Time to walk the walk

 A case study of the impact of Healthy Options

David is a 62-year-old man who was referred to Healthy Options by the physiotherapy department at Lorn & Islands District General Hospital in October 2012.David had undergone surgery to remove a very large cyst from his brain and otherwise suffers from chronic asthma caused by invasive aspergillosis. After an initial period on the programme, David suffered a setback when he had a heart attack in July 2013 – which led to him having a coronary angioplasty to fit four stents – and has just recently returned to supported gym-based activity having completed cardiac rehab.

David described himself as being ‘very inactive’ on referral to Healthy Options, having become in his words “institutionalised” after spending three and a half months in hospital. He recalled that “I was pleased to get out, but was very weak – I couldn’t do basic things on my own, requiring help with the basic functions and being registered disabled. I was really frightened and my confidence was gone”. “I couldn’t make a cup of tea or boil an egg”, he added. Prior to becoming ill, David considered that he was of average fitness bearing in mind he was a chronic asthmatic, having been a hill walker and climber and pursuing physical work overseas.

The goals David set at the initial consultation were short term and related to survival – he had been told that he had a long way to go and might not recover at all, while his ultimate aim of returning to work was not on the table at that stage. David also recalls that falling ill “had been psychologically traumatic – there had been only about thirty percent chance of coming through the operation without major problems”. He said that it “was also difficult to see yourself as disabled – I didn’t”, emphasising that he had a strong desire to “control rather than be controlled” by his condition and told himself to “get on” every morning, despite being in chronic pain. In all of this David describes Healthy Options as providing “a lifeline”.

During rehab in hospital David had felt “like an old man in a dressing gown who couldn’t do anything”, such that “getting out of hospital, returning to the real world, wearing a tracksuit rather than pyjamas, going to a gym…was psychologically a huge barrierto break through – you realise you’re not an idiot and you’re not disabled”. He recalled that “initially it was scary, very frightening”, yet due to the support of the Healthy Options staff who were “absolutely superb and never wrote me off” he never found the gym environment intimidating and his confidence grew overtime. After four months of supported activity, David’s condition had improved substantially – “my strength had improved…I could walk to the gym without a stick and walk some places without a stick…I walked through the doors of work again and was back driving, which was another confidence booster”. This led on to “going for walks twice a day, which I wouldn’t have done before” and “setting some goals on walking distances in the summer”. David is clear that central to this transformation was the highly individualised support he received with Healthy Options – “When I did the cardiac rehab there were 13 or 14 of us in the class together – although I’m not complaining, there was only so much you could do. When I went to Healthy Options it was one-on-one, they understood what was wrong with me and did everything possible to tailor something to fit my needs”.

As David improved physically, his attitude to his condition also changed, his outlook shifting from being “happy just to live another day” to “thinking a bit more long term, that I might be around a little longer – I started to think I might make retirement age”. Indeed, for him, the psychological aspect of being unwell had been the hardest part – “after brain surgery I had zero confidence and didn’t know if I’d survive. Psychologically, this dominates your life” – the key to recovery being to “get off this downward spiral, stop facing the wall and start looking outwards again”. This change in mind set had a huge impact on David’s home-life – he “had been given hope and started becoming interested in other things again” and started going for walks together with his wife, who David said “would agree that Healthy Options was the lifeline which got me moving again”.

David’s motivation to work through pain and to control his condition moving forward was crucially driven by his desire to return to his work in international development, for which he has an obvious passion. He explained that “once you’ve seen abject poverty, you can’t not be involved…so my job wasn’t just a job”. Returning to work, having doubted whether he’d  ever get there, was obviously a great source of pride for David, although he did concede that his perspective had changed a little. “I’m working half days and will work through till three o’clock if I need to…but I’m probably taking more time out to spend with my children and grandchildren”.

After his heart attack, David admits that he’s “slid back to probably seventy-five percent of where I was”, but he very confident moving forward and “can’t wait to get back in the gym and start building up my strength again”. He’s very mindful of the support he’s received, acknowledging that “after three months of being in hospital,  the gym…is the last place I would have gone to…there’s no way I’d have done that myself”. Turning more contemplative, David recalled “having an image of myself sitting in front of the fire at home, on an oxygen bottle with maybe a year left and just fading away into nothing”. Whilst apologising for what “might sound dramatic”, he concluded that “Healthy Options gave me a way out”. He said he’d “recommend it to anybody – I could not praise the Healthy Options team and Atlantis enough”.

Further, it was clear that David had thought more deeply about the social and political issues, explaining “there’s something joined up here which hasn’t been joined up in the past…we should have more than a safety net…we need to have a society which cares for its most vulnerable”.