Resilience and wellbeing

Focus on what’s important

Earlier in my recovery I blogged about the importance of minimizing stress when returning to work. The central idea was to give you time and mental space to come to terms with the changes in the various parts if your life – diet, exercise, mortality etc. What I failed to realize at that time is how fundamentally important building your resilience is. I learned this the hard way by allowing work pressures to get the better of me. Over time this pressure took a hefty toll on my mental health and physical.

Failing to build personal resilience can have serious consequences for anyone. However for those if us living with heart disease the implications can be even more serious. Chronic stress has been linked to elevated cortisol levels which in turn raises cholesterol (http://www.precisionnutrition.com/all-about-cortisol). Also when we are in this stressed state we are less likely to remain committed to the nutrition and exercise goals we might have set that support a heart healthy lifestyle.

So if resilience is the ability to recover quickly from difficulties, then wellbeing is the foundation for resilience. There are many debates in academic circles about the definition of wellbeing versus the theory of wellbeing, but what it comes down to in my mind is that there are a range of elements that make up wellbeing and to have a sense of wellbeing these elements need to be balanced against the challenges an individual faces.

Dodge et al (2012) define wellbeing as a balancing act between psychological, social and physical resources and challenges. I would add spiritual resources to that list too.

Martin Seligman refers to the five elements of wellbeing: positive emotion, engagement, relationships, meaning and accomplishment. Seligman’s theory says that an individual can achieve wellbeing by focusing on just one of these elements. However, it seems unlikely that you could achieve real resilience by focusing on just positive emotion (for example).

Wellbeing and heart disease

My personal focus is on wellbeing and heart disease. That’s because I believe that it is even more important for those of us who have already had a cardiac event or those at high risk of a cardiac event to minimise future risks.

The Heartcoach approach programme is divided into four parts:

  • physical wellbeing
  • emotional wellbeing
  • social wellbeing
  • spiritual wellbeing

More about these in future posts.

Back to work

Some people may be itching to get back to work. How long it will take before you are able to get back to work will depend on a number of things including whether your work is physical or sedentary, how invasive your surgery was and your employment contract. Here’s a few things to think about before you rush back into it:

Firstly, take as much time as you can. Your body (and mind!) have just been through a lot, and you may be surprised how much it has taken out of you. I thought I was going to be back at work within four weeks. I’d even lined up a job interview (haha) in about week four or five of my recovery. Needless to say that didn’t happen. I eventually went back to work after 9 weeks. So take your time, rest up – you’ll be back at work before you know it.

Secondly before you do head into the office for work, go in for a coffee or lunch one day. It will give you a chance to answer questions and catch up with people informally before you have to do any real work. There will be lots of people who want to hear your story and it’s nice to get this out of the way before you officially return to work. There will still be questions later on, but it gets some of the awkwardness out of the way. It also gives you a chance to get used to the work environment again.

Thirdly When you do to work start back part time for a couple of weeks if you can. It is surprising how exhausting even that can be. It also gives you a chance to continue working on your physical rehabilitation, without the pressure of full time work. I found it much easier fitting in my rehabilitation classes, daily walks, doctor’s appointments etc, without the pressure of a 9-5 job.

Finally, if you can try and reduce the amount of stress or responsibility you have in your work. Take a less demanding role for a while, make sure you stick to the minimum hours and prioritise your health. I have done that for the past twelve months (although I changed jobs during this time, it is a much less stressful environment and the management team are incredibly supportive) and  I’m just starting to feel now that I can take on more. I’ve heard other people who have been recovering from a major illness say the same thing. It isn’t that you can’t handle the same level of stress anymore, it’s just that your “bucket of stress” is already quite full – just think of what you’ve had to deal with both from a medical procedure and a mortality perspective! That’s bound to create a little anxiety.

So be kind to yourself, take your time, acknowledge what you have just been through and ease back into work.

Pilates

This is just a short post to say I’ve found an excellent Pilates studio in Wellington – Body Magic Pilates. The Pilates method they teach is Stott Pilates.

I’ve been thinking about doing Pilates for some time, and thought it would be good to help strengthen my chest and regain some flexibility. I had a lot of cutting through the muscle in my chest as they used a couple of arteries from there for my bypass surgery. I had thought about the mechanical stress of having my chest opened up, but not the scarring from harvesting the arteries. So the Pilates is great on two fronts – 1. it focusses on the placement of my ribcage (which obviously got a bit out of whack – and 2. it focusses on stretching the scar tissue.

I’ve had a few sessions and I’m feeling great. I know there’s staying on top of my aerobic fitness and fat burning etc, but this is a great foundation. I’m having 1:1 sessions with Bruce at the moment and will probably keep that up for 6 weeks or so. The team and setup are really professional, and they know their stuff. I’m not sure what I’ll do after that. hopefully I’ll be able to maintain a regular Pilates routine.

This has been a great find as I haven’t found any one place that specialises or is experienced in working with people who have had open heart surgery. I know there are classes run by Massey University, but they are over the other side of town and are early in the morning, which makes it impossible for me to get to.

Anyway, I’m very happy to have found Body Magic Pilates!!!

Recovery Stage 3 – staying on track

Out of the system

I’d be interested in hearing others thoughts on this, because personally I found this stage of my recovery the most challenging. There are a number of things that I think combined to make this time so difficult:

  • The support of the hospital rehab programme is no longer there. This was a regular exercise and education programme that kept me motivated. Without that external motivator it was up to me to keep on track with my recovery.
  • I chose not to join one of the local heart clubs. This was perhaps a mistake, but at the time I was determined not to be defined by my heart disease and thought that participating in a heart club was a step n that direction.
  • Despite having been confronted with my own mortality, the further I got from the main event, the more my motivation flagged. It’s difficult to recreate the motivation you have when first told you are going to need a quadruple bypass!
  • It was also a time when I was starting to get back into a “normal” routine with work, family, exercise etc. Staying focussed on healthy eating and staying active seemed to much. It was very easy to let my own health priorities slip in favour of other commitments or priorities.

Finding support

I recently attended a seminar run by the New Zealand Heart Foundation. They were traveling the country with the aim of helping people like to me stay on track. They had a range of presenters from cardiologists to everyday people sharing their experience with heart disease. One of the sessions was on motivation and goal setting. One thing that struck me was that I’m a bit of a drifter – I don’t really set goals. And so setting a goal of healthy eating, monitoring it and having some kind of reward system seems like a good idea, but I have just never managed to stick at it.

If this sounds like you one of the presenters suggested finding your motivation externally. That is, find other people who can help you stay motivated. For example, arranging to meet a friend or group of friends before or after work for a walk, run or swim. Or finding a coach that you have to report in to every week or month. I have a friend at work who offered to be my coach, however she’s a seasoned multi sport athlete and more than a bit of a hard arse – so I politely declined 🙂

One thing I have found useful is the Green Prescription available here in New Zealand. More information is available on the Ministry of Health’s website. You can aso check out the Green Prescription Wellington’s Facebook page for more information. Basically it’s a recommendation from your GP to make exercise part of your ongoing health management. The Green Prescription entitles you to discounts on health providers and some council run facilities, such as swimming pools and gyms. As well as the discounts you are assigned a case manager, who will ring and talk through what actions you can take, send you information and do research on your behalf. They will also keep track of your goals and help you stay on track. I’m fortunate enough to have a case manager who has been through the hospital cardiac rehab programme as part of her exercise science degree, so has a good understanding of my situation.

So for the first time ever I’m going to make a list of goals and stick them on the fridge. I have no idea if it will work or not – I’ll let you know!

Recovery Stage 2 – outpatient rehab

Hospital based rehabilitation programmes in NZ

In New Zealand we are very fortunate to have a fantastic hospital based rehabilitation programme. These are publicly funded and available to anyone who has had a cardiac “episode”. For more information about cardiac rehabilitation as well as contact details have a look at the Heart Foundation’s webpage on rehab.

For me this part of my rehab started at about 4 weeks after my surgery. The programme is 6 weeks and is made up of a 1 hour exercise class followed immediately with a 1 hour information session on various aspects of heart health -nutrition, exercise, stress management, medication – were among the topics. Patients attending the classes ranged in age and degree of severity of illness. All classes were supervised by cardiac nurses, hospital physiotherapists and students from Massey University’s Exercise Science programme.

This programme really gave me the confidence to start exercising again. Up until that point it was a little scary going for my regular walks on my own, wondering what would happen if I keeled over in the street. I found being surrounded by a bunch of highly competent health professionals very reassuring and it meant I could push myself physically again.

The first session was quite slow and easy. I was still getting used to how far I could push my body, given my bones were still knitting back together again and there had been a lot of muscle damage to my chest wall from harvesting arteries, and of course the grafts. My lungs were still getting back to capacity to, so I was out of breath quite quickly. After a 2 or 3 weeks I was starting to feel stronger and exercising harder. It felt like I’d be back on my mountain bike in no time!

Over the 6 week programme I lost about 10kg (22lb) – a combination of the exercise, eating ridiculously healthily and not drinking any alcohol. I never thought I had that much to lose – but there it was (or wasn’t!). Having a record of my “vital stats” at the beginning of this programme was hugely motivating and kept me on track for sometime afterward. And now that I think about it, it has taught me a heap about the importance of benchmarking, setting goals and monitoring progress. It’s not rocket science, just discipline 🙂

If you’re reading this and have the option of attending one of these classes, I highly recommend doing and sticking at it for the full 6 weeks. You won’t only benefit from the exercise, the information sessions will give you a good understanding of how to better manage your heart disease. You may also hook up with others in your area that can help keep you motivated when if things get tough further sown the track.

Recovering: Stage 1 – the early days

In hospital

I can’t speak highly enough of the staff that looked after me in hospital – before, during and after my surgery. Friends and family who visited me before my operation often commented how well I was taking the whole ordeal . My response – “my choices are pretty limited and these guys know what they are doing”.

Now I’m not saying I never flipped out. There were tears and “I’m too young” and “it’s not fair, I’ve looked after myself”. However I was where was and at some point I accepted that I needed bypass surgery.

I have always felt very fortunate I didn’t have a heart attack. At worst my wife would have been without a husband and left to raise 3 children on her own, and my kids would grow up without their dad. At best I’d be taking a lot more drugs and having to manage the side effects of those. Thankfully things worked out differently for me.

Immediately after my surgery the best thing is to get moving (so they told me when I woke up from my surgery!). I was very surprised at how weak I was – barely able to stand up. This improved over the next few days but it took some determination to keep up with all the exercises at hourly intervals. Personally I found I was very focussed and resolved to recover as soon as I could. So I didn’t find it too hard to keep moving.

Dealing the the wounds and dressings was unpleasant but not painful. I hadn’t thought about that aspect of my surgery so when a nurse announced she was going to remove the chest drain tubes and the wires that had been stitched to my heart, I got a little anxious. Once again though, my choices were limited and I trusted the medical team implicitly. Yes there is some discomfort and it takes a while to get used to moving without hurting (coughing, sneezing and hiccoughing were the worst!), but it’s all absolutely bearable.

Mentally I felt great. I was alive, I had survived the surgery and my recovery (at this very early stage) was going well. I had great support from people who visited me hospital. I looked forward to company every day and probably didn’t get quite as much rest as I should have. A few truly great friends would stay on even while I was asleep so I had someone there when I woke up. I’m very grateful to those people.

On the not so great side, I have always had this little voice in some dark recess of my mind saying “but how do they know the surgery worked?” other than the usual vital stats – blood pressure and whatnot – they don’t do a before and after angiogram just to make sure they plumbed everything correctly and everything is working as it should. The fact that I was walking, talking and breathing didn’t carry much weight. After all I was walking, talking and breathing with 90% block! This continued to be a source of anxiety for me until much later in my recovery, when I had a second angiogram. This showed that only 3 of the 4 grafts were still working, but the 3 remaining grafts were working perfectly and my bloodflow was fine.

Back home

This early stage of recovery continued at home and it was increasingly difficult to stay upbeat. The gaps between visitors got longer and my wife having to continue on with the daily routine with the kids. Keeping up with the exercise regime was also difficult. It was the middle of winter which made getting out for walks challenging and mildly unpleasant.

I had periods where my levels of pain were quite high. They were usually associated with times when I had overdone things – too many visitors in a day, too much exercise and not enough rest. This is difficult to manage because people want to see you, more so than in hospital. Perhaps they think that because you are home, you’re on the mend. I remember seeing the look of deep concern on a friends face when he dropped in unannounced. I was having a bad day and had made it half way up our hall. I had to stop and lean against the wall I was so sore and out of breath. I don’t think he realised how big an operation a CABG is. At times like that the best thing I could do was rest. Shut myself in a dark bedroom and sleep for a few hours. Inevitably I’d wake up feeling much better.

Despite all this I remained focussed on recovering as quickly as possible. I had no trouble at all eating well, in fact you couldn’t have paid me to eat anything “bad”. I had no desire to eat anything that might have a negative impact on my health. I started researching the best cooking oils to use, which fruits and vegetables had the greatest benefits for people with heart disease, in short – I was obsessing! This didn’t last long and it has resulted in some long term changes to my diet

I guess, in hindsight, this is a time of extremes. Extreme highs and lows, overwhelming joy and absolute despair. The best you can do is enjoy the highs and be courageous through the lows (with a little help from your friends and family).

Welcome to theheartcoach

Hi there. This is the first post for theheartcoach. This is an idea that has been bubbling away since my heart surgery nearly a year ago. I’ve finally decided to just start writing and see what happens! I hope you find some useful info here to help you on the road to recovery – or to just plain get your head around what has just happend to you and what it means from here on in.

I’m writing this based on my own experience with heart surgery and heart disease, which is quite recent. You can read more about about it here