I’m coping with lockdown fairly well. All those suggestions about having a routine, exercising, learning a new skill I’m killing them. I even managed to go to a virtual party last night and practiced my crochet triple stitch at the same time. I’m reaching new heights where my lack of coolness is concerned.

My one worry is what lockdown is doing to my warfarin Ievels.

Warfarin is not a drug that can be messed with. Once on it you have to be tested regularly and maintain a consistent lifestyle. Diet, exercise, activity and alcohol. Change something without changing the warfarin dosage could be disastrous. A bleed if the dose is too high, a clot if it is too low.

Life would also be so much easier and safer if I could self manage my dosage in the same way diabetics manage their insulin. But the NHS claim it is too expensive. I can’t help thinking that it is due to most warfarin users being elderly. Age discrimination being alive and well within the bureaucracy of the NHS.

When I was a nurse forty years ago I looked after patients on warfarin. Not much has changed since that time. New anticoagulants have come on the market but for some conditions it has to be warfarin. Mechanical heart valves being one of them.

I occasionally think back to the decision I made the night before having open heart surgery. A tissue valve that may need to be replaced after ten years or a mechanical valve plus a lifetime of warfarin. I remain uncertain as to whether I made the right decision. Maybe if I had a half decent GP I’d be happier but just getting a regular prescription of the stuff is a constant battle.

And lockdown has brought additional challenges. I was having fairly frequent checkups as I’d been out of therapeutic range on a couple of occasions. My last checkup was a couple of days before lockdown. The hospital anticoagulant clinic then closed and my care was transferred to a pharmacy a few miles away. A pharmacy that doesn’t have voicemail nor an email address. It took me days to get through by phone. I had visions of having to write to them requesting an appointment. I now have an appointment for next Tuesday.

Am I right to worry that lockdown has had an adverse effect on my levels. I’m eating the same, exercising the same but my activity has dropped. I can’t replicate the 14,000 steps I usually do during my normal working day.

I am right to be worried. Yesterday I cut my finger. I am usually so careful but a nanosecond lack of concentration resulted in a sliced forefinger. Not severe enough to warrant treatment but it hasn’t stopped bleeding. I’m overwarfarinised. I put a pressure bandage on it which then gets wet with the required hand washing. I take it off. My finger bleeds. I put on another pressure bandage.

Should I ring 111? I’m sure they have more important things to be dealing with.

Should I stop or reduce my warfarin? Not a good idea.

Should I increase my vitamin K intake? Vitamin K will reduce the effectiveness of warfarin. A spinach smoothie it is.

Lockdown is challenging particularly if you have a long term condition or other medical needs. It certainly brings home how much we usually take for granted.