Oh What a Tangled Web We Weave

When First We Practice To Deceive.

Sir Walter Scott

Ready for more garbage?

I understand that you may find this very long which it is, but if you persevere you will learn much about the workings of an NHS hospital ward and the drugs which were given to my mum in profusion, despite her not being too unwell, which was confirmed by Two Consultants. 

You will also learn in-depth about the effects of these said drugs, and hopefully you can put this information to good use!

Thank you for reading this – My Mum’s Story!

~Act Twenty~

FOURTH OVERDOSE!

Clexane+Dalteparin

  • N.B. The last Clexane was given 10-12pm on the 2nd, therefore 2 days + 10-12pm on 4th.  This was before lunch time on the 4th!
  • Who authorised stopping Clexane  and Why?
  • There is no signature on the prescription to close it!
  • How did nursing staff know to stop prescribing it?
  • Verbalisation again like some game of Russian Roulette?
  • Why was it stopped the night before FY2 was starting mum on Huge doses of 2G Ceftriaxone the following day?

At the time FY2 wrote this early on the  morning of the 4th mum had her *Last dose of Clexane at 10-12pm on the 2nd, therefore it was Not 2 Full days!

*Two full days are required between Clexane and Dalteparin!

Dalteparin – N.B. Clexane is Not interchangeable with other low molecular weight heparin (LMWH) products.

Dalteparin is Not superior to unfractionated Heparin in preventing blood clots.

Careful attention should be paid to elderly patients below 45kg.

  • *Mum was below this!

Moderate risk patients 20mg.

High risk patients: 40mg.

Do Not have this medicine if/Drug Disease Contraindications.

Cerebrovascular Haemorrhage – Yes!

You have a problem with bruising easily.  – Yes!

Call your doctor at once if you have easy bruising!

  • What doctor?
  • This wouldn’t happen to be the ‘same’ one who prescribed Clexane by any chance?

A different site should be used for each injection to prevent the development of massive haematoma!

Can you imagine the state of her stomach?

You are underweight –  Yes!

And becoming more so each day!

  • Patients over 60years may have higher serum levels and clinical response as compared to younger;
  • Lower doses may be required!
  • Elderly patients may be more sensitive to the effects of this medication!

You are taking Prednisolone – Yes!

You are taking Furosemide – Yes!

PRECAUTION:  INCREASED RISK OF HAEMORRAGE, ESP., FEMALES.

ADVERSE EFFECTS:  Most Frequent:  Heparin-Induced Thrombocytopaenia is the most drug-induced thrombocytopaenia because of its high frequency and association with arterial thrombosis!

Drug induced immune thrombocytopaenia is a condition in which the use of drugs leads to the formation of antibodies against clot-forming cells in the platelets.  These antibodies can cause a low platelet count, which makes it more likely.

ADVERSE REACTIONS:  Dilution of serum electrolytes, overhydration, (this medication contains sodium) hypokalaemia.

  • Did you ever hear anything more mad than this?
  • Pump this shit into a frail little lady, Overhydrate her, and then suck the liquid out of her with Furosemide.
  • Oops too plump looking today, time for a little mummification!
  • Do you absolutely believe they really know what they’re doing?
  • Because I don’t!

Local: Thrombosis.

Respiratory: Pulmonary Oedema.

Overdosage: Toxcology Symptoms – Hypokalaemia.

HEPATIC:  Elevated Liver enzymes (AST/ALT)

  • Wait until you see the results on the 5th!

Seek immediate medical attention if these allergic reactions occur!  Trouble breathing, confusion, swelling, severe dizziness, pain or swelling in one or both legs, speech or balance.

  • Well now, let’s see?  What in the shit did not happen from the above list?
  • Was any of it flagged up?
  • Guess?
  • The elderly may be at greater risk for bleeding while using this drug.
  • Unbelievable!

Anaphylactoid reactions.  Adrenal insufficiency.

Monitor/Modify:  Diuretics, potassium sparing – Furosemide!Cephalosporins – Ceftriaxone!

  • Ceftriaxone on 3rd: 2G 7-9am, 2G 12noon, 2G 12mid., plus 2G 7-9am on 4th!

PRECAUTIONS:  A preservative (benzyl alcohol has been associated with toxicity) in this product or in the liquid used to mix this product (dilutent) can infrequently cause serious problems   SOMETIMES DEATH!

  • N.B. This is not to mention that Sodium Heparin is from Porcine (Pig) Intestinal Mucosa!

*Patients with heparin-induced thrombocytopaenia, a serious adverse effect of heparin mediated by platelet activating heparin-dependent antibodies (with or without thrombosis) require alternative anticoagulation because of their extreme risk of new thromboembolic complications.

  • Remember FY2 suspected ‘is there a possibility of a P.E’,  in her notes but told me the opposite and that it was merely a precaution!
  • Could this have been because she took mum off this for the entire day previous when she started the Ceftriaxone mega doses, then asked another doctor about ‘starting’ Clexane or Dalteparin the next day of the 4th, which was about 10 hours too soon?
  • What about the effect of this crossover of the two different heparins still in mum’s body?
  • Would the human body not be almost guaranteed to try to make the blood capable of clotting once more when an anti-clotting agent was withdrawn?
  • Strange thing is, this was the same day FY2 re-started mum on this alternative heparin, so why did she suspect this BEFORE the 7500units of Dalteparin were administered at 12-2pm, as she ‘proposed’ giving this when she spoke to me at 1pm?
  • No Antidote is available.

Wow!

Bleeding complications are the most important adverse effects.

  • With a cerebrovascular stroke already, Plus a further ischaemic attack?

Thrombosis is a common and potentially serious complication of immune-mediated heparin-induced thrombocytopaenia!

Really?

The risks of total minor bleeding with LMWH, were significantly higher than the risk with pneumatic compression stockings. (in a meta-analysis.

  • FY2 Notes:

Wedge shaped opacity?

Oedematous legs.

No chest pain.

Is there a possibility of P.E?

For treatment dose Clexane? Dalteparin?

  • Plan:

Give treatment dose Clexane to management. This was changed to: Add treatment dose of Dalteparin to management.

I will discuss the case with Dr ………. on call.  signed  FY2.

Dr ………. suggests 40mg IV Furosemide at 2.20.

  • FY2 wrote a One Only prescription for this.

At 10.52am the biochemistry results (Bloods taken by a nurse on 3rd at 9am Before most of the 2G’s Ceftriaxone were in mum’s body, if any?

No Nebulisers, Clexane stopped, No diuretics, so a lovely concentrated amount of drugs would be in her system on the 3rd After the blood tests?

  • Does this make sense?
  • Now for another eye opener!
  • FY2 then proceeded to write Blood Results:

From the results at 11.51am.

*WCC 14.71

*Hb 12.0

*Plts 297

  • Remember the notes from the 2nd stating Plan Bloods?

Which could only have been verbalised to a nurse to take these bloods on the 3rd!

  • Well the Haematology results above were taken from these bloods which a nurse took on the 3rd! With the results dated 4th @ 11.51am.
  • Before mum had a Terrible Night!

*CRP 301

*Na 138

*Urea 11.9

*Creat. 75

  • The Biochemistry results above were taken from these same bloods which a nurse took on the 3rd!  With the results dated 4th @ 10.52am.
  • FY2 Notes continue:

CRP 301 – Same  (This was actually down from 316 on 1st and 316 on 2nd but FY2 wrote ‘Same’?)

  • Ah, but remember this was being written as though these figures were from the 4th and not the 3rd when the bloods were actually taken.
  • Before mum took ill overnight 3rd/4th!

Na (Sodium) 138

Urea 11.9 – down.

Creat. 75 (No notes that this was down from 80 on the 2nd?)

Inflammation markers not improving.

Really?

What about the CRP at 301?

Is this not an improvement from 316?

  • FY2 did Not note that mum’s Potassium was NA H on these results from the 3rd, which were exactly the same as the test results on the 2nd, even although on the 2nd she added KCI 20mmol given at 00.00 on 2nd  by the sister of the disgruntled nurse, (over ten  hours later after the results came through).
  • FY2 also added KCI 20mmol to 3rd date on the chart which was never signed as given?
  • FY2 also altered this chart from 6 hourly to10 hourly on the 3rd, without writing a new chart!
  • FY2 took None on the 4th at all, apart from the Arterial sample and this was after the emergency FY2 had already taken one at 9am!
  • Would it not make sense to to take both of these After the extreme reaction the night before which required an emergency doctor plus a phone call to her daughter to come to the Hospital?
  • Ah, but then all of this Shit would have shown up and there would be questions from the Laboratory Technician!
  • Ah, good point.  Just wait until tomorrow the 5th!

Of Much more significance is the fact that All of the above figures were lower than the 1st and 2nd figures, so Before all that Shit was put into mum on the 3rd and more on the 4th she was gaining ground!

  • At 11am mum was given:

20mg Furosemide Susp.

1G Paracetamol Disperse

20mg Prednisolone Oral

5mls Carbamazepine Oral

  • At 12-2pm mum was given:

7500 units of Dalteparin (Fragmin) SC

  • Ten Hours Too Soon!

N.B. The average weight is 4500 daltons.

500mg Clarithromycin IV

1G Paracetamol Disperse

5mg Salbutamol Neb

0.5mg Atrovent Neb

~Act Twenty One~

FIFTH OVERDOSE!

Mum was given 5mls Carbamazepine at 7-9am, 5mls at 11am and 5mls at 10-12pm.

This is 15mls within 5 hours, and especially 10mls within 1 hour!

It is recommended to start a lower dose of the suspension since this will produce higher peak levels than the same dose given as a tablet.

You don’t say!

  • Before taking Carbamazepine be sure to mention if you are taking Paracetamol, anticoagulants (Furosemide), Clarithromycin.
  • Carbamazepine levels are elevated when taken with Clarithromycin.
  • Carbamazepine may cause syndrome of inappropriate anti-diuretic hormone (Furosemide).
  • In addition it has been linked to serious adverse cognitive anomalies, including EEG slowing, and cell apoptosis.  It is CYP450 inducer and may increase clearance of many drugs, decreasing their blood levels.
  • Aplastic Anaemia has been reported in association with Carbamazepine.  Although reports of transient or persistent platelet or white blood cell counts are not uncommon in association with Carbamazepine, data are not available to estimate accurately their incidence or outcome.
  • No systematic studies in geriatric patients have been conducted!

Good Idea!  And Guess What?

There is No Specific Antidote!

Now is that Brilliant or is that Brilliant?

So, not only did FY2 dispense this in a cavalier fashion, do you think the G.P. knew about the Carbamazepine Aplastic Anaemia association?

  • Carbamazepine can lower the blood cells that help your body fight infections, and can make it easier for you to bleed from an injury, or get sick from being around others who are ill!

You Couldn’t Make It Up!!!

  • It should be taken with meals?
  • In the morning 7-9am? and 10-12pm?   No Chance!
  • It should NOT be administered simultaneously with other liquid medications!
  • What about the 1G’s of Paracetamol Disperse?
  • It induces hepatic (liver) CYP activity and causes decreased levels of Prednisolone.
  • Baseline and Periodic eye examinations are recommended since many phenothiazines and related drugs have been shown to cause eye changes.

Was mum or I ever told of this?

You Guessed! 

  • No!

SIDE EFFECTS:  Abnormalitites in Liver Function Tests, Jaundice, Oedema, Thromboembolism, congestive heart failure, Dyspneo, Pneumonia, Confusion, Fatigue, blurred vision, Visual hallucinations, Speech Disturbances, abnormal Involuntary movements, etc. etc. etc.

OVERDOSE SYMPTOMS:  Fast Heartbeat, Tremors, nausea, Shallow Breathing, Swelling of Ankles or Feet, Dry Mouth, joint or muscle pain, leg cramps, feeling light-headed or fainting? headaches and migraines, etc. etc. etc.

  • Every one of these in Red happened to my mum in that hospital ward!

As for the rest I shall never know what else affected her on that ward!

What about the G.P. Oedema, dyspnoic, Confusion?

  • Plus – Avoid cold or allergy medicine!
  • Piriton doesn’t count then?
  • Fever and sore throat should be reported immediately to a physician even if mild!
  • They are joking of course if they mean our very own FY2!!
  • The ward manager told me she had a sore throat, and I saw her fevered!

This was the reason for changing the horse pills for IV, because they insisted, despite my telling she could not swallow tablets hence the requirement for liquid Carbamazepine, on giving her huge tablets; some halved in two and still large with jagged edges; to swallow until her little throat couldn’t take it any more!

  • Do you think they cared?
  • Nurses notes:

Daughter now in attendance.  Spoken to by FY2. IV Antibiotics as prescribed.

2G Ceftriaxone?  Catheter nurse signed this. Chest X-Ray.

Commenced on Fragmin 7500.

On IV fluids, recently due to poor oral intake.

  • This is absolute garbage, as endless amounts of people who have had an elderly person in a British Hospital will be able to vouch that food and drink are left on trays outwith the reach of the person.  This may not apply to every Hospital and I pray not but it applies to a Hell of a lot of them!  Chance would be a fine thing!
  • More FY2 Notes:

Urine dipstick negative.

Still feels O.K.  (After all she was put through!)

  • This beggars belief!
  • If only she had not been continually doped and could have told me what was happening!

When I was phoned on the 4th around 9.20am-9.30am I was told ‘Your mother’s had a bad night’.

I flew into that Hospital as fast as I could (A taxi at the corner of my road,  and I was there in about twenty minutes).

  • FY2 told me ‘I do not know exactly what is going on, but her infection does not seem to be improving and she possibly has fluid on her lungs.
  • FY2 wrote in her notes that I thought my mother should not sit in the chair or mobilise to the toilet.

I had deliberately brought mum’s short dressing gown in case she tripped on her long one going to the toilet, and it was only when I saw her in that toilet; where the nurse had left her alone and I tried to steer her from facing a wall and to face me in order to guide her out; that I asked for a commode and for no other reason.

She was so doped up even then that she could not understand what I was saying, and for these beings, each and every last one who knew she was on All of these sheer amounts of drugs which even I could not fail to be confused with, to dare to continue to write that mum was confused is verging on Demonic!

She was never Confused since making a remarkable recovery after her stroke years before,  and only very slightly at home, until she arrived in that place.

  • What A Liar!
  • No,No,No! Not on my Watch do you tell all this garbage in my name and think to get away with it!
  • FY2 also wrote I wanted my mother kept in bed.

I never suggested anything of the kind.    I never ever thought to want her kept in bed. 

Why on Earth would I want her in bed?

I wanted her desperately to get out of there! Strengthened and walking out or even in a wheelchair if she was still a bit weak!

  • Remember this is written on doctors notes and completely unknown to people, so they write what they like, and who is going to know?

The truth was that I was unhappy with my mother sitting in front of the only open window in the ward about a meter away, frozen to the bone with only a thin cotton nightdress on, no bed-socks, dressing gown or even her own nightdress, and her feet; like ice in her slippers; swelling worse every single day.

When I tried to warm mum I could not rub her little limbs so put her on top of her bed the day before and said to her ‘I don’t want these nurses thinking I’m intruding or stealing their thunder (this describes the ward manager precisely) so I’m just putting you on top of the bed covers mum with your blanket around your legs to try to thaw them out, and put her dressing gown over her shoulders and chest, with her socks on. 

Mum nodded in agreement to this!

  • FY2 ‘I stated *that as she is unwell today she will be kept in bed, but that on this ward we like to mobilise people as much as possible if they are well in order to further rehabilitation.’

Rehabilitation for What?

How is a patient like this expected to mobilise when they are drugged up to the hilt, and staring into space?

I would have been overjoyed to see her up and moving around!

  • N.B. FY2 stated*’that as she is unwell today she will be kept in bed’.
  • This appears to state that this is temporary, yet mum was catheterised at the same time, so when was this temporary event supposed to end?
  • Sounds Good, Dinnit?
  • FY2 ‘I also explained that ankle oedema is common in patients and that we have been keeping her legs elevated’!
  • Never!  In her dreams!
  • I can absolutely believe that ankle oedema is common when patients are pumped full of Steroids!
  • Did FY2 mention to me about mum having been given Steroids?
  • You Guessed!
  • No!

I was the one who had to go looking for a stool for her feet which were swelling, and in fact when she sat on top of the covers I gave this stool to another lady across from mum who had been sitting in a chair with her feet down and swelling grossly (I realise now that she and others in that ward were so intimidated and frightened and that they also knew the score about getting into bed).

  • Ah, but this is one way of getting back at the relatives and to hell with the patients.
  • Make out as much as possible that these relatives are disruptive; instead of helpful; and write a case against them just in case they should ever decide to spit back!
  • As stated before, this will Never wash with this daughter!
  • Not a chance in Hell even if it freezes!

Waken Up folks, and smell the roses, not the dung you have been dished for too long, with a measure of chemicals added to lure you into thinking it is the real thing!

If you do so then you will realise that you ought to examine just how much the ‘System’ has brainwashed you into being a little submissive sheep, following all the others to their deaths – Dutifully I may add!

  • FY2’s next load of garbage ( I honestly do not know how this female sleeps at night with all her lies and cunning!).
  • ‘I have explained the rationale behind giving LMWH (Low Molecular Weight Heparin) to the patient’s daughter.’
  • Now get this one folks!
  • She UNDERSTANDS THIS and SEEMS HAPPY with it?????

This is pure conjecture to allay the fact that I knew nothing of the previous Heparin, along with all the other Drugs, and to suck me into her plan of making it appear as if I was in full agreement!  Talk about trying to pass the buck!  The fact is I was anything but happy with it but what would I choose? I most certainly did not know what this stuff was made from!

  • Nothing could be further from the Truth!

She said this in a manner suggesting this was a new procedure and omitted to mention that my mother had already been on Clexane until the 2nd!

When I asked the name of this drug she ‘mumbled’  ‘Rocephin’ in such a low pitch I had to ask her twice.  Such was her usual reluctance to tell the daughter anything at all!

  • I also witnessed another side to this individual, later on; which was normally kept well in check by her; and this behaviour was anything but pretty.

Had she revealed the details regarding the Heparin dose previously, I would undoubtedly have wanted to know why this had been stopped, and why the proposal was being made to start a Heparin (even of a different type) once more?

She already knew I was interested in the drugs being given to my mother as I had questioned her before on this matter; although I usually got a murmur below her breath, and a shake of the head;.  In fact this was a common occurrence and par for the course for FY2!

My mother did not even take aspirin before or after her stroke some years previously and her system was pretty clean, so anything would hit her strongly.

As for the Heparin, it is dangerous to mix the two types, and a mandatory time elapse is necessary!

When questioned about the efficacy FY2 reassured me saying ‘ I don’t believe she has a D.V.T.  It’s merely a precaution.’

  • Yet, on her notes written before our meeting she wrote ‘Is there a possibility of P.E.?
  • She never even mentioned Pneumonia!
  • Something strange occurred also. 
  • WhenFY2wrote in her notes about our conversation, she not only separated these; which could be explainable; But she added the time of 13.00hrs, although our conversation took place much earlier?
  • Other than this particular time when FY2 ‘spoke to me’ In every single doctors notes there are No Times written whatsoever.
  • This was the only Time?   
  • Why?
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