Welcome to Dr. Warrick's podcast channel. Warrick is a practicing cardiologist and author with a passion for improving care by helping patients understand their heart health through education. Warrick believes educated patients get the best health care. Discover and understand the latest approaches and technology in heart care and how this might apply to you or someone you love. Hi, my name is Dr. Warrick Bishop, and I'd like to welcome you to my podcast and videocast station. And today I'm absolutely delighted to have as a guest from the other side of the world, but previously from this side of the world, Angela Hartley, who's a registered nurse with a strong interest in cardiac rehabilitation. Welcome, Angela. How are you? Thanks. Thank you for having me. As we were talking about before, you were trained in Australia, but you've ended up back in the United Kingdom. Tell me how your training led you towards cardiac rehabilitation. Well, I did all of my nursing training in Australia, always in cardiac, which I loved, even as a student, just did cardiac, cardiac, cardiac. Worked in Brisbane, one of the big hospitals, did all my training there. And then when I moved to the UK, just for a little working holiday, While I was waiting for my nursing registration over here, which takes about a year, I worked in a gym and I never previously worked in a gym. It was just an easy way to get going in the UK. Then when my registration came through in the UK, I worked in some cardiac wards for a few months and then into ICU and recovery. And always in cardiac, so still kept up with all the heart patients. And then after a couple of years of doing that, a job came up in cardiac rehab. And I thought, why not combine the two? So to combine the exercise and the nursing, which is the perfect job for me. So I understand that you've actually, you're now running your own cardiac rehabilitation business, which is exciting. What's the passion for you about this area of medicine? What would you say makes you passionate about cardiac rehabilitation? Well, the reason I set up the business about doing cardiac rehab is I found that there was a real gap from when people went home from hospital after a cardiac event. So if they'd had a heart attack or a pacemaker put in or any cardiac surgery. there was this big void. And whilst many people in the UK do get entitled to cardiac rehab, which is once a week for between six and eight weeks, I found that after that, they felt really left out in the wild and they didn't have that support network afterwards. So I'm sort of trying to fill that gap and give people the confidence to carry on after their... state-led cardiac rehab and to carry on with exercise and get back to doing normal activities and feel really good about themselves. So I'm really passionate about really getting people their confidence back, in particular with exercise. Do you find that these regular visits that you're structuring with these patients are part of not only moral support, but accountability to make sure that they stay on the right path, because it is easy to return to old habits that may have got them in the wrong place in the first place. Yeah, absolutely. And it's a little bit of an ongoing joke, but I've become... part counselor, part friend, part slave driver. So, you know, it's sort of mixing them all together to say, right, you have to turn up at least once a week. Some people do more often, some people do less often and they're just checking in with me every now and then. But I have a little homework book for them and I fill it in with what I'd like them to do throughout the week. And that might be, depending on the stage they're at, they might just need to do a 10 minute walk every day. And then for other people, it might be significantly harder than that, depending how far down the line we are. But yeah, absolutely. Accountability definitely helps. And having someone be your cheerleader and having someone check in on you every week to say, oh, you know, this happened this week. What should I do next time? You know, I was walking up a hill and I felt breathless. Did I go too fast? What should I do next week? So do you find within the groups that you take who run through your course, is there a lot of interaction between the individuals participating? Do they support each other as well? And is that a valuable component of rehab to your thinking? So at first I didn't have that component and it was all one-to-one work. And people really loved that and they got the benefit and they really felt listened to in comparison to the group classes they may have been to in the past. But once we were a few weeks or months down the line, what I felt was missing was that group element. So I did set up. a local group. So we meet once a month and there's between 20 and 30 people a month come and they have a little chat and a cuppa. And then, you know, I give a speech about a different topic and then I try and get guest speakers along every month as well. That's fantastic. A nice cuppa with 20 or 30 people on a regular basis sounds like a really good get together. exactly it's it's a nice place for them to chat about you know all my medication and this you know this has happened and my doctor this and you know like even if it's um we're not giving medical advice we're there just to sort of have a bit of a mutual um chat about our own problems because sometimes your family doesn't understand certainly I would imagine that for individuals, it must be nice to know that they're not alone travelling this particular path. So there's strength from others' experiences and surely the interaction gives support both ways, I would think. Yeah, and there's that moral support as well. We've got a guy who is now running... uh 10k every week and you know he's our inspiration because some of us are at the beginning of the journey and he's you know obviously quite far down the line and just listening to people how they've been through so much but there is another side and you can come out you know stronger and and do more again so one of the things that intrigues me a bit is uh obviously men and women are affected by coronary or cardiac disease, whatever it may be. In your experience, do you think that men and women travel a similar path or do they have different journeys? I'd say they're fairly different and it depends obviously personality to personality and how they got to the place that they're in. But I find that the sort of more, the men in particular are sometimes a bit more pragmatic sort of tell me what to do and I'll do it um whereas the women maybe need that more emotional support the encouragement they may not have exercised for many years because they've been looking after families they didn't have the time and they may have never prioritized their own health so sometimes it's getting the women into the healthy habits um and that can be you know a challenge because they're still looking after brown kids or kids or working but in terms of the differences in like their journey I feel like women are a bit more shocked perhaps that they've got a heart problem and the men can sort of blame a few things they say I've been drinking and eating and not exercising for a few years whereas the women tend to be a bit more shocked that they've got this diagnosis. I think my experience is fairly similar. Blokes will put up their hand and recognise where they've maybe strayed off the healthy path. I think sometimes I see men display a bit of depression after their events more obviously than women. And I think that men, at least in my own experience, are sometimes confronted by that inability to... take on everything in the world. And I think that knocks them a little bit emotionally at times. But it's interesting to hear your thoughts about that. Yeah, I totally agree with that too. And I feel like having me as that ear, like I said, I sort of turn into a counsellor. That's often more the men than the women because they don't have the... They don't want to worry their wife or their children or their... you know, work colleagues. But here is a bit of a safe space to open up and say, you know what, I'm quite scared and I'm not so sure about myself anymore. And it's sort of building them back up again. So, Angela, one of the things that I think is a priority is seeing the significant other half. So if it's a woman having... her husband or partner in if it's a man having his wife or partner in so that we have everyone on the same page in your rehab do you engage the partners in the same way and what's your thoughts about engaging the partners yeah it's a great idea i do get them in at the initial assessment if they're both happy to come along and they both want to um but then during the exercise not so much um only if um the partner really wanted to or whether they were a bit worried about things and they wanted to just check in and make sure you know it was a safe environment but in the support group so the monthly support group a lot of partners come to that they like to meet other partners they like to have a chat they like to ask me lots of questions and they like that reassurance that oh you know this seems a safe space and um she knows what she's talking about Perfect. And it makes perfect sense because they can have a cup of tea as well. So a win all round, I think. Look, one of the other things that intrigues me is the rehab from two very common interventions. One is stenting and one is coronary artery bypass grafting. Now I've got my own thoughts about the rehab process after those, but I'd be interested if you think there's a... you know what you see as differences or not or similarities or not after an individual's had stenting or bypass grafting and for those who are listening who may not be sure stenting is when we put a little spring inside the artery to open it up a small little structural architectural device if you like all done through small tubes with without any major surgery in coronary artery bypass grafting is of course major surgery where we open up the heart and re-plumb the arteries so a significant a significant surgery over to you Angela what do you think about the differences or similarities um so first we'll start with the similarities in that usually they get referred to their NHS which is our health system rehab after about six to eight weeks But often by the time they get there, it might be slightly longer than that. So they sort of all turn up at the same length of time after their procedure, whether it be stents or bypass. And they do the same sort of exercise and they do the same talk and they do the same heart rate monitoring. And for myself, when I'm seeing people, I always start with an assessment. So that would be the same for both. And I would always start them with a little exercise test to see where they're at and tailor the exercise, the heart rate zones that they should be exercising at around that. And sort of building them back up, I like to say it's a fitness pyramid. And the very first foundation of that pyramid is there. Walking, so getting them both doing more walking, building that up gradually, then adding the harder exercise on top of that as we go and we get gradually more difficult. In terms of the differences, I'd say it obviously depends person to person, but the bypass patients tend to have a bit more pain and a bit more fear around using the upper body. and more discomfort in terms of moving around and there's a lot stiffer in terms of their shoulders droop forward because of that protection mechanism and they may have had to sit sleep in an armchair or you know in a recliner chair so they've got a lot more postural issues we do have to work on that and then the confidence to be able to use their upper body Obviously, we start gentle and we move on as the weeks progress. And with the stenting patients, because they can't see it, I would say there's a lot more psychological issues with the stenting patients. They can't see that they've been fixed, whereas with the bypass patients, they sort of do have that, I'm a bit safer to exercise, I've been fixed, but it's the pain and the discomfort to overcome and the lack of sleep. Whereas the stenting patients are sort of, oh, am I okay? Can the stent collapse? Is it really in there? What about the arteries they didn't stent? So I feel like the psychological issue is a little bit more on the stenting side. Yeah, that's interesting. I completely agree. I see similar responses from my own patients. But one that sort of sticks a bit in my mind is that the magnitude of the intervention, A cardiothoracic surgical procedure is a big deal. And I think my observation to a degree is also patients are more likely to change more to make sure that doesn't happen again to them. Whereas I do have some patients who I have to say, I think they're a little bit guilty of breezing in one day with a whiff of chest pain. They get a stent and they're back on the road and they don't really think that much. too much has happened. They don't actually realise they got very, very close to the edge of the cliff and then walked away from it. Yeah, that's a really good point as well. And, yeah, that is also sometimes down to the doctor. So a lot of people don't have that fear put into them of, like, you do need to change. And there's only so much that someone will do with me telling them that. So, yeah, sometimes it is that. They're a bit more lackadaisical about it, aren't they? It's a tricky one. You don't want them fearful, but you also don't want them complacent. Look, we're going to have to come towards an end, but there's a couple of things I do want to ask you. If you've got three main goals, three aspirational goals or three golden rules or three tips for your rehab patients, what would it be, Angela? Three tips. So number one is go slower than you think. And so by that, I mean, I want you to be a tortoise, not a hare. People sort of come saying, I'm getting breathless. I'm feeling tired. I can't do this anymore. And I say, well, do it slower, which can be frustrating. But often by doing things slower, stopping smelling the roses before you keep walking, you know, that will gradually build up their fitness. So always go slower than you think you should. Even if you're already slow, go a little bit slow. Number one. Number two, take one step at a time. So don't worry about the end goal. And this could be whether you want to lose weight, whether you need to get fitter, whether you want to get back to work. You've got to just take one step at a time and think about what do I need to do today? So that might be your 10 minute walk. Or that might be, you know, next week's a 15-minute walk and the week after's a 20-minute walk. But just worry about today. So one step at a time. And thirdly, get some support. So having a really good support network. So someone like myself, you know, in your corner who's saying, come on, you can do it. Let's try something else this week. Let's do a little bit more. It could be a partner. Could be a friend who's a walking buddy who you meet up with every week. Could be the dog who drags you out for a walk. But getting some support would be really key to keep you motivated and keep you accountable, like we said at the start. Oh, I like that. So little steps. Don't be overambitious on your goals. Sorry, go slow. Little steps on your goals and moral support. Makes perfect, perfect sense. Look, I'm going to ask you to indulge me with one last thing. And I would love if you've got a great cardiac rehab story that you'd like to share. And then we'll pretty well wrap it up. So I'll talk about one of my guy patients who had full open heart surgery and his aorta repair. So he had bypass and his aorta repair. So it was all of an emergency. and he was very shocked by it. So he rushed off to hospital, you know next thing we knew he woke up, he was in intensive care, spent a good week in hospital, came home, did the NHS rehab and then sort of fell off that rehab bit. Like I was saying there's not that much support after you finish those classes. So medically he was quite stable. His doctor had sort of said, you know, carry on, you can go back to work if you want. But a lot of things mentally weren't quite there. He'd lost his confidence. His family said he was cranky all the time. So he came to see me. He was probably about four months post bypass by then. And a lot of what we worked on was his confidence to do it. So whilst he'd been trying to do some walking, like I said in my tips, he'd been going off quite fast. You know, you put the trainers on at the door and get to the end of the street, feel knackered and end up going home a bit depressed about that. And I said, like, we need to slow down. So that was obviously my first tip. Slow down and you'll be able to get to the end of the block and then come home. And then the next week, the end of the, you know, the suburb. you know and so on and we built it up more slowly than what he probably thought he should be doing but by going slower he was able to do it for much longer and secondly we worked on his mindset so he was really afraid and this is not something he said sort of out loud but it's what we got to the bottom of is I'm afraid that I'm this old man who's not going to be able to contribute anymore And that took a lot of work, and he obviously worked with a counselor as well during his time. But that was really key, is working on the mindset to say, look, you are still funny. We've still got plenty to contribute. He went back to work. We had to encourage him to go out with friends again to get his sort of old personality back. And just the realization, I think, for him. that he wasn't a write-off I think that was really key to say hey there's still plenty you can do and plenty can contribute and so those first few months I think were really crucial for getting his confidence back and so at the moment we're doing lots of fun stuff now and we're doing boxing every week we're doing some resistance exercise he's loving his walking now he's doing 12 000 steps a day Whereas previously hated walking, hated exercise. So I think that's massive progress. And the key thing is that he took it slow. He listened. He did the homework. He got gradually more and more, you know, walked further and further each week. And now, yeah, now I wouldn't say he loves exercise, but I would say he turns up and does the work and he's got his confidence back. Well, he's a perfect example of how the surgery isn't the fix for the whole lot. It's only the beginning of the journey of restoration of health and cardiac rehab. And what you've given this man is you've actually continued that therapeutic journey for him. It's a beautiful story, Angela. Thank you so much for sharing it. No problem. Look, I am going to wind up there. two parts because we talked far more than I thought we were going to because it's been so great sharing information with Angela. I'm going to thank you for joining us. Say goodbye. Fabulous. Thanks for having me. All right. So I'm going to wrap up there. I really hope you've enjoyed this interview with Angela Hartley. Cardiac rehab nurse who runs her own business in the United Kingdom. She's obviously got some absolute pearls of wisdom. It's been a pleasure sharing with you. I've learned from you. If you have any queries or questions, please drop me a note at info at drWarrickbishop.online. And thank you for sharing today. Take care. Bye for now. I wish you the very best. And as always, don't die from a heart attack. Goodbye. You have been listening to another podcast from Dr. Warrick. Visit his website at drWarrickbishop.com for the latest news on heart disease. If you love this podcast, feel free to leave us a review.
