Second week at the Weird Gym

I am happy to say that my real class at Cardio Rehab is nothing like my first visit for orientation.

Mostly, it is like going to a real gym. It is still a lot quieter, and you have an older population than 24 Hour Fitness. My class is mostly men and they wear gym clothes. They sweat. Well, mostly. They know how to work the machines and in fact, most of them, exercised quite a bit in their lives.

My class consists of 10 or 11 people. One day there were three women in it but most days there are two.

I have only met one other person who had a similar procedure as me, valve replacement. Talking to Meg ,she had many complications. I don’t want to scare anyone but it made me very happy for myself and very compassionate toward her. She seems fine now, but it has taken quite a long time for her to get back on her feet. She now has a mechanical valve that seems to be working, and she can once again care for her 3 year old. I think that gives her a lot of peace of mind and it is easy to root for her.

The others in class can be divided into open heart for by-pass procedures, people who have had a heart attack, and people who have not had a heart attack yet and are there to try to avoid one.

We don’t talk much about what happened that brought one here because it can easily turn in to “I can top that.” (If so, Meg would win and I mean crush.) Everyone just supports each other and treats all cases as equal. It is true we are all working toward the same thing. Getting our lives back to normal in a healthy way and learning how to deal with the new reality we face. For me, this is just getting back to normal in a gradual way. For others, it is learning new things.

The class also has a lecture one time a week. This week’s sessions was on anger management and how to control stress in your life. The lectures are optional. So far, I have not attended mostly because it would add an extra hour of waiting to whoever is driving me. Next week, I will drive myself so I might attend. Most of the classes do not pertain to me. My diet is pretty good. I understand a lot of what to expect because this is not my first time around. I already treat my mental health, for example, because I was depressed the first time. Now, I have a lot of resources for building my own resiliency.

I look forward to the class and got my heart rate up to 135 in my third of fourth class. That felt good and safe. I still have sternal precautions until next Wednesday so I’ll be able to use something other than 3 pound dumbbells.

I am off all my medications. That proved to be something of a roller coaster. I am having a bit of something like withdrawal from the beta blocker, mutoprolol. As a result, my heart rate is somewhat elevated at rest and a bit sticky. If I raise it, I have to really sit down and get calm for my body to slow it back down. And, my BP is hard for them to measure. At first, they freaked out a bit. They ended up taking it with a Doppler so they can really hear where the pulse changes.

After a bit of a tense day, and several calls back and fourth to my cardiologist, it appears to be a temporary condition that some people have and perhaps just a idiosyncrasy in measuring my BP.

My heart is loud. Other doctors and nurses have remarked on this too. It probably won’t change much and that’s just my physiology. I certainly can feel that my pulse if faster than normal. That did get my attention. However, I have been assured that it is normal in some percentage of people when they stop this drug. In the meanwhile, we keep tabs on it by measuring a bit more often, and I know what the numbers are when we call someone.

Talking to people in the class is good for me. Mostly it is just what you might expect. Guys who are a little bummed to have needed a bypass but grateful that it was caught in time. These two guys both look healthy and were athletic. One guy was actually riding his bike to prepare for STP when he noticed going up hills was a lot more labored. The other guy had a similar observation while hiking. So you never know. Keep tabs on it. Get check-ups and if you feel weird, go get it check out.

Both guys are not anything you would call fat. Both guys are in their 50s maybe early 60s. Neither is challenging about this. They both want to get back to normal and start doing things they did before and will work hard in class.

Some of the heart attack and heart disease people (non-surgical) are overweight but not all. They are not all as chipper about being there. I think it is a wake-up call and maybe a bit embarrassing but they do the work. One guy worries me. If anything he works too hard and occasionally is told by coaches to throttle it back. I don’t get it. There is some kind of denial going on there.

I will be a bit happier myself when my body works through the withdrawal. Then I’ll have a better understanding of where I am. And next week, maybe even 5 pound dumbbells.

First day at weird gym

[I hope this isn’t viewed as me making fun of “old” people. After all, I’m old in the eyes of my kids, nieces and nephews. It is more of an observation on a particular set of people who happen to be older than I am.]

I went to the first day of Cardio Rehab yesterday. It’s a very nice facility, filled with fancy tread mills, stationary bikes, and steppers. In the middle of it all is a rack of small dumbbells and some fancy medical equipment. Plus, around the perimeter, there are screens showing the Today show or some other day time TV. In contrast with a real gym, it is fairly quiet. No Zumba classes; no blaring music. No voice over a microphone saying. “10 more…and 9, 8…”

Just off to the side, is a circle of chairs. It looks like a nice gym that surrounds an absentee kindergarten class.

The other difference is that the people at the gym average 83 years old.

Almost none of them are wearing gym clothes. And not a single one looks like they are sweating. In fact, I don’t think they look like they can sweat.

There is one man. He is wearing blue chinos, a checked flannel shirt, white undershirt and blindingly clean white sneakers. They look brand new. His hair is white, full and combed to the side as if he is taken a shower and gotten dressed to go out in the world, not the gym. The only tip-off is that he has the Nikes on his feet. And for some reason, they look like they weigh him down. They look huge and heavy. They are tennis shoes, not running shoes and they look like they are somehow too big and heavy for his frame.

He has a walker so when he goes from the stepper to the circle, it takes 5 interminable minutes. I had the urge to get of my machine and just carry him to the circle.

M, W, Th are heart days. On T and F, it is lung day. It’s Friday and these people all had some kind of lung surgery or treatment. I didn’t see any oxygen tanks. Lung issues are not good. I’ve concluded this from my unscientific observations both here and in the hospital.

My job today is to give my medical history and learn how to use the equipment. Therefore, I’m just getting a private tour in the middle of a normal class. I’ve been shown how to put on the heart rate monitor. It isn’t like the Polar- one strap around the chest. It is like the hospital: four individual leads and a fairly large (think older, heavy cell phone size) transponder. You put that in a neck holder that you wear. Each person has one and there are stations where they monitor your ECG the whole time you are there. At the stations, you can see a list of 10 different ECGs.

I’m riding a recumbent bike for 10 minutes. The level was 2. I pumped it up to 3 and the therapist yelled at me. Ok. This is going to be a slow progression. She also takes my blood pressure three times, beginning, middle, end. They want to be sure that you don’t pass out or have some other issue. This is all my “base line”.

I also do a three minute cool down, which is hard to distinguish from my workout. But they are just showing me how it is going to go each time. This follows a long conversation about my heart history. As usual, they expected a much worse case. That means, most cases they see of AVR are worse than me. They deal from experience. That means, even though I don’t feel it, I’m the lucky one. I didn’t need my valve replaced because of some other big problem, which is more typical. As a single case, I don’t know that.

During the 13 minutes I am on the bike, I mostly get to see the class do their strength training. It is soooo funny. One lady looks like Madea-meets-Hillary-Clinton. Her hair is nicely done up but looks a bit like a gray helmet. She has giant glasses. She’s short but healthy looking except for the glazed look on her face. She never stops smiling but is the face of someone who looks a tiny bit lost.

Most of the exercises are seated. The teacher is younger than me. She cajoles and has a very pleasant way of leading. But if I were to take away your view of the class, you’d swear she was talking to a pre-school. Everyone looks almost surprised to be there. No one looks like anyone you see at a real gym. No one is in charge of their workout. It looks more like field trip of unwitting participants who had no idea that their destination was the gym. They go through the motions pleasantly but as if they find it more amusing than anything else. “Look Martha. I’m making circles with my arms!”

I don’t know if they just don’t have any experience at a gym or doing exercise for some meaningful reason or what? As time passes, I begin to think they all look like marionettes. They aren’t in charge of their actions; it’s the people who are pulling the strings. And it’s all just a beat too slow. And there is a noticable lack of eye contact with anyone. They don’t look at the teacher or really each other. Eyes are down or looking out the window in bit of far-off stare.

I finish up and remove my monitor. I don’t know what my class is going to be like. It should, at least, be amusing.

Two weeks, one day post-surgery

I remember this last time too. I cannot regulate my body temperature. I sweat like a pig at night. I’m cold other times. I sometimes go out in 4 layers and it’s in the 50F range.

Both my kids were here last weekend. And now both are gone. It was great to see Marc and Nathalie. Marc was here for the weekend and did some “lifting” for us. Nathalie was here from Friday to Wednesday. They helped out around the house. Nathalie took me on my first outing, then lost me in parking lot. I was walking around looking for her with two coffees in my hands and not knowing if I set them down would I be able to pick them up again. Eventually she found me.

It was great for Amy to get some relief after a tough week. Paul, Amy’s brother, was a great comfort in the hospital. Amy was there for hours each day. Paul came and spent several hours on different days just hanging out.

I get better everyday. And that feels good. I think I might be slightly ahead of where I was last time. I don’t know what that means but thinking about last time, we must have gone to the tulips a month or so after the surgery. I still couldn’t drive, if I remember correctly. I don’t remember being tired but I do remember not being 100% either.

I did better with the pain management this time too. But compared to brain surgery, this looks easy. You don’t actually have a lot of nerves in your sternum because it is where the nerves terminate. I get a weird pain in my leg that is referred pain from the “cut-down” where they attached the heart/lung pump to a vein in my groin.

I am only taking Tylenol now and at a fairly low concentration. But it still helps. If I forget or try to stretch too, too much, I feel it. And then it is tough to catch up for a while.

I have a cough, too. Also normal.

I feel good most of the day until about 8:00. Then my shoulders, neck, chest start to get a little achy and I really want to go to bed so I’m in bed by 10 and up at 6 or 6:30.

Today I thought I would see the surgeon for the final follow-up. Instead, I saw the nurse practitioner. That’s ok. I had my final sutures removed. And everything looks good. Therefore, I am “released” back to the care of my main cardiologist. I see him Oct 17 so not quite 2 weeks later.

This time, I’m going to do one thing different. I’m signed up for cardio rehab. I will go to some therapy where they get me on stationary bike and, with a lot of supervision, help me get back to some level of exercise. My doctor told me that I didn’t need to do this last time. He said that my exercise program would be good enough. I should insisted because I spent too much time thinking my heart would explode. In other words, the main point is to help you get over the mental hurdle that you are indeed healthy and that you can TRUST your body. That really took a long time last time.

The soonest I can start that is October 24. And that should go for 6 weeks. I also have been cleared to drive two weeks earlier than originally planned so that should make some of this easier.

I think this might be my last direct missive on the subject of my heart. Might be time to get back to my other giant thoughts. I think I’m gonna be fine, knock wood.

Nurses

I don’t know if this is different from last time, but nurses care for you. There are plenty of Nurse Practitioners, Nurses, and Care Assistants (Nurse Techs). Most of your contact in the hospital will come from a pair of people who will dispense your medications and help with bodily fluids over a 12 hour shift.

For the most part, you might see a Nurse Practitioner once a day; they make the plan. The nurse carries it out. The care assistant fills in gaps.

Nurse practitioner removes the chest tubes. The nurse practitioner is paired with a team. Nurses removed the v wires for the temporary pace maker I had. Usually they would assisted by another nurse.

A nurse or nurse tech would/could remove a failing IV line after 4 days. They might also give you a bath.

I also dealt with Occupational Therapy and Physical Therapy. Occupational comes form activities that “occupy” your day, not from the usual sense of your job. OT taught me to wipe my butt a new way to conform to sternal precautions. And how to shower. Very helpful young man named Henry.

PT checked that I could walk up stairs. Gave me a light exercise program. Reinforced the sternal precautions.

https://www.verywell.com/sternal-precautions-2696084

In ICU you have one nurse who stays with you, more or less in your room, at all times. They seem super capable. My day nurse is in training to become a Nurse Practioner, which in WA, as of 2014, requires a doctorate degree.

Compassion

I told a friend about this. He is studying nursing. He said they are trained to be silent and dignified. Never have two words captured a professional ethos, in my opinion.

And I needed it. I felt bad when I destroyed a bathroom and needed someone to clean my backside. In fact, I was quickly reminded that I was the one making it a big deal and my assistant was just there to do his job.

I encountered a bunch of specialists too. Phlebotomist, xray technicians, even transporters. They were all cordial, unflappable and a big help. I thought, “everyone here is smart. How is that possible?”