Shout what you like, it is never over.

"Well you've just dodged a bullet" my GP says to me. " When the LAD blocks, well they are the ones we just prop up in the corner and make them comfortable"

For those who have not been listening, the LAD is the left anterior descending artery in the heart, the M1, the Numero Uno Highway, a major arterial route!

He writes me a script for Plavix or Clospidogrel, the drug I was advised I would have to take for a year or two to help stop a clot forming and blocking the stent. He writes me a referral again to the heart specialist who I see in four weeks time for  more testing.  This is the first post hospital visit to a doctor since the procedure and we are getting the paperwork in order.

"So what about the lab results from the hospital?" I ask. "They indicate a high total cholesterol, high LDL and a low globulin as being out of the ordinary"

I was very interested in the results as I have been taking medication to lower my cholesterol for twenty years. The lowering has been significant but it has not helped with the ratio of HDL to LDL.

He looks through all the results but says nothing.

"So what do I do about my LDL?" I ask. The low density lipoprotein portion of the total cholesterol reading should be low as a factor for a good cardiovascular risk assessment.

"Exercise and diet" he replies, his years of medical expertise now shining through.

" I do exercise daily. Walking at least forty minutes per day and my job means I walk all day. We eat lots of vegetables and fruit, we minimise our meat consumption, I am doing a lot. We have cut out salt as much as we can."

"Genetics. See you"

I pay my bill and make a mental note to find a new doctor.  One thing I have gleaned in life is the more you know the less you know. Therefore when you don't know something, you need to find someone who does. You need to ask questions and be questioning, do not assume those that say they know or imply they have the knowledge, actually do so.

Following my procedure I convalesced in the Coronary Care Unit at the hospital overnight. This was to ensure there were no issues with bleeding and presumably no adverse reaction arising from the stent. I was attended to by a number of different nurses as time passed and new shifts came on.

When  morning finally arrived I was brought a container of pills.

" Here take these."

"What are they?" I replied always wondering what I am being given.

" Aspirin, Plavix, Irbesartan and Atorvastatin."

" I have already had my Irbesartan and my Atorvastatin"

The face of the nurse went ashen but quickly recovered. " So you brought your own medicine in with you?"

Not wanting to be a smart arse I tried to reply tamely.

 "Yes I always ensure I have my supply with me if I am not going to be at home or might not get home for any reason"

Another bullet dodged. A doubling of the blood pressure lowering drug Irbesartan could have had disastrous consequences. It pays to be alert and ask questions.

In Australia within hospitals, the administration of medications have an error rate of between
5% and 18%.

In another study by Professor Roughead it was reported  12% of all medical admissions and 20% to 30% of all admissions in the  population aged 65 years and over are estimated to be medication-related.

In other words know what you are taking and why.

So if a relatively fit, slightly overweight, non smoking healthy person can have heart issues, what are the best methods to reduce the risk of heart disease and heart attack?  The journey to sort through fact and  fallacy will continue. The information provided by the hospital is directly geared to those that smoke, are obese and who do not exercise. Those that have the genetic curse are overlooked.

Ring out the old, ring in the new.

He tells to get myself up onto the table and lie down. Now this table does not look like a table, there are no place settings and I would never use a sheet as a table cloth but I know what he wants. It isn’t much of a bed either, hard and unyielding.

The table sits in the middle of an oblong room which has a high ceiling with one wall of glass. Behind the glass I can see lights twinkling on expectant machines and the faces of people. I suddenly flash to the last cop show I had watched on television only a few nights before this. I was to be interrogated and the people behind the glass would be talking about how I had reacted and what did it really mean. Was I guilty or innocent?

The other wall has an array of cupboards.  The table on which I lie is large with no legs, just a massive motor looking support. Above and almost around the bed is a beige arm with a soccer sized head. This is the imaging equipment.

I have not seen the professional, the cardiologist, since my first set of tests well over six weeks ago. He had only spoken to me on the phone to say I needed to be where I now was. Worried this meeting too may be as fleeting, I had a number of questions ready to ask as and when I could. I did not want to interfere with his concentration nor did I want to be one of those patients who made a pest of themselves by muttering inanities.

The team start filtering in, first donning lead aprons to protect them against the X rays before washing hands for minutes on end and donning sterile gowns and gloves. The cardiologist leans over and says hello. He says he is going to have a look and see what is going on. I am really just one of many, I have not set eyes on him now for six weeks so our relationship is hardly deep but he is there to look after me and get things done.

I am very tall at 203 meters and he observes, “I hope our wires are long enough to reach your heart” Thinking that I thought that should have been considered earlier I take the opportunity to ask my first question.

“Why do you use the femoral artery rather than one in the arm?” I had read on Dr Google the arm was once used and still was occasionally. It seemed like a shorter route to the heart and might be an alternative if the wires were not long enough.

“They used to use the brachial artery but the femoral artery is bigger. It is a direct route up to the heart like a highway and that is what I use and what I am familiar with. Some people use the radial artery and I have on occasion but it is much trickier so unless you are doing them all the time it is not the approach to use.”

So I think, if the wires are not long enough, I am fried for today. So close and yet even at this stage possibly so far.

 Soon my robe is lifted and my groin area is washed in betadine, a disinfectant that when applied looks like instant tan, or shit. I mention this last aspect as you can get a fright when you find traces of it on your robe when you wake up. A large sterile sheet or drape is placed over the area and work begins.

“Just numbing the area with some local, a sharp pain coming now.” I think to myself, I am glad he did not use the “ Just a little prick “ joke. I suppose a guffawing convulsing patient is not a good thing.

“Can you feel it now when I touch it? Good, you will feel some pushing and pulling but you should not feel any pain.”

I can feel his hand pushing on the area and “things.”  I assume these are pieces of the equipment or instruments and are being dumped over my nether regions which are not anaesthetised. I hope he does not drop anything heavy there as I might jump!

“I am just injecting some dye it might make you feel a rush of heat and make you think you are wetting yourself. Don’t worry you will not be.”

Within a minute or so I feel the rush of heat like a rash over my chest followed by a very intense wet feeling heat around my backside as if a mild acid had been poured there. Quite disconcerting but I was reassured by his words about feeling you are but not actually doing so. Thankfully the felling passed reasonably quickly.

I can feel a tickling below the site where he is working where I am not numb.  I assume this is something to do with the wires the cardiologist is introducing into the femoral artery on the highway to my heart and the suburban maze of arteries once he gets there. I can see nothing of this and there is little sound except now the whirring as the imaging equipment starts to move.

“Take a big breath in and hold it….breathe away.” I suspect this is the universal language for any imaging worldwide as I have heard these exact words spoken now in three different countries.

The imaging head swirls about in its radiographic dance routine and the “hold it and breathe away” message is repeated a number of times.

“I have found a little time bomb here Shaun and we are going to stent it whilst we are here”

On which artery is that” I ask, “the left anterior descending?”

“Yes that’s it, we just call it the LAD”

“What about any others?”

“They are fine for the moment”

A nurse appears at my left hand side to access the cannula.

“Just giving you some antibiotics. The last thing we need is for you to get an infection and also something to relax you.”

A few minutes later I feel nothing so I continue to ask questions in order to find out some information whilst I am here with the cardiologist and to let them know that if they thought the medicine would relax me, it has made no discernable difference!

“So afterwards, is there any exercise that is bad exercise? You know, digging, chopping wood that sort of thing. I do live out in the bush.”

“You can exercise as soon as you get home in a day or so. You will be in hospital tonight but can go after twenty four hours. You can go back to work after a week but take it easy. We have made a hole in your femoral artery we do not want that blowing out. No heavy lifting. You need someone to pick you up as you cannot drive for two days”

“What sort of stent are you putting in?”

“It is a drug eluting stent. We do not want the stent to block off with a clot so the stent has medicine within it that helps to stop this. You will be on aspirin for life and “clthisiffyohpril” or Flavix for a year or so.”

 The first name sounded like he was trying to say a word and he had food in his mouth as I really could not hear it. I had at least its common brand name to check on it at a later date. I presumed it was a drug that stopped the platelets from being so sticky and therefore less able to stick to each other and form a clot.

I could hear him talking to the others around him. “It is a bit tricky as the lesion is between two branches. We have the choice of a 24 or a 26 and really we could use a 25.”

A few moments later and after a bit more whirling of the imaging machine head,

”There, that is in place and is working well. You were about 70% blocked but luckily we were in there in time.”

“ Nearly done just clipping off the artery in your leg where we have made a hole. You might feel a lump there for a time but it will slowly go and is perfectly normal. Do not bend your leg. We will get you to lie with your leg straight for six hours.”

Before I know it the drape is whisked away.  I am surrounded by people who roll me towards the left first whilst a board and sheet are placed under me. I am then whisked onto the waiting bed on the right that has been brought in close proximity to the table I have been lying on. Off to recovery, to recover from the procedure and recover more slowly from the shock that I now have an artificial “thing” inside my body that without which I might not have made sixty.

The Time Cometh

Time is such a relative thing. Six weeks ago when the date for my procedure was allocated, it seemed like that hill you can see on the horizon when you are driving a long journey. The azure blue hump is so far away as to not seem a tangible destination. Ah, the somnolence of a long journey by road. Alert but in a dream as the asphalt rolls underneath like a conveyer. The distance and time eaten up insatiably like a bag of potato chips, once started you keep churning through them. Without even thought the time has gone, that future time is now present.

The biggest apprehension derives from not knowing what is going to happen and more pervasively what they will find. The angiogram is the procedure, what they find on examination and testing determines what will happen not only today but from now on. This is ground zero for me .The homework has been done to understand what the procedure involves and what might happen; now it is the nitty gritty of actually what is to happen.

After a light breakfast we drive to the hospital. We walk up to the Cath Lab and I kiss my wife farewell, unfortunately tearfully for her. This is not a place to have someone holding your hand, it is simply not permitted.  The procedure is all about me but the journey is very much an “Us” thing. I am suddenly acutely aware of the stress that must be enveloping her.  

The nurse and I both agree I am who I say I am and they have the correct person.  I change into my hospital robe, all white, open at the back, stark and naked underneath. My clothes and belongings are placed in a locker. I am asked a few extra questions and then placed in a bed.

Basic observations are taken and a cannula is inserted in the back of my hand as a precaution. In the event there is an issue during the procedure a quick portal into the blood stream is required to administer medication without delay. The groin area on both sides is denuded of hair. Ha a free Brazilian, now that’s a bonus. I am beginning to feel like a chicken being prepared for the oven minus the stuffing thankfully. Ha ha if something does go wrong is this a premonition as to where I might be heading? As some clever person once noted, there is only a stairway to heaven but a highway to hell!

I am nervous. Actually anxious would be a better way to describe it. All that has gone before in my life is suddenly concentrated on now.

I soon return to a chair and sit and wait.

“Wrap a blanket around yourself. We don’t want to give the ward clerk a fright as you sit down.”

The ward clerk is talking to a nurse.

“Look at this will you” she says holding up her phone. “Isn’t that the saddest Christmas tree you have ever seen? I mean have you ever seen anything as bad?”

She brings it over for me to see. A scrawny bush standing about a foot high with five scraggly branches and six decorations hanging limply greets me.

“Ha" I say, "I hope that doesn’t scar the children for life!”

The normality of people calms me until a man in blue scrubs appears and says,

 “Come on, you are up now.”

Spanner in the Head

I should be old enough and ugly enough not to fall to the opinions of others. Maybe that is what life is a constancy of errors, re learning over and over again. Conversation and discussion are the basics of social framework and let's face it, you can learn from others. So when an anaesthetist friend was complaining about his weight and lack of physical fitness and how he was revolted by himself, I casually mentioned my confrontation with the aging process and the frailties of existence.

"Yeah I understand. I've got to have a stent next week."

"What do you mean?"

"Well I had a CT angiogram and it indicated I had some narrowing and now I have to have a stent."

"I would get  a second opinion if I were you! Who said you have narrowings?"

"It was in the report from the radiologist."

" Who was that?"

"Not sure. Debbie someone"

" You know you can die from that! Putting the stent in."

" Yeah 1% chance something like that"

"Yeah well that is one in a hundred. That's not very good odds if you ask me. I would be getting a second opinion. They've got a vested interest in putting a stent in you know, I mean that is their job"

Great I thought. A bloody great way to start my shift. The personal opinion of everyone is based around the factors that affect that person.  They are specific to that person. The person whose opinion I had indirectly sought had touched on a lingering fear. However he had no knowledge of me and my set of circumstances.

Should I get a second opinion?  Firstly I have been trained since an infant not to make a fuss. When a waiter at a restaurant asks if the bile and crud masquerading as the dish of the day we have just managed to consume but not yet digest was to our liking my answer is generally "Yes". This is despite the fact Trip Advisor will later get the full story. Another word for this approach is gutless. On that basis alone I could not cancel the procedure and go through the rigmarole of getting a second opinion. I could not look at my current Professional and accuse him of not knowing what he is talking about. I have done my homework enough to know he is well regarded.

Secondly, I have an appalling family history and have been treated for high cholesterol and high blood pressure for nearly two decades. Come on, it stands to bloody reason that if they say I have an issue, I do.

Thirdly, well there is no thirdly as one and two were so convincing. (Joke stolen from Rik Mayall). There was the lingering worry though about early demise, falling off the perch, becoming deceased, being an ex human. ( Joke stolen from Monty Python). If the odds were one in a hundred, if forty or so procedures are performed per week at the institution where my procedure was to take place, surely there must be a death every so often.

Not every procedure would be insertion of a stent but every few months at least one would expect a death, surely. I bailed someone up whom  I knew who had good "inside" knowledge and came straight to the point.

" How often does someone die having a stent inserted over at the lab?"

" Mate can't remember one dying. Oh wait, we had one a while back but he was in a bad way and his artery bifurcated. Not much you can do about that and he was always going to be a risk."

I felt considerably better. It was as I thought, the odds are assessed on all comers in all establishments and all proceduralists. Like all things in life, some people, some places, some doctors are better than others. I had covered all bases and was as happy as I could be. No one wants a complication like death  on their hands, the paperwork is terrible!

Two days to go. I will get any heavy jobs done today and will spend tomorrow with my wife pottering about in town and having a nice lunch.  I am cheered by the words of writer Elizabeth Scott who wrote, “The thing about hearts is that they always want to keep beating.” 

D Day

A date for my coronary angiogram and probable stent insertion has been set. Let the invasion begin, in this case the invasion of my body, with the heart as the target!

It really is quite simple. I should have a light breakfast, drink fluids as I wish, shower and have someone to drive me home. Dr Google recommends a two to six hour fast prior to the procedure so I will take the conservative path. Should anything untoward happen, the last thing I want to be doing is vomiting fluid into my lungs!

If I am released from hospital on the same day as the procedure, I must stay within thirty minutes of the hospital should there be any bleeding from the insertion site, the groin. A full scale bleed from the femoral artery will kill you pretty quickly.We live an hour from the hospital so a contingency plan is in place so we can  remain close by if needs be.

If a stent is placed, there will be an overnight stay in the Coronary Care Unit at the hospital.  After that, well I will await instructions from the professional. There are still many unanswered questions but at least now some closure is imminent.

My "last meal" the night before the planned hospital visit is organised. When I call it my "last meal" my attempt at humour falls very flat as far as my wife is concerned. And here I was, silly me, thinking laughter was the best medicine!

Look whatever happens I have always been here for a good time not a long time! Well that is what I say but there are too many things still to do and see to think this is nothing other than a blessing in disguise and an issue to confront and bypass.Whoops, hadn't wanted to think of that one! Bypass and now the questions start to come back but they cannot be answered for three days now...and counting.

The hospital I will be attending performs around forty such procedures a week, forty nine weeks of the year, every year. It is incredible really what is done these days to stave off what was once a death sentence.

The mind is still swirling and whirling and pondering. It comes down simply to apprehension and a certain sense of unknowing. The questions I asked originally have to a degree been answered. At least with enough information to be ready for the further questions that need to be posed and hopefully answered by the professional, not Doctor Google.

So what exactly is involved with the issue and my heart?

The electrics of the heart are fine. The structure of the heart is excellent. The plumbing is stuffed. The Right coronary artery, the Circumflex artery, the Left anterior descending artery, the Circumflex artery all showing calcification and narrowing. The coronary artery calcium score is 1301.1. A high score is not good a low score is. Yahoo, I have finally become a number!

From the report: " Coronary calcifications are a marker for coronary atherosclerosis. The more calcium is detected, the higher is the likelihood for an obstructive coronary disease.However, there is no unique relationship  between the amount of detected calcium and the extent of localisation of this disease. The amount of calcium is closely correlated with the extent of coronary atherosclerosis, although the true "plaque burden" is underestimated. With a high amount of coronary calcium, a moderate to high risk of a cardiovascular event within the next 2 to 5 years can be assumed."

Hmmm, welcome to shit city!


What are the potential remedies?

Two options basically, stents or coronary by pass surgery. Stents are employed in a relatively non invasive manner. A wire is passed up from the groin into the femoral artery to access the internal working of the heart. Dye is injected and the heart is viewed like an X ray. Measurements are made, flows are watched and if possible a stent is employed. A stent simply opens up the area of narrowing and stays in place afterwards to maintain the passage for blood flow. This procedure in the main is performed whilst you are awake and requires an overnight stay.
Coronary bypass surgery requires opening the chest, accessing the heart , removing the blocked piping and reattaching all the plumbing. This is pretty major surgery.

What are the complications to any remedies?

There are a long list of potential complications to any surgical procedure but there are usually only one of two more common ones. With stents the issue during surgery is a reaction by the patient to the dye used to "see" within the heart. The literature reports a 1-2% incidence of death or urgent surgery required. You never hear of this "on the street" so I suspect it is overstated as it involved data from all manner of places performing this type of procedure.
Longer term, stents can move, stents can re-block, stents can become blocked due to clotting. With medication in the form of blood thinners, with medical check ups in the future, these risks are minimised. So I believe. So I hope.

Having been treated with cholesterol lowering drugs since my late thirties, have I been paying money needlessly and been ripped off?

At this stage, no idea! Let's leave it as not enough information to provide answer but will keep looking.

What exercise is potentially bad exercise?

Will ask the professional. Certain exercise such as rowing and digging pump a lot of blood only around the top regions of the body. These are the exercise types that may cause an issue but we shall see.

If my heart is affected by narrowing of the arteries, what about arteries in other parts of my body and how will I know about these?

There are certainly areas that can be affected by the formation of plaque and have the resultant narrowing. This needs further answers from the professional especially as to how this would manifest then what the options are.

What can I change today to help me in the future?

• Stop smoking-did that years ago.
• Exercise-do heaps of it but now want to know what I should be doing-talk to the professional.
• Eat less fatty foods- did that years ago with the exception of cheese., and have not cut out all meat.
• Reduce salt intake-did that years ago.
• Reduce stress- ??? What constitutes stress? One needs to live, one needs to be on time, one never has enough money, I have not heard from the kids recently, the dog has run off, where did I leave my wallet?  Talk to the professional.

I am now actively awaiting my coronary angiogram where I will be talking to the professional and hopefully fitting a few more pieces into the jigsaw puzzle. The procedure is soon but I will tell you about that later.

So I did tell my children. At some stage they did have to know and in time so will the wider family so they too can consider action to have their heart checked for the genetically inherited bomb!

It is the modern age, so I sent them an email.

Hey my lovelies, am leaving my original message below as it does have more of the hard data so to speak, but basically having an op soon which has potential ramifications for you due to genetics, and any op has potential downsides. I am sure I will be alright, I was pretty smacked when I was originally told as I am fit I am strong, my heart is strong etc just stuffed plumbing due to genetics...we calcify our fats ...any way, I have to tell you as I am advised you might think of me as a turd if I did not as my action was going to be not mention it. So that is how I rate it bit I will leave my original message as I was feeling a little low and it does contain factsI 

Love you as always and do not worry..

Dad and 2nd Dad

I could tell you this face to face but I struggle with how I might just drop it into the conversation without it becoming bigger than Ben Hur. This way will take some of the emotion out of it and will allow what is known of the truth to be displayed like a pack of spread cards. I need you to come on a little journey with me. I have been given some news which requires sharing but I am unsure as to what the future will hold.

I have recently been having my  heart checked. To this end I have had an ECG which tests the electrics of your heart. I had an ECG test performed whilst undertaking a stress test.  They get you to exercise on a treadmill whilst they monitor the performance of your heart. They pushed me heaps making the treadmill work faster and steeper and I came through that one with flying colors. I then had an ultrasound of my heart which as they described is like looking at the founndations and structures of the heart  if it were a dwelling. Everything was perfect. The heart specialist was very pleased but when I reiterated my family history;

• Mother having by pass surgery at 58 years old
• Mum's dad dead at 47
• 6 or so of Mum's brothers dead by 50 although they were smokers

he said "If you like we can do a CT scan of the heart. Nothing to be lost and the procedure is not invasive as an operative angiogram would be." The CT scan is like checking out the plumbing. What the heck I thought, better to be safe than sorry so I booked and had my CT angiogram.

They were to get back to me pretty quickly once they had read the CT scans so when I had not heard anything I assumed I was in the clear.
I rarely answer the phone at home but happened to Tuesday morning as I was preparing for work that afternoon.

"David H******* here, we need to check you in for an operative angiogram. You have a blockage in one of your arteries."
"Will you stent this?" I asked
"I will try to get a stent in... it isn't always possible".

A stent is a tube or balloon that is inserted into the area of the blockage in the artery and expanded and then left in place effectively opening the blockage.

My heart was racing, this was not the news I had wanted to hear but I could think of nothing to ask him.

"So is that just a day off work?"I asked ever so practical," and how soon?". The answer was within four weeks. It needed to be done soon.
Anyway, I was now in a bit of a blur as I had no real information. I got on line and filled my head with as much basic information as I could find.There is as you know lots of information on the net but you need to be sceptical of it all as to what really is the truth. 

Two weeks later I was able to collect my films and read the radiologist report directly.It made sobering reading I am afraid and I await further answers when I see David H********* again at the time of my operative procedure.

I will admit that I was loathe to tell you as I did not want to worry anyone, I do not want to be my mother and there are still many questions to ask and answers to be revealed. For the moment though, the arteries that are associated with my heart are mildly or moderately blocked. I have the heart of a seventy year old.
The report says I will without treatment be dead in two to five years. Yes, I thought so too!
However, I have the knowledge and now comes the future. What that will be is of course uncertain but I know with your love there will be a satisfactory outcome.
Look at my mother, she hardly died prematurely at 83 or so!

As you can imagine my brain has been racing and covering all sorts of ground in so many far off and convoluted pathways. Nothing like a disaster to hone the mind.

I was in my mid thirties when I was asked to provide a blood sample during a conference so the company with the machine which analyses the sample, could get a good range of what levels of cholesterol existed in the population.My result was alarming as it should read around 4 or less and I came in at 12! I went for further tests, I had a young family, I needed to know more about this problem.A strict diet that eliminated all fat reduced the cholesterol figure to 10.6 or thereabouts. A reduction in total cholesterol of ten percent is about normal and about the highest that can be achieved without medication.

Total cholesterol is only part of the issue anyway, it is a crude measure.You need to have total cholesterol broken down into its components of HDL high density lipoproteins, LDL low density lipoproteins  and triglycerides. HDL is good,  LDL is bad and trigs are not great. You. can change the levels of the components with diet and especially exercise.However the issue was my cholesterol was too high, medication was and is still used to bring it down but despite my level now being around 5, I have still got hardened and blocked arteries. This is as a result of genetics.Familial hypercholesteraemia. You too could have it and at some stage you should get it investigated. I gave been on cholesterol lowering drugs for over twenty years now. People with high cholesterol do not seem to get cancer as a general rule, low cholesterol is associated with higher rates of cancer. Hey there has to one bonus ha ha.

So at some stage they will give me a date for the next stage in this new journey and I will have my operative angiogram. I will then know more about my predicament. There will be plenty of questions to ask...I have been making a list. There are some risks with having a wire poked into an artery in your groin and this wire under x ray visualisation, being guided into the various sections of the heart. There is a 1% chance I could die. There is a 2% chance I will need to be flown to Sydney for emergency heart surgery. Complications are a part of life but always happen to other people okay.Let us deal with the positives and there are always opals in the dirt if you are prepared to look.

• At least I found out earlier than some fateful unaware day of being somewhere and suddenly clutching at my chest gasping for air to fall off this planet so gracelessly.
• I don't think there is anything unresolved between us.
• I believe you know how much I love you and how my life has been so enriched by my experiences with you.That is a constant.

So let us not worry, let us move on and lets get the next bit out of the way. At least you know what is happening and at some stage you should have your own set of basic tests to evaluate your own risks of taking on an inherited issue.

Verbose as always. All my love

Dad

I wish now I had kept it simple. Oh well.

Making Sense.

After the initial period of continuing a daily life uninterrupted on the surface but with the mind swirling, and feeling like the hand of death was dancing over my head in the same way as Paul McCartney was depicted on the cover of Sgt Peppers Lonely Hearts Club band when his demise was being "proved", a series of questions have evolved.

The Questions:

So what exactly is involved with the issue and my heart?

What are the potential remedies?

What are the complications to any remedies?

Having been treated with cholesterol lowering drugs since my late thirties, have I been paying money needlessly and been ripped off?

What exercise is potentially bad exercise?

If my heart is affected by narrowing of the arteries, what about arteries in other parts of my body and how will I know about these?

What can I change today to help me in the future?

Do I tell my children?


I have been dealing with the answers to these questions with enough success to know what is going on but not enough to answer them all. In time that will be clearer. What is quite clear though is when the pack of genetic cards were shuffled in my making, the last laugh was with the shuffler as it was ensured there was a joker in the pack. Whilst my dealt cards contained fitness, good looks, modesty and the ability to sing the song" That's the way aha aha I like it aha aha" entirely using burps, the latent card of high blood pressure and hypercholesterolaemia ( high cholesterol) was the hidden gem.

On my fathers side their hearts were like the Volkswagen Beetle, low revving and indestructible. My mother's contribution however reads more like the MG Rover in a study by Warranty Direct, with the worst possible failure rate of any motor car. It had virtually prematurely eliminated her side of the family although not entirely,( yahoo for genetic variability, there is hope) and had lead her to bypass surgery at fifty eight years of age. The surgery it must be noted led her to the ripe of age of eighty three. Yahoo, thank you modern medicine!

You can't blame existence, you can't lay blame at anything really. It is what it is.Make the most of any situation and proceed with factual answers. And therefore to the list of questions, next time.

There are plenty of things that are on the  loose out there that can wreak havoc with one's life. Some we can prepare for, some we can insure for, some we can do no more than sit and wait to see if the gun pointing in your direction is loaded and actually aimed at you.

A good world is a world where you can be appreciated and at least given the time of day when you make mistakes. Mistakes are part of life and can lead to a learning experience. Mistakes are the progenitor cells of change. Mistakes are the tear drops from the marbled statues of the God of Freedom and The God of Happiness.

Not all change results from mistakes. Sometimes serendipity lends a hand or it's opposite face, zemblanity. The smile and the sneer. As they say, " Shit happens."

It has been my knowledge for two weeks now that I require a procedure on my heart. Fifty nine years old, fit, active, an ox of a man ha ha.

The stress test had  resulted in the comment by the person conducting the test,

 "Not many people can go as long as you have!"

 The ultrasound had all provided a very positive result.

"Your heart is very strong and performing well."

Given a family history of heart issues, the cardiologist felt is reasonable to have a CT angiogram.

"It is non invasive compared to an operative angiogram and look, it is up to you but I have never felt that having one was a waste of time."

The wonders of hindsight! It was a shock to be given a phone call two weeks later, outside what I had thought was the danger time when I would have received a call if there had been an issue, to be told I had numerous narrowings in the arteries around the heart and I needed an operative angiogram and quite likely a stent or stents.

Right I thought, wondering now if any movement might be my last. What does this all mean?  A brain fog descended. Thoughts drifted eerily through the clouds unable to form questions and without the questions there could be no answers.

It would be some time within the next four weeks that I would have my procedure. I needed to take some time just to think and that is what I have done. The biggest tension  is the emotional wrangle. This is suddenly "Your Life" and it is no longer a game show. At the same time you have to quickly rise above the melodrama and get on with it.

I have decided to involve you in my having a coronary angiogram. Yeah, it might read like a soap opera, but it will be true.  It will be a reflection of not only the procedure and operative and post operative care,  but of restoring or making the most of someone's emotional and sensual self.