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Cardiac Rehab - Waste of Time

  • 1.  Cardiac Rehab - Waste of Time

    Posted 06-20-2020 23:49
    Edited by Herb Greenberg 06-21-2020 00:54
    *Meant to have a question mark on the subject line.

    At the risk of sparking some disagreement....

    I'm 4 months post-op and started cardiac rehab about 3 weeks ago, once things reopened. I had my aortic valve and root replaced, my AA repaired and, as a bonus, CABGx1. I've been pretty gung-ho and positive about everything related to what I had done and went into rehab with a good attitude. However, after my handful of visits: My take is that if going into heart surgery I had terrible eating habits, didn't exercise and in general didn't take care of myself – I could see where rehab would beneficial. And I would add...especially if I had suffered a life threatening heart attack. I also think I could have benefited if I did rehab starting 4 weeks post-op. But even before I started rehab I was walking close to 4 miles daily at my pre-op pace, which is fairly quick. Yet when I go I feel like they have their protocol and it doesn't really matter what you had or when you had it: Start with a warm up, go on the machines, then (and I asked for this) head to the weight machines. Blood pressure pre-and-post. Heart monitored throughout. Honestly, the weight machines and weights/stretching are all I'm interested in in a way that doesn't hurt my chest, which seems pretty much healed. I get my aerobics at home. And later in the summer hope to restart with a pilates/stretching trainer I was using pre-op. If it wasn't for the scar I wouldn't know I had surgery. I consider myself lucky to have been in pretty good shape going in. I started walking immediately once out - including hills. I've just been listening to my body.

    I realize there is no one-size fits all, and I've spoken with some terrific folks here who have encouraged rehab and served as great sounding boards pre-surgery. But starting months out seems pointless and I will likely bow out. It's two hours out of my day an I am not retired. And I just don't see the benefit for me. And I stress...me.

    I welcome any comments and discussion and respectful disagreement. I fully see the benefits of rehab. But after researching the topic, I realize I'm not alone with these thoughts and think it deserves air time.

    Thanks for listening.

    Herb


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    Herb Greenberg
    San Diego CA
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  • 2.  RE: Cardiac Rehab - Waste of Time

    Posted 06-21-2020 01:22
    Have  you discussed this with  your cardiologist?  Maybe the doctor  will tell you to skip it ( the Dr gets a report from the therapists)
    The monitoring of your heart during exercise is the vital component that is probably the deciding factors here.

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    Marilyn Rosenhouse
    Dallas TX
    (214) 850-0219
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  • 3.  RE: Cardiac Rehab - Waste of Time

    Posted 06-21-2020 01:23
    Hi Herb
    You won't get a negative reply from me at all,  I dropped out
    of Cardiac Rehab after only 7 sessions..

    I take care of my own house, and a oversize property with Gardens and animals every day, winter and summer, along with dozens of hobbies that involve movement and lifting  heavy various items on a regular basis

    Shortly after I did get home from the hospital, it was found that I had fractured my sternum, and surgeon admonished me to go back to lifting 5 pounds until further notice

    I did tell Cardiac Rehab Team what the surgeon suggested, but
    they wanted me to lift weights and do chest pulls and use my arms on the walking machines for 30 minutes.  I told them about the popping and clicking of my sternum when I did those types of exercises, and they wrote me up as someone who was trying to get out of working a cardiac program.

    When I realized it was taking more pain and energy going to the rehab then what I was getting out of it, I gave my notice I was not coming back.  They wrote me up as a Failed Patient.  

    What failed is that no one was listening to the patient 

    It was only a couple of weeks later in February that then the Covid 19 shut everything down. 

    Mary Hedtke









  • 4.  RE: Cardiac Rehab - Waste of Time

    Posted 06-21-2020 06:53
    Herb,

    I agree that the cookie cutter cardiac rehab you are describing seems like an utter waste of time in your case.  By way of contrast, in my case, it was critical to my recovery, perhaps even the difference between life and death.

    I too was a lifetime athlete prior to my heart attack and surgery, and I still am today thanks to my surgery, rehab (inpatient and outpatient), the support of my wife and daughter and my own fighting spirit and recognition that nothing is impossible.  I have been to the brink of death, faced and embraced it as part of the fabric of being itself and, like the ancient mariner, am here to tell the tale.

    When I started rehab, I was three weeks post CABGx5, having spent two weeks on a ventilator recovering from pneumonia and cdiff. was was taken by anbulance from the acute care hospital to inpatient rehab, still in the throes of ICU delusions and actively hallucinating.  I was so weak physically that I could not stand or hold a pen to sign in to the rehab hospital or feed myself.  I remained in inpatient rehab for three weeks, during which time I made amazing progress on a daily basis, astounding even my therapists, and on the night before my discharge I hope I saved the life of my roommate when he had a stroke and I walked to the nurses station to have them call a code.

    When I came home, finally, I kissed my front door, and saw my old dog, Argus recognizing Odysseus, and I began outpatient rehab a few days later.  I graduated at three months postsurgery, fully one month before you even started your rehab.  By four months, I was lifting weights and doing pushups again.  By five months I was beginning to do handstand pushups and pullups again.  A month after that I was running again (although I use the term loosely compared to what I used to do in my long, and sometimes competitive career as a distance runner in my twenties through fifties before overuse took its toll).

    So, yes, in your shoes, I would feel the same way and no doubt would have quit doing something that I was "supposed" to do but for which I derived no benefit.

    Seize the day, brother.

    Ira

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    Ira Reid
    Hoboken NJ
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  • 5.  RE: Cardiac Rehab - Waste of Time

    Posted 06-21-2020 07:57
    Hi Herb!
    Glad you are doing great!!

    I too started cardiac rehab a bit late, maybe 2 months post op. I was already walking 30-45mins a few times a day but wanted to get back to my strength training/HIIT training. I was lucky to have an incredible rehab team that helped me feel comfortable starting to push it more and more each week. I completed 12 weeks but it did become sort of redundant after a while, I had to keep telling them to let me work a little harder each week.

    I wasn't sure how I would feel or if my heart would handle the high intensity training again so being monitored helped me feel comfortable ramping things up week after week. Each week they would program a little more work load for me so I was ready to go when I was done.

    I am now doing a training template where I am strength training 3x a week and jogging/running 3x a week(from sprints to 5k runs) and feel confident that everything will "hold up."

    So to answer your question, rehab did become quite stale for me especially taking time 3 days a week out of my schedule. I did however find it necessary for me to get on track to move toward my fitness goals.


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    Cole Morrison
    772-215-1621
    Saint Simons Island, GA
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  • 6.  RE: Cardiac Rehab - Waste of Time

    Posted 06-21-2020 09:40
    Fascinating, not the reaction I expected! I am guessing that a few other regulars here, including Brett and Vic, may have a differing opinion.

    Marylin – early on my cardiologist said that I probably wouldn't benefit from it. I think he understood that my personality combined with the time lapse were – plus my overall physical shape – were not a good match or use of my time. He was hoping pre-Covid that I would go into a more experimental group program he had helped develop. I wrote him an email the other day with my concerns but have not yet heard back.

    Mary - I stuck with the low weights but really wanted, needed any stretching to open my chest without hurting it. Their view is that you first have to warm up, which is 30 minutes on the machines. The frustration is that by that point I already exercised (fast walking) earlier in the day. I've been very concerned about hurting my sternum and the one good thing I got from rehab, via phone with the nurse when it was still closed, was NOT to do some exercises I really wanted to do until certain intervals. I find the stretching on the weight machines helpful, but after a quick instruction you are pretty much on your own. And you can't use the machines until you have "warmed up" on the machines. (After the first visit I specifically said I would not do one of the machines - a sitting stepper - b/c I found it ridiculously boring. I'm not sure my insubordination as appreciated.) ;-)

    Ira – you're a special case! (In a good way!) I've followed your experience and your rebound is inspirational. If I were in your shoes, no matter what shape I was in pre-op, I'm sure I would eagerly be embracing rehab. The fact that they started so soon would have appeared to be a big plus. Also, I'm very lucky I did not have a heart attack. The artery that was surprisingly 80% blocked (marginal obtuse 1) would have likely given me angina or a heart attack. I think a heart attack and major CABG has a totally different impact than what I had, which was CABG light. How light? They removed a vein from my leg using an endoscope, so no long scar, nothing taken out of my chest. Cleveland suggested rehab (pre-Covid) start at 4 weeks. The protocol out here was closer to 8 weeks. Pre-op I told my cardiologist (at Cleveland's behest) that I wanted to start at 4 weeks - and suggested I get on the waiting list then, which was 4 weeks pre-surgery. I'm not sure he agreed, but we will never know! (Thanks, Covid!)

    Cole – I remember that you started late and was interested to see how you would respond. I could see, if I were into weight training the way you were, why I would stick with it. You were getting back to your pre-op program under supervision. I got home from Cleveland on Day 10 and started walking here Day 11. There are varying degree of hills in my neighborhood, from very mild to intense. After a day or two I stretched to the mildest of hills and immediately realized I couldn't do them at my immediately post-op regular walking pace, so I slowed to a snail's crawl walking up a very minor upgrade.) Over the weeks I continued and then varied the path to different levels of hills, listening to my body. One day it all clicked and I could go up one of the mild hills without slowing down. That was a huge victory. I celebrated 8 weeks by walking up the steepest hill!! Rehab now feels like stepping back.

    PS, I forgot to mention: Exercising wearing a mask is a non starter. It's not fun and I suspect not necessarily healthy. In one of my early rehabs my BP was high. The nurse said take off the mask. It then reverted to somewhat normal.

    Best,
    Herb

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    Herb Greenberg
    San Diego CA
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  • 7.  RE: Cardiac Rehab - Waste of Time

    Posted 06-21-2020 09:47
    Hello Herb and all other rehab alumni,
    You are quite correct that rehab is not the same for everyone. We also have to keep in mind that like doctors not all rehab is the same. The staff can make all the difference. As was mentioned if they do not listen to the patient or they might not be the right fit.
    I found rehab useful for my recovery as I too was very weak after my CABG. 
    Not everyone has a good routine before a heart issue sends them to surgery. They need baby steps. I am glad you had a good routine prior to your issues.
    However the monitors we wore during rehab noted issues with several patients including myself that would not have been noted if I had not attended rehab. Some of the patients like you were in very good condition post op.
    PVC's do not always give you symptoms and without the monitor at rehab I and others might have had undetected issues that could have caused larger heart problems down the road. I always suggest rehab unless the cardiologist clears you to stop for that reason.
    I was lucky to have a nursing staff that communicated with my cardiologist and when he made changes to my routine they listened and they referred me back to him whenever they saw any issue.
    It might have been a waste of time in your case but for others it prevented worsening heart issues, me included. I did have to have a pacemaker about a year post op as the issues detected in rehab did not go away. I would always recommend caution before dismissing rehab, unless the cardiologist gives the OK.

    Richard Short 
    Chapter 395







  • 8.  RE: Cardiac Rehab - Waste of Time

    Posted 06-21-2020 10:06
    Hi Richard,

    I appreciate the feedback and what you say makes sense. The monitoring is the one thing that kind of keeps me hooked, but so far there has been zero feedback, which I guess is a good thing. Because of my defective valve, and knowing that some day I would need surgery, I tried to watch what I ate and keep a regular routine of aerobic exercise. Years ago it was running; once my knees complained, it was walking, with pilates and/or some other stretching/strengthening added in.

    Also, I failed to mention: If rehab could guarantee that my valve would not re-calcify - that would be incentive enough to keep going. But even the Ornish program, which is offered at UCSD's rehab program, doesn't guarantee that, at least not based on an answer to a question on its website.

    Thanks,
    Herb

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    Herb Greenberg
    San Diego CA
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  • 9.  RE: Cardiac Rehab - Waste of Time

    Posted 06-21-2020 11:09
    Herb and Ira,

    I agree with both of you. In my vernacular, rehab is a management process, meaning that it involves both mental and physical aspects. Rehab can, initially, help patients understand our opportunities, and restrictions, immediately following surgeries and/or procedures. Again, in my vernacular, it helps train us, and give us confidence, in self-monitoring. Once we "graduate" from the program, the responsibility shifts to us to apply, and refine, the self-monitoring to fit our desires and capabilities.
    Part of any management process is using, and/or acquiring, the  resources that would be helpful for our success. I tend to think of it as "Superman died," meaning I am not immune from needing the help of others, like cardiologists, internists, MH, and most of all family. All of this starts with knowing yourself, perhaps through meditation. We are blessed to be the only living thing that can control our own lives.

    Hope this is helpful.

    Brent Zepke

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    Brent Zepke
    Santa Barbara CA
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  • 10.  RE: Cardiac Rehab - Waste of Time

    Posted 06-21-2020 12:10
    Thanks for the insight, Brent. And earlier I referred to you as "Brett." Won't happen again! Herb

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    Herb Greenberg
    San Diego CA
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  • 11.  RE: Cardiac Rehab - Waste of Time

    Posted 06-22-2020 07:17
    I was willing to give cardiac rehab a try but never got to do it because the only facility near me (living in a rural area) doesn't accept my insurance. I was frustrated by that, but when my cardiologist gave me the OK to return to the fitness studio where I've been working out daily for 7-8 years, I found that the studio's owner (who has a BS in health and human performance) provided great support on several levels. She has been so helpful and encouraging, and takes the initiative (along with her instructors) to suggest modifications of moves to make them manageable for me. For me, the hardest part is accepting that constantly pushing myself (as I did pre-heart failure) is not beneficial. Unfortunately, I'm the only one who can fix that. My only advice is to be open to learning and rehab opportunities wherever you might find them.

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    Jean McMillan
    TN
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  • 12.  RE: Cardiac Rehab - Waste of Time

    Posted 06-22-2020 07:29
    Actually, Jean, and everyone, constantly pushing yourself is never good, even if you are an elite world class athlete.  Your body adapts to exercise when you rest and recover from exercise, not when you are working out.  Constantly pushing yourself leads to regression, a weakened immune system, injury and/or no progress.  It's the primary reason mist people you see at the gym look like they never make any progress despite their obvious dedication.  It's not poor genes as much as it is overtraining.

    Take things slow and steady, work hard when you workout but gave yourself all the rest you need.  And the older you get, the more recovery time you need.

    Best,

    Ira

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    Ira Reid
    Hoboken NJ
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  • 13.  RE: Cardiac Rehab - Waste of Time

    Posted 06-22-2020 07:49
    You are (as usual) absolutely right, Ira. For me, cardiac rehab is as much mental as physical. Hard work for a lifelong "Type A" person!

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    Jean McMillan
    TN
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  • 14.  RE: Cardiac Rehab - Waste of Time

    Posted 06-24-2020 11:16
    Herb,
    I'm glad your cardiac rehab is beginning after the COVID-19 shut down.  As a review for other readers, I had two heart procedures and completed two cardiac rehab sessions. One in 2007 after the repair of an ascending aortic aneurysm and again in 2017 after the repair of  a aortic arch aneurysm.  My personal experience with the cardiac rehab has been very positive.  The nurses will monitor your progress and review best exercises routines for your recovery. The physical therapists encourage patients to continue with a phase III program at a local gym, health club or rehab facility.  These include a minimum of 30 minutes of daily aerobic exercise plus anaerobic (resistance training). AHA research has shown heart patients who complete the program recover quicker and live longer.  It has been three years since my last OHS and I now exercise at least 60 minutes a day either speed walking, bike riding or swimming. Now that the community pool is open, I try to get my laps in each afternoon.  


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    Victor Fabry, CEO
    Greylock Advisors, LLC
    Short Hills, New Jersey
    fvfabry@gmail.com
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  • 15.  RE: Cardiac Rehab - Waste of Time

    Posted 06-24-2020 12:44
    Herb's remark: "One size does not fit all" should be the conclusion of this debate.
    In my case, i was a "poster child" for all the rehabilitation types (cardiogenic shock, having been in a coma with my chest open for 10 days and i was "deconditioned" ): in hospital, rehab facility ( 3 weeks), at home (4 weeks), and out patient cardio vascular ( 6 weeks) and then maintenance at the out-patient rehab.  My husband was benefited too: he felt that i was safer there then going to a local gym ( nurse/therapist  supervision and the Emergency Room nearby).  Each case is different.  Check with your doctor.
    I tell people ( and you athletes writing here prove my point) that being fit  and healthy (while it doesn't prevent heart  problems or other medical conditions) sure makes recovery easier!!!

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    Marilyn Rosenhouse
    Dallas TX
    (214) 850-0219
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  • 16.  RE: Cardiac Rehab - Waste of Time

    Posted 06-24-2020 14:29

    Marilyn,

    Being an athlete makes recovery from heart and other medical problems easier for more than just the obvious reason that the athlete is more physically fit.  It is also because the athlete has learned that his or her body is capable of adapting and performing at levels that most nonathletes would consider extraordinary.  The marathon runner knows what it takes to run 26.2 miles and knows the type of training, diet, state of mind and effort it took to achieve that milestone.  The athlete also knows the travail and setbacks he or she overcame to achieve the training goals that had to be attained.  Along the way, the athlete, through athletic endeavor, through success and failure, learns about himself or herself and what it takes to go the distance.

    One of my favorite athlete writers, Dr. George Sheehan, was a cardiologist who, later in life, wrote many books about running and its meaning in life.  He was very well known during the "running boom" that began in the late 1960's and early 1970's and was a rather erudite armchair philosopher as well as a physician and talented masters marathon runner.  His last book, written when he was dying of prostate cancer, was titled "Going the Distance." It had nothing to do about running in any direct way.  It was about living until one died, going the distance in life, filled with the wisdom of the philosophers that influenced him and influenced him still as he approached death.  He never could have written that book if he hadn't learned the lessons he learned from being a long distance runner.

    It is what we all are doing.  We are going the distance.  It's just that the athletes among us experience this in a very small way every day that we train, and it is the lessons that we learn on the road, as our feet slap the pavement and we look at the stars during our predawn runs in winter, that make all the difference in the world. In a larger sense, though, we all are athletes.  We are athletes of life.

    Ira



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    Ira Reid
    Hoboken NJ
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  • 17.  RE: Cardiac Rehab - Waste of Time

    Posted 06-24-2020 18:05
    Ira: thanks for your letter 
    meanwhile i am trying to get over my "allergy" of exercise. 

    Marilyn B. Rosenhouse
    Mobile: (214)850-0655






  • 18.  RE: Cardiac Rehab - Waste of Time

    Posted 06-24-2020 22:51
    Marilyn, that's some story - about what happened to you? How long ago? What did you have done? The important thing is that you survived. You have been through the wringer. Knowing nothing about you (age, etc) but knowing by your area code you live in a hot, humid place - have you ever thought of walking early in the morning? With your husband? Or by yourself with headphones. With goals to extend your walking to 45 mins? I have an allergy to exercise machines, but after I could no longer run (like 15 years ago) I turned to machines (the elliptical) and then ambitious walking. My wife, who is not an exerciser, walks with me most days. We have some pretty steep hills here that she used to loathe. Now she can get up them pretty well and the asthma she used to have when she walked up those hills has pretty much disappeared - probably because of improved lung function. My knees act up occasionally and that's a thing with age, but you'd be surprised how much better you will start feeling, regardless of whatever shape you are in.

    And, Ira, I used to have one of Sheehan's books...way back in the day.

    Best,
    Herb

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    Herb Greenberg
    San Diego CA
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  • 19.  RE: Cardiac Rehab - Waste of Time

    Posted 06-25-2020 14:23
    Ira, as always, wise words, beautifully said, and God's truth.


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    Jean McMillan
    TN
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