Isn’t life risky?

I got an email from my GP last week asking me to make an appointment for a blood test because in October 2019 I’d been perceived as being of medium risk of developing diabetes type 2. They’d given me a blood test then and they said that it was time to repeat it.

You get your diabetes risk as a result of who you are. I’m a white male and I’m not overweight so that’s good. Unfortunately I’m over 70, that’s also good because the alternative is that I wouldn’t be writing this post but it’s bad for diabetes, and I’m on medication to keep my blood pressure down. I score just enough points to qualify for medium risk. Then the thinking is that you need to be extra careful about your blood glucose (sugar) level which is measured by an HbA1c test and should be below 42mmol/mol (or 6% in the old money). The ‘normal’ upper limit is 48 but I guess it’s lower for us medium riskers ‘just to be on the safe side’.

The NHS round here is super efficient and I’m signed up to MyChart which gives me access to all my (recent) test results (and much more) so I can see that in October 2019 my HbA1c result was 44. My GP at the time, one of the trio of heroes who sorted out my cardiac problem in August of that year, described it as borderline and told me that I should not worry.

As it happens I reckon that I knew the source of the problem and that coincidentally I’d already addressed it. Before the big cardiac event of the year I’d had what I regarded as a virtuous habit of walking to the village every morning to get my Guardian and a croissant for breakfast. I though that was good exercise and hadn’t worried about the sat fat content of my croissant and the sugar in the very generous spread of jam which I enjoyed with it. Jam is 50% sugar! Anyway as a result of the cardiac event I stopped eating my daily croissant so that meant no more jam. I was sure that that would address my blood sugar issue.

This week I’ve had my blood test and yesterday MyChart reported an MbA1c of 40. That sounds like a result.

Whilst I was having my blood test I asked the nurse to take blood for a lipids test at the same time; that would give me an up to date read on other stats relating to my cardiac condition. After some debate about whether or not one was due or would give any sort of useful data she agreed.

My cardiac story starts maybe 5 years ago. GPs routinely screen their clients for the risk of heart attack and, as with diabetes type 2, I was largely low risk, non-smoker, not overweight, good diet and physically active, but my overall score was skewed by a moderately high cholesterol level. It was therefore recommended that I start taking a statin.

Statins are controversial. The NHS website says:

‘A review of scientific studies into the effectiveness of statins found around 1 in every 50 people who take the medicine for 5 years will avoid a serious event, such as a heart attack or stroke, as a result’.

That doesn’t seem like much of a payback and there are lots of scare stories about side effects so in my wisdom I said no.

Fast forward to August 2019 and I ended up in Royal Papworth to have my right coronary artery unblocked and a stent inserted to keep it open. And why was that necessary? A cholesterol induced blockage. As the doctor who did the op said ‘if you hadn’t had it you’d probably have had a heart attack later in the year.’

That did it. I did not object when one of my basket of drugs post op was a statin and, to complement this, I put myself on an aggressive, nay brutal, low sat fat diet: no more fish and chips, no more fried food, no more croissants or bakery products and no more cheese.

I’m on so many drugs now who knows which are causing the side effects because I do have some. None of them are life disabling but I do have a bit of a flatulence problem, my sleep is not as perfect as it used to be although Fitbit tells me I’m getting enough, and I do get occasional aches and some stabbing pains in my calf muscles.

The combination of diet and the statins seemed to work with my cholesterol level shortly after the op coming in at 2.6mmol/l compared to a healthy level of 5 or below. I’ve had it checked a couple of times since and it’s remained OK but last time when I spoke to the GP she suggested that there’s no point in testing it further because even if it goes back up again there’s nothing more modern medicine can do. It’s statins or nothing.

My point is that my current level is a combination of diet and statins and I need to know that the combination is working. If not then perhaps my diet needs to become more brutal. Fortunately both the GP and the nurse have bought into my logic and allowed me to get my cholesterol to be measured more frequently than the NHS standard.

The result of all this is that I’ve now got 5 points on my cholesterol chart and although the level went up a little to 3.0 it’s now down again to 2.8 with all the other ratios moving in the right direction as well. That makes me comfortable. Although my diet is constrained, I would like a plate of fish and chips once on a while, I do otherwise eat exceedingly well so it’s good to know that that is consistent with keeping my cholesterol in check.

I’m of the opinion that checking what you can is a good way to get an early warning of health problems. That’s why I should have noted my elevated cholesterol and heeded the advice that I was given. However there’s another useful indicator and it’s much easier to measure. It’s blood pressure and I suspect that if mine had been checked some weeks before my cardiac event it would have told me that something’s amiss.

That’s why I can’t understand the NHS advice:

‘It’s recommended that all adults over 40 years of age have their blood pressure tested at least every 5 years so any potential problems can be detected early.‘

Blimey a lot can happen in 5 years. Wouldn’t once a month be a little more sensible?

I’m an obsessive of course and I now check my blood pressure every day and it’s stable at around 120/60. Occasionally it goes up and then it comes down. I’m just making sure that the trend is good and at present it is.

The other data which I collect daily is my weight. I’ve been measuring it for a long time, ever since we bought our first set of bathroom scales, but only during the Fitbit era have I been doing more than simply ‘noting’ my weight. It’s always been around about 70kg, rarely, if ever higher than 72kg and then down towards 68kg whenever I’ve spent time working in Spain. Exceptionally it went down to 65kg in the early 90s during a year when I did a lot of cycling with the Dow velo club.

70kg is of course 11 stone in the old money which sounds rather a lot given that I’m not really the 5 ft 8 ins which I claim. However even at 5 ft 7 ins, for some reason I do weights in metric but my height in feet and inches, my BMI would have been 24.1 which is fine but at the top end of fine.

Fitbit will record that my weight took a dive after my cardiac event and it is now stable at 65-66kg. That gives me a BMI of 22.6 which really is just fine.

The above seems to cover four of the five cardiac risk factors. The fifth is smoking. Fortunately I’ve never been a serious smoker and 20/week would have been a maximum for me. However even that level is bad enough and I haven’t smoked since the mid 80s. When I did it was really social smoking with a tendency to pose: Disque Bleu when I was a student and Rothmans later on although to be fair I did smoke an awful lot of OPs.

The final cardiac risk factor is the one that I can’t control viz age and at 73 I recognise that life is rattling on. I’ve still got lots to do and Covid and its shutdowns aren’t helping. This year had better be ‘visit the UK’ year and then I can get on aeroplanes again in 2022. There’s a limit to how long I can be deprived of a dose of Italian climate, cuisine and culture. Roll on.

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