Ask the Doctors November 2013 Issue

Ask The Doctors: November 2013

I believe Medicare will cover up to 36 weeks of cardiac rehabilitation, and longer if necessary. But how do you know how long a cardiac rehab program youíll need?
Cardiac rehabilitation (or rehab, for short) is an exercise-training program that seeks to improve patientsí physical condition after they have undergone heart surgery, experienced a heart attack, or have been suffering from chronic angina. For heart surgery, phase I cardiac rehab starts in the hospital. Its intention is to get you moving, and consists of simple, everyday-type activities, as well as exercises for improving range of motion. Phase II cardiac rehab classes are done on an outpatient basis, and generally start six to eight weeks after surgery. In most cases, such rehab classes take place three times per week over a period of three months, which comes out to 36 sessions. Aerobic exercise, such as treadmill workouts, are performed under the close supervision of exercise physiologists. Frequent blood pressure and heart rate checks, as well as continuous monitoring with an electrocardiogram (ECG), are all standard practices. Within the scope of three months, the underlying goal is not only to get patients in better shape, but to educate them how to pursue an individually-tailored program after rehab.

We recommend Phase II rehab for nearly all of our post-operative and post-myocardial infarction (MI), patients, because of the many benefits they can expect to receive. Studies have demonstrated (not surprisingly) that people participating in cardiac rehab have better stamina and strength than those who do not participate. But these studies have also shown improved control of weight, blood pressure, and cholesterol in those who did rehab. It is also likely that these classes improve the mood and emotional status of patients after heart surgery, and for prior smokers, reduce the likelihood of their taking up the habit again. The main point here is that cardiac rehab puts heart patients on a better, stronger, and healthier road than they would be without it. And their risk of having other cardiac problems in the future is significantly reduced. These benefits appear to accrue for everyone in the rehab class, regardless of age, gender, or initial exercise capacity. If you are likely to need cardiac rehab in the near future, I would not be overly concerned about the duration you will need. You will receive close attention from your exercise physiologists, and they will help determine if additional time in rehab is likely to benefit you. Phase III cardiac rehab can continue for an indefinite period of time, and even without Medicare coverage, it is quite affordable and undoubtedly worth the nominal expense.

What is the connection between thyroid disease and heart disease? Iíve read that hypothyroidism raises cholesterol levels.
The information you have read is correct. Thyroid gland hormone influences the activity and function of nearly every physiological process in the body. In general, more thyroid hormone will rev up metabolism, while less thyroid hormone will slow it down. People with low levels of thyroid hormone (hypothyroidism) tend to move more slowly and gain weight. A hypothyroid state will also slow the breakdown of cholesterol, and its levels will increase. Other fatty substances in the blood, triglycerides, tend to accumulate.

These changes increase the risk of coronary artery disease development and subsequent MI. In contrast, hyperthyroidism generally leads to a thin, hyperactive-appearing person. It also tends to lower cholesterol and triglyceride levels, which might superficially sound attractive. But donít expect cardiologists to be prescribing thyroid hormone for this reason anytime soon. Hyperthyroidism accelerates wear and tear on body organs, and also increases the likelihood of dangerous cardiac arrhythmias, such as ventricular tachycardia and ventricular fibrillation. When it comes to heart health, keeping thyroid function normal is of prime importance.

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