QR9

No…i haven’t completely run out of logical and descriptive labels to head my posts : 9 in the title refers to this post being postoperative week 9 and ‘QR’ refers to Q risk which i guess most of you won’t have heard of.    The actual inspiration for the odd title actually came from seeing fishing boats in Norfolk and as many of you will know all fishing boats have a port designation and a number, in this case i don’t know of and can’t think of a port with a QR designation though.     Of course this is a health post and  I hadn’t heard of Q risk until this week either and i really should so i have been doing some fast reading.

For me it’s postoperative week 9 then and it hasn’t exactly gone to plan.   This week i should have been all bright eyed and bushy tailed back at the hospital and i’m not because the new knee just isn’t right yet.  It’s still very boggy and swollen, still gives me a fair amount of pain at night and i still can’t stand on that leg particularly well.  Even despite doing all the exercise, in fact rather over doing it i still have a lot of muscle loss that side which looks and feels pretty horrible.   So this week i have had a return trip to the GP, been poked and prodded rather nicely and had bloods taken because of the new medicines that i am on.  Just to recap from earlier posts that my GP discovered that i was moderately hypertensive just before my surgery and that everyone else….nurses, anaesthetist etc re-discovered the same fact during my short stay in hospital.   So, i’m on an anti-hypertensive medicine and the blood-taking was all a part of that. I thought that the bloods taken would be mainly about renal (kidney) function but it looks as though they did a more complete set including my lipid profile.

Feeling a bit like this at the moment….old, knackered and beached in a muddy creek.

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So, Q Risk then and ……what is it ?

Well basically Q risk is a mathematical algorythym for assessing cardiovascular risk based on several risk factors.   Some of those risk factors are modifiable and some aren’t : i can’t for example alter my gender or age but can or could modify some of the others for example my BMI (body mass index) and blood pressure.                 It seems that i am in the moderate risk group, of having a having a heart attack in the next ten years with a calculated risk of 13 % with my ‘numbers as they are today.  What that meant in terms of my interaction with  the GP that i saw is that she said it is now normal practice to discuss the risk and offer another medicine ie a statin.   As it is i am a bit wary about statins but that’s another story.   Not having met Q risk before and for my part mainly being at the surgery to work out what to do with my knee next i was caught a bit on the fly with the percentage risk and what to do about it. However it works out though i have to accept that i am 60 year old male with some degree of cardiovascular risk….in fact i’m a moderately hypertensive fat bastard…so there you have it.

I had to do a bit of quick thinking and throw some questions up, mainly about the actual risk factors that i don’t have, for example that i have never been a smoker, both parents still alive and no significant cardiovasular risk in my immediate family.           I am very pleased to say that we had a quick but useful discussion about which way to go with this and what i decided is to work on the 2 risk factors which can be modified very quickly. I have already started on a low dose anti-hypertensive  so although not exactly ‘box ticked’ that one is being worked on.  What i thought i can quickly start to modify is my BMI ….essentially my weight.   Now that is a problem because as my GP accepted the main reason for me being overweight right now is a lot to do with the last 18 months having become very lacking in terms of my normal exercise.  That’s been made much worse in the last 8 weeks after surgery when i really have been sitting around a lot more than i would do normally and also that i have got into the bad habit of going out, just to get out of the house, for coffee and inevitable cake.  I have also been doing a lot of just sitting at the computer and writing/editing posts and because my concentration wasn’t good at first having many coffee and biscuit breaks.

Back at home i had a good look at the Q risk website and played around with the risk calculator myself.  Unfortunately i didn’t ask my GP what my LDL/HDL (lipid profile) ratio was as that is an essential part of the model.  What i must say is that the model is quite clearly a work in progress and other risk factors have been added since the model was first put together.  As far as i can see there are a lot of risk factors that i just don’t have , for example i’m not and never have been a smoker, don’t have diabetes and don’t have significant mental health problems.  I do want to take a look at that last one again though because in the past i have been prone to SAD (seasonal affective disorder) and that is a form of depression.   What isn’t represented at all in the model is any consideration of exercise or ‘fitness’.  Right now i am clearly overweight and under-fit, by my own standards, and they are quite easy things to modify……even with a knee problem.

So i have a plan…..at this stage a first 6 week plan, which is the additional time i have been signed off work for.   That plan has 3 aspects : the dietary aspect, a training plan and a ‘work’ plan.  Right now i am working up an exercise regime that will hit the weak quad very hard and stimulate muscle growth again, alongside that is a more general fitness plan which, i think, will have me back in the gym next week.  The dietary plan is to essentially do an Atkins-style induction and basically induce ketosis on a daily basis and with an overall reduction of calorific intake.  As always i will work those 2 sides together, for example i have just done an hour’s walk including hill work as a warmer and then done a set of partial single leg squats to really hit the weak leg.  It did feel pretty horrible and gave me a good ‘Elvis’ on that side.  Immediately after that short exercise routine i had a protein shake and a small amount of carbs.  Since inducing ketosis, now 5 days ago, i have had an absolute waterfall effect of water dumping which will account for a rapid but not quite genuine weight drop.  My aim is to get 5-6 kg off in this first stage and then at least 15 kg off by my next birthday.

Here is the link to the Q risk website and risk calculator.

https://www.qrisk.org/

https://www.qrisk.org/2017/

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