Tag: Side effects

Something’s wrong. I can’t believe it.

I’m thinking of launching a new range of badges. Something along the lines of ‘Broken Heart on Board.’ You know a bit like those ‘Baby on Board’ badges that you can get on the Underground in London if you are pregnant. These aren’t anything to do with a failed subscription to an internet dating site. These are for people who have had heart attacks and to the outside world look just like anyone else. But they aren’t. They really aren’t.

“Yes, I know I don’t look like I have.”

“But I have. Honestly.”

“Yes, I know I don’t seem old enough.”

“No, I’ve never smoked.”

“You are right, I’m not that fat.”

“Yes, thank you. I will let you know if I need any help.”

And so the conversation goes. Time and again. Time and again.

I’m not sure how I am meant to look. I’m not sure what people expect to see. I’m not sure how people expect me to behave.

I’ve had a heart attack, I’ve got no visible physical scars. I still have all of my limbs. I can still talk coherently, I can stand and walk without too many issues and do it all unaided. And I can see, with my glasses anyway. No one walking past me in the street would be able to tell that just over two months ago I had major invasive surgery because the most important organ in my body decided one day that it wasn’t going to work like it was supposed to.

And so the first time I see people after the attack, I sometimes think they can’t really comprehend what has happened. It’s as if the lack of anything visible, anything other than a bloody big pile of pill boxes in the corner of the kitchen, means that it is harder to process for them. Harder to grasp that there is a piece of drug soaked scaffolding in the middle of my heart that is keeping it going and keeping me alive.

So I’m going to launch a range of badges. That should sort it. And maybe a range of FAQs. Something to hand out to answer all of those questions. You know the type of thing. That’s definitely the answer.

And it won’t just help other people, it will help me. It will act as a grounding point. Because often I need to be grounded. Sometimes I’m as guilty as those around me who can’t comprehend what has happened. Sometimes I just don’t get it. Me. And I’m the guy it has happened to. So if there are days when I don’t get it, then is it any wonder that there are a bunch of other people out there who are equally confused.

It’s simple really. I’ve had an operation and I have something in my heart which is helping me stay alive. But It doesn’t mean I am fixed. It doesn’t mean I am in the clear. It doesn’t mean that it won’t ever happen again. And it doesn’t mean that I can do everything that I used to be able to do before, either physically or mentally. And that is frustrating. Really bloody frustrating. Particularly if you are me.

And some days I need to keep reminding myself of that. I need to give myself a break. Sure, most days I feel better than I have felt in years. I’m fitter than I’ve probably ever been. I eat far better than I think I ever have. I weigh less than I have for some considerable time and I sleep. Boy do I sleep.

But I also tire easily sometimes and my heart can’t really deal with sudden explosive bursts of power. I think I may have to hang up my 100m sprinting spikes, if I had ever bought any in the first place. Yes I can walk, I can walk for miles, but anything that needs a sudden burst of pace or energy that has not been built up to becomes tough. Stretching and lifting are equally difficult on occasions. I’ve never been a bench pressing sort of guy, but if I had there would be days when that would be pretty impossible. I mean it looked hard enough in the old world. Now it’s pretty much out of the question. I suppose everything has its upsides. Beggars can’t be … and all that.

Those are just a couple of examples of the things that I can’t do properly any more, but there are plenty of others and getting your head around all of the things that have changed can be a real challenge. When I look at myself I see what others see. I see a guy that on the outside looks pretty good, looks as if he can cope with most things. But now I know he can’t. I’m coming to terms with the fact the world post my heart attack is a completely different beast and just because I look well and I’m not wizened and grey and stooping over a walking frame doesn’t mean that I am fixed.

I’ll never be fixed. I can’t be fixed. But I am able to understand now what my body is capable of, both physically and mentally. And you know what? I’m going to accept it. So it’s not what I want it to be. So what? Get a grip man and accept it, life could have been so very different two months ago. I am going to accept that I have had a heart attack, despite what I look like and how old I am. I’m going to cut myself some slack, I’m going to accept this ‘new’ me for what I now am. I am going to believe it.

So does anyone fancy joining me in making some badges? I think they could become a ‘thing.’

The Sleeproom.

I’ve always prided myself on not needing that much sleep, on being able to make it through on 2-3 hours a night and on occasion (when work required) not sleeping at all and going straight through. I’ve done that on quite a few occasions. It’s been like that for a long time. I know Maggie needed 4 hours, but she was running the country, so I think it’s only fair that she had that extra hour or two.

Sleep used to be a bit of a distraction for me. An inconvenience. It used to get in the way of other things, rudely insisting that I attend to it when I was just in the middle of something else. Jumping up and shouting ‘look at me, look at me’ when all I wanted to look at, focus on, attend to, was something else, something different. Something far more interesting and definitely more useful.

A large part of my work takes me to Oldham, just east of Manchester. My finance team are based there. I always used to try and get there before most of the guys arrived for work, in my mind it shouldn’t matter where you live, your start time should be the same. That meant getting up at 4:00 to leave at 4:30hrs and sloping into the office, M60 allowing, after a number of motorway drive through coffees, at about 8:30hrs. I’d often then work through until about 20:00 or 21:00hrs before driving south and home, eventually arriving about 01:00hrs and getting up a few hours later for the start of the next one. And when I say drive home, it wasn’t really. It was more taking the handbrake off and letting the car go. After all it’s all down hill from up there.

That routine did however introduce me to one of life’s great experiences. Driving down the M6 Toll at about midnight with my favourite music on. Often mine was the only car on either side of the deserted highway as I hurtled through the darkness in my tiny metal tin, isolated and alone but very alive. Invigorated and excited in equal measure and just a little more deaf than when the journey began.

So that was me and sleep. We weren’t happy bedfellows.

How times change. How different could the world be? Now I look back at that person and wonder how I managed it, well I know actually, I managed it on coffee, Diet Coke, chocolate and adrenaline. But how did I cope with so little sleep for so long? Sometimes I look back with respect and admiration, occasionally I clap, but mostly I look back with a lot of concern and a little bit of ‘WTAF!’ However at the time it just felt ‘normal!’

Now I sleep. Boy do I sleep. I positively snooze my way through the week. If there is a comfy chair with a plumped up cushion or in fact no cushion and just one of those curvy metal benches that they have at railway stations then I’m gone. I’m snoozing away like my life depended on it, which bizarrely it sort of does.

Since the attack I’ve slept an average of about 8 hours a night and most of it has been quality deep sleep. And by hell it’s been good. The sort of sleep that you wake up from actually feeling rested rather than wondering what the point was for huddling under the duvet for a couple of hours. I’m not quite springing out of bed and stretching with a big beam of my face like they do in the adverts. I’m not really a morning person, but I am recharged, a Duracell bunny that has been plugged in overnight. That’s me now.

So why?

The tiredness that descends on you once you have had a heart attack is caused by the fact that your body is repairing itself. After all it’s been through a hell of an experience. An attack causes damage to your heart muscle because there has been a lack of oxygenated blood flowing to it. That damage needs to be repaired and whilst it is, that part of your heart is less efficient. It pumps less efficiently and blood flow reduces.

You also aren’t helped in the tiredness stakes by some of the drugs that are often prescribed. Beta blockers and statins, two very common drugs prescribed post attack, can both contribute to high levels of fatigue.

So that’s why I’m tired now and it’s likely to be like that for quite a few months. But the importance of sleep isn’t something new, we’ve all read and heard about how important sleep is, in fact Matthew Walker has just written a best seller called ‘Why We Sleep.’ Sleep doesn’t just make you feel refreshed it has a significant role to play in your mental health, physical health, quality of life and ultimately your safety.

There are bucket loads of studies out there that show that sleep deprivation has been linked to an increased risk of kidney disease, diabetes and stroke. It also increases the risk of obesity and in children sleep helps healthy growth and development. Alongside all of that, your immune system depends on it. And all of this is the good stuff that sleep does before you even get to your heart.

If you deprive your body of sleep, your heart suffers. Badly. Your heart rate accelerates and your blood pressure increases. None of that is good. At all. A lack of sleep also leaves your body in an almost permanent state of ‘fight or flight’, it increases levels of a stress hormone called ‘cortisol’ which constricts your blood vessels and increases your blood pressure further. Sleep deprivation also limits the release of growth hormone which is essential for the blood vessels to repair their lining alongside a bunch of other really important stuff. If those vessels don’t repair properly then there is a hugely increased chance of heart attack and stroke.

And if you wanted anymore reason to hunker down under the quilt, then adults 45 years old and over who sleep less than six hours a night are 200% more likely to have a heart attack or stroke than those sleeping 7 or 8 hours.

So when sleep comes snapping at your heels like one of those annoying yappy-type dogs. Don’t ignore it, don’t ‘shoo’ it away. Pick the little fella up, give him a big cuddle, rub his wet nose and snuggle down under the duvet with him. Your body and the dog will thank you and if it helps you can always consider it training for the British Olympic Sleep team that I hope to lead in the Paris Olympics in 2024.

Everything bleeds.

I’m going to create a new noun, it feels like that sort of week. A new word that describes what seems to be happening to me so much since my heart attack. Ladies and Gentlemen may I present to you ‘barnie’.

Just so it can start being used correctly by everyone from the outset, I thought I would provide it in a similar manner to the way that the Oxford English Dictionary would in order to have the grammatical context. I always find that sort of thing helps.

“Barnie (bär′nē) [noun] an injury appearing as an area of discoloured skin on the body as a result of the rupturing of underlying blood vessels for absolutely no apparent reason whatsoever.”

If I may, before the doubters and naysayers begin to take offence as seems to be so prevalent with the current snowflake generation. Before they say that what I am describing is in fact a ‘bruise’, a word which has been perfectly suitable for the English language since the twelfth century. Before all of that silliness starts, I need to point out that a bruise happens when you walk into a wardrobe or a bookcase or a wall, whilst a ‘barnie’ happens for absolutely no reason. No bloody reason whatsoever as far as I can make out. None.

I’ve never been someone that bleeds. I am the guy who the nurses at the blood donation clinic ask not to return, not because of some rare infectious sub tropical blood infection. No, just because it is too difficult to find a vein to place the cannula into. That’s me. And to think I only used to go for the free biscuits and half of Guinness at the end. In the old days, if I was cut my body would do its best to give the impression that I had 8 pints of blood in it, but it wouldn’t be that good an impression, it would never be invited back for a second audition and you could be excused for thinking that I was some kind of bloodless android. I’m not by the way.

Well not anymore. Boy do I bleed, I positively spurt at the faintest opportunity. I spray. And it doesn’t stop. It just keeps coming. I’ve thought of talking to BP about getting them to sponsor me because I can’t be too dissimilar to an oil gusher. They are interested, but because of Deepwater Horizon I’ll probably give it a miss this time.

I’ve also never really bruised. I used to find this a real bonus because I am really clumsy and bruising easily would have shown just how clumsy I am. In the old days the world was none the wiser. Bruising was what happened to peaches or Jackie.

How things change. And not for the good. Now I bruise at the drop of a hat. Actually now I bruise from the draft of the drop of a hat. I bruise from being within 2m of anything that could possibly cause a bruise, even if it is round a corner in another room.

So why the bruising and torrent like bleeding? Well it all comes down to the drugs. I’ve talked before about the drugs that I am on and two specific ones have caused this rather ‘desirable’ side effect. They are the antiplatelet drugs – Ticagrelor and Asprin.

Platelets are cells that are responsible for blood clotting. Normally this is pretty useful, if you cut yourself it stops you from bleeding too much. But with heart disease platelets are trouble makers. Real rabble rousers. A heart attack happens when plaque (a combination of fat, cholesterol, calcium and other substances) builds up in the arteries that feed your heart. If the plaque ruptures then your body tries to clot around the rupture and it uses platelets to form the clot. The clot can block the artery and could prevent blood from reaching your heart muscles. With no blood supply the cells in the heart muscle would be starved of oxygen and would start to die, and in some cases this could cause heart failure.

So what antiplatelet drugs do is to reduce the chance of a heart attack by stopping excessive clotting in the arteries by preventing the platelets from sticking together to form a blood clot. They effectively stop the platelets from doing what they are meant to.

Sounds good? Well it is most of the time. And to be fair the bonus of not having another heart attack does have its upsides, but the side effects of the antiplatelet drugs are that you bruise far more easily and more often and sometimes from only the smallest of knocks. If any knock at all. And when you bleed it just keeps on coming, which is a real shock if you aren’t used to bleeding or you forgot to warn the health assistant who was taking your bloods. Oh, and the other really serious side effect is that all of a sudden the world realises what you have known for ages. That you are clumsy. Super clumsy.

So the next time that you find that you have a bruise that seems to have no apparent cause could I ask that you to call it a ‘barnie’. I reckon it could catch on. And if it did, that would be really peachy.

In a dark place.

It’s not all glitz and glamour this heart attack lark. It’s not all tributes to Ray Wilkins, silver pill boxes and Berghaus’ (If that’s the plural?)

Sometimes it can be dark. Really dark. You know the type of dark when you wake up in the middle of the night and try and find your way to the loo in an unfamiliar room without waking your partner up. That dark.

But the thing about this darkness is you don’t know when you are going to want to go to the loo. It catches you complexly unawares.

At the moment for me the biggest challenge is a mental one. It’s way harder than the toughest Times’ Sudoku. It’s trying to come to terms with what has happened to you, what could have happened and how you prevent it ever happening again. Its about understanding what it means for the future. It’s realising that you are mortal. Very mortal. And it’s nowhere near as easy as trying to get 1-9 in a 15×15 box without any duplication.

Since the attack, I’ve fallen into the new necessary daily routines quite easily, the blood pressure tests, the pills, the exercise and the diet. None of those have been as hard as I would have anticipated had someone talked to me about them before the attack. In fact, I’ve particularly enjoyed learning about nutrition and becoming more active than I was in the past. I’m also now the proud owner of a pile of books and pamphlets about coronary care, sleep and diet. They were notably absent from my library prior to the attack.

Of course there are an incredible amount of changes that follow an attack. Changes to lifestyle, changes to your body and changes to the way that your body copes and responds. I’ve talked about some of the side effects of the drugs, but there are others. Many others and I’ll write about some of those another time. But one of the biggest challenges, for me anyway, is a mental one. And there isn’t very much written about that at all.

I’ve talked about not knowing when you will want to go to loo in the dark and that is what has really surprised me. The darkness catches you unawares as it does in all the best horror films and it does so often when you are least expecting it and sometimes when you feel most ready for it. But you aren’t. You rarely are. And it comes and gets you and it envelops you and absorbs you. For those of you that remember, it’s a bit like standing at a bus stop in a Tango advert and a big guy dressed in orange comes and slaps you round the sides of the face and then runs off as quickly as he had arrived. And you are left wondering where he came from. The darkness is a lot like being ‘Tango’d.’

Most of my days are good, great actually. I feel as if I am making some really positive steps on the way to recovery and rehabilitation. Sure I feel tired a lot, often really tired, but each day I set my self some targets, some goals to achieve and most of the time I achieve them. Sometimes those targets are a little bit over ambitious and I don’t quite get there, but this feels like a bit of a long game as our friends in the States would say and it’s all about making positive steps forward each day. Often quite literally.

And then you get ‘Tango’d’, when you are at a bus stop or walking along a path by the Thames or sitting in an office talking to a colleague about returning to work. You get slapped around the face and someone turns the light off on your way to the loo. And the darkness comes.

I wish I could say that there was a simple answer to being able to turn the lights back on, but as with so many things linked to mental health the answers are far from simple. There is no sure fire way to avoid being ‘Tango’d’ and I suppose part of this journey to recovery is about being able to see the orange guy coming and knowing how to walk to the loo in the darkness.

I’ve always considered myself to be mentally resilient and that has been challenged a lot in my life, particularly in my working life. Work is a huge passion of mine, alongside Jackie, Freya, Ed and my family, it is what inspires me. It is what drives me.

When I was in hospital I wanted to return to work as quickly as possible. I needed to. When I was signed off for a month when I left hospital I was incredulous. I’m sure I asked the doctor if that note was the start of their stand up comedy career. There was no way that I wasn’t going to be in work the following week. No way at all. But I wasn’t and I haven’t been and it’s likely that I won’t be for a while.

After that month I desperately wanted to return, I needed to. Despite the fact that work almost exclusively contributed to my stress levels that were off the scale, I love it and feel so emotionally involved with it. And yet when I met with work to talk about returning, Heather, who is our wonderful HR Director, had a Tango suit in her bag. She didn’t know that she had and nor did I, but she did and boy did I get ‘Tango’d’, someone turned the lights off on the way to the loo and left some some slippers and a pile of dirty laundry to navigate just for good measure.

So for me this part of rehabilitation has been about understanding that it is more than just pills and exercise and nutrition. It’s also about mental well-being, you know that thing that men don’t really talk about. It’s about understanding that you take time to fix, often longer than you think you should. And that’s ok. It’s really ok. And the mental part of being fixed is as important, sometimes more so, than all the stuff that the pills and potions sort. It’s about understanding that just because your blood pressure is in the right range and your cholesterol is under a certain number it doesn’t mean you are ‘better’, it doesn’t mean that you are fixed.

It is said that not all challenges are visible. And this challenge certainly isn’t. It also doesn’t manifest itself in the same way for everyone, but it will be there and it will be dark. For some that darkness will last longer than others, but for all it is about learning to identify when that orange guy is going to strike and how to find your way through that darkness.

So it’s not all glitz and glamour this heart attack lark and I’d be really grateful if the last one up could leave the light on and not drop their slippers and dirty washing on the floor on the way to the loo.

‘It’s cold outside…’

There are a few aspects to being mortal that I’m not enjoying that much if I am honest.

Some things that the nice people in the hospital don’t tell you and a few facts that the cardiac rehabilitation team fail to mention in the ‘FAQ’ handout that they give you on day one.

And when I say ‘mortal’ I really mean ‘normal’ and when I say ‘normal’ I really mean ‘not someone who has ridiculously high blood pressure, high cholesterol, is stressed to buggery, hardly sleeps and thinks having an Aloo Gobi with their curry constitutes a balanced diet.’

And the things that they don’t tell you are the changes that happen to you after a heart attack. Not the emotional changes, not the processing that your brain needs to go through. Because that is massive, well it’s massive for me, my brain has only just got used to the fact that the 80’s hasn’t gone on forever and that Maggie isn’t P.M., let alone the fact that I am almost 50 and have had someone rooting around in my heart with what felt like a pipe cleaner. For me it feels as if that processing is going to take some more time and I’m not sure I’m ready to write about that yet.

No, it’s not the emotional changes. It’s the physical ones. The fact that in the real world it’s bloody cold. All of the time. Always.

Since my heart attack my favourite and most used piece of clothing has become a black Berghaus fleece. ‘Bergy’ and I have become inseparable. Well I’m not sure a garment that is 100% polyester is actually capable of emotional feelings at any level, but I certainly don’t go anywhere without it. And it seems to be on virtually all of the time. It’s even on now as I write this. It’s become almost like a comforter to me, a bit like those things that young kids have that mean provided that they have it with them then their parents can take them anywhere. A bit like Freya’s ‘Oshie’. Oshie was our daughter’s toy bear that went everywhere with her, everywhere that is until I left it on the Eurostar on the way to Euro Disney in 2007 and it hasn’t gone anywhere with her since. If Freya is reading this I am still so very sorry about that sweetheart. Bergy is my Oshie, only I’m 49 and Freya was 6.

I’m not sure it’s ever been clinically proven that high blood pressure makes you hot or warm. There are schools of thought that high blood pressure manifests itself in a physical form by redness of the face and in unusual levels of sweating, but little has been written about a correlation between body heat and blood pressure. And those symptoms are also synonymous with so many other things.

What is apparent though is that some of the drugs that are used to treat a heart attack have side effects. They don’t really tell you about those and they are certainly not on any handout I’ve received so far. Amongst the 66,000 tablets I will have to take, I am on Bisoprolol which is a beta blocker, Ramipril which is an A.C.E inhibitor and Asprin. And these do exactly what they say on the tin. Well exactly what they say on the box anyway. Beta blockers reduce or block the impact of adrenaline which means the heart beats more slowly and with less force leading to lower blood pressure. A.C.E. inhibitors can reduce the activity of an enzyme called angiotensin-converting enzyme, or A.C.E. for short and this causes the relaxation of blood vessels as well as a decrease in blood volume, which also leads to lower blood pressure. Whilst Asprin thins the blood and prevents clotting.

In thinning the blood and lowering blood pressure these three tablets also have a side effect and that is that the extremities of the body, the fingers, the hands, the toes and the feet become cold. They feel the cold more. For me that feeling also seems to extend to the rest of my body. This effect seems to be more pronounced in me, because prior to my attack I was always so warm. Rarely did I wear coats out and as far as I was concerned hats and gloves were for losers. Berghaus was where the guy who wrote ‘Lady in Red’ lived.

This feeling of coldness was one of the immediate things that I noticed after the attack. There are many other side effects of the drugs and I’ll write about them separately, but in the ‘normal’ world that you guys live in and which I now seem to inhabit it’s cold. Really cold.

I wonder if you can get a Berghaus on prescription. They don’t tell you about that either on those handouts.