Cardiac rehab

This post is well overdue, I’ve now had 6 rehabilitation sessions with another 6 to go, so that makes it half-way … right?! Of course there’s a serious point to that comment. CHD does affect your short-term memory, but not your reasoning or analysis – as far as I can tell. So what is cardiac rehabilitation and how is it helping me (and hopefully others)?

The idea is this. Your body has had a bit of a battering – you may have had surgery like me, or a heart attack, or had some stents put in. All are manifestations of CHD, and all have had a number of effects on your heart which need to be tackled through physical exercise full-on if you’re going to have a good recovery, and you also need to understand how and why you got to where you are, so that you can attempt to change your life-style.

Life-style changes (including exercise) are of the greatest importance if you’re going to attempt to minimise the risk of recurring CHD episodes. So this is important stuff. It’s also important as a guide to how to minimise your risk of having CHD in the first place, though (as in my case one suspects) your genes may have a say in the matter and of course (as is said) you can do something about your friends, but not your family – so you MAY be stuck with genes that are not too helpful; but you can try and postpone (or reduce) that genetic effect.

So for me rehab is about a) getting my brain in gear to understand what and why all this happened; b) getting my heart working well – understanding the amount and type of physical exercise I require to get it supporting my ambitious life plans; and c) learning a little bit about relaxation as this may, just may, be helpful in preventing me get into the wrong place in the future. There have been other unforeseen consequences of rehab which I’ll cover in another blogpost which are linked to the personal reflection that has been a consequence of having so much time to think, rather than do, and some of that has been very revealing and scarey as well.

The rehab programme at UHW is organised by cardiac rehabilitation nurses in a multi-discplinary team that brings in physiotherapists, organisational therapists and other specialists such as pharmacists and dieticians as well.

For me the programme started with an assessment of my physical fitness and the range of heart-rate that I should attempt to keep within for moderate activity which I know now I should attempt to do for 30 mins every day, maybe in three slots, but I should try not to miss a day out. The exercise is important not only in getting my heart as a muscle working efficiently and well, but also in balancing my cholesterol; so if you see me sitting down in front of a screen too much – tell me to go and have a 10min walk! Now after 6 sessions of aerobic exercise in circuits, I’m about to move into the final “advanced” phase of rehab where I use equipment and learn how to use all those torture devices that I’ve shied away from learning how to use (and why) in the gym. So one outcome of this is that I may join a gym. I may also ask for a GP Referral, which is available in Cardiff( and Wales I think) to get an induction to the gyms in our leisure centres.

The exercises I’ve been doing to date are not in any way that extending, but what is important is the recognition of what actually constitutes “moderate exercise”. That is what I need to do regularly, so the class aims through the use of “the Borg Scale” to teach you to relate how you feel about the exercise (perceived state of exertion) against the actual heart-rate that has occurred during the exercise. It’s tempting to push yourself – I do – but that’s not the object. It’s an educational session rather than a fitness session – that comes later and it may be still a number of months before I climb a Lake District or Snowdon peak.

Before the exercise session there have been a number of talks on for instance physiology and exercsie, on diet, on stress, on cardiac drugs – which have been interesting an rewarding and which have served as a stimulus for the participants to also talk about their experiences all of which are different – that’s been the surprising thing! There’s so much information on the web but these sessions allow you to bring much of it together and contextualise it into your personal situation. Really worthwhile.

And then there’s relaxation … I enjoy these sessions, whilst I’m there, but can I remember to put what I’ve learnt into practice and use it away from the sessions? Of course not! That’s so alarming. I know I should relax more, but I can’t for the life of me apply the techniques at times when I really need to. It’s just so easy to relax after physical activity. Can I remember to do it before I get “het up” – no! So, MUST do better is the lesson here.

In all, half-way through, I can honestly say that cardiac rehabilitation is the most important part of the episode I’ve been experiencing. I (as readers of earlier posts will well know) was in denial for all the period pre-operation; had my anger and operation-related depression afterwards; but it was not until cardiac rehab that I, yes me, took some control over what was happening to me. Everything before then was essentially being done for, or to, me. So now it’s down to me. Do I want to come out of this better than when I went in, or don’t I care? Do I want to have a fit and healthy life from now on, or don’t I care? Do I want a second chance that really means something, or do I just want to drift?

The answers are easy.

Into action – Week 0

Hopes and fears – everyone minimises the risks of the operation, pointing at 80 year old smokers who’ve come through it fine, but I could just be the one that generates the “well I never” scenario – so I’m scared – OK. I hope that once this is over, and with a healthier diet, that I’ll eventually (and this is a long time into the future “eventually”) die peacefully in my bed from nothing connected to CHD.

Objectives for the week – just to survive; aim to be out of hospital as quick as I possibly can, realistically 6-7 days, but maybe, just maybe I could manage to get out in 5.

Day -1 – 15th October: Admission … again!

I’m a trusting soul – although everyone’s saying “you can’t be bumped again!” I could be and I could find myself sitting in the hospital bed waiting my turn – in other words squatting for an operation. That I really don’t want to do – so please don’t let it come to that. Admitted back on to the same ward I greet fellow patients and nurses as long lost friends and settle down to a quiet night in a side-ward – is this compensation for the “bumping”. I don’t know, but it does mean I get a good night’s sleep. I’ve been told I’m on second tomorrow, I’ve been “there” before too, AND it’ll be Friday afternoon. My normal optimism is being challenged seriously.

Anyway with MrsJKH sat beside me I manage to annoy her intently by doing “household business” that should have been completed only 15 months earlier :-). She took some photos of the “patient at work” on the iPhone – which is rapidly becoming a friend – and I sent them off to Posterous for the family to be able to see.

[NB Found out on one of the earlier visits that I’m Blood Group AB- . Don’t know how that came about but it does mean I’m going to have to seriously consider giving blood. My weight on entry to hospital c.74kg and blood pressure good too – c.126/86 with a pulse rate of c.66]

Day 0 – 16th October: The Big O

Not many recollections of the day; I woke, had my shower, dressed myself up in the gown and natty pants they give you and waited. Probably tweeted a bit whilst I waited for the pre-op to be administered. MrsJKH came in to keep me company for a while and then c.13:30 I was off down the corridor, into the lift and on to theatre on C3 and there waiting for me was the team that was going to do the operation – and that was the last thing I remembered.

I’m told that I was in theatre until c.19:00 and that according to Dr N I now had a Mercedes Benz of a heart and that there had been no complications. I was also told that they had been able to re-cycle all my blood and I hadn’t needed any additional blood – amazing!

All I remember was that I eventually a came out of the anaesthetic and I don’t remember any of the pipes being taken out. [This I was tested by Dr P (the Consultant Anaesthetist) a couple of days later and he was delighted to hear my account of how little I remembered. Glad to have been a model patient.]

Unfortunately, or fortunately, I really don’t remember much of being on ICU or HDU. I was aware of the ministrations of my dedicated nurse who was so kind, supportive and who MrsJKH has been so praising of as well. It’ll be nice to go back and meet them when I’m able to.

Day 1 – 17th October: Back to the Ward

Sometime on Saturday afternoon I was put into a chair and wheeled up to the ward and put in a chair beside my bed – again in a side ward … I was getting favouritism treatment :-). So for the rest of Saturday I had a few pipes and a catheter left in me, a drip and they were giving me a nebuliser for my asthma to help me breath and clear my chest.

Day 2 – 18th October

Sometime during the Sunday I was moved back on to the ward where AR, AM, GL were waiting to “greet me”. I’d had all the pipes removed, but still had heart tracing wires in place – they were to come out on Monday and I’d be then free from all the operations gubbins. My dressings had been removed as well and I was able to see the scar on my leg – ankle to groin, and chest – “the zip”. Everyone was saying what lovely scars they were. Me, I somehow coudn’t share their enthusiasm, but I took their word for it!

This had been a momentous day for RH and RM as well. They’d completed the Cardiff Half-Marathon running on behalf of Breast Cancer Care, had finished the race in 2hrs 12mins and raised more than £1000 in the process. So very proud of them both, to do this at the same time as their studies, coping with the illnesses we were going through and the support they were giving us – all in just over 7 weeks – and soing a very creditable time, was immense.

I took my first walk down the corridor, bolstered no doubt by the anaesthetic that had probably not worn off; sat down and washed myself at the sink and generally felt that this getting better was “easey peasey”.

Day 3 – 19th October: Climbing the stairs and walking the corridors

Huge progress today, and then a setback. The physiotherapist dropped by and showed me the exercises I needed to follow, helped me with “solving” problems of how to get out of bed, sit-up using my stomach muscles alone, and encourage me to cough. But most of all I was taken to the stairs and “tested” on whether I could climb them, and then descend. I passed that test with flying colours – I found going up much easier than coming down – and for the first time the possibility of a Day 5 discharge entered my psyche.

Not to be however, by the end of the day a persistently high temperature was being recorded and I had an infection … somewhere.

Day 4 – 20th October: A temperature set-back

I was put on to one of the most evil anti-biotics known to man. Each tablet was the size of a cocktail sausage and I was blitzed. “If this doesn’t get your temperature down … nothing will”. I also began to feel a little down on Monday, and even with AM’s constant atempts to cheer everyone up, I was finding it hard to be cheerful.

The other patients on the ward who were with me through the majority of this week were AR an Immam; GL who’d been torpedoed three times in the war, had escaped without a scratch on each occasion, and was in his nineties, DB who’d come down on to the ward on Monday after having his heart bypass on Sunday. But it was AM who, although I’m sure perplexed at the inability to find a correct diagnosis of his condition, kept us all laughing – even sometimes when it was too painful for us.

It was great to see JN during visiting. He came with a card signed by my colleagues and with a copy of Glen Povey’s “Echoes” biography of Pink Floyd. I was pretty sure I had it so had to check with RH to confirm that fact. In the confusion of the messaging MrsJKH thought I’d requested for it to be brought in for me, and when she arrived later her forst words were “You can’t have this, it’s too heavy for you to lift”, which is indeed very true.

Day 5 – 21st October

By thn end of the day my temperature had dropped, I’d had X-rays, ECGs and I was ready for the discharge. In fact I could have left as early as 7:30 but MrsJKH didn’t fancy having me back that soon – something about preparing things for me. “There’s lovely”.

So the day was spent talking and resting – we’d had a terrble night the night before when another emergency case was admitted to the ward at about 02:00. I was still listening to Alan Bennett on the iPod so was very aware of what was happening, but everyone said the same – it had been a terrible night’s sleep.

So we rested and waited for the visitors at 15:00. This can be tiring in itself, but on this occasion for me it was great to see CL and DH drop-in to see me from Duthie downstairs in The Heath.

The pattern of visits had been established. Mrs JKH would come-in and thern go home, bring back some goodies and RH would join her when she could.

I’d had guidance from RO, a student physio who was very good at getting me to do the exercises that I’d been shying away from doing and all the medical staff had been round to sign me out. I was about to escape!

Day 6 – 22nd October: Discharge day

You’d think I’d remember more about this day, but I don’t. MrsJKH had an appointment downstairs with the Breast Cancer Nurse, dropped in some clothes and left me to pack and sort things out, dispensing items to the remaining patients in the ward that I wasn’t going to take home – hankies, orange juice etc. AM pinched my chair, and DB got a second pillow – that’s the way things happen in NHS-land I’m afraid. Really sorry to have not been able to say farewell to AR who was deeply asleep when I left after lunch. AM (a Pentacostalist) and I (a Methodist) had been having a number of interesting conversations on the similarities between Chritianity and Islam and how the divide had come about. I learnt a lot, but am very aware there’s a lot more I NEED to learn on this subject, as do many of us.

It was good to be home. BT was house-sitting when we arrived home, and the church bollards had been borrowed to preserve a parking place outside the front door. I waddled in through the front door and sat down. Home-cooking, phone-calls and visits from neighbours followed – I was back where I belonged.

Early evening and RMH pops in to see me. He’s between jobs at the moment and we had a good chat.

So to sleep in my own bed again. Nine pillows are stacked-up to try and make me comfortable. I’m SO looking forward to being able to sleep on my side though!

Day 7 – 23rd October: A first day at home

One week after major surgery and I’m thinking about how to fit my first walk outdoors in. [We went round the corner and back.] I went down the garden to feed the fish and replenish the bird feeders – everything was back in its place. I was home! I’m sleeping in the back (guest) bedroom and this has been turned into a mini-hospital ward by MrsJKH. I’m persuaded to try a foot spa (not the greatest of success – I just didn’t “get it”) and have my hair washed – heaven.

I fit a sleep in according to plan, manage to setup the structure of this blog and start thinking about a return to work (no I didn’t … honestly). I was finding things “remarkably easy however. The paracetemol was controlling the pain, the other pills had stopped being an imposition and I was coming to terms with what was going to a recovery. I had a little back pain but nothing I couldn’t handle. Everything is good with my world.

Late evening and DJ and P arrive to see us. They’re staying with the dogs at P’s parents. I don’t think we could have managed the dogs with our cats, and since we’re in the guest bedroom, hospitality would have been difficult. Great to see them. It’ll be good to see them over the next couple of days. With P having trained as a Physio, I’m looking for some feedback!

Learning points

  1. It’s a good idea to have a plan and set yourself objectives for discharge. The recovery is down to you after surgery; that’s when the baton is passed over to the patient and the quickest and best recovery will be the one where the patient “owns” the process.
  2. Take all the pain killers that are offered; they help your recovery by ensuring that your body is able to repait itself all the time, not just at those times when you’ve just had your last dose of regular pain-killer.
  3. Do the exercises. I began to resemble a tortoise towards the end of my stay in hospital as I “protected” my chest by scrunching my shoulders forward – not a good move. Do the opposite of this as soon as you can.
  4. Learn some relaxation techniques – I do so wish I’d concentrated on this wise advice from many family members prior to the operation.
  5. Don’t be surprised at what you don’t know! One consequence of the anaesthetic is that your mind seems to get paralysed to the point where simple tasks seem impossible. What’s the best way of moving your bottom up the bed? Get out and then get back in … duh! How do I manage to get myself into a sitting position? Use your stomach muscles, stupid and use those nice little holes in the foot of the bedframe to hook your toes into to give yourself some purchase … duh! How do I manage to swing my legs out of bed? Well … you could use your “good leg” to provide purchase, couldn’t you … duh! It seems strange to say this, but in the days following the operation your mental capacity is impaired, you ponder and worry about about the most ridiculously simple things and sometimes things seem impossibly difficult. This is standard. The nurses are there to advise, not do, it’s up to you to resolve things for yourself. That way recovery is that more rapid.