Coreg (Carvedilol)
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25 mg | ||||
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12.5mg | ||||
| 30 pills €52.86 | 360 pills €347.39 | ||||
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25mg | ||||
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25mg | ||||
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| leadmedic "Coreg" | 25 mg | 14-21days/$10
5-7 days/$25 | | every country | |
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12.5 mg | ||||
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| med-pen "Coreg" | 25mg | 14-20 days/$10
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12.5mg | ||||
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6.25mg | ||||
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| ourpharmacyrx "Coreg" | 25 mg | 14-21 days/$15
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12.5 mg | ||||
| 30 pills $29.4 | 90 pills $54 | ||||
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6.3 mg | ||||
| 30 pills $14.7 | 90 pills $27.9 | ||||
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REHABILITATION FROM HEART DISEASE: FORUM (JOE): GETTING INTO GEAR
Joe is a sixty-three-year-old accountant who has mild diabetes and is slightly overweight. He has never smoked and, aside from being inactive, has been, as far as he was concerned, in good health all his life. So, when he suffered a fairly large heart attack, it came as a complete surprise to him. Although he had no complications in the hospital and was able to do an exercise test on the treadmill quite well before going home, he never really was able to resume his former activities.
He didn’t have side effects from the medications, and didn’t have shortness of breath or chest pain or dizziness, even with climbing stairs or walking briskly. However, he could never get his motivation or energy high enough to want to go out, go for walks or attend social events with his family and friends; he also completely lost interest in sex. Although he went back to work, he found himself staring out the window and unable to concentrate. Rehabilitation was recommended, but he found the appointments difficult to manage and attended sessions only once in a while. He really didn’t feel like driving for thirty minutes in order to put shorts and a t-shirt on and walk around a small track with other heart-attack victims.
It was only when Joe’s business partner was reminded of his own brother’s depression that the “penny dropped” and he called Joe’s wife. Soon thereafter, a clinical depression was diagnosed, and Joe was started on antidepressant treatment, as well as given supportive psychotherapy; his wife attended sessions as well.
Soon Joe’s mood lifted considerably, his motivation returned, he began to be interested in the world around him and he was able to eventually start the rehabilitation program. For the first few months of rehabilitation, Joe had no major problems.
Joe attended this forum with his wife, Dr Baker and Dr Dorian.
Joe: I found a lot of things to interest me in this particular chapter, although personally I think that most of the drama for myself had occurred in the previous phase. Rehabilitation itself went quite smoothly.
Wife: Not the first time you tried to join the program.
Joe: I was depressed at the time. I wonder how many others are dropping out for that or other reasons.
Dr Baker: After heart attack there are about one-third of patients who have some form of depression and this could well affect compliance. Also, there are those people who live far away from the rehab programs, those who get involved in work commitments and also those who shut their minds off from their having heart disease (what we called “maladaptive denial”). These people probably don’t want to face up to the challenge of what it means to have heart disease.
Joe: Well, I can sympathize with those who have been depressed, especially all those people who don’t even know about it.
Wife: You talked about work commitments. I think Joe doesn’t admit to how much work he takes on.
Joe: I do what I have to do.
Wife: We have discussed this many times. When it comes to sharing the work, Joe always lands up with the lion’s share. It’s been going on for years.
Joe: It’s true that I have trouble saying no.
Wife: Yes, you’re always “Mr Nice Guy.” Remember, “nice guys finish last.”
Dr Baker: If you are not assertive, you may be taken advantage of, even though your partners may not be aware that they are overloading you and don’t mean any harm to you.
Joe: No, they don’t. They were wonderful to me when I was not up doing things after the heart attack, and especially when it turned out that I was depressed.
Wife: You were delayed in starting the rehab program the second time, but we were just relieved that you were feeling well. In the end it doesn’t seem to have mattered so much as long as you eventually did what you had to do.
Dr Dorian: Joe, I understand that you developed problems later on.
Joe: Well, I had no problems at first, but it must have been about six months after the heart attack, I suddenly became dizzy and my heart started to pound. This went on for half an hour. I went to my doctor and he said that my heartbeat was irregular. I had to wear a Holter monitor and, during that time, I had a bout of palpitations, recorded on the monitor, which they later told me was “atrial fibrillation.”
Dr Dorian: This is a form of heart rhythm disturbance, or arrhythmia, which is non-life threatening but can be problematic. The good thing is that it can be effectively treated with drugs.
Joe: Yes, once they got the right combination of my medications, I have stayed well ever since.
Dr Dorian: How did you handle it compared with the heart attack?
Joe: Well, it was completely different! When I first had the heart attack, I felt completely at a loss. I thought my life was basically over, even though I realized somehow that I could still function physically. I felt guilty at not having taken better care of myself with regard to my diet, not having exercised more, not having watched my diabetes more carefully. I just couldn’t motivate myself to go to the exercise classes because I just couldn’t see any point in going through all that if it wasn’t going to help me. When the doctors would explain things to me, I don’t think I was really listening, because I thought it was really hopeless. A few weeks after I started taking the medication for depression, I began to see that I wasn’t quite so sick as I had feared, and that if I participated fully in the program it could help me. Only then did I find that I could exercise, and concentrate on my work, and began to be much more hopeful that I would continue to improve.
Wife: He’s asking you about how you handled the arrhythmia.
Joe: Sorry. So, as I was saying, when the atrial fibrillation suddenly happened, I discovered I had confidence and I wasn’t devastated by it. I am sure that had I had the arrhythmia earlier after the heart attack, the dizziness and the heart irregularity would have made me think I was dying, that my life was in danger.
Dr Baker: For you, the decision to move on on the road of rehabilitation was easy, once your depression lifted. It is not always so easy for others. As a cardiologist, what do you do, Dr Dorian, to motivate patients after a heart event, those not clinically depressed?
Dr Dorian: I think getting patients to go even once to the program, just to try it out, can give a boost. Once patients see how helpful the staff are, that they are not alone, and that others have taken the same route and done well, they can see a light on the horizon.
Dr Baker: Joe, what was your experience of the supervised program like?
Joe: After I began the rehab program, although I must say I wasn’t very optimistic about it in the beginning, I gradually began to get some pep and energy back, and I could see how it could help me. I was also able to listen more carefully to my doctor and follow the coaches in the program. The good news is that the better I felt, the more eager I got; and the more I did, the better I felt. I began to look forward eagerly to my three-times-a-week sessions at the rehab center and was even able to help convince some of my fellow patients that they should hang in there with the program.
Wife: I must say it was a pleasure to see how enthusiastic he became with the program. He was also very strict when it came to cutting down on the fats in his diet and continuing to exercise religiously.
Joe: Well, it seemed to give me more meaning in my life. Sticking to the diet took some getting used to, but I like my wife’s cooking, whatever she makes.
Wife: I think Joe is flattering me to keep me cooking up a storm for the next few years!
Dr Dorian: What about exercise?
Joe: Being at the program really helped me get used to doing exercise. I feel good during and also after I have completed my prescribed program.
Wife: Joe, don’t you think you became so much better when you met your friend over there?
Joe: That’s right. You know, even though I had been down in the dumps and not very keen, when Fred came into the program, I felt so good being able to convince him of the benefits of the program. As time went on, we saw that we had a lot in common and became good friends. We encourage each other driving together to the rehab center, discussing our diets and walking together.
Dr Baker: One cannot overestimate the value of friendship and generally the social aspects of rehabilitation programs. This certainly seems to have given an impetus to you, Joe, in helping you along the road to recovery. What about your handling of stress?
Joe: From what I’ve read here, I think I’m okay.
Wife: You still haven’t stopped taking on too much work.
Dr Baker: Well, if this continues, I suggest you do assertiveness training.
Wife: As long as he is not like that at home!
Cardio & BloodWife: I think I can handle that. I’m only too pleased that Joe is getting his life in order.
Joe: My wife hasn’t mentioned how wonderfully supportive she has been. She has helped me so much. Things look so different at the end of rehabilitation, compared to the beginning of it!
*40/214/2*
