Category Archives: Cardiac Rehabilitation

Changing treatments

I heard about two more Heart Attack Survivors at work recently. Apart from the fact that there seem to be more cardiac emergencies around today than in the past (probably more to do with me than everyone else!), I was struck by the way they had been treated… the two gentlemen had received 8 and 12 stents respectively.

Apparently the guidelines for treatment have changed recently…

When I had my Heart Attack, the approach was to just treat the blockage that was causing the immediate problem. For me that meant fitting two stents in my Left Anterior Descending or LAD artery. During the procedure they identified that another of my arteries (Right Coronary Artery or RCA) was partially blocked, but as it wasn’t causing any distress so it was left untreated.

Apparently now the approach has been revised so that they address any blockages during the initial procedure. As a result, the patient leaves hospital safe in the knowledge that they have no blockages. I guess it maximises the value of the angioplasty procedure, and reduces the chances of having a repeat performance,

There is a point of view that stents aren’t great for you. Yes, they are helpful in an emergency situation like mine, but many people are treated with stents as a preventative measure.

The argument is that the stent treats the symptom rather than the disease, and in the process reduce the chance that any action will be taken to address the root causes themselves. In addition, they leave the patient dependent on a concoction of medication and exposed to the side-effects and potential complications (for example, risks associated with future, non-heart related medical procedures).

Personally I haven’t thought much about whether my situation would be significantly different if my other artery had been treated at the same time. Given the emergency nature of my treatment, I obviously didn’t have an opportunity to think about it in advance. There was certainly no debate or discussion as I got wheeled into the “Cath Lab” (See: The Cath Lab (FD ~02:30)). I didn’t have an opportunity to weigh up the pros and cons.

There was no cosy chat for me when I arrived at the hospital!

To be honest, it doesn’t feel like a huge deal right now, but I recognise that it could turn out to be a big deal at some point in the future. It seems strange to me that if I’d had my Heart Attack today I might have been treated in a very different way than 6 months ago.

I guess I have little option but to carry on taking my medication and stay disciplined, it’s up to me to do the work to address the underlying disease (or at least to prevent it from getting any worse). For me, watching what I eat and drink as well as exercising regularly are the key to my long term health.

I can’t rely on stents to return me to “normal”. Now it’s all about establishing a new, safer, healthier normal.

Just the three of us

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The maintenance work at the Local Pool finished yesterday bringing the week-long closure to an end. I don’t usually swim on a Saturday, but I was keen to get back in the pool, particularly as we have visitors this weekend and an early morning swim seemed like a good way of getting some exercise without impacting our plans for the day.

Not being a regular on a Saturday, I didn’t quite know what to expect. Given it had been shut all week I assumed the pool be busy.

I arrived to find 6 lanes marked out. Normally the swimming team would have been using 4 of the lanes but today they were all available to the public. There were some early comings and goings, but shortly after my arrival there were only three of us in the pool, and it stayed that way for the duration of my session. What a difference it makes to have a dedicated lane. A rare luxury. Bliss!

Sharing a lane can be frustrating!

After the session, one of my fellow swimmers asked me a question:

“What are you training for?”

I thought this was a fantastic question to ask in a Swimming Pool / Gym type setting. There’s no real downside… if you’re not training for something you’re likely to be pleased that someone considered you might be, and if you are it’s obviously a good conversation starter.

Personally, I was really pleased to be asked. It’s the first time anyone’s openly mistaken me for someone who’s fit for a long time. I took it as a sign that I’m making progress.

As it turned out, the chap I was speaking to is training for an Ironman event in South Africa in April next year (2.4 km Swim, 120km Cycle and a 28km Run). Clearly he has a little more conditioning under his belt than me!

The delights of competitive Open Water Swimming!

I have to admit, I was a little bit jealous. I suspect I’ll never be in a position to take on such a gruelling challenge. I’ll continue to set myself challenging goals, but they will always be within the context of my medical history, long term medication, etc.

I was recently asked a question about what I can’t do as a result of my Heart Attack. The list of things didn’t extend much beyond “some rides at Disney” and “scuba diving”. I suspect in reality the list is much longer, but I’m not going to add Ironman events to it just yet. Instead I’ll focus on doing what I can, taking it one step at a time. Who knows where the journey will end up!

Probably a step too far for me right now!

A User’s Guide to Cardiac Rehabilitation

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After 8 weeks and 16 sessions, I’ve finished my Cardiac Rehabilitation Programme. Yahoo!

The course is complete however graduation will need to wait for my final assessment – to measure my progress since I started back in mid-July – I’ll do this in a couple of weeks.

A huge thank you to all the staff!

The Rehab Dream Team: Kirstein, Maggie, Brenda and Bernard

The experience has been a wholly positive one for me. Helping me to come to terms with the whole Heart Attack experience and get back to some sort of normal routine (although it will change again now Rehab is finished!).

One of the things I’ve never understood about the Cardiac Rehab is why more (eligible) people don’t make more use of it?

After you’ve had a Heart Attack, or been treated for some sort of Heart condition, you would imagine that you’d be past the denial stage – the game is up! For many of us, we are in the fortunate position to make changes that will improve (and extend) our lives. So why doesn’t everyone?

From my perspective, it’s time to make a positive change! The Cardiac Rehabilitation Programme is what’s on offer to help… so take advantage of it!

I thought Rehab was a really important opportunity to take action, regain control, learn and reflect. I’m therefore dedicating this update to de-mystifying Cardiac Rehab for people that may need it in the future…

The Structure of the programme

There were 3 distinct sections to Cardiac Rehab which ran two sessions a week:

Exercise – 30 minutes of exercise tailored to your personal capability (using Treadmill, Cross-Trainer, Step Machine) with a facilitated warm up / cool down to get your heart working
Relaxation – 30 minutes of relaxation to help you learn how to take control and chill out
Education – 60 minutes of education on a variety of Heart & Lifestyle topics (once a week only)

In addition, your first (and last) session will be a Physical and “Happiness” Assessment. You will be asked to do a “Beep Test” and to answer some questions on your state of mind (e.g. Are you happy? Yes / No) .

Wear clothes that are suitable for exercising in – I went for full gym kit, but it really depends on what you’re comfortable in. Don’t worry, it’s definitely not a fashion parade!

Free up time

The Cardiac Rehab sessions will take a minimum of 2 hours per week. That’s if you just do the Warm-Up, Exercise and Cool-Down. You’ll need to add an extra 1 hour per week for the Post-Exercise Relaxation and another hour for the Education session. Factor in the journey to and from the hospital, and the time it takes to shower and change, and you’re looking at a fair commitment of time over the 8 weeks.

Personally, I considered this an investment in myself, in my future, for myself and my family. A long overdue investment in my health and wellbeing. Worth it?

Before you start

If you’ve followed the guidance, you will have been exercising regularly since leaving hospital. Starting very gently, maybe 5 mins twice a day, and building up slowly. You may be up to 30 mins twice daily, and feeling good, stronger and fitter. You will hopefully have gained confidence and be ready for the next stage.

As you start Cardiac Rehabilitation, you may well feel like you’re being held back, forced to go backwards even. You will likely start your exercise sessions with 1 to 1 or 2 to 1 (minutes on a Heart Exercise Station to “rest”), slowly working up the amount of time you spend working your heart.

As you demonstrate your fitness and strength, the duration of exercise will steadily increase. “Steadily” being the operative word!

Monitor your status

The Exercise sessions start and finish with Pulse and Blood Pressure measurements. Changes in medication are also recorded. I’ve found seemingly small changes in medication have had a big impact on how my heart responds to exercise – well worth monitoring so exceptions can be identified more easily.

I used my own Heart Monitor to keep an eye on my pulse throughout each exercise session. It’s not really a requirement as there are monitors on most of the machines, but personally I found it reassuring to know where I was against my upper limit.

One of the key outcomes from Rehab will be to have an increased awareness of what you can safely do and how you feel when exercising at the right level of intensity.

Our “State of the Art” Cardiac Rehab Gym

The warm up

I found the warm up quite uncomfortable the first couple of times I did it (embarrassing uncomfortable not physically uncomfortable). If you imagine the lightest, lowest impact aerobics ever, and then tone it down (right down) you’ll get a sense of the level of exertion.

I realised after a while that it is, after all, a warm up for a group of people suffering from Heart Disease. Gentle is probably the way forward!

I got used to the Warm Up after a few weeks. I guess this is a reflection on how well you’re coming to terms with toning down your behaviour to take account of the fact that you’ve had a Heart “Event”!

The cool down is similar, but even more gentle!

Pace yourself

You need to bare in mind that 8 weeks is quite a long time. Although I’m sure you’ll be keen to get back to normal, it’s an opportunity to build up at a sustainable pace. You will make progress, just don’t be in too much of a hurry.

If someone turns down the resistance on your work-out machine, reducing the intensity of your work out (and they may well do!), take a deep breath and, if you’re feeling strong, increase your speed. You can still do the same amount of work, but in different ways.

Build confidence

You’ve probably already realised that the aftermath of a Heart Attack isn’t all about you. To a large degree, the people that you’re close to, that you interact with from time to time are more important.

Part of the recovery process is giving everyone (including yourself) time to re-build confidence in what you can safely do, to trust that you’re not going to do yourself damage or put yourself in danger again.

Well, the Cardiac Rehab Team are people too. They too will build confidence over time, but it does take time.

Do your homework

I think it’s important to continue to exercise regularly while you’re on the Programme. That means continuing to exercise at home, between Rehab sessions. That way you’ll really feel the benefit of the exercise and build your strength over the duration of the course.

Relaxation

The Relaxation sessions followed a common routine… participants either lie on a bed / floor mat, or sit in a chair, and start by focussing on deep breathing, followed by tensing and relaxing muscles from Toe to Head. The process is facilitated by an instructor reading a well-worn script.

There then followed a variety of other relaxation techniques, again following instructions.

Imagine yourself in a warm, comfortable place…

To be honest, for the last few weeks, I switched off by the time the initial relaxation was complete. Overly relaxed perhaps? I have to admit, I was guilt of being the rogue snorer on one occasion (one that I’m willing to own up to anyway!). I definitely wasn’t the only one!

The relaxation techniques are useful for winding down in everyday life, both to take a few minutes out from a stressful day, or to help respond positively to difficult situations (deep breath, drop your shoulders…).

Education Sessions

The education sessions included: Diet, Medication, Preparing for the future, Stress Management, Anatomy of the heart, Getting back to “normal”.

One of the major benefits of Cardiac Rehab is having the opportunity to talk to other people in a similar situation. As the members of the group change over the 8-weeks, you will meet and share experiences with people at different stages of their Rehabilitation. This is informal, but valuable and rewarding. I really enjoyed seeing people’s confidence growing week by week.

And then it’s over…

I’m more or less on my own now, at least for the time being. I already have a gym assessment scheduled and I’ve signed up for swimming lessons.

Swimming… yes. Butterfly… I don’t think so!

For me, Cardiac Rehab created some structure to the recovery process. I had come through my initial 4-week recuperation, and was ready to return to work. Cardiac Rehab made me focus on myself 2 mornings a week.

Memories of the initial feelings to the Heart Attack are quickly forgotten. It’s all too easy to fall back into bad habits, to proceed as if nothing has changed. The 8 week Rehabilitation process provides some extra time to fall into good habits, to seek guidance and support.

It was also really nice to be part of a little group. Although there were a diverse range of individuals participating, we all had something in common, none of us were strange (at least not because of our Heart conditions!). Most importantly, I think everyone genuinely cared about each other.

Good luck to my fellow participants current and future!!!

Artists impression of my Cardiac Rehab group!

Developments

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Stress, noun
1. Pressure or tension exerted on a material object:
2. A state of mental or emotional strain or tension resulting from adverse or demanding circumstances:
3. particular emphasis or importance

A typical Cardiac Rehabilitation Relaxation session

At the end of each Cardiac Rehabilitation session, we have 30 minutes of “relaxation”; gentle music, overlaid with softly spoken instructions to focus on eliminating tension from different parts of the body (“now we’ll focus on our thighs…”), breathing deeply and generally chilling out.

It feels good, indulgent. It rounds off the Rehab session before heading out into the big wide world.

According to Wikipedia; “the body’s way to respond to stress is by sympathetic nervous system activation which results in the fight-or-flight response”.

I’m not entirely sure where lying down with your eyes closed, chillaxing fits in to this evolutionary response – I’m sure it will become clear in time, but we haven’t done our “Stress Management” education session yet! (It was actually supposed to be last week, but it got switched with “Medication” at the last minute!)

I guess that we are made to deal with our challenges face on, or to turn tail and run away! Biologically, we’re not made to dwell some things too much. Relaxation is a good way of re-establishing a sense of calm and stability after doing what you need to do.

The bottom line is, we all face stressful situations of differing degrees every day. They cannot be avoided. Even locking yourself away can be stressful for most of us (“What’s going on outside?”)…

Which brings me to my stress of the week…

We recently received a Planning Permission notice for a house to be built at the top of our garden. Seven houses in total, in two plots, but it’s the one that will overlook our house, replacing a nice wooded area that I’m concerned about.

Fortunately, there’s a simple solution that will allow the development to proceed without giving us too much cause for concern.

Unfortunately, the people that have applied for the Planning permission seem to think it’s OK to ignore us, and have been doing so for several years!

It’s very frustrating!

I find I need to think relaxed, warm, calming thoughts each time the potential development enters my mind… slow, deep breaths… “You are feeling relaxed”.

We will fight. There is a course of action we can follow.

I will practice my relaxation, and hope they have a section on “responding to unwanted planning applications” as part of the “Stress Management” session when it’s eventually held!

Ch… Ch… Ch… Changes (FD +50)

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Doesn’t time fly!

It’s the big Five-Zero! Fifty days since I had my Heart Attack. Seven weeks and a day. Forever, and no time at all.

Doesn’t time fly when you’re having fun! 🙂

To say a lot has changed would be an understatement. Some changes have been forced on me. Some have been voluntary*. Others have been a consequence of circumstances.

Scary?

“It must have been scary!”… No, not really. At no point over the past 51 days have I felt like my life was in imminent danger. However, it doesn’t take much imagination to see that things could have gone that way. In the UK, one in three people who have a Heart Attack don’t make it to hospital.

The next time you’re in a lift with two other people, imagine one of you not making it to your floor. I was in that lift. I was lucky. I didn’t realise how much danger I was potentially in until afterwards. By that stage, the immediate danger was over and the ball was in my court (more or less).

A new Dad (in reverse)

In some ways, it feels like part of me died when I had the Heart Attack. Not in a bad way. In a way that created space for new parts of me to grow in their place. In fact, its probably more correct to say “dormant” rather than “new”, many aspects of the “new” me have been there before. A very long time ago! So long ago that only close family members and very old friends might recognise them. As far as the girls are concerned, I am a new, thinner, slightly bizarre, “active” Dad.

Even knowing what I know now, I’m not sure if there is anything that would have convinced me to make some of the changes I have done in advance of something “happening”. It still all seems slightly surreal. Perhaps if someone I knew well, who I could easily relate to, had been through the same thing as I have, it might have been enough for me to take action. Perhaps.

The bottom line is, if you want to, it’s not that difficult to convince yourself that it won’t happen to you. That you’re low risk. Different from people like me.

Awareness isn’t enough!

You need to take action to make a difference.

It doesn’t surprise me that prevention of Heart Disease is such a challenge. For many (me included) it requires big changes to make a difference. I guess the key is to keep any changes small, to recognise when you’re veering of course and make minor corrections to keep you on track. So many people are so far off course that small changes just aren’t enough.

For me, my broken heart has been fixed, the course has been corrected and I’m looking to the future.

Catching up

I have some catching up to do – a holiday with the family (although Florida must wait!), recognising the patience of my colleagues, repaying the goodwill of our clients, and sustaining the lifestyle I’ve adopted since leaving hospital so none of us have to go through this again!

Here’s to the next 50 days… and making it count!

***

*Voluntary is probably a bit strong. I’m not sure I had a huge amount of choice in any of the changes, but I guess even the perception of choice makes them more palatable.

It’s never too soon

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No-one ever thinks they will get impacted by Heart Disease. We live in blissful ignorance until one day, if they’re lucky, they get a “warning”, a “wake up call”.

Many aren’t that lucky.

In 2010, over 45,000 people under the age of 75 died of Heart Disease in the UK.

That’s certainly how it was for me. I was bullet-proof. Until I wasn’t.

Once a week, the Cardiac Rehabilitation sessions have an hour of education. I consider this the “Community Service” session, where I do the time for the crimes I’ve committed in the past. The same crimes as many people, but I got caught!

This morning we talked about the anatomy of the heart. We covered much of the same ground when I was in hospital (see “You are what you eat“). I’ve had 5 weeks to think about what I could or should have asked… our questions and concerns were on a completely different level back then.

What I learnt today…

The reason why atheroma builds up in some arteries and not others is not known
The build up can start early (in your teenage years)
Once it’s there, there’s nothing that can be done to reverse the build-up of atheroma
It can only get worse, not better (drugs can help reduce the associated risk, but don’t reverse the build-up either)
The only way of assessing the build-up is by performing an angiogram which itself carries a risk of 1 death in 1,000 from Heart Attack or Stroke
Prevention is the best strategy
It’s too late for me to adopt this strategy (but I knew that already!)

What’s happened to me could happen to anyone. It’s never too soon to become aware. Never too soon to take evasive action.

I know it doesn’t seem real, particularly if you’re young, fit and healthy. It won’t. Until it is. And then it’s too late.

Standing up and Sitting down (FD + 31)

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We are encouraged not to “blur” at Cardiac Rehabilitation as it can result in over-exertion

It turns out that standing up and sitting down on a chair repeatedly over even a relatively short period of time can be tiring.

Yesterday turned out to be a an introduction and assessment day at Cardiac Rehabilitation. A bit of an anti-climax to be honest, but not a disaster. The “proper” sessions started this morning.

So… I discovered that walking on a treadmill is fine, cycling on an exercise bike is a breeze, cross-trainer (minus arms) is comfortable, but standing up and sitting down (poor man’s squats, I guess) hurt. Not a scary, Cardiac Rehab, “somebody get a doctor” kind of hurt, but my legs clearly weren’t used to that kind of exertion. They hurt then and ache now.

[Try it yourself. Sit on a normal dining-type chair and stand upright, sit and stand, sit and stand. Repeat continuously for 3 minutes. If you struggle, perhaps you need to get some more exercise too!]

It was a different exercise experience for me. I guess I’m starting from a different place. I’m not just a little bit unfit. I have had a Heart Attack. I don’t really want another one. So this needs to be about taking the exercise seriously, but not doing too much serious exercise: Warm up. Work out (moderate exertion). Cool down. And relax.

I now have a maximum Heart Rate. I’m not sure I’ve ever had one before. If I have, I’ve certainly never owned a device to monitor it. I do now. I’ve got a shiny new watch that tells me everything I need to know (unfortunately only while exercising). My magic number is 118! [220 minus 42 (age) minus 30 (drug factor) multiplied by 80% if you’re interested.]

I tend to keep my shirt on… it reduces stress all round!

I was the only person with a (personal) heart monitoring device (no-one commented, but I did get a few looks). Everyone else relied on the kit provided – which involved a single measure mid-way through the exercise programme. I guess there’s a risk that I take this a bit too seriously, but I don’t think it’s over the top to want to know if you’re approaching your maximum heart rate, is it? (I maxed out at 112 bpm, incidentally).

Anyway, 1 session and 715 calories down…
15 and lots more to go!