An apple a dayDrug-eluting stents

NICE to have you back in the real world!C. Diffi cile – the new hospital superbug

Technology and using it to your advantageGlossary

Issue 159 April / May 2008

J urnal BCPA

THE PATIENT

AND CARERS INDEPENDENT

VOICE The offi cial magazine of the BRITISH CARDIAC PATIENTS ASSOCIATION

3 From Me to You – Keith Jackson 4 Ricky’s Quickies. Drug-eluting stents – Richard Maddison5 NICE to have you back in the real world! – Nick Curzen6-8 News from around the Areas – Bedford to Wirral9 Dates for your diary9 Recipes: Grilled turkey with charred broccoli; Green pea, mint and onion soup – Janet Jackson10 Apple polyphenols and vascular health – Dr Amy V Gasper and Dr Paul A Kroon11 C. diffi cile – the new hospital superbug – Paul Giannasca11 Papworth Direct launched. Papworth Volunteers12 Smart heart holidays 13 Technology and using it to your advantage – Corey Beecher14 Glossary Quiz14 Co-ordinators, Contacts and Affi liated Groups15 Membership

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 Apr, 20 June, ... ie 20th of an even month. Please phone me 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: An apple a day keeps the doctor awayMy grandmother told me this proverb, which may date from 100 years ago or more. Now we may have its justifi cation. See the article on Apple polyphenols and vascular health. Flavonoids in the diet lower heart disease risk. Quercetin and epicatechin are the major fl avonoids in our diet – their main sources being red wine, cocoa, onions, tea, (and particularly) apples – ROTA. RM

For sale – CoaguCheck S A member who no longer needs to be able to carry out blood coagulation at home has given this almost new CoaguCheck S Monitor to the BCPA for sale.

Would you fi nd it helpful to be able to monitor your blood without the need to visit your doctor’s surgery or hospital?• Hand held and simple to use• Results within two minutes• Cuts the number of visits to hospital or surgery• Test strips available on the NHS

Many BCPA members and others have purchased these machines, which are designed for home use.

We invite offers, hopefully around half the purchase price of about £400 for a new machine.

Please phone Keith Jackson 01954 260731 or email keith.jacksonmail@btinternet.com

Donations

The Journal is the bimonthly magazine of theBRITISH CARDIAC PATIENTS ASSOCIATION

also 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 212293 Email: richard.maddison@virgin.netTreasurer Derek Holley OBE FCA

BCPA Head Offi ce 2 Station Road, Swavesey, Cambridge CB24 4QJ Tel: 01954 202022Email: 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.

© Copyright 2008 BCPA and/or the authorsDesign and production – john@cartog.co.uk Printed by – Printhaus

Fred Chapman of Dereham, a BCPA member, in celebration of his 65th birthday arranged a party and trip on the Mid Norfolk Railway with a fi sh supper. The evening went very well and everybody enjoyed themselves. He asked his family and friends not to give him presents, and kindly collected £200 for the BCPA.

At his funeral Victor Pollard’s wife Sonja and family collected £617.02 for the BCPA Papworth Fund, as in the Peterborough report.

Aubrey Logan of March, a BCPA member, has sent £65.We have received £170 in memory of the late Alfred Smith of

Cambridge.Janette Main of Glasgow, a BCPA member, collected £100 at the

Parents night at her Speech & Drama Group.We have received memorial donations of £75 following the

death of Jim Treanor, a Lincoln member.

From Me to YouKeith Jackson, National Chairman

BCPA Annual General Meeting weekend9th – 10th- 11th May 2008, at The Westminster Hotel, Nottingham

3

AGM 2008You still have time to book accommodation for the weekend. Please give me a call on 01954 260731 to book. We shall be delighted to see you. Of course it is not necessary to book to attend just the AGM.

Membership We thank you for your support over the past year. Annual subscriptions are now due. A renewal notice was enclosed with the February Journal.

Alternatively you can use the form printed on the inside back page.

As an annual member might it not now be time to change to life membership thus saving the need to make an annual renewal. It would help the Association if we had more life members.

You may feel that you are no longer in need of our support, but please remember, it is only by you giving your support to the Association that the Association in turn is able to help others.

As you know, the AGM weekend is at the Westminster Hotel, part of the Best

Western Group, one mile from Nottingham city centre. This traditional hotel with its variety of rooms makes a welcome change from the modern uniform chain hotel approach. Access to the hotel is good – being only 10 minutes from M1 motorway Junction 26.

Members wishing to visit the city may travel in by car, bus, or the fast effi cient tram service that runs close to the hotel.

Friday evening gives you an opportunity to meet up with friends from previous years and to make new ones. Regular attendees at AGM weekends will assure you of our warm welcome and friendly company.

This year the Saturday morning outing from the hotel is something different – a visit to Laxton Medieval Village. Laxton is nationally known for the survival of the system of Open Field Farming. It continues to be managed by 14 Open Field Farmers – open fi elds farmed in common with tenants holding land in strips. The visit will also take in the castle and museum.

Our Saturday afternoon speaker will be Sister Lynn Holt, who has a vast experience in cardiac care and will have much to share with us all.

This is followed by the Annual General Meeting and the Open Session, which is your opportunity to ask questions about the Association and its activities.

Saturday evening will be the Gala Dinner – a further opportunity to relax and enjoy a time together.

For further information and a booking form please telephone the Chairman, Keith Jackson on 01952 260731 or Head Offi ce on 01954 202022.

BCPA Annual General Meeting

Notice is hereby given that the 26th Annual General Meeting of The British Cardiac Patients Association will be held on Saturday 10th May 2008 commencing at 2.45pm at the Westminster Hotel, Mansfi eld Road, Nottingham.

The full afternoon’s proceedings will start at 2.00 pm.

Programme for the afternoon2.00pm Welcome by Mr Keith Jackson, Chairman2.05pm Lynn Holt, Speaker 2.25pm Questions to the speaker2.45pm Annual General Meeting

AGM AgendaNotice of the MeetingMinutes of the 25th Annual General MeetingChairman’s ReportTreasurer’s Financial Statement and Statement of Financial ActivitiesAuditor’s ReportElection of AuditorElection of Offi cers and Executive Members

Announcement of the ballot results for the appointment of:• Association Treasurer• Four Executive Committee Members – two for three years, one for two years, one for one yearSee note below.

4.00pm Open MeetingAn open meeting will follow immediately after the completion of the formal business of the AGM. Members are invited to submit any questions that may require prior research to Head Offi ce by the 6th May 2008.

The Executive Committee reserves the right to impose a time limit on items for discussion in the Open meeting.

Note The nominations received by the closing date were as follows.

• For Treasurer: Derek Holley. So Derek Holley is declared elected for three years from the close of the 2008 AGM.• No nominations for Executive Members.

This leaves vacancies as above for Executive Members. So a postal ballot is not required. Nominations to these remaining vacancies will be taken at the meeting in accordance with paragraph 6.5 of the Constitution.

Signed: Keith Jackson, Chairman

4

Ricky’s quickiesRichard Maddison

NICE reported on this on 1 February 2008. ‘Drug-eluting stents DES are recommended for use in Percutaneous Coronary Intervention PCI for the treatment of coronary artery disease, within their instructions for use, only if:• the target artery to be treated has less than a 3 mm calibre or the lesion is longer than 15mm; and• the price difference between DES and bare-metal stents is no more than £300.’

This good news for patients was not suffi ciently disastrous or headline worthy to get reported on radio or TV news!

BackgroundCoronary heart disease CHD is narrowing of the coronary arteries by fatty deposits of plaque, which reduce the oxygen to the heart muscle. One or more arteries, possibly of different diameters, may be partially or totally blocked.

The narrowing may have no symptoms; or produce angina – chest pain that may restrict or prevent exertion. A critical reduction of the blood supply to the heart may result in destruction of an area of heart muscle or death.

DESs have been saving lives for more than four years and the BCPA is hugely relieved that access to this essential, life-changing procedure will continue.

CalculationSuppose 100 such patients get a bare metal stent BMS, and another 100 get a drug-eluting stent DES costing £300 more. All incur the same much larger appointments, diagnosis, and operation costs.

Of the BMS group perhaps 20 will get another blockage, have poorer health, and need another operation within three years.

But only a quarter as many – fi ve – of the DES group will get any such later blockage. So 15 will have better health and quality of life, saving their later operation and its costs.

If (as in the unreasonable preliminary draft guidance by NICE last August) no funding for DESs was allowed, about 12,000 patients annually would instead have needed a coronary artery bypass graft. A CABG involves much longer in hospital, much longer recovery and rehabilitation, and far higher costs. Also, the disruption of routine, employment, and lifestyle creates more burdens on carers, relatives and friends.

Lobbying and thanksThis preliminary NICE draft guidance immediately came under fi re from patient groups and cardiologists, who sent in comments to NICE. There were real fears that these recommendations would be unchanged in NICE’s fi nal decision, which would then have had a profound impact on patients and the NHS.

Many cardiologists and other people and the BCPA recommended that NICE look again at the technology and the available evidence.

We thank the cardiologists and others who created publicity and sent in comments.

You are not aloneOccasionally a member contacts me saying they have a similar condition or situation to the writer of a letter in the journal. If the author doesn’t want their identity divulged, I cannot put them in touch with each other.

Free loft and wall insulation if 70+From January 2008 if you are a homeowner or renting privately and aged over 70, you qualify to have both free cavity wall insulation, and free loft insulation if you have 4 inches or less of such.

This should reduce your fuel bill, and help the government reduce CO

2 emissions.

To apply call Energy Grants Direct on 0870 042 1267. You can apply now.

As a howler, the government leafl et says ‘Help the Government reduce their CO2 omission targets’.

Gift aid 25%After 5 April 2008 Gift Aid will be worth 25% instead of 28%.

Not a bit OFF‘THE EMBANKMENT IS CLOSED FOR

CHRISTMAS LIGHTS SWITCH ON’Council notices on roads to Bedford Embankment in late Jan 2008. [Presumably reusing the signs while removing the lights and then not removing the signs.]

Not more than 79mph over limit‘Thousands more motorway drivers will be hit with speeding fi nes in a new speed camera blitz. …

‘The ‘speed threshold’ – the amount drivers can stray above the limit without getting a ticket – is also being lowered. Police sources say it will be set at 79mph.’ Daily Mail 6/2/08

LINks replace PPIsFrom March 2008 Local Involvement Networks (LINks) replace Patient and Public Involvement forums. LINks will be regional and not be specifi c to any particular hospital. LINks will work with existing voluntary and community sector groups, as well as interested individuals to promote public and community infl uence in health and social care. Funding through local authorities was allocated in December 2007. The National Centre for Involvement is at Warwick University. Source Department of Health website.

Organ Donation TaskforceThe UK-wide Organ Donation Taskforce, chaired by Elisabeth Buggins, was established in 2006 to identify barriers to organ donation and to recommend actions needed to increase organ donation and procurement within the current legal framework.

The Taskforce wants 50% more UK organ donations in fi ve years, saving many lives by 1,200 more transplants annually.

At present the UK has about 100 local donor transplant coordinators to guide bereaved families through the process.

The report proposes a radical shift from existing arrangements. They want 100 more coordinators – all employed centrally by NHS Blood and Transplant rather than by individual Trusts. Improved donor coordination services could give a 10% increase in the 60% donation consent rate.

Sources Department of Health news releases and website. 4/1/08, 16/1/08

NICE work not on news – drug-eluting stents

recommended

5

NICE to have you back in the real world!Nick Curzen

UK Interventional cardiologists welcome back government healthcare watchdog from Planet Zanussi

Back in October last year I wrote an article about the provisional outcome of the appraisal of drug-eluting stents (DES)

for percutaneous coronary intervention (PCI) by the National Institute for Health & Clinical Excellence (NICE). The article was (appropriately?) pregnant with frustration and sarcasm because the overall provisional conclusion was ‘Drug-eluting stents are not recommended for use in PCI in patients with coronary artery disease.’

To a clinician at the front line, equipped, like my interventional colleagues across the UK, with both a good handle on the current evidence base and a desire to provide the best possible care for the patients I look after, this conclusion was incomprehensible.

Furthermore, the more information I discovered, it got harder and harder to fathom. Firstly, how many people would set up an appraisal group for such an important treatment that contained not a single expert in the fi eld of coronary stenting? Secondly, the balance of the conclusion was unashamedly biased not to the pursuit of ‘Health and Clinical Excellence’ but to cost-effectiveness – employing a model that was patently fl awed!

The consultation document was, I suggest, a low point in the history of NICE. For all the reasons that I set out back in October, implementation of this provisional recommendation would have led to thousands of patients receiving unnecessary CABG operations and being denied PCI.

Fortunately, built into the NICE Appraisal process is a period of public consultation. The fi nal conclusion has now been published following several months of consultation – a period of time that has been repeatedly extended due to the weight of submissions.

I am pleased to report that the fi nal appraisal represents a major revision of the original, and outrageous, conclusion. The overall conclusion is as follows.

‘Drug-eluting stents are recommended for use in PCI for the treatment of coronary artery disease, within their instructions for use, only if:• the target artery to be treated has less than a 3 mm calibre or the lesion is longer than 15mm; and• the price difference between DES and bare-metal stents is no more than £300.’

This represents a major climb down for the anti-DES health economists who dominated the original appraisal process. It is very good news for many patients.

This conclusion doesn’t by any means incorporate all of the patients at highest risk of restenosis following PCI, but will allow interventional cardiologists to treat most of them appropriately.

The largest group that are not included, but who in my view defi nitely should be, are diabetics whose arteries for treatment are not this narrow and whose lesions are not this long. Ideally I think the NICE appraisal should have included all diabetics in their DES recommendation because diabetes has consistently been a risk factor for restenosis in almost all published studies of PCI. However, the dominant response in the interventional cardiology community (we happened to hear this result on the last day of our annual national conference!) is one of relief, I think.

Forgive me for quoting the last portion of my October piece.‘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%. The following patient subgroups are likely to fall into this category: diabetics; small

vessels (i.e. less than 3.0mm); chronic total occlusions; lesions over 15mm; and bifurcations.” ‘Come on NICE, you’ve got this wrong. Think a bit more about

clinical excellence and patient care and we will compromise on cost-effectiveness by limiting DES use to only high-risk patients.

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

Thus we have probably arrived at a compromise that is reasonable for the provision of care for most patients. It will allow me, and doctors like me, the freedom to continue to choose with patients what is their best and most appropriate treatment option between CABG and PCI.

Nevertheless, this experience leaves an uncertainty in my mind about the process employed in the appraisal by NICE.

Is it a failure that the original appraisal group could get this so badly wrong according to the judgment of the specialists in the relevant fi eld? And they be so dominated by health economists that they have to be reminded that they have lost sight of the clinical excellence part?

Or does the fact that the public consultation has yielded an almost complete reversal of the original recommendation actually represent a triumph for the overall process? In other words, is it more reassuring that the fi nal conclusion is clinically appropriate than that the original conclusion was so pitifully of the mark?

You decide! It is important that we understand the answer to this question, however, because we work in a fast-moving fi eld in which high-quality clinical trial evidence is being generated faster than in any other medical fi eld at any other time in history.

Appraisals of new treatment and technologies are therefore inevitably to be required regularly in the future. The mechanism of such appraisals is key. The great Henry Ford was once asked about his vision of the potential for the motor car. He replied ‘If I had asked the customers they would have asked for a faster horse!’

With regard to cost, the reason that the fi nal appraisal document has insisted upon a difference in cost between bare metal and DE stents of ‘no more than £300’ is fairly obvious considering the dominance of cost effectiveness in the modelling process. It has occurred to quite a few cynics involved in this process that this could theoretically be achieved in one of 2 ways – only 1 of which was intended by NICE! The intention, of course, was to drive down the price of DESs towards the cost of equivalent bare metal stents, hence saving money. It would, in fact, be entirely within the NICE guidance for the companies that make stents to simply raise the price of their bare metal devices in order to achieve the stated £300 gap!!

I am reminded of the absurd relevance of some Top Tips from Viz that seem to fi t with this theme of concern for government spending!

‘These so-called speed bumps are a waste of money. If anything they slow you down.’

‘I heard on the news that the 2007 January storms had cost this country a billion pounds. What an utter waste of money. If anything, they did more harm than good.’If I didn’t know better, I would suggest that perhaps we could be

a bit more relaxed about the money we are spending on DESs if we weren’t waging dubious war in Iraq and Afghanistan?

Finally, I would like to formally welcome back my NICE colleagues from their uncomfortable trip to the Planet Zanussi. I hope that they decide to stay with the rest of us in real world for the foreseeable future. (Although if any Health Economists fancy a trip in a space rocket, I am sure the UK interventional cardiology community would be prepared to organise a whip round for you).

We are saddened to report the death of Alan Luff.

Alan was the Co-ordinator of our Chester Area Group, offering help and support to all those he came into contact with.

In addition to providing leadership to the Chester Group he was also a keen supporter of national events and those organised by the Northern Cluster Groups. He had been a member of the Association since 1994.

It was a tribute to the esteem in which he was held to see most members of the Chester Group present at his funeral.

Our thoughts go out to Christine and her family at this diffi cult time.

KJ

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.

East SuffolkAnita Postle & helpline 01473 829777

Spring is just around the corner as I write this news and by the time you read it we will already have celebrated Easter.

I hope you have all escaped the fl u bugs and are ready for the better weather although we have had some lovely sunny days with glorious sunsets this early part of the year.

Our numbers have dwindled even further with only a handful of members coming to the AGM in February. Dot Wigg told us about her Tea with the Queen.

We thank Jean and Les Collins for the time they have given as Committee Members and in charge of refreshments at meetings. The rest of the Committee remains the same.

If any of you have never been to a meeting do please think about coming to our next meeting on 24th April. We have a new group called the ‘Willing Warblers’ to entertain us and you may fi nd you enjoy our meetings. Do bring your friends along, the more the merrier.

Then on 26th June Prue Gardiner will tell us her TV experiences.

Bourne Win Felstead 01778 423869

Greetings to one and all. I hope this fi nds you well and by the time this is in print enjoying some spring sunshine.

As you may all be aware, Bourne is no longer active as a Group; numbers had been falling due to illness and aging members not being happy about coming out in the evening but to change to afternoons would have been unfair to members who were still working so we decided to call it a day.

I must admit I was not looking forward to our November meeting but it turned out to be a very happy, upbeat evening with all members making an effort to attend as did Keith and Janet Jackson along with Keith and Dell Atherton.

Representatives from Bourne Red Cross and Lincolnshire Air Ambulance joined us and cheques for £350 were presented to both for their funds. Richard Foers, Group Chairman, was presented with a bottle of wine; whilst I was the recipient of £30 M&S vouchers from the group, and some fl owers from Keith & Janet. A buffet by Clark Catering was much enjoyed together with wine or fruit juice.

I was amused by the Perks of being over

We had a good attendance at the Group’s Annual General Meeting at Shelford Memorial Hall on 27 February. We also hadgood attendances at meetings and events throughout the year – including speakers on a wide range of subjects ranging from nursing in Uganda, to visits with the Royal Family. During the year we had trips to Aldeburgh theatre and to Stowbridge.

Our tombola stalls at various places have been a major fundraiser for the group over the years; but refl ecting on the commitment members can give we agreed to have fewer in future.

Members were pleased to have donated £1,200 worth of monitoring equipment to Saffron Walden hospital.

Ken & Janet Starling and Maurice & Jean Garner were thanked on their retirement from the Committee. We welcomed the new members Michael & Barbara Clegg. Bert Truelove continues as Co-ordinator along with D & B Mottram, B Truelove, M & A Ling, and A Ward.

Cambridge Bert Truelove 01223 844800

Chester

Wow what has happened to the weather! I am sitting here on 20 February in short sleeves with the windows wide open, it’s glorious - long may it continue.

I would like to say a huge thank you to Stan, June, Rosemary, Jason, Ron and Richard for all their help in January raising £218.29 at a store collection at Sainsbury’s.

I am afraid a couple of the dates on your recent local newsletter were indeed wrong (I blame my age). The dates for the last two meetings of the year should have read Wednesday 22nd October and Thursday 4th December. Thank you Ron for pointing this out to me – you win 1st prize!

I am afraid I do not have too much to report as we have not had any meetings since the last journal and our AGM is not until next week.

Wednesday 23rd April is a very busy day for us, because not only is it our Beetle Drive at Kesgrave, but we are also going to Pakenham Village Hall in the afternoon to give our dear friends from West Suffolk a run for their money in the Annual Inter-Suffolk Quiz. I need as many of you as possible to come and support us and to help make sure we bring the trophy back. Also to Brian and friends – please be gentle with us.

Wednesday 28th May sees our own

70 in the February Journal and feel that something similar must have happened with the captions below our photographs. We do not have a Daphne Hill. The lady in question is Kathleen Wade, our Treasurer, presenting cheques to Air Ambulance representatives and Bourne Red Cross. Also, it wasn’t a Christmas Party but our Swan Song – November 12th, which happened to be my Wedding Anniversary – the 6th year without Fred. Please Sir, the errors were not caused by me!

Margaret McGarry, one of our members, had to use the services of the Air Ambulance when her car was knocked off the A15 by a lorry. Margaret and her passenger had to be cut free and air lifted to hospital. Fortunately no serious injuries – so our donation was put to good use.

I shall look forward to reading the Journal and keeping up with all your news, and from time to time will send in a little bulletin. Until the next time keep well, keep smiling and look after one another.

We apologise for the errors. Ed

version of a homemade produce night, not just food but anything as long as it’s homemade. Please come along and the more imaginative the items you bring the better.

Take care of yourselves and each other and hope you all have a super spring.

The swimming at Wragby is also going well, Bill Lawton (Vice-Co-ordinator) arranged with the over 60s to amalgamate with group members to make it a more viable proposition.

We also have a good selection of speakers lined up over the next month or two. On Tuesday April 15th Richard Fines, BCPA member, will be giving a talk on Diabetes. The May meeting date may possibly change. All being well we are having a Buffet Meal, and Robert Thompson will entertain us with his experiences of a journey across the Sahara desert Marathon Sahara Dessibles – 150 miles long. Along with a game of Bingo during the evening in The Social Club, Moor Lane, North Hykeham. We will notify members in plenty of time.

Several trips are in the pipeline – more information in next issue of this Journal.

We have also purchased a television for the Cardiac Clinic at the Lincoln County Hospital, which is now waiting for the powers that be to install it.

HaltonStella Bate, 01928 566484

7

PeterboroughGordon Wakefield01733 577629

LincolnBrian Bigger,01522 880843

From Margaret RimmerOur AGM was held on 13th February. John Fahey retired as Co-ordinator. He was presented with a small gift as a token of appreciation for all his hard work over the last two years. We are pleased to report that John and his wife Margaret will continue to be committee members.

We welcome Stella Bate as our new Co-ordinator. The rest of the committee agreed to stay on in the same roles. The evening ended with an enjoyable quiz and we would like to thank all the members who attended.

We thank Pat Williams and Trevor Bowyer for bringing their guide dog puppy, Lake, to the January meeting. Pat gave an interesting talk about her experiences of being a guide dog puppy walker.

We also thank Liam Meagher, who came to one of our Thursday sessions to tell us about his involvement in the Youth Mission Project South Africa 2008.

On Valentine’s Day the group had lunch at The Evenwood Farm. All the ladies were given a teddy bear, which was appreciated.

Eleven of our members were invited to a Volunteer’s Reception at Halton Hospital. They had a lovely meal and they were waited on by the doctors at the Hospital.

By the time you read this we will have had our trip to North Wales on 19th March – I will be able to tell you about this in the next Journal issue.

We also have two visits to The Brindley Theatre planned – one on May 8th All Our Yesterdays, and the other on May 29th Billy and Wally.

We are going to Llandudno on 1st July – this is always a lovely day out.

We meet every Monday morning at 10.30 in the café at The Brindley for a walk and coffee; and every Thursday from 1pm until 3pm at The Grangeway Centre for various activities.

New members are always welcome; please ring the above number for more information.

Valentine’s Day Lunch at Evenwood Farm

It is with sadness that I report the death of Jim Treanor who had been poorly for some time, a most loyal member, well liked by all that knew him. Our condolences go to his wife Julie and family.

I must apologise for no letter in the last issue – computer problems or maybe a touch of old age, things can only get better.

We held our AGM on February 5th, which was well attended. Keith Atherton retired as Co-ordinator after two very successful years. Three committee members also stood down – Ron Newman, Diane Eastham and Jean Brookes, all of whom will be sadly missed after a job well done.

I now have the honour of being the new Co-ordinator for the next year. Keith will be a hard act to follow but I’m sure that with the support of the committee and members we will go from strength to strength.

Group members can now enjoy the pleasure of going on walks that are now being organised by John Phillips, which take place once a month – short walks to suit cardiac patients which finish off with a pub lunch for those interested.

Trip to Northumberland

Memories of Laxton

LlandudnoPaul Williams, 01492 540073 or 07717 474242With regret the Llandudno Area Group has to close as a formal group but will go forward as a social group only. Please phone Joan Williams on 01492 876926 for details.

We in Llandudno have had 14 years of love and friendship amongst our members and we thank them all.

Our only news is that our January meeting went very well: Ann Caprio, the landlady of the Cherry Tree where we have our meetings, gave us an excellent talk on Italian cookery – together with food and wine.

Victor Pollard’s wife Sonja and

family presenting cheques for

£617.02 collected at his funeral to be paid into the

BCPA Papworth Fund.

Volunteer Reception at Halton Hospital

Our AGM is at 7.15 for 7.30 on 14th March 2008. If you have any points to raise or would like to become a Committee member please let me know.

Our New Year Social took place on 18th January. Everyone who attended had a good time and I would like to thank Jane and Graeme Deves, who were unable to attend this year, for their donation to the table and for buying their raffle tickets, and trust you enjoyed your prizes. The attendance numbers were down on previous years due to sickness and other commitments.

Our social events started Wednesday 20th February seeing Pinocchio at the Lewisham Theatre. For information on further Social events, please contact Jane Gilbert.

It does not seem so long ago that we were all looking forward to Christmas 2007 and by the time you are reading this article we will be in April. I am convinced that as we get older time seems to go quicker. So all I can say is enjoy life to the full whenever you can, so that you don’t miss anything.

I am pleased to say that in 2007 we were able to purchase £12,247.52 worth of equipment for our local hospitals’ cardiac wards and departments – taking our total to £115,034.22. Thank you to everyone that has made this possible. In 2008 so far we have already agreed to furnish a quiet room for relatives, and put some new recliner chairs for patients use in the Cardiac department and in Ward 76 day room.

In your March newsletter we will have sent all our area group members a questionnaire to ask what activities you would like to do at our social nights, and where would you like to visit on our coach trips this year. So if you have not yet done so, please return it to us to help us set up the type of social events you would prefer.

Best wishes.

FromBarbara Atkinson

Hi Folks. In February we held our AGM your committee members are Dennis Co-ordinator, Barbara Secretary, Dave Rowe Vice-Co-ordinator, Tommy is still our long suffering Treasurer bless him, Brian does social, Irene is almoner. Not to forget the rest of the group thank you all for supporting us.

On Saturday March 15th we are having a bowling evening at LA Bowl with a meal afterwards – if you would like to come please contact Dennis.

The car boot sale season will soon be here. Saturday 5th April is our first one – to be held at the Birchwood Centre Car Park 3. For all the members who cannot make the meetings why not come along to the car boot and make yourselves known to us. It would be lovely to meet you.

Saturday 12th April we are going to the Holly Bush for a meal again – please contact Dennis. If you have a problem with transport please let us know and we will do our best to get you there.

Our next meeting is 7pm on March 20th at the Post Graduate Centre Warrington Hospital.

Until next time please all try to stay happy and healthy.

Hello there, isn’t it nice to see the early spring flowers, particularly the daffodils just looking wonderful! I hope you all got over the Christmas and New Year storms and are keeping well.

Unfortunately my little Mary had a nasty stroke two weeks ago, she is now fortunately recovering but she is still a poor little thing.

To brighter things, the following programme of events is now settled. The last magazine said that the BBQ would be at The Bushell but in fact it will be at our old venue – The Royal Anglian Club, Bury St Edmunds. We hope that many of you will attend, if only in memory of the NINE Royal Anglians that were killed on duty last year.

The Quiz with our old friends from Ipswich will take place in the Women’s Institute at the lovely village of Pakenham. There is a nice little pub opposite, if you would like a meal. Hope to see you then, though we will provide tea and coffee etc. We hope also to have a draw.

When you read this, our AGM will have been at the Westley Community Centre, Bury St Edmunds on 11th March 2.00pm for a 2.30pm start.

8

South-East London & KentChris Howell 01689 821413

Staffordshire and DistrictAlan Lea 01782 838730

WirralMartin Legge 0151 625 6529

West Suffolk & South West NorfolkBrian Hartington 01284 762783

WarringtonDennis Atkinson 01925 824856

I start my report with the sad news of the loss of one of our members, Mrs Audrey Benson. Our condolences go to Gerald and his family. Audrey will be sadly missed by us all.

I was sorry to hear that Alan Luff, the Chester Group Co-ordinator, had passed away. Our condolences go to Mrs Luff family & friends at this sad time.

We held our AGM meeting on Monday 11th February. We were pleased to welcome to the meeting Keith Jackson, our National Chairman, and his good wife Janet – their support is very much appreciated by us all. The meeting was well attended by members and friends of the group.

Mr Brian Norman, our Chairman, after many a year, has stood down from the chair. We thank Brian for all his hard work in that job over many years.

The following people were elected for 2008/09: Group Co-ordinator Mr M Legge, Treasurer Mr B Norman, Minutes Secretary Mrs J Parsons, and Assistant Co-ordinator Mr G Bird.

We also have a Social Committee to organise trips out to places of interest. There will be again be a programme of events so if anyone would like a copy sent to them please contact me.

With spring in the air do try to get out & about more. Let’s hope that we don’t get the rain as we got last summer; it was a wash out.

At the meeting on Monday 14th April our guest speaker will be from St John’s Hospice talking on the workings of the hospice. On Monday 12th May we are pleased to welcome the British Red Cross talking about their work across Wirral. This will give use a chance to see the workings of other charities here on the Wirral.

Please come along to any of our meetings – we would be pleased to see you. Please remember that the subs are up for renewal on 31/03/08 – the more members the better.

Well I’ve run out space again so if I have forgotten anyone or anything I say sorry now. Take Care. Martin.

Helen McCall and Irene Brett 2007

Winners of the Zipper Bowls Cup, 5th

August 2007

Wirral members enjoying the Christmas Social

Members at the New Year Social

Bedford Th 24 Apr 7.30Th 26 June 7.30

Entertainment by the Willing Warblers. Putnoe Heights Church.Prue Gardiner: TV experiences. Then 28 Aug, 23 Oct, 18 Dec

Cambridge Usually 4th Wed of even months at Memorial Hall, Great Shelford

Chelmsford and District Cardiac Support Group

8.00 All 8.00 at Broomfield Parish Hall

East Suffolk W 23 Apr 1.30 for 2W 23 Apr 7.30W 28 May 7.30W 25 June 7.30

Quiz with West Suffolk. Pakenham Village Hall. Beetle Drive. All Kesgrave Social ClubHomemade produceTom Tyler: When motoring was fun.

Halton Th 8 MayTh 29 MayTu 1 July

All Our Yesterdays. Brindley TheatreBilly and Wally. Brindley TheatreLlandudno tripEvery Th 1-3 at The Grangeway Centre. Every M 10.30 at The Brindley Café

Havering Hearties 2nd Th 7.30 At Conference Centre, Oldchurch HospitalKing of Hearts,

Redbridge, Essex3rd Wed 7.30 At Ford Sports and Social Club.

For details contact Tony Roth 020 8252 0877

Lincoln Tu 15 Apr 7.30 Richard Fines. Marathon Sahara. The Social Club, Moor Lane, North Hykeham.

Martlets, Sussex 2.30 Lancing Parish HallMerseyside First Wed All at OPD at the CTC, BroadgreenPeterborough Tu 20 May 7.15 Usually Tu 7.15 at Cherry Tree Public House, Oundle Road

Then 15 July, 16 Sep, 18 NovSE London & Kent F 16 May 7.15 for 7.30 All Victory Social Club, Kechill Gardens, Hayes

Then 18 July, 12 Sept, 14 NovStaffs & District Tu 29 Apr 7.30 for 8

Tu 27 May 7.30 for 8Tu 24 June 7.30 for 8

Security in the Home & Car. Bill Jeynes. Thistleberry Hotel AuctionCoal Mining. David Nixon All last Tu at Thistleberry Hotel, Thistleberry Av, Newcastle ST5 2LT

Take Heart, Southend

Second Th 8.00 At Eastwood Community Centre, Western Approaches, Leigh-On-Sea

West Suffolk & SW Norfolk

W 23 Apr 1.30 for 2Sun 25 May 12.30 for 1

Quiz with East Suffolk. Pakenham WI. See reportBBQ. Royal Anglian Club, Bury St Edmunds

Warrington Sat 15 MarTh 20 Mar 7.00Sat 5 Apr Sat 12 Apr

Bowling evening at LA Bowl & meal afterwards. Contact DennisAt Post-Graduate Centre, Warrington Hospital. All such start 7pm Car boot sale at the Birchwood Centre Car Park 3Meal at Holly Bush. Contact Dennis

Wirral M 7.30 Heswall Hall, Telegraph Road, Heswall

Wrexham Third Tu 7.00 At Association of Voluntary Organisations, AVOW, Egerton Street, Wrexham

9

Dates for your diary

Recipes – Janet JacksonGrilled turkey with charred broccoli (Turkey is low in fat)

Serves 22 turkey steaks2 tbsp olive oil1 tbsp chopped tarragon100 g sprouting broccoliJuice of half a lemonSalt and pepper to taste

MethodPut the turkey in a bowl with 1 tblsp of the oil and the tarragon. Season to taste. Cook the broccoli in boiling water for 1 minute. Drain and rinse under cold water.

Drain again and dry with kitchen paper. Heat a griddle pan until hot. Put the turkey in the pan and cook for 4 minutes on each side or until cooked through.

Toss the broccoli in the remaining oil and put in the pan. Cook for 2 minutes until tender.

Green pea, mint and onion soupServes 450 g butter4 spring onions chopped450 g frozen peas600 ml chicken or vegetable stock2 large mint sprigsPinch of sugar (optional)600 ml milkSalt and pepper

MethodHeat the butter in a large saucepan, add the spring onions, and cook gently for a few minutes until softened but not coloured.

Stir the peas into the pan, add the stock and mint and bring to the boil. Cover and simmer very gently for about 15 minutes until the peas are very tender. *

Pour the soup into a blender, add the milk and puree until smooth. Then return to the pan and reheat gently. Season to taste, adding a pinch of sugar if liked.

After * you can freeze the soup for up to two months. Allow to thaw in the fridge before pureeing and reheating.

10

Apple Polyphenols and Vascular HealthDr Amy V Gasper and Dr Paul A Kroon

Phytochemicals and Health Programme, Institute of Food Research*

There is increasing evidence that diets rich in fruits and vegetables are

associated with a reduced risk of chronic disease such as cardiovascular disease. This may be due to the abundance of phytochemicals (plant chemicals) known as polyphenols that occur in these foods.

At the Institute of Food Research in Norwich, we are researching protective effects of a particular class of polyphenols occurring naturally in apples against vascular disease.

Apple polyphenolsThe main function of polyphenols in plants is to improve their ability to withstand disease and to promote pollination by providing colour to attract insects. Apples contain a class of polyphenol known as fl avonoids, which are further subdivided into categories such as anthocyanins, fl avanols, and fl avones found abundantly in certain foods (see table).

Classifi cation Examples Food Sources

Anthocyanins Delphinidin Cyanidin

Strawberry Grape

Flavanols Epicatechin Catechin

Apple Tea, Cocoa

Flavonol QuercetinKaempferol

OnionTomato

Flavanones Tangeretin Hesperetin

Citrus fruit Liquorice

Flavones Luteolin Apigenin

Red pepper Celery

Dietary sources of polyphenols

In Europe, 74% of total polyphenol intake can be attributed to fruit consumption, with apples providing 30 and 40% for women and men respectively.

Intake varies greatly depending on the variety of apple consumed and other factors such as climate, growing and storage conditions. Cider apples such as the bittersweet English varieties, Michelin and Dabinett, are characterised by a higher level of phenolics compared with desert apples.

Evidence for health effects of polyphenolsThe potential health effects of consuming polyphenols have been studied for many years using cell culture model systems, where cells are grown in petri dishes in laboratories. These models help us to understand the underlying biological

mechanisms for a protection against cardiovascular disease.

Much of the interest in the potential health benefi ts of polyphenols has focused on their antioxidant properties, but it is becoming apparent that the protective effects may also be due to alternative mechanisms. The IFR scientists previously showed that quercetin metabolites at concentrations achievable in the diet, when applied to a cell culture, stopped the cells making adhesion molecules involved in infl ammation, a key event in the development of cardiovascular disease.

Other effects seen in laboratory studies include improvements in the cardiovascular system, including decreasing oxidation of LDL cholesterol, reducing its accumulation in blood vessels, inhibiting the aggregation of blood platelets (which contributes to the risk of blood clots that produce stroke and heart attack) and increasing blood fl ow to the brain. However it’s important to consider that eating apples results in changes to polyphenols within the gastrointestinal tract prior to absorption into the body, due to metabolism or colonic fermentation by gut bacteria. Studies using model systems to study biological mechanisms may not take these bio-transformations into account.

In addition, even a single item of food consists of a complex mixture of phytochemicals and nutrients which may interact, possibly synergistically, with each other. Therefore a major challenge is to design human intervention studies in which health benefi ts of normal dietary intake can be assessed using whole foods in order to discover the underlying mechanisms within the body. Existing human intervention studies of fl avonoids and fl avonoid-rich foods in relation to cardiovascular disease risk tend to involve sources from tea, cocoa and soy. A recent review of these studies concluded that future studies should examine dose-response effects and be of suffi cient duration to assess clinically relevant endpoints.

An apple a day: the FLAVO StudyThe aim of the FLAVO study is to compare the effects of eating two varieties of apple puree, high and low in polyphenols, and low doses of aspirin on risk factors of cardiovascular disease. Acute effects seen in the fi rst few hours and more long-term effects over a period of two weeks will be measured. The apples are pureed to reduce differences in the way people chew, which may affect the concentration of polyphenols absorbed into the blood.

Analysis includes measurements of the activation of platelets before and after consumption of the apple purees in comparison with aspirin, which is a known inhibitor of platelet activation.

Platelets are a component of the blood and are involved in blood coagulation. When platelets become activated in response to injury, they change shape and stick together. Under infl ammatory conditions, such as inside an artery where vascular disease is present, reducing the activation of platelets with anti-platelet drugs such as aspirin improves clinical outcomes. We will test whether the apple containing higher level of fl avanols has similar effects to aspirin. In addition biomarkers of cardiovascular disease will be measured, and also the concentration of active metabolites that reach the blood and excreted in urine.

And the results?The FLAVO study is funded by the European Union and is expected to present the results after the volunteers have completed the study in the summer of 2008. A summary will be published at humanstudies.ifr.ac.uk/

Current advice on effectiveness of polyphenolsTo conclude, while there is growing evidence to support an association between consuming dietary polyphenols and a reduced risk of cardiovascular disease, there is still considerable uncertainty in the precise mechanisms that underlie these health benefi ts. The challenge for the future is to undertake longer-term human intervention studies, such as the FLAVO study, coupled with analyses of target tissues to help defi ne public health messages for the future.

Apples are a good source of nutrients essential for health, low in fat and relatively cheap. So the general advice to consumers is to include the humble apple as part of your 5-a-day and as part of a varied, balanced diet. And in case you were wondering about the polyphenolics present in cider, a recent study analysing the phenolic content of apples for cider-making resulted in a very wide range in content depending on the variety of apple and processing method. However, unlike a glass of whole apple juice, this won’t count as one of your 5-a-day!

* Norwich Research Park, Colney Lane, Norwich, NR4 7UA

11

C. Difficile – the new hospital superbugPaul Giannasca – Project Leader for ACAM-CDIFF™, Acambis1

Until recently, anyone asked to name a hospital-acquired superbug was almost

guaranteed to say MRSA. Now, Clostridium difficile (C. difficile) is capturing the national headlines and there’s a growing recognition that this is an even greater issue for our hospitals. So what is C. difficile and why is it a cause for concern?

C. Difficile is a spore-forming bacterium widely present in soil and the intestinal tracts of animals. It is naturally present in approximately 60% of healthy newborns and infants, but in only about 3% of healthy adults, and is now the most commonly identified cause of antibiotic-associated diarrhoea2.

The presence of C. difficile in adults is asymptomatic (shows no symptoms) until the balance of the natural microbial flora in the gut is disturbed by antibiotic treatment, which enables C. difficile to colonise the intestine. The bacteria release two toxins, A and B, which cause the gastrointestinal pathologies known collectively as C. difficile-associated disease or CDAD. The symptoms of CDAD vary from mild diarrhoea and abdominal pain to fever and dehydration. Pseudo-membranous colitis, the most serious form of CDAD, is life threatening.

Hospitals and long-term care facilities have become reservoirs for this bacterium since the spores are difficult to eradicate and can persist for many years. Studies have demonstrated that around 1% of all patients admitted to hospital develop CDAD3 but the numbers are higher in at-risk groups such as the elderly, those with underlying illness, and those immuno-compromised by disease – e.g. AIDS or chemotherapy.

In the UK, compulsory reporting of C. difficile cases in people aged over 65 has

Papworth Direct launchedGPs can now refer patients with suspected heart conditions, breathlessness, or specific respiratory conditions directly to Papworth. They have created a new state-of-the-art cardiothoracic diagnostic centre. They have developed the service in consultation with GPs and Primary Care Trusts, to ensure they provide the service that patients need.

In a single half-day appointment a patient can have any of: Discussion with Clinical Co-ordinator on arrival, Nurse clinic, Specialist Registrar clinic, Repeat ECG, Exercise treadmill test, Echocardiography, Chest X-ray, Lung function tests, Spirometry, Computerised tomography, Consultant clinic, Nurse review, Clinic Co-ordinator discussion on discharge.

This innovative service puts an end to wasted or duplicated tests and the need for repeated attendance as all the required tests are performed during one visit wherever possible – a better patient experience.

Twas brilligI have already been a Papworth Direct patient, and received brilliant service. RM

Papworth VolunteersPapworth has about 120 volunteers who help with many aspects – helping patients and visitors find their way around, assisting on the day ward, greeter desk, ward visiting, helping in ward areas, assisting with general administration tasks, mobile gift shop trolley service, and running the shop. For further information contact 01480 364896.

been in place since 2004; and since April 2007 the Health Protection Agency has extended mandatory collection of data on cases in those aged 2 to 64. In 2006, there were over 55,000 cases of CDAD, which is estimated to have cost the NHS £250m in treatments and extended hospital stays4. In the European Union as a whole, the cost of CDAD is estimated to be £2.2bn5.

Despite the fact that CDAD is triggered by antibiotic usage, the disease is typically treated with one of two antibiotics and there is considerable concern that C. difficile might become resistant to these antibiotics. A recent article in Scotland on Sunday reported that the Health Protection Agency Centre for Infections had seen “evidence of a reduced susceptibility to metronidazole” during ongoing studies looking for potential antibiotic resistance by C. difficile6.

In an estimated 20-30% of patients receiving antibiotics for CDAD relapses occur, which require repeat treatment. This serves to continue the cycle of dependence on antibiotics. Alternatives to antibiotics are needed and preferred by doctors as they recognise that a properly balanced intestinal flora naturally protects against CDAD. Vaccination has recently been identified as the most logical option for combating CDAD by breaking the cycle of antibiotic usage7.

To date, Acambis is the only company to have tested a vaccine against C. difficile in human clinical trials.

Our vaccine, ACAM-CDIFF™, uses a toxoid-based approach, which has been used extensively in licensed vaccines against tetanus, diphtheria, and whooping cough. We aim to use the vaccine both to prevent disease recurrence and to protect people most at risk of CDAD before they enter a

high-risk setting, such as a hospital. So far, we have successfully undertaken

Phase 1 safety studies in approximately 200 subjects, which suggest that our vaccine is well tolerated and generates a solid immune response. Interestingly, in a small study conducted at Harvard Medical School in Boston, three patients who had suffered multiple relapses over a period of years recovered from CDAD after receiving our vaccine7.

Our next step is to take ACAM-CDIFF™ into the second of three stages of clinical trials, where we will initially test whether our vaccine can prevent relapse in people suffering from CDAD. CDAD is now a major public health problem and our goal is to progress this vaccine towards approval as rapidly as possible.

1 Acambis is a vaccine development company headquartered in Cambridge, UK. It conducts its vaccine research and development work in Cambridge, Massachusetts, US. 2 Centers for Disease Control (CDC). Clostridium difficile information for healthcare providers. August 2004. 3 CDC4 European Centre for Disease Prevention and Control. ECDC Summary of CDAD infection, 2005- 20075 The same as 46 http://scotlandonsunday.scotsman. com/scotland/Hospitals-on-alert-as- superbug.3715418.jp7 VacZine Analytics 8 “Clostridium difficile toxoid vaccine in recurrent C. difficile-associated diarrhea”; Gastroenterology 2005; 128:764-770

Ken and Janet Starling, Cambridge members, have been Volunteersfor 13 years.

The Papworth Direct Steering Group. L to R back row: Nick Skelton, Simon Roberts; front: Sarah Clarke, Laura

Cook, Richard Rowlands, Sue Mepham, Catherine Francis, & Jackie Younger.

12

BRITISH CARDIAC PATIENTS ASSOCIATION

SOME HEALTHY WEBSITES...

www.dh.gov.uk/en/index.htm www.bcpa.co.uk

www.nhsdirect.nhs.ukwww.bhf.org.uk www.diabetes.org.uk

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 852144Email: alec@aleckeeble.wanadoo.co.ukWebsite: www.lechampdelacroix.com/index.htmPost: Alec Keeble, KMEC Dereham, GTE House, Yaxham Road, Dereham, NR19 1HD

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

Smart heart holidays

Glossary terms – see page 14

1 Angioplasty2 Body mass index, BMI3 Embolism4 Nerves 5 Restenosis 6 Sino-atrial node7 Allergy8 Monounsaturated fat9 Arrhythmia10 Cholesterol 11 Haemoglobin 12 Prophylactic13 Risk 14 Aorta15 Analgesia16 Atheroma 17 Congenital

Jokes from the Internet suggesting what to look forward to as we get olderSent in by Stan Rushton

When three old friends were out walking, one said ‘Windy, isn’t it?’ The second said ‘No, it’s Thursday!’ The third said ‘So am I. Let’s go and get a beer.’

A hospital’s regulations said that when patients with certain disabilities were discharged they required a wheel chair. While working as a student nurse, I found a disabled gentleman sitting on his bed already dressed and with his suitcase. He insisted he didn’t need help to leave the hospital. After a chat about rules being rules, he reluctantly let me wheel him to the lift. On the way down I asked him if his wife was meeting him. ‘I don’t know,’ he said. ‘She’s still upstairs changing out of her hospital gown.’

18 Palpitation 19 Sedative20 Statins21 Cardiac arrest 22 Elixir23 Septicaemia24 Adjuvant25 Polyunsaturated fat26 Antibiotic27 Bile 28 Hormone29 Pulmonary arteries30 Ultrasound31 Enzyme32 Artery33 Saturated fat34 Anaphylaxis

35 Anaemia36 Pulmonary veins37 Carcinoma38 Overweight39 Bradycardia

We apologise for the error in the Feb / Mar journal crossword clue 13 across on page 14. It was correct on page 12.

13

Technology and using it to your advantageCorey Beecher

We are in an age where we cannot avoid technology for too long. Even the

simplest of our daily tasks are managed or monitored or started by the smallest of technology. Now there is a laptop computer that is only 4mm thick, about the same as a thin CD or DVD case. Remarkable really, “Where do they put all the doings?” as my Nan would have said.

So can technology help us in our drive to get and then keep ourselves fi t? You bet your bottom dollar it can. From the cheapest of stopwatches to a hi-specifi cation computer, they all have they uses in the race to stay fi tter.

Here I hope to show just a few of the ways in which we can use technology to our advantage. As with everything it does appear to be very frightening at the beginning, but given a few hours spent looking around you can fi nd the things that will suit you and your needs.

Let me take Walking as an example. This time of the year with the sharp frosts and slippery roads can cause problems of their own. Waiting until later in the day when the frost has melted and the sun has broken through the clouds give us the opportunity to see all that is beautiful with our world. Nature walks or just a few steps down by the river can brighten anyone’s day and lift our spirits – the sound of Spring and the smell of the fl owers.

Mmm, I’m losing my way a bit here. How can we motivate ourselves to open the front door? We all appreciate the walk after it has fi nished so you would think that it would be easy to become motivated. Us humans are competitive by nature, we all began life in the same way and we must have at the very earliest stage have been the fastest and best swimmer around (if you understand what I am saying) so we have all felt the elation of crossing that fi nish line fi rst. With that apart, competing against yourself is often very satisfying.

Walking that fi rst whole mile after we have been discharged from hospital, Oh, what a feeling. We soon forget how ill we really were, and things become mundane. We focus on having completed that walk route thousands of times, but do we change it? No! We even know how long it will take us to complete the course and plan our day from there on.

How about a bit more of a challenge? It does not have to be a big step. Just to walk the route the other way around or time it? How long does it take now? Practice walking a bit further each day.

Then, maybe, measuring your heart rate. You can choose to measure it the old

fashioned way, taking your pulse. Or, if you are as lazy as I am you could buy a Heart Rate Monitor. They currently cost between £30 and £400. The basic models will just measure the heart rate. For some reason we all want to take our blood pressure, but rely then on our doctors and consultants to reduce the blood pressure for us with medication. Why not measure our heart rates and take this information to the doctor next time we see them. They will be much more impressed. Explain how you are using a GPS system to track your walks and measure the distance, speed, and time of your walk.

The Nike kit comes with a 'gadget' to insert into their shoe

A Garmin Forerunner wrist worn GPS personal training device –

with heart rate monitor

You may by now be beginning to lose your doctor completely, unless he or she is a fi tness fanatic – as many doctors are and which could get their interest even more. The walking / running GPS systems are fast becoming a great way to check your walking / running. If you turn the last corner of your walk and can beat your fastest time by 30 seconds, this may get you walking a touch faster to beat that time. These systems are currently going for £99 to £300 and can be used for cycling also.

Using music is another way of passing the time you are out. You can forget the weather and listen to the latest Wogan download, or walk to the thrashing sounds of the Rolling Stones.

Nike, the footwear and clothing giant, has teamed up with Apple to bring you Nike+ – a system where you can listen to an iPod Nano and it will tell you your speed and distance as you walk along. The system costs £50 to £60 for the trainers, and an additional £20 for the Nike+ kit, and around £50more if you need the iPod Nano.

A Timex heart rate monitor

...and a 'transmitter' to slot into your iPod nano

Trying some of these technologies can act as a great tool, but please remember that all the information sold with the item is for the members of the public that are not taking any medication to lower blood pressure or heart rate. Therefore, don’t be alarmed of your heart rate is lower than the suggested guidelines.

Use these products only as a tool. Your heart rate is your heart rate and the only way to lower it naturally is to EXERCISE IT. So Bonjour, as Delboy would say, and I’ll write the next article with a second child on my lap, if all goes well.

Then just strap it on and get jogging!

14

Co-ordinators, Contacts and Affiliated Groups

Co-ordinatorsBedford: Eileen Marriott 01234 303834 Bourne: Win Felstead 01778 423869Cambridge: Bert Truelove 01223 844800Chester: East Suffolk: Anita Postle & helpline 01473 829777Halton: Stella Bate 01928 566484Lincoln: Brian Bigger 01522 880843Llandudno: Paul Williams 01492 540073 or 07717 474242Martlets, Sussex: George Beer 01903 763902Merseyside: Douglas Broadbent 07751 254444Peterborough: Gordon Wakefield 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 352 862

ContactsVice President: Alan Bowcher 01284 830542Belfast: John Hamill 028 9081 3649Cannock 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 Defibrillator ICD Group: James Lyons 01782 852509New Zealand: Neil Kerr enkay@wxc.net.co.nzOxfordshire: Chris Gould 01491 872454Swindon: Jim Harris 01793 534130

Affiliated 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 01902 755695

QuizHere are some definitions of terms. You are asked what are the terms? Or you could look at the list of terms on page 12 and try to define them!

Fold back this page down the middle to see the answers at the same time.

1 Passing a catheter along an artery to the heart. 2 The weight in kilograms divided by the square of the person’s height in metres.3 A part of a blood clot that breaks away and flows in the blood to somewhere else.4 Fibres that transmit sensory impulses.5 Becoming stenosed again after treatment such as a stent being fitted.6 The place in the heart where the electrical impulses for each beat begin.7 When a substance triggers an undesirable or over-reaction in the immune system. 8 Fat in olive oil, groundnut oil, and rape oil. 9 An abnormal rhythm of the heart.10 A white or pale yellow almost insoluble waxy chemical in animal tissue, blood, bile, and animal fats.11 The component of blood that carries oxygen from the lungs to other tissues.12 A drug or procedure to prevent disease.13 A calculated probability or chance of some future result or outcome.14 The large artery that emerges from the heart’s left ventricle, and carries blood towards the rest of the body.15 The inability to feel pain. It also means relieving pain by drugs.16 The term for the fatty material that builds up on the inside walls of arteries, particularly the coronary arteries.17 A non-hereditary condition existing at birth, usually an abnormality.18 A feeling resulting from an erratic heartbeat, often felt in the chest or stomach.19 A drug to reduce the activity of the central nervous system, making the patient somewhat sleepy. 20 Lipid-lowering tablets.21 The heart has suddenly stopped beating.22 A clear sweetened liquid forming the base of eg cough medicine.23 A bacteria infection that causes the immune system to go wrong and start to attack the body instead of giving protection.24 A drug that enhances the effect of another drug.25 Fat in corn oil, sunflower oil, safflower oil, and soya oil.26 A substance that kills a particular bacteria or fungi.27 A greenish to golden brown liquid produced by the liver and stored in the gall bladder.28 A chemical produced in an endocrine gland and transported in the blood to a particular tissue where it exerts a particular effect.29 The two arteries that take low-oxygen blood from the right ventricle to the lungs.30 Sound waves above the highest frequency that can be heard by a human ear.31 A protein that controls the rate of some chemical process in the body.32 A blood vessel in which blood flows from the heart to part of the rest of the body.33 Fat in dairy fat, red meat fat, coconut oil, and palm oil.34 A severe allergic reaction, with swelling of the throat or tongue, hives, and trouble breathing. When it strikes, life is at risk. So time is critical.35 A deficiency of red blood cells and/or in their haemoglobin content.36 The four veins that take oxygen-rich blood from the lungs to the heart.37 A malignant tumour, or another name for a malignant cancer.38 BMI 25 to under 3039 Abnormally slow heart rate, usually below 60 beats per minute.

Glossary updated

The Glossary has recently been updated and is available on the BCPA website.

As previously BCPA give permission for copies to be stored and made within the BCPA and any UK

hospital; and these hospitals may give printed but not electronic copies to patients provided the

source and copyright is acknowledged on the copies – eg include the page footer.

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MEMBERSHIP

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Whatever your interest it may be that becoming a member is something you have never considered.

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 considered. May we invite you to consider it now. We would be delighted to hear from you.

Bristol-Myers SquibbPharmaceuticals Limited

Supports the work of the

BRITISH CARDIAC PATIENTSASSOCIATION

Further information from:Bristol-Myers Squibb Pharmaceuticals Limited,

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Telephone Number: 01895 523000 Fax: 01895 523010

Email: external.affairs@bms.com