Transcription:
Rehabilitation After a Heart Attack

Melanie Cole (Host): Welcome. In today's patient story, we're talking about the importance of a structured rehabilitation program after a heart attack. My guests are Dorinda Perez — she's a Registered Nurse and the Program Manager in the Cardiac Rehabilitation Center at Henry Mayo Newhall Hospital — and James Lau. He's a former deputy with Los Angeles County Sheriff's Department and a patient in the Cardiac Rehab Center at Henry Mayo. Dorinda, I'd like to start with you. For people that don't know what cardiac rehab is, tell us a little bit about what it is and who it's for.

Dorinda Perez (Guest): Our program here, at the Cardiac Rehab Center at Henry Mayo, is an individualized program that includes a comprehensive evaluation and instruction on physical activity, nutrition, stress management, and other risk factors for heart disease. Eligible patients generally have had a heart attack, a stent placed in their coronary artery, open-heart surgery, heart transplant, or a valve replacement.

Host: James, let's go to you — because that's really what this is all about. Tell us your story. Tell us what you were doing for a living and then what happened to you?

James Lau (Guest): Well, Melanie, I had been the Deputy Sheriff for 35 years. I was just getting off of work heading home. When I was stopped at a stop light, I felt this heavy pain on my chest that felt like somebody stepping on it, and the pain ran to my left arm. From all of the training I've had, the first aide, to recognizing heart attack symptoms at my job, I knew immediately that I was having a heart attack, and I made the decision to try to go home. I didn't know whether that was a smart decision, but that's the decision I made. I was able to make it home. I got some Aspirin in me, and I sat and waited for the paramedics. The paramedics came, they took vitals, they took me to Henry Mayo, and at that point, they said you're having a heart attack — you've had a heart attack too.

It was really scary at that point. I am one of the fittest persons in my office. I run, I walk, I watch what I eat, I eat a very low-fat diet, things like that. I thought I was doing all of the right things, but yet, I had a heart attack. When I got the stent put in, and they told me later on that I lost about 30% of the usage of my heart, I thought my world was at an end. I thought, "Wow, how could this happen to me?" That's when Cardiac Rehab at Henry Mayo — when I went there, they started to explain to me that sometimes, heart attacks will pick whoever they want to pick. There is no rhyme or reason sometimes. Some people are at higher risk, but the heart attack will pick whoever they want.

Many of the nurses there — Dorinda, all of the nurses there made me feel at ease and actually started to show me what the program was about. Sometimes you have to realize that you can do all of the right things, but there is always something else you can do to make sure your heart is functioning and being as well as possible. Some of the programs there taught me how to eat, some of the medicines I would have to take, some of the supplements I'm taking, how it reacts to my body, how it reacts to my life. And also, of course, food. Dorinda is the champion of that. Every time she hears me going out to lunch somewhere, she always looks on the menu and tells me, "You can have this. You can have that. Watch out for that."

That's the kind of program that Henry Mayo has. You're not only just a patient, but they're somewhat like a family there. A lot of patients there feel like their family, too, in a little group there. After that program, I felt like — well, I can survive this. I know I can survive this now because I have a support system at home with my wife, with my family, and I also have a support system with the cardio rehab and the maintenance program that they have there. If I have questions about certain types of food or if I have a certain pill that I might want to take, I consult them. They give me an honest answer. That's what I really love about that program.

You're scared in the beginning when you start, but by the time you're finished, you realize this is one of the best programs there is for someone in this situation because you realize that you can go on from what happened to a life beyond the heart attack.

Dorinda: I would like to add some things that James has touched on. Sometimes patients, unfortunately, do have risk factors for heart disease that we can't control. Sometimes it's a family history of heart disease, sometimes just being male is a risk factor. As you age, your risk increases as well. We can't really do anything about those risk factors. In the program, we do try to concentrate on those risk factors that we can have some control over. Your diet is one, obviously, losing weight, getting on a really good routine exercise program, stress management is a huge thing right now as far as some of our patients are concerned. We do want to really try to modify those risk factors as best we can.

Sometimes patients are disappointed that they've done everything that they can to be well, and then something like this happens. Our response is, "If you hadn't done all of those things, something would have happened to you earlier." It is still something that people can get better from, and that's what I like to tell them, as well.

Heart disease is not something that has to be chronic. If you have kidney disease or back problems — those things, generally speaking, as time goes on, get worse, but heart disease doesn't have to be like that. That's why we're here, to give you that support, get you on the right track, and then you go on to have a happy, healthy life.

Host: That's really great to hear, Dorinda. And James, what an interesting story. People typically don't think of somebody as having a heart attack as somebody who is doing all of those things that you're doing. I'm an exercise physiologist. Your story is definitely unique in that you were doing all of those things. You were running, and you were taking supplements and taking care of yourself. What is life like now? What's different about what you did then versus what you're doing now?

James: Well, what I did then, I was working. The job I had there was a lot of stress. From what I've learned from Dorinda and the crew there at Cardio Maintenance and Rehab, is that you learn to take that stress and blend it out throughout your life, throughout your week, throughout your day, not let it sit within you all the time. Also, even the food that you eat, you look at it differently. You read labels more now. You look at the calorie count when you go to the restaurant, and you always are trying to think about how this affects your heart.

You're always knowing by thinking that way. You are now taking care of that muscle that's in your chest that gave you a little warning. You're trying to take care of that to make sure that it's going to last you even longer. That's what I really do appreciate about this program is that it's helped me fully understand what I can and cannot do in a way that it's not going to hinder my life. It's just changing it a little bit to make my life better all the way down.

Host: James, do you feel — based on what you were doing for a living, that was a pretty high-stress job — scary, and most of us can't even imagine the kind of hero work that you were doing. Do you think that stress was one of the bigger contributors to what you were doing? If you were a runner, your heart — as you said, you called it a warning, which is really a great way to look at it. Do you feel that stress — because I feel that's something that most of us have to work on today?

James: Yes, you're absolutely right. Stress does play a big part. Especially in my job, I had — I learn now to take the day and look at it what I can and cannot do during the day and what I had to deal with during the day and learn how to handle that a lot better. Instead of holding it in, I'll talk to people. I'll talk to my coworker, I'll talk to my wife, or talk to some friends about the situations that we're in. It kind of gives you a release valve — you have a release valve in your life because of this situation. I never did that. When I was working in my younger years, I held everything in. I thought that was the macho thing to do was to hold everything in and not to talk about it. Now, later on, as you get older and after having a heart attack, you realize that you need to release it.

I made it clear to some of the younger guys now it's like the InstaPot. It's going to build up pressure in there, and sooner or later, you've got to let that pressure out. If you don't, that pot's going to blow. You've got to learn how to release that pressure every now and then just, so it's good for you in the long run.

Host: Dorinda, tell us a little bit more about the program itself, the lifestyle changes that you're working so hard to teach people like James and people with risk factors, as you mentioned before.

Dorinda: I would like to start out by saying what some of the actual benefits of coming to a structured cardiac rehab program will provide. These are all really based on evidence within the past five years. We do know that it does improve stamina and strength. Most of our patients who exercise here do graduate with us feeling better. They also have said that it improves their confidence and well-being. They feel like after they've been here for three months that they can go out and do most things that they were able to do prior to joining the program.

One of the biggest things, also, is that they do feel better emotionally. As James has mentioned, it is a scary thing to have to now be faced with changing a lot of things in your lifestyle that you were doing previously. They do feel better with that. We have shown that attending a cardiac rehab program reduces readmission into the hospital. And really, who wants to go back into the hospital? We do try to mitigate that.

People do live longer when they come to a cardiac rehab program and have a better quality of life. I think that's important too. We want to be able to enjoy the time that we have doing the things that we like to do and not feeling like we can't do them.

One of the things that I think is important about coming to a structured program is in our case, at Henry Mayo, we have group exercise. That group in and of itself becomes a support system. Say, for instance, James could be working out on the bicycle next to a new person, and he can say to them, "Hey, welcome to the class. When I first started, I felt this way. You may feel this way as well." The people who have been in the program provide support for the new people coming in. I think that's really important. It's difficult to get that when you're working out at home.

We are all here to help motivate and encourage as well. We do talk about what it looks like on the heart monitor. Patients do feel relief when they know that on the heart monitor they can exercise and do everything that they can do to get their heart rate and their blood pressure up, and we're watching them. If they feel the same way at home, they know that nothing bad is going to happen to them. We're always focused on risk factors. We do an extra 30 minutes of education every week for our patients so that they get the information that they need so that they don't have to have any problems down the line. I always tell patients you could probably exercise anywhere. You know how to self-limit yourself. If you start to have pain, get shortness of breath, obviously, you're going to stop, but the education portion of our program is key. That is where they're going to get the information to make good choices and ultimately, stay out of the hospital.

We're also very good at communicating with everyone's doctor. We have a medical director, Dr. Douglas Gadowski, who is here to oversee the program. If anything happens to anyone in our program, we will contact their doctor directly. We have very good communication with regards to any other provider that the patient may have.

I think those are some of the things that are important for us and important in providing that continuity of care for our patients. I think it's very difficult for someone who has had open heart surgery, or a heart attack, or anything heart related to be discharged with — go home, and exercise, and eat better. I don't really know if patients understand what that means. There's so much information on the internet that can be misleading. We want to be able to provide them with that information that is evidence-based, as I said, coming from a reliable source so that they can take that information and make better choices.

James: She mentioned that when people come into the program, when they're new, just like I did, I'm scared. I felt alone. What am I doing here? How is this going to work for me? Having the people there in that program that have gone through what I have, whether that be open heart surgery, to heart attack, to stents, and whatnot, you realize I'm not alone in this. People respond to this, and that's when you start talking among all of the other participants in the program, and you realized I'm not alone. I can do this. There are other people doing this. That's when you start feeding each other support, and that's one of the great benefits of this program is that you always feel that you have a support system.

Host: That camaraderie, James, with others that are going through the same thing — when I was working in cardiac rehab, I was always so pleased to see people working out, together, talking to each other, laughing. They made sure to meet at the same time. Are you feeling that camaraderie with other patients in the program?  

James: Oh, yes. As a matter of fact, some of the patients that were in cardio rehab with me that have finished the program, we meet for lunch every month. We'll choose a lunch place, we'll sit there, we'll talk to each other see how our life is going, see how we're feeling, everything that's in our life. Everything comes back to how's your heart? This started from being in the program, and you have an outside support system beyond the program just like that. People that you meet there for lunch all had something happen to their heart one way or another, and you feel that you can talk to them about maybe you're feeling a certain way from pain or something. They can say, "Hey, I felt that too, or you may want to see Dorinda and tell her this is what you're seeing or this is what you're feeling in your exercise program," and things like that.

It's something that — that camaraderie that you have, it's like making new friends all the time. You just feel like wow, this is like a family. You feel like family and friends in this program. You're not alone, and that's a key thing that I think everybody has to realize — whoever goes through this program, you're not alone in this program. There are people in this program, both patients and nurses that are there for you.

Host: If you'd like to say one thing to the staff, James, wrap this up for us — and Dorinda, your going to get to say a last word as well — but James, if you would like to speak to the staff, tell them how you had felt going through this program when you were scared at the beginning, but now here you are being a great patient advocate for them. Please tell them what you would like them to hear — and other listeners that might be afraid to ask the questions you asked and to get involved in the program themselves.

James: The only thing I can say about this program, and me is that yes, I started when I was scared, and I finished like I had a family. You feel loved. That's all. That's the only word that I can think of right now is that you feel loved. They look after you. They're always asking you how you're doing. If you even look like you're having a hard time, they'll come and talk to you. Not just one of the nurses, all of the nurses will come and talk to you and say, "Hey, are you doing okay?" Things like that. That's the kind of program you want. You want a program to where the nurses are very caring, and they are generally caring and loving to you. I can only say I love all the nurses there, and they know that too. Dorinda knows that, and all of the nurses know that I love them for what they do and what they do for everybody there. I think all of the patients feel the same way. That's the key thing. You always have love and support at this program.

Host: That's lovely. What a great description and a great testament, Dorinda, to you and your team and what they're doing for patients like James. Tell us what you would Ike us to know about the program, about why patients like James are saying such great things. Tell us about your team.

Dorinda: I have to say that I have never worked with a team like this before. They are amazing. It really does take a special type of person to work here. People who are outgoing and confident in their knowledge, but also compassionate in their care. We have a special bond with our patients. They can feel it when we care about them. Our team is composed mostly of nurses, but we also have an exercise physiologist here. Not many programs have that, and Amanda Forgione, who is our exercise physiologist, actually brings an extra element to the way that our program is designed as far as our strength training. If patients have different physical or orthopedic limitations, she is very helpful in that way. She really helps bring our patients to a different level.

As far as the rest of the team goes, they are very cohesive. I think, as James said, it's not just one person. When I have done rounding on our patients, I will ask if anyone, in particular, has done anything that you would like to recognize them for. Every single time, without fail, they always say I can't name one person specifically because everyone on your team does such a great job in watching out for me, giving me recommendations, and helping me along through my day. We're very grateful for that.

The other thing that I think I want to mention is our administrative support, as well. Roger Seaver, who is our CEO of the hospital, has been so supportive of this program. Alex Diebold-Fox, who is my director, also has been very supportive. Without that, we wouldn't be here today. When I need something as far as equipment, or space, or time, they're always there to provide that. That really has helped grow our program. We started out very small. We've been here for six years now, and really literally have helped thousands of patients, and I'm so grateful and thankful for that.

Host: What a great program and such a testament to the quality and how you work with patients, Dorinda. Thank you so much. James, thanks for coming on and telling us your story and being such a great advocate for the importance of a structured rehabilitation program after a heart attack. Thanks for everything you're doing. That wraps up another episode of It's Your Health Radio with Henry Mayo Newhall Hospital. Head on over to our website at HenryMayo.com for more information and to get connected with one of our providers. If you found this Podcast as cool as I did, please share it with your friends on social media so they can hear all this great information, and be sure to check out all of the other fascinating Podcasts in our library. This is Melanie Cole.