Interview HA23

Age at interview: 61

Age at diagnosis: 49

Brief Outline: Heart attack 1991. Heart attack 1998. Five blockages in main coronary artery. Stent or coronary artery bypass surgery not possible. Current medication' aspirin, diltiazem, losartan, isosorbide mononitrate

Background: Retired P.E. Teacher; Married, 2 childrenEarly medical retirement, age 56

The cardiac nurses were very good at explaining procedures and giving information.

Rushed as they [the nurses] were, they always had time to talk to you about what was going on. They would explain procedures to you. I think you have to ask in some cases, but once you have asked, or once I had asked, they were quite willing to go through and tell you.

I think they want to be fairly convinced that you aren't going to panic or misconstrue what they're saying, so maybe they'll be a little bit guarded at first. But generally I think that they're there to help you get better and if they perceive that what you're asking is because you want to know and it's going to help you get better, they'll give you the right answers.

I didn't find anybody holding back. I think perhaps if you start saying things like, 'well I'm going to die after this aren't I?' [laughs], they won't do anything to alarm you there but in any case usually it's good news, you know. Once you're in hospital your chances are better every day. So they're all there to see that you, you get the best out of the treatment and if you let them see that you're not panicking, then that's fine.
 

He had none of the risk factors for a heart attack but had a heart attack at the age of 49.

We never really suspected there was anything wrong until the actual heart attack happened and in fact it was one of the things that I didn't ever think would happen to me with my background. I've never smoked, not been overweight. I was a physical education teacher and had always thought that it's something that happens to other people

I don't have a strong family history of heart disease. My mother had a couple of heart attacks but then she had rheumatic fever shortly after the end of the second world war and that had weakened her heart. So that really doesn't count in terms of inherited problems with heart diseases and I have a sister who has had problems, but she's quite a bit older than me. So again, that tends to weaken the family trait a little bit. I was quite a surprise to them all. A heart attack at 49 with a background like mine, surprised everybody. Surprised me a bit.

I think I'm unusual in that it came out of the blue and I didn't really have any pre-disposing risk factors in there. I've never, ever smoked. I have never drunk to excess. I was fit, I wasn't overweight. So all those usual things weren't present in my case. So I'm unusual in that respect.

After a short period of feeling sorry for himself he decided to get on with his life.

I didn't really attach too much importance to it all. I'd had the heart attack, which surprised me. I couldn't really figure out why it had happened to me and after the short period of feeling sorry for myself and wondering why it happened to me, I just adopted the attitude well it had happened, so it was nothing unusual, so just get back on with life, which I did. 

The only thing I was a bit cautious about was doing any sort of sport, which involved explosive activity. So squash was out for instance, not that I played a great deal, but sort of things like that were out. But I still tried to keep myself fit, moving around and didn't really let it affect me all that much.

He runs the community based GP by referral exercise programme, which continues after cardiac rehabilitation.

So what happens at the classes?

We have an exercise circuit. I get details from the surgery of patient's conditions, which drugs they're on and the background history and from that I work out a level of effort and strenuous type of activities for them. So we do aerobic work and strength training work and this improves their overall fitness and over a period of time, it will actually strengthen some of the blood vessels in your heart, take some of the load off it. 

Over a period of time, it brings their blood pressure down, it brings their resting heart rate down. It makes them more flexible, stronger and fitter and the whole group now are much fitter than they were before their heart attacks, or their bypasses or whatever. And they're sold on the idea of keeping themselves fit. 

I think what most people appeals to them is that they meet a group of people, that they come together socially with and they're safe and comfortable in the knowledge that these people have been through the same sort of experiences themselves. I think it helps as well that I've been through the process, because when I first see them a lot of them are really quite worried about the idea of taking exercise. 

Their wives and partners, or husbands and partners are also worried because they're afraid that they're going to do too much. So I always invite them to come along to the exercise sessions as well, so they can actually see what they're doing, they can take part as well. 

They get an idea then of what's a suitable level of exercise to be doing and they all surprise themselves; they all do more than they thought they could. And as they get fitter and stronger, they're doing more and more and they look back and think that they never thought they'd be doing this again. 

But most people, exercise is hard work, so if you can have a laugh while you're doing it and you're doing it with a group of people and you can look around and see that they're working as hard as you, so you're not the only one. There's a little bit of perverse satisfaction in doing that, it makes what you're doing a bit easier to bear. So the emphasis always is on let's have some fun.
 

Describes how he felt when he had to take medical retirement at the age of 55.

I was quite angry at first that I'd had to give up. It was a decision that was made for me and I really was quite upset that I had to stop before what I thought was the time I should. I really felt I'd got more to give and I could do more. As time has gone on, I have sort of come to terms with that and no longer does that form a, a massive thing in my mind now. 

I'm a lot more satisfied with what I'm doing, because by doing these courses, I feel that I'm putting something back in and getting some, well a lot of fulfilment from doing that. So that feeling of anger has gone now. I've accepted it; it did happen so I just have to get on with it.

Since early medical retirement he runs exercise programmes for the GP exercise referral scheme in his local area.

So I also started to think well I could get a part time job and started looking around. And one of the most depressing experiences is to go in to the labour exchange, it's not a labour exchange, it's a job centre isn't it. Showing my age. And all the, the staff there are very nice people but they really weren't interested in finding me something that I could use my talents and there was just nothing, and I really did think, well I'm on the scrap heap now. 

I'm in my fifties, I'd been a teacher for thirty odd years. I'd worked for some time in Industry before that. I've got lots of skills and nobody was interested in making use of them and I thought that was short-sighted, but it's also depressing. 

I heard about a course of training you can do to get qualified in what they call 'GP exercise referral.' So I took the course and passed it and when I got back, I was put in touch with the local primary care trust, who asked me to write a scheme for a rural exercise programme, which I did in conjunction with the local surgery and we decided to put on an exercise scheme for people who've had heart attacks, bypasses and so on, some years ago who had stabilised and this would be a form of secondary prevention. 

So I started that nearly three years ago and patients are referred from the surgery. It's grown quite considerably over that time; we have about fifty patients who come to the classes. I do three sessions a week. Now that my wife's retired, she comes down and helps as well and just over a year ago, I took the course offered by the British Association for Cardiac Rehabilitation, which is quite a stiff course and I now work with the local non-acute hospital, who do what they call the phase three rehabilitation with patients who've just had heart attacks. 

And then they pass them on to me and I do, what's called the phase four, community-based exercise rehab and we have about a dozen of those who come now. And I put in to place an evening session for them, because some of them are men who have had heart attacks but are still having to go back to work afterwards, so they can't do the day time classes. So we do a course for them as well and there are some women on it, but predominately they're men.
 

Talks about the different sources of information he found helpful.

Some I've got off the Internet, but you have to be careful with the Internet. Just typing in heart disease and seeing what comes up can sometimes be a mistake. You have to make sure you go to the right sources. So I tend to rely on the British Heart Foundation's web site for that sort of information because I know it to be well researched and it's a respected source. Some of the other stuff that you get, particularly from American sites, is not always applicable to over here. 

A lot of the British Medical Association booklets and information leaflets are very good and others I've got from references from good medical textbooks, that if the book is good then the sources are likely to be good, and also from that you can actually go and look at the original research material that they've used to write their own articles. 

So that's not a route that many people outside would take, but there is a wealth of good information there that is very well and very simply put. 

As I say the British Heart Foundation, the BMA stuff, the Family Doctor series. There's a lot of good information out there. The BHF in particular do some very useful booklets, which put things very simply and very clearly and a lot of those are enough for most people.

The family doctor series, is that journals?

No they're booklets you can pick up in the chemists. They're quite readable, small booklets, fairly cheap and they set out things very clearly, very straight forward and they help people to understand what's going on and once you've got people who do understand what's going on, they're better able to gauge what they should be doing themselves and more importantly what they shouldn't be doing. 

Taking medication is a routine you get used to. He warns people to get advice if they have side effects.

Taking tablets is a routine you have to get in to. Most of mine I take first thing in the morning. I'm supposed to take one at midday or rather half way between the morning one and the night time one. So it's not quite midday, it's usually the middle of the afternoon and I frequently have to be reminded about that one. 

But it's not critical that one, so that is one of the things that can be a bugbear, you can almost get to hate your tablets and I know people who've really got quite upset about the idea of having to take tablets and I try and put the point of view, well you'd be a lot worse off without them and it's a small price to pay for getting back an almost normal lifestyle. 

So it doesn't represent a problem for me that. I'm quite happy to take the tablets, particularly because I know so much about what they do for you, and I understand why you've been given them and how much worse I'd feel without them. But I guess there are a lot of people out there who are not taking all of their tablets, because they've had what they think is an adverse reaction and instead of telling somebody they've just decided to take themselves off the tablet. 

But I still think that a lot of people don't mention to their GPs, or the practice nurse that they're not taking some of the tablets because they've had perhaps an adverse reaction and there can be, but people mustn't just accept that and say I'm not taking that. They must go back and say, 'this is happening, what can we do about it?' The drugs can be changed, there are others that will do the same job with perhaps different effects. So that's important.

  
 

He had two heart attacks but refuses to be dominated by the possibility that he might have another.

I think the second time I was a bit more fed up. I think after a few weeks, months, I did begin to think that it really wasn't very fair at all. This shouldn't happen to me and I suppose my bouts of feeling sorry for myself then were a bit more prolonged, but eventually they go away. 

You just have to accept the fact that it has happened and you can't turn the clock back. So you then just make the most of what you've got and then you make sure that you don't do anything ridiculous, but at the same time you don't let it take over your life. I think you have to get hold of it and make the most of it you can. 

It would be very, very easy to say, 'Well that's it, I'm not going to take any more chances and just sit down and don't do anything.' Which as it turns out would be quite the wrong thing to do. So I've just kept that attitude.  

I think we've both come to terms with the fact that because my first heart attack came out of the blue, there could be another one that comes out of the blue. But it's no good worrying every day that today could be that day. It might be, or it might be in another twenty years time. 

You can't live your life thinking that it will be last. Maybe you should look at things and think, well let's do it now, because this might be my last day, but that's a bit morbid. You just, you take things as they come. We have a little motto for our heart group, 'Carpe Diem' 'Seize the day' and I think that pretty well sums it up. 

You have to, just make the most of what you've got. Don't go around worrying about it. If it happens, it happens. But the more you're doing to put off the time it happens then the better it is.

It's not always as bad as you think.

Most people can do a heck of a lot more after a heart attack than they think they can. We've got people who come to the class who really have had very bad heart attacks and what they can achieve is quite amazing and they surprise themselves. They surprised me at first. I'm getting less so now because with the number of different people we've got, I can say, well you're not as bad as you think and get them to believe that, and that's important.

Having a heart attack can bring on all sorts of mental pictures and worries and because it's the heart, it does strike right in to the middle of people's consciousness and I think it's important to get them to realise that it's not always as bad as they think. There is a way out.

Find out what is on offer to help you recover.

I think they've got to start off with the hospital or with their GP, asking what can they do in the subsequent time when they're discharged. I think a lot of hospitals now employ what's called the Heart Manual and that's a very, very good resource to use because it has set out there what people can do and a diary of what they're doing. 

How to record their feelings and everything about it and that's enormously useful in bringing people's confidence back. If they've never heard of it, then they should make enquiries. It is available. Most hospitals now I think use it, if they don't they should be and the thing to do is not to be put off with vague answers. 

It's all there and they should ask their GPs or the cardiologist and if they don't get a satisfactory answer, just keep asking. There are people out there who will help; there are support groups. 

I think what we're doing here with this is another good way because there are very, very few cases of heart disease that disbar you from doing something to get your health back and for those people, it's unfortunate but a cardiologist will tell them. But for most people they've got to get out and do it and they can.