Wednesday, 30 October 2013

HG Library: Heart attack

As he convalesces from a quadruple heart-bypass operation, Ivan Tyrrell provides an inside
view of needs being met, and thwarted, during his NHS experience. 

This article was published in Human Givens journal, Vol 20, No 1 (2013). For more articles like this subscribe to the Human Givens journal.
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There is nothing like a heart attack to remind one of how little time we all have on this earth, and that we waste most of it. On a damp Tuesday afternoon last October, the Fates decided that it was my turn to have one. It led me to an intimate experience of the NHS and also to discovering more about our innate physical and emotional needs.

This is what happened. I was at the office in Sussex, writing a letter, when a tight pain in my chest hit me out of the blue. At the time I had no idea what this paroxysm, clamminess and awful faint feeling signified. My first thought was that I had a sudden case of really bad indigestion, so I staggered out to my car to find some Rennies. Yet, on popping two into my mouth, the pain got worse. I felt so awful I sat still, slumped in the driving seat, feeling frustrated and decidedly uneasy. But, after about 10 minutes, the pain stopped as suddenly as it had started. Shortly afterwards, feeling a little wobbly at first, I made my way back to my desk and got on with my work. Being a bloke, I told no one and quickly became absorbed in tasks, thinking nothing more about it. As far as I was concerned, the Rennies had worked.

That evening, in torrential driving rain, I made my way to Ditchling, a few miles from the office, had supper with an old school friend, then drove back to our home in the Cotswolds arriving at about 11.00pm feeling shattered and worn out, but happy to switch off and go to bed. I slept soundly. On Wednesday life went on as usual – working, walking and reading. The next day I took my wife, Véronique, to catch a train to York where she would be staying for two nights. Suddenly, at 2am the following morning, I woke up with that same squeezing pain, only this time it was worse. I broke out into a cold sweat and, feeling nauseous, slowly felt my way downstairs, where I sat in front of the dying fire, trying to keep calm and attempting to treat myself with a cold laser machine that I had been experimenting with to improve my immune system. I began to face up to the fact that something was wrong with my heart. After half an hour or so, the pain subsided and I climbed slowly up the stairs and went back to bed. Sleep evaded me for a while, kept at bay by the worrying thoughts going round in my head.

I told no one.

Next day I felt fine again and went for a long walk. I was still feeling fine when Véronique returned mid-evening on the Saturday. However, in the early hours, the pain returned yet again, not quite so severely but enough to make me resolve to see my GP on the Monday. I mentioned this plan to Véronique on Sunday morning and, not unnaturally, she wanted to know why I needed to go. So I explained what had been happening. Although I told her I didn’t want any fuss, she called the doctor at once and, between them, within an hour, they had me admitted to the local hospital, where I was immediately given a blood test. During a heart attack, apparently, heart muscle cells die and release proteins into the blood-stream, which a blood test can detect. I had higher than normal levels of these proteins, revealing that I had had a heart attack – or probably three.

The benefits of hindsight 

I was asked if I had been doing anything phsically strenuous when the first attack occurred and I said no. (It was only later that someone at the office reminded me that, about an hour before the first attack, I had unloaded two pallets of heavy books into the store room, which had made me breathless and a bit weak. At the time I just thought I was out of condition.) Nurses injected me with a blood thinner and gave me a statin.

With the benefit of hindsight, my advice to anyone suffering severe chest pains would be to call the doctor or, at least, tell someone, not foolishly play down the seriousness, as I did to myself. Looking back, I still can’t explain why I exhibited such wilful blindness with regard to my obvious malfunctioning body, other than that I felt that I had too much work to do, couldn’t see how I could take time off and so couldn’t sanction the possibility of illness. A doctor at the hospital said that Véronique’s prompt action might well have saved my life, because the next heart attack could have been fatal.

I was transferred by ambulance to the Heart Centre at John Radcliffe Hospital in Oxford for an angiogram, which revealed damaged arteries. They couldn’t fit stents and kept me on a ward by myself for five days while they decided what to do. Then David Taggart, professor of cardiovascular surgery, came to introduce himself, and said I needed a triple bypass operation and that there was a 99 per cent chance I would survive. (Good odds, I thought.) I was to go home and prepare myself – and not walk up steep hills or lift anything heavier than a kettle because that might kill me. Slim as a whippet himself, he added that I ought to lose some weight as quickly as possible because being overweight is a prime cause of heart attacks. I asked him how I could do this and shall never forget his reply: “You’re obviously an intelligent man. You don’t need me to tell you how to lose weight; find out for yourself.” Not a man to mince his words!

A dream 

As I look back I can see there were clear signs well before these events that things were not right with my heart. A few weeks before, for example, I had arrived at the B&B in Bristol where I was staying before giving a seminar the next day. The room I was allocated was on the top floor of a five-story Georgian building. Grabbing my suitcase, I started to climb the stairs two at a time, as was my wont: first floor, second, third. Suddenly I caught my foot on a stair and stumbled back into the proprietor, who was following me. I insisted there was no harm done and continued a few more steps, now taking them one at a time. Then I stumbled again and this time crashed into the bannisters. The proprietor decided to put me in a room on the third floor, so I wouldn’t have to climb any further. I was quite shaken by having so nearly tumbled down the steep stairway. I assumed I was tired because normally I’m quite nimble for my age. Now it seems more likely that my heart was not pumping hard enough to get me up the stairs.

Once alone, I sat on my bed musing about how easily a simple thing like a stumble could change one’s whole life, perhaps even cause me to lose it, just when so many possibilities seemed to be opening up: I had a lovely wife, a beautiful new home that we had shaped together, and was living in a quintessentially peaceful part of the English countryside that I wanted to continue enjoying. I was also relishing new challenges involved in bringing the human givens approach into organisations and was writing another book.

That night I had a dream that metaphorically encapsulated my ruminations. I was high up on a hill progressing along a difficult path from where I could occasionally glimpse an amazing view of a beautiful coastal town down by the sea – a better world. Someone was with me and I offered to take a photograph of the view for them with their camera because they couldn’t quite see it. Doing so, however, involved me leaning out from the path into a lot of vegetation that concealed the cliff edge.

When I looked at the view through the camera I became aware that the edge of the cliff was crumbling away and I was beginning to fall to a certain death, all the time thinking that this meant I would no longer reach my destination: the beautiful scene ahead. Then I woke up, sweating, to discover, to my great relief, that I was safe in bed and it was time to get up and start work.

Hospitalitus

I was given a bag of tablets to take home with me. I took these pills as directed for six weeks, until I received a letter giving me the date of the operation and telling me to stop taking them seven days before. However, I stopped as soon as I read the letter (10 days before the operation date) because I could feel the drugs were dulling my brain, interfering with my memory and my ability to concentrate, and depleting my energy levels. They also gave me a nasty rash. Within a couple of days I felt much better and mentally sharper: my ‘mojo’ had returned to such a degree that family, neighbours and colleagues all noticed.

While waiting for the operation I began reading about the side effects of the drugs I had been given, particularly statins and beta-blockers. I also looked into losing weight. A few years earlier I had read The Diet Delusion by Gary Taubes that tells an astonishing story of just how much vested interests distort ‘science’ and create harmful public perceptions about what is good or bad for us. So I decided to read his later book, Why we get fat and what to do about it, which shows all too clearly that what we are so often told is necessary for healthy living ain’t necessarily so. With my wife’s support, I adjusted my diet. At this point, with the operation looming, I had complete trust in the hospital and the swift actions and recommendations of those assigned to care for me.

Chaos ahead

And then I discovered for myself the chaotic way NHS administration functions, and the severe distress this causes to both patients and staff. It started when I received a letter asking me to attend a preadmission appointment, at which time an X-ray of my chest and ECG would also be taken. After the X-ray and ECG, Véronique and I made our way to the preadmission clinic and arrived on time at 12.30pm. After waiting for over an hour and still not being called, we queried when we would be seen and, at that point, discovered that I was “not on the list”. When we showed the appointment letter to the nurse, she was clearly frustrated that the information had not been passed through to her and very kindly stayed late and saw us anyway.

We got back home to find on the doormat the letter giving the date for my admission for surgery. Consequently, we booked and prepaid for a B&B near to the hospital, so that Véronique could stay close by. We also made a multitude of other arrangements, including driving the cat to be looked after by a friend in a different county. On the appointed day, I duly turned up at 3pm at the cardiothoracic ward, where they were expecting me, and was put in an overflow ward with other heart patients. At about 10pm I was told by a bank nurse that she was very sorry but I did not seem to be “on the list” for surgery the next day and that she couldn’t understand why. As I had spent weeks preparing myself mentally for the operation and its aftermath, I had a frustrating and restless night, not knowing what would happen the next day but comforting myself by reflecting that, when something one expects doesn’t happen, new insights often occur.

In the morning Professor Taggart, a busy man, took time out to find me and profusely apologise on behalf of the hospital for the fact that I couldn’t be operated on that day. He said this would most assuredly not have happened had he still been in charge of his list but that was not how the current system worked. He was, therefore, quite unaware that I was in the hospital until that morning. Professor Taggart’s evident distress, honourable apology and prompt action impressed me. However, I received no explanation or apology from the administrator at fault.

An irritated email 

I was so inflamed by all this that I emailed the chief executive of the Oxford University Hospitals NHS Trust, Sir Jonathan Michael, detailing this series of events. I also caustically pointed out that, as psychological stress is known to be the principal cause of heart problems, the way I had been treated led me to suspect that management is unaware that their job should involve keeping heart patients as calm as possible. I suggested that they were badly in need of basic training about innate human needs – not just those of patients but also those of the clinical staff, who were clearly frustrated by their lack of control over important aspects of their work.

I concluded by saying, “When an organisation functions well, it is like any flourishing living organism: all its systems work together in a healthy, meaningful way. A mature organic organisation is not easily taken in; it questions its own assumptions, is flexible and adaptable and the people in all departments take full responsibility for their work, pulling together in an organic way for the good of the whole. Its philosophy is that everyone’s emotional needs should be met in balance, because creating an environment where that is possible is what moti- vates people. One incompetent, unmotivated staff member at any level in an organisation damages the health of the whole.”

I signed off as director of the Human Givens Institute, and copied the email to my MP, the local press and my GP. The very next day Sir Jonathan emailed me back (at 9pm on a Sunday evening, to be precise), which was pretty impressive. Other apologies from various people lower in the hierarchy soon followed during that week and were profuse. The local paper took my photo and gave the incident a whole page, with the heading, “Hospital blunder delays operation”. The article also featured an apology from the director of clinical services at Oxford University Hospitals NHS Trust.

No one engaged with the important points I raised in my final paragraph, however, which suggests that these executives are so busy ‘putting out fires’ that they have no spare capacity to step back and look at the bigger picture.

The operation 

Two weeks later, I was back in the John Radcliffe – and this time all went well. After the operation, which turned out to be a quadruple bypass, Professor Taggart told me my heart was in good shape and it was just the arteries that needed replacing. During our conversation, he told me of another shocking hospital management blunder. Apparently, I and others could have had our surgery a day earlier because his team had been all set to start work that morning when they discovered that there was nobody on their list for that day, even though many patients were in the queue for a bypass. So eight or nine highly skilled people were paid a lot of money by taxpayers to sit around drinking coffee, with nothing else to do but moan about the system of management that can allow such things to happen.

Support 

I was again given drugs to take but felt too weak to protest. My attention was focused on recovery, getting home and becoming active again as quickly as possible. Despite feeling extremely tired and weak, which I’m told is normal after a major operation, as soon as I could I started to walk around the wards once or twice a day. On my perambulations, I often struck up conversations with other patients. Véronique spent as much time with me as she was allowed, which was almost all day, and her company had a greatly calming effect; my children visited or kept in touch on the phone. Colleagues and friends also called. This was in contrast to several patients we met who had little or no support: consequently, their anxiety levels were higher than mine. One man seemed terrified at the thought of being sent home alone so soon after the operation, with no one there to look after him.

To know that other people are thinking about you and care for you is a major factor in recovery and it was no surprise that the lonely people we spoke to were the most anxious and unhappy – something all human givens practitioners would expect. We know how important it is to feel positive and how the heart patients who do worst are those who are depressed or feel ‘out of control’ because their heart let them down. I would tell anyone in similar circumstances to remember their own emotional needs; getting them met well has a major impact on recovery.

The cholesterol myth

One thing that helped me meet my need for autonomy and control was gathering information. I continued reading books about the life-style causes of heart attacks, diet and the side effects of drugs, particularly of the statins. I was particularly impressed by Dr Malcolm Kendrick’s The Great Cholesterol Con and Dr Duane Graveline's books, The Statin Damage Crisis and The Dark Side of Statins.

Cortisol is the culprit 

Dr Kendrick makes the case that it is not cholesterol but cortisol that is the primary cause of the inflammation of the arteries. Cortisol is the hormone released in response to stress and a low level of blood glucocorticoids. Its primary functions are to increase blood sugar, suppress the immune system, and aid in fat, protein and carbohydrate metabolism. Stress levels are raised, as we know, when innate emotional needs are not being adequately met. And a physical stressor that also leads to increased cortisol production is our un-natural modern diet, over-loaded as it is with sugar- producing carbohydrates and processed foods. Perhaps, I reflected, my heart attacks were the price for my lifelong addiction to honey on toast, potatoes and fruit juice.

Graveline is a highly respected American physician, medical researcher and NASA astronaut. After he was prescribed statins to reduce his cholesterol level, he developed transient global amnesia – he could not even recognise his family. His memory only slowly recovered when he stopped taking the statins. NASA physicians prescribed them again at just half the dose, but the amnesia returned, so he stopped them for good and has since become an authoritative critic of them.

Cholesterol plays an important role in the body and the metabolic pathways in the brain, contributing vitally to the brain’s proper functioning, including mediating the formation of new synapses. It is the precursor of vitamin D and all our steroid and sex hormones. It also acts as a vital component of the immune system and as a protective antioxidant in its own right. Graveline refers to clinical trials and studies whose data show that cholesterol-lowering statins have negligible impact on heart disease in those who have not been diagnosed with cardiovascular disease, yet increase mortality rates overall from all causes.

Statins and saturated fat

The over-prescription of statins over the last 40 years was generated on the back of the ‘diet– heart’ hypothesis that suggested that dietary saturated fat raises cholesterol levels, and that these two substances somehow clog up our arteries, causing heart attacks. This notion would seem to have been thoroughly debunked by better science (as well as common sense and experience) but it still clings on in the collective mind and is still accepted as true by most doctors, partly, no doubt, because of the PR efforts of the pharmaceutical industry, for whom statins have generated vast fortunes. The food processing industry has also benefited from the cholesterol myth, introducing thousands of ‘low cholesterol’ products – cheap to produce margarines and spreads etc – to sell to an anxious public.

Graveline points out that having ‘normal’ or even ‘low’ cholesterol levels does not eliminate the risk of heart attack or stroke. In fact, 75 per cent of heart attack victims have normal levels of cholesterol. In the hospital, I was told mine was ‘normal’. Studies show that, while statins do fairly reliably lower blood cholesterol, taking the drug brings no improvement in terms of risk of heart disease or heart attack and no reduced risk of death, compared with not taking it. As Graveline provides evidence to show, people with high cholesterol often tend to live longer than those with low levels, and those with heart disease tend to have low levels of cholesterol. This rather suggests that the cholesterol levels that statin drugs are purported to reduce have little or nothing to do with heart disease in the first place.

Microbiologist, immunologist, and pioneer in the development of human cell culture technology Dr Myron Wentz puts it very succinctly: “There is no part of the body where cholesterol does not play important roles in physiology and metabolism. Just because it is found in arterial plaques does not mean it is the cause of heart disease. Rather, cholesterol is there as a repair molecule, called on to mend damage caused by inflammation. Because you usually find firemen at the location of a fire does not mean that they started the fire. Indeed, there is mounting evidence that cholesterol is involved in preventing cardiovascular disease rather than in its development.”

Statistics unchanged 

Since statins were introduced as a wonder drug in the 80s, the incidence of heart attacks and strokes has not changed. If they worked in the way that the pharmaceutical studies appear to show, the numbers of strokes and heart attacks should have fallen dramatically. They have not. However, the list of officially acknowledged statin side effects has grown, the main ones being damage to the peripheral nervous system, causing tingling, numbness, prickling of the hands and feet, and burning pain and paralysis; muscle damage, causing severe muscle weakness, intense muscle aches and pains, and disabling fatigue; kidney damage, which can be fatal; immune suppression; increased risk of diabetes; increased risk of cancer; heart failure; and decreased mental functioning, including confusion, memory loss, and transit global amnesia.

Other problems, including cataracts, liver dysfunction, rashes, hair loss in women, upset stomach, headache and insomnia have also been linked to statins. In addition, some GPs have described side effects such as irritability and ‘generally feeling old’ that are never mentioned in studies, yet are common. It would seem that many people are undoub- tedly being damaged and subjected to premature degenerative disease and death as a result of inges- ting statins and I resolved not to be one of them.

Convalescence

On the sixth day after my operation I was discharged and for the first couple of weeks or so I felt extremely uncomfortable and weak and experienced a lot of pain in my chest and the leg from which a vein had been extracted for the transplant. I kept falling asleep and had to take paracetamol a few times, especially at night. It took a while before I really felt on the mend. My GP encouraged me to resume taking the statins and other medications, which I had stopped again as soon as I got home (except for one soluble aspirin daily, which is said to thin the blood and has the same anti-inflammatory effect on arteries that statins have). I also began taking vitamin D supplements to counter the lack of sunshine this winter and was eating well again, thanks to Véronique’s care and the information we began gathering together about eating more healthily.

At home it was a relief to re-engage with work and colleagues again, albeit gently to begin with. Between sleeps and short walks I also read a few novels, something I rarely do these days. The one I enjoyed most was sent to me by my son, Mark. This was Musashi, by Eiji Yoshikawa, an epic samurai tale based on real characters. It was great to disappear into an exciting, exotic alien world for a while and mentally disengage from pain and inconveniences. The main character overcame great difficulties, including injury, heartbreak and being endlessly hunted, attaining wisdom from doing so. Just the tonic I needed.

 Not so intelligent now 

Six weeks after leaving hospital I was back at the John Radcliffe for X-rays, an ECG and other tests, before seeing Professor Taggart for a check up. He told me that the X-ray results were excellent and all the tests confirmed that the operation had been successful. Moreover, he said, he could tell just by looking at me that I was well.

“How come?” I asked.
“It’s your colour, your demeanour,” he said, with a smile.
“You are obviously healthy.” Then I made a mistake and said,
“That may be because I’m not taking any of the medication, apart from the aspirin.”

This did not go down well.

It was a clear example of his earlier observation conflicting with the beliefs he held about the value of statins. When I explained that I had read up on statins and did not trust the research on which their use was based, Professor Taggart’s immediate response was to say that trawling the internet for conspiracy theories was easy to do but an unreliable way to inform myself. This came across to me as a bit patronising. He evidently no longer thought I was “an intelligent man”. I didn’t bother explaining that I was basing my decision on several fully referenced books by respected doctors and professors, so I promptly shook his hand and thanked him for his skill and care. He said he would write to the pharmacist and ask her to discuss my medication with me.

Dishing out ‘meds’ 

Doctors, I realise, are obsessed with dishing out ‘meds’. (There were even posters on the hospital walls featuring TV celebrities, with speech bubbles coming out of their mouths, saying, “Don’t forget your meds!”) They seem to assume it is not normal if, by my age, a person is not taking some medication or other as a matter of course. I’m not against drug treatments but I do question ones where the side effects might be worse than the condition they are treating, the practice of mixing several potent drugs together, and the research funded by drug companies on which these regimes are based. (The evidence for the unscrupulous claims that the industry makes can be found in Dr David Healy’s brilliant book Pharmageddon.)

At home we got seriously interested in food. Another book we both read avidly, twice, was Trick and Treat, by Barry Groves, a real page turner for anyone whose attention becomes focused on their physical state – as my heart attacks made me focus on mine. It was the best book I came across about looking after your own health and is well worth reading for its common sense advice about diet and exercise, much of which contradicts the absurdities recommended by ‘nutritionists’ and the health-care industry.

At home we now generally avoid bread, pota- toes, pasta, rice, fruit juices, skimmed and semi- skimmed milk (we drink full cream milk from a nearby farm). We happily eat cheese, fatty meat of all kinds, fish, eggs, salad and green vegetables. This keeps the weight down and energy levels up. We never have margarine, processed ‘yogurts’, or any product labelled ‘low fat’ or ‘low cholesterol’. Instead we cook with butter or cold-pressed olive oil. As a result I have lost over a stone.

If you are interested in health, it is worth- while remembering that hydrogenated vegetable oils, and the trans fats they contain, are some of the most harmful substances you can put into your body and are the main causes of the epidemic of obesity and diabetes. They are found in practically every processed food and fizzy drink including cakes, bread, biscuits, soups, cereals and takeaway foods.

Fear of dying 

After a bodily setback like a non-fatal heart attack many people become anxious and begin to worry excessively about the future. As we know, it is worrying that causes depression. Conventional doctors seem often not to realise that one leads to the other, but they do take the risk of depression seriously. Despite loading me up with medicines (and medicines to counteract the side effect of the medicines), two doctors separately suggested that I should be prepared to take anti-depressants as well, in case I got depressed during my convalescence! No attempt was made to find out if I was worrying or suggest any better way of keeping depression at bay (such as getting one’s needs for emotional support, connection, sense of purpose, status and security met).

Worrying about one’s inevitable demise doesn’t make for a clear spirit. I take my inspiration from the words of Mark Twain: “The fear of death follows from the fear of life. A man who lives fully is prepared to die at any time.”

A decade or more ago I had an intense near-death experience. During a medical crisis in an intensive care unit I stopped breathing several times and, on each occasion, became aware of passing through the REM state portal into a realm beyond space and time where things that puzzled me were explained. Back in the hospital little time had passed, only enough for me to eventually gasp in a little breath or two before passing out again and returning to that place. Since then I don’t fear dying as I used to do when a child and will submit readily when my time comes.

Of course, I still think that I have things to do and enjoy on this earth, but death doesn’t wait to see if we’ve finished all our projects or had our fill of earthly enjoyments before it calls us back whence we came. It is the price we pay for freewill and having the chance to observe and participate in the wonders of creation: we all leave this familiar home, stepping out the door as it were, to rejoin the conscious universe, taking with us our contribution to it. In the meantime, I am grateful for the continuing ability to marvel at Reality from my current perspective, whilst preparing for that event as best as I can. And I thank the doctors, surgeons and nurses, and my wife and family, colleagues and friends for the opportunity.


This article was published in Human Givens journal, Vol 20, No 1 (2013).



For more articles like this subscribe to the Human Givens journal.