Women have heart attacks that are so much different than men's.

It's not typically your classic, you know, clutching the chest, the

left arm, the jaw pain, the back pain. Like

it's not usually those signs.

Welcome to open heart surgery with Boots. The

podcast that gets to the heart. Of what it's really

like to go under the knife. I am your host,

Boots Knighton, here to share the ups,

downs and everything in between about

heart surgery from the patient's perspective.

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shared experiences, please make sure this

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openheart surgery with Boots. There you'll get

exclusive content, behind the scenes stories, and

a chance to connect with other heart warriors.

But for now, let's open up and explore the world

of heart surgery from the other side of the

scalpel. Thanks for coming back

to another episode of Open Heart Surgery with Boots.

I am your host, Boots Knighton, and today I get to

introduce you to another canadian friend of

mine. I am losing track now of all the wonderful

Canadians I've been able to invite onto the podcast. I love

y'all. Please keep coming back. And today is a

super special guest from Ontario, Canada,

Jennifer Johnson. Wow, she has so much

to teach us. Jennifer is an

emergency room nurse and she has

spent the last 16 years of her career

in the ER, in big and small hospitals

all over northern and southern Ontario. So she's seen

a lot. She has personally been part of all the heartbreak, the

drama, bullying. She's got to tell us about that

life and death moments and then also trying to cope in the

ER during the ongoing pandemic.

She has since written a book about how nurses

are struggling through the post pandemic era

and burnout and she is just an absolute

treasure. She is starting to teach folks about how to use

their intuition in nursing and she's going to tell us about

that as well. And then ultimately she is going to

coach us heart patients on how to show up

to the ER, prepared, what to expect in the

ER, and how to help nurses help us.

So Jen, thank you so much for saying yes to today

and welcome to the podcast. Thank you so much for having me.

I'm so pumped. It's gonna be. And I hope I said all

that right. Like, you, you're doing so many great things.

And I've experienced from the heart patient's

perspective, I have experienced burned out nurses since the

pandemic. And I thank them. And I thank you

for continuing to serve because we

need. We heart patients need all the help we can get.

I'm sorry in advance for the burnt out nurses.

They. They know not what they do or how they come

across. And I'm sorry. Typical

canadian fashion. I'm so sorry. And an

accent. My gosh, I love

it. I love it. I may put it on a little bit more and

I may pick up yours just for fun. I don't show.

That's the great thing about podcasts is around the

world, we are listened to, and I get to hear so many

different accents. So set the scene for us

and your nursing career and the

book you wrote and your intuition, like, give us the

down low so we can understand who you are before we dive in.

Into the emergency room scene. Absolutely. So I'm

Jen. I'm based out of Hamilton, Ontario. I've

been nursing for 16 years now and continue

to nurse at the bedside in a few different

ers. And it's just one of those things

where even if you try to leave the ER, if you're

drawn to it, if you're a lifer, you can't quite get away.

So no matter how hard I try to kind of try other things,

I always end up going back to the ER. So it's been, yeah,

16 years of highs and lows and. And super

lows with COVID and, you know, it's one of those things where you

look back and you're like, how has it already been 16 years?

Cause it feels like it's. It's gone by in an instant. It's

absolutely hilarious to kind of take a step back and go like,

okay, well, I guess I'm the senior nurse. When somebody calls out, we need a

senior nurse, and you're like, who's going to be it? It's like, oh,

I'm the senior nurse. Like, okay, I guess I can fill that

role for you. So just kind of, you know, going through the

motions and going through, you know, pretty wicked depression

with COVID Ended up kind of hitting all

sorts of rock bottoms that, you know, you didn't even know were possible

until you hit them. And through that, I ended

up just kind of writing into a book, a bunch of

experiences for my kids because we thought we were going

to not make it home some days. And so it was one of

those things where it's like, okay, well, if I end up passing, and

this is the end of my career, this is the end of my life, I

want my kids to understand a little bit as to why I

kept going back and why I kept working during COVID because how do you

explain that to a four and a five year old that if mom

had not made at home, how do you. How do you explain that kind of

thing? So, started writing the really good stories about the times that

I helped and. And the. Some of the things that I've done. And

with that, then comes the lows of not

wanting to. To revisit some of the super hard cases

that absolutely broke you as a person, but that needed to happen,

too, and writing them down, and it's like, okay, well, what do the.

What do all these have in common? And it's. Well,

it's intuition. Like, I trusted my gut and a lot of these cases,

even though I didn't know what I was doing at the time, but

I was going with my gut, and then I was advocating for my patients, and

sometimes the docs would listen to me, and sometimes they wouldn't. And that's their

own. That's of their own rights kind of thing. I get it.

But the times that they listened to me, the patient outcomes were so much better.

And so went back and said, okay, is this just

me being super woo woo and coming at it out of

left field and ended up doing some digging into the

research on intuition. And so not only is there a ton of research

on intuition that is peer reviewed and supported by

evidence, there's also specifically intuition and nursing

that has been reviewed and presented,

and it's there. So if the. The evidence

is there, if it's peer reviewed, if it's supported, we should be teaching it. So,

that was the thought process behind intuition and nursing,

and my book, nursing, how to trust your gut, save

your sanity, and survive your career.

And that's kind of led me to this moment of all of a

sudden, getting on a couple of podcasts and really opening

myself up left, right, and center. And you know what? Just

going for it and being excited to be on the ride.

Incredible. And thank you, because we are, all

of us patients are clearly beneficiaries

of your willingness to be courageous

and step out and be like, this is my story. This deserves

to be told. We've got to do better. That's what I'm hearing you say.

Yeah. And this isn't just in isolation

to Canada. No. This is everywhere. Most of this

is everywhere. Most of the statistics and the evidence

is coming out of the states. So I'm so proud of the

US for being forward thinking with this and putting it

out there. Now it's just up to the rest of the world to kind of

pick it up and run with it. Yeah. Wow.

So, okay, so obviously you have some

credibility. Thank you for sharing all of that.

Just like a little wisp of incredible. Don't

belittle yourself. You have shared that. You have

witnessed a few cardiac patients in your 16 years

where we want to start there. What do you wish you could yell from the

mountaintop to cardiac patients as they

prepare to go to the ER? Like, what do

you wish you could just yell to all of us? What do

we need to know? First and foremost, please, if

you're not just straight up bringing all of your bottles of

medication with you, please, please, please bring

a list of your medications and up to date

recent lists. You know, people, I can't tell you how

many times in a day both heart patients and others will sit in front of

me and go, oh, I take a little white pill for my pressure,

and you understand how many little white pills there

are for blood pressure alone.

And it's one of those things where it can have a

huge impact, especially if you're unwell enough to become

admitted to the hospital. We need to know where we're

starting at, especially heart patients, your water pills, how much

you're taking, how often you're taking them, what time you're taking

them, because a lot of times people will be taking their water pills at dinner

or later, and you poor souls, like, you're going to be up

peeing all night long, and, and then you're going to be exhausted, and then

you're not going to want to take your water pills. So, you know,

please keep track of, of your pills. Any recent

cardiology appointments, like if they've changed anything recently,

please mention that if you've been having chest pains,

please. Oh, my God. You've already got a cardiac history.

You're already, you want to talk about credibility? You're already ten times

more credible than most patients that I'm seeing. And your

history alone already kind of jacks you head

in the line. So with coming into the emergency room, we

triage you. We have to sort everybody by, like sickest to non

sickest. And your medical history alone

puts you in the middle of the pack just to start. So I don't care

if you're walking in out of nowhere, if you're telling me you've got a history

of heart failure, you've had bypass, you've got stents,

and then on top of that, you're either having dizziness or chest pain

or shortness of breath. You've caught my attention, and

I. I don't want you catching my attention because that means you're pretty

sick. So if you're. If you're coming to hospital,

if you're having new weight gain, all of a sudden,

you've put on quite a few pounds. That needs to be

noted because that's probably just water weight and it's probably in your poor

legs, and so that needs to be assessed as

well. How can we make sure that there's been a

change? So all of a sudden, are you having chest pain or tightness?

Are you then having an increase in your water weight, even though you're taking your

pills as prescribed? And are you then not able to do what

you normally do? So letting us know that there's been

a change in your weight is fantastic.

I never, ever get that information at triage, and I would love

to know if all of a sudden, you've had a three, four, five pound weight

gain in a week or two, that's significant. So I need to

make sure that's looked into. Are your legs open? Are they

weeping? Are all of a sudden your calves swollen when it's only your

feet that are swollen? Because the swelling truly will just

continue to come up your body in gravity

so it can get to the point where then it gets to your lungs.

And so this is why, if all of a sudden, you can normally sleep laying

flat or maybe with just a little bit of, you know, one or two

pillows, if all of a sudden you can't sleep, you have to sleep in the

recliner. That's a big problem. So please,

if that's the change that's been happening, please tell us, because then I worry

that the fluids gone into your lungs, if you're coming

upstairs, and the stairs, just doing that alone, just even a couple

stairs or walking a couple of steps, gives you chest pain.

Please, please, please tell me that and be open and

honest with your level of pain. I understand that everybody feels

pain differently. I understand that everybody

reports things and feels things a little bit differently.

And after multiple ER trips, after multiple years of being

a heart patient, you kind of. You shrug it off. You've been to the ER

enough, you don't want to go. So then you start saying, oh, it's not a

big problem. You start putting it off and

I get it. If I didn't have to be in the ER as a

patient, I absolutely would not be.

Truly, I understand. But it's one

of those things where as time goes on, the more chronic your

condition, the less you want to come to the ER. And unfortunately, by

putting off coming into the ER when you're really not feeling too well at the

beginning, leads you to have bigger cardiac

events and potentially longer hospital stays

or even, you know, instead of. If you would have come after a day

or two, we would have just given you maybe a little bit of extra water

pills, we would have seen that you're peeing out all that extra fluid, you're feeling

better, we can send you home versus waiting a

week, and then all of a sudden, oh, no, this is going to take a

little bit of time. Now you're on oxygen. We can't send you home.

So now you've earned yourself an admission. So it's one of those things

where sometimes coming earlier, as much as it sucks to come to the

ER, if you can, if something has changed, go,

like, go to the ER. And truly, I'm not one ever

to tell anybody to go to the ER, but

having chronic heart conditions, you're kind of already at a loss.

So you need to be able to recognize

when something has changed, when something's feeling off. And

again, trust your gut in your own care, like, you know your body

much better than I do. So if you're telling me

something's wrong, I don't know what it is, I'm just not feeling right.

I'm feeling off. I'm going to take you at your word

and I'm going to mark it down, and then I'm going to talk to my

doc to be like, hey, here's the vitals. Here's what I'm seeing, here's what

they're experiencing, but they're telling me something's wrong. And

so I will take that to the moon and back, because

really, the number of times people have said flat out,

I'm going to die, they've been right and we haven't

listened. And sometimes you get a little burnt out and you kind of want to

kind of pat people on the hand and be like, no, it's fine, you're in

the right spot. All these kind of things. After one,

two, three, people do that to you. You start listening and you start paying

attention. And so, you know, your body,

if you can let me into what's going on in your

body, you know, please do, because

I want to help. I'm here to help. I don't want to keep you. I

want to make you feel better. And then I, you know, the joke is treat

them and stream in the ER. Wow. I've

never heard that. No, we're going. Oh, my

gosh. Treat them and straight up. You know, that's the whole goal of the

ER, is just to bring it in. Let's, you know, overall,

let's make you feel a little bit better so that you can go back home.

We're not looking to keep you. We don't want to keep you. Trust me.

The hospitals in Canada alone are overrun at this

point. And if we didn't have to keep you, we wouldn't.

So, please, just. The sooner you can come to

an ER or even your family doctor, like, if you can scooch in to see

them or your cardiologist, when things start to change, the sooner you

can kind of get on it, the less likely that you'll potentially have to stay

in hospital. Okay, so I'm hearing a

few things here. Whoa.

I'm hearing that humor helps.

Laugh about it. We'd be crying all the time. Oh, I'm sure, I'm

sure. But awareness. So the

patient having an awareness of self. Yep.

Cause I have spoken with so many

heart patients now who were so

disassociated. Cause it was so hard to

come to terms with the situation. So it's this

double edged sword. Cause disassociation serves us right. It

makes everything less scary. However, if you're

disassociated and you can't speak up for yourself, that's

scary, too. That's even, dare I say it, more scary.

Yeah. So that's probably why it's good to also have an advocate

with you and then also showing up

prepared. Please. That was really the only

two. Just showing up prepared and having the awareness of

the situation. And for me, I

keep a running, like, notes

tab open in my phone, and I just keep track

of all the symptoms. Oh, I know what I was going to

say. Being proactive. Yes. Less

reactive. More proactive. Right. And so

here's a struggle I've had, and I don't know if

you can appropriately answer this. Well, I mean, just

like, because it's hard to speak in the hypothetical, but. And

especially because, like, you're not my care provider and you're in Canada,

but it's hard to know

as a heart patient, like, what

truly is an emergency. And I'll admit to

you just now, I learned so much from you. I mean, I've been on my

own heart journey now for four years. And with this

podcast and talking to so many healthcare providers, you would think I'd know

a few things by now. And this is the first time

I've heard someone say to me, hey, if you've gained

weight and you. You quantify it, and it's in a certain

amount of time, like, I had not thought of that before, and I've

actually been on frickin weight pills or water pills. I

mean, and so it's. It didn't come with a

manual. Like, when I was diagnosed with my heart stuff and

then had surgery, I didn't get a manual. I didn't get,

like, this full on education that I needed, which is. That's

why I started this podcast. Yeah. And good on you,

because, like, truly, again, it's. It's not. The

things I'm doing are not just for me, the things you are doing are not

just for you. But we all end up learning

in. In the overall. Right. Like, we're making up words now,

but we're all. We're all learning. And that's just it. And

it's. It's things that come up that

I think are second nature. You've got a heart patient. They've put on

some weight. Their legs are. So if you can push into your legs

and your fingerprints stay. So that's pitting edema,

and that's extra fluid in the area that needs to be kind

of looked at. If that's worse than that normally, is that right

now? So they

can quantify it with how deep you can actually put your

fingerprints and push in. So if there's

1234 plus pitting edema, and

most times by the time you're actually leaving a fingerprint, that's

two to three plus pitting edema. But it

gets to the point where a lot of her patients will have then cellulitis

because your poor legs will get so swollen and you've put it

off for so long that the pressure in the legs,

it pushes against the skin, it stretches the skin. And then I've literally seen

water drops come out of people's legs because

the. The water retention is so bad and it stretch the skin to

absolute max point and their poor legs start weeping. So at that

point, your legs are open to then bacteria getting

in. So then you can have really wicked

leg and, like, cellulitis. So skin infections that

are extremely hard to treat and to get under

control, because once the legs are open, it's hard to come back from

that. And I've seen people who are battling chronic

cellulitis for years. They'll come in, we

admit them, we treat them, we give them lots of water pills so that we

take that pressure off the skin. Then we're giving them antibiotics to treat the

infection. It takes days for them to kind of be

able to heal well enough that they can. The skin

stops weeping and, you know, the redness stops

spreading and the sores kind of start to heal. But again,

heart patients, if you've had cardiac surgery,

you're more than likely they've taken vessels out of your legs, which,

unfortunately, then your circulation to your legs and the return

circulation from your legs is not nearly as good as it once was.

I so then again, leads you to swelling in your

legs that is harder to kind of deal with because

that's one, two, three vessels that potentially

you've lost to your heart to keep the heart going. But now your poor

legs, now you have to try and deal with the swelling

in your legs. So it's. It's a hard journey. I wouldn't wish it

on anybody. But it's one of those things where

there's a lot of things that are involved in

cardiac care that people don't think are involved in cardiac

care. So if all of a sudden you're short of breath, a lot of people

don't equate that to your heart. They think, oh, it's respiratory. I'm sick

with the flu or pneumonia or something like that,

when in reality, it might just be that the fluid in your lungs has come

up to the point where you just can't breathe. So then we

have to come in and we have to deal with that, or your heart, the

ejection fraction. So how well your heart's pumping. Your heart's been

stressed, and now all of a sudden it's not pumping as well as it was,

again, allowing for that buildup of fluids. So we

typically, when you come in to the ER, you've been triaged,

we've brought you back, we start doing tests. A lot of times

we'll do what's called a troponin. So in Canada, we call it a troponin, which

is one of the cardiac markers. So if it's an enzyme that's

specifically in heart tissue, if there is suddenly a

detectable rise in your blood work, that means there's been

damage to specifically heart tissue. Whether it's been a lot of

damage or a little, it's hard to tell, but we then will

do another one, three to 6 hours later to make sure that

there hasn't been an increase in it. Sometimes people will

come in, I've been having chest pain for 20 minutes. Okay, we bring

you back, we do all the blood work. There's no troponin in your system, but

when we repeat it three or 6 hours later,

all of a sudden there can be a rise. And that's because it takes time

for the cells to leak the troponin to be able to have it come into

your blood system. So a lot of

cardiac patients, unfortunately, are always in for a three

to six hour visit after getting blood work.

And I like to tell people, hey, I've done the blood work. Coming back in

45 minutes to an hour, depending. Unfortunately, the troponin usually

takes roughly an hour in Canada to come back. But by that time, the

clock has already started. So we need to do a troponin either three or 6

hours from that original poke. We can repeat

it, see if it's gone up, down, stayed the same.

Perfect. So, you know, if you're coming in, you're having

chest pains, but your troponin's fine and it's. It's either negative

or stable. Some people will continually

have just a little bit of troponin in their system because they've

got cardiac conditions that, unfortunately, their heart's been strained.

Either they're waiting for cardiac bypass or they're waiting

for angiograms to be able to put stents into the heart.

Sometimes we know where people kind of sit. So

even if your troporin is a little bit elevated, if that, if we can go

back into previous visits over the last six months, year, two

years, and see that that's kind of your normal. We're like, oh, okay. That's kind

of where they sit. That's acceptable. Wow.

Honestly, it makes me want to do a, like, create a journal for heart

patients. And I'm literally, my head starting to, like, go right now to be

like, oh, I need to create this journal

so that you can kind of have a daily map of like, okay, what's my

weight? How are my legs? How is my shortness of breath? Do I have any

chest pain? Is the chest pain same or different than the

time I had my heart attack? Because again, if you say

my pain feels the exact same as the last time I had

a heart attack, we move a little bit quicker. Please don't

use it as a get out of jail free card to kind of move through

the ER a little bit faster. But again, you know how you

feel. If this is feeling exactly the same as the last time you had a

heart attack. I'm taking you five times more seriously than I

already previously was. There's just sometimes key phrases that catch me,

that go, oh, okay, no, we gotta, like, we gotta move this

a little faster. There's a little bit more going on. And I want to know

not only what the troponin is, but I wanna know what your blood pressure is,

I wanna know how you're feeling, and I definitely wanna see your legs for

sure. So, yeah, don't mind us if we're all, like, looking at your legs.

It's just. It's a really random, great

way to understand how much fluid retention you have, because you

can. You can almost map it as it slowly moves

up the body. And I've seen people where they've got generalized swelling,

like, up past their waist, and you can do the

fingerprint kind of push in and they stay and you're just like,

oh, my God. So here's all the swelling on the outside of your body. Now

putting pressure on the inside. You can't feel very good, and you're probably

super short of breath to boot. Yeah, yeah.

Wow. I think I just thought of a great collaboration for

us.

Yeah. I'm just sitting here with feeling so much

gratitude for you and just knowing how much

this episode is going to help heart patients.

And I wish I had heard this years ago,

and I just remember the first time I showed up to the ER

not knowing anything was going on with my heart. And

I had been trained as a wilderness first responder, so I

knew all the symptoms of a heart attack and I knew

deep down something was wrong, but I talked myself out of it.

And how many patients have you had in your

career where especially women who, like, talk

themselves out of it or, like, it's probably just anxiety, or, you

know, like, it's. Do not get me started on that. It's just

anxiety line, because that drives me up a wall.

I can't deal. And women have heart attacks that are

so much different than men's. It's not usually your classic, you

know, clutching the chest, the left arm, the jaw pain,

the back pain. Like, it's nothing. Usually those

signs, it's nausea. Oh, man. So I had a

patient when I was first starting my career. She was this

lovely 70 ish year old woman. She comes into my er, and again,

it's a very rural hospital, so we don't have access to a lot. And she

goes, oh, I'm just having, like, this two out of ten reflux

and so you're going, oh, well, that's not a big deal. Like, wow, whatever. So

we get her in, we end up doing the ECG, and it's a

massive stemi. So the St elevated

myocardial infarction. So the stemi is the one

where on an ECG. So we put all the stickers on you. We

asked you to stay still. It takes about 10 seconds. It's with that

tracing, so we can actually trace the electrical input of your heart. And so

we know how the electrical input in a normal heart is supposed to look.

And depending on if there's stress in the heart or if there's been

damage, the pathways will change. So just like, all of a

sudden, you're walking your normal path, and

all of a sudden, somebody's thrown in a big block of rocks that you

can't get. Like, you can't do your normal path. You go around it,

but that changes your path. So it's with the ECG that

we can then see. All of a sudden, there's been changes in the path, some

changes not super concerning, but may have. May let us

know that maybe there's been damage in the past, other times, like

in a stemi. So s T E M I. That is

the classic big heart attack. You know, the very

large. We have to do something absolutely

immediately, heart attack. So, you know, we do

this ECG. We see on the ECG that

the ST segment of your heartbeat is

elevated, so, which means there's been huge damage. So

all of a sudden, everything changes. We're doing everything

we can. We're in a very rural hospital. We give

blood clot busting drugs, which, as

a newer grad, were very intimidating because they're very high risk

and they're very expensive. So you want to make sure that

you're doing everything right. And so this poor patient,

we bring her in. We're doing all the blood work. We're getting things going.

We're trying to find a way to ship her out to the bigger center

so that she can actually get then follow up. But in the meantime, we've been

advised that we need to give this to rhombolytic, the clot busting

drug. And so we give this clot busting drug, and,

you know, unfortunately, you will see

changes in the ECG, because, again, you're getting rid of all that

block in the way. So then you're. You'll see the heartbeat, kind

of the ECG. You'll see it change. And so it's called a

repolarization rhythm, and it is very

unnerving as the healthcare provider to watch this

happen because it's happening 510 15 minutes

after you've given the drug. And the patient

sometimes really doesn't feel well because again, you're suddenly

creating. You're opening up the pathway again, and then it's

re hitting all the areas that were damaged. So it's a lot. And

this poor woman, she's saying, like, oh, I don't feel so good.

And you can see her kind of. Her color kind of

starts to sour a little bit, so she gets very pale, then she

kind of goes green. And you're like, oh, this is not good. And she goes

gray a little bit. You're like, oh, man, this is so not good. But in

the meantime, we're waiting for the chopper to come in,

pick her up, and then take her to Thunder Bay, that the

nearest large medical center nearest us. And

so we're waiting. We're waiting. We hear the chopper land. I'm like, okay,

thank God. Like, let's get this going. And, you know, you're trying

to get things organized. Well, she says, like, oh, you know, she's kind

of getting a little delirious and is kind of getting

a little agitated and all over the place. And you're going, well, what's happening

here? And she's like, I have to poop, I have to poop, I have to

poop. And you're like, well, you know, at the time, I'm going, oh, well, I

don't understand. So we put her on a bedpan, and as, unfortunately, she's

pooping, she arrests. And so

then it's a code blue, and we're trying to resuscitate her.

And unfortunately, after. And that's just as

orange is coming in. Like, the team is coming in to pick her up,

and, you know, we're trying 2030 minutes. And unfortunately,

she did pass. And it's one of those things

where that patient is going to stay with me

because it was two out of ten

reflux feeling. Wow. And you're

going, that's not what I've been taught. That's not what I've been. That's

not how I think a classic heart attack would look like.

That's not what I would expect. I don't even think she had any cardiac

history. You know, lovely 70 ish year old woman

just walking in, no big deal. And you're going

like, oh, man, this went sideways so fast.

And, you know, in talking to other nurses after everything had been

done, because it's kind of, you do a debrief. So you kind of go through

everything. You look at it again, you're like, okay, could we learn anything? Could we

do anything differently? Was there anything we missed that we can make sure that we

don't miss for next time? Like, you use it. It's kind of not just a.

An emotional dump of all your issues, but

you also learn. Use it as a learning opportunity. And

so, you know, in talking, it's like, well, no. Like, this is what

happened. And one of the older nurses kind of pipes up. She goes, oh,

well, she was having the death poop. Like, what are you talking about, death poop?

And she goes, well, it's when people have the urge to go,

and they bear down, right? Like, you push to

get everything out, and it's while you push down, you stimulate your

vagus nerve in your neck, which then can drop your

heart rate. And that was probably what

allowed her not to be able to. Her heart to beat as well as

it could have. So it's just some other weird,

random sign that when people are very sick

and they say, oh, no, I got to get up, and I got to poop,

you'll see your experienced nurses. You're absolutely not getting up. It's

not happening, because we've either heard or seen

ourselves of people that you either get up to the commode or you get up

to the bathroom, and. And they. They bear down, and

they. They. So it's vasovagal. They

vasovagal, and they. And they pass out,

and they then either fall completely over

or they. They stop their heart. So it's.

It's a very odd thing. But, you

know, if you were to google the number of people who pass away while

on the toilet, it's. It's a thing, and

it's people stressing their heart. Their heart as they're bearing down

so hard that they activate the nerve and they just kind of throw everything into

chaos, which is a really weird side conversation that we

got down. Yeah, but

nothing's ever a side conversation on this podcast.

You never know who needed to hear that story truly.

Right? Yeah. And we. At least in the United

States, I don't know how Canadians are. Y'all seem a little more proper

than us, but we don't talk about poop enough,

and it's so important. And

your quality of poop and how often you go. And I've

had other guests on other healthcare providers who, you know,

it's so important to have a healthy poop after heart

surgery to start the detoxification process,

and we've got to normalize. Talking about

poop, asking about it, like, don't be, like, gross and

perverse, but, like, it's so. It is such a

vital function. And who knew that it

could, like, the vasovagal response? Is that how you say

it? Yep. You're banging on, okay, could result

in death. That's bananas. To be fair,

it's usually 80 and up,

super unwell kind of population, but there are a lot of

younger people who end up getting constipated. And so they're pushing and

straining and they're pushing and straining and they end up same thing.

They cue up the vasovagal response and usually they just pass

out. And so they pass out. They hit their head on either the tub or

the floor or sometimes the sink next to them, and

they come to the ER that way, and it freaks

them right out because they've never done this before. And you're like, yeah, well, this

is what happens. And so, again, if you've had this,

you know, we always worry about heart first, right? You know, we

understand that nine times out of ten, it is just a vasovagal response and

we're not super concerned about it, but we will investigate the heart because you

can't not know that it's the heart that actually caused that in the first place.

And then they passed out. So it's something

to kind of keep in mind. And even after heart surgery, like, you're on opiates,

like, the opiates slow your bowels and it's going to

cause constipation. And you need to ask about stool softeners.

You need to understand, at what day do I become very

concerned? You know, like, sometimes it takes a couple of days to really get your

bowels going properly again, and you're scared

because I'm sure it hurts like the dickens, like, to your

chest. So you don't, you know, you don't want to strain too hard because that

then puts pressure on your chest, and that's got to hurt like anything.

And so then you're not pushing as probably as hard as you normally would, so

that you end up just getting backed up. But

anytime there is a opiate prescription

for more than I would think, five pills, I

swear there needs to be a duplicate prescription for

something for constipation. You know, I usually tell

my patients that if you're going to be taking this and you're going to be

taking this on a fairly routine basis, you're. You're having gallbladder

attacks or you're. You're having diverticulitis or other things

that cause chronic pain. Every time you take the pain

medication, I want you to take a stool softener with it. That way, at

least you're trying to keep yourself semi regular,

because truly, there's nothing worse than a

bowel obstruction where you can then actually vomit up fecal matter.

Because if it's not coming out one way, it's going to come out the other

way. Yeah. And that sounds like that could be catastrophic.

It's not pleasant. That's usually a surgical.

A surgical fix at that point. Yeah. Yeah.

Thanks for taking us to medical school today.

Yeah. It's these bodies of ours. I tell you,

it's a privilege to age. It's a privilege

to access medical care very

much. It is not lost on me how

lucky we are in the United States and Canada. And I know that I

have european listeners, and I'm starting to get more listeners

from Africa as well as Asia. And I want

to. Yeah, I want to hear from all of you. I know I had some

Senegal, Senegal listeners. I've been hearing

from the Caribbean. I know I have folks listening to me in the

Philippines. I mean, I could go. There's, like 55 countries

now, and I want to hear your stories. Like,

what? What is it like as a cardiac patient in these

other countries? I would like to know. We've spent time today

talking about the United States and Canada with nurse Jen

Johnson. But what is it like accessing healthcare

in Hong Kong, in Australia and New

Zealand? Like I said, I could go on listing all the countries, but

it is insane. And the universal truth

is, a heart is a heart. We all

deserve access to medical care. No matter the color

of our skin, no matter our economic status, pooping

is for everyone. Everybody poops. Yep.

It doesn't matter where you live. It is really important to poop every

day. So let me just normalize that. Hi. I'm 46 years old, and I'm

talking about pooping. But, like, seriously. And

that the heart is our greatest

teacher. And so whatever you're facing

today, I'm not talking to you necessarily, Jen. I'm

talking to the listeners. Listen, whatever you're facing today,

like, it's scary, get curious. What is

this here to teach you? What is this about? And

you have a choice today in choosing your attitude and

how you choose to think about the situation

and allow any emotions to come up. But if that emotion

is not serving you, let it go and just

keep advocating for your health care, no matter where

you live. Can I say one more thing? I was going to ask

you to. To be fair, no one

tells you that you're allowed to grieve the loss of your health. Ah.

No one tells you that the loss

of the ability to just shrug your shoulders and be like, that's nothing.

You know, once you have a chronic condition, you can't just shrug your

shoulders anymore and pretend like it's nothing. Like it's.

It is a huge change. And, you

know, the worry that that brings is

understated to the nth degree. And, I

mean, you're losing a part of your health that you

didn't realize you had to worry about. So

it can be extremely stressful. And then throwing in medications

and doctors visits and er visits and nurses

and all these other things that you now suddenly have to think about

is a lot. And I

will vouch for therapy 16,000 times

over. You are allowed to be sad about losing

that ability to just not worry about it because now, unfortunately, you

have to worry about it because it could be something. Now that you've got

this past medical history, it could be something.

So feel free to take all the time you need to

grieve and to be mad and go through all

the five stages of grief. You know, you can be angry,

you can deny it all you want, but it's still going to happen. But you

need to get to acceptance, because that way you can be

an active participant in not only your own health, but then advocating for your health.

And that truly is something that, you know, the more you can

understand about what's going on and honestly ask questions, please ask

all the questions. People sometimes will get upset because you're taking a lot of

time, but if you've got somebody who's got any sort of

medical background and you've got them not necessarily hostage, but,

you know, you're their patient, ask them. Ask them all

the questions. Because honestly, you will learn so much, not only by being

kind and appreciative, please do not ever

scream or hit your nurses or your physicians or

anybody trying to help you. The nicer you are, the more we're

willing to give. And so if I come across you,

and you're super appreciative, you're very nice, we just want to figure

out what's going on. You can still be afraid. You can still be upset

without taking it out on me. Not to say I don't understand to a point,

but it's not exactly going to endear me to wanting to go above

and beyond and help you. So the nicer you can be, the

more appreciative you can be. We can't take

cash gifts. Donuts are always appreciated. Coffee is

always appreciated. And honestly, just a thank you card,

because we never. The thank you cards are the things that keep us

going. So if you happen to remember the name of your nurse and just

send a thank you card afterwards, it means a lot

and it lifts us up. When we have just a really

bad day, when nothing seems to go right, we can go back to that and

say, okay, I did okay here, and I did what I needed to do

here. And it gives you a little bit of. A

bit of strength in continuing on because it's a.

Not an easy gig, and neither is living with heart disease. So,

you know, let's work together and let's get you feeling partnership.

Yeah, it sounds like a partnership. Yeah.

Thank you for that. And I said all what I said from the

place. I've reached acceptance because I'm

now in year four of my heart journey, and I've been working

intensively with a therapist and doing EMDR and

all the things to get to where I'm at now, but I had to go

through all the grieving process. And then when

there's a new symptom or there's a new issue, because I'm still

a heart patient, I have to start the grieving process all over

again. So I just want to, like, normalize

saying, what the fuck?

Absolutely. And then. And then I have your pity

party and then get in the driver's seat of your healthcare.

Yeah, yeah. If you're passive about it,

you know, it doesn't really lend us to be like, okay, well, if you're super

non compliant with your medications, you don't even know what you're taking. You don't know

how often you're taking it. If you're playing around with it, if

you're not taking things seriously, we can figure that out pretty quickly by

past medical history. So, you know, again, it doesn't endear us

to go above and beyond. If it's an issue of not being able to afford

medication and that's why you're non compliant, please tell your physician, because

there are a multitude of drug companies that

have extended coverage for certain

medications. And if your doctor can get you into one of those

programs or do a referral, get in there and take the

drug companies for all they're willing to give, because sometimes they'll do

free samples, sometimes they can decrease the amount that you're the

paying depending on which medications that you're on. But

honestly, go to your family physician or your cardiologist and

say, like, hey, I'm having a really tough time affording everything, and I understand

that I need to be taking these daily or twice a day or

whatever, but I'm having trouble affording them. Is there a way, is there anything that

you know of that I could apply to or participate

in to be able to make sure that I can afford my medications?

Wow. I feel like we could talk all day. Listen,

I probably could. I just so appreciate

your generosity and giving to the

audience. And I will obviously have links in the show

notes for how to get in touch with you. But do you just want to

quickly verbalize how folks can find you? Yeah. So

you can find me at rxforgrowth. F o r g r

o w t h. You can find me on

Instagram at Ernurse Jen with two ns. You

can find me on LinkedIn b.

Scnrn. You can find my journals on

Amazon. If you ever want to gift one to your

nurse, man, they will love you forever

and shameless. Plug on my half. So if you look up

100 shifts, a care planner for nurses on Amazon, they're

available on Amazon. I'm on Etsy. If you want to find me on

Etsy at the intuitive nurse, I'm kind of all over the place.

TikToker nurse Jen with two n's, you know, usually

just, wow. Usually just goofy stuff for nurses. I love it.

Yeah. But, you know, we. We want to be here to

help. And there's nothing better than watching someone come in

really sick and being able to watch them walk out the door. Door,

whether it be that shift or in a couple of shifts or in a couple

of weeks. There is something so satisfying about knowing

that I was able to help. And that's what we're all

doing it for. You know, it's not for usually

any other reason because it's too hard to do it for any other

reason than if then you have to love it. So. Yeah,

yeah. It's just, it's a lot. So understand that

we're just people, truly and honestly.

Well, thank you so much. And I hope, listeners, you will

blow it up for nurse Jen Johnson and give her a

follow. And I have a feeling we can learn so much more from her.

So, Jen, thank you so much. And for my listeners,

please be sure to come back next week for another episode of

Open Heart Surgery with Boots. In the meantime, if you have already,

please subscribe to this podcast. And you know what will

really make my day is if you leave

a review. And then, most excitingly, what

will make my day even more is if you

will check out my Patreon community. I

am just now launching it and there are three different

tiers of membership and I

am so excited about this. I have been naturally

communicating or connecting heart patients around the world.

It's kind of banana pants how folks are starting to find each

other through this podcast. And so now I'm formalizing

it and so the Patreon link will be in

the show notes and I would love it if you

would take a risk. Give me just the cost

of a coffee and a muffin

and join the Patreon community so we can all come together

for our hearts and tell poop stories. So,

until next time, I love you.

Your health matters and your heart is your greatest teacher.