October 28, 2015
Story by Gregory Kennedy; photo by Dale MacMillan
EDMONTON — Active and fit all his life, Robert Preston is no stranger to mountain-climbing to the legendary Inca citadel of Machu Picchu in Peru, or strapping on a backpack for global hiking adventures over his 68 years. In fact, he couldn’t have been more surprised when his doctor told him he needed a triple coronary bypass.
But rather than cave in to the fear which can see pre-operative patients afraid to even go for a stroll, the Sherwood Park retiree took action and advantage of a new option offered through Alberta Health Services (AHS) at the Mazankowski Alberta Heart Institute.
Getting into the best possible shape physically and emotionally prior to surgery makes recovery easier — and the province’s first Cardiac Pre-hab Program is doing just that for more Albertans like Preston prior to their coronary bypass surgeries.
“When I first found out I was going to need surgery, they shared good information on what I should expect down the road,” says Preston, who underwent a triple bypass in August, and who credits his pre-hab for putting his mind at ease.
“Obviously, you want to work out a little bit and try to do as much as you can,” says Preston, whose surgery date was swiftly moved up when his heart was found to have increasing symptoms during a pre-hab appointment. “It was just wonderful care. I felt more comfortable with the process. It helped with my anxiety. After all, it is major surgery. But I never really worried about it too much, thanks to the program.”
Studies indicate patients who opt to take part in coronary pre-hab can look forward to shorter hospital stays, fewer complications and faster healing, says cardiologist Dr. Gabor Gyenes, medical director of the new program.
Patients also find it easier to stick to their post-surgery rehabilitation program, he adds.
“It has been shown that patients who are recommended for bypass surgery, when it’s not urgent, may have to wait several weeks at home,” says Dr. Gyenes. “They tend to not do anything physically — because they are worried — and that’s the worst thing.”
Nurse practitioner Andrea Van Damme, program lead, says cardiac pre-hab also:
Allows for frequent re-evaluation of the patient’s symptoms and heart stability.
Reduces patient anxiety by providing knowledge and emotional support.
Helps patients to better manage risk factors, such as diabetes and blood pressure.
Provides nutritional counselling to support healthy weight loss.
Shares appropriate physical activity guidelines for patients to follow at home.
“We teach them correct lifestyle, correct diet and do supervised exercise programs with them,” says Dr. Gyenes. “We start with low-level exercise and build it up from there, so that they do not become couch potatoes while waiting for surgery, or become de-conditioned and gain weight, or wind up in worse physical condition than they were.”
Van Damme adds: “This program goes a long way to providing patients with the resources they need to make positive changes before their surgery. The fear alone can be disabling. This allows patients to regain some control during a time of high anxiety and stress.”
During coronary artery bypass graft (CABG) surgery, the surgeon uses a healthy blood vessel from another part of the patient’s body to create an alternate route, or bypass, around narrowed or blocked sections of their coronary arteries — thus allowing more blood to reach the heart muscle.
Patient safety is the priority, says Dr. Gyenes, who expects 150 to 200 patients a year to take part in cardiac pre-hab — but only if they are among those deemed stable enough to be on a waiting list. Those who require expedited surgery will receive it sooner.
Meanwhile, pre-hab patients also benefit by being able to spend time and swap stories with rehab patients as they exercise together and attend the program clinic.
“They can see for themselves what’s happening with a patient who had the surgery,” says Dr. Gyenes. “As they share stories with those who have already been through a bypass, it’s basically like being in a support group.”
“They stick to rehab better after surgery,” adds Van Damme, “because they’ve seen some of the benefits already before surgery.”
The Cardiac Pre-hab Program is part of the Northern Alberta Cardiac Rehabilitation Program, which sees patients from Central and Northern Alberta as well as across Edmonton Zone. Out-of-town patients, if they wish, can receive their consultations via AHS Telehealth video conferences.
“We’re fortunate to have an incredibly dedicated multidisciplinary front-line team,” says Kara Penney, program manager for the Northern Alberta Cardiac Rehabilitation Program. “Our team consists of nurse case managers, exercise specialists, occupational therapists, a social worker, a dietitian and a pharmacist. It’s through their dedication and commitment to patient care that we’re able to deliver a pre-hab program that meets both their physical and emotional needs.”
Participants in the Cardiac Pre-Hab Program exercise in the state-of-the-art Jim Pattison Centre for Heart Health, thanks to $2.5 million raised for equipment, research and education through the Jim Pattison Foundation, in partnership with the University Hospital Foundation, which helps make programs such as this possible.
In recent years, the foundation has also funded the Pattison Centre with $384,000 for operational costs in support of programs such as cardiac pre-hab and rehab, as well as $1.125 million in capital funding and $750,000 for equipment for cardiac rehabilitation — with an ongoing commitment of $1.7 million more for cardiac rehabilitation research and education.
Dr. Gyenes says the team also intends to conduct further research to add to the body of knowledge of how a groundbreaking program, such as pre-hab, can positively influence the outcomes of CABG patients.
“It’s always exciting when you bring something so simple and yet so new,” says Dr. Gyenes. “This is not earth-shattering. We know what’s good for a patient after surgery — and now we’re applying it before surgery. It makes perfect sense.”
And Preston agrees.
“In the wintertime, I like to go to the Millennium Place (recreation facility) five days a week with my wife. We also like to do some snowshoeing,” he says. “I would say we’re fairly active. Now, since my surgery, I’m ready to go again.”
