Why Heart Patients Must Monitor Symptoms and Be ER Ready: Critical Insights
Hey Heart Buddies! Oooooo today's episode is another episode I needed when I was starting my heart journey. I interview Jennifer Johnson, an ER nurse, who dishes on all the things our doctors aren't going to tell us heart patients... at least I haven't had one tell me all that Jenn shares in this episode. She emphasizes the importance of being proactive about health, grieving, and understanding women's unique heart attack symptoms. The discussion covers practical tips for heart patients, including keeping a detailed symptom journal, bringing medication lists to the ER, and financial assistance for medications. They highlight the significance of humor, intuition, and having an advocate in healthcare settings. The episode underscores the value of early intervention and proactive care to prevent severe cardiac events and complications. Subscribe to join the supportive heart patient community on Patreon.
Find Jenn's books here
30 Days: A Symptom Tracker for Heart Patients: Johnson RN, Jennifer A: Amazon.com: Books
TheIntuitiveNurse - Etsy Canada
About Jennifer Johnson
Hi, I’m Jennifer Johnson, and I am a wife, mother of two, and a Registered Nurse in Ontario, Canada. I have spent the last sixteen years of my career in the emergency room of big and small hospitals all over Northern and Southern Ontario. I have personally been a part of all the heartbreak, drama, bullying, life to death moments, and then also trying to cope in the ER during an ongoing pandemic. My books are my rally cry to all the other nurses struggling through this pandemic and finding that they are losing their love of nursing. They (as well as I) are burnt out and depressed and feeling hopeless. The love, caring, and camaraderie of nursing have changed for all of us, and the expectation that we continue to show up to a job that puts our lives on the line is new to us, and we are not doing well. I wanted to put this book out there to let nurses know they are not alone. Bringing back the love of nursing is possible. Now more than ever, we need to support and help raise each other.
Join the Patreon Community! The Joyful Beat zoom group starts in September 2024.
**I am not a doctor and this is not medical advice. Be sure to check in with your care team about all the next right steps for you and your heart.**
How to connect with Boots
Email: Boots@theheartchamberpodcast.com
Instagram: @openheartsurgerywithboots or @boots.knighton
LinkedIn: linkedin.com/in/boots-knighton
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Transcript
Women have heart attacks that are so much different than men's.
Speaker:It's not typically your classic, you know, clutching the chest, the
Speaker:left arm, the jaw pain, the back pain. Like
Speaker:it's not usually those signs.
Speaker:Welcome to open heart surgery with Boots. The
Speaker:podcast that gets to the heart. Of what it's really
Speaker:like to go under the knife. I am your host,
Speaker:Boots Knighton, here to share the ups,
Speaker:downs and everything in between about
Speaker:heart surgery from the patient's perspective.
Speaker:Before we dive into this operating room of our
Speaker:shared experiences, please make sure this
Speaker:podcast stays on the healthy side of the
Speaker:charts. If you're finding this podcast helpful or
Speaker:inspiring, please subscribe and leave a
Speaker:review. Your support is the heartbeat
Speaker:that keeps the show alive. And
Speaker:if you want to be a part of an even closer knit
Speaker:community, come on over to our Patreon.
Speaker:Join us in the heart chamber. You can
Speaker:find
Speaker:us@www.patreon.com
Speaker:openheart surgery with Boots. There you'll get
Speaker:exclusive content, behind the scenes stories, and
Speaker:a chance to connect with other heart warriors.
Speaker:But for now, let's open up and explore the world
Speaker:of heart surgery from the other side of the
Speaker:scalpel. Thanks for coming back
Speaker:to another episode of Open Heart Surgery with Boots.
Speaker:I am your host, Boots Knighton, and today I get to
Speaker:introduce you to another canadian friend of
Speaker:mine. I am losing track now of all the wonderful
Speaker:Canadians I've been able to invite onto the podcast. I love
Speaker:y'all. Please keep coming back. And today is a
Speaker:super special guest from Ontario, Canada,
Speaker:Jennifer Johnson. Wow, she has so much
Speaker:to teach us. Jennifer is an
Speaker:emergency room nurse and she has
Speaker:spent the last 16 years of her career
Speaker:in the ER, in big and small hospitals
Speaker:all over northern and southern Ontario. So she's seen
Speaker:a lot. She has personally been part of all the heartbreak, the
Speaker:drama, bullying. She's got to tell us about that
Speaker:life and death moments and then also trying to cope in the
Speaker:ER during the ongoing pandemic.
Speaker:She has since written a book about how nurses
Speaker:are struggling through the post pandemic era
Speaker:and burnout and she is just an absolute
Speaker:treasure. She is starting to teach folks about how to use
Speaker:their intuition in nursing and she's going to tell us about
Speaker:that as well. And then ultimately she is going to
Speaker:coach us heart patients on how to show up
Speaker:to the ER, prepared, what to expect in the
Speaker:ER, and how to help nurses help us.
Speaker:So Jen, thank you so much for saying yes to today
Speaker:and welcome to the podcast. Thank you so much for having me.
Speaker:I'm so pumped. It's gonna be. And I hope I said all
Speaker:that right. Like, you, you're doing so many great things.
Speaker:And I've experienced from the heart patient's
Speaker:perspective, I have experienced burned out nurses since the
Speaker:pandemic. And I thank them. And I thank you
Speaker:for continuing to serve because we
Speaker:need. We heart patients need all the help we can get.
Speaker:I'm sorry in advance for the burnt out nurses.
Speaker:They. They know not what they do or how they come
Speaker:across. And I'm sorry. Typical
Speaker:canadian fashion. I'm so sorry. And an
Speaker:accent. My gosh, I love
Speaker:it. I love it. I may put it on a little bit more and
Speaker:I may pick up yours just for fun. I don't show.
Speaker:That's the great thing about podcasts is around the
Speaker:world, we are listened to, and I get to hear so many
Speaker:different accents. So set the scene for us
Speaker:and your nursing career and the
Speaker:book you wrote and your intuition, like, give us the
Speaker:down low so we can understand who you are before we dive in.
Speaker:Into the emergency room scene. Absolutely. So I'm
Speaker:Jen. I'm based out of Hamilton, Ontario. I've
Speaker:been nursing for 16 years now and continue
Speaker:to nurse at the bedside in a few different
Speaker:ers. And it's just one of those things
Speaker:where even if you try to leave the ER, if you're
Speaker:drawn to it, if you're a lifer, you can't quite get away.
Speaker:So no matter how hard I try to kind of try other things,
Speaker:I always end up going back to the ER. So it's been, yeah,
Speaker:16 years of highs and lows and. And super
Speaker:lows with COVID and, you know, it's one of those things where you
Speaker:look back and you're like, how has it already been 16 years?
Speaker:Cause it feels like it's. It's gone by in an instant. It's
Speaker:absolutely hilarious to kind of take a step back and go like,
Speaker:okay, well, I guess I'm the senior nurse. When somebody calls out, we need a
Speaker:senior nurse, and you're like, who's going to be it? It's like, oh,
Speaker:I'm the senior nurse. Like, okay, I guess I can fill that
Speaker:role for you. So just kind of, you know, going through the
Speaker:motions and going through, you know, pretty wicked depression
Speaker:with COVID Ended up kind of hitting all
Speaker:sorts of rock bottoms that, you know, you didn't even know were possible
Speaker:until you hit them. And through that, I ended
Speaker:up just kind of writing into a book, a bunch of
Speaker:experiences for my kids because we thought we were going
Speaker:to not make it home some days. And so it was one of
Speaker:those things where it's like, okay, well, if I end up passing, and
Speaker:this is the end of my career, this is the end of my life, I
Speaker:want my kids to understand a little bit as to why I
Speaker:kept going back and why I kept working during COVID because how do you
Speaker:explain that to a four and a five year old that if mom
Speaker:had not made at home, how do you. How do you explain that kind of
Speaker:thing? So, started writing the really good stories about the times that
Speaker:I helped and. And the. Some of the things that I've done. And
Speaker:with that, then comes the lows of not
Speaker:wanting to. To revisit some of the super hard cases
Speaker:that absolutely broke you as a person, but that needed to happen,
Speaker:too, and writing them down, and it's like, okay, well, what do the.
Speaker:What do all these have in common? And it's. Well,
Speaker:it's intuition. Like, I trusted my gut and a lot of these cases,
Speaker:even though I didn't know what I was doing at the time, but
Speaker:I was going with my gut, and then I was advocating for my patients, and
Speaker:sometimes the docs would listen to me, and sometimes they wouldn't. And that's their
Speaker:own. That's of their own rights kind of thing. I get it.
Speaker:But the times that they listened to me, the patient outcomes were so much better.
Speaker:And so went back and said, okay, is this just
Speaker:me being super woo woo and coming at it out of
Speaker:left field and ended up doing some digging into the
Speaker:research on intuition. And so not only is there a ton of research
Speaker:on intuition that is peer reviewed and supported by
Speaker:evidence, there's also specifically intuition and nursing
Speaker:that has been reviewed and presented,
Speaker:and it's there. So if the. The evidence
Speaker:is there, if it's peer reviewed, if it's supported, we should be teaching it. So,
Speaker:that was the thought process behind intuition and nursing,
Speaker:and my book, nursing, how to trust your gut, save
Speaker:your sanity, and survive your career.
Speaker:And that's kind of led me to this moment of all of a
Speaker:sudden, getting on a couple of podcasts and really opening
Speaker:myself up left, right, and center. And you know what? Just
Speaker:going for it and being excited to be on the ride.
Speaker:Incredible. And thank you, because we are, all
Speaker:of us patients are clearly beneficiaries
Speaker:of your willingness to be courageous
Speaker:and step out and be like, this is my story. This deserves
Speaker:to be told. We've got to do better. That's what I'm hearing you say.
Speaker:Yeah. And this isn't just in isolation
Speaker:to Canada. No. This is everywhere. Most of this
Speaker:is everywhere. Most of the statistics and the evidence
Speaker:is coming out of the states. So I'm so proud of the
Speaker:US for being forward thinking with this and putting it
Speaker:out there. Now it's just up to the rest of the world to kind of
Speaker:pick it up and run with it. Yeah. Wow.
Speaker:So, okay, so obviously you have some
Speaker:credibility. Thank you for sharing all of that.
Speaker:Just like a little wisp of incredible. Don't
Speaker:belittle yourself. You have shared that. You have
Speaker:witnessed a few cardiac patients in your 16 years
Speaker:where we want to start there. What do you wish you could yell from the
Speaker:mountaintop to cardiac patients as they
Speaker:prepare to go to the ER? Like, what do
Speaker:you wish you could just yell to all of us? What do
Speaker:we need to know? First and foremost, please, if
Speaker:you're not just straight up bringing all of your bottles of
Speaker:medication with you, please, please, please bring
Speaker:a list of your medications and up to date
Speaker:recent lists. You know, people, I can't tell you how
Speaker:many times in a day both heart patients and others will sit in front of
Speaker:me and go, oh, I take a little white pill for my pressure,
Speaker:and you understand how many little white pills there
Speaker:are for blood pressure alone.
Speaker:And it's one of those things where it can have a
Speaker:huge impact, especially if you're unwell enough to become
Speaker:admitted to the hospital. We need to know where we're
Speaker:starting at, especially heart patients, your water pills, how much
Speaker:you're taking, how often you're taking them, what time you're taking
Speaker:them, because a lot of times people will be taking their water pills at dinner
Speaker:or later, and you poor souls, like, you're going to be up
Speaker:peeing all night long, and, and then you're going to be exhausted, and then
Speaker:you're not going to want to take your water pills. So, you know,
Speaker:please keep track of, of your pills. Any recent
Speaker:cardiology appointments, like if they've changed anything recently,
Speaker:please mention that if you've been having chest pains,
Speaker:please. Oh, my God. You've already got a cardiac history.
Speaker:You're already, you want to talk about credibility? You're already ten times
Speaker:more credible than most patients that I'm seeing. And your
Speaker:history alone already kind of jacks you head
Speaker:in the line. So with coming into the emergency room, we
Speaker:triage you. We have to sort everybody by, like sickest to non
Speaker:sickest. And your medical history alone
Speaker:puts you in the middle of the pack just to start. So I don't care
Speaker:if you're walking in out of nowhere, if you're telling me you've got a history
Speaker:of heart failure, you've had bypass, you've got stents,
Speaker:and then on top of that, you're either having dizziness or chest pain
Speaker:or shortness of breath. You've caught my attention, and
Speaker:I. I don't want you catching my attention because that means you're pretty
Speaker:sick. So if you're. If you're coming to hospital,
Speaker:if you're having new weight gain, all of a sudden,
Speaker:you've put on quite a few pounds. That needs to be
Speaker:noted because that's probably just water weight and it's probably in your poor
Speaker:legs, and so that needs to be assessed as
Speaker:well. How can we make sure that there's been a
Speaker:change? So all of a sudden, are you having chest pain or tightness?
Speaker:Are you then having an increase in your water weight, even though you're taking your
Speaker:pills as prescribed? And are you then not able to do what
Speaker:you normally do? So letting us know that there's been
Speaker:a change in your weight is fantastic.
Speaker:I never, ever get that information at triage, and I would love
Speaker:to know if all of a sudden, you've had a three, four, five pound weight
Speaker:gain in a week or two, that's significant. So I need to
Speaker:make sure that's looked into. Are your legs open? Are they
Speaker:weeping? Are all of a sudden your calves swollen when it's only your
Speaker:feet that are swollen? Because the swelling truly will just
Speaker:continue to come up your body in gravity
Speaker:so it can get to the point where then it gets to your lungs.
Speaker:And so this is why, if all of a sudden, you can normally sleep laying
Speaker:flat or maybe with just a little bit of, you know, one or two
Speaker:pillows, if all of a sudden you can't sleep, you have to sleep in the
Speaker:recliner. That's a big problem. So please,
Speaker:if that's the change that's been happening, please tell us, because then I worry
Speaker:that the fluids gone into your lungs, if you're coming
Speaker:upstairs, and the stairs, just doing that alone, just even a couple
Speaker:stairs or walking a couple of steps, gives you chest pain.
Speaker:Please, please, please tell me that and be open and
Speaker:honest with your level of pain. I understand that everybody feels
Speaker:pain differently. I understand that everybody
Speaker:reports things and feels things a little bit differently.
Speaker:And after multiple ER trips, after multiple years of being
Speaker:a heart patient, you kind of. You shrug it off. You've been to the ER
Speaker:enough, you don't want to go. So then you start saying, oh, it's not a
Speaker:big problem. You start putting it off and
Speaker:I get it. If I didn't have to be in the ER as a
Speaker:patient, I absolutely would not be.
Speaker:Truly, I understand. But it's one
Speaker:of those things where as time goes on, the more chronic your
Speaker:condition, the less you want to come to the ER. And unfortunately, by
Speaker:putting off coming into the ER when you're really not feeling too well at the
Speaker:beginning, leads you to have bigger cardiac
Speaker:events and potentially longer hospital stays
Speaker:or even, you know, instead of. If you would have come after a day
Speaker:or two, we would have just given you maybe a little bit of extra water
Speaker:pills, we would have seen that you're peeing out all that extra fluid, you're feeling
Speaker:better, we can send you home versus waiting a
Speaker:week, and then all of a sudden, oh, no, this is going to take a
Speaker:little bit of time. Now you're on oxygen. We can't send you home.
Speaker:So now you've earned yourself an admission. So it's one of those things
Speaker:where sometimes coming earlier, as much as it sucks to come to the
Speaker:ER, if you can, if something has changed, go,
Speaker:like, go to the ER. And truly, I'm not one ever
Speaker:to tell anybody to go to the ER, but
Speaker:having chronic heart conditions, you're kind of already at a loss.
Speaker:So you need to be able to recognize
Speaker:when something has changed, when something's feeling off. And
Speaker:again, trust your gut in your own care, like, you know your body
Speaker:much better than I do. So if you're telling me
Speaker:something's wrong, I don't know what it is, I'm just not feeling right.
Speaker:I'm feeling off. I'm going to take you at your word
Speaker:and I'm going to mark it down, and then I'm going to talk to my
Speaker:doc to be like, hey, here's the vitals. Here's what I'm seeing, here's what
Speaker:they're experiencing, but they're telling me something's wrong. And
Speaker:so I will take that to the moon and back, because
Speaker:really, the number of times people have said flat out,
Speaker:I'm going to die, they've been right and we haven't
Speaker:listened. And sometimes you get a little burnt out and you kind of want to
Speaker:kind of pat people on the hand and be like, no, it's fine, you're in
Speaker:the right spot. All these kind of things. After one,
Speaker:two, three, people do that to you. You start listening and you start paying
Speaker:attention. And so, you know, your body,
Speaker:if you can let me into what's going on in your
Speaker:body, you know, please do, because
Speaker:I want to help. I'm here to help. I don't want to keep you. I
Speaker:want to make you feel better. And then I, you know, the joke is treat
Speaker:them and stream in the ER. Wow. I've
Speaker:never heard that. No, we're going. Oh, my
Speaker:gosh. Treat them and straight up. You know, that's the whole goal of the
Speaker:ER, is just to bring it in. Let's, you know, overall,
Speaker:let's make you feel a little bit better so that you can go back home.
Speaker:We're not looking to keep you. We don't want to keep you. Trust me.
Speaker:The hospitals in Canada alone are overrun at this
Speaker:point. And if we didn't have to keep you, we wouldn't.
Speaker:So, please, just. The sooner you can come to
Speaker:an ER or even your family doctor, like, if you can scooch in to see
Speaker:them or your cardiologist, when things start to change, the sooner you
Speaker:can kind of get on it, the less likely that you'll potentially have to stay
Speaker:in hospital. Okay, so I'm hearing a
Speaker:few things here. Whoa.
Speaker:I'm hearing that humor helps.
Speaker:Laugh about it. We'd be crying all the time. Oh, I'm sure, I'm
Speaker:sure. But awareness. So the
Speaker:patient having an awareness of self. Yep.
Speaker:Cause I have spoken with so many
Speaker:heart patients now who were so
Speaker:disassociated. Cause it was so hard to
Speaker:come to terms with the situation. So it's this
Speaker:double edged sword. Cause disassociation serves us right. It
Speaker:makes everything less scary. However, if you're
Speaker:disassociated and you can't speak up for yourself, that's
Speaker:scary, too. That's even, dare I say it, more scary.
Speaker:Yeah. So that's probably why it's good to also have an advocate
Speaker:with you and then also showing up
Speaker:prepared. Please. That was really the only
Speaker:two. Just showing up prepared and having the awareness of
Speaker:the situation. And for me, I
Speaker:keep a running, like, notes
Speaker:tab open in my phone, and I just keep track
Speaker:of all the symptoms. Oh, I know what I was going to
Speaker:say. Being proactive. Yes. Less
Speaker:reactive. More proactive. Right. And so
Speaker:here's a struggle I've had, and I don't know if
Speaker:you can appropriately answer this. Well, I mean, just
Speaker:like, because it's hard to speak in the hypothetical, but. And
Speaker:especially because, like, you're not my care provider and you're in Canada,
Speaker:but it's hard to know
Speaker:as a heart patient, like, what
Speaker:truly is an emergency. And I'll admit to
Speaker:you just now, I learned so much from you. I mean, I've been on my
Speaker:own heart journey now for four years. And with this
Speaker:podcast and talking to so many healthcare providers, you would think I'd know
Speaker:a few things by now. And this is the first time
Speaker:I've heard someone say to me, hey, if you've gained
Speaker:weight and you. You quantify it, and it's in a certain
Speaker:amount of time, like, I had not thought of that before, and I've
Speaker:actually been on frickin weight pills or water pills. I
Speaker:mean, and so it's. It didn't come with a
Speaker:manual. Like, when I was diagnosed with my heart stuff and
Speaker:then had surgery, I didn't get a manual. I didn't get,
Speaker:like, this full on education that I needed, which is. That's
Speaker:why I started this podcast. Yeah. And good on you,
Speaker:because, like, truly, again, it's. It's not. The
Speaker:things I'm doing are not just for me, the things you are doing are not
Speaker:just for you. But we all end up learning
Speaker:in. In the overall. Right. Like, we're making up words now,
Speaker:but we're all. We're all learning. And that's just it. And
Speaker:it's. It's things that come up that
Speaker:I think are second nature. You've got a heart patient. They've put on
Speaker:some weight. Their legs are. So if you can push into your legs
Speaker:and your fingerprints stay. So that's pitting edema,
Speaker:and that's extra fluid in the area that needs to be kind
Speaker:of looked at. If that's worse than that normally, is that right
Speaker:now? So they
Speaker:can quantify it with how deep you can actually put your
Speaker:fingerprints and push in. So if there's
Speaker:1234 plus pitting edema, and
Speaker:most times by the time you're actually leaving a fingerprint, that's
Speaker:two to three plus pitting edema. But it
Speaker:gets to the point where a lot of her patients will have then cellulitis
Speaker:because your poor legs will get so swollen and you've put it
Speaker:off for so long that the pressure in the legs,
Speaker:it pushes against the skin, it stretches the skin. And then I've literally seen
Speaker:water drops come out of people's legs because
Speaker:the. The water retention is so bad and it stretch the skin to
Speaker:absolute max point and their poor legs start weeping. So at that
Speaker:point, your legs are open to then bacteria getting
Speaker:in. So then you can have really wicked
Speaker:leg and, like, cellulitis. So skin infections that
Speaker:are extremely hard to treat and to get under
Speaker:control, because once the legs are open, it's hard to come back from
Speaker:that. And I've seen people who are battling chronic
Speaker:cellulitis for years. They'll come in, we
Speaker:admit them, we treat them, we give them lots of water pills so that we
Speaker:take that pressure off the skin. Then we're giving them antibiotics to treat the
Speaker:infection. It takes days for them to kind of be
Speaker:able to heal well enough that they can. The skin
Speaker:stops weeping and, you know, the redness stops
Speaker:spreading and the sores kind of start to heal. But again,
Speaker:heart patients, if you've had cardiac surgery,
Speaker:you're more than likely they've taken vessels out of your legs, which,
Speaker:unfortunately, then your circulation to your legs and the return
Speaker:circulation from your legs is not nearly as good as it once was.
Speaker:I so then again, leads you to swelling in your
Speaker:legs that is harder to kind of deal with because
Speaker:that's one, two, three vessels that potentially
Speaker:you've lost to your heart to keep the heart going. But now your poor
Speaker:legs, now you have to try and deal with the swelling
Speaker:in your legs. So it's. It's a hard journey. I wouldn't wish it
Speaker:on anybody. But it's one of those things where
Speaker:there's a lot of things that are involved in
Speaker:cardiac care that people don't think are involved in cardiac
Speaker:care. So if all of a sudden you're short of breath, a lot of people
Speaker:don't equate that to your heart. They think, oh, it's respiratory. I'm sick
Speaker:with the flu or pneumonia or something like that,
Speaker:when in reality, it might just be that the fluid in your lungs has come
Speaker:up to the point where you just can't breathe. So then we
Speaker:have to come in and we have to deal with that, or your heart, the
Speaker:ejection fraction. So how well your heart's pumping. Your heart's been
Speaker:stressed, and now all of a sudden it's not pumping as well as it was,
Speaker:again, allowing for that buildup of fluids. So we
Speaker:typically, when you come in to the ER, you've been triaged,
Speaker:we've brought you back, we start doing tests. A lot of times
Speaker:we'll do what's called a troponin. So in Canada, we call it a troponin, which
Speaker:is one of the cardiac markers. So if it's an enzyme that's
Speaker:specifically in heart tissue, if there is suddenly a
Speaker:detectable rise in your blood work, that means there's been
Speaker:damage to specifically heart tissue. Whether it's been a lot of
Speaker:damage or a little, it's hard to tell, but we then will
Speaker:do another one, three to 6 hours later to make sure that
Speaker:there hasn't been an increase in it. Sometimes people will
Speaker:come in, I've been having chest pain for 20 minutes. Okay, we bring
Speaker:you back, we do all the blood work. There's no troponin in your system, but
Speaker:when we repeat it three or 6 hours later,
Speaker:all of a sudden there can be a rise. And that's because it takes time
Speaker:for the cells to leak the troponin to be able to have it come into
Speaker:your blood system. So a lot of
Speaker:cardiac patients, unfortunately, are always in for a three
Speaker:to six hour visit after getting blood work.
Speaker:And I like to tell people, hey, I've done the blood work. Coming back in
Speaker:45 minutes to an hour, depending. Unfortunately, the troponin usually
Speaker:takes roughly an hour in Canada to come back. But by that time, the
Speaker:clock has already started. So we need to do a troponin either three or 6
Speaker:hours from that original poke. We can repeat
Speaker:it, see if it's gone up, down, stayed the same.
Speaker:Perfect. So, you know, if you're coming in, you're having
Speaker:chest pains, but your troponin's fine and it's. It's either negative
Speaker:or stable. Some people will continually
Speaker:have just a little bit of troponin in their system because they've
Speaker:got cardiac conditions that, unfortunately, their heart's been strained.
Speaker:Either they're waiting for cardiac bypass or they're waiting
Speaker:for angiograms to be able to put stents into the heart.
Speaker:Sometimes we know where people kind of sit. So
Speaker:even if your troporin is a little bit elevated, if that, if we can go
Speaker:back into previous visits over the last six months, year, two
Speaker:years, and see that that's kind of your normal. We're like, oh, okay. That's kind
Speaker:of where they sit. That's acceptable. Wow.
Speaker:Honestly, it makes me want to do a, like, create a journal for heart
Speaker:patients. And I'm literally, my head starting to, like, go right now to be
Speaker:like, oh, I need to create this journal
Speaker:so that you can kind of have a daily map of like, okay, what's my
Speaker:weight? How are my legs? How is my shortness of breath? Do I have any
Speaker:chest pain? Is the chest pain same or different than the
Speaker:time I had my heart attack? Because again, if you say
Speaker:my pain feels the exact same as the last time I had
Speaker:a heart attack, we move a little bit quicker. Please don't
Speaker:use it as a get out of jail free card to kind of move through
Speaker:the ER a little bit faster. But again, you know how you
Speaker:feel. If this is feeling exactly the same as the last time you had a
Speaker:heart attack. I'm taking you five times more seriously than I
Speaker:already previously was. There's just sometimes key phrases that catch me,
Speaker:that go, oh, okay, no, we gotta, like, we gotta move this
Speaker:a little faster. There's a little bit more going on. And I want to know
Speaker:not only what the troponin is, but I wanna know what your blood pressure is,
Speaker:I wanna know how you're feeling, and I definitely wanna see your legs for
Speaker:sure. So, yeah, don't mind us if we're all, like, looking at your legs.
Speaker:It's just. It's a really random, great
Speaker:way to understand how much fluid retention you have, because you
Speaker:can. You can almost map it as it slowly moves
Speaker:up the body. And I've seen people where they've got generalized swelling,
Speaker:like, up past their waist, and you can do the
Speaker:fingerprint kind of push in and they stay and you're just like,
Speaker:oh, my God. So here's all the swelling on the outside of your body. Now
Speaker:putting pressure on the inside. You can't feel very good, and you're probably
Speaker:super short of breath to boot. Yeah, yeah.
Speaker:Wow. I think I just thought of a great collaboration for
Speaker:us.
Speaker:Yeah. I'm just sitting here with feeling so much
Speaker:gratitude for you and just knowing how much
Speaker:this episode is going to help heart patients.
Speaker:And I wish I had heard this years ago,
Speaker:and I just remember the first time I showed up to the ER
Speaker:not knowing anything was going on with my heart. And
Speaker:I had been trained as a wilderness first responder, so I
Speaker:knew all the symptoms of a heart attack and I knew
Speaker:deep down something was wrong, but I talked myself out of it.
Speaker:And how many patients have you had in your
Speaker:career where especially women who, like, talk
Speaker:themselves out of it or, like, it's probably just anxiety, or, you
Speaker:know, like, it's. Do not get me started on that. It's just
Speaker:anxiety line, because that drives me up a wall.
Speaker:I can't deal. And women have heart attacks that are
Speaker:so much different than men's. It's not usually your classic, you
Speaker:know, clutching the chest, the left arm, the jaw pain,
Speaker:the back pain. Like, it's nothing. Usually those
Speaker:signs, it's nausea. Oh, man. So I had a
Speaker:patient when I was first starting my career. She was this
Speaker:lovely 70 ish year old woman. She comes into my er, and again,
Speaker:it's a very rural hospital, so we don't have access to a lot. And she
Speaker:goes, oh, I'm just having, like, this two out of ten reflux
Speaker:and so you're going, oh, well, that's not a big deal. Like, wow, whatever. So
Speaker:we get her in, we end up doing the ECG, and it's a
Speaker:massive stemi. So the St elevated
Speaker:myocardial infarction. So the stemi is the one
Speaker:where on an ECG. So we put all the stickers on you. We
Speaker:asked you to stay still. It takes about 10 seconds. It's with that
Speaker:tracing, so we can actually trace the electrical input of your heart. And so
Speaker:we know how the electrical input in a normal heart is supposed to look.
Speaker:And depending on if there's stress in the heart or if there's been
Speaker:damage, the pathways will change. So just like, all of a
Speaker:sudden, you're walking your normal path, and
Speaker:all of a sudden, somebody's thrown in a big block of rocks that you
Speaker:can't get. Like, you can't do your normal path. You go around it,
Speaker:but that changes your path. So it's with the ECG that
Speaker:we can then see. All of a sudden, there's been changes in the path, some
Speaker:changes not super concerning, but may have. May let us
Speaker:know that maybe there's been damage in the past, other times, like
Speaker:in a stemi. So s T E M I. That is
Speaker:the classic big heart attack. You know, the very
Speaker:large. We have to do something absolutely
Speaker:immediately, heart attack. So, you know, we do
Speaker:this ECG. We see on the ECG that
Speaker:the ST segment of your heartbeat is
Speaker:elevated, so, which means there's been huge damage. So
Speaker:all of a sudden, everything changes. We're doing everything
Speaker:we can. We're in a very rural hospital. We give
Speaker:blood clot busting drugs, which, as
Speaker:a newer grad, were very intimidating because they're very high risk
Speaker:and they're very expensive. So you want to make sure that
Speaker:you're doing everything right. And so this poor patient,
Speaker:we bring her in. We're doing all the blood work. We're getting things going.
Speaker:We're trying to find a way to ship her out to the bigger center
Speaker:so that she can actually get then follow up. But in the meantime, we've been
Speaker:advised that we need to give this to rhombolytic, the clot busting
Speaker:drug. And so we give this clot busting drug, and,
Speaker:you know, unfortunately, you will see
Speaker:changes in the ECG, because, again, you're getting rid of all that
Speaker:block in the way. So then you're. You'll see the heartbeat, kind
Speaker:of the ECG. You'll see it change. And so it's called a
Speaker:repolarization rhythm, and it is very
Speaker:unnerving as the healthcare provider to watch this
Speaker:happen because it's happening 510 15 minutes
Speaker:after you've given the drug. And the patient
Speaker:sometimes really doesn't feel well because again, you're suddenly
Speaker:creating. You're opening up the pathway again, and then it's
Speaker:re hitting all the areas that were damaged. So it's a lot. And
Speaker:this poor woman, she's saying, like, oh, I don't feel so good.
Speaker:And you can see her kind of. Her color kind of
Speaker:starts to sour a little bit, so she gets very pale, then she
Speaker:kind of goes green. And you're like, oh, this is not good. And she goes
Speaker:gray a little bit. You're like, oh, man, this is so not good. But in
Speaker:the meantime, we're waiting for the chopper to come in,
Speaker:pick her up, and then take her to Thunder Bay, that the
Speaker:nearest large medical center nearest us. And
Speaker:so we're waiting. We're waiting. We hear the chopper land. I'm like, okay,
Speaker:thank God. Like, let's get this going. And, you know, you're trying
Speaker:to get things organized. Well, she says, like, oh, you know, she's kind
Speaker:of getting a little delirious and is kind of getting
Speaker:a little agitated and all over the place. And you're going, well, what's happening
Speaker:here? And she's like, I have to poop, I have to poop, I have to
Speaker:poop. And you're like, well, you know, at the time, I'm going, oh, well, I
Speaker:don't understand. So we put her on a bedpan, and as, unfortunately, she's
Speaker:pooping, she arrests. And so
Speaker:then it's a code blue, and we're trying to resuscitate her.
Speaker:And unfortunately, after. And that's just as
Speaker:orange is coming in. Like, the team is coming in to pick her up,
Speaker:and, you know, we're trying 2030 minutes. And unfortunately,
Speaker:she did pass. And it's one of those things
Speaker:where that patient is going to stay with me
Speaker:because it was two out of ten
Speaker:reflux feeling. Wow. And you're
Speaker:going, that's not what I've been taught. That's not what I've been. That's
Speaker:not how I think a classic heart attack would look like.
Speaker:That's not what I would expect. I don't even think she had any cardiac
Speaker:history. You know, lovely 70 ish year old woman
Speaker:just walking in, no big deal. And you're going
Speaker:like, oh, man, this went sideways so fast.
Speaker:And, you know, in talking to other nurses after everything had been
Speaker:done, because it's kind of, you do a debrief. So you kind of go through
Speaker:everything. You look at it again, you're like, okay, could we learn anything? Could we
Speaker:do anything differently? Was there anything we missed that we can make sure that we
Speaker:don't miss for next time? Like, you use it. It's kind of not just a.
Speaker:An emotional dump of all your issues, but
Speaker:you also learn. Use it as a learning opportunity. And
Speaker:so, you know, in talking, it's like, well, no. Like, this is what
Speaker:happened. And one of the older nurses kind of pipes up. She goes, oh,
Speaker:well, she was having the death poop. Like, what are you talking about, death poop?
Speaker:And she goes, well, it's when people have the urge to go,
Speaker:and they bear down, right? Like, you push to
Speaker:get everything out, and it's while you push down, you stimulate your
Speaker:vagus nerve in your neck, which then can drop your
Speaker:heart rate. And that was probably what
Speaker:allowed her not to be able to. Her heart to beat as well as
Speaker:it could have. So it's just some other weird,
Speaker:random sign that when people are very sick
Speaker:and they say, oh, no, I got to get up, and I got to poop,
Speaker:you'll see your experienced nurses. You're absolutely not getting up. It's
Speaker:not happening, because we've either heard or seen
Speaker:ourselves of people that you either get up to the commode or you get up
Speaker:to the bathroom, and. And they. They bear down, and
Speaker:they. They. So it's vasovagal. They
Speaker:vasovagal, and they. And they pass out,
Speaker:and they then either fall completely over
Speaker:or they. They stop their heart. So it's.
Speaker:It's a very odd thing. But, you
Speaker:know, if you were to google the number of people who pass away while
Speaker:on the toilet, it's. It's a thing, and
Speaker:it's people stressing their heart. Their heart as they're bearing down
Speaker:so hard that they activate the nerve and they just kind of throw everything into
Speaker:chaos, which is a really weird side conversation that we
Speaker:got down. Yeah, but
Speaker:nothing's ever a side conversation on this podcast.
Speaker:You never know who needed to hear that story truly.
Speaker:Right? Yeah. And we. At least in the United
Speaker:States, I don't know how Canadians are. Y'all seem a little more proper
Speaker:than us, but we don't talk about poop enough,
Speaker:and it's so important. And
Speaker:your quality of poop and how often you go. And I've
Speaker:had other guests on other healthcare providers who, you know,
Speaker:it's so important to have a healthy poop after heart
Speaker:surgery to start the detoxification process,
Speaker:and we've got to normalize. Talking about
Speaker:poop, asking about it, like, don't be, like, gross and
Speaker:perverse, but, like, it's so. It is such a
Speaker:vital function. And who knew that it
Speaker:could, like, the vasovagal response? Is that how you say
Speaker:it? Yep. You're banging on, okay, could result
Speaker:in death. That's bananas. To be fair,
Speaker:it's usually 80 and up,
Speaker:super unwell kind of population, but there are a lot of
Speaker:younger people who end up getting constipated. And so they're pushing and
Speaker:straining and they're pushing and straining and they end up same thing.
Speaker:They cue up the vasovagal response and usually they just pass
Speaker:out. And so they pass out. They hit their head on either the tub or
Speaker:the floor or sometimes the sink next to them, and
Speaker:they come to the ER that way, and it freaks
Speaker:them right out because they've never done this before. And you're like, yeah, well, this
Speaker:is what happens. And so, again, if you've had this,
Speaker:you know, we always worry about heart first, right? You know, we
Speaker:understand that nine times out of ten, it is just a vasovagal response and
Speaker:we're not super concerned about it, but we will investigate the heart because you
Speaker:can't not know that it's the heart that actually caused that in the first place.
Speaker:And then they passed out. So it's something
Speaker:to kind of keep in mind. And even after heart surgery, like, you're on opiates,
Speaker:like, the opiates slow your bowels and it's going to
Speaker:cause constipation. And you need to ask about stool softeners.
Speaker:You need to understand, at what day do I become very
Speaker:concerned? You know, like, sometimes it takes a couple of days to really get your
Speaker:bowels going properly again, and you're scared
Speaker:because I'm sure it hurts like the dickens, like, to your
Speaker:chest. So you don't, you know, you don't want to strain too hard because that
Speaker:then puts pressure on your chest, and that's got to hurt like anything.
Speaker:And so then you're not pushing as probably as hard as you normally would, so
Speaker:that you end up just getting backed up. But
Speaker:anytime there is a opiate prescription
Speaker:for more than I would think, five pills, I
Speaker:swear there needs to be a duplicate prescription for
Speaker:something for constipation. You know, I usually tell
Speaker:my patients that if you're going to be taking this and you're going to be
Speaker:taking this on a fairly routine basis, you're. You're having gallbladder
Speaker:attacks or you're. You're having diverticulitis or other things
Speaker:that cause chronic pain. Every time you take the pain
Speaker:medication, I want you to take a stool softener with it. That way, at
Speaker:least you're trying to keep yourself semi regular,
Speaker:because truly, there's nothing worse than a
Speaker:bowel obstruction where you can then actually vomit up fecal matter.
Speaker:Because if it's not coming out one way, it's going to come out the other
Speaker:way. Yeah. And that sounds like that could be catastrophic.
Speaker:It's not pleasant. That's usually a surgical.
Speaker:A surgical fix at that point. Yeah. Yeah.
Speaker:Thanks for taking us to medical school today.
Speaker:Yeah. It's these bodies of ours. I tell you,
Speaker:it's a privilege to age. It's a privilege
Speaker:to access medical care very
Speaker:much. It is not lost on me how
Speaker:lucky we are in the United States and Canada. And I know that I
Speaker:have european listeners, and I'm starting to get more listeners
Speaker:from Africa as well as Asia. And I want
Speaker:to. Yeah, I want to hear from all of you. I know I had some
Speaker:Senegal, Senegal listeners. I've been hearing
Speaker:from the Caribbean. I know I have folks listening to me in the
Speaker:Philippines. I mean, I could go. There's, like 55 countries
Speaker:now, and I want to hear your stories. Like,
Speaker:what? What is it like as a cardiac patient in these
Speaker:other countries? I would like to know. We've spent time today
Speaker:talking about the United States and Canada with nurse Jen
Speaker:Johnson. But what is it like accessing healthcare
Speaker:in Hong Kong, in Australia and New
Speaker:Zealand? Like I said, I could go on listing all the countries, but
Speaker:it is insane. And the universal truth
Speaker:is, a heart is a heart. We all
Speaker:deserve access to medical care. No matter the color
Speaker:of our skin, no matter our economic status, pooping
Speaker:is for everyone. Everybody poops. Yep.
Speaker:It doesn't matter where you live. It is really important to poop every
Speaker:day. So let me just normalize that. Hi. I'm 46 years old, and I'm
Speaker:talking about pooping. But, like, seriously. And
Speaker:that the heart is our greatest
Speaker:teacher. And so whatever you're facing
Speaker:today, I'm not talking to you necessarily, Jen. I'm
Speaker:talking to the listeners. Listen, whatever you're facing today,
Speaker:like, it's scary, get curious. What is
Speaker:this here to teach you? What is this about? And
Speaker:you have a choice today in choosing your attitude and
Speaker:how you choose to think about the situation
Speaker:and allow any emotions to come up. But if that emotion
Speaker:is not serving you, let it go and just
Speaker:keep advocating for your health care, no matter where
Speaker:you live. Can I say one more thing? I was going to ask
Speaker:you to. To be fair, no one
Speaker:tells you that you're allowed to grieve the loss of your health. Ah.
Speaker:No one tells you that the loss
Speaker:of the ability to just shrug your shoulders and be like, that's nothing.
Speaker:You know, once you have a chronic condition, you can't just shrug your
Speaker:shoulders anymore and pretend like it's nothing. Like it's.
Speaker:It is a huge change. And, you
Speaker:know, the worry that that brings is
Speaker:understated to the nth degree. And, I
Speaker:mean, you're losing a part of your health that you
Speaker:didn't realize you had to worry about. So
Speaker:it can be extremely stressful. And then throwing in medications
Speaker:and doctors visits and er visits and nurses
Speaker:and all these other things that you now suddenly have to think about
Speaker:is a lot. And I
Speaker:will vouch for therapy 16,000 times
Speaker:over. You are allowed to be sad about losing
Speaker:that ability to just not worry about it because now, unfortunately, you
Speaker:have to worry about it because it could be something. Now that you've got
Speaker:this past medical history, it could be something.
Speaker:So feel free to take all the time you need to
Speaker:grieve and to be mad and go through all
Speaker:the five stages of grief. You know, you can be angry,
Speaker:you can deny it all you want, but it's still going to happen. But you
Speaker:need to get to acceptance, because that way you can be
Speaker:an active participant in not only your own health, but then advocating for your health.
Speaker:And that truly is something that, you know, the more you can
Speaker:understand about what's going on and honestly ask questions, please ask
Speaker:all the questions. People sometimes will get upset because you're taking a lot of
Speaker:time, but if you've got somebody who's got any sort of
Speaker:medical background and you've got them not necessarily hostage, but,
Speaker:you know, you're their patient, ask them. Ask them all
Speaker:the questions. Because honestly, you will learn so much, not only by being
Speaker:kind and appreciative, please do not ever
Speaker:scream or hit your nurses or your physicians or
Speaker:anybody trying to help you. The nicer you are, the more we're
Speaker:willing to give. And so if I come across you,
Speaker:and you're super appreciative, you're very nice, we just want to figure
Speaker:out what's going on. You can still be afraid. You can still be upset
Speaker:without taking it out on me. Not to say I don't understand to a point,
Speaker:but it's not exactly going to endear me to wanting to go above
Speaker:and beyond and help you. So the nicer you can be, the
Speaker:more appreciative you can be. We can't take
Speaker:cash gifts. Donuts are always appreciated. Coffee is
Speaker:always appreciated. And honestly, just a thank you card,
Speaker:because we never. The thank you cards are the things that keep us
Speaker:going. So if you happen to remember the name of your nurse and just
Speaker:send a thank you card afterwards, it means a lot
Speaker:and it lifts us up. When we have just a really
Speaker:bad day, when nothing seems to go right, we can go back to that and
Speaker:say, okay, I did okay here, and I did what I needed to do
Speaker:here. And it gives you a little bit of. A
Speaker:bit of strength in continuing on because it's a.
Speaker:Not an easy gig, and neither is living with heart disease. So,
Speaker:you know, let's work together and let's get you feeling partnership.
Speaker:Yeah, it sounds like a partnership. Yeah.
Speaker:Thank you for that. And I said all what I said from the
Speaker:place. I've reached acceptance because I'm
Speaker:now in year four of my heart journey, and I've been working
Speaker:intensively with a therapist and doing EMDR and
Speaker:all the things to get to where I'm at now, but I had to go
Speaker:through all the grieving process. And then when
Speaker:there's a new symptom or there's a new issue, because I'm still
Speaker:a heart patient, I have to start the grieving process all over
Speaker:again. So I just want to, like, normalize
Speaker:saying, what the fuck?
Speaker:Absolutely. And then. And then I have your pity
Speaker:party and then get in the driver's seat of your healthcare.
Speaker:Yeah, yeah. If you're passive about it,
Speaker:you know, it doesn't really lend us to be like, okay, well, if you're super
Speaker:non compliant with your medications, you don't even know what you're taking. You don't know
Speaker:how often you're taking it. If you're playing around with it, if
Speaker:you're not taking things seriously, we can figure that out pretty quickly by
Speaker:past medical history. So, you know, again, it doesn't endear us
Speaker:to go above and beyond. If it's an issue of not being able to afford
Speaker:medication and that's why you're non compliant, please tell your physician, because
Speaker:there are a multitude of drug companies that
Speaker:have extended coverage for certain
Speaker:medications. And if your doctor can get you into one of those
Speaker:programs or do a referral, get in there and take the
Speaker:drug companies for all they're willing to give, because sometimes they'll do
Speaker:free samples, sometimes they can decrease the amount that you're the
Speaker:paying depending on which medications that you're on. But
Speaker:honestly, go to your family physician or your cardiologist and
Speaker:say, like, hey, I'm having a really tough time affording everything, and I understand
Speaker:that I need to be taking these daily or twice a day or
Speaker:whatever, but I'm having trouble affording them. Is there a way, is there anything that
Speaker:you know of that I could apply to or participate
Speaker:in to be able to make sure that I can afford my medications?
Speaker:Wow. I feel like we could talk all day. Listen,
Speaker:I probably could. I just so appreciate
Speaker:your generosity and giving to the
Speaker:audience. And I will obviously have links in the show
Speaker:notes for how to get in touch with you. But do you just want to
Speaker:quickly verbalize how folks can find you? Yeah. So
Speaker:you can find me at rxforgrowth. F o r g r
Speaker:o w t h. You can find me on
Speaker:Instagram at Ernurse Jen with two ns. You
Speaker:can find me on LinkedIn b.
Speaker:Scnrn. You can find my journals on
Speaker:Amazon. If you ever want to gift one to your
Speaker:nurse, man, they will love you forever
Speaker:and shameless. Plug on my half. So if you look up
Speaker:100 shifts, a care planner for nurses on Amazon, they're
Speaker:available on Amazon. I'm on Etsy. If you want to find me on
Speaker:Etsy at the intuitive nurse, I'm kind of all over the place.
Speaker:TikToker nurse Jen with two n's, you know, usually
Speaker:just, wow. Usually just goofy stuff for nurses. I love it.
Speaker:Yeah. But, you know, we. We want to be here to
Speaker:help. And there's nothing better than watching someone come in
Speaker:really sick and being able to watch them walk out the door. Door,
Speaker:whether it be that shift or in a couple of shifts or in a couple
Speaker:of weeks. There is something so satisfying about knowing
Speaker:that I was able to help. And that's what we're all
Speaker:doing it for. You know, it's not for usually
Speaker:any other reason because it's too hard to do it for any other
Speaker:reason than if then you have to love it. So. Yeah,
Speaker:yeah. It's just, it's a lot. So understand that
Speaker:we're just people, truly and honestly.
Speaker:Well, thank you so much. And I hope, listeners, you will
Speaker:blow it up for nurse Jen Johnson and give her a
Speaker:follow. And I have a feeling we can learn so much more from her.
Speaker:So, Jen, thank you so much. And for my listeners,
Speaker:please be sure to come back next week for another episode of
Speaker:Open Heart Surgery with Boots. In the meantime, if you have already,
Speaker:please subscribe to this podcast. And you know what will
Speaker:really make my day is if you leave
Speaker:a review. And then, most excitingly, what
Speaker:will make my day even more is if you
Speaker:will check out my Patreon community. I
Speaker:am just now launching it and there are three different
Speaker:tiers of membership and I
Speaker:am so excited about this. I have been naturally
Speaker:communicating or connecting heart patients around the world.
Speaker:It's kind of banana pants how folks are starting to find each
Speaker:other through this podcast. And so now I'm formalizing
Speaker:it and so the Patreon link will be in
Speaker:the show notes and I would love it if you
Speaker:would take a risk. Give me just the cost
Speaker:of a coffee and a muffin
Speaker:and join the Patreon community so we can all come together
Speaker:for our hearts and tell poop stories. So,
Speaker:until next time, I love you.
Speaker:Your health matters and your heart is your greatest teacher.
