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Cardiac Comeback (transcript)
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[Narrator] Behind every heartbeat is a story we can learn from. As we have for over 80 years, Blue Cross and Blue Shield Companies are working to use the knowledge we gain from our members to better the health of not just those we insure, but all Americans. Some call it responsibility. We call it a privilege. "Second Opinion" is funded by Blue Cross Blue Shield.

 

[Announcer] "Second Opinion" is produced in conjunction with UR Medicine, part of University of Rochester Medical Center, Rochester, New York.

 

[ Applause ]

 

[Dr. Peter Salgo] Welcome to "Second Opinion," where, each week, a panel of medical experts comes together to discuss a real-life case. I'm your host, Dr. Peter Salgo. I want to thank all of you for being here. Now, our experts today are cardiac psychologist Dr. Sam Sears from East Carolina University; cardiologist Dr. Seth Jacobson, University of Rochester Medical Center Cardiac Rehabilitation director; and primary care physician from the University of Rochester Medical Center, Dr. Lou Papa. And now I'd like you to meet our special guest, Olympic gold medalist Kris Thorsness, who is here to discuss and share her personal story.

 

[Kris] So, after the Olympics, I continued rowing. I competed on the national team for years after that, and got another silver medal at a world championships in '87, And then retired after the Olympics in Korea in '88, and started competing in Masters events, both nationally and internationally. I have a good friend, DeDe Birch, who was my double partner. It's a two-man boat. And we raced together for a number of years and were very successful at that. And then we moved out here in 2001. Once we got settled in, I

started rowing here again, too, and rowed with some friends up on the Genessee River. And -- And in fact, on July 1, 2007, that's where I was. I was out rowing in a four-man boat with some friends of mine

up in -- up on the Genessee River. Had a great row. Felt fine. And went to bed that night, you know, probably the healthiest 47-year-old woman you'd know, and had no idea what was gonna happen to me at 5:00 the next morning.

 

[Dr. Peter Salgo] Kris, thank you so much for joining us. We're going to be talking a lot about what happened to you in July of 2007. But tell us a little bit more about your sports career. And I must tell you, there's something on the table here that I have never seen in person before. Why don't you just pick that up and -- and show it to our audience, as well. For those of you in our audience who have never seen one, that's an Olympic gold medal. That's pretty darn impressive, Kris.

 

[ Chuckles ]

 

[ Applause ]

 

[Dr. Peter Salgo] Notice, there was no "Aw, shucks" there.

 

[Kris] [ Laughs ]

 

[Dr. Peter Salgo] You earned that thing. So, I heard you say, "This is July 2007." What happened that morning?

 

[Kris] Well, I woke up at about 5:00 in the morning. A little discomfort right back here -- my upper -- my upper back. Thought I had maybe just pulled a muscle, 'cause I'd been out rowing the day before. I got up, went downstairs. I was on the floor in the living room, doing stretches -- you know, trying to stretch it

out. And wasn't really loosening up. So I thought, "Oh, I'll just lay down on the couch and read my

book for a little while and maybe go back to sleep." But as soon as I lay down, felt like I'd been stabbed.

And I -- I jumped up, and then everything went crazy.

 

[Dr. Peter Salgo] Describe that.

 

[Kris] Um, I was soaked with sweat.

 

[Dr. Lou Papa] Hmm.

 

[Kris] I was nauseous. I ran to the bathroom and threw up. And I had the most incredible pain in my arms and my head. It felt like they were being crushed by a steamroller.

 

[Dr. Peter Salgo] Now, that's a pretty classic symptom of heart pain that I was taught. You called your doctor, and what did your doctor say?

 

[Kris] Well, I got a doctor on call, not my regular doctor, and he listened to my symptoms and had me take my temperature, and then told me that I had the flu, and I should take some Tylenol and go to bed.

 

[Dr. Peter Salgo] Lou, if she had called you, what would you have said?

 

[Dr. Lou Papa] Well, those are definitely very worrisome symptoms. There's a couple things that go

through your mind – cardiac symptoms, aortic dissection. There's a number of things that are very concerning. But the cold sweat, you know, is -- and the nausea also raises concern that, you know, it could be cardiac or, you know, posterior-inferior wall.

 

[Dr. Peter Salgo] So you would have said?

 

[Dr. Lou Papa] "Go to the --" "Call 911," is what I would have said.

 

[Dr. Peter Salgo] Yes. And what did you do?

 

[Kris] Well, I went upstairs and told my wife what was happening and -- and told her what the doctor said. And she said, "No, no, no, we're going to the E.R."

 

[Dr. Peter Salgo] Smart. So, at this point, Seth, you're gonna, if you were, getting thispatient up at your hospital, what test do you want? What do you think your doctors were doing at that point?

 

[Dr. Jacobson] Well, the first thing you need to do is take an EKG -- number-one step. And while they're doing an EKG, you begin to take a history, and you understand some of the symptoms that they're describing.

You need to get bloodwork, you need to get blood pressure. You usually give some oxygen and an aspirin, because even if it's not your heart, an aspirin is not gonna hurt you at the time.

                                            

[Dr. Peter Salgo] Let me stop you there for just a second, because that's really important and it's something that people can do at home if they're having this kind of symptomology. An aspirin -- why?

 

[Dr. Jacobson] Well, the aspirin is a platelet blocker, and it will go right into the bloodstream, especially if you chew it, which is how we usually recommend. It's the fastest way to get it in. And it blocks the platelets, and the platelets are what cause blood clots and they cause the heart attacks.

 

[Dr. Peter Salgo] So, the blood -- In this construct, there's a clot in an artery feeding the blood to your heart muscle. Your heart doesn't have any oxygen, 'cause the platelets have glommed together.

Turn that off, maybe things will reopen or at least not get worse. In the meantime, they've done all these tests on you. And what did they tell you?

 

[Kris] They said, "There's good news and bad news."

 

[Dr. Peter Salgo] I hate that.

 

[ Light laughter ]

 

[Kris] I said, "I'll take some good news, please." And they said, "The good news is that your aorta is intact. And -- But that the bad news was that you've had a heart attack."

 

[Dr. Peter Salgo] And when you heard that, what went through your mind?

 

[Kris] I thought, "What?!" My father had had heart disease. But, you know, he wasn't an Olympic athlete. And I --

 

[Dr. Lou Papa] How old was he when he first had his heart disease?

 

[Kris] He had his first triple bypass when he was 48.

 

[Dr. Lou Papa] Okay, that changes everything.

 

[Kris] Yeah, yeah. And so I -- Then, they said, "We're going to have to do an angiogram to determine whether you just need a stent or whether you need bypass surgery."

 

[Dr. Peter Salgo] So, the angiogram is an X-ray picture of your heart with dye, which lights up the arteries in your heart. And they can see if one is blocked, and if it is, then they're gonna do something to intervene. But there you are, before all of this, you're awake, you've gotten this news. Sam, what are people going through -- not just Kris but --

 

[Dr. Sears] Yeah, well, this is a real medical ambush. I mean, this is just out of nowhere for her, given her cardiac risk factors.

 

 

[Dr. Peter Salgo] And she's an Olympic athlete. They can't have a heart attack, Sam.

 

[Dr. Sears] Right, so, psychologically, the preparedness of herself and everybody who knows you was, "That's quite a shock." And therefore, it starts this process that can be very difficult to overcome.

 

[Dr. Peter Salgo] What did they find? They took you to the cardiac cath lab, and they looked at

your arteries. What did they tell you?

 

[Kris] I had some blockage, but not a lot. And -- And the blockage that I did have couldn't be stented, because of the location in the branch arteries. They concluded, probably what had happened was that the muscular wall of the artery had spasmed around the blocked area and that that had closed it off completely for a period of time.

 

[Dr. Peter Salgo] All right, so, they can't do anything in terms of mechanical intervention. They're not gonna put a stent there, which would open those arteries. They're not gonna go to the operating room and bypass those arteries. They put you on medication, sent you home, and said, "Good luck."

 

[Kris] Essentially.

 

[Dr. Peter Salgo] Is that how it felt to you?

 

[Kris] Yeah, in a way. And I was -- I was -- I was impacted physically to a very dramatic degree.

 

[Dr. Peter Salgo] How so?

 

[Kris] When we got home from the hospital, I went upstairs to go to bed, and I had to take the steps one at a time and stop and rest in between.

 

[Dr. Peter Salgo] Now, just put this in perspective. You had just come off the river.

 

[Kris] Right.

 

[Dr. Peter Salgo] Rowing, right? And you're in great shape. I -- You've got a gold medal here.

Going up one step at a time?

 

[Kris] Yeah, it was -- it was a shock. It was a real shock.

 

[Dr. Peter Salgo] You must have been terrified.

 

[Kris] Yeah, and I -- I -- And then that lasted for -- for about 10 days, where I was -- you know, I couldn't walk out to the mailbox to get the mail in the day. And it was -- you know, I had to stop and I was exhausted all the time. And -- And it was -- I was starting to wonder whether this was how my life was going to be. And -- And I had always defined myself by my physicality. And suddenly, it was – you know, the rug was literally pulled out from under my feet.

 

[Dr. Peter Salgo] Sam, this is what you were talking about, isn't it?

 

[Dr. Sears] Yeah, it's that ambush, and she -- you can see right away, she moves to trying to forecast,

"How long is this gonna go on like this?" And it is that kind of beginning of that process that has so much

to do with the psychologic and the physical recovery. You got to have hope at some level. And we're often waiting on cardiology's medical --

 

[Dr. Peter Salgo] And you're gonna blame him, is that it?

 

[Dr. Jacobson] Well, I mean, you have to give time for the heart to recover.

 

[Dr. Sears] Absolutely.

 

[Dr. Jacobson] The heart gets stunned. So, when the heart does not get enough blood supply for a period of time, it stops working. It -- The muscle doesn't contract, and that's what the heart is supposed to do. And if it doesn't contract, you're going to feel tired, you're going to feel short of breath. It can, potentially, lead to life-threatening heart-rhythm problems. Then, of course, beyond that, she's on a whole bunch of new medications that she was not on before. She has to get used to being on a beta blocker, which is a

common medication for people who have had heart attack. They're on -- Often, people are on ACE inhibitors, which are medicines that help the heart get stronger. Usually, a cholesterol-lowering medication, depending on if your cholesterol was high and if you had some plaque. And certainly an anti-platelet drug, like aspirin or sometimes Plavix.

 

[Dr. Peter Salgo] Kris, were you taking any medication prior to this?

 

[Kris] I was taking some blood-pressure medication because I had had blood pressure -- marginally high blood pressure -- for years.

 

[Dr. Peter Salgo] Mm-hmm.

 

[Kris] I couldn't actually go onto some of those ACE inhibitors, because my resting heart rate is so low, and --

 

[Dr. Peter Salgo] That's what comes from being an athlete.

 

[Kris] Well, right. And it's kind of funny 'cause my cholesterol had always been very low, to the point where I would get, like, little note—my doctor would write notes on my -- on my test results, "Wow! Great!"

You know? So I really wasn't expecting any kind of coronary problem.

 

[Dr. Peter Salgo] Again, this sets her up.

 

[Dr. Lou Papa] But she had a dad that had heart disease.

 

[Dr. Peter Salgo] That's one of the --

 

[Dr. Lou Papa] It's where genetics meets reality.

 

[Dr. Peter Salgo] That's a marker. Now, did they talk to you about rehab?

 

[Kris] They suggested that I go to cardiac rehab, but that I had to be able to walk for an hour before I could start my rehab.

 

[Dr. Peter Salgo] How long did it take for you, Olympic athlete, in great shape, rowing, to get back to where you could walk one hour?

 

[Kris] It was about three or four weeks. And there was a lot of fear. You know, my body had – had been there for me all the time, and it had -- and then, suddenly, I was afraid that, "Gee, if I break a sweat, am I gonna drop dead?"

 

[Dr. Peter Salgo] Reasonable fear. Sam, people live in fear.

 

[Dr. Sears] Absolutely. I mean, this is the reality now. We help people survive cardiac events, but the rest of the story comes after the acute crisis.

 

[Dr. Peter Salgo] Let me put this out there. Is her previous physical condition, being as outstanding as it was, an advantage for her, going into this rehab?

 

[Dr. Jacobson] I think so. It's not only an advantage – a survival advantage -- when this occurs but it's also a survival advantage after she is in the process of recovery.

 

[Dr. Peter Salgo] That's what I was getting at.

 

[Dr. Jacobson] So she has to go through a series of processes. She has the physical recovery that she has to go through, getting used to her medications, and getting back exercising. She has the psychological aspect that you've talked about -- understanding what she's going through, being able to have confidence in herself and her medical team. And then she has the social aspect of getting back to work, getting back to meeting with her friends, being confident enough to go out in public and not fear that you're gonna pass out or something bad is gonna happen to you, getting back to sexual activity, getting back to, like I said, schooling, depending on what people are doing.

 

[Dr. Peter Salgo] Did you fear -- I know you alluded to this -- that every step of this rehab, which is more and more gradually increasing physical exercise, at every point, this is gonna kill you?

 

[Kris] No, as it progressed, I gained confidence.

 

[Dr. Peter Salgo] Ah.

 

[Kris] And the cardiac rehab was a huge piece of that.

 

[Dr. Jacobson] Mm-hmm.

 

[Dr. Peter Salgo] So, rehab, though, is critical, right?

 

[Dr. Sears] Absolutely.

 

[Dr. Peter Salgo] That you've got to overcome the fear. And I'm listening to -- I'm hearing some fear in there, despite what you're telling me.

[Kris] Oh, absolutely, absolutely.

 

[Dr. Peter Salgo] That exercise, "Geez, if I stress my heart," to quote Arnold, "all hell is gonna break loose," right? This is not good, Sam.

 

[Dr. Sears] Yeah. Well, one of the things we know is that getting back into the activity brings the attitudes and psychologic side. Sometimes we've got to start with the action before we develop the attitude. Essentially, you are gonna make this comeback. You're gonna start in small ways, rather than wait for the mind to say, "I'm gonna do it."

 

[Dr. Lou Papa] That's one of the beauties of the cardiac rehab structured program, is that there's that built-in reassurance. It's kind of like you have your safety vest on...

 

[Kris] Absolutely.

 

[Dr. Lou Papa] ...so that you can see there's experts there, you're being monitored.

 

[Kris] That there's a crash cart in the corridor.

 

[Dr. Lou Papa] Exactly, to give you that sense that you're not gonna fall apart.

 

[Dr. Jacobson] Cardiac nurses, exercise specialists, cardiologists in the building.

 

[Dr. Lou Papa] Right.

 

[Dr. Jacobson] So it really breeds the confidence that people can get back and do what they want to do, because we wanted you back just how you were before. Studies show that people who attend and graduate from a cardiac-rehab program have a 25% lower mortality rate, 30% lower trips to the emergency room or to their physicians, they have a higher quality of life, they have higher endurance

levels, and they have a higher amount of social support and compliance with their medications.

 

 

[Dr. Peter Salgo] Can you --

 

[Dr. Sears] It's really a therapeutic soup. There's a little bit of everything.

 

[Dr. Jacobson] And it's cost-effective.

 

[Dr. Sears] And it's cost-effective. So, we have something here that's just underutilized, though, and fortunately, someone did refer you to cardiac rehab. That doesn't always happen.

 

[Kris] There's a piece of it, too, that we haven't really mentioned that is really important, and that is the other people who are participating in the program.

 

[Dr. Lou Papa] Mm-hmm.

 

[Kris] You know, we've all had one of these events. You call them -- You used that word, and we used to joke that, "They call it a cardiac event like it's some kind of party, but it ain't no party." [ Laughter ] And -- And -- And you're in a room, exercising with people who've been in the same position that you have.

They've been in the E.R. and been told that they've had a heart attack or that they have to have bypass surgery or something like that. And they've all been through that together, and that piece of it is huge, as well – the encouragement that the participants give each other.

 

[Dr. Peter Salgo] Is it ever too late to start a cardiac-rehab program? I mean, if you wait a year, is that too late?

 

[Dr. Jacobson] It's never too late to reduce your cardiac risk, going forward. You can always improve your

diet, always improve your psychosocial aspect, always improve your endurance and your compliance with your medications.

 

[Dr. Lou Papa] But the other part of it is, there's a lot of people that don't have any idea of what a healthy diet is. They have no information on their drugs. They have no idea about what an exercise program is.

Getting that started sooner than later is kind of critical before they get back into their routine, so that that

educational portion, above and beyond the survival benefit, that's huge for my patients.

 

[Dr. Jacobson] We tailor our programs for the patient.

 

[Dr. Lou Papa] Right.

 

[Dr. Jacobson] A program for you, we would be able to start at a much higher level because that's where you were physically, but like you said, there are some people that have never exercised.

 

[Dr. Lou Papa] That's right.

 

[Dr. Jacobson] There are some people that have very little cardiac knowledge, or knowledge of their own healthcare. So we tailor our programs to the individual. We educate the masses, but we tailor the exercise to their individual aspect of what they can do.

 

[Dr. Peter Salgo] And, Lou, is there a place for you in all this, or you just dump this all on the cardiologist and walk out?

 

[Dr. Lou Papa] Absolutely, because one of the problems, believe it or not, is getting people to do it. A lot of people think they know it, they don't need that information. "I know how to eat healthy. I know I should exercise." It's a commitment in time. It's a reminder that they had a heart attack. They've got to be around these people that are wearing events. There's a lot of negative reinforcement that's associated with it, so a lot of the encouragement is, "This is lifesaving. This is really important. If it was all about that, then why do professional athletes need to go to rehabilitation? Don't they know about fitness? There is additional information that you're getting that is gonna be important for your survival and recovery."

 

[Dr. Sears] About 25% of patients referred to cardiac rehab, or after a cardiac event, deal with depression and anxiety. So it's a significant barrier. If you don't think it's gonna help, most people won't try it. And part of depression and anxiety is evaluating situations and saying, "It's just not gonna go my way." So one of the first things we do is sort of deal with true psychologic, psychiatric problems. It is -- It's -- It's disheartening, it's discouraging to have your health suddenly snatched from you, particularly as dramatically as you did. And so, even though you didn't have any particular diagnosable psychologic condition, you realized and acknowledged just how much fear and worry you had about the future. So re-establishing that future orientation that's hopeful is important.

 

[Dr. Lou Papa] That depression issue is very important also, not only just from, "You should be feeling better," but people who are depressed that have heart disease have a higher risk of death.

 

[Dr. Peter Salgo] So, let's pause just for a minute, because every day, we hear about medical innovations that make an impact and hold promise for improving our healthcare. So take a look at this.

 

[Gosev] Left ventricular assist device, or LVAD, is a small mechanical pump that is helping failing hearts pump blood across the body.

 

[Knight] As we move through generation after generation of ventricular assist devices, this has enabled us to create novel surgical plans for the installation of these devices.

 

[Gosev] Patients that require an LVAD are usually very, very sick patients. If they had a really bad heart problem for a long time, they would be bedbound or housebound, and they would have problems walking to their kitchen. Just recently, a couple of years ago, we got this new pump, where, because it's much smaller, we can do that through a smaller incision. That way, you avoid opening the chest widely. Minimally invasive left ventricular assist device implantation involves two small incisions -- one in the right upper chest, about 5 centimeters in length -- so 2 inches – and the other one, 3-inch incision on your left lower chest. That way, you avoid going through the breastbone, that has then multiple benefits for the patient. Down the road, when the patient is ready to get and receive a transplant, it's easier to do the act of transplant at that point in time.

 

[Knight] Even patients who are not considered candidates for transplantation benefit greatly from this minimally invasive approach, because they recover much quicker. And it appears that the cardiac function is actually better preserved, and bleeding is a lot less with this minimally invasive approach. Dr. Gosev is an expert at ventricular assist devices, has done hundreds of them.

 

[Gosev] Dr. Knight is a well-known minimally invasive cardiac surgeon, and he's a leader in his field.

 

[Knight] He had done some minimally invasive surgery, but not through the chest incisions that we are currently employing.

 

[Gosev] This new technique came out of a collaboration between two cardiac surgeons that do different things. And I think a lot of stuff in medicine, and life in general, can come from joining forces with someone that works close to you but not exactly with the things that you are working on. Every success, every patient that does well, that goes home, it's a feeling that I can't describe. It's really a great, amazing feeling.

 

[Knight] When I see people in the clinic and we talk about the operation and I get to the part of the operation where we discuss the incision, it's a palpable sigh of relief that you feel from the patient, 'cause they dread this big incision. Everyone knows somebody who's had a sternotomy and cardiac surgery that way. And -- And everybody hopes never to need it themselves.

 

[Dr. Peter Salgo] And, Kris, we're back. You know, with all of the story you've told us, the unsung hero here -- you alluded to it – is your wife. And she's with us right now. Hi, Lynne.

 

[Lynne] Hi, there.

 

[Dr. Peter Salgo] Tell me a little bit what that was like from your perspective.

 

[Lynne] It was one of the worst experiences of my life -- probably the worst. Kris came upstairs, after having tried to take care of herself in other ways, in such a state of pain that I was terrified. We then -- She was moaning and holding her head as if it was going to split open. She couldn't stand up. She had no idea what was going on, and usually, of the two of us, she's the one who always knows what's going on physically.

 

[Dr. Peter Salgoo] But the doctor had told her it was the flu, take some Tylenol, and get over it. What was -- What was different? What told you to disregard that? By the way, that saved her life.

 

[Lynne] Yes. Well, I remember calling and Kris barely being able to speak to the doctor, and them saying, "You have the flu." And -- And we hung up, and I went and packed a bag and said, "No, we're leaving." Kris competed for years at the highest level of a sport that requires cardiovascular ability. And people are in pain constantly when they row. And she has a threshold for pain that, over the years, I've come to know exceeds no one's that I know. So, for her to be in that kind of pain signaled to me that some extraordinary thing was going on and that it was terrible. So I -- We were young. She was fit. I had no idea about calling 911 or an ambulance. I had -- All I knew was that she needed to get some help. And so I bundled her into a car and drove way, way beyond the speed limit to get to an emergency room so that she could be helped.

 

[Lynne] Well, you're a true hero. I don't think it is too much to say you saved her life.

 

[Lynne] Mm-hmm.

 

[Dr. Peter Salgo] And that's just great.

 

[ Applause ]

 

[Dr. Peter Salgo] Now, Kris, I guess we'll give you the last word. What is your advice to anybody who's had a cardiac event?

 

[Kris] Well, clearly, you have to be an advocate for yourself. I think we're trained to listen to doctors and do what they tell us to do, but sometimes you have to take things into your own hands and be your own advocate. You need to pay attention to your body. And when -- when you're not feeling well, when things aren't normal, you need to pay attention to that and you need to reach out to your primary care physician. Or if you have a cardiologist, reach out to your cardiologist to let them know what's going on, because then they can guide you.

 

[Dr. Peter Salgo] And what about rehab? What's your view on that? What's your advice?

 

[Kris] I'm a huge fan of cardiac rehab. I -- I think that it should be -- that those numbers should be, 100% of people who have cardiac events should be sent to cardiac rehab. It gave me my life back, and that's not an understatement. And it -- it gave me the confidence to go out and get into my boat again and be out on the water and to take up ice hockey at age 50 and – and to -- to really get back to living life fully.

 

[Dr. Peter Salgo] That is wonderful. Normally, we'd ask the doctors for comments, but nobody's improving on that.

 

[Kris] [ Laughs ]

 

[Dr. Peter Salgo] We're done. Congratulations. We are glad you're back. You know, I want to thank you for being here, I want to thank our panel for being here. I want to thank our studio audience, of course. It was great having all of you with us here today. I want to thank you at home for watching, as well. Remember, you can get more second opinions and patient stories at our website at secondopinion-tv.org. You can continue the conversation on Facebook and Twitter, where, every day, we're live with timely health information for you. I'm Dr. Peter Salgo, and I'll see you next time for another "Second Opinion."

 

[ Applause ]

 

 

[Narrator] Behind every heartbeat is a story we can learn from. As we have for over 80 years, Blue Cross and Blue Shield Companies are working to use the knowledge we gain from our members to better the health of not just those we insure, but all Americans. Some call it responsibility. We call it a privilege. "Second Opinion" is funded by Blue Cross Blue Shield.

 

[Announcer] "Second Opinion" is produced in conjunction with UR Medicine, part of University of Rochester Medical Center, Rochester, New York.