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

It’s not always easy to bring up certain topics with your care team — and that’s okay! Dr. Mike is here to answer the questions you might feel too nervous or embarrassed to ask. Remember: when it comes to your health, no question is too small or off-limits.

Cartoon of a doctor playing the guitar
Cartoon of a doctor talking to a pregnant woman

Sex and Reproduction

What pregnancy prevention options are safe if you have received a heart transplant or are living with heart failure?

Is it safe to become pregnant and give birth while living with heart failure, a VAD, or after a heart transplant?

What Dr. Mike Says

It is essential to discuss family planning strategies with your specialist. Any patient with a history of heart failure or heart transplantation should be referred to a multidisciplinary program that specializes in higher risk pregnancy and obstetrical care. Every individual’s situation is different, and the risks of pregnancy and delivery should be carefully reviewed and discussed to make a fully informed shared decision. Until a decision to become pregnant is made, effective birth control strategies should be used.  

For patients living with heart failure, pregnancy is a big stress on the heart and can worsen heart function, particularly in the later stages of pregnancy and the early post-delivery period. This can have significant consequences for people living with heart failure. In addition, some heart failure medications are not considered safe in pregnancy (as they can cause birth defects) and should be discontinued and substituted under the supervision of a specialist. 

For heart transplant patients, successful pregnancy can be possible, however there are some important issues to consider. For example:  

  • Pregnancy is not advised in the first-year post-transplant
  • Heart function should be normal 
  • Pregnancy should be avoided if there are significant concerns about rejection or cardiac allograft vasculopathy (CAV) 
  • Some transplant medications are associated with fertility problems and birth defects; these should be carefully discontinued and substituted under close supervision of a transplant cardiologist
  • Surveillance for rejection may still be required throughout pregnancy, including the need to undergo heart biopsies  

For those on LVAD support, pregnancy should be avoided given the very high risks. 

Sex and Reproduction

When is it safe to resume sex (both alone or with a partner) after a heart transplant or when living with Heart Failure?

Is it safe to have sex (either alone or with a partner) while living with a VAD?

What Dr. Mike Says

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.

Cartoon of a doctor with birds and bees flying around his head
Cartoon of a doctor looking at medication bottles

Sex and Reproduction

Can heart failure medications or post-transplant medications cause a loss of interest or desire in sex?

Is there any way to manage this?

What Dr. Mike Says

There are many factors that can influence libido or interest in sexual activity. Medications for heart failure and medications following transplant can have a range of effects on mood, sleep, irritability, and interest in sex. In many cases, these symptoms are temporary and resolve on their own as medications are adjusted. However, it is also common to have more persistent or lasting symptoms which can require specific therapies. Speak to your healthcare team to learn about support options.

Alcohol and Drugs

Can I consume cannabis while living with heart failure, a VAD, or after a heart transplant?

Is it safe to smoke or to use edibles?

What Dr. Mike Says
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.

Cartoon of a doctor reading a research paper
Cartoon of a doctor declining a glass of wine

Alcohol and Drugs

Can I consume alcohol while living with heart failure, a VAD, or after a heart transplant?

What Dr. Mike Says
Regular alcohol use can have several negative effects on heart function and the cardiovascular system. For patients with a history of any heart disease, there is no known amount of alcohol consumption that is considered “safe.” For those who wish to drink alcohol on occasion, it is a good idea to discuss individual risks with a healthcare provider.

Recent Canadian guidelines from the Canadian Centre on Substance Use and Addiction recommend fewer than 3 standard drinks per week to avoid risks of certain types of cancer, and fewer than 7 drinks per week to minimize the risk of heart disease and stroke in the general population. These guidelines are more stringent to reflect the growing research around multiple potential harmful effects of alcohol.

Higher-Risk Activities

Can I use a hot tub/pool/sauna/cold plunge while living with heart failure, a VAD, or after a heart transplant?

What Dr. Mike Says
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.

Cartoon of a doctor sitting in a hot tub
Cartoon of a doctor getting a tattoo

Higher-Risk Activities

Can I get a tattoo or piercing while living with heart failure, a VAD, or after a heart transplant?

What Dr. Mike Says

Patients should do their due diligence to ensure that standard health and safety precautions are followed by the tattoo or piercing artist. There is an elevated risk of skin infection in the first 6 months post heart transplant. Patient should wait until after this period before getting a tattoo or piercing.

Patients on LVAD support require blood thinners and would be high risk for bleeding if they undergo piercing or have a tattoo.

Higher-Risk Activities

Can I get laser treatments such as hair removal after a transplant while living with heart failure, a VAD, or after a heart transplant?

What Dr. Mike Says
Yes, you can safely receive laser hair removal. 
Cartoon of a doctor getting laser hair removal
Cartoon of a doctor getting a face mask at a spa

Higher-Risk Activities

Can I get cosmetic treatments (chemical peels, Botox, facial filler) while living with heart failure, a VAD, or after a heart transplant?

What Dr. Mike Says
Yes, provided standard health and safety precautions are followed.

Higher-Risk Activities

Is it safe to fly while living with heart failure, a VAD, or after a heart transplant?

What Dr. Mike Says
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.

Cartoon of a doctor flying an airplane
Cartoon of a doctor riding a horse

Higher-Risk Activities

Is it safe to take part in more extreme physical activities (such as skiing, zip-lining, horseback riding, skydiving and scuba diving) while living with heart failure, a VAD, or after a heart transplant?

What Dr. Mike Says
Yes, provided symptoms are well controlled, and exercise capacity is good enough to tolerate these activities. If in doubt, patients should discuss with their specialist.

For patients with a LVAD, extra care should be taken to ensure that the driveline is protected and not at risk of pulling/tugging during the activity.

Higher-Risk Activities

Is there any concern having or caring for pets while living with heart failure, a VAD, or after a heart transplant?

What Dr. Mike Says
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. 
Picture of a doctor with petting a cat. The doctor has a lizard on this shoulders
Cartoon of a doctor eating sushi

Higher-Risk Activities

Can I eat food with a higher bacterial risk, such as sushi or soft cheeses while living with heart failure, a VAD, or after a heart transplant?

What Dr. Mike Says
Patients who have undergone heart transplant or who are immunocompromised for any reason should avoid uncooked meat (including sushi) or unpasteurized foods (such as soft cheeses) due to the risk of certain types of bacterial infections that can cause severe illness.

Meet Dr. Michael (Mike) McDonald

Dr. Michael McDonald is Associate Professor of Medicine at the University of Toronto and Medical Director of both the Ted Rogers Centre of Excellence in Heart Function and the Ajmera Transplant Centre at Peter Munk Cardiac Centre. His clinical efforts focus on advanced heart failure, transplant and implantable device therapy. Dr. McDonald holds the Martha Rogers Chair in Heart Failure Education at the University of Toronto. He is past-president of the Canadian Cardiac Transplant Network and past co-chair of the Canadian Cardiovascular Society’s Heart Failure Guidelines Committee.

Photo of Dr. Michael McDonald