“Stranger in a strange land”
A big part of post-heart attack recovery is cardiac rehab. For me, that means I go to the hospital two mornings a week to exercise for 45 minutes or so on an assortment of treadmills, stationary bikes, ellipticals, and this thing called a ‘NuStep’ while someone watches my heart rhythms.
It is not often someone of my background and with my lack of experience is permitted into cardiac rehab. It was only under the recommendation of a highly trained medical professional that I was able to gain access to such an exclusive club. Here I will attempt to describe the geography of this exotic land and the detail the inner workings of the exclusive organization housed therein.
The Land of Cardiac rehab
Nestled between the Budge Clinic and the hospital at Logan Regional is a small room about 30’ by 20’. It houses four treadmills, two exercise bikes, three “NuStep’s”, one elliptical, a weight bench, a set of rubber weights, several oxygen tanks, 12 chairs, 4 TV’s and a mysterious box labeled “Christmas”. Near the door sits a “command center” from which all cardiac rehab operations are directed. Adjacent to cardiac rehab, with a connecting door, is a small office where all patient files and the portable EKG machines are stored.
Opposite of the door are six large windows. Just outside these windows, is a construction site, then a parking lot. Off in the distance lie the Wellsville mountains. As I walk on the treadmill and spin on the elliptical I like to imagine myself galloping over those mountains. Bursting through the brush, leaping over rocks. I can almost hear the crunch of the trail under my shoes and feel the wind on my face.
The rundown
A typical day at cardiac rehab goes like this: I show up at around 7:30, part of the first wave of rehab goers for the day. There are usually one or two other patients and a couple of staff members in the room at this point.
I hang my jacket on the rack and step onto the scale. The most availible staff notes my weight. This person will follow me the rest of my appointment , help me setup the machines, watch my EKG readout, and take notes on my chart. It is like I am a puppy dog and they are “my person”. In true puppy dog fashion, after I finish working out on a machine I will saunter over to the next one and wait quietly, trying to hide the expectant look on my face, until they come over and get the machine ready for me.
Once I’ve been weighed I step into the office where the same person who took my weight pulls out my chart and sets me up with a portable three lead EKG. One sticker goes by my right collarbone and one just below my ribs on each side.
The EKG’s are numbered 1-12; in the waiting area there are just as many chairs each with a corresponding number. The staff member who set me up with the EKG tells me which chair to sit in while they go check me in. When the portable EKG readout is pulled up and looking good on the “command center” screens they take my blood pressure.
Every morning I also take a blood pressure reading before I take my medication. My blood pressure at cardiac rehab always seems to be a little lower than it was that morning. I would guess this is because the lisinopril has kicked in for the day.
Once the blood pressure cuff is off, I hop on one of the two warm-up bikes. These are your traditional stationary bikes. I spin the pedals at 0 resistance for 5 minutes before I start any of the real work.
After the warmup I go take my puppy stance next to the treadmill. When my “person” notices I’m done warming up they come over, assign me a treadmill, and set the speed and distance. Sometimes they just tell me where to set the treadmill and I do it myself, sometimes they do it for me. Sometimes they set a countdown timer on the treadmill and sometimes they just tell me how long to go for and let me stop myself.
My first day on the treadmill I think I did 10 minutes of real easy walking, at a slight grade. A few days later I got bumped to 11, then 12, 13, 14, and finally 15. Every few sessions they also bumped up the speed and incline a few points.
Eventually we did a little test to see how my heart held up when I jogged. I started at a easy walk and every two minutes we increased the speed until I was jogging. I must’ve passed because now I am on the treadmill for 10 minutes at 5% incline but instead of walking the whole time I alternate every 2 minutes between walking at 4.1 mph and jogging at 5.6 mph (that means I jog for a whopping 4 minutes total…). To be honest, that sounded a lot better the time. Now its a little underwhelming.
After the treadmill, I usually end up on the recumbent bike. Each machine has a little magnet with a red sticker on one side and a green sticker on the other. The staff member will flip the green sticker to red when they start you out on a machine and then flip it back to green when they wipe it down. I’m glad they do, becuase I work hard on those machines, and sometimes I leave my mark… Nobody else seems to sweat all that much. I don’t think its the sweating crowd that ends up here.
I don’t love the recumbent bike, most of the time I feel like I’m going to slide off the seat and end up on the floor. I’m getting used to it, though. The last couple of times I’ve been pushing 200 watts. Usually they tell the guys next to me to try and “keep it above 60” so this makes me feel a little cool. The amount of time I spend on the bike is the same as the treadmill, 10, 12, 13, and so on until I hit 15 minutes on the bike.
The bike is nice because, unlike the treadmill, the speed isn’t set, just the resistance. I have a heart rate range that I’m supposed to keep to. I never get near the top end of that walking on the treadmill. On the bike however, I can push a little harder, get my heart rate up a bit, and burn off a little bit of that puppy-dog-needs-his-walk energy.
About halfway through my bike my person comes and takes my exercising blood pressure, and asks me what my RPE is.
The first time I exercised at cardiac rehab I did the NuStep after the recumbent bike. They must’ve been able to tell I was uncomfortable. My next session I got swapped to the elliptical. There is only one elliptical at cardiac rehab. I’ve never seen anyone else use it.
I’ve always thought ellipticals were kind of fun. I am more comfortable with its motion than the recumbent bike. I wear my heart rate monitor watch to cardiac rehab and I’ve noticed I can usually achieve a similar heart rate to the bike at a much lower rate of perceived exertion (RPE).
After the elliptical, I sometimes do the “Arm Bike” for 5 minutes or so (more on that later). Then grab a drink of water from the drinking fountain and sit back down on my assigned chair. There I wait until my heart rate comes down enough to take another resting blood pressure reading. After that, I’m done and I go home.
Even though the structure is the same, every day at cardiac rehab is not the same…
Day Zero
The 6 minute walk test
The first time you go to cardiac rehab is an initial consultation. Its a lot like a doctors visit. They take your medical history, and run a couple tests. The most important part might be the 6 minute walk test. They use this to gauge your starting ability.
I decided it would be silly If I wore my race shirt to cardiac rehab. I didn’t really know what to expect but I had high hopes exercise would be involved. I walked in dressed in my longest running shorts (in the name of decency), the t-shirt from the antelope island race, my split out running shoes, and my White Pine 50 “champion” hat.
I may have over prepared.
I was fitted with a portable EKG and the lady in charge of cardiac rehab got a cone out from the office and placed it at one end of the hall. Then, with a clipboard under one arm and stopwatch in the other hand she pulled a chair out into the hall, sat down, and told me to walk down around the cone and back around the chair until 6 minutes were up.
Down around the cone I went; then back around the chair while she counted laps. I think she gave up stopped counting after a while. About two minutes in her neighbor came walking down the hall and they started chatting.
The consult “I wont take away your ice cream”
After the walk test there is the initial cardiac rehab consultation. In a sperate office I filled out a survey on my eating habits, and they got my medical history. I still haven’t quite memorized the list of meds I’m on. I need a pneumonic, maybe: RUN LAPS (RosUvastatiN Lisinopril Aspirin PraSugrel). Then I’ve got to remember what everything is for, that’s trickier.
We went over my diet survey and made cardiac rehab goals. The four cardiac rehab goal areas are: Exercise, Nutrition, Psychological, and an “Other” goal. My goals are:
Exercise: 45 minutes, 6 Mets (metabolic equivalent). I’m pretty sure this is the max cardiac rehab exercise goal, the appointments are limited to 1 hour so I cant really fit more than 45 minutes of exercising into one.
Nutrition: Move to 1% milk. I think we eat pretty good for twenty-somethings. Its mostly because we’re too cheap to eat out or buy red meat and lots of junk. Most of our diet is lean poultries, veggies, rice, beans, caned tuna, some pasta, and a lot of diary. Even eggs have been too pricey to eat many lately. We do like our whole milk, and our ice cream. Looking through my diet survey, I could tell the lady helping me was as confused as everybody else. When she got through, she said: “The best thing I can come up with is let’s have you move to 1% milk. I wont take away your ice cream though.” 🙂
Psychological: Improve energy level. I noticed, especially at first that my focus and energy levels had taken a hit. I think I got in running, to some degree, what some people get in coffee, and my routine has been disrupted.
Other: Understand cardiac medications. This goal comes out of a dropdown menu with seven or so options. It was a crap shoot. The rest of the options were stuff like: stop drinking, stop smoking, tone back the caffeine. We chose the “most applicable” option so I came home with a packet about statins, blood thinners, and beta-blockers.
At the bottom of the sheet there is a list of 8 cardiac risk factors with check marks next to them. All of mine are blank. I am finding that not having problems sometimes makes your problems a little harder to figure out.
I would say learning you had a heart attack will shake your world, proverbially. This cardiac rehab consult was also shook my world; amidst the construction, someone was working a jackhammer right below the office.
Day 1
Look, a DOG!
My brain is really only good to focus on one thing at a time (just ask Emily). Trying to get my attention while I’m doing homework is sometimes like making a long distance phone call. If the TV is on I am VERY good at getting sucked in, doesn’t matter what’s on. For some reason a TV is like a black whole with an extra strong attraction to my attention. To avoid getting sucked in at cardiac rehab, in case somebody needs to ask me something or want to chat, I try to pay as little attention to M.A.S.H as possible. Instead, I watch the construction or daydream about being in the mountains.
Usually, all that happens on the construction site is the reorganization of dirt piles. The first day at cardiac rehab; however, as I’m walking on the treadmill, I notice a little dog run up to one of the construction workers. He gives it a pet and it runs over to his friend. I was feeling chatty so I said, facetiously: “I think the construction workers got a dog!”
The guy on the treadmill next to me had noticed the dog before I had. Turns out it had run over from across the street somewhere and had been rolling around in the dirt and playing with the construction workers for some time. The whole room gathered around the windows to watch.
I guess it doesn’t take much to keep us entertained.
A birthday surprise
As I was leaving cardiac rehab the first day, an older couple was coming in. She had a large pastry box in her hands and I think he had some flowers. As she came in the staff got quite excited: “You’re graduating today Mrs. so-and-so”.
“I am!” she replied.
Then she asked for a specific person. They had just stepped out of the room for a moment. The patient lifted the box of donuts and said: “Its her birthday today so I brought these in.”
That’s the kind of crowd that spends their time at cardiac rehab.
After Day 1 a few days going to rehab, things start to blend together, the next few stories are not necessarily in chronological order.
Accruing a fan base?
One time, as I was spinning away on a warmup bike, one of the staff came up to me and asked: “That man over there, he’s really interested in your story. He wants to know why you’re here but I can’t tell him. Is it alright if he talks to you about it?”.
I chuckled and said “Sure.” It almost felt like an interaction a group 3rd graders might have.
A few minutes later, the man in question finishes up his exercise and walks over to me. He comes right up to me and says, a little out of breath: “You don’t belong here,” and then, leaning in a little closer, “I was watching you the other day on the elliptical and there’s nothing wrong with you.”
I filled him in on the important details of my story and he responded with the typical amazement. Then, with a little spark of mischief in his eye says “Usually the girls (referring to the cardiac rehab staff who are mostly female) don’t have much to look at in here. You got that covered though.”
I wasn’t sure how to respond to that so I just said: “Well, I’m just trying to keep everybody entertained.”
He left me with: “You look like you’re training for the Olympics over there.”
A few days later, during my appointment, after he’d left, the person that had originally been our go-between told me what had happened to her. She had been chatting with him when he asked: “There’s a young kid with the long hair and he puts is up lie one of those… what are they called? its cool these days…”
“a man bun?” She replied.
“Yeah!” he says “what’s the kid with the man bun doing here? He’s too young to be here.”
“You’ll have to ask him” she replied. “Why don’t you go over and tell him he has a nice man bun too.”
“Nooo” he says, “I couldn’t say that.”
The Mash Encyclopedia
Another day, I was riding a recumbent bike next to an older gentleman. He was chatting to one of the staff while she did his 30 day survey. On the T.V. above us a M.A.S.H episode was playing (big surprise!). Hawkeye and Nurse Houlihan are trapped behind enemy lines and it appears a romance is begrudgingly is budding between them.
At some point, something pulls everyone’s attention towards the T.V. and the rehab lady says: “Oh! this is the one where they kiss!” Sure enough it was.
She goes on to explain most of the rest of the episode in detail, relating it to several other episodes. Turns out, she has been working there for over 25 years (my whole life). Twenty or so years ago they started a “maintenance” club where previous patients would come exercise on a regular basis and pay a monthly fee. This must happen before normal open hours because they always pick what’s on T.V. One guy has been going for 18 years. EVERY day they ask for M.A.S.H. By her estimates, she’s seen the entire show at least 9 times. If I’m ever at a M.A.S.H. trivia I want her on my team.
Arm Bike
Before I started jogging at cardiac rehab I would spend 15 minutes each on the treadmill, recumbent bike, and elliptical. The first day I jogged at cardiac rehab, they reduced my treadmill time to 10 minutes. I figured this was to account for the added intensity of the jogging but after I finished the elliptical my person said: “We have a little surprise for you.”
I figured it was another form for me to fill out. To my surprise, she had me sit down at the “Arm Bike”. Its a funny contraption, kind of like an exercise bike but the pedals are up by your face.
To fill up my full 45 minutes the added 5 minutes on the arm bike. Once, when I had a foot injury, I took up boxing training to try and stay in shape. This was a similar enough motion to get the adrenaline going.
I hammered.
The next time they had to up the resistance so I didn’t break the bike. It was fun while it lasted though.
Further Adventures
If all goes well, I’ve probably got a month or so more of cardiac rehab. At first, my hr allowance was 65% of my max hear rate (MHR) or 137 bpm. Just a few days ago I got upped to 80% of 156bpm. Things are moving along well.
While this isn’t the adventure I planned to have this summer its the one I’m having. I can’t complain. I’ve met some cool people and I’m doing something I’ve never done before. If you really think about it, isn’t that why we go on adventures?
You thought you were here for a good time but actually it was just a long time. If you put your email below then you’ll get notified next time.
Leave a Reply