by Carolyn Thomas ♥ @HeartSisters
Since returning from my 2008 WomenHeart Science & Leadership training at Mayo Clinic, I’ve spent a lot of time meeting, listening to, speaking with, writing for and hearing from countless other heart patients. Once the dust settles immediately following a cardiac diagnosis – that time my heart sister Jodi Jackson engagingly calls “post-heart attack stun“ – I’ve observed that a recurring theme among so many of the freshly-diagnosed is a sense of anger at what has just hit them.
Here’s a fairly typical example.
A woman I met recently had spent decades making good health an important priority in her life, and then – WHAM! – a heart attack, out of the blue. Her subsequent anger is hardly surprising: “How could this have happened to ME, of all people? I’ve been doing everything right! I never saw this coming! And now you’re telling me that I’m stuck with this chronic and progressive medical condition for the rest of my life?!?”
Here’s how the Glasgow National Health Service helped to explain this common reaction:
“Some people feel angry that they have had heart problems. They may feel they have ‘done all the right things’ and that their heart condition is unfair. Thoughts of ‘why me? why now?’ are common as we begin to realise things we thought would never happen to us, DO happen.
“Sometimes being angry with others – or at yourself – is a way of covering up underlying fear and anxiety.”
Sometimes, by the way, “being angry with others” can extend to people you don’t even know.
I went through a period like this in the early days after my Dad, a non-smoker, died at age 62 of metastatic lung cancer. For a time after his death, I became really annoyed at old people. All old people. Any old people. I’d watch them with barely concealed outrage while they shuffled slowly across the street. Why were these useless old folks still alive when my own fit and active father was dead?
Sometimes our anger is simply misdirected. We’re angry because of this new diagnosis, and we’re reminded how ticked off we are every time we have to take those pills we’re expected to take every day for the rest of our natural lives, or modify our diet, or interrupt our lives for cardiac rehab classes and medical appointments.
And what if part of you now feels guilty for past behaviours that you believe may have contributed to your current condition? Sometimes heart disease survivors can feel upset or angry at themselves, especially if they – or somebody they care about – suspects that their lifestyle choices might be at least partly responsible for what’s just happened.
Whether they’re mad at others or mad at themselves, no wonder heart patients can feel so ticked off. Surviving a cardiac event can seriously affect careers (as happened to me), finances, personal relationships, quality of life, basic daily decisions, and even one’s sense of self.
As I’ve written previously, something you’ve taken completely for granted so far (that your heart would simply continue to beat regularly and pump blood like the owner’s manual says it’s supposed to do) has suddenly and catastrophically let you down – which means you may feel like you can no longer trust the heart that has betrayed you like this.
And there’s something else: unlike cancer patients, for example, who fear the external enemy that has somehow invaded their bodies, heart patients fear the threat that actually lives within.
The American Heart Association warns that extremes of emotions can affect at least two important aspects of life after a cardiac event:
- our recovery from that event
- our risk of having a future heart issue.
That’s why the AHA says it’s important to understand those feelings, recognize problems and get help when needed. For example:
” Many heart patients feel angry and upset about what’s happened to them. But frequent or extreme anger can cause your blood pressure and heart rate to rise, and make your heart work harder. Sometimes anger also causes angina (chest pain) because vessels narrow, reducing blood flow and oxygen to the heart muscle.”
Anger can be a problem if you find that you often:
- lose your temper
- feel rage at people who are in your way in daily situations, such as at work, in traffic or waiting in line
- feel that people around you aren’t skilled or useful
- don’t trust the people around you
Jenni Prokopy, who blogs at Chronic Babe, has written about emotions, including anger – which she describes as “completely normal” – among those living with a serious health condition. I liked her wise take on how to manage that anger:
“Diagnosis of a chronic illness is one of the most stressful life events we can imagine. Even 17 years since my own diagnosis, I can still get pissed off and bummed out. But my solution is coming back to the concept of acceptance, recognizing that illness is part of my life and isn’t going anywhere.
“But if we fight our illness when we’re angry at ourselves and at our body for being sick, we’re fighting facts, we’re fighting with ourselves, fighting things we don’t have control over. Getting angry at our illness causes self-harm. And don’t we already have enough pain and suffering without causing ourselves more though anger at our situation?”
“Because I’m not perfect (no one is!), I still get angry, but the trick is to try to spot it early on and pause that process. One way I do that is to make a list of behaviours that show up when I’m feeling grief or anger, and then watch for those behaviours as signs I’m headed to a dark place.
“Rely on your team! Your friends, family, your manicurist, your mailman, anybody who will hear you out and not let you host an enormous pity party. It’s fine to talk through feelings of anger, but then you need to get back to a happier place.”
Social worker Stephanie Best had some other good suggestions in her Psych Central column to help patients manage those angry feelings, and most of these focus on challenging the way the chronically ill may think about their reality:
- When you’re angry, you tend to believe you’ve been wronged in some way. You know this is happening if you find yourself accusing others with the words “you always…” or “you never…”
- Remind yourself that acting out your anger in hurtful ways runs the risk of turning away the very people who might be most able to help you.
- Talk to those close to you using words and a tone that is more likely to get you the results you want. For example: “I know you are really busy, but could you please ______?”
- Exercise! Take a walk or do some simple stretches to relax your muscles.
- Remind yourself that frustration and powerlessness are a part of daily life for everyone – whether they live with a chronic illness or not. Stop thinking of yourself as a poor victim.
If it starts to feel like your anger is out of control, or if your anger is affecting your relationships with others and/or your health (blood pressure, sleep, diet), consider seeking professional counseling to help you through this.
Please don’t let the short-term anger that’s so common after a serious diagnosis morph into a toxic longterm way of life.
Q: What has helped you manage angry feelings about your diagnosis?
NOTE FROM CAROLYN: I wrote much more about coping with life after a cardiac diagnosis in my book “A Woman’s Guide to Living with Heart Disease“. You can ask for it at bookstores (please support your local independent bookseller!) or order it online (paperback, hardcover or e-book) at Amazon – or order it directly from my publisher Johns Hopkins University Press (if you use their code HTWN , you can save 30% off the list price).
♥
See also:
Deep thoughts about death and heart disease
The day I made peace with an errant organ
Living with heart disease – and your whole family
The weirdness of post-heart attack stun
Looking for meaning in a meaningless diagnosis
How we adapt after a heart attack may depend on what we believe this diagnosis means
Are you a victim or a survivor?
.
Heart Sisters 
I don’t believe ‘depression is anger turned inward.’ That has always seemed like a stupid statement (a friend who battled depression always quoted it, and I bit my tongue).
Depression is an unrealistic appraisal of what’s going on – I have been fighting back since grad school (try being the only woman in your nuclear engineering cohort). Gratitude helps, but what helps me most is knowing that depression always LIES – and finding where it is lying to me today, and talking back. I deal with fear the same way – it’s always a lie, but I need to figure out today’s lie.
The problem with having cardiac events is that they literally can kill you. It’s not all in your head. It’s not a lie.
As you said in another post, it’s a different reality.
The techniques will work – and we’ll all have to go some day (my application for a waiver was not granted) – but none of us want to go over something stupid and too soon. I just have to find the new balance between technique and doing things wrong enough to land me in trouble.
I did find out that incompetence in the medical profession is rampant – as is their total inability to explain things properly. Oh, well – so what else is new?
I am too new to this to have figured out exactly how that works to get rid of depression and new fears – but I think it will now include paying very careful attention to any FUTURE worrying symptoms and events, and not ignoring that I may need to head for the ER and the cardiologists again some day. I have been warned.
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I am angry with the medical system that I feel has failed me for many years.
I was finally diagnosed with congestive heart failure in May when I was pregnant with my fifth child. They took the baby early — she’s fine! And now I need a heart valve surgery. It’s hard to process.
I am angry that I have been presenting with the same symptoms of breathlessness and fatigue for the past 7 or 8 years, and I was always brushed off. If I hadn’t insisted on having an echo this past May, I still wouldn’t know. And now it’s so bad that I will die if I don’t have a surgery!
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Thanks for sharing your perspective here, Alma. No wonder you are angry – 7 or 8 years is too long to go without an accurate diagnosis. Thank goodness you finally insisted on that echo, got that diagnosis, and now have surgery planned. It must seem like a whirlwind now! It may be hard to believe, but soon you will be feeling MUCH better post-op as your symptoms are addressed during your procedure. You might enjoy reading Andrea’s comment (below) on the concept of Radical Acceptance. Best of luck to you!
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Radical Acceptance. That’s really interesting, because it sounds similar to what Christians do. If you’ve heard a Christian speak of “giving it to the Lord” or “leaving it at the cross,” it’s basically the acknowledgment that there is nothing we can do to change the situation, so we need to accept it and leave the outcome in God’s hands. “Be still and know that I am God.”
And you’re absolutely right. It is way too long to go without an accurate diagnosis, and it is crazy what a whirlwind it feels like now.
Thanks so much for the encouragement!
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You’re so welcome! Concepts like radical acceptance are of course not limited to Christians. Buddhists, for example, have been teaching “acceptance as recognizing the truth of this moment without resistance” for 2,500 years. The application of acceptance, from a non-religious perspective, has also been studied in pain research. We can rage against “what is” all we want, but anger is highly unlikely to change what’s already happened – that’s just the simple truth. By the way, my first grandbaby Everly Rose was also born in May – hope your little one is doing well!
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No, I didn’t need to imply that it is limited to Christians. The verse I quoted is actually from Psalms, written long before Christ’s time.
I was (finally) diagnosed in May, had an emergency C-section, was told in July that I’d need a heart surgery in a year or two, and then was told yesterday that I need the surgery now, like in the next month.
And now my husband and I are researching valve replacements and looking for care for our five children (all under 8) during the surgery and recovery!
Talk about whirlwind! But one day, I hope to look back on this and see it as the start of a whole new symptom-free life.
Your blog is a wonderful find. Very encouraging to myself, and I am sure to many others!
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You know, I never said ‘why me?’ when I was told I had cancer, because I know how random health catastrophe can be. But I’ve certainly felt anger at doctors who didn’t help enough, the collateral damage I live with from treatment, and the overblown pink marketing extravaganza that Breast Cancer Awareness Month has become.
But I usually manage to turn my anger around with humor or writing or taking some action to help someone. I still struggle with the acceptance thing, though. Working on it. It’s all about perspective. As usual.
Another great post.
Kathi
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Really great examples of personal strategies to counter that anger, Kathi – (humor, writing, action). All good. It’s not that feeling angry is in itself bad, but it’s how we react to it.
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Yes, exactly. We can choose how we react, and that makes all the difference. xo
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Anger has served me well. After so many parts of my serious but (admittedly) complex health conditions were dismissed, and for so long, anger gave me the fuel to fight for appropriate diagnosis and care. Given that resistance was rather solid, many have said that it was a wonder I did not become depressed. So hooray for anger! I did try to direct it appropriately.
Just a point on heart vs. cancer patients: It has been a long-standing metaphor that cancer is an alien invader. But more and more research shows that in fact our own cells malfunction, not infrequently, and sometimes that malfunction becomes cancer. But in both heart and cancer patients it is our own bodies that betray us. Annihilating the invader used to be the governing metaphor for cancer treatment, but some promising new cancer treatments enlist the body to defend itself, and even repair cells to resume normal function.
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Hi Kathleen – interesting way to view that anger. Much of the great advancements in history (overthrowing despots and such) started with someon’s burning anger… I’ve heard depression defined as anger turned inward. I often think that I would never have started this blog if I hadn’t become so outraged by what I was learning about women’s heart disease being so often under-diagnosed (and under-treated even when appropriately diagnosed!)
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After my heart attack, I was very angry. Every time someone (friends, family and doctors) told me that I was depressed, I replied that I wasn’t depressed but mad as hell. Like Peter Finch’s character in the movie Network, I was “mad as hell and was not going to take it anymore”.
I was angry at everyone that eats poorly, smokes and didn’t take care of themselves. I ate well, didn’t smoke and was in good shape. Why me? Of course, serious family history of heart disease was the critical factor and there wasn’t anything I could do about it.
I did eventually give in to a mild anti-depressant and started therapy, which did help immensely. My therapist realized in our meeting that despite the heart attack, it was my life before the incident that was depressing me and she helped me turn my life around.
Today, I have made huge changes in my life, all for the better. I do still worry and have anger about my heart condition. You never know when the next shoe will drop. Actually, it did just a couple of months ago, when I needed a stent but all is well now.
Anger can be a strong motivational factor if it’s focused appropriately.
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So glad you mentioned how helpful your talk therapy was, Eve. Far too many of us suffer silently, or feel like we’re the only ones who feel the way we do. Professional counselling therapy can help us to gain perspective on what we’re experiencing. Thanks for sharing your story here…
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I agree Carolyn. After working hard in psychotherapy for most of my adult life to overcome serious mental illness (anorexia, severe depression, borderline personality disorder) and reach a point in my life where I am content (the first time ever), and I have learned to manage my chronic migraines to a point where they are no longer disabling (after being treated at The Cleveland Clinic’s IMATCH program), this year I have been diagnosed with chronic obstructive asthma, Prinzmetal’s Angina and tonight I have an appointment with a rheumatologist because my cardiologist did some blood work and my rheumatoid factor came back elevated.
I try to practice a concept I learned early on in therapy called Dialectical Behavior Therapy called Radical Acceptance. You can read more about it here.
It’s just a form of acceptance of life’s events without asking why, without questioning, just opening up one’s mind and coping using certain skills as best as one can, and then moving on to the next task. I try to use it for both large and not so large events in my life and I always find myself coming back to it because it works.
I hope others find it helpful as well.
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Thanks so much for weighing in here, Andrea. You know what you’re talking about when the topic is chronic illness. Sorry to hear about this year’s new diagnoses (we know, by the way, that there is a link between conditions like rheumatoid arthritis or migraines and cardiovascular disease) – I hope that your practice of Radical Acceptance continues to help you along that path. Thanks for that link to Dr. Linehan’s site, e.g. when we have a catastrophic problem in life, no matter what has caused it, we have only four possible responses: solve the problem, change the way we feel about the problem, accept it, or stay miserable. So simple yet so profound. Best of luck to you…
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When I’m angry I try (TRY being the operant word!) to check in with myself to understand what I’m afraid of (future) and/or sad about (past). I know that chronic anger is always a lid on the vulnerability fear and sadness produce. One benefit of fibromyalgia/CFS is that I’m usually too exhausted to work up any anger . . .
Your suggestion about gratitude reminds me of my mother’s words “There’s always someone better off than you and always someone worse off.” I thank God daily for what he didn’t give me!
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Hello Judy-Judith and thanks for your wise input. I too TRY that checking-in technique – with refractory angina, it’s usually pretty darned quick before the (future) fear identifies itself: “Oh no! Is today the day I’m having another !@#$!!! heart attack?!?!”
P.S. Your mother was right…
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I am so glad to have “found” this site. I echo Irene’s comment, why do we have to go to UK or Canada for this sort of info, but not my country Australia. When I in utter frustration tried googling a whole sentence…eg ‘continuing discomfort, left side, chest/arm/neck/jaw after all clear angiogram, ECG, etc” ….up came all these wonderful letters from mostly women who had had exactly the same symptoms as me, and had been told “it is not your heart!” when you/we just knew it was!!
Suddenly there WAS a reason and I was not turning into a hypochondriac. I have been able to get my GP to really listen to my story this time, backed by Dr Google, and am being referred to another Cardio chap, complete with detailed explanatory letter.
The comfort I take from reading all these comments is…. you are all alive and kicking, YAY!! Some of you have been living with heart disease for years. YAY!!
Thank you. Thank you.
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Hi Joan and welcome! YES, we are all alive and some of us are actually kicking! If you’re reading this, you are definitely still alive, too! Best of luck to you at your upcoming cardiology appointment…
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Anger is a completely normal and understandable emotion to a serious and life threatening illness. But as you point out, it can also be counterproductive. I really like Jenni Prokopy’s emphasis on acceptance, and recognizing that illness is part of life.
None of us are guaranteed an easy glide through life. Adversity is an excellent teacher. The lowest periods of my life were also times that I developed better coping strategies, resilience, and a deeper sense of gratitude for the many blessing in my life. When my life was going well, I took a lot of things for granted. The inevitable rocky periods gave me the contrast and focus I needed to see things in a better light.
I now take a few minutes every day to cultivate a greater sense of gratitude by identifying something in my life that I’m grateful for. The daily practice has helped enormously.
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Such good points, Denise. I love your suggestion about cultivating gratitude! I started a gratitude journal years ago (at bedtime, write down 5 things you’re grateful for that happened today). Honestly, on some days, all I could think of was “I’m grateful this day is over!” but almost always, I’d think of one or two or five things to write, even tiny inconsequential little things (“two hummingbirds in the garden!”)
And if what we’re counting on is an “easy glide through life”, we’re guaranteed to be angry and disappointed quite a lot of the time. It’s coming to terms with those predictable emotions that is the challenge especially during a catastrophic health crisis – feeling resilient is best appreciated in hindsight, not when you’re in the thick of things.
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Hi Denise,
Thank you for sharing about gratitude in the face of adversity. I wanted to briefly share that through my study program this year, I found an interesting connection between keeping a gratitude journal and cardiac benefits.
“We found that more gratitude in these patients was associated with better mood, better sleep, less fatigue and lower levels of inflammatory biomarkers related to cardiac health,” said lead author Paul J. Mills, PhD, professor of family medicine and public health at the University of California, San Diego. The study was published in the journal Spirituality in Clinical Practice®.
I realize there are a vast array of emotions that patients experience after a cardiac event or diagnosis. Understandably so. However, new research is starting to shed light on how something like gratitude may have a positive impact on our heart health.
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Thanks so much for sharing a link to that journal article, Aida. It focused specifically on patients living with asymptomatic heart failure (for whom keeping gratitude journals showed positive results). But I’d love to see comparable research someday on those actually living WITH symptoms! As a person with refractory angina caused by Inoperable Coronary Microvascular Disease, I can tell you it was way easier to cultivate gratitude back in the days when I didn’t know what trying to cope with daily chronic pain was like…
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Nice to meet you Carolyn.
Thank you for your response. It sounds like it has been a battle and it is ongoing. I admire your determination in spite of the challenges. As for the study, I would love to see more research in this area as well. So, I am committed to continue exploring and learning all that I can to be able to help my husband and others too.
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Keep up the good work, Aida!
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I was diagnosed with heart failure this year and I am only 30, I never had any issues with heart, nor does it run in my family. But, I do have this issue and it’s so hard for me to understand how and why? I eat healthy and exercise daily… walking, being active. I am scared and my doctors don’t have anything to say to me about how or what brought this on; why it’s happening to me. I don’t want to die in the next few years. I can’t even have a normal/any relationship because of my illness, it has gotten to the point where my kidneys are in failure because of my heart problem. What can I do? What should I be doing? 😔😪
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Hello Nikki and thanks for sharing your story here. You’re still in relatively early days, so no wonder you’re feeling overwhelmed and scared. Follow your doctor’s recommendations closely, and learn as much as you can about this diagnosis.
I wish doctors would change the name of your diagnosis. Just hearing the words “heart FAILURE” is in itself a traumatic event, especially for young people like you. Read this medical journal article called “A Patient’s Guide to Living Confidently With Chronic Heart Failure.”
You might also want to check out this British website all about heart failure – Pumping Marvellous.
Finally, please make an appointment to see a psychologist or counsellor to help you get through this; talk therapy can be an absolute life-saver for heart patients – especially during those early months post-diagnosis. Best of luck to you…
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These are really good links, Carolyn. My question is, why is this stuff always from the UK? Why do we not have resources like this in Canada? I have found some other good resources to do with cardiomyopathy. Again from the UK. What is wrong with us in Canada?
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Good question, Irene. I always try to seek out Canadian resources first (and to be fair, I do quote Canadian sites as well on occasion). Only one of the links in the comment above is from the U.K. By far, most of my go-to resources are American (so much bigger, more research, more cardiologists, more money). Canada lags far behind the U.S. in many cardiology issues; for example, I just learned this week that Vancouver is the only city in Canada where patients with coronary microvascular disease can have coronary reactivity testing done – and that patients from back east sometimes travel to Vancouver to consult with cardiologists there. Let’s ask Mr. Harper how that is even possible in a country like ours in 2015?
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Nikki … I hope you come back again so you can read my response. Just a little over a year ago I was also diagnosed with heart failure. I had never heard of it, and was sure that was it for me. Research on the Internet did not give me any reassurance. I was confident my doctors were doing the best they could, but when they looked at me I had a feeling they did not expect me to live very long. I turned 70 three months after my diagnosis, but I’ve always been strong and healthy and was not prepared or ready to die. My ejection fraction was 20, and I had read that if it’s below 30 you were in jeopardy of dropping dead any time. I followed doctors’ orders, took all my meds, changed my diet (giving up salt was BIG for me).
Two months ago I had an echocardiogram; my doctor seemed pretty sure I’d need a pace maker, which I was dreading. But … guess what! … my ejection fraction is now 60!!! I could not believe it! Nor could my doctor and CHF nurse! I feel like I’m living a miracle.
Follow your doctors’ orders, read all you can and ask questions. Exercise. Watch what you eat and get plenty of rest when you need it. CAROLYN’S NOTE: pharmaceutical drug recommendations deleted here.
I wish you the very best,
Nikki
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Karen, thanks for sharing your positive ejection fraction outcome story with Nikki. I’ve heard from many of my readers diagnosed with heart failure who report their ejection fractions going up over time (from 10% to 40% over nine months is just one example from today’s email) so there is always hope. In Nikki’s case, however, she’s not only dealing with a low EF, but as a 30-year old healthy young woman, she has faced the shock and grief of this overwhelming new diagnosis. I have edited your drug recommendations for Nikki because we are not her physicians here, so cannot recommend specific pharmaceuticals to anybody – even if they worked for us.
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