Sunday, November 27, 2011

Everything is Normal Until it’s Not

With serious illness, things that were normal before are not anymore. You're grateful to be alive but, some days, something is missing. There is this cloud over your head; a nagging feeling that things aren’t quite like they used to be.

It’s hard to put your finger on it – to describe to others what you are feeling. And others don’t understand why you can’t explain it.

It can be as simple as realizing your own mortality. 

You likely don’t have a fear of dying but you do have a fear of not being there for your family, of seeing your kids graduate, of seeing your grandchildren grow up.  And you feel that you can’t control any of this.  No one else seems to understand. Yet, you are the only one who can take the treatments or can die. Some days you may feel very alone.

Every ache and pain scares you.

All of this is normal.

If you are reading this, you are one of the lucky ones. What you are experiencing is still better than the alternative. (an estimated 17.5 million people died from cardiovascular disease in 2005, representing 30% of all global deaths. Of these deaths, 7.6 million were due to heart attacks & 5.7 million due to stroke. )  You have been given a second chance at life and the sooner you accept that your life must change, the longer you will live.

You and your body are in this life together.  You were living your life as you wanted but you were taking your body for granted.  A heart attack is one way that your body demands your attention.  Control over your life changes.  Your priorities in life change.  Your focus changes.  Your body demands it.  Listen to your cardiologist.  He speaks for your body.

You need to learn all about the requirements of your new life; this is your new normal

1.    You realize that you can’t do all the things that you used to do.  An example is sports. You probably used to do more than you can now.
2.    You have to spend more hours on your health each day than in the past.  Don’t take your health for granted; make it a priority.
     a.    You have to spend more time learning about your health.
     b.    You have to spend more hours on exercise than before. And exercise is now critically important to your continued health.
     c.    You have to pay much more attention to food because it is now more important than ever before.
     d.    If you weighed too much before your heart attack, now is the time that you must lose it.
     e.    Some days, you will need more sleep than before. (Studies show that a nap of 30 minutes or more at least three times a week produces a 37% lower risk of dying from heart disease. (
3.    You must reduce the stress in your life.
4.    You need to surround yourself with positive people.  Consider speaking with a counselor (a minister, a priest, a mental health professional, a family social worker).
5.    Involve your family as much as you can. This is also a major event for everyone in your family, except maybe the dog.  Yet, even the dog knows that you have suffered a trauma.  You may not realize that some days things are different; you are different. Try to be considerate and understanding.
6.    You may feel healthy but you now find that you’re not going to live forever, that you should plan for the future.  Things like wills, life insurance and health care become a priority.
7.    Once the necessities of life and death have been addressed, then consider one more.  Make a list of things that you have wanted to do but have been putting off until later. This is later.

You cannot ignore the trilogy of diet, exercise and stress.

Start each morning with:
          “I’m going to live, live, live until I die and not get the two confused.” 

Saturday, November 19, 2011

Organize your Medications - Set timers to not miss meds

The medications that you are taking for the recovery from your heart attack are critical to your ongoing good health.  In most cases, the choice of drugs, the quantities and the frequency have been carefully considered by your cardiologist, taking into account the other aspects of your health.  These parameters will be checked by your pharmacist as he knows, or should know because you always use the same drugstore, what other medications you are taking. By the way, be sure to keep your pharmacist up to date when your physicians have you stop taking a drug so that they can keep your records current.

I think that, before you take any new medication, you should research it on the internet. Look for side effects, how to use the medication and any conflicts with what you are already taking.  Sometimes you will find that an error has been made. Go back to the pharmacist first and your doctor second to correct such an error.

Also check on what to do if you miss a dosage or you take too many.  Know these things before they happen.

Some of the heart meds may need to be spaced out through the day so that they don’t interact incorrectly.  Some can counteract an earlier med from the same day.

To lessen the chance of making a mistake, use pill packs to plan your medications one week at a time.  You will then not have to think at each pill-taking time and you will be much less likely to make a mistake.

I also like to use reminders with alarms.  In particular, smart phones and computers can be give you visible and audible reminders.

Thursday, November 10, 2011

Prepare to Manage Your Medical Appointments

Your medical appointments are very important to your recovery and continued good health.  This article will detail things that you should do to manage your appointments.

1. Prepare for your medical appointment
  • Make a list of questions and prioritize them
  1. You will need to know various things about your condition, your meds and what you should be doing next.  You will have questions as the days between appointments go on and, unless they're written down, may be forgotten. Make a list of questions to be addressed.
  2. When you do meet with your doctor, if you are organized, you’ll be able to get the answers and information that you need. You will also likely get more time with your doctor and the time you do get will be more productive.
  3. Most doctors will appreciate you being organized and considerate of their time.
  4. Doctors also appreciate when you have times and dates of symptoms written down, and do not have to rely on your memory.
  5. Be prepared to answers all of their questions.
  • Prepare a food diary
Your doctor will want to know what you eat. You should keep a detailed diary so that you will know what you ate. I recommend keeping track of calories, sodium, cholesterol, total fluid intake and total fat.

  • Prepare a symptoms diary
You need to be able to answer questions accurately about how you feel, what pains you may have and what your reactions are to various meds. Write down daily everything that you are experiencing.

  • Decide what to take to the appointment
  1. List of questions and concerns.
  2. List of current medications and doses (include over the counter medications).
  3. Food and symptoms journal.
  4. Blank paper for notes.
  5. Spouse/friend/family member (your advocate) to assist.

  • Research and prepare for your appointment
Get on the internet and find information on your condition and your medications. Check for drug interactions that they may have missed.

  1. Gather information from reputable websites. Government health websites and those maintained by medical associations, large nonprofit groups dedicated to a single medical condition, and university medical centers have the most trustworthy, up-to-date medical information.
  2. Make notes and write down any questions.
  3. Don’t try to diagnose your symptoms or self prescribe your remedies.
  4. By being knowledgeable, your doctor’s instructions will be more understandable by you.

  • Prepare your list of meds and take them with you

Your doctor needs to know what you are taking, from all sources, to be able to understand if you’re experiencing any problems with drug interactions or if you’re taking any drugs you really don’t need. You should also have only one pharmacist. National pharmacies now keep good track of their customers’ meds and can advise you, and your doctor, about dangerous interactions.

2. Detail your family history

Tell your doctor everything that they should know about you.
This includes your past health history, your family’s health history, and your own lifestyle history at your next annual check-up. When discussing your own past, include major illnesses, allergies, and drug reactions. Summarize the major illnesses of your first-degree relatives (parents, siblings, aunts and uncles, grandparents), and pay special attention to medical conditions such as diabetes that seem to run in families. Clue your doctor in on your own lifestyle—tell her how much you exercise, what and how you eat, whether you have a pet you enjoy, how stressed you are, whether you smoke tobacco or drink alcohol, any over-the-counter or prescription drugs (from another doctor) that you take regularly. Tell about any recreational drugs that you use or have used in the past.  And be totally honest. Your life may depend on it.

3. Have an advocate

With a major illness, it is difficult to remember and understand everything that your doctor will tell you. It is important that you have someone else with you to help with this information and to ensure that you don’t miss anything important. This person can also help you remember the questions that you wanted to ask the doctor.
  • This advocate can be a family member or a good friend. It should be another person who knows about your health and your concerns and can help you listen carefully, ask the right questions, and even help you make important decisions during a doctor’s appointment. The person you chose should be supportive and understanding of your needs.
  • When experiencing stress, it’s easy to miss details and significant information. If you have a doctor’s appointment coming up where you expect to discuss significantly important test results, treatment plans, prognosis, etc., ask a supportive person in your life to come along. Not only will they be able to support you, but you’ll have an extra pair of ears to take in the information and help you to process your options later.
  • Bring a notebook and write down everything your doctor says …
  • It’s easy to forget key information after you’ve left the doctor’s office, so write down everything your doctor says.
  • Remember: Your doctor will welcome another adult with you.

4. Detail your lifestyle

You probably already know that to avoid another heart attack, you have to manage your lifestyle and likely change the things that caused you to have this one.  These changes will include the trilogy of diet, exercise and stress reduction. You will have to make changes. And, we will talk about these in a later post.

But, for now, we are discussing your doctor’s appointments. The doctor needs to know about your lifestyle to be able to diagnose what caused your heart condition and how to prepare a program of response to treat this one and avoid another one. So, be honest with your doctor.

5. During the appointment  

Ask your questions. Have your questions printed, if possible, with a copy for the doctor. Give him the list. Most doctors can quickly read the questions and give you answers immediately. Remember that they have done this before.
  • Take quick notes and have your advocate do the same. You will forget facts if you don’t write them down now.
  • Ask if you can communicate by email if you are comfortable doing this. Then, you won’t another appointment for the questions that you either forgot or are unclear about.
  • Take down some quick notes on answers to questions, or other comments made by the doctor. Ask for the spelling of tests, medication, or other unfamiliar words. You can go over your notes after the appointment and further flush them out.
  • Ask the doctor if there is any reading material (books, pamphlets, etc.) available that may help answer any questions you might have. Some questions about tests, procedures, and medications may be thoroughly answered through pamphlets, and the doctor can offer some highlights during your appointment.
  • Most doctors are very busy and they will appreciate your being organized and efficient. You will get better service from them.

Wednesday, November 2, 2011

Anxiety & Depression 2

Does psychological counseling as part of cardiac rehabilitation reduce the risk of dying?

Heart patients who underwent psychological counseling as part of cardiac rehabilitation programs have greater reductions in psychological distress, blood pressure, heart rate, and cholesterol levels than people who underwent cardiac rehabilitation without a counseling component.  Some studies found that people who participated in cardiac rehabilitation with psychological counseling were less likely to die or experience future heart problems but counseling done outside of a cardiac rehabilitation program did not appear to provide the same benefits.

How important is emotional support from family and friends?

Social ties and emotional support from friends and family are important during the recovery process. Social ties can include a spouse, close family members, and friends, as well as participation in group activities (social gatherings, religious organizations, etc.). Socially isolated heart attack survivors are four times more likely to die than survivors with social ties. Heart problems, such as chest pain (angina) or another heart attack, also occur more often in isolated individuals. Emotional support from friends and family helps prevent depression, which in turn can reduce your risk of dying. It's important to discuss your fears and concerns with your family members because people who suppress their feelings tend to do worse over time.

How can I cope with the reactions of my friends and family to my illness?

It's very common for your family and friends to experience anxiety, depression, and fear after you have a heart attack or heart procedure.  Studies of people who had a heart attack, angioplasty or bypass surgery found higher levels of anxiety and depression in the spouses than the patients.  It's actually possible that your spouse's stress could delay your recovery.

Sometimes the reaction of your friends, children, or significant other may manifest as denial of the severity of your illness or even anger. This negative reaction may be a coping mechanism used to deal with their feelings of fear. Your family members and friends may be afraid that you'll have another heart attack, or die. It may ease their fears to know that there are steps you can take to reduce your risk of future heart problems, such as taking your medicine as prescribed, eating healthier foods, and getting more exercise.

Depression And Anxiety Can Double Chances Of Heart Ailments

In an article in ScienceDaily (
 Jan. 18, 2008), a study found that major anxiety and/or depression, can double a coronary artery disease patient's chances of repeated heart ailments. This is one of the first studies to focus on patients with stable coronary artery disease -- not those who were hospitalized for events such as a heart attack.

“Both major depression and generalized anxiety disorder were more common in cardiac patients than in the general community." "On average, cardiac patients without these disorders had about a 13 percent chance of a repeated cardiac event over two years, compared to 26 percent of those with either major depression or anxiety."

 “ . . . anxiety and depression can have a strong impact on people with stable coronary artery disease"

Major depressive disorder was diagnosed in roughly 7% percent of patients while about 5% had generalized anxiety disorder.

"since both disorders may respond to antidepressants."

ref: University of Montreal (2008, January 18). Depression And Anxiety Can Double Chances Of Heart Ailments. ScienceDaily. Retrieved November 2, 2011, from /releases/2008/01/080118093328.htm