Dear Melissa

I would like to share the approach I have had in dealing with situations of this sort which do occur all over the world ( trust me) and it even gets uglier when original drugs are replaced by ineffective generics or fake "original drugs" that are cheaper !!!

With the advent of prasugrel on top of clopidogrel ( and the competition it has created for market share)  I have  been able to broker the following deal for many needy patients. I made the respective drug companies agree to provide free of charge a 2 month supply of the platelet inhibitor ( Plavix or Effient/when appropriate) in return for my commitment to continue the platelet inhibitor for the remaining 6-12 month total. 

Now I have a private practice in a community hospital NOT in the US and ,,,, maybe ,,,, a similar approach could be suggested. I tried on a personal initiative  with no written commitment on my part or theirs  and the patients were delighted. It is working so far.

 Kind regards and best wishes.

Hi Melissa

Two quick queries

 

why wasn't followup arranged for this patient after he was d/c'd from the first hospital? did he miss his follow-up appt?

also, i am just curious, but will these hospitalizations bankrupt him? who will have to pay for his medical care or will his wages be garnished for life?

Dan 

Alex,

I think your idea is a good one but I think there are restrictions on how much drug each rep can supply . I believe their access is limited.  Plus....."Plavix" is going generic again and we won't get samples for long.  

 Dan, the patient had not been out of the hospital  quite long enough for his appointment, plus he relocated.  This gentleman will probably never have to pay a penny on his bill if he gets "disability" and even if he doesn't, then the hospital can take the course of laying claim to his property but I've rarely ever heard of that happening. The admninistration usually tries to work out a payment plan. 

Thanks for reading and sharing! 

Melissa

Melissa, thanks for the update. As they say, there are two sides to every story and we don't have the story of the admitting physician or interventionalist at the first hospital (though perhaps you know him/her by "reputation" - always a dicey thing as well). What I am saying is that patients absorb 5% of what physicians tell them - this statistic has been proven in communication studies. It is more than likely he was told the importance of adherence to long-term clopidogrel, statin, beta blocker, aspirin, ACE inhibitor, and the vital importance of smoking cessation. I would be very interested to hear or see documentation of this in the discharge  summary or cath report, and it is likely they would have stressed these points at the follow-up visit. We should hesitate before casting blame on our colleagues - who smoked themselves into this situation anyway? Don't people know by now that smoking is bad for their hearts (and brains and lungs) and those who continue to smoke are being reckless with their health? Even if the cardiologist didn't say a word to him it would have been obvious that he had to give up smoking on the basis of his heart attack (please find me someone who doesn't know in their hearts that smoking causes heart attacks).

Dan,

I could not agree more. I am merely reporting the events as they unfolded and the perception of the patient looking into the rear view mirror.  I do know that many many patients discontinue their "Plavix" for multiple reasons but most of them don't ever really understand the gravity of the risk of SAT. I don't think we are doing a very good job  in conveying that message. We need to say the words "heart attack" and "death" and "damage" more often when we explain that issue.

Having said that, I'm absolutely certain that as much as I talk the patient to death, some of them go away and report that "that doctor never told me anything" as well.

thanks for your insight as usual Dan.

Melissa

 

You're right. I have patients all the time who discontinue their medications for a variety of reasons. And this after showing them a picture of their arteries and stressing the importance of the reasons behind each drug prescribed. There is only so much we can do - we can't take the patient home to babysit their bottle opening. And we are incredibly busy....patients have to take responsibility - at least a bit - for their health. Notwithstanding the case you discussed. The guy does not strike me as being the sharpest tool in the shed.

Maybe we use the wrong scarecrow. While "death" or heart attack" could do the job on some patients (not as many as we'd like to think), the vast majority are immune to these threats. A strong, often overlooked weapon in our armamentarium is "erectile dysfunction". It does wonders in "selected patients", proving, one more time, that Eros beats Tanatos.

You are right Dan. The patient should take responsibility. Perhaps he's just so depressed over his "break-up" that he's really not thinking. 

 

Constantin, RIGHT YOU ARE!  I do toss in the ED grenade fairly often, for two reasons:  (1) it's absolutely true that our smokers have so much difficulty with ED (2) Sometimes, I'm just tired of fighting those who won't listen to logic from the perspective of death, angina, stroke risks. However,  they are usually VERY interested when the argument gets into their bedroom and it certainly holds their attention.

 

Melissa

Dr. Melissa- I am researching the best postoperative ways to help CV patients alter their lifestyles/depression/anxiety. Can you direct me to any hospitals/docs that have done well in this arena?

A psychologist in a cardiothoracic & vascular surgery dept.

Dr. Ken,

I'm ashamed to say that I really don't know of any programs that provide a separate program for counseling post CABG patients.  Our rehab nurses probably come about as close to that as anyone. They will occasionally contact us to let us know when someone seems a bit more depressed or anxious than the average patient. We then refer them to their family physicians.  It's a shame, but our area is underserved with both psychiatric and psychology services.  

Thanks for your post and thanks for reading HEARTFELT! I wish you good luck in your endeavors!

Melissa

Dear Melissa et. al,

As a nurse and public health student, I am well aware of the burden post intervention patients can pose to our system, communities, and themselves without appropriate adherence to care and utilization of recources.  One way to reduce this burden is through referral into cardiac rehabilitation following discharge from the hospital.  Research supports rehab as a standard of care in reducing rehospitalization and improving overal morbidity and mortality.  Unfortunately it is underutilized.  We are able to interact with patient as often as 3x/week, while physicians only make contact at follow up appointments (which we know are limiting).  Rehab nurses and specialists are able to recongnize complications and communicate back to the apporpriate practitioner thus reducing the scenario described above.  Physician reccomendation is a huge predictor in patient compliance of rehab and yet, we are begging physicians to send their patient to us.  I hope this has provided a little insight...we do more than just make people exercise!  Thanks Melissa, I am new to your site and really enjoyed reading. 

Alissa

Alissa

You are so right. Our nurses at our hospital are begging for rehab patients as well.  Patients suffer in silence not knowing about that as an option. I try to understand why it's that way. I think if we had a check box on the discharge orders, we could just check it for a rehab consult and it would be very painless for us.

  I subconsciously think that we just don't want another topic to have to deal with (selfishly) because we're hoarse from teaching diet, medication compliance, explaining the procedures, coronary anatomy, why you need to take your statin, follow up plans, etc. etc. then we take a big long sigh of relief and dictate the discharge summary, proud of our accomplishments! Then,.....the rehab program languishes because of our passive stance but more importantly, the patient misses out on so much positive reinforcement, teaching and monitoring. 

 Thanks for your post and focusing on this important point!

Melissa

Dear Dr Ken  There were two outstanding papers in Circulation earlier in the year.  Chow et al outlined their 41 country study on diet, exercise and smoking modification with risk of early cardiovascular events.  Patel and Balady wrote an editorial on the rewards of good behavious in the same issue.  One very important take home was the note by Patel that the benefits of cardiac rehabilitation and secondary prevention appeared "dose dependent" not on the metal but on the compliance with the multifaceted approach.  In conducting a cardiac rehab program for the last 12 months I'm convinced that we often need much longer care, often at a lower level than is generally conducted.  Prevention works, but it works over the long haul, rather than greet, treat and eject. 

 

As someone who has been able to verifiably and dramatically reduce my risk factors by following the Esselstyn diet for over three years now, it saddens me to see this kind of thing, especially knowing how it is repeated daily throughout our country.  Although I don't believe the Mediterranean diet goes nearly far enough, and there is no proof that it results in reversal of disease like the Esselstyn diet has, it's not a bad start, and might slow this poor man's disease progression.  Will anyone tell him that all these stents won't significantly reduce his chances of another MI?  Without major changes in lifestyle that go well beyond the Med diet, all the drugs and stents will just be band-aids on a steadily declining, and ultimately fatal condition.  

Agree with Dan, and with Melissa. Both the patients and the Interventionalists are at fault. Patients do hear selectively, and we Interventionalists may lack in stressing the importance of discharge instructions.

A thorough D/C instruction will take at least 45 to an hour if done appropiately. Those that think that just telling the patient to stop smoking because is harmfull, then you are not aware of the spectrum of smoking adiction. Lifestyle modification involves many visits and many followups, mainly if smoking is involve. I don't know about other interventionalists, and I hate to admit it, but the lack of time added to the reimbursement for time spent, makes it very difficult to integrate a proper life style/smoking cesation into daily practice of an interventionalists, specially with ongoing cuts in reimbursement. A proper smoking cesation visit can take more time then the actual PCI itself.

I think one way to address this, is for hospital and or interventioanlists to use dedicated and properly trained in life style modification Nurse Practioners and P.A. for those situations. 

Also, when doing an emergency case, social aspect of a patient needs to be consider and take it into consideration when performing therapy, i.e. bare metal vs DES. For those that will have dificulty paying for their  meds, 6 wks vs 1 year of plavix. I rather have a patient expose to 20% ISRS, then to late stent thrombosis 

Melissa,

I'm impressed that you actually asked your patient why he stopped taking Plavix. And then found out what other barriers he had to adhering to his medication. It's easy to throw up our hands and say why don't patients listen to us! But are we listening to our patients? We forget that we have a relationship with our patients and that relationship can help them make changes. As you've seen, scaring them doesn't work. We can find out what would motivate them to change their lifestyle and help them find the resources they need to support those changes. Doctors will say they don't have time. But they do have time to put in a stent after hours. Our incentive system is all screwed up.

 I'm a specialist in clinical preventive medicine and this kind of story sickens me.

I applaud your article.  It is essential for MD's to discuss risk factors and medication compliance in the 5 - 10 minutes alloted for discharge instructions while the patient is in the hospital.....It should be mandatory that MDs refer and insist that the patient attend Cardiac Rehabilitation where we spend approximately 36 - 48 hours with the patient in 3 -6 months hammering the modifiable life-style risk factor message again and again and again....in every way possible...we are dietitians, exercise physiologists and cardiac nurses.  We know the drill and our services are underutilized.  Taxpayors take note..."an ounce of prevention is worth a pound of cure" 

It is too easy to judge this patient and thereby decrease any sense of compassion or responsibility we in the health care system might have.  The average person smokes, not because they are stupid or reckless, but because they come from a childhood full of trauma and violence and nicotene was available legally over the counter.  Nicotene is an excellent antidepressant and antianxiety drug.  It also happens to be highly addictive.  Look up Dr. Vincent Felitti's work on ACE scores.  ACE means Adverse Childhood Events: parent in prison, parent with substance abuse, parent with mental illness, missing biological parent, witnessing domestic violence against your mother, sexual abuse, physical abuse and emotional abuse.  Yes = 1.  A score of 4 or more means statistically that you spent much of your early life with stress hormones coursing through you body - you will develop chronic disease 20 years earlier, you will die 25 years earlier then a person with an ACE score of 0.  You are also at much, much higher risk for smoking, obesity, hypertension, substance abuse, and every other risky behavior.  These are damaged people carrying a heavy past and with a high incidence of PTSD.

We want to sever someones head from their body and believe somehow that just telling them to stay on meds (not our problem they are unaffordable - should have gotten that GED), stop smoking, lose weight and eat better (fruits and vegatables and low fat/low glycemic foods are much more expensive and lets not get into the sodium levels of processed foods that this man is likely to be living on given his social situation). 

How successful have you been lately losing that 20 pounds?  We need reform of the health care system at every level.  We need to know who are patients are, where they come from and put as many resources into lifestyle change as we do the high tech services we offer.

That's right - blame the environment and upbringing, there is no such thing as free will in life, absolve the patient of all personal responsibility for smoking, drinking, and destroying their health. After all, we have a free and open health care system (at least here in Canada) and can thus 'afford' to do so. 

 

The counterfactual to this is that some people come from terrible environments and actually do quite well, become very productive citizens and do not damage their own or others' health. I do not agree with the deterministic bias in the previous post. 

I believe that the first and the last day of a patient's admission are the two most important days. The first to assess and make the plans for getting the person better.  The last day makes sure that the patient is safe and that they appropriately prepared to go home!

Cardiac rehab is great...but this guy wasn't going to get it....heck he couldn't get Plavix!

I agree-perhaps in this guy, the best intervention might have been BMS or perhaps even POBA with concommitant medical therapy.  He certainly could have afforded aspirin.

 

I would like to comment that you shouldn't assume the gentleman would not attend cardiac rehabilitation due ti financial reasons. There are many programs that will provide rehab through grants, or are covered by the hospital foundations, or programs such as Michigan Works, or CHAPs program...we have lots of safety nets, just like the safety net of Plavix being available in sample, or MEDs programs for those patients that cannot afford them.  If we can get the patient referred to Cardiac Rehabilitation we can make sure that the financials are covered for at least a few session to re enforce the education in a time, place and setting where the pateint is receptive to the educational materials.  I agree with what was posted ealier, if the patient was in rehab we most likely would have caught and addressed the medication compliance issue, the smoking cessation, the nitro not being ordered...it's what we do every day.  I have the same issue with Peripheral Artery patients...we do an intervention, educate the patient while in the hospital...not the best setting...tell them to exercise - but don't send them to Cardiac Rehabilitation...because insurance won't cover it. And yet there are hundreds of cardiac rehabilitation programs that will do peripheral artery disease programs for a very minimal and affordable cost to the patient. We just need to get the physicians to write the referral.

 

Melissa Walton-Shirley'

 Dear Doctor, (sentence redacted by the editor).

Now for thanking you on this article and addressing you to the need of an anti-platlet over time. How long is long enough? Stentis with heart pain due to the med regimen need reief that will not send them into cardiac arrest or affect the flow to and through the heart.

Are you saying that a nitro is a substitute for the remedy of exercise or exerxcise and diet? If post communications are understood by a senior dropout or an advanced engineer as the easy way out; What makes you believe each will not join those in the gulf, oily in the morning?

One more, do all heart Docs clump their patients rich or poor into a category, Metal Alone?

joseph

I would like to add that patient's can have extensive explainations as to what they should do and not do, but the fact is that while going through a cardiac event the patient's mind is on other things. Trust me for I have had 7 angioplasties and 4 stents over the years. I don't smoke, I eat right, I exercise and I have been in the medical field marketing cardiovascular monitoring devices to hospitals and physicians for nearly 25 years.

Issues like how much will it cost me, will I lose my job now that my company knows of my condition, and what will I do once they lay me off because it costs the company so much for my health insurance scare patient's to death. (Trust me, at $4,000/month a company thinks twice about keeping some one on the payroll).

The patient does not listen to what the drugs are for because he is too focused on the issues mentioned above, but he knows that he should take them everyday. Everyone knows you should stop smoking, eat right, and get exercise, but life style changes are the most difficult, so it's up to the drugs to keep the patient alive. Cost of drugs is an issue, and if you do not have insurance, or can not make the insurance monthly payment it becomes a matter of paying the electricty bill or paying for drugs. Electricity wins every time.

Yes, we bring heart disease on ourselves 98% of the time, but that keeps doctors employed, so to make everybody happy and to keep doctors employed we need to have Universial Healthcare, bring down the "cost" of providing healthcare, or the cost to our society will continue to go up while the number of people covered will go down.

Respectfully, my COBRA costs were nearly $2,000/month for my family and I. That means I need to spend $24,000 a year just for insurance coverage. What does someone have to earn to be able to pay for that healthcare, food rent, auto, etc...? If you are not earning $60,000/year you are out of luck. What % of families do not earn $60,000/year? My bet is that 75% of US families do NOT earn $60,000/year.

Yes, we may have the best heathcare in the world, but the vast % of American families can not afford it.   

 

I just love it when a bunch of wealthy educated doctors sit around and make smart cracks about poor, fat, uneducated slobs with no medical insurance who stop taking their Plavix and keep smoking. Very frustrating for the medical profession. It sucks to be you...

But honestly, can you try to put yourself into that man's shoes for a few nanoseconds worth of empathy? He cannot afford to take Plavix - all the doctor-lectures in the world are not going to pay for his Plavix. What MIGHT, and what you and all his health care providers should be providing him with - is a list of the Big Pharma companies who offer some version of the Prescription Partnership programs offering free drugs to those who cannot afford them.  Every drug company's website contains a link to a program like this.  Print a list of them - and hand copies of this list out to ALL patients.

I am neither fat nor poor nor uneducated, but after surviving my own heart attack, I was gobsmacked by the obscene cost of the fistful of cardiac meds I was suddenly taking every morning!  I was also overwhelmed, terrified, angry, tearful, in denial, and just about every other negative emotional adjective you can imagine.  If somebody had lectured me at the time that I needed to go back to school now so I could afford my heart drugs, I can't even imagine how I would have responded to such disrespectful 'advice'.

The difference between me and that poor schmuck who upset you so much was that I had a loving family, supportive friends, a successful career, a nice home, and I wasn't in the middle of an emotionally traumatic break-up.

Five months after my heart attack, I attended the annual "WomenHeart Science & Leadership Symposium for Women With Heart Disease" at Mayo Clinic in Rochester, Minnesota - the first Canadian ever invited to attend.  There I met 45 other survivors - all American women, ages 31-71 - who told me horror stories about their medical crises causing them to lose their homes, their businesses, collection agencies at the door, and scared because they would be unable to take their children to their local E.R. because they still owed money from their last cardiac event. 

I too am interested in Dr. Vincent Felitti's work on ACE scores as mentioned above by Valli Geiger.  And no, I'm not suggesting that patients shouldn't be held accountable for their own lifestyle decisions. 

What saddens me is the elitist class differences glaringly evident in the comments here by the 'haves' towards the 'have nots'.

I guess your patients are just lucky that you folks are practising cardiology and not oncology - just think how annoying all those self-inflicted lung cancer patients must be to treat.

 http://www.myheartsisters.org

I was told by my cardiologist, 4 months post-CABG that 

since I  already was a runner  that I didn't need any "formal rehab" program.

When I told him that I was wondering about where I could go for help

regarding feeling of depression about what had happened to me, he told me that

if I really wanted to just listen to "some women" going on about their issues, then join

THAT group !

Only after I read about a local private rehab program ,did I discover that, in fact, there were places

that could help me. Needless to say, I quickly made it a point to find a new cardiologist ....one by

the way  with an integrated holistic approach. Now almost 4 years after my triple by-pass, I'm

doing fine !

DS,

It is wonderful that you are doing so well.  I'm glad that the exchange on this topic has really brought to the forefront the very important need for Rehabilitative services.  There is no doubt in my mind that the patient described above would not have suffered another near fatal heart attack if he had been able to attend classes and put into contact with caring nurses who would have made a few phone calls to try to find samples, get him into local programs to help with his needs.

 As for the post from myheartsisters.org, I commend you on your compassion for fellow patients.  I sense your frustration with the current medical systems and what part we physicians have played in any scenarios that would have made patients uncomfortable. However, in South Central Kentucky, it's very common that the 5 family members who are visiting the patient with their 2nd or 3rd hospital admission because of noncompliance with meds are all smoking.....that amounts to around $40,000 per family spent for tobacco products every 5 years, (and in one instance, incredibly I calculated over $200,000 per five year period for one family) yet no one seems to understand that  impact that this money could have had if utilized for positive action, i.e. purchase meds/enroll in a fitness center/purchase better quality foods/etc.  Believe it or not, most physicians did not come from "elitist" backgrounds. We actually went into this profession to help patients and thus, it's very very frustrating when most of these second occurrences are completely preventable. It's even more frustrating when no one took the time to help the patient empower themselves so they never find themselves in this position again. 

It is difficult to put an entire 5 -day hospital stay and all the conversations that go into that stay into a few short paragraphs. I want to assure you that the rapport I enjoyed with that patient was excellent and though perhaps not conveyed well within the constraints of this blog, he and I both are looking forward to his first office visit. With tears in his eyes, he thanked me for getting him samples and going the extra mile to try and make sure he is as safe as possible until our next visit.  

I hope that you and your support group enjoy much success and good health. 

Melissa

Hi

    I also saw many interventionist just put the stent without educating the patient how to care their hearts. I did see many interventionsit just put the stent without caring the patients' blood pressure, lipid and sugar (no more blood test after they are discharged from the hospital).

 

   God bless the patients.

I would like some feedback from Dr. Melissa, i am not a health care provider but a 9 month post heart attack /CABGX3 diabetic patient. First some history, heart disease in my family from father's side, I knew about it and have ran and biked miles, pumped iron, never smoked and practiced good diet for years. At 56 i went for a physical and diagnosed with diabetes, took the oral medication, passed an EKG and was improving my numbers, after 3 weeks had pain in back around to chest, thought i had pinched a nerve in back form cutting down oak trees in yard. started getting the symptoms and wife drove me to emergency room, all hell broke loose, invasive cardioligist worked for 2 hours to unplug arteries, installed a balloon pump to get through weekend until surgery on monday,  had to have CABGx3, 14 days in hospital, congestive heart failure, etc. etc. Really got an education on all of this, i have never been near a hosptial or medical folks let alone stuck in one for 14 days. But first I must say I do love and respect my nurses, doctors, and many people that kept me alive. I discovered this blog from a on line heart patient support group www.inspire.com that i use since the mended heart support group at my hospital is dysfunctional and off for the summer. I have read all the posts here, heard many complaints from patients when i was in rehab, talked to many heart patients, had many converstions with my rehab nurses, etc. I do know we patients think you medical people are superhuman, and we forget your just like us, with the same hopes, desires, fears, and problems. I understand frustration with patients that do not follow diet, excercise, take required medicines, but the largest issue for someone like me is after discharge when the real fun begins. We patients do not have the knowlege, we are bascially blown off when we have all kinds of pains or ask questions, we have intense emotions and mood swings, we can really sense when no one cares about us, the battles with insurance companies are brutal, many of my fellow patients need help, and understanding, not talked down to and ignored. As for myself I do not accept this condition, i developed my own strength training, aerobic excercise system that is working, i think a heart disease patient needs more follow-up care than any other patient, but it is so difficult to get anyone to listen. Sorry to rant and vent so much,

Thanks for listening,

Rick

Teng-Yao

I share your concerns, 15 years ago, all we thought that was required of a cardiologist who treated angina or infarction was to "diagnose and open the blockage". One of my old attendings used to always say that we  should "worship at the tomb of the open artery".  The conversations I have now with my patients are much different. I usually hold up an ink pen and explain that the stent opened the blockage in the middle of the vessel, but that with better stent platforms, we have very little restenosis, so what we are fighting now is to keep the non-stented areas (either end of the ink pen) of the vessel writhe with wall pathology free of vulnerable plaque. Then, I have  a conversation about the avoidance of  sedentary lifestyle, avoidance of 1st and 2nd hand smoke exposure, abnormal post prandial sugar levels, abnormal lipid, BMI, mediterranean diet, BP control and sodium avoidance is of EVEN MORE importance than ever.  I'd say that putting in a stent without having the above conversations makes about as much sense as buying a brand new car but never changing the oil or filling it with gas. It looks great for a little while, but it won't get you very far. 

Melissa

Rick,

I wanted to reply to your post when I'd had a iittle rest and had a little more time. First of all, though I can't give you direct advice about specifics of your care, I certainly don't mind to speak to you in generality. 

I'm so sorry that you don't feel as if you have an advocate for your health.  I think there are a few basic tenants of the doctor patient relationship that are optimal.  

   I would encourage you to try at first to sit down and talk with your health care provider.  Sometimes, the direct approach is best.  Sit down with your physician and just say something like "doctor, I want to emphasize to you  the depth of my concern for my health and the enthusiasm I have for secondary prevention. I wonder if you are willing to partner with me on the long term to help me stay as healthy as possible?  Would you be willing to let me know early on if there are any new developments that might impact my care? Do you have any specific advice regarding diet, exercise, etc.?"

That might open a dialogue that could change the course of your follow up visits for a lifetime. Then, realistically speaking, there is a time factor that might impact the length of your conversations with your health care provider. We must understand that some patients may be a fairly quick and easy office visit and others require longer convesations at each visit. If I sense that a  patient will usually require more time at their office visits, so as not to delay other patients , I try to book those patients at the end of the day. Patients are human and we each have unique interests and needs. We try in our practices to get a sense of that and book accordingly. You might just speak to the  office manager or nurse and just quietly ask at what point during the day would the physcian be most apt to offer a few more minues to answer your questions.

Any physician would be proud to have a patient so compliant and enthuisastic. Good luck and congratulations on your new found health!

Melissa 

Dr. Melissa,

Thanks for listening and responding, I must admit i sent the first post during a mood swing and it may appear more negative than it really should be. It is a snap shot of my experiences of 9 months post op from emergency room to today. I was reading all your posts and could tell you care about us patients, are very knowlegable of all the issues, and seem easy to talk to. I do understand about time constraints with patients, and i agree with your direct approach method, i will try that my next appointment, with my cardiologist. I don't understand why you cannot give advice on excercise?? That is where the conflicting information seems to be, my heart surgeon Dr. Sheridan is the best, easy to talk to, I do running, bike riding, and weight lifting, he agrees except for no bench pressing until 12 months post op and then very light and slow. My cardioloigist is opposite with aerobics-treadmill, walking, I follow my doctors/nurses advice and orders to the letter, I always montor my heart rate when excercising and listen to my body when it is saying enough. Also my favorite rehab nurse works out at my fitness center I use and keeps an eye on me, my heart unit critical care nurse lives down the street and caught me running in the 107 degree central west florida heat index the other day and straightened me right out about it. They care even when their not at work, I appreciate them so much. I may be somewhat crazy and fanatical but I just want to defeat this heart disease as much as humanly possible.

thanks for listening

Rick

My one piece of advice Rick is always to remember that you don't want to be the most physicially "fit" person in 10 years with regard to cardiovascular issues but the most broken down and orthopedically challenged individual in the long run. Do something that keeps you fit and injury free. I'm not a big fan of running because most runners eventually have knee, foot and hip issues in the long run. (no pun intended!!)

Good luck!

Melissa

Dear Melissa,

I have been an avid reader of theheart.org since my MI 5 1/2 years ago and have learned much since then,  thanks to this blog and all the commenters.  And I am an extremely compliant patient, love my wonderful cardiologist, and he loves me back (as a patient of course). I have 5 siblings who are also MI, AAA, etc survivors, with a very bad CVD history.  We all have different doctors, some in different parts of the country, and have all had different experiences and given different advice.  They aren't all compliant either, which has led to declines in their health, whereas my health has greatly improved.  I speak as a women's heart health advocate at many events, and I can tell you that I ALWAYS tell people to LISTEN to their physicians, and either take the prescribed meds or tell their doc that they're not going to take them.  I also advise them to speak up, ask questions, always request a rx for Cardiac Rehab if they have an event, along with other ideas on getting healthier.   I've had feedback from a few women that I probably saved their life, which is the only reason I speak...to keep people from going through what I have.   I've gone to Washington DC to speak to legislators about research money, and heart health issues.  But, I do believe that all docs don't take the time to discuss/explain medications to their patients...and that a lot of patients don't seek to understand either.  I know that physicians must get frustrated with some of their patients, but some of us really do appreciate all the time, compassion and care you give to us.  Thanks for this great blog.

Jo,

Forgive me. I thought I had responded to your comment. I thank you most sincerely for your advocacy on behalf of women who suffer from heart disease.  I congratulate you on your improved health. If only there were more folks like you.....the world would be a better and certainly healthier place with fewer expenditures for health care issues.  

I am so happy that you enjoy our blogs and hope that you can put them to good use in your quest for continued personal health improvement. Thanks so much for helping so many  others!

Melissa