Shortlived but there's no change that and then I was saying that there's a lot of video and people's experiences and symptoms can last much longer and be more severe for some the impression I get the coal face is actually nicer but behind again on this that most G.P.'s are aware of the issues and already weaning many patients off slowly I agree so nice have been saying that we should reduce the do is normally over a 4 week period my experience and I think that of my colleagues is that most of the time we're doing it much more slowly and much more cautiously than that and I think this is probably pragmatic on the going to experience that isn't absolute death of good quality clinical trials and what the best way is to bring people off these drugs safely and without side effects which is really astonishing considering that this is a well recognized problem that has been going on for decades but the aim is to go slow and one of the things that concerns many patients is this is a sign that they're potentially addicted to these drugs and people worry about addiction to antidepressants but we don't regard them as an addictive group of drug Yeah and I think this is a really unfortunate issue when I think about someone being addicted to something and thinking about someone that's creating something someone who's trying to escalate their doors someone who's feeling that they get hit or feel high from something none of those things apply to antidepressants a moment talking about withdrawal effects what are the most common symptoms that people what it's going on with there are lots and lots is a huge lest I suppose I'm with dizziness nausea people just feeling ever suppose feeling tired and quite often people describe these electric shock type symptoms in their head or down their arms or legs people really feeling they on whale and I think quite disconcerted with him and while they're feeling there's also a bit of an issue about people wondering whether it's a relapse into depression again I think that means that quite often people restart that antidepressants when Actually that might not be what they want to do if they knew I had considered that perhaps some of these might be done to withdrawal side effects so I think that's another reason is to fight to do these things slowly if you're going to reduce that down to make sure that you're not. Having any symptoms that could be a chubby to depression when it's really just withdrawal effects were talking about thank you Margaret and there's a link to the revised nice guidance on depression on the inside health page of the Radio 4 website now to the sort of n.h.s. Innovation that we'd love to hear it inside health it improves quality of life for people in this case those with cancer it helps the hospitals looking after them treat more people and it's counter to cheat if this is your backpack that he would be having with you 24 seventh's Yes thank you thank you. Ok We're going to attach showed him a fair shake. And one of the signs goes to the flash guys that came in their tank. Chemotherapy straight to go off in about an hour and if you put 4 hours and then 10 minutes after that at the flash will thank you this will go a long record on when I'm using the moment it's got to shore called Oh Ok so when I was in bed last hours and you just get in bed next to me Ok. You know you get used to you like the wiser the books are set up to you that every visitor should pack sandwich day to get Kota and pay for. Last left on 1st century why was a little concept beautiful Yeah they were Ok but of course you can stay on the sci fi to stick thanks very much I'm off. When I was actually years old when I was diagnosed with acute myeloid leukaemia about 2 months guy which type of blood cancer. I thought sad classic man flu for a couple of weeks which I didn't really manage to shrug off after a bit of nagging from the wife at home who sent to the doctors they did a blood test and then I was rushed into hospital later that day and didn't come out for 6 weeks I took the 1st round of chemo quite well didn't affect me too badly I got about halfway through and because I'm quite young and fair they did mention to me that I might be out to have a backpack on my 2nd course I didn't really understand it to be honest at 1st I was very confused as to how it would work got picked on which goes in Iraq which go into one of my main veins or arteries and then that runs right run into my heart and the chemotherapy goes straight into the system that way the cab pump attaches on to one of the lumens and then stays attached which is makes a little bit difficult for getting changed but of a challenge but yeah give yourself next 10 minutes in the morning you're fine you have still come in every day top of the backpack and things but it's about 247 Hello my name is Dr Demerol Soko and I'm a human teller to consultant at the Royal Marsden Hospital I think the key thing is these could be potentially suitable for patients that traditionally have needed to stay in hospital to have the chemotherapy through their veins through an infusion but otherwise did not need to be in hospital for any other reasons that the monitoring wouldn't have to be that intensive and so then it's delivering that intravenous chemotherapy but outside the hospital setting so what would be the normal for somebody with leukemia they'd have to come in here how long would they be in hospital if they're having the chemotherapy given into the veins so for the actual delivery of the chemotherapy it could be up to 10 days for the treatment itself so they could be coming in here for as long as 10 days and then often needing to stay for a lot longer to monitor for complications so they may be in at a month at a time in total and delivering the chemotherapy as an outpatient doesn't stop them necessarily having to come in if they develop complications but it might keep a certain proportion of patients that side the host. At all and how often would they have to come back for more treatment for an acute leukemia it can be 3 cycles it can be more than 3 cycles there's lots of variables so it could very easily be 3 months and in all spittle I guess if something goes wrong with the pump to the people have to come in here would you have a community service that can go to them at all now you're suggesting pipe dreams for us that would be fantastic and I think that that is certainly something that we would love to develop. So we would love to have something like that but currently they would come into hospital I think it is looking at how we can deliver these treatments more in the community it's almost one in 2 people are going to get a cancer in their life time so we can have that number of people in hospitals we need to look at ways of giving therapy outside in the community like yesterday I spent quite a bit of time in a just because that was my day one of my thoughts are going to chemo is going to be ordered and made and put in the backpack so it's all going to be rigged up to day one is always a longer day but day 2 very short you only have to come in and have your flush changed Day 3 of the back in but they'll have the chemo ready for me when I arrive you know just be a case of swapping over the chemo inside the backpack and send it off again so I could be in there for as little as powerful hour and be gone again. From the ward sister clinic in West hematology they have to me a certain criteria to be able to have the chemotherapy and the left have to live within our distant 2nd come in they need to have a care at home 24 hours and they need to have no other problems going on with spiritual cardiac wise actually had to come in a fork in the morning because his pump was alarming that he came in had it sorted and went straight home within the hour less risk of infection been at home they better when they sleep that's right there's medical benefits so although people tend to feel safe having treatment and hospital we all know hospital is full of sick. People with infections actually paradoxically they may be safer having it outside the hospital away from the other patients that may be harboring infections what about safety these a potentially dangerous drugs patients on chemotherapy get lots of complications things like infections and things how do you monitor all of that so it isn't suitable for everyone but your empowering patients to look after themselves and to pick up the signs and often they do pick things up before us even when they're in hospital anyway that they start to feel unwell so there's that side of things and then from the technical side they are having infusions through their veins and things can go wrong with a quick movement but they can do that just as easily if someone's having it in hospital as it can with someone having an out of hospital and the Quitman has facilities that it will alarm if there's a problem if it stopped infusing and then the patient makes their way in and then we reassess whether it we can restart it or then whatever drug hasn't been used and remake the drug that is being given but then I don't think that being out of hospital changes that risk and that's one of the plumbing This is going into the event normally would have a dedicated special line put in it's not going in through a little dip in their arm so it's going to be have to have a dedicated line so either a pick line which is a line a tunneled line through the arm which is a bit like a canyon or a vent flung to the usual drip you see in Holby City or medical dramas but with a longer to being so it goes into a more central vein or they may have a tunnel line through the chest so access that's buried underneath the skin and how onerous are the sorts of regimes that you're using in these backpacks in terms of symptoms I mean computer lead relatively normal lives what they're being infused with do they feel poorly often with these patients that we're giving their backpacks to it isn't the 1st time that they're having the chemotherapy so often. When you've got the most disease on board you feel most unwell because you haven't had any treatment but often when we're giving the 2nd cycle or the 3rd cycle when we would be proposing this way of delivering the treatment then often they're feeling a lot better by that stage because there's less cancer in their body and the main reason we're giving the treatment is to get rid of the small amounts that might still be remaining and then in terms of other complications and how unwell they might feel directly related to the chemo that then becomes a lot more variable and some patients carry on working and then also from a psychological aspect that having a diagnosis of a cancer obviously has a big impact on everybody but on top of that having to then have treatment that removes them from their family their support net work can be very hard as much as the physical side of things and then this allows them to continue having the treatment but also not having to stop their lives completely they've still got their family around them mentally it makes you feel a lot better and you're not looking the same for all of the time of course you get out of breath a lot quicker doing things you'd normally do you still got to be sensible you can't go home with a backpack and think you're going to be running marathons consist not going to happen just over allows you that freedom to be able to live a normal life as close to normal as going to get when you're going through chemotherapy that's for sure I've got a young boy at home as well he's only 11 months so one thing I would have definitely missed out on would have been his 1st steps because he's literally just started walking in the last few weeks which should have been a period I've been in here for me it's been fantastic. Ashley and the team looking after him at the Royal Marsden more details on the website we can also find out about how to get in touch following our report on acute kidney injury earlier in the series when we mention the commonly prescribed medicines like canteen Flamma. It can damage the kidneys a number of you have e-mailed asking for other examples all combinations of drugs that can cause mischief Priya Patel is a pharmacist at the Chelsea and Westminster Hospital Priya lots of drugs can affect the kidneys which ones might you commonly use in hospital we do prescribe certain antibiotics which are given intravenously by drip so straight into the vein an example of this would be gentle mice and this is commonly prescribed for severe infection in hospital and people might be surprised that they can cause kidney problems but they will ring alarm bells for health care professionals when we see them being prescribed but that's potentially a double whammy isn't it because they go in with the infection that's made them very ill which makes them more susceptible to kidney damage and then they're given a drug that could add to that exactly exactly and in hospital settings we're lucky because we can monitor people closely we can look at their urine output we can look at how well hydrated they are needs or really important signs to get kidney function but in the community it's a very different picture and it can be very grey and complex at times so we have people who may be prescribed multiple medications that could have an impact on their kidneys and we also have people who are seen by multiple health care professionals and him actually by medications and sells over the counter and all of these together along with certain conditions can lead to kidney injury so as a pharmacist when you're looking at somebody the list of drugs their own what would make you think who Scott's going to be hard on the kidney or could be hard on the kidney so as we've discussed previously antiinflammatories anything that ibuprofen approx 10 years long term would trigger in my head also things I want to tablet so things like 1st might this in combination with certain blood pressure tablets so you've got a separate is which are your drugs like ram a perl or anything ending in prole And you've also got the other similar group which for example people maybe on things like this are tan and these can also cause kidney problems in combination with conditions Doris x. Or an interesting the water because they work effectively is very simply. If you will they work by locking the kidneys to mate and produce more year and that's how you get rid of excess fluid used to treat high blood pressure and heart failure include retention and things but you know you are flogging a kidney that could potentially be failing and that's how they put them under strain simply isn't it yes it is and then you could have potentially other exacerbating factors such as dehydration So that knocks 2 kidneys and then on top of that you've got this cocktail of medications and you suddenly find someone in acute kidney injury one confusing area is that drugs like Ram approach the ace inhibitor used to treat heart failure high blood pressure is also used in people who go slightly poorly kidneys as well as a way of protecting their kidneys on the one hand it protects the kidneys but on the other hand it can cause home yeah difficult to get ahead and yeah it is and we have a number of other drugs like that where we don't necessarily want to use them in patients who have kidney problems but they can actually in certain situations and certain kidney issues they can actually be protective so it is a really gray area at times and it's not always easy to pick up in the community the symptoms aren't always that you can only pick it up with a blood test this makes it even more difficult but this is what it's about isn't it picking up signs that Brewer treatment was somehow overloading their kidneys exactly so these blood tests can tell you how patients kidneys functioning but also there's other conversations we can have a starting these medications if there is a potential risk for kidney injury then we need to be talking about at the start and likewise if they get you know these severe bouts of diarrhea vomiting and dehydration or they get infections then it's things that we need to be counseling the public on so they know when to seek help prepare and there's a link to the n.h.s. Think kidney's campaign on our website. Time now to continue our guide to over the counter treatments with Dr Margaret McCartney and Professor Carl Hennigan this week they have you on gels and tablets aches and sprains 1st question the rubble inversions actually work yes they do and I have to say I have changed my mind over this because my impression when I was a junior doctor and just started was that these were effectively placebos I always thought that would come in a flashy chips with a kind of subconscious appeal that these were going to cure use all kinds of clever branding around them the boxes of the crate red and flashy and sort of promise all sorts of things but I was wrong so when you go and look at the evidence behind it you actually find that you only need to treat about 30 people with a deck of preparation to make a difference to their pain and key to profession jail and other type and you need to treat about 2 and a half people to get one person that benefits from pain and although that statistic might not sound very good in terms of the medical treatments we offer day to day that has actually not bad at all the big appeal to me for these details is that you can avoid most of the side effects that you get with and him from a cheat tablets have talked about this previously in the program the gastric side effects the kidney side effects you can get and the jail's almost entirely avoid these Not completely but they certainly cut down the rescue enormously So I think they probably are a good option for many people so I agree that non-steroidal anti-inflammatory tablets are useful effective pain relief but you're right the adverse effect means the gel for the brain is more if you are a really useful treatment remember a couple of things the 1st thing is that actually from time they don't work immediately where the tablet can be absorbed in 2030 minutes because it's got to come from the skin it takes longer so you have to reapply it more than once and actually can take up to 2 days to get the maximal effect so keep going with the jail the 2nd thing is this issue of branded poor old versus what we call generic products and what you find when you go in the shop is you get the specific pain names and they'll be talking to. Certain conditions what I would say is I have never bought one of these branded products not least they tend to be free times as expensive and they generally contain exactly the same product and have just generic ibuprofen so in my house I have an ibuprofen jail and that is the pharmacies own brand and it's not the one with the fancy name by the cheapest and you to apply that to tablets tablets have 2 things they do they try and say with faster onset and they do put certain compounds license for something called life seen but we're talking about many this is ibuprofen Yeah and partially have their own fat because they're absorbed quicker is a couple of minutes Well that's not going to be of that important to you the 2nd thing is that actually sometimes they targeted a lot migraine only and again that there's no evidence for that for being specific generally their pain relief and you need to take an approach where you understand the amount of this active ingredient you can take onboard and then work on the packet and say Is this the arbor Grove in 200 milligrams if so I buy them for about 50 paid for a packet of 60 so I've done a bit of skating around my local shops and wife I find is that the expensive drugs sold under brand names are generally in red packets with sort of Soeharto goals and bossing them on top of them with a flashy names things that insinu