The Anonymous Widower

A Double Database Cock-Up From The NHS

At three on Sunday morning, I phoned NHS 111 to ask for a bit of help with my terrible cold that was stopping me from even getting to sleep.

I had some advice which helped, but I was also booked in to see a doctor at 09:00 in a surgery a short bus ride away.

So far so good and no complaints.

I duly saw the doctor and he prescribed several drugs, which I took to my local Boots later in the morning.

I should say at this point, that four years ago, I officially changed my name from the one my parents gave me to the one I’ve used continuously since 1968. I was starting to get problems with some airlines, where my passport had a different name to my bank account. My current GP has only ever known me by the latter name and I’m registered with their surgery using it.

When I got to Boots, they initially rejected the prescription, as for some reason it showed by old name, although my address, NHS number and other personal details were correct.

How did the wrong name get on the prescription?

Luckily, Boots were pragmatic and as they recognised me, I got some of thew drugs.

But not all!

The pharmacist recognised that two drugs were incompatible with the Warfarin I take.

So why did the NHS computer system allow the doctor to prescribe the drugs?

As someone who was at the forefront of database technology, I believe, these two problems are inexcusable.

My incorrect name could have led to failure to obtain needed drugs.

The lack of interaction checking, could have led to serious problems for a patient.

January 7, 2019 Posted by | Computing, Health | , , , , | 4 Comments

Preparing For A No-Deal Brexit

I am doing a few things to make sure, that I survive a no-deal Brexit, as unscathed as possible.

Savings

I keep all of my spare cash in Zopa, moving it in and out as required. Effectively for about seven or eight years now, I have used the first peer-to-peer lender as a high-interest, thirty-day access deposit account.

It has probably paid around five percent before tax in that time and it has safely ridden the peaks and troughs of governments and financial instability.

Today, I calculated how much cash, I need in my current account to see me through to end of the year, and the spare money was tranferred to Zopa. It was a fast painless transaction and now it is available to lend to Zopa’s customers.

Warfarin

Warfarin stops me having another stroke.

As it only comes from Eastbourne, I suspect supply of this comment drug.

But I have enough to last me to until Summer 2019.

INR Testing

I test my own INR, which determines the Warfarin dose.

Today, I ordered enough test strips to get me through to Summer 2019.

Beer

Every time, I go walking around London, I take a large bag, that can hold up to eight bottles of my favourite beer from Marks and Spencer.

Supplies from Adnams in Suffolk seem good at the present and I usually liberate a few from a boring life on the shelves on every trip.

As with other products, I aim to have enough to last me through to Summer 2019, at a rate of three a day.

November 30, 2018 Posted by | Finance, World | , , , , | 2 Comments

Thoughts On Alcoholism

In the last month or so, I’ve done something that I’ve never done before in my life.

I’ve drunk perhaps half a bottle of beer when I’ve got up. Admittedly, I’d left the bottle half finished by my computer.

It was good.

In the 1960s, I could drink a lot of beer. I just seemed to need it.

About that time, I decided I needed to drink large amounts of fluids and swapped to tea and Coke.

My doctor understands my needs for fluids and the practice nurse has the same problem. The nurse puts it down to leaky skin, which he has.

I actually love walking in the rain, so that might help explain it. We all live by the laws of physics.

My father warned me off alcohol in a practical way, by giving me halves of Adnams down at Felixstowe Conservative Club, whilst we played snooker, when I was about fourteen.

My father drank a lot of fluids, but I never saw him drunk and most doctors would say he was a sensible drinker. Like me, he also drank a lot of tea!

He had a reason to control his drinking! His father had died from complications of being an alcoholic at 40, when my father was about twenty.

My grandfather had lived just around the corner from where I live now and my father had once told me, he had drunk large amounts of beer and had moved on to whisky.

Around 1900, there was very little to drink except beer, so did my grandfather’s need for fluids mean that he turned to what was available?

Now I like a good beer and know of its properties to slake a thirst when you’re dry. I’ve worked in foundries in the 1960s and beer was always available.

So is there a type of person, who needs a lot of fluids and if beer is available they turn to it. In some cases does this lead to alcoholism.

As to myself, I must have gluten-free beer and because I’m on Warfarin, I must keep my alcohol consumption down.

So I now drink a gluten-free beer, that is just 0.25 of a unit and tastes like real beer from Marks and Spencer.

But then it is real beer, as it is brewed in Southwold by Adnams.

My life has come full circle.

 

 

March 18, 2018 Posted by | Food, World | , , , , , | 2 Comments

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

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.

 

November 20, 2016 Posted by | Health | , , , | 1 Comment

INR Testing Around A Simple Procedure

A couple of weeks ago, my dentist found a small lump in my mouth,so he advised getting it removed and tested to see that it was nothing serious. The procedure was booked to take place on Thursday, the 30th of July and he advised me to make sure my INR was lower than 2.4 and not to take any Warfarin on the day before. Obviously, he didn’t want me to bleed too much, especially as the position of the lump made stitching impossible.

My INR had been 2.6, 2.5 and 2.6 on the Sunday, Monday and Tuesday, taking my normal dose of 4 mg., which as I take it most days, is unsurprisingly my average dose.

On the Tuesday, to lower te INR slightly, I cut my dose to just 1 mg., with the consequence by Wednesday morning the INR had dropped to 2.3. As the doctor had said no Warfarin on the Wednesday, my Control Engineering training said that could drop the INR below 2. So I just took 1 and the INR was 2.1 on the day f the operation.

After the operation, as I wasn’t bleeding I took 3 mg of Warfarin, but by the Friday morning my INR had dropped to 1.6, so that evening I took 6 mg. On the Saturday morning, the INR had gone up a bit to 1.7, so to nudge it towards the desired value of 2.5, I took six that day.

In the week of the operation despite changing the dose to control my INR, I sactually averaged 3.8 mg. over the week.

Since then I’ve taken my normal 4 mg. and my INR has been fairly steady around 2.4.

I think this exercise shows the value of self-testing your INR. Admittedly, I was employing my Control Engineering training and experience to give the doctor what he wanted and keep my INR at a reasonably safe level, but the ability to self-test regularly around an operation must make things better for everybody concerned.

The doctor told me afterwards that I hadn’t bled too much, but then when I’m cut by a professional as opposed to torn in a fall say, I don’t seem to bleed much!

In the end, the lump had been removed and I heard today, that it was totally benign.

 

August 10, 2015 Posted by | Health | , | 3 Comments

Is Drug Packaging Distinctive Enough?

I take quiet a few medicinal drugs. Every day, I test my INR and then put the drugs for the next twenty-four hours in an old black 35 mm. film canister, which fits neatly into the bag I generally carry or a pocket of my coat.

When I go away for a few days, I put the required drugs plus a few for luck, in a white film container, which I then transfer to the black one every morning.

Look at these two pictures of two strips of drugs.

One is Spirolactone and the other is 1 mg. Warfarin. When I went to Glasgow because I was in a hurry, I took two Warfarin instead of two Spirolactone. It didn’t matter in this case, but for others similar mistakes could be more serious. A contributory factor in this mistake, was that Boots have started to give me a differently packaged brand of the Warfarin.

The top side of the drug packaging should be distinctive. I think too, that the old brand of Warfarin had the writing on the back in the same colour as the drug. i.e. brown in this case. The new one is just an anonymous black.

August 10, 2014 Posted by | Health | , | Leave a comment

INR Results Of A Coeliac Using Warfarin And Taking Terbinafine

This graph shows my INR a period between the 20th of May and the 25th of June.

INR May-June 2014

I should say that I have a degree in Control Engineering from Liverpool University.

My aim here is to keep my INR between two and three, with a target value of 2.5.

Since starting to self test, I normally take around 4 mg. a day of Warfarin, but I have found that five is a better dose for when I’m taking Terbinafine, which has been prescribed by my GP for a fungal infection. The drug is well-known to affect the action of the Warfarin.

So now I take 5 mg. unless the INR is 2.8 or more. In which case I reduce the dose from five to four. On the other hand, if the level is 2.2 or below, I increase it to six.

The average INR value for the period shown was 2.6 with a standard variation of 0.2.

The peak at the beginning of June may have been caused by a B12 injection  or hot weather. Both of which seem to raise my INR.

You will notice that the INR went up around the beginning of June. I can’t be sure, as I don’t have the dates, but this may have been caused by having a B12 injection.

June 25, 2014 Posted by | Health | , | Leave a comment

Interaction Between Warfarin And Terbinafine

A few weeks ago I was prescribed a course of oral Terbinafine to clear up a fungal infection. It seemed to work well, except that there is still some of the tinea in my toe-nails.

But over the time, I was taking the drug, I have felt that my INR was constantly wanting to slip downwards towards and below two.

Luckily I test my INR daily, and use a simple control algorithm to calculate my Warfarin dose. Normally, it is 4 mg, but if it goes below 2.3, I increase it to 5 mg, and if it goes above 2.8, I reduce it to 3 mg. So the algorithm got me taking a lot of 5 mg doses as opposed to the usual4 mg.

Only since I finished the course of Terbinafine has the INR stabilised around 2.5, which is my target value.

I didn’t at first see any link until everything settled after the course finished.  But I decided today to type “Warfarin Terbinafine interaction” into Google. I found this paper from the BMJ entitled Drug points: Serious interaction between warfarin and oral terbinafine.

I think this minor incident shows the value of regular INR testing! Because I was testing daily, as the INR started to drop, my algorithm told me to increase the dose to 5 mg.  In fact my average dose has gone up from 4 to 4.5 mg. in the period that I was taking the Terbinafine.

So there was no harm done at all!

April 25, 2014 Posted by | Health | , , , | 2 Comments

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

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.

November 30, 2013 Posted by | Health | , , | Leave a comment

My Poor Hand

This morning, I cut my hand accidentally, as I walked the Regent’s Canal.  How I don’t know, but despite timely repairs by the nurse at my surgery nearby, the wound refused to stop bleeding and I had to go to A & E at University College Hospital.

The nurse at UCLH, who bandaged my hand, put the bleeding down to the interaction between Warfarin and the other drugs I am taking.

The strange thing is that I can now type easier and get the Shift and Control keys right.

October 29, 2013 Posted by | Health | , | 3 Comments