A Little Heart And Soul

 Wednesday. 7.15 a.m. I have worn the heart monitor since yesterday afternoon. One of the contacts came off yesterday, probably because I was so hot, so I managed to use Sellotape to reattach it. It takes some time to get used to having the thing attached, so I couldn't shave this morning because I must not get it wet. I haven't done any washing up, so there's still dirty pots and pans in the sink. It will have to wait until tomorrow, after I've been to return the heart monitor. 

I was just thinking about the heart monitor. It's small and relatively easy to deal with. You have to plan ahead when you need to do anything, which was what I did when I went to bed last night. I was conscious of it becoming disconnected from my chest, that it might fall on the floor and that it would get in the way, and I was likely to lay on it. I didn't. Then I compared it with the complex and bulky heart monitoring system I had to put up with when I was last in hospital. I had no end of contacts placed on my body, and it was all connected to a large monitor, which kept on bleeping if I moved only slightly, and it was more or less impossible to sleep at night or lay down with all the cables everywhere. Surely they could have used a similar monitor to the one I have on at the moment.

Thursday. 6.15 a.m. It's foggy this morning. It's not thick and is likely to clear as soon as the sun gets warm.

I have had more problems with the heart monitor, because one of the contacts keeps on coming off, and I have had to use Sellotape to keep it on. Also, it's very itchy around the point where these contacts are stuck on my skin.

10.55 a.m. At around 9.20 I drove to the hospital to return the heart monitor. I must have made a wrong turning somewhere on the route, because I landed up goodness know where, somewhere down Chaffron Way, but I managed to get back on track and got onto Marlborough Street, which runs alongside Eaglestone and went into the hospital campus and then park in the street-level car park without any problems, where Carol and I used to park when she was going for chemotherapy. I went into the cardiology department and handed over the heart monitor and then returned to the car park and found, on putting the card in the machine which you pay, I found the barrier lifted without me having to pay, which is not surprising, as I was there for no more than five minutes. I then drove towards the ESSO filling station in Childs Way, to put some diesel in the car, ready for my journey to Chipping Norton on Saturday morning.

Then I drove to Sainsbury's (you never would have guessed, or would you?) Some stocking up was in order, and then back to Dexter House.

9.00 p.m. I got a letter this morning, from the Cardiology department at Milton Keynes Hospital (no, that isn't exactly correct, The letter had an address in Bristol, as the return to sender address. Which would suggest it wasn't sent from Milton Keynes Hospital.) Never mind. I have an appointment there on 19th June at 9.30 a.m. The appointment is supposed to take three hours, in which time they will be various tests, my weight will be taken and no doubt I will be put on a treadmill, to check my heart function and so on. I am only working on supposition, but I do have some idea what they are likely to do with me.

When I was there the other day, I was intrigued by the door with the title 'Echo Room.' I know, it's for doing tests on heart patients, using some sort of echo test (I think I've had it done at some point or other. I have an idea that the procedure is called an echocardiogram) But I can't help having this picture, in my vivid imagination, even though it's totally crazy, that it's a sort of vast echo chamber, where people go to let of steam, when they are having a terrible day, for example, so they go in there, shut the door and shout at the walls, and it echoes back at them (presumably it's totally sound-proofed?) I know, it is bonkers, but, if you've read some of my earlier posts, you will have realized that I am somewhat bonkers. 

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.

Volunteering at Camphill

I've been volunteering at Camphill, as I think I've mentioned in an earlier blog post. I'm working with the drama workshop group, and at the moment I'm doing a few hours on a Tuesday morning. I'm aware that, due to my heart-health issues, I get very tired and by 2 o'clock I am beginning to feel wiped out. I hope to discuss this with my cardiologist when I go for my follow-up appointment on 2nd May, which will be four months after the stent procedure which was done at the John Radcliffe in Oxford. I have got someone from church who will take me. I had considered driving there myself, but  I think it's going to be quite stressful having to drive all the way to Oxford and find a parking space at the hospital. As the appointment is at 11 o'clock there are likely to be no spaces in the carpark, and I had thought perhaps I could park in one of the park-and-ride carparks which ring Oxford and then take the bus to the hospital, but even then it's going to be quite stressful getting to the JR on time for the appointment. So, after this appointment I hope they might either reduce the dosage of some of my medication, such as the atarvostatin which I take at night. I have a feeling it's this particular medication which makes me feel so tired and it causes some side effects, such a stomach and muscle cramps. There again, they might change some of my other medications. Just have to wait and see. It's somewhat annoying that I have to go all the way to Oxford, because the Milton Keynes Hospital Cardiology department is a mere 10-minute walk from this house.

Camphill are going going to do a disclosure because I am working with a vulnerable group of adults with learning disabilities. I have taken all the identification material with me so that the disclosure paperwork can be sent in.

We were discussing various things before we did several hour's of rehearsal for the 'Stranger Danger' play and planning for the next production which is going to be loosely based on Robert Louis Stephenson's 'Treasure Island,' which is one of my all-time favourite books and has to probably be one of the best children's adventure stories ever written. I can't wait to see how this develops, as we were discussing having songs in it, so it's likely to be more like a mini musical than a straight play.

Later. Goodness! The weather has changed. For the worse it would appear. As I write this,  at 5.20 p.m.it's raining. I couldn't believe how hard it's raining.  It's running down the road outside in a torrent, almost like a mountain stream. It has been clear and bright most of the day, although it was quite mild earlier. No frost on the car windscreen first thing when I went out with Alfie at around 6.20. But it clouded over during the afternoon and I thought it was going to rain and it got colder so I put the central heating back on. I have 'Pointless' on television as I write this. It has to be one of the more intelligent of the current crop of television gameshows. Gets you thinking.

I'm amazed. Twice in one blog post. Is this a record? Probably not. But the Christmas tree, which we bought a good three years ago from Dobbies and was potted in a rather splendid pot we got in Homebase (I think it was called something else at the time, but has since returned to being Homebase. How odd is that?) Anyway, it's started showing signs of growth, lots of little green shoots. It appeared as if it had died, probably due to the heatwave we had last summer. It has what look like scorch marks on some of the branches, but it has obviously decided to perk up and continue to grow. It was intended that it could be moved indoors for the Christmas period, but didn't last year due to the passing of my lovely Carol. I wasn't here for the festive period. I spent nearly two weeks with my daughter, Chloe, and her ever-growing family, in Worcester. But to have this Christmas tree growing again is somewhat good news. I kept it fed with plant food and it obviously paid off.

Second Stent and Third . . . Possibly

If you read my blog posts on a regular basis, you will know that after I had my heart attack at the beginning of September I was taken to the John Radcliffe Hospital in Oxford when I had a stent inserted. I then had to go for a scan using what is called a 'Gamma Camera,' which showed that I had some damage to my heart and a blockage which needed treating with a further stent. I was booked to have this procedure done on 12th December and had arranged to be taken by someone from church, but this was the day after Carol passed away and when I arrived at the unit at the hospital in Oxford I was in something of a state because of Carol's passing and the procedure was postponed. The new date was offered, for yesterday, 30th January.

The procedure I was about to have is called a Percutaneous Coronary Intevention (PCI).

I had to be at the Cardiac Angiography Suite (which is part of the Cardiology Department at the John Radcliffe Hospital in Oxford) for 7.30a.m. So Tim O'Brien (who was driving me there).) arrived at 5.45a.m. to make sure we arrived at the hospital in good time. As it turned out we were there by a little after 7.a.m. Fortunately, because of the abortive appointment, we knew exactly where to go and could park the vehicle on the lay-by directly outside. I was let into the waiting area and so had to wait until the unit was officially open.

People began to arrive. Around 7.30 one of the nurses came in and told us we could go through to the ward. I began to change into a hospital gown. I find these garments difficult because you have to tie do up the ties at the next and lower on your back. You really need someone to do it for you, but I eventually managed. I had bought a bag with my things in it. I was told I needed to bring a dressing gown and slippers. Which was just as well, because I didn't fancy wandering around the ward in that hospital gown because they have no back and you need to tie them up tightly otherwise you reveal all and sundry if you're not careful. Then it was just a question of waiting (which you seem to do a great deal of in a hospital, which I can testify to with some authority over the last year-and-a-half or probably more.)

A nurse came to ask me questions about my health, for example, did I have any allergies, was I diabetic, as well as going through my medications. I had bought the entire lot of medications and he went though it all and made a list. Then, the usual 'obs' were done, (observations), temperature, blood pressure etc etc. This is done at regular intervals when you are in any hospital.

Patients were coming and going, some in wheelchairs, others on beds which were trundled about by nurses and porters. People went off to have their procedures. I wasn't long before I was taken into the lab (not an operating theatre.) I had to have a catheter inserted in my right arm. I'm not much good with needles or other sharp items, particularly if they are inserted into my person, at times such as this or when giving blood, but they managed to do this. All part of the preparations necessary before the procedure can be carried out.

Then it was my time to be taken into the lab for the procedure sitting in a wheelchair. I'm not sure whether it was the same 'lab' as the one I was in for the first stent to be inserted after my second heart attack. There was a long, narrow bench or bed which I at first sat on and then laid down on. A series of monitors overhead and a range of what looked like cameras or perhaps they were X-ray machines, because the team who would do the procedure were viewing my arteries and veins on the X-ray monitors so as to find where the blockages in my heart were which were to be opened up by the stent during the procedure.

I was given a local anathesthetic in my right arm (which was laying on the edge of the bed.) Because I had become somewhat stressed by the whole process I was also given a sedative to help me get through the procedure.

It was rather uncomfortable having my right arm put into a somewhat difficult and unusual position. I could barely feel a thing as the procedure continued. Quite a few people in the room, but I kept my eyes tightly closed throughout. I think there was a sort of sensation as the stent was pushed through a vein in my arm and into my heart. The whole process lasted around 45 minutes. At the end I was told I could sit up, but, due to the sedation, I was not able to do this myself and required assistance from one of the nurses. I was then able to lay on the bed in the ward and after about an hour or more was taken up to the ward where I had a single en-suite room. A good deal larger than the room Carol had in Milton Keynes hospital and with a good deal more room to store clothes and personal belongings.

I was expecting to be discharged fairly quickly. I had intended phoning or texting Tim so that he could come back to the hospital to collect me for the journey home, but I was then told that I would need to stay over-night. I rang Tim more or less immediately because I didn't want him waiting around in Oxford unnecessarily. He told me that he probably wouldn't be able to come back to collect me the next day, so I began to enquire as to busses or taxi cabs into the centre of Oxford as I had thought my only alternative transport would be to catch an X5 bus back home to Milton Keynes from the Oxford central bus station, which was how we had often visited Oxford in the past. I was also told that I wouldn't be able to drive for a week. No problem there. It would mean I wouldn't be able to do any shopping. That is, to drive anywhere in order to do shopping. But then it occurred to me that this wasn't actually a problem because I could do an on-line shopping order with Sainsbury's and have the order delivered. No need to lift anything, particularly with my right hand which was where the wound for the stent was. At that time, tightly bandaged and taped.

I had a ham sandwich to eat some time after I had the procedure. It was just as well I had that to eat because I wasn't supposed to eat anything after 4a.m. I had a meal as I usually do at home at 6p.m., so it was a long time to wait for food and my the time I was done with the procedure I was hungry. Then I was told that I would be moving to a ward upstairs and this move was done fairly promptly. So I was taken to the Cardiology ward and had an ensuite room. A good deal larger than the one Carol had when she was in Milton Keynes hospital. I noticed how quiet it was, too.

I was seen by a doctor and told that I ha actually had more than one stent fitted during the procedure. The wound on my right wrist seemed to be healing quickly, there was no bleeding or redness. As it was tightly bandaged and taped (with that adhesive tape which is very tacky and when they come to take it off it's so sticky it almost takes your skin with it!) I had the obligatory ECG done which showed no problems with my heart and I knew I would then have to spend the night at the John Radcliffe until I was discharged in the morning or whenever the doctors did their ward rounds.

I had an evening meal. I will say one thing: the food at the John Radcliffe is  good deal better than you get as a patient at Milton Keynes hospital.

So, I spent a relatively good night. None of the noise you usually get on a hospital ward. I felt sorry for Carol having to endure screaming and dreadful noise when she was on the various wards at Milton Keynes hospital. Even the staff were quiet, not talking and keeping me awake. I suppose having a room to myself did help, but in all honesty I think I prefer to be on a ward with other people and enjoy having conversations with other patients, but I shouldn't complain. At least I had my own toilet which meant I didn't have to go gar, although things were impeded because I had a heart monitor affixed to my person and a little later I had to have a saline drip, which was on a wheeled stand which I had to push around if I needed the toilet. The drip was because I had a dye put in my veins so that they could see clearly what they were doing during the stent procedure. The drip was for four hours.

In the morning I had breakfast at 8 o'clock and the usual obs were done and eventually a doctor came at around 10-11 and I was told I could be discharged. It all depended on the relevant paperwork being ready as well as any new medication I was to be put on. I was originally told it could be 'lunchtime,' but then I was told 'late afternoon.' I wasn't sure how I was going to get home. I had decided I would need to get a bus from Oxford bus station, the X5, which goes through Oxford to Cambridge, stopping at Bicester, Buckingham and Milton Keynes on the way. As I have a bus pass I wouldn't have to pay. Carol and I had used it on several occasions when we'd visited Oxford and when we didn't want the bother of driving and then having to find a carpark, although we usually used the Park and Ride system which made life easier.

I then got a text from Tim to say he had managed to reorganise himself and he would be able to come back and collect me, which was a relief as I wasn't keen on using the bus because I wasn't certain what would happen if I had a problem with the wrist wound, whether it would bleed and what I would do if that happened. I just needed to be able to text him or phone him once I was certain that everything was done, including the medication and the paperwork before I let him know so he could drive over from Milton Keynes (which takes at least and hour and a quarter.)

I got a visit from the pharmacist who went through my medication (I had taken all my proscribed medication with me.) and I was even given some which was at the point of running out, which meant I didn't have to put in a repeat prescription when I returned to Milton Keynes.) Even the paperwork was complete which meant I could ring Tim. I was at last able to go home. So, at around 4.30 Tim texted to say he had arrived on the hospital campus. I was taken down stairs to street-level by one of the nurses and Tim arrived and I was able to leave. The journey back to Milton Keynes was relatively stress-free, apart from a built up of traffic on the A34, basically because it was, by now, home-going time for most people and we arrived back in Eaglestone at around 6.30-7.00. The house was cold because the central heating hadn't been on for well over 24 hours and it took me a while to get it set up to warm the house.

Not The Best News

Alfie was quite insistent that he was going to be taken out for an early-morning walk. I got up as usual and he was sitting on the sofa watching me like a hawk, following me around the house, staring  at me and it was quite clear what his game was. He wouldn't let me off the hook, so I had no real choice but to put on my jacket and shoes and then connect his lead to his harness and then go out the front door. I haven't been on a long walk since my heart attack, so I walked relatively slowly as I did have a vague feeling of an angina attack, but nothing more. I even took my mobile with me, just in case. Eaglestone Park is beginning to show real signs of autumn. I also had my G.T.N. spray in my jacket pocket.

I had to do some shopping early, so I went to Sainsbury's, going at around 8.40 and avoiding traffic as well as dawdling shoppers which you tend to get on a Saturday morning. A few items as I'm having to make myself a meal of some sort with Carol in hospital at the moment. A few odds-and-ends to stock up on, those things that having a bit of running out when you least expect it.

Once I'd returned home I put the food items away, some in the fridge, as I didn't fancy the idea of them sitting in the back of the car when I parked at the hospital. It was around 10 o'clock when I eventually drove into the hospital campus and drove around to the ground-level carpark near Cardiology. I think we're becoming extremely familiar with the layout of the hospital of the last year or so and I've discovered where exactly Ward 2 is in relation to, say, the Macmillan unit as well as Oncology and Cardiology (which is handily just opposite Oncology.) You can see the windows of the ward as you walk through the courtyard on your way through and Ward 22, where Carol was a couple of weeks ago, can be seen through the window of Ward 2.

Carol had a visit from Doctor Saka, the cancer consultant with whom she was supposed to have had an appointment yesterday morning (Friday.) Unfortunately I wasn't with her when he came to the ward. We've now learned that the tumour has increased in size unfortunately, as shown on the recent scans. The plan is for her to have 6 months of more chemotherapy, but a more intense treatment which will leave her with no hair as well as possibly making her feel quite sick. Not something we are looking forward to. We were expecting her to have radiotherapy at the Churchill Hospital in Oxford, but none of this can be started until the pain she is experiencing is under control. But we know we can get through this, however difficult it turns out to be. Me having my recent heart attack hasn't exactly helped matters. I am feeling fine, apart from the occasionally twinge. I have become very aware of my heart-rate when I'm lying down and I can feel quite nauseous at times, which is as a result of the medication, also, feeling a little bit light-headed, but all in all I'm not feeling too bad, perhaps getting tired easily, but if I rest it makes things easier. Just something I have to live with, and, anyway, I went through similar things after my first heart attack in 2006.

Ward 2 is a short-stay ward. During the afternoon Carol was asked if she would like to move to a side-room? Her answer was that she would love to get away from the noise of the ward. There are a couple of elderly ladies who make a lot of noise in the night, and one was moved to a side-room because of this. So we bundled up all her belongings and a porter trended her off up the corridor. It's  Ward 20, which is opposite the first ward she was on last year, Ward 20, and just above the Macmillan unit and extremely handy for me coming in to park near the Cardiology department so that should make things easier. 

Heart Disease and Fatty Foods A Myth?

The following is taken from a website called Healthy3.co.uk  and may be of interest to those people who have had a heart attack or have been prescribed the use of statins in order to lower their cholestrol levels. I take statins, having had a heart attack and as a result my cholestrol level has been maintained at a reasonable level. I’m not sure whether I would want to risk having another heart attack, as a result of having a blood clot, but the information below is very interesting

Fats- The Cholestrol Myth?

‘A cardiology specialist has written about the “myth” of saturated fat in a leading medical journal. Dr Aseem Malhotra suggests that full fat butter and cheese are not as bad for the heart as previously been suggested. This view goes against that of the majority of the medical establishment.’

‘Dr Malhotra, a cardiology specialist registrar at Croydon University Hospital in London says that four decades of medical wisdom of cutting down on saturated fat to reduce the risk of heart disease may be wrong. He argues that the saturated fats have been given a bad reputation since a major study in 1970 linked high levels of heart disease with high cholesterol and high saturated intake. Dr Malhotra even suggests that eating foods that have not been processed such as cheese, butter, eggs and yoghurt may even be good for the heart.’

‘Saturated fat should not be confused with “trans fats”, which are found in margarines, cakes, chocolates and biscuits. Trans fats are universally recognised as being bad for our health, and unlike saturated fats from dairy food, do not contain any vitamins or minerals. Dairy foods are rich in vitamin A and D, calcium and phosphorus, which can help to support cardiac function.’

‘Cutting down on saturated fat has been the mantra from the health authorities, but these fats are being replaced with refined carbohydrates or sugars which are thought be more dangerous for cardiac health.’

‘The current NHS guidelines recommend that the average man should eat no more than 30g of saturated fat a day and the average woman should eat no more than 20g of saturated fat a day. Cutting down on sugar should be more of a priority according to Dr Malhotra.’

‘Dr Malhotra said, “From the analysis of the independent evidence that I have done, saturated fat from non-processed food is not harmful and probably beneficial. Butter, cheese, yoghurt and eggs are generally healthy and not detrimental. The food industry has profited from the low-fat mantra for decades because foods that are marketed as low-fat are often loaded with sugar. We are now learning that added sugar in food is driving the obesity epidemic and the rise in diabetes and cardiovascular disease.”’

‘Dr Malhotra also questions the mass prescribing of statin medications, as he believes that doctors are not assessing the risk of heart disease correctly. Decades of warnings that high cholesterol levels cause heart disease have led to over medication of statins in health patients, he claimed.’

‘“The fact that no other cholesterol lowering drug has shown a benefit in terms of mortality supports the hypothesis that the benefits of statins are independent of their effects on cholesterol,” he wrote in the British Medical Journal.’

‘He goes on to suggest that a Mediterranean diet is more effective than taking a statin to promote a healthy heart and cholesterol levels.’

‘Dr Malhotra also pointed out an interesting fact that although the amount of fat consumed in the US has gone down in the past 30 years, obesity rates have rocketed. This is linked to the amount of carbohydrates and sugars that are in “low fat” versions of processed foods.’

Article written by Rahul Shah and published on October 23^rd 2013

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.'

Cardiology Appointment

It's really mild at the moment. There's quite a strong wind blowing, but it's unseasonably warm. We have had the central heating on last night, but we decided to turn it off as the lounge was far to warm. 

I had an appointment at the Cardiology Department at Milton Keynes Hospital at 10.50 this morning. It's no more than a 15-minute walk from here, along the Redway that runs behind this house and into the hospital campus, and a short walk around the ringroad within the hospital grounds. The waiting area was really packed, and I was called into a room to be weighed and have my blood pressure checked before going in to see the consultant. The queue seemed to go down fairly rapidly as people were called in one by one and then I was sitting all on my own. It must have been a good 45 minutes after I arrived that I was called into the consultant's office. It seems odd that I have to keep on repeating what happened the last time I was taken in to hospital through Accident and Emergency, as I would have imagined that it would have been in my clinical notes. I had to describe the sort of pain I get when I have an angina attack. A sort of persistant pain in the middle of my chest, usually brought on by something strenuous or stressful. Sometimes it can be bought on by stretching up, (ie putting something on a shelf where I have to lift it above my head) carrying something, pushing (ie a shopping trolley) or generally just doing light exercise, like walking. I have felt very dizzy when I have bent down to pick something up quickly, but all this usually goes away if I sit or lie down for a short time. The last time I was in hospital and had to call an ambulance I wasn't doing much of anything, just about to read a book, quietly sitting in an armchair, so I can't pin any one thing on what caused that attack.

The consultant suggested having another stress-echo test. I then told him I thought that was what I'd had a few weeks ago. He wasn't sure and had to look on the computer to find documentation. He told me they had a new computer system and it was taking a while for people to get to grips with it and it was difficult to find anything. It seemed a somewhat random system. Anyway, he then decided that it wasn't really necessary to have another similar test. Which pleased me, as I'm not too keen to go throught all that again in a hurry! Anyway, it would appear that there is nothing wrong with my heart and that the 'prognosis was good.' I still don't need any sort of surgery and I should keep on with my medication.

He went through my medication. I said that I had started taking the Pravastatin again, and that there was no muscle pain as a result. I said that the Isosorbide Mononitrate was giving me headaches, and that I had changed the times which I took it from 8 a.m. and 2 p.m. to around 4 p.m. and 9 p.m. I told him that I was having trouble sleeping, and then he said that he would recommend changing this medication to something which worked in a similar way but which would not cause headaches. Also, I have been having really bad heartburn, so he will prescribe something to ease that and also I am to be prescribed something which should help my heart function better and help reduce blood pressure, although I don't have excessively hight blood pressure. I wanted to know about my cholestrol levels and that we had seen that this had been checked when my blood was tested when I was last in hospital. He told me that it seemed alright.

He is going to write to my G.P. and tell him the recommendations for my medication-changes and that the doctor will give me the required prescription so I can get it made up by a pharmacy.

Anyway, it's good to find that things are going O.K. I left the cardiology department and walked the short distance home.

Heart, Hospital and Home . . . Part The Third

Sorry to keep you chaps and chappesses waiting to find out the out-come of my stay in hospital, but there's been a weekend since the last post and I haven't really had the time or inclination to write anything further.

 To business. 

I was told that I would need to have a visit from someone from the Cardiology department before any decision could be made as regards my discharge, and nobody could give me any definite time as to when this was likely to be, so I was going to have to endure a further day, at least, just sitting and staring at the four walls of Ward 2. I was hoping that I wasn't going to have to stay in hospital over the weekend, as someone had said that there was a chance that I might not get a visit from Cardiology until Monday.

Carol came back and it was good to have her company. She was told, rather unceremoniosly and rather abruptly by one of the nurses I thought, that she wasn't really supposed to be there, and would need to leave until the correct visiting time. I can't see what the problem was, as she wasn't in the way. I do remember, the last time I was on the C.D.U., there being a woman who seemed to take it upon herself to make life difficult for all and sundry, mostly, any visitors. Carol had nowhere to sit, as there were no chairs near the beds. There was a pile of folding chairs elsewhere on the ward, which were intended for visitors to use. Carol managed to take one and sat near my bed. I think, before you left the ward, as a visitor, you were expect to fold the chair and return it to it's rightful place. Carol forgot, and got told off, in no uncertain terms, by this bossy old woman. Then Carol decided to read my notes and this dragon of a woman shouted across the ward that she wasn't to look at my notes. Why? We are husband and wife. What was her problem? I am fully aware of confidentiality, having worked as a carer, and I wouldn't expect to read anyone else's notes, so what was so bad about Carol reading mine? I read my frequently, but, to be honest, you have to be fairly up in the ways doctors and nurses write things, as it's all in their own style of writing which they seem to have. I have a vague idea of what some of the terminology means, so I don't bother that it's written in unintelligable language. Anyway, that dragon of a woman on the C.D.U. was there this time, although she didn't seem quite as agressive to everyone as she was on my last visit. Perhaps someone has complained and she has toned down her behaviour. It seems that, given some sort of power, some people let it go to their heads. This woman certainly had let it go to her head.

It's no good feeling hungry if you're in hospital. Granted, you don't expect it to be like a hotel, and certainly, as mentioned before, it's not the sort of place for rest and recuperation, as it's so noisy. You aren't always that keen on food if you've been ill (why else would you be in hospital?) so trying to eat can be rather an effort.  But the food can be good or just plain awful. Breakfast consists of a bowl of cereal, a cup of tea and bread and butter. Why not toast and marmalade or jam? As for lunch, or evening meal, you have to decide the day before what you're going to have, as they come round with a sort of menu that you have to tick. I'm not always feeling hungry when I have to choose, so I end up with something really revolting. If you have breakfast too early, then you end up feeling hungry around 10 o'clock. I realise that they have to get breakfast out of the way quickly so that the ward can be tidied before the doctors do their rounds, but does it really have to be so early?

Anyway, let's get to the end of this post. I eventually had my visit from two people from the  Cardiology team at around around 3 p.m. When they arrived on the ward. I was told that I would need to have further tests, and that I would soon get a referral from the department in the post. I was to be put on new medication, isosorbide mononitrate , which works in a similar way to the nitrolingual spray. It's supposed to open up your blood vessels to increase blood flow and help decrease the possibility of a further blood clot. After using the spray I generally get headaches, which would be the result of blood vessels in the brain opening up. It usually goes off after about 15 minutes. I mentioned that I got muscle pain, as a result of using pravastatin. I was told that I could stop taking this medication for a month to try and relieve this side effect. As I write this I have been off it for two weeks and I must say the muscle pain has virtually gone. It seems that whatever you take it has some side effect or other. When I originally was put on statins after my heart attack the medication had the effect of me having flu-like symptoms, and I would only have known this when I spoke to one of the nurses, so I was put on another type of statin. I'm not sure what this original statin was, but I tried several versions, Simvastatin being one of them.

Anyway, I was that the treadmill test hadn't uncovered anything suspicious, and that I was free to go home.

I telephoned Carol to give her the news, and she immediately came back to the hospital. She came in the car, which meant that we would incur a parking fee. It does seem unfair that you have to pay to park your car when visiting hospital. As we live so close to the hospital it seems crazy to use the car as it's just a relatively short walk through the back of the hospital from our home, but she thought I might need a lift home as I wasn't feeling to bright.

It took some while for the discharge paperwork to be completed, and they had to organise my medication. When I was in Bedford Hospital I'm sure I had to pay for my medication when I left, but this time, on leaving Milton Keynes Hospital, I did not have to pay. Then I was told that it wouldn't be ready for a few more hours, so we said that we'd come back in the morning to collect it.

So, we walked out of the hospital and back home in the car. It was nearly three days since I had telephoned 999 and been admitted through Accident and Emergency.

The house was so quiet, apart from Poppy and Alfie running around barking when I walked in, being able to sleep in my own bed again after the noise and confusion of the hospital, sheer luxury!