A month on from my heart attack

 A real milestone passed – was it that big a step? Am I well or not well? I feel OK... Schrodinger's health – I continue to be simultaneously healthy and unhealthy until a doctor peeks inside and collapses the wave function into one or the other. But what if it's neither black nor white but somewhere along a continuum?

A threshold has been crossed; life will never be the same. I had always considered myself a healthy individual until a month ago; as of now, I can no longer do that.

I'm taking the following medication, something I've never, ever, done before in my life; never taken more than the occasional aspirin for a hangover. So that's a clear before/after step. It's a new discipline; I have added it into my regular exercise/diet monitoring, with a new sheet attached to my Excel file.

The pharmacological barrage looks like this.

First thing in the morning:

• IPP 20mg: reduces the amount of stomach acids produced; to be taken on an empty stomach* before the onslaught of the pills that go with breakfast...

With breakfast:

• Acard 75mg: essentially aspirin, an over-the-counter low-dose form of aspirin to thin the blood. A side effect I've noticed is that scratches that bleed release slightly more blood.
• Efient 10mg: taken together with aspirin to reduce the risk of clot formation in the arteries, prescribed after insertion of stents. 
• Beto 50 ZK: a beta-blocker which leads to a decrease in heart rate, the strength of heart-muscle contraction and blood pressure.
• Forxiga 10mg: a sodium-glucose co-transporter 2 inhibitor which works in the kidneys to prevent the reabsorption of glucose into the blood, removing excess glucose from the body through urine, lowering blood sugar levels. Intended to decrease risk of death due to cardiovascular problems or kidney failure.

Around lunchtime:

• Inspra 25mg: One of two drugs to reduce blood pressure. Works by by blocking the effects of the hormone aldosterone, which can help lower blood pressure and reduce strain on the heart.

In the evening:

• Roswera 40mg: a statin aimed at lowering high levels of LDL ('bad') cholesterol, total cholesterol and triglycerides, and to increase HDL ('good') cholesterol, thus reducing risk of heart attack and stroke. The blood test in hospital showed my LDL cholesterol was 151 mg/dl, when the level for a person at risk of heart attack should aim for below 55 mg/dl. Now, that's a target for me to reach!
• Tritace 5mg: another drug to lower blood pressure; intended to manage symptoms of heart failure when the heart is not pumping effectively, reducing risk of heart attack or stroke. It improves survival rates in people who have had a heart attack and have signs of heart failure. The active ingredient is ramipril, an angiotensin-converting enzyme inhibitor. (My mother took ramipril daily from her first heart attack in August 1986 up to her death in November 2015).

I presume that prescribing this battery of pills is standard operating procedure for a patient (I never considered myself one of those before!) following a heart attack. To what extent has this been customised to my unique biology, or is the prescription the same in all cases?

I familiarised myself about this octet of drugs I'm taking (Google Gemini AI is excellent for this type of question – no danger of it making shit up, just a snappy summary of what's important). Side effects? Other than blood taking minimally longer to clot on a cut or scratch – nothing that I've detected for now.

Am I tethered to all this stuff for life? We shall see – I have an appointment with a cardiologist within the next fortnight. My first question to them will be: do I have to keep taking all of these? Can I cut the dose of some or all of them, depending on indicators such as blood pressure, cholesterol levels and general wellbeing? Can I alter the prognosis through exercise and diet – and the power of positive thinking?

Exercises: I am still walking my 12,200+ paces a day. I try not to stray too far from home in case of emergency; two short laps rather than one long one typically. I have dropped pull-ups and push-ups; these do create a strain on the heart. Plank, back extensions, sit-ups and squats I continue with; weights now focus on maintaining flexibility in my spine rather than on the rotator cuffs; I intend to trade down to smaller weights (3kg rather than 5kg).

Diet: I have stopped adding salt to my food, either when cooking or from the salt cellar. I am limiting my cheese intake, going for lower-fat cheeses such as cottage cheese or Feta, rather than those high in saturated fats (the ones I like best, such as Cheddar and Parmesan). Out goes Chorizo (sadly). To be enjoyed once in a while, rather than an omnipresent staple in my shopping basket and fridge. Alcohol intake has been nicely under control for some years now (below the NHS safe limit since 2021)

No longer can I fill in a form or answer a questionnaire and say with a clear conscience that I'm not taking any medication. My medical history until a month ago was exemplary. Never had any health issues before. And now this... Will I be able to get travel insurance?

Psychologically, I have crossed a threshold, from carefree middle age (though one in which I did look after myself) to what can only now be described as early old age. Now I must really look after myself!

The most important thing is a) not to feel sorry for oneself (which I don't) and b) get on with it. But c) don't go at it too hard. 

* 'on an empty stomach' – six syllables, 'na czczo' – two syllables; a rare instance where Polish beats English in terms of the whole brevity thing

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