A Happy New Year!

 Tuesday. New Year's Eve. 9.50 a.m. Yet another mild but rather dull and overcast sort of day. The weather is expected to get worse, with more wind and rain, and in Scotland, Hogmanay has been cancelled in Edinburgh, due to the weather which is forecast. I simply can't imagine Scotland foregoing their New Year's Eve celebrations.

I needed to do a top-up shop in Sainsbury's. Christmas is over, although stuff like mince pies are on offer, or, at least, they are very much in evidence. But there are Valentine's Day cards already on sale. No doubt there will be Easter eggs on sale soon.

I had a package arrive via Royal Mail this morning. It was the Bisoprolol tablets which I have been waiting for and which were actually ordered when I went to the surgery on Friday morning. It just goes to show that Pharmacu2U can deliver quickly when needed.

Wednesday. 9 a.m. I did see the New Year in. I watched the Jools Holland show on BBC 1.

This morning it is very windy. I took Alfie out, and it was difficult opening the door with the wind pushing against it and making weird noises. The strength of the wind was almost enough to blow you over.

Friday. 8.10 a.m. It's getting a good deal colder. Snow is forecast. An Amber alert has been given, meaning that temperatures below zero can be dangerous for those over a certain age (probably me included.) Also, danger of slips and falls, and dangerous driving conditions are expected.

Saturday. 7.35 a.m. I had the foresight to buy an extra bottle of antifreeze spray for my car. I got it when I was in Sainsbury's a couple of weeks ago. I also bought a large bottle of spray which you have to spray on your car's windows the night before and it is supposed to prevent them freezing over. I did this yesterday evening but I'm yet to find out if it has worked.

When I went out with Alfie about an hour ago, I found it was frosty, but as yet, no sign of snow. It seems that the north of England and Scotland have had snow, and it is causing problems with transport. I'm not so sure if we will get it this far south.

Sunday. 7.15 a.m. There was a scattering of snow overn night, but it's more like a dusting than what they have had in the north of England. I'm yet to take Alfie out, as he's fast asleep, so it seems unfair to wake him up.

9.05 a.m. I think Alfie was somewhat shocked by the cold when I eventually took him out.

I wasn't feeling very good when I got up. A bit light-headed and wobbly. I was scheduled to do refreshments at church, so I have sent a message via WhatsApp and someone will step in. I didn't think it was a good idea to continue, because of the blackout I had a year ago as well as the heart attack I had in church six years ago. Better to be safe than sorry.

Monday. 7.45 a.m. The snow has gone, but there's a thin fall of rain, if you can call it that.

I decided to come off the refreshment rota at church. I have been involved in this for well over a year, so it's time for others to step forward. I am still on the rota to set up communion, which I shall continue with.

3.15 p.m. I was doing my washing up at the kitchen sink this morning, when I notice a group of men in the community garden. They were all dressed in overalls, and I remembered that work was to be carried out, including the scooter stores which have been in place for around 3-4 years, but cannot be accessed from the main building here at Dexter House, because there is no ramp or specially adapted doors to allow the scooters to be taken out into the stores. An orange digger appeared and there is a fenced off area further over which is no doubt where equipment will be stored. Later, when I took Alfie out onto the grass along Strudwick Drive, I noticed a small truck being unloaded and the gate open and another larger lorry parked in Dexter Avenue, just below where the door comes out of Dexter House and I imagine it had further equipemt to be used by the workmen. Oh, the excitemnt of all this (Not. Scarcasm I'm afraid.) I will keep my readers imformed as this work progresses, or not.

Cardiology Review

Yesterday I got a letter from the Cardiology Department at the John Radcliffe hospital in Oxford, following the consultant's appointment I had there two weeks ago. This is what the diagnoses reports:

1: Chronic total occlusion LAD
2: Primary PCI to right coronary artery- September 2018
3: Elective PCI to intermediate coronary artery- January 2019
4: Conserved left venticular function- ejection fraction on MPS 52%

'From a cardiac perspective he is well. He does not experience chest pain, or undue shortness of breath. Although he did not undertake a course of cardiac rehabiliation, he is to return to regular exercise, walking his dog. He does not experience limitation. His symptom currently is one of fatigue. Nonetheless he has started (voluntary) part-time work.'

'Current medication comprises Candesartan 4 mg od, Isosorbide mononitrate 20 mg bd, Bisoprolol 2.5 mg od, Ticagrelor 90 mg bd, Asprin 75 mg od and Atorvastatin 80 mg od.

'I have not recommended any changes. He should continue Asprin and Ticagrelor 12 months. He should take Asprin indefinitely thereafter. Secondary prevention is otherwise in hand. Given the symptoms of fatigue a tril off Bisoprolol would not be unreasonable. If his symptoms are unaltered I woul re-start the beta-blocker. I have mde no plan for further follow-up in this clinic. His preference would to to be seen in Milton Keynes for reasons of convenience should follow-up be required in the future.'

Yours sincerely,

Prof. Robin Choudhury DM, FRCP

Professor of Cardiovascular Medicine

HonoraryConsultant Cardiologist

I don't understand all the medical jargon, but I suppose if I was minded to, I could look on the internet to find out what all this means. I don't like to be fobbed off with simplified language. I am reasonably intelligent. But at least I know the situation regarding my health. I've had a heart-health problem for most of my adult life and especially since my heart attack back in 2006.

Tuesday morning. It's bright and sunny as I look out of the lounge window. It's 7.55 and in about 45 minutes I will be driving to Camphill for another morning with the drama group.

Yesterday evening I took the MacBook to Curry's so that their engineer could sort the thing out and make sure there is no malware on it. I just hope I get it back relatively quickly. It shouldn't take more than two days, so possibly Wednesday at the latest. Unfortunately, I forgot to take the charging cable and device. I had the foresight to make sure the MacBook was fully charged, but I will take the lead with me in the car, so if I get a phone call from Currys I can always take it there once I finish at Camphill. Just annoyed with myself for forgetting this item.

Later. I've been to Camphill this morning. In the afternoon there is to be a community assembly and the drama guys will be showing the video of 'Stranger Danger; The Three Little Pigs', (or is it 'The Three Little Pigs; Stranger Danger'?) Each of the actors is going to be interviewed as part of the proceedings and have to answer questions about their favourite bit in the play and the video. It took some time to get them to project clearly and remember the answers which were pre-selected. They did extremely well. It was a shame that I was unable to be there this afternoon, but I'm sure they did really well. This will be the World Premier of the video! It is possibly going to be uploaded onto YouTube and Vimeo which means it can be watched anywhere in the world!

The weather continues to be really warm and sunny.

Changes To Medication

What I haven't mentioned, since describing in fairly accurate detail, my couple of days in the John Radcliffe in Oxford, were the changes  made to my medication. Some were added, whilst some were removed and some had their dosage changed.

I had taken Isoborbide Mononitrate 20mg, Bisoprolol 5mg, Candesarten 4mg, as well as Lansoprazole 20mg. and soluble Asprin 75mg.

The Candesarten has now been removed and the dosage of the Bisoprolol reduced to 2.5mg. I now have Ramipril 2.5mg and a statin called Atorvastatin 80mg as well as a drug to help protect the stent called Ticagrelor 90mg which I have to take twice-daily and they've told me that I have to take this for a year as it's to prevent any clotting around the stent which could lead to further complications.

I was reluctant to continue with any type of statins because I have had side-effects. At the time of my first heart attack in 2006 I was put on one called, I believe, Clopodrogel and a statin called Pravastatin (I may be wrong as to brand name or which is or isn't a statin.) At that time, during the week I was in the C.C.U. unit at Bedford Hospital, I began to develop what seemed like flu-like symptoms, so the nursing staff moved me off the main ward and into a side-ward, as they thought I might be infectious. As it turned out it wasn't actually flu but the side-effect of the possible use of the statins I was on. I have been tested over the last few years to keep my cholesterol levels as low as possible, but I had side-effects from taking which ever type or brand of statins it was (at the moment I have forgotten the brand name, but possibly called Plavix.) Because I managed to have my cholesterol levels at a well-controlled level, done mostly by eating healthily, taking a fair amount of exercise (we used to be members of a gym, and used the swimming pool regularly until Carol's cancer diagnosis.) I got the cholesterol levels in my blood to around the target of under 5mmol. So my doctor took me off the statin drug because I had muscle pain and some digestive problems. I got a certain amount of discomfort in my stomach, for example. The lansoprazole capsules are to protect my stomach as a result of taking most of the other medications.

As I have only been taking the new medications for a few days, I haven't experienced any side effects. I do get a dry cough which comes from nowhere. I'm not sure which medication causes this. But yesterday evening, after I'd taken the medications for my 6 o'clock administration, I had very violent diarrhoea. Sorry, but there's no other way to describe it. I'm fairly certain it was caused as a result of one of the medications I was on, possibly the Atarvastatin or a combination of that and another medication. I had to take Immodium to control this. As I write this post at 6.35 a.m. on Saturday I feel queasy and just hope I don't get the 'runs' again. 

730th blog post: Ashfield Surgery Appointment and Over-night stay at Milton Keynes Hospital

Over the course of the past six weeks or so I have been experiencing a rather nasty pain in my chest, rather like an angina attack, bought on by some form of exertion, such as walking. It usually goes off with rest. This happened a few weeks ago when we went to Stowe Landscape Garden and started up as we walked back to the car. I had to stop and sit and it gradually went off. It also happened again last Friday after we'd been to the restaurant for a meal with Carol's work colleagues and we were walking back to the car. It's almost like a sort of 'spike' of pain, as I say, similar to an angina attack. I have used my G.T.N. spray which is supposed to relieve an angina attack.The G.T.N. doesn't seem to make much difference to reducing the discomfort.  I was prescribed insoborbide mononitrate last time I was admitted to Milton Keynes Hospital when I had an angina attack which didn't subside after a particular bad attack. It has a similar effect to G.T.N. spray as it makes your blood vessels open up to allow a better flow of blood and so reduce pain. I had got to the point where I was really suffering with this discomfort but was reluctant to go to the doctor because we have been going there quite a lot recently, and in particular, after the last few weeks with Carol's medical problems. I was prompted to get advice for this situation when I went to Sainsbury's pharmacy to collect a repeat prescription and the pharmacist did a review of my medication (as they do every six months or so.) I managed to mention this chest pain and he said that perhaps it was caused by one of my current medications, such as bisoprolol, which helps maintain a slower heart rhythm and possibly the dosage I'm on needs reducing or increasing and that, as a result, I should make a doctor's appointment and discuss this chest pain with my doctor and get him to either increase or reduce the bisoprolol dosage I'm on. So, yesterday morning I decided to ring the surgery to get an appointment with the doctor (or 'a doctor' as there are several doctors at the Ashfield Medical Centre.) As mentioned in an earlier post on here, they have changed the appointments procedure and you now have to ring and go through a sort of 'triage' system so that they can decide which medical problem are more urgent than others and then get  a doctor to telephone back to discuss the problem and then make an appointment for later in the day. I eventually go through at around 10 o'clock. Then a doctor rang me around 45 minutes later and I was able to discuss the chest pain to him and as a result was given an appointment at the surgery at 4.30 yesterday afternoon.

When I got to the surgery the first thing I realised as soon as I got through the door was that the computerised check-in system wasn't working. You're supposed to put the initial of your surname in the program then the month and day of your birthday and it's supposed to bring up yout appointment-time and the doctor your're booked with. But because this wasn't working (it's a common fault that this sytem crashes whenever I need to go to the surgery and sign in with the system.) so I had to queue up and check in with one of the receptionists. It transpired that I was seeing one of the practise nurses and not a doctor. Having waited for a further ten to fifteen minutes I was called in by the nurse (because the computer system wasn 't working, it meant that the digital display which informs patients when their appointment is ready so you go through to the relevant room.) and then had to explain what I have already described above. I had to have an E.C.G. which is something I've had several times before and when she had the print-out from this it was taken to a doctor elsewhere in the surgery. I had to sit and wait a further ten minutes and she returned to tell me that I would need to go to the hospital.  Which was not exactly what I wanted to hear as I had expected this to be an 'in-out' appointment so I could go home immediately afterwards. She then said that they would need to call for an ambulance to take me. Which seemed amazing since the hospital is barely a five-minute drive away from the surgery. So the ambulance came (within around ten minutes.) and I had to then describe the symptoms of the pain in my chest  to the paramedics and they took notes and took me out to the ambulance and did a further E.C.G. scan and my blood pressure.) We eventually moved off and got to Accident and E I mergency, being taken inside sitting in a wheelchair (which is strange for me, having been a carer, where I often pushed other people around in a wheelchair.) Once at A and E I had to go through the process of describing my symptons yet again. By this time I had called Carol on the phone to let her know where I was and to let her know what was going on. Meanwhile she had arrived in A and E. I was taken to a cubicle and settled in. We were then told that I was likely to be there for around 2 hours. When they insisted that I must wear a hospital gown did I realise that all this was going to take a good deal longer than anticipated. I had to go through the rather unpleasant ordeal of them taking a blood sample. Unpleasant, because, as you know, if you've read any of my previous blog posts, taking a sample of blood has caused stress as well as problems. As it turned out it did cause some problems as the nurse couldn't find a vein that would yield  sufficient for them to sample and consequently it took quite a long time, but eventually it was successful. That done, we had to wait, and wait and wait. It wasn't excessively busy in A and E, so I don't know why they couldn't deal with me quicker. I think they soon realised that my case wasn't particular urgent although, anyone who has a history of heart problems or had a heart attack gets priority which would be one reason why I was taken to A and E so quickly. They then put other patients at the front of the queue and my case was much further down the list which was why I had to wait around 4 hours before anything could be done as regarding what had caused my chest pain. Carol decided that she would need to go home as it was getting late and I would be staying at the hospital over-night. I then was taken to have a chest X-Ray and by the time that was done the doctors could have a look a my notes as well as the X-Ray and blood test results to give a clearer picture of what was going on.

Sometime later, getting on for around 10 o'clock, one of the doctors came to tell me that, having looked at past E.C.G. records and other material they had from earlier hospital visits that there was no evidence to show that what had caused the pain I had been experiencing had anything to do with my heart and that I could go home. But by that time I was really tired and felt that I wouldn't be able to drive let alone walk, even though 'home' was so close. So I rang Carol to say I would be home in the morning. Earlier the doctor had said that whatever it was that had caused the problem had been because things 'had been stable for a long time, but now they had become unstable' but at that time they could not see what it could have been that had caused the pain.' But by now they had decided that the problem wasn't heart-related, which was a relief to me. So, I was moved into a sort of holding ward, away from A and E, as they have to free up beds for incoming patients. Then, having got to sleep and was well settled in for the night, I was woken at around 3 a.m. to be told I was being moved once again, to yet another ward. I was pushed there by a porter and nurse, through the corridors of the hospital, into a ward that reminded me strongly of the C.C.U. at Bedford Hospital (Coronary Care Unit) because it was almost exactly the same sort of configuration of beds with curtains around them and facing one another (I think the Bedford C.C.U. has eight or perhaps six beds, in two blocks, one for men and one for women.) I was once again checked in, with 'obs' (observations) blood pressure, temperature and another E.C.G. I suppose they have to adhere to certain procedures, but by this time it was becoming somewhat annoying. How many times did I repeat the symptoms? It seemed somewhat obsessive. Could they not have kept the various sets of notes and referred to them? Build up a set of notes from each successive examination? It does seem that the N.H.S. is somewhat over-staffed with people pushing bits of paper and in some cases, over-sensitive to such things as targets and statistics, which would be what most of this is about.  I spent a somewhat restless night attempting to sleep, as it was so noisy. Staff walking about, doing such things as 'obs' of other patients and someone talking in the next ward very loud and squeaking trolleys and electronic gadgetry making strange beeps and burps at irregular intervals. But I think I did manage to sleep for two or three hours. At 5.45 my mobile alarm went off, as it's set to that time because we always get up at that time every day, starting off the day with me making us both tea. Incidentally, I didn't get a cup of tea early as I would have expected when I had had to stay in hospital, although we did have tea and a sandwich given us as we waited in A and E, nor did they ask me what medication I was on which was rather a surprise. At 6.30 Carol phoned and said she would come and pick me up later and the doctor re-appeared to reiterate what he had said the previous evening about the pain being unrelated to my heart but at that time they could put a finger on exactly what had caused it. So, I was free to go home. A further lot of 'obs' were done and I got dressed and walked out of the ward. I went to the nurses station to tell them that I was leaving expecting there to be some paperwork to sign or allow me to be discharged. But the staff didn't seem that interested so I walked out. I didn't get so much as a cup of tea when I was on that final ward. I hadn't eaten anything since having the sandwich when we were in A and E. Not so much as a packet of crisps. I'm somewhat surprised. It seems I was totally ignored. They kept an eye on my blood pressure, temperature and so on, but not one offer of something more substantial to eat. When I was a carer I could have been done for neglect if I didn't allow one of my clients a drink or something to eat if they were unable to provide something for themselves. So I'm shocked to think I got nothing except a rather lack-lustre sandwich and a mug of tea. But I got outside and couldn't work out exactly where I was, and certainly not near the front entrance of the hospital as I had expected of even near when I had entered A and E when the parmedics had brought me in in the ambulance. I had a call on my mobile and Carol came and collected me from near where we had gone the other evening when we'd visited the former Walk-In Centre. So, we drove home, to be met by our two dogs, Poppy and Alfie, who were pleased to see me as they were totally confused by having their routine upset when I had gone out and left them alone in the house the previous afternoon.

Beta blockers don't work, new study finds

 I came across the following article on the New Scientist website. I reproduce it below. As I am myself on beta blockers since having a heart attack (I am on Bisoprolol Fumarate.) so I am now somewhat concerned that these types of drugs don't actually do what they are supposed to do, or so the newest research would suggest. The article is dated 12th November 2012, so it is pretty recent. The article is fairly complex, but it is worth reading it in full to understand what the content of the report says.

  'Beta  blockers are busted- What Happens Next?'

'They have treated heart disease for 40 years but it now seems that beta blockers don't work. What went wrong?'

'IT IS very rare for new evidence to question or even negate the utility of a well-established class of drugs. But after four decades as a standard therapy for heart disease and high blood pressure, it looks like this fate will befall beta blockers. Two major studies published within about a week of each other suggest that the drugs do not work for these conditions. This is a big surprise, with big implications.

The first beta blocker, Inderal, was launched in 1964 by Imperial Chemical Industries for treatment of angina. This drug has been hailed as one of great medical advances of the 20th century. Its inventor, James Black, was awarded the Nobel prize in medicine in 1988.'

'The 20 or so beta blockers now on the market are very widely used - almost 200 million prescriptions were written for them in the US in 2010. They are standard issue for most people with heart disease or high blood pressure. This may now change.'

'A large study published last month in The Journal of the American Medical Association found that beta blockers did not prolong the lives of patients - a revelation that must have left many cardiologists shaking their. (JAMA, vol 308, p 1340.)'

'The researchers followed almost 45,000 heart patients over three-and-a-half years and found that beta blockers did not reduce the risk of heart attacks, deaths from heart attacks, or stroke.'

'While this is not definitive, it's pretty damning, especially when another study - published just days earlier - found pretty much the same thing.( Journal of the American  Geriatrics Society, vol 60. p1854.)'

'The goal of this second study was to examine the effect of drug compliance on death rates in patients who had had heart attacks. About half of patients complied with their drug regimen. Unsurprisingly, these people were nearly 30 per cent less likely to die than those who did not comply.'

'This was to be expected, but there was one big surprise. While the result held for the standard classes of heart drugs - statins, anticoagulants and antihypertensives - it did not for beta blockers. Regardless of whether or not patients stuck to their regimen, their risk of dying was the same. Taken together with the JAMA study, it becomes very reasonable to question the benefit of beta blockers for treating these conditions.'

'To understand what is going on, consider how they work. Like many drugs, beta blockers target receptors embedded in the surface of cells. Receptors are "molecular switches" - when a specific molecule binds to them, they change shape and send a signal to the cell to perform a certain function. Beta blockers target beta receptors, which respond to the "fight or flight" hormones adrenalin and noradrenalin.'

'In humans, there are two principle types of beta-receptor - beta-1, primarily found in the heart, and beta-2, located at multiple sites, including the smooth-muscle cells of the bronchial tubes and in veins.'

'When adrenalin and noradrenalin bind to beta-1 receptors, they signal the heart to beat faster and pump harder. Binding to beta-2 receptors causes smooth muscle relaxation, especially in the airways, explaining why beta-2 activators are used as asthma drugs.'

'Beta blockers bind to both types of receptor, but do not activate the cellular response. This blocks adrenalin and noradrenalin from reaching their target and activating the response. By preventing the normal hormone-receptor interaction, the beta blockers slow the heart and cause it to pump less forcefully, lowering blood pressure.'

'The premise of beta-blocker therapy has been that giving the heart a rest will diminish the frequency of heart attacks. In the light of the two new studies, it is clearly time to question this.

Which raises the question: why has it taken so long to find out? It is worth noting at this point that this is not yet another case of a drug entering the market only to be withdrawn later because of lack of efficacy or even adverse reactions which could have been noticed with longer or larger trials. It is simply a new medical revelation. The authors of the JAMA paper provide a reasonable explanation of the conflict between their results and earlier studies.'

'The key word is "earlier". Most clinical trials on beta blockers took place before reperfusion therapy became standard treatment following heart attacks. Reperfusion involves opening the blocked artery by surgery or pharmaceuticals, and has been shown to significantly reduce damage to the heart.

Damaged hearts are more prone to fatal irregular beats, and beta blockers are useful in controlling this. But with the advent of reperfusion therapy, people who survived heart attacks suffered less cardiac damage, so the frequency of fatal arrhythmias was lower. Put simply, the beta blocker effect was significant before the advent of this improved treatment, but the beneficial effect has since disappeared.'

'Additionally, newer and better drugs such as anticoagulants, statins and antihypertensives are now routinely used in heart disease. These more effective therapies swamp any smaller benefit that the beta blockers might provide, minimising any measurable effect.'

'What comes next is impossible to predict, but we may well be seeing a rare case of medical wisdom being overturned almost overnight. Beta blockers are not dangerous and have been in use for such a long time that it is unlikely that we will see an immediate cessation. But these results are hard to ignore, and cardiologists will be paying careful attention.'

Medications Side Effects

It's one thing having had a heart attack, but it's quite another that you have to contend with the side effects of the medications that you are prescribed. When I originally went into hospital, having had my heart attack, I was put on a range of medication, mostly to relieve pain. I had Warfarin to thin my blood and thus to prevent further blood clots. I recall that when a nurse was taking out the canula which was in my wrist, at around the time I was discharged, there was a quite a spectacular flow of blood as she had not noted that I was on Warfarin (which prevents not only blood clots, put prevents wounds from healing quickly.) I was put on statins, and the first type had the effect of giving me flu-like symptoms, which were rather unpleasant, to say the least. It wasn't until I discussed my state of health with one of the nurses on the C.C.U. ward that I learnt that this flu-like symptom was a side effect of taking this particular statin drug (which is used to control cholestrol levels in the blood.) I don't exactly remember what the name of this drug was, but I was soon put on another statin which didn't at first appear to have such violent side effects. I was also put on Bisoprolol (which I am still on, but at a much lower dosage, 5 mg.) I was also on Clopodogrel and soluble asprin (another drug to keep the blood thin and thus prevent clots.) 

Some of the side effects of the drugs, particularly statins, are that they give you muscle cramps. Without beating around the bush, another is rather unpleasant, bloating, flatulance and diarrhoea. Sometimes this can be very violent and you can spend quite a lot of time running to the toilet, and it can be quite uncomfortable. On the other hand, it can also have the opposite effect, constipation. Sorry if this is rather  too graphic for some people, but I'm writing this on this blog to try and help anyone else who is going through a similar experience. If my experiences can be shared with others then I hope it comes as some sort of comfort to know that there are others who have had a similar experience.

According to the leaflet which comes with a packet of Pravastatin it gives a list of possible side-effects. It reads as follows:
Dizziness
Headache
Sleeping problems
Sleeping disturbances
Vision disturbance such as blurred or double vision
Stomach upsets (such as feeling or being sick, constipation, diarrhoea, flatulance, indigestion and stomach pains.)
Hair loss
Rash
Itchiness
Tiredness
Feeling of weakness
Changes in the way your liver works
Heartburn
Bladder problems (painful or frequent urination

Very rare side effects:
Numbness or loss of sensation in the arms and legs
Tingling or pins and needles (paresthesia)
Inflammation of the liver or pancreas
Severe allergic reactions including localised swelling of the face/lips and/or throat
Yellowing of the skin and whites of the eyes (jaundice)
Muscle and joint pain

When I was first put on statins (although it might have been caused by other drugs I was on.) I used to get tingling in my feet and sometimes my fingers, and a sort of numb sensation in the soles of my feet, but that gradually went off after a couple of weeks. 

Immediately after I had the heart attack (which was back in May 2006.) I felt really depressed. I was told that this was a normal reaction to what had happened to me. I discussed this with a nurse on the C.C.U. Most men don't like to talk about their health, and particularly not depression. I have had a few periods of clinical depression, a couple of years before my heart attack, but I haven't experienced anything that severe since my heart attack. 

I was put on isosorbide mononitrate fairly recently, as an alternative to using glycerol trinitrate spray, which I used whenever I got an attack of angina. It was prescribed the last time I was in hospital back in October. It does seem to work, and I haven't had any severe angina attacks since then. But I get quite severe headaches and I'm sure it's that medication which causes insomnia. I go to bed as normal, but after a few hours I wake up, generally to go to the toilet, but then I cannot get back to sleep. I was told by my consultant at Milton Keynes Hospital that this drug would cause headaches for the first month or two, but that it would gradually ease off, which it did, but the headaches seem to have come back, but not quite as severely as when I first took this drug. The drug makes the blood vessels widen so as to increase blood flow, and this is very prominent in the brain, hence headaches (if you use the red spray,glyceryl trinitrate, you do find that you get headaches, as well as feeling light-headed, which is another effect of the iosborbide mononitrate, although I admit that it's not unpleasant, rather similar to the feeling you get when you've had one too many alcoholic drinks, but without the other unpleasant side-effects you get with alcohol.)

I can feel extremely tired. This particularly was a side effect of not only taking some of the drugs, but the effect of actually having a heart attack. A heart attack is a very traumatic experience in itself, and tiredness is the body's way of repairing itself. If I over-exert myself, like going on long walks, I find that my leg muscles can get quite painful, but if I rest for a short while, stop and sit down, this soon eases off. 

Cardiology Department Diagnosis

This morning I had a copy of the letter the Milton Keynes  Hospital cardiology department sent my G.P. following my recent appointment. The following is a report in that letter. If it is in any way helpful to anyone who has had a similar medical problem, had a heart attack, suffers from angina, or in any way identifies with my medical history, then I am recording it here.

Diagnosis list

'1. Myocardial infarction 2006 (angiogram at Bedford, conservative management.)

2. DSE 2008: no inducible ischaemia.

3. Hospital admission with troponin negative chest pain and equivocal exercise test- September 2010.

4. DSE October 2010: negative for inductible ischemia.

Medication List

Asprin 75 mg od

Pravastatin 20mg od

Isosorbide mononitrate 20 mg

Plan

1. GP to please discontinue isosorbide mononitrate and commence Amplodipine 5 mg od- uptitrating to 10 mg od

2. GP to please commence proton pump inhibitor

3. GP to please commence ACE inhibitor if no contra-indications.

On his admission his troponin was negative and he went on to have an exercise tolerance test which showed no gignificant changes, although there were some equivocal lateral ECG changes. He had no limiting chest pain but managed 6 minutes, 7.3 METS.

Cardiovascular system examination was unremarkable and his blood pressure today was 129/72.

He had a dobutamine stress echocardiogram on 16th October which was negative for inducible ischaemia.'

 I have Googled 'ischemia' as I had no idea what it meant, and this is what I found:

'Myocardial ischemia is an intermediate condition in coronary artery disease during which the heart tissue is slowly or suddenly starved of oxygen and other nutrients. Eventually, the affected heart tissue will die. When blood flow is completely blocked to the heart, ischemia can lead to a heart attack. Ischemia can be silent or symptomatic. According to the American Heart Association, up to four million Americans may have silent ischemia and be at high risk of having a heart attack with no warning.

Symptomatic ischemia is characterized by chest pain called angina pectoris. The American Heart Association estimates that nearly seven million Americans have angina pectoris, usually called angina. Angina occurs more frequently in women than in men, and in blacks and Hispanics more than in whites. It also occurs more frequently as people age—25% of women over the age of 85 and 27% of men who are 80-84 years old have angina.

People with angina are at risk of having a heart attack. Stable angina occurs during exertion, can be quickly relieved by resting or taking nitroglycerine, and lasts from three to twenty minutes. Unstable angina, which increases the risk of a heart attack, occurs more frequently, lasts longer, is more severe, and may cause discomfort during rest or light exertion.

Ischemia can also occur in the arteries of the brain, where blockages can lead to a stroke. About 80-85% of all strokes are ischemic. Most blockages in the cerebral arteries are due to a blood clot, often in an artery narrowed by plaque. Sometimes, a blood clot in the heart or aorta travels to a cerebral artery. A transient ischemic attack (TIA) is a "mini-stroke" caused by a temporary deficiency of blood supply to the brain. It occurs suddenly, lasts a few minutes to a few hours, and is a strong warning sign of an impending stroke. Ischemia can also effect intestines, legs, feet and kidneys. Pain, malfunctions, and damage in those areas may result.'

Overnight Snowfall

We've had quite a bit of snow falling on Milton Keynes overnight. The car had a blanket of the white stuff on it as I walked Carol over to the Academy. She's still not completely over the throaty bug she's had for the last day, but if she stays off work much longer she will need to go to the doctor's for a sick note. Another case of burocracy. When I got back to the house I scraped the snow off the car windows as I need to go out later to do some shopping. We're down to 68p on the electric meter. The gas ran out yesterday and we had to use emergency, so that will need topping up too. According to the B.B.C. weather forecast we can expect more snow, but it can't be as bad as Scotland, which has had something like two feet of snow over the past week or so.

During my last doctor's appointment the other week I mentioned some of the side effects of the drugs I am taking for my heart. I have changed the times I take the Isosorbide Mononitrate, from 4 and 9 p.m. to the original 8 a.m. and 2 p.m. I have some slight headaches (these were really bad when I was originally prescribed this medication, but it wore off after about a month.) I have found that I wake in the night and cannot get back to sleep. I was informed by my doctor that it wouldn't be the Isosorbide Mononitrate that cause the sleeplessness, but the Bisoprolol which I have been taking since I had the original heart attack in May 2006. I have done some research on the internet and one site has mentioned 'sleeplessness' as one side-effect. Certainly, I can say that at times I have the opposite, I get very tired, usually during the afternoon, but at the moment I am finding that I do wake in the night and cannot get back to sleep. I am currently trying other things to help me sleep, such as having a bath before I go to bed and sometimes having a warm, milky drink, such as hot chocolate to help me sleep. My dosage of the Bisoprolol have been halved, from 10mg to 5mg, but I cannot say I have noticed any difference as regards my sleeping pattern. The other side effect has been muscle cramps, which was the chief reason for halving the dosage, and the muscle cramps seem to have subsided, although at times they can be fairly mild. 

Doctor's Appointment

On Friday I put in a repeat prescription at the doctor's surgery, as my medication is beginning to run out. I like to get this sorted out fairly rapidly, as I don't want to find that I am down to one or two tablets before I put in the repeat prescription. Then, at midday, I got a call from the surgery to say that I would have to make an appointment with one of the doctors before they'd give me a prescription. I think it's the statins that they are concerned about. As I've mentioned in this blog elsewhere, I have had problems with statins from the first time I was prescribed, and have been taking Pravastatin for quite a while without too many side effects. One of them has been muscle pain. So I attempted to make an appointment by telephone this morning. I started ringing at 8.15, and the automated system told me 'the surgery isn't open at the moment . . .' and a few minutes later I got through and the message was 'the surgery is experiencing a hight demand' etc. I then decided, as the surgery wasn't too far away, I'd drive there. The traffic was quite heavy, but I got there fairly quickly, parked the car and then walked into the surgery. There was quite a long queue at the reception desk, but I got to the receptionist and managed to get an appointment at 9.50, so I returned home as there was no point waiting at the surgery for an hour and a half.

On returning I didn't have to wait long. I was hoping that the surgery would have had the letter from the hospital regarding my consulatant's appointment last Thursday, and the doctor had it on his computer screen. I mentioned that I was getting headaches and imagined it was a result of taking Isoborbide Mononitrate. The doctor now tells me that it would be as a result of taking Bisoprolol, the headaches are the cumalative effect of taking this particular drug, and that I should take only 5 mg rather than 10 mg each morning. I am to continue taking the Isorbide Mononitrate. I am to have a blood test and he wants to check my cholestrol, so on the way out of the surgery I made an appointment at reception and have to come back at 9 tomorrow morning. The doctor printed out a prescription and I took this to the pharmacy in Netherfield, a short walk from the surgery, to get it made up. One of the advantages of reaching the age of 60 is that I don't have to pay for my prescriptions, which is quite a considerable saving. The prescription was made up, except of part of the Pravastatin order, which was incomplete, so I will have to return tomorrow sometime to get the remainder of the prescription.

I got home to discover the Post had been delivered. There was a bank statement and a buff, official-looking envelope, which I never like the look of as they invariably mean trouble, but, on opening it, I discover it contains good news. A cheque from H.M. Inland Revenue, a rebate of Tax for nearly £500. I was expecting it, so I immediately drove into the centre of Milton Keynes to deposit it in my Nationwide account. It should be cleared through the account by Friday.

Sunny, But Cold

The weather is deceptive. If I look out of the window it is bright and sunny, but as soon as I get outside it's strikes really chilly, so a coat is required. I did some washing on Tuesday, when it was sunny and warm. It was hung out on the line in the garden, but there was a short sharp rainstorm so we bought it back in, but next day I put it all out once more and it was soon dried.

We took both dogs for a walk along the Redway as far as Woughton Green (actually pronounced 'Wow-ton' and not 'Wuff-ton' as I had expected. It doesn't make a lot of sense when there is a village near here called Loughton which is pronounced 'Low-ton.') We let the dogs off their leads. Poppy just pootles around, sniffing and exploring, whilst Alfie runs off and enjoys his freedom. Every time someone comes along, either walking or on a bicycle, Alfie has to run up to them and ingratiate himself, going 'hello, talk to me, stroke me!' and so on. He doesn't run off far, and just a call from us brings him back. As long as we're within ear/eye shot he's happy. We have to put their leads on when we approach the road, as there is no telling whether there will be traffic, although the road is devoid of any cars or other vehicles. We go under the main road, Marlborough Street and walk over the canal bridge at Peartree Bridge. I'm not so sure that either dog won't decide to jump in the canal, so we are glad that the dogs are on their leads again. There is a dog being walked along the opposite side of the canal and ducks that Poppy looks likely to decide to chase. Several months ago we walked in the opposite direction with both dogs, let them off their leads and Alfie ran off, jumped a low wall and landed up in the canal, much to his great surprise! I don't think he'll be trying that trick again in a hurry. We managed to fish him out, and he had to run around for quite a while, looking for all the world like a drowned rat, until he dried out completely. Anyway, there are a couple of young swans drifting along on the canal, and as soon as the dogs approach they hiss. I think it's more a sort of 'keep your distance' sort of sound rather than any sort of aggressive intention, but I'm not too keen to discover what they're likely to do. We walked on along the canal until we came to the next bridge back over the canal and walked back the opposite way through Woughton village, following a path which goes through this really nice orchard and then back across the village green and back, in a loop, towards the canal and then eventually along the Redway towards home.

We took the dogs out again this morning, when we walked through the park in Eaglestone, and as we were about to leave the house the workman came to the door, ready to install two smoke alarms and put some hardboard along the landing where he'd repaired the floor. We let the dogs off to run in the park, Alfie going crazy and barking madly, and he jumped up to grab the lead and nipped Carol on the arm in the process. I don't think he meant to hurt her, he was just being over-zealous. Just the thought of going out and being free to run for a while had gone to his head. We went as far as the shop and bought some rolls for our lunch and some chocolate. One can never do without chocolate, as I'm sure you'll agree.

I must have told you that I'd stopped taking Pravastatin. This was a result, if you remember, of my last time being in hospital, when I mentioned to the consultant the muscular pain I have experienced since having my heart attack. Mostly due to taking statins. I was prescribed this medication as it controls my cholestrol levels. I was prescribed various types of statins, which do more or less the same thing in that they keep my cholestrol levels within safe boundaries in order to prevent a further blood clot and another heart attack. The first sort I took, when I was originally in hospital, gave me side-effects similar to flu. I only knew this when I discussed it with one of the nurses who cared for me on the C.C.U. I eventually ended up taking Pravastatin, which seems the statin that my body is most tolerant of, apart from the muscle pains, particularly in my legs and stomach. Well, I have started taking Pravastatin again, as the one month's rest from it has come to an end, and what happens? The muscle pain has started up again.  My medication at present is at follows: Bisoprolol 10 mg tablets and Dispersible Asprin 75mg, one tablet dissolved in water. Taken around 6 a.m. each day. Isorbide Mononitrate Tablets 20mg. currently taken at 4 p.m. and 9 p.m. Originally taken at 8 a.m. and 2 p.m. but times changed due to side effects. The headaches have now worn off, but I still feel somewhat light headed as a result of taking this medication. Pravastatin taken in the evening, round about bedtime.