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Vaseretic (Enalapril Maleate-HCTZ)

###table###Vaseretic(EnalaprilMaleate-HCTZ)
GETTING THE PSYCHOLOGICAL ADVANTAGE OVER HEART DISEASE
Which organ of your body do you suppose is most affected by heart disease? It’s not your heart, or your coronary arteries, or any other part of the cardiovascular system. The organ most likely to affect your life and to determine the success of your recovery and ultimate return to vibrant good health is that bit of grey matter between your ears.
Most of the disability patients experience comes from anxiety, depression and distress. Those problems are the rule, not the exception, so don’t feel that you’re all alone out there. In fact, anxiety and distress are virtually universal. Young or old, rich or poor, educated or not, male or female, we all go through a period of mental disturbance.
When patients suffer from other kinds of illnesses and disease, even those which are life threatening, they typically get involved in the battle against the disease. This helps them to remain in control. Not so with a heart attack, which is most often followed by feelings of helplessness.
The psychological toll of a heart attack, or other events including surgery, cannot and should not be overestimated. According to Dr Paul Thompson, medical director of cardiac rehabilitation at Brown University, “Even among patients who outwardly function well and appear to do just fine, they too may have a lot of psychological problems.”
In two reports of the Journal of Psychosomatic Research, 23 per cent of post-heart attack patients showed mild psychological distress and 30 per cent had moderate and severe symptoms, with depression and anxiety being the most common. Worse yet, researchers noted little change in these statistics even a year after the heart attack.
Dr Thompson notes that in his own practice a large number of the men and women he sees report sleeping problems once they return home from the hospital. Many also go through a period of depression. The limitations on activity, chest pains, the family’s overprotectiveness, fear of another attack and the sick role in general are all new and discouraging experiences for previously well individuals.
“After a heart attack there is a lot of grief, a feeling of loss. It’s as if a part of that person has died. They lose a part of their self-image,” Dr Thompson explains. He says that men are, in effect, emasculated by a heart attack. Physicians tell patients to be careful, to avoid arguments, and pretty soon wives won’t even let their husbands sign any cheques.
He says, “Look, if I tell you I’m going to help you live ten years longer, but I’m going to make you miserable and frightened for every one of those years, nobody would accept that. But all of us [physicians] who have not had heart attacks have neglected the quality of life issues with these patients.”
I couldn’t agree more. My own first experience after release from the hospital was a horror. I felt totally out of control, filled with fear, anger, anxiety and an overriding feeling of depression. Of course that was many years ago. But for many people, things haven’t changed. Even when patients receive a briefing before leaving the hospital, many if not most of their questions remain unanswered.
I’ve accompanied nurses and doctors on their rounds as patients were getting ready to return home. They seldom get down to practical issues such as sex and work. Instead, they typically give patients a few brochures and a photocopied list of dos and dont’s.
It’s no wonder patients and their spouses have a lot of fear. And fear leads to unwarranted anxiety and distress. If the doctor didn’t feel a patient was perfectly capable of living quite well at home, with no particular danger, he or she simply wouldn’t be released. Moreover, no doctor expects spouses to be qualified 24-hour nurses.
Most patients are remarkably capable of a wide range of activities, right from the start. Unless there are particular complications to be considered, the majority of men and women can carry on without fear of relapse. Probably 80 per cent can expect a completely uneventful recovery, perhaps even more.
Yes, there are patients who have suffered irreparable damage to the heart muscle and will have a degree of debilitation. Most don’t. Talk turkey with your doctor. If he or she tells you that your case is uncomplicated, you really have nothing to fear. And, in all cases, listen to your physician’s recommendations.
For most of us, successful recovery will hinge more on how much you do rather than how little. As we’ll see in chapter 7, most patients could have sex the very day they return home. And they can enter a program of physical activity from the very beginning. That’s particularly true for surgery patients.
If nothing is done to curtail fears, they’ll continue for years. Los Angeles psychologist Herb Budnick has spent 12 years specialising in counselling patients with heart disease. “When I was growing up, my dad suffered four heart attacks,” he recalls. “That was back in the 1950s when treatment was a lot different. He was laid up by that first heart attack for about a year. I watched a really nice guy turn into one big bundle of anger which generally got more directed toward my mother. He eventually just isolated himself emotionally. He died of his fourth attack when I was 15.”
Today almost all people experience many of the same things Dr Budnick’s father went through after a heart attack. He says most people could benefit from some basic insights into how to cope with this traumatic period of recovery.
“That’s where cardiac rehabilitation comes in handy,” Dr Peterson at Brown says, “because it lets you know you’re not going to die. It lets you know you can exert yourself and the quicker you do the better.” We’re going to get into the details of a solid cardiac rehabilitation program in the coming chapters.
But to make the most of cardiac rehabilitation, and to ensure the success of other lifestyle modifications which can result in long-term health for your heart, you must first come to grips with the psychological distress that’s keeping you in a vice-like grasp. Dr Budnick points out that “when people become emotionally overwrought they begin to feel overwhelmed and helpless. Life after heart problems can be rich and fulfilling, but only if the patient and his family take the steps needed to assure that recovery includes treatment of both the mind and body.”
Psychological recovery from a cardiac event is more a family matter than strictly an individual one. A spouse’s notions about the patient’s physical capabilities can either assist or impede the recovery process. Even in low-risk patients whose potential for recovery is greatest, medically unwarranted fears and concerns from the spouse may seriously impede functional recovery.
In a hospital-based cardiac rehabilitation program, wives were invited to take a walk on the treadmill at the same level of exertion their husbands were doing. They were amazed at just how much physical ability their spouses actually had. So much so that they stopped treating their men like fragile china dolls.
*1/85/2*

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