Shownotes
Hey Heart Buddies! Wow! This week's episode is what I needed when I was facing heart surgery and I know you'll find it super helpful too.
I interview Dr. Laura Suarez Pardo, a psychocardiologist from Mayo Clinic! Together, she and I explore how mental health impacts cardiac health. Dr. Suarez emphasizes the need for support programs for those with chronic heart conditions. The conversation underscores the importance of addressing psychological issues like depression and anxiety to improve cardiovascular outcomes. I share my personal journey with congenital heart disease and how nutritional changes and mental health therapy aided my recovery. The episode highlights self-compassion, the significance of a supportive healthcare team, and the transition to a "survivorship mindset."
More about today's guest:
Laura Suarez Pardo, MD │ Senior Associate Consultant │ Consultation-Liaison Psychiatry -- Psychocardiology│ Assistant Professor of Psychiatry │ Mayo Clinic College of Medicine
Patient Support Networks
♥ AHA: https://supportnetwork.heart.org/s/
♥ AHA Caregiver support: https://www.heart.org/en/health-topics/caregiver-support
♥ Mended Hearts: https://mendedhearts.org/connect/chapters_groups/
♥ Women Heart: https://www.womenheart.org/find-support/
♥ Congenital Heart Disease MN: https://www.conqueringchd.org/minnesota/
♥ Adult Congenital Heart Association – Heart to Heart Peer Mentors: https://www.achaheart.org/your-heart/programs/heart-to-heart/
Books
♥ Facing Heart Disease: A Guide for Patients and Their Families by Theodore A Stern MD, Scott R Beach MD, James
L Januzzi MD
♥ Anger Kills: Seventeen Strategies for Controlling the Hostility That Can Harm Your Health by Redford Williams
♥ ICD connection: Living with an implantable cardioverter by H. McFarland.
♥ One beat at a time – Living with sudden cardiac death by M.D. Noble, M. D.
♥ Russell Douglas Publishing.
♥ defibrillator. A collection of patient & family stories. Ann Arbor: MPublishing.
♥ Mindfulness for Beginners by Jon Kabat-Zinn.
♥ Full Catastrophe Living by Jon Kabat-Zinn
♥ A Mindfulness-Based Stress Reduction Workbook by Bob Stahl PhD, Elisha Goldstein PhD, Saki Santorelli EdD MA
♥ Mindfulness Meditation for Pain Relief by Jon Kabat-Zinn, PhD
♥ The Happiness Trap: How to Stop Struggling and Start Living Paperback by Russ Harris
♥ Overcoming Depression: A Cognitive Therapy Approach by Mark Gilson and Arthur Freeman
♥ Unwinding Anxiety by Judson Brewer
♥ Mastery your Anxiety and Worry by David H. Barlow and Michelle G. Craske
♥ The Invisible Kingdom: Reimagining Chronic Illness by Meghan O'Rourke
♥ How to Be Sick: A Buddhist-Inspired Guide for the Chronically Ill and Their Caregivers by Toni Bernhard
♥ Minding the Body Workbook by Jason M. Satterfield
♥ Coping with Chronic Illness: A Cognitive-Behavioral Approach for Adherence and Depression by Steven Safren, Jeffrey Gonzalez,, Nafisseh Soroudi
♥ Self-Compassion: The Proven Power of Being Kind to Yourself by Dr. Kristin Neff (Author)
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Join the Patreon Community! The Joyful Beat zoom group is where you'll find connection and hope that you aren't alone in your journey.
If you just want to support the show as a one-time gift (thank you), go here.
**I am not a doctor and this is not medical advice. Be sure to check in with your care team about all the next right steps for you and your heart.**
How to connect with Boots
Email: Boots@theheartchamberpodcast.com
Instagram: @openheartsurgerywithboots or @boots.knighton
LinkedIn: linkedin.com/in/boots-knighton
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Transcripts
We are not a heart, right? We're not our lungs, we're not our liver.
Speaker:We are human beings, right, who have lots of things, right?
Speaker:We have a body, we have health, we have family, we had a
Speaker:job, we have things we like, things we
Speaker:enjoy, we have physical needs, right? If we think about our sexual
Speaker:health. So there's lots of things that make us a human. So
Speaker:fixing a heart is part of it. And it's great if
Speaker:you're able to fix your heart, but what comes with it.
Speaker:Welcome to Open Heart Surgery with Boots,
Speaker:a podcast for heart patients by me, a
Speaker:heart patient. Join me as I take you on a journey through
Speaker:the intricacies of the human heart, revealing
Speaker:the triumphs and challenges of those who
Speaker:undergo the life changing event of heart
Speaker:surgery. We're not just exploring medical procedures,
Speaker:we're delving into the human experience.
Speaker:Be sure you hit subscribe and also
Speaker:leave a review. That means the world to
Speaker:me and I read every single one. Also, if you
Speaker:have a story to share or want to hear something that I haven't
Speaker:covered on this program, you can send me an email which is
Speaker:linked in the show notes. But without further delay, let's
Speaker:get to this week's episode. Welcome back
Speaker:to another episode of Open Heart Surgery with Boots.
Speaker:If you've been along with me for a few weeks now, I have
Speaker:been re interviewing a few heart
Speaker:patients that were some of the original
Speaker:friends I've made through this podcast and a series
Speaker:called Hope for the Holidays. If you haven't gone back and listened to
Speaker:those, I highly recommend it. It is really amazing
Speaker:the perspective we heart patients gain through our
Speaker:experience and then once we kind of let things
Speaker:percolate and cook and
Speaker:ferment, it's amazing like a couple of years
Speaker:and for me it's four years how like our perspective continues
Speaker:to shift and grow. So I do recommend you listeners
Speaker:going back and checking that out. And to round out the
Speaker:series, I am so excited to welcome today Dr.
Speaker:Laura Suarez from the Mayo Clinic and I want to tell you real
Speaker:quickly how I got to meet Dr. Suarez. So I was
Speaker:at the Mayo Clinic in October 2024 of
Speaker:this year for Women Heart. It was my second time
Speaker:participating in the Science and Leadership Symposium. I am something
Speaker:called a heart champion and basically
Speaker:what we do is we are advocates for
Speaker:women with heart disease across the United States
Speaker:and we get to mentor and help
Speaker:educate people in our communities. I'm using my podcast as
Speaker:my platform and Dr. Suarez was there
Speaker:and gave an incredible talk on cardiac
Speaker:psychiatry. Am I saying that right Dr. Suarez.
Speaker:Yeah, yeah, yeah. So it was amazing.
Speaker:And I thought to myself, if only I had had her in my
Speaker:life four years ago when I was facing my open
Speaker:heart surgery. So I, like, quickly ran up to
Speaker:you, Dr. Suarez, like a fan girl afterwards, and gave you my
Speaker:business card and invited you onto the podcast and you
Speaker:very, very graciously said yes. And amongst
Speaker:all your incredible things that you do, and if
Speaker:I may just real quick brag about you, I am looking
Speaker:at your incredible bio. It's amazing
Speaker:what you do in your days. I have so many
Speaker:questions about it. But you're a board certified
Speaker:consultation liaison psychiatrist, which
Speaker:I'm going to want to hear about that, what that means in a second with
Speaker:expertise and the impact of psychiatric
Speaker:illness in the adjustment and trajectory of
Speaker:patients with chronic medical illnesses, mainly
Speaker:psychocardiology. And that's just amazing to
Speaker:me. And I have so many things I want to unpack with you there.
Speaker:And you originally come to us from Bogota, Colombia,
Speaker:correct? Correct. But then you've done so many
Speaker:incredible things between then and now at the Mayo
Speaker:Clinic, and the things that you research, you
Speaker:are. Your clinical focus is on the treatment of
Speaker:patients with medical conditions and comorbid
Speaker:psychiatric illnesses, with a primary focus on patients
Speaker:with cardiovascular disease. I
Speaker:cannot thank you enough because I talk to so
Speaker:many patients who struggle, and I see it in,
Speaker:like, Reddit platforms and on Facebook
Speaker:platforms, and I just couldn't believe that
Speaker:it took me four years and going to the Mayo Clinic
Speaker:and hearing what. I mean, I did Hear you in 2023 in the
Speaker:virtual Science and Leadership Symposium, but I don't know if I was
Speaker:ready to let that sink in yet. It's just, it's just such
Speaker:a big topic, and I just cannot wait for you to educate us on
Speaker:the nuts and bolts and then we'll get our hands dirty as
Speaker:we dig into all the great things that you do. So, welcome. Yeah,
Speaker:well, thank you so much for the invitation. It's really a great pleasure to be
Speaker:here. So what is
Speaker:the consultation liaison? What does that mean? I've never heard
Speaker:of that. Yeah. So consultation liaison, previously known as
Speaker:psychosomatic medicine, is the area within psychiatry that
Speaker:focuses on the overlap of psychiatric and medical illnesses.
Speaker:So we. It's a subspecialty training, a
Speaker:fellowship training, and what we do is really
Speaker:focus on the management of psychiatric illness. And when
Speaker:I say psychiatric illness, it can be kind of an array
Speaker:of things, I would say depressive disorders, anxiety disorders,
Speaker:trauma, psychosis, like schizophrenia,
Speaker:bipolar disorder, among other, you know, things
Speaker:in those patients who have Medical illness. So within consultation
Speaker:liaison, there's more sub, sub specialties, right? So
Speaker:there are patients, there are psychiatrists who focus on,
Speaker:for example, psychiatric illness and HIV or
Speaker:psychiatric illness and dementias or
Speaker:psychiatric illness and neurological disorders
Speaker:or Parkinson's disease. The practice of
Speaker:psychiatric medicine in the hospital, right, There are all different
Speaker:subspecialties, but for me, really, it was
Speaker:cardiology. So I started my
Speaker:psychocardiology adventure over 10 years
Speaker:ago when I started doing research in patients with cardiovascular
Speaker:disease. And that really made me
Speaker:really excited to say, boy, there's so much to unpack and
Speaker:so much to do that this is the field I really want
Speaker:to focus on. So I did my training on consultation liaison,
Speaker:giving myself experience to manage all sorts of patients with medical,
Speaker:chronic ill illnesses, you know, diabetes, surgical,
Speaker:medical patients, hospitalized outpatients.
Speaker:And because of the time I've been doing this work in cardiology,
Speaker:now I have the luxury of having a practice with
Speaker:cardiovascular disease patients. I mean, what was like the moment
Speaker:that you knew cardiovascular disease or cardiology
Speaker:was your passion? Is it your passion?
Speaker:Is that ver to say? Yeah, I think that's fair to say. So I
Speaker:think a couple things. So if we think about, for example, cardiac illness, I mean,
Speaker:it's the number one cause of death, I would say,
Speaker:worldwide, it touches so many people.
Speaker:And what we've learned is it's not a one problem,
Speaker:right? There's so many contributions to cardiac illness, and actually there's
Speaker:a lot of environmental problems, and that includes psychological
Speaker:health, you know, our behaviors, you know, how much we exercise, how easy
Speaker:is for us to a healthy diet, why do we drink sometimes
Speaker:or smoke or how do we cope when we're
Speaker:stressed, not to say stress alone. And part of my research
Speaker:back then was that how to help people engage in those healthy
Speaker:behaviors. What can we do to improve
Speaker:the ability to stay on task in those healthy
Speaker:behaviors? And I thought that was quite interesting because we always think
Speaker:about just do it, you know, and. And
Speaker:truthfully, it's easier said than done. And then I started to think,
Speaker:well, there's so many layers to that, right? It's not only
Speaker:doing it, but how can I adjust and change all my life and
Speaker:all, all I have to be able to do this, to do this kind
Speaker:of diet, or to exercise regularly. And then
Speaker:as a woman and thinking about, you know, especially young women with younger
Speaker:kids, boy, how can you, like, adjust even to that and
Speaker:be able to maintain your role as a mom, as a wife
Speaker:or with your children? And last thing is cardiac patients
Speaker:who have cardiac illness sometimes develop symptoms that are chronic. You know, I
Speaker:think particularly about heart failure patients who
Speaker:have chronic illnesses who come into the hospital
Speaker:often with cardiovascular symptoms whose quality of life is
Speaker:this poor and yet we haven't developed anything to
Speaker:support them. Right. I mean, there are some things that we're starting to do.
Speaker:But if I was thinking about, you know, patients with cancer
Speaker:or, you know, patients with other chronic illnesses that have a lot
Speaker:of things surrounding them, and my sense was,
Speaker:why are we not developing programs or
Speaker:establish multidisciplinary care teams to care for these patients
Speaker:who struggle for their whole lives? So. So all of those
Speaker:things really made me be part of that
Speaker:process and get into this line of
Speaker:work. Wow. Yeah, I just as like
Speaker:a personal side note. So I'm just think like there's just so much I want
Speaker:to unpack in all of that, you know, I just
Speaker:shared. It's been four years for me since my congenital heart disease
Speaker:diagnoses. And for those new here, I was diagnosed
Speaker:at the height of COVID which made it so much more fun. June of
Speaker:2020. And then I had my surgery
Speaker:January of 2021. And through this podcast
Speaker:I met a cardiac dietitian. And we actually,
Speaker:she and I just did a whole series in October
Speaker:because she changed my life. And she and I
Speaker:started working together just this. May I bring this up
Speaker:because I've always considered myself very healthy. I
Speaker:haven't had a drink in 14 years. I've never smok, eat
Speaker:organic. I work out. And I'm like the epitome of like
Speaker:health. Right. So when I meet her and she
Speaker:starts educate and I had her on the podcast months ago
Speaker:and she just blew my mind. I had no idea the
Speaker:role of nutrition in cardiolo in my cardiac health because I
Speaker:wasn't told that by my cardiologist or my surgeon, which
Speaker:is just mind blowing to me. And it was
Speaker:amazing. Here I am right, like picture of health
Speaker:and I'm doing that in air quotes right now because I really
Speaker:wasn't. I thought I was. And it, it
Speaker:was really incredible to me how long it took me
Speaker:to make the changes that she was
Speaker:suggesting. All science based it, it, it. She is
Speaker:really. Her name is Michelle Rothenstein and she just has,
Speaker:like I said, done nothing but improve my life. And
Speaker:I am continuously amazed at how many months it
Speaker:took to start instituting these changes. I needed my mental health
Speaker:therapist to help and so I just want to normalize.
Speaker:Yes, you're right. It takes so much
Speaker:willingness to reflect and the
Speaker:courage to say, oh, actually I Haven't been
Speaker:making the right changes. I haven't been. And having the
Speaker:grace to. Giving ourselves the grace to
Speaker:accept that maybe the choices we've been making were more
Speaker:coping than help than, like, for our health. Right.
Speaker:Which, I mean, coping is a way to help our health because it helps our
Speaker:nervous system, but at least that's how. Correct me if I'm
Speaker:reflecting incorrectly, but, yeah, I just
Speaker:want to normalize that. Oh, my gosh. It's hard.
Speaker:Yeah. Oh, absolutely. And I want to touch on that because I
Speaker:think that's actually a very important point, is we are not a
Speaker:heart. Right. We're not our lungs, we're not our liver. We are human
Speaker:beings. Right. Who have lots of things. Right. We have a
Speaker:body, we have health, we have family, we had a job.
Speaker:We have things we like, things we enjoy.
Speaker:We have physical needs. Right. If we think about our sexual health, so.
Speaker:So there's lots of things that make us a human. So fixing a
Speaker:heart is. Is a part of it, and it's a great. If you're able to
Speaker:fix your heart, but what comes with it, right. If fixing
Speaker:your heart means that you have to quit your job, that maybe it was
Speaker:your passion, or that you cannot run around with your kids
Speaker:anymore, right. What. What does that mean? Or that you cannot
Speaker:eat your favorite meal anymore. So all of that really impacts who
Speaker:we are. And we have to sort of think that when illness and
Speaker:this type of illness that make us face mortality, we have to
Speaker:sort of reinvent ourselves. Right. How do I be
Speaker:the person I want to be, knowing that I cannot do the things I'm used
Speaker:to do and that it's not easy
Speaker:there. You have to grieve. Yeah. So that's the first
Speaker:thing I think, is we have to first understand that this is
Speaker:grieving, losing health. It's part of grieving. And we have to go
Speaker:through the process of that until we accept it. But it's important to recognize
Speaker:and sort of be okay with feeling that way. So when you
Speaker:say normalizing, I think, yeah, we have to accept that there's an emotional response to
Speaker:what's going on, and it has to be. And we cannot put
Speaker:it aside. And sometimes your cardiologist might not be able to recognize
Speaker:it, but I want to invite people to be okay with feeling,
Speaker:you know, with having an emotional response, maybe being angry,
Speaker:because that's part of the process of acceptance, and that's where it's
Speaker:important to. To. To do that. And the other thing, as you mentioned, you
Speaker:know, before you being a healthy person, and doing everything you need to do
Speaker:to be healthy. We always forget about sometimes that psychological
Speaker:piece. So I often see patients who are doing everything right
Speaker:again, air quotes. But they're angry. They, they
Speaker:have stress in their lives, they are depressed. They might not
Speaker:be enjoying what they do. They might have a history of trauma
Speaker:as a child or a difficult upbringing. And all of those things
Speaker:really compound and actually impact the way we do things and how our body
Speaker:reacts. We have one body again, so our brain and our body are
Speaker:connected and there's a lot of influences. And I'll just give a quick
Speaker:example with heart dis, when we get excited, our
Speaker:heart races. And when we're
Speaker:happy, our heart races. When we're worried, sometimes actually
Speaker:get diarrhea or our GI tummy. And those
Speaker:things helps us understand that there is a connection between our
Speaker:brain and our mind and our body and how we need to really
Speaker:appreciate that connection and how to work as a whole as opposed
Speaker:to dividing, you know, our brain and our heart.
Speaker:Yes, and I can attest to that. I mean, I just, my
Speaker:husband just had shoulder surgery yesterday
Speaker:and I, my heart was skipping
Speaker:and it's been doing so great. But the day before my
Speaker:heart was skipping and it was racing. And then yesterday
Speaker:it was like all over the place and having a party in my chest.
Speaker:And then we had like this big winter storm that hit, of course. And
Speaker:then we get stuck in the car for five hours on our way home from
Speaker:shoulder surgery. And it is just amazing how that
Speaker:has affected me physically. You know, I have all the self care skills and I
Speaker:got acupuncture today and everything's calmed down. But
Speaker:yes, it is amazing how I became like the skipping record
Speaker:for 48 hours for shoulder surgery for my husband. Right.
Speaker:And, and I just, now I have the awareness of it and I just talk
Speaker:to my heart and I put my hands on my chest and I take deep
Speaker:breaths and make warm tea and you know, can comfort
Speaker:it. But before I had this awareness, it would be so
Speaker:scary. Yeah, I think that that's the other thing is
Speaker:sometimes even you have those symptoms and it's
Speaker:scary and you don't know what to do. And now sometimes
Speaker:realizing that there might be a component of anxiety or stress give
Speaker:gives you permission to do something about it. And that
Speaker:actually is helpful because you have some tools you can use and maybe you
Speaker:need to still go and see your cardiologist and do that, but you
Speaker:now have other things that you can do and perhaps decrease, you know,
Speaker:the severity of the symptoms. Right, right, exactly. And
Speaker:probably four years ago, I would have run to the ER because I didn't
Speaker:understand. And in the communities that
Speaker:I am part of and like Reddit and some Facebook support
Speaker:groups, you know, I see people posting, is this
Speaker:normal? Should I go to the er? And it's. I mean,
Speaker:I. Obviously, I'm not a doctor, I can't give medical advice, but I
Speaker:can see myself reflected in those questions, you
Speaker:know, four years ago. Right. And so that
Speaker:brings me to the next thing I wanted to talk about, which
Speaker:is, I mean, we. We could talk all day. This is so amazing. I'm just
Speaker:so excited you're here. How, like I said, I had not
Speaker:heard of you and the type of you. Right.
Speaker:So how. It doesn't seem like what
Speaker:you do is commonplace across the United States. Am
Speaker:I correct on that? Yeah, so. So there's actually
Speaker:a number of groups working on understanding
Speaker:the overlap between psychological, psychiatric illness, psychological
Speaker:health and cardiovascular illness. Now, what I think it's
Speaker:a lot of this work is research. So we do a lot of research and
Speaker:investigative work in learning about the connections.
Speaker:And I would say in the early 2000s, there was
Speaker:a huge load of information about
Speaker:there is reality with this connection. Actually, depression and
Speaker:depressive symptoms have been strongly associated
Speaker:with worsening of cardiac symptomatology and even
Speaker:development of new events that really actually put
Speaker:this idea as a risk factor. Even the American Heart association
Speaker:embraced the fact that we need to really identify depressive
Speaker:symptoms. What I've noticed happened is we do the
Speaker:research, we identify the problem, we kind of get it
Speaker:out there, but then it's hard for us to move to the practice.
Speaker:And in part it's because we're still learning and we're still working. And
Speaker:part of my kind of argument, or
Speaker:when I wanted to become
Speaker:more be able to practice this, I said, well,
Speaker:we cannot wait until we know it all, because it's going to take some time.
Speaker:So we need to do two things. We need to go out there
Speaker:and start doing what we know how to do, help
Speaker:patients, help cardiologists in this area,
Speaker:and then at the same time learn from our patients so we can continue to
Speaker:do research and develop treatments. Because
Speaker:there's a lot still to learn. But I think that's what I
Speaker:wanted to do. I would say there's a few groups, I
Speaker:think one in the east coast, there's a group in Canada
Speaker:who've done more of that practical work, kind of that translational work of
Speaker:from research to practice. But. And
Speaker:psychology and psychotherapy has actually evolved
Speaker:some more. There's more of those psychologists doing that kind of mental health
Speaker:work in cardiology. So I think that's sort of picked
Speaker:up more than us in psychiatry working with patients.
Speaker:But hopefully it will continue to evolve. I see, for example,
Speaker:a lot of the trainees and medical students who are actually interested
Speaker:in learning about this. So eventually this can become more of
Speaker:a standard of care, actually, than just a one
Speaker:off. Incredible. That warms my
Speaker:heart. Pun totally intended. What?
Speaker:Like, do you have a part. Is a portion of your
Speaker:job educating, like getting the word out? Like,
Speaker:hey, this is what we're doing at Mayo? Because I didn't y'all
Speaker:mention at Science and Leadership that there's like a 20 year lag
Speaker:between like the research and then when it's kind of like
Speaker:the rubber meets the road to help patients on a more
Speaker:national scale or global scale.
Speaker:Yeah, I think, you know, at May, of course, we've started to develop this
Speaker:program and helping other departments and
Speaker:specialists to really think about the importance of
Speaker:psychological health and mental health. And then we do. The other part
Speaker:of our work is really trying to fight stigma because one of
Speaker:the big problems that we struggle with in psychiatry and psychology is
Speaker:that there's a lot of stigma for mental illness. So
Speaker:people are embarrassed and are afraid of saying they might be depressed
Speaker:or that they have an anxiety disorder. And it's sort of better
Speaker:to just bottle things up and don't share anything and kind of go
Speaker:with the flow. And we're starting to see more
Speaker:spaces for mental health, you know, care. I think if we
Speaker:incorporate psychiatric care in the standard of care practice
Speaker:where cardiologists, GI docs, primary care
Speaker:providers do that work, I think that normalizes it.
Speaker:Insurance companies have started to also help us covering
Speaker:mental health needs because that's a big barrier. Right. If you need to go to
Speaker:a therapist and you have to do out of pocket weekly for
Speaker:12 weeks, I mean, that's. That's pretty daunting. So I think
Speaker:we're starting to see more of that openness to
Speaker:mental health. And again, I will emphasize is the. Is that really
Speaker:understanding of that. It's one body.
Speaker:Right. One. The brain and the body are connected and just
Speaker:natural. There's going to be some exchange and that's starting to
Speaker:become more common and opening those spaces for
Speaker:patients and for providers certainly too. Right,
Speaker:right. Okay, so what's your
Speaker:advice then for my. For all the
Speaker:listeners out there like myself, who
Speaker:are in front of their local cardiologists and
Speaker:I'm like, give us some basic vocabulary
Speaker:questions, statements to help us
Speaker:advocate for ourselves. And, I mean, I
Speaker:love my cardiologist. She really is incredible.
Speaker:And I feel like I've won the lottery with her, but she's
Speaker:one person, and I. Before I let you speak, I
Speaker:just want to share one other thing. I had a naturopath on
Speaker:a while back that actually specializes in the
Speaker:MTHFR mutation. It was a
Speaker:fascinating conversation, and something she said
Speaker:really just hit me in the
Speaker:right, necessary ways, which is we can't
Speaker:expect any one medical
Speaker:provider to hold all the answers, to
Speaker:hold all the knowledge. Right. And I
Speaker:realized that I had been kind of expecting
Speaker:that of my cardiologist. And so it's like, we've got.
Speaker:We really have to build these teams behind us. But,
Speaker:yeah, that's just a side note, but I do think it applies to
Speaker:what I just asked of you. Like, how do we. Yeah, we just. And I
Speaker:also. I swear I'm going to let you talk in a second, but
Speaker:I've had several patients or listeners tell me that
Speaker:they've learned how to advocate because of this
Speaker:podcast. And so this is your teachable moment of
Speaker:help us help ourselves when we sit down with our
Speaker:cardiologists. I think that's really important. And
Speaker:I would say multidisciplinary treatment approach.
Speaker:Right? Having a group of people who helps you in the different
Speaker:areas is actually most helpful. We cannot
Speaker:know it all. And really, the best way to help
Speaker:patients is by actually connecting and collaborating with our
Speaker:colleagues. And that's when you think about my subspecialty,
Speaker:which has the word liaison. That's really what that means.
Speaker:How can I connect, collaborate with my
Speaker:colleagues and help the patient move to where they need to
Speaker:go, as opposed to me doing everything. With that said, I
Speaker:would say first, you have to accept that you are having
Speaker:maybe some emotional concerns or some
Speaker:difficulties with your kind of, I would call it, emotional
Speaker:world. So if you feel like you're crying more
Speaker:often than not, or you're not able to really engage and
Speaker:enjoy the things you used to enjoy, and I would say that this is not
Speaker:a physical problem. A lot of the patients do have physical symptoms that don't
Speaker:let them engage. But if you feel like you can do it physically, but you
Speaker:cannot really get the motivation, that should be for you, like a red flag
Speaker:that there may be some psychological component to it. And what I
Speaker:would say is that's an opportunity for you to say to your
Speaker:doctor, there's something that's not physical, that it's
Speaker:impacting my ability to engage in life. And I would
Speaker:Appreciate, you know, either a referral or your guidance
Speaker:in how to manage that. If you think about anxiety, anxiety is
Speaker:tremendously common, right? And anxiety is normal to a degree. We
Speaker:all have anxiety to be able to do our life. But when you feel
Speaker:like anxiety is really taking over your life, where you sit down
Speaker:and watch a movie, your brain is going right, is
Speaker:nonstop. You're, you're concerned about your health
Speaker:24, 7, someone is talking to you and your brain is
Speaker:somewhere else worrying about your health. You're maybe
Speaker:searching online constantly about your symptoms, you're checking your Apple
Speaker:watch constantly for your heart rate, and that's taking you away
Speaker:from life. That's another red flag to say, boy,
Speaker:I may be worrying excessively and I need to ask
Speaker:and see what guidance to get. Those are two major
Speaker:problems that are really common when patients have cardiovascular disease.
Speaker:Certainly if you know and you've had a difficult upbringing, that
Speaker:you've had any exposure to trauma or to life threatening
Speaker:experiences, and perhaps you start having nightmares,
Speaker:flashbacks, and you know, it's often that some patients don't ever
Speaker:have any symptoms until they have a cardiac surgery. And after
Speaker:surgery, things happen. And
Speaker:that would be a red flag again to say, boy, I never had
Speaker:these thoughts, I never had my sleep get disrupted with nightmares.
Speaker:I need to ask and see if I can get guidance for it.
Speaker:So I think those are areas and part of it, it
Speaker:starts with you accepting that there may be something beyond your physical
Speaker:health, trusting your family members. Sometimes, you know, family would
Speaker:say, boy, you, you're different, you're not as joyful,
Speaker:you, you don't listen to when we're talking. And then maybe that
Speaker:should resonate and give you some indication to get the help
Speaker:you need. Certainly if you're engaging in alcohol use more
Speaker:than the normal, or smoking or
Speaker:any unhealthy behavior, that was not something you used to do. That
Speaker:also should tell you, why am I doing this? Maybe I'm trying to
Speaker:cope for some problems that I don't know. And then can I
Speaker:help get the help you need? Stress is a buzzword, but I think stress
Speaker:is normal. We all get stressed. But if the stress gets to the point where
Speaker:you again, cannot function, cannot enjoy, that's another
Speaker:area that should prompt you to talk to your doctor. And again, don't
Speaker:expect the cardiologist to necessarily treat you, but at least put it out
Speaker:there so that person can help you get to the person
Speaker:or the team that can help you with those symptoms. Right?
Speaker:And as we were mentioning a few minutes ago, it's Important
Speaker:to treat well, just because we all deserve to have a
Speaker:great quality of life. Right, Number one. But number two, it affects
Speaker:your heart, it affects your whole body. So, you know, there's many
Speaker:reasons to advocate for yourself. And we
Speaker:deserve good health, we deserve happiness, we deserve
Speaker:joy, peace, we deserve to
Speaker:advocate for our health. We are in the driver's seat of our
Speaker:healthcare. And I would add that the fact that you've
Speaker:had a cardiac event or have cardiac illness should not
Speaker:take you completely away from having an enjoyable,
Speaker:meaningful life. And sometimes pain and
Speaker:physical health does takes us away from that. So thinking that
Speaker:you could certainly regain the meaning of life despite of having an
Speaker:illness, but you may need someone to help you in the process of
Speaker:adjusting to that. What do I need to reinvent
Speaker:myself to get that meaning back? But don't feel like because you're
Speaker:ill, sort of. That's it. I should feel this way.
Speaker:My whole body just relaxed when you said that. I mean, my
Speaker:surgeon told me to go live my best life at my six
Speaker:week follow up after my open heart surgery, which
Speaker:was awesome. And I, I continue to
Speaker:replay that in my mind. He was just so thrilled for my
Speaker:outcome. But I don't know if it's
Speaker:commonplace for heart patients to be given their
Speaker:permission to thrive. Not
Speaker:that they're being told not to thrive, but to
Speaker:set the intention of you're going to go out now
Speaker:and kick ass. I mean, that was the
Speaker:whole point of my podcast, was I kept talking to people
Speaker:who weren't necessarily thriving and felt alone. And I felt
Speaker:like one of the lucky ones who was doing well. And I mean, I feel
Speaker:like I've had to claw my way to get to where I'm at four years,
Speaker:but I'm living a really beautiful life that I never thought
Speaker:possible. But there's a lot of people out there who, yeah,
Speaker:like, stay in that victim mindset. I definitely was in the
Speaker:victim mindset for a while. I got mad. You know, I went through all the
Speaker:stages of grief. But even just hearing you say it again,
Speaker:like, we can have amazing lives, like,
Speaker:that's my spin on it. Like I still needed to hear that
Speaker:again today. Yeah. And I would say the survivorship
Speaker:mind actually helps recovery. Okay. I've never heard
Speaker:that say more. And there's actually some work about
Speaker:being a survivor versus being a victim. What I would say is
Speaker:that takes time to get there. Don't feel like it's easy
Speaker:to become, have that sense of survivorship, but it
Speaker:takes some time and that's when that's Another reason to ask
Speaker:for help is if you feel like that victimhood has become
Speaker:really part of who you are and it's really hard to get out of your
Speaker:physical symptoms. They're sort of the, your new identity
Speaker:and driving your life. That's something that I always say,
Speaker:well, that there might be something else that we're missing. And then that's
Speaker:another reason to get some psychological support.
Speaker:Incredible. Before we wind down here,
Speaker:I wanted to give you the opportunity to shout
Speaker:from the mountaintop for two reasons.
Speaker:One thing you wish all patients knew,
Speaker:and then one thing you wish all cardiologists
Speaker:knew. Okay, so I think I will
Speaker:start with patients and I would say two things. The first
Speaker:is knowing that this
Speaker:is hard, right. And I will speak about
Speaker:self compassion because I think oftentimes we forget about
Speaker:that and we get into the mode, almost autopilot of
Speaker:doing all the things they tell us to do to recover, but we forget
Speaker:about the process of that and how difficult some of those
Speaker:things could be. So I think the recognition
Speaker:that this might be a hard part of your life
Speaker:and that we need to always have some self compassion, be kind to
Speaker:ourselves, be concerned and get the support you need. Which is
Speaker:the second thing that I'll add kind of
Speaker:thing about support is you're not alone. Even
Speaker:if you're, if you feel like you're alone because maybe your healthcare team
Speaker:doesn't get you or you don't get the help you need, there's a
Speaker:lot of other resources and people who can help you.
Speaker:Primary care providers are very well
Speaker:trained and actually manage a lot of our patients with psychiatric
Speaker:illness. So they are a great resource. There's a great
Speaker:number of psychotherapists and psychologists that can also guide
Speaker:you. And although there's not enough psychiatrists, as
Speaker:many as we would like, I think there's also enough of us to help
Speaker:you. So always remember that you're not alone.
Speaker:You can ask for help. And I think important is to recognize you need help
Speaker:because then that becomes a barrier and then be able
Speaker:to do that with kindness and with
Speaker:compassion. Now, for cardiologists,
Speaker:the one thing I would like to know is that untreated
Speaker:psychological and psychiatric illness impacts
Speaker:cardiovascular outcomes. So someone
Speaker:who has severe depressive symptoms or depression
Speaker:and has cardiac events, we know that they have a higher risk
Speaker:of having more cardiac events. And there is a
Speaker:connection, both biologically within our bodies that connects
Speaker:depression, anxiety and cardiovascular disease. As it is
Speaker:environmental, right? People tend to eat unhealthier,
Speaker:tend to do poor coping skills like smoking and Drinking,
Speaker:they are more sedentary. I've done some work before,
Speaker:and optimism, for example, helps patients be more active.
Speaker:And if you think about when we wake up and we're feeling
Speaker:tired or more pessimistic, it's really hard to get into the
Speaker:treadmill and do some running as opposed to feeling really excited.
Speaker:So the negative affect really impacts the way we do and connect
Speaker:with our bodies. So it's important to recognize that
Speaker:if this illness is present and is not treated or
Speaker:addressed in the way it should, getting cardiac illness
Speaker:under control is going to be very difficult. And that we.
Speaker:I personally advocate for multidisciplinary approach. So not feeling
Speaker:like they have to be the people treating, you know, symptoms
Speaker:they might not be comfortable treating, but that we can work together to
Speaker:give best to our patients.
Speaker:That's. I chill. Sounds incredible for the listener
Speaker:out there who's really struggling to make these, like,
Speaker:initial changes that, you know, might have
Speaker:some unhelpful coping strategies. Is that
Speaker:a nice way? Is that a good way of wording that? No, I like
Speaker:that. Okay. What do you want to say to them right now?
Speaker:I think that, again, it's part of the process, and change is really
Speaker:hard. I. I always think about how we. We have
Speaker:habits. Our brain is very good about learning habits, and we
Speaker:oftentimes live our life in autopilot. So if you think about
Speaker:stress, and let's think that every time, for
Speaker:example, we get home, the way we. We sort
Speaker:of reconnect is by watching TV and eating
Speaker:a bowl of cereal. And we've been doing that for five years.
Speaker:The brain learns that habit. So every time we open
Speaker:our door, the brain is going to immediately recognize that it's
Speaker:time for a couch and cereal. So it's something that we.
Speaker:It's automatic. So. So part of the idea is
Speaker:we need to change those habits with good habits.
Speaker:But that takes time, right? Because, of course, we've
Speaker:had years in the making of having these bad habits. So the first thing
Speaker:is understanding that it's going to take time and effort to make those
Speaker:changes, but that our brain learns as they learn bad habits, it learns good
Speaker:habits. The other thing is that we sometimes put
Speaker:ourselves, give ourselves big goals, too
Speaker:big. I'm going to run a mile and a half, five days a week. If
Speaker:you haven't exercised for a while, that's probably too much. So
Speaker:I always like to talk about something called smart
Speaker:goals, which helps us really, what I would
Speaker:summarize as baby steps, right? Having
Speaker:really small steps to get us where we need to be.
Speaker:And if you think about you needing to do
Speaker:multiple things at once, well, pick one because you're not going to be able to
Speaker:change all of them and start small. And
Speaker:when I say small is if it exercises going to be your goal,
Speaker:the first thing would be to take your shoes out and leave them out.
Speaker:That might be just the beginning. And then from there you can
Speaker:start right now you put your shoes on and maybe you watch the same
Speaker:TV and the same serial, but with the tennis shoes
Speaker:on. And then as you go, you know, you keep increasing that
Speaker:goal into more exercise or
Speaker:more specific to exercise. And in that way
Speaker:you're going to be more successful at making the change. And
Speaker:also it's going to feel less sort of
Speaker:difficult because when you put big goals on yourself and
Speaker:you're not able to accomplish them, it really feels like a failure.
Speaker:Yeah, so sort of it's that defeat defeated sense
Speaker:of why try if I never make it?
Speaker:But perhaps it's because your goals are too, too big. And then the last thing
Speaker:I would say is that sometimes we need accountability because again, our
Speaker:brains and our bodies are used to the way we live. So we need to
Speaker:really have that accountability to be able to exercise change. So
Speaker:maybe it is my son who's going to take me out with the tennis shoes
Speaker:or it is my dog who's going to make me walk or maybe my friend
Speaker:will call me every time I get from work and instead of me sitting on
Speaker:the couch, I'm going to go to their house and walk. So
Speaker:that support is important because being and doing things alone
Speaker:tend to be more difficult. Right.
Speaker:And I can attest to the small
Speaker:incremental changes because that's what I did with my, the cardiac
Speaker:dietitian. We just started with breakfast
Speaker:and I did that for a month and then we
Speaker:layered in dinner and lunch was last. It
Speaker:took months and it was, it was all of a sudden, I thought
Speaker:it was going to take forever at the start of it. And then we
Speaker:all know how fast time goes by and now it's,
Speaker:now it's like nothing. It's just this automatic more healthy choices
Speaker:when I go to the refrigerator. So I just, you know, just as a
Speaker:side note of like, yep, I get that. Start with the tennis
Speaker:shoes, start with the, with the breakfast.
Speaker:It's. This has been great. Anything else that
Speaker:we haven't covered that you are just wanting to talk about?
Speaker:Well, the last thing I would say kind of from that is
Speaker:recognizing what also is getting in the way. And sometimes it's
Speaker:psychiatric illness. So if you're depressed, your
Speaker:ability to get up and do things is going to be
Speaker:diminished. When you're depressed, you're going to be craving
Speaker:carbs, not carrots. Right. So if we
Speaker:don't treat that, it's going to be really hard, even
Speaker:if it's a small goal. So make sure that as you put those baby
Speaker:steps in, you also recognize what are other things that are getting in the
Speaker:way, so you get all the help that you need. I would say that treating
Speaker:psychiatric illness is doable, is safe in patients with cardiac
Speaker:illness. So sometimes there's a lot of fear,
Speaker:but I would say that it can be very successful, and
Speaker:it's just giving yourself the opportunity to at least understand what
Speaker:treating psychiatric illness and psychological stress
Speaker:means. Thank you so much. You kind of froze there. Probably. Probably
Speaker:because I'm on the side of a mountain in Idaho.
Speaker:Definitely has nothing to do with Rochester. I could tell you that.
Speaker:Yes. And. And I will say, you know, I broke my leg
Speaker:a year ago, almost a year ago, and I did get sad because it
Speaker:was a really sad event. I was very sad. So
Speaker:I've had. I had all kinds of things I had to undo,
Speaker:and I was craving carbs. That is very real.
Speaker:Oh, yeah. Yes, it was. It was a very sad
Speaker:event. So. Well, Dr. Suarez, thank
Speaker:you so much for your time today. If people
Speaker:would like to find you, what is the best way. I
Speaker:can put it in the show notes, but would you like to verbalize to us
Speaker:the best way to connect with you? Actually, do you want to be connected
Speaker:with. Should ask you that. Yeah.
Speaker:So I don't have any. Any kind of public
Speaker:presence. I'm not so huge into social media, so
Speaker:that's. That makes it challenging in terms of finding me, you know, publicly.
Speaker:I'm part of the, of course, psychiatrist psychology department at Mayo
Speaker:Clinic. And of course, this podcast is something
Speaker:I do personally and independent of the clinic. But if you. If you
Speaker:get care. If you have that, that's. And the place I
Speaker:work, I collaborate. You know, the Academy of Consultation
Speaker:Liaison Psychiatry is the group of
Speaker:psychiatrists who get together once a year and exchange ideas. So I do
Speaker:collaborate with a number of other practitioners around the country
Speaker:who are doing this line of work. So I would say I
Speaker:would ask your doctor about, you know, the possibility of a
Speaker:psychocardiologist or a consultation liaison psychiatrist.
Speaker:And if there's any way you could get to me, you know,
Speaker:I'll be happy to help you.
Speaker:And I have had the benefit of going to the Mayo
Speaker:Clinic, and it really is as a patient and it really
Speaker:is unlike anything I've ever experienced as far as just
Speaker:feeling cared for and seen and heard.
Speaker:So thank you for being a part of it. Thank you for today.
Speaker:I can hardly wait for this episode to hit the airwaves.
Speaker:And thank you from my heart to yours for everything
Speaker:you're doing for us for weak cardiac patients
Speaker:nationwide, worldwide. Yeah, well this was
Speaker:really wonderful. I appreciate the invitation and the space to really share
Speaker:this line of work which as you said, it's not many
Speaker:people know about. I will. I would say that it's cardiac psychiatry, but
Speaker:also you can find it as psychocardiology in Europe and Australia.
Speaker:That's the term they use the most. So if you want to learn a little
Speaker:bit about those two terms will get you some information.
Speaker:But so excited to be here. Thank you. Yes, thank you.
Speaker:So you've heard it here today listeners. Thanks again for
Speaker:joining us as we wrap up Hope for the Holidays.
Speaker:I deeply hope that the series
Speaker:has fed you, has given you hope and
Speaker:inspiration and things to think about as you head into
Speaker:the holiday season. I for one am not a huge fan
Speaker:of the holiday season, so I'm also doing this for myself.
Speaker:This is my own self care of surrounding myself
Speaker:with people who are joyful and
Speaker:wise minded and are thriving despite
Speaker:circumstances they've been dealt. So I hope that this has
Speaker:been helpful and I would love to know if it has. You can send me
Speaker:an email that's in the show notes. You can always connect with me over social
Speaker:media. Please consider joining our Patreon. We meet up
Speaker:once a month on Zoom and it has been amazing
Speaker:to see other heart patients come together and
Speaker:form a community through this podcast. So in case
Speaker:no one's told you today, you are loved, you matter and your
Speaker:heart is your best friend. Be sure to come back next week for
Speaker:a couple of reruns of the most downloaded
Speaker:episodes of 2024 and then
Speaker:2025 is already looking really
Speaker:amazing for this podcast, so I can't wait to keep
Speaker:bringing the heart patients and healthcare providers to you every week
Speaker:through open heart surgery with Boots. I love.
