Last week was another step forward in working towards some sort of improved quality of life. Meaning, I finally had that cardiac rehab (aka exercise) evaluation that I’ve been putting off. Since Dr. Wilson made such a good case for it at my appointment with him, I knew I had to try.
I felt a bit crappy in the morning, so I’m glad my dad was here to be able to take me. We weren’t sure how much the test would drain me and if I’d be able to drive afterwards, so we decided it was better safe than sorry. We got there early because I wanted to get those dozen or so labs drawn, but apparently one of them, Cryoglobulin, can only be drawn at main campus. Hmmph. So I ended up being 25 minutes early for my appointment. But I had lots of paperwork to fill out anyway.
I was called back as soon as I finished the paperwork. I had a really nice nurse whose name was Bob. We went through the usual computer stuff and then he hooked me up to the 12-lead EKG. After running an EKG, he had a cardiologist come look at it. He saw something he didn’t like, so Bob had to readjust a few of the leads; I think he had initially been trying to not have to reach too far under my sports bra. I wanted to say, “Dude, I’ve had six surgeries. I’ve had a nurse wipe my nether regions when I was covered in blood and dye. Nothing you can do will faze me.” After running about four more EKGs, the cardiologist was finally satisfied.
Then it was time for the dreaded treadmill test! It started out flat at low speed, as a warm up and to get acclimated to the machine. Then the speed increased a bit. Then every two minutes, the incline and speed would increase and Bob would take a manual blood pressure (how he could hear properly with the whir of the treadmill and my feet thunking away is beyond me!) Since I’ve only been on a treadmill once or twice before, I was really hoping I wouldn’t suddenly lose concentration and trip over my own feet and wipe out.
Although Bob reassured me that he would catch me before I fell off the end of the treadmill. I trust that he would have.
I only made it to six minutes out of a max of ten, which I was a little disappointed in myself for. I really could have pushed harder, but my gut told me not to. As it was, once I had cooled down and stopped walking, I had to stand still on the treadmill for a bit until the dizziness subsided enough for me to get to a chair. Then I sat in the chair for another few minutes, while Bob was still taking readings, then he was finally able to unhook me.
The hard part over, we moved to an exam room and my dad came back. We waited half an hour for Dr. B, the exercise physiologist, to come in. He was a very nice and knowledgeable man. He had me talk through my POTS history to make sure he had discerned everything correctly from my chart, which it seems he pretty much had.
He then talked through the studies that demonstrated the role exercise plays in improving POTS symptoms. My understanding is that in both of these studies, patients had to stop all medications they were taking for POTS prior to the start of the study.
- The first study had 15 patients and through a gradual exercise program (essentially cardiac rehab), 70% of them showed improvement.
- As a follow-up, another study was performed with 250 patients and to everyone’s surprise, 80% of patients showed improvement, some with complete resolutions of symptoms and/or less or even no need for medication!
Then we went through my specific regimen. Since it’s too complicated to type out, I just took a picture of it to explain. These goal ranges are based on my maximum heart rate during the treadmill test of 157 bpm and a functional capacity of 7.0 METS (whatever that means.) My heart rate only got to 83% of predicted for my age (which I know is 189 bpm) and my functional capacity was impaired by 21-30%. Hmm.
So basically I start on the recumbent bike for 20 minutes three times a week and very slowly work my way up to an upright cycle and then finally to a treadmill for 45 minutes five days a week. I’m pretty sure most people in this country don’t exercise that much.
Luckily, I already have the Polar H10 chest strap heart rate monitor and know how to use it, so that’s one less thing to worry about. They recommend Polar because they studied a few different options and Polar came out on top with a 0.99 correlation, versus a Fitbit that only had a 0.75 correlation. (Basically, the Polar is accurate 99% of the time and a Fitbit is only accurate 75% of the time. Or something along those lines. I hate biostatistics.)
And for anyone science-y, I circled in yellow the citations for the studies this program is modeled after. That’s what we call evidence-based medicine. Oh yeah. ?
I’ll see Dr. B again on August 30th, which will be in the middle of week six, to see how things are going and if any adjustments need to be made. I’m a bit worried about how my left knee is going to hold out with those longer exercise durations; I think the treadmill will be better than the elliptical for the upright weight-bearing portion.
I’m really glad I went to see Dr. B. He came recommended from other POTSies in my area and I can see why. He truly understands POTS and the physiology behind how it affects the body. In addition, he understands what a challenge it is for a person to deal with and he designs his programs to be as beneficial as possible based on evidence from recent scientific studies. I can’t wait to see if this actually works for me!
So here goes nothing!