Sex, Drugs, and Rock ‘n’ Roll with Dr. Mike

Yes it is! Sexual activity usually requires the ability to perform a moderate level of physical activity without becoming excessively fatigued or breathless. As a general rule of thumb, if you feel well enough to walk a couple of blocks or up a flight of stairs, you should be well enough to engage in sexual activity.

Following transplant or LVAD surgery, the sternum (breastbone) is not fully healed for about 10-12 weeks. You may need to adapt sexual activities to avoid excess physical strain on the chest wall (e.g., lifting, pulling, or pushing) until the sternum is fully healed.

For patients with a LVAD, you will need to avoid any physical activity (including sexual activity) that can tug or pull the driveline at its exit site from the skin.

The effects of cannabis in patients living with heart failure or patients who have had a heart transplant have not been well studied. Heavy use of cannabis and dependence on cannabis has raised concerns about poor adherence to medications and other unhealthy behaviours and is discouraged.

An additional concern for heart transplant patients is that smoking cannabis can increase the risk of certain types of lung infections, particularly fungal infections which can cause severe pneumonia.

For patients living with heart failure, extreme hot and cold temperatures like those in hot tubs or cold plunges should be used with caution. The warm temperatures can cause vasodilation (where the blood vessels open up) which has the effect of lowering blood pressure. Cold temperatures can cause vasoconstriction (where the blood vessels narrow), which has the opposite effect of increasing blood pressure. This can cause severe light-headedness or even fainting, especially in patients taking medications that lower blood pressure.

For patients who have had a transplant, similar effects can be seen (especially for those taking blood pressure medications). Hot tubs should also be avoided altogether for the first several months post-transplant as this is the highest risk period for skin, wound and systemic infections from bacteria that live in hot tubs.

Patients who have had a LVAD cannot submerge themselves in a hot tub or swimming pool under any circumstances.

Yes, however there are a few important considerations:

For patients living with heart failure, commercial flying and travel should be avoided for those with more severe symptoms that limit ordinary daily activities. If flying is absolutely necessary for patients with severe symptoms, arrangements should be made with the airline to ensure supplemental oxygen is provided. Patients should discuss their individual risks for flying and travel with their specialist.

For patients who have undergone transplantation, travel outside of Canada is not recommended until after 1-year post-transplant. This is because the risk of complications (including rejection and infection) is highest in this time period and there are also frequent tests and appointments with the transplant team during this time period.

For patients with a LVAD, additional precautions are required; most programs recommend packing back up components, including spare controller, batteries, wall power unit and battery charger in carry-on luggage. Travel to countries with frequent power outages is not recommended. Travel is restricted to countries that have a LVAD centre in case of a LVAD emergency.

As a general recommendation, all patients with a history of heart disease should understand the requirements from their insurance providers for travel insurance when leaving Canada.

Patients who have undergone heart transplant or who are immunocompromised for any reason are susceptible to certain types of infections associated with pets. 

Some general recommendations to reduce the risk of infections include: 

• Careful hand hygiene – washing hands after handling animals.
• Avoid contact with animal feces wherever possible and delegate cleaning of litter boxes, bird cages, fish tanks, etc. to another person. Litter should be changed daily. 
• Do not place litter boxes in the kitchen, dining room or other areas where food is prepared or eaten. 
• If you are scratched or bitten by your pet, connect with the transplant team so that the site can be monitored and treated appropriately.  
• High risk pets include reptiles, baby chicks, and exotic animals.