éWhen I’m not noodling away here on Heart Sisters articles, or writing my book about living with heart disease (due out November 2017!), or doing presentations on women’s heart health, or playing with the world’s sweetest, happiest and smartest grandbaby, one of the activities close to my heart involves a local non-profit agency called Island Heart To Heart. In 2008, as a freshly-diagnosed heart attack survivor – overwhelmed and frightened – I learned so much from the assorted guest speakers at these weekly classes for heart patients! Eventually, I became further involved with this unique organization – first volunteering with patients and family members on the cardiac ward, then as a member of their steering committee, and most recently as one of the facilitators who help to run these ongoing cardiac education classes throughout the year.
With her kind permission, I’m running this guest post by Thelma Fayle (a recent Heart To Heart “graduate”) which sums up beautifully three compelling stories:
- the awful night her partner Daryl suffered a heart attack
- what she and Daryl experienced week by week at their seven Heart To Heart classes
- a moving tribute to the visionary young nurse who started Heart To Heart as a pilot project 29 years ago to help newly-diagnosed heart patients like her own Dad
Thank you so much for this, Thelma!
Improve your Cardiac IQ
by Thelma Fayle
At first it seemed like simple indigestion. We had had a fun dinner with friends and then went to a public lecture at the University of Victoria. Within a few minutes, my partner said he didn’t feel well and stepped out of the room. When he returned a few minutes later, Daryl motioned to me that he was okay and didn’t want to cause a fuss.
He didn’t look okay to me. He kept touching his chest, and leaning forward and shifting in his chair. A few minutes more went by and I passed him a note that we could leave anytime. He shook his head. After five more minutes, I wrote again: “I am leaving.”
As we stood to go, the lecturer asked if my partner was alright. In spite of him having no history of heart disease, I thought he was having a heart attack and said I was taking him to the hospital. The professor asked if he should call 911. I said no, figuring I could get him to the hospital faster.
That could have been a fatal mistake.
When we arrived at the emergency ward of the Royal Jubilee Hospital in Victoria, B.C., more than a dozen people were in line and Daryl, with violent chest pains, sat down to wait. That’s when I told the triage nurse he was having a heart attack. Within a couple of minutes, he was on a speeding gurney. I sat at the desk to register him and the triage nurse said what I knew in my gut I should have done: “You should have called 911.”
I burst into uncontrollable, terrified sobs.
The nurse reassured me, saying, that Daryl was in the right place now. She ushered me to where a group of doctors surrounded him, looking at an ultrasound of his heart. The head cardiologist told me they would take me to a waiting room and he would tell me how things went after they performed an angioplasty. The procedure would take between 30 and 90 minutes, and the cardiologist suggested I could give Daryl a kiss before he went with the doctors. I said I would give him not one kiss, but three.
Then I was alone in the “family room”, overwhelmed, feeling guilty and acutely aware of a vague and terrible risk. A nurse brought me tea and cookies, Kleenex and one of those warm hospital blankets that I held tightly as I stared at the floor in shock.
I called my sister. Barb arrived in 15 minutes. I called a friend who is a nurse, her husband a doctor. “What is an angioplasty?” I asked. They explained – doctors thread a thin tube into the heart and inflate a tiny balloon to open the blocked artery – and they assured me Daryl was in the best place. “Victoria’s Royal Jubilee cardiac unit offers some of the best cardiac care in the world,” they agreed.
An hour and a half later, the cardiologist returned and reported the damage. He said several things that I tried to process but all I heard was “blockages” and that “getting to the hospital as quickly as we did” meant Daryl’s heart was not badly damaged. And finally he said, “I expect Daryl will make a complete recovery.”
They were helpful words.
I am not a weepy person, but I started sobbing again. I wanted to hug the cardiologist, but decided that might be weird, seeing as how he was a perfect stranger. I just stood there like a dummy, looking at him with my mouth agape. Clearly this was not the first time this had happened, since the doctor said the look on my face was the best part of his job.
He directed me to the cardiac intensive care unit where Daryl was attached to lifesaving equipment. I looked at a screen with a pulsing line moving in a measured up and down pattern. The cardiac nurse, articulate and caring, tended to Daryl every five minutes for that first hour. She was efficient in the way you hope every nurse will be. She told me to go home and try to rest and try to eat a good breakfast. Her voice sounded wise and soothing. She gave me a phone number and said I could call the cardiac unit at any time. I thanked her for her beautiful work.
Four hours after Daryl started having a heart attack at UVic, he had had two stents put in (tiny mesh tubes that help restore blood flow through blocked arteries) and he was healing in the good hands of our Canadian medical system.
The cardiologist recommended we sign up for a heart health education program called Island Heart To Heart. Fortunately, the next series of classes was starting six days after Daryl’s heart attack.
One night a week for seven weeks, we listened to experts talk to our Island Heart To Heart class who had, like Daryl, recently experienced some form of cardiac event. (Partners are also encouraged to attend, as any cardiac diagnosis is viewed as a family event.) We were part of the 227th offering of the Island Heart To Heart class here in Victoria, and just two of thousands of local heart patients and their family members who have attended since the program began in 1987.
The program, developed by a team of committed health-care workers, with retired nurse Cherie Davidson primarily credited as a key person behind its success, has been the model for similar programs in cities all over British Columbia. (See Sidebar below*)
On our first night, each participant who had been diagnosed with heart disease described their experience. Some heart attack survivors had chest pain, others shoulder pain or jaw pain, and one woman had had no symptoms other than an unrelenting cough. Every story was different, and the wide-eyed expressions of the tellers relayed a personally terrifying experience. We listened to each other with unflinching attention.
The people who run the program know from experience what we are going through. Carolyn Thomas explained how her heart attack was initially misdiagnosed and dismissed at the hospital emergency department, as women’s heart attacks often are. Henry Wilting explained how he suspected his early childhood experience in a Japanese prisoner of war camp may have had an impact on his heart history.
Just sitting in a circle on that first night with a group of people who had recently become heart patients, hearing their varied comments, helped to normalize our experience.
We were not alone.
The next morning, Daryl and I woke up feeling happy and relaxed for the first time since his heart attack. It dawned on me that for all that time, I had very nearly held my breath; hovering over his every move in my waking hours and having disturbing dreams in my sleep – in which I was swimming in the ocean, and couldn’t see Daryl on the shore.
The introductory evening began to give us a new understanding: we have some control and we can do our best to work through this challenge. Not exactly jubilation, but close enough.
Our first guest lecturer, Dan, has been a Royal Jubilee Hospital pharmacist for 26 years. He spoke to us about cardiac medications. But he started his presentation by clearly stating that the premiere line of defense for all heart patients is to consider lifestyle changes. “Exercise, change your diet and keep in mind that quitting smoking is better than any drug for preventing further heart problems.” Dan went on to use a diagram to explain how the heart works, how it can break down, and how current heart drugs can help.
By the end of the two-hour lecture, we became saturated with facts and understanding: anyone can use the online Framingham Risk Factor assessment tool to determine “heart age”. Coated ASA (aspirin) is easier on the stomach. Don’t forget to prime the nitro spray before you use it to manage angina pain, and if it doesn’t work after three sprays, call 911. The genetics factor is a big indicator of cholesterol problems. Statins, used to reduce bad cholesterol, are the #1 selling drugs in Canada, but there are alternatives for people who suffer with muscle pains or are otherwise intolerant to statins. Generic drugs are good and often five times cheaper. These were just a few of the themes.
A number of participants in the class did not know that a handy little pill-splitter from the drug store can prevent chopping pills with a knife and having them sail across your kitchen counter. Someone mentioned that pharmacies sell the device for $8 or $9, and the Dollar Store sells them for $1 or $2.
Barbara, a longtime cardiac social worker at the same hospital, introduced psychosocial aspects and the four stages essential to recovering from heart disease: survive the crisis, create a coping strategy, handle the homecoming and learn to live with heart disease.
Barb led our group in a discussion of the different ways each of us were learning to take our foot off the gas. All acknowledged that changing habits can be a challenge.
She reminded us that discomfort is an integral part of how we grow, and a cardiac event can offer an opportunity for a new beginning. She cautioned that depression can be a barrier to recovery. The Mayo Clinic suggests that one in five heart attack sufferers will experience depression. She offered us a variety of ways to cope. See also: 10 Non-Drug Ways to Treat Depression in Heart Patients
An engaging part of the evening transpired when she asked each of us to consider what was ‘lost’, ‘gained’ and ‘unexpected’ in our heart attack experience. The responses were rich, beginning with one elderly man who said he had lost his innocence. We began to learn how to face the common emotions (mostly fear) associated with being a heart patient.
Registered dietician Sara walked us through Canada Food Guide recommendations and went over the nuances of label reading on food packaging. She described wise eating habits for heart patients, and we discussed the gamut of food issues on the ever-changing landscape of ‘what is best?’ She suggested a variety of healthy oils. Daryl and I decided to stick with canola for high heat, olive oil for medium heat, and made a note to introduce more flax oil, a good omega 3 source, for unheated use on salads and oatmeal.
This class offered another evening full of tips: Trans fats are bad. Saturated fats may not be as bad as once thought. Beans, peas and lentils are good. Look for ‘sodium free’ or ‘low sodium’ on labels. Sara has found that eating enough soluble fibre is where many people tend to fall down in their dietary habits. She recommended 10-25 grams per day of foods like barley, prunes, oat bran, legumes, grains, veggies, fruit and seeds. She also suggested checking out Half Your Plate for more good ideas.
How often do you ever get two hours of a cardiologist’s undivided attention?
“I think of the heart as a pump,” is how cardiologist Dr. Chris began his informative two-hour talk. He introduced himself by telling us that he started out as a mechanical engineer. There was something very practical and comforting about that reference! He described his important work, and he left plenty of time to answer our many questions about heart disease.
With each lecture, we learn to get more accustomed to the uncertainty of heart disease and the vulnerability it highlights. The course is helping me to envision that emergency room cardiologist’s prediction of a “complete recovery” for Daryl.
Kam is a kinesiologist who spoke to our group about the importance of regular physical activity for heart patients. He handed around two pieces of rubber that had our group as transfixed as a bunch of grade school kids, complete with screwed up faces and tongues sticking out. One was a red five-pound replica of a piece of muscle and the other was a yellow five-pound replica of a piece of human fat. The point: the fat was about three times the size of the same weight of muscle! He mentioned the fat was typical of what you might find on the thigh or backside of an overweight person. And just to pound the message home: he explained that you need to burn 3,500 calories to lose one pound of fat. Burning just 215 calories after eating 40 grams of a chocolate bar takes 54 solid minutes of brisk walking. Burning 3,500 calories takes a lot more walking!
He cautioned that with the many phone apps available, some people can become too obsessive about counting calories. The subtle message about moderation came through with every speaker.
I noticed the initials next to Kam’s name in tiny print on the bottom of one of his presentation slides. This guest speaker has earned Honours Bachelor of Kinesiology, Bachelor of Education, and Masters of Science degrees. He was typical of the high calibre of speakers in the Island Heart to Heart program.
On our last night of the program, occupational therapist Brittany led a conversation about ways of coping with and reducing stress. “Self awareness is key,” she began.
Another onslaught of tips follow throughout the evening: Learn to recognize your own stress. Figure out what triggers your stress. Be aware of how stress feels in your body. Relaxing can take practice – just like any other skill. Recognize your gains. Set yourself up for success. Step back when you begin to feel stress. Get enough sleep. Connect with others. Exercise. Play. Meditate. Focus on one task at a time. And we ended the evening with a soothing five-minute guided relaxation exercise.
At the end of the Island Heart To Heart program, Daryl and I wondered why all people aren’t taught these life skills, pre-cardiac event. But as one lecturer advised, we may not be motivated learners then. Nothing, after all, focuses your attention quite like a heart attack.
This well-established program gave participants a high Cardiac IQ.
And as A.O. Wilson, famed biologist, points out in his latest book, The Meaning of Human Existence,
“We are hard wired by evolution to hope.”
That helps, too.
SIDEBAR: “Thank you, Cherie Davidson!”
After Cherie Davidson’s parents left Vancouver Island on a summer road trip heading east to visit relatives, she received a call from Abbotsford. Her father had had a massive heart attack en route and was being sent to hospital in Vancouver. Cherie remembers the long, painful saga for her family dealing with fear, uncertainty and extended hospital stays.
It was the 1960s, and cardiac patients were sent home from the hospital with only an appointment to return to see the cardiologist six weeks later. Most people who were having heart attacks were poorly informed about pharmaceuticals, diet, emotional aspects of heart disease, and even the straightforward biology of the heart.
As a young nurse, Cherie did some old-fashioned (pre-internet) research and collected information that might help her parents. She was thankful she had a nursing background and knew where to look. A few years later, Cherie did a stint of nursing at Stanford University in California, working with a cardiologist who was doing research on stress as a contributing factor in heart attacks. Cherie explained:
“I had this personal family experience and professional nursing experience and when I came back to Canada I learned there was a group of social workers and cardiologists in Victoria who were getting together to develop a heart-health education program. Of course I was very interested; I didn’t want to see other people go through what my family had experienced.”
Even in the early 80s, heart patients were still going home from the hospital without much information.
In 1987, Cherie helped a group of social workers and cardiologists to design and run a pilot program similar to an educational series of classes that was just starting up in Ontario. She volunteered her time in the beginning, and years later it became a paid position because there was a profound need for so many classes in Victoria.
Twenty-nine years later, the current Island Heart To Heart program still offers the same format Cherie and her colleagues designed.
Two years ago, while the long-retired Cherie was in Cranbrook, B.C. visiting her daughter, her son-in-law had a heart attack. When his cardiologist recommended he attend a local heart-health education program, Cherie offered to go along with him. As it turns out, the very same program she helped to create decades ago in Victoria was once again benefiting her own family!
Cherie Davidson photo: Don Denton/Victoria News
Thelma Fayle is a member of The Writers’ Union of Canada, the Professional Writers Association of Canada, and PEN Canada. Her work has been published in The Globe and Mail, CBC, The Reader’s Digest, the Institute for Public Administration Journal, among many other media. She is also the author/biographer of Ted Grant: Sixty Years of Legendary Photojournalism (Heritage House, U.S. 2014). She lives, writes and volunteers in Victoria, B.C. Canada. Photo of Thelma and Daryl courtesy of Thelma Fayle.
Heart image: Volkan Olmez
Q: Does your community offer comparable educational classes for heart patients like these Island Heart To Heart classes?
NOTE FROM CAROLYN: I wrote more about the importance of educating ourselves after a cardiac event in my book, “A Woman’s Guide to Living With Heart Disease“ (Johns Hopkins University Press, November 2017)