James

Age at interview: 63

Age at diagnosis: 62

Brief Outline:

James had a heart attack in February 2011 and a stroke in 2010. He had primary angioplasty and two stents fitted. He completed the six weeks cardiac rehabilitation programme and continues attending the weekly sessions as part of a local community health programme. James has made significant changes to his diet, levels of exercise and has given up smoking.

Background:

Widower, has two daughters and grandchildren and all live in the same town. He and his partner live in separate homes. Until his retirement, he was a manager in an insurance company. Ethnic background' White British.

More about me...

James had a stroke in 2010 and a heart attack sixteen months later. The symptoms leading to his heart attack were not what he would have recognised as classic symptoms. Over the weekend he felt cramp-like stomach pain and on Sunday developed a tingling down his neck and chin. It was this last symptom that prompted him to seek medical advice. He went down to his GP surgery on Monday morning. His doctor commented on how poorly he looked and examined him including an ECG test. He then called for an ambulance. The ambulance team did another ECG that was sent to the cardiac team in the hospital ahead of his arrival.

In hospital, the cardiologist explained his condition and the need to do a primary angioplasty without delay to minimise damage to his heart. He consented and under local anesthesia he underwent the procedure and two stents were fitted. Later it was explained that his heart had suffered 35% damage. In retrospect he thinks that he should have sought medical help earlier than he did.

 

He recovered well from his primary angioplasty but was kept in hospital for eight days, after an X-ray showed that he had a chest infection. He said that the care he got at the hospital was second to none. He is also grateful for all the information given to him which has helped him reassess his lifestyle.

 

James has made significant changes to his daily life. Before his heart attack, James did very little exercise. He worked long hours and found it difficult to fit in regular physical activity besides the odd golf game. The experience of illness has changed all that. In addition to completing the six weeks cardiac rehabilitation programme, he has continued attending weekly sessions as part of a local community health programme. He also walks and plays golf regularly.

 

James has also made significant changes to his diet. Before his heart attack he had a poor diet but he became increasingly aware of the importance of a healthy diet. He says that his intake of fruit, vegetables and fish has increased a lot. He has also learned to cook and take-away meals are now off the menu.

 

James had a demanding and stressful work life. His working routine included very long hours, leaving little time for recreational activities and relaxation. James admits that losing his work identity was a difficult thing to deal with and takes an antidepressant to help smooth the transition from a hectic work pattern to retirement. Sharing time with his partner, children and grandchildren is important to him.

James was a heavy smoker. He started smoking cigarettes aged thirteen and on average he smoked around thirty a day. After his stroke and heart attack he reduced the number of cigarettes but did not give up completely. James thought it was crazy to continue smoking but that was what he did. For the last two months he has been able to give up with the help of “stop smoking” tablets; Champix.

James explains that a stressful work life, heavy smoking, lack of exercise and poor diet all contributed to his stroke and later to his heart attack. Champix helped him give up smoking.

 

My biggest problem was I smoked.

 

You smoked?

 

Up until my stroke of course.

 

OK how many did you smoke?

 

I was smoking I would say twenty a day but I was probably smoking thirty. I knew they were bad for me. Everybody said it's about time you gave up. I promised I'd give up at fifty, fifty five and sixty and there I was at sixty and I still hadn't given up. Make so many excuses why you shouldn't [laughs], yeah.

 

Was it difficult to give up smoking after your stroke?

 

Yes, yes I mean I lapsed a little bit at times I've got to be honest and in fact there have been times I have lapsed over the last period and that got sorted out by my nurse with Champix. I'm actually finishing off the course on Champix and I haven't smoked for two months now.

 

What's that? Champix – can you explain that to us?

 

Champix is a new drug to help people who can't give up smoking. It makes the cigarette taste horrible and its well worth a try. If obviously you have to check with your doctor and make sure that it's OK but I sound like an advert for it don't I? [laughs] But it does help and you’ve got to be in the right mind, you want, must give, want to give up; a friend told me about an elderly woman who had to have Champix to give up smoking and he asked her how she was getting on and she said, "Oh I threw the Champix away because the cigarettes tasted horrible." That is the sort of mentality you don't want. You've got the mentality, "Yeah they do taste horrible, I must admit," and that is a good, another good thing that's come out of this is the fact that I don't smoke any more. I don't smoke at all. It's very difficult. You think to yourself, 'Well I've had a heart attack, ' but you're thinking, 'I'm going to have a fag,' and then you smoke the cigarette and you think, 'I shouldn't have had that,' [laughs] but you still yeah, whatever, you light another one and that is where the problems can really begin.

 

Where you smoking the same amount?

 

No, no, nowhere near. I reduced after my stroke, it was probably five a day something like that and that wasn't immediately, that came about a month to six weeks afterwards and it came at the time when I probably was depressed most actually after my stroke.

 

So your diet was kind of the wrong diet?

 

[laughs] It was completely the wrong diet yeah, yeah, yeah.

 

Big cheese rolls for lunch as well. You know those type of things with a rush, a rushed lunch as well which you're fitting in between working and half the time you don't eat half of it before you'll be back to work and this type of thing. It was very hard, hard mentally the job that I was doing, it was very stressful.

 

OK so would you say that sort of lifestyle was a big contributor to you having heart problems?

 

Yes, yes, yes. I mean the smoking, the eating and the lack of exercise. I mean three classics aren't they? [laughs] you know.

 

And the stress?

 

Yeah the stress. I mean yes which I'd probably put as the lowest one but nowadays they're saying probably it's the highest one, I don't know, you know, but those three were obviously my, my reasons that I had that heart attack most definitely.

 

James' GP did an ECG and sent for an ambulance. The ambulance crew also did an ECG which was sent to the hospital. At the hospital he was told he needed a primary angioplasty immediately.

 

I had a stroke in February 2010. This had meant that I'd given up work and at the time of my heart attack I was retired. I find, the thing I find amazing with my heart attack was the fact that I never had any chest pain or any arm stiffness, tingling, nothing at all. The only pain I felt was a very strong stomach, like a cramp which came and went and also a tingling down my neck and in my chin. These were with me for the night and I rang in the morning to see the doctor who asked for me to come down. I went to the doctor and he looked at me and said, "You don't look too well." By then I was sweating, I was also trembling. He immediately put me on an ECG and also gave me some pain relieving drugs for my stomach, I assumed stomach cramps. Once he saw the results of the ECG he then rang the hospital and an ambulance arrived within fifteen minutes. The ambulance also took an ECG and that ECG was sent through to the hospital. This, this ECG was probably the most important because the doctors that were going to operate on me later were able to see the information of what my heart was doing at the time I entered the ambulance. Thirty minutes later I was laid in the emergency room at the [Hospital name]. They were very good, everyone was there, I had a specialist, there were doctors and there were nurses. They explained to me the problem with my heart and the fact that they wanted to do an antiplasty…

 

Angioplasty?

 

Angioplasty as soon as possible as this would then not damage the heart any more than it had been damaged by my heart attack.  

 

The ambulance also took an ECG and that ECG was sent through to the hospital. This ECG was probably the most important because the doctors that were going to operate on me later were able to see the information of what my heart was doing at the time I entered the ambulance. Thirty minutes later I was laid in the emergency room at the [Hospital name]. They were very good, everyone was there, I had a specialist, there were doctors and there were nurses. They explained to me the problem with my heart and the fact that they wanted to do an antiplasty…

 

Angioplasty?

 

Angioplasty as soon as possible as this would then not damage the heart any more than it had been damaged by my heart attack.

 

The ambulance crew did an ECG which was sent electronically to the hospital. On arrival, the doctor told James that they would like to do a primary angioplasty without delay.

 

The ambulance also took an ECG and that ECG was sent through to the hospital. This ECG was probably the most important because the doctors that were going to operate on me later were able to see the information of what my heart was doing at the time I entered the ambulance. Thirty minutes later I was laid in the emergency room at the [Hospital name]. They were very good, everyone was there, I had a specialist, there were doctors and there were nurses. They explained to me the problem with my heart and the fact that they wanted to do an antiplasty…

 

Angioplasty?

 

Angioplasty as soon as possible as this would then not damage the heart any more than it had been damaged by my heart attack.

 

The cardiologist at the hospital told James that he needed primary angioplasty without delay to avoid further damage to his heart.

 

They explained that my heart had had; the blood flow in my heart had actually in two cases nearly blocked completely. It was channelling through a different channel to make my heart continue to; the longer they left this procedure the longer, sorry, the larger the damage to my heart, that is how it was explained to me which is why I had absolutely no objections to anything they said and to be honest because obviously I knew of people who had had heart attacks and to what they'd suffered and I had no doubts about having that operation on that day, no doubts at all because they explained it in such a way that if it left, if I left it any longer the damage could increase. They needed to do it immediately, the sooner they do the operation after a heart attack the less damage. The longer they leave it then the damage can increase.

 

James explains primary angioplasty and the care he received after the operation.

 

I signed the acceptance form and within thirty minutes I was in the operating theatre. The operation was very easy for me probably than it was for the doctors. The operation was done with local anaesthetic which was fantastic. The actual stents were fitted through my groin and through my wrist, the wrist one being one that they needed to take because of the angle they wanted to come in from the heart. The pain, there was very little soreness afterwards when obviously the local anaesthetic wore off. While I was in the operating theatre I was able to watch what they were doing. It was very interesting to see my own heart on a screen and something moving within it and it was reassuring in some respects that something was being done. I was still not certain I'd had a heart attack that was probably the worst thing. I was being operated on for something that I had not had real symptoms for. After the operation I was taken back to the cardiac ward; in the cardiac ward excellent set of nurses who were there at all times, they looked after me. I was put on a drip primarily because of obviously I had not had anything to eat and the, obviously dehydrated a little during the day. I'd also picked up a chest infection which they say I had before I went in which they treated with antibiotics.

 

James talks about the practical help and encouragement he got from nurses.

 

How did you feel during the first few days in hospital in terms of the support given, the care given?

 

Yeah very, very good. I got to know a few of the nurses, first we got on first name terms and yes they were very, very helpful and kind. I found them very what should I say? They wanted me to do things for myself as well which was a good thing. You know I mean not too quickly but you know, like going to the toilet and this type of thing. And when you're first; they obviously helped me out of bed the first time as I was still probably a little bit dozy from all the bits and pieces but that was only once and from there I, I would get up, dress and sit for most of the day you know, that's why they moved me I think [laughs]. Yeah I found them very good, they, they're an excellent caring crew and you know people down cry them a bit but they should really think it's the job they have to do. It's a very difficult job and I'm very thankful to them for what they did for me.

 

 

 

James discusses the medication he is taking and its side effects.

 

How often do you need to take them?

 

I take four tablets in the morning, that's aspirin, citalopram which I still take which is a relax, yeah to relax me, my bisoprolol – actually that's the only three I take because of course actually those three in the morning now. Sorry I was still, I, originally it was four because I was on clopidogrel as well which was a blood thinning drug which obviously I've stopped taking after a year having just stopped taking that so, it's only three in the morning and two in the evening which is the anti-statin and another bisoprolol. I take a small bisoprolol in the morning and a small one at night so they split during the day.

 

So the statin has been working very well and that's been working well for me you know to keep my cholesterol down. Prior to that it was higher from a test I'd had done for years, done years ago now but where I think it was 4 or something but it, it dropped down to 2.5 on this one. My last one I had from the hospital was 2.5, that's the one I remember and my doctor says it's always between 2.5 and 3 and that's the reading so not to worry on that.

 

Have you had any problem, any side effects with any of the drugs apart from the one that you were telling me about?

 

Yeah the ramipril. I think probably when I first started taking statins was, it's not really a side effect. I'd I didn't feel too well, I felt a bit lethargic and a little bit achy but that is part of the, the effect of the drug. You know it was just an achy sensation – so nothing to worry about, it passes with time but of course you have to, there's no pain without gain as they say.

 

The cardiac nurse was sympathetic when explaining James' condition and what he needed to do to avoid another heart attack.

 

I was in hospital for seven days. During that time I had an echocardiogram, this was done on a portable machine so I was not even moved from my bed. She came to the side of the bed and actually did that there and then. The results of that showed that my heart had been damaged by the heart attack and also gave them an idea of how my heart was working now that the stents had been fitted and blood flow etc.

 

The nurses also came to me to explain what I would need to do. When I left the hospital obviously I needed to change my life quite considerably. The diet I was on was much too much carbohydrate [laughs]. I have since altered that to a much more fruit, salad and fish type of menu. I also, follow my stroke with not working so the stress levels have been reduced. Perhaps I was putting some of the stress on myself following my stroke that I should be working. I think I accepted after my heart attack that that was the end of my working life, I would not work again and that's a hard thing to have to accept but it's a realistic one and I think this is where you have to fill yourself up with things you want to do and things that you enjoy doing.

 

Did they explain that your heart has been damaged, who explained it to you, how did they explain it to you?

 

It was explained in a sympathetic way, it wasn't, and “Well sorry you've got a damaged heart, that's it." She explained exactly what the damage had done, what parts of my heart had been affected, how it would affect me in the future which luckily the damage was not great. It was 35% of one side so I was able to not step back and say, "Oh I won't be able to do anything." I was able to come out of hospital and think, 'Well I can get on with my life, yeah.'

 

 

 

The cardiac rehabilitation programme has made James very aware of the importance of exercise.

 

Exercise I immediately applied to go on the cardiac rehab programme that they run at our local, local health centre, leisure centre not health centre. The, the leisure centre was great. I did ten weeks of an hour a week where they would check things with me, check my blood pressure, check my heart rate and also ask me whether I, anything had happened during the week, that there were strange, they also checked on what drugs I was still taking, whether I was taking the same ones that were recommended from the doctor in the hospital as against my own doctor who I'd since seen anyway and obviously tied up with him appointments to see him when he needed to see me.

 

So long after your heart attack and your treatment you started the cardiac rehab?

 

I started that on the…

 

How many weeks roughly?

 

Roughly it was, sorry [rustling of papers], roughly it was six weeks.

 

Six weeks after?

 

Yeah. 30^th of March I started the rehab and that went through till the 1st June and it was, it was good to see other people talk to other people as well. That was one of the advantages of those classes; its fact that you're talking to people that suffered something like you've suffered. Some of them more major you know, where they've by-pass surgery etc but the majority of them with stents and the type of thing that I'd been put through and that was part of the therapy is talking to other people, it helps.

 

So you do an hour a week of kind of…?

 

Exercise. Yeah mild exercise to start with which they increase each week trying to get your heart rate up and making your heart work that little bit more so that it helps to repair itself.

 

And after do you do anything else in term of exercise apart from that hour?

 

I was walking and also I was playing golf. I go out and I think I amazed the doctor when he said, I said I'm playing eighteen holes because of course he thought I'd only be playing nine with my problems but I was going out and I could play eighteen with not too much problem. A little bit puffy at times especially up the hills but, you know, the rest of it was very, very enjoyable.

 

OK

 

You know just thankful that I could still play.

 

And do you go for a walk how often during the week?

 

I would try to do walks of at least three days a week and vary it probably between half an hour to an hour you know, I would walk out; there's some nice little bits to visit that I can walk out to. Shopping just down the town and this type of thing.

 

James talked about what he learned while attending cardiac rehab and the independent yet supervised nature of Phase 4.

 

… the girls there [cardiac rehabilitation] they, they would check and watch you as well which was good and if they saw you were straining a little bit or puffing they would be over and say slow down a bit or whatever you know because some of the people obviously were going a bit too fast, you know. Just follow the advice that they give you. Yeah they said I should work on my heart beat going back over a hundred. It was eighty normally and it dropped a little bit with the blood pressure down to in the seventies and possibly even high sixties at times and they wanted that to be over a hundred so that was what they were working on, that was why they were increasing each week the effort level that I did in those classes. They were good classes, they, they were machines I'd never used as well, you know, I'd never been on a treadmill properly. Joked on one before but I've never been on one and thought I'm going to walk, you know, for the next ten minutes at such a speed. Cross trainers, rowing machine, bike, they're all, they're all different and they all hit different parts of the body so. At first you might feel that you know, that's a bit achy but after a while it becomes yeah…

 

You get used..?

 

You do yeah.

 

Do you enjoy doing the exercises now?

 

Yes, yes I do. I go twice a week which is the follow up to the cardiac rehab , this is one I have to pay for but it's only £2.65 so, each lesson £2.65 and it's an hour where you can more choose of what you actually do, what effort you put in. You're not, there's somebody there to keep an eye on you but you can stretch yourself that little bit more which you need to; if you don't stretch yourself and you don't start upping the breathing then you're not going to get the results that you're hoping for from that.

 

 

 

At the time of his heart attack James was coping with medical retirement with the help of antidepressants. He thinks that giving up smoking helped his moods.

 

Yeah as I explained earlier about my stroke I was one day working very hard and long hours and the next day I'm basically retired. So when the heart attack came it was like a double whammy you know, I'd already given up my job now there was no chance of me getting another job; my age and my health. I could do something manual but I don't think anybody of sixty three or sixty two as I was then would want me. So it was one of the hardest thing to accept that you're not going back to work and I think that's the probably the one thing that got me down the most, you know, because I miss the tomfoolery and the rivalry, everything about the job which you, you miss so much. I probably hit my worst part then when I realised this and this is why I'm still on citalopram (antidepressant) because obviously they help me through the worst of the winter which is the worst months because of course there's not much to do for an agile mind I suppose, that's one way to put it. But I try to, I fill my week with my children, my grandchildren, they're a blessing. I've got my partner and I've also got my golf when I can play. In between that I've learnt to cook [laughs] which amazes me at times and my partner says I do the best roast potatoes she's had so that can't be bad. I don't know, getting over that, it's difficult, it's not something you could say, 'Well I'm going to do that within a week or two weeks or a month or a year,' it's however quickly you can do it. It's, I personally probably got over it the day I decided that I wasn't going to smoke anymore. That I think has been probably the big saving of me. I think that not smoking has made me feel that I've got control of my life again. While I was still smoking I hadn't got control of my life, I was basically stressed out at being doing nothing which is [laughs] a strange way to be. It's very difficult to explain, it's, and it’s not something that you can put into words. I think it's a feeling that you know that you're, you're in the right place and that is where you've got to aim to be I think, yeah.

 

James feels part of the cardiac team that is looking after him and thinks that the quality of care he receives is excellent.

 

Can you tell me what has been good about the care you received from the hospital and from the GP?

 

The good part …

 

The good and the bad if they are any bads.

 

Well the good has got to be the friendliness of the nurses and the people involved, the doctors, everybody. They, they were there for me and that's what mattered at the time that I needed them. I think everybody's followed on as well, has done an excellent job of looking after me I feel I'm part of a team now which is the team of looking after me [laughs] which is quite important. Bad things I don't think there were. I can't really think of a; probably at times when you're laid in the bed in the hospital, you'll think to yourself, well why's nobody interested in me but then again they've got a lot of other patients to look after not just me and I probably like anybody else would think, 'Well why are they dealing with all these other people instead of coming and helping me?' But I don't need any help I'm recovering. Strange, strange sort of feelings you get.