1351 TAKOTSUBO: REASON TO CHANGE MY ATTITUDE AND MINDSET

2015
The heart-ballooning nature of takotsubo, which
Thankfully resolves within days, is not yet common knowledge
In fact, knowledge of this phenomenon is still
So new outside the realm of cardiology that
Will, a surgeon with a sterling reputation
Had never heard of this particular
Heart-wrenching reaction to stress until after
He'd watched it happening to me
And once again ...
Truth proves stranger than fiction

While working (too hard) to maintain my line of control during (and after) a family conflict, which took place on Saturday, June 26th, my heart (flooding with adrenalin in reaction to fending off judgements of condemnation aimed at my character) was taxed to an overwhelming degree.  Over the next 24 hours, the relentless nature of deeply repressed stress caused the apex of my heart to dilate instead of contracting, which, in turn, caused the bottom of my left ventricle to balloon.  Though very few have heard of this physical reaction to being personally persecuted, knowledge of this phenomenon has become widespread throughout the world of cardiology, over these past twenty-five years.

Though takotsubo was unfamiliar to me, I keyed into the fact that each person on the medical team in the ER asked me if anything exceptionally stressful had taken place.  Each time the question came, my answer was yes.  Though two reasons for stress flew through my mind, I offered only one.  More about why I chose not to disclose Saturday's stormy conflict (at which time condemnation rained down on my character) when intuition suggests that readiness to expose this second reason feels ripe.

Once the interventional cardiologist (who examined me in the ER) performed an angiogram (based on my symptoms and the elevatation of a  heart enzyme, troponin) I was diagnosed with takostubo as confirmed by these facts:  During the angiogram the cardiologist saw that my major vessels were clear, indicating that arterial blockage had not caused this attack.  In addition to that, the cardiologist witnessed this fact:  The apex of my heart had dilated, which is why the bottom of my left ventricle could not contract.  As this ballooning effect (resulting from an excessive production of adrenalin) was discovered in Japan, the angiogram confirmed the cardiologist's diagnosis of takostubo.

Upon receiving this diagnosis from the interventional cardiologist Will was stymied as he'd never heard of this particular attack.  The next day, I had an echocardiogram, and after a second cardiologist gave us those results, our confusion increased, so Will called two of his cardiologist friends, both of whom knew exactly what he was describing, and as our friends listened to my surgeon husband describe the results of both tests and both stressors (one of which I'd disclosed in the ER while thinking it best to suppress the other), both cardiologists concurred with the interventional cardiologist's diagnosis.

In most cases of takotsubo, the heart muscle suffers no permanent damage and the apex returns to its natural size within 24 to 48 hours.  Once the patient's physical disorder has fully resolved, as did mine, he or (most often) she is discharged.  As Sunday's angiogram showed no blockages (only one of my mjor vessel is 30% occluded)—and as Monday's echocardiogram showed that the apex of my heart had returned to normal size, freeing my left ventricle to contract, naturally—and as the echocardiogram showed that my heart muscle had suffered no damage, I was ready to be released from intensive care, where the irregularity of my ventricle and low blood pressure had been closely monitored until both test results confirmed my heart function to be as healthy as that of a race horse, not ready by a long shot to be put out for pasture.

I believe it's important to note a conflict of opinions, which arose during my hospitalization:  Though the interventional cardiologist, who administered the angiogram (on Sunday) observed ventricular distress, that irregularity had resolved by Monday when I had an echocardiogram, which was read by a hospitalist cardiologist, who had not seen me previously.  On the basis of the echocardiogram, the hospital its dismissed the diagnosis of takostubo before discussing my case with his colleague, who'd seen fit to admit me to intensive care after he'd witnessed the ballooning reaction of the apex of my heart, the night before.  The serious nature of this kind of diagnostic confusion is indicative of the decline in continuitity, regarding patient care, which has resulted since hospitals began to hire hospitalists, who change from one shift to the next, suggesting that no one doctor captains the ship, as had been true in the past.  Hence patient care is no longer as shipshape as had been true when your internist or mine had been instrumental in overseeing our charts while making daily rounds.  As that is no longer the case, it's not uncommon for diagnostic confusion in today's hospitals to reign supreme in the same way that too many cooks spoil the broth.  As Will has been heard to say:  Change does not always lead to progress.  Though medical technology continues to advance, patient care has seriously declined.

Since this change-not-for-the-better makes blood boil in older physicians, who deplore today's lack of detailed professional communications), poor patient care was a major factor leading to Will's decision to limit his practice to out-patient surgeries, several years before he retired.  He was beside himself when nurses aides replaced nurses who had received training in caring for orthopedic patients following hip surgeries.

As hospitalists, changing from shift to shift, and aides, replacing nurses, are not new to medicine in the Southwest, Will's frustrations, concerning the downhill slide of patient care, shot through the roof as was true of many of his colleagues, who chose early retirement, too.  Don't even get me started with how often Will turned purple while describing his struggles on the phone with insurance companies, whose manuals dictated medical decisions that belonged solely to the surgeon, most especially at those times when a patient's specific needs deviated from the norm.

Though insurance companies may argue that doctors are employed as adjusters to oversee these decisions, they omit this essential fact:  for the most part, those docs, who have the final say, are general practitioners, whose brains have not absorbed knowledge imparted during a five year residency in orthopedics.  It's become known that insurance companies hand out bonuses based on how often an adjustor's denial of a claim saves cold, hard cash.  These conflicts of interest are appalling to say the least, because decisions based in cold hard cash prove dangerous to your good health, my good health and the health of everyone we love.  More about each of these sore subjects, which are not in your best interest or mine, down the road.

Fortunately, my episode of ventricular cardiopathy resolved quickly, and as every cardiologist Will had conferred with gave me clearance to fly home, that's exactly what we did on Tuesday, as originally planned.

As this bare bones explanation of what I experienced physically does not express that which was felt emotionally (between Saturday, when emotional turmoil has cause to erupt, and Tuesday, when we landed in the desert) my emotional reactions during that four day period will be fleshed in when time offers my powers of reflection the hundsight necessary to write with clarity intact.  At this moment, I'm writing in our car as we leave our cool forest retreat in the pines behind and drive home, which, thankfully, offers my character traits safe haven, as well.

Suffice to say that Steven and Ravi welcomed us home when our plane landed, last Tuesday.  Then on Friday, they, including Celina, awaited our arrival at the cabin to celebrate the fourth.  As you can imagine, finding myself the recipient of unconditional love (which proves to be a non-judgmental salve, necessary to soothing the rawness of deep emotional wounds) is the best medicine for 'broken heart disease', over all.

Since experience has offered me insight into how the heart reacts when overlapping layers of stress are suppressed or repressed more deeply than the conscious mind can know, I'll become more attentive to acknowledging stress on the rise instead of denying the depth of my distress to such a heart-threatening extent.

As last week's experience offered reason to confront my denial of the truth, concerning depths of emotional distress—you'll watch me work to change my attitude, which compelled me to brainstorm through family strife that just won't quit.  In short, this captain, whose self confident compass had focused all sense of hope on being instrumental to creating positive change, will clearly steer my ship away from any stormy conflict that has done nothing but worsen, considerably, over these past seven years.

If you ask how my mindset has changed, I'd reply:
Throughout my adult life my mindset has placed
The welfare of family first
This is the third time that I've encountered need to
Expand the selfless nature of that mantra in this way:
Family first unless ...
The good health of my mind, spirit, body or character
Suffers unrelenting attack, which upon reflection, proves undeserved

Though accepting the reality of this situation draws forth grief due to loss of hope, feeling sad is better than denying the overwhelming nature of repressed frustration, which resulted in a physical reaction as seriously scary as last week's experience proved to be.  Though this reaction to repressed and suppressed stress did not damage my heart muscle as would have a conventional heart attack, this heart wrenching episode served as a warning of consequences, which I hope not to repeat—suggesting a lesson in personal growth is in order, again.

And now that common sense has clarified why my attitude is changing my focus away from extended family harmony toward concentrating solely on reality, concerning my health, here is my new goal:  I hope to do whatever is necessary to keep my heart healthy—after all, my mother lived to be100 years young, and I 'plan' to do the same.

Once again, I'll end today's post by saying:  What a difference a week makes in terms of giving each one of us reason to deposit heart-healthy knowledge into our memory banks!  And having offered you this detailed account of everything I've learned about takostubo, which results most often in women, who are taught (worldwide) to place the welfare of everyone above their own ... I remain your goal-oriented, open minded, insight driven, attitude redirected, more realistic, heart-healthy friend,

Annie
Holy cow!
I just reviewed Post 1344
Though I still believe that train of thought to be true
This week's eye-opening experience has certainly offered my attitude sound reason to expand!