5 months since being hospitalised with Multi-Focal Pulmonary Emboli I’m back into an exercise program. I left hospital bursting with vim & vigour and was somewhat surprised when the Doctor insisted that I take 3 weeks off work then a staged return to work. I really couldn’t believe I was that ill... Actually if you’d told me 2 months earlier I might have believed you, but by the time we realised what was wrong the blog clot was splitting and I’m eternally grateful that the fragments lodged in fairly benign places rather than taking the opportunities for mischief that they had.
It didn’t take long for it to sink in though that there had been a significant hit on my health. Everyday life was wearying - possibly a wee bit psychology involved in that too? Up in the morning and ready to take on the day very quickly dulled into tired afternoons. I tried to lose some weight and took to walking, which was wonderful. For some reason Spring came to Scotland exceedingly early this year, February was fabulous and I made the most of it. The outcome of which was that I quickly escalated my walks too much and ended up with a spot of Plantar Fasciitis.
Regret 1 - Should have invested in better shoes for walking.
For all that the heel pain of P.F. Makes the mornings a bit miserable, it’s actually fine once you’re up and about and just requires a bit of stretching and taking care of your feet - I had the time, so no problem.
Having previously played rugby for too many years, I have a few wee niggles here and there that will always be with me. I’m missing a ligament in my shoulder that means I need to keep it conditioned so that the muscles provide the necessary stability. Those muscles have a habit of atrophying more quickly than the others and if I don’t maintain it, I end up with an unstable and painful shoulder. It really doesn’t take much to maintain them either, but as I was in complete rest, I didn’t...
Regret 2 - Should have added a daily movement routine to my schedule. Just running the joints through a sequence of moves designed to ensure the stability was maintained. No need to view it or manage it as ‘exercise’; no need to get tired or stressed (physically) by it, just keep things ticking over by moving those joints, maybe even tai-chi style... think that's what I might recommend rather than anything even as stressful as Yoga.
Regret 3 - Whilst doing that sequence of joint mobility exercises should have introduced some moves to make me less right sided. See the above comment on tai-chi, damn! Should have thought of that, it always seemed a bit of a weird thing to be doing, but actually kicking myself now that I didn't do that.
The move I’m using just now to return my shoulder to form is a bit like Saturday night Fever dance move. The Physio calls it ‘drawing sword from scabbard’ but I’m definitely more John Travolta than Braveheart, so ‘Staying Alive’ it is. She’s given me one of those rubber bands to add resistance, but honestly, just doing the move on it’s own and twisting the hand at the end so that the palm faces upwards is enough.
See a video version of it here
Most of the problems I had with it in the first instance I’m sure are to do with the fact that my brain didn’t know which order the muscles should be firing in. Getting there though.
Regret 4 - See all of above but apply it to the left knee, which is only slightly less damaged than the left shoulder
Regret 5 - Should have learned to juggle
Regret 6 - Should have played more guitar
Regret 7 - Didn’t make enough use of my Busuu account to practise languages
Regret 8 - Should have played more guitar
But here we are. Nothing to be done about what I didn’t do. I’m now back on the machines at the gym (cross trainer is nice and easy, rowing machine a brute) and I’ve been in the pool getting a few lengths done, so we're well on the way to recovery.
In the interest of balance, I don't regret stopping the booze for the last 5 months. It was pretty easy for the first couple of months as I felt so shitty anyway. After that it just seemed to come down to reminding myself that I didn't drink when people offered - which is more difficult than you might imagine, but with the negative impact of a bang on the head when on Warfarin, the internal debate doesn't take long to reach a conclusion.
Trials, tribulations, tales and titillations of a now 50- something year old, Scot, determined to stave of his cultural and genetic destiny with sporadic efforts to attain Physical perfection impaired by unhelpful refueling strategies and familial responsibilities. This blog will now track my efforts to recover from Multi-Focal Pulmonary Emboli, caused by a dislodged DVT.
Thursday, 13 June 2019
Tuesday, 26 February 2019
The Recovery - a wee bit of perspective
I was discharged from hospital on 27 January after 5 glorious days of complete rest.
If you ever find yourself in such a position or are in anyway the type of person who gets a bit restless or fretful, then I recommend that you read 'My Name is Doddie', the biography of Scottish rugby legend published last year as part of his efforts to raise money and awareness of the mind bogglingly awful condition that is Motor Neurone Disease. They way the big man is dealing with this cruel card he's been dealt would bring a tear to a glass eye.
In hospital, I put my feet up, read a little, watched Peaky Blinders on Netflix, moved around the room to have my meals with different views and went to the toilet occasionally. I had frequent checks on my blood pressure and oxygen levels, a bit of fussing over changes to the medications that had been used to treat my misdiagnosed heart attack and changed my compression socks daily. In the end, the hospital realised that if they didn't kick me out they might run into a tea shortage well before Brexit even started to take effect, so as soon as my INR finally reached the minimum acceptable level I was out on my ear.
In that time my resting heart rate dropped from 75 back down to 60. In the 5 days after leaving, it crawled back up to 65 and has stayed around that level pretty consistently since, up to 68 briefly and down to 63 occasionally - funny wee vagary of the Fitbit, you can often be relaxed with a HR below what it records as your Resting Heart rate, something to do with how you sleep I believe, but I often see it a few beats below 60.
There really isn't a lot of information out there about what you can expect in the next stage. Take it easy is the main thing, don't exercise too vigorously for a couple of weeks, but no way of knowing when you can get back in the saddle - and this is what you really want to know in the early stages.
Most recovery plans I've been offered aim to get the patient up to walking for 40 minutes a few times per week, whilst I'm looking to set my bar a wee bit higher than that and after 1 week was pretty much walking 40 minutes daily - albeit, I was feeling the effects of that initially - getting up to 1 hour in the 2nd week and by the 3rd week easily able to get out for a good 2.5 hour hike every couple of days.
What you can't really account for is just how much rest you also need at this point. I left the hospital feeling revitalised and full of vim & vigour and feeling desperate to get out for a run or a bike ride, almost fantasising about doing circuits or lifting weights. Just a week of having a fairly easy time of it at home showed me that this condition isn't just as simple as take some medicine, feel better, get back to training. There's a real need to come to terms with the predicament that has just been survived. There's also a need to realise that the body has had a bit of a kicking and could still yet suffer unwanted long term consequences if you get the recovery wrong. On the other hand though, there is a tremendous amount of good to be gotten out of a period of more gentle exercise. The walking has been uplifting. The need to have a more stable diet has been beneficial too, although it has highlighted my terrible discipline when it comes to peanuts. I'm allowed alcohol if I want, but actually there are too many risks associated with head knocks, so I've just completely knocked the drinking on the head and I have barely missed it at all - I'm now a fizzy water with a wee dash of cordial guy. I can do press-ups no problem and I quite like doing them, but I think I need to spend some time working on my flexibility, so I'm going to avoid strenuous exercise for another few weeks and focus on yoga type stretching - I am a tree! I am the mountain! I am the soft breeze!
In the meantime, I'm really enjoying getting out for my walks. It's good to reacquaint myself with the city and the parks that I'm lucky enough to be surrounded by. The weather this year is freakish though and at the end of February, 1 year on from us enduring the 'beat from the East' it's now way too warm. The flowers are already out in force - not sure how the next deep frost will affect them, but in the meantime I'm enjoying this very early start to Spring and am much more aligned with my need to recover physically more slowly than my ego would like, but even that has taken a few weeks to accept.
If you ever find yourself in such a position or are in anyway the type of person who gets a bit restless or fretful, then I recommend that you read 'My Name is Doddie', the biography of Scottish rugby legend published last year as part of his efforts to raise money and awareness of the mind bogglingly awful condition that is Motor Neurone Disease. They way the big man is dealing with this cruel card he's been dealt would bring a tear to a glass eye.
In hospital, I put my feet up, read a little, watched Peaky Blinders on Netflix, moved around the room to have my meals with different views and went to the toilet occasionally. I had frequent checks on my blood pressure and oxygen levels, a bit of fussing over changes to the medications that had been used to treat my misdiagnosed heart attack and changed my compression socks daily. In the end, the hospital realised that if they didn't kick me out they might run into a tea shortage well before Brexit even started to take effect, so as soon as my INR finally reached the minimum acceptable level I was out on my ear.
In that time my resting heart rate dropped from 75 back down to 60. In the 5 days after leaving, it crawled back up to 65 and has stayed around that level pretty consistently since, up to 68 briefly and down to 63 occasionally - funny wee vagary of the Fitbit, you can often be relaxed with a HR below what it records as your Resting Heart rate, something to do with how you sleep I believe, but I often see it a few beats below 60.
There really isn't a lot of information out there about what you can expect in the next stage. Take it easy is the main thing, don't exercise too vigorously for a couple of weeks, but no way of knowing when you can get back in the saddle - and this is what you really want to know in the early stages.
Most recovery plans I've been offered aim to get the patient up to walking for 40 minutes a few times per week, whilst I'm looking to set my bar a wee bit higher than that and after 1 week was pretty much walking 40 minutes daily - albeit, I was feeling the effects of that initially - getting up to 1 hour in the 2nd week and by the 3rd week easily able to get out for a good 2.5 hour hike every couple of days.
What you can't really account for is just how much rest you also need at this point. I left the hospital feeling revitalised and full of vim & vigour and feeling desperate to get out for a run or a bike ride, almost fantasising about doing circuits or lifting weights. Just a week of having a fairly easy time of it at home showed me that this condition isn't just as simple as take some medicine, feel better, get back to training. There's a real need to come to terms with the predicament that has just been survived. There's also a need to realise that the body has had a bit of a kicking and could still yet suffer unwanted long term consequences if you get the recovery wrong. On the other hand though, there is a tremendous amount of good to be gotten out of a period of more gentle exercise. The walking has been uplifting. The need to have a more stable diet has been beneficial too, although it has highlighted my terrible discipline when it comes to peanuts. I'm allowed alcohol if I want, but actually there are too many risks associated with head knocks, so I've just completely knocked the drinking on the head and I have barely missed it at all - I'm now a fizzy water with a wee dash of cordial guy. I can do press-ups no problem and I quite like doing them, but I think I need to spend some time working on my flexibility, so I'm going to avoid strenuous exercise for another few weeks and focus on yoga type stretching - I am a tree! I am the mountain! I am the soft breeze!
In the meantime, I'm really enjoying getting out for my walks. It's good to reacquaint myself with the city and the parks that I'm lucky enough to be surrounded by. The weather this year is freakish though and at the end of February, 1 year on from us enduring the 'beat from the East' it's now way too warm. The flowers are already out in force - not sure how the next deep frost will affect them, but in the meantime I'm enjoying this very early start to Spring and am much more aligned with my need to recover physically more slowly than my ego would like, but even that has taken a few weeks to accept.
Friday, 15 February 2019
Deep Vein Thrombosis - the signs
Having established that I'd probably suffered a DVT sometime last Autumn, it slowly dawned on me that my body had been screaming this at me, but I'd ignored it.
In October at some point I had what I assumed was a calf cramp. I haven't suffered such an incident since I was in my 20s. Back in those days I did occasionally wake up in excruciating pain during the night - these are known as nocturnal cramps and the NHS have a page here, back then they were probably caused by the effects of rugby training in the deep mud that passed for Anchor Playing fields in Paisley. I brushed this incident off without considering fully that it's about 25 years since I had my last cramp like that, even if it did take a few days to feel like my calf was recovering - I put that down to old age - and I certainly hadn't been putting any great stress on my calfs in recent weeks.
I also noticed that my ankle was slightly swollen, socks were leaving much more pronounced marks around my ankles at the end of the day and I did consider that I might need to see the dr. about why that might be happening, then of course the swelling disappeared of it's own accord, so I did nothing about it - it seemed harmless.
Both of these signs are pretty major indicators that there was a DVT causing a blockage in my leg. Hindsight is a wonderful thing!
Thursday, 14 February 2019
Deep Vein Thrombosis - the causes
So having come to terms with the facts of Multi-Focal Pulmonary Emboli and addressing the immediate dangers of the condition, it's time to review how this has come to pass.
Having reviewed the scans, the cardiologist was able to identify certain characteristics about the clots quite accurately and this led to the conclusion that a DVT breaking free from my leg was the most probable cause.
Normally I'd associate DVT with long haul flying and I must confess I've probably been a bit blazé about those concerns. I fly long haul not much more than once a year, but certainly make sure that I get up and about when I do. I never wore compression socks though and I do enjoy a few drinks whilst I'm being served them.
Actually there are more than a few contributing factors to DVT, of course. In my case, I frequently fly short haul, but when you travel from Glasgow to go anywhere, more often than not it's a short flight to Amsterdam, before another flight to your final destination - In the worst period last year I took 14 flights in 15 days.
The issue with long haul flying seems mainly to surround the fact that you can find yourself seated for 3 hours or more, here's the bit that bothers me now, for although most of my flights are cramped into cattle class short haul jobs where the flight time might be no more than 90 minutes, you can sit on the plane for 45 minutes before taxiing and take another 20 minutes at the other end (try landing at an outer runway at Schiphol), suddenly those short haul adventures are much closer to 3 hours seated than you think.
Beyond flying though, recent months have seen me slumped at my desk in the afternoons. From quite active mornings, as in getting up and down from my desk occasionally to make a cup of tea, the afternoon can go from the lunchtime van delivery - it arrives in the car park at 12 noon daily - to having sat at the screen for anything up to 4 or 5 hours solid. During the Autumn period, my Fitbit was warning me that I was inactive. Reviewing the records, I slipped into barely doing any exercise at all for 2 & 3 weeks and my belt got accordingly tighter.
Simply sitting at my desk getting fatter could be a major contributing factor to the development of this DVT.
Why post this part of the story? Well, I have had a Fitbit for a number of years. I got around to viewing it as a bit of a waste of time. Basically it reflected whether I'd had an active day or not. If I walked into town for lunch, I easily scored my 10k steps. If I took lunch from the van, I barely scored 7k steps. But looking at the Fitbit daily, isn't the only point. It is actually a very good indicator of long term trends, so whilst I was failing to score any stars for 1 day per week, who cares, but start failing for 3 or 4 days a week, then start stretching that out to 3 & 4 week periods... well it's not rocket science is it. Getting heavier AND spending more & more, longer & longer periods in a sitting position is not a good trend, but that is what I was doing and I have the records to prove it...
The other thing that my Fitbit was also screaming at me was that my resting heart rate had made a step change from constantly below 60 to sitting above 75 for a period. Like a true eject, I just ignored this and assumed it would rectify itself once I started exercising again - Should have gone straight to the Dr. with that information alone.
This isn't an advert for Fitbit - other activity trackers are available; but if you invest on one, you should at least make use of the information it provides you!
Having reviewed the scans, the cardiologist was able to identify certain characteristics about the clots quite accurately and this led to the conclusion that a DVT breaking free from my leg was the most probable cause.
Normally I'd associate DVT with long haul flying and I must confess I've probably been a bit blazé about those concerns. I fly long haul not much more than once a year, but certainly make sure that I get up and about when I do. I never wore compression socks though and I do enjoy a few drinks whilst I'm being served them.
Actually there are more than a few contributing factors to DVT, of course. In my case, I frequently fly short haul, but when you travel from Glasgow to go anywhere, more often than not it's a short flight to Amsterdam, before another flight to your final destination - In the worst period last year I took 14 flights in 15 days.
The issue with long haul flying seems mainly to surround the fact that you can find yourself seated for 3 hours or more, here's the bit that bothers me now, for although most of my flights are cramped into cattle class short haul jobs where the flight time might be no more than 90 minutes, you can sit on the plane for 45 minutes before taxiing and take another 20 minutes at the other end (try landing at an outer runway at Schiphol), suddenly those short haul adventures are much closer to 3 hours seated than you think.
Beyond flying though, recent months have seen me slumped at my desk in the afternoons. From quite active mornings, as in getting up and down from my desk occasionally to make a cup of tea, the afternoon can go from the lunchtime van delivery - it arrives in the car park at 12 noon daily - to having sat at the screen for anything up to 4 or 5 hours solid. During the Autumn period, my Fitbit was warning me that I was inactive. Reviewing the records, I slipped into barely doing any exercise at all for 2 & 3 weeks and my belt got accordingly tighter.
Simply sitting at my desk getting fatter could be a major contributing factor to the development of this DVT.
Why post this part of the story? Well, I have had a Fitbit for a number of years. I got around to viewing it as a bit of a waste of time. Basically it reflected whether I'd had an active day or not. If I walked into town for lunch, I easily scored my 10k steps. If I took lunch from the van, I barely scored 7k steps. But looking at the Fitbit daily, isn't the only point. It is actually a very good indicator of long term trends, so whilst I was failing to score any stars for 1 day per week, who cares, but start failing for 3 or 4 days a week, then start stretching that out to 3 & 4 week periods... well it's not rocket science is it. Getting heavier AND spending more & more, longer & longer periods in a sitting position is not a good trend, but that is what I was doing and I have the records to prove it...
The other thing that my Fitbit was also screaming at me was that my resting heart rate had made a step change from constantly below 60 to sitting above 75 for a period. Like a true eject, I just ignored this and assumed it would rectify itself once I started exercising again - Should have gone straight to the Dr. with that information alone.
This isn't an advert for Fitbit - other activity trackers are available; but if you invest on one, you should at least make use of the information it provides you!
Tuesday, 12 February 2019
A very Cardiac Christmas tale
It's been quite a journey recently - and not much of a fitness one either!
In December 2018 I was in Paris for work when I noticed I was struggling for breath as I walked up a hill chatting on the phone. Quite unusual for me (the breathless bit rather than the chatting), but maybe just a cold or 'something' getting to my chest, I postulated.
Returning from my business trip I was greeted with the news that my younger brother had died suddenly, just 2 months shy of his 45th birthday. It would be fair to say that over the years we have taken very different approaches to our health and he had required some emergency surgery in the summer to resolve Perforated Duodenal ulcers, which he had allowed to go untreated for too long. Nevertheless, he should have been on the road to recovery, but some questions over his attitude towards the lifestyle changes he was going to need to make for a full recovery. There remains an unresolved concern that he may have suffered some kind of cardiac issue, but in the absence of a post-mortem for whatever reason, we shall never know.
The following weekend, the kids were playing rugby at East Kilbride which has a bit of a steep climb to get from clubhouse to pitch. By the time I'd jogged up to the pitch and across to join the team, I realised I wouldn't be able to speak to them. At this point, my fellow coach who also happens to be a pathologist warned me that they had seen quite a surge in Pneumonia cases in Glasgow recently. He urged me to see my doctor asap, which I guess I thought was a good idea, but I've slipped into a pretty shoddy way of expecting to be told that "it's probably a virus come back in 2 weeks if you're still ill".
On Monday whilst I wrestled with how complicated December was turning out to be with Christmas, a family wedding, now a funeral and my own health somehow letting me down, Craig once again texted to urge me to see my Doctor. I realised this was the one thing I could actually do something about, so called the GP and was invited to the surgery that morning after a phone call to discuss my symptoms. On meeting my GP, he checked the lungs and said they were clear, but given a poor family cardiac history and the fact that I live in Glasgow, where our record of cardiac ill-health is second to none, he decided to refer me to the cardiologist, put me on aspirin and beta-blockers in the meantime. 3 days of Beta Blockers and I was in the position that despite feeling grand normally I had to stop for a rest halfway up the stairs and could not quicken my pace to cross the road without stopping to catch my breath after. Strange days. Totally ok on the flat, but knackered as soon as I hit any incline.
Decided to make use of the work insurance plan and see a cardiologist privately - so on the last Friday before Christmas, just after 6pm, I get an ECG with the diagnosis that I've suffered a significant heart attack recently... Here's how the system works in the UK. Your NHS doctor can prescribe drugs which you get for free from the Pharmacy. Private consultants can not prescribe out-patients drugs - normally they write a letter to the patient's GP and make a recommendation. They can also write a private prescription, which the patient takes to the Pharmacy and pays for the medication at market rate. With the ECG suggesting 'significant' Myocardial Infraction (MI), it's straight onto extra some blood thinners to complement the aspirin I'm already on, something to address the high blood pressure I'm exhibiting and Statins to deal with the elevated Cholesterol level detected by the GP blood test (which also showed the presence of some proteins that could be indicative of heart issue). Fortunately for me I'm in the position where an extra £24 the week before Christmas is manageable, but it got me around to thinking about how much I agree with the Scottish government policy of free prescriptions and why it's important.
Quite an amusing discussion with the consultant followed where he agreed with me that even light housework might be too much of an undertaking at this time (I was only joking, but he was stressing how easy I should take things) but disagreed with my wife that I should avoid alcohol altogether, recommending that a wee glass of red wine might be just the thing to help me relax, so long as I didn't overdo it. R&R was the key!
1 week later in between Christmas & New Year and I'm back at Ross hall for an Echo Cardiogram and cardio stress test. I've done my best so far to stick to the instructions and my wife has been a superstar in making it possible. First up is the cardiogram and I sense some frustration from the Cardiologist. In the end he reveals that he's not seeing anything like the damage that he's expecting to find. The stress test goes pretty well too. In my mind I'm readying myself for the Drago lab scene from Rocky IV, as the nurse manscapes my chest and attaches the electrodes. The mood is somewhat ruined by the nurse checking everything is attached before asking me whether I've used a treadmill before - Everyone's a comedian these days! Anyway, it's quite an easy start before the incline increases and the speed steps up to a brisk walk. Although I'm way more breathless than I would expect, my heart is responding exactly as it should to the changes in stress and it's not getting out of kilter at all. In the end the doctor sees that I'm more breathless than I should be but declares that I'm fit enough to be an HGC driver. With all due respect, I've seen some of those boys and I set my bar a wee bit higher than that, so we need to look at something else.
An MRI and a cardio angiogram are next on the list of tests. The MRI (the gold standard of scans) turns out to be something of a claustrophobic yoga class, as for 90 minutes I'm trapped on a gurney in a tunnel doing breathing exercises. Each scan is taken at the end of an out breath. There's no indication how many pictures it will take (you get a beep per picture), but it ranges from 1 to 24, with 6 being pretty typical. The result is a full 3D image of the heart working and blood flow. The end result of my scan is that I am showing a perfectly functioning heart with no indication at all of any damage. The subsequent consultation with the cardiologist turned into something of an episode, with him expecting this news to be greeted euphorically. He hasn't counted on my wife working back in her mind how many times she has gone our of her way to make me as comfortable as possible on the couch with a glass of wine whilst she dealt with our unholy brats on a Christmas sugar rush. As I accept his view that this could have been some kind of myocardial virus with what I consider good grace, I note with some concern that my wife appears to be raging that I've somehow managed to malinger through the festive period and this cardiologist has been complicit in facilitating it. He points out that blood tests and ECG are still indicative of an issue, just that we're discounting Heart attack now and looking for another cause, hence why I've to get back for the Cardio Angiogram, where they will check out the state of my arteries.
We're now into mid January, and I'm actually feeling noticeably better. Also pleased to know that I can drop the blood thinner (Clopidogrel) and blood pressure pills (forgotten already). Really starting to buy into the Myocardial virus story and feel like there has been a sudden vast improvement, although I'm still not feeling like I'll be going for a run anytime soon, but my Fitbit, which I've started paying much more attention to is showing that my resting heart rate which had suddenly stepped up to 75 from 60 in December, is now showing signs of lowering back towards that original level.
For the Angiogram I'm back at Ross Hall and the requirement is that I need to get my Heart rate constantly below 60 for the test to proceed - again there's a bit of manscaping and some electrodes connected up. Sitting just on 60bpm in the relaxed pre scan position with beautiful cherry blossom tiles looking down, they decide to apply some beta blockers to get me down a bit, soon sitting at 54bpm and the test begins. Much quicker than the MRI, but halfway through there is an injection which helps build up some contrast for the analysis. Quite a strange wee experience with a cold flow up the arm before the feeling that I'm wetting myself, although not as unpleasant as that sounds...
Sliding out of the machine I notice that my eyes are wee bit itchy and the nurse notices too. An allergic reaction isn't unknown, so they decide I should hang about for a wee bit and they make a cup of tea. Finish my tea and I'm ready to go but the nurse says the Dr. would like a word - that's not good news thinks I, but she says something about the allergic reaction. I don't believe her, but let's hear what he's got to say.
In the background of the cardiac scan, where initial impression is that heart and arteries are in good nick, he's spotted what he thinks might be a Pulmonary Embolism - Blood clot on the lung. After a bit of discussion, where his first thought is that I should take my scan directly to A&E, they agree that I should just get a full lung scan and see whether Ross Hall can treat me. Full lung scan reveals Multi-Focal Pulmonary Emboli (blood clot on each lung) and hospital Admin have rules that as its discovered on site I should be treated immediately. Very quickly meet a new Cardiologist, who explains just how dangerous this situation is and its straight upstairs into bed to be attached to a Heparin drip 24/7 until the Warfarin Therapy becomes effective. The easy explanation is that the Intra-Venous (IV) Heparin is very quickly effective but not long lasting, whilst the longer lasting Warfarin pills are not immediately effective and require some fine tuning as the effectiveness is seriously affected by diet and metabolism. The not so easy bit to handle is that I've got some blood clots on my lungs which could dislodge and kill me or at least make me seriously ill.
The explanation for my apparent recovery is that the blood clots appear to be fragments of a much larger clot, with the theory being that the larger clot was initially blocking a major artery - making me feel really crap - before splitting to block less major arteries - making me feel less crap.
Pulmonary Embolism (PE); that's a world of trouble that you don't want to hear your doctor saying at any time. You really, really don't want to hear - Multi-Focal Pulmonary Emboli. On the other hand 5 days in a private hospital is a pretty decent way to get the headspace required to move into recovery mode and that's where I am right now.
In December 2018 I was in Paris for work when I noticed I was struggling for breath as I walked up a hill chatting on the phone. Quite unusual for me (the breathless bit rather than the chatting), but maybe just a cold or 'something' getting to my chest, I postulated.
Returning from my business trip I was greeted with the news that my younger brother had died suddenly, just 2 months shy of his 45th birthday. It would be fair to say that over the years we have taken very different approaches to our health and he had required some emergency surgery in the summer to resolve Perforated Duodenal ulcers, which he had allowed to go untreated for too long. Nevertheless, he should have been on the road to recovery, but some questions over his attitude towards the lifestyle changes he was going to need to make for a full recovery. There remains an unresolved concern that he may have suffered some kind of cardiac issue, but in the absence of a post-mortem for whatever reason, we shall never know.
The following weekend, the kids were playing rugby at East Kilbride which has a bit of a steep climb to get from clubhouse to pitch. By the time I'd jogged up to the pitch and across to join the team, I realised I wouldn't be able to speak to them. At this point, my fellow coach who also happens to be a pathologist warned me that they had seen quite a surge in Pneumonia cases in Glasgow recently. He urged me to see my doctor asap, which I guess I thought was a good idea, but I've slipped into a pretty shoddy way of expecting to be told that "it's probably a virus come back in 2 weeks if you're still ill".
On Monday whilst I wrestled with how complicated December was turning out to be with Christmas, a family wedding, now a funeral and my own health somehow letting me down, Craig once again texted to urge me to see my Doctor. I realised this was the one thing I could actually do something about, so called the GP and was invited to the surgery that morning after a phone call to discuss my symptoms. On meeting my GP, he checked the lungs and said they were clear, but given a poor family cardiac history and the fact that I live in Glasgow, where our record of cardiac ill-health is second to none, he decided to refer me to the cardiologist, put me on aspirin and beta-blockers in the meantime. 3 days of Beta Blockers and I was in the position that despite feeling grand normally I had to stop for a rest halfway up the stairs and could not quicken my pace to cross the road without stopping to catch my breath after. Strange days. Totally ok on the flat, but knackered as soon as I hit any incline.
Decided to make use of the work insurance plan and see a cardiologist privately - so on the last Friday before Christmas, just after 6pm, I get an ECG with the diagnosis that I've suffered a significant heart attack recently... Here's how the system works in the UK. Your NHS doctor can prescribe drugs which you get for free from the Pharmacy. Private consultants can not prescribe out-patients drugs - normally they write a letter to the patient's GP and make a recommendation. They can also write a private prescription, which the patient takes to the Pharmacy and pays for the medication at market rate. With the ECG suggesting 'significant' Myocardial Infraction (MI), it's straight onto extra some blood thinners to complement the aspirin I'm already on, something to address the high blood pressure I'm exhibiting and Statins to deal with the elevated Cholesterol level detected by the GP blood test (which also showed the presence of some proteins that could be indicative of heart issue). Fortunately for me I'm in the position where an extra £24 the week before Christmas is manageable, but it got me around to thinking about how much I agree with the Scottish government policy of free prescriptions and why it's important.
Quite an amusing discussion with the consultant followed where he agreed with me that even light housework might be too much of an undertaking at this time (I was only joking, but he was stressing how easy I should take things) but disagreed with my wife that I should avoid alcohol altogether, recommending that a wee glass of red wine might be just the thing to help me relax, so long as I didn't overdo it. R&R was the key!
1 week later in between Christmas & New Year and I'm back at Ross hall for an Echo Cardiogram and cardio stress test. I've done my best so far to stick to the instructions and my wife has been a superstar in making it possible. First up is the cardiogram and I sense some frustration from the Cardiologist. In the end he reveals that he's not seeing anything like the damage that he's expecting to find. The stress test goes pretty well too. In my mind I'm readying myself for the Drago lab scene from Rocky IV, as the nurse manscapes my chest and attaches the electrodes. The mood is somewhat ruined by the nurse checking everything is attached before asking me whether I've used a treadmill before - Everyone's a comedian these days! Anyway, it's quite an easy start before the incline increases and the speed steps up to a brisk walk. Although I'm way more breathless than I would expect, my heart is responding exactly as it should to the changes in stress and it's not getting out of kilter at all. In the end the doctor sees that I'm more breathless than I should be but declares that I'm fit enough to be an HGC driver. With all due respect, I've seen some of those boys and I set my bar a wee bit higher than that, so we need to look at something else.
An MRI and a cardio angiogram are next on the list of tests. The MRI (the gold standard of scans) turns out to be something of a claustrophobic yoga class, as for 90 minutes I'm trapped on a gurney in a tunnel doing breathing exercises. Each scan is taken at the end of an out breath. There's no indication how many pictures it will take (you get a beep per picture), but it ranges from 1 to 24, with 6 being pretty typical. The result is a full 3D image of the heart working and blood flow. The end result of my scan is that I am showing a perfectly functioning heart with no indication at all of any damage. The subsequent consultation with the cardiologist turned into something of an episode, with him expecting this news to be greeted euphorically. He hasn't counted on my wife working back in her mind how many times she has gone our of her way to make me as comfortable as possible on the couch with a glass of wine whilst she dealt with our unholy brats on a Christmas sugar rush. As I accept his view that this could have been some kind of myocardial virus with what I consider good grace, I note with some concern that my wife appears to be raging that I've somehow managed to malinger through the festive period and this cardiologist has been complicit in facilitating it. He points out that blood tests and ECG are still indicative of an issue, just that we're discounting Heart attack now and looking for another cause, hence why I've to get back for the Cardio Angiogram, where they will check out the state of my arteries.
We're now into mid January, and I'm actually feeling noticeably better. Also pleased to know that I can drop the blood thinner (Clopidogrel) and blood pressure pills (forgotten already). Really starting to buy into the Myocardial virus story and feel like there has been a sudden vast improvement, although I'm still not feeling like I'll be going for a run anytime soon, but my Fitbit, which I've started paying much more attention to is showing that my resting heart rate which had suddenly stepped up to 75 from 60 in December, is now showing signs of lowering back towards that original level.
For the Angiogram I'm back at Ross Hall and the requirement is that I need to get my Heart rate constantly below 60 for the test to proceed - again there's a bit of manscaping and some electrodes connected up. Sitting just on 60bpm in the relaxed pre scan position with beautiful cherry blossom tiles looking down, they decide to apply some beta blockers to get me down a bit, soon sitting at 54bpm and the test begins. Much quicker than the MRI, but halfway through there is an injection which helps build up some contrast for the analysis. Quite a strange wee experience with a cold flow up the arm before the feeling that I'm wetting myself, although not as unpleasant as that sounds...
Sliding out of the machine I notice that my eyes are wee bit itchy and the nurse notices too. An allergic reaction isn't unknown, so they decide I should hang about for a wee bit and they make a cup of tea. Finish my tea and I'm ready to go but the nurse says the Dr. would like a word - that's not good news thinks I, but she says something about the allergic reaction. I don't believe her, but let's hear what he's got to say.
In the background of the cardiac scan, where initial impression is that heart and arteries are in good nick, he's spotted what he thinks might be a Pulmonary Embolism - Blood clot on the lung. After a bit of discussion, where his first thought is that I should take my scan directly to A&E, they agree that I should just get a full lung scan and see whether Ross Hall can treat me. Full lung scan reveals Multi-Focal Pulmonary Emboli (blood clot on each lung) and hospital Admin have rules that as its discovered on site I should be treated immediately. Very quickly meet a new Cardiologist, who explains just how dangerous this situation is and its straight upstairs into bed to be attached to a Heparin drip 24/7 until the Warfarin Therapy becomes effective. The easy explanation is that the Intra-Venous (IV) Heparin is very quickly effective but not long lasting, whilst the longer lasting Warfarin pills are not immediately effective and require some fine tuning as the effectiveness is seriously affected by diet and metabolism. The not so easy bit to handle is that I've got some blood clots on my lungs which could dislodge and kill me or at least make me seriously ill.
The explanation for my apparent recovery is that the blood clots appear to be fragments of a much larger clot, with the theory being that the larger clot was initially blocking a major artery - making me feel really crap - before splitting to block less major arteries - making me feel less crap.
Pulmonary Embolism (PE); that's a world of trouble that you don't want to hear your doctor saying at any time. You really, really don't want to hear - Multi-Focal Pulmonary Emboli. On the other hand 5 days in a private hospital is a pretty decent way to get the headspace required to move into recovery mode and that's where I am right now.
Monday, 4 November 2013
Myvember 2013
Hat tip to everyone raising money for male cancer issues this month. Movember is a terrific concept and every year new generations of young men will come awkwardly stumbling through puberty with the same concerns that ever other generation of men have faced. It's for those young fellas that we need to continually push the need for education, awareness and the importance of visiting your doctor to discuss honestly and without fear of embarrassment matters pertaining to our physical well-being.
Summary:
I started the month @ 86.3 Kg and finished at 85.9 kg - that's just measurement noise unfortunately, so we can't claim any great weight loss.
Just by looking at the alcohol consumption in a very specific way it seems that I've had at least a glass of wine, if not more, on exactly 50% of the days this month. If you'd asked me to predict what days I might drink during the month I'd have said probably about 6-8 days, so that's a bit disappointing - but quite telling in it's own way.
I had 12 fitness sessions lasting 30 minutes or more that I would class as working hard with 5 sessions of moderate effort and 8 easy sessions.
Interesting, as I feel pretty good generally, but I do think I need to lose weight!
I have only one concern and that is that sometimes we might just be missing the elephant in the room; that in our typical male zeal for competition where we challenge one another to grow the finest tache, or to raise the most money are we putting the cart before the horse. Shouldn't we simply make our own efforts to raise awareness. Highlight to one another that we need to ask our doctors for prostate tests and to have abnormalities examined; acknowledge that there are other benign conditions which could have similar symptoms to those of a cancer, but it's a whole lot smarter to get a benign condition checked out than to allow a cancer to develop unchecked - never mind the mental relief when that dark shadow at the back of your mind has been addressed. No point growing a big gunslinger for money and not getting your own issues addressed.
For My November this year, I'm going to sport a tache in support of the bro's who do so, but I don't want your money. I want you to look after yourself and go and get those things that checked out, checked out. Go and see your Doctor about that creaky knee - get some physio organised and get active again. Go talk about your digestive issues. Drink less this month - have a few extra AFDs (Alcohol Free Days)! Do something for yourself and your health every day whether it's a cardio session or as simple as a health check - that's what I'm going to do, even if it is just getting my teeth checked, it counts!
Starting at 86.3kg, this is MYvember:
| Day | Activity | Effort | A.F.D. |
| 1 | Treadmill 5km | 26 mins Hard | Y - 1 |
| 2 | Boxing circuits (Sweeneys) | 30 mins Easy | N - 1 |
| 3 | Road Running 6km | Easy | N - 1 |
| 4 | Dental Checkup | n/a | N - 1 |
| 5 | Spin Class | 300 kCal - Hard | Y - 2 |
| 6 | Swimming | Moderate | Y - 3 |
| 7 | KickBox Circuits | v. Hard | Y - 4 |
| 8 | Gym stretch & Swim | v. Easy | Y - 5 |
| 9 | Watch the rugby with a bottle of wine | n/a | N - 5 |
| 10 | Swimming training | Moderate | Y - 6 |
| 11 | Body Pump Class | Hard | Y - 7 |
| 12 | Spin Class | Hard | Y - 8 |
| 13 | Swimming | Easy | Y - 9 |
| 14 | KickBox Circuits | v. Hard | Y -10 |
| 15 | Walk | Easy | N -10 |
| 16 | Watch Rugby | n/a | N -10 |
| 17 | Swimming & watch Rugby, Travel to Paris | v. Hard | N -10 |
| 18 | Jogging Champs Elysee, Arc de Triomphe | Easy | N -10 |
| 19 | Conference & Travelling home | n/a | N -10 |
| 20 | Walking | v. Easy | Y -11 |
| 21 | KickBox Circuits | v. Hard | Y -12 |
| 22 | Gym & swim | Moderate | N -13 |
| 23 | Swim & Squash | Moderate | N -13 |
| 24 | Daughter's birthday party ;-) | n/a | N -13 |
| 25 | Pump Class (30 mins) | Hard | Y -14 |
| 26 | Spin class (30 mins) | Hard | N -14 |
| 27 | Swim & stretch | Moderate | Y -15 |
| 28 | KickBox Circuits | v. Hard | N -15 |
| 29 | Squash League match | v. Hard | N -15 |
| 30 | Kids Swimming | v. Easy | N -15 |
Wednesday, 23 October 2013
Bike rollers
First session on cycle rollers.
Been slacking for a while using a sore knee as an excuse, but really feeling the need to get something done I finally built the bike rollers I bought in summer for winter training - easy as pie.
First thing that struck me was how much higher the bike sits of the ground when up on the rollers. Still, I gingerly climbed aboard and using the kitchen benches for support got going (I've wedged myself and the bike into a galley kitchen till I learn how to ride these things).
No freewheeling at all...
Pedal stroke completely erratic...
No balance...
Tyres were flat...
Pumped them up...
Bit better...
Got riding with hands on the handle bars for short bursts, but nothing like these guys who post internet videos claiming to have just opened the box and can ride no problem... Suspect they might be exaggerating their capabilities somewhat.
Was quickly sweating like the proverbial. Maybe due to the need for total focus, maybe due to cycling with no ventilation - although I don't sweat like that in spin classes until we really get going, so suspect it's the hidden effort of trying to stay upright.
Overall, I'm quite pleased. I can see exactly how poor and lacking in smoothness my pedal stroke is and how little I engage my core when riding. Time for some new skills and this looks like exactly the machine to help me develop those techniques!
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