Cardiac Rehabilitation in Canada
The Grim Reaper tapped me on the shoulder one day in August.
“Where do you think you are going?” he asked. (Although it might have been a she, the usual authorities are silent on the gender.)
“I’m on my exercise walk round the neighbourhood.”
“Oh, I don’t think so,” said the GR. “You’re coming with me. Haven’t you noticed that pain in your jaw?”
Actually, I wasn’t aware of the slight ache until it was mentioned.
Then it spread to my right shoulder and down my arm. Something in my addled brain was saying this was not good, so I stopped for a rest. The pain went away, but when I started walking again it came back. I took a very gentle amble back home and called my doctor.
She said, “Time to see a cardiologist.”
Cardiac Stress Test
With sensors stuck all over my upper body, I huffed and puffed my way on a treadmill. Faster and steeper went the treadmill; huffier and puffier went I. The cardiologist gave me a failing grade at stage one.
That’s kind of like setting out to hike the Trans-Canada Trail and not getting past the Duke of Duckworth pub in downtown St. John’s, Newfoundland.
The cardiologist booked me in for an angiogram and, perhaps, I would meet her Irish cousin angioplasty (profound apologies for the dreadful pun).
Now, what genius came up with the idea for these procedures?
“Hey. Let’s stick a tiny tube into an artery, shove some miniaturized equipment up it until it reaches the heart, and then take some X-ray pictures to see what’s going on.” What an incredibly goofy notion—thankfully, it works.
There are a couple of routes available to the surgeons; through the groin or the wrist. A friend who had the groin treatment said he looked like he’d been kicked by a horse for days afterward.
Fortunately, I got an arm man. The downside is that the only evidence of a surgical intervention to show to people was a tiny scar that could easily be mistaken for an insect bite.
Gowned and prepped, I climbed on to a gurney and was surrounded by a team of highly skilled people whose sole concern seemed to be my comfort. They covered me with a warmed up blanket and continued the pampering with some lovely drugs that put me into a sublimely relaxed state. Sadly, doggy bags for unused meds are not available.
In my case, the angiogram found one artery that was narrowed by the remnants of seven decades worth of potato chips, cheese, bacon, and other yummy stuff. It was 99 percent plugged. No wonder the Grim Reaper fancied me as a recruit.
If you’re lucky, an angioplasty comes next. If several arteries are really badly clogged they’ll zip you up and send you off for bypass surgery, a quantum leap in invasive procedures.
I got the angioplasty treatment, which involves expanding a tiny cage where the artery is narrowed and pushing the goopy sludge up against the blood vessel’s wall. Proper blood flow is restored and peace and harmony return to the Taylor household.
I’d be lying if I said there isn’t a little bit of discomfort, but you are given plenty of warning. It’s not as bad as you think it’s going to be, and it only lasts a couple of seconds. The whole procedure takes about 40 minutes, and you come out floating on a chemically induced puffy white cloud, to be greeted, in my case, by a tearfully relieved spouse. Bless her.
You are kept in the hospital overnight; ostensibly so nurses can make sure the arterial puncture doesn’t spring open up and cause you to bleed to death.
However, I think there’s a secondary motive; it means you have to eat hospital food at least twice, so you’ll be reluctant to come back. And, there is a plan for that.
If you behave yourself, you go on to cardiac rehabilitation. There, you get seminars on heart disease, nutrition, and exercise. Then, you complete a three-month course of exercise on the government’s dime, after which you are offered continuing rehab for a small monthly fee.
The Old Hearts
I took up the offer of continued rehabilitation, and I'm so glad I did because of all the lovely people I've met there.
Twice a week, a group of about 20 of us with wobbly hearts spend an hour pounding (not really, more like ambling) along on treadmills, peddling on stationary bicycles, and pumping iron on weight machines.
This Old Hearts group is a convivial bunch and there is way too much laughter for people who have caught a glimpse of the Grim Reaper’s stink eye and turned away. Perhaps, that's why there's so much humour and sociability; we all know we're living on borrowed time and are quite accepting of that.
Our ailments run the gamut from heart transplant through octuple bypass and other very serious conditions. I feel like a bit of a fraud with my single stent but I wouldn’t give up the Old Hearts group for anything.
My cardiac care companions are wonderfully supportive even if there is an occasional unseemly rush to get on a favourite exercise machine when the session starts.
There are those among us who quietly confess they would not go to rehab if it wasn’t for the social side. Birthdays, family events, and sadnesses (we are a somewhat rickety old crowd) are shared. Someone collects for flowers, or a card of condolence is passed around. Phone calls and e-mails are offered to those who might be having a rough time.
The huffing and puffing is done under the supervision of kinesiology angels trained in matters cardiac. If one of us has what is known in the trade as “an event” these folks will leap into action. Although the subject of the episode might feel “event” doesn’t do justice to the situation; “Holy Ghost on a tricycle, I’m dying,” might be more appropriate.
However, our supervising angels are very accomplished and I am quite confident they could perform open heart surgery on the gym floor with nothing more than a Swiss Army knife and a teaspoon.
If bumping into the Grim Reaper was the cloud, the Old Hearts are a very silver lining.
The Canadian Heart and Stroke Foundation points out that “Only approximately 40 percent of patients who are eligible for cardiac rehabilitation enrol in a rehabilitation program.”
And, “Participation in a cardiac rehabilitation program, after being hospitalized for heart disease (heart attack, angina, heart failure, or arrhythmia), is associated with a 50 percent reduction in death rate.”
Perhaps, postponement would be a better word than reduction.
Jack Nicholson Has a Heart Attack
My out of pocket expenses for the procedure, hospital stay, and three months of cardiac rehabilitation was $20. This was two parking fees; once for my wife to drop me off and get me settled and a second time to pick me up the following morning. Of course, we have paid taxes over the years to support our health care system, but we’ve been happy to do this so that it’s there when we need it.
CostHelper.com says the average cost for a single angioplasty at Legacy Health in Portland, Oregon is $36,221. At the Aurora Sinai Medical Center in Wisconsin the median cost is $41,228. Without insurance, the total bill is the patient’s responsibility.
Meanwhile, eHealth says in 2016:
- "Premiums for individual coverage averaged $321 per month while premiums for family plans averaged $833 per month.
- "The average annual deductible for individual plans was $4,358 and the average deductible for family plans was $7,983."