Getting to the heart of the matter: Peconic Bay Medical Center program supporting cardiac patients

He was suddenly, fully awake from a sound sleep at 1 a.m., the Saturday of Labor Day weekend. Something was seriously wrong.

He felt as if his upper torso was encased in a band, tight and growing tighter. And it hurt. And he had a strange taste in his mouth.

He knew what it was, but as he got out of bed, he was already in the process of denying it. Downstairs he walked around, drank ginger ale, spending close to an hour as the pain increased. Finally, he woke his wife and told her how he felt and that he had to go the emergency room.

She was calm, asked a couple of questions, and said she’d call an ambulance, already starting to get dressed. No, he said, he’d drive. She said quietly that if he insisted on being mule-headed about the ambulance, she’d drive. No, he told her, let’s go. I’m driving. Not wanting to upset him further, she reluctantly agreed.

He’d already made three huge mistakes. First, if you have symptoms of a heart attack, don’t deny it. Second, don’t wait to get help. And third — never drive yourself or have someone drive you to the hospital. Call an ambulance. It will respond quickly, make no driving errors, and most importantly, will have on board experienced professionals who can administer medicine and first aid.

The Riverhead resident, who preferred not to give his name for this article, said that at the Peconic Bay Medical Center (PBMC) Emergency Room, after giving his symptoms to a nurse at the desk, he was put on a gurney and wheeled into a room. Blood pressure and heart rate were recorded, blood was taken, and other data recorded.

A doctor saw him and spoke with him for a few minutes and morphine was administered for the pain. In his 70s, he had never had any serious illnesses, he told a nurse who was taking more data, and lived a relatively healthy life. When asked if there was any cardiac illness in his family, he told her that his two brothers and his father had died of complications of cardiac disease.

“Classic,” she said.

Within a few minutes he was taken upstairs to the Kanas Regional Heart Center facility where he was prepped for surgery. He was given fentanyl, and soon a surgeon and his team were cleaning out plaque blocking arteries by running a catheter through his wrist before inserting two stents — tiny metal coils that keep the artery open and blood flowing.

Discharged from the hospital after three days, he had recovered, and felt lucky for the speedy, efficient, and professional care he received. Many are not so lucky. According to the Centers for Disease Control and Prevention, heart disease is the leading cause of death for men, women, and people of most racial and ethnic groups. In the latest statistics available from the CDC, in 2022, 702,880 people died from heart disease.

At home, he and his family gave thanks for his recovery. But had he really recovered? Research shows that many cardiac patients experience waves of depression, anxiety, fear, anger, and overall helplessness. For our patient, he summed it up to his wife: “I feel beat down. Diminished.”

But a program run by PBMC called Cardiac Rehabilitation, a 12-week course of supervised exercise in their own gym, and lessons about nutrition and lifestyle, brought him back to himself. It was by being in and completing this program, that he considered himself truly lucky.

ON THE WAY BACK

Shelter Island Town Justice Stanley Birnbaum also participated in PBMC’s Cardiac Rehab program and has high praise for the activities and lessons provided, but most of all for the staff.

“Coming to grips with your own mortality is a unique experience,” Judge Birnbaum said, not completely tongue-in-cheek, after completing the program.

It started for him last July, when he began feeling fatigue nearly every day. After tests from a cardiologist, he was diagnosed with an irregular heartbeat. An angiogram found he had a 90% heart blockage, and a stent was inserted.

“Cardio rehab was next for me,” Judge Birnbaum said. “Each staff member is a true, dedicated professional. Their knowledge, courtesy, patience, consideration, and skill sets are second to none. Each patient receiving treatment is respected and catered to. The attention that is shown to everyone is meticulous. Health, exercise, hydration, follow-up treatment, aftercare, and diet are all emphasized. They dot their i’s and cross their t’s.”

MAKING IT WORK

In an office off the gym where patients work out three days a week for 12 weeks, Anna Szlejter, director of Rehabilitation Services at PBMC, said the program “is for any kind of heart condition — heart attacks, stent replacements — anything to do with the heart muscle.”

Unique to the region, it’s been accredited by American Association of Cardiovascular and Pulmonary Rehabilitation, and staffed by specially trained physical therapists and registered nurses certified in advanced Cardiac Life Support. In 2024 there were 6,261 visits, Ms. Szlejter said, with 174 patients completing all 36 sessions. Over the past few years, PBMC’s Cardiac Rehab has the highest program completion rate in New York State.

Every patient, upon arriving for each scheduled session at the gym, is asked by the staff how they’re feeling and if there has been any change in medication or lifestyle. Blood pressure is taken on arrival, the first of three times during the hour-long session, again after the exercise session is over, and finally after “cooling down” for a few minutes.

Before exercise starts, wireless leads are attached to the patients’ chests that record a constant EKG, monitored by the RN at the desk.

The workouts involve treadmills, a stair-stepper, weight training equipment, an elliptical, an arm bike, and what most patients start with, the NuStep, a recumbent cross-trainer working the arms and legs. The staff gets them started and checks in throughout the workout.

Every session is monitored electronically, and patients are asked to rate how they feel after each exercise, and are asked to increase the difficulty, if they’re able.

Speaking with Ms. Szlejter at the gym’s office, the sounds of therapists speaking to patients drifted in — upbeat conversations, with occasional laughter, the back-and-forth of friends encouraging, razzing and complimenting each other.

A testament to the staff’s dedication is that more than 80% of patients complete the 36-session program, Ms. Szlejter said.

As Judge Birnbaum said, “No one is overworked. Each patient does the best that he or she can do.”          

HEART AND HEAD

“The psychological aspect of the program is on par with the physical exercise and the discussion on nutrition,” Ms. Szlejter said.

According to an article published by the National Institutes of Health, evidence suggests that between 30% and 40% of cardiac surgery patients experience a form of psychological depression before and/or after the surgery takes place.

Each patient in PBMC’s cardio rehab is twice given what the therapists call “homework” — professionals know it as PHQ9 scoring — to evaluate their emotional health.

Sample questions given to patients are: does the individual have little interest or pleasure in doing things; is she/he feeling down, depressed, or hopeless; has trouble falling or staying asleep, or sleeping too much; has poor appetite or is overeating; is feeling bad about themselves or that they are a failure or have let themselves or their families down; or have had thoughts that they would be better off dead, or of hurting themselves.

“Based on that scoring, we try to cater to their limitations,” Ms. Szlejter said. “And if they score a certain level, then we’re involving a psychiatrist to come and speak to them.”

Ms. Szlejter said more women than men are in the category of needing counseling. “A lot of women care for their families first before themselves,” she said. “They put their emotional health on the back burner because they think, ‘Oh, I have to take care of X, Y and Z before I get to me. How am I going to be the caregiver?’ But, of course, this also happens to men, too.”

THE ORIGIN OF COMING BACK

Paul Furbeck, formerly PBMC’s director of therapy, along with physical therapist Claudia Cebada Mora — who is still with the program — R.N. Ruth Gueli and Ms. Szlejter took 18 months of research and studying other rehab centers before designing and launching the program here.

Ms. Cebeda Mora, who has a doctorate in physical therapy, spent time at the Mayo Clinic Health System in La Crosse, Wis. studying their Cardio Rehab program to apply methods and procedures at PBMC to gain national accreditation from the American Association of Cardiovascular and Pulmonary Rehabilitation.

As a physical therapist, Ms. Cebeda Mora evaluates each patient and works with them on their exercise routines. She also throughly monitors their workouts, and their emotional states.

“Managing stress is key to being heart healthy,” Ms. Cebeda Mora said. “We want this to be social, fun, and want people to speak to us. We always make it personal, that they aren’t part of a mass production.”

The work is extremely rewarding, she said, especially when the staff sees a patient progressing and eager to work out, and “when we see people sticking with it and continuing after they leave.”

Judge Birnbaum spoke about the restoration of emotional balance and optimism given to patients by Cardio Rehab staff after the experience of heart surgery. “Confidence was instilled from the very beginning. Encouragement never disappeared,” he said. “The staff is the epitome of the adage, ‘Pick yourself up, dust yourself off, start all over again.’”