to pick up a prescription from Boots on Moorgate in London.
I use them, as they are by the 141 bus stop, that I can use to get home, so I pass their outlet regularly throughout the week.
After picking up my prescription, I looked at their small food counter. I was actually looking for milk, as I am out and nowhere on the West side of Moorgate sells small one pint bottles.
They didn’t have any, but they did have two flavours of gluten-free sandwiches; cheese and egg.
So I bought a pack of the egg sandwiches.
These pictures show the one, I have just eaten for lunch, with a beer and a banana.
Note.
- In the last picture, the Adnams 0.5 % Ghost Ship can, is marked with the gluten-free symbol.
- The only allergens noted on the sandwich packet are egg and mustard.
- The bread looks like it could be Genius, which is a brand of gluten-free bread, that I trust.
- The packaging can be recycled.
The sandwich was excellent, but then on past experience at the Tate Gallery and Blackburn Cathedral cafe, gluten-free egg sandwiches are a good combination of flavours.
So next time, I’m hungry, I’ll march into Boots.
£20 Electronic Ear-Clips Train The Body To Decrease Blood Pressure
The title of this post, is the same as that of this article in The Times.
These two paragraphs outline how the device is used.
A £20 device that delivers “tingling” electric pulses to the ears and can be worn at home could be almost twice as effective as drugs at reducing blood pressure, a neuroscientist has said.
Early trials suggest that wearing the small electrodes clipped to the ears for half an hour per day over two weeks while relaxing, watching TV or eating can reduce blood pressure by up to 15mm of mercury (mm Hg), compared with 8mm Hg to 10mm Hg for drugs such as Ace inhibitors or beta-blockers.
It appears the device has been developed at University College London.
Would I Use Electronic Ear-Clips To Control My Blood Pressure?
Soon after my wife died in 2007, my cholesterol levels rose.
The Ipswich Town Physiotherapist, who was a drinking partner before matches at Portman Road, recommended that I see his dietician.
She identified the following.
- My diet had changed since my my wife’s death, as I was choosing the food and doing the cooking.
- She suspected, that I wasn’t eating enough soluble fibre.
- I was eating enough fruit and vegetables.
Her solution was two-fold.
- Swap butter and other spreads for Benecol.
- Make sure, I eat, at least one small tin of baked beans every week.
Obviously, as I had been found to be coeliac in 1997, I should stay gluten-free.
I’ve seen other dieticians since and none have criticised, what she said.
No doctor has also ever said, that there is something wrong with my cholesterol.
After my stroke in 2010, I was put on Warfarin to thin my blood.
The only addition to my cocktail of drugs, was that after an unexplained collapse, I was put on blood pressure drugs.
So to return to the question I asked at the top of this section.
I may take six or seven drugs and vitamin tablets every day, but swapping one or two for half-an-hour with an electronic device wouldn’t be too much trouble.
That is, if I could tolerate the device, as I’m not keen on headphones.
But it could be an interesting alternative to taking pharmaceutical drugs.
This Hydrogen Engine From Kia And Hyundai Heralds A New Dawn In Automotive – Everything Will Change – Lagrada
The title of this post, is the same as that of this article on Hydrogen Central.
These are the first two paragraphs.
Hyundai and Kia recently unveiled in Korea a zero-emission hydrogen engine that could disrupt the EV market. Both automakers are at the forefront of the development of hydrogen technology, focusing on both fuel cell systems and investigating the possibilities of sophisticated hydrogen engines.
The future of sustainable mobility is being shaped by Hyundai and Kia’s continuous research and dedication to hydrogen as a clean transportation solution. An increasing number of manufacturers are developing hydrogen engines as an alternative to electric cars and vehicles that use polluting combustion engines.
These three paragraphs outline more details of the engine.
What’s more remarkable about this new hydrogen engine presented in Korea is that it solves all the problems of durability and large-scale viability that hydrogen engines have presented until now.
The project team successfully ensured that the Hyundai-Kia hydrogen engine, designed to burn hydrogen, could sustain high thermal efficiency throughout its operation by infusing hydrogen into the combustion chamber at a pressure of 30 bar.
Although the device’s performance was enhanced by the use of a turbocharger, it was found that the enhanced performance and lower pollution emissions of this kind of “direct injection” eliminated the problems that most automakers have with hydrogen engines. As the emissions of carbon dioxide and fine particles were reduced by 99% and 90%, the Hyundai-Kia hydrogen engine would be considered to have zero emissions.
Thirty years ago, I was involved with a company called DMW.
- The company’s first product was an aerosol valve, that instead of using CFCs or HCFCs as a propellent used nitrogen. The patent was sold to Johnson and Johnson, after being shown during the discussions, that led to the Montreal Protocol and the phase out of CFCs.
- This led to a deal with Glaxo to investigate if DMW’s technology could be used in a metred-dose-inhaler for asthma drugs.
- The successful idea was eventual sold to Boehringer Ingelheim and is now marketed as Respimat.
I can compare the Hyundai-Kia hydrogen injector and the Respimat inhaler
- Hyundai-Kia appear to be using a high pressure of 30 bar to sustain high-thermal efficiency.
- I know that the Respimat inhaler uses high pressure to obtain a fine mist of the drug.
It sounds to me, that both companies are using the same properties of applying high pressure to a small hole, to disperse one fluid in another.
Application Of Control Engineering Principles To The Calculation Of Pharmaceutical Drug Doses
Today, I was asked by an eminent cardiologist to give my opinion on this scientific paper in the Journal of the American Heart Association, which was entitled Personalized Antihypertensive Treatment Optimization With Smartphone‐Enabled Remote Precision Dosing of Amlodipine During the COVID‐19 Pandemic (PERSONAL‐CovidBP Trial).
This was the background to the study.
The objective of the PERSONAL‐CovidBP (Personalised Electronic Record Supported Optimisation When Alone for Patients With Hypertension: Pilot Study for Remote Medical Management of Hypertension During the COVID‐19 Pandemic) trial was to assess the efficacy and safety of smartphone‐enabled remote precision dosing of amlodipine to control blood pressure (BP) in participants with primary hypertension during the COVID‐19 pandemic.
These were the methods and the results.
This was an open‐label, remote, dose titration trial using daily home self‐monitoring of BP, drug dose, and side effects with linked smartphone app and telemonitoring. Participants aged ≥18 years with uncontrolled hypertension (5–7 day baseline mean ≥135 mm Hg systolic BP or ≥85 mm Hg diastolic BP) received personalized amlodipine dose titration using novel (1, 2, 3, 4, 6, 7, 8, 9 mg) and standard (5 and 10 mg) doses daily over 14 weeks. The primary outcome of the trial was mean change in systolic BP from baseline to end of treatment. A total of 205 participants were enrolled and mean BP fell from 142/87 (systolic BP/diastolic BP) to 131/81 mm Hg (a reduction of 11 (95% CI, 10–12)/7 (95% CI, 6–7) mm Hg, P<0.001). The majority of participants achieved BP control on novel doses (84%); of those participants, 35% were controlled by 1 mg daily. The majority (88%) controlled on novel doses had no peripheral edema. Adherence to BP recording and reported adherence to medication was 84% and 94%, respectively. Patient retention was 96% (196/205). Treatment was well tolerated with no withdrawals from adverse events.
These were the conclusions.
Personalized dose titration with amlodipine was safe, well tolerated, and efficacious in treating primary hypertension. The majority of participants achieved BP control on novel doses, and with personalization of dose there were no trial discontinuations due to drug intolerance. App‐assisted remote clinician dose titration may better balance BP control and adverse effects and help optimize long‐term care.
About Myself
I am a Graduate Control Engineer, who graduated from the University of Liverpool in 1968.
I then worked at ICI in Runcorn for eighteen months, before moving to ICI Plastics Division, because of the untimely death of my father-in-law.
One of my tasks at Welwyn, was to look at control algorithms for chemical plants. For this I often used a PACE 231-R analogue computer.
Note.
- These computers could solve up to a hundred simultaneous differential equations at one time.
- They were programmed by wiring the various amplifiers and potentiometers together to simulate the equations.
- There were only a few transistors in these powerful machines, as all electronics were thermionic valves.
- Two of these machines wired together, were used to calculate the trajectories of the Apollo missions.
They were the unsung heroes of bringing Jim Lovell and Apollo 13 home safely.
Determining Control Algorithms
In a typical problem, I would model the a section of a chemical plant and the control system around it.
This would then lead to recommendations, as to the design and operation of the plant, so that it performed as required.
It could be argued that the body of an animal, is a very complicated integrated chemical plant, with a sophisticated control system.
For instance, if sensors around the body, say you are slightly low on fluids, your brain determines you should have a drink.
Many control loops on a chemical plant are controlled by proportional–integral–derivative controllers, which are commonly known as three-term controllers.
This is the first two paragraphs of the Wikipedia entry for three-term controllers.
A proportional–integral–derivative controller (PID controller or three-term controller) is a control loop mechanism employing feedback that is widely used in industrial control systems and a variety of other applications requiring continuously modulated control. A PID controller continuously calculates an error value
PID systems automatically apply accurate and responsive correction to a control function. An everyday example is the cruise control on a car, where ascending a hill would lower speed if constant engine power were applied. The controller’s PID algorithm restores the measured speed to the desired speed with minimal delay and overshoot by increasing the power output of the engine in a controlled manner.
I wouldn’t be surprised that the app in the smartphone used in the PERSONAL‐CovidBP Trial contained a form of three-term controller.
These are some points about three-term control algorithms.
Changing Of External Factors
One that was the villain in a problem, I dealt with, also affects my body – the weather.
I was asked to look at the problem of a chemical reaction, that overheated in hot weather. But the plant operators solved it by better insulation and ventilation of the plant and the standard three-term controller adjusted itself automatically to the new conditions.
After my stroke, I am on Warfarin for life. I test my own INR with a Roche meter and I have noticed that atmospheric pressure affects my INR. I change my deose accordingly, using a simple algorithm, of my own design.
The More You Test The More Precise The Control
If you take the cruise control example used by Wikipedia, speed is monitored continuously, as I hope, it would be if you were driving yourself.
But obviously, in many systems, where you are using an input with discrete values to control a system, you can’t be as precise as the data you collect.
When my son was dying from pancreatic cancer, he was fitted with a morphine pump, that he could adjust himself to dull the immense pain he was enduring.
- His nerves and his brain ascertained the pain level.
- He then adjusted the morphine level.
- He could get very precise control of his pain, because he was measuring it continuously.
But he was only using simple one-term control (proportional).
Derivative Control Can Be Difficult To Get Right And Can Even Go Unstable
Derivative control is mainly to stop overshoot, but sometimes you will find that it can go unstable, so two-term(proportional+integral) controllers will be used.
How I Control My INR
As I said earlier, I am on Warfarin for life and test my INR with a Roche meter.
The NHS typically tests patients about once every six weeks, which in my opinion as a Control Engineer is too infrequent.
I usually test myself a couple of times a week.
But every so often, I evaluate what daily dose gives me an equilibrium INR level of 2.5.
For the last three years, I have found a dose of 3.75 mg keeps me more or less on 2.5.
- As Warfarin comes in 1, 3, 5 and 10 mg. tablets, I alternate 3.5 and 4 mg.
- Warfarin tablets are easily cut in half using a sharp knife.
- I record INR and dose in a spreadsheet.
I have been doing this now for over ten years.
Is This A Unique Property Of Warfarin?
In this time, I have had five medical procedures, where surgeons were worried, that as I was on Warfarin, I might bleed too much.
For the first, which was to remove a lump from my mouth, the private surgeon wanted to charge extra for an anaesthetist. In the end, I asked what INR he wanted and he said 2.1 should be OK!
- So I reduced the Warfarin level and tested every day.
- I judged it correctly and had an INR of 2.1 on the day of the operation.
- The operation went incredibly well and I went home on public transport.
- The lump turned out to be benign.
- I’ve not had another lump.
After the operation, I increased the Warfarin level and tested every day, until it regained a level of 2.5.
On analysing my doses through the date of the operation, I found that the total amount of Warfarin, I didn’t take to reduce my INR to 2.1, was the same as I took to bring it back up again to 2.5.
Is this a unique property of Warfarin?
Since then I’ve had two cataract operations performed in a private hospital, where the NHS paid. Interestingly, they wouldn’t trust my own INR readings, so I had to get my GP to take the measurement.
I’ve also had gallstones removed by endoscopy at the local Homerton NHS hospital.
- For cases like mine, the hospital hire in a surgeon from the posh Wellington private hospital for one day a week, who brings the specialist tools needed.
- I wrote about this in Goodbye To My Gallstones.
- As it was a more serious procedure, I reduced my INR to a requested 1.0.
Interestingly, I still have my gall bladder, but the surgeon put it on notice to behave.
Conclusion
I would totally agree with the conclusion given in the PERSONAL‐CovidBP Trial.
Personalized dose titration with amlodipine was safe, well tolerated, and efficacious in treating primary hypertension. The majority of participants achieved BP control on novel doses, and with personalization of dose there were no trial discontinuations due to drug intolerance. App‐assisted remote clinician dose titration may better balance BP control and adverse effects and help optimize long‐term care.
I would add some conclusions of my own.
- The app used in the PERSONAL‐CovidBP Trial, seems to have had a good algorithm.
- I suspect the app could also be Internet-based.
These are some general conclusions.
- If you are on Warfarin and have access to a Roche meter, it is possible to lower your INR to the value required by a surgeon for an operation or a procedure.
- Since starting to take Warfarin, I have had four operations or procedures, where others would have had anaesthetic or a sedative.
- In those four operations, I was able to go home on public transport. If I still drove a car, I could have driven home afterwards.
- Private hospitals like to use an anesthetist, as it pumps up the bill.
- Avoiding anaesthesia must save hospitals money.
Well designed apps, based on Control Engineering principles, that help the patient take the best dose of a drug will become more common.
The Anonymous Widower 