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PMR and Heart

Posted , 8 users are following.

julian.
julian.

my very astute GP suggested that since I didn't like statins based on my risk factors I should take some tests. I didn't have symptoms but outcome has been a coronary stent to unblock an artery. In my mind the difference between "public health" and "individual health".

I've found (even though it was never lost) a 2014 paper that suggests a 2.5 times greater risk of vascular events (heart / stroke) in patients with PMR than normal. Keele University paper using the UK General Practice Research Database. I guess its easy to find anything on the internet to support one's beliefs. So I'm wary. The suggestion of increased risk is consistent with my simple perception that I exercise much less than I did without PMR and lack of exercise is accepted as increasing the coronary risk. My simplistic interpretation of the conclusions in the paper is that the inflammation plays a role.

Something about the way the statistics have been exposed in the paper caught my attention in a way the statistics used for coronary risk factors in general didn't. Perhaps the tightness in the connection between the statistics and the narrative, I could follow and reproduce the argument. Even a chart that included the 95% confidence limits (my industrial experience says I need those limits). The equivalent chart for the general coronary risk factors (age, cholesterol, smoking, etc) has eluded me which contributed to my scepticism.

The coronary rehab is excellent. While the staff are allowing for the PMR there's seemingly nothing explicit in any of the materials (principally of Heart Foundation origin) that relate to any uncontrollables apart from diabetes. Very difficult of course with a group where everyone probably has different complications.

Of course resolving my conflict between "exercise reduces risk of heart attack" and "exercise increases PMR pain" and "pred side effects reduce my effectiveness and are unhealthy" and "inflammation is bad" is an interesting challenge. One that we all face in various ways. I have a feeling of more than one rock and many hard places to choose from. :-)

Some days I wish it would all go away, but the wishing well is dry so I just have to get on with it and remain positive. So far so good. And knowledge is power - even if I did gather it after my "coronary event".

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  • paul45653
    paul45653 julian.

    Posted

    Julian,

    Your inspection of the total medical problem involving drugs, GPs and specialists with a backround of statistics and their influence, makes an intense study in itself.

    I will have to read yoyr post several times before or if, making an intelligent comment.

  • Anhaga
    Anhaga julian.

    Posted

    Julian it sounds like you are having a pretty tough time right now.  Are you able to walk?  Even a little walk every day will benefit your heart and won't intensify your PMR symptoms, and will also help to counteract the possible pred side effects. All the best.
    • julian.
      julian. Anhaga

      Posted

      thanks for concern, I'm reasonably active - apart from the 20 minutes treadmill and stationary bike at rehab I was better after 5km walk yesterday than I've been for a while. The heart thingo was relatively quick - 2 weeks from test to fix. Almost an intellectual exercise as I wasn't aware of any symptoms, though in retrospect possibly masked by PMR. But basically now trying to find a better balance which includes more exercise.

      Difficult to describe but I'm pleasantly surprised at how positive I've managed to remain for the last couple of years.

    • Anhaga
      Anhaga julian.

      Posted

      It is interesting isn't it just how much time and attention illness can take up.  Your positive attitude is very encouraging!
  • macas02
    macas02 julian.

    Posted

    Thank you for the info, I have felt there my heart probs were caused either by the PMR or the steroids. The Cardiologist was adamant that there was no connection!!!!!!

    But I suppose whatever the reason I have it and I have to try to get on with it and be positive just like you.

    Mary

    I

    • julian.
      julian. macas02

      Posted

      yup, the reading helps me understand what's happening, but at the end of the day I just have to get on with it.
  • tina-uk_cwall
    tina-uk_cwall julian.

    Posted

    Julian, I am into my 5th week of wearing a cast on my right leg, from the tip of my toe to my knee. I broke my heel bone some 6 weeks ago. I wore a half cast for one week and that was replaced by the full cast a week later when I had my first appointment with the fracture clinic.

    after one week of wearing the full cast I was rushed to hospital as I was so ill. I couldn't breathe. I was gasping for breath and I had a terrible dry cough that hurt my chest. I was diagnosed with substantial numerous pulmonary embolisms. I was terrified. I was immediately put on blood thinning medication for which I've been on fire 4 weeks now.

    however, when the PE nurse phoned me after 3 weeks to see how I was getting on i asked her why if clots are possible results of leg casts why are such patients not automatically given anti clotting drugs. She replied that there are certain long term medical conditions whereby patients are automatically put on these drugs and such conditions included patients who are suffering from inflammatory type conditions!!!! (The blood becomes more sticky). When I told her I was suffering from pmr and I take prednisolone to control the inflamation she was a bit taken aback. I told her that when I visited the fracture clinic no one asked me if I suffered from any medical conditions or if I was on any long term medication. She has flagged up my condition on my notes for when I visit the fracture clinic next Wednesday. I will also mention it the minute the dr sees me. Regards, tina

    • EileenH
      EileenH tina-uk_cwall

      Posted

      Thought you had been very quiet Tina! Hope you're on the mend now.

      You might be interested to know that when I broke my leg here in Italy I was discharged with instructions to give myself heparin injections every day - and at the time I wasn't even in a cast, it was just pinned. When I got back to the UK I called the GP to ask for a home visit and prescriptions: antibiotics and heparin which here are standard in such a case. I was refused the home visit and told I didn't need any of that as I was mobile - I could wiggle my toes! I was sent to the fracture clinic at the local hospital where they put me into a full leg length cast - in plaster, not the lightweight stuff, it weighed a ton! Still no heparin - I told them that if I developed a clot I'd sue them. I was very lucky and nothing happened - but when I told doctors here they were horrified - as far as they were concerned, not to give heparin to someone post serious fracture was tantamount to medical negligence.

      When my a/f was found here they wouldn't let me out of hospital until the warfarin was adjusted to their satisfaction, David was only allowed out because he was already on warfarin. Lodger was admitted as an emergency in the UK with a pulse of 230 and a/f! She was sent home on aspirin after 4 hours. I told her to go straight to her GP who did the needful. 

      I'm speechless! There's something wrong when the patient needs to practice due diligence to avoid hospital errors isn't there?

    • tina-uk_cwall
      tina-uk_cwall EileenH

      Posted

      Hello Eileen, yes I am doing very well but you can imagine how I felt when a consultant walks into the little examination cubicle in A&E and says that the CT scan has confirmed their initial suspicions. He followed by holding my hand and saying "are you aware just how seriously ill you are?" Anyway hopefully my clots are devolving well.

      i feel that for many years the health system works reactivity and not proactively. In 1989 I was working as a stewardess on the cross Chanel ferries. I fell on the car deck whilst docked in Bologne, France. I was taken to a tiny local hospital, no larger than a penny and they diagnosed a fractured broken collus. The bone had fractured into six pieces. I was operated on the next day and it was all pinned together. I was discharged with my x Ray's and a letter to show my GP. When I visited my GP he laughed at the treatment I'd been given finishing with "what a waste of money, here we would have simply put you in a cast"

      i was so upset that I rang my mother who was a nurse at the time and she retold my story to an orthopaedic surgeon. He told my mother that by the sounds of things I had received the best of care, by pinning the bone together it would result in a neater knit of bones, there is also evidence that suggests pinned bones are less susceptible to arthritis and finally that we in England don't consider such treatment because it costs more - but only in the short term!

      i have a wrist that to this day has never given me any jip and to look at it you would never believe it had ever been broken. 

      regards, tina

    • EileenH
      EileenH tina-uk_cwall

      Posted

      Like my leg - though you can see the beautiful scar that is like a knee replacement.

      I would have had great difficulty in not thumping that ignorant GP.  I truly don't want to have to come back to the UK for all sorts of reasons.

      And yes - the PE patients who arrived for scans in David's department were VERY POORLY PEOPLE. You were amazingly lucky and obviously got a very nice consultant - and I'm very pleased to hear you are recovering.

    • julian.
      julian. tina-uk_cwall

      Posted

      ouch,

      good to hear you are coming right.

      Mildly humourous was my stress echo test. During after treadmill ultrasound I overheard supervising doctor send technician for some aspirin so I figured there was something amiss. Like something from medical soap sympathetic doctor informed unprepared patient of bad news. Just that the patient was prepared, hadn't read the script, and GP had described likely next steps. "Magic, I'd hate to come all this way and not find something". I somehow got the impression I wasn't supposed to be smiling - I'd already moved on to "what do we do about it?".

    • EileenH
      EileenH julian.

      Posted

      Yes - David was happily pedaling away and then a doctor came and took a closer look at the trace. "Do you feel OK?" "Yes." "We'll just slow you down now..."  He was transferred to a trolley and BP and stuff checked - and a cannula inserted and iv set up with magnesium I think. Aspirin? No, here in Italy they go about things rather thoroughly! He was only let home because he was already on warfarin! I got a phone call asking me to fetch him - he'd intended walking home, about 40 min walk. But he said to them he was intending to "Lauf nach Hause" - unaware that while where he learnt German "laufen" means to walk, here "laufen" means to run. Perhaps not ideal under the circumstances when you have just been diagnosed with excercise induced a/f.

      Bless him - it was his birthday and we'd arranged to go out for dinner but that went by the by as he felt a bit overwhelmed!

    • julian.
      julian. EileenH

      Posted

      it was an odd stress test, I stopped because it didn't occur to me to run (what, with my funny back and all, running is more like a trailer for funny walks than the anticipated fluid athletic motion of others) and my legs were getting a bit stiff. My pulse was above "typical max for age". I was just getting past the stage where conversation stopped so was getting a bit bored. I already knew I was unfit.

      The ecg and bp were normal. The ultrasound showed a couple of spots of hypokinesia - they do like their pseudo latin technobabble don't they - which means some of the bits of heart muscle weren't moving as fast as they did at rest which implies a problem. But I still didn't have any symptoms so I guess the aspirin, rest and see the cardio the next day, was reasonably appropriate. Also the test, like lots of medical tests, isn't definitive with a (IMO) relatively high rate of false positives and negatives. Similar rates to breast screening (which I only have second hand experience of).

      The angiogram was fascinating watching the dye meet the blocakge in major artery and find its way through others to back fill and carry on - cardio reckoned I'd formed my own bypass. Reminded me of my daughter aged 9 reading map of Europe to navigate - "Europe is just a big plate of spaghetti".

    • EileenH
      EileenH julian.

      Posted

      Because I COULDN'T do a full ergonomic stress test I was sent for the "chemical" one with echocardiograph imaging. Can't say I enjoyed it but it beat riding a bike given all they actually found (or in my case, didn't find).

      I don't mind the technobabble - but then, my life has centred on medical science so I'm used to it and it does say things in shorthand doesn't it?! Hypo - lower than it should be, -kinesia - movement, muscular activity: one word instead of 8. Very handy when you are writing a publication with limited space!

      Yes - I like watching the screens during any tests - and get quite annoyed when it is behind me or tipped the wrong way! Useful things collateral circulation - but it does suggest that artery had been at least almost fully blocked for some.

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