Cardiac monitoring may be an event unto itself
The debate over life and death often focuses on the heart and the brain. Some believe life ends when the brain ceases all activity – a term called brain death. Others believe death results when the heart ceases to beat. In a blog published in January 2014, the mind-body dialogue was discussed by Michael Sefton. He described the rudimentary force of life as the heart’s beating “which begins and ends with the inimitable squeeze of the cardiac muscle.” For patients who are being monitored the experience is highly stressful and often evokes fear and dread.
The link between what happens to our body and its effect on our mood and feeling state is well documented. Just as we must adjust to the early developmental changes of our children so must we adapt our own thinking and lifestyle to the changes brought about by the empty nest. Events such as having children leave home and head off to college and other events associated with empty nesting require flexibility and adaptation of roles for success. These important transitions signal an advancing age that sometimes accompanies physical decline in health and body. With that said it is important to note that many American’s are living healthier lifestyles and thus preserving physical health well into the eighth and ninth decades of life.
“Don’t ever get old”
Retirement was once described as a period of “golden years” and was thought to represent the final stage of one’s life during which the experience of freedom and contentment proffered a whimsical enjoyment of lazy, carefree days. It meant taking time to share one’s wisdom with those who are younger and pass on the stories of family, culture, and life itself. This is often not the case and I have had patients suggest that I should never get old. For many older Americans, retirement is a time of unbearable loss and despair.
One factor affecting quality of life is the sense of physical well-being. Retirement sometimes triggers an erosion of self-esteem and productivity which can impact physical health. In truth, what may be a glorious time is now marred by fear and trepidation about one’s physical well being, declining cognitive prowess and the monotonity of endless doctor’s visits. Most American’s spend a vast majority of their health care dollars in the final 3-5 years of life.
It is well known that poor cardiovascular health is an underlying cause of many chronic disease processes like stroke, heart attack, diabetes, and a host of auto immune disease. Heart attack remains among the leading precursors to early death and researchers are racing to uncover treatment options including early identification of those most at risk and life saving surgery to open clogged arteries. Meanwhile, people should take greater responsibility for their own health by eating better and building exercise into their changing lifestyle. Things like moderating use of alcohol, 7-9 hours of nightly sleep, and eating plenty of fruits and vegetables become the specter of truth and failure to an ever-growing problem with obesity. This is an important lesson for young adults to discover but is easier said than done.
The mind-body dialogue is one that matches wits with any great debate. What are the best methods for identifying ‘problem’ hearts before they reach a penultimate, fibrillating finale? Some doctors ask their patients to wear special monitoring devices – little boxes attached to the skin that permit the ongoing monitoring of life threatening changes in rhythm. Patients sometimes wear the monitor for a month or more. These monitors have the potential to catch irregular heart beats and allow physician’s to see a patient’s electrocardiogram on a minute to minute basis. The monitor requires that the person wearing the device to upload his data via a telephone line each day sometimes with little to no training. Each recording represents a cardiac event that the person wearing it is asked to chronicle in terms of action and feeling state when the device is active. The events are uploaded via telephone land lines in real-time that seems almost tortuous to those bearing the burden of wearing the device. The rhythms are quickly edited, analyzed and more often than not result in nothing more than a friendly vote of confidence – “you’re all set”.
Greater thought and training should be afforded to patient’s wearing event monitors. As time goes on most patients become accustomed to the vagaries of the heart and the sound it makes – lub dub, lub dub. The event recordings come in one after another and become part of the month-long survey of heart activity. Some people call two and three times daily worried that they are having a serious cardiac event. After 30 days the monitor is turned in for analysis by the cardiologist. These daily rhythms go on to become the underpinnings of a cardiac care regimen that may offer treatment alternatives that can save a life. The clinicians go on to new patients and new rhythms and new reports. But each person who wears a monitor is brought to bear the feelings of their own life force beating in his or her chest sometimes wildly out of control. For those with irregular heart beats it can be 30 days of fear, impending doom, and personal paroxysm that seems to go on forever as skipping beats and pulsating rhythms. And even those with a normal EKG, the fear and worry of not feeling well can be just as agonizing as the beats are uploaded one at a time with not so much as a “job well done” and encouragement to call again tomorrow.
The fundamental appetence for living is shaped by the relationships made during a lifetime. Those relationships that nurture and sustain may extend ones years of viability. Some believe the force of life is the beating heart. For without a healthy heart the quality of life may become desultory and life itself may become nothing more than a daily upload of irregular beats on the telephone, in real time.
To read the former blog click on the link below.