blood

Work and stuff . . .

/ Tony / 8 Comments

I need another job. I’m having issues with one of the ‘the team‘ and have just found out that I cannot take some time off as the chef is off at the same time. I’m a kitchen porter! I wash up! I don’t really see how my taking time off can affect the chef. It seems it can. I am looking for another job, but I’m limited in the hours I can work or to be more accurate, the days I am able to work.

I have done this job for four years now and can say that I know it inside out and it bugs me when a new member of ‘the team‘ try to tell me what I’m doing wrong. I’m not saying much more, but it could get …

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I would be intrigued if anyone has a definitive answer to this one. When the access from the village to the motorway was changed, a cycleway/footpath was created along the side of the new access road. This cycleway/footpath is wide enough for both cyclists and pedestrians to use safely. So my question is, why do the majority of cyclists not use this facility? Is it some kind of protest against motorists? Or is it a case of ‘… it’s my road too …’? Either way, it can be dangerous for all.

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Well, the blood test was fine and as expected my dosage of Rampiril has increased to 2.5mg a day. So I will jave another blood test in 2 weeks and we will see what happens then. I’m expecting it will increase again to 3.75mg, but who knows. I’m not sure it has any effect on my warfain, but my INR was too high again. That’s after six weeks of it being in range. It shouldn’t cause a problem, but knowing my luck these days.

I’m also having to monitor my blood pressure. I’m checking every couple of days, but from 19th of this month, I will have to do a check twice a day for four days and submit the results to the Dr’s. Then the following week I will get my flu jab followed a week later with the Covid booster. It’s all go!

It’ll all be fine . . .

/ Tony / 4 Comments

Toward the end of last month, I had to go back to the hospital to review where I was after my stay back in February. I was scheduled to go in the middle of June, but with one illness and another, it got cancelled and rescheduled. We had been watching the news programs which showed patients waiting in corridors for long periods, waiting to be admitted to a ward. This was not our experience at all. More on this in a while.

Electrocardiogram
Echocardiogram

I was to have an Electrocardiogram which shows a graph of my heartbeat followed by an Echocardiogram, to get a look at how my replacement Mitral valve was working. The Electrocardiogram showed that I still had what the medical people call Atrial Flutter/Fibrillation. This is where the heart is beating irregularly. The image shows this quite well. The large peaks show that the blood leaving the heart is going at the correct pace, whereas the small peaks show the problem with the irregular heartbeat. The Echocardiogram however showed that the valve was behaving itself.

Cardioversion

The next step is I will need to wear a portable ECG monitor for 24 hours. this will give the Cardiologist a more accurate picture of the problem. The stage after that is the more worrying one. Once the data from the portable monitor has been analysed, the Cardiologist will decide If I need to undergo Cardioversion. Cardioversion is a medical procedure that uses quick, low-energy shocks to restore a regular heart rhythm. It’s a treatment for certain types of irregular heartbeats (arrhythmias), including atrial fibrillation.

As mentioned above, there had been TV news videos showing patients on trolleys, and in corridors for hours on end. My appointment was at 14:30. I arrived at 14:25. after both procedures and a good talk with the Cardiologist, I was out at 15:20. A total of 50 minutes. I was amazed as I was expecting to be there until 18:00ish.

Strange and scary . . .

/ Tony / 4 Comments

It started Saturday morning. I began to notice a slight ache across my chest. I thought it was the result of coughing and that I had strained some muscle. However, it seemed to get stronger slightly as the day went on. By around 6:30, it was a lot more noticeable, but I still put it down to the previous coughing.

Went off to bed around 11:30 and the ache had now become a pain. I was now beginning to wonder what was going on. I couldn’t sleep or get comfortable and went downstairs to get a warm drink. My wife followed asking what was wrong. I explained about the pain, which was now much worse. We decided that we needed to call someone, as I was beginning to think along the Heart Attack lines.

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K**h called the Ambulance Service and they arrived within about 15 minutes. The Paramedic and his partner were amazing. He asked a lot of questions and then wired me up to his portable ECG machine. He explained that he would do three scans to check the readings were all correct. After a quick study of the print-outs, he declared that he was convinced that I was suffering from Atrial Fibrillation and his partner quickly agreed.

Then the scary bit came, when he said, “Right let’s get off to the hospital!” Neither I or K**h knew what to say. It certainly wasn’t what I expected to hear. I’m not sure what I expected, maybe a tablet to put under my tongue (not sure what that does, but I had heard of that) and advice to see a GP. But the hospital was not on my radar at all. We asked what I should take and he joked that all I needed was a phone and a good book.

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The next thing I knew, I was strapped to a trolley and we were hurtling along the roads to Harrogate. With blue lights flashing, as the paramedic wanted to get me there quickly, we soon arrived at the A & E of Harrogate district hospital. Things moved quite quickly. After the usual blood taking and a chest X-ray, I was found a bed in a Critical Care ward. All in all, about 45 minutes.

I was hooked up to a full ECG monitor and was placed on oxygen as my saturation levels were low. Well, sleep was out of the question! The ECG machine was constantly beeping as my heart rate changed and if you have ever had the cause to use a Nasal Cannula then you will know how uncomfortable they can be when lying on your side, trying to sleep.

I was in my own room, and there was nobody to talk to. The door was kept closed as there was a patient with dementia, that was trying to go home and would go into the rooms if the door was open. I had a full day and night of this before a doctor decided that I should be on a Cardiology and not Critical Care. I was moved to another ward at 8pm. This time it was a five bedded ward, with four other patients. Although they were all around my age, they were all local people talking about local issues. Not as boring as before, but I had nothing in common with any of them.

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I now had a portable monitor which was linked by wifi to somewhere. This meant I was mobile and didn’t have to unplug anything to go to the toilet. I was still on oxygen though. Monday night passed without any issues and I found that I had slept for about six hours.

Tuesday was as boring as the other two days. For some reason, televisions are not on any of the wards. Something to do with the licence fee which I didn’t understand. So the only entertainment we had was a small radio playing music from a local radio station.

Later in the afternoon, a different Cardiologist saw me and explained that the increase in one of my medications had regulated my heart rate enough for me to go home. Hopefully that day. However, my blood oxygen levels were not good enough and I was to stay another night.

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Wednesday morning came and the nurse that was taking my blood pressure and oxygen levels told me to take really deep breaths when the oxygen was checked as that increased the levels. She also told me that I should regularly take a couple of deep breaths throughout the day as a matter of course.

The Cardiologist came again and explained that all the signs were good and that I could go home that day. This was around 10am. I now had to wait for my new medications. The Pharmacist turned up at around 1pm and took some details about the medication I had at home. She explained that she would put the prescription in and that as soon as it was ready, I could go.

I called K**h and explained that I was waiting for my meds and I would call her again when I had them. It was 4:30pm before the Dispensary called the ward to say my stuff was ready. It annoyed me that with all the bed shortages around, I was taking up a bed, whilst waiting for someone to fulfil my prescription.

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It was getting on for 6pm when we finally got home, and I have never been so happy to see the house again. It had been a scary episode and has given me cause to ponder on life, work and things.

Higher than expected …

/ Tony / 4 Comments

I had my INR (international normalized ratio) test yesterday and it was a lot higher than I expected. My range is 2.5 to 3.5 with a target of 3.0. Yesterday it hit an all time high of 4.3. I have put a short guide to INR on a page on this site for those who are not aware of what the INR is.

I take Warfarin, which is an anticoagulant (commonly known as a blood thinner) to control my INR and I have a regular test to ensure that it stays within the range decided for me. I have been on Warfarin since my Mitral Valve replacement back in 2014. As I understood at the time, the surgeon has three options when performing the surgery. The ideal option is a repair, then the next option is a replacement with an organic valve (usually from a pig) or a mechanical valve. The surgeon will decide when the chest is opened which option is required. For me he opted for a mechanical valve. As it could be dangerous if blood clotted in or around the valve, an anticoagulant is prescribed to increase the time taken to clot.

For a long time, my test has been within the range and often hitting my target. Back in August last year, I had a small infection on my leg for which anti-biotics were prescribed. I was advised to get an INR test after taking the anti-biotics as they are known to have an effect on blood clotting times. And indeed this proved to be the case as my INR went as high as 3.9. It seemed to take a long time to get back to ‘normal’ but by the end of the year it was looking better.

I had my previous test mid January this year, and whilst it was in range, it was only just. The nurse decided to increase my Warfarin from 15mg to 16mg (3mg Sunday and Tuesday, 2mg every other day). Not a huge amount, but I think it proved a significant change. After yesterday it is now back to what I was taking before, which is 3mg Tuesday, 2mg every other day. I’m back for another test in three weeks and we shall just see what happens.

It just didn’t work …

/ Tony / Leave a comment

After seeing a couple of my colleagues wearing them, I decided it might be good idea to get a smart watch. Nothing expensive as I don’t really like wearing watches as they tend to irritate my skin. But, I thought it may have it’s benefits. I trawled through eBay and there seemed to a lot of really cheap ones around the £3.00 mark with a larger number between £10.00 and £30.00. Then there were the popular branded ones going up to £150.00 +. I wasn’t that desperate, so I plumped for one at the lower edge of the mid-price range.

Everything went well, I bought and paid for the unit on Tuesday evening and it was delivered on the Friday, by first class post. All was good and it arrived within the stated time frame. I was surprised by the appearance, as it looked good quality and it felt quite comfortable to wear. The English instructions were well written and easy to follow. I plugged the charger in and left it overnight to fully charge.

It can only be a small battery and usually these kind of things need a good charge to start with, but after 12 hours it was still only 50% charged. I realised that when I placed the unit on my desk, the two pins that charged the unit were not in the right place. This time I got everything right and within 2 hours the watch was fully charged. I installed the software on my ‘phone and I was good to go. It correctly picked up the time and date from my phone, and I began to play around with the numerous displays. The only few things I wanted it for was:
a) a step counter
b) blood pressure monitor and
c) heartbeat monitor
It did all these and many more.

Skip forward to Sunday lunchtime and I became aware that the time on the watch was wrong. The clock said 11:40 yet the watch said 00:04 with a date of 01/01/01. I thought at first I had set it wrong. I re-synchronised the unit with the software on my phone and everything went back to how it should be, Except … all the data from the previous day was gone! This happened again later that day and it seemed that the unit was resetting itself back to its factory settings. I read some of the reviews and soon realised that the phone an watch connect via blue-tooth so both needed to be near to each other. That seemed to make sense, so where I went, the phone went with me.

All was now good, or so I thought! Monday morning and again, the watch was showing a random time. I wasn’t happy about this to say the least, so I contacted the seller with all the problems I was experiencing. About 2 hours later, I received an email telling me that I had been refunded in full and that there was no need to return the unit. I checked PayPal and indeed the refund had passed through and was now in my back account.

I was one happy chap, especially as I didn’t need pay for any postage to send it back. That bothered me a little. How much did the thing cost to make and sell, if he can simply refund me with getting the unit back?

Patience is a virtue…

/ Tony / 1 Comment

I had my INR blood test appointment of Friday. It is one of those finger prick tests that only takes about 45 seconds. I fact the pre-test questions take longer than the actual test, it is usually about a ten minute job. It was an early appointment, 9am. Don’t ask me why I chose that time, because as usual with me, I can’t remember. I pulled into the car park 15 minutes before my appointment as I hate being late. We have one of those self-sign-in screens which told me that I was the next in the queue.

I sat down in the waiting area and started to look at my phone, as I didn’t really want to catch anyone’s attention. However, there was a lady sat two seats away from me, that I had seen entering the centre when I parked. She was holding her yellow record book so I assumed she was waiting the same as me. She would have been (and I’m being kind here, I think) maybe three or four years older than me. I was amused to see her tapping her foot and humming along to the music being played in the background … “Paint It Black” by the Rolling Stones is not the kind of music I would expect a person of her apparent age to listen to. It wasn’t until I got home, that I fully realised that it was highly likely that she would have listened to that music.

But I digress from the main point of this tale. I glanced up at the clock and saw that it was now 9 o’clock.
“She’s late!” said the lady, “She should be here before now!“
I smiled and said something like “She has a long way to come…” or words to that effect. The clinician does have to travel over eighty miles from Newcastle to get to our Medical Centre, so delays are quite reasonable and understandable.
“I can’t stay here all day, waiting for her,” she said. “I’m going to make another appointment!” And with that she stormed off. Meanwhile a gentleman had sat beside me and witnessed this bit of a tantrum. He asked me if she was the first in the queue and I said no, I was the first. He said he was the second, so that made the lady the third. That meant, her appointment was for 9:20 at the earliest, so why she was going off in a huff, fifteen minutes before her allotted time I will never know.

Ten minutes later, the receptionist came to inform the INR people that the clinician had been held up and would not be at the Medical Centre until early afternoon, and that she would ring to make new appointments.

I went to pick up my prescriptions and it was while I was discussing this with the dispenser that the title of this post came up. I was always under the impression that it was the younger members of society that had no patience … seems I could be wrong.

All over …

/ Tony / Leave a comment

Well … almost “All Over”. I’ve just got to get through binnedthe copious amounts of “Happy New Year” messages and we’re done until next September/October when the whole farce starts again. I think I’ve said enough about me and Christmas over the years, so I’m drawing a line under it (see below) except to say that it is only 363 days until Christmas day (again)!

So what’s in the future? Well tomorrow I have my Medication Review, whereby the doctor ‘reviews’ my current medication, and advises accordingly. Now, as I could be seriously compromised if four out of the five were ever stopped, it seems a little bit of a waste of time to actually review them. But review them he must, so that’s happening as 09:20 tomorrow. I suppose it will give me a chance to query the changes that are being made to the way my blood is tested. With being on Warfarin, I have to have regular tests to ensure the level of the medication is correct. At my end it is a simple extraction of a few millilitres of blood which is sent off to the Anticoagulation clinic in York. Two days later I get the result. At the last test, the phlebotomist mentioned that she did not know what would be happening in the future with blood tests and here words of comfort were “No-one knows what will happen in the New Year!” The health-care assistant hinted that it may be an all day clinic, once  fortnight or so, but she really was clutching at straws. However maybe, one of the senior practitioners will know a little more.

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Didn’t last …

/ Tony / Leave a comment

So much for increasing the regularity of my posts. I think it must have been the ‘double’ post on the 8th that upset things. Joking aside, not much has really happened over that past week. Did a couple of short walks but nothing spectacular.

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I had my Warfarin review on Wednesday. Now I think this is a silly idea. Because it is a controlled drug or POM (prescription only medication) the law says I have to have a review every 12 months. After my operation, the the surgeon explained that I had been fitted with a metal valve and as such I would need to take an anti-coagulant (ie Warfarin) for life. My GP confirmed this during my first appointment with him, a week after leaving hospital. It was also explained to me when I had my first INR blood test. So why do I need to have a review? Nothing has changed. I still have the replacement valve and it’s not going to go away. I don’t really see why I need a review. I did ask the GP at the time of the review, but he was very non-committal and answer. However, he did come up with a new idea!

Every so often, I have a blood test in which a phial of blood is taken from a vein in my left arm (a venous draw) . This is then sent to the Anti-Coagulation Clinic for analysis. I get the results, typically two days later. The new idea is to do the testing at the GP surgery. Basically I will have a pin-prick test, like the blood sugar test and the results would be available within minutes. It will still take ten minutes to do the test, but it would cut down on a lot of other time.

I have to book a special session with the lead clinician on this, but it sounds like a great idea.

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So that’s about it for the past week. Lets see what the next one brings.

Back on track … hopefully

/ Tony / Leave a comment

My INR results came back today, and it had gone down to 2.7, which is around about the target date. The anti-coagulation clinic still wants me to be checked in a week, but strangely they have requested that I be tested on Wednesday instead of the more usual Tuesday. It’s not a problem changing the date, as Tuesday has always had issues with work. Only thing that concerns me is that is now the middle of the week, which could have implications when we have time away. However, we shall cross that bridge when we come to it.

Tomorrow sees me paying a visit to the Cardio-Respiratory unit for an ECG. I’ve not had one of these since before I had my operation, and I’m more bothered by how I can get parked than what the results will be. This is a pre-cursor for the appointment with the doctor (or Consultant as I like to think of him) next week. I’ve not seen Dr Me****y since before the procedure back in March 2014. I would have thought I would have seen him before this, but I think there has been some mix up with my post-care appointments over the past two years. It will be good to see him again

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From his ‘homebook’, R**s seems to have had a reasonable day. There had been a couple of issues at the beginning of the day, due to a delay in getting in to the unit, but they say it improved during the day. It was a little unusual, but he was apparently wearing his ‘weighted blanket’ in the taxi home. He came out of the taxi in a happy mood and seemed okay. Around about 7ish, K**h took him his usual meal and he seemed to snap, which we were not really expecting. The usual nipping occurred and it required a dose of his PRN medication. He calmed down after about 15 minutes, but one of the after effects is to reduce his hunger. So not much dinner tonight.

He is full of cold, and I think that has had an effect, but he seems a bit more settled now.

Bit of a shocker …

/ Tony / Leave a comment

I was sat at work, chatting to one of the IT partners when I got a text message. By the time I had finished talking, I had almost forgotten the text. It was from the doctors confirming my next INR test date. Strangely, they had simply sent a previous message which was stating that I was booked in for a test on the 9th February.

I rang the wife and asked her if she had booked me an appointment and I explained that the date was wrong. She told me that the anticoagulation clinic had left a message and that I needed a test on the 8th March.

The shock was that my INR, which should be in the range of 2 to 3.5 with a target of 2.5 was actually 4. This is the highest it has ever been and was strange because my last test was  back to around 2.6.

Now I’m putting this down to a combination of stress and the fact that I had drunk a bit more alcohol (although not much more) than usual. The doctor has said that he has not heard of any research into stress and INR levels, but it was quite feasible given what stress can do. However, I think it may have more to do with the alcohol!

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Here’s a question for you. The clinic should have rung me on my mobile as that is my primary number, and the phone did ring at around 10:30. However, there was no number and the display simply said ‘Private Number’ which means nothing really. I tend to ignore calls like that, on the grounds that if it is important, then they will leave a message. I don’t like the fact that callers can hide their number and given that I already have 2 numbers for the clinic, I would have thought they would have used one of them.

I’m wondering how many of you answer calls from people that hide their number?

Been another long day …

/ Tony / Leave a comment

INR blood test day today. Now that the footbridge over the Wharfe in Tadcaster has been installed,Damaged bridge going for the test has got a whole lot easier. Instead of a  20 miles detour, it’s now more or less back to the usual 8 mile trip. The old road bridge was severely damaged in the floods in December. So badly damaged that it partially collapsed and has had to be closed . For the past two months or so, the town of Tadcaster has been virtually split in two. It has had a lot of television coverage, footbridgebut it is only when you see the damage and what it has done to the town that you really appreciate the new footbridge and the near normality it has brought back. So back to the blood test. It was my favourite phlebotomist that was in today, so it was a quick ‘in & out’ and the job was done. Well almost a quick in and out. The usual vein proved to be rather obstinate and it took a couple of attempts before she got a flow. But I was still in and out, before half past 8 and was on my way to work in good time.

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Work proved a little stressful. It was ‘go-live’ day for part of the project I’m working on. It should have gone without a problem, but as is normal for this project, it all went wrong. We had to get the engineer for the software house out, who after a few tests decided that a part of the equipment was faulty. So that was the end of that. The part has been ordered and we will start again on Thursday of Friday. I’m hoping for Friday, as that would mean having to miss the team meeting (sad face, tears, depression etc etc.) Hopefully, that will fix the issue and I will be the hero of the day!

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Serious Autistic melt-down from R*** tonight. We had been concerned since he got in that all was not well with him. He was ‘droning’ which is basically him walking around with his fingers in his ears humming loudly. It sometime is indicative of him having a headache, but this has never been proven. We gave him the usual 20mils of liquid paracetamol, but we knew that it was probably not going to work. Ninety minutes later it went downhill really quickly. He completely lost all control. K*** managed to give him his ‘come-down’ medication, and eventually he started to settle. We are now two hours on, and he is still a little distressed, but at least the violence has stopped.  

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This was supposed to be the start of my ‘short and often’ posts, but it still has gone over 450 words. Maybe 450 words is becoming my norm, or maybe I had a lot to say today …

An old friend returns …

/ Tony / Leave a comment

The thing about getting a new computer is that you never remember what software you need, until you realise it’s not on your new machine. Now I thought I had been clever, and had made a list of the stuff I use all the time. Which is fine in as far is it goes. Then you start to do some work or something and you find that you haven’t got that little bit of software that you always use, but never think about. Still, I think I’m almost there now. The old machine is in the spare room (in case I need something) and I’m beginning to get the hang of Windows 10. It has it’s pro’s and con’s, but I think a lot of it is just familiarity. It too me a couple of weeks to get used to Windows 7 after XP, and I still miss some of the things that XP did, but we move on.

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Now, to the title of this post “An old friend returns …”! The old friend in question is my first blogging editor (back to Windows XP here) good old ‘Windows Live Writer’  (WLW). I always felt it was one of the best tools for the job, and was very disappointed when Microsoft decided to no longer support it. Since then I have used a variety of editors and am still inclined to use the Blog Post template in Microsoft Word and occasionally I will use the WordPress desktop application.

Yesterday, whilst reading an article about Windows 10 compatibility issues with some older software, I saw a mention of WLW and how much it was missed. There was a list of alternatives, but near the top was a link to a website called ‘Open Live Writer’ which wimageas offering Open Live Writer as a free download. My initial thoughts was that this must one of those awful clones that seemed to perpetuate throughout the internet. After a little bit of research it looks like pressure from users made Microsoft turn WLW into an open source application and the result is Open Live Writer.

I downloaded it this morning and have used it for this post. To all intents and purposes it looks and feels the same as before. Everything seems to be as I remember WLW, and it feels quite nostalgic to be using it again. I shall test it further over the next few weeks and see how it goes, but things look promising.

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On a completely different tack, my INR blood test seems to have been a bit off the wall. INR is the International Normalised Ratio and is a measure of how much longer it takes the blood to clot when oral anticoagulation is used. For example, if your INR is 2 the blood is taking twice as long as normal to clot. I have a range which my INR has to fall within, of between 2.0 and 3.5 with a target of 2.5. Since I have been taking an anti-coagulant, my INR has usually been within the range, with the occasional blip. However, since middle of December I have three times been ‘over my limit’ so to speak. I have put it down to what I have eaten and drunk (which does have an effect), but it made me wonder if stress could be a factor. Over the December/January period, it has been quite a stressful time what with Christmas (humbug) and work. I asked the doctor at my medication review, and although he had not heard of stress being a factor, he did say that stress does have an effect on our metabolism so in theory there could be a link. However, I got the impression that he thought it was probably down to food and drink.

Awful afternoon

/ Tony / 1 Comment

I was about a hundred metres down the road, when I spotted the Police car behind me. A quick look at the speedo’ showed me I was under the limit. Just! So I drove the whole road at 58 miles per hour, with the police car 20 foot behind me. Now, will he turn into the village, or is he going straight on? Nope, he’s sticking with me. Should I go along the main road, or up the hill? Main road, I think? Bloody cop is still with me. He’ll be on to Clifford, I thought as I turned into my street. Oh dear, an ambulance. I wonder who has died now. Just a minute….. it’s just moved, then stopped outside our house. There’s a police car there too. What the fuck is going on? I parked and got out of the car. The police that had been behind me was now parked outside our house too!!!! What in God’s name…..

“Alright mate?” asked the police officer that had been behind me.

“Er…..yeah. Thanks. What er……”

I went inside, and the scene that greeted me was bizarre to say the least. S**** was sat on the floor, holding onto R***. K*** was trying to explain to the two paramedics, what R*** and his Autism was about. R*** was looking very pale and shaken, and sobbing a little. The two paramedics were trying to talk to R*** to see if he was okay, but getting no response as usual. The two police officers were stood around, looking genuinely concerned but clueless (not their fault, probably never dealt with someone like R*** before).

Apparently R*** had had an ‘episode’. Not the usual, type of ‘episode’. This time the medication did not work and he had completely lost it. Both K*** and S**** were concerned for theirs and R***’s safety, and that’s why the emergency services had been called. It must be standard if there is any kind of violence that the police attend, which is why the ambulance had parked up before our house first.

The paramedics were great. They asked what we wanted to do with R***. Did we want him to go to hospital or what. Well, I thought that if he went to hospital, the first thing they would do would be to get a psych doctor, and sedate him. That would not solve anything. The paramedics stuck with us, and were there a good hour, testing his blood pressure, SATS and everything. The police were being looked after by S****, doing his ‘coffee shop’ thing.

He calmed down, enough for them to leave, but he was still very hyperactive after they had gone. It is now 23:45, and he is still up. Quite calm, but it is like living on an knife edge. We just don’t know if he is settled or if we are going to have some more.

I have to say though, I felt that the paramedics did a brilliant job. What did get me though was the paperwork they had to fill in. That took over 20 minutes to do. C’mon, give them some technology!!! I mean, in this day and age, they still have to fill in paper forms. Dear Health Secretary, if those forms were electronic, and on a Tablet PC or an iPad, then maybe less time would be spent filling in  paper!!!!