I have the helm: over and out

Again, this post is overdue. I am now out of Phase 3 Cardiac Rehabilitation and essentially in charge myself of whatsoever is to be my continuing odyssey. It’s thus time to mothball this blog and to move back to “real life” and “living” rather than reflecting upon the CHD Odyssey I’ve been on. Before I do that however there are a few reflections that I must make/record and a few resolutions that I should commit to and then it’s really up to me!

So the first point is to praise to the highest level possible the work and programme of the Cardiac Rehab Team at the University Hospital of Wales, Cardiff (The Heath … as it’s known to the locals). The team of cardiac nurses, physiotherapists and occupational therapists, with inputs from others – such as pharmacists  have developed a progressive programme of activities that meet the needs of the full range of those who have encountered and been challenged by CHD – from surgery to stents; of all levels of fitness, age and understanding. A terrific success and one worth celebrating loudly. Well done and thanks a million!

For a six week (12 sessions) period, extended because of a gap over Christmas and then cancellations due to the snow, I attended the 2 hour programme of talks, exercise and relaxation. A group that started small – about 6 of us,  grew to one in excess of 12 at times. You could see the confidence grow in the people that left the group, having passed through the programme; and then for me towards the end, see the apprehension (and scepticism in some cases) of those joining the programme. The objectives of the programme were made crystal clear to everyone – you need to know your body; how to exercise – healthily; how your heart works and how to “listen” to it and adjust your exercise accordingly; what you can do to “help” it and yourself – in diet, stress reduction and relaxation; and finally, and most importantly, prepare you for life without their support.

So in this second half of the programme (the first half is reported here) we had a discussion (with a video) on sex and CHD – focussing on the psychological as well as the physical, and the way your partner may be feeling about your condition as well; we had more discussions about stress and how to reduce it; and most valuable for me – we had some elementary biology of the heart.

Everyone to whom I tell this is amazed at my ignorance of the heart and how it works. I stopped doing biology in school at the age of 14. [Even managed to miss sex education by switching schools so had to have a crash course (a book and a 20mins chat) on that from the biology teacher – who just happened to be a monk (but that’s another story)]. So … I imagined the heart to be much bigger than it actually is; I didn’t know really what it did or how it worked; I didn’t know the difference between an artery and a vein (seriously … I didn’t) and I had no real idea what the surgeons had done in the by-pass procedure. But now I do, thanks to my cardiologist (NG) too, and for that I’m really grateful. I’m actually amazed in fact – this amazement increased by the reporting from a close friend and colleague who had been privileged  to be able to be present during a heart by-pass operation. I won’t record her descriptions here, but I think the most telling thing she said was “how relaxed it all was” – that really makes me feel good because up to that point I had imagined feverish activity verging on panic as the team battled to do the plumbing that would make my heart work better. How wrong could I be!!

So I know how my heart works; I know I have to exercise it, but not too much – I have learnt how to recognise “moderate activity” by listening to my heart rate and I have begun to get much fitter – in body if not in mind at least … but we’ll come to that later. The exercise programme in the second half of the programme introduced me to the rowing machine, the treadmill, the cross-trainer and the exercise bike. All pieces of equipment that I’d been scared of showing my ignorance of before … if I’d thought it worthwhile going into a gym. Of course, being the rather competitive type I am, I pushed myself on occasion further than I should have – but that was good in itself as it re-enforced  the knowledge of what “moderate activity” should be. I did get fitter … much fitter, and am now committed to staying in the Cardiac Rehab programme in Phase 4 as an adjunct to the hill-walking and cycling which will continue to be my main form of exercise. So tomorrow I attend the local leisure centre for an induction into the gym equipment – I can’t attend the classes as they occur during the working day … but someday, maybe ?? I hope I’ll be disciplined enough to go to the gym twice a week (Resolution One) and to augment this with walking to work (Resolution Two) – once the weather improves.

So we come to my mind and my mental state. What this episode and odyssey has told me is so comprehensive and weird that I’ve been told by my nearest and dearest that I’m almost a different person. I doubt that, but I have learnt a few things which I’ll (perhaps rather foolishly) share with you.

Firstly, I’ve learnt how much I need to feel in control of myself: not in control, but in control of myself – there is a difference. When I’m not, I get anxious. I really had never recognised that and would not have described myself as an anxious person, now I do and that’s scary and the most important thing that faces me now is to find ways of reducing that anxiety state (Resolution Three).

Then there’s reflection and recording. I’d already discovered amazingly after 40+ years of zero-reflection that this was something I should work on; and this, and my other blogs are therapeutic in that sense. They are also practically very supportive as a means of capturing ideas, feelings and observations that previously had been soon forgotten. Reflective thought takes a lot of practice; I’m just at the beginning  of the journey – but I have taken the first steps and I must continue on that journey (Resolution Four).

Thirdly, there’s depression and stress. I would never have thought that I was someone who got depressed, or who got stressed, but I do both … and I believe (for me) that they’re inter-related and are usually the result of me not recognising one state or the other. So I must listen to my mind (as well as my body) and behave accordingly. As another very close friend and colleague has just said to me, I must “focus on the fun things” – that I intend to do (Resolution Five).

What I don’t of course know is whether experiencing any of these feelings is unique to me, or whether similar feelings are shared by others who’ve gone through a CHD episode. I won’t ever know – unless I get some comments on this blog. However I do feel it was important to share them just in case my observations have a resonance with someone else going through the same kind of journey of “self-denial”.

So now I’m back in work. I’m on a return-to-work programme that’s supposed to finish this week, so next week (if I wasn’t away for most of the time) I’d be be back full-time. I can’t deny that I get tired. I must admit (like the admission of my competitive approach to exercise) that I’m probably “doing too much” against all the advice that many family, friends and colleagues are giving me. [I probably do need protection against myself but it’s all about convincing myself that I’m back to “normal” {joke}.] So, I suppose Resolution Six is to slow down a bit, try and relax, not take a rucksack of conscience reading home with me that never gets read, put the laptop aside (occasionally) and recognise that I’ll never be in control of myself … as long as I’ve got lots of good family and friends around me, because they deserve a “slice of the action as well” and I need to let them into my life and I need to involve myself more in theirs.

Here ends The #hospitweet Blog.

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.