Maggie McKay (Host): Cardiac surgery is serious and so is the recovery time. So, getting it right is crucial. Today, we'll talk with Kelli O'Harrow, cardiac rehabilitation nurse, about what comes after surgery.

Welcome to Wise and Well presented by Community Memorial Healthcare. I'm your host, Maggie McKay. Thank you so much for joining us today, Kelli.

Kelli O'Harrow: Hi, Maggie. I'm excited to be here and talk to you about all things heart.

Host: Yes, absolutely. Can you start by giving us a brief overview of what cardiac rehabilitation at Community Memorial Healthcare entails?

Kelli O'Harrow: Yes. Cardiac rehab, along with being a top tier recommendation by the American Heart Association and the American College of Cardiology, cardiac rehab is one of the most fun, uplifting places in our whole healthcare system. I mean, who wouldn't want to hang out for an hour and talk about good food, moving our bodies to feel good, learning new things, and being the happiest version of ourselves?

So, yeah, cardiac rehab is a program that's designed to support people recovering from a recent cardiac event or heart diagnosis. Participants get referred to the program by their doctor. It's usually a cardiologist. It's an outpatient program that takes place at CMH. Sessions occur every Monday, Wednesday, and Friday for an hour, and they take place in a small group setting. The program itself lasts for up to 12 weeks and it covers all aspects of heart health. It's covered by health insurance for folks with qualifying diagnoses.

Host: And a lot of people might think cardiac rehab is only for those who have had open heart surgery. Can you clarify who can benefit from this program? I know you just mentioned, but maybe expand on that a little bit.

Kelli O'Harrow: Many people can benefit from cardiac rehab. It is designed to support people with all types of health-related conditions. And, yes, certainly people who've had open heart surgery will benefit, including those who've had the heart bypass surgery. People who've had a heart attack within the last year and those who've had stents placed within their heart will also benefit from cardiac rehab.

In certain instances, people who've had a heart condition called congestive heart failure will qualify for cardiac rehab too. Having a heart valve repaired or replaced also makes one an ideal candidate for rehab, and the same is true for people who've had a heart transplant. Within cardiac rehab, there's benefit to everyone. All ages and all levels are welcome. We have folks who we work with from age 30 to 90 plus, people who use a walker or a cane, people who've neve, "been into exercise," or folks who aren't sure just where to begin.

I've also had the privilege to meet an elite athlete just weeks after his heart surgery, and I had the opportunity to support him into reentering the fitness world, only to then watch him perform at world-class levels. And then, just today, I met a gentleman in his 90s who was thrilled to complete his first minute on the treadmill ever. So, in cardiac rehab, there really is a place for all.

Host: Oh, my gosh. I had no idea it covered so many bases. What are some of the key benefits that patients can expect to experience through cardiac rehab?

Kelli O'Harrow: So, cardiac rehab, it's really just a great place to start living life again after a major heart event. It's a place to learn about and implement strategies that will support recovery and health. We learn about heart-healthy lifestyles, yes, but we also practice what we preach in real time.

Patients can feel secure by trying out exercises here that perhaps they've never done since their heart surgery or maybe even ever. They can feel comfortable knowing that they're in a safe place to work out their heart. Cardiac rehab is a great spot to troubleshoot issues that might come up in real time. While folks are exercising here, we can distinguish what the expected stages of recovery are from a heart event versus some abnormal symptom that might actually require follow up.

The cardiac rehab nurse serves as part of the patient's Cardiology team, communicating with the cardiologist, troubleshooting certain issues without the need for like a separate doctor's visit and certainly preventing a trip to the hospital. There's also a sense of camaraderie here and that's a key component too. Cardiac rehab sessions do occur in a group setting, so it's a unique opportunity for people to connect with others who've had a similar experience. You might be the only person in your circle who's had a heart transplant or been on ECMO life support. But in cardiac rehab, you'll meet other people who have. And to be with folks that you can connect to on something so, so personal and powerful is important.

And then, kind of related to that is the care that we give for the loved ones of our patients, meaning friends and family. It can be a really scary time if someone you love has had a major cardiac issue, so it can provide assurance to the friends and the family. They're welcome to come in and watch their loved one work out on a treadmill. They're invited to our education sessions about nutrition. And even when the friend or family isn't physically here, often issues will come up. A participant, for example, might say, "My girlfriend is so nervous every time I leave the house now. She won't even let me walk the dog since my surgery. Can you help me assure her that I'm okay?" Or, "My husband is nervous to have sex since my heart attack. Am I okay to?" Or even simple things like, "How can I eat heart-healthy when I go out to lunch with my co-workers now?" At cardiac rehab, we take on all of these kind of real life questions and challenges that arrive from the patient themselves, but also everyone in their life.

Host: Very encouraging, and you kind of answered this question, but I know your staff takes a multidisciplinary approach. Can you elaborate a little on the different aspects of care that patients receive with the program?

Kelli O'Harrow: Definitely. I mean, our health itself, as humans, is so multifactorial, multidimensional. And in cardiac rehab, we take a similar approach. We look to address the many aspects of health, the physical, the emotional, a large part of the program does focus on movement and exercise and how it relates to the heart. Nutrition and how we fuel our bodies is a core component of rehab as well. And the program does collaborate with CMH's registered dieticians in helping people meet their nutritional goals.

Of course, medications play a huge part in optimizing heart health. And at Cardiac Rehab, we collaborate with our pharmacists here too to provide support in this setting. Cardiac rehab's also a really great place to make sure a person's specific medication regimen is working effectively. During the sessions, the cardiac rehab nurse will check blood pressure, will continuously monitor the heart rate and the heart rhythm. And so, we can notice subtle changes that perhaps don't come up during a doctor's visit. We work with each individual patient and their cardiologist to make recommendations that are appropriate. And we also discuss strategies for taking meds and remembering how to or when to and methods of recording blood pressures and heart rates at home so that way when there are follow up appointments, the person has that information and can make good decisions with their team.

Host: You guys have thought of everything, Kelli. It's amazing. We've got to talk about exercise. You were mentioning the 90-year-old who had never even been on a treadmill. When it comes to cardiac rehab, how is it tailored to individual patient needs, exercise?

Kelli O'Harrow: Exercise is a huge part of cardiac rehab. It's a defining piece of the program and it's where we spend a bulk of our time together. Cardiac rehab is unique, in that exercise is monitored. So, it takes place under the supervision of a cardiac registered nurse and all the aspects of the exercise are monitored.

The session itself is a does occur in the cardiac rehab gym and participants will have their resting heart rate and blood pressure checked on arrival to each session. We check in with each other and discuss if there's been any changes in their health or meds since the last visit. And then, we connect each patient to a portable telemetry cardiac monitor, which displays their heart rate and heart rhythm on a screen here in the gym where the nurse can see and the patients as well. The patients are then guided in a warmup routine and initiate their exercise. Of course, all the exercises are individualized to meet the person's needs and their goals. The sessions do occur, like I said, in a groups format, so we just then take turns using treadmills, stationary bikes, an upper body machine. We use some resistance bands and handheld weights. And throughout the session, we discuss guidelines like, "What's a good maximum heart rate for me to achieve? What should my exertion level be? When is it safe to push forward and push through something challenging? And when is it smart to back off?" We talk about what we should expect exercise to feel like and monitor for those sensations in real time, because people do need help clarifying like what's an appropriate response here and what's the cause for concern. "Is my heart rate up because I'm working hard or is something more serious going on?" We'll also review heart medications because those can affect how our hearts respond when we work out.

And ultimately, the whole point, of course, is to exercise here, but it's to develop a strategy for maintaining an active lifestyle outside of cardiac rehab. Not everyone's going to be a gym lover. Not everyone's going to love the treadmill. But the whole idea is to get people to a place where they can feel fit, energized, and excited to do what they actually do love.

Host: That's great. Stress management, I imagine, is a key component. Can you share some of the specific techniques or classes that you offer to help patients cope?

Kelli O'Harrow: Yeah. This is such an important topic, stress. It is definitely part of being a human, and stress does serve a place in our lives. It's the stress response that keeps us safe and alive in times of a crisis. But on the day-to-day, when stress is no longer serving in our best interest, that can be when it really interferes with our well-being.

So, there are so many different ways to handle stress, and what works for some won't work for others. Many people swear by meditation, and it can be a great tool. But for other people, sitting still in silence with their own thoughts could make them really antsy. So, maybe for them like reading or playing the piano will turn off parts of their brain and help them relax. Some folks need to make a list. Others want to practice a certain religious or spiritual practice that's important to them. Cuddling with a puppy, sometimes it's the hard things like saying no more often in life or setting boundaries to get to the source of dealing with stress. While there's no perfect one way to handle it, it is important to kind of experiment and see what works for you.

That said, a great practice we do use in cardiac rehab can alleviate acute stress within seconds, and that's just the simple act of deep breathing. It's really basic and boring, but boy does it work. It activates our parasympathetic nervous system in our body, which then will positively affect our cardiovascular system, relaxing our bodies, restoring and resting, giving us a sense of calm. And in the cardiac setting here, we practice this technique and we see firsthand how just a few intentional breaths really affects the heart rate and the blood pressure.

But in cardiac rehab, stress, it is important, but we also encourage an open conversation about mental health in more specific sense. And it is known that people who've had a heart event have higher rates of anxiety and depression afterward. It isn't something that the person chooses by any means, and it kind of feels like contradictory sometimes. But we talk about how it is possible to be both very grateful to be alive and well and to feel deeply sad. I mean, people by nature who are very steady and grounded and otherwise chill will find themselves just rattled, and it's very, very common, but no one is expected to kind of suck it up and power through.

Studies show that treating the anxiety and depression in cardiac patients actually reduces future heart-related events. So, getting the care is important, whether it's in cardiac rehab, in individual therapy, support groups, and antidepressant medication, those are among some of the most effective treatments. At cardiac rehab, we review and screen for symptoms of depression and anxiety. And we seek out solutions that work for each person, that's kind of how we partner up with primary doctors, with social services, support groups and resources in the community to care for the emotional well-being of the people, in our circle here.

Host: I'm sure it's crucial, for sure, like you were saying. How can listeners learn more about cardiac rehabilitation at Community Memorial Hospital?

Kelli O'Harrow: So, they can simply go to our website and search cardiac rehab.

Host: Well, anything else you'd like to add in closing that we didn't cover?

Kelli O'Harrow: Thank you so much for talking about cardiac rehab, and I'm excited for us to do the work that we do in our community.

Host: Well, thank goodness there are people like you who are so positive and upbeat and caring to do this work. So, thank you again for sharing your expertise. We appreciate it.

Kelli O'Harrow: Thank you, Maggie.

Host: Again, that's Kelli O'Harrow. To find out more, again, visit mycmh.org. If you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. I'm Maggie McKay. Thanks for listening to Wise and Well, presented by Community Memorial Hospital.