Why the Cardiologist Recommended the Rehab Facility

I thought I was in good shape before my 'heart events'. I was playing hockey twice a week, skiing, biking, even walking. But, two years ago starting at 2pm while sitting in my car, I had the first of 15 heart attacks in nine hours.

I was in the heart institute for a week and lost the first 15 pounds of 41 that I eventually lost. In my last post, I talked about what the cardiologist told me (and my wife, who was there as my advocate) as we left the hospital. The staff there had set up several appointments for me for follow-on and continuing ancillary care. One of these was at the rehabilitation facility (hereafter called rehab). I wasn't sure that I needed/wanted to do that; it was for 'sick' people, or so I thought. I read about how important it was to get some exercise and to start by walking up and down in front of your house and gradually extend your distance. I could do that.

So, I tried to walk to the end of the block. I quickly developed chest pains. And, like most other first time heart patients, I 'knew' that I could die from that. So, I didn't exercise.

My first appointment at the rehab facility was in a month. At my first appointment, they had me come in early to get the background, etc. There was a nurse and a physio in attendance and I explained what had happened and why I had not done any exercise for the past month. They wired me up and told me to walk around the track while they watched on their computer monitor. They said "Come in as soon as you have pains". I said "I'll see you in five". So I walked out on the track and developed pains in less than one circuit. When I went to see the monitor, they could not see anything wrong and said that was normal and not to worry about it. They did show me a confidence booster. "Put both arms straight up and, if there is a change in your chest pain, then it's not cardio". So, with that relief I went back onto the track and walked confidently for 45 minutes. And, I never looked backed.

The program offered at our heart institute is free for survivors and consists of sixteen sessions, two per week. They have a short, oval track and the regular gym machines (treadmills, bikes, elliptical trainers) and you are free to use whichever of these you want. There are 16 people in each session and you are free to use all of the facilities as you wish. There are medical personnel there at all exercise times and they take your vitals before each session.

After getting my confidence and learning what I could do, I eventually built up to my current level. It's been two years and I walk or bike for an hour per day and carefully watch all of the other risk factors (diet, stress, polluted air, meds, depression). Some say that I'm anal about how closely I monitor these things. I even photograph every meal so as to not miss any that I need to record for the next time.  My blood pressure (both arms) and pulse is amazingly low (but safely so). Even the cardiologist (also a survivor) is envious. I have not returned to hockey but I began skating and skiing again this winter and they both feel fine. I still make the same mistakes in those sports as before.

Is rehab important ? In my opinion, absolutely. Without that confidence boost, and the associated exercise value, I definitely would not feel as good as I do.

What should your cardiologist tell you as you leave the hospital

Congratulations !  You will be leaving the hospital today and, although we enjoyed having you here, we don’t want to see you back.  Except, of course, for your visits to our rehab facility. I’ll get to that in a bit.

In the past, a heart survivor would be patched up, maybe receive a new transplant, maybe a bypass or some angiography and then sent back to live as they did before. Research over the years determined that survivors should change their lifestyle to increase their chances of not having another attack.  So, there are five things that you should address. These will become part of your new lifestyle.

These are:
1.    exercise – It is important for you to do regular exercise. This can be as little as walking for 30 minutes 3 times a week up to 60 a day every day.  In the rehab program, we will be able to determine how much and what activity you can do.
2.    diet – What you eat is important. You should be knowledgeable about the amount of sodium and fat that you eat.  The people in our nutrition program will help you to understand what this means and how to do it.
3.    stress – Stress is one of the things that is impossible to see but can have large effects on your body. If you are a stressed person, you may want to work on that.
4.    sleep – Sufficient sleep is necessary to help your body repair and to maintain itself. You should have 8 hours per night and a short nap 3 times a week.
5.    smoking – Smoking is bad for your heart and second-hand smoke is thought to be as bad, if not worse.
6.    depression - I would suggest a sixth thing cardiologists should discuss with their patients -- the risk of depression. More than half of all heart attack survivors suffer from depression after their heart attacks, and being depressed can increase their risk of a second heart attack two or three-fold! I think patients should be warned that this may happen and educated about potential signs of depression. It's also worth discussing with the survivor's family (similar to the counseling new fathers receive about how to spot post-partum depression).[this point is thanks to Jen Thorson @jen_thorson on Twitter]

Stop these five things to greatly reduce your risk:

Smoking (or hanging around with smokers). Smoking is the most dangerous -- yet most reversible -- risk factor for heart disease. If you are under 40, quitting smoking and avoiding secondhand smoke today can lower your heart disease risk to that of a nonsmoker over time.

Eating trans fats. Synthetically created to extend the shelf life of baked goods and snack foods, trans fats can raise your level of LDL ("bad") cholesterol, too. Best bet ? Check the label for trans fats (also called partially hydrogenated oils) and avoid them entirely.

Adding salt. Eating a lower-salt diet can lower your blood pressure by five points, which for many people can mean one less prescription to buy. Most people consume as much as 3,500 mg of sodium per day. This comes mainly from processed food but also added at the table. You should aim for a maximum of 1,500 mg per day for at least the next year.

Gaining weight. You likely have lost weight while here. You need to keep that weight off and maybe even lose some more. In rehab and nutrition, they will advise you you’re your desired weight should be.  Processed food, oversized portions, snacking and a sedentary lifestyle have added inches to our waistlines and layers of risk to our hearts. Losing weight can help.

Giving up on medications. No one likes to take pills. But blood pressure, cholesterol, and diabetes medications will also reduce your likelihood of a heart attack. Talk to  your doctor about a medication regimen that will work for you, then stick with it. You want to be rigid consistent about your meds .

I want you to record your foods, daily, for at least three months, maybe even longer. You should record the numbers for everything you eat so that we can see how your body is responding to your new lifestyle. So record:
•    calories
•    sodium
•    cholesterol
•    total fat
•    sat fat
•    fluids
•    carbohydrates
•    potassium
•    protein

In some cases, you can get these numbers from the food packages. If not, search for them online.  Eating in restaurants will be a challenge, as it is difficult to get the numbers and there are some foods that you will have to avoid.  These include things like hot dogs, regular bread, canned soups, many pastas, ham, bacon, most condiments, soft drinks (especially power drinks).  But there are many things that you can have, like steak, beef, fish, some pastas, some cereals, most vegetables, most fruits, wine, beer, liquor.

We’ll set an appointment for one month and see how you are doing. The appointments have already been made for in the rehab facility and with the nutrition department.

I look forward to meeting you again in a month. Take care of yourself and I mean that.