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Brian

Age at interview: 76
Age at diagnosis: 70
Brief Outline: Brian was diagnosed with low to moderate heart failure following an increased in his breathlessness and a slowdown of his physical activity. His GP is also a heart specialist. After retirement, Brian kept his private medical cover to begin with but he has since cancelled it because he feels he is getting excellent care on the NHS.
Background: Retired company director, married. In his first marriage he had three children; two in their fifties and one is deceased. Ethnic background: British.

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Brian was sixty when he first became aware that he had a heart problem. Regular annual check-ups showed that there was a bit of a problem with his heart valves; the aortic and mitral valves. Fortunately, he had no symptoms, and says he was fit and felt fine. But in 2003, he was fitted with a pacemaker to help sort out a heart blockage and within a short period of time he began to experience breathlessness that doctors put down to the deterioration of his heart valves. The possibility of heart surgery was considered but test indicated that his heart was too weak and therefore surgery was not an option. He was started on diuretics. Brian was still playing golf five times a week.

In 2005, his GP, who also is a heart specialist, diagnosed him with mild to moderate heart failure. It has been this GP who supervises his heart condition. Brian has complete trust in his GP – cardiac specialist. He sees him every three months and undergoes a series of tests and answer questions regarding his state of health and how he is getting on with his medications. Once a year his GP sends him to have an echo cardiogram. Brian knows that his GP’s care and medications are aimed at slowing down the deterioration of his condition. Brian’s job came with a private health insurance and after retirement he kept the private cover. But, he eventually cancelled it because he feels he is getting excellent care on the NHS. 

Brian has had side effects from his medication which in some cases has been relieved by changing the drug. In others side effects have disappeared with time but with some, he has learned to accept the side effects because there is no alternative.

Impotence is one side effect that unfortunately has affected Brian and his marriage. He has tried Viagra and other drugs but to no avail. Brian’s second wife has been extremely supportive and at the time of their marriage, she knew that Brian’s heart condition was deteriorating. They have been married for about six years.

Since diagnosis, Brian’s breathing problem has deteriorated steadily and described himself as being ‘fairly immobile’. He still plays golf but he no longer walks and instead, he uses a buggy. Lack of physical activity has meant that he has put on weight - something he is trying to deal with as he recently started to attend a cardiac rehabilitation programme. Brian pointed out that he has always had a healthy diet, that he has always had low cholesterol, but that his weakness is alcohol. He knows that the amount of alcohol he drinks is well above the recommended limit and that it is one main factor that has contributed to his weight gain.

Brian says that if he were twenty years younger he would have a different outlook on things but that at seventy-six he does not want to be tee total and on a permanent diet. Thus, he is prepared to take a risk and continue doing some of the things that give him pleasure.  He has talked with his wife and GP about his attitude to life.
 

Brian says that his GP has carefully monitored his medication, prescribing alternatives to ACE inhibitors.

Brian says that his GP has carefully monitored his medication, prescribing alternatives to ACE inhibitors.

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And he’s [GP] monitored very carefully how they’ve affected me. One example was ace inhibitors which I can’t exactly remember what they do but, one of the unfortunate side effects was coughing. Coughing like mad and he changed that prescription to an alternative, can’t remember what that’s called, or can I? Candisatin, yes candisatin which is an alternative to an ace inhibitor and that has certainly not caused any side effects. So he regularly checks on the medication and the side effects.
 

Brian feels that age and beta blockers caused his impotence. His GP prescribed Viagra but didn’t help.

Brian feels that age and beta blockers caused his impotence. His GP prescribed Viagra but didn’t help.

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One of the other side effects of probably beta blockers which I take, great limitation on one’s married life. It, impotence is a possible side effect with some of these things. I understand from talking to the doctor and from reading the literature that that is a problem that affects some people but not all people and sadly it has affected me. Now I’m also in my late seventies, so maybe an ageing factor alongside the effect of the medication. 

If I were younger, I’d be very, I’d be very unhappy because I’m so limited in what I can do and if I were younger and I couldn’t do jobs around the house and I couldn’t do jobs in the garden and I couldn’t carry the luggage and things like that, I’d be pretty depressed but at, but to be honest that side of it doesn’t really bother me now, I just accept it’s my condition. I’m disappointed that the side effects of medication have affected the physical side of, of a marriage. I’m, I mentioned earlier on that with, with beta blockers it is, I think a much higher risk of impotence than the medical profession allow for. They say it’s a possible side effect. Well it might be possible if you’re thirty of forty but if you’re my age it’s a, it’s a no, no. Once and I know perfectly well that it was when I started taking them, I immediately became impotent so it’s not , it’s not guess work, I mean even though they say it’s a fairly rare problem, it just happened. So I’m pretty disappointed with that. 

Have you discussed that with your wife?

Yeah, yes she, she accepts it. She sometimes gets a bit upset but on, because she’s younger than me you see. And we weren’t married more than a few years before this happened. I’ve discussed it with Dr [name] and he very kindly prescribed some medication, I tried Viagra, no it doesn’t have any effect at all. So I think that that would be one of my main problems with the health condition. 
 

Brian explains why he didn’t have any more surgery after his pacemaker was fitted.

Brian explains why he didn’t have any more surgery after his pacemaker was fitted.

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Well, the, the pacemaker was fitted in eight years ago, so, so that was minor surgery and it was in 2005 which is six years ago that I had , I believe it’s called an angiogram but the; I had a number of tubes shoved up from my groin into my heart.

And this was an assessment of the condition of my heart prior to the possibility or even the probability of having heart valve surgery, having the valves replaced and it was then that this diagnosis was made, that my left ventricle was so far below normal levels of activity and was probably the main problem and may in fact of developed as a result of my heart struggling with the weak valves [clock chimes] for maybe who knows, maybe ten years. I had no symptoms of a problem prior to that but, but it is believed that, that, the poor fitting of the two valves resulted in the heart having to work harder and this resulted in the left ventricle weakening and so the decision was taken that heart surgery would not help me and therefore the only invasion of my body that I’ve had [laughs] is a pacemaker and an angiogram but I’ve had no other surgery.
 

Brian explains how his referral to a cardiac rehabilitation programme came about.

Brian explains how his referral to a cardiac rehabilitation programme came about.

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I’ve seen Dr [name of GP] regularly who’s prescribed medication and I have a chat with him now and again and I think it must have been about three or four months ago, I talked to him about my physical, my lack of physical activity, is there anything I can do? And he has put me in touch with an outfit, I think run by the local hospital in [name of town] whereby they do exercise programmes for heart patients. Now the other patients in that group have other problems; coronary problems, and they’ve had by-pass operations and that sort of thing. 

I’m in this group of about ten or twelve patients because of my heart failure [clock chimes] and there’s a couple of nurses and a couple of guys who are expert PT instructors and they can work out a programme which is just appropriate to your personal condition and I’m going there twice a week at the moment and I’m getting a bit of exercise under very close supervision because they want to avoid the patient getting any distress overdoing it a bit and in my case, overdoing it is very easy . But I am already, after just a few weeks beginning to feel some benefit.
 

Brian talks about the care he gets during exercise sessions and his trust in the staff’s expertise.

Brian talks about the care he gets during exercise sessions and his trust in the staff’s expertise.

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Well they’re checking blood pressure and pulse. And while you’re exercising they’re continually going from patient to patient, talking to them to make sure they can talk. Apparently, when you exercise in this condition you know, feeling a bit of fatigue, bit of breathlessness is normal and what, what they actually want to achieve but there’s a point where you lose your breath and you can’t actually speak. Now they want to make sure you don’t reach that stage. So they keep coming round saying, “Are you alright?” and you’ve got to talk to them and if they detect any struggling to speak then they, they’re assuming that you’ve done a bit too much and slow you down.

Were you apprehensive?

No, not at all actually I suppose I’m one of these fortunate people in that, trust me I’m a doctor is not a joke to me. I trust people who have expertise. I mean I used to have some expertise myself, you see [laughs]. Not in medical matters but in other things and I do, I simply trust them, you know, they they’re expert in, in what they’re doing and it would be silly for me to have any doubts about their ability or their commitment to what they’re doing, they’re very committed and, and very helpful.
 

Brian explains that his cardiac rehabilitation programme includes circuit training, a gym session and relaxation.

Brian explains that his cardiac rehabilitation programme includes circuit training, a gym session and relaxation.

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So, what type of exercise have you been given?

Well, I suppose two types mainly. One is what they call circuit training where you move from station to station approximately one minute per station and at each station you do a different level of exercise. Now some of it is using weights which for the fitter people are like up to 5 kilos and for somebody like me at the beginning, maybe just 1kilo. Some of the exercises involve bending and stretching, some of them involve running or walking on the spot, but what you do is you move from station to station, a different exercise every minute and you’d start off with about eight of these and then they gradually build it up week by week until you’re doing about twelve.

OK

And the other form of exercise is in the gymnasium where you operate a treadmill and also a bicycle. The advantage of those two pieces of equipment which never having been in a gym in my life before, I didn’t know but they can be set at different levels appropriate to the person who’s operating them and I started at what I assume was the bottom level for about six minutes and after only two or three weeks, I’m now up above that level. I’m now able to operate those machines for nine minutes whereas initially I was exhausted after six. I can now do it for nine at a slightly higher setting. So I’ve had quite a bit of benefit. But those are the two types, circuit exercises and gym, two items in the gym.
Sounds quite a lot

And it takes two hours by the way because in between you have warming up exercises, cooling down exercises and also a lesson in how to relax, which isn’t very helpful to me, I can’t relax [laughs].
 

Brian cancelled his private health insurance because he regards the care he gets on the NHS as excellent.

Brian cancelled his private health insurance because he regards the care he gets on the NHS as excellent.

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I cancelled my health insurance a few years back because I’d always had private health cover when I was working and when I retired, I continued to pay for it myself but I never had needed one, I never used it because I only hit these problems in my sixties and I was immediately put on National Health treatment because with, whatever they say about the Health Service, if you have a, a serious health problem like a heart problem, you’re seen straight away and I found that it was just pointless retaining medical insurance so I just cancelled it and I’ve found that the treatment I’ve had under the National Health, both GP and hospitals, but also these ancillary things like the exercise, always excellent. Now what’s it like if you want a new hip or a new knee, I don’t know [laughs] but to me it’s been excellent. 
 

Brian explains how his GP monitors his heart failure and what he is trying to achieved.

Brian explains how his GP monitors his heart failure and what he is trying to achieved.

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I mentioned to you earlier that I’d be seeing my present GP for about five or six years having moved into this area in [town]. Prior to that the GP I had used to refer me to the local hospital to see a cardiac specialist. But since I’ve been living here, I’ve seen Dr [name] roughly at three monthly intervals. It’s not always the same. Approximately, annually... he organises an echo cardiogram for me which gives them an up to date picture on whether my condition is deteriorating or remaining stable. Every appointment I have, he checks pulse, which is always the same because I’ve got a pacemaker and blood pressure and I’m fortunate in that my blood pressure has always been at normal levels. And normally asking me questions about whether I have any ankle swelling, breathlessness and all the typical symptoms of heart failure. Now in the event, of course, I probably am in the moderate stage at the moment rather than the advanced stage because I’ve never had any swellings or things like that but he’s checking regularly in order to monitor the rate of deterioration. He also, bearing in mind when I met him, five, six years ago, I was only taking diuretic medication. [Clock chiming in background] He, having diagnosed the heart failure, increased the prescription to, I think, five different items.

Obviously what the doctor has explained to me is he wants to reduce the workload on my heart. Because is so weak he can make it last longer if he reduces the work it has to do so in that respect, reducing blood pressure, reducing blood viscosity, as a matter of interest, my blood pressure is normal but I still have medication to keep the blood pressure down because he doesn’t want to risk that anything that I do pushes the blood pressure up so I do take medication to keep blood pressure down and in terms of blood viscosity , I think aspirin is one of the medications I take which thins the blood somewhat.
 

Brian continues playing golf but rather than walking he drives around in a buggy.

Brian continues playing golf but rather than walking he drives around in a buggy.

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From about 2005/6, for the last five years or so, there’s been a steady deterioration. The main problem has been breathing problems as my heart has become weaker and during that time, my ability to play golf disappeared completely. Now I have to say, I still play but I use a buggy, I can’t walk. My walking limitation which, a matter of four/five years ago, I walked the complete golf course four/five times a week. Now 200 yards maximum, so the only way I can play golf is jump in the buggy and drive around. So really my main limitation is lack of physical strength. No matter what I try to do, if I do a little odd job around the house or garden, once I start doing it, within a minute or so, I get muscular aching and breathlessness and I have to rest. So I’m fairly immobile. 
 

Brian thinks it is lack of exercise rather than diet or alcohol intake that has caused his weight gain.

Brian thinks it is lack of exercise rather than diet or alcohol intake that has caused his weight gain.

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Although I’ve always had a healthy diet, I confess that I enjoy alcoholic drinks. I’m pretty healthy in that respect so I’m not going to call myself a heavy drinker but I drink enough to, I’m afraid, put on weight if I’m not getting the exercise. When I was playing five times a week, playing golf five times a week, that was enough exercise to match my calorie intake and I had a fighting weight, I refer back to my days playing rugby and boxing of about 12½ stone. Unfortunately I’ve put on about 1½ stone, I’m now 14 stone without any change in diet or drinking habits so it’s entirely down to lack of activity. I’ve thought about it a good deal because obviously being overweight is not a good characteristic if you have heart problems. But nevertheless I’m pushing on towards 77 and I’ve had a good innings and so to some extent, I look at the quality of my life and think, “Would I prefer to be tee-total?” and on a permanent diet, the answer is no, I wouldn’t prefer that, I’ll take a chance because I know that my kidneys and liver are all healthy because I have annual regular checks. My main health problem is lack of energy, breathlessness and because I don’t get physical activity.
 

Brian feels he has lived a good and long life and the prospect of dying doesn’t upset him.

Brian feels he has lived a good and long life and the prospect of dying doesn’t upset him.

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I have pretty frank conversations with the doctor and indeed with my wife also. I’m fairly philosophical about it. I think that, I had rheumatic fever when I was sixteen and that may be at the root of some of the problems I have. But as a youngster, I was conscious of the fact that a lot of the people, boys I knew who had rheumatic fever, actually died. I was very fortunate in that my problem came right in the very early days of penicillin being available through the National Health and I was taken to hospital and I was there ten weeks and treated with penicillin and although it didn’t make the problem go away completely, it apparently did because for the rest of my life right up until my early sixties, I was fit and healthy. I boxed and I played rugby and I’d had no problems physically or from a health point of view. So I think I’ve, I’ve been very fortunate and the way I look at it now to, to come right back to your question, is, if I was sitting here talking to you with a serious heart problem and I was ten of twenty years younger, I’d be pretty fed up. But I’ve had a good active life and I’m now approaching 77, I’m being well looked after, both by my doctor and by my wife and I must admit, I’m very philosophical about it. I’m, I, quite comfortable. Dr [name] reckons he can keep me going for a bit longer [laughs] and as I say, that wouldn’t sound too good if you were fifty or something like that. But at my age I’m quite comfortable with that so I don’t have a problem. I’m quite relaxed about it.
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