Graham Higgins Illustration

In case of emergency:-

Warfarin 8mg

Ranitidine 150mg twice daily

Furosemide 40mg

Perindopril 2mg

Cardicor 2.5mg

I’ve joined the anticoagulant subculture. I’m a Warfarin baby now. My blood has been thinned to stop my prosthetic heart valve whipping up a little black-pudding.

The only tangible measure of this effect I’ve seen so far is the cotton wool taped over blood-sample punctures. Where before they used to be pretty much a formality, they now peel off properly bloody.

I’d only previously known Warfarin as a rat-poison, odourless and tasteless so that the vermin keep returning to the bait until they succeed in poisoning themselves. I’m very grateful to my friend Sue Jones, indefatigable source of interesting but overlooked factoids for the information that the ominous name is a hybrid of Wisconsin Alumni Research Foundation plus the tail of coumarin, the active ingredient the drug synthesises, found naturally in liquorice and lavendar.

Sadly I’m not allowed St. John’s Wort as well as Warfarin, which at least confirms that the herbal antidepressant is genuinely active. I’m sorry about that because it had been a habit since the mid-90’s when a good friend in Berlin had urged me to try it to counter depression and to my surprise it worked. I didn’t get the sensation of spacey well-being I’d expected but after a month I found I dwelt less on the minor mundane niggles and anxieties that had taken up so much thinking-time before. My mind still turned to them but I likened the effect to those fairground toy cranes that in theory grab soft toys and deliver them to a chute but which in practice are too puny to hold on long enough. I really appreciated that extra time freed-up to think more constructively.

OK, so now my mind turns to the possible effects of any skin-breaking mishap – I even bought an electric razor on advice that razor-nicks incurred before school might still be going at morning break.

In the event that I find myself pinned under a toppled car-transporter with sufficient wit to remember, I can maybe advise the paramedics to consult my blog for a list of my meds but it would make sense to have something at hand while I spurt like a garden hose punctured by Quentin Tarrantino.

I’m sure I once saw a rather nice identity bracelet built like a spring-loaded watchstrap with a snap-open compartment to hold notes, but a walk to the local independent jewellry shop on Poplar Rd. was fruitless. The owner hadn’t seen one but suggested I go for an SOS Talisman, the default standard medical identity bracelet with a fireproof, waterproof screw-top capsule containing a strip of insoluble paper (a bit belt-and-braces in a waterproof container) to list your meds and allergies. That’ll be another £30 or thereabout.

Choices, choices. The standard bracelet comes on a chain that looks as if it could punch its chunky imprint into your flesh and bone on impact, but you can order it with a caduceus design (the snake around Hermes’ wand). There’s a rather fetching sporty-looking velcro band but that only comes with the SOS logo.

Granted, in circimstances where instant access to my current meds may be urgent I’m unlikely to be apologising to the crew for my style decisions but for everyday potential-emergency wear something discreet and elegant would be nice.

[After writing that I found exactly what I was looking for at:-

http://www.universalmedicalid.com

...an expanding wristband with a snap-to compartment for med notes]

The tablets all come with informative introductory notes about their function, recommended dosage and side effects. Like Jerome K Jerome’s brush with a medical dictionary and discovering he has everything except cholera and housemaid’s knee, it’s hard to read the possible side-effects without little shocks of recognition.

All of the leaflets helpfully advise against taking the meds if you’re allergic to them, which is a relief. Happily I’m neither currently pregnant nor breast-feeding, so I skip those cautions. All suggest taking the meds as advised by my doctor, which seems eminently reasonable because he’d be my first port of call if I wanted to know about medicine. Frankly I wouldn’t rely on my newsagent or the postman.

Each morning I pop a variety of tablets onto the kitchen work surface, a little constellation comprising:-

Perindopril – Sounds like a Thai deity. It’s an angiotensin converting enzyme (ACE) inhibitor, OK? It keeps blood-pressure in iffy plumbing down to acceptable levels.

You’re advised not to take it if it’s previously given you ‘a hypersensitivity reaction with sudden swelling of the face and lips, neck, possibly also hands and feet’. I try to imagine the patient presented with Perindopril who says ‘Oh, those again, the ones that make me look like a Pilsbury dough-boy.’

There’s also a caution about taking potassium supplements. Note to self: consult Dr. Miller re. how many bananas will induce anaphylactic shock. A three-banana day is rare but not unknown. In case of emergency should I leave the skins on display for the ambulance-crew to count? Would a bunch constitute a cry for help?

Possible side-effects:-

Mood or sleep disturbances – this keeps me awake at night, waiting to see if my mood changes.

Ringing, buzzing, roaring, clicking sound in the ears -  This would be more alarming if they didn’t specify the ears.

Among the common side-effects: headache, dizziness, vertigo, pins and needles; feeling sick, being sick, abdominal pain, changes in taste (dysggeusia), dyspepsia, diarrhoea and constipation; muscle cramps; weakness (asthenia).

Ranitidine – An emissary from the court of Tambourlaine. It’s a histamine H2 antagonist, reducing acid production in the stomach, a heavyweight Rennie.

Possible side-effects:-

Page 3 of the leaflet looks promising, only listing as possible side-effects: diarrhoea, dizziness, rash and tiredness; very rarely jaubndice and pancreatitis. It is, how you say, the nothing.

Then you turn over and realise this was only a pause for breath -…blood abnormalities, allergy, mood changes (yep, that’s alredy started by this stage), confusion (uh-huh), psychoses or hallucinations, pain in muscles and joints, slow heartbeat and heart block (which can cause dizziness or fainting).

Furosemide – The Furosemides should be angry Greek deities but the tablets are diuretics, to treat oedema – ‘too much water in your body’… uh-wha…? ‘…This could be due to problems with your heart,kidneys, liver, blood vessels and high blood pressure.’ OK. They might help to prevent the side effects of jaundice from the Ranitidine.

And hold on, among the conditions that mean you shouldn’t take Furosemide are ‘not passing any urine’ – not any? Presumably in that case a hat-pin is indicated. And ‘low levels of potassium in your blood, which will make your muscles feel weak or you may suffer paralysis.’

Well pardon me, and see the Perindopril banana-balancing act. Suddenly I have to treat bananas, the clowns of the fruit-bowl, with caution.

Side-effects? Red and lumpy skin rash, difficulty breathing, swelling of the face, mouth and eyelids (again?), unexplained high temperature (‘fever’, it adds helpfully) and feeling faint.

…purple spotting or unexpected bruising of the skin, sensitivity to sunlight, spasms, muscle twitching and cramps, inflammation of the pancreas causing severe pain in the abdomen and back…. breathe…

Liver problems, jaundice, dark urine, and a liver disorder called hepatic encephalopathy. Symptoms include forgetfulness, fits, mood changes or coma(!).

OK, so far so good. I haven’t become a swollen jaundiced comatose psychotic  unable to decide how I feel about it. I trust that on balance I’m getting all the good stuff and none of the interesting side-effects. However, I’ve saved these insidious heart-shaped little bastards till last:-

Cardicor – The militant wing of The Acceptable Knitwear Front. Beta-blockers.

These little guys lower blood-pressure and regulate heart rhythm and that’s fine, all in favour, thank you Merck pharmaceuticals.

Not listed in the side effects is one I thought I noticed and was glad to have confirmed by a beta-blocker veteran who arrived on the ward a couple of nights before I left: procrastination on steroids. The tablets promote an air of Buddha-like serenity, a mood of manana without its sense of urgency. The part of your mind that notices nothing’s getting done is answered by another part shrugging… you know… whatever… later… and it feels OK. No problem, because in the moment you don’t feel dull, not at all, in fact a degree of passivity makes you a good and attentive audience.

Official side effects… oh, see the usual suspects: liver malfunction, rash, itching and flushing, breathlessness, tiredness and dizziness, insomnia and depression, yada yada… yawn…

To anyone embarking on a post-op battery of meds I warmly recommend these leaflets as a rich source of hypochondria. It’s amazing that the pharmacists have been able to isolate therapeutic effects amongst the dire possible consequences.

If I’d ever heard any instance of a reiki master or a crystal therapist being rushed to the site of a medical emergency it would be enough to drive me to folk-medicines. (B-but they’re the stuff of Ancient Wisdom! Yes, and so is dinking in the top of your skull to release evil spirits. Here, have an energised magnet and some oil of hyssop and clear off)