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British Heart Foundation
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Tired with Stents

Had 2x stents in 90% blocked LAD on 17 December (no heart attack). Went back to work on 2 Jan, flew to US for a work trip on 21 Jan. I coped pretty well.

Thought I was doing ok - but I’ve hit the wall now. Permanently tired and lacking drive. Scared not to work as it’s taken me 20’years to build a position in my company. But I think I need a break. It’s not a job I can half do - my dept has gone from 3 people in October, to just me now. Everyone at HR says the right things about putting myself first, but in reality i still feel overloaded. No evidence they can do anything to give me practical help.

Not sure if I’m emotionally spent, or physically struggling. I’ve a son at uni and a 16 year old daughter doing GCSEs. I feel very responsible for both of them - don’t want to let them down. I do have an amazing partner who does everything she can to help.

Scared that the stent hasn’t fixed me - I’ve not pushed hard enough to really know. I do get back pain, but no idea if it’s cardiac or muscular (been down that road before). I’ve still got one narrowed artery they didn’t want to stent until they knew if there were symptoms. I’ll find out within the next month.

Just said goodbye to my son (back to uni) and flying to Scotland for a meeting today. Can barely keep my eyes open.

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What medication are you on? Many people have reported a reduction in energy due to medication, there are alternatives so it's worth discussing with your GP.

I'm on the normal range of medication following a bypass in November last year (statin, ACE inhibitor, beta blocker, plus aspirin) and I also feel more tired. However, I'm finding that aerobic exercise really helps to restore my energy levels, plus as I'm slowly losing weight this also helps maintain a virtuous spiral.

The other option is that it's psychological, that you're confronted with hard evidence of your own mortality and it's rewired your thinking, habits, and priorities. Maybe your company, or your company medical insurance, would fund some counselling?

Incidentally, before retiring I also did an international job, I know how debilitating jet lag and constant travel can be. In particular flying back to the UK from the US leaves most people pretty wasted so maybe defer judgement for another week or two!

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Hello David I am now retired but things in your post triggered clear memories of the pressure I felt under during times of my working life. I always wanted to be in control of work situations - not controlling of others, but more my my own role and when you are interdependent on others as invariably we are this leads to stress. You don't have full control of your health situation as you are reliant on the medics looking after you who are both financially and time constrained. You fear what would happen if you were no longer able to do your job and how you would be letting your family down. Well I am saying what you are feeling but what can you do about it that's the big question. You have given yourself very little time to recover both physically and emotionally. Have you pursued rehab as that is a good first step to physically get to grips with the best fitness programme for you and also the opportunity to speak with and listen to others. It's good that HR say the right things but as you say words mean little - I wonder if you pass over following up asking them what they can suggest in order that you can put yourself first for a while. This is not a criticism of you but more recognising that even those in Senior roles need support as well. In some ways you have done amazing, stoic getting back to work etc just like it always was but don't be too hard on yourself it's not your 'fault' that you feel exhausted it's normal 6 weeks post stent with your schedule. Maybe think about some counselling as a way of identifying issues and to gain support. This could be a safe space for you like here but in more depth. Keep in touch with us.

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Thanks Nathan - think you’re very close to summing it up. I have my assessment with the rehab team on Wednesday - I’m hoping that might reset my brain somehow. I’ve made a mistake in getting back to work too soon - people think I’m back to normal, when I know that I’m miles away. Didn’t want to look like a weak link, someone who would jump on illness as a way out. It’s hard to take a step backwards now I’m back in the system - but I will try. I’ve watched two male family members married to their jobs, retire into poor health and decided long ago the same wouldn’t happen to me. Hence staying fit and active through my 40s. Just last year I was coaching a decent standard of U18s football and very capable of joining the drills. So a shock to realise I’m probably not going to breeze from 65-85 on a diet of golf and swimming. I just wish I could hit a pause button with work and recalibrate a bit.

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I echo absolutely what the other two have said and pleased that the opportunity for rehab is looming. It is another tool to help in your recovery and a safe environment to tackle those issues and niggles that crop up as well as the physical aspect of the sessions.

It really is early days and you have a lot of demands on you and it takes a lot of energy trying to being ‘back to normal’.

Nathan eloquently captures the sentiment of vulnerability and loss of control whilst at the same time having to make an effort to assure everyone around you that things are getting back to normal. We want it to be so but it isn’t at the moment and the doubts and concerns are constantly churning over in our minds, we internalise it because we don’t want to worry others and out of concern for them make every effort to be better than we are. I have seen a counsellor and am considering accessing more privately and whilst I am slightly embarrassed to label it as such I have been told it is a manifestation of Post Traumatic Stress Disorder.

Like you I didn’t have a heart attack - the angioplasty was done quickly as an emergency and it was only after that the shock set in. In my exploratory angiogram the cardiologist suggested there were a couple of fuzzy areas besides the main blockage on the LAD to be explored by a pressure wire test. I have never had the detail - I was sent out to day room for recovery and then sent home, I have asked to see a cardiologist to get that information. To be honest it worries me, but on the basis that knowledge is power I have pushed for a follow up as just being discharged via the cardiac nurses leaves a void.

The medication definitely has an impact I haven’t slept well since this occurred and as a consequence I am still off work - physically improved but I dread the demands and expectation of my job.

So a long way of saying where you are at is very true of many of us.

My priorities around work are altered but I am at a different stage in life to you, there is a value to the social interaction, distraction, sense of achievement and accomplishment that comes with employment and of course the income is important!

Every step of the way I have been told not to make any immediate decisions and to give myself time to recover, how ever you can negotiate it please do the same.

Like Nathan says use this space to park things - given time I’m sure things will get better

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Thanks Susie. I’m so confused and angry with it all right now. Head won’t stay in one place.

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Oh gosh an addendum to the other comments, you are a young man and this has been a shock, I have to chip in again with this early days and you need make no sudden decisions just sensible choices. Trying to pick up life just as it was is understandable but now you need some adjustment and that need not be forever just hit the pause button.

I have to say I haven’t watched this fully but have had this series recommended to me and have read lots of positive comments and maybe it will provide some light relief They reflect on ‘heart issues’ both having experienced stents/by-pass.

bbc.co.uk/programmes/b0b7r2kb

Lots and lots of people go on and resume their lives this has been a shock physically and mentally and you need some time to heal that’s all. I would explore counselling if it’s not right for you nothing lost - this was recommended to me but again you have to find what is best for you

counselling-directory.org.u...

We can only share experiences, at times it’s a horrible place to be but not all the time and a balance will be restored.

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You have been through a traumatic experience and you need looking after, by yourself and health professionals.

I recommend that you watch the film "Forks Over Knives". It will show you that you can clear out your arteries. It is on Netflix, YouTube and a website of the same name. It is about medical dietary research, including a massive study of 800,000 Chinese people. You might find it helpful, I did.

In the film, there is a bloke with 27 diseases. After 6 months on a WFPB diet he was down to 1.

The ideal BP is 120/80. Mine has been as high as 240/140 but went down to 190/100 with treatment in 2016. I still had a mini-stroke in 2017 though. It is now 120/80.

The ideal cholesterol is below 5. Mine was 6.5 for years, nothing budged it until this diet. It is now 3.7.

My weight was 14.5st and is now 12.5st, the same as when I was in my twenties.

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Jimmy - I’d heard about the film, but lost it amongst all the conflicting info. I will definitely check it out now. Thank you - just what I needed.

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Just a guess but initially I would blame the medications. Beta blockers and blood thinners and blood pressure medications all make you tired. Beta blockers make you extremely depressed which also brings on fatigue. Obviously I wouldn’t discontinue any medication without talking to your provider first but I would let them know how you feel. With increased blood flow you should have more energy not less.

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Thanks. I’ve got NHS rehab session 1 tomorrow. Questions I can ask.

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Hello & thank you for sharing your stories. I will also watch ForksOverKnives. How long should it take for the rehab team to arrange a session as I share similar feelings to you both :(

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I’ll let you know. I think this is an assessment I’m having today.

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Hi you seem to mirror me completely. I have had three stents in two years the last one in January this year and both were on holiday in another country as well so not an easy process either. On top of that, I also contracted Pneumonia. The notes suggest further coronary damage and a perfused heart?

I too have been trying to work having my own company and being co-director, so it hasn't been easy to balance the two, what with the many appointments I have had to attend. Energy has been considerably lacking and also breathlessness so I really have had to back off anything that involves anything physical.

Haven't had any good support from my local hospital over the past two years so have asked for a referral to a specialist heart hospital outside the area for an independent assessment of my heart and welfare ... Could you do the same? The alternative is to do a bit of research on finding a good cardiologist, pay to go private for one appointment for the diagnosis and then see the same consultant back in the NHS. I did this for my wife and she is still seeing the same consultant after 5 plus years ... At least you have then got someone who can support you through this difficult time .. regards

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" I’ve watched two male family members married to their jobs, retire into poor health and decided long ago the same wouldn’t happen to me." - you haven't though have you? Why on earth did you go back to work so soon? You really need to have a big rethink on this, I feel.

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I had heart attack and 4 stents fitted. I was not allowed back to work because my job entailed long haul flights and my company would not have me back unless the doctors said in writing I was fit enough. Took 6 months before they would do that. I am not surprised your tired to be honest. I could not have gone back so soon. When I did finally go back I was chomping at the bit. But soon realised I didn't want to work anymore.

We are all different though.

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Well you appear to have so much that many are envious of, good job, nice family, both doing well, no doubt a a nice house - just this bothersome hick up to get over with. Don't trust doctors will ask on line and get the SP from some experts - and here we are!

Well at least you have given us all of your medication so are up to date there - ??? No one here is an expert, other than their own experiences, which is actually worth a million, but when it comes to medication and treatment ? Well intentioned amateurs at best. Furthermore, you will hear from many that each and everyone of us is different and what you have been told is probably closest to the best advice, given they know everything and you are in front of them!

The one thing I believe we can help on is exercise but again it is subjective so you must be the one to make the decision since you know best.

You probably have had the best advice - to liaise with cardiac specialist and try and get into Cardiac Rehab but before that lets consider your present situation that I made an assumption of in the first paragraph. On face value I would get another employee and at least split the work load! "It's a cost I cannot stand" I hear you say - well what would your business thrive on - your death perhaps? If you are part of a company then tell them the same and for the reasons listed and insist on assistance. What would keep your family in the manner they have become accustomed - your death? Well with insurances that could be true but would they be happy, if they had a choice what would they choose? Remember one thing - every grave yard is full of hard working businessmen, usually covered in weeds and soon forgotten.

Don't keep thinking what would be the best for the business think about what would be best to keep you alive and what would be best for your family. You already have as much as some families and probably more than many - wife, two children, home, work etc. Is all that worth the gamble of your life? Would your premature demise affect your off springs education? Things to dwell on hopefully

Worry and exercise - were we are all worried, probably the shock of finding we are mere mortals, not superhuman or thinking it would never happen to you? Concerned the stent won't work? Everything pretty standard, with respects. Given you are now in the Cardiac system, you have experienced people looking after you - who have a duty of care, who will base their diagnosis and advice on you! Trust them but not too much - if you feel unwell or are experiencing anything that is not normal (for you) and depending on intensity get to A the A and E or B the doctor. Don't be fobbed off by the doctors saying no appointments, insist on emergency appointment and emphasise you are a heart patient at hospital and I assure you they will see you - thats their duty of care. Other than that, have faith in the system that has probably saved your life to date and wan't to keep it that way.

From a purely personal point of view, nothing is worth the gamble with the possibility of leaving my wife and family prematurely, especially globe trotting all over the place - even internal flights have risks, pressurised cabin etc, stress levels etc and BEING TIRED. Have another word with hospital or doctor and lay it on the line and ask if you should have some sick leave and see what they say. Apart from any insurance, would your firm look after your family to retirement age? Never happen. This is a long post where I could just be brutal however this is padded (I hope, for I would never wish to upset anyone) and hopefully some good advice.

Think about your future LIFE and FAMILY and then WORK and which you should look after FIRST. Good luck to you and please let us know how you get on.......No one is indispensable at work - ever.

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I’m in to see HR this am. Just weighed myself and I’m now under 10stone. So looks like the work is taking too much out of me. Thanks for the kick.

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Thank you. Arrived home at 11-30pm last night from my flight. Just woken up and late for work. I really need a rain check. Not working out the way I’m tackling things.

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You are having a laugh yes?

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Nope - think that’s pushing my luck?

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Perhaps the most basic question is why did my arteries clog up in the first place, and what can I do to stop them clogging up again?

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Million dollar question.

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Cause = de novo lipogenesis. Prevention = reduce insulin production.

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OK . How about dumping the coffee for water, losing bread cakes and biscuits and anything containing sugar permanently, going vegan for a while, no sandwiches, rolls, etc. Airports are desperate places for eating healthy food, but it can be done. You don't mention your age - is early retirement an option?

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Whats wrong with bread? I agree with the rest but there is nothing wrong with bread, especially wholegrain, in a balanced diet. Also best to dump the butter, cream and so on.

I understand it is a "million dollar question" but I am quite convinced the root of the problem lies in diet and is often compounded by genetics. I would doubt from this guys lifestyle that he has much time for exercise, which is also a vital component in the campaign to prevent further clogging. At the end of the day the NHS has done their bit, now it's the patients turn.

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I agree with you comments - I was thinking more about standard white bread with lots of sugar baked in, which is what you usually get in airports. Sounds like David is running himself ragged, on the wrong diet with lots of activity but no exercise.

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Yes I thought you might be thinking of mothers pride. Agree with your comments though, I fear this guys on the road for a re-visit in the future unless he gets a grip.

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What's wrong with bread? Well, if you have insulin-resistance you produce more insulin for a given glycaemic-load phcuk.org/wp-content/upload... . As Dr. Unwin says, moderation in everything to someone who is carbohydrate intolerant is moderately poisoning them.

So technically you're right, bread can be eaten as part of a balanced diet, but the more your metabolism is broken, which chronic heart disease is evidence of, the less you can tolerate.

I hope that clears that up.

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Cakes, chocolate, biscuits are long gone. I’m eating brown bread - is there an issue with that? Vegan would be tough - but I’m down to chicken and fish. Just had my NHS rehab assessment - they think I’ve gone a bit too extreme on diet. Other than saturated fat intake - is there another reason for cutting out meat?

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If you look at KETO, Atkins and other diets eating cooked unprocessed meat is essential . My comments regarding vegan, etc, were aimed at airport/ airline foods where almost all the food you can get has been processed.

Some diets say lots of low carb and healthy fats will encourage your body to stop creating fat and go back to burning it as your most important nutrient.

Others say a balanced diet is essential, with a good mix of nutrients.

Most seem to agree that the amount hidden sugar in your diet is critical and is driving diabetes type 2, heart disease, cancer, hypertension and stroke.

The relation ship between sugar levels and insulin is critical and there is plenty of evidence to demonstrate this link .

Sugar levels are easily identified - a quick pinprick. Insulin levels require drawing blood and sending it off for analysis. Ironically you can have normal levels of sugar while your insulin levels are going off the clock, until the insulin can't control the sugar any more.

Good to hear you are taking up exercise - brisk walking you can do anywhere and a daily mile,20 minutes is a good start

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Managed to get heart to 70% exertion at NHS assessment - so looks like pipes are clear. Food advice - everything in moderation does clash a bit with some advice I’m getting here. Will start exercise classes next week and had the all clear to start swimming - which I’ll try tomorrow. Will carry on working, but try to limit travel and stress.

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Hi David,

I don't really have much advice beyond others but I'd give you some similar context. I am 43 and to all intents and purpose fit and healthy but ended up with 2 Stents in September 2018. I also didn't have a Heart attack. I just suddenly had chest pain walking the dogs in August 2018. They found my LAD was 95% blocked but because I am quite fit it must have masked it for quite a while. I am at 4.5 months since stenting and only really just getting to grips mentally and physically.

Before all this I had a resting heart rate of 55-60 and cholesterol was always <4 and BP was always 120/80, don't smoke and rarely drink. So you'd think I was doing all the right things part from I am a bit overweight (middle age spread!). But you can't fight genetics and I have a strong family history.

I had planned to be back at work (I work in IT and have a desk job) 2 weeks after Stenting but I felt rotten. My cardiac physiology meant they struggled to get the wire into right place and I was in surgery for an hour. I had 'truck loads' (cardiologists words!) of the dye pushed through which consequently meant my Kidneys got quite work out. I ended up having 7 weeks off and a phased return to work over a period of 4 weeks. Like you I am in position where I am the only person who does what I do. My company were great in terms of support and just telling me to take all the time I needed but they are big company and it's not the same for everyone. Also a chat with my doctor soon got me the relevant sick notes.

My main issues,feeling tired and getting lots of niggles in my chest, seem mainly been all round the medication. It's taken quite a few tweaks by GP and Cardiac Nurses recommendations around dosing to sort me out. My RHR had been as low as 39! They've backed off some the Beta blockers to lowest dose and reduced some of the BP meds (which I am still not convinced I should be on, they were a pre-stent thing as precaution while I was waiting for surgery) and stopped the anti-nausea stuff . I feel generally much better, although my RHR is still 45.

TBH as someone else said I actually feel much better, if not my best, when I am exercising rather than sitting around. I actively get up at work and have a walk around more often now. I've lost some weight (8kgs) and I have done the NHS rehab with physios (local hospital offer a 12 session gym based rehab) and that has really helped building trust back in body and got me back exercising at previous levels. Also I find drinking plenty of water through the day helps.

hadn't planned to write something that long but Hope some of that helps.

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No - that’s great thank you. How did they explain the block in the first place? As your cholesterol was so low.

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De novo lipogenesis. This video is only 8 minutes to improve your healthy life-expectancy

Reduce your insulin levels, reduce your chronic ill-health insulinandmore.com/2018/01/...

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I watched the video. I’m under 10 stone - I’m not obese and never have been.

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No, I understand that. I used this to illustrate where the visceral fat came from.

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No had no explanation as yet- due to speak to consultant again in next month or so just waiting on appointment. All other arteries were clear as bell when had angio.

I meant to say I am impressed with your positive approach so far. Keep going. I’ve been much more tentative than you by the sounds of it.

It does appear to settle more as time goes on from my experience. I have put it down to my body adjusting to its new medicated norm. I’ve no medical basis for that but it’s what keep telling myself :)

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Keep in touch - id like to know how it all pans out. My cholesterol was 6.3, so they’ve highlighted that as my issue. When I hear of others having same blockage, but lower cholesterol - it makes me wonder. Don’t be mislead by my ‘positive’ approach. I don’t feel positive - more like a burden at the moment. Home, work - all of it.

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Sounds like you narrowly missed a 'widowmaker' . There is a film of the same name that is worth a look. Have you changed your diet to remove the underlying causes?

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Yes - have made changes. As a result have lost best part of a stone now. Though with all the conflicting theories, not sure if I’m working on the right things. NHS view is everything in moderation - no suggestion of cutting out meat / carbs. More extreme views live online. My cholesterol was 6.3 - but I’ve just read another sufferer with blocked LAD who had a 4.0. So not overwhelming evidence that a lower cholesterol will avoid a future block.

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if you can get sugar out of you diet you will remove the most damaging agent in the whole process. Not an easy task , its in almost everything.

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Back in the swimming pool today.’ Swam a very gentle 6 lengths and then forced myself out of the pool - before I was tempted to push too hard. Felt fragile, but was good to even try. Put my head in a better place. Could have slept all afternoon.

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Did you get a beta blocker prescription I found it took a while to get past fatigue after my HA. My LAD was totally blocked by a clot so had an emergency angioplasty. The meds took a while to settle in.

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I’m on BBlockers. Maybe that’s a factor.

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