Wednesday, October 10, 2007

Gosh, look at all these trees!

Bert’s angina has been playing him up. Over the past few years he has been a diligent attender at the CHD clinic, and his blood pressure, cholesterol, glucose et al are all perfectly managed. He takes his allotted and guideline mandated handfuls of pills as required. In short, Bert is a model patient, and he is managed to the last scintilla exactly to protocol.

As a result, he is a bit put out to find his angina back again. It isn’t that severe. He can still manage hills and stairs pretty well. He just has to remember to pace himself a little better. And if he forgets (because inside he still feels closer to twenty eight than to his chronological “pushing eighty”) he gets a short sharp reminder. Given that he had been symptom free for much of the past three years this has come as a bit of an imposition, and he is keen to learn what I am going to do about it.

“These pills are no help at all!” he says, brandishing a green and white packet at me. It’s not one I immediately recognize, and with all the waving I can’t quite manage to read the tiny stick on pharmacy label that would inform me as to which precise anti-anginal medication has been letting him down. I take the packet off him, and call up his current meds on the screen. The box contains his statins (cholesterol meds useful for preventing further deterioration—but not for relieving the pain of angina when it hits). The screen shows he has no regular anti-anginal medication. But then, until the past few weeks he has not has regular angina either…

The screen shows his last script for any angina reliever medication was over two years ago, and this has long run out.

So he leaves with a script for a new spray, and my encouragement that he ought also to continue his statin and other meds as well. He’s also going to have a few follow on tests to make sure he hasn’t become worse, but all the evidence of his last investigations shows things were quite stable within the last three months.

I am a little troubled that both he and we have slightly lost the plot here. After all he did already have angina when he began attending the CHD clinic , and for all the preventives he is now receiving, it remains the case that his pre-existing ischaemia will, from time to time, make itself known, and when it does it is quite o.k. for him to react to this with reliever medication. It seems we both need to learn to see the wood again, as well as focusing on the trees...

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