Another Week

 Friday. 9.45 a.m. It seems bright and sunny outside, but I have a sneaking feeling that it's cold. I will find out when I take Alfie out again later. Currently, the digital thermometer, which incidentally is indoors and sitting on the television unit, is displaying the temperature at 23ºC.

Monday. 10.25 a.m. There's not a great deal to report on here over the last day or so, hence, nothing on here!

It's bright and sunny as I write this. It can be chilly first thing. So I put on a fleece and then, by the time I get back indoors, I'm really hot. I suppose it's just that time of year, moving into autumn, when the weather is undecided.

I have been doing homework for the Camphill World War Two project. Doing a bit of research on the internet on various aspects of the war, such as ARP Wardens, the so-called 'Phoney War' etc. I have got it on a Word-processed document and have printed it out and will take it with me when I go to Camphill tomorrow.

Tuesday. 4.25 p.m. I have just got in from Camphill. I have to say it has been really successful. We are putting together ideas for the World War 2 theatre piece and the group is suggesting what they want to put in it and how the story will be told. A lot of material about Bletchley Park and the Codebreakers.

Wednesday. 1.00 p.m. I have been having problems receiving some of my medication on order. I went to the doctor around two weeks ago and was prescribed tablets to help me sleep. I also had to order Atorvastatin, which I have been on for years, I think, since the time of my first heart attack in 2006. In fact, I was put on a different type of statin at that time, but that particular version had a bad effect on my stomach and I had to try several different statins before settling on Atorvastatin which doesn't have any side effects. 

I was also given a prescription for sleeping tablets. This prescription was supposed to be sent to me via Royal Mail, through Lloyds Direct, but I found out that there was a manufacturing problem somewhere in the system. I found this out because I was sent an email which had a barcode in it, which I took to the branch of Boots next to Central Milton Keynes Medical Centre. I was told by the pharmacist that I would need to contact the surgeon, which was closed because it was a Saturday. , 

Thursday. On Monday, I rang the surgeon and they sent me a code via text, which I took back to Boots on Wednesday and managed to collect the Atorvastatin. A long and complex situation. THEN I got an email from Royal Mail, informing me that the remaining medication, the sleeping tablets (called Zolpidem). Two of these are to be taken before retiring for the night, which I took at around 10.30 last night. I did sleep, but still woke at around 4 a.m. 

A Bureaucratic Nightmare

Thursday. 7.30 a.m. It's a great deal colder and far wetter than it's been in quite some time, so it was something of a shock to myself and Alfie when I took him out at around 7 o'clock. He didn't intend to hang around too long outside and soon took me back inside and, as I write this, is tucked up on my bed.

Friday. 4.00 p.m. Some things defy description or logical explanation. Let me elucidate further. I may have mentioned them in these blog posts before, so, if you have read about them before, bear with me. The first is Mears, the contract company who do the maintenance in Dexter House. You may recall that my kitchen was upgraded during the summer. In fact, the work began at the beginning of July and went on for around a month or more. Before the work began I had a visit from two ladies who set out my options for such things as the type of worktops I could have, the cupboard fronts as well as handles on the drawers and cupboards. I asked at that time about the possibility of having an extractor fan fitted, because of the fire alarms being set off when I burnt toast or something in the oven. This has already happened and it means the entire place has alarms set off and the arrival of a fire engine which can be very embarrassing. I was informed that, yes, I could have such an extractor fan and that it would be fitted in the window near the sink. All well and good. There was even a special socket installed near the window, which was where the phantom extractor fan would be located.

Work on the kitchen was completed. I was told by the foreman or manager of the work that the extractor fan would be installed once the kitchen was finished. But nothing happened. And nothing happened, and I waited and, nothing happened. This went on for weeks. I rang Mears and got nowhere. I rang a few weeks ago and had another go and was told 'an order has been raised.' Which raised my hopes that the work would be done. How long would it be before I heard anything? Pigs might fly. Who knows? Then, a day or so ago I was speaking to Barbara, the SHO here at Dexter House, and she told me a workman had turned on Tuesday, totally unannounced, when I was at Camphill, ready to do the installation of the extractor fan. My question is, why just TURN UP unannounced? Did they just expect me to be at home, ready to let them in and do the work? Why did they not contact me via email, text message or phone, to arrange a convenient time to do the installation of the extractor fan? I still await some sort of communication regarding this issue.

The next issue regards my glasses. I had my eyes tested by a visiting optician and around a week later the completed glasses arrived at my door. I had distance glasses as well as reading glasses, but the reading glasses fell apart around six weeks ago. The lens of one side just fell out of the frame. I hardly touched them and I have to wear a pair of ready-made reading glasses I bought in Sainsburys.

I didn't have any idea what the name of the company was who tested my eyes, or any idea how to contact them, but I have now found it, thanks to Barbara, the SHO (Supported Housing Officer) at Dexter House, who has given me a card with the optician company's name on it, together with two telephone numbers to ring. (The company is called Kindsight.) So, I rang the first number and, lo and behold! There was nobody on the other end, just a recorded voice. (How many companies work on this principle? Just a remote telephone number, not even a call centre with a human answering the telephone, and working from 'computerized 'voice activation'?) I had to 'speak after the tone,' and then press the hash key on my telephone keypad to 'save' the message. Will I get a response and get my reading glasses repaired? It is, as they say, in the lap of the gods. When these companies rely on digital or telephone communication, I'm not sure how much you can actually trust them.

The third and final issue revolves around one of the medications I take and have on repeat with my doctor's surgery and then made up at Lloyd's pharmacy in Sainsbury's. I have Atorvastatin which I take in the evening with other medications. I do a regular check to see what I have left and whether I need to do a repeat prescription. Having been a carer, I used to look after peop-le's prescriptions and medications and in some cases do reviews for them. I do the ordering via an app called Airmid, which is connected to my doctor's surgery, Central Milton Keynes Medical Centre in Bradwell Common. You used to be able to contact the pharmacy and then would put the order in, but now you have to go direct to the surgery and they do all the ordering (they use electronic prescriptions which, I presume, saves paper and should, in theory, be far more efficient.) 

I found, when I came to do the order on the Airmid app, that Atorvastatin was 'greyed out', meaning I couldn't order it for some reason or other. I did put in the order through the 'message' feature on the app and assumed that would be fine. On picking up the order the following day (they seem to be able to make the prescription up relatively quickly these days. It could be up to a week after I put in a repeat order.) Atorvastatin wasn't included. I was told by the pharmacist that I needed to have a review, and then I thought I might be able to have that done by Lloyd's. But apparently not. The doctor needs to do it. WHY? I would have thought the pharmacist, whose job it is to know all about the various drugs they deal with, could have done that. Then it turned out that the surgery had rung me so I rang (a day or so after the message had been left as a voicemail, which I never think to listen to. Perhaps, on reflection, I ought to.)

I rang the surgery and got through relatively quickly and spoke to a receptionist. I was expecting to have to make some sort of appointment with a doctor to review the Atorvastatin, but the receptionist ordered the meds for me and the repeat has been sent to Lloyd's pharmacy in Sainsbury's and, as I write this post, the order is ready to collect from Lloyd's as I had a text to tell me it was ready yesterday. So, what's this about a review? Have I still got to have an appointment? What ON EARTH is all this about? I just don't understand any of this. It's no wonder the NHS is in such a mess. Far too much bureaucracy. Things have really got worse, not better. It is stressful, first off, not knowing if I will actually GET the meds, and attempting to be offered some sort of appointment at the surgery. Even now, I don't have any idea of the outcome of this issue.

Cardiology Review

Yesterday I got a letter from the Cardiology Department at the John Radcliffe hospital in Oxford, following the consultant's appointment I had there two weeks ago. This is what the diagnoses reports:

1: Chronic total occlusion LAD
2: Primary PCI to right coronary artery- September 2018
3: Elective PCI to intermediate coronary artery- January 2019
4: Conserved left venticular function- ejection fraction on MPS 52%

'From a cardiac perspective he is well. He does not experience chest pain, or undue shortness of breath. Although he did not undertake a course of cardiac rehabiliation, he is to return to regular exercise, walking his dog. He does not experience limitation. His symptom currently is one of fatigue. Nonetheless he has started (voluntary) part-time work.'

'Current medication comprises Candesartan 4 mg od, Isosorbide mononitrate 20 mg bd, Bisoprolol 2.5 mg od, Ticagrelor 90 mg bd, Asprin 75 mg od and Atorvastatin 80 mg od.

'I have not recommended any changes. He should continue Asprin and Ticagrelor 12 months. He should take Asprin indefinitely thereafter. Secondary prevention is otherwise in hand. Given the symptoms of fatigue a tril off Bisoprolol would not be unreasonable. If his symptoms are unaltered I woul re-start the beta-blocker. I have mde no plan for further follow-up in this clinic. His preference would to to be seen in Milton Keynes for reasons of convenience should follow-up be required in the future.'

Yours sincerely,

Prof. Robin Choudhury DM, FRCP

Professor of Cardiovascular Medicine

HonoraryConsultant Cardiologist

I don't understand all the medical jargon, but I suppose if I was minded to, I could look on the internet to find out what all this means. I don't like to be fobbed off with simplified language. I am reasonably intelligent. But at least I know the situation regarding my health. I've had a heart-health problem for most of my adult life and especially since my heart attack back in 2006.

Tuesday morning. It's bright and sunny as I look out of the lounge window. It's 7.55 and in about 45 minutes I will be driving to Camphill for another morning with the drama group.

Yesterday evening I took the MacBook to Curry's so that their engineer could sort the thing out and make sure there is no malware on it. I just hope I get it back relatively quickly. It shouldn't take more than two days, so possibly Wednesday at the latest. Unfortunately, I forgot to take the charging cable and device. I had the foresight to make sure the MacBook was fully charged, but I will take the lead with me in the car, so if I get a phone call from Currys I can always take it there once I finish at Camphill. Just annoyed with myself for forgetting this item.

Later. I've been to Camphill this morning. In the afternoon there is to be a community assembly and the drama guys will be showing the video of 'Stranger Danger; The Three Little Pigs', (or is it 'The Three Little Pigs; Stranger Danger'?) Each of the actors is going to be interviewed as part of the proceedings and have to answer questions about their favourite bit in the play and the video. It took some time to get them to project clearly and remember the answers which were pre-selected. They did extremely well. It was a shame that I was unable to be there this afternoon, but I'm sure they did really well. This will be the World Premier of the video! It is possibly going to be uploaded onto YouTube and Vimeo which means it can be watched anywhere in the world!

The weather continues to be really warm and sunny.

Statins Cholestrol protecting properties called into question

 The following is an article I found  from the C.B.C. website via Statin Nation through a post on Facebook


 'Cholestrol-lowering statins are heavily promoted for heart patients but new research is calling into question their use as a preventative medicine.

Statins such as atorvastatin (Lipitor), rosuvastatin (Crestor) and simvastatin (Zocor) are among the widely used prescription drugs.

Since the drugs were first marketed 30 years ago in the U.S. for preventing a second heart attack or stroke in those who've already had one, there's been a shift toward prescribing statins for otherwise healthy people in Canada and the U.S.

"These are patients who really haven't had an event, a cardiovascular event, but they seem to be at high risk," said pharmacy Prof. Muhammad Mamdani, who works at St. Michael's Hospital in Toronto.

"You also get populations where people seem to be relatively healthy, their cholestrol-lowering aren't that high, but for whatever reason, they are placed on a statin. That's a patient population that is a lot more debatable and some practices may not be warranted."

More than 38  mllion prescriptions for the class of medications that includes statins were dispensed in Canada last year, according to IMS Brogan. (Kas Roussy/CBC)

The medical community is debating the pros and cons of using statins for prevention as more independent research comes out on side-effects. This week, a study in JAMA Internal Medicine suggested statins may be associated with an increase in musculoskeletal conditions and pain, especially in physically active individuals. 

"If you look at all the studies that have ever been done with statins for primary prevention, so for people who have never had a heart attack or a stroke, if you give a statin to a patient for about five years we can reduce the chance of a person having a heart attack or a stroke by about one per cent," said James McCormack, a professor of pharmaceutical sciences at the University of British Columbia. Shifting focus from cholesterol numbers.

Other potential side-effects include risk of Type 2 diabetes, reversible muscle damage and short-term kidney damage.

In Canada, as in the U.S., the majority of statin prescriptions go to primary prevention patients, not people with established heart disease, said Dr. Lee Green, a professor and chair of the department of family medicine at the University of Alberta who has surveyed doctors on their prescribing.

"It seems we need to retrain physicians, and the public, to focus on actual risks, not on a convenient number like cholesterol level," Green said in an email.

In March, epidemiologist Colin Dormuth, an assistant professor in the department of anesthesiology, pharmacology and therapeutics at the University of British Columbia, looked at the use of high potency statins and rates of admission for acute kidney injury.

"There are a lot of patients out there taking the drugs right now who don't have a history of heart disease who are hoping to prevent heart disease and in all likelihood will derive absolutely no benefit," Dormuth said.

In medical circles, discussions continue. A review published in January by British researchers who combed through trials sponsored by drug companies concluded that "statins are likely to be cost-effective in primary prevention."

People like Jim Matheson, 62, of Toronto, are left to decide with their doctor.

"Within five years he told me that I had a 20 per cent chance of either having a stroke or a heart attack," Matheson recalled. "He offered me the pill but I didn't want to take it."

Instead, Matheson opted to eat healthier foods and exercise more. His brother on the other hand decided to go on statins.

"I have sent him, probably for every article he has sent me on how good they are I have sent him 20 that says how bad they are. We're still having the dialogue," Matheson said.

"We'll see who lasts longer," he quipped.'