INDIAN RIVER COUNTY — Nancy Geary went into Sebastian River Medical Center for a test last January. She was nonchalant about it and told her husband he needn’t bother come along as it was just an exam to find out more about a nodular that was detected on her lung.
She told him she’d be home in a couple of hours. But he insisted on coming and it was a good thing he did because it turned out Geary had a 95 percent blockage in an artery to her heart and within hours was transferred to Holmes Regional Medical Center in Melbourne for open-heart surgery.
“They call it the ‘widow-maker,’” said Geary, 74, of Sebastian. “If it wasn’t for that test…well, they just about lost me.”
Geary is among more than a thousand heart patients who have been cared for at SRMC.
Although she had her bypass surgery and removal of the benign nodular at Holmes, her immediate urgent care and follow up cardio rehabilitation were addressed by SRMC’s ER and Cardio Rehab Department.
“They gave me wonderful care,” she said. “They saved my life.”
Her sentiments are echoed by other cardio patients who have cycled through the hospital’s circle of care.
Many of the cardio patients come via the ER where they undergo an electrocardiogram, or EKG, a test that checks for problems with the heart’s electrical activity.
If deemed necessary, the patients are taken to one of its two catheter labs where a specialist performs interventional procedures to help save their life and/or reduce their pain.
Physicians at the hospital have performed 980 heart procedures since April 2012 that include either stents angioplasties.
If it isn’t an urgent cardiac “event,” the doctor recommends they connect with one of its local cardiologists for ongoing follow-up and care.
In addition, the patient meets with Carol Lehoullier, an registered nurse and cardio rehab specialist, to establish a rehabilitation plan to get them back on their feet and prevent future problems from occurring.
In cases such as Geary’s, where a patient’s heart is in ‘code blue’ mode or indicating likelihood of cardiac arrest – swift action is taken.
Brad Guffin, a registered nurse and director of the ER, said time is of the essence when it comes to treating a person suffering a heart attack or edging toward it. He said people should call 911 immediately.
“Time is cardiac muscle, just like time is brain for stroke.”
For those who walk into the ER with complaints of chest pain, they are whisked to a room where they are given an EKG which produces results within a minute or two to determine if they are having a heart attack, said Guffin.
If so, the catheter lab is notified while EKG results are faxed or sent via iPhone to the patient’s primary care doctor and/or cardiologist.
Meanwhile, a myriad of tasks are performed by medical staff such as taking blood work, hooking the patient up to oxygen and connecting them to a cardiac monitor, attaching an IV, taking a chest X-ray to make sure the person isn’t having an aneurism, consulting with the patient’s cardiologist and keeping the patient calm.
The goal is to work expeditiously. If it doesn’t appear to be a major cardiac episode, staff will run blood work every eight hours two more times just to keep a close eye on what the heart is doing.
“Everyone presents differently,” said Guffin. “There’s not a cookie cutter way to describe symptoms. Some experience left elbow pain, but are really having a heart attack; others have back pain, jaw pain, heaviness in the chest or shortness of breath.”
Complaint of chest pain is among the top 10 issues reported to ER staff, said Guffin. However, it’s not always a cardiac issue. It could be a painful pulled muscle, blood clot in their lungs or heart burn.
“Until we know, we assume the worst until it’s ruled out.”
Procedures that could be necessary include angioplasty and applying a stent. These patients usually stay in the hospital at least one night to be monitored closely.
The next step after surgery is rest, and then rehabilitation which takes place at the Cardio Rehab Department where patients are monitored by Lehoullier, whose job it is to help cardiac and pulmonary patients build up strength after undergoing angioplasties, stents and bypass surgery.
During 2012, 75 patients were involved in the program.
Rehab for each patient varies, she said. Classes are small with just four patients in each hour-long class. Attendance is preferably three times a week for 12 weeks, the amount of visits Medicare will cover.
Each patient works at his or her own level.
For example, a 50-year-old who is in great shape and an 80-year-old who has other medical issues and bad knees and a back problem may be in the same class but working at different levels.
“All things have to be taken into consideration in addition to cardiac issues. Don’t push them more than they think they can be pushed.”
Each patient wears a cardiac monitor and the nurse checks their blood pressure and oxygen levels to be sure they are exercising at a safe limit.
“Lehoullier is big on education while they are exercising,” she said. “I’m always up there yakking about something!”
That is, giving them guidance on safe exercise limits, explaining what a heart attack is and offering them suggestions on how to carry on.
“Some of them are scared to death,” she said. “For example, a 50-year-old had no idea he had a heart issue, and went from a stress test lab to a catheter lab immediately into surgery. That was wham-bam-thank-you-man.”
“I try to give them confidence they are going to be OK, they aren’t going to die, they can go back to their normal life,” she added.
Doing exercise with others who’ve experienced a major heart issue is healing for patients.
“They learn more from each other than they do from me some days as they exchange stories. They have met someone who is going through the same thing they are – heart attack, raising children, the stress of all that. Sharing stories helps build a good camaraderie among each other.”
The goal of cardio rehab is to make the heart stronger as well as the rest of them stronger. Equipment includes a stationary bicycle, machine that works the legs and arms simultaneously and treadmill.
Lehoullier demonstrates the use of free weights and encourages patients to do them at home.
“Exercising is one of the best things to do for anything that ails you,” she said. “It brings the cholesterol down, controls weight, helps with arthritis, reduces depression and helps you sleep better.”
Once patients have completed the standard rehab program, they are encouraged to continue the program on their own or sign up for the maintenance program which isn’t covered by Medicare.
That’s for people who may have a hard time with self-discipline when it comes to exercise, or are on oxygen or a walker and can’t go to a gym easily. These patients aren’t on a monitor but are watched by the staff nonetheless.
To get approval for rehab, the patient has to have a doctor’s referral, then Lehoullier will do an assessment.
Medicare will pay up to 36 visits – that’s three times a week for 12 weeks, which Lehoullier says is a good basis for getting patients established on an exercise routine.
Lehoullier is avid about boosting spirits along with improving strength.
“I try to have fun, I wear goofy socks which gets them to laugh. They need to enjoy coming here, and feel like it is not a chore or else they aren’t going to come back. If I have them get on a treadmill, stare at them, and tell them to go fast, they wouldn’t enjoy it. What I have to offer is the education, but also the fun while they are doing it.”
“Some of them are scared out of their mind, afraid of doing anything,” she said. “If they come here, they learn they don’t have to be worry-warts, and can put life into perspective to carry on.”
