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John

Age at interview: 67
Age at diagnosis: 67
Brief Outline: In October 2011, John suffered a heart attack and had primary angioplasty and a stent was fitted in the artery that needed urgent treatment but while in hospital, they fitted a second stent in another blocked artery. Test results show that his heart was only minimally affected by the heart attack. John is full of praise for the level and quality of care he has been receiving on the NHS.
Background: Retired Trauma Counsellor; married with two children aged 43 and 40. Ethnic background; white British.

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John was always aware of the possibility of a heart attack because both his parental grandfather and his father died of a heart attack in their fifties. In October 2011, at the age of sixty-seven, John suffered a heart attack for which he received prompt and effective care. Previously, John has been diagnosed with psoriatic arthritis and with ankylosing spondylitis and only three weeks before his heart attack he was diagnosed with prostate cancer.
 
Following symptoms of chest pain and forearm and neck discomfort, John’s wife called NHS Direct and a nurse indicated it was a heart problem and she should drive him to emergency or, alternatively, they would send an ambulance. In fact, a helicopter and an ambulance were sent to his home and arrived around the same time. Paramedics decided to take him by ambulance, and while travelling they sprayed GTN (Glyceril trinitrate) under his tongue to help dilate his arteries. He also had an ECG which the results of were then transmitted to the hospital.
 
On arrival at the hospital, a registrar was waiting for him, climbed into the ambulance, introduced himself and starting asking a few questions as he was wheeled on to the Cath lab where there was a medical team of about eight people waiting for him, including the consultant cardiologist. The consultant explained that three of his arteries were affected but that only one was urgent to treat. John underwent a medical procedure called primary angioplasty and a stent was fitted in his artery. One of the other arteries was dealt with while he was still in hospital, before he went home. Test results later revealed that the heart attack had only minimally affected his heart. John has only praises for all the medical health professionals involved in his care' ambulance paramedics, nurses, cardiologist consultants, etc. John described how it took three minutes to take him from the ambulance to the Cath lab and fourteen minutes to have a stent fitted and be wheeled off from the Cath lab to the Cardiology Care Unit. In there, he was looked after by nurses whom he described as ‘very dedicated’, who also provided him with all the information and advice he needed.
 
Three weeks after his heart attack John started his cardiac rehabilitation programme twice a week. Initially he was started in a low taxing exercise programme. Gradually his routine has been increased in time and endurance. John said that his diet was a healthy one but he started to pay attention to food portions and cut down snacking. In total he has lost two stones.
 
There are several medications that John needs to take on a permanent basis' Clopidogrel, ß-blocker, statins and Olmesartan. One of his medications; clopidrogel, has complicated the treatment of his prostate cancer. His healthcare team has concluded that he can’t stop using this drug and therefore, surgery is not an option to treat his prostate cancer. John will be receiving radiotherapy and his taking a hormonal implant, called Zoladex which inhibit the production of testosterone.
 
John is optimistic about the future. His work as a trauma counselor, he says, has equipped him well to deal with his own personal challenges.

 

 

John lives in the countryside and an air ambulance was sent by NHS Direct to take him to hospital...

John lives in the countryside and an air ambulance was sent by NHS Direct to take him to hospital...

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We took the dogs for a walk and coming back I started to feel a bit out of breath and I also felt slight pains, just on the side of my chest and started coughing a bit but thought no more about it. And especially two days after that I was talking to my sister on the telephone and she happened to mention she’d had this terrible cough which she couldn’t shake off. Described the symptoms and it sounded very similar to what I was going through so I assumed that’s what it was.
 
On the Monday, I spoke to her on the Sunday, on the Monday I went up to my study to go and do my 2011 self-employed tax assessment. Not that it was that stressful but it just struck me as ironic that it was then. And as I sat down at the desk I had pains, these pains came back in the side of my chest and I had sort of down the sides of my throat and to some extent like a pain in the forearm but not terribly intense. So I sat there thinking, ‘It will pass off’ but already slightly suspicious then it might be heart. I then went downstairs to my wife who was sitting in the kitchen and I said, ‘I think you’d better call NHS Direct because I’ve got these pains and see what they think.’
 
So she phoned NHS Direct which looking back was a mistake because NHS Direct weren’t really geared up to deal with this sort of thing. Spoke to a lay person. Went all through the thing with her. She then said, ‘I am going to get a nurse to talk to you.’ The nurse then went through it and said, ‘It sounds like it might be heart. Where is your nearest hospital?’ so my wife told her and she said, ‘Well you could drive him there.’ Which, of course, everybody else I spoke to after that said, ‘That was the worst possible thing you could have done.’
 
‘Or he said, ‘We can get you an ambulance.’ So my wife elected to get an ambulance. We were phoned back I guess about 10 minutes, quarter of an hour later to say there was no ambulance available in the area but they had alerted HeliMed and they would be there fairly quickly but they’d got to come from [Town].
 
So it’s really weird because the symptoms weren’t that chronic for me. They were, they seemed quite ok but I did accept that it was a heart problem at that stage. They actually came into this room and sat in the armchair you are sitting in now and while I was there I saw a helicopter going around looking for somewhere to land and they had difficulty finding somewhere but they actually went up the hill the other side of the church into a farmer’s field. So they came chasing down and came in. They put an ECG on but the stickers that they had, you know, they said were new. They were one-use-only stickers and they didn’t work properly and they were complaining about how the old ones were much better. And while they were trying to do that they couldn’t get an output, not because I’d stopped, you know, heart beating but because they were just saying, ‘This is really frustrating.’
 
Anyway a few minutes later a land ambulance arrived. They came in with the old fashioned stickers and put it on and said, ‘Yes it was definitely a heart attack.’ They then debated whether it was best to take me by air or by land ambulance. So they decided they’d decide that when they got me to the helicopter. So they drove the ambulance up the road to the helicopter. There was some discussion about whether to go. The pilot eventually said that he thought there was nothing in it in terms of time because they would have to take about 10 minutes to load me onto the ambulance this end and ten minutes to unload me the other end and it’s about a 40 minute drive to the hospital anyway. So li
 

Once it was established that John was having a heart attack, it was agreed that he should be...

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So in the land ambulance they connected me to the ECG. I was feeling not terribly well at that stage but not in huge pain still and they confirmed that it was, again confirmed that it was, the ECG was showing something, they kept referring to as ST which I didn’t understand at the time but now obviously realise it’s part of the heart pattern. And they said, ‘We’ll give you some GNT’. Just so GTN isn’t it. So, you know, I can’t remember was it TNG, trinitroglycerine and they actually sprayed some under my tongue which I knew was designed to dilate the arteries but the reality was. It was awful because the. I just suddenly said, ‘I feel very, very faint’. So they put my head down and they had previously put an injection into the arm. So they said, ‘We are going to push some saline into you now because your blood pressure is dropping through the floor’. So that was going on while they were actually driving off. As they drove off they were in touch with the [Hopsital name] in [City] and because this is [County], [Hospital name] was asking them to send telemetry of the ECG outputs but they couldn’t because [Town] don’t carry telemetry for it. So there was a lot of debate between the [Hospital name] and the ambulance as to whether it was ST but once they knew that it was, the [Hospital name] said, ‘Yes we are happy to admit him.’ So we just proceeded and I drove feeling more uncomfortable because of the angle I was at more than anything else but not, not too. I mean in the whole scheme of things it’s pretty small.

 

John said that his wife arrived to hospital anxious and fearing the worse.

John said that his wife arrived to hospital anxious and fearing the worse.

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Now in retrospect my wife says she should have come in the ambulance and I can see that would have made sense. But that would have left my daughter to drive on her own over to the [Hospital name] which she doesn’t know the way or anything like that. So they drove there. When they got there they couldn’t remember what they’d been told by the ambulance crew to go to the Cath Lab so they couldn’t, neither of them under the stress could remember where they had been told to go. So they found their way up to the Cardiac Care Unit, knocked on the door of, I assume it was the sister in her office outside and said, ‘Could they, could she tell them where I was’. And she said she felt as though she had interrupted her in doing something. So sister went off, came back, was much more consolatory and said, ‘Would you like to come into this room?’
 
Well of course they then feared the worst. So my daughter was in floods of tears and she [the sister] said, ‘No it’s ok. He is in the lab, sorry, in the ward. You can go through and see him.’ But by not being there in the ambulance they missed out on that bit so some unnecessary anxiety was raised because they weren’t there. And I think that’s true all the way through the thing.

 

 

The heart monitor was set off every time he breathed less. At first John was concerned until he...

The heart monitor was set off every time he breathed less. At first John was concerned until he...

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 So I was immediately wheeled in there. I was then wired up to an ECG monitor which monitored not only the heart but the breathing and blood pressure as well. So I was connected by all these wires for quite a while. And if the things went out of range then an alarm would go off but I very quickly realised that some of these alarms were quite unnecessary, well I mean they were necessary in one sense but for example I normally breathe quite slowly but the alarms are set, I think it’s to 12 breaths a second and when I’m concentrating I probably reduce to something like 6 breaths a second. The moment I’m starting to think about something I stop breathing. I breathe in quite deeply but then it stops and the alarms would go off which at first I found slightly concerning but then I worked out what it was I realised I only had to breathe again to get out of the situation.

 

 

John talks about the side effects of taking Clopidogrel.

John talks about the side effects of taking Clopidogrel.

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Clopidogrel the main impact of that is I bruise very, very easily and slight knocks, I’ve got some massive bruises on my arm which looks as though I have been assaulted by something. I threatened my wife that I’d say it was her but it can be just a gentle knock and because it’s stopping the clotting it just bleeds and so you get these huge bruises. If I go for a blood test I know that I’m going to have a massive bruise on my arm. And if I just nick myself shaving it takes a lot of stopping. It’s not like bleeding to death or anything but it, whereas normally it would have clotted up very quickly now I have to really press on it for quite a long time to stop it. So that’s been a slight disadvantage to that and it’s a slight worry because you think, if I’m in a car accident or something like that ambulance has got to be there a hell of a lot faster than it normally would to avoid me bleeding out.

 

 

John was diagnosed with prostate cancer shortly after his heart attack. Clopidogrel prevents him...

John was diagnosed with prostate cancer shortly after his heart attack. Clopidogrel prevents him...

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Then they put me on clopidogrel which of course is a very, very powerful blood thinner, anticoagulant. They put me on to a ß-blocker and then they. What else did I have? Oh yeah I was on statins and sorry I was also on a olmesartan [olmesartan medoxomil] before any of this had happened to reduce blood pressure. So they kept me on the Olmesartan and, don’t think, there’s one other drug. I can’t think what it is offhand which they then said to me, ‘You need to keep on this for the rest of your time here and you’ll have to be on the clopidogrel for a year at least because they don’t want the stent thrombosing. And so that’s and that has been a major problem because when I then got, just after I came out and I saw the urologists and the oncologists who wanted to operate on the prostate because it was 8 on the Gleason Scale which is pretty high up on the Gleason Scale. But they couldn’t operate because of the clopidogrel and hence the compromise was radiotherapy for that.
 
So I’m now going to have two months of radiotherapy every day or every weekday I should say. So that’s something coming up. But it’s amazing how one medication impacts everything else.
 
So the radiotherapy was decided by your consultant around your needs?
 
Yes, yeah.
 
As an option to surgery?
 
Yes. Because of the clopidrogel they can’t. You can’t possibly contemplate surgery because it’s too aggressive, the type that I’ve got, they can’t use the radioactive grains that they can use in some cases. And so it’s only a one choice, there is no choice. Its radiotherapy or just being held on Zoladex [goserelin] which is the sort of hormone implant that I’m on at the moment just to hold it because Zoladex turns off testosterone and because prostate cancer thrives on testosterone. So it’s…
 
So that was the only alternative that would. But then to keep you on Zoladex for a long period of time actually brings a risk of, guess what, heart attack [laugh]. So yeah it’s all wound in with one another.
 

 

 

John talks of his experience of receiving primary angioplasty.

John talks of his experience of receiving primary angioplasty.

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Do you remember much about the procedure [primary angioplasty]?
 
Oh I remember it completely yes.
 
Can you take me through that?
 
Yes. So other than the sort of being slightly uncomfortable because of the way my arm was, I remember them feeling and they talked to me about exactly what they were going to do all the way through. They sprayed my groin, and shaved it and obviously the spray was a local anaesthetic or something. And then they, I just felt a slightly sharp pain as they cut into the artery and then went up through that. And I was, could watch on the television, the same television screen that the surgeons oh sorry the cardiologists, were looking at and was watching this go through. I’d seen it on television as a process but slightly surreal watching somebody pushing something into your own heart on this. So it, and it was over quite quickly. So my main feeling was of slight discomfort rather than anything else and gratitude of course because the team was superb. And I was then taken out of the Cath lab and I had to wait in the corridor for five minutes I think it was on the trolley. And then was taken up to the Cardiac Care Unit and again superb. I mean the nursing staff were absolutely brilliant there.

 

 

His hospital notes show that John's primary angioplasty and the fitting of a stent was done in...

His hospital notes show that John's primary angioplasty and the fitting of a stent was done in...

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As we got to the [Hospital name] they pulled up and as the doors opened a registrar got in, introduced himself to me and said, ‘Do you mind if I ask you a few questions as we are making our way to the Cath lab?’ And so he was running alongside the trolley. At the time it seemed like it was only seconds but in fact their log which I had a copy of, they sent me a copy of their log, showed it was 3 minutes to get me from the ambulance to the Cath lab [catherisation laboratory]. We went into the Cath lab which is like a really 21st Century, almost 22nd Century lot of robotic equipment in there, massive amount of people. I think there were probably 8 people in there or something like that' radiographers, surgeons and so on. I noticed this one guy who was already capped and gowned and he said, ‘Oh Mr. [Name] you’ve had a heart attack, my name is Professor [Name] which filled me full of confidence at being dealt with by a professor and he said, ‘We are going to go in through your groin and stent you.’ He said, ‘There are three arteries which are suspect but only one of them is, you know, urgent.’ He said, ‘So we are going to do that one which is the really urgent one and then you will have the option of either while you are here having them done or you could come back as an outpatient because they’re not urgent that we deal with the other two. They are mild in comparison.

 
So you had the angioplasty and the stent?
 
Yes
 
At the same time?
 
Yes, yes. So he went in and they blew up the artery with the balloon and then they put a stent in. The next thing, I mean it was slightly uncomfortable because I was still in my working clothes and they had sort of not even taken my shirt off. They’d sort of ripped open some of the button and I ended up being told, you know, ‘Keep your hands away from there because this is a sterile area but it was amazing. I have nothing but praise for the team.
 
There was no time to do anything.
 
No [laugh]. But anyway with, and again their log shows that within fourteen minutes of entering the Cath lab I was out again with a stent fitted which is phenomenal.
 

 

 

John talks about his experience of following a cardiac rehabilitation programme, including...

John talks about his experience of following a cardiac rehabilitation programme, including...

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Can you tell me what happens when you go there? How they assess you? What information they give you?
 
Right. I went. Well my wife drove me to [Town] and to the [Hospital name] and we had an appointment to see a cardiac nurse who went through the whole thing about what was appropriate. Then she took notes about my medication, everything like that and arranged for me then to go for the start of the programme. I think the following week I think I saw her, about a fortnight afterwards. And I went Week 3 after the heart attack and I went over again they, every time you go in they check your blood pressure and your pulse. And then the first time you go you are introduced to a physiotherapist, specialist physiotherapist who leads you through the sort of exercises and obviously starts you off at a fairly low level.
 
So you went and you saw the physiotherapist?
 
Yes and so the physiotherapist then took me around and showed me the machines and then put me on obviously a very low taxing exercise regime. And then after each sort of mini session on a particular machine she would come along and check blood pressure, sorry and pulse particularly interested in pulse. So she came along and checked each time how that was and gradually upped it until she felt comfortable it was something I could do which was, as I’d said earlier and, that was just on the edge of your comfort zone but not over taxing you.
 
And how often were you going to these sessions?
 
I went twice a week which was the most you could do but you do have the option of just going once a week if you wanted to.
 
So have you completed your 10 weeks or?
 
I complete it tomorrow.
 
Ok.
 
Yeah
 
And then do you have any plans to continue?
 
They have what they call the graduate programme. So when you finish that you graduate and they will offer you either a place there. Excuse me. They come, you go at different times to the normal programme but they do have supervision a cardiac nurse and physio there or they will offer you a reduced rate at a local gymnasium. I am hoping and I will talk to them tomorrow about it but it will be there. I prefer, it feels quite comfortable to be there and have those facilities on hand.
 

 

 

John describes what happened during his first cardiac rehabilitation exercise session.

John describes what happened during his first cardiac rehabilitation exercise session.

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They start you off. First of all you do something like 5 minutes on perhaps an exercise bicycle but it’s set at quite a low resistance so that it’s just to get you warmed up. Then you probably do 5 minutes on a reclining bicycle at low resistance. And then you do a series of warm up exercises. After that then you go back to whatever machines they’ve chosen for you to do but at a much higher resistance and I’m now up to 10 minutes on each machine. And usually I get through 4 or 5 machines during the time I’m there and at the end of it then you also do a sort of 5 minute walking around just calming down and then another lot of their, we’ll say, wind down exercises but they are the same exercises you do like stretching and so on. So do that at the end. So overall it’s probably an hour and a half to an hour and a quarter that you are there although you‘re not obviously exercising the whole of that time. But it is probably 40/50/60 minutes of that hour and a quarter is actually exercise.

 

 

John said that in his cardiac rehab group he found more women and 'normal' weight people than he...

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And were you meeting other patients?
 
Yes it was quite an eye-opener meeting the other patients because I assumed that I was a fairly classic profile but I was amazed when I saw other people there. There were some were quite young people. More women than I thought because particularly it used to be a male disease and I guess with women taking more and more stress in jobs that has actually, they seem to be getting on an unwanted sort of consequence of equality is that I guess they’re probably pretty much equal in the numbers represented there, maybe slightly more men than women.
 
And the other thing that really amazed me was that, because I expected to see a lot of overweight people and again there were some but I’d say the majority were like myself, you know, just maybe very slightly overweight. But some were stick thin and there was one woman there that I think the first time I was there I got chatting to her. We were on sort of treadmills next to each other and she was tiny. She was probably about five foot two or something like that and size 8 or 10, 8 I’d guess and had just had a heart attack. And you think, ‘Well there are a lot of factors obviously at work in deciding whether or not you have a heart attack.
 
So it was quite interesting, you know, meeting people and finding out, you know, how long ago they’d had their heart attack although because it was a skewed population because you’re only there for usually about 10 weeks at the most afterwards so none of them are likely to be, having had their heart attack many years ago. Although one or two that I met subsequently have actually had a second heart attack many years after and are back going around the same sort of loop again.

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