Question about Cardiac Rehab

[Marge]

Does anybody know of any sites with studies showing whether Cardiac Rehab programs are effective or not?

I had a bit of a set-to with my cardiologist today.

I have been trying to find an exercise program for CHF patients, which my HMO (Kaiser Permanente) does not have. My cardio just says, "Walk." Which I do. (His nurse suggested I might like Tai Chi.)

I said to the cardio today: OK, you don't have an exercise program for CHF, that's fine, but when I get through with this valve surgery, you will eventually have me in a Cardiac Rehab program, right? Nope, sez he. You'll meet with me and a cardiac postop-care nurse, and we'll talk about what you need to do, including exercises. I said: That sounds great, but I want a Cardiac Rehab program too.

He says that I can do these exercises on my own and he claims that "There are NO STUDIES that indicate that such programs are any more effective" than exercising on my own.

There is a Cardiac Rehab program offered by one of the local hospitals that I have heard is really excellent. You need a doctor's referral to get into it, and he did agree that he'd give me a referral if I wanted to do that program -- but I'd have to pay for it myself. (Which I will if I have to.)

 

[terry40]

Marge

Marge

I feel strong about cardiac rehab also, I had to fight with my insurance company for 6 months, but they finally paid in full for a shorten program (only 9 weeks)

They "didn't" recommend it after my surgery either, I asked for it and set the wheels in motion myself, setting up a stress test and finding a local rehab center that would accept my insurance, and having all the paperwork sent there ASAP.

There was this fear of mechanical failure that was alieviated after starting the program, I also exercised faithfully the days I wasn't physically at rehab.

Don't give up fighting for your health, it's worth it!!!

terry40

 

[tlhudson]

I strongly recommed that you push for rehab.

I can't tell you how much it helped me. I actually miss it now that I've been out for a while.

I was in better shape then than now. Although I think my right arm is stronger now (from the 12oz. curls) (but we won't go there).

Contact your insurance company directly and also talk to your surgeon. See what their thoughts are.

 

[maxximom]

I went into a 12 week rehab program after my AVR and triple bypass. It is my understanding that most insurance companies will not pay for rehab after valve replacement..but will after Bypass surgery..go figure.. I was on Medicare, so I had no prooblem
I chose to travel almost a hour 3X a week to Duke for rehab..because they had the Nu Step machine, and none of the local rehab centers here in Raleigh had one. This is a wonderful piece of equipment to use. I also used the Treadmill, Dumb Bells, and various CyBex machines to work out as well as a hour of water airobics..all and all I worked out for 2 hours 3X a week. I hated every minute of it I have just started back at water airobics at my local "Y" I get a really good workout. I will start working out with the Cy Bex equipment as soon as I am in better shape again. I still hate it all..I am the ooooriginal couch potato..but at 73 I had better do whatever I can. I have a real problem walking, for many reasons so the eqipment and working in water works well for me.
I would fight to go to rehab... Its the thinmg you love to hate
Joan
AVR,Triple bypass Sept 25 2001,St Judes Toronto Porcine Stentless Valve, Duke Medical Center. Dr. Donald Glower

 

[ccrawford]

Marge - I was a little skeptical about rehab programs, but I thought I'd try one. It was sponsored by a hospital near me and I figured a few visits wouldn't hurt. I ended up staying for about three weeks until I had built up some confidence re "how hard and how long do I exercise" The two gals that taught the class were well informed, and it was a positive experience. I now have a bike trainer, some dumbells, and a treadmill at home so I can avoid the trip to town. The comforting thing about the rehab course is that you are wired to a monitor the entire time, and they won't let you do certain things if your BP is too high. I'd do it again in an instant, and take good notes so your home program can be of max benifit to you. Chris

 

[bvdr]

Marge,

I came across this and maybe it will help.

http://www.cnn.com/HEALTH/9911/11/rehab.barriers/


I'm a firm believer in cardiac rehab as I know it helped me.

 

[Harpoon]

From what I know, most cardiac rehab is offered to patients after surgery, as part of their recovery process. It's a great thing though the programs can vary. Generally you're talking about regimented light exercize, a few times a week with a nurse or some other medically trained person in attendance. You're on a heart monitor and things like blood pressure and weight are checked regularly. BP is taken before exercise, during, and afterwards.

You can run around all you want on your own, go to some gym or take long walks around the neighbrohood, but if you have a problem come up, if you get shortness of breath or your heart starts skipping wildly out of sync, there won't be anyone there who's trained to help you.

That's the key with cardiac rehab. They know what you have and they know how to keep an eye on you and even keep you from getting to that point of needing medical assistance.

My program was 3 days a week from mid-May until the first week of September. I was on a treadmill, stationary bike, rowing machine, argometer (hand crank kinda thing) and
pullys to build up arm strength. They checked my heart and weight when I came in then I did some light stretching and they hooked me up to a monitor and set me on my routine. It was great and I always felt really good afterwards.

I dunno much about perscribing rehab as a treatment for CHF, however if you're active now, the set routine of a rehab clinic might help you a lot, at least build up some of your strength before you need surgery.

 

[bvdr]

Marge, here is a link to a Scottish study that might help.

http://www.sign.ac.uk/guidelines/published/support/guideline57/resource.html

 

[Georgia]

Sounds to me like your cardio is spouting the Kaiser corporate policy. This whole thing is nonsense. For some reason the health insurers are too cheap to pay for rehab for us valvers but automatically pay for bypass patients. Given that only 10% of ohs is for valve work, their return CAN'T be very good, given that rehab is wonderful for us. They've already paid something approaching $100K for surgery etc., and won't cough up another $3,000 (max) for improvement in overall health, balance, and conditioning. Shame on them.

I would have paid out of pocket if I'd needed to (my insurer was great about Phase II). I've stayed with the same people for Phase III (which is very reasonable - $45 per month) and love it.

 

[Marge]

<< Sounds to me like your cardio is spouting the Kaiser corporate policy. >>

Georgia, that is EXACTLY it. And it's CRAP, forgive my language.

I am lucky -- I can afford to pay for cardiac rehab if necessary and there is an excellent program at one of the non-Kaiser programs in my area, so, one way or the other, I'll get it.

In many ways, however, I've been quite pleased so far with the way the Kaiser "system" has dealt with me, so I don't want to diss them TOO much.

I've had no hassle with a number of things that I know others with private insurance have had hassles with, and my case has been dealt with thoroughly & quite expeditiously since my PCP discovered the "murmur." I don't like my cardio very much personally (but then, I don't think he's crazy about me either), but I think he's competent, except for this wrong-headedness about cardiac rehab. I dearly love my PCP, and I like and am very impressed so far by my surgeon. So two out of three ain't bad. Also, my husband, who's had a slew of medical problems and surgeries over the years, has had excellent care from Kaiser, so we're not dumping our Kaiser coverage any time soon.

 

[Marty]

Rehab forever?

Rehab forever?

I'm still in "rehab" 5 years later. Can't do without it.

 

[Gail in Ca]

I've had both my surgeries at Stanford Hospital.
After each, I was given a folder with lots of info, and told to start walking, adding more time each day. That was my rehab.
I didn't even know about cardiac rehab and it wasn't suggested.
Walking really works, and you can feel yourself getting stronger as each day goes by.
Of course , I missed walking with my terrier for the first few weeks, because she might have pulled me and I didn't want to hurt my sternum.
I have exercised regularly since before my surgeries, so walking was not hard for me.
Now, I do aerobics (step) 3X's a week and walk for at least 45min.
2 days a week.
For someone like me, official cardiac rehab is not necessary.
Gail

 

[Blanche]

When my husband had his valve replaced in l990 I saw a program on TV sponsored by the Arizona Heart Hospital. They recommended cardiac rehab for all of their valve replacement patients. Al's cardio said it was unnecessary. And, I suppose that it is for those who are disciplined, used to regular exercise, and have the proper mind set. That was not Al. Cardiac rehab is more than supervised exercise. It brings a sense of security to know that one is doing the right exercises for their condition and doing them properly. It also brings a sense of belonging and confidence to be with people who have the same kinds of heart issues. And, should there be problems, as there were with my husband (irregular heart beats), medical attention is immediate.

Al's cardio would not issue the order, at first. We didn't know him well. We had fired Al's first doctor and then got this one. I told him right out, " I hired you, I can fire you. I did it once and it gets easier the second time...has something to do with the learning curve!" I was ready, able, and willing to get a different doctor from the Arizona Heart Hospital. The cardio did sign the orders, after he told us that the insurance would not cover the rehab because it "was unnecessary." I told him I'd send the insurance supporting materials to show necessity from the Arizona Heart Hospital. Insurance covered the rehab. The cardio called me a bloody *****. Five years later, this same said cardiologist and his 9 partners started recommending cardiac rehab to all of their valve replacement patients.

The more things change the more they remain the same. Good luck to you. Remember, just because the doctor says so doesn't make it so. If cardiac rehab is covered by your insurance and he plans to state that it is unnecessary in your case, you might want to consult another doctor. So sorry you must endure this.

Kind regards,
Blanche

 

[Marty]

Good advice

Good advice

Good post, Blanche. I don't know why the decision was made by
some doctors, Medicare, etc. that rehab is indicated only for CABG and not for valvers. This certainly not the view of my cardiologist who incidentally is also the admnistrative doc in charge of rehab. I admit I was a little nervous when I was discharged from the hospital program and went to my own fitness center. They have good people there but its not like the hospital monitoring. My prescription when I left was to do 45 minutes treadmill at speed and elevation to get my heart rate near 120 bpm for at least 20 minutes 3-4 times a week. For me at age 77 this is 4.3 mph at 3% grade. I did it this morning. I was a little down feeling a bit sorry for myself before the workout but I felt those endomorphins kick in and now feel really good. I think it is best to participate in hospital monitored rehab post op but then its fine to do whatever makes you feel better later on. Just keep on keepin' on.

 

[Kathy]

I really enjoyed rehab. At 52 and 120 lbs. I was the youngest and slimmest in the crowd. As the mother of an 8th grader, I am used to being in a crowd of parents and wondering if I am the oldest one in the room.

Although I have walked consistently for quite a few years and have a treadmill for inclement weather, I was afraid to push myself after all my problems with a-fib. The nurses were very encouraging. I was glad that someone was monitoring my heart.

I had two cardiologists, one at CCF and a local one. When I aksed each of them about rehab, they said they would recommend it, but that most insurance plans didn't cover it for valve patients. I called my insurance and they said they would cover Phase II for 8 weeks. Phase I was provided in the hospital.

I am torn between Phase III at the hospital and the local health club. I didn't think either one was a good investment around the holidays, because I would be too busy. I have done stretching and walked daily at home.