Terry Paulsen's 43rd birthday began as it should. His son Patrick, 6, gave him his present early in the morning. Then Paulsen jumped in the shower to get ready for work and take his son to school.
But as soon as he stepped under the hot water, the heat activated the pain near his heart -- again. He had been having dizzy spells for more than a week. Doing chores like pushing a lawn mower or picking up a tiny twig left his heart throbbing.
On the morning of his 43rd birthday, however, the pain was excruciating, as if he was being "stabbed repeatedly by a hunting knife." Lying down didn't help, but Paulsen still needed to take his son to school.
Normally, Paulsen walked Patrick to the door of his first-grade classroom at Soda Creek Elementary, but on this day he struggled to get to the steps outside. The worst pain of his life hit at Pine Street, and he knew something was drastically wrong.
"I turned around and kissed Patrick goodbye, and I started to hyperventilate," Paulsen said. "That was the hardest thing to do was leave him at school."
Paulsen, a part owner of Russell's Auto Salon, had been previously misdiagnosed with a pulled muscle, but on this day he was having a heart attack, and he didn't know if he would see his son again.
That was nearly two years ago. Paulsen is preparing to celebrate his 45th birthday Oct. 2. Patrick is now 8 and in the third grade. Paulsen counts himself as one of the lucky ones for surviving a heart attack, but he admits he should have known one was coming. He had the symptoms and was genetically predisposed to heart problems. Both of his grandparents on his mother's side died of heart attacks before 50.
Now, he is one of the success stories of the Yampa Valley Medical Center and its Cardiac Rehabilitation Program. With the help of program coordinator Susan Cowan, MN, RN, Paulsen is back doing the things he enjoys, such as snowmobiling, riding ATVs, bowling and golfing. His eating habits and exercise habits have changed. He is taking his pills.
"I used to take the tomato and slobber it with salt until it was white," Paulsen said. "I don't do that anymore. Red meat, I can't eat that every day. Everything is based on moderation, basically. Before the heart attack, I was drinking three cups of regular coffee or six or seven Mountain Dews a day."
The Cardiac Rehabilitation program at the YVMC is designed to help patients that have suffered a "cardiac event achieve and maintain an optimal level of health and fitness through exercise and education," according to the program's orientation booklet.
A "cardiac event" includes heart attacks, coronary bypass surgery, angioplasty and stent placements.
Patients progress through different phases until they can begin to work independently and be monitored less extensively. After two years, Paulsen, who had a stent placement, is in Phase III, and he rarely misses an appointment.
"I push it to the limit," Paulsen said. "I know I have to be there. I can miss now and then, but I make it a point to go. I have partners that are very understanding and let me go. ...I don't care where you do your exercises you have to do them the rest of your life if you want to live."
The Cardiac Rehabilitation Center is filled with exercise machines, heart monitors and hope. Every cardiac patient in the room lived through his or her event, which doesn't always happen. Coronary heart disease is one of America's leading killers. It is the No. 1 killer of women, according to the American Heart Association.
"The worst part of a heart attack is that you deprive an area of the heart muscle oxygen and it dies," Cowan said. "Cardiac rehab brings some of that back. It makes the heart more efficient. The damage isn't felt as much because you are stronger. Recovery is more complete with people that come to rehab with the skills to do the right things."
Cowan integrates exercise, education and weight training. Phase I begins with helping patients get their confidence back. Goals are set in the short-term, on a weekly basis. It serves as an introduction.
Phase II continues for about 12 weeks. During this time, patients participate in supervised exercises sessions three times a week.
While exercising, heart rate, blood pressure and EKG rhythm are monitored by a registered nurse and exercise specialist.
Phase III provides a structured environment in which to exercise. Patients are monitored less extensively, but assistance is available if problems arise.
"Even though three months seems like a long time, sometimes I don't feel like we get enough done because these people have had a lifetime to develop these habits," Cowan said.
Paulsen admitted it was tough to cut salt and sugar from his diet. Both Cowan and YVMC dietitian Pam Wooster, who works with patients to help improve quality of their diet, come across patients who have difficulty changing their lifestyle.
Both said they try to work with the patient to improve what they can.
"There are some that are resistant because they've enjoyed how they've lived their life," Wooster said. "You move someone along until they are comfortable."
Wooster often recommends increasing fiber intake. Fiber is found in fruits, vegetable and whole grains. She also incorporates leaner meats like fish, chicken and lean beef and pork into diets. Wooster also may incorporate more Omega 3 fatty acids to help lower cholesterol and triglyceride levels, while having a positive effect on HDL, or good cholesterol, levels. Omega 3 fatty acids are found in fish like tuna and salmon.
In addition, Wooster tries to limit patients' use of foods high in saturated fat, such as butter, lard and hydrogenated oils. She advises patients to use olive, sesame seed or canola oil.
"If they are gaining benefits on the changes I'm making, that's wonderful," Wooster said. "They will be out there enjoying life and that's the ultimate thing."
Paulsen said he and the others in the Cardiac Rehabilitation program at the YVMC are fortunate to have such a facility in Steamboat Springs.
"That's a heck of a program, and they make it affordable," he said. "No one should have to go through a heart attack. I'd take a broken arm or blown out knee anytime.
"You should get a check-up once a year. Have everything checked. It can happen to you."