Are Bodies Cleverer Than We Think?
Because, I had a serious stroke thirteen years ago, I am on Warfarin for life to thin my blood, so that I don’t have another stroke.
INR is short for International Normalized Ratio, which diverts on Wikipedia to the Wikipedia entry for Prothrombin Time, where these is the first two paragraphs.
The prothrombin time (PT) – along with its derived measures of prothrombin ratio (PR) and international normalized ratio (INR) – is an assay for evaluating the extrinsic pathway and common pathway of coagulation. This blood test is also called protime INR and PT/INR. They are used to determine the clotting tendency of blood, in such things as the measure of warfarin dosage, liver damage, and vitamin K status. PT measures the following coagulation factors: I (fibrinogen), II (prothrombin), V (proaccelerin), VII (proconvertin), and X (Stuart–Prower factor).
PT is often used in conjunction with the activated partial thromboplastin time (aPTT) which measures the intrinsic pathway and common pathway of coagulation.
That is very technical and complicated, but what does it mean practically?
Those on Warfarin to thin their blood are generally supposed to keep their INR between 2 and 3.
I test the INR myself with a Coaguchek meter from Roche and have done so for nearly ten years.
Every, so often, I discuss the level of Warfarin with my GP and we adjust the level accordingly.
Typically, NHS patients on Warfarin have their INR checked every few weeks.
But as I am a Graduate Control Engineer, who has written control strategies for chemical plants, I feel this checking every few weeks, is not enough.
At times, I have checked at a higher frequency.
Four times, I have had minor operations.With the first operation, I agreed with the surgeon, that I would lower my INR to 2.1 for the operation and raise it back to 2.5 after the operation.
It all went well and I repeated the exercise for the three other minor operations.
I have checked daily since about the beginning of April, before which, I generally tested on Mondays and Thursdays.
There were two reasons for the change of frequency.
- Regular storms seemed to roll in and for some reason, they tended to lower my INR.
- I also wrote Do Thunderstorms Cause Strokes?, after reading a paper from the United States about the relationship between thunderstorms and strokes.
So I took the prudent decision to test my INR daily.
Then on the 30th May, disaster struck.
My Coaguchek meter found out it had the wrong firmware and Roche implored me to change it.
But I am not a hardware person, so I was left unable to check my INR.
Luckily, I remembered a story from the 1960s about one of ICI’s chemical plants.
This plant was one of the first fully-digitally controlled plants controlled by an IBM 1800 computer.
It also ran 24 hours a day, seven days week.
So in the middle of the night, the plant operators got out all the computer printouts, which showed how the computer had set all the valves and controllers.
One-by-one they reset all the controls on the plant to the settings that the computer had used for the last few days.
Using, this computer-assisted mode the plant was kept running, until engineers could fix the computer.
On the 30th May, my INR was a little bit high at 2.9 and I was using a dosage of Warfarin of 4 mg. one day and 3.5 mg. the next.
The strange dosage was one, that I know from experiment over time produces an INR of 2.5.
My actual average Warfarin dose was 3.73 over the last thirty days and my INR, as measured most days was 2.6 over the same period.
So, I did what the engineers did on the chemical plant, kept calm and carried on.
Yesterday my son fixed the Coaguchek meter and I was able to take my first reading for 17 days. It was 2.7 and only 0.1 higher than the 30-day average on the 30th May.
I had successfully jumped the gap in the readings.
Conclusion
Most systems have an equilibrium. Make sure you know it.
Northern Lights Stun UK In Spectacular Display
The title of this post, is the same as that of this article on the BBC.
This is the sub-heading.
The Northern Lights have made a rare appearance across the UK, delighting sky watchers up and down the country.
These three paragraphs add more detail.
Excited onlookers shared pictures of the lights, also known as aurora borealis, visible right across the country, including the south coast of England – and if you missed it you are likely to have a chance to see it again on Saturday night.
They could be seen after one of the strongest geomagnetic storms for years hit Earth, with the US National Oceanic and Atmospheric Administration (NOAA) issuing a rare solar storm warning.
Such storms increase people’s chances of seeing the lights.
But how did the weather effect me?
- Yesterday, my INR was 2.4.
- I then had a terrible night, as I tossed and turned.
- I even had to get up twice in the middle of the night to remake the bed.
- This is so unlike me.
- In the morning my INR was 2.2.
Was the reduction because low pressure sucked the water out of my body?
That is nnot in itself dangerous, but I do think, that there will have been a lot of strokes last night.
I wrote about this in Do Thunderstorms Cause Strokes?.
Nitrous Oxide–Induced Vitamin B12 Deficiency
The title of this post, is the same as that of this peer-reviewed paper on the National Library of Medicine.
This is the abstract.
Nitrous oxide is a gas that is odorless, colorless, and has a sweet taste at room temperature. Nitrous oxide has several uses, including in surgery and dentistry (referred to as “laughing gas”), in automotive racing, and in aerosol spray propellants. The aerosol spray propellants that typically use nitrous oxide are whipped cream canisters and cooking sprays. Unfortunately, these over-the-counter household items are a source of nitrous oxide that can be used for recreational use. The most popular is the use of industrial-grade canisters having the slang term “whippets.” The nitrous oxide can be extracted by pushing the nozzle down slightly to the side and catching the released gas with a balloon. The contents of the balloon can then be directly inhaled, giving an instant feeling of euphoria. This is not a benign means to achieve a euphoric state but can cause severe nitrous oxide–induced B12 deficiency, which is presented in this case report.
An estimated 800,000 young adults abuse inhalants every year, and almost 11% of high school seniors report using inhalants at least once in their lifetime . Heavy inhalant abuse can result in a variety of side effects, including cardiac arrhythmias, hypoxia, metabolic acidosis, and neurologic deficits. Of all inhalants, nitrous oxide is particularly toxic due to its conversion of the active monovalent form of vitamin B12 to its inactive bivalent form. We present a case of subacute combined degeneration of the spinal cord due to nitrous oxide–induced vitamin B12 deficiency.
Basically, don’t inhale nitrous oxide, unless it’s being administered by a anaesthetist or a dentist.
Interestingly, because I was an undiagnosed coeliac my vitamin B12 was running on empty for much of the first fifty years of my life.
As my B12 was so low and didn’t really respond to regular injections, I was sent off to Addenbrooke’s, where they quickly diagnosed coeliac disease.
I wonder what would happen to an undiagnosed coeliac, who was low in B12, who got addicted to nitrous oxide.
The abstract implies that inhalants can cause cardiac arrhythmias, which has this Wikipedia entry, where this section talks about atrial fibrillation.
Arrhythmia affects millions of people. In Europe and North America, as of 2014, atrial fibrillation affects about 2% to 3% of the population. Atrial fibrillation and atrial flutter resulted in 112,000 deaths in 2013, up from 29,000 in 1990. However, in most recent cases concerning the SARS-CoV‑2 pandemic, cardiac arrhythmias are commonly developed and associated with high morbidity and mortality among patients hospitalized with the COVID-19 infection, due to the infection’s ability to cause myocardial injury. Sudden cardiac death is the cause of about half of deaths due to cardiovascular disease and about 15% of all deaths globally. About 80% of sudden cardiac death is the result of ventricular arrhythmias. Arrhythmias may occur at any age but are more common among older people. Arrhythmias may also occur in children; however, the normal range for the heart rate varies with age.
Doctors tell me, that my stroke was caused by atrial fibrillation.
Do Thunderstorms Cause Strokes?
On Saturday evening, we had a severe thunderstorm in North London.
All day long, I’d been drinking heavily, but as it was only tea and low-alcohol Adnams Ghost Ship 0.5 %, the worst that could happen is an accident on an extra visit to the toilet.
I came to the conclusion though, that most of the fluids was leaving my body through my skin.
Does this lower my INR? I do know that in hot and humid weather, I have difficulty raising it. In the last week or so, it has been hovering around 2.2, but yesterday, it was a very safe 2.7.
But as I test regularly, this may well help to protect me from another stroke.
Typing “Thunderstorms and Strokes” into Google, I found this paper on the National Library of Medicine, which is entitled Relationship Between Weather Conditions And Admissions For Ischemic Stroke And Subarachnoid Hemorrhage.
It is an interesting read.
This was the aim of the study.
To assess impacts of different weather conditions on hospitalizations of patients with ischemic strokes and subarachnoid hemorrhages (SAH) in South Florida.
And this was the conclusion.
Higher number of ischemic stroke and SAH cases can be expected with the daily lowest and highest air pressure, highest air temperature. Presence of hurricanes or tropical storms increased the risk of ischemic stroke but not the SAH. These findings can help to develop preventive health plans for cerebrovascular diseases.
From my own observations on INR for nearly ten years, I certainly believe that INR moves up and down with the weather because of the laws of physics.
Next time a severe thunderstorm is forecast, I will track my INR throughout the day.
Coeliac Journey Through Covid-19 – A Few Bad Years
A Few Bad Years
In 2007, my wife died of what her consultant at Papworth said was one of the worst cancers he’d ever seen. It was a squamous cell carcinoma of the heart.
Her’s was the only occurrence in the UK that year and someone told me, there were four in the United States.
Our youngest son; George, then died of pancreatic cancer in 2009.
When I had been diagnosed as a coeliac in 1997, my wife and I had told our sons to get themselves tested, as is now advised on the NHS web site.
But George was a sound engineer in the music business, who lived the unhealthy rock-and-roll lifestyle.
A year later, I had a serious stroke in Hong Kong.
I had had a warning a year or so before and Addenbrooke’s recommended I go on Warfarin, but my GP in Suffolk, talked me out of it.
Now twelve years later, my GP and myself manage my Warfarin, where I do the testing of my INR on my own meter from Roche.
But then I am a Graduate Control Engineer!
A couple of doctors have said I have made a remarkable recovery, and I’ll go along with that as the only thing I can’t do, that I could before the stroke is drive, as the stroke damaged my eyesight.
On the other hand, the latest therapy for stroke in the United States is B12 injections and I haven’t missed one of my three-monthly injections since 1997.
If anybody is doing serious research into B12 and stroke recovery, then I would be happy to be a lab-rat.
The Luck Of The Genes
There’s an article in The Times, which is entitled When It Comes To Success, Luck Can Trump Intelligence.
It got me thinking about my life.
I have been pretty successful in life, and I put it down to winning the gene lottery, with a part-Jewish father and a part-Huguenot mother, who taught me hard work and everything they knew. So were my genes forged by religious persecution in the harsh conditions of the ghettoes of Europe?
But luck has always played a great part in my success. On the way, three or four successful men have chosen me for projects and I’ve repaid them by succeeding. I’ve been at the heart of the creation of two world-changing companies.
But the luck turned bad, a dozen years ago. My wife and our youngest son died from cancer and I had a serious stroke.
But the genetic lottery of being coeliac and therefore having B12 injections, has meant, I’ve made a good recovery from the stroke. The B12 injections is a stroke recovery method from the States, but is considered quackery over here. I believe it saved my life.
And then during the pandemic, those coeliac genes and the gluten-free diet I need for health, seem to have protected me from a severe dose of the covids. I’ve yet to find a fellow coeliac, who has had one either. Scientific research from Italy and Sweden, is also backing up my observations.
Lady luck has smiled on me. Or does the devil, look after her own?
I Need To Regularly Eat A Large Plate Of Calves’ Liver
I’ve always liked liver, as did my father and we would eat it regularly at home. We were the two coeliacs in the family, although neither of us had been diagnosed at the time.
My late wife never ever cooked me liver, but would always be happy to go with me, when I ate it. I remember once in Berlin, she found a wonderful restaurant that served liver, on the other side of the city to where we were staying.
I also used to eat it regularly in restaurants when I moved to London, especially in Carluccio’s. The one round the corner from me in Islington is long gone and I used to eat liver there often.
But now finding a restaurant that serves calve’s liver in London is extremely difficult. Marks and Spencer also used to sell it, as I wrote in Lovely Liver. They still sell lamb’s liver but it’s not the same.
I’m certain, if I don’t supplement my B12 injections with a nice plate of liver, I get medical problems.
I suspect that my stroke-damaged brain, may well snaffle a lot of the B12 injection, thus leaving the rest of my body with just a few dregs.
So does anybody know of a quality pub or restaurant within easy reach of public transport from London, that sells liver?
Or failing that a proper butchers, that can prepare it for me to cook.
It should be noted, that I’m not good at cutting up meat, as my left arm is damaged. Not by the stroke, but by the school bully, who broke my arm, when I was fourteen.
Ease Up IPA Goes Gluten Free!
The title of this post, is the same as that of this page on the Adnams web site.
I am now 75 and I have been drinking Adnams beer, almost exclusively since I was thirteen.
My father introduced me to halves of Adnams bitter, whilst playing snooker at Felixstowe Conservative Club.
Part of his logic behind doing this was to teach me to drink alcohol responsibly, like he did and to prevent me ending up like his father, who was a drunk, who died before the age of forty.
The other thing, that my father’s teaching did was give me a preference for good real ale. And especially Adnams!
As I write this, I’m drinking a bottle of their 0.5 % Ghost Ship.
I drink it for three reasons.
- Obviously, I like the taste.
- It is low-alcohol, so it doesn’t affect the action of the Warfarin, that stops me having another stroke.
- I also find, that because the beer is made with low amounts of barley to keep the alcohol low, it doesn’t affect my gut, despite the fact that I’m a coeliac.
I have yet to find a low-alcohol beer, that has had an adverse effect on my body.
But Will Ease Up Be Safe For A Coeliac To Drink?
These paragraphs describe how Ease Up is brewed and the testing of the product.
When producing Ease Up, we now use an enzyme called Clarex® which breaks down gluten-type proteins, reducing gluten content to below 20 parts per million (ppm). Only foods that contain 20ppm or less can be labelled as ‘gluten-free.’ According to Coeliac UK, research shows people diagnosed as coeliac can consume products with gluten present at or less than this level, but customers are advised to consider their own individual tolerances.
Clarex® is added in the fermentation vessel, where it mixes well during a normal, vigorous fermentation. Our beer is tested at the end of fermentation and then, after packaging, it is put on hold while it undergoes a thorough external validation process before it is confirmed gluten free and released. Just look out for the new, updated branding.
Note the phrase about individual tolerances.
Conclusion
It looks like Adnams have produced the ideal real ale to have in your pub, club or house, if you have some coeliac customers, family or friends.
Never did I think, I would ever write about disruptive innovation in the brewing industry.
Vitamin B12 For Stroke Recovery: Understanding The Benefits & Safety Tips
The title of this post, is the same as that of this article on the FlintRehab web site.
I have posted the link, as I was talking to a doctor earlier and they might like to look at it.
Consider.
- I am coeliac on a strict gluten-free diet.
- Since the coeliac diagnosis in 1997, I have had a B12 injection every three months.
- I had a serious stroke ten year ago.
- Some doctors feel, I have made an excellent recovery from my stroke.
Could my regular B12 injections have aided my recovery?
Note, that I have cleaned up the Vitamin B12 tag in this blog.
I Was Struggling In The Heat
Early last week, I was struggling in the heat.
On Wednesday, I had my three-monthly B12 injection injection and since then I’ve been feeling a lot better.
Yesterday, when I went to see the Oxted Viaduct, I climbed a couple of short hills in the heat and had no problem.
I have my B12 injections because I’m coeliac and I was at one time low on B12.
Given too, that some web sites report than B12 helps stroke recovery, does that explain, why I made a better than some recovery from my stroke?
At least three doctors, I’ve met, have used the word remarkable when talking about my stroke recovery.
I certainly would create a fuss, if the GP, thought I should stop taking B12. But then I’ve been taking it for at least thirty years.
The Anonymous Widower 