Systemic Antiphospholipid Antibody Syndrome, Antiphospholipid Antibody Syndrome, APS, APLS, Hughes Syndrome, Sticky Blood, Clotting Disorder, Stroke, TIA, PE, death

Warfarin

Aspirin 75mg

Tramadol 50mg daily 5-6 moderate strength analgesic

Side Effects Due to Medication

No reported side-effects.

Hospital Treatment and investigations within the Last 12 Months

Please see details in Diagnosis History section.

Where is this, or does Dr Peel mean those in the completed form? No mention of visits to Stroke rehabilitation courses or to the speech therapy clinic.

Mental Therapy Received Within the Last 3 Months

None

Report on EDWARD BULFIN completed by Dr Martyn Peel on 24 October 2003 Ref: 57753

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a disturbance of clotting the condition is likely to vary during the average week and if the function can be carried out regularly and repeatedly taking into account, fluctuation, pain, fatigue, stiffness, breathlessness, balance problems etc, the description of functional ability is as follows: I have highlighted this as there is no mention of the extreme fatigue that I mentioned in my form and the notes that Dr Peel admitted he had not read. The Consultant at The Royal National Hospital for Rheumatic Diseases advised me that both Psoriatic Arthritis and Antiphospholipid Syndrome (APS) will causefatigue. Dr. Cuadrado at the Louise Coote Lupus center at St. Thomas Hospital London also advised me that I should not expect to be able to work with the fatigue that is normal with Antiphospholipid Syndrome (APS or APLS). I really do need to see this doctors qualifications and resume

Antiphospholipid syndrome - Diagnosed last year on investigation for transitory neurological disturbances speech, balance mobility and cognition over last few years this condition is a disturbance of clotting (it is a lot more than that, which leads me to believe this doctor has not followed the last 20 years of research into the disease).

commenced on Warfarin last year 6.5 to 7mg daily INR level 4.2-4.4

believes stress of visit here has upset it

awaiting appt with Dr Hughes Special Clinic at st Thomas 11 November (why did nobody get a copy of the report from this consultation before stopping my benefit and causing distress?)

Psoriatic Arthritis - Diagnosed at Mineral Hospital several years ago periodic reviews 6 monthly

Claimant states no other problems � That cause me to claim Incapacity Benefit

Lives in a second floor flat same level with wife

2 flights of stairs

Drives not informed DVLA � Nobody told me that it was reportable. If it is then surely it is a lot more dangerous than this doctor is saying (in his terms a disturbance of clotting) � Which is it nothing really or a dangerous disease?

Last worked as a coordinator of work

for Open world Ltd in Bath been there for two years

Involved computer s/ websites.

Oct02 � Unemployed due to redundancy, and at this point the doctor had to move on quickly as I could not work out when I finished work due to memory problems and my wife and I were obviously taking too long to work it out.

Rises 8am

no particualr problem � Other than the pains from the feet, hip, knees, hand, head

makes tea for self and wife

then showers and dress

without assistance (see next item)

cannot squeeze toothpaste tube easily wife puts on brush (in other words WITH assistance � OK minor, but deteriorating rapidly)

wet shaves if cuts does not bleed - shows that even with high levels of anti-coagulation I still clot more rapidly than is normal

shops several times a week takes car � I said TWICE not several times

Tesco or town separate days � That makes TWICE when I counted them

taken up photography � Returned to Photography to see if long term memory has as many problems as the short term memory

flowers, waterfalls visits parks � I feel that I cannot give in to this disease, or I would just sit and deteriorate quicker. Dr Peel did not finish the sentences; only typing what he felt would help in the report. This inability to show complete answers makes the end result look different. This was one visit to a local park, not many as his short reply denotes.

stopped riding bike does not trust - Again did not complete the typing of the words I used, as I said I did not trust my balance as that had changed since the damage to my brain from the recurrent TIA�s, and that I did not want to chance a fall which may aggravate my mental problems with an intracranial bleed.

computer several hours most days � I did not use the word SEVERAL My wife and I agreed on a couple (we had to discuss this as my memory is poor on details such as this).

TV one hour in evening will watch film

never been that sociable, This was in reply to going out with friends, I did quantify this statement with I used to like going out with work colleagues and to club, but not any longer.

two children with grandchildren see regularly and keep me busy � I did not add AND keep me busy . I said who keep me busy and used a hand gesture to infer confusion as I said the word busy as this is how I feel when there is a lot of noise around me.

wife cooks

No difficulty washing and drying dishes after a meal. I said That Jen washes and I dry (ususlly and then only what I can hold without pain

helps with making the bed. Once a week to help in changing the Duvet cover

stopped DIY finds holding tool hurt and he loses temper with himself � when I could no longer do simple tasks or follow simple instructions. Again he did not finish what I had said.

Report on EDWARD BULFIN completed by Dr Martyn Peel on 24 October 2003 Ref: 57753

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Medical Examination Findings

Lower Limbs 7(cont.)

Spinal Curves: Are normal Are you sure this is me as I have a curvature of the spine that I was given exercises for by the Stroke Rehabilitation unit

Palpation : There is no tenderness or muscle spasm Hands feet and thighs are tender, but he did not ask, nor did he check.

Forward flexion to : Mid shin Are you sure the doctor could get to mid shin I told him and demonstrated I can touch the floor.

Squat and rise : Is full While holding a chair, but he did not ask if it hurt to do this.

Straight leg raising is: More than 70^s right and left Not Tested so where did this figure come from

Hip flexion is: 130⁹ (normal) Right, 130^Q (normal) Left Not Tested so where did this figure come from

Knee flexion is : 120^s (normal) Right, 120⁹ (normal) Left Not Tested so where did this figure come from

Knee extension is: Full Right, Full Left Not Tested so where did this figure come from

External hip rotation : 45⁹ (normal) Right, 45⁹ (normal) Left Not sure if this was tested, but both hips have a loss of rotation as noted by Dr Cox Rheumatologist at The Minerals Hospital in Bath.

Lower limb : Power and tone is normal Right, Power and tone is normal Left Not Tested so where did this comment on �Normal� come from

Upper Limbs 7(cont.)

Neck tenderness: None

Neck crepitus: None What is it

Chin to chest: No gap

Neck extension : 80^Q or more (normal)

Neck rotation : 80^s or more (normal) Right, 80^s or more (normal) Left

Ear to shoulder: Yes Right, Yes Left

Shoulder external rotation : 70^a (normal) Right, 70- (normal) Left

Hands behind neck: Fingers overlap mid-line Right, Fingers overlap mid-line Left

Hands behind back: Finger to mid scapula Right, Finger to mid scapula Left

Scapular movement from : 90⁹ of shoulder abduction (normal) Right, 90^s of shoulder abduction (normal) Left

Shoulder abduction : 170⁹ (normal) Right, 170⁹ (normal) Left

Elbow flexion : 130⁹ (normal) Right, 130^s (normal) Left

Wrist pronation : 70^s - 80� (normal) Right, 70⁹ - 80� (normal) Left No question of pain � Should I have stopped trying at the point of pain

Wrist supination : 70^s - 80� (normal) Right, 70⁹ - 80� (normal) Left No question of pain

Wrist dorsi-flexion : 30^s or more Right, 30⁹ or more Left No question of pain

Wrist palmar-flexion : 30⁹ or more Right, 30⁹ or more Left No question of pain

Pinch-grip: Normal (thumb to index finger) Right, Normal (thumb to index finger) Left Absolute rubbish as he stopped pulling at exactly the moment my right forefinger and thumb separated.

Power-grip : Normal Right, Normal Left Again absolute nonsense as this was tested recently and the time delay on the right is highly noticeable and makes it feel a lot weaker due to the pain.

Upper-limb power: Power and tone are normal Right, Power and tone are normal Left Not Tested so where did this remark come from.

Vision, Speech, Hearing 7(cont.)

Heard conversation at normal volume without apparent difficulty. Normal intelligible speech.

Again not what I said, not what was put in the notes and the form, and definitely not tested in any way.

What I did say was that when more than one person was in the conversation, I could not follow the conversation, not because I couldn�t hear, but because the sounds became muffled and I could not distinguish what was being said. I also mentioned that if the TV was on I could not follow a conversation in the room and had to turn off the TV.

Speech gets effected when under duress or in times of stress, I felt relaxed and rested at the time of this (I was going to use the word examination, but that is not what it was) appointment.

Consciousness 7(cont.)

no history of altered consciousness

Had he read any of the form or notes or asked for reports from the hospitals he would have seen this for himself. I mention loss of understanding, loss of cognition, short term memory problems �How many more ways should I have mentioned this, and should he not have read the notes.

Continence 7(cont.)

Report on EDWARD BULFIN completed by Dr Martyn Peel on 24 October 2003 Ref: 57753

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Claimant states no problem with these activities.

Mental State __ ____________________________7(cont.)

Friendly and cooperative. A good sign that I was relaxed and open with my replies.

Made good eye contact during the interview. A good sign that I was relaxed and being honest

Speech was normal A good sign that I was relaxed

Did not appear to be withdrawn. A good sign that I was relaxed, and trusted this doctor who told me he knew all about Antiphospholipid Syndrome (APS or APLS)

The appearance was normal. A good sign that I was relaxed

Mood appeared to be normal. A good sign that I was relaxed

Appeared relaxed during the interview. A good sign that I was relaxed

Normal behaviour during the assessment. A good sign that I was relaxed and not under stress

Intellect appeared normal Again I was not under stress and not being asked questions that would create problems for me. None of the questions were of a technical nature, or contain words or phrases that were new to me and give me cognition problems. Absolutely no test was carried out that could be used to assess any change in intellect. What exactly is NORMAL, I have previously carried out mass training sessions on technical equipment, written training manuals for use in international companies and fought and won an Industrial Tribunal. That was NORMAL, things that I could no longer hope to do without putting my health or even my life in danger of intracranial bleeds or clots.

Concentration appeared to be normal. I had to concentrate very hard to make sure I did not miss questions or answer wrongly.

Report on EDWARD BULFIN completed by Dr Martyn Peel on 24 October 2003 Ref: 57753

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Medical Opinion

I have considered the possible PCA functional descriptors and my advice is that the following apply:

Lower Limbs - Sitting, Rising, Bending

Sitting Activity 3

This means sitting comfortably in an upright chair with a back, but no arms. Sitting comfortably means without having to move because the degree of discomfort makes it impossible to continue sitting.

Si f No problem with sitting Disagree To disagree to �No Problem � = A problem

Rising from Sitting Activity 5

This means from an upright chair with a back but no arms without help of another person.

R d No problem with rising from sitting to standing Agree

Bending or Kneeling Activity 6

This means reaching the posture from a standing position and not from sitting. Bending or kneeling means that activity can be done by either bending or kneeling or by a combination of both.

B d No problem with bending or kneeling Agree

Medical Evidence Used to Support Choice of Descriptors

Prominent Features of Functional Ability Relevant to Daily Living 8

Rises 8am

no particular problem

TV one hour in evening will watch film Was asked on time of activity not on comfort. During this hour I get uop and walk around the room at least once to help with the circulation, and reduce discomfort.

No difficulty washing and drying dishes after a meal. Not what I said, I said I helped by drying, not that I had no difficulty. I only dry the light or easy to hold items, and those that require a grip will cause pain.

helps with making the bed. Again not what I said - Once a week I help put on a clean Duvet cover

Behaviour Observed During Assessment 9

Sat in an upright chair during interview for 25 minutes and could clearly sit for longer. Stood up easily in the waiting room and after interview. Outright LIE the whole interview only lasted 30 minutes including the walk to the office from the reception. Check the times entered by Dr Peel, he actually completed the report within 39 minutes of collecting me from the reception and in that time he escorted me to the reception area.

Also to the question of sitting (Activity 3) Dr Peel has entered that he disagrees with the comment �No problem with sitting� so here he has actually contradicted himself.

Relevant Features of Clinical Examination 10

No abnormal findings on musculoskeletal overview examination. Dr Peel missed the Curvature of the spine, the swollen left foot (even though I had told him I had to go up one complete size in shoe because of the swelling), the fact that the right leg is shorter than the left, that there is a distinct deformity of the right hip and finally missed the swollen right hand that is over 1 inch larger than the left. There was no physical examination other than the one I have reported as a complete and accurate list of tests. Had a physical examination been carried out he may also have seen the reduced rotation of both hips mentioned by Dr Cox at the Minerals in Bath, and included in a written report to my GP.

Summary of Functional Ability 11

No functional impairment.

With so many anomalies and discrepancies in this form, I would question the competence of this statement.

Report on EDWARD BULFIN completed by Or Martyn Peel on 24 October 2003 Ref: 57753

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Activity 4

Lower Limbs - Standing, Walking, Stairs

Standing

Ref: 57753 Page 8 of 14

Report on EDWARD BULFIN completed by Dr Martyn Peel on 24 October 2003

Vision, Speech, Hearing

Vision Activity 12

This means vision in normal daylight or bright light with glasses or other aid if such is normally worn.

V f No problem with vision Problems some days when had a TIA in the night Agree

Speech Activity 10

Language and accent difficulties should not be taken into account.

Sp f No problem with speech Thanks to hard work and concentration and speech therapy Agree

Hearing Activity 11

This means normal hearing with a hearing aid or other aid if normally worn.

H f No problem with hearing Unclear

Lots of problems when in 3-way conversations or if concentrating on something other than the speaker. This reply was given and was failed to be noted, the doctor seems to suffer from selective hearing.

Medical Evidence Used to Support Choice of Descriptors

Relevant Features of Clinical Examination - Not done 22

Heard conversation at normal volume without apparent difficulty. Normal intelligible speech.

Summary of Functional Ability 11

I have discussed this with the claimant. The claimant states there is no problem in this area and I have no evidence or opinion to the contrary. At no time did I say I had no problem! I mentioned my hearing and understanding in the (unread) notes, in the form and during the conversation.

Report on EDWARD BULFIN completed by Dr Martyn Peel on 24 October 2003 Ref: 57753

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Consciousness

Remaining Conscious Without Having Epileptic or Similar Seizures During Waking Activity 13
Moments

This includes epileptic seizures or a similar loss, or change of consciousness occurring while awake. It does not include simple faints, dizzy spells, vertigo, giddiness or fits of temper.

F g Has no problems with consciousness Unclear

Dr Peel obviously felt unable to answer this as he is unsure of the disease and its symptoms, he therefore put �unclear�. The disease could cause a TIA at any time, and the warning signs do come quite regularly. The pains cause damage and the damaged cells can create a mood swing due to the lack of understanding by others (including doctors) of the disease. The loss of short-term memory and the loss of understanding could be classed as a �change� in consciousness.

Medical Evidence Used to Support Choice of Descriptors

Relevant Features of Clinical Examination

no history of altered consciousness Not sure what is meant by altered consciousness, but the changes in my short-term memory and the loss of understanding could be classed as a �change� in consciousness.

Summary of Functional Ability 11

I have discussed this with the claimant. The claimant states there is no problem in this area and I have no evidence or opinion to the contrary. Does this just mean functionality of the consciousness? If so what does it mean in plain language?

Continence

Continence Other Than Enuresis (Bedwetting) Activity 14

Do not include conditions that may only cause constipation, upset stomach or a need to use the toilet often.

Cn h No problem with continence Agree

Medical Evidence Used to Support Choice of Descriptors

Summary of Functional Ability 29

Claimant has no problem with these activities Not sure what is meant by altered consciousness, but the changes in my short-term memory and the loss of understanding could be classed as a �change� in consciousness. No real conversation on this subject (remembering that the whole interview lasted only 15 minutes).

Report on EDWARD BULFIN completed by Dr Martyn Peel on 24 October 2003 Ref: 57753

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Mental Health

��

Evidence to Support the Decision Not to Apply the Mental Health Part of the Assessment 31

Based on the medical evidence on file, the history obtained and my assessment today, there was no evidence of any mental health problem. What! There is a load of evidence in the notes (unread), in the form (not sure if it was read or not) and during the conversation, of changes in my learning ability, my memory, my levels of stress changes, my inability to understand simple written instructions or verbal instructions.

http://exess.virtualave.net/ime.htmlReport on EDWARD BULFIN completed by Dr Martyn Peel on 24 October 2003 Ref: 57753

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Exceptional Circumstances and Prognosis

Non-functional descriptors

My advice based on the Personal Capability Assessment medical examination I have carried out 58 as a doctor approved by the Secretary of State, is that this person:

� Is not suffering from a severe uncontrolled or uncontrollable disease. Only the clotting is controlled by the Warfarin not the damage caused to the living cells by the Antiphospholipid antibodies (every living cell is surrounded by a layer of Phospholipids). This disease is therefore not controllable. Further stress from the result of this report led to hospitalization as the INR became uncontrolled and I suffered internal bleeding(999 call 08:30 Wednesday 19^th November 2003)

� Is not suffering from some specific disease or bodily or mental disablement and because of this there would be a substantial risk to the mental or physical health of any person if they were found capable of work. Due to the above comment and that the antibodies could cause damage at any time the health of my wife (who has suffered anxiety and depression since my diagnosis) would be compromised if I was in work and able to be taken ill at any time.

� Is not suffering from a previously undiagnosed potentially life-threatening condition. Does this doctor possess some �sixth sense� or is capable of foreseeing the future? If it is previously undiagnosed, how can a doctor comment on it without testing and examining the patient? This comment cannot possibly be substantiated without further tests for a great number of Autoimmune related diseases, such tests are still being carried out as the specialists believe that I may also have Lupus, which is slightly more aggressive and life-threatening than Antiphospholipid Syndrome (APS or APLS).

� Will not, within three months have a major surgical operation or other major therapeutic procedure.

As the experts who have been studying this disease for the last 20 years cannot make such a firm prognosis, I fail to see how this doctor (not a specialist in this field of blood disorder) can do so!

Evidence Which Has Led to This Opinion 59

None of the exceptional circumstances appear to apply in this case. What are the exceptional circumstances that Dr Peel mentions?

Prognosis

Expected Change 60

Functional Problems:

I advise the claimant's condition is unlikely to change in the longer term.

I am still having TIA�s which effect the brain every time, making my problems a little worse each time, these have been recorded in my medical notes by my GP, so this prognosis is not accurate, As the experts who have been studying this disease for the last 20 years cannot make such a firm prognosis, I fail to see how this doctor (not a specialist in this field of blood disorder) can do so!

Reasons for the Opinion Given 61

The condition is not causing significant functional impairment and this is unlikely to change in the foreseeable future.

Further Medical Evidence on Re-Referral 62

If this case is re-referred for medical scrutiny further medical evidence need not be requested on the IB113.

Does this imply that this doctor is infallible and cannot be contradicted with better informed medical opinion?

Report on EDWARD BULFIN completed by Dr Martyn Peel on 24 October 2003 Ref: 57753

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Declaration

This form has been completed by a doctor approved by the Secretary of State for Work and Pensions.

I have completed this form in accordance with the current guidance to Incapacity Benefit examining doctors as issued by the Department for Work and Pensions.

With the discrepancies and contradictions of his own answers, I feel that the other 57 patients that he has carried out �examinations� on should be investigated further with the view of removing him from the list of approved Independent Medical Examiners.

I can confirm that there is no harmful information in the report other than indicated.

Doctor's Name Dr Martyn Peel
Date 24 October 2003

Report on EDWARD BULFIN completed by Dr Martyn Peel on 24 October 2003 Ref: 57753

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Harmful Information

Harmful Information - Not to be Copied to the Claimant OOPS I got a copy. 63

Report on EDWARD BULFIN completed by Dr Martyn Peel on 24 October 2003 Ref: 57753

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Page forms part of www.apls.tk, the information site on ANTIPHOSPHOLIPID SYNDROME (APS or ANTIPHOSPHOLIPID SYNDROME (APLS))

Medical Keywords: systemic antiphospholipid antibody syndrome, Antiphospholipid, Antiphospholipid Antibody Syndrome, Antiphospholipid Syndrome, APS, APLS, Hughes Syndrome, Sticky Blood, Clotting Disorder, Stroke, TIA, PE, death, Antiphospholipid Antibody Syndrome, Antiphospholipid Syndrome, APS, APLS, Hughes Syndrome, Sticky Blood, Clotting Disorder, Stroke, TIA, PE, death