Wednesday, June 25, 2014

Recovery Day 11: Cardiac Rehab

It's now been 1.5 weeks, more or less, since I was hit with a heart attack during a trail half-marathon. I'm still trying to explain - to myself, to doctors and nurses, to friends and colleagues - why this could have happened to me. I'm supposed to be the guy who's more fit than everyone else, the guy who seems so much younger than 52 years. Sigh.

After all, I had basically NONE of the common risk factors that are under one's control:
1. Smoking tobacco - I've never smoked a cigarette, not even one, honestly
2. High cholesterol - only once in all of my life did I have a number above 200, and my HDL ratio is usually good
3. High blood pressure - never
4. Physical inactivity - please! I've done some sort of exercise, on average, 350 days per year for over 3 decades
5. Obesity - nope
6. Diabetes - never
(By the way, if you have any of these risk factors then PLEASE start working with your physician to reduce them as quickly and as permanently as you can. Not only will you reduce your risk of heart attack, but you'll have a higher quality life too.)

There are also three "uncontrollable" risk factors, but even they fit my case only a little:
1. Increasing age - but not yet hitting 65, which seems to be the magical number for heart attack
2. Being male - can't do much about that, I suppose
3. Heredity - my father has had bypass surgery, but the rest of the family has no real heart issues

I guess whatever factors were involved, even though technically minor compared to the overall statistical average, ended up being enough to trigger a heart attack for me. Darn.

Anyway, I had my first session of cardiac rehab, and I think it went pretty well. After checking in and providing all of the information (again), I took a short quiz to test my knowledge about my condition. I did okay, but didn't nail it. I wasn't sure what the appropriate level of exercise should be, and (embarrassingly) I was a bit unsure on some questions about heart attack v. cardiac arrest v. cardiovascular disease. Not a bad approach to start with a quiz, getting things "wrong" helps me to focus on learning what's right.

The American Heart Association has a ton of great information on their website. I highly recommend you spend some time there, and especially a good idea to do an honest self assessment of your risk.

After a chat with the nurse, they hooked me up to a portable EKG unit and had me do a six minute walk test while they monitored all of the readouts. I circled the perimeter of the indoor facility and ended up passing with flying colors, I guess. They said I was moving at about 3.5 miles an hour and that my heart rate never exceeded 85 beats per minute.

Next up was the treadmill. Just walking, but gradually increased from 3.2 mph up to 3.8 mph without too much strain. They asked me to keep my RPE within 11-13, and really I was probably around 10 or 11 most of the time (about 15 minutes in total).

Having succeeded at that (heart rate, blood pressure, and cardiac rhythm all fine), we next moved to a stationary bike. The nurse set me up to maintain first 90, and then 100 watts of output. That put me at about 80 rpm and maybe 12-13 mph. Pretty comfortable. This was the first time that I started to just barely break a sweat, so I think my RPE went up to 12. Again, no major alarms went off, so after 15 minutes of spinning I walked a little to "cool down", and then scheduled up about a dozen more appointments for the coming weeks. The goal: to try a short jog at the rehab clinic while hooked up to the EKG by the end of July! Fingers crossed on that one.

They encouraged me to repeat a similar effort on my own daily, between appointments. I will admit to some trepidation - I don't want to experience another heart attack! The nurse assured me by putting it like this: two weeks ago, I was basically a ticking bomb waiting to go off, clueless and unconcerned. Now, not only is the blockage in my right coronary artery opened up, but I'm also on medications and being monitored regularly, so it's actually SAFER for me to exercise now than it was two weeks ago!

Hmm. I'll ponder on that one.

In the meantime, I'll overcome my anxiety and get about 30-60 minutes of light aerobic exercise daily (probably by walking briskly or cycling at an easy spin) to see how it goes. This is all in the service of healing and re-invigorating my damaged heart muscle tissue. 

Taking it day-by-day, inch-by-inch. I'm a runner at heart and by experience, so I just need to convert this process into the familiar pattern of a "build-up" in training - adding just a little bit at a time, slowly increasing the workload until it becomes easy, then adding a little bit more, in a carefully choreographed cycle. 

I assume many of you have had to work your way back from one injury or another, or a major life setback or two ... maybe even multiple times. If you are doing so right now, at the same time as me, then let's be kindred spirits and tackle the physical, emotional, and psychological challenges together. Best of luck to us all!

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