After the surgery, the feet swell
In February of this year, I caught my eyearticle "Shunts are not eternal". The correspondent of the newspaper "Evening Moscow" talked with the head of the laboratory of X-ray-vascular methods of the cardiological research center, doctor of medical sciences A.N. Samko. It was about the effectiveness of aorto-coronary bypass surgery (CABG). Dr. Samko drew a sad picture: a year later, 20% of shunts are closed, and in 10 years, as a rule, everything! To conduct repeated shunting, in his opinion, is risky and extremely difficult. And this means that life is guaranteed for only 10 years.
My experience of a cardiosurgical patient with a largean experience that has undergone two operations of aorto-coronary shunting, suggests that these terms can be increased - primarily due to regular physical exertion.
I view my illness and operations as a challengefate, which must be actively and courageously confronted. Unfortunately, physical activity after CABG is only mentioned in passing, by the way. Moreover, it is believed that some patients after surgery on the heart live safely and for a long time, without putting any effort. I have never met such people. What I want to tell you is not a miracle, not luck and not a lucky combination of circumstances, but a combination of the high professionalism of the doctors of the Russian Research Center for Surgery and my persistence in carrying out my own program of the regime of restrictions and loads (RON).
My story is as follows. He was born in 1935. In his youth, he had many years of malaria, in war - typhus. Mother - core, died at 64 years old.
In October 1993, I transferred an extensivetransmural posterior-lateral myocardial infarction of the left ventricle, and in March 1995, I was given aorto-coronary bypass - four shunts were injected. After 13 years, in April 2008, angioplasty of one shunt was performed. The three others functioned normally. And after 14 years and 3 months I suddenly had angina attacks, which had not happened before. I went to the hospital, then to the Scientific Cardiology Center. Further examination I took place at the Russian Research Center for Surgery. The results showed that only two shunts out of four functioned normally, and on September 15, 2009, Professor B.V. Shabalkin did a second operation for aortocoronary shunting.
As you can see, I managed to significantly extend the average life spans with shunts, and I am convinced that I owe this program to RON.
Doctors still consider my postoperativephysical exertion is too high, it is advised to rest more and drink medications constantly. I can not agree with this. I want to make a reservation right away - there is a risk, but this risk is justified. Realizing the seriousness of my position, from the very beginning I introduced certain restrictions into my system: I excluded jogging, exercises with dumbbells, on the crossbar, push-ups on the hands from the floor and other power exercises.
Typically, doctors at polyclinics refer to CABG surgery asaggravating factors and believe that the operated one is prepared for one: quietly, calmly live out his life and constantly drink medicine. But shunting provides a normal blood supply to the heart and the body as a whole! And how much labor is invested, resources and resources are expended to save the sick from death and give him the opportunity to live on!
I am convinced that even after such a serious operationlife can be full. And I can not accept the categorical statements of some doctors that my loads are excessive. They are feasible for me. But I know that if there was atrial fibrillation, severe pain in the heart or lower limit of blood pressure exceeded 110 mm Hg. Immediately call an emergency doctor. Unfortunately, no one is immune from this.
My RON program includes five items:
1. Physical training, permanent and gradually increasing to a certain limit.
2. Restrictions in nutrition (mainly anti-cholesterol).
3. Gradual reduction of taking medications until they are completely abandoned (I take them only in emergency cases).
4. Prevention of stressful conditions.
5. Constant employment is an interesting activity that does not leave free time.
By gaining experience, I gradually increasedphysical exercises, included new exercises, but at the same time strictly controlled his condition: blood pressure, heart rate, did an orthostatic test, a test for heart training.
My daily physical activities were foldedfrom dosed walking (3 -3,5 hours at a pace of 138-140 steps per minute) and gymnastics (2, 5 hours, 145 exercises, 5000 movements). This load (dosed walking and gymnastics) was performed in two stages - in the morning and in the afternoon.
To daily loads were added seasonal: walking on skis with stops every 2.5 km to measure the heart rate (only 21 km in 2 hours 15 minutes at a speed of 9.5 km per hour) and swimming, one-time or fractional - 50-200 m (800 m for 30 minutes).
In the 15 years since the first CABG operation,I walked 80 thousand kilometers, covering a distance equal to the extent of the two equators of the earth. And until June 2009 did not know what attacks of angina or dyspnea.
I did this not because I wanted to demonstrateits exclusivity, and because of the conviction that the vessels, natural and artificial (shunts), fail (clogged) not from physical exertion, the more tense, but because of progressive atherosclerosis. Physical loads restrain the development of atherosclerosis, improve lipid metabolism, increasing the content of high-density cholesterol in the blood (good) and reducing the content of low-density (bad) cholesterol - thereby reducing the risk of thrombosis. For me this is very important, since the content of total cholesterol in me fluctuates at the upper limit. Only the fact that the ratio of high and low density cholesterol, triglyceride content and the cholesterol coefficient of atherogenicity never exceeds the established norms.
Physical exercises, graduallyincreasing and giving an aerobic effect, strengthen the muscles, promote joint mobility, increase the minute discharge of blood, reduce body weight, favorably affect the work of the intestines, improve sleep, improve tone and mood. In addition, they help in the prevention and treatment of other age-related diseases - prostatitis, hemorrhoids. Nasal breathing is a reliable criterion that the load is not excessive, so I breathe only through the nose.
About dosed walking, everything is enoughinformed. But I still want to confirm the usefulness and effectiveness of the opinion of a well-known surgeon, who did not do sports himself, but was fond of hunting. And hunting is a long walk. It's about academician A. V. Vishnevsky. Since his student years, fascinated by anatomy and perfectly mastered prozectors of art, he liked to tell his acquaintances all kinds of entertaining details. For example, there are 25 articulations in each limb of a person. At each step, thus, 50 articulated areas are moved. 48 joints of the sternum and ribs and 46 bone surfaces of the spine do not remain at rest. Their movements are hardly noticeable, but they are repeated at every step, with every breath and exhalation. If you consider that there are 230 joints in the human body, how much will they need a lubricant and where does this lubricant come from? Asked this question, Vishnevsky himself answered it. It turns out that the lubricant is supplied by a pearly-white cartilaginous plate, which protects bones from friction. There is not a single blood vessel in it, and yet the cartilage receives food from the blood. In its three layers there is an army of cells-"builders". The upper layer, worn out due to friction of the joints, replaces the lower ones. This is similar to what happens in the skin: with each movement, clothing wipes dead cells of the surface layer, and they are replaced by the underlying ones. But the cartilage does not die ingloriously, like a skin cell. Death transforms him. It becomes soft and slippery, turning into a lubricant. So on a rubbing surface a uniform layer of "ointment" is formed. The more intensive the load, the more "builders" die and the faster the lubricant is formed. Is not it a hymn to walking!
After the first operation of CABG my weight was kept inlimits of 58-60 kg (with the growth of 165 cm), I took medicine only in emergency cases: with increased blood pressure, temperature, heart rate, headaches, arrhythmia. The main difficulty for me was my excitable nervous system, which I could not cope with, which influenced the results of the surveys. A sharp increase in blood pressure and heart rate due to excitement misled doctors about my actual physical abilities.
Analyzing the statistical data of long-termphysical exercises, I determined for my operated heart the optimal pulse, which guarantees safety and aerobic effect from physical exercises. My optimal pulse is not unique, as in Cooper, has a wider aerobic range of values, depending on the type of exercise. For gymnastic exercises - 94 beats per minute; for dosed walking - 108 beats / min; for swimming and walking on skis - 126 beats / min. The upper limits of the pulse were reached by me very rarely. The main criterion was that the restoration of the pulse to the initial value passed, as a rule, quickly. I want to warn: the optimal pulse recommended by the Cooper for a man of 70 years is 136 beats / min after myocardial infarction and CABG surgery is unacceptable and dangerous! The results of long physical training every year confirmed that I'm on the right track, and the conclusions made after the first CABG operation are correct.
Their essence is as follows:
• the main for operated is deepA conscious understanding of the significance of CABG surgery, which saves the patient, restoring the normal blood supply to the heart muscle, and gives him a chance for the future, but does not eliminate the cause of the disease - atherosclerosis of the vessels;
• The operated heart (CABG) has a lot of potential capabilities, manifested itself in a properly chosen mode of life and physical training, which should be dealt with constantly;
• The heart, like any machine, needs to be trained, especially after myocardial infarction, when more than 25% of the heart muscle has turned into a scar, and the need for a normal blood supply remains the same.
Only thanks to their way of life and systemphysical training I managed to maintain a good physical shape and postpone the re-operation of CABG. Therefore, in any conditions, even in a hospital, I always tried not to stop physical training, albeit in a reduced volume (gymnastics - 10-15 minutes, walking in the ward and corridors). While in the hospital, and then at the Cardiology Research Center and in the Russian Research Center for Surgery, I went through a total of 490 km before re-operation of the CABG.
Two of my shunts out of four, delivered in March1985, lived through physical training for 14.5 years. This is a lot compared to the data of the article "Shunts are not eternal" (10 years) and statistics of the Russian Scientific Center for Surgery (7-10 years). So the effectiveness of controlled physical exertion with myocardial infarction and aorto-coronary shunting seems to me to be proven. Age is not an obstacle. Necessity and volume of physical exertion should be determined by the general condition of the operated and the presence of other diseases that limit its physical activity. The approach must be strictly individual. I was very lucky that next to me was always an intelligent, sensitive and attentive doctor - my wife. She not only observed me, but also helped to overcome both medical illiteracy and fear of a possible negative reaction of the cardiovascular system to ever-increasing physical exertion.
Experts say that a particular difficulty forsurgeons around the world are repetitive operations. At me after the second operation the rehabilitation proceeded not so smoothly, as for the first time. After two months, there were some signs of angina in this type of exercise, such as dosed walking. And although they were easily taken with the use of a single tablet of nitroglycerin, this puzzled me greatly. I understood? that you can not make hasty conclusions - after the operation, too little time has passed. Yes, and rehabilitation began in the sanatorium on the 16th day (after the first operation to more or less active actions, I started 2.5 months later). In addition, it was impossible not to consider that I was 15 years older! All this is true, but if a person, through his system, achieves certain positive results, he is inspired and self-confident. And when suddenly fate throws it back, making it vulnerable and helpless, it is a tragedy connected with very strong experiences.
Taking myself in hand, I began to work out a newprogram of life and physical training, and quickly became convinced that my work was not in vain, since the basic approaches remained the same, but the volume and intensity of the loads will have to increase more slowly, taking into account my new state and in the conditions of strict control over it. Starting with slow walks and 5-10 minutes gymnastic workouts (head massage, rotational movements of the pelvis and head, inflation of the ball 5-10 times), 5 months after the operation, I increased physical activity to 50% of the previous ones: gymnastics for 1 hour 30 minutes (72 exercises, 2300 movements) and dosed walking for 1 hour 30 minutes at a rate of 105-125 steps per minute. I perform them only once in the morning, and not two, as before. For 5 months after the repeated shunting passed 867 km. At the same time, twice a day, I conduct auto-training sessions that help me relax, relieve tension and restore working capacity. My gymnastic equipment includes a chair, two gymnastic sticks, a ribbed roller, a roller massager and an inflatable ball. On these loads, I stopped until the full explanation of the causes of angina pectoris manifestations.
Of course, the very operation of CABG, not to mention therepeated, unpredictable consequences, possible postoperative complications give rise to great difficulties for the operated, especially in the organization of physical training. He needs help, and not only medicinal. He needs a minimum of information about his illness in order to competently build a further life and avoid undesirable consequences. I almost did not get the right information. Even in the book by M. DeBakey with the intriguing title "New Life of the Heart" in the chapter "Healthy Lifestyle", the main focus is on eliminating risk factors and improving lifestyles (diet, weight loss, salt restriction, smoking cessation). Although the author also pays tribute to physical exercises, but warns that excessive loads and sudden overloads can end tragically. But what is excessive load, what they are characterized and how to live with the "new heart", nothing is said.
Develop a competent approach to the organizationphysical training in my time helped the article NM. Amosova and D.M. Aronov, as well as K. Cooper and R. Gibbs, although all of them were devoted to the prevention of a heart attack using jogging and did not affect CABG operations.
The main thing I managed to do is savemental activity and creative activity, to maintain the spirit of cheerfulness and optimism, and all this, in turn, helped to find the meaning of life, belief in oneself, in their ability to improve and self-discipline, in the opportunity to take responsibility for their lives in their own hands. I believe that there is no other way and I will continue to continue my observations and experiments that help me overcome the emerging health problems.