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

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.

Nitro-Dur 5 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.

Blood sugar level converter

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

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!

www.heartattackstore.com

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.

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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/