A Slow Bus from Cambridge to Ipswich
After the film, I did a bit of window shopping in Cambridge and then had lunch in Carluccio’s before catching the four o’clock bus to Haverhill, where I was going to get the coach at six o’clock to Ipswich for the football.
The weather was atrocious and it was almost pleasant to be at the front on the top of a warm 13 bus, as it meandered its way through the villages to Haverhill. At least, I had a little shelf in front of me, which allowed me to do the Sudoku.
Haverhill though is not the place to spend an hour at five ‘oclock on a very wet Tuesday afternoon. There was no cafe open and the one or two pubs that were looked very much like the places I would only visit in direst need. The rain looked friendlier! I walked up to Tesco’s as I needed a banana and a juice with which to take my Warfarin. They did have single bananas, but I couldn’t find any small drinks of juice or smoothies. As everything was in litre bottles or larger, I decided that it would be better to try elsewhere. I got what I wanted in the Co-op. But they didn’t have a gluten-free section, so my thought of buying a packet of suitable biscuits went out the window. Tesco’s did have a gluten-free section, but it was rather poor, with no nice biscuits. I did ask in the Co-op about gluten-free and they said it had been successful, so they stopped it.
So supper consisted of some sandwiches, I’d made before I left, some chocolate, a smoothie, a banana and a 5mg. Warfarin tablet.
The coach from Haverhill to Ipswich was probably the fastest part of the journey as the weather seemed to have kept the crowd very much below what I would have expected.
Fragile Warfarin Tablets
The pharmacist recently changed my Warfarin tablets to a different make; Teva UK, Leeds LS27 0JG.
TEVA Warfarin Tablets
Medically, I ASSume they’re OK, but I tend to break them getting them out of the packaging. The dog doesn’t mind, as she’ll eat anything that can go down a basset.
My Father Would Turn in His Grave, if He Had One!
I had a good day yesterday, in that I made a video of the Tour of Britain at Clare and successfuly posted it on this blog. But my arm is starting to work a bit better and I’m in less pain. Perhaps, my brain is winning in its battle with my nerves and is understanding them better! If it can’t understand them, the brain says pain!
My computer told me today, that I must get ready for my Warfarin test on Monday. I do it a couple of days early, so that I can find the form that I must take.
The Dreaded Hospital Form/Letter
These letters are a disgrace and the man, who designed them should be dismissed from all his jobs immediately. I would suggest capital punishment, but even for design crimes as heinous as this, I will not ease my stance on the evil death penalty.
So why do I hate these letters so much?
For a start, they are so difficult to open, even for someone like me with only a good right hand! And one that can efficiently wield a pair of scissors. Suppose you were more decrepit than me, with perhaps severe arthritis or a missing hand. You wouldn’t stand a chance of opening the letter without damaging it, so much that it became unreadable.
Then when you have opened it, it refuses to lay flat, so it is not an easy thing to store and retrieve. I usually pin it to a notice board, but as it doesn’t do flat very well, it sometimes manages to force itself to the floor.
Perhaps, the main reason, I hate these letters so much, is that they are in many ways unnecessary. If you need to change your dose, the hospital phones you! If you forget the form, when you have a blood test, then the nurse knows the questions to ask!
But as I said in a previous post, why can’t you be informed by SMS message or e-mail?
So why would my father be spinning? He was a printer, who made a lot of money by designing paper systems that worked. He would have known how to do this form/letter better.
If I had my way, if a letter needs to be sent, then I would send a postcard. I know to some this wouldn’t be confidential, but it certainly doesn’t matter to me, that the world knows my Warfarin dose is 5 mg. a day!
Is There A Need for a National Anticoagulation Service?
Like many people in this country, I’m on Warfarin. This means that I have a blood test every week or so and answer a few questions about how you are getting on and if you have missed a dose. The hospital managing your anticoagulation service, then does the analysis for your INR and calculates your daily dose and date of the next test. If there is a change in the dose, you are told immediately by phone, usually within twelve hours of the blood test. On the next day, you get a letter from the hospital confirming the dose and giving the date of the next test.
I have found that one of the subsidiary effects of my stroke, is a need to solve problems and design systems that work. So after the problems with the phones last week, where if there had been a dose change, they wouldn’t have been able to phone, I got to thinking about how the service could be improved.
So what problems can I see?
- For me giving blood for a test is very easy. Although I am right-handed, because of my gammy left arm, I prefer the test to be taken out of my right arm. A week ago, they took blood in the hospital on the Friday and then I had another test on the Monday for the Warfarin. It was no problem at all. But my late wife, C, found giving blood for a test almost impossible. So we’re all different.
- The letter I get for each dose, is one of those awful NHS letters, that because of my hand, I find very difficult to open. Or I would, if I didn’t have a very good pair of scissors! There must be many on Warfarin, who have much worse hands than me!
- I live in the countryside and I have the blood test either at the GP surgery or at my local hospital. As I can’t drive, this means I have to make sure on test days, my driver comes in. It’s not a great expense and I usually do all my food shopping at the same time, but it could difficult for those who have to go to the local hospital, where transport is difficult.
- Perhaps my biggest problem, is that I travel a lot and might not be in the right place for a test. I can have them a day late, but I like to be precise in getting my dosage right! This travelling might also mean that I don’t get the letter until a few days after the test. This doesn’t matter as regards the dosage, but knowing the next test date might be important.
So what is available to improve the excellent service, I get from the NHS. And in these times of austerity, could a service be designed that was not only failsafe but cost less to run?
There are machines now to self-test for your INR, just like diabetics test for the amount of insulin they need. I used to think that this might be the way to go for me, as I’m pretty tech-savvy, but the machines aren’t cheap and it means that when I travelled, I’d need to take it with me. I’ve tried hard to avoid carrying excess baggage for years and now that I’m not as strong as I was, I don’t want to start adding to it. And my gammy left hand might drop and break it!
On the other hand, these machines only take a pin-prick of blood. So would they be much better for people like my late wife?
Technology has also moved on in the fields of communication and I now am reminded of my hospital appointments by SMS message. So there must be ways that technology can improve the service!
So what could a service look like?
I have said in the title to this post, that it might be National, but that might bring in other problems, like Data Protection. Incidentally, I don’t bother about that for my health records, as anyway most of my problems are already available to everybody in this blog.
Like now it should be based on a network of testing stations. There could be two sorts; ones that worked as now and sent the blood samples to the hospital and others that worked using pin-prick style machines, which give a direct INR reading. In the case of the simpler systems, all it would need would then be to enter them into the Service through a web page or even by phone to the hospital. Obviously, various routes could be allowed, so that patients who might be confused, weren’t upset.
The advantages of multiple testing stations are that you can go to the one that is most convenient. Suppose too, that pharmacists were licensed to do the test, so that you could do your test when you went to the shops. It would be much easier for me to go to Boots in Newmarket, than have to go all the way to the West Suffolk Hospital, because the blood nurse at the surgery was too busy or on holiday.
Multiple testing stations would also mean that, when I was travelling, all I’d need to do was find an accredited testing station.
As the testing stations would get your INR almost instantly, once it was in the Service, the results would be immediately available.
But it is in the distribution of those results that the greatest improvements can be made. We have five basic methods of communication; letter, e-mail, phone, mobile phone and SMS message. You should be able to choose how you want to be told and all of them can now be done automatically. I would take an SMS message with a letter for backup.
I elieve that properly designed such a system would work very well. The problem with it would be that some anti-coagulant departments in hospitals would no longer be needed. So what would the Unions have to say on that one!
At Last Some Good Health News!
I went to see the cardiologist yesterday afternoon. It was the sort of doctor’s visit that we all like!
He indicated that he had reviewed my X-rays ans scans from Addenbrookes and then asked me how I was getting on with the Warfarin. It has not been a problem for me and the anlysis at West Suffolk Hospital has gone very smoothly and professionally. He then said that the Warfarin should protect me from another stroke and that the leak in my heart valve was moderate and probably should be OK for ten years. As he knows, I’m a technologist, we talked a bit about how software and techniques are improving for a few moments. After the chat, I felt that if I did need an operation it would be a lot less serious than the ones my Mother-in-law had thirty years ago.
He then said that I should come back and see him in six months.
That last point really cheered me up!
My Poor Feet
My feet are very painful at the moment! Is it the stroke, some of the drugs I have taken like Warfarin, a lack of vitamin B12 or just the shoes, I have been wearing?
At least, I’m seeing the GP tomorrow!
The Levington Ship
On the way back from Felixstowe, we stopped for a glass of Aspalls at the Levington Ship.
The Levington Ship
We actually arrived at the time I needed to take my Warfarin, so I asked the landlord for a glass of tapwater. IT was no problem.
But then you’d expect that sort of sdervice from a pub that serves beer in the traditional Suffolk way by gravity.
Gravity Fed Adnams
Warfarin
I don’t know whether I said, but I’m on warfarin now.
It’s a complicated regime with regular blood tests, the need to be careful with certain foods and alcohol, and avoid getting cut or bruised. But it obviously works, as there wouldn’t be so many people on it.
It strikes me though that it’s a big opportunity for the pharmaceutical industry, in that if you could create a new and much better drug and regime, which was less hassle and avoided the expensive blood tests, you’d laugh all the way to the bank.
If you search the literature, things are stirring, so let’s hope.
Going on Rat Poison
I’m being put on Warfarin to thin my blood. Some might say appropriate.
The Anonymous Widower 