medicine - A Latent Existence

Review: Tabtime Super 8 pill reminder

I have been using this pill tray for a few weeks courtesy of Eleanor Independent Living Aids. The concept is simple but incredibly useful - it combines a pill tray and alarm clock in one.

The Super 8 is a blue rectangular box made of two halves folded together in a clamshell format a bit like an older folding mobile phone. From the outside there isn’t much to see apart from a battery compartment on one edge and a red LED light on the front. The Tabtime is easy to open: the right edge has tabs with cutaway parts to allow easy opening with less-than functional fingers and the magnet which holds secures the Tabtime has just enough force to keep it shut but opens easily with minimal pressure.

The Tabtime opens to reveal a pill tray on the right with eight compartments and a large clock on the left. The pill compartments are again easy to open, with a tab protruding from the edge of the lid which can be lifted easily. For the most part the lids are secure, although I did find some becoming loose when opening the opposite compartment. This isn’t a problem when the device is closed as the compartments are kept shut by the folding of the two halves. I found the compartments are about the same size as my seven-day pill tray with enough room to hold quite a few tablets, or four of my huge Metformin tablets.

Turning to the clock then, it has a nice large display which shows the the current time, and it has several buttons for setting the timers and a volume switch with options for Hi and Lo. Personally I have the volume always set to high as I have found that the low setting is not audible from the next room, or when the Tabtime is kept in a bag while outside. The high volume setting is loud enough most of the time but could do with being a little bit louder.

The Tabtime very usefully has a timer for every pill tray, eight in all. Used in this manner it is possible to have an alarm go off at the same time every day for each set of pills. On opening the Tabtime up after an alarm has sounded the screen shows a number along the top edge to indicate which alarm sounded and which compartment to take pills from.

If like me you don’t always take pills at specific times, painkillers, for example, there is also a countdown timer which I keep set to four hours. After taking my painkillers I can bring up the countdown timer on the screen - an action which unfortunately requires nine presses of the Mode button to cycle through the eight alarms - and press the Minute button to start the countdown to my next dose. Used in this way it does not give the benefit of indicating which pills to take, but that isn’t a problem if working through the compartments in numerical order. The red light on the front of the Tabtime is very useful since it starts to flash when an alarm sounds and it will keep flashing until the Tabtime is opened, even if the alarm sound stops. That makes it easy for me to know when I can take painkillers by looking for the red light even if I miss the alarm.

Of course eight compartments isn’t enough to replace my seven day pill tray. I tend to use my larger tray as usual, but keep painkillers in the Tabtime where I can make use of the alarm. When I go out I can fit my painkillers and all the other pills that I need for a day in the Tabtime and keep it in my bag.

The Tabtime isn’t perfect. It could do with a louder alarm, and perhaps an extra button to access the countdown timer in a less tedious way but it is very useful as a reminder while at home and for carrying pills when I am out. It serves its purpose very well and if you have to take a lot of pills then I can thoroughly recommend that you get one.

You can obtain a Tabtime Super 8 from Eleanor Independent Living Aids for £20 including postage.

Acupuncture

I have already written about Homeopathy and Chiropractic. It should be no surprise to my regular readers that I am contemptuous of acupuncture too. There are several problems with acupuncture.

It is based not on knowledge of biology, but on “qi” (energy.)
It does not cure, but it practitioners claim that it can.
Needles can damage nerves and may cause infection if not sterile.

The first point is important. With most medicines we know the mechanism through which they affect the body. We know which part of the body they alter, and we usually know how they work. Acupuncture is based on the idea of qi, pronounced chi, and meaning a kind of energy that supposedly flows around the body through channels called meridians. We have no evidence of qi or of meridians, but we do have evidence of nerves, hormones, chemicals and all the other concepts that make up the human body. Qi was an attempt to explain life before we had the modern knowledge of how the body works. Now we know better.

Acupuncture does not cure anything. We know it doesn’t, because there have been trials of acupuncture. The acupuncture page on Wikipedia lists many of them. Acupuncture may be effective against pain, although the findings of studies vary and there is insufficient evidence to say either way. It is likely that reported pain relief from acupuncture is largely a result of the placebo effect. This is not necessarily a bad thing, since the important thing here is relief from pain and the placebo effect can do that. Acupuncture may also help relieve pain by distraction through simulation of the nerves and the release of endorphins. This is not proven.

While acupuncture can provide pain relief, it cannot cure disease. It cannot flush out virus or bacteria infection, or cancer cells, and it cannot repair the body when it has gone wrong. The British Acupuncture Council claims that acupuncture can help with all sorts of things - colds and flu, infertility, chronic fatigue syndrome. This is of course absurd.

For the most part, acupuncture is safe, but as it is an invasive procedure there are risks. There is a danger of infection if the needles and the environment are not sterile. There is a danger of damaging a nerve. There is a danger from a needle entering a lung, kidney or other organ if the needle is inserted too deeply.

Overall, then, some people might like to use acupuncture to provide relief from pain, if it works for then. Unfortunately it does not work in enough people to produce a significant result in tests, and the results that it does produce are likely to be from the placebo effect. It certainly doesn’t cure anything, and if people use acupuncture in preference to tried and tested medicine then they may prolong their illness or endanger themselves by effectively leaving themselves untreated. Acupuncture is not entirely risk free anyway.

I know that in spite of my arguments here many people will choose to believe in the curative abilities of acupuncture anyway. That is their right to do so, but they should understand that belief in qi and the manipulation of qi through the use of needles is not a scientific belief. If anything, it is a religious one.

If someone wishes to choose to use acupuncture instead of researched and tested medicine, I cannot stop them. If it provides pain relief for them, then I am happy for them. I think it is fair to say that of all the alternative treatments, acupuncture shows the most promise of a plausible mechanism and of tests showing a useful difference, at least for pain relief. I take issue with practitioners that make absurd claims about what acupuncture can do; if someone chooses acupuncture because they think that it will cure their viral infection or cancer then they have been conned. At the very least, we have laws against obtaining fees through false claims and against making false claims in advertising material. If someone believes that alternative medicine replaces the need to have vaccinations, then they would be putting the rest of us in danger and that idea would need to be stopped. I wrote about this in my previous blog post, Alternative medicine - a dangerous game.

Bust and boom, a spoonie tale

Yes, I know that the title has the phrase the wrong way around. But bust and boom perfectly describes what has happened to me in the last few hours.

Last night after dinner and watching Doctor Who my wife and I decided that we wanted cheesecake for desert. The nearest cheesecake was at the co-op which is about half a mile away from us. My wife asked me if I wanted to come out for the walk to go and get the desert. I stood up, stretched, checked whether I was able to stand without wobbling and walk without hurting, and said yes. I regretted it almost immediately, with pain in my left leg and foot, and I was putting weight on my stick from the start. After a short distance I had to stop and lean against a lamp post for a minute while I waited for pain to go down and dizziness to stop. A bit further and we started to go uphill. I was using my stick to push me uphill and was leaning on the hand that my wife was holding too. I was dizzy and out of breath, I had pain coursing through my feet, my legs, my arms, back, shoulders, neck and probably other bits if I thought about it. At the top of the hill was a low wall. I sat on it. I couldn’t move for fifteen minutes.

Having sent my wife on without me to get the cheesecake and waited for her return, I managed to stand up (just about) and stagger home, held upright by my wife and leaning heavily on my stick. On getting home I collapsed in bed, ate a slice of cheesecake, looked at twitter, and then promptly passed out. When my wife came to bed at 9:30 I took my medicine and went back to sleep. Although I woke up for a few minutes after midnight, I slept the whole night through and woke up shortly before 5am feeling pretty good! I amused myself with twitter, trying to stay in bed a bit longer until the rest of the world woke up. Sometime around 6am my wife woke up too, and she helped me fill up my medicine tray for the week. That was actually a fairly interesting half hour, as I talked her through the medicines I take and what they are all for. The only problem is that while distracted by talking about my medicines I accidentally took two doses of paracetamol. We checked up on it, and apparently the toxic dose for my body mass is 16g and I took 2g so I am not too worried about it.

Since I was obviously feeling quite well this morning I suggested that we go out for breakfast. This time although I was using my stick I wasn’t leaning on it that much. We walked all the way up to the pub, about the same distance as the co-op, with only one pause to sit on a bench halfway there. So now I am sitting in the pub writing this on my netbook. My wife has gone off to church, and I’m writing, websurfing and drinking coffee, and not feeling too bad. Which almost makes up for my disastrous walk last night.

Do you know what Chiropractic really is?

Do you know what chiropractic is? Most people that have heard of it will generally hazard a guess that it is something to do with bad backs. They are sort of right. Chiropractors do manipulate the spine, and other parts of the musculoskeletal system. But they do it in the belief that some or all other medical problems are a result of problems with the spine, and can be fixed through manipulating the spine.

Daniel David Palmer invented the theory of chiropractic in 1895. He decided that all living things have vital energy called Innate Intelligence. Innate Intelligence supposedly flows out of the brain and through the spine to the organs. According to Palmer, misaligned vertebrae block the flow of Innate Intelligence, and that is the cause of all other illness. Palmer also rejected the idea of germs and of vaccination because he thought that all illness is caused by this blockage.

These ideas, of course, have no basis in science at all, and there is no evidence that things work this way. In 2008 the British Chiropractic Association launched a libel case against science writer Simon Singh over an article that he wrote in The Guardian. I have reproduced the relevant part here. See the rest, with notes in this article: The libellous Simon Singh article on chiropractors.

First, you might be surprised to know that the founder of chiropractic therapy, Daniel David Palmer, wrote that, “99% of all diseases are caused by displaced vertebrae”. In the 1860s, Palmer began to develop his theory that the spine was involved in almost every illness because the spinal cord connects the brain to the rest of the body. Therefore any misalignment could cause a problem in distant parts of the body.

You might think that modern chiropractors restrict themselves to treating back problems, but in fact they still possess some quite wacky ideas. The fundamentalists argue that they can cure anything. And even the more moderate chiropractors have ideas above their station. The British Chiropractic Association claims that their members can help treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying, even though there is not a jot of evidence. This organisation is the respectable face of the chiropractic profession and yet it happily promotes bogus treatments.

This lawsuit caused uproar in the scientific world because the BCA was effectively using libel law to silence scientific opinion. Simon Singh’s defence effectively put the efficacy of chiropractic on trial. The BCA dropped their case in April 2010. The idea that chiropractic can be used to treat colic, habits, ear infections and asthma is not only without scientific basis, but also dangerous. Someone seeking treatment for these things will not get the real effective treatment that they need. Promoting the use of chiropractic to treat babies for these things is just cruel. The lack of proper treatment will lead to suffering for the baby, and the chiropractic treatment can itself cause injury and prolonged pain.

Chiropractic does seem to fill a gap in health services. I have spoken to several people in both the UK and the USA who have Ehlers-Danlos Syndrome (EDS) and visit chiropractors. The problem seems to be that physiotherapists and other specialists within the NHS and conventional healthcare don’t seem to have the knowledge or the time necessary to deal with problems caused by hypermobility. Chiropractors appear to know the musculoskelatal system and especially the spine in a lot more detail, and are willing to help reset subluxations. (Partial dislocations) Chiropractors also take the time to listen to their patients. This could be because they are generally seen privately and so have more incentive to earn their fee.

Unfortunately despite them offering useful help with back and joint problems, I think any good in Chiropractic is negated by the rest of what they believe. For a start, there is room for confusion because chiropractors use the term subluxation in a different sense to the medical profession - they believe that there are dysfunctional segments of the spine that block innate energy, and they call this a subluxation too. Chiropractors believe that these vertebral subluxations (which aren’t subluxations in the normal sense) block innate intelligence and prevent if from reaching the rest of the body. They think that this is the cause of infections and illness. I think possibly the worst thing that chiropractors do is to advise people not to get their vaccinations. I have said before when talking about homeopathy that we all rely on “Herd Immunity” for vaccines to work, and telling people not to have them in the hope that chiropracty or homeopathy will prevent viral infections is not only obscenely stupid, it’s a danger to the whole of society.

Some people will argue that it is acceptable to use a Chiropractor if they stick to actual physical problems and avoid other issues, but in my opinion this is that this gives them some respect in the mind of the public and opens the way for people to fall for the rest of what they say. Ultimately, if a person is spending their own money, and receives some benefit from chiropractic treatment for physical problems, it isn’t my place to tell them to stop seeing a chiropractor. I do think that they are making a mistake though, and I really hope that no one else will see it as a reason to trust a chiropractor for anything else.

More Information

UK Skeptics - Chiropractic

The libellous Simon Singh article on chiropractors

On Putting Chiropractic On Trial - Simon Singh’s Defence

Simon Singh libel case dropped

All in my head

In one of those odd random blips of popularity, my description of M.E. has been circulating around twitter and Facebook today. I found it quite interesting to read the way people described what I had written. People identified with it, and said that I had described the symptoms well. I found that comforting, in a way, because their identification with it means I haven’t imagined everything. When enough people tell you your illness is all in your head, it’s hard not to question if it is. Even to the point of wondering whether I’m saying I need to rest because I really need to, or because I’m lazy.

M.E. has a long history of controversy. Until very recently, no physical markers have been found for it. Diagnosis has been based on description of the symptoms and by ruling out everything else. Because there is no way to be certain of the diagnosis, public attitude to M.E. has been poor. Names such as “Yuppie Flu” are derisive and contribute to the attitude that people with M.E. are simply faking their illness, and are lazy or work-shy.

Many doctors have held the opinion that M.E. is a mental illness. They conclude that the fatigue and the pain are due to depression, and hold the belief that only therapy such as CBT and a slow increase in activity is necessary to cure the patient. In actual fact, the World Health Organisation classifies M.E. as a neurological disorder under Diseases of the Nervous System, G93.3. The Department of Work and Pensions also categorically states the CFS/ME is physical. Despite this classification, many doctors still believe that M.E. is purely a mental illness.

What is the impact of this belief? One of the defining features of M.E. is that fatigue is not explained by exertion, and in fact is out of all proportion to any activity. In my experience, the best management strategy for M.E. is Pacing. It involves making an effort to stick to a timetable of rests and a set level of activity, and working out how much activity can be undertaken and how much rest is necessary by gradually increasing activity until the maximum level is found, and staying at that level. If pushed into too much activity a person with M.E. will “crash” and may be completely incapacitated for a long time. The standard treatment for M.E. as a mental illness is CBT or GET which will push a person far beyond their safe limits.

Treating M.E. as a mental illness also appears to attach a stigma to it that just shouldn’t be there. Suppose for a moment that M.E. actually is a symptom of severe depression. It may change the treatment, but would it change anything else about the abilities of a person suffering from it? Would it mean that it was OK to tell someone “it’s all in your head” and “snap out of it”? Of course it wouldn’t. Depression itself is a real illness, needing treatment and medicine. Someone with depression cannot simply “snap out of it.” There are M.E. sufferers who are also depressed - I am one of them - but it is important to distinguish one from the other. I have had M.E. for ten years, and depression for a few months. It would be surprising if I didn’t get depressed at some point given the situation I am in.

If I could choose to be better, I would. Of course I would. I’m currently useless, stuck at home, in bed most of the time, my business is failing because I can’t work, I can’t even do any housework. I WANT to be well. I want to be rid of the crippling pain, the migraines, the dizziness, the insomnia. I want to be able to walk, to run, to ride my motorbike. So don’t you ever tell me to snap out of it. I might just have to beat you with my walking stick, just as soon as I find the energy.

A personal update

I know a few people are concerned about me after reading my recent blog posts, so this is an update on my health and situation. It’s quite detailed so you might not want to bother, or just skip to the summary at the end. I’m also writing this partly for my own record.

Pain and fatigue

I’ve been taking pregabalin (Lyrica) for a few weeks now. For the first week I was quite ill, with dizzy spells and lots of fatigue. During that week I spent several hours in a car and stayed with my wife’s parents, and for a few days after we returned home I couldn’t really get out of bed because of the fatigue. The pain started to ease after that, and within two weeks of starting pregabalin I was nearly pain free. I also had a lot more energy and started to spend twelve hours a day or more out of bed and sitting on the sofa or at my desk.

Unfortunately that was short lived, and the burning pain started to creep back, and I had more fatigue again. The levels of pain are low enough to handle with paracetamol and codeine, so this is what I am doing rather than increase the levels of pregabalin and risk more side effects. I’m currently able to spend about eight hours out of bed, a few days per week. I’m crap at pacing myself, but if I can impose some self-discipline then I might manage to build that up.

Diet

I started following the Atkins diet at the start of March. Atkins, although considered a fad by many, is actually thought to be quite good for diabetics. It had an instant effect on my blood glucose, dropping down to 4 - 6 mmol/l. I dropped my gliclazide which I had previously been taking 120mg / day of. After two and a bit weeks I was very very fed up with Atkins, and I had lost only 1kg, so I stopped the diet and decided just to follow a reasonably strict normal healthy diet as recommended in my diabetes books. At this point I have resumed taking gliclazide again, but less than before, and my blood glucose is within normal ranges most of the time. I’ve also lost 2kg since stopping Atkins! You can see on this graph where I was on the Atkins diet, and how bad I was before I started that.

Depression

I posted an article about depression just over a week ago and worried a few of you. I have been really depressed since before Christmas. I seem to have dips in my mood of just a few hours, sometimes even just one or two and at these times I can be suicidal. Most often the dips leave me lying there unable to make myself do anything apart from concentrate on an overwhelming sense of dispair. My friends on twitter have been really helpful in getting me through some of those dips. I have told my doctor about everything and I have been taking Duloxetin for the last month. It clearly hasn’t worked and so today my doctor has switched me to Citalopram.

Benefits and Housing

I wrote an email to my MP about our chaotic situation with our benefits. He has written to our council asking them to look again at our claim, but as yet we have not heard back from them. As far as we know, our court date is still going ahead. In the meantime, my wife has been hired for a full time supply teaching job until the end of the summer term, which is fantastic. It should mean that we can pay the council tax to stop the court case now, and hopefully apply the payment to future council tax when they finally realise that we shouldn’t have had to pay it in January.

Since our landlord decided to kick us out and gave us two months notice we have applied to the local housing scheme. I’ve been really happy to find them moving quickly - because of my health, and our being evicted, we have been classed as “Gold Plus” priority for a new home. The only difficulty now is that they have hardly any homes to offer.

Summary

In summary then, my pain is under control, my diabetes is just about under control, we (probably) won’t be homeless, but I’m still suffering from the depression.

A general health and medication update

This is a general update about my health and medication. Hey, it’s my blog so I can do that! Feel free to skip it if you want.

I’m currently suffering from:

ME
Migraines
Diabetes
Restless Legs
Depression
Neuropathic pain of unknown cause
Other random stuff

Just after the new year I had a massive relapse. I was overwhelmed by pain and fatigue, and I ended up stuck in bed almost all of the time. My blood sugar spiralled out of control, and my optician found retinopathy in my right eye, which means my diabetes is getting serious.

I have tried all sorts of pain medication in the past, mostly finding it ineffective or getting too many side effects from it. For the last couple of years I had only been taking paracetamol and codeine for the pain. Recently my pain has been on a whole new level and of new types so last month my doctor gave me naproxen to try and stop the burning neuropathic pain, as well as co-dydramol for the muscle aches and cramp-like and stabbing pains. I was actually a bit miffed about the co-dydramol because she gave me 10/500 tablets (10mg dihydrocodeine and 500mg paracetamol) whereas previously I had separate codeine and paracetamol so that I could use only paracetamol if that was all I needed, and then take codeine later in whatever amount I required at the time.

The naproxen took the edge off the pain, but not enough so I recently started taking pregabalin. Despite the horror stories and huge list of side effects it has actually turned out very well so far. In my first few days on it I was drowsy, dizzy, and had no balance, but that has all settled down now. I’m getting a lot of pain relief from it, and I actually seem to have more energy too! I’ve also got seperate codeine tablets again. My current cocktail of naproxen, paracetamol, codeine, and pregabalin takes most of my pain away. I still hurt after waking up until my morning tablets start working, and I still get aching and occasional slight burning but things are much better now.

My pain is now at a low enough level that I can start to function again. That is, the level that I am used to putting up with for the last few years where I have had reasonably good health. (About 80 - 90% of normal functioning.) Today my doctor and I decided against increasing any medicine for fear of bringing on side effects. Having said that, I am about to start duloxetine for my depression, and that can also treat neuropathic pain so things might improve a little bit more.

So now that I am not crying at the pain all the time, and I have also found a little bit of energy, I am able to spend a few hours out of bed on most days. I usually waste this on sitting at my desk to use my computer. (The netbooks that I use in bed are sloooooow!) The problem is that I have forgotten how to pace myself, so every time I feel OK I do too much and stay out of bed too long, so that the next day I suffer the consequences and end up too tired to get out of bed and in more pain. I’ve got a huge pile of notes on pacing from a few years ago and a new book that I need to read, then back to trying to have a routine of eating, resting, and activity at the right times. I find that very difficult.

The other problem that I have to sort out is my diabetes. I have only had it for two and a half years, but in that time I have progressed to the maximum dose of metformin and gliclazide and still don’t have my blood glucose under control. Every time I step up a drug or get stricter on my diet things get a bit better but deteriorate rapidly. Here’s my last month of blood sugar readings.

The next step from here could be a new medicine in addition to the two that I already take, or insulin injections. My doctor is of the opinion that the rapid progression of my diabetes means that I would be better off going straight to insulin. She explained to me that the earlier the onset of type 2 diabetes, the faster the progression seemed to be. She mentioned people in their 30s and 40s for this example. I had to point out that I was diagnosed the day before my 30th birthday, and so actually I became diabetic in my 20s which probably makes me one of the youngest people to get type 2 diabetes. I have been against the idea of taking insulin because I really want to train up and ride blood bikes and I think taking insulin would be a problem but I think at this point I have to accept that my health problems mean that I will never do that. With that ambition crushed, I might as well start insulin and have an easier time of it. As it stands, my doctor is going to wait until my next diabetes check up in just under three months, and if things aren’t under control then, I will be referred to a specialist to start taking insulin.

So that’s me at the moment. Some improvements, some deterioration. My diabetes is far worse and going downhill fast and taking my ambitions with it. My pain is down, although still probably what most people would rate as high, and my depression will be treated. As consollation prize at least I can get out of bed occasionally now.

The cost of living

I have just started taking pregabalin (Brand name: Lyrica) to treat the neuropathic pain that I have been suffering from. When I was discussing it with some friends I discovered something that seemed quite shocking to me. In the USA there are people that need this drug, have been prescribed it by their doctors, but have been deprived of it because their insurance companies have refused to pay for it. This refusal could be because they do not think it appropriate, or do not accept the reality of an illness that is not necessarily detectable in tests, but the most common reason is expense.

It hadn’t actually crossed my mind that pregabalin might be an expensive medicine. My doctor has a nice flowchart of what drugs to try for my illness and what order to try them in, and this one was next on the list. In my blissful ignorance, I simply take the prescription from the doctor to the pharmacy, and walk away with the drugs. All costs covered by the NHS. Since I have long term chronic illness, I am exempt even from paying the £7.20 prescription charge that most people would pay for their drugs.

All of this got me thinking; what if I had to pay for my medicine? Would it even be possible? I currently have twelve medicines on prescription. If I were to pay even the standard prescription charge, with the NHS covering the rest, my medicine bill would come to £86.40 per month. At the moment we are struggling to even pay for our rent, bills and food, so this cost would be crippling. But without the NHS? My drugs would cost much much more. I did some research, and I present here what I would pay for my most important drugs.

Metformin (Glucophage) £12.28
Gliclazide £1.86
Olmesartan Medoxomil £10.95
Bendroflumethiazide £0.91
Pramipexole £35.66
Sumatriptan nasal spray (Imigran) £35.39
Naproxen £4.20
Pregabalin capsules (Lyrica) £64.40
Codeine £5.39
Paracetamol £1.62

Total cost: £172.66 per month.

In the USA it would be even worse. Here are the best prices that I could find. (Via www.pharmacychecker.com)

Metformin (Glucophage) $50.40
Gliclazide $17.22
Olmesartan Medoxomil $18.20
Bendroflumethiazide - no price found
Pramipexole $29.68
Sumatriptan nasal spray (Imigran) $114
Naproxen $11.76
Pregabalin capsules (Lyrica) $161.28
Codeine - no price found
Paracetamol (Acetaminphen) - no price found

Total cost: $411.54 (£255.68)

That is an astonishing difference between UK and US price.If I had to pay all of it myself, I would have to go without many of my medicines, which would basically leave me unable to control my diabetes and my migraines. Apart from the Lyrica, my pain medication is actually very cheap and I would still be able to afford that. Without diabetes medication I would be practically unable to eat and would still have hyperglycemia. Without sumatriptan, my painkillers would not help and the other symptoms of migraines would keep me firmly in my bed. Fortunately the NHS covers my costs and I have some chance at recovery and leading a relatively normal life. Some people will no doubt argue that it is unfair for me to drain so much money from the NHS. They have failed to understand how this system works. When Aneurin Bevan launched the NHS in 1948 he gave the NHS three aims:

That it meet the needs of everyone
That it be free at the point of delivery
That it be based on clinical need, not ability to pay

Treatment for any given individual may very well be expensive, but it all works out in the end. I have paid National Insurance whenever I have been well enough to work. I receive my medicines without paying when I need them. With those medicines, I may well improve enough to work again and pay more National Insurance. The NHS provides for both people that will one day repay their healthcare costs, and people that might not. Even those that will never be able to work and contribute financially will still contribute something to their society by their very existence. And regardless of future financial contribution, would you really want to live in a world that simply leaves the sick to die?

I am very glad that we have the NHS and I will fight as hard as I can to keep it.The government must not be allowed to ruin what we have.

What price on being pain free?

The biggest symptom that I have suffered from in the last ten years that I have had ME has been punishing, disproportionate fatigue. Recently, though it has been overtaken by pain. All the old aches, headaches and migraines that I have had for years as part of M.E, but also sharper pain in my muscles especially when touched or pressed, and burning pain through my arms, legs, hands and feet. I’ve already exhausted a few types of medicines over the years, having worked my way through the standard painkillers, (paracetamol, ibuprofen) Tricyclic Antidepressents (Amitriptyline, Dosulepin, etc) which are used for their pain killing properties rather than for depression, SSRIs, (Prozac) and Opiates. (Codeine, Dihidrocodeine) There are a good few that I have tried but can’t remember too.

I never had much success in quelling the headaches and muscle aches before, but this new pain is even more persistant. I have reached a point where I am taking paracetamol, naproxen, and codeine but still at points can be found curled up in my bed shaking with pain.

When I saw my doctor on Monday she took me through the flowchart of drugs for treating neuropathic pain and the next on the list was pregabalin, otherwise known as Lyrica. (Note: Lyrica, not Lycra. My pain treatment is not stretchy obscenely tight clothing.)

When I told other people that I would be starting Lyrica, I got some very strong reactions. Several people told me that they had had a horrible experience taking it and would never advise anyone else to do so. Several others told me that it was alright for them, and some told me that I was very lucky to get it and that they were jealous!

So what could be wrong with Lyrica? Well it certainly isn’t a drug that you turn to first. In fact you have to be quite seriously ill before a doctor will even consider giving it to you. It can be very effective in the treatment of pain but the drawback is that a great many people taking it suffer side effects. Wikipedia lists these as follows:

Very common (>10% of patients): dizziness, drowsiness
Common (1–10% of patients): visual disturbance (including blurred vision, diplopia), ataxia, dysarthria, tremor, lethargy, memory impairment, euphoria, constipation, dry mouth, peripheral edema, loss or decrease of libido, erectile dysfunction, weight gain

Quite a list, that as many as 10% will encounter, with even more becoming dizzy and drowsy. Stopping taking Lyrica can also be quite a problem:

After stopping long and short-term pregabalin treatment, you need to know that you may experience certain side effects. These include, trouble sleeping, headache, nausea, feeling anxious, diarrhoea, flu-like symptoms, convulsions, nervousness, depression, pain, sweating, and dizziness. (Taken from the Patient Information Leaflet)

I already knew this information at the time I had been prescribed the medicine, but after I announced on Facebook that I would be starting to take it, I got a new rather panicked message in reply.

The side effects are horrendous, you wouldnt even be able to do any writing as your brain will not work. sure , it did take away all my pain which was wonderful but i was left as a vegetable, not even able to watch tv! i was put on them by the pain clinic but my gp took me off them and it took months to come off them as they are so potent! and the pain came back with avengance! but on good days i do have a brain ! it still only you that can decide and hey, you may be the fortunate one that gets all the benefits and none of the side effects. i do understand your pain but it was a disaster for me and another friend who was prescribed it for deep seated pain. it was awful! i was a zombie! life was not worth it. i couldnt walk or talk straight so was on the sofa all day every day and i didnt even get to the dosage that they wanted me on….but i did sleep!

Not a hopeful outlook then. However, I considered this carefully. As far as I can tell, less than ten percent of patients get these side effects, which means that 90% don’t. I think, on the whole, the possiblity of escaping the pain is worth the risks of trying it for a while, even if I then have a few more days of problems as I come off of it. If it kills my mind, there is no question, I will stop taking it. I would rather be stuck in my bed crippled by the pain but still be able to think and communicate than to be a mindless zombie but not in pain.

Today I had my first side effects. I was trying to get out of my flat and into a car. I was distinctly wobbly as I left the house, using my walking stick without even complaining (I hate the bloody thing) as I was that unstable. When I got to the car I started to turn to try and sit down and I collapsed. My legs went form under me, my world was spinning round and I was falling, grabbing on to the car and completely failing to stay upright. Having decided that going to the train station to continue with the journey as planned was not the best idea, my dad offered to drive us there instead. (100 miles each way! My dad is awesome.) We stopped at my parents house on the way for a a bit. I tried to take my coat off before sitting on a sofa, and once again collapsed, face forwards into the sofa. Fun.

I’m hoping the wobbliness will cease, but tomorrow is a busy day with a funeral and a family gathering to deal with and I am quite worried that I am going to have to be more or less carried everywhere.

What I need to focus on is that point in a few days time when the Lyrica starts to work, and I might, if I’m lucky, be rid of the endless pain that is burning and tearing at my body. Then it might just be worth it.

In which I talk about abortion and upset everyone

A lot of my friends on twitter have been discussing abortion from a feminist pro-choice point of view. Many of my friends on Facebook have mentioned abortion from a Catholic pro-life point of view and requested that I go and sign petitions or join groups against it. I’ve decided to try and work out what I think, and probably upset all the Christians AND the feminists in one go. This is an emotive subject and it can’t be written about or debate without upsetting someone. I have been assured by several people that they will still be my friend whatever I write here, so I just want to remind them that I have that in writing! If you’re going to be upset by reading opinions, or call me names because of it, don’t read this.

As a thirty-something man I often feel that feminists think I am not allowed to comment on some issues. I comment here as a husband who knows what it is like for his wife to have a pregnancy scare at a bad time, and also as a former Christian, a skeptic and an advocate of science. I am not telling anyone what to believe, and I do not force anyone to change their behaviour because of my opinion on this subject. This is what I think, not what I am telling you to think. So don’t attack me on it.

Unlike the idea parodied in the famous Monty Python song, I don’t believe that every sperm is sacred, nor every egg, and not even every fertilised egg. How can it be, when of thousands of sperm and thousands of eggs, only a very few will meet and fertilise, and of those, most will not implant, and even then, a blastocyst may well not stay attached to the lining of the womb? The logic that says otherwise does not stand up to scrutiny. Accordingly, I have no problem with the morning after pill. (There goes the Christian vote.)

At some point between fertilisation and birth, a fetus becomes a living human being, conscious, and capable of feeling pain. We don’t know at what point that happens. Once you have a baby that can move, kick and feel pain, I think a woman’s choice is no longer relevant. There are two people involved, not just the mother. The baby is a living being, a human, and has human rights. End of story. (There goes the feminist vote.) I am fairly sure that self awareness and learning to respond to outside stimulus continues long after birth, and so what is the difference in consciousness between a 23.5 week old fetus and a week old baby? That is a genuine question, I’m not trying to evoke emotion to back an argument either way.

Currently the law allows abortion up to 24 weeks through a pregnancy. Some MPs have campaigned for that limit to be reduced to 20 weeks. The earliest known surviving birth is at 21 weeks. I believe that the 24 week limit is political, not based on facts. I’ve heard a fetus described as “just a clump of cells” but I have also seen abortion decscribed as “deliberate procedure of hacking an unborn child to pieces in the womb.” In reality the development of a baby is a continuum and we do not know enough to be able to pinpoint a change between clump of cells and living baby.

In 2007 the commons science committee investigated the issue. A Guardian report said this:

“A report on the scientific issues surrounding abortion published yesterday by the Commons science and technology select committee finds that survival rates of babies born before 24 weeks are not high enough to warrant cutting the limit.”

I strongly object to that phrase “not high enough to warrant” as I am of the opinion that any possibility of survival from that early means that an abortion could be ending the life of a living being. Ultimately though, I have no more knowledge of when the limit should be than anyone else does.

I accept that abortion is a necessary evil in some cases. UK law currently allows an abortion to take place later than 24 weeks in certain circumstances:

if it is necessary to save the woman’s life
to prevent grave permanent injury to the physical or mental health of the pregnant woman
if there is substantial risk that if the child were born, it would suffer from physical or mental abnormalities as to be seriously handicapped.

I think those are a good guideline for when an abortion should happen at all, not just when a late abortion is allowed. I don’t like the idea of aborting a baby because of detected illneses, but I can live with that. I certainly don’t like the idea of ending pregnancy for other reasons such as finance, career, or just not wanting to be a parent. I honestly don’t know what I think in the case of rape.

However, and this is important, where I have said that I don’t like it, that is my opinion and I do not have any right to force that on anyone else and so I won’t.

Soph Warnes has put up a very insightful response with lots of links to more information on her blog.

Tag: medicine