Pradaxa (dabigatran) degrades on removal from original packaging; do not place in a pill organizer.

Formerly Pradax in Canada, the name is now Pradaxa in both Canada and the U.S.

Note: The following is an UPDATE to a blog originally posted in early 2013. The views are of a patient taking Pradaxa and are NOT the views of a medical expert.
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If you take Pradaxa (dabigatran) rather than coumadin, you must be aware of the following taken from the Pharmacist's Letter of October 2016:

Pradaxa must be protected from moisture.
All capsules must be used within four months of opening the original container.
Pradaxa must be dispensed in the original container. The bottle has a desiccant in lid.

Now, you know the core concerns. Please, read on.
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I started taking Pradaxa, originally called Pradax in Canada and Pradaxa in the States, more than four years ago. So, I am not addressing a new problem. And yet, this serious problem is still with us. Contrary to an FDA warning, some pharmacists are continuing to dispense Pradaxa capsules repackaged in standard pharmacy vials.

Why is this a problem? According to Boehringer Ingelheim, Canada, "Pradaxa is very sensitive to moisture in the air." For this reason, the drugmaker recommends keeping Pradaxa in its original foil blister pack or in its original special bottle with a drying agent in the lid. The company warns, "Do not put the capsules in pill boxes or pill organizers . . . " The FDA also adds a warning about storing the drug in areas which are subject to temperature extemes, either hot or cold.

Pradaxa is an anticoagulant replacement for Coumadin (warfarin). Both drugs are taken by those in danger of suffering a stroke. Compared to aspiring, Pradaxa poses less danger of causing serious intracranial bleeding. After an MRI, I was diagnosed with micro-bleeding in the brain. I also suffer from TIAs or small strokes. Small strokes can lead to large strokes if an anticoagulant is not taken regularly. I take Pradaxa twice a day.

Without my anti-clotting medication I have a six percent chance of suffering a serious stroke in any given year. That's six strokes in a hundred at risk patients. One of the six will die and the other five will suffer strokes causing differing degrees of debilitation. Strokes are the fourth leading cause of death in the U.S.

If you take Pradaxa, check your prescription bottle. My last one was a palm-and-turn plastic bottle with a lid riddled with holes. Pradaxa is only good for four months after its original bottle with the special desiccant-containing lid has been opened.

How long my three month supply of Pradaxa, dispensed in a bottle with holes in the lid, retained its potency is anyone's guess. There is no question the last capsules would be markedly degraded. That much is certain.

Atrial fibrillation (AF) affects a great many people and according to the Mayo Clinic is increasingly common in seniors. AF is a type of irregular, often rapid, heartbeat that can lead to the formation of blood clots in the heart. These clots can migrate to the brain where they cause a cerebral infarction, a cerebrovascular incident — a stroke in simple terms.

My heart is in constant atrial flutter, similar to, but not quite the same as, atrial fibrillation. My daily low-dose Aspirin is not strong enough to protect me from the increased threat of stroke. My doctors discussed my situation and settled on Pradaxa 110mg as the best option. Pradaxa also comes in two other strengths: 75mg and 150 mg.

Black marker dates Pradaxa still in foil.

Transferring Pradaxa to a pill organizer is a common mistake. Lots of people do it. There is an "Important" instruction on the side of the box but it is at the bottom of a list and in the same type style as the other notes. For a truly important instruction, it does not jump off the package as one might expect it would.

I confess, when I first started taking Pradaxa I missed the warning. I'm an old geezer. My making a mistake is not surprising. It is to be expected. But clearly my pharmacist has also missed the warning. How common is the mistake? Like so many today, pharmacists are overworked. The staffing at my drugstore has been cut and this, I believe, can lead to errors.

I have now had Pradaxa dispensed in both the original bottle and the blister packs. I prefer the blister pack. I'm old. My memory is not good. Unable to continue using a weekly organizer for my Pradaxa, I take a Sharpie permanent marker and write the day and time of day, AM or PM, that each pill must be taken on the blister pack itself.

I believe this is very important. Pradaxa has an extremely short half-life. The concentration in your body drops drastically in just 24 hours. For this reason taking a dose quite late, or completely forgetting a capsule, increases the risk of stroke.

I find it strange that if grapefruit should not be consumed while taking a drug my pharmacist has a sticker for this. The sticker is slapped on the pill bottle at the time the prescription is filled. Pradaxa needs a similar day-glow sticker to warn folk not to expose the capsules to air, to keep the medication in its original container until it is taken.

If a druggist dispenses Pradaxa in anything other than the original packaging, one pharmacist told me the capsules should be immediately returned to the drugstore to be safely discarded. The pharmacist should replace those capsules with new as it is difficult to know how much humidity such capsules have encountered. Were they kept in a bathroom with a steamy shower, or stored in a kitchen near pots of boiling water? The druggist told me not to take a chance. Return the capsules.

One last thing about Pradaxa. There is now a reversal agent available. In an emergency situation where there is a need to reverse Pradaxa’s blood-thinning effect, Praxbind (idarucizumab) is now available. I personally know how important this can be. I had to have emergency bowel surgery a little more than 12 hours after taking my last dose of Pradaxa.

For more info on Pradaxa, check out the Pradaxa website or follow this link to a story in The Globe and Mail: Questions raised about new class of blood thinners.

Read the Globe story and you will realize that Pradaxa has had mixed reviews, especially in the media. A word to the wise, don't rely too heavily on media reports when it comes to medicine. Yes, Pradaxa is a dangerous new drug, but then weakening the blood's ability to clot is clearly a dangerous practice. Warfarin, formerly the drug of choice, is also a dangerous drug.

As I said earlier, I was once on warfarin. I had to have my blood regularly tested to be certain I was getting the maximum benefit from the drug. Warfarin, in some people, can be notoriously difficult to regulate.

It must be noted that the maker of Pradaxa has claimed no regular blood testing was required with the new anticoagulant. MedPage Today and others are reporting that monitoring drug plasma levels could improve the safety of Pradaxa. I have had my blood tested twice and so far Pradaxa is working as promised.

According to the Mayo Clinic, warfarin reduces the risk of stroke by about 64 percent. Unfortunately, ". . . only 50% of patients with atrial fibrillation who would benefit from warfarin therapy receive it, and the discontinuation rates are high. At 1 year, more than 25% of patients stop warfarin . . . " For these reasons, drugs like Pradaxa are very attractive.

My doctors believed Pradaxa to be better at stroke prevention than warfarin and with a lessened chance of major bleeding. Some time ago, I had an MRI that revealed micro-bleeding in my brain. Not enough is known about micro-bleeding for my doctors to feel confident putting me on warfarin. The rate of intracranial bleeding with Pradaxa has been shown to be less than that of warfarin. To lessen my risk of suffering a major bleeding event in my brain, and after consulting with the neurology department, my doctors decided the best alternative for me was Pradaxa110 mg taken twice daily. I continue to take an aspirin daily, the 81mg kind.

There's a lot of which to be aware when taking a drug like Pradaxa. Read the warnings that come with all your meds carefully. Check out the Pradaxa info online. Click on the links that I have supplied. If your doctor advises a drug like Pradaxa don't be too quick to dismiss the suggestion. Doctors go with the best odds. I liked one comment made on another site discussing Pradaxa: "You can transfuse blood, but you can't transfuse brain".

Lastly, here are a couple of websites you might find interesting. The first is a website run by the Harvard Medical School. The article is titled: Is the alternative to warfarin safe and effective? The second is a site dedicated to AF: StopAfib.

Good luck with your meds.

And if you are interested in knowing more about my emergency operation, done before the release of the reversal agent Praxbind, here is a link: 16 hours in the ER; 16 hours well spent.

Film: Humbug.

Digital has eliminated neither art nor craft from photography.

The New York Times has published another in a seemingly unending parade of eulogies to the passing of film: Picturing the End of Analog.

I don't miss film. If I had to use just one word to describe film, I'd say expensive. It was expensive to buy, expensive to use, expensive to process and expensive to store.

And, if you will allow me the luxury of adding just one more word to my description, I'd say difficult. It could be difficult to find when needed, difficult to process and difficult to store.

Close-up, wide angle, telephoto: One digital camera.

One reads all sorts of stories about the artsy qualities of film. Some of the stories are true. But some of the art was the result, not of craft, but of ignorance.

I knew a rather famous photojournalist who was well known for his contrasty colour images. He captured the grittiness of the news, the harshness of those moments with a style unmatched by other shooters. All his pictures weren't rendered with bald, stark highlights, that would have made his approach simply a style gimmick.

Then I met the great man. Working outside the country on assignment for the local paper, I had to have some colour film processed by this famous photojournalist artist. He processed the film by hand, dunking it in stainless steel tanks immersed in a water bath to stabilize the temperature of the processing chemicals.

When the film was dry, I picked an image and stuck the negative into a portable Leaf scanner to transmit three colour separations back to the newspaper. The image I saw on the little Leaf monitor was awful; It was contrasty; The highlights were bald.

See it, shoot it. The power of small, ever-present, digital cameras.

I removed the film from the scanner and examined it under a strong light. The colour film was suffering from silver retention. There was a black and white negative hiding in the colour negative.

At that time, colour film went into a bleach bath before going into the fixing bath. The bleach bath converted metallic silver in the film back into the silver halide it had been before being dipped in the developing tank. Thanks to the bleach bath, the fix bath removed all the silver from the film. Fix only removes silver halide; It does not easily remove metallic silver.

I had learned the reason for the contrasty images this photojournalist was known for. He didn't understand the chemistry involved in processing colour negative film. Most of the time he dumped his bleach before it lost it potency. He used his chemical bath for a set length of time, regularly replacing it with fresh chemistry. But sometimes, if he processed more film than usual, his bleach grew weak and failed to convert all the metallic silver created during development back into silver halide.

At those times he produced art. Film: Humbug.

Digital encourages experimentation. No film, no expense. Just fun.

Will boomers bankrupt the medical system?

This post was knocked off far too quickly and the well-thought out comments appeared to punch holes in my position. I admit, I was far too quick out of the gate. I made the mistake that newspapers make daily. I am now in the process of taking another look at rising health care costs and the part played by the rapidly growing senior segment of the population.

In the meantime, here is an article worth a read despite being a little stale dated: What is driving health care costs? And here is anothe: The Costly Paradox of Health-Care Technology.

The problem appears complex -- this should come as no surprise -- and the media's immediate scapegoat, seniors, may be wrong. For an example of a well written but quite possibly wrong-headed take on seniors and their affect on the healthcare system, read this piece by Larry Cornies which ran in The London Free Press: Boomers duty-bound to reduce health-care footprint. Compare the Cornies article with this one from The Economist with a section titled: Money and mortality: the implications of aging on healthcare costs.
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According to The London Free Press reporting on a talk by David Foot, the demand for health care in Ontario will ramp up sharply when baby boomers hit their senior years. Foot believes, "We have about a decade to get health care right before it hits the fan."

Many would agree with Foot that there is a growing problem, but many would argue that the health care issue is not driven by the increasing costs associated with health care for the elderly. The Globe and Mail, a competitor to The Free Press in their home market, carried a story with quite a different slant. Globe writer Andre Picard wrote:

"This alarmist view of our aging society is challenged in a thoughtful new report from the Institute for Research on Public Policy.

"Instead of falling prey to ageist fear-mongering, Neena Chappell, the Canada research chair in social gerontology and a professor in the Centre on Aging of the University of Victoria, takes a level-headed look at the data and offers up practical solutions for meeting the health needs of the baby boom generation."

The Globe piece goes on to argue a position that I have seen in print many times. I wondered why The Free Press reporter didn't question Prof. Foot on this point. The Globe accurately reported the following:

"There have been, of late, a number of studies debunking the notion that seniors are principally to blame for spiraling health costs. In fact, it is new technologies, new drugs and higher wages for health professionals (physicians in particular) that are pushing up costs."

 To read the two stories, here are the links:

• Baby boomers blamed for sluggish economic outlook in Ontario
• We need a health plan for boomers now

This is an issue that is very important to me. I am a senior and a baby boomer. I watched as my maternal grandparents aged and finally slipped away. Both lived into their 90s and neither was a big drain on the health care system. They lived in their own home until their mid 80s and then they moved in with my mother and me for their remaining years.

When my mother found herself on her own after the death of my grandparents, she moved in with my sister. After more than a decade living in Oakville, she packed her bags and moved in with me in London. When I got married my mother was part of the package. She lived with me and my new family until she died at 89.

Families taking care of loved ones in their final years are more common than you might think. The government should encourage families and support them in their efforts to take care of aging parents and grandparents.

In one area both The Globe and The Free Press reports agree: We, as a society, need a plan as we prepare for the dramatic growth in the number of seniors. What we don't need are scare stories.

London police did excellent job putting injured deer down

A deer was struck recently by a vehicle in London, Ontario. It was left severely injured. It's limbs smashed; Its antlers broken. When police arrived, the fatally injured animal was suffering in a parking lot, unable to walk.

It was a tough situation but the London police made the right call by ending the animal's misery quickly. But many didn't view it that way, and many people did view the shooting of the deer. A Londoner captured the incident on his cell phone and posted the video on YouTube. It has had more than 15,500 viewings.

Deer are common in the city and collisions with vehicles all too frequent.

The London Free Press quotes a police constable: "We have to consider the surroundings. If we used a round that penetrated through the deer, we would have to be prepared for ricochet." The officer used a 12-gauge shotgun to put the injured deer away with three shots in less than half a minute.

The truth is dying is tough. It is not often immediate. I did some research and found what hunters themselves have to say about their kills.

"I shot one whitetail doe there [behind the shoulder, in the heart/lung area] and she ran at least 60 yards before dropping. I shot a fallow doe last Sunday and the shot went through the lungs and out the other side of the deer. She hobbled down off the little hill she was standing on, then down a draw about 150 yards from me. By the time I got to her she was giving up the ghost, but she had lived for a minute or two."

Another hunter listed his kills, saying:

• '05 Shot a big bodied buck, 50cal muzzle loader, thru the heart. Ran 100 yards decent blood trail.
• '07 bigger bodied buck, 7RM ballistic tip center of the shoulder. Dropped dead, three men could not find a bullet hole. NO blood.
• '08 .50 cal thru the center of one shoulder, exit 4" behind other. minimal blood hard tracking approx 100 yards.

I don't hunt but I did once work for the Ministry of Natural Resources. I used to hear the hunters with whom I worked chatting. I learned a quick kill did not mean immediate death. The London police officer was armed with a good weapon for discharging in a built-up urban area. His weapon was less than ideal for killing a deer. He did a good job, weighing his options, and carrying out a difficult duty.

Urban Outfitters: myths surround successful retailer

Urban Outfitters has come to London, Ontario. According to the local paper, this is "the first store it has opened west of Toronto." It isn't. There are already outlets in Vancouver, Edmonton and Calgary, and I expect there will be a lot more both east and west of Toronto in the near future. UO is in expansion mode, opening 21 new stores in 2011 and an additional 16 in 2012.

The Philadelphia-based retailer does not "shun malls"; This is a myth. Richard Hayne, the brilliant businessman behind Urban Outfitters, realized years ago that placing stores only in downtowns or urban areas was a dead end approach. He branched out into enclosed malls and lifestyle shopping centers, ensuring that his stores attracted the target market -- those between 18 and 30.

Once ubiquitous; Now, gone.

If you don't agree that Hayne is a brilliant business man. Consider this: He has kept a retail operation going for 43 years. This is no  small feat. Selling stuff, at least selling lots and lots of stuff year after year, decade after decade, is hard. Think of all the chains that once rode the crest of popularity only to fall, fail and fade: Tabi International, Au Coton, Beaver Canoe, Cotton Ginny . . .

Hayne got into retail with his first wife Judy Wicks in 1970, opening the Free People's Store near the University of Pennsylvania campus in Philadelphia. A pair of  old-fashioned men's long johns hung on the front door and during store hours the rear flap would be unbuttoned to display a sign reading "OPEN."

Despite what one often reads, Hayne was not hippie retailer. Reporter Jonathan Valania makes this clear in a story he wrote for Philadelphia Weekly: Clothes Make the Man.  In those early years, Hayne had long hair and he was against the war in Vietnam, but at that time who didn't and who wasn't? He was simply in tune with the era.

As the era ended and the tune changed, so did Hayne and his store -- it was now his store as he and his wife had separated in '71. Free People's Store became Urban Outfitters, stocked with an eclectic mix of merchandise for the chic, young urbanite. Urban Outfitters, under the guidance of Hayne, sold more than just stuff, it sold "cool." But, sometimes selling cool buys problems.

(Zach Klein - courtesy Zach Klein, Flickr)

• The Anti-Defamation League got its dander up in 2005 over a T-shirt sold by Urban Outfitters that said "New Mexico, cleaner than regular Mexico."
• The Navajo Nation sued for trademark infringement after the company sold items labeled as “Navajo,” suggesting the merchandise was made by the tribe when it was not. Under the federal Indian Arts and Crafts Act, making such a false claim is illegal.
• At various times the company has angered the Jewish community, gays and the Ancient Order of Hibernians in America. The Irish group protested a T-shirt saying, "Kiss me. I'm drunk or Irish, or whatever."

UO even managed to offend transgendered folk with a card advertised as "charming" containing the word "tranny." A slang term considered insulting and degrading by the transgendered community.

It isn't always easy being hip. And my guess is the company has had some big failures in the area of cool because at its corporate core it is not cool. It is a business. A successful business.

But don't make the mistake Buzzfeed makes, reporting that Urban Outfitters is run by a bunch of lame old men. Richard Hayne is a senior but he is not lame. His personal politics may be far right, years ago he and his present wife donated money to Rick Santorum, but today he keep his politics and his businesses separate.  Urban Outfitters shows more interest in Twitter, Tumblr, Vimeo, Pinterest, YouTube and the UO Blog than the Republican party and right wing causes.

The London Free Press interviews one young shopper who says, "It's cool, it's trendy and I am just glad I don’t have to go into a mall." --- at least not for the moment.

Let's be honest, Urban Outfitters is not about being cool or being chic but it's about making money. Clearly, UO believes there is more money to be made locating at the far north end of Richmond Row, a location that puts them close to the university crowd.

Despite the claims of the chief executive of Downtown London, the American retailer didn't choose London's core. Nor did it choose one of London's large malls. Yet, for many retailers the malls and big box developments are where the shopping action is in London.

So let's cut to the chase: Urban Outfitters is a global, multi-brand empire encompassing not only Urban Outfitters but Anthropologie, Free People, Terrain Garden Center and BHLDN (a wedding store). It had an increase in annual sales in 2012 of nine percent over the previous year. Since taking back the reins of control in early 2012, the stock under Hayne's leadership has risen 34 percent. 

Will the London store succeed? Maybe. But Urban Outfitters, like other chains, is not adverse to closing a store if the location doesn't deliver. Roots closed their store on Richmond Row. The once popular, locally owned Muskox, selling such iconic brands as Royal Robbins, is gone. The Richmond Row mystic attracted but failed to hold on to these and other stores.

The biggest threat to the future of the London store may simply be the age of  the savvy Richard Hayne. He will not be around to work his retail magic forever.

For an interesting take on what it is like to work, more often than not part-time, for a big chain, read:
A Part-Time Life, as Hours Shrink and Shift by Steve Greenhouse in The New York Times.

How much value is Facebook?

Newspapers, like The London Free Press, see themselves as riding the crest of change. They have a Facebook page and Twitter account.

Only 16 Likes, two Comments.

Ah, the all important social media. I'll bet the department heads at the paper thought the readers would find the Facebook page indispensable. But I checked a page of pictures posted from the Knights vs. Ottawa 67s game and found only 16 likes and two comments.

I checked a few more photo groupings. The post that did best attracted 26 likes and five comments. Another got nothing, nada, zilch. It got absolutely no likes and not even one comment.

Wow! Those numbers are low. Heck, back in December I did a little shoot at a London school of Irish dance and got 201 hits, 19 likes and six comments. Of course, not being as cool as the LFP, I didn't post to Facebook.

Maybe newspapers would do better if they paid more attention to their core business: news. Maybe Quebecor and Sun Media should consider hiring a few more reporters, photographers and copy editors. (For a story on the loss of copy editors, read Copy editors laid off more than other newsroom staffers in the King's Journalism Review.)

A dedicated online copy editor might cut down on errors like this one found on the Free Press Facebook page: National Ballet School audtions (sic) in London

My photo essay attracted more than two hundred hits.

Some of my online posts have attracted nearly 8000 hits on their own and some months I get more than 5000 hits for just one blog. I've got seven blogs!

I use both Facebook and Twitter but I find Google sends me the most readers. And Google is the gift that keeps on giving.

Since the early '90s, at least, I've wondered if newspapers would profit by forming an alliance with Google. Possibly they should consider making it easier for Google to track all of a newspaper's content. Newspapers should negotiate a deal along the lines of Google Adsense. Everyone would benefit.

Maybe Google could show the papers a trick or two on how to make money on the Net.

Journalists: Frontline historians

Dan Brown, an editor at The London Free Press, recently wrote a piece entitled: Journalists are not wannabe historians.

"Every time I hear someone describe journalism as “the first draft of history,” I shudder inwardly.

It’s not a fair definition of what reporters, photographers, columnists and editors do on a daily basis.

Even worse: It’s kind of insulting to the members of my chosen profession. It suggests all we journalists are is second-rate historians."

Dan Brown is right: Journalists are not automatically historians, not even second-rate ones. Furthermore, a good argument can be made that journalism is not automatically a profession. J-Source, the Canadian Journalism Project, delved into this question last January with an article, "Can journalism be a profession?"

Media law specialist Klaus Pohle, an associate professor at Carleton University, is quoted in the J-Source article: "In our system . . . anybody can be a journalist . . . ." Therefore, he argued, journalism is not a profession.

Personally, I have never been enamored with the job titles of journalist and photojournalist. I have always preferred reporter and photographer. I came to the newspaper business straight from three years of art school. My friend, hired at the small Ontario daily at the same time as I, had recently graduated from university with a BA in English. In later years, my friend became the news editor putting out the front page of a large, important Canadian daily.

But, maybe I'm wrong. Maybe Dan Brown's is right. Maybe he is a professional journalist. I assume as a professional journalist, he must report serious infractions of his profession's code of conduct. I'm not sure to whom Mr. Brown reports, nor do I know where to find the universally accepted code of conduct, but I am sure Mr. Brown, as a professional journalist, knows these answers.

While working in the newspaper game, I was often shocked by the stuff that masqueraded as news. For instance, I was totally appalled when the Ottawa Sun hired two young models to pose topless for a news story — the young women took turns playing the topless sunbather role with their bare backs kept modestly towards the camera. I wrote about this in a post, Who's a photojournalist?, that has been hit by journalism students and others from around the globe.

Here are the Ottawa Sun cutlines that accompanied the posed photo, left, run when the paper retrieved the archived image to illustrate another story a year after running the first piece: "Last summer, Lisa Regimbal, left, bear (sic) it all while chatting with Connie Morden." (Yes, bares was spelt incorrectly. And I discovered the names of the young ladies were switched from first publication to second.)

After Mr. Brown gets this breach of journalism ethics dealt with by the profession's ruling body, I hope he gets in touch with me. I'll give him a few more iffy items to look into. He tells us, "I take this [journalism] seriously. As a journalism educator, it’s up to people like me to dispel these myths."

I liked it better when journalists, working closely with talented editors and skilled photographers, were proud to put together a rough draft of history on a daily basis. I don't imagine respected journalist Alan Barth meant to insult Mr. Brown when he used the phrase in a book review appearing in the New Republic in 1943. (Yes, the phrase was coined and popularized by journalists.)

Perhaps, Mr. Brown needs to grow a thicker skin. Maybe, just maybe, he is too easily offended. I have hunch that most in the news business would agree with Jack Shafer writing in Slate:

"What makes 'first rough draft of history' so tuneful, at least to the ears of journalists? Well, it flatters them. Journalists hope that one day a historian will uncover their dusty work and celebrate their genius."

Will those historians also sift through blogger posts?

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Addendum: If Dan Brown takes offence at this post, I'm sorry. Like Mr. Brown, I care deeply about journalism and the direction in which it is headed under the guidance of huge companies like Quebecor, owner of Sun Media and The London Free Press.

Since getting into blogging, I've learned that people working in the media have the thinnest of skins when it comes to criticism. This is not to say that Mr. Brown will take offence, but he might.

If I write a harsh piece on financial advisers, I get well thought out, well reasoned and very polite e-mails. But from reporters I get e-mails banged out using the largest of fonts in the boldest typeface. Reporters often earn their income holding others up to intense examination. Being taken to task in a small, inconsequential blog does not compare to being criticized in a daily newspaper.