Interview HA14

Age at interview: 51

Age at diagnosis: 51

Brief Outline: Heart attack February 2003. At time of interview, waiting for an angiogram. Current medication' aspirin, ramipril, atenolol, GTN

Background: Farmer/Teacher; Married, 2 grown up children

He felt he could do more than his wife thought he should be doing.

So I was in hospital ten days and did a successful treadmill, which is sort of passport to get out really. That was easy because I was fit. And went home, you immediately feel very inadequate at home. Of course [my wife] was anxious as well when I got home because it was all down to her then which was worrying and she wouldn't let me do a thing, which was very frustrating. You know I mean, hospital's all on one level, obviously we've got stairs here, to go upstairs. 

She said, 'no you're only walking up the stairs once, don't come up and down two or three times for this and that, you're going to bed you're just going to tackle the stairs once a day and this sort of thing.' And I thought, 'well that's ridiculous because I certainly felt a lot stronger than that.' But well I try to do as I'm told [laughs], it isn't easy.

Is that hard then, when you're feeling well?

Yes, yes it is and I felt oh don't make a fuss. Please don't make a fuss. In a way that made me feel worse. It made me feel an invalid and I wasn't an invalid but [my wife] was only taking good care of me, which was wonderful. 

Achieving different milestones during the first year, helped him feel that he was getting back to...

You want to get back to normal as I said before, that helps you cope as well. I didn't enjoy having a month without driving although I could see that was sensible but you want to get back to normal, that helps you. As soon as I could start to drive myself, even though I didn't go very far, just up to the village for the papers or something like that. 

That was a big boost, you say, 'Oh I'm getting better, I'm getting back to normal.' And then going back teaching, going back to work is a big, big hurdle as well. And the first few days you think, 'Oh gosh, how am I going to cope with this,' but that goes well and it helps you mentally. And so I've been out teaching for the day, I come back and I haven't thought about my heart for the day. 

Whereas when I was at home, that's all you did think about to be honest you know, you tried to listen to the news and read the paper and so on but it's always in the back of your mind that you know there's something wrong with your heart. But as soon as you get distracted by your work or things that are going on and you can participate of them, it does help to get over a heart attack. 

He found the heart manual marvellous.

The heart book has been marvellous, I haven't mentioned that. That, that was introduced to me in the hospital and I kept that faithfully. I'm fairly organised person and I can keep a diary, I do anyway and to read that every day was very, very helpful and fascinating. Lots of it didn't apply to me, like being overweight or being a smoker or drinker but lots of it I could identify with and say yeah that's me.

It's a fascinating book. It takes you through six weeks at home, the first six weeks at home after a heart attack and it will help you build up your exercises bit by bit, which wasn't all that relevant to me but I still did the exercises that they recommended and walked a bit further each day and that sort of thing. 

And then it encourages you to start with at least to keep a food diary of what you've eaten and then gives pages of approved food and others that are not, not so good for you. So that was good. 

And then the heart manual talks about adjusting your lifestyle really and that's been really good. To be able to, to space out your work really and I, I always wanted to get everything done at once, this was me you know, fit as much in a day as I can until it's time to go to bed or until you drop you know [laughs] and you can't do any more and after a heart attack you realise the futility of that really. 

Talks about going back to work as a teacher.

I was a bit nervous about going back to work, although I wanted to go back to work. I'm getting angina very occasionally now and I'm wearing, I keep this [GTN] spray round my neck on a piece of string because it's all right for ladies, they've got handbags but men haven't you see.

Anyway I keep it round my neck and that's very reassuring to know that's there and going back to teaching was a bit, a bit nerve wracking to start with because I thought well what if I have an angina attack, will I be able to stop mid lesson and take a spray under the tongue and sit back and rest. But that situation has never arisen mainly because I think I have still paced myself, even though you know I'm back in a busy environment. 

I've prepared my day before I go to do it the easiest way, to make it as simple and flow as smoothly as possible which has worked and at the moment I'm only getting angina when I'm excited not when I'm stressed. I mean, I never thought I was a stressed sort of person. People said 'Oh [patient's name] doesn't seem a stressed sort of person.' I don't think stress [is] a cause of my heart attack. 

I think probably being too busy, trying to do everything was one of the causes but not stress, because I could just sort of drop things and forget. But teaching could be stressful but I've tried to plan everything so it doesn't cause stress and so far it's been good. 

The ACE inhibitor made his heart beat loudly when he took it at bed time.

I take two aspirin and then I have a beta-blocker and an ace inhibitor; that's four. And then I take another ACE inhibitor in the evenings as well. That was a funny thing because the ACE inhibitors, I have another one in the evening and I usually go to bed you know, well it's bedtime I take the pill and go to bed. And as you lie in bed waiting to go off to sleep, the ACE inhibitors which if I'm right they open up the arteries. 

They really make your heart beat loudly, you can really feel your heart beating. Which in the first few weeks while I was home, I said, 'There's something wrong here, I'm getting worse, this is terrible.' But we've got a doctor friend and well we've got two or three people that have had heart attacks that we know of. 

Speaking to them, this is quite normal. I've lost an artery; there are other arteries that are having to do the work and they've got extra blood to carry and because I've just taken an ACE inhibitor, they all open up a little bit and they feel strange, they feel different. And there've been times when I've lain on the bed in the evening waiting to go to sleep and I felt that I could feel every artery in my chest sort of pulsing, carrying blood around. 

But I've been told this is quite normal, so I've learnt to live with that now. And sometimes if it's early evening and there's nothing else that I was doing, I take the pill then and while you are reading the paper or watching television, doing something you don't notice it actually. It's just that when you go to bed and you've taken the pill, the pill is sort of in first mode of action really and it's opening up all those arteries and making them feel very strange.

Describes the benefits of using relaxation tapes.

And the relaxation came much easier with these audio cassette tapes. There's two tapes that came with this, from the [local] area health authority and the first tape just gives you questions and answers that typical people with heart attacks would ask and the answers, and then the other side was for the spouse. 

And then the second tape was a relaxation tape, which was amazing. I mean I've always poohooed relaxation, you know, think it's a bit oriental, a bit weird and unusual but relaxation in these tapes was completely neutral. There was no religious undertone or anything, which I've always thought of as relaxation; Maharishi and that sort of thing.  

So the relaxation they went through was just sitting in a chair in a quiet room with low lighting and just getting yourself very comfortable and just letting each limb go looser and looser. And then the second stage is breathing. Being able to breath very regularly, very shallowly, very, very, without much energy involved, no deep breath, just a steady breath. 

And then the third stage is to imagine yourself in a favourite place, like on a beach or under a tree, or by a stream or somewhere just that you know, that you like, that you can be completely relaxed in. And those three stages; by letting your limbs go and then your breathing and then imagining a place that you're relaxed in really works. That really works, I'm very impressed with that. 

Through using relaxation tapes, he can now relax within two to three minutes and he recommends...

Did you find you were able to do it? Was it hard?

I didn't believe I could do it to be honest. We, my wife and I, we did it together and she said it helped her as well but I've kept it up obviously because I was the one that had the heart attack. 

And you get better at it all the time. It really is worth persisting and now I can relax much quicker whereas it would have taken half an hour to actually get in a very relaxed state before when I started; now I can relax within two or three minutes. 

You know how to sit and how to breathe and it all comes very, very quickly. You know the bits that you find are tense; in me it helps me to drop my shoulders, your neck and your shoulders sometimes are tense when all the rest of your body is relaxed. You know I can do that very quickly and that helps a lot. 

Brilliant techniques, absolutely brilliant. So you know, the tape says there's lots of books about relaxation as well which are all equally valid you know it isn't just that system that comes from the health authority but get a book on it if you're struggling or you think you could do better. I would recommend that.

Taking the GTN spray was difficult at first but he soon got used to it.

But I wouldn't recommend anyone doing what I did because I was here on the farm after about three or four weeks, still wearing this spray around my neck and doing something in the yard, getting excited about doing something, I can't remember what it was even. 

And I thought I better take a spray here, I'm not feeling too good and then I wasn't very used to using this spray, you have to aim it under your tongue you see. 

And the first one I sprayed mostly on my teeth, I thought well that's no good. So I sprayed again and it went on my lip and it wasn't until the third one, I tried again the third time that I actually sort of satisfied myself that I've got it on, because I was panicking and thinking about angina and everything else. 

Gave myself three doses of this spray and I fell over. I completely collapsed, I just couldn't believe it. It just, it lowers the blood pressure so much that it's virtually zero. And when I hit the ground, I woke myself up again and I staggered in and Lynn [my wife] was here and gave me a cup of tea and sat down and didn't do anymore for the day. 

But that frightened me, I thought is this another heart attack but of course it wasn't. But that [GTN] spray is pretty powerful stuff.

Had they given you any warning that might happen?

No, no, when I left the hospital it came with my pack of pills and another [GTN] spray and the nurse had told me then that if you do feel angina or any chest pain, give yourself a spray under the tongue or she said, even two if it's bad, so I thought two would be all right. But I hadn't had any experience of using it, you see. 

When I was in hospital I did have it administered for me, the nurse said hold your tongue up and just sprayed it in for me, which was easy. When you do it yourself the aim is a bit doubtful. So you get used to that. I didn't expect it to hit me like that either. 

Of course it says on the packet, that's something that I learned, if you read the label, the slip that comes with the pills because a lot of these frights that I had with the sort of palpitations and feeling arteries pumping with blood. I thought gosh you know what's happening here, this is another heart attack. 

Then one day I took the tablets all out and I took out the little leaflet that comes with them and saw all the contra-indications and when you read all the things that could happen with the pills and the side-effects and how you should take them and everything, yeah, that's me, that's what happened and it's not so unusual. 

So I would recommend anyone who gets pills, not just to read the box but read the slip inside as well.

He gets an angina attack when he is looking forward to doing something.

Now the angina comes with excitement and that is really annoying. When I am going to enjoy something, when I'm looking forward to seeing some friends we haven't seen for a long time, they're coming for the evening or something like that. 

Or we're going out to go and do something and you know, I just cite the example of when I had my heart attack, you see I was going to cycle out in the New Forest and I was really looking forward to that and I think looking back now that it was the excitement and the adrenaline that caused the heart attack in that instant, that moment. 

And likewise now it's giving me angina, which is really annoying, just at the moment when I say right we're off, we're going to do something you know I'm going to go for a lovely long walk or going to see family or friends, people we haven't seen and I get chest pain again.

The different reactions of his two sons helped him during his recovery.

My family too, they've looked after me. Two sons and one says 'Oh don't fuss Mum, Dad can do it.' And the other one is more quiet and considerate and caring and he'll look after me, which is lovely. It's good to have that balance really. You don't want to be put in cotton wool but it's nice. 

They, they always think of me, 'Are you sure you can go up these steps, do you want to sit down or you know or just take a short walk or something like that'. And that's lovely, that's lovely. On the other hand, the other son he says, 'oh come on we're going on, Dad will be alright, I'll look after him.' And I don't want to feel an invalid. I want to be able to do all the things I did before, which I can more or less, which I can, yeah. 

He makes time for relaxation during his day.

I try to relax once in the morning or at least lunchtime and then once in the evening, so that fits in two a day quite nicely. That's coming on for an hour each day that I'm relaxing, giving your heart a chance, open up your arteries and letting everything slow down and I'm beginning to like that. 

I feel very indulgent, I'm not a couch potato, I'm not an inactive sort of person and it was a real hardship to start with, to actually relax. But you begin to enjoy it. If anybody tries it, I would thoroughly recommend it. You really do enjoy it.

Do you feel the benefits from it?

Oh yes. It's marvellous, yes. And I've told colleagues at work and they've been absolutely fascinated because I can see them just rushing around and trying to do everything and fitting the most in a day, which is wonderful I loved doing it as well but actually for your heart and for your body generally, you do need to slow down occasionally and I've done that and it really does pay off. 

Get the information you need to understand what is happening to you.

I would ask all the questions that you can, you know, just, try and, because you do need to get it straight in your own mind that was what I found. I wasn't just satisfied with being told, 'here, these are the pills, these will make you feel better and that's it.' 

I really wanted to know why and what was going to happen next and you know the consequences. So don't be satisfied with just having the treatment but say, 'what else is there? What are the alternatives?' and 'What does it mean? because I think you have to mentally get over the heart attack as well as physically. I think you have to be on top it.