I got a call from the Cardiac Rehab Program at St. Joseph Hospital. They were asking me if I was interested in finishing up the program. Not really… but I said yes. Evidently they are opening up the gym to 4-6 patients at a time for 45 minutes. You have to wear a mask and maybe surgical gloves to enter. I have 10 out of 24 sessions left to complete the program.

I’m really there because it was required by UCLA Transplant Center. Now that they’ve put me back on the active list but my donor was rejected, I don’t know if I need to finish up. I could do all the stuff at home without the costing me (or my company) anything. I guess I better call UCLA to see if they’re okay with me not finishing the program.

Okay, the title is a bit misleading. I actually didn’t go to rehab this morning. The alarm went off at 6:30 am and I turned it off. Then I went back to sleep and woke up at 7:30 am. I think it was early enough for me to rush to rehab then to work but I ended up sleeping another 30 minutes and finally got up at 8:00 am. I managed to get ~4 hours of sleep total which is more than typical but not enough.

I’m stuck at nine sessions completed out of 24. I know UCLA is waiting for me to complete the program but it’s hard to be motivated each morning. I though it would have been cool to work out with my coworker but he’s “grounded” until they fix his pacemaker so he’s not attend rehab either.

After getting emails from the rehab nurse and clearance from my vascular surgeon’s office, I felt like I should continue with cardiac rehab. I ended up going on Monday, Wednesday, and Friday. Since Monday was President’s Day, I only had to bring clothes to change for work on Wednesday and Friday. I would get there around 7:40 am and get done right before 9:00 am. I was still able to arrive at work before 10:00 am both days so the schedule is fine.

That means I’ve completed eight sessions out of the required 24. I still have a lot of appointments on Tuesday afternoons so it’s hard to go four days a week. However, I think I should be able to complete all 24 sessions by the end of March, in time for UCLA Transplant Center to clear me starting April.

The cardiac nurse asked me about my coworker on Monday. I think he showed up for orientation or first session. However, I heard his pacemaker is acting up, activating when it’s not needed. I think he stopped rehab until he has another surgery to fix the pacemaker sometime in early March so I haven’t seen him at rehab yet.

The last time I went to cardiac rehab was on Monday, January 27th. I had a dentist appointment on January 28th, and my mouth was hurting afterwards so I skipped January 29th. My outpatient surgery was on January 31st, and I haven’t gone to rehab since then.

I wanted to go this morning but I couldn’t get out of bed at 6:30 am when my alarm went off. I guess I got in the habit of not exercising after only a week. I have a endodontist appointment tomorrow so I can trying going Wednesday morning. The vascular surgeon said no heavy exercise for three weeks, and do not life over 5 lbs with my right arm for two weeks. His office was supposed to communicate that to the cardiac rehab nurse last week but I’m not sure if that’s been done. I think the rehab program won’t let me continue without the written note from the surgeon anyway.

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Oops, this was in draft since yesterday. I think I went to bed last night without clicking on post. I emailed the cardiac rehab nurse and she just called me back. I guess they did get a note from my vascular surgeon on February 4th. I can go in tomorrow but no arms exercises until the 18th. I told her I would restart tomorrow with cardio so I’m committed. A bit of accountability is good, otherwise I’ll sleep in again.

A coworker told me Friday that he has to attend the cardiac rehab program at St. Joseph Hospital as well. Since we’re both working, I guess we’ll see each other MWF at 7:30 am when the gym opens. It’s the only time we can go and still make it to work at a decent time. He had a pacemaker put in last year sometime. I don’t know why he needs to do cardiac rehab now; I don’t think he has any external factors like a transplant center asking him to go.

I did say that the gym was pretty small and I haven’t been too impressed with the program after five sessions. The facilities at Hoag Hospital seem much better equipped but I think St. Joseph Hospital is the closest program and kind of on the way to work. It’s probably impractical to drive to Irvine or Newport Beach for Hoag.

Ugh, I’m so unmotivated. After weeks of having daily doctor’s appointments, I have nothing scheduled today. I was planning to go to cardiac rehab this morning at 7:30 am, but I ignored the 6:30 am alarm. It’s almost 10:00 am now and I’m still sitting at home blogging. I really wanted a day of doing nothing before my “minor” surgery on Friday, but I fear I’ll never complete the rehab program if I don’t go daily and complete is as soon as possible.

Alright, I’ll go after lunch. They’re open from 1:00 pm to 4:00 pm and it’s less busy in the afternoon anyway. I just hope my blood pressure will be low enough with just the 10 mg of NIFEdipine, since the other two meds I took in the morning will probably wear off by then.

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It’s ~2:00 pm and I’m still at home. I think I’m not going to make it today. I just measured my blood pressure sitting and it’s 192/100. I took 10 mg of NIFEdipine but not sure if that will work by itself if the other two meds have worn off. I don’t want to go to rehab and sit waiting for my blood pressure to drop.

When I return to work, I’ll have to get to rehab at 7:30 am in order to finish by 9:00 am, which will get me to work before 10:00 am.

I feel bad writing this since everyone at the rehab center is very nice but the program is an insurance scam. I’ll pass final judgement when I find out how much they are charging my insurance for each session. Here’s what I do for each session:

• Sign in at the door and pay my insurance co-pay ($25)
• Measure blood sugar
• Attach a wireless EKG transmitter so they can monitor my heart
• Measure blood pressure
• Cardio exercises for 30 minutes, typically walking on a treadmill
• Measure blood pressure again
• 4 minute exercise on a hand pedal machine
• 15 reps of three exercise for each arm on rope machine
• 15 reps of five exercises using free weights
• Measure blood pressure
• Measure blood sugar

That’s it. All they really do is measure my blood pressure three times and watch my heartbeat. Usually there are two nurses and an assistant watching 10-12 people. It’s like a gym except I’m paying by the hour instead of monthly. I would probably stop going and do the exercises at home if UCLA didn’t require me to finish the program to put me back on the active transplant list.

5 down, 19 sessions to go. If I take a week off after my surgery this Friday, then I can finish the program by March 10th. That assumes I go four days a week, including after dialysis on Tuesdays. If I only go three days a week, then I won’t be done until the end of March. UCLA expects me to be done mid to late-March so I can’t slack.

Since I only got a little over an hour of sleep this morning, I’m going to try and take a short nap. I didn’t exert myself too much during rehab and it’s supposed to get a lot warmer outside so I’m going to try and take a walk in the park later this afternoon.

During orientation, the nurse handed me a packet of reading materials. Inside was a sheet with risk factors and goals. I’ll summarize:

Risk Factor	Goal
Physical Activity	> 30 – 45 min. 5 to 6 days/wk (3 – 5 METs achieved)
Diet	Saturated fat < 15 g/day Salt intake < 1500 – 2000 mg/day
Diabetes	Fasting Blood Sugar < 100
Blood Pressure	< 120/80
Lipids	Total Cholesterol < 200 Triglycerides < 150 HDL (m) > 45 (f) > 55 LDL < 70
Weight/BMI	< 25
Stress Management	Practice stress management techniques: relaxation, yoga, exercising at least 25 minutes
Depression	No depression
Substance Misuse	Alcohol <= 2 (m) / 1 (f) drinks/day Caffeine < 2 – 3 cups/day (24 oz brewed) Recreational Drugs = 0 Tobacco = 0

The problem is that after orientation and four sessions, I’ve only seen a few nurses helping with the exercise portion. I have not seen or even heard mention of nutritionists or psychologists. Also, I hope they aren’t grading me at the end of the program (24 sessions) based on the above goals. There is no way I will meet the Weight/BMI goal since that means another 25 lbs of weight loss after losing 25 lbs post surgery. The blood pressure goal will be hard too. I only come in at ~140/80 after taking all three medications beforehand. My nephrologist will need to increase the dosage on something to lower it more. Likewise for blood sugar. I’m on less than minimal dosage with one medication only in case of a hypoglycemia repeat so we may need to increase dosage or add more meds.

Looking through my lab results, the last lipid panel I could find is from late 2016. In it, my HDL is 43, LDL is 71, triglycerides is 184, and total cholesterol is 151. The triglycerides number is a bit high but I think the numbers should have improved in the last three years. I just drew blood for labs that my cardiologist ordered; it included a lipid panel so I’ll know more next week. The rest of the goals are doable.

Four down, 20 to go.

Like on dialysis days, I took all three blood pressure medications before going to rehab this morning. Once again, the meds were pretty effective. My starting blood pressure was 137/72 which meant no complaints or delays from the rehab nurses. Even though the gym was pretty full, there was no one on the treadmills so I didn’t have any problems with the cardio portion. My arms are still pretty weak though; I think they also look a lot flabbier than before surgery. All this from sitting around for four weeks?

One interesting observation. The treadmills face a large window which overlooks the entrance to a large parking garage for CHOC (Children’s Hospital of Orange County) employees. On the entrance, there is an electronic counter that show the number of open spots remaining. Each time a car enters, the number would decrease by one, and when a car leaves, it would increase by one. Anyway, on Wednesday morning, the signed showed only three spots were open at 8:00 am. Today (Friday) at 8:30 am, there were over 150 spots open. Does CHOC schedule less people to work Fridays or employees starting the weekend early? Make sure your kids don’t get sick on Fridays.