Final post

Feeling bad because my last post was on 16th August, over 6 weeks ago.  But the fact is that nothing much has happened over the last six weeks, which is probably good.  When I say nothing has happened, what I mean is that life is going on and I continue to get closer to normal health.

Actually quite a lot has happened, I have just been too busy, or lazy, to write about it.  At the end of August Helen and I went to UK Nash Hash 2015 near Oxford, a weekend of hedonistic fun, where critically, as well as dancing several hours each evening, I also did my FIRST RUN (actually an 8k run-walk around the Blenheim estate incorporating a couple of drink stops and finishing with the usual circle and beers).  Since then I have run regularly and am now managing 8 k on hilly Parliament Hill (including some hill intervals) with an average speed of 9kph.  That is not too bad considering a) the hills, b)I stop running when my pulse gets to 140 and 3) I stopped to take my pulse because I was not wearing a monitor.  We also had a substitute summer holiday (a week old convalescence with dear friends in Devon) and I have now completed Phase 3 of the rehab physio and start Phase 4, which is tailored to individuals' strengths, next week.

I have to say that I have been very impressed with the Whittington cardiac rehab team; Carol, Tina, Angela and their supporters.   Not only are they all lovely people but they are doing a really good job and I hope that the efficacy of this pro-active approach is appreciated  and they will continue to be supported in what appears to be the car crash that is coming that we call the NHS (it is apparent from the increasing number of trusts that are in financial trouble, and the fire fighting that happens on the ground that a point is coming where the whole service implodes if major remedial action is not taken in the near future).

But while I continue to improve, there is not really enough going on to populate this blog regularly.  As a result this will be my last post.  If I feel the need to blog about the NHS or any other aspect of my health it will be under my general blog.  Not that many has been following...but thank you for the few who have taken the trouble.

Sunday 16th August. Insurance companies are discriminating against heart patients

We have booked a holiday to Cuba later in the year.  Having cancelled 4 holidays we thought we needed to get away.  The holiday company includes free insurance with the package, so on Friday Helen rings the insurance company to provide the medical information they require.  They say they want to charge Helen £50 extra because she broke her shoulder skiing in February, and her leg when running in June.  no reason given other than "the computer says...".  She is understandably annoyed that they do so without giving any reasonable explanation.  Not to annoyed as we both are when they refuse absolutely to insure me at all.  Again the only reason given was "the computer..."   I suppose you cannot expect much more from the call-centre operative.  But she did not endear herself to us by refusing to accept that I was not suffering from high blood pressure and taking drugs to control it.    We decide to write to the insurance company for an explanation.

Why do insurance companies refuse to cover someone who does not have high cholesterol, who has had an operation to address coronary artery disease and who is less likely to be ill when travelling as a result?  The Times yesterday ran a major article about this very topic  "Taking Statins Doubles Insurance Costs".    It seems that that it is common practice to load premiums for people who are taking Statins whether or not they have the elevated cholesterol, and in some cases to refuse cover altogether.  In my case I take Atorvastatin not because my cholesterol levels are high but to keep my new coronary arteries clear of platelets but to help remove any clogging that Is still there.  

I accept that someone with a medical condition is a greater risk for an insurance company than someone without the same condition.  So refusing to insure, or charging a higher premium appears to be a case of simply limiting their exposure.  You might think this is no different to charging smokers higher premiums.  But the comparison is not valid because a smoker is someone who knowingly increases the exposure, whereas someone who takes Statins is someone who is reducing exposure.  Taking the drug may also be an indicator of poor lifestyle, since high cholesterol may be due to a bad diet or lack of exercise.  But it may also be for other reasons, as in my case.  

According to The Times, The British Insurance Brokers Association admitted that the additional risk is negligible but that a simplistic algorithm is used not to make quotations over the Internet complicated.  I applaud their quest for simplicity but is it fair that some people cannot get insurance, or pay too much as a result?

Friday 14th. Phase 3 physio begins

Back to the Sobell Centre, I and 6 or 7 others plus two physics do some warm ups then relatively gentle aerobics, followed by warm down stretches.  Feels like a real gym class, though not so stressful.  The others are all different sizes and states of health.  Some cope with the exercise pretty well others make a token effort.  The physio is quite attentive, ensuring that I don't do too much.  "No racing" she says.  Anyway, notwithstanding that the exercises were pretty pathetic by most standards I enjoyed the class and found it helped loosen up my chest muscles.

Tuesday 11th August. Physio Phase 3

Busy day today.  I walk down to the Sobell Centre, the local municipal sports centre for a physio assessment before starting the cardio rehab programme.  I have been logging lung capacity, blood pressure and pulse together with the length and time taken on my walks (very anal I know but the physics did ask that I keep some sort of record).  The physio is very impressed with the record keeping but somewhat alarmed by the fact that My pulse was going so high on my walks.  I was aiming for 120-130 on my faster tempo walks - what I called my "cardio range". and it was up to 140 on steep hills (even peaked once at 150).  Apparently it should not go above 100, which because of the Beta blockers is at least 20 beats lower than it would normally have been.  I am disappointed because I though my exercise programme was a good one, but I will comply anyway.  At 6 weeks it is still apparently too early to push the heart.

From the physio I go on to Stepney Green to the London Independent to see the surgeon.  Mr Shipolini is also delighted with my progress, and tells me that the soreness at the top of the sternum is  due to the damage caused to cartilage and other soft tissues during the operation.  This takes much longer to heal than the broken bones.  He also  wants me to take stronger doses of Statins and beta-blockers, "as much as I can stand". Unfortunately side effects may include tiredness, dizziness and even impotence!  Hopefully the drugs can be cut back until normal service is resumed.

But at the end of the day he signs me off (or over to the NHS cardiologist).  I give him a bottle of Arran single malt "founder's reserve" (I still had 3 bottles at home which I bought in 2000, when visiting Arran.  Made in 1995 it was bottled after 5 years so I had to wait to receive the bottles).   It seems to me that just saying thank you to someone who possibly saved my life and definitely extended it by 20 years, is not enough.  Unfortunately I don't think he likes whisky, but he said he knows someone who does.

Onward and upward then.

Tuesday 4th August. Visit to the Cardiologist

I walk to Whittington hospital, just 18 minutes at the usual "tempo" walk of 6kph.  The consultant asks how I am  and is pleasantly surprised that I had actually had the CABG 5 weeks previously. It seems that the paperwork is stuck somewhere between Barts and The Whittington.  Either that or the surgeon did not bother to write typo the referring cardiologist (on the other hand the CABG was done privately, so perhaps his secretary just forgot to cc the letter sent to my GP).

The Consultant is delighted with my condition.  She wants to see me again, in 9 months!  

Tuesday 28th July. A charity board meeting, then Hash night!

Today I have two real reasons to get out, but I decide to take it easy on the exercise, walking at a reasonable pace, not trying to elevate my breathing or pulse.  I know that even sitting and concentrating, whether in a social or other situation, is itself tiring and it is going to be a long evening.

First I head off to tower Hill for an Arts4Dementia trustee board meeting.  Shortly before I discovered the heart problem I had applied for the role of Treasurer (and Trustee) of this small, but incredibly productive, charity. While I had had a couple of meetings with the charming CEO and her brother, and helped them in some small ways, I had to cancel an all-important meeting with one of the trustees as part of their due diligence around my appointment. Now I will have an opportunity to meet them all.  The meeting is lively and educational for me and I was appointed subject to some due diligence, which I think means checking my cv is legitimate and I am not on any police lists of "bad boys".  I don't think I am.

Afterwards I have a drink (softie) with a few of the Trustees and make plans for some meetings in the next couple of weeks.  Looks like I am getting my normal life back, but still need to take it easy.

But if you know anyone affected by dementia (including Alzheimer's), whether people with dementia or their carers or family, please have a look at the website, which points to lots of activities across the UK that can really help.  And of course consider supporting them.  This is a small charity that promotes game-changing ways to improve the lives of both people with dementia and those around them.


Tuesday Night is Hash Night (even though I am not running)
 Then a short walk to Monument where City Hash are running from the Loose Cannon, EC4R 3UE.  This is the Hash Oscars night, with awards given for the last 12 months (best trail, best fancy dress etc..).  The pub has an amazing space under the arches of Cannon Street Railway bridge, big enough for a party of 1000 I should think.  Unfortunately for me, the trail is short (5k) and the pack has already returned and eaten all the free food.  On top of that the chef has gone home so I cannot buy dinner!  If only the board meeting had finished in 90 minutes as I had been promised!  Nil desperandum,  Condor (a hash name) buys me a half of Guinness and I grab a few handfuls of garnish from the plates!

The awards make change from the usual circle.  The RA, Lexy looks very sexy in his gangster outfit, and his glamorous assistant Bent Roy a little less so in a floral print dress.  The  awards themselves, made by the hare from old trainers spray painted and mounted on painted wooden stands, are amazing.  Imagine my surprise when i am called up to receive an award for the best (or worst?) misdemeanour on a run, which apparently was having a heart attack and still finishing the trail (the truth is stretched a bit, but I did have angina, without realising what was happening!).

And here it is!

Saturday July 25th. Adapting a runner's training programme for cardio rehabilitation

Today it is just under 3 weeks since I left hospital and I walked over 80 minutes up and over Parliament Hill and on to Kenwood.  Am I doing too much exercise?  According to the standard instructions I was given in the hospital I am, but I don't think so; I felt fine during and after the exercise and my greatest fear is losing all my muscle mass by doing too little.  I have decided to take the advice of one of the hospital physios who was also a runner.  He said that so long as I listen to my body I could do as much as I felt comfortable with.  No running of course for at least 6 weeks, until my sternum has healed.

The standard instructions clearly assume patients are overweight, unused to exercise, old or very unfit.  Starting at just 5 minutes exercise a day in week one (after leaving hospital), exercise increases by 5 minutes a week.   Effort is measured on the "Borg" breathing scale.  I should keep my breathing in the scale range 2- 4 which means from light to moderate-severe (the scale is 1-10 with 10 being extremely severe).  Unfortunately no one has explained what "moderate-severe" feels like and in any event if I only exercise according to the instructions I would never reach these levels anyway.   So on the basis that the scale is somewhat subjective, using terms like moderate and severe begs the question "severe for whom?") I have interpreted the scale, based on my experience running, as follows:

The TOB-interpreted Borg scale
1. No exertion (resting)
2  Slight effort - no noticeable increase in breathing
3  Slight effort - steady breathing, increased effort apparent at rest.
4  Moderate effort  - steady breathing 3 paces in/3 paces out
5  Moderate/Severe - Steady Breathing 3 paces in / 2 paces out
6 
7  Severe - 2 paces in / 2 paces out
8
9  very Severe - faster than 2 in/ one out
10 Uncontrolled breathing (gasping).  Probably standing still (ie: cannot continue exercising)

Borg is not enough
 
Just relying on the "Borg" breathing scale to assess my effort does not seem to work mainly because there are too few hills long enough to push me much past level 3.  So I am taking a leaf out of the runner's approach.  Running coaches talk of 4 different types of training (eg: see @letsgetrunning's guide "going through the gears" ), which encompass long slow runs for endurance (aerobic training), faster sessions to strengthen the heart and develop aerobic capacity, and speed sessions or intervals to train anaerobically.  I have adopted a similar approach in my exercise plan with three main elements, monitoring pulse as well as breathing.

1.  endurance:
Long flat/gentle hill walks typically at a high pace (6 kph) get my breathing to Borg level 2-3 and pulse in the range 90-110.

2. Threshold / cardio / aerobic capacity:
Moderate hills (average grade 4/5, probably only 3-5%, but can be steeper sections) at a high pace (5kph).  Breathing Borg 3-5, pulse can reach into 120-140 range on steeper sections. It is difficult to find hills that are of a consistent gradient and sufficient length to count, so usually shorter ones are interspersed with downhill or flat sections.

3.  Anaerobic:
Fast stair repeats (2 story repeats * 6- 10, walking down for partial recovery).  Borg 4-6 and pulse 120-140.

My programme will include a couple of each of these each week.  I am thinking of adding a stationary cycle (which does mean reinstating my gym membership) as an alternative threshold session.  The advantage of this is that I can sustain a desired level for a longer period which walking cannot do as there are no hills in London big enough.

I have no idea if I am doing too much, but if I monitor outputs and still feel good at the end I hope that I am at least doing no harm and will be in a better place to start training more quickly when I can get back to running.   Lets hope so! 

NB: this programme is for me, and is not a recommendation for anyone else.  You should do what is right for you, given your underlying fitness, medical condition and the advice that you have reeived from professionals.