Heart Attack: Rehab 3

Last Monday I had my first visit with Dr. Paul Kang after leaving Hamet Hospital in July. The results were very encouraging. Just previous to this visit I completed cardiac rehab, in half the allotted time, and returned to playing tennis. During a vigorous tennis match, my average heart rate was 105, the top of my target zone, and included a twenty minute cool down. My highest heart rate was 230. I asked Dr. Kang if this was OK for me, and he inquired about symptoms, including palpitations. I had none and felt fine. He concluded that I have an excellent tolerance for physical exercise.

In addition, my cholesterol numbers were 150 total cholesterol with excellent “bad” and “good” cholesterol numbers. Dr. Kang said, “I couldn’t have written them down any better.” My wife and I were very happy to know that the dietary changes and exercise we’ve been doing, supported by Crestor, my cholesterol medication, have done the job!
As luck would have it, I was immediately put to the test. Friday I played in a tennis tournament to raise funds for an Edinboro University Sociology scholarship. I played three hard-fought sets in unseasonably high 83 degree October sunshine. Early the next morning I arose to play clarinet for the Zem Zem Band at an Autumn Leaves Festival in Clarion, Pennsylvania. Two full days of activity tested my tolerance. I was tired and somewhat stressed at the end of Saturday, but a good night’s sleep and a forty minute walk around campus have returned my good spirits.

At this point, I can say I feel as good as new, if not better. My biggest problems are mental, with slight cases of psychosomatic symptoms and occasional bouts with stress. The biggest change that has occurred is I feel less like an invalid and more like a normal person. I believe that the more I can put my heart attack to the back of my mind and view the present in clear, appreciative focus, the better off I’ll be.

I have an important Echocardiogram coming up on October 16. Hopefully I’ll learn that the pumping power of my heart has improved.

Heart Attack: Rehab 2

A progress report.

When I walked into the Cardiac Fitness Center the other day, I was shocked to see an overweight man in his Sixties sitting in the waiting room happily munching a fast-food hamburger. Obviously, he dismissed the message his cardiologist gave him about a low-animal fat diet. While his action was extreme, many of my fellow patients at the rehab center are repeat heart attack victims who didn’t follow their doctor’s orders. For me, their errors are my inspiration to succeed.

Routine is the name of the cardiac fitness game. Upon entering the center, the first thing you do is sign-in and report your weight; current blood pressure; whether you’ve taken your meds; and how you feel, such as good, fair, or poor. Then you pick up and attach a heart monitor to your body, and record your monitor number, so the cardiac fitness staff can track you during exercise.

Three therapists and a dietician are available to seven of us, three women and four men, while we exercise. One therapists keeps constant surveillance of our heart rate, so we don’t exceed our target heart rate . The other two nurses help us with the machines, keep an eye on our condition, and answer questions we have about our therapy. Part of their routine is to take our blood-pressure during exercise, as well as before, and after a cool down period when we finish. Constant monitoring of our heart-rate and blood pressure helps the staff determine appropriate levels of exercise for us.

During my seventh day at Hamot Cardiac Fitness Center, I achieved new levels of difficulty for my exercise routine. My first exercise is on a stationary bike. After a five minute warm-up at 35 rpms. I increase my speed to 50 rpms for an additional fifteen minutes. Biking is the most taxing of my exercises, and I like to do it first. Blood pressure rises during exercise, and the bike gets my blood pressure and heart-rate pumped. Each outpatient exercises at a pace suitable to his or her condition.

After the exercise bike, the treadmill is next. Initially, I walked at a 2.2 mph pace. Now, my pace is 2.8 mph on a 3% incline. I walk for 20 minutes. My final exercise is ten minutes on a NuStep, a recumbent cross-training machine operated with legs and arms to work all the major muscle groups.

Overall, I’m currently doing fifty (50) minutes of cardiovascular exercise at a heart target rate compatible to my age and heart’s strength. My goal is to strengthen my heart’s pumping ability measured as an “Ejection Factor” (EF). A normal EF is 55. Through systolic failure my EF became 35. Heart muscle damage cannot be repaired, but I can improve my EF to above 40%. As a practical goal, I want to once again be able to play tennis at a high level for my age.

Heart Attack: Rehab

Three and a half weeks ago I was released from Hamot Hospital after suffering a heart attack. My doctor told me at that time that I should be able to return to normal activities, including tennis, in six weeks. This is a progress report.

My rehabilitation has centered on four basic areas: (1) a daily weigh-in, (2) a low-animal fat & low sodium diet, (3) taking my medications, and (4) a gradual return to physical activity. The hospital has provided some educational guides for me including a “Heart Owner’s Manual: Your Personal Guide to a Healthy Heart,” and “Strong Hearts: An Educational Guide for Heart Failure Patients.” While I was in the hospital I received healthy heart education and dietary guidelines. All of this information has helped me understand and follow four basic areas for rehabilitating my heart and my life.

The principal reason for weighing myself each day is to be alert to the possibility of congestive heart failure (CHF). An indicator is a sudden weight gain of two pounds over my weight as I left the hospital. My weight the morning after returning home was 203. Today, after a little Saturday night celebration, it is 200. I have been as low as 198. So, far my weight is doing fine.

Since I had a clot in my left ventricle, the hospital emphasized the importance of following a low animal fat diet. In addition, the “Strong Hearts” book recommends a low sodium diet. Fortunately for me, the transition to a heart-healthy diet has been reasonably easy. Partly because of changes my wife introduced to our diet over the years, and partly because of her devoted effort to prepare food that meets my guidelines and tastes great. Another help is that we both enjoy a variety of foods and like fish. When eating out or choosing food it is easy to make mistakes, especially by eating foods that are too high in sodium, a hidden ingredient in most prepared foods. It’s important to read the Nutrition Facts on pre-packaged foods and choose wisely. Learning the foods to avoid and the foods that are recommended eases the decision making process. I’m still learning, but for the most part I’ve been able to follow my low animal fat-low sodium diet.

I’ve established a routine for taking my medications and have yet to forget. My medications include asprin as a preventive measure; Plavix to prevent blood clots; metoprolol for myocardial infarction; Crestor, for cholesterol; and a blood pressure medication. Within a week I developed a cough from taking the ace inhibitor, Altace. My family physician changed my blood pressure medicine to Diovan, an ARB, two weeks ago and my cough is nearly gone. I cough only occasionally, and this is a great relief to me because coughing is a symptom of congestive heart failure. Now I know my cough was a side effect of the ACE inhibitor. The cough was also constantly annoying and made some of my activities more difficult, especially playing the clarinet. I take my blood pressure daily and have achieved a desirable range. My medications are doing their job.

In addition to the basic three steps to survival of diet, medications, and weigh-ins, I’ve started exercising. On the day after leaving the hospital I took a slow, twelve-minute walk. I gradually increased the tempo, length, and time of my walk. Today I walked three miles. Last Wednesday, three weeks to the day after leaving the hospital, I started therapy at the Hamot Cardiac Fitness Center.

“A medically supervised, insurance based, monitored exercise program designed to restore one’s strength and stamina. Walking, biking, strength training and education on heart risk factor reduction are offered. Physician referral required.”

A monitored exercise program restores my confidence that I’m progressing at an appropriate pace. I’ve started doing more chores around the house and yard, and I’m gradually returning to normal activities.

My rehabilitation appears to be progressing according to plan. I’ve been fortunate in my health care from the time I left my front porch with the medics dispatched from our 911call through my restoration at Hamot Hospital, one of the best hospitals in the nation for cardiac treatment, to my wife’s loving care at home. Half of the people who have a heart attack, such as the one I experienced, die. The care I received has already extended my life, and by following the “doctor’s orders,“ I will have more good years to come.