From Chapter 10. More on the jagged progress forward

Tips for Mood Swings During Heart Surgery Recovery

Mood swings enter into the recovery picture and they can be very disconcerting. By undergoing open heart surgery, every cell in our body receives a call to arms. Head and heart will need time to realign, because a powerful body shake-up has just occurred.

Here’s a composite snapshot on the blues drawn from several patients I’ve interviewed: The first four to six weeks you can expect tears to come for no specific reason. You can expect to wake up in the morning feeling down, even temporarily hopeless. During any day after a positive couple of hours you can expect a reversal. But remember too, the operative word here is temporary. Things will change. You will go back to feeling your true self again.

In the meantime, what can you do to shift your mood?

I have often found that reviewing what I am grateful for in my life can dissolve tension and negativity. I turn to that activity often and can feel so much better after reminding myself of all my blessings – my partner in life, my children and their partners in life, our grandson, our entire family’s level of good health, the blessed environment in which I live. By simply saying thank you, even out loud as I consciously visualize the abundance in my life, I am restored and renewed.

What else can be done to avert intermittent depression? If depressive episodes are running you more than you are on top of them, discuss your symptoms with your health care professional. Here are some other diversions and coping strategies:

• Take a walk in the fresh air. Force yourself to get some exercise despite lethargy
  
• Set your mind to finding a good book that really involves you; don’t try too hard to cover “important” material.
  
• Explore meditation. Try sitting in peaceful solitude, following your breath, even just five minutes a day.
  
• Go into prayer. Explore the “faith effect.” A University of Michigan study in the fall 2004 issue of Journal of Health Psychology reports on the ongoing research to identify a mechanism that triggers the “faith effect” in patients undergoing open-heart surgery. U-M researcher of integrative medicine Amy Ai and her colleagues, “pioneers in the new field of positive psychology, link optimal expectation with faith.”
  
• Watch some comedy that tickles your funny bone – Comedy Central? Saturday Night Live?
  
• Listen to favorite upbeat music.
  
• Bake a cake with a friend (rest when you get tired),
  
• Exchange supportive phone calls with another heart patient. Swapping experiences is especially valuable to put smaller questions to rest.
  
• Sit in the sunshine; take in a view.
  
• Don’t play The Lone Ranger. Ask for help! Call on old friends as well as new ones.
  
• Review your prescription mix with your doctor.
  
• Discuss taking a sleeping remedy or an antidepressant for the short term.

Begin a Cardiac Rehabilitation Program — Eureka!

Two months after my surgery, through my cardiologist’s referral, I was cleared to begin a physician-sponsored cardiac rehabilitation program. Some patients are healed enough to begin sooner, some later. The gym facility where I live in Santa Fe, NM, called the Center for Living Well, is spaciously housed in the basement of our one hospital. In the last thirty years, thousands of cardiac rehabilitation programs have sprung up far and wide in the U.S. alone, all featuring similar characteristics. Here are some of my program highlights.

Beginning a cardiac rehabilitation program is truly an exciting moment. I was finally up to moving my body for real. I knew I had made tangible progress or I wouldn’t be there. I was assigned an exercise physiologist, or case manager. After a general orientation (completing a detailed questionnaire, learning to take my pulse, oxygen usage and rhythm monitoring guidelines) I was given a personal exercise worksheet. Preferably three times a week for one hour, I was to track my gentle progress forward in a customized program -- using the treadmill, bike, stairs, UBE machine (aerobic ergometer), and so on. Adding weight training to the regimen was to come later, at the discretion of my case manager. In addition, numerous classes (stretching, therabands, free weights) and support groups (smoking cessation, stress management, osteoporosis and diet education) were all available in the package. Once a month there was an “Ask the Cardiologist” Q&A hosted by one of the New Mexico Heart Institute cardiologists. Most of all, the staff were caring, devoted, highly attentive, good-humored professionals. There was a palpable air of camaraderie and developing friendships that evolved into a memorable support group experience for me.

I was accepted into the program provided I agreed to wear a wireless heart monitor during exercise. What a good thing! My heart was still ricocheting in and out of irregular rhythm (atrial fibrillation). There was always someone at a computer screen monitoring my rhythm. If, as is more likely with exertion, my a-fib returned, even if I didn’t notice, a nurse or exercise physiologist would check in with me. How was I feeling? Did I feel lightheaded? Did I need to slow down? Maybe end my session for the day? Your pulse is x, let’s check your blood pressure.… Since a patient’s inclination may be to push through (my common approach in the past), the permission to simply stop, give yourself a break, can be welcome. I felt completely taken care of. With so many dedicated professionals around me, and the new friends I was making, I could never run too far into trouble. Although physically challenging at times, the cardiac rehab environment made for a positive, confidence-returning experience.

In the book, Heart Attack: Advice for Patients by Patients (Yale University Press, 2002), most of the eleven contributors go out of their way to rave about their cardiac rehab program experience. “The highlight of my day…”, “I credit the program with getting my life back on track…”, “I’ve been a member now for ten years and I know it is keeping me healthy…”, “My wife is now in the program with me. We’ve made some great friends….” The social and emotional support received can be priceless. Rather than returning to one’s previous gym or yoga class, many heart patients take advantage of ongoing membership in their cardio-directed program.