Wednesday, January 13, 2010

Women and Heart Disease: The Heart of a Woman

As I post this chapter of my writings, a new year -- a new decade -- has begun. There are challenges and opportunities; there are difficulties and demands; there are, as always in my life, beginnings. Happiest New Year to All, and now please read on...

Beginnings: Life Changes, Life Laws and Letting Go

The sense of "here we go again" was ringing in my ears. I was hypersensitive, attuned to my body as well as my feelings, quite aware that my emotions were raw and tenuous. On one hand, I was in a honeymoon phase of living with myself and enjoying it immensely! Nothing moved unless I moved it; there was silence broken when and how I preferred it; effort was expended in the directions of my choosing. I continued to work, but no longer for the business, so the phones were quiet, the voluminous paperwork non-existent and the endless diplomatic interventions with staff and clients absent. On the other hand, this immediate change in life style was shocking, and it would not be long before I had to ask myself what was next.
Following Phil McGraw's Life Laws and intertwining them with my own philosophies, I began the first leg of this necessary journey. All ten of his laws have incredible merit and I highly recommend both of his books, "Life Strategies" and "Relationship Rescue". Your ways of handling the particular challenges you face will likely be augmented by his ideas.
Life Law #2 states that you create your own experience and are accountable for acknowledging and accepting what you have created. This does not imply that if you have had a heart attack that you have chosen it or are to blame or are a hapless victim. In fact, there are no victims, according to Dr. Phil, just "volunteers". The truth is that you are responsible for reclaiming your life, for putting yourself back on track and moving forward past the point of survival - you have won that battle - and onward. "Change" is not a dirty word; it is inevitable, meaningful, exhilarating and strengthening. I can almost hear you thinking "Easy for her to say, but I'm frightened and I don't want to face any more difficulty than has been thrust upon me ". But you have already begun anew and you have proven yourself. You have emerged victorious at least on a physical level and I believe that without a reservoir of desire to stay in this world that you might not have achieved that. Give yourself more credit and begin to realize that a beginning has crept into your life scene, and in confronting it you are astronomically increasing the possibility of thriving! If you insist upon fighting change, you are failing to acknowledge that you are accountable for your choices and the consequences of those choices. You are taking away from yourself rather than embarking on the quest to become more.
I could not remain numb because to do so would have robbed me of the payoffs of new, or at least improved behaviors, ways of being in the world that would enhance me.
Although it was tough to face, this was actually a good time for me to go through the separation. It was an opportunity to re-examine my choices and decisions, rejecting what had not worked and welcoming different strategies. We cannot allow emotional blindness to thwart us or frustration to stop us. I knew that I was foisting myself into a fearsome state but that avoiding it would keep me burdened with the tension and stress of staying in a situation that was not working. Fear and escape from pain have a seductively narcotic effect, but that anesthesia leaves you emotionally stranded, disabled from taking positive action. This is real life and you need results, not excuses. Harsh though it may seem, my goal is to help jet-propel you to where you need to go. Your job is to trust the process, immerse yourself in it, embrace it with open arms.
I was still coping with changes in medications, trial and error additions and subtractions attempted according to my doctor's wisdom. Every test, every symptom, every report had to be examined. Fatigue was limiting, fear was still hard to quash and the reactions of doubt and anguish among my closest friends and family made me so emotional. Although I was optimistic, I could not help but become impatient with the slowness of the healing process. Not knowing what to expect, what baseline would eventually be achieved was baffling. I so wanted a working crystal ball! When would I reach my maximum in terms of energy level? When would I stabilize on the medications and perhaps reach the lowest possible dosage levels? What could I reasonably expect of myself in rehab? We all pose similar, unanswerable questions and doubt creeps in even when we are determined to remain positive -- it is the reality check syndrome. Once again, the issue of control, or lack of it, enters into the picture in its many shades of gray. I consider myself to have a rather high level of self-awareness, and well I should, but I was amazed somehow that the further I was from the heart attacks, the more I was able to give over control. It was taking root more and more deeply, sometimes consciously and more often as a matter of course. To me the latter provided a modicum of proof that this was going to become permanent, not just situational. Some examples seem minute, but they were winking at me on a more regular basis: "Where would you like to go for dinner" would be met with "It's up to you" and not followed by suggestions, complaints or comment. I did not have to participate in everything but could allow others to take the ball. Life had become easier because I had made it become easier! It was not mysterious and certainly not impossible.
I had yet another opportunity in November to go to Florida with my wonderful, supportive, spirited daughter and she made all the arrangements, she drove, she navigated, she led me. I was calmer than ever, easier with myself and finding that the smallest pleasures put a silly grin on my face. Thriving was taking on so many definitions, including simply enjoying life and recognizing it. The full blown meaning (prospering, succeeding, growing or developing vigorously, flourishing), could be taken down a notch to mean feeling content more frequently. It is important to take notice of your own progress, especially when it is inherently slow. I was not entirely without responsibility for my medical condition, but once I could at least allow my doctors to guide me, I could bow out of the brunt of the work that I was not knowledgeable enough to handle. I was careful about food, exercise, rest, pill-taking, but the rest could be up to them. I had chosen them wisely and had a high level of trust and respect for their judgement. If I was too hesitant to report to MaryAnn an incident known to my support system, I could accept their nudging me and make a phone call, without resisting. One of the byproducts was a reduction in my general level of fear, the affliction of "what-if". In fact, days after our return from the trip I was scheduled for another stress test and was actually excited rather than unnerved. This time I would be strutting my stuff instead of fearing that I would fall apart! Indeed, my exercise tolerance had grown, but there were still abnormalities evident, just as on my ECG's, but nothing dire, and, most importantly, I was continuing to develop collateral vessels, "extra" blood vessels capable of taking over for blocked, plaque-filled ones that may have caused the heart attack. Hurrah for rehab!
Perspective is of such great import and, by definition, can take place only with the passage of time: Thanksgiving was coming again and the differences in the long year that had passed were actually dramatic. I was brighter and cheerier, much more energized, had greater stamina and concentration. Overall, I was involved, enlivened, peaceful and filled with optimism, quite a counterpoint to the dulled, tired, unenthusiastic participant just twelve months earlier.
My strong sense of realism was at play, too, and I knew that I would be thrust into periods of sadness and loneliness despite my inner strength. I had made a decision that was not without difficult consequences. My initial inaction was inherently emotionally costly but now I had to develop strategies that would allow me to cross this next threshold, not a simple task. Bathed in a variety of side effects from the many medications I had to ingest, ranging from the ridiculous (a puppy-cold nose) to the sublime (those wondrous vessels), I had to admit that it would be with considerable difficulty that I would move forward.
In our moments of greatest difficulty, forward motion seems so daunting. Getting real, accepting what is, holding yourself accountable for where you are - all of these notions that I hold dear - will sometimes leave you feeling overwhelmed. Life may seem so difficult to manage, as though you need to be made of steel, while feeling more like Jello. As a people-person, I can vouch for the value of being active and among those who make you feel most alive. It is a natural phenomenon to feel alone from time to time, even if you are in a rewarding relationship, working, parenting, taking advantage of avocations, participating in group activities or individual counseling and invested in attending to your own needs. There has always been some controversy regarding the differences between "alone" and "lonely". In my experience, heart patients who identify their lives as being full still speak about a specific type of loneliness/aloneness that is based on the uniqueness of the nature of the disease. You may feel a distance from your significant other, best friends, close family members who can sympathize but not empathize and an uncanny closeness to your classmates in a cardiac rehab program. When you awaken with symptoms in the middle of the night and you are alarmed - "Oh, no, is it happening again?" - your doctor, your trusted medical resource, is not likely to be present and neither are your compatriots. Your spouse may be lacking patience, certainly lacks expertise and/or may not know how to be available to you in the way you need him/her to be. These are moments when you are most likely to feel like you are in a morass and on your own (alone) and unable to use the usual resources to fill the immediate need (lonely). I made reference to the 5 AM syndrome concerning my mother, but it still happens to me some early mornings, too. If I am awakened for any reason at that hour, I have to remind myself of all the positive results of my last tests, convincing myself that no, it is not happening again, that I am receiving excellent care. My only job is to soothe myself back to sleep; anxiety breeds like little rabbits and can drive you needleessly nuts! It is essential to have a well-thought out plan of action in case serious symptoms arise, since logic so easily gets thrown out the window when anxiety slinks in. Perception, your own personal way of reacting to a situation that presents itself, is the key: I can feel a flutter and decide I'm in trouble or I can choose to process my reaction through a decidedly calmer filter. I can panic or I can summon my most forceful, diligent, rational thinking mode. I can run for the phone, get all worked up, no longer able to distinguish between fact and fear, and create a vicious cycle leading to a place I do not want to be; I can also be still, pause, listen. Just as in other aspects of our lives, we can use as life lessons the issues of the past without allowing ourselves to be controlled by them. It is not our particular life situations that shape us, but rather our reactions to them. We all have a certain way of filtering our perceptions, so the physical stimuli can be distorted or addressed calmly. You need to be aware of whether you are creating an opportunity to examine yourself, or falling apart in advance of true knowledge, even at five in the morning. How many times do you hear about someone screaming through childbirth while the woman laboring in another room is brimming over with delight and awe? Their pain thresholds may be similar but their filtering systems are likely quite different. One may be frightened of the unknown and the other more educated; there may be many elements to the equations, but one thing is certain: the screamers among us often find themselves reacting to their difficulties with less forethought, probably in large part due to their lack of ability to test their assumptions prior to exhibiting their reactions. So what does all of this mean in the scheme of things? How can our perceptions help us simplify our lives? How do we objectify reality so that we can make sense of our thoughts, actions and reactions? When we sift through Phil McGraw's ten laws of life, we begin by becoming accountable for our lives, willingly, purposefully and consistently, without blame and with true acknowledgement. When perception is clouded by past experience and negative expectations, we fall prey to limiting rather than challenging ourselves. Self-fulfilling prophecy can cut both ways: if we believe that we can get well and fight for ourselves, the outcome is nearly always positive; conversely, if we are pessimistic, refuse to accept what is, become filled with self-pity, we are apt to induce distress and exacerbate the negatives of our situation.
During a rehab session recently, an upbeat, pleasant, bright woman suddenly sat down, lowered her head and nearly passed out. Her blood pressure had soared, her face was blazing and she was dizzy and near tears. She was attended to by the nurse and doctor on staff and told to sit quietly, stop exercising and just breathe. I made my way over to her and she immediately began telling me exactly what she was reacting to. Her daughter-in-law had written a letter to her filled with complaints about the difficult issues in her marriage, demanding that Lois do something about her grown son. Lois reacted strongly and negatively to the nerve of this woman. Upon reflection, she realized that whatever the intent of the letter, it was her responsibility to own her reaction. She slipped, forgetting that this woman could not cause her to react in any particular way, and that Lois's reaction was purely driven by her own thoughts. The daughter-in-law did not make her blood pressure rise, Lois had done that to herself. The good news is that when it happens, we all can take the liberty to adjust our reactions. She nearly slipped further by chastising herself rather than using the "Aha" moment to assist her. She was proud to come out of the incident with her thoughts intact and her blood pressure back to normal. She will write a positive, simple, short letter back acknowledging that married life can be difficult and that she is certain that they will find solutions on their own. She went home feeling renewed and relieved that she does not have to solve their problems and she does not need to allow herself to be negatively affected by their issues. We can choose what to react to and how much precious energy we want to expend. We do not have to drive ourselves into a tizzy unless there is something at stake that is worthy of our attention, and then we can work through these moments in ways that are helpful, not harmful. A "heartache" can be dangerous, even life-threatening for us. We absolutely must protect ourselves from reactions that can bring about an array of symptoms that can become precursors to disaster. We are fully responsible for managing our dis-ease, which is good news! We have ample motivation to make sense of each troubling situation with simplicity and clarity. There are no guarantees, but it is tempting to tell you that if your thinking is sound, your judgement will be too, and your life will be easier, more pleasant and healthier if you learn to think before you act or react. Lois had allowed herself to become immobilized by the frustration and annoyance inherent in the situation, and it had affected her health. Her stark awareness will be a terrific reference point so that she can choose other ways of handling similar incidents if they occur.
So now I had to ask myself some questions: would seeing clients, writing diligently, going to dinner with special friends, a birthday party for Mom, the routine of seeing the dentist, going to doctors, exercising three days a week enable me to practice what I preach and live what I had not only learned, but was teaching? Questions like these served as markers for my worst moments, red alerts to remind me to empower myself. I was nearing empty and refueling was a necessity. Back to the wisdom of Iyanla Vanzant's quiet pause. Back to the trust in my abilities. Back to the life experiences that prepared me for this one. Forward, using what I call the "movie camera" in our brains. Time to reflect on reasonable, short-term goals. Time to appreciate and luxuriate in the joy of my daughter, the dearness of my mother, the specialness of my friends and family, all earned by my being who I am. Time to enjoy the holidays and the coming of a new year - the millenium, in fact! There were days that getting out of bed in the morning was a chore and sleep a refuge. There were days that dragged on slowly and days that were unproductive. There were thoughts that demonstrated a longing to know my future and conflicting ones that knew better than to take more than a day at a time. If all of this sounds familiar to you, that should not be surprising, but while it is happening it is so difficult to take it all in. Becoming entrenched in a negative mode is a prescription for trouble, limiting the ability to filter and to be open to finding new ways of coping. Rather, you need to remind yourself yet again that you have survived, so you have already come out on top! Your attitude about striving to thrive is where your power resides. You may have been knocked down by your heart attack, but what matters now is getting back up and staying there! You're not on this life journey alone, and you do not have to be totally in control, but you must take charge of managing your life. I have often joked with clients that if challenge builds character, we can readily understand why there are so many characters among us! Expect the hurdles, but don't label every situation a disaster; know that there will be pain and difficulty, but do not react in advance, daunting yourself before you have the opportunity to create an efficient, realistic plan. Become your own top-flight manager, allowing the perhaps unexpected, yet predictably present changes in your life to function as opportunities for furthering your growth. I recently asked the director of a private school for children with learning disabilities what she would like to do differently in her already remarkable school. She told me that she starts every day as though she was about to be replaced by someone else. She then becomes that new person - a new broom, as she phrased it - and she tries to be that new broom every single day, because a new broom always does a better job. She is always open to new ideas and approaches and is an incredible motivating force for both staff and students.
One of the major responsibilities of parenting is to instill in our children the ability to adapt to change, for we know that it is inevitable. We also know that beginnings are created by endings, even unwanted ones. I could not know what the future design of my life would bring, but I certainly knew that I would be the driving force. Why-me and what-if questions are debilitating and unnerving, involving a remarkably useless expenditure of energy, yet leaving us devoid of answers. I had to re-invent parts of myself, mindful of my good skills and abilities as well as my areas of lesser ones. The natural fear of the unknown is based on needing to know the answers to unanswerable questions. In terms of CAD, great advances are being made in the field, so I feel assured that within the next five years and subsequent similar blocks of time, I will benefit from gains in the treatment and management of cardiac patients. I know that closure in the relationship was critical and had to be addressed fully in order for me to move forward without having a chip on my shoulder, let alone, as my mother phrases it, “an entire lumber yard”. Determination and commitment are central in this important task. Remember, too, that behavior is purposive and self-rewarding. It is essential that you reflect on why you act the way you do so that you can choose to eliminate behaviors that limit you. You will have command only if you take note of the consequences of your actions and you will move forward by planning, not wishing, hoping or dreaming. It is a tall order, this life based on deep thought, but I assure you that having been through all you have - and I say this with true empathy - the rewards are going to be extraordinary. One of the ways that I can assess my own progress is by noticing the reduced frequency and duration of the inevitable lows. It may serve you well to keep a diary or a journal as you go along, particularly if you are experimenting with new strategies. It will keep you honest and involved and help you to integrate the new with the old. You already have a core from which you operate, based on your lifelong value system, experiences, desires, needs, expectations, successes and failures. You may need to make adjustments, admissions, acknowledgements. You may actually find that you are closer than you thought to achieving your goals, attending to the meaning of your life and becoming your own patient, realistic manager. It is magically uplifting to see yourself recognize the quality of your life plan as it takes shape. Of course, the path is bound to be bumpy. It is appropriate to demand command of your own life with conviction and boundless determination. Don't cut corners by setting your standards too low. Try to find a balance between striving for great heights and deciding it is too difficult to create a life that can be more than it is right now. Neither settle for nor create an unrealistic scenario that is bound for disaster. Success breeds more of the same and as you and the people around you notice that you are fighting for yourself and are determined to become more, you will flourish.
You may want to ask yourself specific questions, such as:
- Am I managing my financial life appropriately?
- Am I killing time or utilizing and appreciating it?
- Do I need to develop my interests or select gratifying hobbies?
- Am I remembering to see the humor in quirky situations?
If finances are problematic, you have a real battle to wage. In my family we say that money is not a problem -- lack of money is a problem! Again, utilize the knowledge and experience of those you trust or to whom you are recommended. If you neglect this issue, I can promise you that it will ferment, grow and taunt you. Solutions abound and must be sought out.
The issue of time is precious. Having come so far, gained so much, worked so hard, your time is so vast in its value. It is not about "one day down", but rather a matter of reveling in the treasure of using and delighting in every moment of every day.
Perhaps you will come to realize that you always wanted to DO IT! Pottery? Reading? Canoeing? Whatever enters your mind, if you cannot arrange to do it, then read about it, talk about, engage in any possible aspect in it, but do not drift away from it.
Humor is my favorite topic. It is health-giving, life-extending, both immediately gratifying and endlessly referential. Sometimes I feel like Dudley Moore in "Arthur", all by myself and just laughing at my own thoughts. It is a lifesaver and a true necessity, especially in tough situations. Whatever brand of humor appeals to you, whether from a book, a comedic performance, a movie, a joke, use laughter as a lifeline - trite as it may sound, every chuckle is worth a million times more than even the slightest frown.
There is every reason not to set yourself up to believe that everything will always work, just because you are designing your life with more thought. To quote Dr. Phil, “Sometimes you make the right decision and sometimes you have to make the decision right". Keep on track, but remember that the softness of the path you are designing allows for flexibility and once you have taken responsibility for struggling to mold it, then your strength lies in not rigidly clinging to what does not work. It is your life, you are the managing agent and you will be able to figure out what works best for you once you commit to the idea of honing your skills and reaching for your particular star.

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