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STEPS TO A HEALTHY HEART: BUILDING A DYNAMIC SUPPORT BASE FOR HEALTHY, HAPPY LIVING
No man, no woman, is an island. Never is that adage more filled with truth than following a cardiac event. We need all the help we can get. In fact, a number of studies have shown that those with plenty of support from spouses, families and friends do the best job of recovery.
Patients with a strong support base demonstrate better compliance in doing the things that will help them recover both for the short-and long-term return to normal life. We’ve discussed the tole of optimism in the recovery process, and once again this comes into play. Except this time it’s the spouse’s and family’s optimism that’s important.
If the spouse and family treat the patient like a sick person, the patient will act like one. Again, studies have demonstrated that “playing the sick role” can have disastrous consequences. An upbeat patient, living with an upbeat family, is most likely to have a spectacular recovery.
The properly functioning support base is effective in cutting through a major stumbling block for virtually all heart patients. After a heart attack or cardiac surgery, we feel tremendous loss of control over practically everything in our lives, including our own health. This lack of control leads to depression. And depression keeps us from doing the very things needed to ensure recovery. The support base can provide that control and lessen depression. Not, as we’ll see, by dictating the patient’s life, but by facilitating it.
When it comes to the support base, the more the merrier. Spouse, children, friends and relatives, doctors and other health professionals and various support groups are all important. But for the heart patient, the spouse is the person best positioned to help the loved one through this emotional crisis.
Ironically, it’s the spouse who is typically left out of the rehabilitation process. And his or her own problems are very much underestimated if not completely ignored.
In many cases spouses receive minimal information about their roles and responsibilities during their loved one’s recovery. This puts both the patient and the spouse under stress due to a perceived lack of control. One study found that stress was higher for spouses than for the patients.
What are spouses concerned about? During the second and third weeks of convalescence, worries centre on the amount, type and level of appropriate activity. They have questions about returning to work, dietary restrictions, medications and other aspects of rehabilitation and treatment. To top things off, tension mounts when the spouse becomes uncommunicative and is subject to wild mood swings.
Especially for older couples, there are problems with role reversals. For years the man took care of the “little woman”, who now has to write the cheques, pay the bills, direct the household, drive the car and, in general, care for the man. All this while worrying about a second heart attack.
Conversely, for younger couples the woman has her own career concerns. How can she take care of her husband while maintaining that career? And is this the way it’s going to be for the rest of their lives together?
Finally, although most heart patients are male, we have an increasing number of women recovering from heart attack and bypass surgery. In many cases, the husband has already died and isn’t available to provide convalescent care. And when he is around, he’s typically not equipped as a nurturing care-giver in our society.
In the coming pages I’ll discuss some options and strategies for various households. Unless specifically addressing the female patient, I’ll assume that the spouse is the wife. However, the concepts remain valid for either sex.
Let’s cut to the chase: how long is this whole recovery process going to take? Asked another way, how long is the household going to be in emotional upheaval? Certainly every case is special and there will be wide variances. But on average, complete recovery takes about a year.
The recovery process gets easier and easier as the weeks and months pass. Certainly those first few weeks will be the worst. As the patient enters the formal, structured rehabilitation program he or she will rapidly return to the person you knew and loved. Yes, there will still be mood swings, easy fatigue, grumpiness and concerns. But it will get easier.
I’ve suggested that all cardiac patients should keep a daily diary to keep track of progress in diet, exercise, stress management, general feelings and so forth. All the same benefits would accrue to the spouse who keeps a daily log. In fact, there’s something very therapeutic about putting one’s thoughts to paper. Don’t hold back, let it all come out, all the anger, all the anxiety, all the emotions.
Yes, this will be an emotionally fraught year. But haven’t you gone through some tough times in the past? Try to put this into a proper perspective of taking the good with the bad. Remember the problems that the two of you faced through the years: worrying about buying a house and paying the mortgage; times when you thought you were going to go bankrupt; troubles with the children; automobile accidents. You made it through those and other times together, and you’ll make it through this one too. Because heart disease does not mean that life as you have known it is over. You can beat heart disease and make it, like other problems, a thing of the past.
The cardiac event does place an additional stress on any marriage, whether rocky or idyllic. But there’s some really good news from a British study that found many couples actually reported an improvement in their marriage. About one out of four said their lives together became better and richer. Couples stopped taking each other for granted and several made deliberate efforts to show more tolerance and consideration for each other. (Of course, that all took time; those first few weeks are tough for everyone.)
The experience in America seems to be about the same. About 20 per cent of spouses rate their marriages as worse while 25 per cent note an improvement; the other 55 per cent indicate no changes one way or the other.
Needless to say, if the marriage wasn’t good to begin with, a cardiac event may be just the straw to break the camel’s back. While most couples in such circumstances remain together during the initial recovery, divorce may be forthcoming. In some instances, the heart attack or surgery may lead to a rethinking of the rest of one’s life. Some decide that they’d be happier alone, or with someone else.
No matter what the state of your marriage before the event, this is the time to improve communications rather than clamming up. Often spouses keep their anger within, fearing that an argument might trigger an attack. That leads to even more resentment. Keeping all channels of communication open is essential. You might even consider some family counselling at this time if communication seems impossible.
Los Angeles psychologist Herb Budnick specialises in helping individuals and couples in their emotional recovery from heart disease. The advice he gives heart attack survivors is to “increase your quality of life by communicating more, by addressing your emotions, by reaching out to your spouse, and by allowing her (or him) to reach out to you”.
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