I have suffered with angina since having a heart attack while at work in 1995. Angioplasty later that year helped but within a few months that awful cold hand which grips the centre of my chest was back again.
In 2008 I underwent a quintuple heart by-pass and within weeks felt like a new man, walking several miles a day and doing physical things I had thought were beyond me. Then in March 2012 while walking in the Lake District my angina came back with a vengeance. A series of angiograms and scans followed but each time the hopeful ‘cure’ I was certain the by-pass had brought was still as elusive as ever. Medication, with all its side effects, was the only thing on offer — my lifestyle had long since been adapted to help my condition.
It was my son who first mentioned refractory angina to me. I had never heard of it but within minutes was Googling ‘refractory angina’ and began reading about a service offered in only three centres in the UK, Liverpool, London and Bradford. My son lives in the United States where it is more widely available and he urged me to find out whether I would benefit from treatment at one of those centres. Living where I do near Grimsby, they all seemed a very long way away.
Earlier this year I was fortunate enough to see a new cardiologist at Castle Hill Hospital at Cottingham, near Hull and, after ruling out any further intervention, he suggested it might be worth referring me to Dr Paul Sainsbury, who runs the refractory angina centre at the Bradford Teaching Hospitals Foundation Trust. Driving to Castle Hill has always seemed a long-enough journey for me; going to Bradford (a 170-mile round trip) was a daunting prospect, gripped as I was by the strait jacket coronary heart disease had imposed on the lives of my wife and myself. But, having been told by one cardiologist that my treatment had ‘reached the end of the road’, I owed it to myself and my family to give it a go.
My attendance involved a two-hour consultation with Dr Sainsbury and specialist refractory angina specialist nurse Simi Thapar at St Luke’s in Bradford, followed by four two-hour weekly foundation course sessions at the Royal Infirmary and a final consultation with Dr Sainsbury. I have to admit to being deeply sceptical at the outset. I could not see what benefit I could take from a series of group sessions centred on a condition which has been my constant companion for over 17 years.
The initial consultation was something of a revelation in that it was informal, relaxed, informative and conducted by a cardiologist who was prepared to listen to my story. Dr Sainsbury went through everything in detail (so much detail, in fact, that some things eluded me) with both my wife and I, something which was important as the effects of angina go beyond the patient to his immediate family. Much of what he said was reassuring. What was made clear at the outset was that he wasn’t offering a cure for angina but, to use medicine’s latest buzz-phrase, a pathway to angina management. That started with my being given a TENS stimulation machine which, via electrodes stuck to my chest, would help the blood flow around my heart, I was told. My previous experience with one of these machines was to help a dodgy knee. It didn’t and I ended up having surgery, so I was dubious to say the least about it.
Six days later we were back in Bradford, this time at the Royal Infirmary for the first of the four foundation sessions. These were taken by Simi and psychologist Sarah Taylor, whose task was primarily to help us get our collective heads around the real message of the clinic – that coping with angina is not just a matter of surgical intervention or taking a handful of pills a day, it is changing the way you, the patient, think about and deal with the symptoms angina sufferers find so crippling and frightening.
Over the four weeks we looked at a whole range of things we could do to improve our lives through both thought and deed. Relaxation, physical exercise, changes in lifestyle (lessons I had learned over the years) all play a vital role as does something I found particularly useful, restoring confidence in yourself.
It was sometimes difficult to reconcile some of what we were told with our own experiences but gradually, through some frank discussions with Simi and Sarah, we were able to highlight areas where we could do things to improve our lives.
There were five patients taking part, a fairly eclectic group which totalled four by-passes, numerous stents and two pacemakers between us. We all had different experiences to relate but the underlying story was the same, of lives shaped and changed by angina. What we got out of the course was very much down to the individual but I’m sure we all finished those four weekly sessions a little wiser and hopefully more capable of confronting our common problem.
The final week dealt with, among other things, the various treatments which are available for refractory angina patients – but, certainly in my case, reality meant continued use of the TENS. That is no bad thing for, despite my initial scepticism, it does seem to be helping. Before Bradford I had difficulty in climbing a flight of stairs without becoming so breathless I had to stop several times and sit down to recover when I reach the top. Now things are a little better. I still do have to use my GTN spray daily, but not as frequently as before, and I still get angina pain. But I feel better able to cope with it, to use the lessons from the course to tackle things that six weeks earlier I would not have considered.
At the final consultation Dr Sainsbury did point out that this was very much the ‘honeymoon period’ for me, that now the hard work began of maintaining the confidence the refractory angina clinic sessions have given me and keeping on board the lessons learned.
It won’t be easy, particularly with winter approaching. He’ll be seeing me again in three month’s time with regular follow-ups and checks later. But for now I’m where I have been for the last 17 years as far as angina is concerned, very much on my own but with one major difference — that strait jacket of angina fear has been loosened.
You won’t find a ‘quick fix’ at the Bradford refractory angina centre but you might come away a little more hopeful.
— PATRICK OTTER, November 2013