Thursday 1 December 2016

Dealing with chronic health issues can be a real PITA!

Dealing with chronic health issues can be a real PITA! BUT, when you know what the problem is and what you need to deal with them you can usually cope pretty well. In my case I am pretty much in control when it comes to dealing with my heart issues (including angina), diabetes and thyroid condition.

BUT, one issue that crops up from time to time is breathing/shortness of breath issues which seemed to get worse after my heart attack and triple bypass back in 2007. Knowing and understanding the consequences of heart muscle damage (lower quadrant in my case) and the implications it could have on my stamina and lifestyle took a while to come to terms with but today, generally speaking, I am pretty good with these.



The breathing problems can include a burning feeling in the upper chest/lungs when I take in breaths. And understanding that this is not an angina related episode is important as I also deal with that but have medication and use a patch each day to cope with that problem.


doing a lung function test in 2010

Now after my heart attack and surgery in 2007 when my breathing issues became worse, my cardiologist sent me off to our local hospital to do a lung function test which came back normal. I was then sent up to Brisbane to Princess Alexandra hospital to do a VO2 Max test to check out my oxygen intake levels. Again, the results came back okay.


VO2 Max test similar to one I did in 2010

Having been a heavy smoker - 33 years and 40-50 a day at the time of my heart attack - I was naturally concerned that I may have a medical issue related to smoking. Xrays and the above tests alleviated me of any concerns.



Whilst not having asthma as such, I did use from time to time Ventolin when I had similar breathing issues before my heart attack, however, after my heart attack I was told I could no longer use Ventolin. To help with my breathing problem I was put on a med called Symbicort 400, an inhaler that I needed to use three times a day.




Symbicort Turbuhaler 400/12 Powder for Inhalation is a brand of medicine containing the active ingredient budesonide - eformoterol fumarate dihydrate.

For a number of years I did this, however, a few years ago I stopped as my breathing improved.

Then, a few days ago, it all started again just as we started with a spate of hot, humid weather. And last night it got a bit too much for me so I reached for the Symbicort - yes, I had new script unopened and in date - and used it. Within a few minutes I could feel improvement so I guess I am back on the Symbicort again.

So it looks like I am back on the Symbicort for the forseeable future and will definitely bring this up when I see my G.P. next.

Saturday 19 November 2016

Going forward after a heart attack/event

A couple of weeks ago I was asked to be an administrator on a Heart Support group on Facebook. At first I was hesitant realizing I don't have the time that I once had to spend on Facebook and also because I wasn't truly sure what was expected of me in this role. I was subsequently told that what was required was positive posts to help those doing it tough and to cover what I did during my recovery period and how I dealt with depression, anxiety, panic attacks etc.

Masters of Rock Show

Anyway, a week or so later I found myself added as an admin to this group and apart from a post introducing myself and another one reminding people that November is Diabetes Awareness month, I wrote a post yesterday which I repeat below.
"When I was asked to join this group as an administrator I wasn't too sure what to expect, nor was I sure of what was expected of me. Jean, as I understood it, saw my role as posting positive items about things I have done over the years since my heart attack and triple bypass back in 2007 but finding the time to actually sit down and write something has not been easy due to always seeming to be busy. But today I have decided to change that and post something, probably spurred on by events of this and recent weeks.

Depression was part and parcel of my recovery period and still continues today, 9+ years on. Dealing with this back then was a challenge and remained so for around a year after my heart attack. Helping my wife look after injured wildlife helped me but rediscovering photography probably was the main thing to get me to start thinking positively.

Living where we live in the Gold Coast hinterland in Queensland, Australia with an abundance of wildlife (birds) visiting us daily provided me with no shortage of ready made subjects to photograph. This is an activity I continue to do today on an almost daily basis.

Rainbow Lorikeet

Along the way I also found I had time to listen to music again, something that had fallen by the wayside over the years due to work, family and all that sort of thing. And then three or so years ago my wife and I discovered tribute bands where we live.


The natural progression for me was to challenge myself to take photos of live shows, teaching myself the skills and the required techniques. In recent months I was asked by one of the largest clubs up here to take photos of their shows (did two last weekend) and me being me agreed to do it not for payment but in exchange for tickets to the shows for me and my wife.

PINK tribute show

Then last week I was asked to do some promo shots for a local group for a small payment and this morning received a phone call asking me to do photos at a show tomorrow night - sadly, can't do this one as since my heart attack I don't travel far at night and this one is over an hour away (they are looking to see if someone is coming from our area who could give me a lift).

And today I received confirmation to shoot another show in three weeks time.

So, what started as a hobby has now developed into something a bit more serious but more importantly, it is something I thoroughly enjoy doing, and may develop into a form of income, albeit small.

Now why have I written all of this? Because I believe it is of paramount importance for those of us who are finding it hard to cope after a heart attack (or any life threatening disease) to find a hobby. I say as much when I give talks to our local cardiac rehab unit which I have been doing since 2008 and I say the same when I give a talk on behalf of our Heart Foundation for which I am a volunteer speaker.

So for those of you who, like me, found they were unable to go back to work or a full-time job, that does not mean that life has come to an end. Now, during the recovery period, is a great time to rediscover an old interest and maybe develop it into something more.

And I do understand that saying the above can be easier said than done but we have to realize that giving up should never be an option.

Happy to respond to questions or comments but as I am not on the computer all the time, my replies may not be instantaneous."

My Facebook page featuring wildlife photos I have taken: https://www.facebook.com/Wildlifeinnerang/posts/1109641512489326

More photos from shows I have shot can be viewed on FLICKR at: https://www.flickr.com/photos/paradisephotos/albums


 Pheasant Coucal

 Kookaburra

King Parrot

Sulphur Crested Cockatoo

Galah (Rose Breasted Cockatoo)

Pale Headed Rosella

Indian Ringneck

ABBA tribute show

QUEEN tribute show

Eagles Tribute show

Elvis tribute artist Dean Z


Masters of Rock Show

Thursday 3 November 2016

Final talk for the year to our local cardiac rehab unit

This morning I gave my last talk for the year at our local cardiac rehab unit. Twenty two people in attendance including the program co-ordinator, psychologist and a medical student. A sign of the times sadly when there are so many people needing to do a program like this.


The first thing I talked about was the fact that I had virtually none of the classic warning signs or symptoms when I had my heart attack and that I was later told this is not uncommon with diabetics, something I did know beforehand.


In addition to talking about my heart event and recovery and my changes in lifestyle I spent a bit of time dealing with the need to find positives in life to help in the recovery process, especially when things are not going all that great and stress and emotional head games may become difficult to cope with

I was able to share about what I did when those times came (come) along and what I did (so) to deal with depression including walking everyday, looking after injured wildlife and probably the biggest thing that happened for me, rediscovering an old hobby, photography.


Could not stress enough to those present the need to have a hobby or two, to have something to look forward to doing. Was a good final session for the year and if required, will be more than happy to do it all again in 2017 when I will be celebrating ten years surviving something I was very lucky to survive.


An interview I did with Channel Nine a year after my heart attack: http://my29lives.blogspot.com.au/p/29-lives-tv-interview-with-channel-nine.html

(Yep, that's me being loaded into the ambulance for the trip up to Brisbane for my triple bypass)

Use this link to view a presentation I put together a number of years ago after a cardiac rehab talk. Whilst the format may have changed over the years, the material I cover and the messages I try and share have not.

Wednesday 19 October 2016

Difference between Cardiac Arrest and Heart Attack

Often, when I talk to people, I refer to what happened to me in 2007 as being a heart attack, it's a lot easier to say this. In fact I had a cardiac arrest which resulted in recurrent ventricular fibrillation requiring 29 electrical cardioversions (electrical shocks with paddles) and resuscitation - see, a lot easier to say I had a heart attack, most people understand that!

Courtesy of British Heart Foundation

And from my experience, people are not interested in details like - I had 100% blockage of the RCA (that was stented on the night of the event), 80% blockage of the left main stem and 40% blockages of the LAD for which I had a triple bypass five days later. Way too much info for most people, a lot easier to tell them you had a heart attack, they operated and they fixed you! :-)

Check out British Heart Foundation at: https://www.bhf.org.uk/

Monday 29 August 2016

Forgetfulness, memory loss - is the culprit Crestor?

In recent weeks, maybe over a month now, I have noticed a worrying sign, a growing incidence of forgetfulness, issues with my memory.


Now after my triple bypass nine years ago in 2007 I, like many others after such operations, had issues with my memory, something which I soon after found out was not uncommon for people who have had open heart surgery and a condition that was referred to as Postperfusion syndrome or "Pumphead". With me, my short term memory after surgery was absolutely "shot" but remarkably my long term memory seemed to improve.

After a year or two (or was it longer?) the memory issues appeared to go away and I was more or less back to normal.

Fast forward to 2016. Over the past 3-4 weeks (or maybe a bit longer) I have noticed that again I am having issues with my memory, particularly short term. At first I simply didn't pay much attention to this but over the past couple of weeks I feel this has been getting worse and it is starting to concern me.

For example, in conversations with people, if I am talking about something and get interrupted, I can find it very hard to find my line of thought, of what I was talking about and it can take me minutes of serious concentration to remember what I was talking about. This has happened more and more over the past couple of weeks.

More worrying, however, has been a couple of issues regarding my medication and this is something I will need to address if it does not improve or in fact if it gets worse.

A week ago today I started using Ntro-Dur 5 patches to help me with my angina. All good, I followed the instructions and Monday through Thursday I placed the patch on a different part of my upper body as directed.


Then came Friday. On Friday evening I realized I had forgotten to put the patch on that morning. Okay, these things happen and I made a mental note not to do this again.

Then came Sunday, two days later. Normally I put the patch on in the morning after my shower and take it off in the evening - on for 12 hours, no patch for 12 hours as per instructions.


So this morning (Monday morning) I am lying in bed at 5.00am wide awake, feeling good and then it dawns on me that I did not take the patch off last night - it had been on since 10.00am the previous morning for some 17 hours. Now I am not sure what the consequences will be for me today but I do know I will not be putting a patch on today.

BUT the worrying thing is that now, within seven days, I have had two incidences regarding medication that I need to take to help me with my issues, in this case my heart and angina.

And then I remember - oh the irony - that one of the side effects of Crestor is memory issues, forgetfulness. After finding a new 99% blockage in my RCA in May I was changed from Lipitor for my cholesterol to Crestor.

Will monitor this situation and will speak to my GP if this situation does not improve or in fact if it gets worse.

More information on side effects of Crestor can be found here: https://medlineplus.gov/druginfo/meds/a603033.html

Monday 22 August 2016

Finally Put the Nitro Patch On

So a few weeks back I posted about my increased angina episodes and the decision for me to start using a low dosage Nitro (glyceryl trinitrate) patch.

Ten days ago I bought the patches but because I was feeling good, had not had an angina episode for a few days, me being me, put off starting to use these patches.


And I won't mention my inherent fear of starting a new medication when it comes to my heart!

Well that all changed over the weekend when early Sunday morning around 3.00am I woke up with pressure on the chest, SOB and a bit of a racing/pounding heart - I have a history of heart arrhythmia and get it from time to time. Got up out of bed and used my GTN spray and things improved pretty quickly. Checked my blood sugar level and it was 3.8 (68 mg/dl) which for me is on the low side and being so early in the morning I knew they would be going further down over the coming hours. I had some juice and nuts and cheese to get the sugar level up and then went back to bed.

For most people a reading of 3.8 would be considered good but I know for me, most times when I go below 4 and definitely below 3.5 I tend to get typical HYPO symptoms and over the years have noticed that at the same time I can also get SOB, racing/pounding heart, pressure on the chest issues and using my GTN usually brings these under control - the racing heart and SOB are not common to HYPOs.

Maybe I did it to myself, overdoing things on Saturday - going to a Jazz festival event during the day and meeting up with friends we hadn't seen for years and then that night going to a music tribute show with me busy taking photos at both events. In a way, I probably brought the latest episode upon myself given I have very low stamina levels and heart muscle damage following my heart attack in 2007.
And having other health issues including a thyroid condition, means I am on a multitude of medications. In 1996 I was diagnosed with Graves disease and two years later had my thyroid burnt out and have been on on thyroid replacement medication ever since.

In May 2014, I had an episode of angina which landed me in hospital. Having just had a sandwich for lunch I started to feel unwell, thought it was angina, took my GTN spray and it didn't help. When the paramedics arrived they found my blood sugar level was 3.8. In hospital a discussion between endocrinology and cardiology decided my angina episode which included chest pain, sweating and pressure down both sides of my neck was related to my diabetes. In the following weeks I did a Holter monitor test (for the heart) and wore a blood sugar monitor for seven days.

Here I am after being brought into hospital in May, 2014

Whilst I have not had such a bad experience since, I am always conscious of my sugar levels and the effect a "low" can have on me when it comes to my heart.

Holter Monitor test in 2014

After the angina/HYPO episode early Sunday morning and then needing to use my GTN spray twice more during the day, once later in the morning and again in the afternoon when I had pressure in the chest and SOB issues I made the decision that today, Monday, I would start using the Nitro patch. The brand my chemist has given me is called Nitro-Dur 5.

In accordance with the instructions I have put one on my upper right arm and leave it on for twelve hours and then take it off tonight and put another one on tomorrow morning after a twelve hour break.

Nitro-Dur 5 patch applied per instructions to upper arm

Need to be aware that as I am getting used to these patches I can get similar side effects like headache, dizziness, light headedness etc. that can come with using the GTN spray.

We shall now see in the coming days, weeks if this will help with my angina issues.

This may be of interest regarding Diabetes Heart Disease: http://www.nhlbi.nih.gov/health/health-topics/topics/dhd/

Another article which may be of interest regarding diabetes and heart disease: http://www.abc.net.au/radionational/programs/healthreport/high-blood-sugar-levels-as-risk-factors-for-heart/3381068#transcript

Tuesday 9 August 2016

Exercising After My Heart Attack and Natural "Collateral" Bypasses

After my heart attack in 2007 I had to make many lifestyle changes. They included:
  • giving up smoking - was doing 40-50 a day at the time and had been smoking for 33 years.
  • changing my diet
  • learning how to cope with stress
  • starting to exercise daily
Thank goodness I didn't (don't) drink much!

The smoking thing wasn't that difficult to deal with, oddly enough, in fact I gave up the night of my heart attack. 

Changing my diet took some work but I was able to make the required adjustments once I understood the impact on my health my bad eating habits were having.

Dealing with stress was and still is my biggest challenge but rediscovering photography and getting involved with helping my wife look after injured wildlife became natural ways for me to destress/avoid stress.  Can not emphasize enough the importance of finding a hobby, an interest when it comes to helping deal with recovering after a heart attack.

Probably the biggest change in my life was making the commitment to daily exercise and it is something I am still doing 9+ years after my heart attack - these days I still try to walk 20-30 mins a day.
photo courtesy of  Heart Foundation of Australia

I am lucky in that I can motivate myself to do something but for those unable to do so there are, in many communities, walking groups or similar activities that people can join in. Heart Foundation in Australia has many walking groups around the country and their locations can be checked out on their website: http://walking.heartfoundation.org.au/

I must admit though, I have had lapses in all of the above from time to time, except for smoking, have never touched one since. And from time to time will have some "fast food" and/or depending on the weather or on how I am feeling will skip my walking for a day or two.

These days, after my angiogram in May when a new 99% blockage was found in my RCA and could not be stented because it was too calcified and tortuous, I can appreciate the importance of my daily exercise since 2007. As my cardiologist explained after the angiogram. my body created a natural "collateral" bypass around this new blockage - new vessels generated themselves to take the blood around the stenosis.
The wealth of "collaterals" creating natural bypasses
around the blockage in a coronary artery (arrow).

What I later found out was the role of exercise in the creation of these "collateral" bypasses and you can bet, I will be continuing my daily exercise given my circumstances.

I also found out that an increase in angina episodes is not necessarily uncommon in people with collateral bypasses which has certainly been the case with me over the past 6+ months.

"In order to stimulate collateral artery flow, try walking for 10 to 15 minutes. This will form the basis of the start of your cardiovascular exercise, and that will help to get blood flowing through your blood vessels. In the event of any type of blockage, walking can help stimulate the growth of new blood vessels that will help collateral artery flow." - http://www.livestrong.com/article/281893-exercises-for-collateral-artery-flow/

In recent weeks, this topic of "natural collateral" bypasses has come up in discussion in some Facebook heart groups I am a member of and as I have found out, many people, like me a few months ago, are not aware of these so for those out there interested in this phenomenon it might be worth reading up on this topic and oh, getting back to daily exercise if you have let it go since your heart event!

Here are some links worth considering on this issue:
http://circ.ahajournals.org/content/133/15/1438.full
http://www.health.harvard.edu/press_releases/do-it-yourself-cardiac-bypass-surgery
http://heartattacknew.com/faq/how-dangerous-are-my-blocked-coronary-arteries/the-riddles-solution/
http://www.livestrong.com/article/281893-exercises-for-collateral-artery-flow/

You can google "collateral bypass" for more sites to visit.

Exercise became part of my daily routine after my heart attack in July, 2007. When my wife took this video in 2010 we had a wild corella we had named Honky visiting us daily. Enjoy.


Dani & Honky Exercising - Mar 10, 2010

Remember, if you don't look after your health, don't expect someone else to do it for you!



Saturday 6 August 2016

Glyceryl Trinitrate Patch for Angina

Thought it would only be a matter of time, what with increasing angina episodes, needing to use my GTN spray almost daily and sometimes twice a day compared to once every week or two last year. And of course not totally unrelated to a new 99% blockage being found during an angiogram in May which could not be stented.

Now getting episodes out of the blue while sitting at the computer or watching TV and even, on occasion, when getting out of bed in the morning after a relatively, for me, good night's sleep. And have even started getting angina when exercising which rarely happened in the past.



Anyway, saw my GP, told him what has been happening and he suggested I contact my cardiologist about going on to a low dose, 24 hour Glyceryl Trinitrate patch which can be used in conjunction with my Isosorbide Mononitrate 60mg tablet which I take each morning - will double check this when I speak to my chemist as I using my GTN spray should angina issues continue although been told the same rules apply with the GTN spray - use up to twice and if it does not relieve an attack then call an ambulance. 


Lucky I can communicate with my cardiologist via email and he replied pretty quickly and agreed. So Monday, it is off to the chemist to get my first box of 5mg/24 hour patches. Just need to find out if I can wear these in the shower and when swimming. I do know you need to vary where you place them on your body to avoid skin irritation.


--------------------------------------------------------------------------------------------------------------------------

Minitran patches (glyceryl trinitrate).

Minitran patches contain the active ingredient glyceryl trinitrate, which is a type of medicine called a nitrate. It is used to help the heart work more easily.

What is it used for?

  • Preventing angina attacks.
  • Minitran 5 patches can also be used to improve the blood supply to the site of an intravenous cannula. In people receiving medicines via an injection or drip (infusion) into a vein of the arm or leg, the patch is applied close to the cannula site to help keep the vein open.

How does it work?

Minitran patches contain the active ingredient glyceryl trinitrate, which is a type of medicine called a nitrate. It is used to help the heart work more easily.

Glyceryl trinitrate works by being converted in the body to a chemical called nitric oxide. This chemical is made naturally by the body and has the effect of making the veins and arteries relax and widen (dilate). When the blood vessels dilate in this way there is more space inside them and hence less resistance. This makes it easier for the heart to pump blood around the body.

Widening the veins also decreases the volume of blood that returns to the heart with each heartbeat. This makes it easier for the heart to pump that blood out again.

As a result of both these actions, the heart does not need as much energy to pump the blood around the body and therefore needs less oxygen.

Glyceryl trinitrate also widens the arteries within the heart itself, which increases the blood and oxygen supply to the heart muscle.

The pain of angina is caused by too little oxygen reaching the heart when its workload increases, such as during exercise. Glyceryl trinitrate improves the oxygen supply to the heart, as well as decreasing the amount of oxygen that the heart needs by making it easier for the heart to pump blood around the body. It can therefore be used to treat angina.

Minitran patches are used on a regular basis to help prevent angina attacks. The medicine is absorbed continuously from the patch through the skin and into the bloodstream.

For more information: http://www.netdoctor.co.uk/medicines/heart-and-blood/a7124/minitran-patches-glyceryl-trinitrate/

Monday 25 July 2016

Why no awareness campaigns for diabetics regarding heart attacks?

A timely reminder. This topic gets brought up time and again in various heart attack survivor groups on Facebook and elsewhere yet is hardly promoted in any awareness campaigns either by the various Heart Foundations and Associations around the world or by their Diabetes counterparts.
Can totally understand why Go Red for Women campaigns take place each year but why not a similar campaign warning diabetics they may not necessarily have the classic warning signs or symptoms before or when having a heart attack? Just don't understand!

Friday 15 July 2016

Nine Years On and I'm Still Standing!

On Sunday July 15, 2007 I survived something that many people do not, a massive heart attack, I had turned 54 the month before. Complications included recurrent ventricular fibrillation requiring 29 electrical cardioversions and resuscitation.

On the night of the heart attack it was found my right dominant coronary artery had 100% proximal stenosis and three stents were inserted at the Gold Coast hospital where we live to open the artery.

Also found was that I had critical left main stem disease with 80% distal stenosis and the LAD was found to be irregular with 40% proximal and mid-segment disease and various other blockages. Bypass surgery was indicated for the blockages on the left side. Five days later this took place in Brisbane having been taken up there from the Gold Coast by ambulance. The bypass operation was supposed to take place the day after my heart attack but the hospital in Brisbane would not accept me because I was too unstable and had other issues going on. 

By Wednesday, my situation was critical and I was ferried up to Brisbane that morning with the bypass surgery scheduled for the next day. Again I was ruled as too unstable and the surgery was postponed. Thursday it was decided the surgery could not be put off any longer and Friday morning, the triple bypass surgery took place. My wife had been advised that my chances of pulling through were less than 50%. Lucky for me I beat the odds, the surgery went well and I am still around to annoy Evelyn. :-)

To the wonderful paramedics, Katherine and Brad, who arrived in time shortly before I had the first of a number of cardiac arrests, to Dr Rahman and cardiac nurse Rachel at Gold Coast Hospital who kept me alive with three stents, to Dr Ura at PA Hospital who performed the triple bypass surgery that saved my life, to Sharon & the wonderful staff at Cardiac Rehab and to social worker Eileen, the biggest thank you possible to all of you - I think of you everyday.

And of course I will be forever in debt to Evelyn for calling the paramedics when she did. They arrived in time to defibrillate me when I had the first of my cardiac arrests. If not for her I would not be typing these words now!

Not a day goes by that I do not think of that day and of all the doctors, nurses and others at Gold Coast Hospital who did not give up on me despite my numerous cardiac arrests.


Special mention needs to be made of the great staff at Gold Coast Cardiac Rehab who helped get me back on my feet and my head around all the emotional head games that played on my mind after my heart attack.


This is an interview I did a year or so later with one of our television stations which details some of what happened and includes comments from my cardiologist, Dr Rahman, who saved me on the night. https://www.youtube.com/watch?v=gqwmKUzvOu4


It was during my recovery that I rediscovered photography while helping my wife look after injured wildlife. Out of this came my Facebook page Wildlife in Nerang - https://www.facebook.com/Wildlifeinnerang/

And also what came out of surviving my heart attack was the desire to share my experience and make people aware that diabetics, like me, do not necessarily have the classic warning signs before or when they have a heart attack - https://www.facebook.com/CHADAwareness

Something else I learnt that night was don't delay in calling for an ambulance. If Evelyn hadn't called 000 when she did, the paramedics would not have been there when I had my first cardiac arrest and that would have been the end of the section for me.

I have had nine bonus years and intend to be around for a quite a number of years more, still so many photos to take and wildlife to help as well as spreading the message about heart disease and diabetes! :-)


Katherine and Brad - the paradmedics who revived me when I had my first cardiac arrest
and revived me a number of times en route to the hospital when I continued to arrest

With Evelyn and Dr Rahman, a year after my heart attack during a photo session when I did an interview for the Gold Coast Bulletin. Dr Rahman stented me the night of my heart attack
and to this today continues to be my cardiologist.

Having an echocardiogram at the old Gold Coast hospital the morning
after my heart attack and after having three stents inserted

Burn marks on my chest from the numerous defibs administered. Photos was
taken the morning after my heart attack

Being loaded into the ambulance for the trip from the Gold Coast to
PA hospital in Brisbane. There were questions so I found out later
as to how I would cope with (survive) the transfer. Cardiac nurse
Rachel accompanied me in the ambulance and monitored me 
the whole trip. I still see her regularly when I get the
chance and those meetings are always emotional.

 Having an echocardiogram at PA hospital the morning
before my triple bypass when it was decided I had to
have the bypass surgery as a matter of urgency

 
Dr Ura who performed the triple bypass surgery

Front page of the Gold Coast Bulletin in which my interview appeared


In February, 2010, I was invited to be the guest speaker on the
Gold Coast for the Heart Foundation's launch of their campaign:
"Will You Recognize Your Heart Attack?"

One of numerous items I have designed to help promote the message
for diabetics about not having the classic symptoms or warning
signs when having a heart attack