This is my own personal journey about heart surgery and I am happy to say, life afterwards. Over the past few months since the operation, I have had time to reflect on my life and how being given a second chance is too good an opportunity to waste. As I have been putting those thoughts together I came up with my own Ten Heart Commandments which is merely a summary of the things to do and not do once you too have been given that second chance. No rocket science here but sometimes you need to go back to the fundamentals of life in order to succeed. I remember reading somewhere that heart surgery doesn’t cure you, it’s what you do afterwards that does. So here is my short book on my Ten Commandments. I hope you find them useful. Oh and by the way, many of these can be applied to any form of recovery regardless of the surgery. Just choose the ones that apply…good luck!

My Ten Commandments are as follows. They all start with “M” for some reason. Maybe that’s because my surname does too…who knows!

1. Mornings
2. Meditation
3. Medication
4. Motivation
5. Mobility
6. Meals
7. Massage
8. Mentality
9. Moderation
10. Music.

1. Mornings.

It’s important to wake up every day with a plan for that day’s activities. I was lucky in as much as I could get out of bed and walk around albeit carrying a catheter bag for a couple of weeks. However at this stage of the game, it’s not just the physical side you are dealing with, it’s the after effects of the surgery, the pain and the drugs that still remain in your system and of course, the unknown…..will I ever get back to normal? That was my biggest fear after surgery and I am now feeling so much better both physically and mentally than I was a few months ago and from a physical sense better than I have been in many years. But even if you are unable to get out and about, putting together a list of things to do that will occupy your mind is just as important. Are there any books you wanted to read but never had the time? Are there friends that you have been meaning to get in touch with but they fell off your radar? Is there some research about cars, or churches or something that may have interested you years ago but work or something else got in the way? As a similar example, a friend of mine was retiring some years ago and I went to his office to wish him well. He had dozens of books on and around his desk and I asked him what they were. He said they were self-help books on what to do in retirement and he said he could summarize them all in 3 words “Have a Plan!” He said otherwise you would just get up, hang around, maybe play some golf, maybe read a paper or go for a swim but he said if you don’t have some form of structure to your day then over a couple of years you will pack on the pounds and get bored. I’m not saying that you have to have a strict schedule of activities after heart surgery but put together a ‘To Get Done” list so that at the end of each day there has been some feeling of achievement.

Back when I lived in England, I used to go camping on a regular basis. Leave on a Friday evening and return on a Sunday afternoon. It was always fun to just throw stuff in the car and get away for a few days, despite the often inclement English weather. One year we went to the South-West of England to a campground we had never been to before. We checked in put up the tent and then I went back to buy some groceries. I got talking to the owner of the place and got his perspective on life which I remember to this day over 40 years ago. It turns out he was the owner of a very successful manufacturing business with over 30 employees. One day he started to feel ill, was rushed to hospital and was told that he needed to cut down on the work he was currently doing and not get stressed out otherwise he would be in line for a stroke. What to do? He ran a great business with a lot of people relying on him for their livelihood. Over the course of the next year he started looking for potential buyers as well as wanting to make sure that his loyal staff was going to be okay too. In the end he managed to get out from under the business and bought the campground. My immediate question was how do you go from running a business and managing people to running a campground?  “Easy” he said.” I make a list of things I need to get done every day. Painting a wall, mowing the lawns, restocking the fridges and freezers, just something that will keep me active both physically and mentally. I actually remembered his comments when I came out of the hospital and it was one of those life changing events that happened to me over 40 years ago that suddenly came back to me in my time of crisis. 

2. Meditation.

If you Google “After heart surgery” as an example, the number of hits is around 8 million. However, very few of the results seem to address the emotional side of recovery, those moments when you wonder if things will ever be the same again. Apparently the number of people who get depressed and continue to do so is apparently around 50%. I can attest to that too as it happened to me on a few occasions. The day after my surgery I just wanted to die. I could see nothing but dark days ahead with constant pain and a restricted lifestyle. No more cheese, no more golf, no more fun. And then I realized something and it was huge. I was alive! I had indeed survived 2 heart attacks (what are those odds) and the open heart surgery but I was still alive. Obviously there were going to be some tough days ahead but as long as I held on to the notion that I was still upright (albeit for small moments the day after the surgery) I figured I had been given a second chance to do something positive with my life. A good friend of mine had introduced me to meditation several years ago and what surprised me was when I mentioned it to my friends, many of them said they had been doing it for years including my 92 year old mother-in-law! There are numerous apps out there that have free downloads etc. but after talking with friends I bought into Headspace. It’s free for the first ten 10 minute sessions and with the free version you can always go back to the previous ones if you wish. However I decided to buy the whole suite which in fact wasn’t that expensive and provides more variety. Besides the founder is a Brit and being from England I liked hearing his British accent! I found the whole Meditation experience useful both pre and post-surgery. Learning to breathe deeply from the stomach and relax the shoulders proved invaluable especially in the hospital when you hear the doorbell going as someone came into the room. By doorbell I mean the mandatory Purell machine that buzzed whenever anyone came in or went out. As soon as I would hear it I would immediately raise my shoulders and then relax them whilst at the same time taking a few deep breaths. By the time the doctor or nurse was with me, I had already relaxed my mind and body albeit a little. Subsequent needles and other probing were a lot easier to take!   

3. Medication.

Chances are that when you leave the hospital you will be on some kind of medication. It’s an obvious fact that you need to continue to do what you have been told to do so read the labels and follow the instructions. I actually made up a spreadsheet with a list on the left hand side of what I was supposed to take and then had the days of the week across the top. Every time I took a tablet I would cross off what I had taken and the quantity. It made it so much easier to remember and I would highly recommend everyone doing this.

I recently read an article that said that almost 50% of patients after heart surgery did not take their meds and frequently missed several during the day. These would include statins and a daily aspirin. If medications are ignored then the chances of some kind of reoccurrence can happen. Statins and aspirin together are needed to keep lifesaving bypass grafts open, but Jefferson researchers found patients are not taking these medications long-term.

Researchers at Thomas Jefferson University discovered that nearly half of coronary artery bypass patients are not taking statins and aspirin together when they are referred for diagnostic cardiac catheterization at least three years after their initial bypass. Their results are currently in press online in the American Journal of Cardiology.

“It is important for patients to understand that bypass surgery is a second chance, not a cure for their disease,” said Michael P. Savage, MD, the Ralph J. Roberts Professor of Cardiology at the Sidney Kimmel Medical College at Thomas Jefferson University and the Director of the Angioplasty Center and Cardiac Catheterization Lab at Thomas Jefferson University Hospitals.

If untreated, about half of bypass vein grafts become occluded within 10 years of surgery and aspirin and statins have been shown to keep grafts open over the long term. The American College of Cardiology and the American Heart Association recommend both medications unless they are unsafe for the individual patient.

“Our study confirms the significant under-utilization of both aspirin and statins in patients during long-term follow up after bypass surgery. This suggests complacency, not only among patients, but also among health care providers regarding the need to continue appropriate prevention measures after successful heart surgery,” Dr. Savage said.

The researchers reviewed the electronic health records of 381 consecutive diagnostic cardiac catheterization patients who had a previous coronary artery bypass graft (CABG) a minimum of three years prior. Their goal was to identify the long-term trends with medication adherence in this high risk population. Only 52 percent of patients were taking both aspirin and a statin medication; 75 percent were taking aspirin and 67 percent were taking a statin. In addition, patients not taking a statin had higher (22 percent) low-density lipid or “bad” cholesterol.

4. Motivation.

Motivation goes back in some way to Mornings. You have to want to get better and not go through the ordeal again. I know that a very large percentage of people get depressed and find it difficult to move forward but I believe based on my own experience that getting yourself back in shape is a whole lot better than having to go back to hospital and starting all over again. My wife made the comment to me a couple of months after surgery about all the food label watching I was doing, to the extreme of course! I burst into tears and said I was scared. I never want to have to go through the ordeal of needles and pain and catheters and not being able to do things the way I used to. So if it takes an effort to stay healthy and a big change in lifestyle then so be it. And if you need any motivation at all, remember what it was like the day after surgery or the day when you got the bad news that you needed bypass surgery. That for me was enough motivation right there so motivate yourself to get healthy and be optimistic that it will help you live a better, healthier and happier life.

The good news for people after surgery is that doctors and nurses now recognize the fact that depression can cause a slowdown in the recovery process.  Depression is very common among post-heart surgery, affecting up to 40% of all such patients. Depression is associated with:

• loss of motivation
• loss of interest in everyday activities
• lower quality of life
• loss of confidence
• sleep disturbances
• change in appetite with corresponding weight change

Many patients feel sad or overwhelmed after a heart event or surgery, but be aware that many heart disease patients experience clinical depression. Like stress, depression is also a risk factor for depression. Research has shown that depression can increase the likelihood of heart disease, a heart attack, or sudden death from heart problems. If you are concerned that a normal reaction of sadness after coronary bypass surgery is becoming long-term, clinical depression, seek help from a psychologist with experience working with heart patients (if possible). A hospital’s cardiac rehab program is one excellent source for identifying a psychologist who can help you and for me was a great way of getting me going.

5. Mobility.

So you are out of hospital and able to get around a little. I had an extra couple of weeks of NOT being able to do that due to my catheter bag being with me at all times but once I was able to, I started walking a little and going to Cardiac Rehab. I have to admit I was a little skeptical about the value of the rehab. People had talked about it in the hospital and the value it would provide but I just couldn’t see myself driving 25 miles a day to the middle of Hartford 3 times a week! Well was I ever glad I did! If you have the opportunity to do it and your insurance covers it, then grab it with both hands. It was an amazing experience and so worthwhile both from a mental and a physical perspective. First of all you have trained nurses and a PT instructor to provide advice and guidance, safety and monitoring of your activities. I was sold after my first meeting there when one of the nurses explained how it all worked. Secondly there are people working out there who are all in different stages of their rehabilitation. Some like myself were new, and others of course had been going there for several weeks or months. Those were the ones who offered encouragement to me as I did to others after I had been there a few weeks too! The first day they do a baseline test so that as the weeks passed you would be able to see the progress. The baseline started with the treadmill. These were mine:

Speed 2.1 miles an hour…Duration 20 minutes. I try to walk that slowly now and realize just how far I have come!

At the end of the 36 sessions, I was up around 3.4 miles an hour 40 minutes plus another 20 minutes plus on other equipment. Since then things have improved yet again but mainly because I was determined to get myself in shape after some of the worst months of my life.

I would also highly recommend investing in a monitoring device such as a Garmin or Fitbit. I bought one with a heart monitor capability that also tracks steps, miles, calories burned, steps climbed and of course has a clock. I don’t go anywhere without it and it has been such a huge motivator and benefit to me as I went through the rehab process. Of course I still use it every day as I like most people who have them have become obsessed with monitoring my progress. Here as an example is the start and end step numbers since I started using it on my first days of rehab on Feb 22nd.

1st Week 30,409

4^th Week 48,559

8^th Week 55,873

12^th Week 67,734

I am now averaging between 60 and 70,000 a week so the exercise has definitely played a significant role in my recovery.

6. Meals.

I knew I had to change my diet dramatically and even though I thought I was a healthy eater it was apparent as I looked at the new menus in my life that I had been deluding myself for a long time. I never eat fast food, I rarely if ever ate fried foods so how could my health have been in jeopardy? Well canned soups, cheese and bread all contain large amounts of fats and sodium…duh! So that was the lifestyle change!

A few weeks after my surgery, I went to a local health store, The Sweet Beet here in town and one of the lady’s there who I know quite well suggested I contact a nutritionist friend of hers. She basically said I looked like hell and should get some help from someone who knows what they are talking about as opposed to Googling every heart website known to mankind! I dropped her a note and told her my background and she was kind enough to provide me with the following. Since then I have joined their board and we are working on many new projects to make people more aware of the importance of healthy nutrition. I was also rushed back to the hospital with a kidney stone so my diet was trying to manage both events! You can find what she sent me under the Meals tab.

As I am writing these notes 6 months to the day that I was admitted to the hospital, I am thinking of the food changes I personally have made. Here are a few of them and by the way, I have lost 20 pounds since I went in and my cholesterol has dropped by over 140 points!

NO LONGER EATING:

Cheese

Beer

Bread

Canned soups

Fried foods

Pork ribs

Steaks with any fat in them (Filet Mignons only and even then only once every 2-3 weeks)

Sour cream

Cottage cheese

Chocolate

Croissants

Starbucks coffee with any milk or cream additives

Sugar

Dry rubs on meats (high Sodium)

Soy Sauce (HUGE amount of Sodium)

Deli meats

EATING A LOT MORE OF:

Home-made soups and hummus for snacks

Low fat and sodium crackers

Ezekiel Bread

Only Organic Strawberries

Fruits and nuts

Vegetables and Salads

Olive oil for cooking

Fish twice a week

All fat cut off meats

A lot of liquids

Low sodium meat rubs (yes there are some out there.

I did some research too on beer and wines and also consulted my cardiologist about whether alcohol was allowed into my diet. The suggestion was 1 12 oz. beer a day or 2 5 oz. glasses of wine. I suggest everyone consult with their doctor to confirm these numbers but I have been religious in following their advice. 

I also find that I am eating at least 6 times a day but snacks are now healthy ones as opposed to crackers and cheese. It’s really not that hard to do once you put your mind to it. 

7. Massage.

After surgery, there are so many things that you have to do differently, it’s hard to keep track. However there are certain fundamental things that you can do to help your recovery. As I mentioned earlier, Meditation was, still is and will continue to be part of my ongoing lifestyle as well as Mobility, getting up and doing exercise if you can. But a more obvious one is your posture and which is why I wanted to include Massage into the messaging. When I came home, I was unable to do much of anything for a few days except of course get up and walk around very slowly. The problem is that your chest hurts for a while and my shoulders where I had the IV’s was also very tender. I actually felt as though I had some weights lodged in my chest which meant standing upright and stretching back my shoulders was an unpleasant thing to try to do so of course I didn’t. After a while you get used to that hunched over position and before too long you realize that you not only stand hunched over, you also walk bent over too. So going back to the Meditation piece try and relax your shoulders which in turn will help your posture.

Massage however is another great way to relax not only your body but your mind too. There are numerous therapists out there who do an absolutely great job. My favorite is my Meditation guru here in Windsor CT called MaryAnn Barber. She is so good, knows such a lot of stuff and is a spiritual lady who helps heal minds and muscles! Of course you are somewhat limited in how you can lie on a table….face down is definitely not an option! But sitting up and releasing the tensions in your shoulders, arms, legs and feet is an absolutely stunning feeling and one that I highly recommend!

   

8. Mentality.

I know this is really hard because you have just been through a traumatic event and the drugs are still in your system as well as the ones you are taking. It’s tough as I mentioned before, to have a positive attitude and there were times when you just want to curl up into a corner and be left alone! Sometimes you have those quiet moments and ask yourself how did all this happen and now what am I going to do? My own motivation is 1. I want to grow old with my wife by my side; 2. I want to be around long enough to watch my grandchildren grow up and 3. I am scared! I have included a couple of pictures of me before and after surgery. I do NOT want to go through that again and if that means trying hard mentally every day to exercise and eat and drink the right foods then those are all pretty good reasons to do so!

I have been in sales most of my life so have always tried to have an upbeat and positive attitude, but sometimes you just can’t see the future being anything other than bleak. However in my case, I honestly felt that God had given me a second chance. Two heart attacks, the second been at home so that my wife could assist me…. how lucky was that? I also had a horrible 2 weeks with a catheter to carry around and a kidney stone to top it all off. And yet as I looked around at the other people in rehab or the doctors waiting rooms on my various visits, I felt grateful that it was not worse. I know a lot of people who read this will be in worse shape than I was but you have to have faith that you will get better. There are so many support groups out there including this one that I hope will provide help and insight into improving you mindset.

9. Moderation.

When I get my teeth into something I am like an attack dog. I just won’t let go of the leg! It was the same when I came out of hospital. I googled everything from what to do after heart surgery, what to eat, how to exercise, what NOT to eat etc. etc. To say I went over the top would be an understatement. I food label watched everything (and still do). One evening my wife remarked on my OCD and I burst into tears. I said I was scared! I didn’t want to go back to hospital ever again with catheters and IV drips and being woken every 2 hours for blood work and so on. If I had to be diligent on my future lifestyle then so be it. I have backed off a little since coming out of hospital but I decided that it wasn’t the end of the world if my low fat milk had 2% fat in it instead of 0.5%. Some doctors’ advocate allowing for one day every so often to splurge maybe have a pizza or some ribs. While I can see the benefits of that approach I haven’t done it. It seems like cheating to me. Once you do it you enjoy it so much that you do it twice a week and not just once and then before you know it your whole strict regimen has changed. If you check out the Meals section above it really isn’t that hard to do once you get used to it.

As I also mentioned, I bought myself a Fitbit and that has been invaluable for motivating me to exercise. I can’t leave the house without it! However Moderation is key here too. I think most people have it set for 10,000 steps a day and achieving that goal is what we all strive for. That being said if you are able to be active and don’t reach the magic number that’s okay. Tomorrow is another day so remember, moderation in everything.    

10. Music.

Last but not least is music. Being a closet musician I have always found listening to music to be a great way to not only pass the time but to reflect and enjoy. If I am working on one of my DIY projects or am on the treadmill at the gym, I have my tunes! It can help the time pass by more pleasantly as well as act as an additional way to relax and start the meditation process. I would highly recommend finding some tunes for your exercise and some different tracks for your relaxing. What’s on my Playlist you ask? The following are a few artists:

Eric Clapton

Tower of Power

Average White Band

Pharrell Williams

Adele

Joe Bonamassa

Coldplay

Dave Matthews

I think that’s a pretty eclectic mix but something that will get me going and enjoy the process. So try to get yourself some great music to listen to and I believe your road to recovery will be a lot less anxious!