Hydroxocobalamin and Chloramphenicol

I had to take my 90 year old, frail and very deaf cousin for a cataract operation yesterday morning. Apart from having to turn up before 7:30am, which was a real challenge for both of us, he was last on the list so we were there for the morning.

Eventually he had the procedure and returned to the waiting area. Then for his discharge a list of medications he was being provided with was read, beginning with Chloramphenicol. He has Pernicious Anemia and gets 3 monthly injections. I asked them, before they went any further, if they realised he had Hydroxocobalamin injections and that Chloramphenicol is the first item on the list of no-no's. All I got was a blank stare and then 'it is only an antibiotic' and of course 'it is what is always prescribed'.

Eventually they went and rang the doctor who commented, so I heard, there are other antibiotics. We then had to wait for another hour before we got the revised prescription.

What bothered me was none of them, including the surgeon, had asked about PA or B12 nor had they looked at his notes. Also it appeared this was something they had not encountered before. That may be because previous PA sufferer (?victims) have their injections by the nurse at the surgery and so don't get to see the medication notes.

The nursing sister in charge was not particularly bothered as as far as she was concerned the prescribing of medication is the responsibility of the doctor and she just does as she is told. They ask if patients have diabetes, but not PA and they do ask for a complete list of medications at an early consultation visit, so obviously they don't consider Hydroxocobalamin is something they should be aware of.

[Hidden]

I will stop worrying about it Eaoz then. Mind, if there are, as the doctor commented, other antibiotic eye drops available then maybe that is better to use one of them.

Thanks for your reply.

[Hidden]

I still think I was right to bring the matter to the attention of the surgeon Eaoz. I have to admit I am somewhat sceptical about the opinions of any doctor I encounter as there have been so many times when they have made errors in the treatment of myself and my family. In this case the medication is being administered, admittedly in drops, but 4 times a day for the next month and patient is somewhat frail and 90 years old. I am rather anxious that nothing which can be avoided is administered when there may be a risk of problems as he has no other relative without 250 miles, and he isn't too anxious to fall back one their tender mercy's; any problems he has become mine.

The nurses weren't bothered and reckon they just did as they were told.

[JGBH in reply to Hidden]

kcbrecks - you are totally right of course! WHY some people are only too keen to defend useless and uncaring doctors who make mistake after mistake - and all is forgiven - while patients pay the cost of their errors or lack of knowledge or concern? This is not acceptable.

Their attitude towards your elderly and frail uncle is unforgivable. If the job is too much for them then they should do something with less responsibility and the equally slimmer pay packet as well as a much reduced "social status".

In any other profession if one makes mistakes and repeats them they are eventually sacked, more so in private companies. The same should apply to doctors: that should remind them why they chose to do medicine in the first place, as long they did that for the right reason, regardeless of the statuus it grants them and a big salary of course.

[JGBH]

Not blaming the nurses is somewhat acceptable as I have discovered most of them are not that well informed. When I asked nurses if they understood what type of vitamin B12 was, ie: is it water or fat soluble (they were trying to tell me B12 was toxic!) they replied "fat soluble"... Well, they don't even know that, CGSEs kids are taught that, so not exactly rocket science. Not a great reflection on nurses' training surely... ?

However, what poor excuse will you give for doctors and haematologists especially as well as many other consultants not understanding that certain antibiotics - even in a less powerful form such as eye drops - should not be given to a patient who has B12 injections, and that B12 is not toxic? I would be, and no doubt many other people on this site, very interested to get an honest reply.

[JGBH]

Well, when I did my O'levels (yes quite a long time ago...) I was taught the difference between water and fat soluble vitamins. It was drilled into us that ADEK were fat soluble... the rest water souble and some a little more complicated. Then at A level this was reinforced at the beginning of the first year A level. Could it be that the standard of education has slipped so low that nurses are not taught such simple fact? If that is the case it's extremely worrying for us, patients. No doubt this explains why such a forum exists, to help ourselves. Many of us are educated, intelligent and aware and refuse to be fobbed off all the time.

PS: you may well be right in saying that "some" people don't read the PIL for their medication...