Cardiac Rehab questions

[Harry]

I am now approaching 3 weeks post stent in my LAD artery. Got a call from Cardiac Rehab clinic saying to come in and start 9 months of rehab. Problem is my health insurance is no good where I am, (living with my Mom) everything is out of network. So a large part of the cost will be out of pocket.

Both my Dad (RIP) and my Mom went through cardiac rehab, and I sat in on the nutrition and lifestyle educational classes with her, so I see little benefit to my attending those again. And from what I can tell, the actual PT, treadmill and bike, are geared toward a turning around someone who has led a very sedentary lifestyle. That’s not me. Unless someone convinces me otherwise, I see no reason to pay $300 per session out of pocket when I exercise all the time anyway.

Any and all input is appreciated.
Thank you.


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[fastfred]

if insurance is paying I'd go
for 300 bucks probably not but you need to work out no matter what
they check all your vitals and hook you up to the ekg and you get to watch it's nice when they tell you your doing ok reassuring that your not dying

my experience was totally skewed so I don't know what the real world cardiac rehab is like the one is vail was 75% above average highly active people imagine that
the old fucks like 80 yrs old were killing it was lots of inspiration they'd talk about hitting up super wall mart and home depot in avon and doing laps around the stores on shitty weather days trying to hit five miles of walking

Total worth it, but yeah its more geared towards the really unhealthy people in the world

[Iowagriz]

Call an in-network program in Bozeman and see if they would do a zoom consult to get you going in the right direction. Maybe supplement that with a few local visits to get the proper vital signs and have those sent back to Bozeman.

[Harry]

Call an in-network program in Bozeman and see if they would do a zoom consult to get you going in the right direction. Maybe supplement that with a few local visits to get the proper vital signs and have those sent back to Bozeman.

That’s a good idea.


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[grinch]

Would uour family dr be able to give you heartrate perimeters for where you are in your recovery? From there you could just set those perimeters on a heart rate monitor to stay within them and recover safely.
Ive seen numerous posts on the emtb forums where people have had a cardiac problem and have substNtially recovered with a hr monitor with the ebike. Amazing transformations actually. From thinking they were done to riding 3-4 x a week and even lessening their medication.speaking of heart meds, i have a friend that in his mid to late seventies was putting the boots to us on the climbs when we were late 40's. We were all reasonably fit. He's been on heart meds for years and he doesnt give it a 2nd thought at this point. He rides 340 days a year and trail builds a lot of those days as well. Not sure of his method after his cardiac event but it seems yo have worked rather well.
The hr monitor tells you where you should be and the different ebike power modes, along with the gears, enable you to stay within that hr zone. I guess it would be at an endurance pace which is generally considered safe and effective for heart health without stressing the heart. You get speed and power from intervals and sprints but its much more enjoyable and safer at endurance pace so at this point i couldnt care less if i do another interval or sprint. At endurance pace you dont go into oxygen debt so thats probably key for safety. I would think a family dr could be more specific with your target hr for that.
A lot of posters are older kn the emtb forums but the younger crowd is definitely expanding. One poster with a cardiac event was in his 40's though. He was healtyy previously too

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[ctsmith]

My experience was similar, it’s pretty much geared for changing a lifetime of bad habits. So probably not worth the $, just ask your cardiologist what heart rate they want you to stay under, and do some cardio that keeps you under the limit.

[old goat]

In your other thread you mentioned that you feel better than before surgery. You haven't had a heart attack. You understand diet. (My cardiologist is big on plant based diet. I try to eat a plant based meal at least once a month. Try to do better than that.) I don't see any real benefit from cardiac rehab. Start exercising, advance slowly, if you feel your heart, skip, race, or flutter stop, check your pulse and see if it's racing or irregular and report to doc and obviously if you have chest pain stop, back off the exercise until you talk to your doc.

I've been started on programs for back and shoulder--I'm doing the last level on the first day and I'm not particularly fit by TGR standards. Then what? Like you said, these programs are mostly designed for people completely out of shape. Basically your cardiac rehab was getting the stent. I had an open chest, open heart operation 2 years ago--aortic valve replaced, ascending aorta replaced, 3 coronary bypasses. Cardiac rehab was mentioned in the brochure they gave me but none of my docs thought it was necessary.. The hard part was waiting 3 months for my sternum to heal and missing the best part of a shitty ski season. They gave me PT who was mainly concerned with my balance. Maybe one of my docs had heard about how I ski. Just progress slowly we guys (way) over 40 like to try to convince ourselves we're not. I don't think I'd start doing leg blasters just yet, which reminds me . . . .

Regarding heart rate--do they have you on a beta blocker? If so it will be hard to get your heart rate up to even 80% of max for age. Like the man said, ask your doc about target heart rate. I'm still on a beta blocker to prevent atrial fibrillation which makes it hard for me to increase my heart rate and stroke volume (ie cardiac output when I exercise--so my legs tire easily. It's either stop a lot when I ski or get afib, get put on an anticoagulant, and not ski at all..

I think you mentioned that after your stent your O2 sats were still low. How about now?

[Harry]

do they have you on a beta blocker?

Im not a med guy, so I’m not sure what a beta blocker is. Here is what I am on:

Plavix 75mg daily
Zestoretic 10-12.5 mg daily
Lipitor 40 mg daily

Are any of those beta blockers ?




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[Harry]

Would uour family dr be able to give you heartrate perimeters for where you are in your recovery? From there you could just set those perimeters on a heart rate monitor to stay within them and recover safely

I like this. I will get a hear rate monitor ASAP. I will ask my Cardiologist what my target is on Friday during our ZOOM meeting.



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[fastfred]

No those aren't beta blockers

If you get some a solid cocktail is an 20 mg of oxy 40 - 60 mg of beta blockers and a couple tylenol pm for a bite cap wash it down w a beer its amazing as you start to pass out

I'm not a dr I just play one on tgr

The hr monitor is key

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[old goat]

Im not a med guy, so I’m not sure what a beta blocker is. Here is what I am on:

Plavix 75mg daily
Zestoretic 10-12.5 mg daily
Lipitor 40 mg daily

Are any of those beta blockers ?




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No.

I like this. I will get a hear rate monitor ASAP. I will ask my Cardiologist what my target is on Friday during our ZOOM meeting.



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You can certainly get a heart monitor if you're looking for a reason to get a smart watch or fitness tracker. Otherwise feeling your pulse should be good enough. I don't know if fitness trackers or smart watches will detect an irregular heart rate but feeling your pulse will. Almost always if someone is having heart rhythm problems--too fast, too slow, irregular--they'll feel it and know it before they take their pulse.
I wouldn't worry TOO much about heart rate. If you exercise and your pulse gradually gets faster and you aren't having chest pain, faintness, or shortness of breath out of proportion to the exercise you were doing than you're good. If you heart rate suddenly goes from 60 to 140 + with no gradually increase that should be reported and you should rest. If the heart rate doesn't return to normal or if you have symptoms that don't go away when you rest that probably deserves a trip to the ER.

But you say you're already exercising and feeling good so it sounds like you're already rehabbed. Now get into skiing shape.

[Dantheman]

Otherwise feeling your pulse should be good enough.

Count beats for 6 seconds and add a zero. Plenty accurate for this purpose.

Good luck, Harry. Since you're on Liptor keep a close eye on your blood glucose and A1c.

[Flounder]

I sprung for an Apple Watch 6 last winter because it is FDA certified to detect AFIB. It’s allowed me to collect a lot of data to share with my doc. I could have tracked bouts and heart rate manually but the watch also recorded ECGs so he could see the variations in rhythm. There’s quite a few apps that can track and analyze heart rate trends. I still use a chest strap to connect to my bike computer but I’d just use the watch if I didn’t already have the computer. If you’re considering one, the 7 will be announced next week so wait a few days and you can get new features or save on the 6.

[Harry]

Fuck me, I have an aneurism in my Aorta. Cardiologist says it is not a bulge, just that my Aorta is larger than it should be. He says it should be 3.7 maximum and mine is 4.0. For now, plan is to monitor it. He says the risk is that it may “shear”. He put me on a 30 pound lifting restriction. I asked about skiing, he said “well….. don’t fall”…

He was impressed that I was doing light aerobic exercise and keeping track of my BP, pulse, and O2 level. He went on to say that he endorses my fitness motivation, plans, and goals.

Visit with Cardiac Rehab staff next week.
Visit with Cardiologist in 6 weeks.

Today’s stats:
BP = 111/76
Pulse = 65
O2 = 95

Yesterday did 30 minute walk at 3mph pace. Pulse got up to 90 and steady. When I stopped pulse was back down to 65 within 5 minutes.

Pre-surgery my pulse was staying up at 90-100 for several hours after exercising.


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[PB]

Good news on the HR recovery post-walk; pisser on the aneurism. Watch that fucker like a hawk. Get multiple eval opinions. If more than one says it's acutely dangerous, do the needful. If it blows, your lifespan is potentially reduced to minutes, or less. My FIL blew his out while in the ICU recovering from colon cancer surgery, which is about the "best" way to have it happen, but his survival was a surprise to the docs.

[yeahman]

Dang Harry, I hope it works out. You've had a rough go lately. Best wishes man. Hope to see you this winter.

[abraham]

Fuck me, I have an aneurism in my Aorta.

PM Iceman.
Seriously. https://www.tetongravity.com/forums/...d.php?t=185525

Good luck and I hope things can be managed well.

[DeepHelmet]

I think it's a good idea you're going to some Cardiac Rehab. If you tell them about your fitness and activity levels, they'll probably give you a "workout prescription" that matches what you're doing. Glad to hear you're improving. 3.7 vs 4.0 sounds like a margin of error thing for me, and sometimes people just have a bigger aorta, especially if you're a bigger guy. Good luck.

[old goat]

Where's the aneurysm--what part of the aorta? Just above the heart (ascending, like mine), in the part of the aorta that runs along the spine in the chest (throacic), or in the abdomen (abdominal--duh.).
How was the aneurysm diagnosed--ultrasound, CT, MRI, echocardiogram?
In measuring aneurysms it's important to measure straight across and not at an angle, which can give a falsely large measurement. As a surgeon fixing aneurysms I measured them myself and found that they were often overestimated by the radiologist who read the study.
At 4cm, regardless of where it is you don't need to be alarmed. Certainly it should be followed. There's no particular need to get a second opinion at this point,
Mine was fixed at 5 cm which is on the small side for an ascending aneurysm but it was associated with a bicuspid aortic valve--an abnormal valve I was born with--which makes them more prone to rupture or dissect at a smaller size. (Ascending aneurysms more often dissect than rupture, abdominal aneurysms almost always rupture if they do anything bad. Dissect means blood gets in between the layers in the wall of the aneurysm which can cause several problems. I think that's what your cardiologist may have meant by shear. )

Glad to hear your 02 sat is up.

[PB]

Great info OG; glad to learn that I was probably overly hysterical.

[old goat]

Great info OG; glad to learn that I was probably overly hysterical.

Certainly it should be taken seriously. I'm not sure it's necessary to put "overly" in front of "hysterical". (Although I don't think you were hysterical.)

Judging the risk of aneurysms by diameter is tricky. On the one hand, bigger people have bigger aortas to begin with, so what's a normal size aorta depends on the size of the individual. OTOH the physics is such that the bigger the diameter of the aorta the more tension there is in the wall, regardless of what size the aorta started at before it started enlarging. Our criteria for fixing aneurysms are pretty general because there aren't studies that would allow fine tuning the recommendation.

BTW--aneurysms rupturing after some other operation, like your FIL, isn't rare. Major surgery or trauma causes elastin--one of the proteins that hold our bodies together, especially our arteries--to weaken, which allows aneurysms to dilate. My aneurysm, which had been stable for years, grew about a half cm in the 6 months after I had my spine fused after I crushed a vertebra skiing. (Technically I crushed it falling.) That's pretty fast growth as aneurysms go.

When we're injured we become catabolic--basically we start consuming ourselves--so that all our bodies resources are devoted towards healing the injury.

Harry, sorry for hijacking your thread. Back to you.

[Harry]

Harry, sorry for hijacking your thread. Back to you.

You didn’t highjack this thread, the info you are posting in this thread is exactly what I asked for. Thank you for posting.

BTW, I was contacted privately by 2 maggots who are both married to Cardiologists. Both showed this thread to their respective spouses, and both spouses concur with your assessment/advice.

I have done 3 echocardiograms in the past 18 months with the same Cardiology practice, I wonder what the measurements were prior ? Although I assume they asked that same question and that they see a larger measurement this time. I will ask at my next appointment.


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[old goat]

It might be a good idea to get a CT or MRI* as a baseline. Since apparently this was diagnosed with an echo I'm assuming you have an ascending aneurysm. Echo is good for looking at the part of the aorta (the root) just above the aortic valve but not much higher. If a CT or MRI shows the aorta normal above the root then it can be followed by echo going forward. If the ascending aorta is dilated they will probably want to continue to follow with CT or MRI.

Regarding lifting--since you don't carry a scale around (or do apple watches have scales now?) a useful rule of thumb is don't lift it if you have to hold your breath. When you hold your breath to lift you raise your blood pressure which stresses the aneurysm. You do want to make sure your BP is well controlled. I can't remember if you said anything about it but I'm assuming you don't smoke. Smoking definitely contributes to aneurysm growth. If you smoke you're going on my ignore list.

*MRI vs CT--CT is quick but a lot of radiation to have every year. MRI takes forever--it got to where my shoulders couldn't tolerate my arms above my head for too long. I went back and forth between the two. For purposes of following an aneurysm for growth they can skip the contrast with either test.

I assume you are on Plavix to prevent your stent from clotting--or do they use something else now. They probably told you that while you are on it not to take a certain class of ulcer/antacid medicines, some of which you can get without a prescription.

[fastfred]

I shouldn't read this thread anymore

Goat sounds like a doctor the problem is I sit there and it all sounds like wha wha wha in the adult voices on charlie brown

Hate that sick to my stomach feeling and blurred confusion fainting

Hary, it's a lot to take in but you will be fine, seriously, eat right, exercise, and maintain a positive perspective. OG couldn't have explained things in anymore of a basic clear right to the point way.

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[Harry]

You do want to make sure your BP is well controlled. I can't remember if you said anything about it but I'm assuming you don't smoke. Smoking definitely contributes to aneurysm growth. If you smoke you're going on my ignore list.

I assume you are on Plavix to prevent your stent from clotting--or do they use something else now. They probably told you that while you are on it not to take a certain class of ulcer/antacid medicines, some of which you can get without a prescription.

Non smoker. Of tobacco. Weed is another story. Although I am about 98 percent edibles these days.

Yes, on Plavix. There is a complete list of my meds upthread.

Thanks for all your advice and guidance. I was feeling so good after the stent, and then being told about the aneurysm hit me like a load of bricks. I’m in a better place now emotionally. Thanks everyone.


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