Archive for the ‘Health’ Category

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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.)