Are Pharmacies usually inept?

 

Since last Friday, owing to the dilatoriness of my local #DayLewisPharmacy, I have been without my usual anxiolitics and twice per day beta blockers which were on a prescription I ordered from my GP on 20 August. From tomorrow morning I will be without my twice per day blood thinners. The pharmacy never answers phone calls and, yesterday I had to wait, discomfortedly, for over 30 minutes, in a queue to speak to the sole person at the desk in the pharmacy who thought the items would be received by them and delivered to me today. It is now 16.00 hours and they have not yet materialised. Today I have been quite light-headed and more unsteady on my feet than usual so, it came as no surprise that my blood pressure was riding extremely high. Can pharmacies be struck off for ineptitude, if so I have a nominee.

just the start of another normal day

Where to start; how to define; what words can be used to describe another normal day. I wish to God I understood what is a normal day? Even my days, curbed by health restraints, proffer plenty of variety in terms of food ate, music listened to, DVD’s  viewed, even times of dining may vary, yet somehow they seem to belong to what could be considered a normal day.

This morning I arose from the duvet realm shortly after 10.00hrs, earlier than some but not much later than most days. Even before I left the bed, a throbbing ache in the sides of both knees caused a little discomfort which, strangely, felt like a painful hollowness between upper and lower components of the lower limbs. Nothing unusual there, apart from the degree of ache and discomfort, for this time of day; a mug of coffee and a bowl of cereal were definitely needed. Of course Piper, our beloved hound, greeted me with tail and rear portions wag and sway as he carefully directed me towards his doggy treat store.

So far so good, it’s just another normal day. Having breakfasted I settle down to read the tabloid-sized i-newspaper for fifteen minutes or so before acing wrists cried enough. After a little doing-nothing break, switched on my android tablet, for a cursory visit to twitter-land and newspaper summaries, surfing for about twenty minutes. Another caffeine intake required to keep me awake, followed by a further few minutes with the i-newspaper, only to have a discomforting sensation, tenderness of the lymph nodes, in the armpits. Time to move to the larger sofa, put my legs up and allow the music from radio 3 to wash over me; Piper swiftly leapt over my lower limbs to snuggle beside me.

Not many restful minutes passed before a throbbing discomfort in my toes demanded I put  some pressure on the soles and arches of my feet to somehow eliminate the toe-tingling sensation. Next, almost as a matter of routine, pains from the armpit had extended a nauseating discomfort to whole of upper limbs.

Yeah, I suppose it is just another normal day; shortly after 13.00hrs my first resort to painkillers (tramadol 2x 50 mg) since late yesterday evening (on that occasion alongside amitriptyline) as I prepared for my return to the bed zone. Of course by this time I have recourse to my usual pre-meal medication as I anticipate a little lunch-time bite to eat.

Amazing how hard one has to work in order to be busy doing nothing; for now I revel in the music zone, forget my minor worldly woes. For music, love and life, I give thanks. Just the start of another normal day!

On the Opening and Closing of Doors

ON THE OPENING & CLOSING OF DOORS

Well, life has certainly been eventful, and frustrating, since my fall (http://sinnaluvva.blogspot.co.uk/2017/09/a-fall-becomes-set-back-and-shaggy-dog.html & http://sinnaluvva.blogspot.co.uk/2017/09/gratitude-for-nhs.html) but, nothing really much in any way I could regard as positive. Because my PPI (omeprazole) was not compatible with the clopidogrel, the GP switched my prescription back to lansoprazole; I had taken lansoprazole for a number of years and had discovered the most effective dosage was 30mg twice per day, morning and evening. It, therefore, came as something of a surprise to find that I had only been prescribed 15mg once per day.

The new medication regime began on the 19^th September but, so painful and discomforting had my GORD and IBS symptoms become, that by the 27^th September it became essential for me to have an emergency appointment at my GP surgery. The appointment was with a nurse practitioner who duly increased my dosage to 30mg once per day.  Even with this dosage, I still had to resort to a strong antacid each evening.

Meanwhile, I was twice proffered an earlier appointment (in a saga which began a few months back) with the surgeon to discuss removal of my gall bladder but, I automatically declined as I now needed to get into a pattern with the amlodipine & clopidogrel and, I realized that if an operation was to take place I would need to be off the clopidogrel for around one week.

By way of diversion, we have an additional resident chez nous. Beth, the eldest of my two step-daughters, was discharged from hospital in York on 10^th October following a bicycle accident on the 3^rd. She has a fracture in the neck of her humerus, necessitating immobilizing of her right arm and plates in her jaw at the sites of two of her three jaw fractures. This latter condition means that she is only able to manage soft / pureed food. My beloved OH has to help her both to dress and to bathe / shower.

Eventually the pre-arranged appointment, on the 23^rd October arrived and ma belle chauffeuse accompanied me to the clinic at the District Hospital. The doctor soon explained to me that as I had recently had a stroke, albeit a minor one, she would be unable to carry out the operation as the anaesthetic required could trigger a further more severe stroke and, although I could apply for referral after six months of reasonably good health, she personally didn’t seem much in favour of this, as she felt there would still be the risk of a more major stroke. When my beloved asked the surgeon what should happen if I had a further infection of the gall bladder, she suggested that antibiotics, albeit with the possibility of increased antibiotic resistance, were much preferable to a risk of paralysis. She was of course aware of my family history [my mother suffered a major stroke within seven days of experiencing a TIA – spending her remaining years with total paralysis of one side of her body – when she was of an age only marginally advanced from my current state of being].

Whilst I was somewhat relieved that the doctor hadn’t pussyfooted about the rather stark options, it did seem to emphasize the whole mortality issue as, later in the day, I began to feel a sense of desolation regarding an apparent futility of existence. I wondered, for a while, if I was reverting to a state of depression! In the clear light of a new day, chronic illness notwithstanding, I was so blessed with a loving wife and family, a catholic taste and enjoyment of various musical genres, literature, fine arts, and a faith that never lets go of me even when belief has evaporated.

Shatteredness Conundrum

A SHATTEREDNESS CONUNDRUM


It's not so much the chicken and the egg as the pain or the tiredness.

Does weariness simply allow a latent pain to exaggerate it's presence or, is it the tired bodies vulnerability that allows a deep pain and discomfort to take hold? Today, a day of only minimal exertion, a sudden onset overwhelming sense of fatigue was swiftly subsumed into an entangling, nerve jangling, multiplicity of pains.

These acute pains, not the overly familiar dull aching wearying variety, swiftly took hold in ankles, knees, armpits and wrists.  The intense discomfort resulted in a sudden welling up, and gushing forth of tears; tears of frustration and, temporarily, despair.

I hate to take my pain medication other than when it's absolutely necessary although, I'm coming back to the notion that I should take the occasional pre-emptive dose as well. The problem then arises as to how I discern whether a lower or negligible level of pain is the result of this pre-emptive strike or, could it simply be a normal spasmodic reduction in pain level.

A SLOW SLIDES JOURNEY INTO DAYMARE

A SLOW SLIDES JOURNEY INTO DAYMARE

Today would be best forgotten but, it’s my failure that I find it hard to forget, just as I find it almost insurmountably difficult to forgive. Much of today’s problems, other than the generally ongoing ME related ailments, emanate from the inappropriate prescribing by a certain medical professional. That GP I am unable to forgive.

This morning I was forced to emerge, from the duvet lair, a good

1 ¾  hrs earlier than is my norm, to keep a previously postponed appointment at the hospital’s orthoptics department. The morning, apart from my unearthly hours emergence into the day, was also greeted with a quite heavy snowfall.

Anyone who knows me, at all well, is all too aware of my difficulty with travel of any kind and, this morning’s short journey, following the main roads rather than our usual shortcuts, was one of following and being followed by skidding and stalling vehicles.  This was just like living through a nightmare for my sensitivities. At one point, even my beloved chauffeuse thought we’d maybe have to call the hospital to cancel the appointment, this time at much shorter notice. In spite of prior weather warnings of snowfall the responsible(!) authorities hadn’t bothered to grit the roads.

Whilst my beloved queued, waiting to access the hospital’s car park, I made my way to the relevant department. As I looked for the right place I wandered past the turning, having been told it was to the left, by a volunteer near reception, whereas it was actually to the right. Having ambled along the corridor a notice clearly stated that patients for Visual Fields Test should take a seat “here”, which I duly obeyed. Several minutes later a couple of hospital staff ambled by and asked if I was alright; I in turn informed them that I was waiting for the visual field test. Evidently I should have first reported to a reception staton some twenty to thirty yards further along the corridor.

By this time I urgently needed the loo, and had a bout of re-active diarrhoea, before entering the surgery. The clinician was quite concerned that my head felt so hot, and I explained how this wasn’t unusual as I could sweat in a freezing environment, my body thermostat being shattered / wildly erratic ever since succumbing to ME.

About halfway through the tests on my first eye I required a break as my chin and forehead were so uncomfortable, and I needed a drink of water before I continued. No sooner was the patch transferred to the other eye, and appropriate lens in place than I became quite headachy and totally incapable of concentrating as all spun around me. I informed the clinician that I wasn’t able to continue the test and also cancelled and discharged myself from tomorrows appointment with ophthalmology.

I simply cannot cope with early hours or concentrated attention. The appointments would not, in any case, have been necessary had my GP not messed haphazardly with my medication. [Earlier postings have already dealt with this situation]

A glimmer of hope

The process of trying to get an urgent appointment proved harrowingly frustrating but, I suspect the age of miracles is not yet dead - we certainly need them!

Anyway, the seemingly impossible happened .....

the space-hopper weighed down

A deep lethargic spirit consumes my very being; a lead weighted space-hopper would be about right as a description of my personage at 11.30 am. Last night was the worst of those seemingly endless, restless, nauseatingly painful nights that I’ve experienced in a long time. Don’t get me wrong, a disconcertingly discomforted restless night is currently par for the course, but last night was topped with added painfulness. Even my regular pre-emptive strike against nocturnal discomfort, amitriptylene and tramadol taken an hour or so before snuggling under the duvet, seems of little if any avail these days.

 

As I fitfully tossed, turned and squirmed au lit, post-nasal drip and gastro-oesophageal reflux added a further frustrating layer of dis-ease to the tenderness of cervical and axillary lymph nodes. Invisible clog dancers throbbed their way from armpit to elbow, elbow to wrist, before treating the rib cage as a xylophone. As I stretched my legs over the end of the mattress, my toes burnt as if they were being scrubbed with a wire brush. Once the nagging aches pulsed through my hands I decided to don my wrist splints which, somehow, seemed to gradually alleviate the pains in my upper arms.

 

Even the weather seemed to conspire against sleep, the roar of the wind was disturbingly amplified as I lay there, watching the flickering shadows which took on a somewhat threatening character in the darkened bedroom. An irrational childhood fear of the dark seems to have re-emerged recently, although it only applies to darkness within a building not in the great outdoors. Switching on a bedside lamp almost miraculously eased some of the bodily tension but, even then, only quite short snatches of sleep, from around 4.00am,were on the menu. It seems to be the rule that only unrefreshing sleep may be proffered to yours truly! The past couple of weeks have also seen an alarming resurgence of diverticular and spastic colon symptoms, no doubt contributing towards the sudden all enveloping exhaustion which erratically disrupts my daytime routine (or lack of such).

 

I am of course in that period of my life when I start to question how many of my ailments, or to what degree, they are symptoms of an ageing body as much as the manifestation of an underlying chronic illness?

 

Now, here’s the surprise. In spite of all the foregoing ailments I still manage to enjoy life, constantly amazed by the intricacy and complexity of the world around us, attempting to interpret one’s relationship not only to the earth and one’s immediate vicinity but, how we fit into the whole cosmic scheme. The joy that I gain by observing the sheer variety of flora and fauna, even just within the confines of our garden, still fills me with a sense of wonderment. That there is something, rather than nothing, into which we have been thrown, is cause enough for celebration; the love I share with ma belle Bright Light ultimately overwhelms a one time tendency of mine towards cynicism.

Woes and Gratitude

It’s becoming increasingly difficult not to sound like a moaning wimp. It isn’t that I feel much worse than has become my familiar norm and, I’ve frequently experienced more excruciating aches and pains than at present, but it’s an overall sense of feeling ‘off-colour’ that nags and gnaws at me for at least half of my waking hours.

It’s almost impossible to get used to those times when one suddenly experiences a cloying, gut-wrenching, nauseating giddiness, and sudden change from warm to cold skin as the colour can almost be felt draining away from ones face. Sometimes the overall sense of queasiness persists for only a few minutes, before the healthier glow returns, at other times the period of dis-ease is much more prolonged.

The spastic colon & diverticular disease randomly asserts itself, with little regard to whether I’ve maintained a regular dose of anti-spasmodic pills (mebeverine) but, fortunately the ppi’s (lansoprazole) function reasonably well in curbing the worst excesses of gastro-oesophageal reflux (although there are some days when, come bedtime, I still require a dose of antacids.

On a positive note, I’ve suddenly realized that up to this point no mention has been made of the painful aches in the upper limbs (not infrequently emanating from the armpit) as these are currently adequately controlled by doses of tramadol. So, I conclude on a note of gratitude once again; if only the flow of thanksgiving could overwhelm the woes that flesh is heir to!

refreshed ... ?

Wow, it’s already 17.30hrs and I’m just beginning to feel awake. Having slept quite soundly, albeit intermittently, retiring au lit shortly after 22.00hrs last evening and emerging from the duvet lair at around 11.00hrs this morning, I should have felt refreshed, right! Truth be told, I can’t quite remember when I last felt refreshed / really awake during any morning or afternoon but, things have got much worse since I started taking the amitriptyline.

Had a telephonic conversation with the duty doctor this afternoon; “Mirtazapine, Amitriptyline and Tramadol, they’re all sedatives”, he says. I explain that I’d only just taken a couple of tramadols today, only resorting to them when absolutely necessary. I suggest that maybe I should ditch the mirtazapine but, he thinks that’s a bad idea and comes up with the suggestion that I take it in the morning (instead of the evening) and just take half an amitriptyline in the evening.

The experiment continues …

False Hopes

Regular readers may have noted my problems with exhaustion and a corresponding lack of refreshing sleep. Much of the time it has not been quite as simple as lack of refreshing sleep, more a lack of sleep (full stop). Out of my current average twelve hours bed rest requirement, a good night’s sleep could be as little as three and a half hours. It’s commonly said that as one gets older they require less sleep but, in my case, when it comes to the amount of bed rest required, this has most markedly increased.

In my youthful heyday the nights when I spent as much as eight hours abed (during the working week) were very much the exception; any hours in excess of this on non-working days were most definitely a pampering luxury, rarely a necessity as they are now.

I have been finding relief from some of the daily aches, pains and spasms, through a combination of tramadol, ibuprofen sundry orthopaedic supports; unfortunately, this still doesn’t prevent intensely discomforting pains interfering with my desire, from a state of shatteredness, to get some sleep. On such occasions, even lightweight pyjama jackets and / or trousers feel like intensely constrictive pain dispensers in their own right.

A couple of months ago the GP put me on a small dose of (the anti-depressant) mirtazapine in the hope that its sedative effect would help me get some shuteye. For a week or two it certainly seemed to be helping, even though it could still take a good couple of hours of excruciating tiredness before mind and body yielded to the land of nod. Some of the more intense pains in the region of the armpit and upper inner arm persistently nagged me back into a fully wakeful state. The doctor has now added an additional anti-depressant, amitriptylene, to my evening medications primarily for its supposed analgesic effect.

Having benefitted from a couple of pain-free, almost completely restful, nights my hopes really began to build up. Yesterday, having taken a couple of tramadol late morning, I felt no need to take further painkillers for the rest of the day, simply taking the mirtazapine and amitripylene in the evening. What followed was the most agonizingly painful sleepless night; admittedly it wasn’t helped by the highly amplified sound pulses emanating (until 2.30am) from a private party a couple of blocks away. A fair bit of time was spent stomping and cussing around the bedroom and landing, experimenting with wrist, shoulder and elbow supports, as well as consuming a couple more tramadol. The pain eventually began to ease by around 4.30am but, my mind was (by then) far too active to permit me any slumbers. Thankfully, by mid-morning I attained some brief, dream-filled, spasmodic patches of slumber.

I am attempting to retain a degree of hope that the recently prescribed medications will eventually fulfil their prescribed function but, it feels rather like a hope against hope!  

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since my previous post I have added a few more snapshots, 'the fuschia is present', to 'Mal's Picturebox'.

Sometimes

Sometimes life just feels good, no matter how ropey ones underlying condition may be. It's the simple things that count for so much; the delights of taking a shower comfortably seated, remembering how much one struggled before that simple installation of a seat was made. To relish a rare good nights sleep, waking in the morning feeling almost refreshed and, the odd muscular spasm responding to an appropriate medication.


Having registered with a different doctors practice on Monday, one fortunately within my restricted walking range,I had an initial consultation yesterday where I was able to initiate an essential modification to my precribed medications. To be honest though, even the most efficacious medications seem to carry with them some undesirable side effects and one has to carefully consider their relative demerits.


The GP I saw also appeared to be quite understanding about M.E. which was a very pleasant surprise, when one has become quite used to a rather dismissive attitude, seeing the importance of pacing and resting. She even seemed supportive when I suggested the importance of campaigning on ME related issues and how important an online presence had been for me. An acceptance (albeit reluctantly) of the quite dramatic limitations that chronic illness imposed on any socializing activity, was for me a significant turning point, I was no longer held hostage by a recklessly seething self-pitying anger. The more I resented the condition, the more difficult it had become to develop any kind of strategy to cope with it; acceptance enabled me to regain myself.


Sometimes, life just feels good - just venture into the garden, take a few snaps - Spring is so much in evidence ...

                                               Click on image to enlarge

Worth A Mention?

strange how medications to alleviate a condition can make that same condition much worse

never sure what's a reaction to new medication and what's part of the underlying condition

Having just "tweeted" the above (apparently trivial) observations, I suddenly realized that they may be expressing a deeper underlying concern

.
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I knew when I made the appointment that it was a follow up to check how a change of ppi is affecting me. Informed GP that for a few days it seemed better, explaining an inadvertent side effect of the extra dosage of the former ppi, but now it didn't seem as effective as I was experiencing a greater degree of discomfort. The GP of course asks me, do I think that my current discomfort, an amplified version of what I'd been already been experiencing, was related to the gastric problem. Having acknowledged fairly recent A&E incidents which confirmed that there was no apparent heart problem, and last years endoscopy finding no obvious cause for my gastric problems, I could only reply that according to previous GP guidance that did seem to be the case.

The outcome was a decision made, with my uninformed collusion, that I should continue with the new ppi but also take a dopamine antagonist 3 times per day. The first couple of days on this new regimen and, I'm feeling markedly more discomforted, in the gastro-intestinal / gastro-oesophogeal stakes, than I've felt for quite some time. The frustration continues. The question is, do I persevere?

Having stated the question, I now return to the larger problematic picture. Any visit to a GP tends to focus on a specific problem and, as a result, other ailments that are part of an ongoing chronic condition are rarely given an airing, in the course of a consultation. The doctor is presumably well aware that I need to take pain-killing medication, primarily tramadol, to treat persistent muscular and skeletal pain but, I sometimes do find myself wondering whether the broader underlying condition could also be responsible for my gastro-intestinal problems.

Unfortunately treatment only seems to be available for specific symptoms whilst the larger underlying picture seems to be trivialised or ignored. Indeed, as an example, there has always been a marked reluctance on the part of the government, and the Medical Research Council, to carry out bio-medical research into the neurological condition Myalgic Encephalomyelitis. One feels, at times, afraid of mentioning the aching tenderness in armpits and under the chin, the sharply bruised leaden hollowness in the lower limbs whilst still abed, a sense of ones skin being pulled too tight over one's flesh, random virulent nightsweats, degrees of orthostatic intolerance, a not infrequent need to don supports on ankles, wrist, back etc in order to cope with the days most basic tasks. 

Don't get me wrong, I've long since learned to cope with the daily onslaught of aches and pains and, I generally manage to pace myself sufficiently to avoid a major crash but, that doesn't mean that life is easy, much as I enjoy it. 

how strange the change ...

How swiftly things change, at least on a superficial level. Although the cause of the sundry ailments my flesh has been heir to of late is somewhat elusive, the symptoms have somehow been alleviated by ... unknown!

What a difference a day makes; after yesterday’s ropiest of starts, as the day progressed, my appetite (for food) commenced a restorative process. After days of picky snacking, and with the comforting presence of ma belle, by early afternoon I felt fully able to contemplate a real lunch; the swiftly prepared baked salmon, served with new potatoes, brocolli  and beans, seemed like a real treat and I even enjoyed a post-meal shared pot of Earl Grey without any adverse reaction. By this time I’m beginning to suspect that some of my most recent discomfort has been a reaction to the Amoxicillin prescribed last Saturday but, I doubt whether I can hold that responsible for the mornings flow of tears.

Late afternoon I got in to see the locum doctor, at my GP’s surgery, and he proved to be a good listener – to me the most important  prerequisite for any GP. After a few minutes, having checked my medical history, he asked whether I felt a need to go back on Citalopram or whether something to help me regain a reasonable sleep pattern would be most appropriate. I settled for the latter as, quite honestly, with the exception of those spontaneous re-active outbreaks like that experienced yesterday morning, my general disposition (even allowing for the aggravating dis-ease I’ve been experiencing of late) is pretty positive.

To assist with my sleep he has prescribed Trazadone ( which I notice is an anti-depressant) but only in a very low dosage, one 50mg capsule to be taken an hour before bedtime. After the first dose I haven’t noticed much change but, at least I had no recourse to wee small hours radio listening. Although my beloved had left a glass of water at my bedside, before she left for work at 7.30am, it wasn’t until 9.30 that I was sufficiently awake to utilize it as I swallowed my cocktail of lansoprazole, tramadol and amocxicillin. Removing myself from the duvet lair, at around 10.00am, I felt really quite refreshed – a relatively unfamiliar early morning sensation - and by shortly after 11.00am had corralled the necessary stamina to manage a quite brisk walk down to 'Open Church'.

When my physio visited, earlier this afternoon, after a while spent in conversation she applied the acupuncture needles in positions most conducive to aiding relaxation and recuperation.