Following the consultation with Mr R last week, he has written to the GP:


I have seen Eric today in my clinic. He was seen recently by my senior registrar, Mr Tiwari, with ache in the legs, generalised weakness and shortness of breath. A duplex scan on Thursday showed that his EVAR graft is running well. However, he has got peripheral vascular disease with damped flow around the ankle. It was my concern that he was anaemic with a Hb of 8.5 when he was last checked, so I am repeating his full blood count urgently today, as well as getting a chest X-ray to make sure that he is not in heart failure, since he has got bilateral leg oedema as well.

He is known to have a small calcified lump in the lateral aspect of the left foot, which is booked for excision in the next couple of months. However, in view of the poor circulation in his foot, I think that this can run the risk of non-healing. Hence I will be discussing with the orthopaedic surgeons about the necessity for this operation.

I will be seeing him with the results in my clinic next week and I will keep you informed of his progress.

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Tomorrow I'm seeing Mr R again and he will have the x-ray, ECG and the latest blood test.

No doubt all these vascular problems are the result of my smoking 20 cigarettes a day until I gave up on July 31, 1976. I have read somewhere that 20 years after giving up, the heart and lungs are back to normal, but I doubt if that is the case.

Self-harm caused by smoking, alcohol, drugs and bad eating is responsible for huge burdens on the NHS and thus on the taxpayer. In the current exercise to balance the books, here is an opportunity for double benefit. Taxing harmful products up to the hilt - including drugs - would generate billions of additional revenue, and at the same time reduce spending on health and crime.