Selection: Heart Issues

Today I had my follow-up stress test from cardiac rehab this past winter. While my blood pressure was still high, and I need to lose weight, the test itself was good. So I am now officially discharged as an outpatient.

An early night, one more day of work, then on vacation until September 5th. Oh yeah, dentist on Friday...

A very touching story on 20/20 about a baby receiving a new heart. Then the parents of the heart recipient met the donor family. Talk about emotions... The donor parents listening to their child's heart, beating in another child's body...

Got permission from my doctor to go back to work fulltime, so I'm starting Monday.

My CEA test (cancer checkup) was also good.

I have put up a calculator based on the Karvonen Formula. Let me know what you think.

Went shopping today and purchased a training bike at Physique Fitness. The model I got was a Vision 2200HRT. This model comes with a chest-belt heart monitor that will increase or decrease the exercise depending on my heart rate. Pretty cool technology. It will be delivered next Tuesday. I'm happy with the model I picked. It is versatile enough to give me a good workout, once I'm ready to push myself more. The cardiac rehab has helped me evaluate equipment and my ability to use it. Rehab gets high marks in my book.

Also bought a heart rate monitor for when I go on walks. I know I can just take my pulse, but I don't find the "manual" method reliable. Perhaps with the gadget and taking my pulse manually, I'll get half decent readings. I'm already getting fairly good at judging my heart rate when I exercise, so perhaps I should consider these other methods as learning tools.

Week 2 at work has not been too bad. I am getting used to a schedule again. Earlier to bed for me...

Progress at the rehab. I've moved from walking 2.5 mph on the treadmill to 3 mph. Getting a better workout...

Tried the treadmill at home yesterday, but it did not work very well for me. The TM is on a fixed incline and the belt slips. I had to quit after 15 minutes. The recumbent bikes at rehab give me a good workout, so I am considering getting one. I may also get a heart monitor. I've been having trouble taking my pulse. 

While continuing my cardiac rehab, I started afternoons last Tuesday. I cannot say that it has been easy. I have been taking half hour to an hour naps every evening after work. The ladies at the exercise program figured my blood pressure was high before I started the exercises, so Wednesday they gave me a note for my family doctor which I dropped off, but no call from his office. Today my BP was a bit lower, I think because I drank less coffee. Something to pay attention to...

All in all not a bad week. I guess I will just have to keep listening to my body, as suggested by several friends. 

My doctor has agreed to go let me go back to work part time and signed off today. I will be working afternoons the next 5 weeks, and if all goes well, go back full time on March 27th. My rehab is also in the afternoon, so I won't actually be putting 3.5 hours every day. That's not such a bad way to start. Gives me more time to adjust.

Finished my first exercise session at cardiac rehab today.

My THR (Target Heart Rate) is between 106 and 132 beats per minute. I did 126 (21 beats/10 seconds) for the better part of 40 minutes. 20 Minutes on a bike, and 20 minutes on a treadmill. They thought I did great for the first time, and I thouhgt so too.

Had a class about "repairing connections" after the exercise class. To my surprise, 90% of the subject matter dealt with sex. It appears that 25% of the people who have a "heart event" never, ever have sex again...

Yet, heart patients can enjoy sex. Just follow some basic guidelines (common sense). Post a comment if you think I should elaborate. 

Had my stress test today, and Dr Fahoum will recommend to my family doctor that I can go back to work part time.
He took me off after 6 minutes because my heart rate was getting about 160/170. Not sure what that means for the exercise program, but I will find that out on Wednesday.
So far, so good. :)

Met with my program nurse today. How come I got the oldest nurse? :)
Did not learn much new. Just confirmation of what I already knew. My goals of cutting down cholersterol and weight will help me in many more ways.
Next Monday is my stress test, so I hope to get a recommendation to go back to work part time. We'll see...

Went for my first session today, two introductory/orientation sessions. Got a bunch of reading material and a schedule that takes me until March 23rd. Tomorrow bloodwork, Thursday a nutrition class. Next week some more classes and a meeting with the nurse. The 13th is my stress test and exercices start on the 15th.

Interesting article was sent to me by Phil:

Emotions and the heart
Recent HeartMath studies define a critical link between the heart and brain. The heart is in a constant two-way dialogue with the brain — our emotions change the signals the brain sends to the heart and the heart responds in complex ways. However, we now know that the heart sends more information to the brain than the brain sends to the heart. And the brain responds to the heart in many important ways. This research explains how the heart responds to emotional and mental reactions and why certain emotions stress the body and drain our energy. As we experience feelings like anger, frustration, anxiety and insecurity, our heart rhythm patterns become more erratic. These erratic patterns are sent to the emotional centers in the brain, which it recognizes as negative or stressful feelings. These signals create the actual feelings we experience in the heart area and the body. The erratic heart rhythms also block our ability to think clearly.

and

Benefits come from being appreciative
The feeling of appreciation is one of the most concrete and easiest positive emotions for individuals to self-generate and sustain for longer periods. Almost anyone can find something to genuinely appreciate. By simply recalling a time when you felt sincere appreciation and recreating that feeling, you can increase your heart rhythm coherence, reduce emotional stress and improve your health.

Read the entire article...

Heard from the Glenrose today, and I start cardiac rehab on January 31st. It's a six-week program, twice a week for a few hours.

After getting an ECG where the heart rate was 80, and then later in the doctor's office where the rate was 72, I'm still sitting at the high end of the good range (60-72).
I will see the doctor again in 10 days during which time he hopes to arrange for cardiac rehab sessions.
On we go...

Just noticed a TV ad for Coreg, the meds that just got increased for me to slow my heart rate. Good to see my docs are up-to-date...

Went to see the doctor again this afternoon. Doubling up on the Coreg beta blockers seems to have brought the heart rate down. I see the GP again in a week, after I go for an ECG first. In the mean time, until he figures out what the problem is, he refuses to let me go back to work. I think that means after next Friday, more tests.

Spoke with Chad from Manulife today. He's extending benefits to mid January. He wants to talk to me again after I see Dr. Holmes on the 29th.

Have had the runs the last few days. I don't think it's diet related, but who knows...

Went to see my GP today and he agrees with the cardiologist to wait at least a month before going back to work. He also indicated it may have to be half days for a while. I'm seeing him again before the end of the month to assess the situation. Doing a full blood test then, including the CEA test.

Took the pressure bandage off the wrist last night. The cut looks like the catheter that was inserted was the size of a knitting needle. This morning the wrist was an ugly yellow colour. Still sore from the clamp that was on it after the procedure. I hope my "mouse hand" will be better tomorrow. Want to do some web stuff...

Slept a lot yesterday afternoon, went to bed early slept almost 8 hours, and going back to bed. I think I caught a cold in the hospital and was getting a bit feverish last night. Come to think of it, the fever may have been a reaction to the procedure and hospital stay...

The angiogram showed 4 areas with blockage. The right coronary artery has a 10% blockage. The left circumflex artery is 70% blocked. The left anterior descending (LAD) has 2 areas that were blocked. One area is 10% and the other was 80% blocked. The LAD 80% was the main cause of my pains. That became the focus of the procedure. Angioplasty (balloon) was done, and then a stent was put in. The stent will keep that part of the artery open. Overall the procedure took about an hour.
While there are 2 ways of doing the angiogram (via the groin or via the wrist), mine was done via the wrist. Dr. Chan figures it's a shorter route to the heart and it's easier to clamp a wrist than a groin area. Because they use an artery, and not a vein, special precautions must be taken not to "spring a leak." So I can't drive for a week, or lift anything more than 10 pounds, or do anything stressfull with that wrist. Left-handed typing is not great for me, so I will watch movies and catch up on sleep for the past 2 months.
If all goes well, I could be back to work in the new year.

Today is angiogram day...

After all the excitement of Cecile coming home, then coming home later, I slept remarkably well last night. Yet around 5pm the normal routine kicked in with being tired, pains (and having to take extra nitro), and headaches. Just getting my energy back now, but it's after midnight already. Yet I feel I need sleep.
I hope they can do angioplasty on Thursday, so I can get some relief. Right now I'm getting close to vegging all day. Even when I walk around the house, I often get pains.

Now that I have a date for my angiogram, I'm really looking forward to having Cecile come home. Her flight comes in at 10:30PM tomorrow. Duncan will come along to welcome her.
Thank you to all of you who are praying for the right solution next Thursday.

Got a call from the hospital that my angiogram is scheduled for next week Thursday, December 1st. I have to be there at 6:30am. If all goes well, I will be discharged around noon or 1pm. If they do angioplasty (the balloon thing) I will have to stay overnight. I'm glad I now have a schedule. Another step toward recovery.

Saw my GP today and the blood test for liver and/or muscle damage was ok. He wants to see me in two weeks if I don't see him in the hospital first.
The pattern of pain has not changed so the weekly visits are changed to bi-weekly visits.
Next week I will start phoning the cardiology department and see if I can move things along. I don't want to do it now and have to go in before Cecile gets home.

Got a copy of a letter from Dr. Chan who administered the stress test on Oct 12th. Apparently I was referred for an URGENT angiogram because the stress test was positive for ischemia (Ischemia (is-KE'me-ah) is a condition in which the blood flow (and thus oxygen) is restricted to a part of the body. Cardiac ischemia is the name for lack of blood flow and oxygen to the heart muscle.).
My question, if this is urgent, why haven't I heard from the hospital yet?

My cholesterol is down. It was 6.6 3 weeks ago (5.0 is a good number) and the test from last week was 4.6. As expected, there was liver damage, so the blood test will be repeated in a couple of weeks. The GP wants to see me weekly to see if my pains get worse, or level off.
Today was not a good day. Was coughing this morning, then puking (even though I had not eaten yet). Even with the nitro patch, I had to use the spray a few times...

Had Jake and Grace stop in for a visit. Jake had a stent put in last year for his angina. He's a changed man now.
Went to see my boss and past boss to see how we can make things less stressful for me when I go back to work. We'll see what happens there.

After 2 days of wearing a nitro patch, here are some observations. Thanks Phil, for your Nitroglycerin link.

The patch is supposed to stay on for 12 hours, then 12 hours off. When I put it on, I get about 2 hours without chest pains, almost euphoric. Then the headaches start. Advil kinda dulls the pain but not really takes it away completely. Face flushing and increased heart rate are also very noticable. Lightheadedness and dizzyness are not a problem, but I get very tired. Not sure if it's the nitro or the Lipitor.

When I take the patch off, it takes about 30 minutes before I feel chest pains again. I'm on 9am to 9pm right now.

The doctor figures my attacks are too frequent, so he's putting me on a nitro patch 12 hours a day. This will give me a continuous dose, hopefully reducing painful episodes. I just wonder about the headaches...
On the other hand, the Lipitor does not seem to bother me much.
No word yet on the angiogram...

Received a letter this morning that I am now on the waiting list for an angiogram. I will be notified 2 weeks prior.

In addition to the nitroglycerin that Dr Chan prescribed yesterday, my GP also prescribed Lipitor (40mg) today, but no calcium-blockers. Lipitor can cause some nasty side effects but it beats the alternative... My GP wants to see me again in a week to see how I'm coping with the chest pains and Lipitor side effects, then in 2 weeks he wants another blood test (not just to check cholesterol levels, but also possible liver damage). My cardiac functional capacity is rated as a class 3, "ordinary physical activity results in symptoms." There are 4 classes, with class 4 being the worst.
I was warned the angiogram might take 2 months before I can get in. The procedure takes about an hour according to the GP, with a stay of at least 3 hours to make sure the artery they use for the procedure does not pop. If there is just a single blockage and they can reach it with the catheter, they may do an angioplasty on the spot. If it's one of the side arteries and they can't reach it, it will be bypass surgery. Stents are almost never done at the time of the angiogram, and if there are several blockages that are candidates for angioplasty, they may just do one and reschedule the rest. All in all, it could turn into a lengthy process. Bummer...

Yesterday was not a good day for me. I counted 8 attacks, 7 in the morning (5:45 to 10:35) and 1 at night (8:30pm). Today was much better. Only a single attack in the morning. My second attack was during the stress test. After getting on the treadmill it took just 5 minutes for my heart to go over the "safe" level. They kept me going for another minute, but I had to make them stop at 6 minutes.
Dr Chan said the ECG results were abnormal. He suspects a coronary artery blockage and has ordered an angiogram. The findings of that angiogram will determine treatment. "Treatment options include rest, medications (nitroglycerin, beta-blockers, calcium channel blockers), percutaneous transluminal coronary angioplasty (PTCA), or coronary artery bypass graft surgery (CABG)." See www.danen.org/h/medical/heart for some articles on heart disease.

Now that I'm doing some research, angina has a few different forms, none of which is very good...

http://www.americanheart.org/presenter.jhtml?identifier=4472

http://www.medinfo.co.uk/conditions/angina.html

http://www.nhlbi.nih.gov/health/dci/Diseases/Angina/Angina_WhatIs.html

The good news is that I just got my appointment for the stress test, next Wednesday. I guess the experts realize the urgency also...

Cholesterol and thyroid test are done, so things are moving along.

I'm doing a lot of resting. Even walking across the street to the mall (fortunately all medical facilities are there) and to the lab is very tiring. It takes me three times longer than normal.

Saw my GP yesterday and he's leaning toward angina. The stress test should be able to confirm that. Even last night there were times that I woke up and felt a tightness in my chest. They use a 0-10 scale to rate pain, and this was a 2 to 3 on that scale.
Going for a cholesterol and thyroid test this morning.

Spent 7 hours in emergency today... Went for a walk at lunch time to clear my head and get some exercise. Had gone only a few blocks and started having chest pains. Walked a bit more, but when the pain did not go away, I went back to the office, had a cup of water and sat down. Ten minutes later the pain was gone. Since a similar thing happened last week Friday, I thought it best to get myself checked out. Two ECG's and two enzyme blood tests later (and the obligatory waiting), I was sent home. ECG's were ok, and enzyme tests were negative, so no heart damage. They want me to see my GP and have sent a referral to a cardiologist for a stress test. This appointment is supposed to come through before the end of the week.