Cardiac

These excerpts are taken from "Coping with Heart Surgery and Bypassing Depression: A Family’s Guide to the Medical, Emotional, and Practical Issues" by Carol Cohan, M.A., June B. Pimm, PhD., and James R. Jude, M.D.

The purpose of the book is to help alleviate the severe depression that can impede recovery from heart surgery. As more than 50 studies have documented, this depression afflicts up to one-third of all heart surgery patients in the weeks and months following their operations. Worse, because of the unique nature of heart surgery, this condition is often masked. Instead of feeling despondent, people suffering post-surgical depression commonly experience poor appetite; difficulty sleeping; lethargy; trouble with thinking, concentrating and remembering; and an assortment of physical ailments that elude diagnosis. Yet these problems are real, and they interfere with resuming work and leisure activities.

This book is an excellent source for patients. It provides information about the basics of bypass and valve surgery, anesthesia, getting ready for surgery, the stay in ICU and the step-down unit, recovering at home, depression, and promoting recovery and good health.

The following excerpts are some of the more important take home points I took away from the book.

• When patients understand their problems and have ready strategies for coping with them, they recovery more quickly.
  
  
• Convalescents benefit from appropriate attention to their emotional concerns.
  
  
• If you know what to expect you can perceive your problems as normal.
  
  
• When patients have time to assimilate information slowly, they process it more effectively and can call upon it more reliably than when they are bombarded with it immediately before surgery.
  
  
• Depression afflicts up to one-third of all heart surgery patients in the weeks and months following their operations.
  
  
• Counseling instituted before surgery and sustained for 3 months afterward was instrumental in reducing debilitating depression. Also, these patients have fewer medical problems.
  
  
• Essential ingredient – a cushion of support during the months when patients feel most vulnerable and find coping particularly difficult.
  
  
• After surgery patients commonly endure pain and discomfort, lingering weakness, and periodic dejection. Most do not feel like themselves for months. When medical personnel underestimate these physical and emotional difficulties, patients sometimes have trouble reconciling the contradiction between what they hear and what they feel. When this happens, they can experience more physical and emotional pain and take longer to recover then those who know what to expect.
  
  
• With successful crisis intervention, people in crisis learn to anticipate what will happen, understand how they normally cope with crises, and then mobilize those strategies. Counseling thus empowers people to overcome their feelings of vulnerability.
  
  
• Coping styles vary from person to person, and there is no right or wrong style. One of the goals of counseling is to help people adapt their most reliable strategies to the demands of the trauma.
  
  
• Arrange for crisis intervention to help you cope if you have experienced numerous or significant life changes in the last six months, if your surgery entails many bypasses, or if you are prone to depression.
  
  
• Experiment with relaxation exercises and positive assertions to help you manage difficult moments.
  
  
• Take advantage of patient education classes and visits from professionals to ask all your questions.
  
  
• PAIN. There is a difference between pain and discomfort. Discomfort implies an unpleasant awareness. It is mild enough that it remains in the background, but it is definitely present. Pain, in contrast, screams for attention. It prevents reading, moving, even listening to conversation. PAIN IS DEMORALIZING AND EXHAUSTING.
  
  
• ANGER is a common emotion in the days and weeks after surgery. Sometimes, it is disguised fear, but not always. It can stem from frustration. The best antidote is to talk.
  
  
• DEPRESSION. It’s a rare patient who experiences no reactive depression whatsoever. These feelings are normal and self-limiting. These emotions and tears are a natural response to an overload of emotional and physical stresses. All patients confront their mortality, surrender to manipulation of their body, and trust his very breath to people he barely knows and returns to consciousness in the cacophony of the ICU.
  
  
• Anger, poor concentration, memory loss, difficulty reading and thinking of words, and seemingly unprovoked weepiness occur when the mind steps off guard. Blue feelings and tears can descend spontaneously on and off for up to 3 months and then gradually recede.
  
  
• To ease depression, be realistic in your expectations. Since heart surgery causes major physical and emotional disruption, healing takes a long time. When fatigue sets in, everything hurts more and emotions are more difficult to manage. Gradually the good days win out. But although the majority of patients can resume most of their activities within a few weeks, many admit it takes months, some say a year, before they feel like themselves in all respects.
  
  
• You will do yourself a favor if you expect the pa ce of recovery to be slow and uneven. If you are inpatient with yourself and unrealistic in your short term goals, you will set the stage for depression.
  
  
• Many feel nauseated and find food distasteful – anesthesia, meds, and electrolyte disturbances can all contribute to this problem.
  
  
• THEME OF RECOVERY. Recovery is not yet completed even though discharge from the hospital means that it is well underway. For at least the next few weeks – and maybe for as long as several months – you must remain dedicated to the hard work of recovery. Inherent in those duties are respecting the healing process with its associated discomforts and fatigue, being dedicated to a life-style governed by exercise and rest, and accepting the emotional trials characteristic of this arduous recuperation.
  
  
• FATIGUE. For many, the most difficult aspect of recovery is the unique brand of fatigue characteristic of recuperation from surgery, caused in part by anemia. Patients describe this fatigue as bone-deep weariness that strikes without warning. Some residual fatigue may linger for at least a year.
  
  
• SIGNS OF SERIOUS DEPRESSION. Research done by authors of this book revealed that patients recover emotionally at different rates, just as they recover physically at different speeds. Normal reactive depression may peak as last as 3 months after surgery. Almost always, it is a reflection of weakness and debilitation.
  

The book then elaborates on the following: what is to be expected at weeks 1 through 5; physical therapy exercises; the importance of knowing the medications; what to do for insomnia (things we already tell patients like eliminating caffeine and alcohol, avoid napping, make an effort to go to bed at the same time every night, and as last resort take sleeping medications); diet instructions and menus; resuming sex; returning to work.

Another chapter dealt with the concerns of the caregiver. The important points were as follows: Satisfy your own needs to acquire information and resolve concerns; try to listen to your patient and accept his feelings without being judgmental; be reassuring and comforting in the ICU; encourage independence later; avoid being overprotective; take care of yourself; seek help and social support when you need it; and try to restore facets of your normal life as quickly as possible.

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