Minutes - March 2008

NATAL BYPASS MEETING 01/2008 held on
WEDNESDAY 5 MARCH 2008
AT ENTaBENI HOSPITAL
at 17:30
PRESENT:
Shane Newman (Chairperson)
Shirley Piek (Secretary)
As per attendance register
1. OPENING AND WELCOME
Shane Newman welcomed all present and asked everybody to stand for a minutes silence in remembrance of the late Chairman of the Natal Bypass Club Jack Piek who had passed away on the 22nd of February 2008, after a short illness.
2. APOLOGIES:
Chris O Flatery – departing for overseas on holiday/business
Neville & Sissy Farr – Sissy is recovering from a hip operation
John & Pat Rider

It was noted that the turn out to the meeting was poor, but also encouraging to note that Mr Dave Perry had traveled form Port Shepstone to attend the meeting – well done Dave on your commitment & enthusiasm shown.
3. IN ATTENDANCE:
Mrs Gillian Adams – Physiotherapist & guest speaker for the evening.
4. VISITATION REPORTS
4.1. St Augustines
There was no representative to give a report.
4.2. Entabeni
There was no representative to give a report.
4.3. Westville
Shane to make enquires from both St Augustines & Entabeni representatives to ensure that visits are being made and that there be some form of report back at the Bypass club meetings.
5. RAFFEL DRAW
The bottle of whiskey, which was donated by Shirley Piek, was won by George Barnes. Thank you Shirley.
6. GENERAL
6.1. Subs
Shane requested that if any members still have fees outstanding for 2008, that they please pay Shirley. The fee for 2008 is still R30 per person.

6.2. Election of Members
Shane mentioned that Jack Piek had requested before passing on that Shane take over the running of the club. Shane mentioned that Chris O’ Flattery (member) & Shirley Piek (secretary/treasurer) have made themselves available to assist him – thank you to both of these members. If there are any other members who feel that they would be available to contribute in the running of the club or have any concerns, they can please contact Shane.
6.3. Updating Membership Details
It was requested that each member check that their personal particulars were up to date and change accordingly, on the lists that were provided.
6.4. Election of Members
Those present were asked if the same venue as last year function (viz: Durban Country Club) should be booked again for November/December 2008. It was agreed and Shirley would make contact with DCC and make a booking.


7. GUEST SPEAKER
Gillian Adams is a UK Charted & SA Registered Physiotherapist with a special interest in hydrotherapy & fitness rehabilitation. She was awarded an honorary certificate in Aquasize Instruction by the SA Water Fitness Association in 1983 for her contribution to the promotion of water fitness in South Africa. Gillian has assisted with Cardiac rehabilitation Phase IV at two of NHS hospitals & attended 4 post graduate courses in hydrotherapy. She received her masters degree in Sports Medicine at RAU in 2004 & the subject of her research was the feasibility of cardiac rehabilitation in water, which she also presented at the International Society of Medical Hydrology Conference in Istanbul in June 2006.

Gillian proceeded to show two PowerPoint presentations, one being of particular interest to the members on hydrotherapy.

Some of the salient points from her presentation on Cardiac Considerations with Immersion were as follows :

… Pressure increases with depth. At 1 metre depth, pressure on ankles is 10% more than on the surface = double layer of tubigrip - Useful for those swollen ankles as this pressure assists blood back to the heart = Preload
… How does this affect exercise in water?
o The relevance concerns how the heart handles Preload
o Preload lying down = standing in water up to the waist, 130ml
o Immersion: 700ml fluid moves upwards in 6 seconds= approx 7 heartbeats: ¼ stored by the heart, the rest in the large thoracic veins and pulmonary circulation.
o The heart rate decreases
o The heart beats smarter, not harder
o Cardiac output increases 30%
… Guidelines for exercise in water:
o Heart condition must be STABLE
o Low & medium risk patients, ejection fraction >30%
o Chest depth is generally safe - (Severe MI and CHF can exercise UPRIGHT, no deeper than the xiphoid if sleeping flat can be tolerated)
o Gradual entry, don’t leap in or out!
o Rather not use step-up and down exercises (fluctuating preload and heart volume)
o Be aware of ‘masked’ angina
o Keep meds next to pool
o Talk test useful, exercise at 60-75%MHR (THT…)
o Swim if previously a swimmer, not alone
o Don’t swim underwater
o Avoid extreme water temperatures - below 16˚C Absolute Contra-Indication
o Rest in sight afterwards for 15 mins, recovery rate NB - Adrenal hormones are raised during vigorous exercise and take a little while to go back to normal. If the person with heart problems does not rest he may experience some irregularity of the heart beat and become distressed
… Calculation of Heart Rate - 4 methods:
o % true HRmax
o Karvonen: calculates Heart Rate Reserve and should use the true HRmax * tables available - (HRR = HRmax - HRrest)
o Age adjusted method: 220-age
§ 20-30 beats above RHR = require an actual measurement of Hrmax from your doctor
o Talk test is practical
… Recovery rate is still the best way to measure how well a heart is doing
o Return 10 beats from resting heart rate within 5 minutes after exercise - can take a little longer in older people
… Check with your doctor, listen to your body, relax and enjoy !
General comments from Gillian :
o Heart & other conditions must be stable and your doctor’s permission is essential before any exercise.
o We as bypass patients must not get complacent, after the operation
o People are more comfortable in water than in a gym
o Water walking (moving of arms and legs under water, as if walking) is sufficient exercise for cardiac patients.
o Get to know your body of what it can do, your resting heart beat, maximum & how quickly your heart beat returns to normal after exercise – any anomalies should be pointed out to your cardiologist or doctor.
o Don’t hold your breath when you pick up things.
o Remember with all exercise to warm up all your muscles, which includes your heart muscles.
o A program of two sets of 10 minutes three times a week is sufficient
o The pressure under the water pushes you Blood Pressure (BP) up.
o In order to realize what your maximum & minimum BP is subtract your age from 220 & multiple by 60% for the minimum and 75% for the maximum i.e. 220 – 60 = 160 * 75% = 120
o Don’t swim alone & not under water
o Rest, re-hydrate and rest.

Questions were raised by those present and the meeting was closed.
8. NEXT MEETING
The next meeting would be on Wednesday the 7th of May 2008 at the Executive Conference suite at the Entabeni Hospital at 17:00 for 17:30.
Complimentary drinks and snacks will be available, to club members.
The Impilo tablets will continue to be on sale at the meeting, but should you wish to secure an order, you can place your order with Shirley Piek. Thanks Shirley for providing this service to the members.
A guest speaker will be invited to come and share with the club in May, so please try & be there.
Issued by Shane Newman – 084 510 8738 or 031 708 5629 (after hours)
Chairman – Natal Bypass Club
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