“I’m just not a pill person” – and other annoying excuses

26 Apr

drugs hands

by Carolyn Thomas    @HeartSisters

Dr. Lisa Rosenbaum writes in the New England Journal of Medicine about a friend who is worried about her father since two of his sisters have recently died following strokes.  She asks her friend:

“Is he on aspirin?”

“Oh, heavens, no,” the friend replies. “My parents are totally against taking any medications.”

“But why?”

“They don’t believe in them.”

Curious about what she calls this instinctive non-belief, a commonly observed reluctance to take the medications their physicians recommend (aka non-compliance or the slightly less patronizing non-adherence), Dr. Rosenbaum wanted to understand how patients feel about taking cardiac medications. The consequences of not taking one’s meds can be deadly, yet almost half of all heart patients are famously reluctant to do so.(1)   Dr. Rosenbaum, a cardiologist at Boston’s Brigham and Women’s Hospital, wondered: Are there emotional barriers? Where do they come from? Can we find better ways of increasing medication adherence if we understand these barriers?*

So she interviewed patients who’d had a myocardial infarction (heart attack), both at the time of the initial cardiac event, and again months later.  Their answers fell into five distinct themes that might be surprising to doctors feeling frustrated by their non-compliant patients. Continue reading

Slow-onset heart attack: the trickster that fools us

19 Apr

snail

by Carolyn Thomas    @HeartSisters

As I’ve noted here previously, there were a number of very good reasons that I believed that Emergency Department physician who sent me home with an acid reflux misdiagnosis. Despite my textbook heart attack symptoms of central chest pain, nausea, sweating and pain down my left arm, these reasons included:

1.  He had the letters M.D. after his name;

2.  He misdiagnosed me in a decisively authoritative manner;

3.  I wanted to believe him because I’d much rather have indigestion than heart disease, thank you very much;

4.  The Emergency nurse scolded me privately about my questions to this doctor, warning me: “He is a very good doctor, and he does not like to be questioned!”  (The questions I’d been asking included, not surprisingly: “But Doctor, what about this pain down my left arm?”);

5.  Most of all, what I had always imagined a heart attack looking like (clutching one’s chest in agony, falling down unconscious, 911, ambulance, sirens, CPR) was not at all what I was experiencing. Instead, despite my alarming symptoms, I was still able to walk, talk, think and generally behave like a normally functioning person, i.e. one who is definitely NOT having a heart attack!*

So it all made sense to me as I was being sent home from Emergency that day, feeling very embarrassed because I had clearly been making a big fuss over nothing.

My experience, however, might have been what researchers in Ireland refer to as “slow-onset myocardial infarction”.   Continue reading

My guest column in Stanford School of Medicine’s ‘Scope’

15 Apr

by Carolyn Thomas    @HeartSisters

John Novack is the Director of Communications at Inspire – the organization that hosts WomenHeart’s online support community of almost 18,000 members living with heart disease. Three years ago, John approached Michelle Brandt. She’s the Director of Digital and Broadcast Media at Stanford University School of Medicine, and also the editor of the school’s medical blog called Scope. John’s suggestion to Michelle: let him help her work what he called “the voices of actual, unvarnished patients” into her publication – normally devoted to coverage of scientific and medical developments around the world. Michelle said yes.

And that’s how Scope’s monthly patient-focused series of unique personal stories was launched. Since I qualified as a contributor (an actual, unvarnished patient myself), John invited me to submit something for consideration – “I’d love a draft column by the end of March!” is how he put it. Continue reading

Living with heart disease – and your whole family

12 Apr

by Carolyn Thomas    @HeartSisters

For more than 30 years, Dr. Wayne Sotile was the director of psychological services for Wake Forest University’s Cardiac Rehabilitation program. Which is to say that he’s spent a lot of time talking and listening to heart patients and their families. In 2008, while recuperating from my own heart attack, I discovered his must-read book called Thriving With Heart Disease.*  That title, by the way, has always bugged my Alaskan friend Dr. Stephen Parker (a cardiac psychologist and himself a heart attack survivor) who once made this comment about the book’s title:

“Just as soon as I can gather myself together, I am planning on writing a book called ‘Thriving After I Lost All My Body Parts’…”

Despite that small quibble about the title, Dr. Sotile is a terrific writer who really nails it when it comes to guiding those who are freshly-diagnosed with a chronic and progressive condition like heart disease.  Another of his many books expands that guidance.  It recognizes that it’s often the patient’s entire family who need help coping with the stresses and changes brought on by a cardiac diagnosis. Such help, he claims, can actually be the key to recovering.   Continue reading

The surprising reasons heart patients don’t go to cardiac rehab

5 Apr

by Carolyn Thomas   @HeartSisters

Cardiologist Dr. Sharonne Hayes, founder of the Mayo Women’s Heart Clinic in Rochester, Minnesota, has this important advice for all heart patients:

 “If your doctor recommends cardiac rehabilitation, go. 

“If you’re not referred, ask.”

. . . and then she adds this gem on Twitter (@SharonneHayes)

Based on what we already know about the shockingly low rates of physician referral to this life-saving treatment, we might expect a flurry of doctor dumping if heart patients follow Dr. Sharonne’s advice to seek out physicians who are more appropriately informed.   Continue reading

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