Wednesday, 11 February 2015

Life in the Rehab Zone

Those who follow my blog will already be aware that we're not your average household. My eldest daughter suffers from autistic and mental health issues, my two youngest daughters with ME, along with anxiety and mental health issues. So I am a stay at home mum and chief carer of the household.

Then, just to spice life up a little more, before Christmas my husband has not one, not two, but three heart attacks! The first heart attack happened at the end of November and was misdiagnosed by the paramedic and then GP at the time as an oesophageal spasm (which can mimic all the signs of a heart attack). It wasn't until 10 days later when he had his second heart attack in front of me in our home that he was diagnosed by the paramedic who came to us and confirmed later in hospital by the Cardiac Consultant via two different types of blood tests that it was definitely a heart attack and in retrospect looking at the paramedic ECG from the first episode that that was one too.  Later, whilst on the operating table having his stent fitted he had his third attack, giving all involved a bit of a scare! Thankfully now his stent is safely in place (his artery was 85% furred up) and all his other vessels, although a little furred, require no stenting and there is only a small amount of heart disease.

We are now in the rehab zone post heart attack. I have to say first and foremost that the medical team at Derby Royal Hospital and associated ambulance men and paramedics were excellent, friendly and efficient in treatment and information provided. The cardiac team couldn't have been more supportive and reassuring which made our time there much easier. Dave is now going through the twice weekly rehab sessions in outpatients with the specialist cardiac rehab team. Every session they check through medications and any issues the patients have encountered since the last visit. Followed by a talk of the day either by a member of the team or a guest speaker. Talks are related to health, relaxation, exercise and diet. The last talk was by a guy from Trent PTS, talking about anxiety, stress and insomnia ~ which can be an issue for some patients.  This talk focused on specific relaxation and breathing exercises to help aid relaxation and sleep (so I'll be trying that!). They are provided as free audio downloads which you can access (if you scroll down to the bottom of the page) here. Finally, they finish each session with a gym work out, individually tailored to each patient to work within their limits.

It has to be said, once you have suffered from a heart attack your life has to change, it was a massive shock and scare but we are grateful that we still have Dave with us, so the changes we are making seem paltry really.

The first change was adjusting to taking so many medications on discharge from hospital ~ there are quite a few, each day Dave has to take...

Aspirin ~ this works by reducing stickiness of platelets in the blood and therefore reduces clotting, and the risk of a blood clot within the heart and a heart attack.

Bisoprolol Fumarate ~ this beauty is used to treat heart failure and works by blocking certain chemicals in the body. It also can help reduce the heart rate and the heart to beat more regularly.

Clopidogrel ~ Like aspirin, clopidogrel is also an anti-platelet medication and is given for a year after the heart attack in conjunction with aspirin to ensure the heart is protected from any further heart attacks. (So when we reach Dave's official heart attack diagnosis anniversary we will discontinue this drug and the aspirin will carry on this job alone)

Lansoprazole ~ this is a proton pump inhibitor (reduces the amount of stomach acid), this is prescribed to prevent ulcers occurring due to long term use of aspirin.

Ramipril ~ this is a Angiotensin Converting Enzyme (ACE) inhibitor, it's specific job is to improve survival after a heart attack and is also used to lower blood pressure and treat congestive heart failure.

Atorvastatin ~ commonly known as "statins" is used to reduce the levels of "bad" and increase the levels of the "good" cholesterol. This in turn helps reduce the risk of further heart damage or heart attacks.

GTN Spray (when required under the tongue) ~ this has to be kept with Dave at all times, it is used to treat episodes of angina, however, we have been told that if the GTN spray doesn't ease any heart pain after three sprays (taken at ten minute intervals) then to ring for an ambulance straight away as could be a heart attack.

So, they are Dave's new medications. We also have to ensure that we change our lifestyle now too - since the heart attack Dave is less physically able to do the work he used to do and becomes exhausted very quickly. He is having to learn the art of delegation, something he is finding difficult after being such a hands on guy. We also have to try and reduce stress as much as possible ~ although there are no medical findings into how or why stress is an indicator with heart attacks, it is a definite common factor with all patients and so a lot of work is done in helping patients to relax and try to avoid anxiety and stress wherever possible. This is far easier said than done ~ especially when my husband is self-employed! The British Heart Foundation have produced this booklet to help patients deal with stress.

Then there is the diet, this is just a basic sensible eating plan to follow for life. Now Dave loses weight if I lose weight, gains it if I gain it because we are both foodies and so one does what the other does. With this in mind, after Dave's' heart attack I was invited into the surgery for a full MOT so to speak because our surgery know of our family situation and the high stress levels and as chief carer thought it would be a good idea.

I had reams of blood tests and a physical exam by the doctor. Thankfully my blood tests have come back all normal, with the exception of my cholesterol which was 5.5 so very slightly up (they like it to be below 5). However, talking about risks and diet I was given a firm telling off for trying so many different diet plans in the past, from Lighterlife, Slimming World, Rosemary Connelly, Cabbage Soup, Fasting diets etc. Now I'm not having a pop at any of you who follow these diets but for me personally this led to the yo-yo effect of weight loss and then gain, which in turn was having a negative impact on my health and mental well-being. The problem is I go full pelt into these diets and follow them by the letter, and this doesn't work for me as I can't sustain it. So, I have been firmly advised to stop seeking fast weight loss and "diets" as such and to just follow the healthy eating advice as given by the British Heart Foundation, which you can find out more about and download from here, as nothing is forbidden, there is no weighing or measuring, it is just common sense and portion control I find I can sustain it and it has become the way myself and Dave plan our food and menus. We don't feel deprived of anything or limited in our choices, we still have the odd slice of cake or chocolate bar and allow ourselves a tipple or two ~ the difference is now we stay within the weekly unit guidelines (something we went WAY over before) and don't binge drink (so bonus is no hangovers either). Another great tip that works in helping to reduce portion size without and kerfuffle is to use a smaller dinner plate but ensure you fill it (not pile it high though). This works well in ensuring you have a smaller portions but also somehow (whether it is psychological who knows but it works) leaves you feeling just as satisfied and full by the end of the meal as you would have done with the bigger portion.

With this new regime both myself and Dave are very slowly losing weight, I have been told that we should aim just for the slow progress of 1lb a week (anything else is a bonus really). This way we should be able to lose the weight and keep it off for good whilst maintaining an easy, sustainable, life-long eating plan where neither of us feel deprived or limited in our food choices (apart from Dave can't have grapefruit as it reacts with his medications).

The girls follow it with us too but with their individual dietary tweaks because of their health issues, Keisha is vegetarian, Tasha has reduced meat (mostly veggie) and lactose free and Tara has low sugar, high fibre, high protein.

So far life in the rehab zone is taking some adjusting to. Reducing stress is something we are working hard at combating, although as I said easier much easier said than done. Trying to find a way to earn a living within the new guidelines is going to be interesting but I know we will find a way. Dave is doing well, he is currently suffering from some side effects from the medications but the rehab team are working at ways to resolve this ~ so more blood tests are being carried out to see if dosages can be tweaked or whether alternatives are going to have to be sought out. This is all normal though and everyone responds differently to this situation. We have been told to be aware that depression may set in due to the changes needing to be made and limitations currently being felt. We acknowledge we are still in the early stages of rehab and being anxious and fearful is a normal response. I hope to blog later in the year to share with you our progress and hope that Dave will be feeling fitter and healthier without too many medication induced side effects.

On the bonus side though the Hairy Trio have been enjoying walks in an evening with both myself and Dave and hope to be resumed very soon. Currently these are on hold whilst the side effect issues are being addressed as exhaustion and dizziness are preventing our walks right now as I don't think I can scoop up Dave over my shoulder whilst holding three darting dogs on leads to get home!

Life is a gift, we take the good with the bad and I am grateful that Dave is still with us and so everything else is easy in comparison to what could have been.


x~X~x