Injuries and RehabTell us where it hurts! Do a quick search before asking about your shoulder injury to make sure your question hasn't already been answered (about 50 times), and read the sticky post first.
Well, this may be first (as well as my first post). I used the search function and could not find any reference to open heart surgery so here goes.
On Friday January 14, 2005, I went in to see the cardiologist for some chest pain newly discovered while working out. (and before you dismiss me as one of the unfit masses, please read my "workout story" at the end of this section). I thought that at the very worst, I was going to end up with an angioplasty and/or a related stint in an artery. Well, imagine my surprise when at the end of the heart cath process, the doctor said, "Well Steve, you've got major (95%-99%) blockage in 4 arteries. The good news is, it's a slow day and we're going to be able to get you into bypass surgery in just about 2-3 hours". This is almost an exact quote. My response was "No that can't be right, I work out all the time. You must have done the test wrong". Well as he showed me the arteries on the "instant replay", I say what he was talking about. Three of the arteries were crimped and had been that way since birth. Two of the three were only about 25% the size of the rest of the artery and one was about 50% of normal size. All four had major corrosion and he said I was lucky to not have had a major heart attack while at the gym. If anyone could actually choose the location of the arteries to be block and the time and location for their discovery, then I was the poster child for bypass surgery.
The surgery went great although they had to open me back up about 10 hours after bypass surgery to stop some excessive internal bleeding. Fortunately, they kept me knocked out until well after this incident.
So here I am now, looking to regain my pre-surgery conditioning level and limited to lifting less that 20 pounds and doing very light impact cardio (basically walking). I am still on beta-blockers to keep my heart rate and blood pressure down. Pre-surgery resting heart rate was low 70's and blood pressure was consistently about 120/70 (and I had even passed a stress test about 4 years ago).
My heart rate concerns me in that even with the beta-blockers, it's high 80's to high 90's. Does anyone know if this will ever come down and what would be the best procedure to re-establish my pre-surgery heart rate?
Are there any recommendations for how to get back into shape? The info provided by the hospital seems to be geared toward someone with very limited physical conditioning and in much worse shape than me.
Any other recommendations on how to "get my work out life" back? While the doctors so far have been fabulous, they are just not very physically fit minded people and don't have the same grasp of conditioning that I've found in this forum.
Thanks.
SteveF
Rest of the story here-----
When I got out of college in 1977 I vowed to never really let myself fall back into that level of fitness again. Over the last 28 years I've trained and ran in a dozen 10K races, I've biked maybe thousands but purely recreationally, I am a fifth Dan black belt at Tae Kwon Do and trained for 26 years. I even plan my vacations based on the availability of a gym or resort workout facilities.
In 2001 I was able to retire from my job due to an excellent retirement plan and some really good (although perhaps a little inadvertently) investments and decided to start some serious training. Lou's TAP had just came out so I got the book and I was hooked. Since then I have done TAP twice, about 18 weeks of HST, the Men's Health Hard Body Plan, at least two Melt Down I's and in October 2004 I completed the year long int/advance Home Grown Muscle program and when I discovered my heart problem, I was into the 13th week of the intermediate Book of Muscle. While my weight did not change radically in this time period my BF percentage went from 24% to a low of 19% (but seem to stick at 20%). "So I don't consider myself to be one of the unfit masses."
Are you on any other medications other than the beta blocker?
For other reader's info: BB's slow the heart rate down by blocking the beta-1 receptors in your heart (beta-1 receptors are where the sympathetic nervous system input into your heart. The sympathetic nervous systems is the part of your nervous system that makes your heart rate go up). As a result, your heart requires less oxygen (your heart's oxygen demands are almost solely a product of heart rate). Additionally, the lower heart rate means that your heart spends more time between contractions relaxing. Perfusion of your heart happens during relaxation (diastole) and can only be efficiently done if the heart is adequately relaxed.
Heart rate aside, I would discuss your concerns with both your cardiologist and your physiotherapist. However, keep in mind that open heart surgery is still considered one of the most traumatic surgeries anyone can undergo (short of multiple trauma), and although your coronary vessels have been bypassed, there is still healing that needs to be done between the old vessel and the grafted vessel. You may also want to find out more about the status of your heart--whether the surgeon noticed any necrosis while in there; whether your present ECG is normal or abnormal and how; if there's evidence that you've had silent myocardial infarctions, as these findings have a significant impact on fitness/rehab program design.
The heart will also undergo some changes as a result of the coronary bypass (a system disturbed will undergo adaptation in some form), so as of yet, you may be considered "unstable" with respect to exercise--which is why it seems like those exercises are so dinky. Your heart has to get used to the fact that blood isn't passing through the normal vessels all the way through from aorta to muscle--it actually takes longer for blood to get from your aorta to the heart muscle when it has to travel through the bypass (like a detour is always longer than the original straight road). While the additional distance itself seems superficially negligible, it may be quite a bit more substantial in terms of exercising and re-conditioning your heart. Your heart muscles before by-pass were used to getting blood and oxygen (though limited) in X milliseconds. The bypass surgery has increased that time and so your heart muscles have to get used to the new transit time as well.
But the bottom line is that you should talk to your physicians and therapists about your concerns and find out what _their_ expectations are with respect to your recovery. Do you have a truly realistic view on a) your time to "full recovery" b) what a "full recovery" actually might be, post-surgery (i.e. might you have permanent limitations on your activity?), and c) if there are any modifications you can do to your program so that _you_ can feel like you're moderately accomplished in terms of progressing to your goals.
Thank Bryanc. You pointed out so many things I was never even aware of and provided some excellent information. I would even say this is more comprehensive than I've gotten from my doctors (who are great btw, they're just not much into fitness)
I'm only on 50 mg of Toprol per day, split into 25 morning and 25 night.
I don't get to see the cardiologist until March 10 so I've got a while to go.
Any other info or internet sources you can list will certainly be as appreciated.
The surgeon said that my heart had no damage whatsoever, i.e no necrosis, so that's one we don't have to worry about.
I don't get an EKG and an echo cardiogram until I see the cardiologist in March.
I probably do not have a realistic view of my time to full recovery (do any of us work out types though?) but according to discussions with the surgeon and the cardiologist while I was in the hospital, I should expect a full and complete recovery at least to my post surgery level and beyond if desired. (I just want it now or much quicker than they are allowing me)
Yeah, I'm not so sure the echo will show a whole lot--mostly they'll want to see that the new grafts are doing well. The EKG will be where the story is at as it will show whether your heart has had any permanent changes as a result of the initial insults. While it's great that the surgeon didn't see any necrosis, it usually has to be a rather large area of heart that is affected before you can see MI (myocardial infarction) with the naked eye.
Stick with your rehab program and have a chat with your therapist though! But it looks like they're not likely to make any large changes before you get that EKG (and possibly a stress test). At any rate, those vessels need time to heal to one another, so make sure you give them a chance to do that before you leap headlong into full activity again. The last thing you want is incomplete or weird healing (beyond the weird healing that will already happen, which is normal weird healing post-graft).
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