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.

Feeling Sick This Morning

I'm not one to go over-board when I'm not feeling very well. Unlike some people who seem to make a great deal of fuss over being ill, for whatever reason, to get attention or even to get to the front of the queue at the doctor's reception desk. I had a chesty cough a few weeks ago and it seems to have left it's mark. I just can never seem to get rid of these nasty coughs and as a result I've had a very tight chest. As I've mentioned in one of my very earliest blog posts on here, where I describe what lead up to my heart attack, the weeks before that incident I had bronchitis which really drained me. So it is with this present bout of cold/flu.  It was very difficult to actually differentiate the pain and discomfort of the bronchitis with the pain of my heart attack. It can also be similar to having heart burn. I think that other people have described the pain of their heart attack as being similar to heart burn. Any sort of chest discomfort is bound to have some sort of concern for anyone with a heart condition and no more so when that condition has lead to a heart attack (M.I. or myocardial infarction to give it the correct medical name.) All the coughing I have been doing has probably caused a muscle to be pulled in my chest and it's really uncomfortable and very similar to an  extreme angina attack or even a heart attack. Any sort of strenuous activity such as walking, which we've been doing a fair amount of since the car has been off the road, can bring this pain on. I have been using my G.T.N. spray (Glyceryl Trinitrate spray.) which you use by spraying under your tongue (hence being described as 'sublingual.') which I have on repeat prescription and it doesn't seem to relieve this pain and so seems even more likely that this is brought on by continued coughing. Things are also not improved by constant running to the toilet (I'm not going into any more detail as you'd be pleased to hear.) But I think if this discomfort continues for any length of time I will have to make a doctor's appointment. But as I write this (at 7.57 a.m.) I have none of the discomfort. I write this sitting up in bed with both our dogs totally confused as I'm not downstairs in the lounge as usual at this time of day and their routine has been completely turned upside down. Alfie is sitting with me on the bed keeping me company. He is a very loyal little dog and follows me around wherever I am in the house.

I have run out of the isoborbide mononitrate tablets which are supposed to help relieve angina pain. It's not like me to run out of any of my medication as I'm usually very good at keeping a track of what  I'm taking as well as re-ordering. Which I will do later this morning when I ring up Sainsbury's pharmacy to do the repeat prescription order for the month.

The day has begun with fog, but it has cleared as the morning has progressed and the sun is attempting to break through. I did managed to see the Blood Moon last night as well as the partial eclipse, although I was somewhat disappointed that we didn't get the large moon we were supposed to get. The moon appeared a lot smaller than I was expecting. I tried in vain to get a photograph with our digital camera but it didn't work. Perhaps I needed to put the camera on the tripod and use a longer exposure or something.

Chilly Weather and Signs of A Cold

The weather has turned decidedly more autumnal. It's been far warmer for the past couple of days, to such an extent that it's difficult to know exactly what to wear when you go out side. This morning has returned to being a good deal colder and as I walked over to the Academy with Carol at 7.30 a.m., there was a very thin and watery sort of rain beginning.

I have had the beginnings of a sore throat for the past couple of days. I think I may be developing a cold. My voice has gone very deep, which always happens when I have a cold. I have an annoying cough which doesn't help, the sort of cough that develops on my chest and goes to the back of my throat and no amount of coughing will clear. It's made worse when I go to bed and lie down and wakes me in the middle of the night. I think I may have to start taking some sort of linctus to sort it out or to at least relieve it. Being on heart medication means I have to be careful what I take as some of these remedies you can buy over the counter in a pharmacy can be dangerous as they contain ingredients which cause side-effects with my heart medication. I should have my annual flu jab in the next couple of weeks, which I get as I have a heart condition. Our doctor's surgery, Ashfield Medical Centre, will do doubt email me or send a letter to say when this is going to be. It's usually done over a couple of weekends, a Saturday morning.

I had a really nasty angina attack on Monday morning when I was walking over to the Academy with Carol. I didn't unfortunately, have my G.T.N. spray with me (Glyceryl Trinitrate). I think it may be because I have been over-exerting myself recently. I just have to slow down a bit. Also, any sort of stress can set an attack off.  The small, picket-sized spray I got the last time I had my repeat prescription has a rather pleasant minty flavour. The car breaking down the other week hasn't helped. Sitting down and letting my heart rate go down helps. Using the spray, which you administer under your tongue with a couple of sprays, does usually work, although you have to be careful as it can make you feel quite light-headed. It can give you a headache and actually the effects can be quite pleasant! All the walking we've done since we've been without the car may be responsible for the angina attacks. I was put on isoborbide mononitrate by the coronary department of Milton Keynes Hospital when I had a bad angina attack a couple of years ago and that medication has the same sort of effect on your heart arteries (it is supposed to make them dilate, or widen, to allow blood to flow more efficiently and reduce the pain of an angina attack.) It has generally been very effective and I haven't had any sort of angina pain for quite a while. But I was warned by one of the pharmacists I spoke to when my medication was reviewed some while ago, that over-use of these medications will become ineffective so you have to be careful how often you use them.

There was a phone call at around 7.15 yesterday evening for Carol. It was Sainsbury's pharmacy ringing about 'flu jabs or something. She had hers done there last year. At her own expense, I may add. Which seems unfair as she'd not only diabetic (diagnosed since last year, I will admit.) and should be done, free, by the Academy. I get mine free because I have a heart condition and am also above a 'certain age.' But I thought it was a bit over-the-top for Sainsbury's to ring so late in the day. I realise it was to get her to book an appointment to have her 'flu jab done for this year, but did it have to be so late?

The motor mechanic who is a friend of Carol's friend and teaching colleague at the Academy, Lois (I forget his name, but I think it might be Mick or Mike.) came to look at the car the other morning and is going to be able to do the required work, something to do with the head gasket. Not being particularly car-engine literate, I'm not sure exactly what the head gasket does, but I know it's important and when it goes it can be an expensive thing to fix. He will be coming to work on it over a few days, actually managing to work on the drive and is able to start this Monday evening. He's also going to service the car after that work is done which will mean, hopefully, the car will be mechanically as sound as it can be to get it through the winter months. We have managed quite well without it over the past month or so, being able to do our weekly shop on-line and have it delivered by Sainsbury's. We are getting quite adept at doing this on-line and I must say it does save time and effort, particularly having it delivered is almost stress-free.

Swimming and Shopping

The summer holidays begin here! Carol is now officially on holiday from the Academy. Which means we don't have to get up quite so early each morning. It takes at least a week to get used to the idea. She told me that yesterday they had no actual training but instead did clearing up the classrooms ready for the new term in September. It seems a lot of the rubbish was caused by former teachers who have now left and they didn't clean up after themselves. Shameful. Apparently there are some schools in Milton Keynes which don't finish until this Friday. Milton Keynes Academy has a different sort of beginning and ending of their terms to the rest of the schools around here.

We went to D.W. Fitness bright and early. The roadworks near the stadium, as mentioned in an earlier post, are causing hold-ups as there are traffic lights to control the flow of traffic and we got caught up in quite a long queue. I suppose at that hour of the morning there will be people going to work. It's unclear exactly what is going on around there. It looks as if they are constructing another entrance to the football stadium campus, no doubt to allow cars to get in to the new cinema and restaurants which opened recently. 

When we got into D.W. Fitness's reception we had to put our car's registration number into a computer as it's to attempt to prevent non-members of the gym to park in the dedicated car park. No doubt they have a number recognition system on their C.C.T.V. cameras which will tell who is parking there illegally. 

The swimming pool was very busy and I only did a couple of lengths and then went in the steam room (or 'drying cupboard' as I call it.) It was far too crowded with people swimming up and down and we then went into the jacuzzi and spent around 20 minutes just enjoying the warm water and bubbles. Once we had come and and got dressed we returned home to have breakfast and then went out to Sainsbury's to do some grocery shopping. While in Sainsbury's we saw a somewhat suspicious character, dressed in black and with a hood down over his face and Carol felt somewhat nervous as he had a bag with him. She wondered quite unnecessarily that he might have had some sort of weapons in this bag. As you hear so many stories in the news about terrorists and what I would call 'loose cannon' gunmen who run amock, one does winder about someone who looked a bit suspicious. 

We picked up a repeat prescription of my medication from the pharmacy and finished our shopping. When we returned to our car in the underground carpark beneath the supermarket and were leaving we saw a group of policeman either taking off some of their protective clothing in the back of a parked car, which we thought was rather surprising and then, when we were out and driving back home along the grid roads we saw a couple of police vehicles, a police car and then a riot van. It seems as if the police might be out on some sort of exercise or about to raid a property, connected with drugs or something. Not quite clear, but it will no doubt come out on the local news.

When we got home I checked my medications and discovered that one of the meds I have was missing, isoborbide mononitrate. I have enough for a week or so, but it was a bit annoying considering I had supposedly ordered via Sainsbury's pharmacy. I immediately rang them, and I was given an apology, but I think it may be the Ashfield surgery because they have prescribed meds which I no longer use and had to send back. As the N.H.S. is supposed to be cutting back on waste, it seems rather strange that they prescribe things I no longer need or use.

I have mentioned in an earlier post that I was working on a new piece of writing. I had the idea for the plot, and had written the central 'nub' of the piece, as well as some of the opening, although at the moment it doesn't work as I would have hoped. I have got a reasonably good idea how it will develop and I'm making notes. I find that, if a story doesn't work and I put it to one side and keep it, on the back burner, as they say, eventually the plot will come together. Infant, I have several story ideas that are in various stages of development. I should imagine that most writers would identify with this. It's surely better to have a number of ideas to work on and bring them out and work on them once plot construction has been developed. 

Doctor's Appointment

I went to Ashfield Medical Centre yesterday morning, arriving outside at around 7.45, having taken Carol to Tesco's in Oldbrook to buy sandwiches and other items for lunch as she can't seem to be able to get a decent snack for her lunch at The Academy. Another story for another day. It's been really pleasant and sunny for the past few days. There are a few other people ahead of me in the queue and soon quite a few draw up in their cars and join behind me. People seem to make a point of not giving any sort of eye-contact with anyone else and seem content to be plugged in with ear-phones to either their mobile phones or iPods or peering at their micro-screens rather than make any sort of conversation. It seems sad that that is the way society is going, no sort of human contact with a real person rather than with a gadget of some sort. The queue shuffles forward and eventually the doors to the surgery opens and we move inside. I manage to reach the reception desk and make an appointment to see Doctor Haye at 5 this afternoon. I return home and spent some time cutting the grass with the Flymo. It takes a good deal longer than it needs to complete the job. The length of the grass doesn't help, neither does the fact that the grass is slightly wet. Last year we didn't cut the grass for quite a while and it got so long it began to seed and it was a real jungle. When we let the dogs out they were barely visible. It is no good allowing the grass to get to that length so it's best to keep it short. Also, the uneven nature of the ground doesn't exactly make life easy, but doing the job in stages means I can complete the entire job over the course of the week. It's a very strenuous work and after a while I get some pain in my chest and arrms so I leave off and wind up the cable and put the machine back in the shed for next time.

I eventually make my way to the surgery for my appointment for 5, arriving at around 4.45. I find it's best to get there a good ten minutes before the allotted appointment as you can sometimes be seen before your set time if the surgery is running to schedule or another patient doesn't turn up on time. There aren't too many people waiting when I arrive so it seemed a good idea as well as being able to get through the traffic. You have to drive through the roundabout on Standing way which can become quite difficult if there is a really heavy amount of traffic. Fortunately this evening it wasn't too bad as it was before the usual going-home sort of time. Also, the weather was sunny and bright, no rain or other weather conditions bad enough to make driving hazardous.

My appointment eventually comes up on the digital display at around 5.10. Never mind the wait and my sitting and observing other people coming and going is useful for character-development for my creative writing. I go into the surgery. I have managed to make a list of things I need to discuss with the doctor. I have also managed to make a longer appointment as you are kindly told to make longer appointment with the doctors if you have more than one thing you need to discuss. Fair point when you consider that the appointments are supposed to be only ten minutes or so. One thing I needed to bring up was last week, when I was coughing on a regular basis, was when I was getting a pain in my chest, something like an angina attack. I can become difficult as you can imagine, having experienced a heart attack. Sometimes it can be very difficult to differentiate between 1- the symptoms of a heart attack 2- an angina attack and 3- a indigestion attack or 'heart-burn.' These there are very similar. having spent a few days coughing, and it has been a v very dry cough with nothing to actually cough our, there was no phlem to cough out, this coughing seemed to be responsible for the chest-pain. I cannot take certain cough remedies and have to be careful as some can interact with my medication. I have been taking one linctus which we bough over the counter in Sainsbury's pharmacy a few days previously. Also, merely sucking some sort of sweet or medicated confection which helps relieve the annoying tickling cough which usually develops when I lie down at night. Anyway, this chest-pain got really bad last weekend and into Monday when we went out for the day to visit Basildon Park. It concerns me to some extent that this is going to be a heart attack, and at one point I had to lie down until the discomfort in my chest subsides. I mention this to Carol, who had been coughing herself and had to spent time in bed because she wasn't feeling well herself. The discomfort I was experiencing gradually went off but as I had to visit the doctor anyway I decided to mention it to him. He listened to my chest and did a blood-pressure test and assured me that there was no problem with my heart. Certainly no chance of a heart attack coming on but I was glad that it wasn't serious. Not a good idea to ignore anything like I'd experienced. I had taken one or two of my isoborbide mononitrate tablets when the pain hadn't gone off last week. I had been prescribed this medication some while ago when I'd had fairly severe angina attacks and had to go into hospital. Up until then I had always used  a glycerol trinittrate spray which I had been given on prescription from the time of my original heart attack back in 2006, but I'd stopped having one for such times as I had an angina attack a couple of years ago.  When ever a bad angina attack happens you merely spray a short amount from the little bottle under your tongue and the pain is reduced. It does work, but I will keep this new bottle or spray in my medications box in case of emergencies. But now I was given a prescription to have a new one which I can use when and if another such angina attack comes on again. The doctor prints out my prescriptions and I leave the surgery and then go into Cox and Robinson's pharmacy which is conveniently located a short walk from the surgery. Within around 10 minutes they have made up my prescription and I leave and drive home.

I have been watching a really brilliant series on BBC2. Well, I have been downloading the episodes on iPlayer, so not actually 'on-air' as it's transmitted or recorded on our Sky+ box. The series is called 'Nurse' and stars Paul Whitehouse and Esther Coles who plays a community psychiatric nurse called Liz and we see her visiting her N.H.S, patients or to be politically correct 'service users.' Puts me very much in mind of my own work as a home carer as well as doing work with those with learning disabilities. We had to refer to our people we worked with as either 'clients' or 'service users,' both of which, to me are really clunky and sound peculiar. 'End-user' is another term I have come across which is even worse. I suppose it come from the Thatcher era when everyone and everything had a cost, had a monetary value when things were being privatised. Anyway, she visits a wide selection of different people in their homes who have mental health problems and is not what you'd describe as a 'bundle of laughs.' I don't think it's supposed to be a comedy in the loose meaning of the term 'comedy' but it has a much deeper meaning and purpose than a lot of what is put out on television but it's all the better that it gives a glimpse of this sort of work and makes the viewer think about mental health in a new way. What I am coming to is that when I arrived in the pharmacy having got my prescription from the doctor a few minutes previously, there was a young man in there at the counter who could have stepped out of one of those 'Nurse' episodes. He seemed to be dressed exactly like one of Nurse Liz's service users and even spoke like one of them. I think it made it seem more relevant this television series has been and how very well developed the characters have been. If you haven't seen this I can recommend it but don't expect a whole load of laughs although it does have a certain amount of humour in it, but in my opinion it isn't always the 'laugh-out-loud' comedy which works best but the work that makes you think that is often the best.

Running Out of Medication

I don't know how I managed it, but I used up my last pravastatin tablet last night. I'm usually very up-to-date with my ordering of the repeat prescription. I usually give plenty of time to ring up Sainsbury's pharmacy to get them to contact the doctor' surgery in Beanhill so as to have the order made up. It takes around a week for the process to be completed. I set up this with them to cut down all the running around and thus make it simpler. It prevented me having to go to the surgery with either a form, filled out with the relevant medication (I have five items. Just as well I don't have to pay as I'm over 60. A single item now costs £7.85. So, in total I would have to pay something like £40 per month. And apparently this isn't for the cost of the actual medication, it's for administration costs. I shouldn't have to worry as I don't pay it. I remember when I first had my heart attack nearly eight years ago I was on sickness pay and I had to pay prescription charges. Seemed crazy when you think that the medication I am on actually keeps you alive. I left hospital and was given the bill for my prescription medication and had to go back to the hospital pharmacy to pay. I imagine that different hospitals run by different N.H.S. trusts or whatever don't all charge because when I was admitted to Milton Keynes Hospital for a short stay when I went in when I had  quite nasty attack of angina I didn't have to pay when I was discharged and they gave me a complete month's supply of medication.

I usually keep a check on my stocks of medication and then give Sainsbury's a telephone call and this, as I say, kick-starts the ordering process. I have, in the past, also ordered on-line which is just as easy and efficient. So it will now mean I will have to go direct to the surgery when it opens at 8 a.m. tomorrow and stand outside in the queue and get an appointment as soon as I can and get the doctor to give me a prescription there and then and go with the paperwork to the nearest pharmacy to get the medication. There is a pharmacy near the surgery in Beanhill and it will be easier to get it done there as it means not having to move the car. I had chosen Sainsbury's pharmacy to have the repeat prescription done because several months ago there was a problem with the isoborbide mononitrate when they couldn't obtain stocks due, I think, to a problem in the manufacturing process and it was difficult to get supplies and Sainsbury's was the one local pharmacy who seemed able to get supplies and so I set up my repeat prescription with them and they do seem the most efficient and there haven't been any problems up until now.

Swimming and Trimming

When we went to Ilfracombe in August we stayed at a John Fowler holiday park. There was a swimming pool within the site and we could use it with no extra charge. I generally love swimming. In fact, it was one thing I did actually enjoy when I was at Rushmoor School. I learnt to swim there. We weren't allowed on my father's boats until we children could swim which seemed a good enough reason to learn. I believe that all children should be taught as you never know when you are likely to need to save yourself from drowning. I used to go swimming regularly at one time every Sunday morning at the Robinson Pool in Bedford. I hadn't swum since I had my heart attack in 2006 so when I went to the pool on holiday I was somewhat wary of actually getting in the water and what sort of stress it would put on my heart. I need not have worried. Although not a particularly strong swimmer I can do quite a few lengths of the pool without any sort of discomfort from angina. I find that if I take one of my isoborbide mononitrate tablets before I go it does prevent any sort of angina attacks. Since I was prescribed this medication I haven't really experienced a great deal of angina discomfort. 

When we came back from holiday both myself and Carol decided that we wanted to keep the swimming routine going and wanted to join a gym in Milton Keynes which has a swimming pool. After doing a certain amount of research we decided to visit a fairly recently opened gym, D.W. Fitness, which is located within the grounds of Milton Keynes football stadium. We had a tour of the premises and then had a free session. There is not only the usual gym factilities within the gym but a very well-appointed swimming pool which also has two spa-pools (Jacuzzis), hot room and even tanning rooms (which we don't intend using, but it's great to have all of this at no extra charge.) As I am over 60 I get quite a reasonable discount and Carol gets a discount being a member of N.A.S.U.W.T., the teaching union. We try to go for a swim at least twice a week, although we didn't go at all for around a month when we had really bad coughs and bronchitis.

On Saturday we went to D.W. Fitness as the gym opened at 8. a.m. It was very pleasant to have the place virtually to ourselves and then to just sit in the spa pool and chill out. We hadn't tried the hot room so we decided to give it ago on Saturday. We didn't spend too much time in there. It was very hot and steamy (!) but I think it would be a good place to go if you have a cold or even any sort of health problem as you would certainly sweat out any impurities. I have been building up my stamina and have managed around 15-20 lengths of the pool but having lost some time not swimming due to the coughs and bronchitis this has had to be built up gradually again from doing only about 10 lengths.

We are getting the benefit of this exercise and I'm sleeping better. In fact, on Saturday I slept on the bed for round an hour as I was so chilled out by 2 o'clock. Also, I feel more invigorated and have lost some of my tummy as a result. We want to buy two bicycles later in the year so we can add cycling to our exercise routine. As Milton Keynes has such an excellent network of cycle-ways (Redways) there is absolutely no excuse to not ride around the city on bicycles. You have no need to use any of the roads and you can pass under, or over, the grid roads instead of actually getting off your bicycle.

Problems With Isoborbide Mononitrate

For the past few months there has been a problem with one of my repeat prescription medications, Isoborbide Mononitrate. Not with me taking it, but it would appear that the factory that produces most of this drug has closed down. I had my repeat prescription made up at Asda's pharmacy in Bletchley at the beginning of this month and at the same time a review of my medications was done with the pharmacist. I imagine they have to do this regularly if you are on repeated medications and have a long-term health issue such as I have with my heart. I was told that this particular drug was to only be produced in 10 mg doses and that the 20 mg strength was to be discontinued, so I would need to get a new prescription for the lower dosage tablets, but then taking two tablets of 10 mg twice a day, at 8 a.m. and 2 p.m. I was put on this medication after my last hospital stay when I went into Milton Keynes Hospital after a particularly severe attack of angina. I had been using a Nitrolingual Spray for such attacks, sprayed under my tongue and allowing it to work by making the heart arteries widen to increase blood flow (I was put on this when I had the first signs of a heart attack by my doctor in Bedford back in 2006, and I eventually had a heart attack over the night of 17th and 18th May 2006. See earlier post for details of this.)

I have  sufficient  Isoborbide Mononitrate for around two weeks, so there was no urgency to get further quantities, but this morning I decided to get a doctor's appointment and get the doctor to give me a new prescription for either an alternative medication or re-prescribed for the 10 mg dosage tablets (ie 2 twice a day as I have already been doing with the 20 mg tablets for the past couple of years. I don't want to run out of this medication so it was important that I got the prescription so that if there were further problems obtaining the medication I had time to get to however many local pharmacies to get them to make up the order.

Anyway, to cut a long story short (this seems a very long story, so to cut it short would be a huge relief as it is or has caused a certain amount of stress, to say the least.) I dropped off Carol at the Milton Keynes Academy and then drove to the Ashfield Medical Centre in Beanhill to be in the queue so that I could get an appointment as soon as possible. Fortunately I was able to see a doctor at 8.30 and I was soon  out clutching my prescription for the new 10 mg medication and at 9 decided to go to Sainsbury's at The Hub to get some bread and to also get the prescription made up by their pharmacy. I was told that they would need to ring their supplier and have now been informed that they can get me the Isoborbide Mononitrate and will make sure it is in stock for me. I have further been told that prescriptions are to soon to become paperless, and that I will have to nominate a pharmacy so that the doctor's surgery can send the repeat prescription to wherever I decide so that the repeat prescription can be made up. This is all very well, but I am not so keen on the idea as what happens if the system crashes? Also, what happens if I order my repeat prescription on-line as I do now (it certainly cuts out paper and means I don't have to fill in the form and go to the surgery to hand it in.) and it doesn't go through for whatever technical reason (ie, crashes, computer goes down, or powercut, God forbid?) Anyway, I am reliably informed by the pharmacist at Sainsbury's that they can get the medication for me and that it will be delivered by around 3 this afternoon.

Blood Test

I had my blood test this morning. I had to be at the surgery at 10.50. The automated check-in system wasn't working. If you know what I'm talking about, you may have one in your doctor's surgery. It is a computer screen with a touch-screen and you have to input your age, sex, date of birth etc and it will then end by telling you the doctor's name you are booked in with. As it wasn't functioning it meant queuing to sign in with the receptionist. If you don't do any of this then you don't exist on the computer system and then you won't be seen and will be wasting your time. I also had to collect a repeat prescription. I now do this 'on-line' and this time I managed to do it using the Samsung Galaxy tablet. It does save having to fill in a form and then physically go to the surgery. Mind you, it isn't always fool-proof, because last time I put in my repeat prescription and I went to the surgery two days to collect the prescription, it was obvious that the system had failed and the doctor had to do the prescription the next day, but it wasn't too much trouble.

As for the taking-of-the blood. There was no problem and it went very well. I think it helps if I have had plenty to drink as I was told that being dehydrated doesn't help the taking of blood. The result should be ready on Friday. Also, the nurse did my blood pressure and that was found to be normal, thankfully.

I wanted to get Carol a present, as tomorrow is her birthday, and I had intended going to Sainsbury's so that I could get the prescription made up at the in-store pharmacy whilst I looked for a present. I got to the store and took the prescription form to the pharmacy and handed it over and was told by the pharmacist that they didn't have one of the meds on the list, isoborbide mononitrate. I was told that there was apparently a problem with supplies, due to the manufacture or something, and they rang to try and get this med from another supplier, but without success. I was then told that I would need to go back to the doctor's surgery and get them to substitute a similar medication on the prescription. So I drove back to Beanhill, where the surgery is, to then be told that the next-door pharmacy, Cox and Robinson, had a supply. Which is what I did and got the whole prescription made up. Problem solved. I THEN drove to Asda in Bletchley to get the present for Carol. Entire mission completed!

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.