Jim's Personal Blog: Recovering from Heart Failure
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Background Story
On October 25, 2021, I woke up with a severe bloody nose, feeling extremely dizzy, not able to hear with my right ear and was out of breath and frightened. It felt like my body was shutting down and I needed to do something quick or else.
I immediately talked to my wife Connie to tell her what was happening and told her it would be best if we moved up north to get intensive medical attention and for us to be close to our son Steven’s home and place of his medical practice Mayo Clinic in Rochester, Minnesota. Turns out Steve and his wife Sara and their three kids had in June 2021 on our first post COVID visit asked us to move up to live close to them given a neighbor’s family’s senior member had just done this moving from Virginia to Rochester MN. At the time Connie and I said: “no way, way too cold for us.” Well in October the fear of freezing was no longer an issue. The major issue was to get the optimal medical care at Mayo and family close at hand incase I passed. We called Steve and Sara that day and told them what we’re thinking, and they agreed it would be best for us to do this.
So, I immediately resigned from my work as a psychologist in nursing homes which were long drives from my home and stressful at best. I hated to stop this work, but it was clear the stress of the work had impacted my health.
I then worked at finding a real estate agent to help us sell our condo in St Pete and began looking at Zillow for places in Rochester, MN. We agreed to a contract to sell our Condo on Friday Oct 29 and the next day our agent showed our condo to three prospects. That Saturday night Bill our agent called to say he had papers for us to sign. I was confused and he came over and he had a sales contract for our condo signed by the now new owners of that condo. Biggest surprise was that they wanted to close on the deal on November 23 giving us less than 30 days to get organized and moved out.
The rush was on, and we began packing immediately: 120 banker boxer boxes, etc. and we worked hard to find a condo near downtown Rochester MN at the same time.
Meanwhile I was seeing doctors in St Pete for my conditions and was given meds and support documents to bring up to Mayo once we moved. At no time was I ever given a hint that my medical problems were “heart related.”
On November 22 our St Pete Condo was packed on its way to Rochester MN and Connie and I flew out November 23 to Rochester MN. We were on our way. We had found a condo near Mayo headquarters downtown and would be able to close on it November 29 and move in on November 30. 2021.
We had sent out slews of emails to inform our family and friends of our sudden and pending move and then I was shut down by exhaustion and could no long handle phone calls nor emails from anyone from November 22 on until the creation of this blog on December 27, 2021.
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Rationale for Blog
Given I had no idea that I was experiencing a potentially fatal heart failure during all of November and December up until my first visit at Mayo Clinic on December 21, 2021. I thought it would be good for me to keep a Blog of what steps are taken in treatment of heart failure similar to mine and to increase my accountability by keeping a chronological account of my progress and efforts in this process.
Also, I do not want to repeat over and over in conversations, phone calls, emails or letters what has and is happening to me as a result of this heart failure. If people ask in the future I will refer them to this blog, which will be a living document of my journey in cardiac rehab and recovery.
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December 21, 2021 Signs of My Near Fatal Heart Failure
On my first visit to Mayo Clinic with Dr Diego Suarez he and his team identified that I had: fluid build-up around my heart and lungs and in my ankles and legs, that I was struggling for breath after walking less than 10 feet, that I would be dizzy after that walk and needed to rest. That in all likelihood my lower heart chamber was out of synch with my upper heart chamber, so he immediately scheduled clinical assessments to clarify what was going on with my heart. I first had a Chest X ray followed by a Electrocardiagram. The Xray showed I had fluid in my lungs and the Electrocardiogram led Dr Suarez to call me to change my other tests and to immediately get to the Emergency Room at Mayo Clinic’s St Mary’s Hospital where he said Dr Narayan Kowlgi and his cardiology team would determine if I would need to be immediately provided surgery to place a Pacemaker into my heart.
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December 21, 2021 Pacemaker Surgery
I met Dr Narayan Kowlgi and his team in the ER at St Mary’s and after going over my tests and records they said it would be best for me to have a Pacemaker placed as soon as possible. The Mayo Heart Rhythm Services were contacted and I was immediately placed in their operating room that afternoon. The rest of the time I don’t remember but when I woke there was a huge pressure on my upper chest. Later that day Dr Kowlgi and his team met with me and explained the “Atypical Ballooning Syndrome” requiring a pacemaker. This means that there is atypical ballooning of the left ventricle of the heart also called “Tako-tsubo cardiomyopathy” named after a pot once used by Japanese fishermen to catch octopus. The pot’s shape is similar to the shape of the ballooned ventricle. (Come on! you needed this cultural perspective to keep your interest in all this! 😊)
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December 21, 22, 23 & 24, 2021 Stay in the Hospital
During my days in the hospital, I received doses of Lasix and by Dec 24 had lost 14 pounds of fluid. On the Dec 22 I had a echocardiogram which led to on Dec 23 getting a coronary angiogram which thank goodness showed no obstructions needing stints or any open hear surgery. My presentation was consistent with stress-induced cardiomyopathy, potentially related to hospital admission and pacemaker implementation. I was kept in the hospital over night on the 23 and finally released on Christmas Eve December 24, 2021.
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December 24 to 28, 2021 Home to recover
I got home on the 24th and spent time with the grandchildren, am weak and still not with it. But I am grateful to God that this problem got addressed and that my recovery has begun from this potentially fatal heart failure of mine.
More to come…
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December 28, 2021 Follow up with Dr Suarez my Internist
My status post discharge from hospital was reviewed. Dr Suarez was pleased with the progress made so far. He did however set up tests for other related physical issues to be done before we meet again. These tests are for issues of: pernicious anemia, pulmonary function to assess level of asthma and thyroid function. I will meet again with Dr Suarez on Monday February 7 2022. Next up is January 5, 2022 meeting with Dr Huntley of the Mayo Department of Cardiovascular Medicine after a series of tests that day.
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January 1, 2022 Happy New Years and Happy New Life
Wow, 2022 has arrived and I am alive. Thank God, my wife, my son and his wife and most importantly the team at Mayo Clinic. I would not be experiencing this new year if it were not for their support and interventions. I will be forever grateful. Now I need to continue the road to recovery and do all that is being asked of me to strengthen my heart! My new year’s resolution is to do everything in my power to comply with the cardiac rehab program being given me at Mayo and to do all I can do to insure my long-term survival. So, my extended family members and friends, this is a new Jim who is not taking any minute in his life for granted. So, I hope you all will proactively take care of yourselves to benefit from such a livesaving change in your own lives - Don't take anything for granted and do all you can to make each minute count!
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January 5, 2022 Series of Events
- Specimen Collection at Mayo building: they found that there is excessive fluid in my body
- Chest Imaging Exam at Mayo building: The Xray showed the excess fluid in my l
- Blood Test at the Hilton Building: This exam found I was low in iron so they ordered an infusion of iron to take place the next day
- Electrocadiogram Testing at the Gonda Building: Confirmation of the fluid still in my lungs
- CT Chest Imaging Exam in the Gonda Building: Continuation of confirmation of fluid still in my lungs which indicated that my heart is still not strong enough to get the fluid out of the lungs
- Consultation with Dr Huntley in the Gonda Building after all the testing was completed: Given the result Dr Huntley put me on a Lasix pill to reduce the fluid build up and he increased the dosage of heart related medications given to me. He told me something shocking in that when they in case conference presented my case the team of Cardiologist were surprised how stress of moving, packing, getting a condo, selling our condo in St Petersburg and getting a new one in Rochester, MN and unpacking and settling down in Rochester was so stressful that it exacerbated my existing heart failure dramatically resulting in the necessity of the emergency surgery for the Pace Maker and post-surgical stay in the hospital. In quotes he said: “Your stress related heart failure was the talk of the Cardiology Department.”
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January 6, 2022 Two additional Interventions
- Infusion Treatment in the Methodist Hospital: A three-hour process of infusing me with Iron resulting in me being and feeling stronger in the hours after this infusion
- Pulmonary Function Test in the Gonda building 18th floor: I passed it but was exhausted once the testing was completed
- I added a third addition point of interest: It took one hour to get my car from Valet parking given the reality that Mayo is a busy place and the best way to park your car is to use Valet.
My next scheduled testing is on January 10, a Blood test to assess the impact of the new and increased meds I was given this January 5th.
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January 10, 2022: Blood Test and Ultrasound and Thoracentesis Procedure
Today Mayo demonstrated its patient advocacy in scheduling today an Ultrasound and Thoracentesis which was ordered by Dr Suarez today. So, they switched my blood test and this Ultrasound process to St Mary’s Hospital. An Ultrasound is used to review the two lungs and how much water each is holding, then a radiologist comes in to drain water out of one lung, and my left lung was drained of about 1quart. After it was drained, I was released and was breathing even better than I was before the procedure. I am done with visits until January 21 when I will get another blood test and chest X-ray before my appointment with my Cardiologist Dr Huntley on that day. I am getting stronger, breathing much better, sleeping with only one pillow through the night and during the day feeling awake and with it and feeling much much stronger. This process is working for sure!!!!
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January 11, 2022: Weight drop after Thoracentesis Yesterday
On January 1, I began weighing myself daily for cardiac rehab which begins in February. On January 1, I weighed 191 and from that day forward each day I was losing about a pound a day, Thanks to Lasix. On January 10, I weighed 186.3, then that day I had the ultrasound and Thoracentesis which took out about a quart of water from my left lung. On January 11, the day after that procedure I weighed 181.4 pounds a drop of 5 pounds. In total since December 21, 2021, when I was weighed on my initial visit to Mayo with Dr Suarez, I weighed 198 pounds. So, in total I have lost 17 pounds due to the water that was building up in my body due to my malfunctioning heart which hopefully will be doing a better of job of eliminating this fluid from my body thanks to the Pacemaker in my body. In late October and all of November, never did we imagine that fluid build up was occurring in my body due to heart failure. So you can guess we have been amazed at this incredible change in weight due to fluid on my lungs, legs, ankles, neck, and other internal organs. Thanks Mayo Team for waking us up to this reality and dealing with it so pro-actively.
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January 21, 2022 One month post Pacemaker placed
Today marked the one month anniversary of my Pacemaker being surgically put in my body and I had an appointment with my cardiologist Dr Huntley after getting a chest x-ray and blood tests. Turns out I am still showing fluid in my lungs so Dr Huntley is continuing me on lasix and increasing the Beta Blockers to help strengthen my heart. He was was very pleased however with my blood test and x-ray but he wanted to be cautious to insure I made steady progress in my recovery. I am sleeping normal now and don't need extra pillows and am no longer out of breath when I walk for any distance. He was happy to hear I am doing 45 minutes on my stationary cycle each day and not experiencing any negative reactions. I have a full schedule of events coming up the first week of February including the start of my cardiac Rehab on Feb 7 the same day I meet with Dr Suarez and a follow up visit with Dr Huntley on February 8 after more blood work and x-ray. I am pleased with my progress and am looking forward to working with the Cardiac Rehab folks. I cannot believe it has already been a month since the surgery and cannot believe how strong I am feeling even though I am still showing small amounts of fluid on my lungs. I am ready to report on Cardiac Rehab since I have been getting loads of reminders about it's starting date and the strenuous nature of the the rehab. BTW it is freezing up here in Rochester and I am ever so grateful that I passed my Minnesota Driver's License test this week and am now a legal driver in this frozen tundra!  I hope you folks have looked at the expansion of my blog with the signature recipes and the review of our Carpe Diem trips we took in 2018 and in November this year. I am inviting you all to send us your signature recipes to add to our blog. We are having great fun doing this. After all you have to find some humor in life after all we have been through.
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January 28, 2022 Blood Work
Today I had blood work done and the results were within normal range. We are in the process of getting ready for cardiac rehab which begins Monday Feb 7th. That week I will be seeing not only the cardiac rehab team but also Drs Suarez and Huntley. It will be a busy week but I am ready to get on with the rehab portion of my care. I am feeling stronger daily and and ready for the next steps in my recovery process. I hope I am not boring you with this progress report but it elimnates my repeating over and over the same thing in separate telephone calls and emails. Thanks for understanding. Jim
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February 7, 2022 First Consult with Cardiac Rehab and Follow-up with My Primary Care Internist Dr Suarez
Today was an interesting day. First, I had a telephone interview with staff from the Mayo Cardiac Rehab and I now have some questionnaires to fill out for them before tomorrow when I have my in-person consultation. Take aways from this phone interview are that I went out today and purchased two 5 lbs. weights, a set of strength Resistance bands and a new mat for use with my exercise ball. I was encouraged to expand my exercises to include some strength training (with weights and resistance bands) and stretching (which was part of my daily exercise program until October 25 when I got sick down in Florida. My second meeting was with Dr Suarez who reviewed my progress to this point, and he too encouraged me to get more into strength training and stretching. Tomorrow I have my in-person meeting at Cardiac Rehab Center and wanted to have the equipment on had and in fact I will begin using them tomorrow before I get to the Rehab Center. Dr Suarez also went over various elements of my overall health and he said they would be monitoring what was working and what wasn’t in my recovery program. Turns out the Cardiac Rehab program lasts 12 weeks and my hope is that I will have a defined workout routine which combines not only my aerobic cardio workout (riding my stationary cycle 45 minutes a day, but 45 minutes of stretching and yoga exercises and at least 20 minutes of strength training with the hand weights and resistance bands. Dr Suarez also expanded areas to be examined in my blood workup which is coming this Friday February 11 to determine what meds need to be continued and which need to be stopped. This new phase in my recovery process is exciting because my weight is now in the low 180’s and my heart and lungs are getting stronger every day. Dr Suarez was very impressed with how strong my lungs sounded which was a far cry from when he first saw me on December 21, 2021.
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February 8, 2022 First In-person session at Cardiac Rehab Center
I met today with Jamison an exercise physiologist at the Cardiac Rehab center. He put me through a series of tests: walking a mile, balancing self on one leg and checking blood pressure, pulse and impact of the exertion. He was happy with the fact that I used my stationary cycle at home for 45 minutes and he encouraged me to continue it daily. We are now adding some additional types of work:
- Walking indoors, walking outdoor and walking a treadmill in my weekly in-person sessions beginning next week on Tuesdays.
- Intensity of exercise: begin at an exertion rate at moderate level
- Use Warm-up followed by aerobic exercise 30-60 minute with a cool down
- Use interval training
- Increase intensity level of exercise over the next 12 weeks
- Work on flexibility and balance of major muscle groups 2-5 times a week
- Strength training: using free weights, elastic bands and use repetitions of 10-15 for each exercise used
Wow, a full program with loads of videos and written materials. I will be in person at the center on Tuesdays and on Thursday do a Zoom meeting with a staff member from home. I will also be meeting a dietician concerning food decision making and doing a DEXA which is a body composition test.
Now for the fun. Later today I got a call from a staff member on the Research Team asking me if I would be interested in participation in the Cardiac Rehab Center’s Research Project. It involves some real thorough testing and was just what I wanted to review my progress. I will have more to tell you about this research program as we dig deeper into it.
Well, that’s it. I expected Cardiac Rehab would be thorough and well organized and I was not disappointed. I am so grateful to have this program to help me feel secure physically, mentally, and at peace with my recovery from heart failure. I am really excited to get into the center to use their equipment which is in well ventilated glass encased individual training areas. This is a journey I am looking forward to experience and hope you guys don’t mind my being so obsessive in reporting on it. Thanks Jim
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Exercise Prescription from Cardiac Rehab on February 8, 2022
Specific exercise weekly routine with cardiac rehab
Type:
Cycle recumbent
Recumbent stepper (with or without arms) in Cardiac Rehab Center
Walk indoors
Walk outdoors
Walk treadmill in Cardiac Rehab Center
Frequency:
5-7 sessions per week
Intensity:
Work at a level that is comfortable but also challenging
Rating of Perceived Exertion range (RPE) to 12-14. See Exercise Program Guidelines pg. 18.
Time:
Warm-up 2-3 minutes
Aerobic exercise 30-60 minutes
Cool-down 2-3 minutes
Interval Training:
to be discussed with staff onsite, in cardiac rehab
Progression:
Use RPE to guide when to increase work level intensity and duration. See Exercise Program Guidelines pg. 18.
Follow/match cardiac rehab intensity
Flexibility and Balance:
Stretch major muscle groups daily
Practice balance exercises 2-5 times per week
Strength Training:
Calisthenics
Free weights
Elastic bands
Sessions per week: 3-4
Repetitions: 10-15
Sets: 1-2
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February 15, 2022 Cardiac Rehab in person session #1
Today was the kick-off session of Cardiac Rehab with staff member Rosalind. It is a combination of initiating some strenuous workout on their equipment and reviewing my progress in the previous week which was as follows:
- 45 minutes of Stationary cycle all 7 days
- 30 minutes of weights for muscle strengthening and 30 minutes of Resistance Bands for muscle strengthening exercises began on Tues Feb 8 and are now continuous daily
- 30 minutes of stretching exercises with the ball and mat began on Sat. Feb 12 and is now continuous.
During the session I tried the three different pieces of equipment in the exercise room and found them shockingly difficult to work with, but I was successful in completing a total of 15 minutes on the tread mill which is more exhausting than expected.
I have a two appointments on this coming Thursday and the staff in the Cardiac Rehab agreed to have my Zoom meeting scheduled that day in person at the center after the first two appointments are completed.
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February 17, 2022 Busy Day
1. Dietician Consult: This was my only consult with a dietician. She reviewed my eating habits and was comfortable with what I shared. I eat a balanced diet, no red meats, high is vegetables and low in carbs. We did cover the use of sodium which is important since they are trying to reduce the fluid in my body, and we went over diets and eating routines to lower sodium intake. Salt is out for sure!
2. Body Scan: My next stop was for a body scan to determine the percentages of fat and lean in my body. Turned out of the 192.5 pounds in my body I had 55.8 lbs fat; 129.1 lbs lean and 7.48 lbs bone. The goal for my rehab is to reduce the amount of fat in my body. They will scan my body again at the end of rehab to see how I did.
3. Cardiac Rehab Consult: Courtney a staff member provided my consult today in person instead of on Zoom because I had the other 2 appointments on site at Mayo. We focused on the muscle strengthening with weights and resistance bands. I do 30 minutes a day each of weights and bands. We looked at the positioning of arms during both weights and bands and length of time with each movement. It was interesting to find there was no need to stand holding the positions more than a full moment. Importance on being straight up and no swinging of the weights was emphasized. I agreed that I will try the recommended procedures this week and hope I have good luck with them.
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February 22, 2022 Cardiac Rehab Session on 222’s President Day
Today was my second day of Cardiac Rehab and Jamison was my provider. We went over my blood sugar and weight as well as I was on a heart monitor for the entire session. In talking with Jamison, I realized that in Cardiac Rehab work they were not looking for how hard I pushed myself but rather how well my heart was handling the exercise I was going through without the need for pushing myself to do more effort and pressure to exceed the requirements asked of me. This was good to learn and keep reminding myself not to push myself so hard to exceed the maximum number of exercises or reps I was being asked to perform. I committed to myself that I would return to the number of reps which were given me by Jamison at the start of my rehab program. This made sense. So today I completed fifteen minutes on the Tread Mill and will be doing 20 minutes on it next week. This was a snowy day and I was admitted to the center earlier than my appointment. Funny how snow affects schedules and routines in Rochester MN which is a surprise to me.
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February 24, 2022 Cardiac Rehab weekly Zoom Session
Today was my second Zoom Cardiac Rehab Session with Kelsey. We reviewed my start of Cardiac events and what got me to Rochester, MN and how my heart failure got emergency attention the first time I visited Mayo Clinic and had my pacemaker placed. We review my daily exercise sessions which consists of 45 minutes stationary cycle, 30 minutes stretching exercises on mat with ball, 20 minutes of hand weights and 20 minutes of stretch bands. I let Kelsey know that I am doing my weights and bands better after my consult with Courtney last week (which was in person since I had two other appointments at Mayo that day). We looked today at my use of stretch bands and after our session she sent me a manual on use of stretch bands to help me improve my use of these tools. It was a great session and I was happy to do it on Zoom rather than travel to Mayo in the cold 
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March 1, 2022 Cardiac Rehab Clinic Weekly Visit
Today with heart monitor in place Jamison had me do 30 minutes on the treadmill at 2 miles an hour. I was able to sustain the 30-minute trip with no stops and needed to straighten up as I was walking. I was able to sustain the trip with no sweat. I knew immediately when I was done that, I would take up the treadmill if available. You see on Monday February 28 I found that the gym in our building which was next to the pool had two treadmills and an elliptical. I don’t know yet if I can survive the use of the elliptical but feel certain that I can work on the treadmill (there are 2 in the gym) only problem is I could not figure out how to turn on the treadmill and need help from the building manager Dustin to find out of the work and how to turn them on. That’s my big task this coming week to solve the mystery of the treadmills.
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March 3, 2022 Cardiac Rehab weekly Zoom Session
Today I gave Kelsey my consultant a tour of my exercise equipment. I showed her im our bedroom the stationary semi-recumbent cycle and the exercise ball and mat for my daily 45-minute cycle routine I have been doing for over 25 years as rehab for my neuromuscular issues and my 30-minute stretching and crunching exercises with the ball and mat which also keep my back and joints moving which I have been doing consistently daily for at least 15 years. Then we went downstairs to see the small gym in our building with the two treadmills which I hope work and then the sauna, spa and pool. I am going to begin using the pool on weekends to start now that the pacemaker scar has healed and safe for swimming. We talked when we got back to our unit about the use of stretch bands which are different from my resistance bands, and I will be picking ups such bands this week to work with. We reviewed my progress this week and highlighted increase strength using the weights and resistance bands and increase of balance doing the balance exercises. I am feeling at peace with the progress I am making, and it has only been three weeks since the Cardiac Rehab program has begun.
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March 5, 2022 What Encanto has to tell us about encouraging Ukraine
Last night my wife and I watched Encanto again alone after our grand-kids went home. In watching it this second time I was hit by the message of this delightful moving movie which had me in tears. The messages I was getting is that we must protect ourselves from ourselves and pull on our resilience to survive whatever crisis we are facing be it anger from our siblings, heart failure or as with Ukraine a horrible attack from an enemy country which wants to destroy its leadership and take over its rule. In watching Ukrainian President Volodymry Zelenskyy we witness the determination and resiliency of a man who is telling his people something they don't want to hear necessarily, which is to have the women and children hunker down or leave the country and to have the men to stay and fight. His voice is like that of Bruno whose gift is to see into the future. Zelenskyy sees the future of Russian troops eventually leaving Ukraine in time and he is telling his home-folk to stay put and remain in Ukraine and fight. This will take strong will and belief in themselves that they can do this major objective. I know that feeling: "Do I have what it takes to succeed over great odds?" l have first hand the experience of overcoming life threatening odds and I know others can do the same if they have strong belief in themselves. In Encanto we see the members of the Madrigal family grow in self-belief, resilience and courage to move into the future as "new people" who give up their fear and only focus on their beliefs in their own power. We as Americans must support the Ukrainian effort from afar and contribute to non-profits who are legitimate and working to support both Ukrainian immigrants but also Ukrainian citizens who have remained in their country to fight and to prove their oppressors as wrong and incapable of killing the Spirit of the Ukrainian People. Thank you Encanto for the strong message of "stay and fight to be yourselves against great odds!"
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Addendum to my note on Ukraine
I wanted to add any additional material on handling the news out of Ukraine to preserve our own mental health. Here is the first article sent to me it is called: Dealing with Stress During International Crisis: The War in Ukraine. You can read it at: https://recoveryteam.org/ukraine
My hope is that you will read it and benefit from using it's suggestions to protect your own mental health at this time.
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March 8, 2022 Cardiac Weekly Clinic Visit
This week I did thirty minutes on the treadmill and did quite well. Jamison and I talked about an unusual episode that happened on Sunday March 6 in the evening. He strongly encouraged me to let Dr Suarez know about it.
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March 9, 2022 Unusual Episode
Here is a portal message I sent to my primary care physician on March 9:
Dr Suarez: I just wanted you to know that this past Sunday evening (March 6) I had a extraordinary experience which I did not know happened. My wife told me I was sleeping in my chair while watching the Paralympics on TV and that I had diarrhea and it came out in my pants in the living room. It took her two hours to walk me to the bathroom, clean me off and finally get me in bed. I was not conscious during this entire experience. I did not respond to Connie except she says that at two points I said her name was two different names. I regained consciousness about 5 am Monday morning when she helped me to get out of bed which was a difficult event given I had no feeling in my legs and feet and she needed to support me into the bathroom and then back to bed where I fell asleep again. About 10 am l awoke and was fully conscious, had feelings in my feet and legs and got up and was my old self, but of course feeling weak. I took it easy all Monday and rested. On Tuesday I drove to Mayo for my weekly in person Cardiac Rehab visit with Jamison and I told him about this event and he encouraged me to to send a message to you describing this even. I am OK now but I am worried I could have another of these events. I am wondering could it be a side affect of one of the new meds I am taking? Was it a response to something I ate on Sunday at my Son's house where they celebrated my 77th birthday? Or is this a sign of degradation of my physical health since this is extraordinary?
Dr Suarez immediately responded:
Thanks so much for letting me know. The episode certainly sounds concerning, especially given the loss of consciousness and unawareness during the episode. The first step would be evaluating you in person to get a better history to understand what happened, But it could be due to seizure from low sugar or the gabapentin, could be an arrythmia and we would need to interrogate your device. We need an appointment soon. I'll order this and they'll call you to schedule.
So there you are and on March 10th I have an appointment at 2 pm to explore this issue in person with a Doctor in Dr Suarez’s group.
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March 10, 2022 Appointment with Dr James Hill
I had my appointment with Dr James Hill who is in the practice with my Primary Care Physician Dr Suarez. Dr Hill identified two potential reasons for my unusual episode they are: Transient Ischemic Attack and Deficit Neurologic Disorder. He ordered a blood test and Electrocardiogram (ECG) (which I had today) and a MRI which is coming soon.
I have been referred to a Neurologist and waiting for that appointment. It is unclear still what we are dealing with and once we get the MRI and meeting with the Neurologist, clarity should be coming.
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March 10, 2022 Appointment with Kelsey
Kelsey gave me my prescription for exercise for the last weeks of Cardiac Rehab and ongoing exercise once rehab ends:
EXERCISE PRESCRIPTION:
Type: Cycle recumbent, Cycle stationary, Walk indoors, Walk outdoors, Walk treadmill, Water-based exercise: swim, aerobics, walk
Frequency: 5-7 sessions per week
Intensity: Work at a level that is comfortable but also challenging
Rating of Perceived Exertion (RPE) Range: 12-14, 15-17 with intervals
Duration:
Warm Up Minutes: 5-10
Aerobic Exercise Minutes: 30-45
Cool Down Minutes: 5-10
Goal Duration: 30-60+
Interval Training: Moderate intensity interval training, 30-120 seconds of higher intensity (RPE 15-17) training followed by 60-120 seconds of lower intensity (RPE <14) training, 3-5 higher intensity intervals per session, Include higher intensity intervals 2-3 sessions per week
Progression: Use RPE to guide when to increase work level intensity and duration, Increase 1-5 minutes each session, as tolerated
Flexibility and Balance: Stretch major muscle groups daily, Practice balance exercises 2-5 times per week
Strength Training: Calisthenics, Free weights, Elastic bands, Stability ball, Sessions per week, Major muscle groups
Sessions per Week: 3-5, alternating muscle groups
Reps: 10-15
Sets: 2-3
Other Exercise: Avoid prolonged sitting, Gardening/Yardwork/Housework, Take the stairs
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NOTE: here is what RPE stands for: Borg Rating of Perceived Exertion (RPE) Scale
6 No exertion at all
7
8 Extremely light
9
10 Very light
11
12
13 Somewhat hard
14
15 Hard (heavy)
16
17 Very hard
18
19 Extremely hard
20 Maximal Exertion
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Dates of Tests at Mayo
March 28, 2022 MRI
March 23, 2022 Urinalysis
March 23, 2022 EEG
March 22, 2022 Pacemaker 3 month Follow-up assessment
Notes on Test Results March 23, 2022 from Dr Huntley
Your blood work shows that your kidney function improved. In addition, the echocardiogram showed that the function of your heart has improved back close to normal, which is excellent news! Interrogation of your device showed that there have been no arrhythmias.
For medications, I recommend that you continue lisinopril 10 mg daily and metoprolol 100 mg daily. I think you should restart furosemide 40 mg daily to keep fluid from accumulating in your legs, heart, and lungs. You do not need to restart the spironolactone.
Thanks,
Dr. Huntley
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March 31, 2022 Update Cardiac Rehab Exercise Prescription From Kelsey
Type: Cycle recumbent, Walk indoors, Walk outdoors, Walk treadmill, Water-based exercise: swim, aerobics, walk
Frequency: 5-7 sessions per week
Intensity: Work at a level that is comfortable but also challenging
Rating of Perceived Exertion (RPE) Range: 12-14, 15-17 intervals
Duration:
Warm Up Minutes: 5-10
Aerobic Exercise Minutes: 45-60+
Cool Down Minutes: 5-10
Goal Duration: at least 30 minutes
Goal Duration per week: 150-300
Interval Training: Moderate intensity interval training, 30-120 seconds of higher intensity (RPE 15-17) training followed by 60-120 seconds of lower intensity (RPE <14) training, 3-5 higher intensity intervals per session, Include higher intensity intervals 2-3 sessions per week, Other (comment) (start with 1-2 intervals in a session and add more as tolerated)
Progression: Use RPE to guide when to increase work level intensity and duration, Increase 1-5 minutes each session, as tolerated
Flexibility and Balance: Stretch major muscle groups daily, Practice balance exercises 2-5 times per week
Strength Training: Calisthenics, Free weights, Elastic bands, Stability ball, Sessions per week, Major muscle groups
Sessions per Week: 4-5 (alternating muscle groups)
Reps: 10-15
Sets: 2-3
Other Exercise: Avoid prolonged sitting, Gardening/Yardwork/Housework, Take the stairs, Walk for transportation
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April 15, 2022 Results of MRI, EEG, Colonoscopy and Interval Exercise Training
After the EEG and MRI were conducted, I also underwent a colonoscopy (on April 7) and saw a neurologist (on April 4). Seizures and stroke were ruled out by the EEG and MRI and in the colonoscopy, they found three polyps and rule out major iron problems. Overall, the conclusion of the cardiologist, my general practitioner and the neurologist the event which raised the question about my neurological function was that the episode was a syncope. It was good to have the major neurological problems ruled out given I only have a few weeks left in my cardiac rehab.
As for cardiac rehab, I have been learning to use interval training with use of the treadmill which is in our condo’s gym. I am using elevated tread (which in results very hard exercise-Rating of 17 on the RPE) for 2-minute intervals and am successful in increasing heart rate and then getting back to normal over the following 3-minute intervals before I elevate the tread again. This is good practice which I will continue to use over my lifetime.
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April 28, 2022 My latest Ejection Fraction Results showed major improvement
Ejection fraction is a measurement of the percentage of blood leaving your heart each time it squeezes (contracts). The heart contracts and relaxes. When your heart contracts, it pumps out (ejects) blood from the two lower chambers (ventricles). When your heart relaxes, the ventricles refill with blood. No matter how forceful the contraction, the heart can never pump all blood out of a ventricle. The term "ejection fraction" refers to the percentage of blood that's pumped out of a filled ventricle with each heartbeat.
The ejection fraction is usually measured only in the left ventricle. The left ventricle is the heart's main pumping chamber. It pumps oxygen-rich blood up into your body's main artery (aorta) to the rest of the body.
- A normal ejection fraction is about 50% to 75%, according to the American Heart Association.
- A borderline ejection fraction can range between 41% and 50%.
When I was given an Echocardiogram on December 21, 2021, my first day at Mayo Clinic my Ejection Fraction was measured between 20-24 which was the reason that my doctor rushed me into the Cardiologist team at Mayo’s St Mary’s Hospital to get an emergency operation in which my pacemaker was placed.
Now at the close of my Cardiac Rehab experience in another Echocardiogram my Ejection Fraction was found to be at 51% which my team at the Cardiac Rehab Department told me this past Tuesday was fantastic and they believe the results were due to my hard work in Cardiac Rehab.
Truth be told, I had no idea what they were talking about when they mentioned the Ejection Fraction results and today Kelsey my Cardiac Rehab trainer explained it to me. Wow all this work is paying off. I only have one week left in formal rehab but I will be continuing all the lifestyle changes I have made while in this program.
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May
3, 2022 Results of End of Cardiac Rehab Body Scan
Today
was the last day of my “in person” Cardiac Rehab program at Mayo Clinic. To
complete the program, they do a follow up Body Scan and compare the results of
the scan done on the beginning of the rehab program on February 17.
The
results were
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Date
Measured
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Total
Mass (Weight)
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Fat
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Lean
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BMC
(Bone Mass)
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May 3 2022
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182.6 lbs.
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25.974 g
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55.542 g
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3.454 g
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Feb 17 2022
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192.5 lbs.
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25.407 g
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58.699 g
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3.442 g
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Fat
Distribution
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Android
(%
Fat)
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Gynoid
(%
Fat)
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A/G
ratio
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Total
% fat
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May
3 2022
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39.7
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36.0
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1.10
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32.7
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Feb
17 2022
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35.2
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34.3
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1.03
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30.2
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Summary
of Results of Scan:
1.
Lost 9.9 lbs. in this program
2.
Total Bone Mass increase .012 grams
3.
Increase in Percent of fat from 25.407 grams to 25.974 grams (not a major concern)
4.
Decrease in Percent of lean from 58.699 grams to 55.542 grams (not a major concern)
5.
Increase in Percent of Bone Mass from 3.444 grams to 3.454 (not a major
concern)
Take
away from these results:
1.
I lost significant weight
2.
I increased in muscle mass
3.
I gained major health benefits from my participation in this cardiac rehab
program
4.
I would recommend the Cardiac Rehab Program at Mayo Clinic to any patient who
has had a major episode of cardiac failure.
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May
5, 2022 Report from Dr Suarez after examination today
Note
to me from Dr Suarez:
Your
target weight is 182 pounds. This is based on your lowest recent weight or your
weight when you consistently have minimal symptoms (swelling or breathing
problems). To maintain your target weight: When your weight increases 3 pounds
above target, take higher dose diuretic
Target
home weight = 182 pounds
Take
20 mg of furosemide daily if at or below goal weight
Take
20 mg furosemide/Lasix twice per day if weight is greater than 185 pounds.
Continue this dose twice per day until your weight reaches goal again
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SUBJECTIVE CHIEF COMPLAINT / REASON FOR VISIT with Dr
Suarez May 5, 2022
HISTORY
OF PRESENT ILLNESS
James
Messina is a very pleasant 77 y.o. male who is here today to discuss the
following issues:
Diagnosis
Overview
1.Polyp
Colon Adenomatous
Colonoscopy (2022) with two <1 cm
adenomatous polyps with low grade dysplasia
2.Failure
Heart Biventricular (HCC)
Acute
Combined Systolic (Congestive) And Diastolic (Congestive) Heart Failure (HCC)
In
the setting of stress induced cardiomyopathy
TTE
(2021) LVEF 24%
TTE
(2022) LVEF 51%
On
metoprolol, lisinopril, lasix
I
received a message from the nurses had cardiac rehab that patient had ran out
of his supply of Lasix and did not take the medication for 5 days. His weight then increased about 8 lb and
was associated with lower extremity edema and some dyspnea on exertion. His Lasix dose was temporarily increased
from 60 mg daily to 20 mg daily until today.
Basic metabolic panel prior to the appointment shows a creatinine bump
from 1.38 to 1.66. No other remarkable
abnormalities. Feels back to baseline
and his current weight is 182 lb.
Resolution of lower extremity edema and dyspnea.
3. Diabetes
Mellitus Type 2 With Diabetic Neuropathy (HCC)
A1 goal <7.0; 7.1 (5/2022)
Microvascular
complications include neuropathy and nephropathy
No
known macrovascular complications
Episodic
hypoglycemia with awareness
On
metformin and degludec
Since
our last appointment he did have 1 episode of hypoglycemia. Recall we decreased his dose of degludec
from 20 units to 18 units at his last appointment.
4.
Chronic Kidney Disease (CKD), Stage 3a Glomerular Filtration Rate (GFR) 45 To
59 (HCC)
Failure
Renal Acute (Acute Kidney Injury) (HCC)
Likely
diabetic and hypertensive nephropathy
Stage
3A
5.
Atherosclerosis Aortic (HCC)
CT chest (2021) showed calcifications
throughout aorta On ASA
6.
Arthritis Spine (HCC)
CT
chest (2022) showed prominent hypertrophic changes in the spine
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May 9, 2022 Completion of Cardiac Rehab
Today is the last day of my Cardiac Rehab program at Mayo and before I move on I have added two components to this special day. The first is the special thanks to the specific staff at Mayo Clinic who made my full recovery possible. The second is my plan of action to take to insure I remain in good health for the rest of my life (for however long that will be).
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May
9, 2022 Final Consultation Comprehensive Visit for Cardiac Rehab
HISTORY
OF PRESENT ILLNESS
James
Messina is a 77 y.o. male who is being seen today for follow-up visit. He began cardiac rehabilitation following
hospitalization for complete heart block and bradycardia status post
dual-chamber pacemaker implantation.
He was noted to have a reduced ejection fraction of 20%; possibly
Takotsubo's cardiomyopathy. Repeat
echocardiography March 21, 2022 noted improvement in ejection fraction to
51%.
He
has risk factors for heart disease to include hyperlipidemia, hypertension,
obstructive sleep apnea, age, gender, and type 2 diabetes. His medication regimen was reviewed and is
on appropriate medical therapy.
We
discussed lifestyle habits, specifically diet and exercise. He notes his diet to be healthy. His exercise habits include treadmill,
bike, walking, swimming. He does
incorporate interval training into his exercise regimen.
He
has completed 12/12 video rehab sessions and 13 of 13 on-site rehab sessions.
He feels as though he has gained
strength and endurance. Overall,
cardiac rehab has been very positive experience for him.
Risk
Factors for CAD:
Tobacco
Use: reports that he has never smoked.
He has never used smokeless tobacco.
High
Blood Pressure: yes
Diabetes:
Type II, insulin dependent
Family
History: no
Hyperlipidemia:
yes
Inactivity:
no
Obesity:
no
The
following portions of the patient's history were reviewed and updated as
appropriate: allergies, current medications, family history, medical history,
social history, surgical history and problem list.
OBJECTIVE
BP
120/56
PHYSICAL
EXAMINATION
Physical
Exam
DIAGNOSTICS
Stress
Test: Non-diagnostic for ischemia due
to permanent pacemaker with below average functional capacity, below average
peak VO2 without evidence of cardiopulmonary impairment, limited heart rate
and blunted blood pressure response to exercise.
6
minute walk test: Initial assessment
76.77% of predicted, final assessment 84.73% of predicted.
DEXA
scan: Initial assessment 30.2% body
fat, final assessment 32.7% body fat
Comment:
Hemoglobin
A1c values greater than or equal to 6.5 percent are
diagnostic for diabetes mellitus.
Diagnosis should beconfirmed
by repeat testing. In diabetic
patients, HbA1c
goals
should be discussed with healthcare provider.
ASSESSMENT
/ PLAN
Failure Heart Biventricular (HCC)
Mr. Messina began cardiac rehabilitation
following an episode of complete heart block with bradycardia for which he
underwent dual-chamber pacemaker implantation. Initial echocardiogram noted EF of 20%
however this has improved to 51% as of mid-March. Coronary angiography noted minimal ASCVD
without evidence of occlusion. He has
risk factors for heart disease to include hyperlipidemia, hypertension, type
2 diabetes, obstructive sleep apnea, age, and gender. Today he is doing well without symptoms of
concern.
We
reviewed final cardiac rehab testing.
Results are outlined above and were discussed with patient in
detail. Of note, VO2 stress test is
nondiagnostic due to permanent pacemaker tracing. He was asymptomatic. His lipid profile is under excellent
control on current regimen of simvastatin.
His blood pressure is under excellent control on metoprolol and
lisinopril. His 6-minute walk test
improved throughout cardiac rehab. His
DEXA scan noted slight increase in body fat composition, however still within
normal limits.
He
was congratulated on his dedication to both healthy diet and regular exercise
and encouraged to maintain healthy habits going forward. Recommend exercise goal of 150 minutes per
week of moderate to intense level cardio and 30 minutes of strength training
per week. Also recommend continued
interval training. He has an
appointment with Dr. Huntley in Cardiology in June of this year.
Goal
blood pressure less than 130/80. LDL
goal less than 100 as primary prevention goal. Both of these goals have been achieved on
current medication regimen.
It
was my pleasure to participate in the care of James Messina. He verbalized
understanding of recommendations and had no further questions.
Alicia
Mickow, APRN, C.N.P., M.S.N.
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SPECIAL THANKS
I
want to thank publicly the following professionals at Mayo Clinic who
assisted me in dealing with and recovering from Heart Failure:
They are:
Dr Diego Suarez MD Internal
Medicine my Primary Care Physician
Dr Geoffrey Huntley
MD my Cardiologist
Members of the Mayo
Cardiac Rehab Staff who worked with me:
Kelsey Paarmann
Jamison Splett
Rosalyn Solstran
Without
the care, support, encouragement and attentiveness to my recovery and healing
I would not be in the place I am today. I owe my future to them and promise
them that all that I learned in this process and in Cardiac Rehab will be
incorporated in my life from this point forward.
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My Commitment to the following:
MAINTENANCE OF HEALTH FROM THIS POINT ON
Physical Exercise:
A minimum of 5 days a week of:
1. 30 minutes on stationary cycle located in our bedroom
2. 2. 20 minutes of stretching exercises on ball and mat located in our bedroom
3. 20 minutes of strengthening exercises with weights, resistance stretch tubes and stretch bands
4. 30 minutes of interval training on treadmill in Condo gym room with intervals of elevated track for 2 minutes followed by no elevated track for 3 minutes
Stress Reduction: On a daily basis utilize MBSR as explained on my website at: (www.coping.us/mindfulnessneurobiology/introtombsr.html) to reduce any tension or stress which comes up during the day and to help me fall asleep at bedtime easily with no problems.
Diet:
Low sodium, no red meat, little to no other meats. More Mediterranean Diet model of meals.
Sleep:
Minimum of 7 hours sleep each night
Social:
1. Engage in Volunteer work at Mayo Clinic
2. Volunteer in our Condo Building
3. Spend one or two times a week playing and having a good time with our 3 grandkids
Health:
Management of Diabetes with daily testing and medications and insuring all of my prescribed medicines are updated and taken daily. Attending every required medical appointment, I am given by my primary physician or my specialist physicians. Maintain my weight below 190 from this point forward.
Weather Permitting:
1. Walking to all appointments or pharmacy pickups at Mayo Buildings
2. Riding my bike in parks and on bike trails
3. Recreational Walking on trails and parks around our neighborhood
4. Swimming in pools
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FOLLOW-UP MEDICAL ASSESSMENTS
June 8 & 16, 2022 Sleep Medicine Assessment
Appearance and Behavior: James Messina is a 77 y.o. male who appeared alert and in no acute distress.
Speech: Normal in rate and volume. Relevant and coherent with no speech abnormalities.
Mood: Affect was euthymic with normal range and reactivity to affect. Affect was mood congruent.
Thoughts: Linear and goal directed with no thought form abnormality. No delusions or thought possession abnormalities noted.
Perceptions: No perceptual abnormalities noted.
Cognition: James Messina was oriented to time, place and person. During the interview James Messina appeared to have normal medium to long term memory and no short term memory difficulties were noted. Attention span and concentration were normal. Judgement appeared to be intact and fund of knowledge was appropriate per the interview.
Risk: Based on current interview no suicidal thoughts and no imminent risk to self were identified. No imminent risk to others was identified.
Insight: Insight was fair.
Neck Circumference (cm): 43 cm
Sleep Medicine provider requested an overnight oximetry test and it was performed on June 15-16, 2022. Results of the overnight oximetry were within normal limits. It showed 2.7 drops in oxygen per hour (up to five drops per hour is considered normal). Therefore, we do not need to make any changes to the CPAP pressure at this time. Sincerely, Carolyn Warner, APRN, C.N.P., D.N.P.
June 16, 2022 Office Visit Dr Huntley Cardiovascular Medicine Clinic
General: Appears comfortable, stated age, and in no acute distress. Pale mucous membranes.
Cardiovascular: soft systolic murmur at the apex. Regular rate and rhythm. JVP is not elevated.
Lungs: Clear bilaterally, normal respiratory effort
Abdomen: Good bowel sounds throughout. Non-tender. Non-distended.
Extremities: No clubbing or cyanosis. 1+ lower extremity edema.
Skin: No stasis dermatitis or ulceration of the lower extremities appreciated.
Neuro: Alert and oriented x 3.
The patient is status post dual-chamber permanent pacemaker on December 24, 2021 for complete heart block. After the pacemaker placement, he was found to have biventricular systolic heart failure with ejection fraction 20%, and this was thought to be stress cardiomyopathy. Ejection fraction has improved to 51% as of 3/21/22. He is on lisinopril 20mg daily, metoprolol 100mg daily, and lasix 20mg daily with PRN 20mg for weight gain. Spironolactone was discontinued due to wavering kidney function and improved EF. He completed participating in cardiac rehab. He currently feels great without signs/symptoms of heart failure.
He has iron deficiency anemia. Colonoscopy with polyps. On iron supplementation.
He has a neurologic spell of uncertain etiology 3/6/22. No cardiovascular cause identified. Seen by neurology, who suspect mild cognitive impairment may have been contributing. No other identified cause on neurologic work-up.
Plan:
- Doing great. Return in 6 months with echo before.
Geoffrey Huntley, M.D.
Cardiology Fellow
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