Issue 184June / July 2012

Journal BCPA

THE PATIENT

AND CARERS INDEPENDENT

VOICE The official magazine of the

British CardiaC Patients assoCiation

www.BCPA.co.uk

admin@BCPA.co.uk

How do we ‘stat up’?A Papworth Hospital patient’s story

Aspirin also helps cancer preventionAtorvastatin cheaper so more to be prescribed

Memoirs of a Voluntary Worker 1981-1996 – Fred RoachA package of insurance products as individual as youRecipes: Tomatoes and rice gratin, Soft fruit pudding

Could readmissions within 30 days be reducedPatients should have a voice too!

‘The Truth About Transplants’Rebalancing the planet

Talks offeredProfessor John Wallwork CBE FRCS (on right) takes over BCPA presidency from Sir Terence English KBE FRCS

Contents3 From Me to You – Keith Jackson3 Ricky’s Quickies: Atorvastatin cheaper so more to be

prescribed; ‘The Truth About Transplants’ book; Could readmissions within 30 days be reduced; Rebalancing the planet – Richard Maddison

4–5 News from around the Areas 6 Aspirin also helps cancer prevention – A summary by

Richard Maddison of research by Peter Rothwell7 A package of insurance products as individual as you

– Unique Insurance staff8–9 A Papworth Hospital patient’s story – William Gordon9 Recipes: Tomatoes and rice gratin, Soft fruit pudding

– Janet Jackson10 Talks offered – Alan Thomas11 Dates for your diary11 Patients should have a voice too! – Nadine van Dongen,

Managing Director, PIP Health13 How do we ‘stat up’? – Corey Beecher13–14 A New Beginning: Memoirs of a Voluntary Worker

1981-1996 – Fred Roach – Keith Jackson14 Crossword14 Co-ordinators, Contacts and Affiliated Groups15 How to join – Membership form16 Servier. Unique Insurance

NATIONAL HELPLINE 01223 846845

DonationsWe acknowledge here donations over £50 unless the donor wishes otherwise. The BCPA really needs the donations.Mrs Joan Edmundson 90th birthday £325 to Papworth Hospital

Fund. Mrs Edmundson received a new valve 24 years ago.£310 in memory of Margaret London, an active member of

Peterborough Area Group.Mrs Helen Whitehand has sent a further £55.00, added to her £315 80th birthday money acknowledged in the April Journal.

Please send donations as cheques payable to BCPA, to BCPA Head Office, 15 Abbey Road, Bingham, Notts NG13 8EE

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 Head Office. Normal closing dates are 20th of an even month –20 June, 20 August ... Please phone me before that date if you may be late.

I’m really appealing for articles from members.

Do 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 first phone or email Richard Maddison as p14, who will try to find 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.

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Annual General Meeting Weekend 11-13 May 2012

The photograph on the front cover and those below show BCPA members enjoying a weekend together at the Menzies Hotel, Cambridge, during the Annual General Meeting and at the Gala Dinner held to celebrate 30 years of the Association.

Having been President since the formation of the Association, Sir Terence English KBE FRCS handed the presidency over to Professor John Wallwork CBE FRCS to acclaim at the Annual General Meeting. Our thanks go to Sir Terence for the support he has given over this long period and we look forward to working with Professor Wallwork as the Association goes forward.

Prior to the AGM Professor Wallwork gave a most interesting illustrated talk ‘Cardiac Surgery Then and Now’ showing the development and advancement in treatments over the years.

At the AGM Dr Richard Maddison was re-elected as Vice Chairman and Dennis Atkinson as an Association Trustee.

Ricky’s Quickies - Richard Maddison

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From Me to YouKeith Jackson, National Chairman

Annual membership renewals and subscriptionsWe value all of our members and thank those of you who have sent in your annual subscriptions. Subscriptions became due on the 31st March.

This is the final Journal reminder for overdue annual membership renewals. If your mailing label shows the number 12 then your membership lapsed on the 31st March 2012.

Encouraging you to continue as a member of the Association, to continue to receive your six issues of the Journal each year and, if you are able, take part in area group activities, we trust that you will renew. Please complete either the renewal form enclosed with your April/May Journal or use the form printed in the back of this issue. Having completed the form please send it with your subscription to Head Office as soon as possible.

It is pleasing to note the number of members who have opted to change to Life Membership thus saving themselves the annual chore of renewals. If you wish to

make this change then please complete the form and send in the appropriate details.

Do please assure yourself that you have renewed your membership. As an Association we value having you as a member and do not wish to lose contact.

Awareness and Area Group eventsAs we move into the summer season, Area Groups up and down the country have a number of activities planned including attendance at village fêtes, disability awareness days, and other events. May I urge you all, members and readers of the Journal alike, that if you are near to an event please go along and have a look. Perhaps take the opportunity to make yourself known and join in with the occasion. You will be assured of a warm welcome.

BCPA website www.BCPA.co.ukNot all members have access to the web, but an increasing number now do. If you are one of that growing number and have not yet looked at what is on our website may I urge you to do so.

Amongst a growing range of information you will find the following.• A membership application/renewal form

should you wish to use it• Past copies of the Journal• Newsletters from some of the BCPA Area

Groups• Travel and other insurances• General health information• Factsheets on a range of heart issues • An extensive Glossary.

Our website continues to attract attention. Why not become one of that growing number of people using this source?

Holiday and other insurances Thank you to those who have taken advantage of insurance through Unique in past months.

If you have not yet given them an opportunity to provide a quote maybe you could do so when seeking your holiday or other insurance cover. They cover the whole range of insurance needs.

To contact Unique for a no obligation quote please call 01603 828246 or visit the BCPA website at www.bcpa.co.uk and look at the insurance section. See page 7.

Colin ReadmanWith sadness I record Colin’s passing on Saturday 28th April. He was Chairman of the Bedford Area Group for many years. The funeral will have been on 16th May at St Andrew’s Church, Bedford. We send condolences to Tessa and their three children Joanne, Colin and Catherine.

Colin Readman at Papworth Fete 11 June 1994

Atorvastatin cheaper so more to be prescribedAs I expected1, the price of atorvastatin has dropped – by 93% after its patent held by Pfizer ended on 7th May, and a legal block on prescribing generic versions was lifted.2 The massive drop in cost will save millions for the NHS and is likely to herald a sea-change in GP management of high cholesterol, with new patients needing a statin given atorvastatin rather than simvastatin.2

Sources. 1 RM Quickies BCPA Journal 182 February 20122 Pulse Today 8/5/2012.

‘The Truth About Transplants’ bookPaulette Pratt, an award-winning medical author, has written this introduction to transplantation, which may be useful to patients and their families, and to relevant medical and nursing staff.

The book charts the history of transplantation, tackles the issues of organ supply and donation, and distinguishes patients suffering from brainstem death from those in irreversible cardiac arrest. It traces recipient experience from pre-op investigations to the operating theatre and the months and years afterwards. Paulette Pratt The Truth About Transplants. Janus Publishing. 162pp, A5 size, ISBN 978-1-85756-743-9, £14.95.

Could readmissions within 30 days be reducedUS policymakers thought of trying to reduce hospital readmission rates, as readmissions are common and costly.1 To reduce costs and

improve care, Congress directed that hospitals with poorer than expected 30-day readmission rates should be penalised. One’s initial reaction might be that this is a good idea. But NEJM authors say this misguided for three reasons1. The situation is not simple. 1 Only 12–20% of US readmissions within 30 days of discharge

are preventable.1 Many readmissions depend on factors that are outside the hospital’s control – patient characteristics, mental illness, poor social support, home situation, and poverty.1 Only those in the first three days are more likely to be caused by the hospital. So 30 days is the wrong criterion.

2 Reducing injuries, infections and mistakes in hospitals, and improving coordination with out-of-hospital services should reduce readmissions.1 Improved outpatient care helps to keep the healthiest patients from being hospitalized in the first place; so readmission rates rise – being the less healthy.

3 Aiming to reduce readmissions may conflict with patient safety1 and survival. Hospitals with lower mortality rates among patients with heart failure have higher readmission rates. After keeping more of their patients alive such patients are more likely to be readmitted. High readmission rates can be from low mortality rates and/or good access to hospital care.

Source 1 N Engl J Med 2012; 366:1366–1369, 12 April 2012.

Rebalancing the planetIssues of world population, resources, consumption patterns and health are rarely discussed together in a scientific and systematic way. Papers for UN Conference on Sustainable Development on June 20–22 in Rio de Janeiro, Brazil, hardly mention health and consumption. Developed high-income nations overconsume, and the bottom billion of the world population need both more calories for minimum dietary requirements and more resources to avoid poverty and poor health.2 Source 2 The Lancet Volume 379, Issue 9827, Page 1678; doi:10.1016/S0140-6736(12)60700, 5 May 2012.

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News from around the AreasLocal news from some of our Groups

Dates for your diary are on page 11, and the list of Co-ordinators and contacts on page 14

Cambridge Bert Truelove 01223 844800

Halton Stella Bate 01928 566484From Margaret Hughes

Sadly I report that Ken Starling died on 28th April 2012.

Ken Starling was in the Black Watch during the 39–45 war, and after the war he gave a lot of service to the Army Cadet Force.

He had surgery at Papworth in 1995 and quickly became involved as a volunteer in the Papworth shop from 1996 until 2010. He was Secretary of our Cambridge Area Group for six years, retiring in 2006. Janet and he were married 58 years with a family of three sons and a number of grandchildren. The funeral is arranged for Friday 18th May at the Salvation Army Citadel, Cambridge, at 1.30pm.

I’m afraid that we have been very lazy in not doing much with the Group over the last two months – perhaps it has been the cold weather.

At the time of writing it is just a few days before our April Group meeting, when we intend to have a quiz evening, which should be great fun. It also gives a chance for people to have a nice relaxing talk together – something I think is very useful if you live on your own.

Once again we had our Annual General Meeting late in February, and sadly I have to report that no younger people came forward to take office, so back to the old brigade – and some of us are old.

Papworth trolley being boughtDuring the last few months we have been discussing the purchase of a trolley for Papworth Hospital. The volunteers who take useful items around to the wards on behalf of the Papworth shop are finding the task increasingly more difficult, because the hospital is built on slopes. They have a trolley that goes around the hospital with refreshments for staff, so we have purchased the same design for the shop volunteers, with the support of the Norma Jackson Fund and our own funds. This was delivered in early May. I know that the volunteers were looking forward to using this.

The trolley is a black motorised Flexicar Snack Trolley, with a top full-width shelf with dividers. The 2nd and 3rd level shelves are half width with sloping shelves and dividers.

It has a removable lockable cash drawer and a sweet rail.

It cost £3594 + VAT. Papworth Hospital kindly agreed to pay the VAT. The £3594 comes half from Cambridge and half from the Norma Jackson Fund.

National AGM weekendBy the time you read this the National Annual General Meeting will have been held in Cambridge. I feel sure that this will be most successful. It will be nice to remember Fred Roach, and not forgetting Norma Jackson who helped him in his visits. They both gave so much encouragement when we needed it in those early days of open-heart surgery. We hope June Roach will be present for the Saturday afternoon and evening.

In the evening we have Jennifer Thompson and friends to entertain everyone after dinner, something that promises to be most enjoyable.

Other activitiesWe have made arrangements for our summer trip to Southwold and the theatre, of course stopping for lunch at the Fox in Darsham. It is always nice to catch up with Brian, Nell and their staff, and enjoy the welcome we always receive from them.

A daughter of a Cambridge Group member is running the Edinburgh Marathon at the end of May to support the British Heart Foundation. Needless to say she is looking for sponsorship, which can be forwarded to me. Those of us who have had surgery owe our good health to the British Heart Foundation for research carried out over many years.

May I wish you all a pleasant summer, and keep well.

The Halton Group’s AGM was held on 2nd March. All the committee were returned with the addition of one new member, Betty Rogers. We welcome Betty on to the committee.

After five years Margaret Rimmer has decided to stand down as Secretary. We thank her sincerely for all her work and dedication, and hope she will enjoy a well-earned rest. She does, however, remain a committee member.

For our Easter meeting on Thursday 5th April we had a games day and held a raffle with lots of prizes. We also had a sale of jewellery made by Mrs Ann Buckly, one of our members.

We are planning a trip to the Imperial Hotel, Llandudno, on 19th June. We will

have lunch at the hotel and spend the afternoon having a look round the town. If the weather is unkind, we are able to stay at the hotel and use their facilities. The coach will probably be full by the time you receive this – contact Beryl McCann at a Thursday meeting.

Joan selecting some jewellery

Playing indoor curling

Pam choosing her prize Ann choosing her prize

Stella with her raffle prize

At our AGM in February Mr Ridley talked about new treatments which were being done and about moving to the new buildings. He also thanked the Hospital Team and our BCPA Group for their support over the last year.

Wednesday 20th June is our annual midsummer trip to see the Lincolnshire Wolds with all their beauty and wealth of history, and with a bonus of a coastal stop for lunch. Depart Lincoln 10.00 am at North Hykeham Methodist Chapel, returning 6.30 pm. Cost £9.00 per person. To book contact Julie Treanor (01522) 685362.

On Monday 13th August we have a coach to Maritime Leisure Cruises, Boston, departing 10.30am from the Methodist Church North Hykeham to catch the ebb tide at 1.30pm. Lunch will be served in the boat saloon – ham, beef, new potatoes, various salads and choice of sweets, with a licensed bar during the five-hour cruise on the Wash. Which direction we take may depend on the sea conditions – if dangerous then we will go inland up the river Witham to Tattersall Bridge. Coach, boat and lunch included in the provisional £18.00 per person. To book contact Julie Treanor (01522) 685362.

LincolnBill May 01522 885756

A similar trolley without sweet rail or

motor

Our hosts at the Cherry Tree Public house, Jess and Ann Caprio, decided to retire on April the 1st, having run the pub for 16 years. We now look forward to meeting our new hosts. Don’t forget, everyone will be made welcome at our monthly get-together on the third Thursday in the month.

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Staffordshire Eddie Coxon 01782 416143

Wirral George Bird, 0151 653 4530

South East London & Kent Chris Howell 01689 821413

West Suffolk & South West Norfolk Brian Hartington, 01284 762783

Peterborough Gordon Wakefield 01733 577629

It is with sadness we have to report the death of one of our long-standing and regular attending members. Margaret London passed away in

February quite unexpectedly, only a few days after our February meeting. We will miss her.

A shared collection at her funeral presented the Papworth Fund with a sum of £268; with a similar amount given to the Sue Ryder Care home, Thorpe Hall. Margaret would have been very pleased with that.

Since the last report we have had another excellent meal on 13th March at the Toby Carvery, Bromley Common.

The next Carvery meal will be on Tuesday 12th June at 7.30 for 8.00. If you do not usually attend and would like to, please contact me.

The Beetle Drive due to be held on 13th April was postponed until a later date. The Hot Cross Buns evening continued, and members were ‘bored’ by me and Ray showing them our holiday photos of South Africa.

Our next meeting at the Victory Social Club will be the Quiz night on the 12th October.

Hi Folks. I hope you are all well. On Tuesday 28th February we had our AGM. Our Chairman Mr P D Ridley gave us an update on the new medical teaching they were doing, what was happening at our new hospital, and that the cardiac department would be moving during the end of March 2012 to the UHNS, which is the old city general site, The same committee members as last year were re-

elected. After the meeting Eddy Coxon announced

that George Austin and Anna Collier, two of our members, had become engaged today. George met Anna during his hospital visiting, and they plan to wed on the 24th November 2012.

Our next meeting was March 27th at which Bill Harrison gave us a very interesting talk on Ancestry and how to start our own family tree. We had our usual raffle – a good evening was had by all.

There is a trip to Bury Market on Wednesday 6th June – please contact Malcolm or Mary Lyth on 01782 398676.

Unfortunately we had to postpone the AGM, and due to my illness I have not yet arranged a new date. I am going into hospital in early May, and we hope to arrange a new AGM date soon.

We intend to arrange a Christmas dinner for the 3rd of December 2012 – time and menu to be arranged.

From Barrie Harding 0151 608 6212Hello everybody from your friends in the Wirral Group.

As I write these notes towards the end of April we are experiencing some severe weather conditions and it is not at all like Spring. It is bitterly cold and gale force winds are driving incessant rain to make things very unpleasant out there.

Getting on to Branch matters, in March we had a visit by Maureen Ellison from the Appeals Office at the Clatterbridge Centre For Oncology. Maureen spoke to us about the work of the unit and we thank her for coming to visit us. Unfortunately only six members were present on the night, which was disappointing, although we do appreciate that several regular members were unable to attend due to health problems.

We had already given some thought to holding a meal at our April meeting but due to a lack of interest this did not materialise. We rearranged a quiz and beetle drive but as only seven members arrived on the night we had to abandon this and we therefore held a meeting between those present to discuss the problems of poor and falling attendances

particularly when we have a speaker on the night.

A suggestion was made that we hold our meetings during the daytime but this was rejected as some members would be unable to attend. Another suggestion was whether we would consider moving to bi-monthly meetings but, again, this was rejected as we felt that it would only serve to make the position worse. On top of this George Bird has received a letter from Heswall Hall Community Trust where we hold our meetings to advise an increase in the cost of room hire to £28.50 plus a surcharge of £25 if we need to use their staff on the night, making a total of £53.50 if we require that facility. We unanimously agreed against the surcharge and have accepted a swipe card to let ourselves in and out and with no other service. However, bearing in mind the current small attendances we did look at the possibility of holding our monthly meetings in a pub with a meal; or as some of those present have access to church hall facilities that may be a viable option at some point if we are unable to increase attendances to reasonable levels.

Although there were only a few of us present we enjoyed a lively discussion (and a cuppa!) and were unanimous that the Wirral Branch will survive no matter what steps we have to take to secure this.

Please do come along and support us. You know where we are and when we meet. Details of our events until early 2013 are shown in the Dates For Your Diary in this Journal and we advertise free of charge in the Wirral Champion every month – thank you to John Birtwistle and his staff at the Wirral Champion.

On other matters, Dr Pip Jones, one of our staunch supporters, is no longer able to attend our meetings due to health problems but he would welcome a visit from any of our members who know him. If you would like to visit Pip please contact me.

Once again Steve Legge, our member, is taking part in the Wirral Coastal Walk on 27th May and would appreciate your sponsorship. Thank you Steve.

On behalf of the Wirral Group I will say Cheerio for now; and look after yourselves.

Crossword answersAcross 1, 4 Living Things 7 Era Anagram EAR 9 Biologist 11 Toes 12 Ever Two meanings 14 Sac Two meanings 15, 17 Chestnut Tree Song: Under the spreading chestnut tree 19 Bird 21 Skippers Two meanings 24 ICT 25 Emma From itEM MAde 28 Pile From reversE LIPid 30 Adaptable Two meanings 33 Its Two meanings 34 Salmon MONSAL anagram 35 Horses Down 1 Lactic Two meanings 2 Irises Two meanings 3 Gel Two meanings 4 Tag Two meanings 5 Insect

IN SECTions 6 Source Two meanings 8 Rod Two meanings 9 Be oBEse 10 TV in whaT Viewers 13 Angst Two meanings 14 Strip Two meanings 16 Ear Two meanings 27 OTT 18 Roe Two meanings 19 Breeds Two meanings 20 Diadem Two meanings 22 Poplar anagram POLAR PARTS without the letters STAR 23 Shells 26 Ma part of EmMA 29 Ie bIEnnial 31 Pin luPINs 32 Ash

With sadness we have to inform you that our member Ella McMullen has died.

Ella had been ill for some time and she passed away peacefully on 3rd May 2012.

We send our sympathy, prayers and thoughts to Ella’s family and her many friends at this sad time.

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Aspirin also helps cancer preventionA summary by Richard Maddison of research by Peter Rothwell*

Readers may remember the article on Peter Rothwell’s work on how Intermittent high blood pressure predicts troubles, in the BCPA Journal for June/July 2010.4

His recent research findings1,2,3 hit the headlines around 21st March 2012. Peter gave a summary on Today on BBC Radio 4. Essentially low-dose aspirin given daily to heart patients for five years or more also helps ward off various cancers – especially of colon.

The Daily Mail quoted Peter as follows.5 ‘As a father of three young daughters all

aged under ten, I try to look after my health, and taking a daily aspirin is an important part of this. I take a low-dose pill, which is equivalent to a so-called junior aspirin (75mg a day rather than the usual pain-killing dose of 300mg). I’ve been doing this for a few years. I know about the possible side effects, but the evidence suggests the advantages of taking aspirin are greater than the disadvantages in my case.

‘I don’t have a history of indigestion, which would otherwise make me more susceptible to gastrointestinal bleeding. The risk of a bleed reduces if someone has been taking aspirin for three years anyway, probably because those at risk have already stopped taking the pill by then.

‘Cancer becomes more common in people aged 50 and over, and so it might make sense to start taking aspirin as a preventive treatment in the late 40s, and to stop at around 65, when the risk of bleeding increases.

‘I don’t want to suggest that people rush out and buy aspirin, but I think it’s at least worth thinking about for healthy, middle-aged people like me.’

Heart disease benefits knownThe benefits of low-dose aspirin to patients who have had heart disease were already well established.

A research trial published in 1974 found that patients who had already had a heart attack had lower risks of dying or further heart troubles if they took low-dose aspirin6; and many subsequent published results have confirmed that7.

Findings are for heart patients, not general populationThe findings below1,2,3 are not based on the general population. They come from analysis of trials of aspirin on patients who already had some history of heart disease or other vascular disease. [Vascular means involving blood flow in arteries and veins]. Thus they don’t suggest that aspirin would be of benefit to the general population as a

primary prevention to reduce the future risk of cancers among those that are healthy. [Primary prevention means trying to prevent a disease before it happens.]

Cancer risks reducedDaily aspirin was already known to reduce the long-term risk of death due to cancer as well as to heart and circulation. However, the short-term cancer effects are less certain, especially in women. The effects of aspirin on cancer incidence are largely unknown. The time-course of cancer risks and benefits in primary prevention were unclear.1

Peter Rothwell and his team studied cancer deaths in all trials of daily aspirin versus control; and the time-course of effects of low-dose aspirin on cancer incidence and other outcomes in trials in primary prevention.1 [Here control means that the patients were randomly allocated either to a group who received aspirin or to a control group who received a placebo dummy pill.]

The team studied individual patient data from randomised trials of daily aspirin versus no aspirin in prevention of vascular events. Death due to cancer, all non-vascular death, vascular death, and all deaths were assessed in all eligible trials. In trials of low-dose aspirin in primary prevention, the team also established the time course of effects on incident cancer, major vascular events, and major extra-cranial bleeds, with stratification by age, sex, and smoking status.1

The team’s work brought together various previous randomised controlled trials and found patterns. In 34 such trials involving data on 69,224 participants, allocation to aspirin reduced cancer deaths over five years or more. In 51 such trials there were also fewer non-vascular deaths overall.1

The reduced risk of major vascular events and of cancer by taking aspirin was initially offset by an increased risk of major bleeding, but effects on both outcomes diminished with time, leaving only the reduced risk of cancer from 3 years onwards. Patient deaths from major extra-cranial bleeds were also lower on aspirin than on control.1

Alongside the previously reported reduction by aspirin of the long-term risk of cancer death, the short-term reductions in cancer incidence and deaths and the decrease in risk of major extra-cranial bleeds with extended use, and their low patient deaths, add to the case for daily aspirin in prevention of cancer.1

Malignant tumoursDaily aspirin as given to heart patients also reduces the long-term incidence of some

adenocarcinomas.2 [Adenocarcinoma is a malignant tumour in glandular tissue – breast cancers are often adenocarcinomas]. But the effects on mortality due to some cancers appear after only a few years, suggesting that it might also reduce growth and/or metastasis.2 [Metastasis means the spread of a cancer from the original tumour to other parts of the body by tiny clumps of cells carried by the blood or lymph.]

The team established the frequency of distant metastasis in patients who developed cancer during trials of daily aspirin versus control.2

Allocation to aspirin reduced the risk of distant metastasis on all cancers taken together; adenocarcinoma; and other solid cancers – due mainly to a reduction in the proportion of adenocarcinomas that had metastatic versus local disease.2 The effects were independent of age and sex, but absolute benefit was greatest in smokers.2

That aspirin prevents distant metastasis could account for the early reduction in cancer deaths in trials of daily aspirin versus control. This finding suggests that aspirin might help in treatment of some cancers and provides proof of principle for pharmacological intervention specifically to prevent distant metastasis.2

Colon and rectum cancer from 20-year studiesBy 2007 researchers knew that high-dose aspirin (≥500mg daily) reduces long-term incidence of colon or rectum cancer, but adverse effects might limit its potential for long-term prevention. In 2010 the long-term effectiveness of lower doses (75–300mg daily) was still unknown. The team assessed the effects of aspirin on incidence and mortality due to colon and rectum cancer in relation to dose, duration of treatment, and site of tumour.8

The team followed up four randomised trials of aspirin versus control in primary and secondary prevention of vascular events and one trial of different doses of aspirin.8 [Secondary prevention is to try to stop a disease getting worse, or at least slow down its progress.]

By analysis of pooled individual patient data, the team established the effect of aspirin on risk of colon and rectum cancer over 20 years (mean 18.3) during and after the trials. They found that those taking aspirin averaged overall had reduced 20-year risk of colon cancer, but not of rectal cancer.8 Also 30mg aspirin daily didn’t help prevent colon or rectum cancer.

Benefits increased with longer treatment. Aspirin taken daily for at least 5 years at

7

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doses of at least 75mg reduced long-term incidence and mortality due to colon cancer and also of rectum cancer.8 Doses greater than 75mg daily were no extra benefit here. [Here daily means the team excluded various trials where patients took aspirin on alternate days, which found that such patients did not have reduced risk of colon or rectum cancer, overall cancer or related mortality.9] Benefit was greatest for cancers of the proximal colon [the right side that joins to the small intestine], which are not otherwise prevented effectively by screening with sigmoidoscopy or colonoscopy.8 [The sigmoid is the S-shaped part of the colon near where it joins the rectum; and oscopy means viewing with a scope inserted.]

Recommend aspirin for cancer prevention?The above gives added weight to hoping that 75mg daily aspirin might reduce various cancers – particularly of colon and rectum.3

It seems to need at least 5 years of taking that aspirin to have the desired extra effects of reducing risks of invasive cancer or death. Aspirin might have an effect on the growth and spread of established tumours as well as on their initiation. Hence the value of the analysis of the 20-year studies. Among patients who presented with localised cancer, those assigned aspirin had a lower risk of developing metastases subsequently, particularly if they continued the aspirin after the cancer diagnosis.3

Caveats and conclusionsThe team’s analyses were of previous researches on patients already on low-dose

aspirin in primary prevention. They excluded researches that were of patients in alternate-day aspirin, ie not daily as explained above. The team chose to do so because of possible differences in the biological effects of alternate-day rather than daily aspirin. Whether such differences, while plausible, actually happen is far from conclusively established.3 The original researches were designed to study cardiovascular outcomes, so in them information was not obtained about cancer screening or surveillance. Some analyses were limited by the quality of the data.

These caveats notwithstanding, the team’s research shows quite convincingly that aspirin seems to reduce cancer incidence and death across different subgroups and cancer sites, with an apparent delayed effect.3

Additionally, aspirin’s known benefits in vascular disease and known toxic effects in causing major bleeding emerged in the short term, but diminished over time. Thus, for most individuals, the analysis seems to favour aspirin’s long-term anticancer benefit.3

* Prof Peter M Rothwell FMedSci, Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, John Radcliffe Hospital, Headington, Oxford OX3 9DUSources 1 Peter M Rothwell et al. Short-term effects of daily aspirin on cancer incidence, mortality, and non-vascular death: analysis of the time course of risks and benefits in 51 randomised controlled trials. The Lancet 2012 Published Online

March 21, 2012 DOI:10.1016/S0140-6736(11)61720-0 ; and its references2 Peter M Rothwell et al. Effect of daily aspirin on risk of cancer metastasis: a study of incident cancers during randomised controlled trials. The Lancet Online March 21, 2012 doi:10.1016/S0140- 6736(12)60209-8; & The Lancet, 379, 9826, 1591–1601, 28 April 2012; and its references3 Andrew T Chan et al. Are we ready to recommend aspirin for cancer prevention? The Lancet Comment Published Online March 21, 2012 doi:10.1016/S0140- 6736(11)61654-1; and its references4 Richard Maddison. Intermittent high blood pressure predicts troubles. A summary by RM of research done by Peter Rothwell. BCPA Jnl June/July 2010. J172p8-95 Daily Mail 27/3/20126 Elwood PC et al. A randomised controlled trial of acetyl salicylic acid in the secondary prevention of mortality from myocardial infarction. BMJ 1974;282: 436-40. 7 Peter Elwood. The first randomized trial of aspirin for heart attack and the advent of systematic overviews of trials. J R Soc Med. 2006 November; 99(11) 586–588; and its references.8 Peter M Rothwell et al. Long-term effect of aspirin on colorectal cancer incidence and mortality: 20-year follow-up of five randomised trials. The Lancet 376, 9754, 1741– 1750, 22 Oct 2010; & 20 Nov 2010 doi:10.1016/S0140-6736(10)61543-7; and its references9 See 3 and its refs 12,13

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A Papworth Hospital patient’s story William Gordon, BCPA member

I was born on 7th March 1935 in an Aberdeenshire village. I had a sister Mary three years older than me who had a problem at birth requiring an operation on her hips, and as this was long before the National Health Service (NHS) all medical attention had to be paid for. I also have a brother three years younger than me.

When Mary was five years old a doctor was found who would try the surgery but it went wrong and she was paralysed from the waist down. Hospital conditions in those days were far from hygienic. Patients with a variety of illnesses could be in the same ward and the night time toilet was a bucket on the centre of the ward floor. Pre-NHS all treatments had to be paid for.

My father was wounded and his lungs seriously burned by a war gas in the First World War. He spent some time in hospital and after recovery became a nurse. He met and married my mother who was also a nurse.

As a nurse my mother was allowed to care for Mary in hospital but in the unhygienic conditions both contracted a series of infectious diseases such as scarlet fever. During one of these infections my sister suffered a stroke which paralysed her right side too. They both recovered but Mary was almost completely paralysed. The local carpenter made a wheelchair for her. When she became too much of a handful for my parents she was admitted to an asylum.

Many years on, following a tragic death in the asylum and when cruel practices were revealed, Mary was moved, happily, to a new purpose-built care home for the disabled. She died aged 50. During the bad times I was often cared for by relations or other nursing staff.

I also had a serious defect at birth but thankfully survived numerous health problems and had to work and play harder than my colleagues while trying to be as good as them. I joined the Boys Brigade at 12 and rose to the rank of Lieutenant.

Career and healthWhile still a Brigade boy and in a five-year engineering apprenticeship I joined 2612 Squadron Royal Air Force Auxiliaries. I became a Senior Aircraftsman gunner, driver, and signaller; and after National Service induction training retained that rank. I served abroad in No 63 squadron. I was invited to apply for promotion but was worried that my underlying health condition could let my team mates down. On completing my National Service I applied for release, and with the help of my father in law who also worked on the RAF station this was granted.

I was working as an engineering fitter in an electric meter factory about 1967 when a mobile X-ray unit came to check all the staff for tuberculosis. They found that I had a mis-shaped and enlarged heart with an irregular beat. Ipswich hospital took me on board with annual checkups by Dr Barry. When Dr Barry retired in 1979 Dr Petch came from Papworth Hospital to take the clinic in Ipswich and invited me to have tests done at Papworth. I was very keen to have them. The tests revealed I did not have a proper aortic valve. Instead of the three opening flaps that let blood pump through but not back when the pump stroke ended I had a disc of tissue with a hole in it that let blood pump through but also some flowed back to the heart.

1 was checked for suitability of available replacement valves such as pigskin, plastic or metal. Each type had a time scale – for example a pigskin valve guarantee was 10 years and a metal valve up to 40 years. Thankfully a metal valve was deemed suitable and I had a Bjork Shiley metal valve implant. This procedure was done by Mr B B Milstein and his team on the 7th June 1982 at Papworth Hospital.

When my wife told Mr Milstein he had magic in his hands, he replied something like ‘I am only a plumber.’ She replied ‘You are a real Gentleman Sir.’

Papworth HospitalI entered Papworth Hospital on Thursday 3rd June 1982 for a Bjork Shiley aortic valve implant on Monday 7th June and had a weekend to learn what would be needed of me.

In the Surgical Unit Top Floor Ward upstairs in the big house I was encouraged to help my fellow patients recovering from their operations – and learning the procedures certainly helped to make my operation and recovery easier.

The weather was warm and sunny, allowing the fire door to remain open. At times I sat there in the sun reading one of the ward’s books, First Overland by Tim Slessor, printed in 1975, about the Oxford and Cambridge Overland Expedition to Singapore involving 6 men and two Land Rovers.

When looking out of the ward window at the old building opposite I read a plaque inscribed thus.

‘Sir German Siros Woodhead KBE 1855-1921 Professor of Pathology in the University of Cambridge and one of the founders of Papworth Colony. A very gallant gentleman.’

At 9pm I was examined by Dr Hodder who let me listen through his stethoscope

to my heart wheezing, and told me my operation would be on Monday morning – a metal valve that clicks but is best and lasts longer. How true and kind Sir! Tomorrow he will show me the Intensive Care Unit (lCD) and will answer any questions I care to ask – X-ray and ECG tomorrow perhaps.

My personal possessions such as my watch, keys, driving licence and money were handed in and I received a receipt for them signed by E H Steele. That sounded like ‘Steal’ and raised a smile.

I believe my ward fellows were: • Mr Bill Wood, a Cambridge Solicitor

aged 74 in the next bed to mine (my bed was behind the door). A lovely man full of fun and we got on very well. He gave me his address and phone number therefore I was very sad when I learned that he had died on 20th of June while convalescing in Mundesley.

• Mr Ken Evans from Hants, who was quite ill.

• Mr Cook who was from near Diss.• Mr Varney from Great Yarmouth.

Next day, Friday morning, I had an X-ray and Mr Milstein came to see me.

After some rain it was sunny again. I walked to the pond, and watched the fish and the birds flying around there. I spoke with Mr David Haggar, a heart transplant patient; and Mr Peter Hart, also a transplant man then a Norfolk man with a lung problem. [Peter Hart died in November 2011, 29 years after his transplant, and thus far is Papworth’s longest transplant survivor.]

Still Friday, indoors, at tea time the TV was switched on for the first time but by then it was stormy and the lightning interrupted it. The lightning also cut out the electricity but the emergency power immediately took over. We switched the lights off.

The lightning interfered with the monitors, especially Mr Varney’s, and caused the staff to run around re-setting them.

The staff were brilliant, not just dealing with the effect of the lightning but in all their work. They were Sister Barker, Staff nurse Othello, Nurse Vanessa (Auntie Nessie), Auxiliary nurse Reed, the male nurse on night shift, the physiotherapist, Norman the domestics chap, and some others whose names I cannot remember. All were kind and helpful.

I took some liquorice allsorts to help me clear my stomach before the operation but then I had laxatives next morning. I hoped the drainage system worked well.

Sunday morning was sunny again so I did some washing and hung it out on the fire escape. My wife and daughter visited almost daily, coming from Felixstowe. My

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daughter drove the car and they took my washing including bed sheets and pillow cases to wash at home, but I like doing things for myself.

The lads in the ward were starting to get onto their feet so I became more useful. If patients lying in bed tried to raise themselves up by pushing on their elbows this would pull out the chest stitches requiring treatment sometimes back in the theatre.

RopeSomeone had an idea to have a rope for patients to pull themselves upright with, as this tends to close the wound instead of opening it. As there was only one rope I had the job of taking it to whoever needed it in the male ward and to nurses in the female ward. I asked my wife to bring some ropes that I had at home and she did. I scrubbed and disinfected them in the sluice room and there they remained until after my operation.

OperationOn the Sunday the anaesthetist came to explain to me all that would happen at the operation, to help me co-operate during the procedures. My wife had asked our friend Mr John Porter, foreman rigger at Felixstowe Docks for more rope. The Docks Manager kindly let us have a whole reel of suitable rope and my wife brought it to Papworth Hospital that day. She usually brought flowers too to brighten the ward.

Monday 7th June 1982 was the operation day. I had noticed earlier that there was a Surgeon and Doctors list in reception that read as follows.

‘Mr Christopher Parish, Mr B B Milstein, Mr T A English, Mr R Cory Pierce, Mr J Wallwork, Mr C M McGregor, Dr G I Verney, Dr C D R Flower, Dr J M Collis, Dr D W Bethune, Dr R Latimer and Dr J Hardy.’

On Tuesday 8th June 1982 I recovered consciousness in the Intensive Care Unit and the nurse immediately came to attend to me. She said ‘Thanks for doing everything I asked you to do. Everything went perfectly, you were the perfect patient.’ I was not very conscious so it must have been the training I had over the weekend. I was so pleased it had all gone so well.

I had the stomach tube removed from my mouth without any discomfort. Then the nurse showed me a valve like the one implanted in me.

RecoveryI was taken back to the ward to the comer bed and not to the one behind the door. I did not feel severe pain – just some discomfort groaning even during physiotherapy. In due course the injection needle in my neck, the two tubes in my chest and the cannula in my left arm were removed. By night time I managed to pull myself upright using the rope and I was able to walk to the toilet to use the jar as everything going in and coming out of my body was being checked.

I was being encouraged to drink a lot, tea and glasses of orange juice, I vaguely remembered having some dinner as well as evening tea. The evening pills trolley came and I started taking the pills: 2 slow K, 1 furosemide (40mg), 1 digoxin (0.25mg), and warfarin.

On Wednesday 9th – I did not note the exact time when – I started making more bed ropes from ropes in the sluice room and those from Felixstowe Docks but it was as soon as I was able to. I cut the ropes into 9ft lengths, made a loop one end and a dog’s tail at the other to loop onto the bottom bedrail, and tied knots at intervals to help patients get a good grip without the rope slipping through their fingers and jarring their body. Nurses brought other patients to see me

working to encourage their recovery. Mr Dennis Day was one of these and we kept in touch for many years – I visited him at Hitchin several times.

When I finished making the ropes on the 13th of June, the day my stitches came out, the nurses got me on to knitting woollen squares for a blanket. My family and I finished making one at home with a red heart and ‘7th June 1982’ at its centre. We took it to the Papworth Hospital fête on Saturday 26th June.

HomeI was still having my morning and evening tablets. My discharge day was on Tuesday 15th June. I was taken to see 19-year old Tracy in the women’s ward as she was terrified of her operation, and I hope I managed to ease her worries. I chatted with the lady in the next bed too. Mr Glennie arrived that day. Mr Horace Simpson (Sam) from Peterborough and Mr Somers from Ipswich are others I met at Papworth earlier. My memory is not as good as it was.

A friend drove my wife and me home to Felixstowe. He wore lead boots and said he was frightened I might collapse on him so he sped us home – safely may I add.

I returned with my family to the hospital fête on 26th of June. My wife had arranged with Sister Barker to help at the fête. We gave the woollen blanket to Sister Barker and Mrs Linda Hart’s stall, but bought it back again for £20. Mrs Hart had been very kind to me during my time in Papworth.

I bought several paintings at the hospital’s annual fêtes. One of them is a View from the Bubble by Mr A Barlow 1979.

I was put in touch with Mr Des Fox, Chairman of the local BCPA Zipper Club, visited him at his home in Elmswell and joined it then. Now it is 30 years on.

Recipes – Janet JacksonTomatoes and rice gratinServes 21 onion chopped1 teaspoon (5ml)

dried oregano1 tblsp (15ml)

vegetable oil5oz (150g) long grain brown rice ½pint (300ml) water1¼ lb (500g) tomatoes, skinned and cut

into slicesSeasoning to taste4oz (115g) Emmental cheese grated½oz (15g) butterMethodHeat the oil in a large saucepan, add the onions and oregano and stir fry over a low heat for 3–4mins or until the onions are soft.

Add the rice and the water. Bring to the boil, cover and simmer over a low heat for 20mins. Transfer the rice mixture into an oven proof dish. Put the sliced tomatoes over the rice. Season to taste, then sprinkle over the cheese. Place the dish in a cold oven then switch on to 200C 400F gas 6. Bake for about 30 mins until the cheese has melted. Serve with a mixed salad.

Soft fruit puddingServes 46tbls (150g) butter, melted1lb (450g) soft fruits – raspberries or

blackberries2¾oz (75g) caster sugar1 egg2¾ oz (75g) soft brown sugar8tbls (200ml) milk4½ oz (130g) SR flour

MethodPre heat oven to 180C 350F gas 4. Lightly grease a 1½pt ovenproof dish. Gently mix the fruit with the caster sugar together in a large mixing bowl. Transfer the fruit mixture into the prepared dish. In a separate bowl beat the egg and brown sugar together. Stir in the melted butter and milk. Fold in the flour to form a smooth batter. Carefully spread over the fruit mixture. Bake for 25-30 mins until the topping is firm and golden. Sprinkle the pudding with a little soft brown sugar. Serve hot.

If anyone has a favourite recipe please send it to me at 15 Abbey Road, Bingham, Nottingham NG13 8EE or to janet.jacksonmail@btinternet.com.

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NICE guidance boost for patients needing TAVIDr Bernard Prendergast, Consultant Interventional Cardiologist,

John Radcliffe Hospital, OxfordGood news for patients with aortic stenosis! On 28th March 2012 the National Institute for Health and Clinical Excellence (NICE) provided updated positive guidance on the use of Transcatheter Aortic Valve Implantation (TAVI) for the treatment of high risk patients with severe aortic stenosis who are unsuitable for traditional open heart surgery.

For interventional cardiologists like me, who have been working on TAVI since 2007, it is welcome recognition of the fact that the procedure is now viewed as an established alternative to surgical aortic valve replacement in the most seriously ill patients.

TechnologyWith TAVI, we are able to implant a new aortic valve within the diseased valve using keyhole techniques – either via the leg artery (transfemoral) or a small chest incision through the ribs (transapical). This technology provides a treatment option for those who are too ill for open-heart surgery or have anatomical reasons why their aortic valve cannot be replaced using traditional techniques.

Our experience with TAVI in the UK has been very positive to date, although expansion of the technique has been limited – of more than 40,000 procedures undertaken worldwide, only 1,500 have been performed in the UK. Nevertheless, our results compare favourably with those of our international colleagues and further expansion seems likely as a result of falling costs, encouraging clinical evidence, recommendations of international guidelines, and the recent guidance from NICE. Consequently, many more deserving patients with aortic stenosis will benefit from what TAVI can offer.

The PARTNER B Trial from the US certainly provides outstanding data to support the clinical enthusiasm for TAVI. In this study, mortality at one year was 20% lower in patients treated with TAVI

than those treated with standard therapy of medication with or without a simple balloon stretch procedure (balloon valvuloplasty).1 In other words, only 5 patients required treatment with TAVI to save 1 life. Furthermore, the trial also showed rapid recovery and convalescence after TAVI, encouraging improvement in day-to-day symptoms (breathlessness, chest pain and dizziness) and overall measures of Quality of Life, and reduced need for repeated hospital admission in virtually all subjects.2 These outcomes match the experiences of clinicians involved in the management of this challenging group of patients.

Specialist assessment essentialTAVI cannot, of course, help absolutely everyone. Some patients may be simply too ill or frail to gain from the procedure and in others there may anatomical issues which make valve implantation impossible. The role of the specialists is to assess each patient carefully to determine whether their condition is most suitable for conventional surgery, TAVI, balloon valvuloplasty, or conservative medical therapy. This decision is best made by multi-disciplinary teams (MDTs) consisting of surgeons, interventional cardiologists, anaesthetists, imaging specialists, and physicians with experience in the care of the elderly, all of whom who have been specially trained in the procedure. These teams must be based at certified centres that have full access to the specialised equipment and resources necessary to perform TAVI.

An inevitable question is whether TAVI could eventually replace conventional surgical valve replacement, in the same way that keyhole procedures for gallstones have superseded open abdominal surgery. At this stage, it is too early to form a conclusion since long-term results are not yet available and superiority over surgery is yet to be demonstrated. The TAVI procedure and associated technology is evolving rapidly and it seems likely that more and more

patients will be treated using the technique in years to come. However, we should remember that it remains a major invasive and high-risk procedure that is still in its development phase. Moreover, conventional surgical aortic valve replacement is a tried and trusted procedure with excellent immediate and long term results in well selected patients. TAVI should not be offered to patients simply out of preference for a less invasive approach.

Most exciting developmentsWithout doubt, TAVI is a ground breaking alternative to open heart surgery and a potential saviour for certain patients for whom surgery is not an option. It is one of the most exciting developments in cardiology that I have seen in my career and I am certain the procedure has a positive future.Sources 1 Leon MB, Smith CR, Mack M, Miller DC, et al. Transcatheter Aortic-Valve Implantation for Aortic Stenosis in Patients Who Cannot Undergo Surgery N Engl J Med 2010; 363:1597-16072 Reynolds MR, Magnuson EA et al. Health-Related Quality of Life After Transcatheter Aortic Valve Replacement in Inoperable Patients With Severe Aortic Stenosis. Circulation 2011;124:1964-197

Talks offered – Alan Thomas, BCPA Life memberA professional speaker for many organisations, I am happy to offer talks without fee to any BCPA Area Group, but would require travel expenses if the venue lies outside the Greater London area. Perhaps there may be another charity that you, a reader, are a member of, eg WI, U3A or some other who may be interested in one of the list I offer. The talks I have available are:• New York – impressions and experiences from many

years of living there; and/or the discovery, development, scope and character of New York city

• Public speaking – pleasures and pitfalls • The lively mind – approaches and techniques for

keeping an active mind

• Our reminiscences – their value, reliability, prompting and recording

• Stories – their multiple uses, including performances of stories of contrasting types

• The Statue of Liberty – precursors, European inspirations, engineering features, Emma Lazarus, the ever-changing meanings of the symbol, and immigration

• Carnegie Hall – origins, development, functions, and how saved for posterity

Please contact me at 0208 579 6606, alro.th@virgin.net, or 16 Park Place, London W5 5NQ.Statue of Liberty,

New York

The SAPIEN XT valve is one of the TAVI valves available to interventional cardiologists and cardiac surgeons.

The TAVI valve is crimped to a pencil thin size

before entering the femoral artery. It is then implanted into the aortic valve by balloon-inflation.

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Dates for your diary

CambridgeW 27 June 7.30Sat 11 Aug

Group meeting. Also W 22 Aug 7.30, W 24 Oct 7.30, W 5 Dec 7.30Southwold trip 4th Wed of even months 7.30 at Great Shelford Memorial Hall

Chelmsford and District Cardiac Support Group

F 15 JuneF 20 JulyF 17 AugF 21 SepF 19 OctF 16 NovF 7 Dec

The Making and History of Decorated EggsRaise Your Glass – A Toastmaster’s TaleThe Easy, The Not So Easy and The Damn Difficult of Nature PhotographyBarges on the BlackwaterThe Inca TrailMidland Grand Hotel Old and NewChristmas Social All 8.00 at Broomfield Parish Hall

Halton Tu 19 JuneEvery Th 1-3

Trip to the Imperial Hotel, Llandudno Every Th 1-3 at The Grangeway Community Centre, Runcorn, for various activities, line dancing, Tai Chi, and gentle exercise

Havering Hearties 2nd Thur 7.30 At The Royal British Legion Club premises, Western Road, Romford, EssexKing of Hearts, Redbridge, Essex

2nd Wed 7.30 The Aldborough Room, Fullwell Cross Library, High Street, Barkingside IG6 2EAFor details contact Tony Roth 020 8252 0877

Lincoln Tu 19 June 7.30W 20 June Tu 17 July 7.30M 13 AugTu 21 Aug 7.30Sat 29 Sept

Bill Hodgson. Walking stick makersMidsummer trip – see reportBob Oakes, Blacksmith All Methodist Church Hall, North HykehamBoat trip on the Wash – see reportKatherine Theabould & Karen Duff. Cardiac Support updateDay trip to Southwell Ploughing Match, Aversham, Newark

Peterborough 3rd Th 12 for 12.30 Lunches on the 3rd Thursday of each month excluding December at the Cherry Tree Public House, Oundle Road. Contact Gordon to attend.

SE London & Kent Tu 12 June 7.30 for 8F 13 July 7.15 for 7.30F 12 Oct 7.15 for 7.30

Meal at the Toby Carvery, Bromley CommonStrawberries and Cream NightQuiz Night All at the Victory Social Club, Kechill Gardens, Hayes

Staffs & District W 6 JuneTu 26 June 7.30 for 8Tu 31 July 7.30 for 8Tu 28 Aug 7.30 for 8Tu 25 Sept 7.30 for 8Tu 30 Oct 7.30 for 8Tu 27 Nov 7.30 for 8

Trip to Bury Market – see reportTalk by Paul Seabridge, Fire safety in the homeQuiz BingoHeart StartCrime Prevention Each last Tu 7.30 for 8.00 atMusic with Karen Shutt on the Piano Thistleberry Hotel, Newcastle, Staffs

Take Heart, Southend 2nd Th 8.00 2nd Th 8.00 at Eastwood Community Centre, Western Approaches, Leigh-On-SeaWest Suffolk & SW Norfolk

TBA3 Dec

Postponed AGM – see reportChristmas dinner Meetings are usually at the Risbygate Bowls Club

Warrington 3rd Th 7.00 All 3rd Th 7-9pm at Post-Graduate Centre, Warrington General Hospital Wirral M 11 June 7.30

M 9 July 7.30M 13 Aug 7.30M 10 Sept 7.30M 8 Oct 7.30M 12 Nov 7.30M 10 Dec 7.30M 14 Jan 2013 7.30M 11 Feb 2013 7.30

Cath James Cardiac Rehabilitation Games NightNo MeetingPat Lloyd Age UK Dr Geraldine Swift, PsychiatristGames NightChristmas Social EveningTo Be ArrangedAnnual General Meeting Each 2nd Mon 7.30 at Heswall Hall, Heswall

Wrexham 3rd Tu 7.00 At Association of Voluntary Organisations, AVOW, Egerton Street, Wrexham

Patients should have a voice too!Nadine van Dongen, Managing Director, PIP Health

Sometimes it might feel like we, as patients, know very little about our conditions and treatment. After all, doctors and specialists have years of training and experience, and could fill many medical encyclopaedias with their knowledge. That’s why we trust them to carry out such delicate procedures! However, as patients we too should not forget that we have a very important role to play in determining the outcome of our treatment.

Numerous studies have shown that the patient experience has a big impact on the effectiveness of treatments. In fact, what doctors call ‘non-adherence’ to medication has been documented in more than 60% of cardiovascular patients (Kravitz et al, 1993), despite the evidence that taking your pills as directed significantly reduces the risk of further complications (Jackevicius et al, 2008).

So why do we patients not just do as we’re told? Well, as many of you will know patients with cardiovascular disease often have so many pills – all of different colours – that it’s hard to know which is which! So surely something should be done about this?

This demonstrates why it is important for patients to share their experiences about their condition or treatment. Through research – whether it is online surveys or group interviews – patients have a way to share these experiences so that doctors and drug companies can do something about it.

That is where Patient Intelligence Panel (or PIP Health for short) comes in. PIP Health is a research company working to improve

healthcare for patients through research. Through their research, they are able to gather robust data from large numbers of people which can be used to improve health services and communication for patients. If you would be interested in hearing more about their research, all you have to do is register on their site. It’s totally free, and each time you fill in a questionnaire they will donate £1 to the BCPA. If you would like more information, or to register, visit their website now. After all, patients should have a voice too! www.piphealth.com/BCPA

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How do we ‘stat up’? - Corey BeecherIt is a commonly known fact that ‘To exercise is better than NOT to exercise’. Well just being a fact does not mean that people will follow the advice given. After all we have a freedom of speech and therefore a freedom of action. Even when armed with the full set of information the choice is still that of the individual – and quite correctly too. We should not be living in a world of dictators informing us of what we should be doing and then checking up to see that we are doing as we are supposed to. It is a free choice as to how we choose to use our own free time and this should be how it stays.

But some things are better for us than others, it has been scientifically proved. Exercise is just one of those areas, where regularly partaking in a form that you enjoy and can will provide you with many benefits.

British Heart FoundationSo how many of us actually pick ourselves off of the sofa and get out and moving? The British Heart Foundation regularly undertake a review of what people are doing in regard to their risk factor profile. They look into such things as cholesterol levels, medication compliance, diet, blood pressure, heart rates and physical activity levels.1

Government guidelinesThe government offer us guidelines in terms of the physical activity we should be completing. The current guidelines are for three formal exercise sessions a week with you reaching a moderate intensity of exercise.

This should be for around 30 minutes,

excluding a warm up and cool down, which should last 15 minutes and 10 minutes respectively. Then having 2 days of daily active living where you are trying to be more active for an additional 30 minutes during the day.

The difference between the exercise and the physical activity is that the exercise will need to be completed in one go, so just under an hour for the full session. The physical activity can be completed in any breakdown of the 30 minutes you can imagine. So if during a day you walked for 10 minutes, gardened for 5 minutes, swept the drive for 5 minutes, wandered around the shops for 10 minutes that would be the 30 minutes total.

The latest published figures are interesting. They show that in England there were 34% of men meeting these government guidelines in 1998 and by 2008 that figure had increased to 42%. In Scotland the picture for men is similar, but the progression is slightly less. It was 40% in 1998 and by 2008 it had risen to 46%, so more men in Scotland were and are achieving the target than in England.

For women, in England it was 21% in 1998 and rose to 31% in 2008. In Scotland it was 29% in 1998 and went up to 35% in 2008. So it shows that the Scots do complete more exercise.

The percentages of people who exercise above, at, or below the government guideline of 5 times a week also paint a picture.

In England 53% of men aged 16-24 exercise above the recommended 5 times per week. However at age 75+ this percentage drops to 9%. 30% of the 16-24

group and 23% of the 75+ group achieve exactly 5 times per week. 16% of the 16-24 age group and 68% of the 75+ group do less than that.

Women in England show similar figures, with 35% of 16-24 group and 6% of 75+ group achieving more than 5 times a week. 33% of the 16-24 group and 16% of 75+ achieving exactly 5 times a week. 32% of the 16-24 and 78% of the 75+ do less than that.

Now with the differing health issues that the older generation need to manage, it is

imperative that they take the time to find activities that help them manage and assist them in keeping themselves out of hospital and on the treadmill – figuratively and actively speaking. So taking the time to try different activities when the opportunity arises can only be a positive move.

Look in your local area for any sports development programme to encourage people to rediscover the sports they left behind in their youth. As an example Bedford Borough Council offer a discounted trial of 8 weeks of activities under their Reactive8 programme. This is for people between 30 and 50. It includes ballroom dancing, kendo, badminton, swim stroke improvement and golf.

Look in your local library to uncover what is available near you to start you off on the quest for a new you.

Compare with EuropeBack to the stats now, with a look at how the UK compares with other parts of Europe. The breakdown is for people over the age of 18 exercising and is not gender sensitive. The categories are • exercising regularly, • with some regularity, • seldom, • never, and • don’t know.

Think about where you may fall in this list of categories.

For example, in the Czech Republic 5% exercise regularly, 23% exercise with some regularity, 25% seldom exercise, and 37% never exercise. In Italy 3% regularly exercise, 26% with some regularity, 16% seldom and 55% never. In the Netherlands 5% exercise regularly, 51% with some regularity, 16% seldom and 28% never.

The UK figures are 14% regularly, 32% with some regularity, 22% seldom and 32% never.

Ireland is the country with the highest percentage of people exercise regularly –23%. Bulgaria has the lowest percentage for any exercise, with 58% never taking any exercise.

It is interesting to look at the figures and see where we, as a nation fall. With everyone doing just a simple short walk each day we could improve the percentage of people exercising in the UK; and maybe, just maybe, we could one day boast that we have the highest percentage of people in our nation regularly exercising and meeting the criteria for a fitter, healthier body.

Let’s give it a go and overtake our European cousins and show them it is possible and that it is FUN.Source 1 British Heart Foundation Statistics database. heartstats.org, 2010

Second copy of the crosswordThis is here so two people may do it. Fold back page 13 down the middle so you can see the clues on the left side of page 14 as well as this copy, without seeing the other crossword itself.

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meet patients and their partners who had been referred to the hospital to be assessed for transplant. If they were suitable for the transplant programme they returned home and would wait anxiously for ‘the call’ from Papworth. During the waiting period I often received calls from them on the helpline and when eventually the call came it was like a re-union of friends.

I remember one incident when I had just returned home from my Sunday visit to Papworth and then received a telephone call from a lady in Kent. Her husband had received ‘the call’ from the transplant co-ordinator and she and her daughter were following the ambulance to Papworth. They expected to arrive around 7.30pm and would like me to meet them to give support. I returned to the hospital immediately and was there in time to welcome the family as the patient was taken to be prepared for surgery. The family went to see the patient prior to his going into the anaesthetic room at around l0pm.

The co-ordinator came to see the family in the visitors’ room about an hour later and said that the operation was going ahead and would take approximately another three hours. The daughter and her fiancé were going to drive back to Kent after being assured that the operation was over, whilst the wife was going to stay in a visitor’s bedroom on the top floor of the Baron Ward. It was quite obvious to me that the wife was extremely tired and under great stress. I tried to persuade her to go to bed but she declined to do so. The next message from the theatre was that the operation was going extremely well and the patient was expected to be transferred to the ‘bubble’ at about 3am.

Again I tried to persuade the wife to go to bed and was supported in this by the daughter and a nurse who also offered to provide a sleeping tablet to help her. I explained that, even if she stayed up long enough to see her husband it would only be through the glass door of his room and he would still be unconscious. I suggested that it would be far better for her to accept the nurse’s offer of a sleeping tablet and go to bed so that in the morning she would be more refreshed when she was able to see and speak to her husband. At 1am she agreed that she needed sleep and would go to bed after being assured that she would be called immediately if she was needed.

There was one personal problem which caused me some concern at the beginning. I was severely hard of hearing in the left ear and wore a hearing aid. The operative word is ‘aid’ and it has its limitations. In a one-to-one situation, providing that the speaker enunciates clearly, there is no problem. However, in a ward there are many noises which override the benefit of the aid, coupled with the fact that many patients do not feel up to speaking clearly. Having been hard of hearing since my mid-thirties I had received training in lip reading or, to be more precise, speech reading. This entailed observation of the lips, eyes, head and shoulders of the speaker. In some respects this reading of body language was an advantage over those people who listened but did not observe.

On one occasion I was about to visit a transplant patient who had a tracheotomy. The staff nurse told me that there was little point in me seeing the patient as she was unable to speak but I was welcome to visit if I wished. I entered the room and spoke to the young patient and she responded silently. I was able to understand clearly what she was saying and we were able to have a long conversation. I was a regular visitor during her stay and it was a delight when the tube was finally removed and I was able to hear her voice.

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A New Beginning: Memoirs of a Voluntary Worker 1981-1996 – Fred Roach Keith Jackson

In the February and April issues of the Journal we recollected some of Fred’s visiting experiences from his chapter headed Smiles and Tears. We continue with Transplantation.

TransplantationOn 18th August 1979 I had an appointment to see Sir Terence English at his clinic at Addenbrooke’s Hospital. There were an unusual number of patients waiting and we were told that the clinic was running late. Suddenly a doctor appeared who was obviously in a hurry and he announced that due to an emergency at Papworth Hospital Sir Terence English was unable to be present and therefore he would be taking the clinic. The patients were seen in record time – indeed it was one of the quickest clinic examinations I had experienced.

Later that evening while I was watching the television news programme it was announced that the first successful heart transplant in the UK had been carried out at Papworth Hospital by Sir Terence English. The patient was Mr Keith Castle.

It was my pleasure to meet Mr Keith Castle and his wife, Doreen, on many occasions during my work in the hospital. Sometimes he would stay for a few days for routine checks, at other times he would have to stay longer. He did not appreciate long stays in hospital yet he retained a good sense of humour.

I remember meeting Keith on Surgical Unit Top Floor one Sunday and when I asked him why he had come in again, he said he must have caught some bug or other. His stay on this occasion was longer than normal and I visited him often during that period. Each time he would make some remark such as, ‘They still can’t trace the bug’. As I went to see him on my next visit to the hospital there was a large notice pinned to the door of his room. I had seen such notices in the countryside to announce a Pigeon Shoot. The notice on Keith’s door was a similar notice with the exception that the two vowels in the second word had been blotted out and replaced by a different single vowel.

Prior to his heart problems Keith had been a builder in London. His sons had since taken over the business. He had visited a site where his sons were demolishing property and as one can imagine, Trafalgar Square is not the only place in London where pigeons congregate or leave their ‘calling card’. The dust from the demolished property had caused the problem. Once the villain had been discovered the Papworth team quickly found a solution.

In 1985 Mr Keith Castle passed away. He and his wife Doreen had been valued members of the BCPA. Since his transplant he had been a fine ambassador for transplantation and had raised considerable funds for Papworth Hospital. Keith’s death was a sad blow but the work of the transplant team continued, in that, during 1985, a further five heart/lung transplants and over forty heart transplants were carried out. I spent a great deal of time in supporting them and their families.

The one hundredth heart transplant at Papworth took place in 1985. The patient, Pamela, was also the youngest, being just nine years old. Her room was well stocked with dolls and Pamela soon became the proud owner of a nurse’s outfit. Hardly a day went by without one of the dolls having to undergo a ‘transplant’. The staff had great fun in supplying the necessary ‘nursing’ aids, hypodermic syringe (minus needles of course), ECG machines, and masks. It was amazing what could be made with silver foil.

The introduction of the anti-rejection drug, cyclosporin, coupled with the skill of the transplant team was to make a dramatic improvement in the progress the transplant patients were making - which resulted in earlier discharge from hospital. Often I would

Fred & June Roach

The Journal is the bimonthly magazine of theBRITISH CARDIAC PATIENTS ASSOCIATIONalso known as BCPA. Registered Charity 289190

President: Sir Terence English KBE, FRCS Vice-Presidents: Ben Milstein MA FRCS; Alan Bowcher DMS FFAExecutive Officers

Chairman: Keith Jackson Tel: 01949 836430Vice-Chairman & Journal Editor: Dr Richard Maddison Tel: 01234 212293 Email: richard.maddison@timicomail.co.uk

Treasurer: Derek Holley OBE FCABCPA Head Office: 15 Abbey Road, Bingham, Notts NG13 8EE Tel 01949 837070

Email: admin@BCPA.co.uk Website: www.BCPA.co.ukOpinions 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 2012 BCPA and/or the authors

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Crossword – second copy page 12, answers page 5This crossword has a theme – the answer to 1 and 4 across.Clues have a straight clue similar to a quick crossword as either the first or last part. The rest usually either gives another definition ie two meanings, or is a cryptic clue such as an anagram or a way to build up the answer. Numbers such as ‘25’ refer to that clue. Across1,4 Alive objects as crossword theme (6,6)7 Muddled 16 period (3)9 Person who studies the theme (9)11 Small parts of feet (4)12 All the time eternally (4)14 Back in case small bag formed by membrane (3)15,17 Spreading conker growth (8,4)19 Two-legged feathered flier (4)21 Leaders of teams or boat crews (8)24 Information, computers, technology (3)25 Girl from where item made (4)28 Mound of 4 from reverse lipid (4)30 Adjustable and changing easily (9)33 It is shortened possessive (3)34 Large fish that spawns in rivers in messy Monsal Dale (6)35 Quadrupeds for riding and pulling (6)Down1 Colourless acid from muscles in sour milk (6)2 Parts of eyes and flowering plants with sword-shaped leaves (6)3 Get on well with semi-solid substance like jelly (3)4 Label something added at the end (3)5 Small six-legged animal grows in sections (6)6 Origin or cause (6)8 Part of eye sensitive to dim light and fishing pole (3)9 Exist among the obese (2)10 In what viewers watch (2)13 Feeling of dread, anxiety about shortcomings (5)14 Undress a long narrow flat piece (5)16 Plant part containing grain for hearing (3)18 Fish eggs or deer (3)19 Produces young distinct strains of animals (6)20 Jewelled headband or crown (6)22 Tall tree from starless polar parts (6)23 Hard coverings of crabs or eggs (6)26 Mother part of 25 (2)27 Over the top of odd octet (3)29 That is part of a biennial (2)31 Secret security code derived from lupins (3)32 17 burnt remains (3)

Design and production – John Hunt, john@cartog.co.uk Printed by – Core Publications Ltd, Kettering

Co-ordinatorsCambridge: Bert Truelove 01223 844800Halton: Stella Bate 01928 566484Lincoln: Bill May 01522 885756 Peterborough: Gordon Wakefield 01733 577629South East London & Kent: Chris Howell 01689 821413Staffordshire: Eddie Coxon 01782 416143 Warrington: Dennis Atkinson 01925 824856West Suffolk & South West Norfolk: Brian Hartington 01284 762783Wirral: George Bird 0151 653 4530Wrexham: Alan Ellis 01978 352862

ContactsBedford: via BCPA Head Office 01949 837070Belfast: John Hamill 028 9081 3649Cannock Area: Brian Nicholls 01922 412753Chester: via BCPA Head Office 01949 837070East Suffolk: via BCPA Head Office 01949 837070Hampshire: Derek Rudland 01329 282809Hull & East Riding: Stephen Hackett 01482 561710Llandudno: Joan Owen 01492 876926Lowestoft: John Genower 01502 511894North Staffordshire Implantable Cardioverter Defibrillator ICD Group: James Lyons 01782 852509Oxfordshire: Chris Gould 01491 872454Swindon: Jim Harris 01793 534130

Affiliated GroupsChelmsford & District Cardiac Support: Malcolm Gibson 01621 893064Chester Heart Support: Peter Diamond 01244 851441Croydon Heart Support: Ken Morcombe 020 8657 2511Havering 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

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

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Membership application or renewalPlease send this application to: BCPA, 15 Abbey Road, Bingham, Notts NG13 8EESubscription enquiries telephone: 01949 837070Membership £10 per annum Life £100 Joint membership £15 per annum Life £150 Overseas subscriptions £10 per annum Life members may pay in two instalments, the second being 6 months after the first.

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