The offi cial magazine of the BRITISH CARDIAC PATIENTS ASSOCIATION

Issue 156October / November 2007

J urnal BCPA

THE PATIENT

AND CARERS INDEPENDENT

VOICE

The experience of a lifetimeThe travesty of the NICE appraisal

of drug-eluting stentsThe national campaign for

cardiac rehabilitation Your body personality

With nearly 80 percent of cardiac arrestsoccurring in the home…… it is important to have defibrillation technology in locations where it can dothe most good.That is why Philips is offering its HeartStart Home Defibrillatordirectly to you.

“Around 270,000 people suffer a heart attack in the UKeach year, about a third of whom die before reachinghospital due to cardiac arrest. A cardiac arrest most oftenoccurs as a result of a heart attack, when the heart is starvedof oxygen,” according to the British Heart Foundation inSeptember 2004.

Fast defibrillation saves livesRapid defibrillation has been identified as the standard ofRapid defibrillation has been identified as the standard oftreatment for cardiac arrest resulting from ventricularfibrillation. Nearly 80% of sudden cardiac arrests occur inthe home. Fewewe er than 5% of victims survive largely becausewer than 5% of victims survive largely becausewa defibrillator does not arrive in time.

Easy to use HeartStart DefibrillatorThe Philips HeartStart Home Defibrillator is the first ofa new generation of defibrillators specifically designed foruse in the home by virtually anyone. Designed around theuser,user,user it provides clear voice instructions that guide

responders through every step of the defibrillation process.It even reven rev eminds them to call for emergency help and offers

instructions for administering CPR. Basic user training is

included in the purchase price of the unit.

Peace of MindPeace of MindAA Philips HeartStart Home Defibrillator provides youand your family with the peace of mind that comes frombeing prepared for Sudden Cardiac Arrest. In the case ofan emergency this device helps you do exactly what mustan emergency this device helps you do exactly what mustan emergency this device helps ybe done until the emergency medical services arrive.

Remarkable valueThe HeartStart Home Defibrillator is remarkable valueand is available now at an excellent price. You can even paymonthly.monthly.monthly For more information or to place an order for

immediate delivery, contact our UK dealer for the PhilipsHeartStart Home Defibrillator via www.homeheart.co.ukor call directly: Home HeartCare 01663 732587.

space for

DonationsWe gratefully thank all those who have sent donations.

Colin Readman has donated £100 to the Bedford Area Group from a sale of plants.

We acknowledge here donations over £50 unless the donor wishes otherwise. The BCPA really needs the donations.

Please send donations as cheques payable to BCPA to:

BCPA Head Offi ce, 2 Station Road, Swavesey, Cambridge CB24 5QJ

4 From Me to You – Keith Jackson5 Ricky’s Quickies – Richard Maddison6-7 News from around the Areas – Bedford to Wrexham8-9 The travesty of the NICE appraisal of Drug-Eluting Stents – Nick Curzen9 Dates for your diary10-11 Letters Ablation – Nick Beattie Trapped nerves – Don Brookman Angina not diagnosed – Barry Mappley11 Vegetable recipes – Janet Jackson 11 Puzzle – abbreviations12 Your body personality – Corey Beecher13 The experience of a lifetime – Derek Holley14 The national campaign for cardiac rehabilitation – Geoff Dorrie Co-ordinators, Contacts and Affi liated Groups15 MembershipSorry, no space for crossword this time.

The Journal is the bimonthly magazine of the

BRITISH CARDIAC PATIENTS ASSOCIATIONalso known as BCPA. Registered Charity 289190

President Sir Terence English KBE, FRCSVice-Presidents: Ben Milstein MA FRCS, Alan Bowcher DMS FFA

Executive Offi cersChairman Keith Jackson Tel: 01954 260731

Vice-Chairman & Journal Editor Dr Richard Maddison Tel: 01234 212293Treasurer Derek Holley OBE FCA

BCPA Head Offi ce 2 Station Road, Swavesey, Cambridge CB24 5QJ Tel: 01954 202022

Email: admin@BCPA.co.uk Website: www.BCPA.co.uk

Opinions expressed in the Journal are not necessarily those of the Editor or the BCPA. No item may be reproduced without consent. Advertisements must conform to the British Code of Advertising Practice. Publication does not indicate endorsement by the BCPA.

Design and production – john@cartog.co.uk Printed by – Arkle Print, Northampton

Journal contributions and datesWe invite members to send in items for publication – not only heart-related information and articles, but also lighthearted items and stories.

Please phone me, Dr Richard Maddison, 01234 212293, to agree the easiest way to send it in: don’t send it to Swavesey. Normal closing dates are 20 Oct, 20 Dec, ... ie 20th of an even month.

Please phone before that date if you may be late.

HelpDo you have concerns or worries that you would like to talk to someone about? Our telephone helpline, as part of our national support services, normally operates 9.00am to 7.00pm Monday to Saturday. If you get no reply please leave your name and number and we shall attend to your call as soon as possible.

If you have a question or issue that is best in writing, please write to our Head Offi ce who will try to fi nd an appropriate person to answer it.

All the people who answer our helplines have been patients or carers so are likely to understand your concerns because they have been there.

National Helpline01223 846845

CONTENTS

Cover photo: Derek Holley riding with the cowboys of Utah on his 'experience of a lifetime'. Below photo, titled 'Magnifi cent scenery' – from Derek also. See his article on page 13.

From Me to YouKeith Jackson, National Chairman

4

It is always more of a challenge preparing From me to you when away from home and the normal round of activity. We’ve

had a somewhat strange summer as Janet and I had planned to explore Ireland during July and the early part of August. Part of this time was to be attending an international gathering of caravanners. Due to family illness Janet had to return to England and due to my international caravanning commitments I spent time alone in Ireland. Family circumstances mean that we are still away from home as I write this in the middle of August and likely to be for some time. This in turn puts additional pressure on other members of the Association and I thank them for this.

To us this was a somewhat strange summer and not the kind of holiday period one would wish to be reporting. Whatever the summer you have been having, be it at home or abroad, we trust that it has been an enjoyable one. Of course by the time this Journal reaches all of our homes we shall be thinking more of autumn as we move toward those long dark evenings.

Grand DrawBy being away from home during this period I know that we shall return to a whole pile of mail. Much of this will be due to the large number of Draw Ticket stubs that you will have returned. Selling tickets in aid of the Norma Jackson General Hospital Fund is just one way in which we can help others, as the proceeds are used to purchase equipment for the use and benefi t of cardiac patients. This opportunity to support the work of the BCPA still gives you plenty of time to complete sales and indeed request further tickets if you are able to sell them.

I am aware that we are all regularly being asked to purchase raffl e tickets and that sales are more diffi cult as people seem to prefer to purchase Lottery tickets. However, this is the one time of the year when we all have the opportunity to contribute to the Association’s work. May I urge to support the Grand Draw as much as you are able.

Drug-eluting stents – NICE Technology AppraisalWhile from time to time the Association is invited to participate in appraisals that the National Institute for Health and Clinical Excellence NICE is carrying out, I cannot recall a time when such an action has been reported to members through the Journal.

However, it would seem appropriate to report on a recent decision taken by NICE.

Early in August NICE made a preliminary decision not to recommend drug-eluting stents as treatment for coronary heart disease on the basis of cost effectivencess. This is despite a ruling in 2003 that approved their use in patients that are at particular risk of restenosis (re-narrowing of arteries), the fact they are now used in up to 60% of angioplasty procedures, and that they have improved the quality of life for hundreds of thousands of patients. If these recommendations are refl ected in NICE’s fi nal decision, this will have a profound impact on patients and on the NHS.

Coronary heart disease, CHD, is the UK’s biggest killer, accounting for 117,500 deaths annually in the UK. Coronary artery disease or the narrowing of arteries is the major cause of CHD.

There are two types of revascularisation procedure that treat this condition:

• invasive open heart surgery (eg CABG); or• a percutaneous coronary intervention,

also known as angioplasty.

Angioplasty involves widening the artery using metal stents. It is a less invasive procedure and now accounts for more than three quarters of all revascularisations due to patient preference (as it means less recovery time and decrease in morbidity) and on the basis of cost (an angioplasty procedure costs half as much as open heart surgery).

Drug-eluting stents were developed to help prevent restenosis that can affect angioplasty patients. If the NICE recommendation becomes a fi nal decision, patients would only be treated with the older technology – bare metal stent – which would represent a complete reversal in the treatment of heart disease.

Treatment using only bare-metal stents will mean thousands of patients will have to undergo unnecessary repeat procedures as they develop restenosis. Moreover, clinicians will refer many more patients to open heart surgery, as the risk of restenosis within certain patient subgroups, such as diabetics, is so high (24.9%). This will impact on patient’s quality of life, recovery times, and on patient choice.

Furthermore, the NHS will be put under enormous strain and forced to absorb extra costs. If many more patients go back to hospital for repeat procedures, this will mean much greater costs to the NHS in the long-term. Additionally, if the trend towards more treatment through angioplasty rather

than open-heart surgery is reversed, the NHS will have to cover the bill for this more expensive procedure and associated hospital stays. This could also mean an increase in waiting lists and put at risk the considerable achievement the NHS has made in meeting the 2000 National Service Framework targets on heart disease. The NHS simply will not have the capacity to deal with more repeat procedures and substantially greater numbers of open-heart surgery cases. None of these points were taken into consideration during the NICE review.

These recommendations have come as a shock to many clinicians and those in the medical world. It represents a huge step backwards for the NHS and condemns patients to an outdated technology. It will have a considerable impact on patient care and overall cost for the NHS. Drug eluting stents are widely used in most other healthcare systems in developed countries around the world and their ban in the UK would send a very unhelpful message to those involved in developing the latest technologies and therapies.

It may be that you would wish to write to the Secretary of State for Health* asking him to ask NICE to look again at this technology and the available evidence. It is inconceivable that a technology that has been used so widely and with such enthusiasm in the NHS by clinicians, and benefi tted so many patients should be withdrawn.

* Rt Hon Alan Johnson MP, Secretary of State for Health, Richmond House, 79 Whitehall, London SW1A 2NS Tel: 020 7210 4850 Website: www.dh.gov.uk

Answers to puzzle on page 11

body mass index, coronary artery bypass graft, coronary artery disease, congenital heart disease, cardio-pulmonary resuscitation, computer tomography, deep vein thrombosis, electrocardiogram, general practitioner, glyceryl trinitrate, heart rate, international normalised ratio, myocardial infarct, millilitres, millimetres, magnetic resonance imaging, methicillin-resistant staphylococcus aureus, nil by mouth, outpatient department, shortness of breath

5

Ricky’s quickiesRichard Maddison

RemindersDo you need a fl u jab?

Some co-ordinators still have Christmas cards and regalia for sale.

The Swavesey offi ce address and phone continue. We may divert the phone to one of the Executive.

If aged 65 or older and not already done, ask at your GP’s surgery to be immunised against pneumococcus. Children under two and anyone else at risk of pneumococcal infection should also be done. One injection gives lifetime cover.

Pneumococcus is a bacterium that can cause pneumonia, meningitis, and other infections. Each year about 1 in 1000 uninoculated adults get pneumonia caused by pneumococcus; and of those about 1 in 5 die from it.

Stir tea when you make itIn the August/September issue I reported research recommending that to get the good-polyphenols benefi ts you should infuse tea for at least fi ve minutes before pouring out. The effect of stirring was not stated. I contacted Dr Duthie. ‘Each tea infusion was stirred once when the water was added, and fi ltered at the end of the infusion time to remove any residual tea leaves.’ They didn’t compare stirred and unstirred.

So, stir when you add the water, and wait fi ve minutes before pouring out.

SourceJ Agric Food Chem 10.1021. 10 May 07

40s-70 to be screenedEveryone between 40 and 70, 14 million people, will be offered opportunity to be screened to see if they would benefi t from taking statins.

Experts predict that up to half will be eligible for being prescribed statins even though they have no outward signs of any illness or heart related condition.

Current guidelines allow doctors to prescribe statins for people at risk of serious illness. About 4 million people currently take statins. This saves about 7000 lives per year, and can reduce cholesterol LDL by up to 45%.

Statins are generally safe: rarely a person on statins has muscle or liver problems as an undesirable side effect.

The proposal will cost £560 million per year, and may save many people from heart troubles and thus save far larger amounts in years to come.

SourcesNICE press release 24/6/07

Measure risk of heart diseaseWaist-to-hip ratio, WHR, has been found to be a better guide to risk of atherosclerosis and/or other heart disease than Body Mass Index BMI, or waist or hip measurements. Atherosclerosis is fatty deposits on artery walls, with related thickening, so the narrowing reduces the blood fl ow.

While standing and breathing normally, measure around your waist – about level with or just above your belly button, half way between the bottom of your rib cage and the top of your hips; without pulling the tape measure tight.

Measure around the widest part of your hips, over your buttocks, similarly.

Divide the waist measurement by the hip measurement to get the WHR.

Women with a ratio of 0.85 or over, and men with 0.95 or over are said to have raised WHR. This is found to be a predictor of atherosclerosis and/or other heart disease – a much better predictor of heart disease than BMI.

To get your BMI, divide your weight in kilograms by the square of your height in metres. BMI under 18.5 is underweight, 18.5 to 25 healthy, 25 to 30 overweight, and over 30 obese. Obesity increases the risks of: high blood pressure, diabetes, high cholesterol, heart attack, stroke, gallbladder disease, osteoarthritis, endometrial cancer, depression, and fertility problems; and shortens life expectancy.

Research at the University of Texas had found that men over 37 inches (94cm) waist, and women over 32 inches (81.3cm) had an increased heart disease risk. The sample was 2744 people. But as a predictor waist size is not as good as WHR or BMI.

SourcesJ Am Coll Cardiol, 10.1016 /j.jacc.2007.04.066. (6 Aug 2007). Also some of its refs.Other refs from web searchesDept of Health statistics, Health surveys

Hole-in-the-heart self repair kitExperts have found a way to employ the body’s natural healing power to treat a common heart defect linked with stroke and migraine.

One in four people has a valve-like hole in the heart, known as a patent foramen ovale, PFO.

PFO is an opening in the wall between the two upper chambers of the heart. It usually produces no symptoms, but in some people it signifi cantly increases the risk of stroke and migraine.

The defect can be closed surgically using a graft, but this can cause damage to surrounding tissue. Dr Michael Mullen, Consultant Cardiologist, and a team at the Royal Brompton Hospital, London SW3, have used a ‘bioabsorbable’ patch to solve the problem. The patch acts as a temporary plug until the body replaces it with healthy normal tissue – usually within 30 days.

A baby in the womb needs an opening to allow effi cient circulation of blood and oxygen before the lungs start working. After birth the hole should close to separate the two chambers. Sometimes, however, this does not occur correctly.

When pressure is created inside the chest eg by coughing, a fl ap can open, allowing blood to fl ow in either direction. Then blood can bypass the fi ltering system of the lungs and if debris such as small blood clots are present in the blood, these can travel to and lodge in the brain, causing a stroke.

Dr Michael Mullen, the Consultant Cardiologist at the Royal Brompton Hospital, who has been using the device to treat his patients, said: ‘The healing is very similar to how the body would heal itself normally. Traditional grafts are permanent and so can cause an infl ammatory reaction, which can lead to problems. Instead, this treatment does the repair job and then disappears in a natural way. The healing is very similar to how the body would heal itself normally.’

With the BioSTAR® device he has treated about 70 patients all at high risk of stroke because of their PFO. Some of these patients reported relief from their migraines since having the treatment. But he stressed that larger studies were needed to confi rm this fi nding. At present the device is only licensed for minimising risk of stroke.

The implant, soaked in anti-clotting solution, is inserted via the catheter, which initially goes through the hole. A patch opens out like an umbrella on the far side of the hole. The catheter is partly withdrawn and creates a second umbrella-like patch on the near side of the hole. The catheter is disconnected from the umbrellas and withdrawn. After about a month the patch dissolves and the hole is sealed by natural tissue.

SourceRoyal Brompton Hospital press release 12/8/07

6

Bedford Eileen Marriott 01234 303834

News from around the AreasLocal news from some of our groups

Dates for your diary are on page 9. A full list of co-ordinators and contacts are on page 14.

I wanted those of you who remembered Peter & Brenda Gilbert to know that Peter has died since my last notes to you. He had not been well enough for some time to come to the meetings and had therefore not renewed his membership but as he and Brenda were in almost at the beginning of the Bedford Group I feel it only right to inform all our old members of his death.

Colin Readman has kindly donated £100 to the Bedford Area Group from a sale of plants.

We had a great laugh at our July meeting trying to remember the Faces from the Fifties and also putting names to them. There were a few more members this time, so keep up the good work, and to those of you who haven’t been for some time we look forward to your return.

For our August meeting we had a superb evening of music from Shaun Millsom, who made the keyboard talk. Everyone thoroughly enjoyed themselves and our feet were tapping along with the music.

Don’t forget Wendy Jones Return to Swaziland on October 25th – at Putnoe Heights Church at 7.30pm. This will be her account of how things are progressing since her last visit.

We have our own Christmas cards and they will be available at the meeting, but if you can’t get there you can always ring me for some on the number above.

On November 26th our Beetle Drive is at Barkers Lane – also a chance to buy your last minute Christmas cards before it’s too late.

We will have our usual party time in December, so keep the 20th free to enjoy a concert by The Melodians. Please bring a plate of food to share plus a wine glass and – if you feel like it – your party hat, or just be prepared to let your hair down.

From next January we shall no longer be having meetings at Barkers Lane and so we will just meet at Putnoe Heights Church.

The fi rst meeting in 2008 will be the AGM at Putnoe Heights Church on a Thursday in late February.

I am glad to report that we are just beginning to settle into our new house and hopefully life is starting to get back to some sort of normality – thank you all for your good wishes and lovely cards – they are very much appreciated.

I think I can honestly report that East Suffolk celebrated our 25th anniversary in true style. 44 of us descended on Cromer Pier for a super day on 25th July. The weather was extremely kind to us. We went to the legendary End of the Pier show, which had everybody in fi ts of laughter; and we fi nished the day with a fi rst class meal at the Pier Restaurant. Thank you to all our members and friends who joined us at Cromer and helped make the day so special.

By the time you read this you will all have forgotten your summer holidays. We are off on our holiday tomorrow, 11 August; and hopefully you will have all enjoyed your breaks by the time you read this.

On Wednesday 24 October we have a guest speaker at Kesgrave Social Club.

With no meeting in November the next meeting will be our Christmas Party on Thursday 6 December. The entertainment will be of the highest order with Mr David Padmore looking after us for the night. Please come along, it will be a lovely night so please bring everyone you can and beat all previous records for the best party yet.

Take care of yourselves and each other.

East SuffolkAnita Postle & helpline 01473 829777

The East Suffolk Group presented fi ve 14-day recorder machines to Mr Cliff Woollard of Ipswich Hospital. L to R:

Cliff, Anita, Stan Madden, Nic Keeble, June Kapitan, and Richard Postle.

A few photos of our 25th anniversary celebration trip on 25 July to Cromer, Norfolk.

From Margaret RimmerWe thank Mrs Woodward for the emotional and amusing talk entitled Light at the end of the Tunnel at the July meeting. We also thank Suzanne Shepherd from Halton Health and Community Directorate for coming to the August meeting to inform members about benefi ts and help available for carers.

The July trip to Halfpenny Green Vineyard in Staffordshire was a great success. After refreshments on arrival, we were taken on a tour of the vineyard. We then had a talk on the history of the vineyard and how the wine was made. Best of all we had a wine tasting session! After lunch we had free time to look around the craft shops before returning home.

In the next edition I will be able to tell you about our days out at Bridgemere on 7 September and Llandudno on 18 September.

We meet 7pm to 9pm on the 2nd Wednesday of each month at Halton British Legion.

We also meet every Thursday at The Grangeway Centre from 1pm until 3pm for gentle exercise. If you don’t want to take part in the exercise just come along for a chat and a cup of tea.

We look forward to seeing you at future events.

HaltonJohn Fahey 0151 425 3212

From Brian Bigger, Secretary, 01522 880843

As the saying goes, Time fl ies. Here in Lincoln in spite of all the awful weather we have had a very busy time. June 17th was our trip to Laxton, mentioned in our June/July report. The weather was good to us, the tour guide explained farming methods which go back hundreds of years. Lunch was provided by the tour guide’s mother: the food could not have been better – good selection, good service, and of course the good company. Finally the day was fi nished off by a surprise visit to the local falconry, where we were introduced to a variety of birds of prey. The falconer put on a special fl ying display, all in all a brilliant day out.

LincolnKeith Atherton 01673 860582

Mrs Lyn Porter, one of our members, and Mr Steve Harborrow, a volunteer about to have his

hair shaved to raise funds.

7

Martlets, SussexGeorge Beer 01903 763902

Strawberry tea

On July 22nd we had a strawberry tea party at Keith and Dell Atherton’s home. After a lot of work by all concerned it was all systems go at 2pm. The weather was very kind to us. We had a wonderful atmosphere with various stalls: bric-a-brac, cakes, wood-turned items, plants, competitions, and last but not least strawberries and cream along with scones and hot or cold drinks. A very Well Done to Keith and Dell. All told, the grand sum of £900 was raised on the day.

Keith Atherton attended the Transplant Games in Edinburgh from 26th to the 29th July, where 600 transplant patients participated to celebrate The Gift Of Life at the 30th British Transplant Games. Sir Jimmy Savile offi ciated at the opening ceremony, which was followed by a parade through Edinburgh. He had opened the very fi rst British Transplant Games in Portsmouth in 1978.

Before we know it Christmas will be upon us. We in Lincoln have booked our Christmas Party. Enjoy life, take care of each other.

Way back in July we held our annual BBQ, which was as expected a great success. Everyone had an enjoyable evening, thanks to the work of Wendy & John Colyer and Prim & Alex McGregor. We were pleased to be able to welcome some new members at this event.

I was unable to attend myself but have been informed that the Greyhound Stadium meeting and meal was a very interesting and sociable evening. Together with other members who did not attend and now showing interest, we are looking forward to a repeat in the near future.

Arrangements had been made for an introduction to croquet on Tuesday 14th August. Members were looking forward to this new venture but unfortunately it had to be cancelled due to the weather. A new date is being arranged.

Another event that had to be cancelled was the Barn Dance at Durrington Community Centre, due to lack of support. At this Centre on the 27th October, we are having a Cockney Night at 7pm till 10.30pm – all at

a cost of £8, when we hope to see as many of you as possible and meet up with your friends from the Cardiac Rehab Supporters.

We have an interesting speaker arranged for the 31st October meeting when the subject will be the Queen Alexander Hospital Home in Worthing. This establishment is a charitable institution for disabled ex-servicemen. It had been known as Gifford House until quite recently. We would like to see as many members and friends at this meeting as can make it.

Please make an effort to support us at as many as possible of the events in Dates for your Diary.PeterboroughGordon Wakefi eld 01733 577629Our 18 September meeting had to be changed to 25 September due to an unforeseen problem. I realise this Journal will reach you after then.

South-East London & Kent

I am sorry to report that Ken Flowers, one of our old and valued Committee Members for a number of years, has passed away. Ken moved to Wiltshire after the lost of his wife to be closer to his family. All those who knew him will miss Ken and our thoughts go out to his family.

On 13th July we held our fi rst Quiz Night. We thank Michael Deves, the Quiz Master, who had prepared a range of questions to tax our brains. The winners were the ‘Crayits’ with 48 points, closely followed by ‘007’ with 40. The evening was a great success and enjoyed by all those who attended.

Due to the bad weather in July, the arranged Cruise on the River Thames from Westminster to Hampton Court was rearranged for the 13th August. The members had a delightful day – leaving the boat at Hampton Court, walking through the garden for refreshments in the Tea Room, and returning home by train after a very enjoyable day.

The August planned visit was Items of Interest at the Imperial War Museum. In September members will be going to Lewisham Theatre to see Paul Daniels and Debbie McGee in the Water Rats Charity Variety Show, supporting actors’ orphans.

All these trips sound very interesting and I look forward to hearing from members how they went.

From Alan EatonOn Friday 6th July 2007, I was invited to a fund-raising evening held at the Terrace Inn, Fenton, Stoke-on-Trent, organised by Lyn &

Staffordshire and DistrictAlan Lea 01782 838730

West Suffolk & South West NorfolkBrian Hartington 01284 762783

Jeff Porter, members of our local BCPA.Amongst a very light-hearted and

enthusiastic audience three brave souls volunteered to have their heads shaved to raise money for the Group, through sponsorship. Lyn was in charge of shaving and Jeff sold raffl e tickets and generally encouraged the pub regulars to part with their money!

At the end of the evening £940 had been raised, which by any standards is an incredible amount. Our heartfelt thanks go to Lyn and Jeff for all their hard work and also to the customers and staff of the Terrace Inn for their participation. This amount will benefi t heart patients in our local hospital as part of our ongoing commitment to supporting the medical staff by providing equipment that may be outside their budget. Once again, huge thanks to all concerned in this superb effort.

We had our annual BBQ at the Royal Anglian Club, and we are indebted to our new cook, Barbara, who – ably supported by John and the rest of the family – gave us a lovely meal.

On 12 July, helped by friends from Ipswich, we visited to Dunwich for their famous fi sh and chip supper. Fortunately the weather was lovely; and although we strained our ears we were unable to hear the church bells of the village that sank due to the ravages of the sea. As this happened before global warming, perhaps we should blame King Canute!

I have arranged two meals at the local Bushell Pub: the fi rst will have been on Tuesday 18 September, and the second is our Christmas dinner on Tuesday 4 December at 12.00 for 12.30. I will send you menu details by letter.

Finally, congratulations to Mrs Iris Andrews who is retiring from our local GP’s surgery on 29 August. She has always been an avid reader of our Journal.

Please look after yourselves. Cheers.

8

The travesty of the NICE appraisal of Drug-Eluting Stents:

A fl awed model of cost-effectiveness could condemn patients to CABG surgery when they could have had angioplasty.

A few weeks ago, the government organisation NICE, The National Institute for Health & Clinical

Excellence, published its appraisal of drug-eluting stents (DES) for the treatment of coronary artery disease for public consultation; and its recommendations were nothing short of astounding. Colleagues in the fi eld of interventional cardiology are dismayed by the shortsightedness and clinically inappropriate nature of the main summary statement.

The main conclusion in this consultation document was:

‘Drug-eluting stents are not recommended for use in percutaneous coronary intervention in patients with coronary artery disease’!

There are a few reasons why this extraordinary statement raises serious questions as to the very competence of this process and the people who prosecuted it, and I shall address them in more detail later, but one reason shines out above all others. That reason centres upon CARING for PATIENTS.

If, after the public consultation period, this guideline is confi rmed, expert clinical doctors on the front line, who deal with real patients (and are not expert in dubious and convoluted models of cost effectiveness), will be faced with an unacceptable prospect. They will have to refer patients with coronary artery disease for Coronary Artery Bypass Graft (CABG) surgery when they would otherwise have been effectively treated with drug-eluting stents.

Let’s be clear: CABG surgery is an excellent treatment for some patients with coronary disease and I refer some suitable patients for CABG regularly. But, how many people would choose to have CABG surgery, with its week-long stay and 6 to 8 week recovery period, when they could have equivalent treatment in a local anaesthetic procedure and a stay in hospital that involves from 0 to 2 nights?

Is that what we, or you, or the members of the NICE appraisal committee want for ourselves or our families? Of course not! So: how did we arrive at this potentially rather ludicrous situation?

Patients with angina or heart attack can be treated in three ways: tablets alone; tablets plus angioplasty with stents (PCI); tablets plus CABG surgery. Some patients

Dr Nick Curzen, Consultant Cardiologist at Southampton General Hospital

have patterns of coronary artery narrowing that are not really suited to PCI and they are referred for CABG surgery. Equally, some patients having heart attacks or with a lot of other medical problems are considered too high risk for CABG and are treated by PCI. Most patients, however, could theoretically have either CABG surgery or PCI, and it is part of the skill of looking after these patients to judge which treatment is the best for each individual.

Often this decision is relatively clear cut, but if not then in the consultation the cardiologist, patient, relatives and a cardiac surgeon are all required. The decision-making process requires a thorough understanding of the current evidence base of research in the fi eld.

The basic facts from this body of evidence could be summarised briefl y as follows. There has never been any reproducible difference in outcome if you compare patients receiving stents versus CABG in terms of subsequent rates of death or heart attack.

However, the original coronary stents, bare-metal stents, BMS, had a chance of developing scar tissue inside them and therefore renarrowing to the point that the angina symptoms returned (most often between about 6 & 12 months after the stent was put in) of about 10-25%. This process of renarrowing will then most likely lead to the patient needing another procedure to treat the coronary artery again (revascularisation either by CABG surgery or more stent). The renarrowing is called restenosis and the chances of it happening vary. It is more likely when a lot of stent is required or stents are put in very narrow arteries, arteries with branches or arteries that were completely blocked before the treatment. Restenosis is also more likely in patients who are diabetic. Studies that compare bare-metal stents with CABG surgery (in patients who would be suitable for both) have shown that whilst the death and heart attack rates are the same, there is about a 14% higher chance of needing another procedure to treat the coronary artery in the stent group compared to the CABG group. This difference is largely accounted for by restenosis.

A few years ago, drug-eluting stents (DES) emerged. These stents are coated with drugs that reduce the tendency to develop restenosis. Over the years, a huge amount of research data has become available to confi rm that the currently utilised DES do

reduce restenosis rates consistently in a wide variety of coronary artery lesions and types of patients. This reduction in restenosis corresponds to an observed reduction in the need for the stented patients to require another procedure to treat the artery again (revascularisation). Don’t take my word for it, or even that of my colleagues in the fi eld of intervention. It is indeed is fully accepted and even reported by the NICE committee.... and I quote from the appraisal document:

‘Rates of revascularisation at 1 year for procedures carried out with a DES within individual trials were less than 5%, and typically in the 10-25% range for procedures that used BMS’.

‘The pooled DES analysis indicated that revascularisation rates were reduced by approximately three quarters compared with BMSs ...’

The benefi ts of DESs over BMSs for revascularisation were seen at 1 year, and this signifi cant difference was maintained up to 3 years.’

DES technology thus represents a spectacular advance in a convenient, patient-friendly but previously fl awed treatment. If you can reduce the restenosis rate you would take away a lot of the difference between the BMS stent therapy and CABG that was seen in previous studies. Sure enough, in the real world (a long way away from the health economy sleight-of-hand of NICE appraisals), we experienced a radical change in our observed clinical practice. From the days of every week in clinic seeing, with depressing regularity, patients presenting with recurrent angina due to restenosis, this became a rare event. What a triumph for patient care!

So, the NICE Committee are clearly convinced that DES reduce restenosis – so what is the problem?

The problem is that according to their calculations, DES are not cost-effective. The details are intricate and too complex to go into here, but suffi ce it to say that the expert clinical cardiologists feel that the methods used by the health economy team are fundamentally fl awed in several aspects. Extrapolated calculations from a completely underestimated level of restenosis in BMS and an overestimate of the cost difference between DES and BMS are two of the most important factors.

9

For the committee, though, the cost effectiveness arguments are the dominant ones. Curiously, their dubious conclusion apparently applies to all types of coronary narrowing and all types of patient.

For the subsets with very high rates of restenosis with BMS this is so unlikely, given the cost difference between the devices, to be almost laughable. There are even very detailed published cost-analysis comparisons available from the scientifically conducted studies that confirm a cost saving for DES compared to BMS!

How did this conclusion ever get written? It is a difficult question to answer. The committee has been persuaded by a group of health economists with a track record of poorly justified criticism of contemporary interventional cardiology practice.

Call me cynical, but perhaps the absence of a single interventional cardiologist or cardiac surgeon on the appraisal committee has influenced the outcome a bit? Whilst the committee took evidence from experts in intervention, there wasn’t a single frontline clinical interventional cardiologist on the committee to contribute to their subsequent analysis and debate. Mind boggling!

I suspect that if the specialty had been properly represented, the process of appraisal would have been extremely useful to both patients and to the DoH purse strings. A compromise would have been reached, and the summary guidance statement would have contained a modicum of common sense and clinical relevance. It might have read as follows:

‘DES are recommended only for patients with an estimated restenosis rate

with BMS of over 10% (or 15%). The following patient subgroups are likely to fall into this category: diabetics; small vessels; chronic total occlusions; lesions over 15mm; bifurcations’.

Come on NICE, you’ve got this wrong. Think a bit more about clinical excellence and patient care (it’s even in your own name!!) and we will compromise on cost-effectiveness by limiting DES use only to high-risk patients.

It was one of the advisers to the great John F Kennedy who said: ‘An economist is someone who, when he finds something that works in practice, wonders if it will work in theory’. How apt!

But please don’t condemn a generation of patients with coronary disease to have a CABG when they didn’t really need it.

Dates for your diary

Papworth Hospital Service at Ely Cathedral will be F 14/12/07 7.30.

Bedford Th 25 Oct 7.30M 26 Nov 7.30Th 20 Dec 7 for 7.30

Return to Swaziland by Wendy Jones, at Putnoe Heights Church, PHCBeetle Drive at Barkers Lane. 4th Mon odd months at BLConcert by The Melodians, at PHC. 4th Th even months at PHC

Bourne M 12 Nov 7.30 Party & Group closure. Red Cross Hall, Harrington StreetCambridge Usually 4th Wed of even months at Memorial Hall, Great ShelfordChelmsford and

District Cardiac Support Group

8.00 All 8.00 at Broomfield Parish Hall

Chester 2.30 All 2.30 at Hoole Community Centre, Westminster Road, Hoole, Chester East Suffolk W 24 Oct 7.30

Th 6 DecGuest speaker, at Kesgrave Social Club Christmas Party at Kesgrave Social Club, with David Padmore, £6. Phone Anita

Halton W 10 Oct 7-9W 14 Nov 7-9Tu 27 NovW 12 Dec 7-9

Hotpot supper & quizLight FantasiaOswaldtwistle Mills. Colliers Street, Oswaldtwistle, BB5 3DETBA. Normally 2nd Wed of month, 7-9pm, Halton British Legion

Havering Hearties 2nd Th of month All at 7.30pm at Conference Centre, Oldchurch HospitalKing of Hearts,

Redbridge, Essex3rd Wed of month All at 7.30pm at Ford Sports and Social Club

For details contact Tony Roth 020 8252 0877Lincoln Tu 9 Oct 7.30

Tu 13 Nov 7.30Wed 12 Dec 7.30Tu 8 Jan 08 Tu 12 Feb 7.30

Martin Hay, History of the English Rose. Paul Brewer. Lincoln’s twinning with Neustade and the FFN Christmas party Swedish MassageAGM. All at Ruston Marconi Sports & Social Club, Newark Rd

Llandudno Tu 7.15 All usually Tu 7.15 at Deganwy Castle Hotel, DeganwyMartlets, Sussex Sat 27 Oct 7.00

Wed 31 Oct 2.30Sat 3 Nov 2.30Wed 28 Nov 1.00

Cockney Night. Durrington Community CentreSpeaker from QA Hospital Home. Lancing Parish HallMac & Mabel. Connaught Theatre, WorthingLunch. Venue being arranged

Merseyside First Wed All at OPD at the CTC, BroadgreenPeterborough Tu 20 Nov 7.15 Social & National Draw, pre-Christmas buffet. Usually Tu 7.15 at Cherry

Tree Public House, Oundle RoadSE London & Kent All Victory Social Club, Kechill Gardens, Hayes Staffs & District Tu 30 Oct 7.30 for 8

Tu 27 Nov 7.30 for 8Tu 11 Dec 7.30 for 8

Speaker TBA. All Thistleberry Hotel, Thistleberry Av, Newcastle ST5 2LTSpeaker TBACarol service

Take Heart, Southend

First Th of month Orchard Rooms, Southend Hospital Social Club

West Suffolk & SW Norfolk

Tu 4 Dec 12 for 12.30 Christmas dinner at the Bushell Pub. Phone Brian.

Warrington 3rd Th 7pm All 3rd Thur 7pm at Post-Graduate Centre, Warrington HospitalWirral M 8 Oct 7.30

M 12 NovKen Allen: Laurel & Hardy. All Heswall Hall, Telegraph Road, HeswallHotpot supper winter warmer. £3

Wrexham Tu 7.00 All 3rd Tu 7pm at Associations of Voluntary Organisations Wrexham, AVOW, Egerton Street, Wrexham

10

AblationFrom Nick BeattieI’m a Visitor at our local Cardio-thoracic Centre. I observe an increasing number of patients coming in for ablation. Would it be possible to run a brief non-technical article explaining what sort of conditions ablation is useful for, and how it is done?

Every good wish.Nick Beattie

Reply Ablation is a general term with three meanings. 1 The surgical removal of an organ, structure, or a part of such. This can apply to any part of the body – it is not heart-related. 2 The melting or wearing away of an expendable part – eg of the heat shield of a spacecraft during reentry. 3 The wearing away of part of a rock or glacier.

We cannot here give all the applications. RM

Sequel I phoned Nick with this reply. He said the question arose from being referred to The Cardiothoracic Centre, Liverpool NHS Trust. He sent me a patient information leaflet on Radiofrequency Ablation of Atrial Flutter, which is a treatment to correct an abnormal heart rhythm.

Through a vein in the groin at the top of a patient’s right leg and/or a vein under a collarbone, wires are passed to the heart. These are used to ablate, ie burn away, the exact pathway in the heart that is causing the atrial flutter. RM

Trapped nervesFrom Don BrookmanFor a year or two I suffered from a trapped nerve in my spine, which caused great discomfort to my left arm and shoulder when my head was inclined over my left shoulder. My doctor said nothing much could be done without invasive surgery, and at the age of 79 years I was not enthusiastic. I received the same information from both a Chiropractor and a Physiotherapist.

However, in January 2006, watching me fight for breath after climbing the stairs, Gwen, my partner, instructed me to report to the doctor. My protest that at the age of 81years I must expect to be short of breath fell on deaf ears. I dutifully obeyed, and guess what? I had a suspected leaky mitral valve!

After a number of tests and examinations at Norfolk & Norwich hospital, it was

confirmed. Luckily, it was also discovered that although my valve was 81 years old the rest of me was nearer 60 years and I was referred to Papworth as a fit and proper person to undergo any necessary operation.

In March, a phone call informed me that due to a cancellation I should report to them at Papworth in 48 hours. No time to have second thoughts or worries! I realised within the first 24 hours that any worries were unfounded: I was surrounded by some very competent staff, and some very supportive patients. A week later I was at home in Gwen’s very competent charge. She cracked the whip and ensured that I did my physiotherapy 100%. Reporting back to Physiotherapy at Papworth I was declared fit, and signed off. I now had a 60-year-old valve to match the rest.

Now here is the bonus. Remember the trapped nerve? It had gone! I just had to tell my doctor, and we surmised that the act of opening my rib cage could have moved the vertebrae a little and released the nerve?

I now wonder should I write to The Lancet and tell them of this treatment for trapped nerve? The fact that it requires open-heart surgery is a little unfortunate.

Yours respectfully, An extremely happy recycled 82-year-old

going on 62. Don Brookman

Reply I have also suffered from trapped nerves in my spine – from when I was a passenger in a coach in a road traffic accident in 1978. My CABG in 1991 aggravated these spinal-nerve injuries. For many years I had various pains and did not understand the causes or treatment till in 2005 my surgeon recommended that I should be seen by Dr Ian Hardy, Consultant Anaesthetist at Papworth. He gave me an excellent explanation. I sent him Don’s letter and he replied as follows.

‘There are many ways that a nerve can become entrapped, sometimes by a mechanical problem which may have been the case for Don. Often the entrapment occurs following direct trauma causing crushing, scar tissue entrapment, oedema around the nerve, etc. The end result is the same – fake messages to the brain – the cure or partial cure can be different as in Don’s case where movement of a bony joint allowed the trapped nerve to be released for good.

Usually, however, the scar tissue and swelling are difficult to totally rectify and so some residual entrapment is evident but the symptoms are reduced.’

Angina not diagnosedFrom Barry MappleyI have recently read the article by Eve Knight concerning angina attacks, and found it lacking in

the correct information for diagnosis. The symptoms given are those that still seem to be taught to GPs, and in my experience are very inadequate.

I had a car crash in 1995, injuring the right side of my body, right arm, and head. Following the accident I was prescribed painkillers and was soon on the maximum amount of painkillers that I could take and still be allowed to drive when I returned to work.

About three years later the pains seemed to increase, with additional and different ones making life increasingly difficult. I had not been able to do much physical activity since the car crash; and when at a birthday party in September 1998 I tried to dance I suffered a different agonising pain in my right arm going up to my jaw and neck. Thereafter I noticed these pains whenever I did any physical exertion or ate a meal.

I had a second car crash in November 1998.

Over the years these pains worsened. Five different doctors saw me and I asked each if I had had heart attacks or angina. They all said no as the pains were only on the right side of my body and in my right arm. They said that to have anything to do with the heart the pain had to be on the left or all across. They all said that the pains were related to the car crashes.

Because of the terrible pains I suffered after eating I thought that I was becoming allergic or intolerant to many foods, as I am intolerant to wheat. So I excluded an increasing number of foods from my diet.

Over the years, because of the ever-increasing pains, my life became intolerable. I did not socialise, except with family members or very close friends, as I was scared that I would suffer agonising pains in public, which would have been highly embarrassing. As, due to my work, I ate late in the evening, I would spend hours sitting on the edge of my bed in agony and in tears, spraying myself continuously with pain-relief sprays. The only way of getting to sleep or reduce the pain was to over-indulge in sleeping tablets and/or alcohol. The latter was known about by my GP.

My work involved calling on people at their place of work or their homes. Because the pains increased with effort I had to stop calling at addresses where I had to walk any distance or climb stairs. Just to walk 200 metres to my bank or to go shopping meant that I would have to stop every 50 metres to rest. Often I had to get on my hands and knees to go upstairs.

Due to my car crashes I was being treated by a very experienced Doctor of Chiropractic and a Sports Injury Masseur who managed to get me back to work. But because of the continuing (undiagnosed angina) pains I carried on being treated by them for years, still thinking that the pains were from the car accidents. I spent thousands of pounds on these treatments, pain-relief sprays, over the

Letters to the Editor

Don Brookman & Gwen

11

counter painkillers, and alcohol. Sometimes in an evening I drank a bottle of port and half a bottle of brandy, just to relieve the pains and get some sleep.

Over the nine years of suffering from the undiagnosed acute angina, the GPs simply increased or changed the pain-relief medication until I was over-indulging daily on diclofenac, co-proxamol, amitriptyline, codeine, aspirin, paracetamol, ibuprofen, sleeping tablets, and other stronger anti-depressants of which I have forgotten the names.

Due to the painkillers I also suffered very severe stomach problems; but not even the specialist that I saw linked them together.

During 2005 the pains were so intolerable that life was really not worth living. My children and grandchildren were all that kept me going.

In September 2005 I suffered pains all across my chest and in both arms and from the Internet diagnosed my condition as unstable angina. I immediately went to a locum GP, who had me in hospital within 30 minutes. As soon as I was given blood-thinning medication nearly all my pains disappeared and I felt like a new man.

If I had been given an angina spray in the previous years I probably could have led a fairly normal life.

Since my heart by-pass operation in October 2005 my activity level has returned to that of 13 years ago and I have lost 2 stone in weight.

I now run an Activity and Heart Support Group called FITTA TIKKA in Falmouth, Cornwall – after nine months we have over 20 members. I work very closely with the Royal Cornwall Hospital, Truro, cardiac rehab nurses, who have one of the best records in the country for seeing 100% of those heart-attack patients needing to be seen.

Some of them have told me that angina pains can occur in many places on their own, not radiating from other places; and not only in the left and right sides of the body and arms, but also in teeth on their own. It has apparently been known for patients to have teeth removed thinking that they had toothache, when actually suffering from angina. One lady member of our group only ever had pains in her right side. So this is not so rare.

It worries me that, if GPs are still taught that angina occurs in the chest (I had no chest pains) or left side of the body and limbs and nowhere else, then there are possibly very many people who are still suffering unnecessarily from the terrible pains of angina with no relief, due to outdated beliefs. If cardiac rehab nurses have improved knowledge, why has it not been passed on to GPs?

I was recently interviewed on Radio Cornwall to comment on the latest British Heart Foundation promotion, which advised people to go to their GPs if they have pains in their chest. From my own experience and discussions with other people who have suffered from a heart condition, I would advise anybody who suffers from any unexplained pains in their body or limbs to see their GP to be safe rather than sorry.

The National Health Service is now trying to get better diagnoses before patients need hospital treatment, rather than waiting until an event happens. GPs are now paid for prevention of illnesses and would rather see you before you need to be admitted to hospital.

I hope this may be of use to others who may be suffering unnecessarily. Unfortunately this will be seen mostly only by people who have already suffered a heart condition or are involved with someone in that situation.

Yours in hope. Barry Mappley

Le Champ de la croix is a bungalow style gîte with two large double bedrooms and a third bedroom with bunk beds which altogether accommodate six people. Ideal for families to

enjoy the peace and quiet of a secluded rural setting or use as a base to explore the Loire Valley. The gîte is located on the edge of the pretty Anjou village, Courleon, 25 kilometres north east of Saumur and 57 kilometres west of Tours. A large open garden surrounds the property and you can enjoy views across the fi elds of sunfl owers and asparagus as well as watch rabbits frolic. There are apple orchards everywhere!

Le Champ has a well equipped kitchen with stainless steel appliances, a cooker, microwave, fridge and washing machine. There is plenty of hot water supplying the bath and shower! The through lounge/dining area has comfortable sofas, table and chairs, a television and DVD player. All of the bedrooms have tiled fl oors and are comfortably furnished with lovely views. Bed linen is included in the price. Cots and highchairs can be provided on request. There is a small patio to the rear off the lounge/dining area and a garage containing garden furniture and the barbeque. The nearby village of Vernoil has local shops including a supermarket, boulangerie and butchers.

Costs and availabilityA special fl at rate of £220 a week all the year round for fellow heart sufferers of coronary heart disease (see BCPA Journal December 2004). Seasonal prices may be found on the web site. Please call, write or email Alec and Viv Keeble – who will be happy to provide current availability and further information. Telephone: 01362 852144; Email: alec@aleckeeble.wanadoo.co.uk; Post: Alec Keeble, KMEC Dereham, GTE House, Yaxham Road, Dereham, NR19 1HD; Website: www.lechampdelacroix.com Our Courleon home is a place where you can enjoy French life at its best. Smart heart recipes, which have been tried by us, are available and all guests will receive a Welcome Pack on arrival – just a few essentials and regional products to tantalise the taste buds and ensure a warm welcome! Please note: NO PETS

e Champ de la croix is a bungalow style gîte with two large double bedrooms and a third

Smart heart holidays

VegetablesJanet Jackson

Italian vegetablesLightly cook some green beans with red and yellow peppers. Toss the hot vegetables in Flora pro.activ and some fi nely chopped dill or fennel. Stir in thickly-sliced pitted black olives.Summer vegetables with garlic, parsley, and lemon glazeLightly steam or boil a mixture of vegetables (such as baby carrots, tiny new potatoes, and sugar snap peas) until just tender. Mix fl ora pro.activ with a crushed garlic clove, chopped fresh parsley, fi ne-grated lemon zest, and freshly ground black pepper. Toss the hot vegetables in the fl avoured spread.Spiced new potatoes with corianderLightly cook some halved new potatoes. Combine Flora pro.activ with a little of your favourite curry paste and plenty of chopped fresh coriander. Toss the hot potatoes in the fl avoured spread.

Puzzle What do the following abbreviations stand for? BMI CABG CAD CHD CPR CT DVT ECG GP GTN HR INR MI ml mm MRI MRSA NBM OPD SOB

Answers on page 4. Sorry no room for a crossword or more puzzles!

Your body personality

Corey Beecher

Calorie burning facts❑ The faster we move, the more calories we burn.❑ The more effort we put into a movement, the more calories we burn.❑ The heavier a person, the more calories burned during any type of movement – more effort to move extra weight.❑ The more muscle/lean weight we possess, the more calories burned even at rest – more cell mass to maintain.❑ Increasing fi tness levels increases the amount of fat calories burned during most movements.So which activities burn the most calories per hour?

Activity 8 stoneperson

9½ stoneperson

11¾ stoneperson

Aerobics 354 422 518Badminton 266 317 388Cycling <10mph

236 281 345

Bowling 177 211 259Child care 177 211 259Cleaning house

207 246 302

Dancing 266 317 388Fishing 236 281 345Golf, carrying clubs

325 387 474

Golf using power cart

207 246 302

Jogging 413 493 604Music, playing drums

236 281 345

Swimming 354 422 518Walking 4mph very brisk pace

236 281 345

With this information now at your disposal, think about how you use your time to exercise: working slower for longer or faster for shorter periods of time. Then think about the activities you choose and the number of calories that will be burned.

I’ll sign off with my job completed for this journal issue, and leave you with the fact that I will be a dad again next March, so I’ll be gaining my fat burning activities with two children under two years of age. Am I looking forward to it? Of course I am.

Best wishes to Clare, Cody and you. RM

12

EndomorphEndomorphs are typically round and described as ‘a barrel of fun’. They tend to have:❑ wide hips and narrow shoulders giving the ‘pear shape’❑ a lot of fat spread across the body, including the upper arm and thighs.

With slim ankles and wrists the fatter parts are accentuated. Psychologically, endomorphs are:❑ sociable ❑ fun loving❑ love their food ❑ tolerant❑ even tempered ❑ good-humoured❑ relaxed ❑ needing affection.EctomorphThe ectomorphs are the opposite of the endomorphs and are physically:❑ narrow shouldered with narrow hips❑ a thin and narrow face, with a high forehead❑ a thin and narrow chest and abdomen❑ thin legged with thin arms❑ low in body fat.

Even with a similar appetite to the endomorph they never put on weight. Psychologically they are:❑ self-conscious ❑ private❑ introverted ❑ socially anxious❑ artistic ❑ intense❑ thoughtful ❑ emotionally restrained.MesomorphMesomorphs are somewhere between the round endomorph and the thin ectomorph. Physically they have the more desirable body, with:❑ large head, broad shoulders and narrow waist (wedge shaped)❑ muscular body, with strong forearms and thighs❑ very little body fat.Generally considered ‘well-proportioned’, psychologically they are:❑ adventurous ❑ courageous❑ indifferent to others opinions ❑ risk takers ❑ assertive❑ have a zest for physical activity❑ competitive ❑ have a desire for power Exercise, metabolism and ageWhatever body personality you have, exercise will help throughout your lifetime. Here’s how in general your lifetime will pan out:

In one’s 20s one is leaner – with less body fat. Without regular exercise the body will begin to decline. Metabolic rate is high, but

Everyone’s body has a Personality; do you know what yours is? William Sheldon (1898-1977) was an American psychologist who, as a boy was an avid observer of animals and birds. As he grew up he turned

his hobby to observe the human body. His research noted three personalities based on body shape.

not exercising three times a week will show muscle mass decline. One’s body fat stores will also increase.

One’s 30s is a time of plateau. Children, home and career developments put restraints on one’s time. Exercise can normally be the fi rst activity to be dropped. Nature dictates a loss of lean muscle and an increase of fat.

In one’s 40s metabolic rate slows down, but most people still insist on eating the same amount and exercise less (as they’ve lost the habit). Making things worse one’s digestive system slows down. It’s a time of hormone fl uctuation. Women may see the onset of the menopause. Thyroid problems are also more prominent. The thyroid gland regulates the metabolic rate. If the thyroid does not function properly energy levels, muscle strength, skin and hair growth are all affected.

In one’s 50s life stabilises again. Work, home and social activities take precedence over making time to exercise. Also this is an era where more health issues can begin to rear their heads.

In one’s 60s and beyond, regular checks on blood pressure, cholesterol, activity levels, diet, and smoking issues are important. Health issues become more urgent.How does exercise help?We nearly all eat too much food. Food is these days more easily obtainable and in relative terms is much cheaper.

Burning calories is the way to keep your weight under control.

Recent research reports suggest that exercising at a lower level will burn fat more effi ciently than higher-level exercising. Is this true? YES!

A light and easy activity such as walking tends to burn much higher percentages of fat. Fat is a slow-burning fuel and it requires oxygen. If oxygen is delivered to the muscle cells in suffi cient quantities the cells easily burn fat for most of the energy needed. Potentially this could be a problem if people are looking to lose weight, as lighter exercise burns fewer calories.

More intense exercise WILL burn more calories. In these cases oxygen cannot always be supplied to the hard-working cells in suffi cient quantities, so cells will burn more carbohydrates to keep the fuel fl owing for the working muscles.

So in order to burn fat directly we need to exercise at a lower level of effort for longer periods. Eg walking 1 mile will burn more fat cells than running the same mile, but fewer calories will be burned.

13

The experience of a lifetimeDerek Holley

On retirement, I gave myself a gift of a very

special holiday; riding with the cowboys of Utah.

On arrival in St George, Utah, it was confi rmed that this was no ‘dude’ or ‘city slickers’ experience. A genuine cattle drive, living the life of a cowboy under the stars at night and in a cloud of dust in the daytime. But what an experience it turned out to be.

Day 1 Arrive at base camp and meet our cowboy hosts. Get settled into our tents; meet the other volunteers (10 all together) and our horses for the week. Allocated a Palomino called Caddy (named as she was traded for a Cadillac!). Shown how to saddle and harness up western style. Get the feel for the horse by walking and trotting around. Back to the camp for evening grub and to do chores. ‘Live like the cowboys live.’

Day 2 7.30am start, saddle up and ride to pastures about 8 miles away. We all help round up about 200 cows and their calves and push them to the base camp where they join the rest of the herd. Check that all cows and calves pair up and ride around to gather any strays. It is hot (30oC+ and very dusty when the cows move). Return to camp around 5.30pm, unsaddle etc, feed and water horses. Time for a cold drink and minimal wash (no showers etc for a week).

Day 3 7.00 start with breakfast and chores around camp. 7.30am saddle up and ride over to pastures. Herd is well spread out over about 1000 acres and we have to gather them all together. Told we have to push

them over a 7,200 foot ‘hill’. Seems like a great big mountain to me! At 10.00 when herd collected and all cowboys and families arrive we start the push. Children as young as three riding horses as big as mine with supreme confi dence – no hard hats! We all wear cowboy hats to keep the sun off.

For 3 hours we push this noisy, dusty herd up the mountain and onto a ridge 7,200ft high above the Utah plains. Views unimaginable: deep blue skies, pine covered mountainsides, and deep green valleys. We get to the top and rest for lunch. Cows all pair up again with calves. Descend into ‘Long Valley’ still at 5,500 ft – heat and dust abound. 4.00pm we bring the herd to halt and make camp. First chore is to unsaddle and water the horses, then erect tents, cold drink and a short nap! 7.00pm brings supper cooked by our hosts. Usual cowboy food of steaks and baked beans, washed down with cold beer or lemonade.

Day 4 Usual routine, the scenery is breathtaking, the air is light and fresh. We prepare out packed lunches, saddle up and get under way. Cowboys show us how to herd and to rope. We come across family campers and I am given the task of making a path through herd for their vehicles. A lot of shouting ‘Yehaa, ya’ cracking whips and using my hat to scare away the cows from the path of these vehicles.

Days 5-6 Similar routines but with every day a new scene, hard work and lots of fun. Calves break away from the herd, we chase them back in. A dog chases a calf back into the herd and the mother cow chases the dog away! Campers watch us in a combination of bewilderment and amusement. But the best time each day is to settle the cows down, have a cold beer and sneak off to the mountain stream for a sluice down – skinny-dipping is a must here!! The water is freezing but welcome.

Days 7-8 Arrive at the summer pastures and start the long trek home over beautiful pine covered mountains. We wind our way up to 9,500ft

with views across Utah, Colorado, Arizona and Nevada. Stunning scenes of great beauty, largely unspoiled.

What struck me is the nature of these gentle folk of Utah, real environmentalists with contempt for the rich and famous environmental publicity seekers. They have very little material things in our terms, children do not have computers – game-boys etc. They live and play outside with their kin and their animals but they are honest and sincere. It was like turning the clock back but in the nicest possible way.

‘If I never live to see another day, I would have had the experience of a lifetime and a better understanding of life. If you have a chance to do the same, don’t let anything stop you’.

Home Again

Across the Ridge

Typical Washing FacilitiesTypical Camp Site

14

The national campaign for cardiac rehabilitation

Geoff Dorrie, BCPA member & BACR Council member

Currently three out of fi ve UK heart patients who need rehabilitation don’t have access to it.

In July 2007 the British Association for Cardiac Rehabilitation, BACR, and the British Heart Foundation, BHF, launched a national campaign. They want better availability and quality of treatment across the UK.

Cardiac rehabilitation involves nurses, physiotherapists, dieticians, psychologists and occupational therapists who work with their patients both one-to-one and in groups. Quality programmes will include: ❑ ongoing advice and support from medical professionals ❑ advice on improving lifestyle and diet ❑ a structured exercise programme; and ❑ counselling.

At the end of the average 12-week programme, patients will understand their condition, have greater confi dence and be able to regain a high quality of life again. Our demand Cardiac rehabilitation must be fully recognised as being central to the treatment and care of heart patients. By the end of 2010, every heart patient must have access to a high quality cardiac rehabilitation programme.Our causeCardiac rehabilitation helps people with heart problems and their families achieve a better quality of life, cope with what can be

a frightening experience and live longer. A team of health professionals that may

include nurses, physiotherapists, dieticians, psychologists and occupational therapists work with the patient to agree and set some simple goals; for example, to safely increase physical activity and move to a better diet.

Ideally cardiac rehabilitation unites the efforts of the patient, the hospital and primary care in the long-term management of the illness. Our messageCardiac rehabilitation is an inexpensive treatment that saves lives and improves the quality of life for people living with the burden of cardiovascular disease.

Quality rehabilitation provided by suitably staffed and resourced teams underpinned by robust clinical guidelines can reduce blood pressure, cholesterol, anxiety and depression and allow patients to self-manage their condition.

It is among the most effective and inexpensive treatments available. At a cost of only around £600 per patient per year for a programme that meets BACR minimum standards, it can reduce the chances of dying prematurely of heart disease by 26%. Yet, in the UK, 60% of the patients who need it do not have access. This is a clear denial of necessary treatment to patients in need.

Universal access to quality cardiac rehabilitation is what people living with

heart disease need, what they deserve – and now what they are demanding.Our objectivesThe National Campaign for Cardiac Rehabilitation has fi ve objectives:❑ that every heart patient who is suitable and wishes to take part be given access to a rehabilitation programme❑ that patients be offered alternative methods, such as home-based rehabilitation, if they prefer not to take part in a group programme or attend hospital as an outpatient❑ that efforts be made to ensure that rehabilitation programmes meet the needs of under-represented groups, such as ethnic minorities and women❑ that each programme meets the minimum standards set out by the BACR❑ that cardiac rehabilitation provision be monitored through the National Audit of Cardiac Rehabilitation.

The BACR and BHF hope that patients and their carers will create a demand for properly funded and staffed cardiac rehabilitation programmes in their home areas where these are not already provided. Eg contact MPs, Primary Care Trusts, and Strategic Health Authorities.

A fact sheet for campaigners is available from bhf.org.uk/campaigns

For further information contact g.dorrie@btinternet.com

Co-ordinatorsBedford: Eileen Marriott 01234 303834 Bourne: Win Felstead 01778 423869Cambridge: Bert Truelove 01223 844800Chester: Alan Luff 01244 373987East Suffolk: Anita Postle & helpline 01473 829777Halton: John Fahey 0151 425 3212Lincoln: Keith Atherton 01673 860582Llandudno: Paul Williams 01492 540073 or 07717 474242Martlets, Sussex: George Beer 01903 763902Merseyside: Douglas Broadbent 0151 425 3040 or 07751 254444Peterborough: Gordon Wakefi eld 01733 577629South East London & Kent: Chris Howell 01689 821413Staffordshire: Alan Lea 01782 838730 Warrington: Dennis Atkinson 01925 824856West Suffolk & South West Norfolk: Brian Hartington 01284

762783Wirral: Martin Legge 0151 625 6529Wrexham: Alan Ellis 01978 352 862ContactsVice President: Alan Bowcher 01284 830542Belfast: John Hamill 028 9081 3649

Cannock Area: Brian Nicholls 01922 412753Hampshire: Derek Rudland 01329 282809Hull & East Riding: Stephen Hackett 01482 561710Lowestoft: John Genower 01502 511894North Lancashire: Alan Egar 01200 424801Norfolk: Anne Caswell 01953 604457North Staffordshire Implantable Cardioverter Defi brillator

ICD Group: James Lyons 01782 852509New Zealand: Neil Kerr enkay@wxc.net.co.nzOxfordshire: Chris Gould 01491 872454Swindon: Jim Harris 01793 534130Affi liated GroupsChelmsford & District: Roger Tulley 01376 514349Chester Heart Support: Peter Diamond 01244 851441Croydon Heart Support: Ken Morcombe 020 8657 2511Freeman Cardiac Rehabilitation Fund, Washington, Tyne &

Wear: Ian Murray 0191 419 1048Havering Hearties: Jackie Richmond 01708 472697King of Hearts, Redbridge, Essex: Tony Roth 020 8252 0877Southend Take Heart: George Turner 01702 421522Wolverhampton Coronary Aftercare Support: Ken Timmis

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Are you reading this Journal as someone who is not a member of the Association? If so we are pleased to count you as a valuable part of our readership.

However, might you take a few moments to consider making use of the application form to join the Association. It may be that you are a heart patient, a relative or carer of

someone with a heart condition, or indeed someone taking a general interest in the Association and the support we are able to offer. Whatever your interest it may be that becoming a member is something you have never given consideration to. May we invite you to consider it now. We would be delighted to hear from you.

If you are sending in your application for membership and have any questions that we can help you with please write them on a separate sheet of paper and we will do our best to help you. We partly rely on donations to help us support cardiac patients and their families or carers. We aim to provide advice, information and support to help anyone who has had a heart condition, and aim to help reduce or prevent heart-related troubles. Your generosity could help us to

help others to live a fuller and healthier life. If you do not have a group near you and would be willing to help start a group in your area, please contact our Head Office for an informal discussion.

Address BCPA, 2 Station Road, Swavesey, Cambridge, CB24 5QJTelephone 01954 202022 Email admin@bcpa.co.ukRegistered Charity 289190

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BRITISH CARDIAC PATIENTSASSOCIATION

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