Tuesday, August 11, 2009

Rehab and the second procedure

I was home on Saturday, May 2 with one of my three blockages corrected. I was sore and pretty slow; when I got home I took an opportunity to look at the site in a full-length mirror. What I saw surprised me: A bruise, the color of black velvet, extending from my midline to my right hip. It looked very much like I was wearing a quarter of a black Speedo. It wasn’t a pretty sight. I haven’t had the body for a Speedo since I spent the summer in the Bahamas during my undergraduate days at the Community College of the Finger Lakes field station.

Over the next few weeks the bruise continued to spread, eventually moving into my upper thigh and beyond the midline. The color moderated somewhat but persisted for at least three weeks into May. At the site of the insertion of the inducer sheath, I had a lump that started out the size of the last segment of my little finger; the lump decreased over time. I knew that I was going back into the operating room in four weeks, so the lump was a concern. The cardiac physician’s assistant told me that the second procedure would be performed from the right side as well, since she said it worked better to go in via the right side from an anatomical perspective, although I haven’t found a clear explanation of why this is so.

When I was being discharged from the hospital, I was told that I would be slotted into cardiac rehab. According to The American Heart Association, “Cardiac rehabilitation is a medically supervised program to help heart patients recover quickly and improve their overall physical, mental and social functioning. The goal is to stabilize, slow or even reverse the progression of cardiovascular disease, thereby reducing the risk of heart disease, another cardiac event or death. Cardiac rehabilitation programs include:

  • Counseling so the patient can understand and manage the disease process
  • Beginning an exercise program
  • Counseling on nutrition
  • Helping the patient modify risk factors such as high blood pressure, smoking, high blood cholesterol, physical inactivity, obesity and diabetes.
  • Providing vocational guidance to enable the patient to return to work
  • Supplying information on physical limitations
  • Lending emotional support
  • Counseling on appropriate use of prescribed medications."

My first rehab session was scheduled about a week before my second procedure, which was due on June 1. I showed up at my session; I brought along some workout clothes because I was told that the rehab folks would do a physical assessment. At the rehab session, the staff took a detailed history and gave me a set of questionnaires to complete. They measured my waist, right below my navel; I measured 46.5 inches. The Heart and Stroke Foundation of Canada showed that men with waist measurements larger than 40 inches (at least for European Caucasian, Sub-Saharan Africans, Eastern Mediterranean, and Middle Eastern men) are at risk for high blood pressure, high blood cholesterol, type-2 diabetes, heart disease and stroke. Not good. They ran me through 10 minutes of exercise on a recumbent bike, and 10 minutes on a treadmill. They set me up for 36 sessions, Monday, Wednesday, and Friday from 8:00-9:00 in the mornings.

Monday morning I showed up for my first rehab session. What struck me was the age difference between me and the other men (by chance, my group was all male) in the group. I was youngest by probably 20 years at least. When you go to rehab, the nurses need to monitor your heart. After all, you were just diagnosed and treated for heart disease. Thus, you wear a battery-powered heart monitor. You stick on three electrodes, one just below your right collarbone, and one each just beneath your rib cage on the left and right sides. The electrode leads snap on to the adhesive electrodes, and you clip the monitor to your waistband. Then during exercise, the rehab nurses monitor your heart rhythm and heart rate.

During a typical rehab session you’ll do several things. Understand that one of the purposes of rehab is to learn about how to safely exercise. Thus, you’ll start out by stretching and warming up with hand weights and then move into some very low-level calisthenics like marching in place. Once you’re warmed up, you start working out. Most rehab facilities have a variety of equipment; mine had recumbent bikes, treadmills, and rowing machines. You work out for 40 minutes (that’s the target, although you’ll work out for less time at first), and then go through a cool-down. Several times while you’re exercising, the nurses will take your blood pressure. All of the measurements during and before exercise (including your weight and resting heart rate) are entered into a computer program to track your progress.

During my first week of rehab, I went Monday and Wednesday. Friday I was scheduled for the second procedure. I was a lot less nervous the second time.

The second procedure went off the same as the first, with two significant differences. First, the bruising at the insertion site was completely different; the bruise was just quarter-sized, and after a few days was barely visible. As I described in this post, the nurses put pressure on the inducer-sheath site with their thumbs, pressing directly down into the soft portion on the front of my pelvis. That left a mammoth bruise. This time, the nurse pinched the site against the ilium or hip bone. The pressure was much less, and there was much less pain. Second, the two remaining blockages were in my right coronary artery; the blockages were about 80% and 90%. When they stented the blockages, I didn't feel a thing, unlike the first time when I had significant pain and shortness of breath. I'd heard of people having "silent" heart attacks; the stenting process reinforced to me just how that was possible.

In the next installment, how to get into an exercise routine.

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