Tag Archives: Heart disease

Confused

Every so often someone will ask me what I’ve done to lose weight, or what should be included as part of a Healthy Heart diet?

Over the past 9 months I have managed to get myself into reasonable shape, partly through exercise and partly through watching what I eat and drink. I’ve taken a fairly hard line in determining what I should be consuming: low saturated fat, lots of fruit and vegetables, no alcohol, no caffeine, low salt. I have not dieted as such, when I’ve been hungry I’ve eaten. However I have generally avoided processed food and stuck fairly religiously to the “good” stuff.

The problem is, having made these changes to my diet, I’m confused myself… what is the “good” stuff?

There’s so much contradictory information out there, new research is released on an all too frequent basis. It’s difficult to know what to do for the best. Since my Heart Attack I’ve been paying fairly close attention, and I’m confused. What is it like if you just catch a newspaper or radio headline? How is anyone supposed to follow a simple, healthy diet based on the “noise” that’s thrown at us?!

Here are some snippets from recent articles:

More research needed into fat guidelines (The British Heart Foundation 17/03/14):

A study suggests there’s not enough evidence to back the current UK guidelines on the types of fat we eat. But we think more research is needed before suggesting any major changes.

At the moment guidelines generally encourage us to swap out saturated fats – found in foods like dairy products – for unsaturated fats found in products such as margarine or sunflower oil.

But this analysis, by researchers including BHF Professor John Danesh from the University of Cambridge, of 72 separate studies suggests this change does not impact on our risk of developing heart disease.

So that’s clear then! Bad fat might not be as bad for us as we thought! Excellent!

Living and working near takeaways linked to obesity: (The British Heart Foundation 13/03/14)

People who live and work near a high number of takeaways are more likely to be obese than people less exposed to these outlets, according to new research we helped to fund.

The researchers found that those who live or work near to takeaway outlets were almost twice as likely to be obese than those who encountered the fewest outlets.

Being obese isn’t good for you, I get that. I’m assuming, although the article doesn’t mention it, that you need to eat the Take Away food in order to put on weight.

Apparently, giving people information to make healthy choices will reduce the risks of living in this sort of environment… assuming they know what a healthy choice is after they’ve absorbed the information!

Are we too sweet on sugar? (The British Heart Foundation 04/02/14)

Added sugar is associated with increased risk of death from cardiovascular disease (CVD), researchers have claimed.

A US study used national health survey data to examine added sugar consumption as a percentage of daily calorie intake. Higher levels of added sugar were then linked to an increased risk of death from CVD.

And so it goes on… sugar, salt, carbohydrates, this fat, that fat, vegetarian diets, Mediterranean diets. There is even news that chocolate might be the answer (or part of it, at least). What to do?

For me, there are some basic guidelines that seem to make sense:

You have to eat. Not eating is not a great idea… not very sustainable.
Things that look like they did in their natural state are generally better for you.
It’s good to eat a variety of different things.
Processed foods can contain a multitude of evils, beware!
Don’t over-eat, manage portions sizes.
Practice moderation and balance.
Try to avoid obsessing over food, it’ll take a lot of fun out of life!

From my perspective, if you’re aware of what you’re consuming it’s a big step towards doing the right things. I don’t feel like I’m in a position to suggest what to eat, or not.

As I’ve already said, there’s plenty of advice out there. Good luck in deciding which advice to follow!

The “E”s

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At Cardiac Rehabilitation, we were taught that many of the key factors that impact the workload on a Heart with an “E”… Exercise, Environment, Emotion, Eating… (I’m sure there were others, but I can’t remember them… please feel free to chip in!).

Many of the “E”s are impacted by travel to foreign lands… strange place, unusual climate, different food, etc. As a result, I think going on a family holiday is a big step in the Cardiac Rehab journey.

A holiday obviously offers an opportunity for some Rest and Relaxation, away from the hassle of day to day life at home / work. For me, it provides a chance to diversify my exercise routine and build on the base I’ve laid down. However, I think it offers something more important. I think it offers the opportunity to embed the change that we’ve been through over the past few months. I say “we”, this definitely applies for me, but in a small way I think it’ll apply for Louise and the girls too.

The whole, “living with Heart Disease” thing was somewhat sprung on us. We didn’t have any time to prepare. One day we were “normal”, the next we were not. In some way, leaving home as a “Survivor”, being away for a couple of weeks, and then returning a “Survivor” makes it more official, normal. A little bit like moving house… you need a break of routine to really make it feel like home.

The Magic Kingdom… not sure my Heart could have taken the fireworks and the emotion of the whole thing!

Our holiday plans over the summer were severely impacted by my Heart Attack. The plan had been to visit Florida and enjoy some of the theme parks we have all heard so much about… you could call it a “once in a lifetime” trip… but when you’ve got growing children, they all are aren’t they!

We decided that a long haul flight, the heat and humidity, the thrills and spills of rollercoasters, driving in a strange place, and the good old American cuisine probably wouldn’t be the best recuperation-aid five weeks after my Heart Attack. So we spent the summer at home, making the best of what Scotland has to offer.

As it turned out, it had quite a lot to offer. We enjoyed one of the best summers for many years, I certainly can’t remember a better one since I’ve been living in Sunny Scotland (and I’ve been there for over 17 year).

The main pool and hotel complex. Always strangely deserted.

To compensate, we decided to book a “special” trip over the October School Holiday (Now!). The girls get two weeks off, so it’s enough time to get away… and really get away! We are in Rhodes enjoying a healthy holiday of sun, relaxation and exercise (in that order).

The “E”s have played quite a major factor so far:

The Environment is much warmer than back at home. The average temperature so far has been in the high 20 degree Celsius range. It’s felt hot! Perfect for lazing around and doing nothing very much!

The Environment impacts everything. It takes time for your body to acclimatise. Quite how and when it’ll make a noticeable difference is unknown, until it does! So, in the short term at least, this provides a need for a certain level of caution.

The lounging pool. Beautiful, but treacherously chilly!

We have access to several Outdoor Pools and the Mediterranean Sea (I’m sure it used to be an Ocean when I was growing up!). Both can best be described “refreshing”. Again, perfect for a cool down if you’ve been lazing around in the sun, but they’re a little too bracing for my liking. I’ve never particularly enjoyed swimming in cold water, but I suspect a fast immersion in any of these could be the last thing I do! Definitely to be avoided!

There are guided Mountain Bike rides twice a day. Definitely for me! The temperature plays a key factors in these too, as well as the terrain over which we ride (I know this doesn’t start with an “E”!). Being on the competitive end of competitive, the key thing for me is to ride at my own pace, to not worry about what everyone else is doing, and to listen to my body (and my heart rate monitor!). My body has definitely reacted differently. I guess I have to learn my limits again given the new conditions.

Dad’s pool… before the kids have woken up at least!

Given I can’t swim in the outside pools, the Indoor Pool has become “Dad’s Pool”. Unfortunately there are some other guests that might also lay claim to it, so I have to pick my times carefully! It’s not big, probably 10m in length, but it’s enough for me to practice my breathing. If it really were mine I’d keep the temperature a few degrees cooler, and get some fresh air circulating in the room. It is as close to a sauna as I’m willing to get right now! Hopefully it’ll serve its purpose.

We’re in a great place to chill out, relax and enjoy a break. There is a lot to do. I just need to make sure I don’t overdo it!

A User’s Guide to Cardiac Rehabilitation

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After 8 weeks and 16 sessions, I’ve finished my Cardiac Rehabilitation Programme. Yahoo!

The course is complete however graduation will need to wait for my final assessment – to measure my progress since I started back in mid-July – I’ll do this in a couple of weeks.

A huge thank you to all the staff!

The Rehab Dream Team: Kirstein, Maggie, Brenda and Bernard

The experience has been a wholly positive one for me. Helping me to come to terms with the whole Heart Attack experience and get back to some sort of normal routine (although it will change again now Rehab is finished!).

One of the things I’ve never understood about the Cardiac Rehab is why more (eligible) people don’t make more use of it?

After you’ve had a Heart Attack, or been treated for some sort of Heart condition, you would imagine that you’d be past the denial stage – the game is up! For many of us, we are in the fortunate position to make changes that will improve (and extend) our lives. So why doesn’t everyone?

From my perspective, it’s time to make a positive change! The Cardiac Rehabilitation Programme is what’s on offer to help… so take advantage of it!

I thought Rehab was a really important opportunity to take action, regain control, learn and reflect. I’m therefore dedicating this update to de-mystifying Cardiac Rehab for people that may need it in the future…

The Structure of the programme

There were 3 distinct sections to Cardiac Rehab which ran two sessions a week:

Exercise – 30 minutes of exercise tailored to your personal capability (using Treadmill, Cross-Trainer, Step Machine) with a facilitated warm up / cool down to get your heart working
Relaxation – 30 minutes of relaxation to help you learn how to take control and chill out
Education – 60 minutes of education on a variety of Heart & Lifestyle topics (once a week only)

In addition, your first (and last) session will be a Physical and “Happiness” Assessment. You will be asked to do a “Beep Test” and to answer some questions on your state of mind (e.g. Are you happy? Yes / No) .

Wear clothes that are suitable for exercising in – I went for full gym kit, but it really depends on what you’re comfortable in. Don’t worry, it’s definitely not a fashion parade!

Free up time

The Cardiac Rehab sessions will take a minimum of 2 hours per week. That’s if you just do the Warm-Up, Exercise and Cool-Down. You’ll need to add an extra 1 hour per week for the Post-Exercise Relaxation and another hour for the Education session. Factor in the journey to and from the hospital, and the time it takes to shower and change, and you’re looking at a fair commitment of time over the 8 weeks.

Personally, I considered this an investment in myself, in my future, for myself and my family. A long overdue investment in my health and wellbeing. Worth it?

Before you start

If you’ve followed the guidance, you will have been exercising regularly since leaving hospital. Starting very gently, maybe 5 mins twice a day, and building up slowly. You may be up to 30 mins twice daily, and feeling good, stronger and fitter. You will hopefully have gained confidence and be ready for the next stage.

As you start Cardiac Rehabilitation, you may well feel like you’re being held back, forced to go backwards even. You will likely start your exercise sessions with 1 to 1 or 2 to 1 (minutes on a Heart Exercise Station to “rest”), slowly working up the amount of time you spend working your heart.

As you demonstrate your fitness and strength, the duration of exercise will steadily increase. “Steadily” being the operative word!

Monitor your status

The Exercise sessions start and finish with Pulse and Blood Pressure measurements. Changes in medication are also recorded. I’ve found seemingly small changes in medication have had a big impact on how my heart responds to exercise – well worth monitoring so exceptions can be identified more easily.

I used my own Heart Monitor to keep an eye on my pulse throughout each exercise session. It’s not really a requirement as there are monitors on most of the machines, but personally I found it reassuring to know where I was against my upper limit.

One of the key outcomes from Rehab will be to have an increased awareness of what you can safely do and how you feel when exercising at the right level of intensity.

Our “State of the Art” Cardiac Rehab Gym

The warm up

I found the warm up quite uncomfortable the first couple of times I did it (embarrassing uncomfortable not physically uncomfortable). If you imagine the lightest, lowest impact aerobics ever, and then tone it down (right down) you’ll get a sense of the level of exertion.

I realised after a while that it is, after all, a warm up for a group of people suffering from Heart Disease. Gentle is probably the way forward!

I got used to the Warm Up after a few weeks. I guess this is a reflection on how well you’re coming to terms with toning down your behaviour to take account of the fact that you’ve had a Heart “Event”!

The cool down is similar, but even more gentle!

Pace yourself

You need to bare in mind that 8 weeks is quite a long time. Although I’m sure you’ll be keen to get back to normal, it’s an opportunity to build up at a sustainable pace. You will make progress, just don’t be in too much of a hurry.

If someone turns down the resistance on your work-out machine, reducing the intensity of your work out (and they may well do!), take a deep breath and, if you’re feeling strong, increase your speed. You can still do the same amount of work, but in different ways.

Build confidence

You’ve probably already realised that the aftermath of a Heart Attack isn’t all about you. To a large degree, the people that you’re close to, that you interact with from time to time are more important.

Part of the recovery process is giving everyone (including yourself) time to re-build confidence in what you can safely do, to trust that you’re not going to do yourself damage or put yourself in danger again.

Well, the Cardiac Rehab Team are people too. They too will build confidence over time, but it does take time.

Do your homework

I think it’s important to continue to exercise regularly while you’re on the Programme. That means continuing to exercise at home, between Rehab sessions. That way you’ll really feel the benefit of the exercise and build your strength over the duration of the course.

Relaxation

The Relaxation sessions followed a common routine… participants either lie on a bed / floor mat, or sit in a chair, and start by focussing on deep breathing, followed by tensing and relaxing muscles from Toe to Head. The process is facilitated by an instructor reading a well-worn script.

There then followed a variety of other relaxation techniques, again following instructions.

Imagine yourself in a warm, comfortable place…

To be honest, for the last few weeks, I switched off by the time the initial relaxation was complete. Overly relaxed perhaps? I have to admit, I was guilt of being the rogue snorer on one occasion (one that I’m willing to own up to anyway!). I definitely wasn’t the only one!

The relaxation techniques are useful for winding down in everyday life, both to take a few minutes out from a stressful day, or to help respond positively to difficult situations (deep breath, drop your shoulders…).

Education Sessions

The education sessions included: Diet, Medication, Preparing for the future, Stress Management, Anatomy of the heart, Getting back to “normal”.

One of the major benefits of Cardiac Rehab is having the opportunity to talk to other people in a similar situation. As the members of the group change over the 8-weeks, you will meet and share experiences with people at different stages of their Rehabilitation. This is informal, but valuable and rewarding. I really enjoyed seeing people’s confidence growing week by week.

And then it’s over…

I’m more or less on my own now, at least for the time being. I already have a gym assessment scheduled and I’ve signed up for swimming lessons.

Swimming… yes. Butterfly… I don’t think so!

For me, Cardiac Rehab created some structure to the recovery process. I had come through my initial 4-week recuperation, and was ready to return to work. Cardiac Rehab made me focus on myself 2 mornings a week.

Memories of the initial feelings to the Heart Attack are quickly forgotten. It’s all too easy to fall back into bad habits, to proceed as if nothing has changed. The 8 week Rehabilitation process provides some extra time to fall into good habits, to seek guidance and support.

It was also really nice to be part of a little group. Although there were a diverse range of individuals participating, we all had something in common, none of us were strange (at least not because of our Heart conditions!). Most importantly, I think everyone genuinely cared about each other.

Good luck to my fellow participants current and future!!!

Artists impression of my Cardiac Rehab group!

Out and about

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It was another cracking morning in the North East of Scotland this morning. I marked it with my latest venture out on the bike. It’s the second weekend I’ve been out early, not quite the crack of dawn, but certainly a good start to the day. It’s definitely a routine to get into!

A cracking morning to be out on the bike!

As a result of my recent “Sore Leg” post, I have received some guidance that the reason my legs have been hurting is because the cleats on my shoes were slightly at the wrong angle. Having made some subtle adjustments to my shoes, it felt much more comfortable. Hopefully problem solved… it’s good to share your woes!

This morning’s ride was the longest continuous effort I’ve put in since my Heart Attack. We went at a steady rate and kept going. We covered about 16.5 miles in just over an hour (including spending some time trying to correct a mechanical “knocking” sound that turned out to be the lid of my water bottle rattling against the frame!!). It didn’t feel fast, but it felt quite tough.

The first of many loops around Westhill – slightly more undulating than the Turbo Trainer!

I do have to remind myself that I’m recovering from a Heart Attack, and back this up with frequent checks of the Heart Monitor. I am however also making up for about 20 years of physical neglect, so my of my body is at the limit, not just my heart!

It really is great to be out and about though. It gives me confidence that I’m making good progress. I’m just about to enter my last week of Cardiac Rehabilitation, so it’s a good time to start to (slowly) push the boundaries!

My poor old legs

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I feel a little sorry for my legs.

After years of neglect, I have asked quite a lot of them recently.

My legs have been abused, but not this badly!!!

My legs had little, if anything, to do with my Heart Attack but they’ve been required to play quite a significant role in my road to recovery. Walking, cycling, cross-trainer… I would have struggled to get this far through my recovery without them!

They have had little in the way of assistance. Other than the occasional stretch, they’ve been left to their own devices. Conversely, my Heart has had the assistance of lots and lots of drugs to help it recover, to make it more efficient, to help it out. My legs have had none.

Over the past couple of weeks my legs have started to fight back. Little niggles have made getting moving in the morning a slow process. Aches and pains have come and gone. Nothing bad enough to stop me from exercising, but sore enough to be a constant reminder.

I’m going to need to cajole my legs into coming along for the ride (quite literally!). They continue to have an important part to play in my on-going recovery. Hopefully the niggles will recede in time. I certainly won’t be taking them for granted again!

Over 40 Health Check

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There have been a number of stories in the UK Press recently about the value (or lack thereof) in “Over 40 Health Checks” (example http://www.bbc.co.uk/news/health-23765083). Given my recent experiences, I feel that I should have an opinion on this.

Cheeky! It tends to be too cold in Aberdeen for this sort of nonsense!

The argument for the tests is that the programme could prevent 1,600 heart attacks and strokes, avoid at least 650 premature deaths, prevent over 4,000 new cases of diabetes and detect 20,000 cases of diabetes or kidney disease earlier.

The argument against is based on the fact that most people who need the test the most are the least likely to volunteer. As a result, people that are perhaps lower risk go through the stress of the tests and may get offered medication they don’t necessarily need. The money could perhaps be spent targeting higher risk groups for more direct interventions.

I’ve had a few days to think about this, and I’ve struggled to reach a conclusion.

From a personal perspective, I have never had a test, and wasn’t planning on getting one in the near future. If I had undergone the test a few days before my Heart Attack, what would it have told me?

I suspect my Cholesterol would have been high, and I would have been told I would benefit from losing some weight. Maybe it could have told me more, but we would have been dealing with degrees of risk (as far as the Heart Attack was concerned anyway) rather than absolute certainties. The tests may have been more conclusive.

Who knows?! I didn’t give it a try.

Having survived my Heart Attack it’s easy to forget the fact that 1 in 3 people in the same situation don’t even make it to hospital. Avoiding Heart Attacks is a very good thing!

I’m not sure what would have prompted me to take the test in the first place. I guess that’s the bigger issue. Perhaps I’m missing the fact that I was one of the difficult to reach, high risk individuals!

Given the tests are available, if you’re over 40, I would suggest you take a deep breath and get yourself checked out. You don’t have an excuse for not doing it… I’ve told you to! We can leave it to the policy makers to worry about whether it’s good value for money or not.

Check Up #2 (FD +61)

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Another beautiful morning in sunny Aberdeen… the summer just keeps on coming!

This morning saw my first visit to the Doctor since 27^th June. It seems slightly strange to be so conscious of all aspects of my health but to have limited direct, regular medical oversight.

I’m not sure what I would have expected, but somehow taking the “let us know if anything changes” approach somehow seems a little “light”.

Is it this type of thinking that creates an unnecessarily high demand on the NHS, I wonder?

On arrival at the surgery, I was slightly surprised to discover that the entertainment was BBC London News. I can understand the News aspect, catching up on the breakfast news seems like a reasonable thing to do.

What I couldn’t fathom was why we should be interested in the traffic around the M25 (London Orbital), or how smoothly the various London Underground lines were running (the Northern was experiencing minor delays, incidentally). I can only assume that someone in the Surgery has a cheeky weekend in London planned and is trying to get into the mood a little early. If that’s you, the game’s up! (But have a great weekend anyway!)

London Underground Map… particularly useful if you’re planning on spending the day in Aberdeen!

The Doctor’s consultation itself was an uneventfully positive affair:

My BP (medical speak for “Blood Pressure”) is fine – artificially kept low to reduce the workload on my heart.
My liver and kidney function is “normal” – good news, as a potential side effect of the drugs is that they “break” something else that was working fine before, in particular my liver or kidneys.
My cholesterol is “abnormal”… abnormally low I guess. My total cholesterol reading was 2.9 mmol/L (Good if less than 5 mmol/L) and my “bad” cholesterol is 1.6 mmol/L (Good if less than 3 mmol/L).

Follow the link for more information on High Cholesterol: http://www.nhs.uk/conditions/Cholesterol/Pages/Introduction.aspx

So, it’s all good! The drugs continue to work!

I was just left with a not so subtle reminder not to rush things or push too hard!

OK… I hear you!

My heart is not allowed to do this… yet!

Ch… Ch… Ch… Changes (FD +50)

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Doesn’t time fly!

It’s the big Five-Zero! Fifty days since I had my Heart Attack. Seven weeks and a day. Forever, and no time at all.

Doesn’t time fly when you’re having fun! 🙂

To say a lot has changed would be an understatement. Some changes have been forced on me. Some have been voluntary*. Others have been a consequence of circumstances.

Scary?

“It must have been scary!”… No, not really. At no point over the past 51 days have I felt like my life was in imminent danger. However, it doesn’t take much imagination to see that things could have gone that way. In the UK, one in three people who have a Heart Attack don’t make it to hospital.

The next time you’re in a lift with two other people, imagine one of you not making it to your floor. I was in that lift. I was lucky. I didn’t realise how much danger I was potentially in until afterwards. By that stage, the immediate danger was over and the ball was in my court (more or less).

A new Dad (in reverse)

In some ways, it feels like part of me died when I had the Heart Attack. Not in a bad way. In a way that created space for new parts of me to grow in their place. In fact, its probably more correct to say “dormant” rather than “new”, many aspects of the “new” me have been there before. A very long time ago! So long ago that only close family members and very old friends might recognise them. As far as the girls are concerned, I am a new, thinner, slightly bizarre, “active” Dad.

Even knowing what I know now, I’m not sure if there is anything that would have convinced me to make some of the changes I have done in advance of something “happening”. It still all seems slightly surreal. Perhaps if someone I knew well, who I could easily relate to, had been through the same thing as I have, it might have been enough for me to take action. Perhaps.

The bottom line is, if you want to, it’s not that difficult to convince yourself that it won’t happen to you. That you’re low risk. Different from people like me.

Awareness isn’t enough!

You need to take action to make a difference.

It doesn’t surprise me that prevention of Heart Disease is such a challenge. For many (me included) it requires big changes to make a difference. I guess the key is to keep any changes small, to recognise when you’re veering of course and make minor corrections to keep you on track. So many people are so far off course that small changes just aren’t enough.

For me, my broken heart has been fixed, the course has been corrected and I’m looking to the future.

Catching up

I have some catching up to do – a holiday with the family (although Florida must wait!), recognising the patience of my colleagues, repaying the goodwill of our clients, and sustaining the lifestyle I’ve adopted since leaving hospital so none of us have to go through this again!

Here’s to the next 50 days… and making it count!

***

*Voluntary is probably a bit strong. I’m not sure I had a huge amount of choice in any of the changes, but I guess even the perception of choice makes them more palatable.

I hate Heart Disease (BHF)

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Don’t start the day in a rush!

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Wake up! Wake up! Get a move on!

Before I had my Heart Attack my day started in a rush. My goal was to get to work as quickly as possible. Time was money. Every second counted.

I didn’t do breakfast.

I’d grab a coffee (and “back in the day”, a cigarette) as a “wake me up” when I arrived at the office.

I realise now that this set the rhythm of my day. I was rushing from the minute the alarm went off. This typically lasted until I’d finished work, usually a couple of hours after arriving home.

A healthy and happy start to the day!

I now have a new routine, enforced by the need to take my morning medication. After that, I sit and eat. I don’t eat anything special, fruit, yoghurt, wholemeal toast, cereal, etc. but it really sets me up for the day. The time I take to sit and eat, just a few minutes, allows me to gather my thoughts, helping establish a more sustainable rhythm for the day.

A recent study published American Heart Association journal emphasises the importance of a healthy start to the day. Men who reported missing breakfast had a 27 per cent higher risk of heart attack or death from coronary heart disease than those who reported eating a morning meal. (Click on the picture below to read more).