BCPA Journal - Issue 184 - British Cardiac Patients Association

Issue 184
June / July 2012
THE
PATIENT
AND CARERS
INDEPENDENT
VOICE
BCPA
Journal
How do we ‘stat up’?
A Papworth Hospital patient’s story
Aspirin also helps cancer prevention
Atorvastatin cheaper so more to be prescribed
Memoirs of a Voluntary Worker 1981-1996 – Fred Roach
A package of insurance products as individual as you
Recipes: Tomatoes and rice gratin, Soft fruit pudding
Could readmissions within 30 days be reduced
Patients should have a voice too!
‘The Truth About Transplants’
Professor John Wallwork CBE FRCS
(on right) takes over BCPA presidency
from Sir Terence English KBE FRCS
Rebalancing the planet
Talks offered
www.BCPA.co.uk
admin@BCPA.co.uk
The official magazine of the
British CardiaC Patients assoCiation

Contents
3 From Me to You – Keith Jackson
3 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 Rothwell
7 A package of insurance products as individual as you
– Unique Insurance staff
8–9 A Papworth Hospital patient’s story – William Gordon
9 Recipes: Tomatoes and rice gratin, Soft fruit pudding
– Janet Jackson
10 Talks offered – Alan Thomas
11 Dates for your diary
11 Patients should have a voice too! – Nadine van Dongen,
Managing Director, PIP Health
13 How do we ‘stat up’? – Corey Beecher
13–14 A New Beginning: Memoirs of a Voluntary Worker
1981-1996 – Fred Roach – Keith Jackson
14 Crossword
14 Co-ordinators, Contacts and Affiliated Groups
15 How to join – Membership form
16 Servier. Unique Insurance
Donations
We 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 dates
We 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.
NATIONAL HELPLINE
01223 846845
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.
2
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.

Annual membership renewals and
subscriptions
We 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
From Me to You
Keith Jackson, National Chairman
Ricky’s Quickies - Richard Maddison
Colin Readman
With 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 prescribed
As I expected 1 , 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 2012
2 Pulse Today 8/5/2012.
‘The Truth About Transplants’ book
Paulette 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 reduced
US policymakers thought of trying to reduce hospital readmission
rates, as readmissions are common and costly. 1 To reduce costs and
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 events
As 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.uk
Not 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.
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 reasons 1 .
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 safety 1
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 planet
Issues 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.
3

Cambridge
Bert Truelove
01223 844800
4
News from around the Areas
Local 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
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 bought
During 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
A similar trolley
without sweet rail or
motor
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 weekend
By 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 activities
We 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.
Halton
Stella Bate
01928 566484
From Margaret Hughes
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 wellearned
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
Lincoln
Bill May
01522 885756
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.

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.
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.
South East London & Kent
Chris Howell
01689 821413
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.
Staffordshire
Eddie Coxon
01782 416143
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-
West Suffolk & South
West Norfolk
Brian Hartington,
01284 762783
Wirral
George Bird,
0151 653 4530
Crossword answers
Across 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
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 6212
Hello 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.
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.
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
5

6
Aspirin also helps cancer prevention
A 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 findings 1,2,3 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 painkilling
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, middleaged
people like me.’
Heart disease benefits known
The 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 aspirin 6 ;
and many subsequent published results have
confirmed that 7 .
Findings are for heart patients, not
general population
The findings below 1,2,3 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 reduced
Daily 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 tumours
Daily 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 20year
studies
By 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 20year
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

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 conclusions
The team’s analyses were of previous
researches on patients already on low-dose
A package of insurance products as individual as you …
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aspirin in primary prevention. They excluded
researches that were of patients in alternateday
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 9DU
Sources 1 Peter M Rothwell et al. Shortterm
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
Unique Insurance Staff
March 21, 2012 DOI:10.1016/S0140-
6736(11)61720-0 ; and its references
2 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
references
3 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 references
4 Richard Maddison. Intermittent high
blood pressure predicts troubles. A
summary by RM of research done by
Peter Rothwell. BCPA Jnl June/July 2010.
J172p8-9
5 Daily Mail 27/3/2012
6 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 references
9 See 3 and its refs 12,13
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7

8
A Papworth Hospital patient’s story
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 health
While 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.
William Gordon, BCPA member
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 Hospital
I 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

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.
Rope
Someone 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.
Operation
On 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.’
Tomatoes and rice gratin
Serves 2
1 onion chopped
1 teaspoon (5ml)
dried oregano
1 tblsp (15ml)
vegetable oil
5oz (150g) long grain brown rice
½pint (300ml) water
1¼ lb (500g) tomatoes, skinned and cut
into slices
Seasoning to taste
4oz (115g) Emmental cheese grated
½oz (15g) butter
Method
Heat 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.
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.
Recovery
I 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
Recipes – Janet Jackson
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 pudding
Serves 4
6tbls (150g) butter, melted
1lb (450g) soft fruits – raspberries or
blackberries
2¾oz (75g) caster sugar
1 egg
2¾ oz (75g) soft brown sugar
8tbls (200ml) milk
4½ oz (130g) SR flour
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.
Home
I 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.
Method
Pre 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.
9

10
NICE guidance boost for patients needing TAVI
Dr Bernard Prendergast, Consultant Interventional Cardiologist,
John Radcliffe Hospital, Oxford
Good 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.
Technology
With 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 essential
TAVI 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 developments
Without 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; 363:1597-1607
2 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 member
A 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
Statue of Liberty,
New York
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.
The SAPIEN XT
valve is one of the
TAVI valves available
to interventional
cardiologists and
cardiac surgeons.
• 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.

Dates for your diary
W 27 June 7.30 Group meeting. Also W 22 Aug 7.30, W 24 Oct 7.30, W 5 Dec 7.30
Cambridge
Chelmsford and
Sat 11 Aug
F 15 June
Southwold trip 4th Wed of even months 7.30 at Great Shelford Memorial Hall
The Making and History of Decorated Eggs
District Cardiac F 20 July
Raise Your Glass – A Toastmaster’s Tale
Support Group F 17 Aug
The Easy, The Not So Easy and The Damn Difficult of Nature Photography
F 21 Sep
Barges on the Blackwater
F 19 Oct
The Inca Trail
Halton
F 16 Nov
F 7 Dec
Tu 19 June
Midland Grand Hotel Old and New
Christmas Social
Trip to the Imperial Hotel, Llandudno
All 8.00 at Broomfield Parish Hall
Every Th 1-3 at The Grangeway Community
Every Th 1-3
Centre, Runcorn, for various activities, line dancing, Tai Chi, and gentle exercise
Havering Hearties
King of Hearts,
2nd Thur 7.30
2nd Wed 7.30
At The Royal British Legion Club premises, Western Road, Romford, Essex
The Aldborough Room, Fullwell Cross Library, High Street, Barkingside IG6 2EA
Redbridge, Essex
For details contact Tony Roth 020 8252 0877
Lincoln Tu 19 June 7.30 Bill Hodgson. Walking stick makers
W 20 June
Midsummer trip – see report
Tu 17 July 7.30 Bob Oakes, Blacksmith All Methodist Church Hall, North Hykeham
M 13 Aug
Boat trip on the Wash – see report
Tu 21 Aug 7.30 Katherine Theabould & Karen Duff. Cardiac Support update
Sat 29 Sept
Day 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 8 Meal at the Toby Carvery, Bromley Common
F 13 July 7.15 for 7.30 Strawberries and Cream Night
F 12 Oct 7.15 for 7.30 Quiz Night All at the Victory Social Club, Kechill Gardens, Hayes
Staffs & District W 6 June
Trip to Bury Market – see report
Tu 26 June 7.30 for 8 Talk by Paul Seabridge, Fire safety in the home
Tu 31 July 7.30 for 8 Quiz
Tu 28 Aug 7.30 for 8 Bingo
Tu 25 Sept 7.30 for 8 Heart Start
Take Heart, Southend
West Suffolk & SW
Tu 30 Oct 7.30 for 8
Tu 27 Nov 7.30 for 8
2nd Th 8.00
TBA
Crime Prevention Each last Tu 7.30 for 8.00 at
Music with Karen Shutt on the Piano Thistleberry Hotel, Newcastle, Staffs
2nd Th 8.00 at Eastwood Community Centre, Western Approaches, Leigh-On-Sea
Postponed AGM – see report
Norfolk
Warrington
Wirral
3 Dec
3rd Th 7.00
M 11 June 7.30
Christmas dinner Meetings are usually at the Risbygate Bowls Club
All 3rd Th 7-9pm at Post-Graduate Centre, Warrington General Hospital
Cath James Cardiac Rehabilitation
M 9 July 7.30 Games Night
M 13 Aug 7.30 No Meeting
M 10 Sept 7.30 Pat Lloyd Age UK
M 8 Oct 7.30 Dr Geraldine Swift, Psychiatrist
M 12 Nov 7.30
M 10 Dec 7.30
M 14 Jan 2013 7.30
M 11 Feb 2013 7.30
Games Night
Christmas Social Evening
To Be Arranged
Annual 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
11

12
How do we ‘stat up’? - Corey Beecher
It 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 Foundation
So 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 guidelines
The 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,
Second copy of the crossword
This 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.
1 2 3 4 5 6
7 8
9 10
11 12
13 14
15 16 17 18
19 20 21 22 23
24
25 26 27 28 29
30 31 32
33
34 35
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 Europe
Back 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

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.
Transplantation
On 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
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 Fred & June Roach
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.
13

Crossword – second copy page 12, answers page 5
This 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.
Across
1,4 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)
Down
1 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)
Affiliated Groups
Chelmsford & District Cardiac Support: Malcolm Gibson
01621 893064
Chester Heart Support: Peter Diamond 01244 851441
Croydon Heart Support: Ken Morcombe 020 8657 2511
Havering Hearties: Jackie Richmond 01708 472697
King of Hearts, Redbridge, Essex: Tony Roth 020 8252 0877
Southend Take Heart: George Turner 01702 421522
Wolverhampton Coronary Aftercare Support: Ken Timmis
01902 755695
The Journal is the bimonthly magazine of the
BRITISH CARDIAC PATIENTS ASSOCIATION
also known as BCPA. Registered Charity 289190
President: Sir Terence English KBE, FRCS Vice-Presidents: Ben Milstein MA FRCS; Alan Bowcher DMS FFA
Executive Officers
Chairman: Keith Jackson Tel: 01949 836430
Vice-Chairman & Journal Editor: Dr Richard Maddison Tel: 01234 212293 Email: richard.maddison@timicomail.co.uk
Treasurer: Derek Holley OBE FCA
BCPA Head Office: 15 Abbey Road, Bingham, Notts NG13 8EE Tel 01949 837070
Email: admin@BCPA.co.uk Website: www.BCPA.co.uk
Opinions 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
Design and production – John Hunt, john@cartog.co.uk Printed by – Core Publications Ltd, Kettering
14
1 2 3 4 5 6
7 8
9 10
11 12
13 14
15 16 17 18
19 20 21 22 23
24
25 26 27 28 29
30 31 32
33
34 35
Co-ordinators
Cambridge: Bert Truelove 01223 844800
Halton: Stella Bate 01928 566484
Lincoln: Bill May 01522 885756
Peterborough: Gordon Wakefield 01733 577629
South East London & Kent: Chris Howell 01689 821413
Staffordshire: Eddie Coxon 01782 416143
Warrington: Dennis Atkinson 01925 824856
West Suffolk & South West Norfolk: Brian Hartington
01284 762783
Wirral: George Bird 0151 653 4530
Wrexham: Alan Ellis 01978 352862
Contacts
Bedford: via BCPA Head Office 01949 837070
Belfast: John Hamill 028 9081 3649
Cannock Area: Brian Nicholls 01922 412753
Chester: via BCPA Head Office 01949 837070
East Suffolk: via BCPA Head Office 01949 837070
Hampshire: Derek Rudland 01329 282809
Hull & East Riding: Stephen Hackett 01482 561710
Llandudno: Joan Owen 01492 876926
Lowestoft: John Genower 01502 511894
North Staffordshire Implantable Cardioverter
Defibrillator ICD Group: James Lyons 01782 852509
Oxfordshire: Chris Gould 01491 872454
Swindon: Jim Harris 01793 534130

Membership and aims
Whatever your interest it may be that becoming a member is
something you have never considered.
Are you reading this Journal as someone who is not a member
of the Association? If so we are pleased to count you as a valuable
part of our readership.
However, might you take a few moments to consider making
use of the application form to join the Association. It may be
that you are a heart patient, a relative or carer of someone with a
heart condition, or indeed someone taking a general interest in the
Association and the support we are able to offer. Whatever your
interest it may be that becoming a member is something you have
never considered. May we invite you to consider it now. We would
be delighted to hear from you.
We partly rely on donations to help us support cardiac patients
and their families or carers. We aim to provide advice, information
and support to help anyone who has had a heart condition, and aim
If you wish to make a donation, please add the amount to your
membership, or send it with your name and address and a signed
copy of the Gift Aid wording if appropriate to the Head Office
address. Donations will be acknowledged.
Amount of donation £ ...........
If over £50 may we also put it in the BCPA Journal? Yes/No
If you would like your donation to go to your local group, give
Name of Group ................................................
Please make cheques payable to: BCPA (The British Cardiac
Patients Association).
Membership application or renewal
Please send this application to: BCPA, 15 Abbey Road, Bingham, Notts NG13 8EE
Subscription enquiries telephone: 01949 837070
Membership £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.
New member Renewal
to help reduce or prevent heart-related troubles. Your
generosity could help us to help others to live a fuller
and healthier life.
If you do not have a group near you and would be willing to
help start one in your area, please contact our Head Office for an
informal discussion.
If you have any questions that we can help you with please write
them on a separate sheet of paper and we will do our best to help
you.
If you are paying income or capital gains tax at the standard rate or
above, you should make the following declaration:
I want the BCPA to treat all donations I make in this tax year
and all donations I make from the date of this declaration
until I notify you otherwise as Gift Aid donations.
I understand that I must pay an amount of UK income tax
and/or capital gains tax at least equal to the tax the BCPA
reclaims on my donations in each tax year.
Yes, Gift Aid No
1 You can cancel this declaration at any time by notifying the
BCPA
2 If your circumstances change and you no longer pay income
or capital gains tax equal to the tax that the BCPA reclaims,
you should cancel your declaration
3 If you pay tax at the higher rate you can claim further tax relief
in your self-assessment tax return
4 If you are unsure if your donations qualify for Gift Aid tax
relief, ask the BCPA or refer to help sheet IR65 on the HMRC
website www.hmrc.gov.uk/charities
Signed………………………………………................................... Date………………………………….
Mr/Mrs/Ms ................... Date of Birth .............................................
Forename(s) .....................................................................................
Surname ...........................................................................................
Address ............................................................................................
..........................................................................................................
.................................................Postcode ..........................................
Telephone .........................................................................................
Email ................................................................................................
Joint member’s name .......................................................................
..........................................................................................................
Address BCPA, 15 Abbey Road, Bingham, Notts
NG13 8EE
Telephone 01949 837070
Email admin@bcpa.co.uk
Website www.BCPA.co.uk
Registered Charity 289190
Type(s) of treatment(s) & hospital(s) ..............................................
..........................................................................................................
..........................................................................................................
Is there anything you would like help with or information about?
..........................................................................................................
..........................................................................................................
..........................................................................................................
..........................................................................................................
..........................................................................................................
..........................................................................................................
15

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