The title does not, in fact, refer to the beautiful Hampshire countryside that we drive through going to and from the Dove Clinic although that has become very green, a bit at a time. What with the blossoms in the hedgerows and in the gardens, the trip has become very pretty indeed.
However, what I was thinking of was the effects of the treatments. But, since I haven't blogged for some weeks, a quick catch-up is in order. The last blog was prophetic and we did indeed not get any treatments done that week. The gout cleared towards the end of the week and so the following week I managed four one-hour treatments. We managed the same the next week, which brought us to the Easter weekend and so a day off on Easter Monday and only three treatments that week, which was last week. This week we are back to four treatments.
I now find that I can tolerate it all much better. I still wouldn't call it enjoyable but it certainly isn't as much like hard work as it was when we started. Also my bladder seems to be improving, I can now get to the half hour (more or less) before needing to go and relieve the pressure and last week I managed fouty-three minutes before needing a break! I can now regularly complete the session without needing a second break.And there are some noticeable improvements in my health - I got a bit of tightness in the chest last weekend after going up and down some very big stairs twice and was feeling a bit disappointed because I hadn't had that for a couple of weeks. Then I remembered that last time I did those stairs I had to stop after only one ascent and use my spray, so then I didn't feel too bad at all! There have been a number of comments that I am looking well again and I feel up to doing much more than I could before (which was, to be fair, not very much at all). So we continue with the treatment and I will try to record it all a bit more thoroughly.
Monday 16 April 2012
Monday 19 March 2012
It was all going so well....
By the end of last week (the third week of treatment) we had reached the stage of achieving one hour sessions without too much trouble although I still have to break after ten or fifteen minutes to go and empty my bladder (which fills up from empty at a remarkable rate)! The water seems to be being squeezed out of me.
Tuesday, though, was a bad day. I was very tired before we started, having worked through the afternoon of Monday in the shop. Long story and essentially my own fault but it did badly affect the treatment. It was a struggle right from the start and I found it very difficult to relax. Never mind, we'll know better in future.
This week there was a bit of a disaster, though. During last night my left ankle started feeling painful and this morning it was a full blown gout attack. I get these from time to time, especially if I get a bit dehydrated - so the squeezing out of the water may be having a deleterious effect on this. I must remember to drink lots of water at the end of each treaatment to restore the balance. As the ankle hurt like mad just resting, there was no chance of wrapping it and applying pressure to it, so we had to cancel treatment for today. This evening it is, if anything, even more sensitive - so sleep will be difficult and the chances of any treatment at all this week, let alone tomorrow, are pretty slim. Let's hope the cardiac situation doesn't go backwards in the interim.
Tuesday, though, was a bad day. I was very tired before we started, having worked through the afternoon of Monday in the shop. Long story and essentially my own fault but it did badly affect the treatment. It was a struggle right from the start and I found it very difficult to relax. Never mind, we'll know better in future.
This week there was a bit of a disaster, though. During last night my left ankle started feeling painful and this morning it was a full blown gout attack. I get these from time to time, especially if I get a bit dehydrated - so the squeezing out of the water may be having a deleterious effect on this. I must remember to drink lots of water at the end of each treaatment to restore the balance. As the ankle hurt like mad just resting, there was no chance of wrapping it and applying pressure to it, so we had to cancel treatment for today. This evening it is, if anything, even more sensitive - so sleep will be difficult and the chances of any treatment at all this week, let alone tomorrow, are pretty slim. Let's hope the cardiac situation doesn't go backwards in the interim.
Thursday 8 March 2012
Some improvements....
Again, the daily blog idea has fallen by the wayside; I find I'm mostly too knackered and busy with other more pressing issues. But it should improve, if this week is anything to go by. On Monday I got back after managing a 25 minute treatment and slept for two and a half hours in the afternoon then another 9 at night. My legs were still a bit sore when I woke on Tuesday, but I felt a bit more refreshed than before. I managed 39 minutes that day. Dee declared herself to be very impressed, though again she could have been trying to help me fel a bit more cheerful about it!
On Wednesday I managed a whole 45 minutes and today we got fairly easily to 50 minutes. I could probably have managed the whole hour at a push but I'll do that next week. I have found that it all seems to work more smoothly if I concentrate on what is being achieved in the way of pushing extra blood supplies into the cardiac arteries and visualise it as a web of red strands spreading over the surface of the heart, getting bigger and wider with each compression. That way I don't have to concentrate on controlling the breathing and it all happens more regularly and efortlessly. Time also goes by more quickly.
Obviously, I can't see this ever becoming a pleasant pastime to be eagerly anticipated, but I can see it being worthwhile. Whilst it is quite uncomfortable to be squeezed so hard so often, it must improve the blood flow through the heart and also all the other organs situated on the aorta run from the heart to the thighs, like the kidneys. This probably accounts for the fact that the bladder, having been completely emptied before we start, is quite full again within 10 to 15 minutes of treatment. After another empty out it is now building up much more slowly and we haven't needed to make another "wee stop" before the end of the treatment. Such is the measure of progress at this stage!
At least the drive down today was pleasant. A great improvement on the grey drizzly rain we ran through yesterday. We drive through some wonderful Hampshire countryside on the way to and from the Clinic and today the sun was shining and the trees are all coming into leaf and blossom. Things are beginning to look more hopeful all round.
On Wednesday I managed a whole 45 minutes and today we got fairly easily to 50 minutes. I could probably have managed the whole hour at a push but I'll do that next week. I have found that it all seems to work more smoothly if I concentrate on what is being achieved in the way of pushing extra blood supplies into the cardiac arteries and visualise it as a web of red strands spreading over the surface of the heart, getting bigger and wider with each compression. That way I don't have to concentrate on controlling the breathing and it all happens more regularly and efortlessly. Time also goes by more quickly.
Obviously, I can't see this ever becoming a pleasant pastime to be eagerly anticipated, but I can see it being worthwhile. Whilst it is quite uncomfortable to be squeezed so hard so often, it must improve the blood flow through the heart and also all the other organs situated on the aorta run from the heart to the thighs, like the kidneys. This probably accounts for the fact that the bladder, having been completely emptied before we start, is quite full again within 10 to 15 minutes of treatment. After another empty out it is now building up much more slowly and we haven't needed to make another "wee stop" before the end of the treatment. Such is the measure of progress at this stage!
At least the drive down today was pleasant. A great improvement on the grey drizzly rain we ran through yesterday. We drive through some wonderful Hampshire countryside on the way to and from the Clinic and today the sun was shining and the trees are all coming into leaf and blossom. Things are beginning to look more hopeful all round.
Sunday 4 March 2012
Starting the treatments
As you will have noticed, I am not religious about blogging on a daily basis. I had intended to be, but life intervenes. Especially, the treatment itself intervenes - in that I have felt very tired after the first few sesssions. However, it is now Sunday and my last session was actually on Wednesday. Today I actually didn't feel tired when getting up, which is nice!
Back on Monday was my first session. I met the lovely Dee, the nurse who will do the sessions on Mondays and Tuesdays, and she explained how it would work in practice. I surmised that all I had to do would be to relax and preferably go off to sleep, at which she laughed and said if I could sleep through this I deserved a medal. I had seen the video and it didn't look too bad - but really there is no way to describe it so that when you experience it you won't be surprised.
A lot of time went in the initial setting up (ECG review, sizing up for the clothing and the cuffs, etc) so it was some time before we were actually ready to turn the machine on. First things were the tights. They look a bit like salopets for ski-ing except that they are sheer. There are seams on the insides of the legs which mean that they fit snugly into the cuffs. These cuff things are a bit like the cuffs used to measure your blood pressure except they don't just cover an area of about four inches on your arm, they cover your calves, thighs an buttocks - they are big. They have to be wrapped quite tightly onto your legs and butttocks so that there is minimal movement between the relaxed and the inflated states. Like BP cuffs, they are wrapped around the limbs then held closed by Velcro. A great deal of care is taken to make sure there are no creases or pinched parts, if there are the skin can be whipped off in a very short time. For me, they fitted perfectly although there was quite a lot of spare cuff beyond the Velcro seal (in a subsequent session we used a smaller cuff and that worked even better). I did notice a tendency for me to be making sure that the old crown jewels, which hang close to the edges of the thigh cuffs, were not in fact being trapped in any way!
The cuffs have quite big corruguated pipes from each limb section to the connections on the bed itself and these pipes tend to dictate how you can arrange yourself on the bed. In the event, I found myself spreadeagled on the bed, the back support was raised a little above the horizontal and covered in pillows into which I sank happily (at least, happily whilst the machine wasn't running!). After a series of final checks about all being snug, not pinched and everything relaxed, Dee started the machine.
The machine itself consists of the bed, with the cuffs as described above, and with a control monitor which lets the operator know what is happening and allows adjustments to be made to the pressure being sent to the cuffs. If you have read any of the references listed on Google, you should have a reasonable idea of how it works but if you didn't this is a potted summary - based purely on my own understanding and of course it may well not be completely accurate!
OK, so I got back to the couch, Dee wrapped me in again and off we went for the second time. This time we did a further ten minutes and the pressure was higher. This, it seems, is a Very Good Thing because the higher the pressure, the more effective the treatment becomes. Dee, at least, seemed to be very impressed with the level we had achieved on the first day (though I accept that she may have been trying to make me feel a bit better about it). I wasn't so sure - I was and still am a bit ambiguous about how I feel on the subject. It is a fairly violent treatment even though it doesn't really hurt because of the care taken with the wrapping. It is, however, very uncomfortable and you really do need to concentrate on letting it all happen and not try to control it or to do anything other than lie still and let it all go on. After the ten minutes, we called it a day and Carol drove me home. I felt a bit, well, "shaken up" I suppose is the best description I can manage.
Next day, I have to admit I wasn't really looking forward to doing it again but I decided that this was a bit feeble on my part so back we went, off down the M3. This time we managed a ten minute session followed by a fifteen minute session. I managed to relax more easily and we got up to maximum pressure during the process. We tried making the wrapping not so tight around the thighs but I don't think that was an improvement, it caused more movement and the pressure was still just the same. My heart must be improving markedly, I'm sure (though we still hadn't managed even a half an hour session yet). Actually, I hadn't felt any angina on either of the days. Of course the weather was warmer and that helps, still it was a good sign - especially if you are looking for one as urgently as I clearly am.
Wednesday was fairly uneventful other than the fact that I had noticed that I had stiffness and discomfort in both shoulders, which I attributed to the shaking they had been subjected to. We managed a ten minute session, then a twenty minute session. We then tried raising the back rest higher so that I was more sitting up than lying back. This caused more pressure around the waist but less shaking of the shoulders and so it should cause less shoulder pain. We might keep it in for the next session. That night, for some reson, I was unable to relax enough to sleep easily, something which is most unusual for me. (My eldest, Stuart, has stated that I could sleep for England and in truth I rarely have had any problem with it.)
As I was still very tired next morning, Carol let me sleep on - so we were late getting moving. We could have been late getting to the Clinic but they apparently agreed that sleep was more important and cancelled that day's session (all this while I was still asleep). I did feel tired all that day and indeed it wasn't really until Saturday that I got up in the morning feeling fresh enough to face the day properly. I'll need to keep an eye on that, clearly.
Back on Monday was my first session. I met the lovely Dee, the nurse who will do the sessions on Mondays and Tuesdays, and she explained how it would work in practice. I surmised that all I had to do would be to relax and preferably go off to sleep, at which she laughed and said if I could sleep through this I deserved a medal. I had seen the video and it didn't look too bad - but really there is no way to describe it so that when you experience it you won't be surprised.
A lot of time went in the initial setting up (ECG review, sizing up for the clothing and the cuffs, etc) so it was some time before we were actually ready to turn the machine on. First things were the tights. They look a bit like salopets for ski-ing except that they are sheer. There are seams on the insides of the legs which mean that they fit snugly into the cuffs. These cuff things are a bit like the cuffs used to measure your blood pressure except they don't just cover an area of about four inches on your arm, they cover your calves, thighs an buttocks - they are big. They have to be wrapped quite tightly onto your legs and butttocks so that there is minimal movement between the relaxed and the inflated states. Like BP cuffs, they are wrapped around the limbs then held closed by Velcro. A great deal of care is taken to make sure there are no creases or pinched parts, if there are the skin can be whipped off in a very short time. For me, they fitted perfectly although there was quite a lot of spare cuff beyond the Velcro seal (in a subsequent session we used a smaller cuff and that worked even better). I did notice a tendency for me to be making sure that the old crown jewels, which hang close to the edges of the thigh cuffs, were not in fact being trapped in any way!
The cuffs have quite big corruguated pipes from each limb section to the connections on the bed itself and these pipes tend to dictate how you can arrange yourself on the bed. In the event, I found myself spreadeagled on the bed, the back support was raised a little above the horizontal and covered in pillows into which I sank happily (at least, happily whilst the machine wasn't running!). After a series of final checks about all being snug, not pinched and everything relaxed, Dee started the machine.
The machine itself consists of the bed, with the cuffs as described above, and with a control monitor which lets the operator know what is happening and allows adjustments to be made to the pressure being sent to the cuffs. If you have read any of the references listed on Google, you should have a reasonable idea of how it works but if you didn't this is a potted summary - based purely on my own understanding and of course it may well not be completely accurate!
- ECG-type connections are attached to three points on the chest. Another monitor is clippped over a finger. These are intended to give the machine an acurate reading of how the heart is beating. This is very important because the pulsations generated by the machine have to reinforce the heart working, not oppose it.
- After the heart makes a beat (i.e. pushes blood out into the aortas), it relaxes. Almost immediately, the machine inflates the cuffs which causes blood to flow back to the heart through the veins and it seems to also create a bit of a "backwash" in the arteries which obviously can't actually re-enter the heart because the valves are closed. This latter means that more blood is diverted into the cardiac arteries around the heart, i.e. it increases the supply of blood to the heart tissues.
- The machine then allows the cuffs to deflate before the next heartbeat, and the process is then repeated. It was interesting to note that the interaction with the machine caused my heart rate to increase a fair bit, especially in the first few attempts.
- As the process repeats, the blood supply to the heart becomes significantly higher for a time. The whole concept of the treatment is that this increased blood supply causes the cardiac arteries to widen and even to produce new branches to cope with it, thus improving the availability of blood to the heart tissues generally - thereby reducing the incidence of angina. (Angina is basically caused by trying to get the heart to work harder than the existing flow of blood can support. Increasing the blood availability means the heart can once again work harder, which is what is needed.)
OK, so I got back to the couch, Dee wrapped me in again and off we went for the second time. This time we did a further ten minutes and the pressure was higher. This, it seems, is a Very Good Thing because the higher the pressure, the more effective the treatment becomes. Dee, at least, seemed to be very impressed with the level we had achieved on the first day (though I accept that she may have been trying to make me feel a bit better about it). I wasn't so sure - I was and still am a bit ambiguous about how I feel on the subject. It is a fairly violent treatment even though it doesn't really hurt because of the care taken with the wrapping. It is, however, very uncomfortable and you really do need to concentrate on letting it all happen and not try to control it or to do anything other than lie still and let it all go on. After the ten minutes, we called it a day and Carol drove me home. I felt a bit, well, "shaken up" I suppose is the best description I can manage.
Next day, I have to admit I wasn't really looking forward to doing it again but I decided that this was a bit feeble on my part so back we went, off down the M3. This time we managed a ten minute session followed by a fifteen minute session. I managed to relax more easily and we got up to maximum pressure during the process. We tried making the wrapping not so tight around the thighs but I don't think that was an improvement, it caused more movement and the pressure was still just the same. My heart must be improving markedly, I'm sure (though we still hadn't managed even a half an hour session yet). Actually, I hadn't felt any angina on either of the days. Of course the weather was warmer and that helps, still it was a good sign - especially if you are looking for one as urgently as I clearly am.
Wednesday was fairly uneventful other than the fact that I had noticed that I had stiffness and discomfort in both shoulders, which I attributed to the shaking they had been subjected to. We managed a ten minute session, then a twenty minute session. We then tried raising the back rest higher so that I was more sitting up than lying back. This caused more pressure around the waist but less shaking of the shoulders and so it should cause less shoulder pain. We might keep it in for the next session. That night, for some reson, I was unable to relax enough to sleep easily, something which is most unusual for me. (My eldest, Stuart, has stated that I could sleep for England and in truth I rarely have had any problem with it.)
As I was still very tired next morning, Carol let me sleep on - so we were late getting moving. We could have been late getting to the Clinic but they apparently agreed that sleep was more important and cancelled that day's session (all this while I was still asleep). I did feel tired all that day and indeed it wasn't really until Saturday that I got up in the morning feeling fresh enough to face the day properly. I'll need to keep an eye on that, clearly.
Wednesday 29 February 2012
A New Adventure
Following my last myocardial (heart attack in plain English) a couple of years ago I was recommended to have coronary arterial bypass graft surgery, endearingly called a "cabbage" (CABG) by the cardiology people. Now, this involves opening up your chest and grafting in a few extra arterial branches onto the heart by using a few lengths of vein which are nicked from other parts of your body. You are then sown up again. During the process, of course, your heart gets stopped and other amazing things are done. The people who do it are of course wonderously skillful and they lose very few people whilst actually doing it. It does, though, take quite a while to recover from the procedure to the point where you can move around easily and freely without hurting. I was reasonably happy to do this but there was a problem in my case which made me more reluctant - my kidney function had already been badly compromised by a very long and not very successful stenting procedure following the first attack. The odds on my surviving a CABG without seriously impairing this further were uncomfortably short, which would have meant me having to go onto a dialysis machine at regular and frequent intervals. Not ideal in any way, really. So I put it off.
Unfortunately the heart started to deteriorate and I started to get angina fairly frequently, especially in cold weather. This angina, for me, feels like someone has taken hold of my heart and is squeezing it (other people have different sensations, apparently). It eases off if I use a spray but it's not pleasant and if it gets too bad I'll probably have another myocardial, which may do some serious damage this time. So as it has been getting worse I reluctantly contemplated doing something about the CABG. Then I came across a reference to EECP in an article about something completely different and for some obscure reason I decided to follow it up. Thus I learned about Enhanced External Counter Pulsation. (If you are interested there are a lot of articles on it if you just Google "EECP" including a short video of someone having the treatment at the Dove Clinic near Winchester.)
We then came up against the issue of paying for it. At £8k for a course of 35 treatments it is of course much cheaper than a CABG. However, although there are numerous studies about its effectiveness in improving angina none of them are the "double blind" studies much beloved by medics. I'm not sure quite how you could even do blind testing on this process but that's another issue, of course. Cardiac theatres already exist in the NHS and PCT's need to keep them occupied, so anything which doesn't involve cardiac surgery doesn't get much consideration, at least in the South of England. Up North there are a number of NHS hospitals which deliver this procedure but I decided I really didn't want to move to Manchester and leave Carol to run the shop here by herself! So we applied to our local PCT (Wokingham) for funding. Unfortunately our PCT is the second worst funded in the country so it isn't easy to get anything unusual funded by them. Although they didn't reject it out of hand (they did ask for some more information) in the end they decided against it. So it was either pay for it myself or go back to the CABG route which of course they would pay for (and also for the subsequent dialysis should it prove necessary) even though the total outlay was vastly more than for EECP. So we decided to dig into the retirement fund and get it done ourselves.
That's a brief summary of how I came to be doing this. In my next posts I will deal with how it works in practice and how effective it turns out to be in the end.
Unfortunately the heart started to deteriorate and I started to get angina fairly frequently, especially in cold weather. This angina, for me, feels like someone has taken hold of my heart and is squeezing it (other people have different sensations, apparently). It eases off if I use a spray but it's not pleasant and if it gets too bad I'll probably have another myocardial, which may do some serious damage this time. So as it has been getting worse I reluctantly contemplated doing something about the CABG. Then I came across a reference to EECP in an article about something completely different and for some obscure reason I decided to follow it up. Thus I learned about Enhanced External Counter Pulsation. (If you are interested there are a lot of articles on it if you just Google "EECP" including a short video of someone having the treatment at the Dove Clinic near Winchester.)
We then came up against the issue of paying for it. At £8k for a course of 35 treatments it is of course much cheaper than a CABG. However, although there are numerous studies about its effectiveness in improving angina none of them are the "double blind" studies much beloved by medics. I'm not sure quite how you could even do blind testing on this process but that's another issue, of course. Cardiac theatres already exist in the NHS and PCT's need to keep them occupied, so anything which doesn't involve cardiac surgery doesn't get much consideration, at least in the South of England. Up North there are a number of NHS hospitals which deliver this procedure but I decided I really didn't want to move to Manchester and leave Carol to run the shop here by herself! So we applied to our local PCT (Wokingham) for funding. Unfortunately our PCT is the second worst funded in the country so it isn't easy to get anything unusual funded by them. Although they didn't reject it out of hand (they did ask for some more information) in the end they decided against it. So it was either pay for it myself or go back to the CABG route which of course they would pay for (and also for the subsequent dialysis should it prove necessary) even though the total outlay was vastly more than for EECP. So we decided to dig into the retirement fund and get it done ourselves.
That's a brief summary of how I came to be doing this. In my next posts I will deal with how it works in practice and how effective it turns out to be in the end.
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