Tuesday, January 6, 2015

Cardiac Rehab Update

My brother-in-law Ken Rodd was out moving snow around in the midwest, and of course he thought about heart attacks, so he asked me for an update.

Much has happened since last I wrote. There was some snow here and I pushed a bunch of it off the driveway. No ill effects.

I had been looking forward to yesterday (Monday, Jan 5's) stress test, which would be the entry to cardiac rehabilitation. Phil Ades has an internationally recognized program here and has been a pioneer in research on the relation between physical exercize and heart health. We all know now that keeping active is the best way to stave off and recover from heart events, but we didn't always know that. I have been seeing Phil running on the Rec Path for decades, but we hadn't said more than "hi" until yesterday during my stress test. The test measures your VO2Max and your peak heart rate in order to set particular parameters for your further training for recovery.

(I had had a stress test for a study in the '70s involving local runners, but I couldn't find the results.)

But I was ready to be cleared to exercize harder than pushing snow and rowing lightly or gently spinning easily on the bike in front of the TV.

Surprize. My test was at the top of the range for normal 70-year olds, and my VO2Max (36.3 ml/kg/min) was well above the heart population in this program. Peak HR= 158 is also pretty high.) It felt absolutely wonderful to breathe hard enough to cough up that stuff at the bottom of your lungs and to sweat more than a little with no heart pain at all.

The beta-blockers I am on limit the heart rate and thin the blood, but they don't limit exercize. Phil Ades had done an early study.

The drug I want to get rid of is KEPPRA, an anti-seizure med that is being prescribed for a seizure that there is no evidence for my having had. There is just no explanation for the TIA-like event which left me aphasic for a couple of days. So I am being treated for 4 possible causes.

I have an appointment to see the neurologist on the 20th to get his judgement about taking me off. He is conservative and thinks there is no harm in going slowly. Keppra is giving me more than one of the side effects on the Drugs.com website. I want off.

This morning I met with Joann, who will manage my case for the 30+ rehab sessions the insurance allows. The insurance specifies that you have to wear a heart monitor while you exercize or they won't pay. But bouncing around on a treadmill produces artifacts on the readout, so Joann had to take my pulse by hand in any case.

What I learned: It is OK to do aerobic exercize every day. It is strength work that breaks down muscle, which then has to be rebuilt with rest. "Interval" work refers to the rest interval, not the intense push phase.
If the attack reccurs, the symptoms are likely to be in the same place as last time. Noted.


The CR gym has lots of good equipment and lots of good advice, including classes on eating, risk factors, reversing coronory artery disease, weight loss and stress management. I ran into an old volleyball teammate. Maybe we can put together a old farts' team.

I'm pretty happy to be back exercizing and doing genealogy. This experience does help put a different perspective on life. If you have read this far, thanks for being interested.

David

6 comments:

George P. Lynes, II said...

Dave,

While this is fascinating, I'm in a quandary about shoveling snow, one of the two activities (skiing was the other) my cardiologist forbade me to do many years ago. He had convincing data about the relation of snow shoveling and cardiac arrest among men over "a certain age." Perhaps he saw more of a danger to me than he might for you if you were his patient, but I offer this as food for thought using the "better safe than sorry" metaphor. I'd love to hear what your experts say on this, assuming that some patients, e.g., you, might be in less danger than others, e.g., me.

Best,

George

P.S.: I never did like skiing and shoveling snow simply sucks!

Aaron Pepis said...

David: keep up the great work.

Jarlath O'Neil-Dunne said...

Love the fact that you are still competitive during rehab. Go Dave!

Bonnie Swerdlow said...

Hi Dave,

Very sorry indeed to hear about your heart attack! You've always done everything right to take care of your health, but when CVD is in your family (as it is in mine), there might be something else to consider besides aerobic exercise: chronic inflammation. It's been linked to atherosclerosis, a build up of plaque and inflammatory lymphocytes in artery walls. No amount of exercise can influence that, but diet can. The guy who wrote The Zone Diet, Barry Sears, seemed pretty persuasive to me. He's a biochemist with a strong history of early, fatal heart attacks in his family, and he's still with us!

Richard and I are sending warm wishes for your full recovery and many more great times ahead :)

Bonnie Swerdlow

Paul Tyson said...

As to the number of rehab sessions start talking to your doctor and therapists at session 20 to see whether you need to build a case for more sessions. it is a time and bureaucracy issue.
Hang in there and continue the family research!
Paul Tyson
Fairfax, Virginia

Richard Swerdlow said...

That's the attitude to have :)

"Surprize. My test was at the top of the range for normal 70-year olds, and my VO2Max (36.3 ml/kg/min) was well above the heart population in this program. Peak HR= 158 is also pretty high.) It felt absolutely wonderful to breathe hard enough to cough up that stuff at the bottom of your lungs and to sweat more than a little with no heart pain at all."

Remember this is a marathon, not a sprint. I think you get that.

I didn't know you were interested in genealogy.

Richard Swerdlow
Gaithersburg, MD