Take control of your health or accept the consequences

I've written before about the need for us, especially those of us with a cardiac and diabetes history, to take control of our health and TO KNOW OUR NUMBERS! About being aware of our levels for:

- blood pressure

- blood sugar

- cholesterol

- weight/waistline/BMI

I've written before and always mention when I give a talk that it is up to us to be aware of what our bodies are doing and to seek out medical help if we feel something is not quite right. After all, who else knows your body better than yourself.

And when I give a talk I always suggest to people that they should request from their doctor a copy of blood test results, and any other relevant tests. Being a diabetic, knowing I have a cholesterol problem, a blood iron (ferritin) issue as well has having (had) Graves Disease (had my thyroid burnt out in 1998), I need to know what my levels are doing regarding HbA1c, LDL (bad cholesterol), ferritin and TSH (thyroid-stimulating hormone).

As I say, knowing our numbers and being aware of changes in our body and the way we are feeling can, for someone like me, often help me work out if I am having a diabetes related episode such as a HYPO due to low sugar or a dizziness and light headed issue due low blood pressure, to one of my heart medications.

And being aware of our bodies can help us make important decisions like when to call an ambulance.

Now I am pretty well attuned to my body and when I am having a HYPO or an angina episode and accordingly usually know what to do in each situation. However, we must always expect the unexpected and I wrote as much in a blog entry about this two years ago - http://my29lives.blogspot.com.au/2014/10/still-feeling-my-way-around-with-this.html:

In May (2014) I had what turned out to be a pretty bad angina attack which landed me in hospital for two days and I learnt a lot from this incident about the relationship between sleep, diabetes and angina. I wrote the following about what happened on my Facebook page:

"On Tuesday, May 13 shortly after lunch I sat down at my desk and began feeling clammy and sweating profusely. I also had a touch of nausea, a queasy feeling and felt light headed but these lasted only a minute or two. In addition I had very slight pressure/ache down both sides of my neck going up to the lower jaw on both sides. I took my GTN spray as I thought this was just another angina attack but the sweating and pressure in my neck did not go away - usually within a few minutes of taking the spray any symptoms I have go away. The week before I had two angina attacks two days in a row, both of which were the worst to date, and my GP said the next time I have an attack to call an ambulance to get it checked out.

Because the sweating and neck ache persisted and given that  I have blocked carotids - up to 69% on the right side and up to 54% on the left - I decided that this time I would get this episode checked out and my wife phoned 000 to get an ambulance. On arrival the paramedics checked my blood sugars which came up with 3.8 and they said I may be having a Hypo/low. Now this was strange as just before I had lunch I had checked my blood sugar at 12.30pm and the reading was 5.2 so to be told I was having a Hypo less than two hours after eating a toasted chese and tuna sandwich and not feeling the Hypo symptoms I usually get had me confused.

The paramedics confirmed that I should be taken to hospital to be checked out, especially given the neck issues. They gave a tube of glucose to suck on which I couldn't tolerate so I opted to eat a bunch of my glucose laden jelly beans. En route to the hospital my sugar levels climbed to 6.2 and from memory, by the time I arrived at the hospital it was around 10.

In addition, they gave me four additional shots of GTN en route and by the time we arrived at emergency the ache on the left side had all but gone - the right side ache disappeared earlier after a couple of GTN shots."

From this episode I was reminded about having "silent" hypos at night while sleeping, something I had not thought about a lot.

I wrote more about this in a NOTE on my Facebook page and also highlighted the need for me (others) to be more vigilant in taking control of our own health, specifically when it comes to CHECKING OUR NUMBERS including sugar levels/HbA1C, blood pressure, thyroid/TSH levels, iron levels, etc. especially if you are someone like me with a number of issues going on at the same time. From this incident I also learnt about the need for me to address my poor sleep patterns and breathing issues both of which I was told during my hospital visit would  be impacting on my heart and affecting my angina.

Which brings me to the point of this blog post. In 2011 I had a couple of visual problems, mainly through my right eye. I would get severe flashes, bright lights and it scared me. 

I went to see my optometrist and he did some tests. He could not see any issues but mentioned for someone with a history or high cholesterol and artery blockages I should get this checked out - he told me the issue could be neurological based but more than likely it was just a passing thing. He did say I should get my carotid arteries scanned just to see what was going on with these - a passing comment about a TIAs and strokes was made.

Well off I went to get the scans and I was shocked by the results - up to 69% stenosis (narrowing) in the right carotid and a narrowing ranging between 50%-55% on the left side. Here is the report:

 Report of first carotid artery scan - Oct. 2011

When I got these results I was in shock, paranoid even that I was on the way to having a stroke given my heart history, a heart attack in July, 2007 - 100% blockage in the RCA (right coronary artery) which was stented the night of the heart attack and an 80% blockage of the left main coronary artery plus 40% blockages of the LAD (left anterior descending artery) all of which required a triple bypass five days later.

And it needs to be understood that at the time of these issues with my eyes I had been dealing with ongoing SOB (shortness of breath) issues and in fact had been referred by my cardiologist a week before the carotid scan to go up to Brisbane hospital to have a Cardiopulmonary test.

And it should also be noted that earlier in 2011 I had a CT coronary angiogram which could not find any reasons for my breathing issues and that before being referred to Brisbane I had done yet another Bruce protocol exercise stress test and only managed to last three minutes. The CT angiogram did find that my stents and grafts were all working well.

Referral letter for Cardiopulmonary test

It would be fair to say I was confused, upset, worried, scared and a lot more when I got these results showing I had significant narrowing in both carotids.

Now I had a good relationship with my GP at the time but he often commented to me that he is not a heart specialist nor someone who could provide solutions for my SOB and lack of stamina issues. For those he would say I need to speak to my cardiologist. That did not make him a bad doctor, on the contrary, it showed that he was not prepared to guess and preferred I sought specialist advice where and when necessary.

With this in mind I took it upon myself to seek out a vascular specialist at our local public hospital. People need to understand that I did (do) not have private health cover so basically I was (am) a patient in the public system. And this being the case I was fully conversant with the process of your GP sending a request (referral) for an appointment as an outpatient with a specialist at the local hospital and waiting for such appointment to be arranged.

So me being me, I took it upon myself to seek out a specialist and I did exactly that. I TOOK CONTROL! 

I wanted to, needed to know what the heck was going on. Rightly or wrongly, I now knew I had what I believed to be significant blockages in both carotids. And I knew that just a few years earlier, in 2007, I had beaten the odds when I had a massive heart attack that involved 29 resuscitations/cardioversions, three stents for a totally blocked right coronary artery and a triple bypass for blockages on the left side. 

And by now I knew that blockages in the carotids can, could lead to TIAs and/or strokes. And having had eye/vision issues it would be fair to say I WAS SCARED SHITLESS!

I had the carotid scans on Wednesday, October 26 and on the following Monday, after a lot phoning around and almost begging for an appointment, I saw a vascular surgeon. He reassured me about the nature of the blockages in my carotid arteries and made it clear surgery was not indicated. It made me feel a whole lot better but not totally, knowing I had these blockages was still a worry. The specialist did suggest that I have a scan every two years to keep an eye on things.

Vascular surgeon's letter to my GP

Bottom line, I found a way to see a specialist without doing the usual roundabout of my GP sending a referral request and then being put on a waiting list - and the specialist's letter above says as much. And I would say that if I can do it, so can anyone else!

A year later I had another scan of the carotids which showed no changes and then in 2014 I had another scan, which noted there was a 60% stenosis on the right side and 40% on the left side plus there was a moderate calcification in each carotid bulb.

Carotid artery scan result from May, 2014

Last month I had another scan which summarized there was a 50-69% stenosis on the right side and less than 50% stenosis on the left side.

Carotid artery scan result from June, 2016

I should add, that in an angiogram I had in May a new 99% stenosis was found in the mid right coronary artery and an attempt to stent it failed due to the blockage being too calcified. Fortunately, so I was told, my body had created a sort of natural collateral bypass so blood flow exists around the stenosis - see my earlier blog post about this issue: http://my29lives.blogspot.com.au/2016/06/a-salutary-lesson.html

It would be fair to say, getting this result from the angiogram in May, pushed me to have the carotids scanned in June and when all is said and done, finding there has not been a worsening of the blockages in the both carotids was a relief, still a concern but a relief.

And getting back to the question of knowing your numbers, with which I started this post, I need to work on getting my bad cholesterol (LDL) down from 2.56 to 1.8 and obviously the benefit of this on the new blockage in my RCA will benefit the carotids and the rest of my body. So doing regular blood tests (every three months), monitoring ALL OF MY LEVELS is very important to me, I NEED TO KNOW what is going, what is improving and what still needs working on!

What is a TIA - Transient Ischemic Attack?

When blood flow to part of the brain stops for a short period of time, also called transient ischemic attack (TIA), it can mimic stroke-like symptoms. These symptoms appear and last less than 24 hours before disappearing. While TIAs generally do not cause permanent brain damage, they are a serious warning sign that a stroke may happen in the future and should not be ignored.

TIAs are usually caused by one of three things:

1.     Low blood flow at a narrow part of a major artery carrying blood to the brain, such as the carotid artery.

2.     A blood clot in another part of the body (such as the heart) breaks off, travels to the brain, and blocks a blood vessel in the brain.

3.     Narrowing of the smaller blood vessel in the brain, blocking blood flow for a short period of time; usually caused by plaque (a fatty substance) build-up.

Some important facts to keep in mind include:

• 40 percent of people who have a TIA will have an actual stroke
• Nearly half of all strokes occur within the first few days after a TIA

 Learn more about TIAs using this link: 
 http://www.stroke.org/understand-stroke/what-stroke/what-tia

Ischemic stroke

Ischemic stroke occurs when a blood vessel carrying blood to the brain is blocked by a blood clot. This causes blood not to reach the brain. High blood pressure is the most important risk factor for this type of stroke. Ischemic strokes account for about 87% of all strokes. An ischemic stroke can occur in two ways.

Embolic Stroke

In an embolic stroke, a blood clot or plaque fragment forms somewhere in the body (usually the heart) and travels to the brain. Once in the brain, the clot travels to a blood vessel small enough to block its passage. The clot lodges there, blocking the blood vessel and causing a stroke. About 15% of embolic strokes occur in people with atrial fibrillation (Afib). The medical word for this type of blood clot is embolus.

Thrombotic Stroke

A thrombotic stroke is caused by a blood clot that forms inside one of the arteries supplying blood to the brain.  This type of stroke is usually seen in people with high cholesterol levels and atherosclerosis. The medical word for a clot that forms on a blood-vessel deposit is thrombus.

Two types of blood clots can cause thrombotic stroke: large vessel thrombosis and small vessel disease.  

Large Vessel Thrombosis

The most common form of thrombotic stroke (large vessel thrombosis) occurs in the brain’s larger arteries. In most cases it is caused by long-term atherosclerosis in combination with rapid blood clot formation. High cholesterol is a common risk factor for this type of stroke.

Small Vessel Disease

Another form of thrombotic stroke happens when blood flow is blocked to a very small arterial vessel (small vessel disease or lacunar infarction). Little is known about the causes of this type of stroke, but it is closely linked to high blood pressure.

Learn more about Strokes using this link:

http://www.stroke.org/understand-stroke/what-stroke/ischemic-stroke

Hemorrhagic stroke

There are two types of stroke, hemorrhagic and ischemic. Hemorrhagic strokes are less common, in fact only 15 percent of all strokes are hemorrhagic, but they are responsible for about 40 percent of all stroke deaths.

A hemorrhagic stroke is either a brain aneurism burst or a weakened blood vessel leak. Blood spills into or around the brain and creates swelling and pressure, damaging cells and tissue in the brain. There are two types of hemorrhagic stroke called intracerebal and subarachnoid

Intracerebral Hemorrhage
The most common hemorrhagic stroke happens when a blood vessel inside the brain bursts and leaks blood into surrounding brain tissue (intracerebal hemorrhage). The bleeding causes brain cells to die and the affected part of the brain stops working correctly. High blood pressure and aging blood vessels are the most common causes of this type of stroke.

Sometimes intracerebral hemorrhagic stroke can be caused by an arteriovenous malformation (AVM). AVM is a genetic condition of abnormal connection between arteries and veins and most often occurs in the brain or spine. If AVM occurs in the brain, vessels can break and bleed into the brain.  The cause of AVM is unclear but once diagnosed it can be treated successfully.

Subarachnoid Hemorrhage

This type of stroke involves bleeding in the area between the brain and the tissue covering the brain, known as the subarachnoid space. This type of stroke is most often caused by a burst aneurism. Other causes include:

• AVM
• Bleeding disorders
• Head injury
• Blood thinners

To learn more about Hemorrhagic strokes use this link: http://www.stroke.org/understand-stroke/what-stroke/hemorrhagic-stroke

What is a Stroke?

A stroke is a "brain attack". It can happen to anyone at any time. It occurs when blood flow to an area of brain is cut off. When this happens, brain cells are deprived of oxygen and begin to die. When brain cells die during a stroke, abilities controlled by that area of the brain such as memory and muscle control are lost.

How a person is affected by their stroke depends on where the stroke occurs in the brain and how much the brain is damaged. For example, someone who had a small stroke may only have minor problems such as temporary weakness of an arm or leg. People who have larger strokes may be permanently paralyzed on one side of their body or lose their ability to speak. Some people recover completely from strokes, but more than 2/3 of survivors will have some type of disability.

Stroke By The Numbers

• Each year nearly 800,000 people experience a new or recurrent stroke.
• A stroke happens every 40 seconds
• Stroke is the fifth leading cause of death in the U.S.
• Every 4 minutes someone dies from stroke
• Up to 80 percent of strokes can be prevented
• Stroke is the leading cause of adult disability in the U.S.

     Learn more about Strokes using this link:

     http://www.stroke.org/understand-stroke/what-stroke

Stroke facts

Although stroke is the fifth leading cause of death in America and a leading cause of adult disability, many myths surround this disease. Test how much you know about stroke today:

                             MYTH                                                                         FACT    

MYTH: Stroke cannot be prevented.	FACT: Up to 80 percent of strokes are  preventable.
MYTH: There is no treatment for stroke.	FACT: At any sign of stroke call 9-1-1-  immediately. Treatment may be available.
MYTH: Stroke only affects the elderly.	FACT: Stroke can happen to anyone at any time.
MYTH: Stroke happens in the heart.	FACT: Stroke is a "brain attack".
MYTH: Stroke recovery only happens for the first few months after a stroke.	FACT: Stroke recovery is a lifelong process.
MYTH: Strokes are rare.	FACT: There are nearly 7 million stroke  survivors in the U.S. Stroke is the 5th  leading cause of death in the U.S.
MYTH: Strokes are not hereditary.	FACT: Family history of stroke increases  your chance for stroke.
MYTH: If stroke symptoms go away, you don’t have to see a doctor.	FACT: Temporary stroke symptoms are  called transient ischemic attacks (TIA).  They are warning signs prior to actual  stroke and need to be taken seriously.

     Learn more about Strokes using this link:

     http://www.stroke.org/understand-stroke/what-stroke