Cholesterol update

27. 02. 2013 at 19:29

Just latest health update

I posted a detailed piece a few years ago on Cholesterol and was happy to report my level had dropped from over  6 down to 3.5.  I had a blood test about four months ago that showed it had risen to over 5 so I’d gone back on the doctor’s radar. After a meeting with the doc I was changed from Simvastatin to Atorvastatin which is a stronger option. The latest blood test shows I’m down to 4.3.

HDL is at 1.04 and LDL is at 1.85

That puts me off concern but I’m still above where I should be – I need to become healthier but struggle doing gym style fitness as I find it so dull.

Anyone got any good ideas? I’m fair walker, get up hills a few times each month and I eat loads of nuts and fruit and less cheese / curries.

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Cardiac Rehab Exercise

01. 09. 2009 at 20:58

leap across the millstonesThe final stages of my rehab program have come in to play. I’m now attending a Cardiac Rehab Exercise class at the hospital.
It’s a series of 12 sessions aimed to teach you how to exercise correctly following a heart attack.

The process is like a circuit training session on sedation.

The first session was strange. A class of 12 or so middle to older aged people all shuffling about for the 15 minutes graded warm up.

The warm up, it’s explained, is to slowly get your body and heart ready for some moderate exercise that follows. The warm up is less strenuous than walking into the hospital, but it’s using each muscle and gradually building up to make you ready for the circuit that follows.

The circuit is a series of cardiovascular based exercises, that takes about 30mins to complete. While doing the circuit you push a little to begin to deepen your breathing, with an aim to reach a moderate breathing level. One where you can still hold a conversation without gasping. It’s all measured on the Borg scale. A scale introduced by Gunnar Borg that rates from 0 to 10 (o being nothing at all and 10 being extremely hard) We have to aim for 3 4 or 5 (moderate).
The circuit is followed by a 10 minute structured cool down. The warm up in reverse.

And then it’s tea and biscuits.

You have your blood pressure and heart rate read before and after the session.

Having been a fairly fit person all my life I’m finding it difficult to adjust to this very sedate process, but I’m doing as told.

Once the session is complete I can go off to a normal gym and start to build up my fitness program.  My aim is to become fit enough to climb mountains again.  I really want to revisit Striding Edge, but for now I’ll have to stick with places like Millstone Edge (that’s where the photo above was taken yesterday)

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What are the odds?

08. 07. 2009 at 13:19

As many who read my occasional diary know, after my heart attack it was discovered that I had a totally blocked artery, and the remedy was an attempt at doing an angioplasty. I arranged a consultation with the cardiologist, Dr Grech, who put my mind at ease and said he had a 70% chance of successfully unblocking the artery. In my mind that’s a high chance of success. It’s certainly at least a glass half full situation. And, at the end of the day, even if it couldn’t be unblocked, there are alternatives.
So I decided to go ahead.

Since that day, the bit that’s concerned my is the odds within the angioplasty procedure. The risks are explained in advance.

Firstly, there’s a 1/100 chance of a groin injury – the angioplasty is performed by inserting a tube into the main artery in your groin and then feeding a catheter through up into the heart. Then hole is a couple of mm thick in the artery, so is plugged up at the end of the procedure to stop the bleeding. I guess it’s quite a strain on this area hence the risk. Now I’d rather have discomfort in the leg/groin than the blocked artery in the heart, so I’ll happily take that 100 to 1 gamble without too much worry.

But there’s also a 1 in 100 chance of a stroke, heart attack or fatality…and it’s this that’s been playing on my mind for a few month since my last health blog post, while waiting for the date of the procedure.

I thought I’d share how I coped with this. If coped is the correct word. I’ve gambled a few times in my life and enjoy playing games that involve the role of a dice. So on one hand I had the thought that 100 to 1 was pretty risky, but on the other hand, and this is the thing that gave me a glimmer of hope in my half empty glass head, is the fact that I rarely get a £10 win on the lottery (54 to 1 chance); I rarely get number 23 on roulette (36 to 1) and would I bet on a 100 to 1 horse? I have done, but I never expect to win. Even down to a roll of a dice. How often does 6 come up when you need it (6 to 1)?

So still with a sprinkling of doubt I entered the procedure room at about 9.15am yesterday in a fairly relaxed (well I hadn’t any brown stains in my pants) state. An hour or so later I was out. I had a sore leg, an aching heart, and three inserted stents, but I was still alive. Of course, I have to thank the skilful cardiologist and his excellent team. And I guess the next time when I’m presented with a health odds situation I’ll feel less anxious.

So anyone reading this with the decision ahead of them, I’d recommend going ahead. Of course this is just an opinion I’m no medical expert – so please seek professional advice.

Stents – good or bad?

12. 03. 2009 at 10:02

I finally got to know an outcome of my next stage of recovery…and made a mistake of doing a bit of research on the web.

I have a totally blocked artery. Fortunately my heart has compensated and grown another artery path near to the damaged area so blood is being supplied. This puts me in a mid way position between a routine stent operation and bypass. It seems it’s going to be a complicated stent procedure, but I’m told being performed by a very good specialist.

So I have a look on the web and the first thing I see is an advert right at the top “Stents are very dangerous” It goes on to sell some wonder medicine that thins out the damaging plaque to unblock the arteries and make you all as new. If I was a blocked sink I guess it’s the difference between calling in a plumber for either rod plunging which normally works well, or a more complex repiping, or just buying some drain block acid.

I start to look at medical sites and many talk about the ease in which stents can be put in…one referred to surgeons doing stents in the same ease they change tyres. But do doctors actually change tires? 😉

The odds
There’s a risk with a stent that the body may not like it and react, or that the stent cannot be manoeuvred into place correctly and cause complications, or that you have a stroke. The odds of dying in hospital are, according to a British Heart Foundation leaflet, about 200 to 1.

There’s some recent research that suggest if you don’t have the stent at the same time as you experience the heart attack there’s not a great benefit from having one fitted later to prevent further attack. Their research indicates that you have as much chance of survival taking the medication that’s prescribed.

So I’m now in a dilemma. Do I have a stent or do I take my chances? I am currently getting chest discomfort when I exercise, but it’s not unbearable. Do the plaque dissolving methods work or is this just another age reducing/baldness curing un-wonderdrug?

I will be seeing the specialist for a pre-stent assessment. I have a few questions. I’ll add my findings here.

If anyone’s been through any of this already please feel free to send me a comment it will make for useful reading for anyone who ends up in the same position in the future.

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I never thought I’d consider my diet!

06. 03. 2009 at 12:01

Following a heart attack you start looking at your life in new light. In my case excessive weight, lack of fitness or smoking could not be attributed to the cause…but one thing that I can change is my diet. Particularly my cholesterol level, which, at 6.6 (post heart attack), is too high for today’s standards. The guideline for UK today is around 3. I was put on statins which reduces this level but it’s time for a diet change as for years I’ve been doing it wrong – very wrong.

Two things I ate almost daily where cheese and chocolate…not together I might add.
I’d have cheese on toast, cheese in sandwiches, cheese on pizza, cheese in dishes.
And, in the evening I’d have a bar of chocolate with a pint. It became regular, and addictive. I’m told cheese can still be eaten, but not the hard variety which tends to have more fat. Basically, if the cheese tastes strong and lovely, like mature cheddar, it’s probably no good. If it tastes bland like Edam it’s better.
And milk chocolate is the one I’d reach for, but plain is the safer choice. I’ve had about two bars of chocolate in three months and miss it badly.

Things I ate weekly: curries, fish and chips, ready meals. I’ve had fish and chips once since and ready meals have been stopped completely.
I love curries…the ones I like are cooked in Ghee (Indian butter). It’s about as fatty as you can get. I enjoy a peshwari naan alongside and pilau rice. In curry terms these are three big bad items. We should be eating dry meals such as Tandori or Shashlik, but I like those runny dishes that soak into the fried rice and go well with the coconut naan.
The naan should be plain and the rice should be boiled. I’ve had two “proper” curries since, and the temptation to go back to what I really enjoy was too great, I can live without the peshwari naan and the pilau rice, but not the flavour rich jalfrezis or dopiazas. Once now and again won’t hurt, he mutters with fingers crossed.

Five a day!
If there’s one thing that’s been well and truly drilled into us it’s the message – five a day. We’ve all heard it, but do we take notice? I didn’t, I do now! So what is five a day? We know it’s fruit and veg but how much? Here are the requirements for an adult:

Something the size of an apple is classed as one portion
A plum or kiwi is half a portion so two would be needed to make a portion
A larger item such as a pineapple would require a thick slice
And a small item such as a grape would need a handful
Dried fruit counts (you need a tablespoon’s worth)
A 150ml glass of fruit juice
A dessert bowl of salad
2 tablespoons of any veg, raw or cooked

Have fruit with breakfast, as a snack and after a meal, include veg with a meal and a glass of juice at some point in the day and you’re sorted.

Something fishy
I regularly ate tinned tuna in sandwiches, and was eating it because I thought I was being healthy. I had no idea why, but thought, it was fish, so it was good. The reason you need fish is for the Omega 3 oils. In tuna it’s unfortunately removed in the canning process, so you need to switch to mackerel or pilchards if canned fish is your thing. Fresh Tuna’s fine.

Milk round
I’ve had semi skimmed milk for years and at least that’s one thing I don’t need to change. I’m told there are some new skimmed milks doing the rounds that have flavour, but that remains to be tested by the Bargh palate.

I also cook using Olive oil which is the best route but reduce the amount of oil you use.

I’ve used spreads as a butter replacement for years too, but there are some that are better than others. Make sure you choose a spread with less than 15g of saturated fat per 100g, and spread thinly.

Are you nuts about nuts?
Research suggests that nuts can reduce your chances of heart attack by up to 35%. This is because they are shown to reduce low-density lipoprotein cholesterol (the bad cholesterol)
My favourite nuts are cashews, but the best appear to be Walnuts (they contain Omega 3 fatty acids) and Almonds that are rich in protein, vitamin E, manganese, magnesium, copper, vitamin B2 (riboflavin), and phosphorus. Other healthy options include peanuts (not Bombay spiced!), pumpkin seeds and cashews.

As a disclaimer I must state that I’m not a dietician just following advice I’ve been given or read. It’s not conclusive; I’ve just scratched the surface, but it may give you a lead to research further. But be warned you will find lots of conflicting info.

btw my cholesterol level is now 3.5. So something’s worked.

Medication post Heart Attack

23. 02. 2009 at 11:56


Nothing can really prepare you for the life changes following a heart attack. Apart from the uncertainty of the future, the restructure of life-style and diet, one of the main changes is medication.

For someone who refused to take tablets when I had a headache or pain, suddenly been told you have to take several, for life, is quite a shock, well not as big a shock as a  heart attack, but still.

Post heart attack there are several things that need to be controlled. In my case these can be split into four areas and involve taking five tablets-

  1. Blood Pressure (using ace inhibitor)
  2. Blood thickness/clotting ability (using aspirin and anti-platelet drug)
  3. Cholesterol (using statin)
  4. Heart rate (using beta-blocker)

Blood pressure is reduced using an ace inhibitor. Ace stands for Angiotensin Converting Enzyme. This drug reduces the activity of this enzyme, making arteries relax and widen, so the blood can travel under less pressure. The effect is your heart receives more oxygen. I take Ramipril.

Possible side effects
Dry cough

Anti Platelet
Blood clotting is one of the main causes of a heart attack. Blood clots in a narrowed artery and blocks the path so the heart cannot function correctly.  The reason for this is that the platelets (small blood cells that clump together to form a clot) are sticky. Anti-platelet drugs reduce the stickiness. I now take Asprin and Clopidogrel.

Possible side effects
Stomach bleeding

Cholesterol is seen to be a serious problem for our bodies. There are two types – one good one bad. The statin’s job is to reduce the cholesterol level but we can make big diet changes to reduce cholesterol naturally. Well, balance it actually, because the good cholesterol has important role – more about this when I touch on diet in a future blog
I take simvastatin,  the other common option is atorvastatin

Possible side effects
Sick feeling

Beta blocker
Reduces the amount of work the heart has to do slowing it down this reducing the risk of failure. It’s like driving at 56mph in a car. You get better petrol consumption and there’s less chance of blowing a gasket  (or what ever the mechanical/electronic term is today).
This drug blocks the affect of naturally occurring substances called catecholamines. I take Bisoprolol

Possible side effects (minor)
Cold hands and/or feet
Disturbed sleep
Depression and or anxiety
Shortness of breath

I also have a Nitrate spray which I have to carry should I get an attack of angina. This spray (sprayed under the tongue) instantly reduces the muscles in the walls of arteries so the blood supply to the heart increases and it gets a quick dose of oxygen.

Other medication you may be prescribed
Calcium channel blockers
Anti-arrhythmic drugs
Potassium channel activators
So lots of drugs and many times more potential side-effects. Fortunately I have just three…cold feet and hands, shakiness (a feeling of lack of sugar type of shaky not nervous) and un-restful sleep pattern

next time I’ll look at diet changes

…to be continued

ps: this is just a light guide of my observations please seek correct medical advice should you need it.

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The Treadmill test

12. 02. 2009 at 10:37


A few weeks past before I received an invitation to take a Treadmill test. As the Angiogram had proved I had a heart problem this test is required to see how the heart copes under pressure. Another name for it is an exercise stress test.  And the medical name is Exercise ECG.

Don’t have a heavy meal before your appointment and where light comfirtable clothes with trainers or running shoes.

At the hospital you meet up with the nurses. Two are present to ensure you are in safe hands.  You remove your top and the patches are stuck to your chest so the ECG can be connected.

You are monitored before going on the Treadmill. For those who don’t know what one is it’s just a flat surface, large enough to cope with a huge stride, and is like a caterpillar track that revolves around. The speed the track moves can be increased and as it moves you walk or run to keep up with the movement. There are bars at chest height that you can hold on to for stability.

You are then asked to step onto the treadmill and the exercise begins. You walk steadily for 3mins and then you are told that the speed will increase. The machine can also be set to simulate a hill so the incline is adjusted too. This means that you are starting to do more strenious exerice and the ECG and any discomfort you feel will tell the Doctors how the heart is coping.

Prior to the heart attack I considered myself very fit. At 5mins I was feeling the pressure, discomfort in the chest and weary. The speed and include is increased at 6mins and then I was really feeling it. They stoppped the test at 9mins.

Throughout the test ecgs were printed off so the Doctors could eximne the changes. And A further three were recorded in the five minutes following the test to see how the heart relaxed down.

I had to wait a few days for the results which were positive. I thought that was a good sign but in this terminology positive means there’s still a problem.

So the latest news is I’ve been referred to a specialist at the Northern General in Sheffield and I await the outcome of their finding and what course of action will be taken.

It’s now just over two months since I had the attack and I feel fine. Apart from when I lift things and I get peculiar chest feeling or when I walk fast. I’m still only allowed to walk for 30mins per session. So I usually wander off around the locality trying to vary the route each day to make it interesting.

It’s funny how you start to take more notice of your surrounds when there’s nothing else to do. I’ve never taking such an interest in how the locals arrange their gardens.

…. to be continued

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the angiogram

21. 01. 2009 at 15:36

An angiogram is a way to determine the condition of the  arteries in  the heart. The doctor puts a catheter (fine hollow tube) into your artery from your groin region and feeds it up to the heart and then pumps dye into the heart so that any artery blockages or problems show up on xray.
You are told that there’s a 1 in 1000 chance of death or a stroke and sign a consent form. I had a certain amount of concern over this element, but not of the procedure itself.

I arrived at the hospital at 8:00 am on Christmas Eve. The ward was quiet, just three patients having the treatment. I was second in line. It’s a very smooth process. They can perform 12 per day in this hospital. You are told in advance to shave the left and right of your groin area. I looked up on the net to see if I could see where the insertion was made so I could determine where exactly to shave.

A photograph of the bruise from the Angiogram

A photograph of the bruise from the Angiogram

I couldn’t find anything so for anyone about to proceed with this treatment, you just need a clear area around the crease of your inner thigh – see pic (area highlighted by red frame is where you need to shave -on both sides)). Hopefully this will reassure you.

The photo also shows the bruise caused by the process taken one week later. Now as I write this, I just have a very faint outline of that bruise. (Edit it took one month to disappear completely)

Is it painful? If you can put up with needles no! The area around your groin is numbed with aesthetic so you just have a weird sensation of the insertion. You lay on a bed and a large 14-16in plate is manoeuvred over your chest area to get a good xray of the heart from all directions. You are asked to take a series of deep breaths and hold as the xrays are taken.

I’d read in the book that I may feel weird in the groin as though I was peeing myself, and also that there may be a hot sensation in the chest. As I lay watching the x-rays being made – I felt none of this. But then when I thought it was over the surgeon said that I may feel the peeing and heat. And I did, but it was just like butterflies you sometimes get and nothing too uncomfortable.   The whole process was about 30-40mins.

To reassure anyone with this a head of them don’t worry it’s no worse than a trip to the dentist for a filling – if anything less uncomfortable. And you wear paper pants so you’re not exposed.

After the treatment A nurse holds padding over your incision point for a few minutes and then you take over for 15mins. Make sure you’re comfortable!

Then you are wheeled back to your ward. You have to lie still for one hour. The you can sit up for an hour, then get out of bed and sit in a chair for an hour and then put your clothes on and return home. During this rehab session the consultant shares the results with you.

It turns out I have a totally blocked artery that cannot be opened using stents. Fortunately a nearby artery is providing necessary blood to that muscle, but I’m told I need to have treadmill test to test my heart stress levels and determine whether an operation is needed.

My leg ached for a couple of days but nothing problematic.

to be continued…

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back home – after the heart attack

21. 01. 2009 at 15:11


After a five day period in hospital I return home with a selection of medicines, a weary body and a mind of mixed emotions. I have a collection of British Heart Foundation leaflets covering the various issues/solutions to my new problem. These include detailed guides to angiograms, surgery, reducing cholesterol, medication and diet. There are many books in the series and they are really informative. I also have a guide written by the local health authority explaining the various phases of rehab and am told I will be receiving a letter in due course to confirm a angiogram. I will also get a visit from a rehab nurse to see how I’m coping.

Despite the trauma. I actually felt generally okay. Slight pressure on the chest and tired, physically and emotionally, but not bedridden.  Guidelines for week one and two are quite strict and very rest based. 10mins walk per day, no lifting, no using arms above head when showering, no work, no sex. Basically chill, do bugger all. The weird thing is that you cannot see any damage. And the best way to describe how to react is consider the heart like a broken arm or leg. It’s put in plaster and you avoid bending it until it mends. In a way the heart is the same, but you cannot see that you’re “bending” it. I’m glad I had this analogy or I would probably be back in hospital by now.

My company had placed strict no-go restrictions on my access to work, as they knew I’d be back in straight away! So TV called. It was a chance to watch lots and lots of TV. About five minutes of Jeremy Kyle made me realise how well I’d been protected from such stuff by working.  So I relived some DVD moments. I watched the set of Planet of the Apes movies, Bang Bang Reeves and Mortimer, Monkey Trousers, first to third series of Peep Show and mixed this with some History channel, Dave repeats and a bit of reading.

Time actually flew by. Each day I spent 10mins walking around the house until I felt comfortable going outside. The first few days outdoors (freezing cold) brought back the pain I’d experienced prior to the heart attack.  I couldn’t determine if this was angina or the next stage of early warning signs  The a would determine the state of my heart so the consultants would have a clear idea of the next stage.  A letter came through to let me know that my angiogram would be done on 24th December.

to be continued…

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From A&E to the CCU

01. 01. 2009 at 15:07

…this continues from the heart attack post

Having spent around four hours in A&E, suffering a heart attack, is was told a bed was available. Lyn, the nurse, apologised for the delay and said that the journey up would be fast.  The porter arrived and he pushed the bed while Lyn controlled the drip – it all happened in a flash and in moments I was being told to shuffle (very carefully) across from the A&E bed onto a bed in the CCU (Coronary Care Unit).

Three other beds occupied the large space. Each one with a patient hooked up to drugs via an intravenous drip and to ECG machines to monitor their condition. I was still in pain so the nurse administered some more morphine.

I was connected to two drips – one was Heparin to prevent the formation of blood clots and I think the other was Isoprenaline to slow the body down, but I can’t remember. These were attached for two days, along with the ECG, so made sleep very uncomfortable. I didn’t get any the first night (Monday 8 December).

The only pain I had was a headache from the drugs and backache from sleeping uncomfortably. The feeling in my chest was tight but not painful. It was hard to describe, but the symptoms did result in the doctors considering moving me to Sheffield for further tests. On day two their concerns reduced so I could stay in Bassetlaw.

The experience reminded me of a long haul flight. You watch the hours, minutes and seconds pass, each minute becomes slightly more uncomfortable. As you try to sleep on a plane you are interrupted by passing trolleys hitting your seat, duty free requests, or an air hostess asking you if you want a drink, or the fasten seatbelt noise alerts, or the nearby cry of a baby, or someone talking annoyingly loud, or the dull sound of the engines, while you continually shuffle in the tight space to gain comfort.

In the hospital bed it’s similar but just a larger space and less rocky! I was constantly woken from my drowsy state by blood tests, other patients calling out, machines randomly beeping, visitors popping in, nurses checking up on you, shift changes,  tea breaks…and all along in a bed that I couldn’t move from or adjust easily.

Day two was easier – I was allowed to dangle feet and have a bed bath. The bath was a nightmare – a bowl on the trolley, doddery on the feet, wires and tubes everywhere and a flannel. I did the best I could. I have to say it was a huge relief when three days later I could walk to the shower and get a proper wash.

I spent five days in hospital – discharged on the late afternoon Friday 12 December.

Throughout the stay I found the nurses and teams were incredibly good. Working long shifts, limited breaks, always smiling, always their to help. You could pick up that they have issues with working conditions, but all gave 100% to patient care. And bizarrely we are in a unit that encourages patients to change lifestyles – relax more, eat better, exercise correctly, work more effectively etc, and here was a prime example of what not to do, nurses rushing from one situation to the next, missing breaks, eating on the go, working 13 hour shifts, working with terrible colds, etc.

…to be continued

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