Archive for the ‘Health’ Category

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Ah, Mr Covid, I’ve been expecting you…

December 30, 2021

After almost two years of the pandemic, I’ve finally succumbed to Covid-19 – almost certainly the recently-emerged Omicron variant. Here’s my account of the experience.

How did I get it?

Sophie, the daughter of some close friends, married Ryan on the Saturday before Christmas. This had been arranged for over a year, but before it even happened the event was affected by Covid – around 40 people cancelled, either because they themselves had tested positive, or because of other events, vulnerable relatives or other family commitments which meant they decided it was too risky to attend.

Everyone was asked to lateral flow test (LFT) before the event. I was careful, but when there are 70 people in a confined space, despite the doors and windows being open the whole day (my frozen feet knew about that), if anyone there had already contracted Covid-19 then someone was likely to catch it. Apparently eight of us did, including the bride. I was the last to test positive. My wife, happily, wasn’t one of them.

Sunday involved a walk on Dartmoor with some of the immediate family, with afternoon tea at the bride’s parents’ house, and then on Monday we stopped off in Somerset to see some old friends. I had taken an LFT every day, and all were negative. But on Monday evening, just as we thought we might have got away with it, I started sneezing and feeling unwell.

On Tuesday the symptoms got worse. I still wasn’t sure if it was a cold or Covid. Again that day’s LFT was negative. But the advice if you have symptoms is not to rely on LFTs but to take a PCR test. I had to lie to get one, as the symptoms the NHS website says you have to have to book a test are those of Delta, not Omicron. Professor Tim Spector of Kings College and the Zoe Project has been telling the government this for weeks, but no-one’s listening…

I booked a PCR test for the following day, the earliest I could get, and began self-isolating – Monday would have been day 0 of my 10-day isolation. I decided it was wise for me to sleep in the spare room and to use the guest bathroom. My wife and I started wearing masks in the house if we were in the same space, and we opened a lot of windows. Dinner was taken together, but we sat at opposite ends of the dining table, me nearer the open window.

Positive tests

Day 3 LFT

On Wednesday I didn’t feel particularly unwell, but I went for my PCR. I was still thinking it might just be a cold. The result hadn’t come through 24-hours later. We were intending to go to my sister-in-law’s for Christmas, in less than 48 hours, and we needed some certainty, so I took an LFT. I failed. Strongly positive. I notified our friends in Somerset, Sophie’s parents so they could let the others at Sunday tea know, and my sister-in-law. Fortunately it seems none of my contacts contracted Covid from me. Some of that was due to our taking appropriate measures, and some to serendipity.

Anyway, as soon as I reported a positive test I started receiving very confusing, and contradictory, messages from Test & Trace. For some things, such as isolation, you take the day you developed symptoms as day 1, but for many other things the NHS regards the day of your positive test as day 1. For example you can’t get a COVID vaccination certificate, or a certificate of recovery, for 14 days after the date of your positive PCR test (which at this point I didn’t have). Also I got a very long and complex questionnaire to complete…

Your self-isolation period ends 10 days after the onset of symptoms, unless you enter your positive test details into the NHS Covid app, which tells you it’s 10 days after the positive test. And then the government says you can be released from isolation if you pass two LFTs, 24 hours apart, the first no earlier than day 6. However once you’ve tested positive and have symptoms you can’t order LFTs – the website says you have to have a PCR test instead. But since I was already expecting to test positive, taking another PCR would have been pointless, they are so sensitive that I’m going to test positive for several days, possibly weeks, to come.

Finally, late on Thursday, I received confirmation of my positive PCR test. So our Christmas was, for the second year running, to be spent in lockdown.

By Friday I was feeling quite unwell, and consuming paracetamol tablets like they were going out of fashion. Symptoms were similar to a bout of flu: fever, aching muscles, shivering and sensitive skin. But no runny nose or congestion. I also found my sense of smell and taste compromised – not completely gone, but certainly changed.

Christmas dinner was a subdued affair, without much alcohol (I didn’t fancy it, and it didn’t taste right). Sunday was day 6, so I thought I’d try the early-release protocol and take an LFT (we did have a few LFTs left). Still failed.

Also one type of LFT we’d got, that comes in a green box, is terrible. The nozzle of the sample tube is supplied separately and has a little filter in it. When you insert the nozzle into the tube and squeeze to get four drops onto the LFT itself, the pressure sometimes forces the nozzle out, and squirts the liquid all over your hands and the work surface, but not into the LFT. We lost two of seven tests this way. Not good when they’re so hard to get hold of!

Image of government website showing there are no lateral flow tests available for home delivery

Throughout this, as we’re both double-jabbed and boosted, my wife has been allowed to leave the house and carry on a normal life provided she passes an LFT each day. She has remained negative throughout; so clearly our living largely separately, ventilating the house and wearing masks worked.

Was it Omicron?

Probably. Not all PCR tests are genetically sequenced, and it seems mine wasn’t as I’ve had no confirmation of which variant I contracted, but at the time of my infection Omicron was by far the more prevalent variant in England, and given that I’m double-jabbed and boosted, and therefore incredibly unlikely to contract Delta, and further given the relatively mild nature of my infection, it was almost certainly Omicron.

When was I released from isolation?

Not until midnight on day 10. In theory if I’d had a negative LFT on days 6 and 7, with the tests at least 24 hours apart, I could have been released on day 7 (Monday), but I’ve continued to test positive up to, and including, day 10. If I recall correctly, shortly after the outbreak of the pandemic back in early 2020 I’m sure we were told not to retest for 90 days after we’d contracted the virus as it would still probably give a positive test. I admit this is a different strain, but still it seems to me that all Health Secretary Sajid Javid has achieved by announcing this day 7 “test to release” strategy is unnecessarily increased the demand for LFTs when few are likely to pass these tests. It looks like just a PR stunt to pacify businesses who are complaining about the length of time their staff are absent.

Furthermore the partner, provided they’re double-jabbed, being able to remain at large provided they are negative on an LFT each day that the infected person is in isolation has further upped the demand for LFTs.

Demand for LFTs

At the current rate of 180,000 infections a day, each infected person requires at least three LFTs (one to test positive in the first place, plus two to release), and their partner requires seven. So each infected person is likely to require 10 LFTs. That’s an increase in demand of 1.8m tests a day! In addition we’re all being urged to take an LFT before going out or mingling with others, then it’s no wonder there’s a shortage of LFTs in the UK at the moment!

Any benefits?

I don’t recommend catching Covid to achieve this, but I lost half a stone (7 pounds) in weight over the 10 days…

And, as one of my friends pointed out, I’m now as immune to Covid as it’s possible to be, with three vaccinations and the Omicron antibodies it’s extremely unlikely I’m going to catch Covid again for several months, or until another, different, strain emerges.

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Living with high blood pressure

July 7, 2020

Diagnosis

Back before COVID 19 rendered most GP’s appointments video or email, I went to visit my doctor about a pain in my thumb (it turns out I’d broken it, but that’s not the subject of this story). My doctor said, “Since we haven’t seen you for four years, let’s check you over.”

So she took my blood pressure:     215/125.

That’s high. That’s really really high. It should be no more than 140/90 and ideally 120/80. So mine was approaching double normal. Anyway she smiled, made an appointment for me to see her the following week, and suggested that if, over the weekend, I had the chance to take my blood pressure I should do so.

As it happens it was that weekend that my Danish niece was moving to the UK to attend Canterbury Christchurch University, and we spent some of Saturday trying to find a bank that would open an account for her. We finally succeeded at Barclays (thank you Barclays).

Anyway, the Stroke Association had a stall in the branch and were taking blood pressure measurements. So I got mine taken. Eventually.

They’d been using their blood pressure machines all day so the batteries weren’t fully charged; trying to inflate the cuff to stop my blood flow exhausted the batteries on three of their machines. The fourth worked. On the form they give you, there are four boxes, and they tick one of them:

  • Blood Pressure’s fine
  • Blood Pressure’s slightly raised, make an appointment with your GP to follow up
  • Blood Pressure’s significantly raised, consult your GP urgently
  • Go to A&E IMMEDIATELY!

As you might guess, my form had the bottom one ticked. I declined the visit to A&E as I had the appointment for the following week.

Medication

My GP took blood samples and performed lots of tests. My weight (BMI slightly over 25, but she was happy with that), diet, blood samples, cholesterol, electrolytes, lung capacity and lots of other measures were all perfectly fine. I simply had exceptionally high blood pressure.

So we began “titration” otherwise known as adjusting the dose.

To maintain my blood pressure at a normal level I take three different drugs:

  • Amlodipine – a calcium channel blocker – vasodilator
  • Candesartan – an angiotensin II receptor blocker
  • Bendroflumethiazide – a diuretic (water tablet – makes me pee a lot)

I will probably have to take these for the rest of my life. Luckily I live in the UK, and under our health system, since I’m over 60 years old, I get all of this medication free of charge. My GP explained these work well in combination, are effective, inexpensive and have few side effects (apart from the peeing).

I also check my blood pressure regularly.

She explained the best way to do that is to use a machine with an arm cuff and sit at rest, on an upright chair, such as a dining chair, with my feet on the floor and my legs uncrossed. I shouldn’t take the measurement if I need to pee as this may give a raised reading. I should then take three readings, discard the first one and average the other two.

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Arm cuff blood pressure meter

She suggested that wrist blood pressure meters can be inaccurate.

Side effects

I was taking all my medication each morning, then sometimes finding myself light-headed in the evening when I stood up. I mentioned this to my GP who suggested that I split the medication, so I now take Candesartan and the diuretic in the morning, and Amlodipine at night. That solved the problem.

Adherence

Adherence is the medical term for how well I stick to taking my prescribed medication each day. I’m pretty good. I rarely fail to take the medication.

However on days when I’ll be travelling for much of the day (not that often any more), I deliberately skip the diuretic. My pharmacist went apoplectic when I told him this, but I reckon that since my body was used to my blood pressure at 215/125, if it’s now normal but slightly raised for 24 hours I’m not going to come to any harm. And it avoids either my spending the whole journey looking for a loo, or having to carry extra clothes in case of an embarrassing accident.

Also, on the advice of a retired GP friend, I don’t take my morning medication before going for a morning cycle ride – his view was you want as high blood pressure as you can get when you’re vigorously exercising – I take it when I finish. Also I’ve discovered that my blood pressure can drop significantly when I finish exercise, particularly if the weather is very warm, and I don’t want it so low that I pass out.

Other medication

It’s a good idea to be aware how your medication works. The effect of the calcium channel blocker is to expand the blood vessels (vasodilation), this increases the volume of your blood vessels and, assuming the volume of blood they contain remains the same, reduce blood pressure.

There are some common anti-inflammatory medications, including Ibuprofen and Naproxen, which work by constricting the blood vessels. This reverses the effect of the vasodilator and so can increase blood pressure. I take them only very occasionally, and only when absolutely necessary. Again my pharmacist gets very agitated about this, but I think I know what I’m doing – it’s my body after all.

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It’s about branding, stupid. (In defence of Nurofen.)

July 25, 2017

This is a post I wrote a while ago about branding and ibuprofen. For some reason I didn’t post it. But having just written a post about migraines, and mentioned ibuprofen lysine, I thought this was appropriate, so I’m posting it now.

The press in the UK prominently featured a judicial ruling in Australia against Reckitt Benckiser (one example) – the UK-based manufacturer of Nurofen. Nurofen’s a brand name for ibuprofen – an anti-inflammatory drug generally known as a NSAID.

Generic ibuprofen is available in the UK for as little as 16p a pack of 200mg tablets (1p per tablet).

However branded Nurofen is more expensive. That’s known as “branding” by marketers. Branding is a normal way of trying to maintain a price premium in a commodity market. And Nurofen has (or had) a very good brand reputation in the UK – but if what you want is generic ibuprofen, you can buy that more cheaply.

But generic ibuprofen, the active ingredient in standard Nurofen, isn’t very soluble, so it takes a little while to work its way into the bloodstream. There is a compound of ibuprofen that will provide faster pain relief: ibuprofen lysine. It’s highly soluble and therefore enters the bloodstream very quickly. It’s marketed by Boots (for example) as Rapid Ibuprofen. Reckitt Benckiser markets it as Nurofen Express which is more expensive than the Boots’ version, but it’s the same stuff. It’s NOT the same as generic ibuprofen – it contains an equivalent dose, but it starts to work more quickly.

ibuprofenlysineSo what’s everyone getting upset about?

First, much of the press – including the Daily Mail linked to above – is confusing generic ibuprofen and ibuprofen lysine. Although they contain equivalent doses, they are different and you would normally expect there to be a price differential. If you don’t care how long the drugs take to work – for example you’re using this drug to reduce swelling and don’t need immediate relief, then buy the cheapest generic. If you have a migraine and want your pain relief as fast as possible then you can pay more for a faster acting version of the drug.

nurofen_migraine_pain_342mg_-_12_capletsBut beyond this, the marketing guys at Reckitt Benckiser have been creating different packages for Nurofen Express and branding it as Nurofen Migraine Pain, Nurofen Period Pain and other variants. The press is getting excited because these are all the same drug in different guises. It’s true that the packaging conveys the impression that the contents are formulated to specifically target different types of pain. However if you read the details and compare the packages to one another it’s clear that each of them contains the same dose of ibuprofen lysine.

So are they trying to fool the public? I don’t think so. Let me try to explain.

In my past I’ve done some work in retail marketing. Retail packaging is all designed to sell your product, so there are three things you design your packaging to do:

  1. Be more attractive to potential customers than the competition – target your market segment
  2. Occupy more shelf space than the competition
  3. Describe the product (complying with relevant legislation)

So by labelling a package “Migraine Pain”, for example, the vendor makes it more attractive to someone suffering with a migraine who’s looking for fast relief from the pain. If they’ve got an excruciating headache they’re unlikely to read the packaging, or the leaflet inside, to see if something generically labelled as “Ibuprofen Express” is actually useful for migraine pain. They’ll simply pick up the one with “Migraine” in big letters on the package. This means Nurofen Migraine Pain is likely to sell in greater quantities to migraine sufferers than Nurofen Express even though it’s the same stuff.

Secondly, if the vendor manufactures multiple packages each for a different market segment (migraine sufferers, period pain sufferers and tennis elbow sufferers, for example) and each of those packages occupies a slot on the retail shelf then they’re denying that space to their competition – so increasing their sales and reducing those of their competitors.

This is an entirely normal retail sales strategy and you see it everywhere. Remember there were different covers printed for the Harry Potter novels – one aimed at adults and a different one at children? Same strategy – segment the market, take up more retail space, increase sales volume.

Is this a problem for the customer?

I don’t think so. Be an informed customer. If you want to know what’s in the packet, read the blurb on the back before you make your buying decision. Buying Nurofen Migraine Pain rather than Ibuprofen Express is no different from buying your electricity without checking to see if there’s a better deal from another supplier, or complaining that the adult version of Harry Potter and the Goblet of Fire is the same as the children’s version.

As a nation we’re getting a bit more savvy about knowing what we’re buying, both in retail and online, but we can still be influenced by imaginative marketing.

Read the packet!

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The weirdest migraine

July 25, 2017

I’ve been suffering from the occasional migraine for some years. My migraines are very consistent and are known as ocular migraines, or migraines with aura. They start with a spot in the centre of my vision. As soon as this happens I know I’m going to get a migraine and I know that the pain will follow in about 20 minutes. (I found this page from the Mayo Clinic informative.)

Either my wife or I generally carry ibuprofen lysine (aka Ibuprofen Express), which is a more soluble, and therefore quicker-acting form of ibuprofen than the regular medication. If I take this immediately the aura starts then I can generally avoid, or at least massively reduce, the pain of the subsequent headache.

When this happens I generally take myself off to bed, or a darkened room.

ocular-migranie-images-300x153The progress is always the same, the spot expands, it becomes a jagged bright diagonal line and I lose up to half my visual field. Which side I lose depends on which side I’m getting the migraine, so if my right visual field disappears then it’s a left-sided migraine and that’s where the pain occurs. The image above is very similar to my experience. This is from a website on Ocular Migraines. Very occasionally I get the same effect on the other side.

After about 30 minutes my vision returns (the jagged line slowly rises up my visual field and out of view) and if I haven’t taken the pain killers, that’s when I get the pain, for a couple of hours. Following that, and for as much as the next two days, my head feels bruised – as if someone’s hit me on the back of the head with something hard.

There’s no particular food, drink or activity that I’ve noticed that triggers one of my migraines. It could happen at home in front of the television, or travelling, or sitting reading. I am aware that a bright polarised light such as sunlight reflected off a shiny surface such as a wet road, a table or a body of water can bring one on though. I try to avoid those situations.

Yesterday was different though.

We were in the car on our way to supper with some close friends when I noticed the first visual disturbance. We stopped and I took the ibuprofen. We contemplated turning back, but ultimately decided to press on. By the time we arrived, I’d lost the right-hand half of my visual field. We explained the situation to our friends, reassured them I’d be ok in a while, and I had a cold (non-alcoholic) drink.

Never before have I tried taking part in a normal conversation during a migraine attack. It was quite bizarre. I’d lost much of my vocabulary, and actually found speaking very hard. When I did speak, I wasn’t making any sense (either to me, or to anyone else). I knew what I wanted to say, but not only could I not find the right words, I wasn’t pronouncing the words I could find properly or in the right order! This isn’t something I’d ever noticed before, but the websites about ocular migraines mention that speech may be disturbed.

After an hour or so, during the lovely meal, I became more coherent. I carefully avoided the classic migraine foods of cheese, coffee, chocolate and alcohol. By the time we left for home I was feeling much more like myself. Just a little bruised and fragile. And because I was the one who hadn’t drunk anything, I drove.

Life returned to (relatively) normal. A most unusual experience. (And yes, I have consulted my doctor in the past, I’ve had an MRI scan of my head, and we’ve ruled out strokes, TIAs and other possible serious causes, so I just have to live with the migraines and keep taking the ibuprofen lysine.)