Interview HA04

Age at interview: 63

Age at diagnosis: 62

Brief Outline:

Heart attack 2002. Thrombolytic (clotbuster) drug. Angioplasty and stent, in hospital eight days. Current medication' simvastatin, aspirin, ramipril, atenolol

Background:

Retired computer manager; Married, 2 children

The first six months were filled with medical appointments, convalescence and restrictions.

Although it was probably only a minor heart attack, it just felt like a major production at the time - the immediate impact was huge. The first six months or so afterwards seemed to be dominated by restrictions, remedial activities and medical appointments. But because it wasn't a severe attack I was able to gain some degree of physical ability and confidence quite quickly. 

After a week at home I started taking gradually lengthening daily walks, and I got involved in rehabilitation activity as soon as I could. In the first year afterwards we had three B&B holidays, of about a week each, touring parts of the UK we hadn't been to for years. Had it not been for the problem with blood circulation in my arm, I would by now be as near back to normal as I am ever going to be - though I have worked fairly hard at it.

The rehabilitation was a huge help, and vital in his recovery.

Initial contact was made in hospital and then I was later contacted at home with dates and times etc. The first stage consisted of four weekly talks lasting, with questions, about two hours each. The venue was a room in a local sports centre. The subjects covered were' how the heart works and common causes of heart disease; the standard types of medication used; the importance of diet and relaxation techniques. 

These were informal but high quality talks given by people who knew their stuff. Speakers included a senior theatre nurse, a hospital pharmacist and a hospital dietician. The dietician also did a supermarket sweep and dealt with issues like, what the labels really mean, economical buys for people with heart disease etc.  

The second stage followed soon after and consisted of two, one hour sessions a week, for eight or nine weeks, in the gym of the same sports centre. These consisted of appropriately graded and progressive exercises, in a carefully supervised format. Most people of my age are naturally a bit resistant to the idea of using a gym. 

I hadn't been in one for over fifty years and it seemed foreign territory. However the only kit you need is a pair of trainers and there's a very friendly and helpful atmosphere. Prior to falling ill, no one could have been more scathingly anti-gym than myself. Now I regularly attend the local gym twice weekly. This is not because I have some abstract target of fitness for it's own sake, but because I realise that if I want to remain fully mobile and active I have to put a bit of effort into it.

The first stage of the rehabilitation programme, the information meetings, help put an apparently arbitrary and frightening event into a less threatening and more understandable perspective. It also shows how the aftermath can be constructively managed to some extent by lifestyle adjustments. 

The second stage obviously improves physical fitness, but perhaps its greatest benefit is that it helps restore confidence. It demonstrates that even after quite severe heart attacks it is possible to gradually work yourself back to a fairly robust state of health. I personally found the rehabilitation scheme an enormous help and regard it as an integral and vital part of the treatment. Without it I don't know where I would have obtained the necessary advice and stimulus to get moving.  

He has side effects but reckons this is a small price to pay and they don't interfere with his...

Have you experienced any side effects from your medication ? 

Yes, plenty, both real and imagined. There was a time when I thought the statin I was taking was responsible for the pain in my hand and wrist, but that was just wishful thinking. However I do experience a number of real effects, but only one is becoming a nuisance and may need a change of medicine. 

I have a frequent and very irritating dry cough, which can escalate almost to a kind of retching. I've recently had a bad spell of bronchitis and I suspect all the coughing and hacking brought it on. My GP reckons it might be due to the beta blocker I am taking and is reviewing the situation.

It does take me time to get up to speed these days and I think that is a consequence of the medication as a whole. For example, if in the morning I walk a few hundred yards around the corner and up a short incline to the post box, I feel completely knackered by the time I get there. If, however, I continue walking for a few more minutes I get into my stride and can walk briskly for miles. It's a bit like doing a warm up period in the gym before getting stuck in.  

I also experience a number of minor reactions; my digestion is upset most of the time to the point of threatening to become inconvenient - I have a small supply of anti-diarrhoea pills just in case but have not yet had to use them; for a good part of the day my fingers are white and cold due to a restricted blood supply but other parts are quite the reverse. 

Unfortunately this is principally my nose, which lights up like I'm a bottle a day man. Apart from the coughing it's all minor stuff that doesn't interfere with my life. It's a small price to pay and I'm not complaining.

Had angioplasty when use of clot-busting drugs had failed. Describes signing the consent forms...

The A&E service was first rate; effective, efficient and reassuring. I was seen immediately and in what seemed like no time at all they diagnosed a heart attack in progress, explained what they proposed to do, got the necessary signatures and gave me an extremely welcome pain killing injection.

Did they admit you to cardiology?

Yes they did. The initial approach was to attempt to dissolve the obstruction in the heart artery and this appeared to be successful. After a couple of days I was moved to a general heart surgery ward. 

The next day I felt like death warmed up and decided that the thing I needed was a brisk shower and a shave. Afterwards I felt much better for an hour or so, but the pain returned in my arms, back and chest. Clearly the treatment hadn't stuck. 

You had a heart attack that day, a second one?

Well, I think I must have done. It certainly felt like it. That was the official view because I later discovered that a message had been sent to my wife saying I'd had another heart attack and had been moved back to cardiology. 

As I understand it, the initial procedure they'd used could be attempted twice, so they had a second go at dissolving the clot. My next memory was being told that it hadn't worked and they needed to move on to Plan B.  

Were you getting enough information about what was going on?

Oh yes. My recollection might be coloured to some extent by things I have heard or read since, but as I recall the medical team were meticulous about consultation and agreement. 

There was this form requiring signatures, which at the time struck me as being bureaucratic, but which I suppose is just part of the usual audit trail ensuring patients have been properly informed and medical staff provided some protection in the event of things going wrong despite best endeavours. 

The doctor doing this liaison certainly got across in general terms what was involved in an angioplasty and stenting, and the risks of damage to a blood vessel or inducing a stroke. I'm sure I was also aware of possible recourse to more major surgery as a matter of urgency if things did not go according to plan. 

I deliberately took ten minutes or so to get my chemically scrambled brains to think through the situation. So information provision linked with formal agreement to undertake a medical procedure simply can't be faulted in this instance.  

How did you make the decision to have an angioplasty?

Well, in truth there wasn't much of a decision to be made. I had complete confidence in the medical team and they had a clear course of action in mind. There weren't any options on offer to agonise about. In those circumstances you'd be foolish to do other than go with the flow. Always provided you had fully understood what you had let yourself in for.

He quit smoking after his heart attack to help his recovery.

You said you were smoking up to your heart attack.  How did you manage to stop?

Yes, although for several years previous to it I had more than halved my consumption to twenty or so a day. Well, a week in hospital without so much as a crafty drag was a good start. Thereafter I just put cigarettes out of my mind. I did not need anything to help with the transition. 

Despite what is said about the powerful addictive nature of nicotine, if you have a strong enough motivation then giving up smoking is not at all difficult. If on the other hand you are applying will power to something you don't really wish to succeed at, then neither chewing gum, patches nor hypnotism are going to be much help.

In my case the motivation was the threat to physical activity  I've never been remotely athletic, or a regular player of sport, but I do like walking and I positively seem to need the more active aspects of gardening and DIY. The immediate consequence of a heart attack made me realise how much I prized this sense of physical freedom and how much it was threatened. 

On that basis anything that might restrict or delay recovery was automatically out, and smoking was the most prominent candidate.

Speak up if you feel your needs are not being met.

I'm a bit diffident about this next piece of advice because we all know the system is over-stretched, cases have to be prioritised, and we just have to wait our turn. Nonetheless, I would urge people not to be afraid of speaking up if they genuinely feel their needs have not been properly understood or they just seem to be falling further behind in the queue. 

Looking back over my experiences I can see at least three points where I should either have followed my own instincts about the seriousness of the situation, or made more of a song and dance about the difficulties I was experiencing, or tried to hurry things up a bit. I think I did neither the system nor myself any favours by not doing so.