Showing posts with label angina. Show all posts
Showing posts with label angina. Show all posts

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.

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/

Friday, 1 July 2016

Angina, GTN and a Humongous Headache

Had chest tightness the other night, have been getting more of these in recent times so used my GTN spray as I usually do. Normally don't have any problems with it, maybe get a bit light headed but that's about it. But that night got a humongus headache after using the spray, head was pulsating and felt like it was going to explode. First time ever in all the years I have been using my GTN. Went away after about 15 mins. I wonder if others get this sort of thing from time to time?


Should add I also take Isosorbide Mononitrate SR 60mg daily in the morning and only use the GTN spray, as instructed by my cardiologist, when the angina symptoms etc. crop up which has been more frequent over the past two years than when I was first given the spray a number of years ago.

As to why I have been having an increase in angina episodes, see my previous post "A Salutary Lesson" and the discovery of a new 99% blockage in my right coronary artery.

Thursday, 16 June 2016

A Salutary Lesson

A week or so ago I mentioned in a post that last month I had an angiogram. I also mentioned that during the angiogram a new, 99% stenosis (narrowing) of the mid right coronary artery (RCA) had developed and an attempt to place a stent (angioplasty) had failed



I wrote then: "This new blockage was below where they put in three stents in 2007 for a 100% proximal RCA blockage. The good news was that my body had created a sort of natural "collateral" bypass around the new blockage. I was also told on the day that there was evidence of my body creating more "new" vessels around where I had previously had heart damage."

Because I had a history of a LIMA graft (bypass) it was decided the angiogram would be through the groin as this would present the best scenario should it be found a stent or two was needed. This is a whole other discussion for another time.

Left Internal Mammary Artery (LIMA) Graft

The positive side of the angiogram was finding out that both the stents and the triple bypass done at the time of my heart attack in 2007 were all "patent", working well with no issues and blood flow in and around these was good.

My cardiologist who did the angiogram explaining
what he found but I was bit out of it to totally understand

I saw my cardiologist recently to review the results of the angiogram and to try and understand a bit more what the implications of this new blockage meant for me - my cardiologist did the angiogram and is also the same doctor who was on duty the night of my heart attack and who stented me that night. So it would be fair to say he knows my body, particularly my heart, pretty intimately.

I wanted to know more, understand this thing about natural "collateral" bypasses so I asked questions. My doctor explained that in some situations new vessels can generate and create a pathway for blood to flow in and around the heart. He indicated that in my case such vessels did exactly this around the new blockage and he also mentioned there was evidence that similar activity had occurred where part of my heart had "died" the night of my heart attack.

Right Coronary Artery Collateral Circulation

Now I recall being told all this the day of my angiogram, however, still being under the influence of sedation I didn't really grasp what was being said. And I recall on the day being told that an attempt to stent the new blockage failed because the blockage was too calcified, too hard for the "balloon" (angioplasty) to penetrate and allow for the placement of a stent or two.

I don't mind saying that between being released from hospital after the angiogram with the above information and waiting three weeks to see the cardiologist I had more than a few sleepless nights. I mean, here I was having been told I have a new 99% blockage in the mid RCA just below where I had a 100% blockage which caused my heart attack in 2007 and then being told its all okay and you can go home.

So at my appointment I found out a lot more - not only was the blockage calcified and too hard for a stent to be inserted but the mid RCA where the stenosis was located was "tortuous" - a tortuous artery is one that twists and winds in a "tortuous" path - and that part of the artery was less elastic.



Tortuous Thoracic Aorta

I found out my natural "collateral" bypass comprises of microscopic vessels, that these in fact are very much finer than the RCA and that while they allowed for blood flow around the blockage, the amount of blood flow was less than what would normally flow through an unblocked or partially blocked RCA. 

However, some blood flow around that part of a blockage in the heart is one hell of a lot better than no blood flow at all!

And in so finding all this out came the understanding of why over the past couple of years I have been having increased episodes of angina related issues - including pressure on the chest, heart burn, left arm/hand tingling, tiredness, lethargy - both "out of the blue" when sitting at the computer and increasingly in recent months when walking, exercising or just exerting myself doing menial activities such as sweeping up around the house.


A few years ago, my cardiologist did suggest when I started using my GTN spray more and more that I have an angiogram just to see what is going on. I had a CT angiogram in early 2011 which showed nothing untoward, this was when I was also having similar issues with SOB (shortness of breath) and tiredness.

Being the "chicken" that I am, I rejected the idea of having a full-on angiogram when it was suggested. My memory from the night of my heart attack was and still is very vivid, of how I woke after having  stents inserted to find a "sand-brick" strapped over my groin. I was told I would have to lay flat on my back for 3-4 hours without moving and this turned out to be an 8+ hour ordeal due to a thrombosis (blood clot) issue. Remembering this and the deep purple my groin turned to after my heart attack was enough to keep me putting off the idea of having an angiogram.

My groin five days after my heart attack in 2007

However, in April at my annual checkup and after mentioning the increasing incidences of angina type issues - pressure on the chest, heartburn, SOB etc. - my cardiologist strongly suggested I not put off having an angiogram and three weeks later, in mid May, that is what happened.

And I should add that for 3+ hours after the procedure I did have to lie flat on my back before the sheath could be taken out of my groin. And then when they took out the sheath and after 15 mins of the area being massaged they found a small hematoma and a modern, mechanical version of the sand-brick was placed over this. And I had to remain quiet, on my back for another 2+ hours. And I did develop a purple patch but not as a bad as that after my heart attack.

Flat on my back after the angiogram

And here is where the salutary part of the whole discussion comes into play. An angiogram 2-3 years earlier possibly would have picked up the new blockage when it was less developed (less than 99%) and may have been more amenable to balloon angioplasty and/or a stent being placed. 

Whilst my doctor could not definitively say when the new blockage started it was clear it was not there nine years ago when I had my heart attack (it would have been picked up then) which means it would have developed over the past 8+ years and because it was so calcified (hard), he felt it would have been there for a while.

So, as I say, the salutary message out of all this for me is that in the future I will listen to my doctor(s) when they suggest something and put aside any petty concerns I might have. It might just be that an angiogram 2-3 years ago would have found the blockage, allowed for stenting and helped me avoid ongoing angina related issues I will now have to contend with.

The outcome of the angiogram given stenting was not possible was that I will be treated medically with an aim to get my bad cholesterol (LDL) down from 2.56 to 1.8 by changing me from Lipitor to Crestor and to do a blood test in three months and if my LDL is still high then Ezetrol will be added to help bring it down. In addition I will continue to use my GTN spray as required as well as continue to take Mononitrate Isosorbide (Duride) and if necessary an additional medication will be added if the angina gets worse.

Monday, 6 June 2016

I've been quiet for a couple of months.....

Well no, I haven't really been quiet over the past few months but I have had to deal with a number of health issues and to be honest, finding the motivation to post here in this blog just wasn't there.


I have written before about depression and dealing with health issues but, as they say, sometimes it is easier said than done!

And not wishing to look like I was complaining or wanting sympathy I simply felt it was best to just not write, leave it alone and wait until I was in a better frame of mind.

Since early February I had to deal with a bout of shingles for the first time which just lingered and wouldn't go away. Although I was able to get it treated quickly, the pain and discomfort went on for well over a month and it was pretty debilitating.


And then a week or so after being diagnosed with shingles, I broke a tooth (molar) which left half a tooth complete with root buried below the gumline, and it was impacting on the sinus cavity. I won't go into the issue of pain this was causing or the worry that an infection could have implications for my heart issues.

Had to deal with this and wait close to four weeks until I could get oral surgery to remove the offending broken tooth and root. And all this whilst I was still dealing with the shingles thing.

And whilst all this was going on I was finding myself reaching out for my GTN spray more than in the past with angina type issues - not surprising I guess, given what I was dealing with and the stress that came with it.


In early April, at my scheduled annual review, my cardiologist suggested I have an angiogram given what was going on with the increased episodes of chest discomfort and tightness and my increased use of GTN .

The angiogram took place mid May and this week I am due to see my cardiologist to get the full results. What I do know having been told this the day of the angiogram is that the stents and bypasses I had in 2007 when I had my heart attack are all working fine.


What got me somewhat concerned was hearing that a new 99% stenosis (narrowing) of the right coronary artery (RCA) had developed and an attempt to place a stent (angioplasty) had failed

This new blockage was below where they put in three stents in 2007 for a 100% blockage. The good news was that my body had created a sort of natural "collateral" bypass around the new blockage. I was also told on the day that there was evidence of my body creating more "new" vessels around where I had previously had heart damage. More details about this I hope to get this week when I see my cardiologist.

Right Coronary Artery Collateral Circulation

So I think you can see that I had plenty on my plate over the past 3-4 months. Just trying to keep a positive outlook over this period was and has been challenging at times but I kept up with giving my talks to our local cardiac rehab unit and last Wednesday did my first session for the year at an ultrasound college where I have been a volunteer patient for the past 5+ years.

A couple of other things that I tried to do whenever possible was my daily 20-30 minutes of walking and probably what was for me more significant was getting out there and taking photos, photos of our wildlife visitors, photos of live music events where we live and photos in and around where we live on the Gold Coast in Queensland, Australia.

For me, photography has become my "go to" activity when things are not going all that well and, as I have written before, I can not stress enough for people to find or develop a hobby/interest when they are dealing with recovering from a health scare or simply when they are finding life a bit challenging.


And I haven't mentioned what is going on in our household with my wife following her being diagnosed with triple negative breast cancer in early 2013 and her having an oophorectomy and bilateral mastectomy in late 2014 and the after effects. Yep, lots of medical related issues over the past couple of months have kept me/us on our toes.

Good luck everyone, life can get tough but with a bit of planning, you and I can get past these obstacles.

Tuesday, 28 October 2014

Another angina episode

Yet another episode of angina occurring out of the blue as I am sitting at my computer. Not unusual and can and does happen these days 3-4+ times a week. Same symptoms as usual: pressure on the chest, SOB, left arm tingling - just took my GTN nitro spray and waiting for it to kick in which it slowly seems to be doing as pressure and tingling is going away and breathing is better.


Seeing my GP tomorrow to get results for carotid artery scans done today and will bring this latest angina episode up with him.

Tuesday, 14 October 2014

Still feeling my way around with this blog thingy - My Angina attack in May, 2014

So still trying to work out how this blog thingy works. Do I construct an historical timeline of what happened to me, before, during and after the heart attack in July, 2007? Or do I post about my heart event and intersperse this with things as they happen now on a day to day basis?

Thought about this yesterday whilst doing some exercise and have decided on the latter. Will post about issues as I recall them taking place and ongoing issues as they occur. I think this is the way to go and more REAL in the sense that it will help illustrate that when you have more than one health issue going on at the same time, 'fixing' one does not necessarily mean that all is hunky-dory.

For example: This morning I get up not feeling 100% - just one of those things that happens with my diabetes and can be the way I start a day once, twice or more times a week. Check my sugars as I do first thing each morning and they are 9 mmol/l (163.64 mg/dl) which is not fantastic but not all that bad given I don't sleep all that well which I now know impacts on my sugars.

I get on with it, have a yogurt and coffee after having earlier taken a shot of both Byetta and Lantus insulin for my diabetes which I do every morning before starting my day. I feel better, check what's happening on the internet and then get to preparing the food for our birds a daily routine which I have been doing on my own while Evelyn has been away this past week.



I take out Gilly (a long bill corella we adopted in 2008) from his room in our house where he spends nights and put him on the patio with the food I have prepared for all of our birds (and even wild birds like this king parrot who wasn't about to wait to be fed!).

This is a photo I took a few days ago. Gilly will sit in his cage watching me feed our other adopted birds and wildlife visitors before I put him into his aviary for the day.


Whilst feeding and watering our birds I start to feel unwell again - headache, bit of nausea, light chest pain and tingling down the left side of my arm/hand. Not uncommon for me, usually happens for no apparent reason like not exerting myself or exercising and been told a while ago I have unstable angina. More often than not, this can happen when I am sitting at my desk at my computer, however, this morning started soon after I got up from bed, improved then got worse as I was outside doing the birds.

Now when this all started a number of years ago I used to get all anxious and even would panic and would pick up the phone, make an appointment to see my cardiologist which a number of times resulted in my having various tests. Over the years since my heart attack I have had numerous stress tests and will talk more about these in a separate post. Even did a CT angiogram a couple of years ago which showed my stents were all okay.

Upshot of all this was being diagnosed with angina and being put on Duride (Isosorbide Mononitrate) to help manage it. I was also given a GTN Nitro spray to be used when an angina event occurred and I guess it would be fair to say that over the past few years I have managed my angina with these two meds.

 Nitrolingual (GTN) Spray

So when I felt unwell again this morning, I took a shot of my GTN spray, sat down for a bit to let it take effect and then went back to finishing up with the birds after feeling better.

I guess if there is a message I wish to share about the above it is one about the need for diabetics to recognize the interrelationship between poor sleep affecting sugar levels which in turn can affect the heart and bring on an angina attack.

Throw in additional issues that can arise for someone who has an endocrinological issue such as a thyroid condition, life can become that much more interesting with the continual battle to balance sugar and thyroid levels whilst managing a heart condition. Did I mention I have (had) Graves Disease? And if you have carotid artery blockages we are really getting into interesting territory.
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In May this year (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.


My final comment in this note was: In summary, this week's events were a more than subtle reminder that I need to be more diligent and attuned to what is going on with my various issues and that to fail to do so could have dire consequences.

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