Life time athletes sharing their recovery program and thoughts after surgery

[bdryer]

Good day gang

I am 56 years old and a life time athlete. I have Sky dived on the Canadian national team. Played both ways in Football, was a gymnast and a greko roman wrestler in my youth. For decades I have snow and water skied. Also for decades I have lived the TRI lifestyle. Weight lifting has continued from my youth to present.

I went through replacement of the AV with a MHV, due severe AS and had a graft of the ascending aorta, due to an aneurism. Diagnosed on Oct 14/10. Surgery was Mar 21/11. I am also living with a blocked LH bundle branch due to the hypertrophy of the LH ventricle. No medical intervention [pace maker] is presently and may never be required.

I was active in the TRI sports and very light weight lifting right up to my surgery date. I was permitted to walk briskly. What I did is carried over the intensity of a brisk walk and applied it to TRI sports and Wt lifting. When swimming I isolated my upper and lower body. I swam only with a pull boy which eliminated the big O2 hogs being the legs and swam purely with total immersion or front quadrant technique. This program was developed by Terry Laughlin. My heart rate was maintained in the mid 80's. Running was with pure CHI Running technique as devised by Danny Dreyer. Heart rate was maintained < 100 BPM. Cycling was done on flats and spun in an easy gear ratio that kept the heart rate from 90-110 BPM. Weight lifting was held to 2 sets of a very easy 8 reps. At no time when lifting did I hold my breath. I made certain I was breathing easy and continuously.

The LH vertical hypertrophy was 16mm as measured by an echo. My aforementioned program kept the hypertrophy from worsening, which was of major concern. FYI 16mm is the upper limit of a diagnosed "athletes heart" condition. The heart can fully recover from 16mm.

I am starting this thread so life time athletes can share our exercise recovery experiences be it within the confines of the recommended recovery text, or improvised by you and or your medical team personally.

I believe the recovery text to be outdated and directed to non athletes. I'm encouraging all athletes to share what they believe to be an intelligent active recovery program. You are also encouraged to share your set backs.

Thanks

 

[bdryer]

I will add my post surgery recovery program to this thread later today. I'm to pressed for time at the present.

 

[normofthenorth]

I've been into, and avidly competitive in, various court sports all my life. Tennis and Badminton, Varsity squash and league squash for decades post-graduation, competitive volleyball after squash-court access got $$$, urban bicyclist who hates to miss a yellow light, etc. Never been one for "pure" running or tri-comps, or repetitive gym routines, etc., but happy to beat my body to a pulp while chasing down and pounding various size balls -- including a few sessions of 3 hours straight of competitive 2-on-2 beach volleyball with 3 guys who were 30 years my junior(!). All those things were done with a BAV that my surgeon said just barely got me to the OR only a couple of years later.

My rehab has been fairly wimpy and gradual, except for two great Whistler ski weeks. Chest-strap HR monitor, played it by ear, stopped often to check the numbers, waited until my HR was <110 before blasting off again, tried to stay <140 before stopping, hit 150 maybe twice on the second trip (w/o Metoprolol). Always felt wonderful during the ski trips.

Started a formal Cardio Rehab class ~a month ago, while still on Metoprolol. I wish they'd redone the initial stress-ECG since I dropped the B-blocker, to get a new baseline. Soon, I think. My prescription started with one 16-minute power-walk mile (plus warmup and cool-down), then switched to two of them. In both cases, 5 days per week. I'm having no trouble walking the two miles, but I AM having trouble finding the time and motivation to do all that boring stuff 5 days per week! My HR seems to be steadily dropping toward my old normals, like ~110 or lower after the 2-mile walk, so I'm not sure it's even still doing me much good. But if I set out to swim with HR in mid-80s like BDryer, I still might never get into the pool!

My resting HR right this minute is around 69, but it's often in the 80s or 90s when I haven't been doing much more than standing or getting out of a chair. I THINK that's still a lot higher than it was pre-op, but I never focused on it much pre-op, other than counting it out some mornings before getting out of bed (usually ~58 or 59) and asking my Docs what they got when they tested my BP (usually ~65-ish).

I've run/jogged a few bursts in the course of ADL, and it's felt terrific. In fact, at almost 5 months post-op, I haven't felt any cardio "symptoms" for several weeks. I'm hoping my rehab class changes my prescription to running or cycling at higher intensity than the walking (I'm not sure I can physically walk a 15-minute or faster mile!), and I'm REALLY hoping I'll be cleared for chasing and pounding a volleyball soon (though Summers are mostly for racing small sailboats).

 

[bdryer]

Hi Norm

Excellent contribution!

Regarding pre surgery swimming, with my heart rate maintained to the mid 80's, you can't imagine how cold I was. Very often the guards would throw a large towel over my shoulders when I exited the pool. That was almost as nice as the warm blanket served up in CICU. It took me almost 40 min to swim 1500 meters or a metric mile. It was so worth it as I was very rejuvenated after the session.

One symptom that I no longer experience pre surgery to now, is that I no longer have heart pain! Pre surgery if I pushed it a little, my ticker would give me notice and I either reduced the intensity or stopped all together. I attribute that to going from an AV opening of .5cm to 2.3cm. Ahhhhhhhh!

 

[johnp]

I covered a lot of this in
Post Op Exercise Stress Test: Good and Bad

But in summary

Major concerns with PVCs and non sustained VT for a couple of months post op, but this seems to be resolving, slowly but steadily.

I supplement my outside running with cardiac rehab 3 days a week. The EKG is helping confirm the points raised above. I really push it at rehab.

I started back into walking and running, mixed, now almost 4 months post op, I am able to run about 5-6 miles, but much slower than I ever did before.

I don't quite understand exactly why my exercise tolerance is so low. I am guessing it has something to do with 02 obsorb or circulation. Its not the end of the world, just a puzzle.

 

[bdryer]

As advertised here is my post surgery exercise regime and progress:

In the hospital I wore out the floor in my cardiac unit. I was hospitalized for 9 days. Released on the 10th day. I walked very slowly yet very often during the course of the day, for periods of 5 min initially to 10-15 min on discharge. In the early days post op, if someone walked with me and we talked alot, I was working for breath. This got better as time progressed.

Home from the hospital and started my walking program. I wanted to do an hour of walking per day. Initially I walked twice a day in splits of 30 min. Walked very slow for the first few days and did not cover a lot of ground. Stopped usually once or twice to just stand and rest.

On the 8th day after discharge I picked up the pace and reduce the duration to 42 min. The next day was same intensity but upped the duration to 55 min. Took the 10 day off from the walking program.

Suddenly on day 11, for the first time in my life I started power walking. I was embarrassed implementing this technique as I believed I looked like a dork! When someone approached I dropped my arms and walked manly. After passing the person I would resume power walking. OMG I thought, all I am missing is an outfit from LuLu Lemon! I could not power walk an entire hour initially and worked up to it. By day 12 from discharge I was walking 1 and 1/2 to 1 and 3/4 hrs with a combination of power and manly walking, sans LuLu Lemon attire!

On day 15 from discharge I was staring at my naked body in the mirror and thought, " I look like a bloody geriatric scarecrow". This when I went downstairs and started to reacquaint myself with my home gym. I lectured myself that, "I AM NOT ALLOWED ANY UPPER BODY EXERCISE". OK legs only and do not use your arms for anything. I did a very very light set of 10 reps just to reacquaint myself with the movement.

On day 16 after discharge I walked two splits of :45 min at a vigorous power walking pace. The sternum was secure so I exaggerated the power walking technique. I no longer switch to manly walking when people approached. I just wave, smile, continue to shift my hips and pump my arms. At 2/3 of the way through the second split I thought Hey, " I must be getting the power walking technique down, as my gluteal muscles were getting sore".

Day 17 was a rest day.

On day 18 into day 19 it snowed 23 cm's. It was a blizzard outside so I elected to mount up my time trial bike on the stationary trainer. I was very carefully about managing my healing sternum. Pre surgery I adjusted the stem so the bars were about 1 inch below the saddle in the anticipation of riding with a healing sternum. The front wheel was placed into a block that made the bike level, eliminating a negative angle. I spun for 46 min. I was able to comfortable ride in the aero position with my elbows in the cups! I started feeling fatigued at 40 min, so backed off and spun easy for an additional 6 min. My goal was for 1 hr but gave up. At the end of the stationary ride I did 2 sets of light leg wts. Felt very fatigued and lounged on the sofa for the rest of the day. Felt like I just did an Olympic distance TRI.

On day 20 after discharge, after rising for my morning cup of Joe I thought I feel great! OK as it's a winter wonderland outside, more Time Trial bike bike on the stationary trainer. Spun a very comfy :56 min. An hour was again the goal but this time, as soon as fatigue started I dismounted. I'm now 1 mth post op and started to rebuild the upper body. My limit is 10 lbs period! I devised a dumbbell work out with NO CHEST. Since I was now an ace at not using my arms, I was able to lay on the floor and do an Ab workout. Straight legs strained the sternum so I did my AB exercise with bent knees. This worked beautifully. Like an experience armless amputee, I popped up from the floor! I had an excellent session and felt great!

On day 21 after discharge, I started doing 1 min very easy running intervals with my power walking. I did a total of 12 min jogging with 48 min of power walking. When running I keep my elbows in and bent at 90 deg with no exaggerated movements to protect the sternum. I incorporated pure fore foot running technique for maximum shock absorption.

On day 22 after discharge I ran very easy for :20 min. I planed the route so it was marginally down hill. I counted out loud every 5 min to make certain I was not overexerting myself. I did a very easy power walk for the following :40 min. I was bagged! Again I felt as though I had done an Olympic distance TRI and spent the remainder of the day relaxing.

On day 23 after discharge, which happens to be today or 32 days since surgery, I woke up feeling great. I did a 1 hr giver power walk. After I finish typing this, I'm going downstairs to work on the geriatric scarecrow. I will repeat my 2nd upper body dumb bell and Ab work out. Again, no chest or exercise that aggravates the sternum limited to 10 lbs.

So far my exercise recovery program is going great. NO HEART PAIN! The Sternum knitting is progressing nicely after 32 days. No clicking or popping sounds. It's still a near death experience when I sneeze! I must continue to be very vigilant of my mending heart and healing sternum. I must listen to my body and be intelligent in my approach to what is a non text book recovery program, which I am winging as I go. So far so good!

I am adhering to the intensity table as my guide. On an RPE scale from 6 to 20, 6 being resting, [if 6 is resting, what's 1? Dead? LOL] I'm maintaing an effort of 6 or fairly light, to 13, somewhat hard. When I ran for 20 min I went over my target to 14, which is talking more then 4-6 words may be difficult. Unfortunately thats running, no matter how easy you make it!

I'm digging this independent nonorthodox approach to my recovery. It makes for great conversation and produces criticism from friends and family. If they the critical, one day wake up in CICU, I may consider their advice. I'm the one who went through surgery and woke up in CICU, not them. I recognize a flaw in the generic recovery text for open heart surgery written eons ago, that neglects conditioned athletes. I'm writing my own. For those that care to join me, please jump in and share your program and experience!

Good luck!

 

[bdryer]

Hi johnp

Are you on Beta blockers. If so that would add to the poor athletic performance.

 

[tprice54]

Nice post! You can tell those life long atheltes (especially runners) and their logs!

 

[bdryer]

You betcha Tom! I've got a closet stuffed with decades of athletic journals!

 

[Greg a]

my hand cramped on the TV remote so I moved to Xbox

 

[bdryer]

Greg a, you kill me! LOL. I so love your marvelous sense of humor! One of these days you will really have to get risky and do the Wii thing!

 

[ar bee]

I took it slow and low for the first three month post surgery, just some walking, slow pace on the treadmill and the like. Then gradually upped the stakes (always with a Polar - trying to stay within 120-140 range with the occasional burst to 150); now Im into high altitiude hiking (last year went all the way up to 4600 above sea level), mountain biking and skiing.

regards
ar bee

 

[Greg a]

Greg a, you kill me! LOL. I so love your marvelous sense of humor! One of these days you will really have to get risky and do the Wii thing!

 

[normofthenorth]

I've got a quick question for AVR jocks: Does anybody know what harm we're risking if we overdo post-op?

The nurse who's running my Cardio Rehab really wants me concentrating on walking 2 miles a pop (@16 mins/mile), with at least 5 mins for warmup and cool-down. Not keen on a bunch of things I want to start doing, like bicycling in traffic and making all the yellow lights. I did some of that last night, and finished with a HR <105, so I think my heart finds it pretty boring, unless I throw in some hills or longer distances. She's made her preferences clear, as has the resident Cardiologist -- including for sustained, whole-body exercise -- but I don't know what I'm at risk of, if I'm "bad".

Many of my Rehab class-mates are at high MI risk or such, but I don't think I am, post-AVR. My sutures and grafts and such should all be healed now, so I'm roughly back to normal except for "remodeling" and such. My main fears are about developing arrhythmias, like A-fib or V-tach. Anybody know if those risks increase with excessive or sudden (or just upper-body) exertion?

 

[bdryer]

Hi Norm

I don't think we can dislodge any sutured repair. This has been my big concern. If any one knows different, please chime in. I have taken an entirely different approach as you know. Today I'm officially 5 weeks post op and did the following :- Rode my Time trial bike on the stationary trainer for 25 min. Did 2 sets of upper body weights, [ I have progressed from 10 to 15 lbs max ]. [This included seated bench press, again no more then 15 lbs]. I then ran a very easy 30 min and walked for 15. My heart rate was kept below the low 90's. The BB help. LOL! I feel great and have no soreness or pain. I'm waaaay outside the recovery manual. For me and me alone, my self made program is going great!

 

[normofthenorth]

My guideline (rule of thumb) has always been ~6 weeks post-op for normal healing -- sutures, sternum, incisions, etc. -- + or - a bit for "YMMW" individual variations. I'm certainly not worried about popping sutures or incisions at 4.5-months-plus. But I can just picture my chief Cardio-Rehab nurse's stern expression whenever she tells me that I'm either in THEIR rehab program, or I'm running my own, but not half-and-half -- and I'm looking for the answer to the classic question in all the jokes and comic movies: "What's the worst thing that can happen?!?"

Today I bicycled aggressively down to the shore of Lake Ontario, toodled hard along the shore for a half-mile or so, then trudged aggressively back home (OK, really only to the nearby grocery store!). I was huffing and puffing for some of the uphill trek, but my pulse seemed to be <110 when I stopped. (No drugs.) Whole trip was maybe 35-40 minutes. Felt great, healthy, normal (though out of shape) the whole time. Normal, healthy out of shape, not clinically out of shape. I can't imagine getting that good a workout by power-walking, and I'm not even convinced that holding my heart rate near 105-ish is enough to do me much good. I'm hoping for a redo on the stress test when I go to Rehab on Tuesday. The only one they've seen was a whle ago, when I was on Metoprolol, and I don't think it's meaningful now.

 

[bdryer]

Hi Norm

Sounds as though you are doing GREAT!I have been through physio on several occasions for sport related injuries. I did their program and added some of my own. Once I learned the exercises I was pretty much on my own, as I am dedicated and self motivated. I maintained the appointment for the additional treatment such as ultra sound and icing.

I still do various phsio exercises on a regular basis for sports injuries from 25 years ago. Helps keep the past injured area strong and free of further injury. Non athletic/fitness folks do not understand that the programs you learn in rehab are for life, not just for the recovery period. I believe the same applies to cardio rehab.

As you are having a stress test in the near future, talk your rehab over with the cardiologist and get some direction from him.

I plan on going through the cardiac rehab program so my progression can be monitored and I can learn from The beneficial exercises. As well I will continue my own program. If they throw me out, so be it!

 

[tprice54]

So now you know that cardio rehab is good, but can be limiting if you are not one of their routine cases. As long as your cardio is okay with your workouot, then no problem. Next time yor are on the Lake Ontario shore line, let me know and I'll give you a wave over the lake!

 

[bdryer]

Tom

If I'm that close, I'm coming across for a beer, a dog and a Yankees game!

 

[tprice54]

Grew up (and am 30 minutes south) of Oswego on Lake Ontario. When I worked at the electric generating station with a 750 ft. stack, you could see the lights of Kingston at night from the top of the stack! Then I moved to Buffalo, where, hey, Canada is like are our suburbs!