Heartfelt with Dr Melissa Walton-ShirleyView all posts »
Women need to go to rehab, but we say "no, no, no"Mar 10, 2013 18:47 EDT
The APPROACH trial studied females who completed a 12-week cardiac-rehab program with a striking mortality reduction. Despite this unrefuted benefit of being "two-thirds less likely to die," women are still MIA. Interestingly, we benefit even more from cardiac rehab than our male counterparts who have the same diagnosis; however, some of us just thumb our noses at the notion, or even worse (well, maybe worse?), fewer of us are invited to attend.
Lack of participation in an organized cardiac-rehab program is puzzling, since there are so many quality-of-life improvement opportunities, notwithstanding the mortality benefit. When we choose not to attend we are turning down supervised exercise programs, access to heart-healthy recipes, tips on stress relief, weight management, smoking-cessation tools, and a fantastic opportunity to learn clinically relevant data about how to control the drivers of vascular disease that got us into trouble in the first place. I would be willing to bet that even compliance with the postdischarge medication regimen improves.
Perhaps our lack of attendance reflects how we are socialized as females in the US. I often hear this phrase applied to an RSVP for social function:
"Well, I got an invitation, but I didn't go . . . but it sure was nice to be invited."
Truth be known, I've said the same thing a hundred times, citing the old "I'm-just-too-busy-this-week" excuse.
The reasons why we don't go to rehab are complex. I often compare the ability of women to get places on time with the ability of men to get places on time. Although my business partner can't defend himself in this comparison (yet he's fantastic to work with and sensitive to the issues of female vs male physicians), I think it makes a great comparison. When Jim goes to work, I suppose he gets up, rides his exercise bike for 30 to 60 minutes, eats breakfast, showers, and gets dressed. I don't begrudge it, but I suppose that's the whole of it most of the time.
When I get ready for work in the morning, it goes something like this:
I awaken without an alarm clock. I stumble toward my treadmill but realize there is laundry on the bathroom floor. I see a glass on the counter and I grab it along with the cup I left last night on the sink and balance the load of laundry in my hands, using all my digits to hang things on as I go through the house, first toward the kitchen and then the laundry room. I drop off the glasses and cups, still holding the load of laundry, dropping a few socks on the way, and realize I didn't boot my laptop. I stop at the couch, boot my laptop, and run to the laundry room. I start to put in the load of laundry only to realize there is still a load of laundry from yesterday, smelling slightly "mildew," but I ignore that, hoping the dryer will take out the smell. I exchange the load, start up the dryer and the washing machine, thinking I need to turn on the Keurig and then put the dishes in the sink, only to realize the washer is full of dishes from yesterday. I go to the kitchen, wipe down the countertops, fix a cup of coffee, empty the dishwasher and refill it, then go to the couch for 30 minutes. I do my theheart.org stuff, which I enjoy enormously—moderate the forum, read and write a little, all the while slurping my coffee. I then change out the laundry, get on the treadmill, walk 20 to 30 minutes, and do upper-body weights. I then eat yogurt, nuts, and fruit, and have a glass of water with fiber. I run toward the bathroom, turn on the bathwater, wash my face, do my Aveda beauty routine, do my makeup, and then get in the bath. The phone rings, it's my daughter or maybe both of our daughters; they have a crisis maybe, or just want to say hi! (And I always want to say hi!) I get in the bathtub, my mom calls, and I talk to her in the bathtub. Dad sat up in a chair all night and couldn't breathe. "Did he bump his Lasix?" I ask. Mom yells at dad, "Did you take your Lasix yesterday?" He can't hear. She yells at him again and finally he comes to the phone. We have the same conversation, "Did you take your Lasix?" I asked. "Yes," he says and finally hears me but asks, "Do you think I need to recheck my potassium?" Yes, I say as I get out of the bath . . . but the office is beeping in. The patient has come early and her INR is 5 and she passed blood into the toilet bowel. I tell my mom and dad, I have to hang up, I put the phone on speaker, balance my iron on the sink and finish getting dressed, but the office can't hear me well on speakerphone so I have to repeat everything until I can get sufficiently dry enough to pick up the phone and put it to my ear. I kiss my husband goodbye as he goes to work. He is a fantastic life partner I dated for six years and have been married to for 28 (I think but am never sure. I don't have time to remember how long we've been married), but by an unwritten agreement, my beloved's job is to take out the garbage, be luggage bearer for trips, do the yard, change out all lightbulbs, trim the shrubs, control the channel-changer (because I'm not paying attention to the TV anyway, I'm writing at night or reading), and cook supper 99% of the time when we eat in.
(I know what you are thinking, so I'll answer it up front.) I have a housekeeper two days per week, but I like to do all these things every morning because it makes me a "real wife and mother." I think it validates my existence on this earth and it makes up for the things I don't take the time to do. So now I can relate to you women who read this blog. You are saying, "In the middle of all of this, you tell me that you want me to go to rehab?" I do get it. I really do, but more important, my job as a physician is to not just relate to your problems and hectic schedule as a woman, but to help you see how important it is to care for ourselves so we can continue to care for others.
As I listened to this presentation on women MIA for cardiac rehab, I heard the infamous words of the late Amy Winehouse and her rehab song, but a bit differently:
They tried to make me go to rehab but I said, "No, no, no!"
I ain't got the time, 'cause I really think I'm fine.
They tried to make me go to rehab but I say, "no, no, no"
But most of the time, we really aren't fine. We are the furthest thing from "fine." Until we change the attitudes of those who are mailing the invitations to include everyone of both genders with coronary artery events and procedures, we will still continue to lose more good women and men to preventable death. But before we point fingers, as women vital to our family, our friends, and our coworkers (and yes, even our patients), it's just as important to change what we do with that invitation to rehab if and when we ever get one.
Just one final thought:
Yes, you better go to rehab. You better go, go, go!"