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Medical Matters - optimism , pessimism and David Cameron

This is a blog, and since one of the things I know well and care about a lot is me, I feel entitled to write on the subject. Perhaps my researches might help someone else.

But, to start with a digression, (and a co-ordinating conjunction), I don't share David Cameron's taste for seven day a week General Practitioners. We've all grown accustomed to 24/7 services - typically your insurance company and your car breakdown service and the Amazon Kindle support line will provide such a service. You ring them up and might get routed anywhere in the world for an answer, from an operator who has been on the basic training and probably not taken it all in, so doesn't understand your problem. And PPI reclaim salesmen, and disembodied American voices telling you you've won a trip to Miami (not true). All these are non-stop incessant services, and I don't want my GP lumped in with them. My GP has undergone many years of training in respect of a very delicate and immensely complex mechanism and deserves my respect for having passed all the exams. She has then spent time in actual real life dealing with the problems that her patients bring to her, and helping them face the tragedies that result. Given any luck she has managed not to take to drink or drugs to deal with the stress. I don't want her either a) trying to wake up during consultations because she's just done a week of lates and her diurnal rhythms are all shot to pieces or b) abandoning her medical skills to manage a complex rota of staff availability. I want a GP who has a calm, well managed working environment in which all the many variables of my condition can be considered fully, and a proper diagnosis reached and proper course of treatment set out. And to help achieve that I am willing to take a morning off work to address this important problem that requires professional consultation. If it is not that important I can probably sort it out myself with some aspirin and some bed rest. I certainly don't want to see a financially motivated character with a non-UK qualification who has flown over on Queasy Jet to moonlight in the UK on Saturday and Sunday, and with whom there would probably some difficulty communicating the subtleties of my symptoms. For where else is DC to find all the staff needed to cover all these hours? (It's Too bad that all the people who know how to run the country are busy driving taxicabs and cutting hair and writing blogs on minor local websites.)

So, (obligatory co-ordinating conjunction for beginning any radio/tv interview answer) back to the crucial matter of my health. In the course of various consultations it transpired that I had high blood pressure. The NHS guidelines define this as a systolic pressure over 140mmHg and a diastolic pressure over 90mmHg . Between us the GP and I tried to ignore the problem, but eventually he felt obliged to prescribe Amlodipine , a calcium channel blocker and a gateway drug to beta-blockers and ace inhibitors. I still have the prescription. I am loathe to start down this route of dependency and side effects. By today's standards I'm still a young man. 

Part of the GP consultation was a visual check for obesity. The conclusion was that I'm not obese, nor, to judge by my midriff, do I have that dangerous layer of fat around my internal organs. Having considered the blood pressure problem before I have already adjusted my diet. I no longer add salt to cooking, nor, alas and alack, do I eat crackling any more (at least not often). But this piece of research suggests that obesity is quite a subtle thing and just a few pounds might make a difference. So, I set out on a determined course of dieting with the aid of a website called MyFitnessPal. This has a really quite easy to use recording mechanism for logging the meals you have eaten. I lunch quite often at Morrison's and all their main meals are already in the database. I cook meals from HelloFresh and many of their recipes are too. So far I've only lost about 4 lbs but my systolic blood pressure has come down from about 145 to about 133 and my diastolic from 91 to 88 (still a bit high that one).

Of course there is no point in doing any of this unless it's actually going to make a difference. The doctors say that high blood pressure is "the silent killer" but that's a bit vague. I want a bit more in the way of solid well-supported scientific fact to demonstrate that what I am doing is worthwhile. Luckily, of course, the internet comes to my aid. Cast about a bit on Google for blood pressure and risk and I came up with two calculators. A little worrying perhaps, that there are two. If this were real science surely there'd only be one. 

The JBS CardioVascular Risk calculator is loaded with graphics and comparisons. Plugging my data into it on the first page, I find that (on the second page) my heart is 3 years older than I am. Pages three and four say I've a 50% chance of reaching 80 without a heart attack or stroke. Page five rates my risks as exactly the same as the general population over the next 10 years (but considerably better over the next 20!) . But it is pages 7 and 8 that persuade me that I can continue as I am, taking care of my weight, but not taking the drugs. Of every 100 people like me 78 of them will be alive and well at age 73. 9 of them will have had heart attacks or strokes. The other 13? They'll be dead anyway from some other cause, and I've recently bought a 700cc motorbike.

The Qrisk calculator is not quite such a super whizzy product, but it has a slightly different optimism/pessimism balance on my behalf. It reckons my heart is two years younger than I, but that 14 people out of every hundred like me will have a heart attack or stroke in the next 10 years, whereas 17 of the general population will.

I must take all this back to my GP, perhaps in the middle of a Friday morning when he/she is looking forward to taking the weekend off.

Views: 97

Tags: attack, blood, death, dependency, drug, heart, pressure, risk, stroke

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