One morning last summer, 68-year-old Janice Byers arrived for her 9 AM-workout at the Penn Medicine Cardiac Rehab at Pennsylvania Hospital but couldn’t make it past the lobby of the Garfield Duncan Building.
The cardiac rehab nurses were summoned. Janice’s blood pressure, it turned out, was very low. They escorted her to the ER, where she was met by her cardiologist, William H. Pentz, MD, FACC. He discovered that Janice had been prescribed blood pressure medication by two different doctors, and they were working against each other.
Janice says she began feeling better almost as soon as the problem was corrected.
The Penn Medicine Cardiac Rehab at Pennsylvania Hospital opened July 19 in suite 506 of the Garfield Building, 700 Spruce Street, Philadelphia. Its mission is to help stabilize the cardiac diagnoses of those patients who qualify to participate.
“Ideally, we want to restore their quality of life to where it was prior to their diagnosis or cardiac event,” says Jenny Galbraith, one of the nurses at the rehab who met Janice in the lobby that morning last summer.
Among the qualifying criteria, a patient needs to have experienced a cardiac event, such as a NSTEMI (a type of heart attack), or have had a stent placed, or had a cardiac surgery for a valve issue or a coronary artery bypass. For people like Janice, a heart failure patient, there is additional criteria needed to qualify for admission.
Once approved qualifying patients are tested and prescribed a certain number of sessions based on the severity of their condition. Patients are prescribed anywhere from 18 to 24 sessions based on a risk stratification system.
This is about more than exercise
Janice was prescribed 36. She was born with a heart murmur that developed into mitral valve regurgitation. About 20 years ago, she had an internal defibrillator placed which paces her heart and triggers a lifesaving shock for arrhythmias if needed. Aside from a lone incident, Janice says her heart condition stabilized after that. But she gained a significant amount of weight over the years, and she often found herself short of breath and dizzy.
Janice had just lost the weight when her cardiologist, Dr. Pentz, referred her to the cardiac rehab so that she could begin rebuilding her stamina.
Three days a week, beginning last July, Janice arrived at the cardiac rehab for the 9 AM session. The nurses develop an exercise regimen for each patient that’s tailored to their functional capacity and ability. During a given session, Janice may exercise for varying intervals on a variety of standard gym equipment. But before she sets foot on a treadmill to warmup, she’s placed on a telemetry monitoring system that enables Jenny and another nurse to monitor Janice’s heart rate and rhythm throughout the hour-long workout.
“We also check their blood pressure at the beginning and end of the workout, as well as on an as-needed basis,” Jenny says. “And if they’re diabetic, we’ll check their blood sugar at the beginning and end and on an as-needed basis.”
Janice says she wasn’t permitted to begin exercising until her blood sugar reached a certain level. Some mornings, that meant drinking some juice and having a light snack after her initial reading.
“This is about more than exercise. It’s also educational,” Jenny says. “While they’re exercising, we’re teaching them about nutrition, stress, and psycho-social risk factors. Patients also tell us about any concerns they have or symptoms they may be experiencing.” All of this is geared toward making them more aware of spotting and preventing another cardiac event.”
On the verge of completing her time at the cardiac rehab, Janice says her shortness of breath and dizziness are gone. She gushes with praise for the nurses—“They’re always happy to talk with us one-on-one, which helps a lot”—but she says she’ll miss the camaraderie the most. (Patients workout together in small groups.) For example, Janice became especially close with a 66-year-old patient named Anna Wheeler.
“I also suffer from depression,” Janice says. “Anna’s support really brought me out of my shell. Usually, I stay to myself. But I get really excited when I’m getting ready to go to the cardiac rehab, knowing she’ll be there.”
Motivated to do more
Anna was referred to the cardiac rehab after she underwent a percutaneous coronary intervention to clear an artery that was 99 percent blocked, a condition she attributes to high cholesterol.
“I have sarcoidosis”—an inflammatory disease that affects multiple organs in the body, but mostly the lungs and lymph glands—“so exercise has always been difficult for me,” she says. “But I was able to take it slowly and gradually build up my stamina.”
In addition to exercise, Anna, who was prescribed 24 sessions at the cardiac rehab, says she learned about the value of eating a Mediterranean diet and using portion control. She didn’t lose weight by the end of her time at the cardiac rehab, but her exit evaluation showed she added muscle, and a number of her health markers improved.
“That motivated me to do more on my own—I bought an exercise bike for home,” she says.
Like Janice, Anna says that appreciating she’s not alone made a distinct difference in her mindset, even after she stopped attending the cardiac rehab.
“Being able to talk with other people really motivated me,” she says. “I’m an upbeat person to begin with, but that really brought more joy into my life, just being able to share the experience. For instance, Janice would ask me, ‘What did you eat over the weekend?’ I’d say, ‘shrimp alfredo.’ And she’d say, ‘Anna! You shouldn’t have had that!’” The banter is supportive so you don’t feel judged or pressured. Patients encourage each other!
In the end, Anna and Janice thoughtfully exchanged small gifts and promised to stay in touch. The two women are planning to share a heart healthy lunch with the cardiac rehab staff during the holidays.