In 2002, Marc Wallack, a surgeon, started having chest pains while jogging. Though heart disease runs in his family—his father and paternal grandfather died of heart attacks—he thought he had heartburn and took antacids. After four days of "heartburn," he finally saw a doctor and learned that all of his coronary arteries were 95% blocked. He needed bypass surgery to survive.

The operation was a success, but Dr. Wallack, then in his 50s, found that his life had changed dramatically. He was afraid to fall asleep at night because he was worried that he wouldn't wake up again. He wondered if his heart could withstand exercise or sex.

What Dr. Wallack realized is that while surgery and cardiac rehabilitation keep patients alive, they don't necessarily help them live. Here, he shares his eight steps to a complete recovery, physically and mentally…

Step 1: Get sleep. The majority of patients who undergo heart-related procedures sleep poorly following their procedures. Nearly half experience some degree of insomnia for eight weeks or more. Even when patients think they sleep soundly, they often have little or no rapid-eye movement (REM) or slow-wave sleep, both of which are critical for recovery.

Nighttime fears-particularly of death and disability-are extremely common in heart patients. The resulting sleep disturbances increase the risk for subsequent heart disease.

I used prescription sleep medications for about three months before I was able to sleep most nights without them. New generations of medications, such as eszopiclone (Lunesta) and zolpidem (Ambien), are extremely safe though carry some risk for dependency).

I also discovered that I felt calmer and slept better when there was static noise in the background. I used a white noise machine. Or you can use a fan, and there are Internet sites that play white noise through the computer.


In addition, I slept with the blinds open so that I could see the lights outside (I live in New York City)-it made me feel alive.

Step 2: Overcome depression. Nearly one in three heart attack survivors experiences post-surgical depression, in part because microclots can travel to the brain and cause mood changes. According to researchers at University of Maryland and Columbia University Medical Center, patients who were depressed after cardiac surgery were twice as likely to die from heart problems within seven years, compared with those who were not depressed.

Talk therapy, sometimes combined with antidepressants, can help patients get past their depression and regain a sense of balance. One study found that patients who attended group therapy after heart surgery and/or a heart attack had a 60% lower rate of rehospitalization than those who didn't get therapy.

Step 3: Get back into the world. It can take months or longer to recover from major surgery. Patients are weak and disoriented. They often are reluctant to leave home, even after their doctors say it's OK to do so, because they're afraid of falling or that they'll somehow damage their hearts.

Getting out of the house is a major step in recovery. Everyone needs sunlight, fresh air and a change of scenery. Even gentle exercise, such as walking to a corner store, can alleviate depression and improve your motivation to recover. Bring a friend or family member if you're not sure of your ability to get around on your own. Eventually work up to driving and going out by yourself to build your confidence.

Step 4: Optimize doctor visits. Patients who have had heart surgery initially have numerous postsurgical doctor visits. These often are stressful because patients fear that they might hear bad news. The anxiety surrounding these visits can undermine the patient's confidence and make him feel more like a patient than a person. To counteract that, my wife and I turned a doctor visit into an outing. We would go out to breakfast or lunch first. (I tried to make my appointments for first thing in the morning or the first appointment after lunch so that I wouldn't have to wait long for the doctor.)

Helpful: Bring someone with you when you see a doctor or undergo tests. Your mind can go blank when you're the patient, so you need someone who can listen carefully, take notes and ask questions

For further peace of mind, ask your cardiologist what's the best way to contact him/her. Get the names and contact information for key people in the office, such as the nurse practitioner. You need to know who to call or e-mail if, for example, you notice that your heart is beating faster than usual.

Step 5: Make love again. After the first few months of recovery, ask your doctor if it's OK for you to have sex. Heart patients often worry that the exertion of sex will strain their hearts. Not true. The odds of having a heart attack during sex, even if you already have had a heart attack, are typically about 20 in one million. Less than 1% of patients who die of a heart attack do so during sex.

Step 6: Eat for recovery. I advise most postsurgical patients to eat small meals frequently. The lingering effects of anesthesia can make people feel nauseous and reluctant to eat. Pain medications often inhibit appetite. So does prolonged bed rest and postsurgical fatigue.

My story: Every time I ate, I worried that the food would instantly clog my arteries or cause a clot to form. This wasn't rational, and it made it difficult for me to gain weight and recover my strength after surgery.

I found that smoothies were ideal.

I made them with low-fat yogurt, skim milk, fruit and ice. They didn't upset my stomach, and the more I ate, the more I wanted to eat.

Step 7: Prepare for career issues. After my surgery, I was surprised to discover that some of my colleagues were vying for my job. When you go back to work, don't talk much about your health history, and don't let people see you taking your medicine.

But ask your boss or human resources representative for accommodations, such as time off for rehab three times a week or the OK to take a 15-minute nap every day. Chronic work stress doubles the odds of experiencing a second heart attack within six years. Give yourself time to get back into the groove.

Step 8: Set an exercise goal. Regular exercise improves cholesterol, lowers blood pressure and reduces stress. Just as important, it gives you a goal. People need strong goals to get through the grueling months of rehabilitation.

My goal was to run another marathon after I recovered. This gave me the internal strength to try to get better even when I was so weak that I could only take a few steps. I did run a marathon in November 2005, a little more than three years after my surgery.

Develop an exercise program with a rehabilitation expert who can work with you for the first few months (this typically is covered by insurance). Your first exercise goal might be to build up enough strength so that you can comfortably walk up and down stairs or to work in the yard without fatigue. No matter what you hope to achieve, the best way to get there is to move your body again.

Secret to Better Bypass Surgery

Bypass surgery using a heart-lung machine D is better than off-pump surgery for low-to medium-risk patients. On-pump surgery uses a heart-lung machine to take over blood circulation. A new method of doing bypass surgery on a still-beating heart was developed in the 1990s. Now a study shows that one year after surgery, about 10% of patients getting the off-pump procedure needed a repeat operation, had a heart attack or died, compared with 7.4% of those who underwent operations using heart-lung machines.

Best Way to Perform CPR

In a study of 506 cardiac arrest patients, reI searchers analyzed the effectiveness of chest compressions given during cardiopulmonary resuscitation (CPR) prior to the use of a defibrillator to restore normal heart rhythm.

Result: Patients' survival rates were highest when study subjects administered continuous chest compressions with the fewest interruptions possible until emergency rescuers arrived.

Theory: Chest compressions prepare the heart to start its own rhythm when a defibrillator delivers a shock. The American Heart Association recommends giving 100 chest compressions per minute.

How to Double CPR Success

According to a recent study, the odds of surviving cardiac arrest outside of a hospital were 5% without CPR...6% with standard CPR (alternating chest compressions and mouth-to-mouth breaths)...and 11% with continuous compressions without mouth-to-mouth. If someone needs CPR, call 911 and perform continuous chest compressions until help arrives.

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