GETTING BACK IN THE GAME AFTER A CARDIAC EVENT

Build your game plan to work through your thoughts and emotions

It’s notGAME OVER.

You’ve just experienced a cardiac event. You may be feeling angry, anxious, and stressed. It’s perfectly normal. Your life has changed, and adapting to that change is not an easy process.

In fact, after a cardiac event most men feel stressed or down, and discouraged about the future. Many men loose interest in their usual activities, or are angry and fearful, especially in the beginning.

Work through your thoughts and emotions after a cardiac event

Know your OPPONENT

Mental health can have a significant impact on heart health. When you avoid talking about depressive symptoms, anxiety, and post-traumatic stress your heart disease can worsen. It may affect your life quality, as well as those around you. Communication challenges and sexual problems are common. Your loved ones want to help but they don’t always know what to do. Even when it’s unintentional, your negative emotions can hurt the people you love.

THE “MAN CODE” OFTEN PREVENTS OR LIMITS MEN’S TALK ABOUT EMOTIONAL DISTRESS. Too often, men are stoic because society expects that, even in the face of significant stressors like heart disease.

THE “MAN CODE” ALSO SAYS THAT men need to be strong, independent, smart, and efficient; they must not cry or express their feelings. Central to this also is that men must focus on problem-solving, performance, and strength without too much introspection or self-disclosure.

Healthy hearts and healthy minds go hand-in-hand

After men experience a cardiac event, many men experience depressive symptoms including:

• Sadness or irritability

• Diminished feelings of pleasure

• Loss of interest

• Noticeable changes in weight or appetite

• Changes in sleeping patterns (too much or too little sleep)

• Agitation or anger

• Fatigue or loss of energy

• Feelings of guilt, shame and sense of personal failure

• Difficulty concentrating or making decisions

• Thoughts about self-harm or suicide

DO YOU HAVE SIGNS OF DEPRESSION?

However, men often express depression differently, especially early on:

• Less obvious sadness

• Aggression, anger, irritability

• Alcohol and/or other drug overuse

• Tendency toward risky behaviours (excessive speeding, sport/physical activity)

• Physical discomfort (pain, headache, sexual dysfunction, etc.)

• Trouble sleeping

MEN OFTEN SAY:

“I’m not the man I used to be...”

“I feel like I’m letting everyone down...”

“I feel weak... what’s happening to me...?”

“I can’t do the things I want to do...”

“I should be happy to be alive, but I feel depressed all the time...”

After men experience a cardiac event, most become anxious. Anxiety can include:

• Constant worrying

• Tension or trouble relaxing or sleeping

• Feeling that something terrible will happen

• Excessive fear

• Overexcitement (tightness in the chest, palpitations, trembling, excessive sweating)

• Feelings of detachment or surrealism

• Sweaty or tingling hands

DO YOU HAVE SIGNS OF ANXIETY?

WHAT MEN ARE TELLING US AT OUR CLINIC:

“I’m more aware of danger...”

“I have to be careful, if not, I’ll have another heart attack.”

“The next one may be the REAL BIG one...”

“I think I’m feeling something in my chest!”

“What will happen to me? To my family?”

“If I can‘t work, what am I going to do?”

We know that cardiac events are traumatizing experiences, and statistics show that some men may develop post-traumatic stress as a result of one. Vividly re-living the event, experiencing distressing flashbacks, nightmares, disturbing mental images, and/or an urge to avoid everything related to the traumatic event may all be symptoms of post-traumatic stress.

DO YOU HAVE SIGNS OF POST-TRAUMATIC STRESS?

MEN WITH HEART DISEASE TELL US:

“ I can’t help but think about my heart attack, where I was, the ambulance, the people running; it was awful!”

“It’s like I’m re-living this all the time...”

“I constantly think of my father; he had one...”

“I try to forget, but it keeps coming back...”

“Now I don’t like hospitals... and white jackets...”

Make your

game PLANYou can help yourself in many ways. Here is some advice on how to deal with the challenges ahead and get back in the game.

Silence can be harmful to your health. Isolating and keeping to yourself is one of the most detrimental factors to your recovery from the cardiac event. Talking about what you’re experiencing and connecting with others are important antidotes. Surrounding yourself with the right people, folks who have your back and can help you adjust and re-establish your health.

Avoid being an avoider. The more you avoid, the greater the risk of isolating yourself, and the greater the odds that your negative emotions will amplify. This can lead to as well as increase depression, anxiety , and post-traumatic stress.

Talk to a friend, your family, your doctor.

TALK ABOUT WHAT’S HAPPENING, WHAT YOU’RE GOING THROUGH, WHAT YOU FEEL.

It will help relieve stress, improve your mood, and increase your energy levels.

Do some light exercise within the recommended limits. Participate in sporting and leisure activities. Re-connect with a hobby and and be social with your family and friends. All of this will help.

Go on – Have fun!

GET BUSY WITH FAMILY AND FRIENDS

• Get busy doing activities with your family, children, or grandchildren

• Re-connect with an old hobby or find one that you’ve always wanted to try

• Plan to relax, and take the time to slow things down

• Take your dog for a walk

• Engage in outdoor activities

• Spend time in the garden

• Hike

• Go golfing or bowling

• Go fishing or hunting

• Go camping or to the cottage

• Try yoga

• Cook your signature dish

• Go out (restaurant, movie, museum, etc.)

• Play cards and board games

• Do crosswords or word search puzzles

• Put together jigsaw puzzles

• Read a book

• Start painting

• Play a musical instrument or listen to music

• Take photos

• Restore old furniture

• Do some volunteer work

Here are ideas for fun activities to help you get back in the game

It’s normal to have an occasional bad night, but you can avoid insomnia if you maintain good sleep hygiene. Adopting good sleep habits will be beneficial:

• Always take an hour to relax before going to bed.

• Know the difference between being “tired” (lack of energy, feeling exhausted) and being “sleepy” (dozing off).

• Go to bed only when you feel sleepy.

• Never stay awake in bed for more than 20-30 minutes, otherwise you’ll associate your bed with an inability to fall sleep. This is called a conditioning phenomenon. So, if you can’t fall asleep within 20 to 30 minutes, get out of bed and do something to relax or go rest in another room.

• Only go back to bed when you feel sleepy enough to fall asleep. If it still doesn’t work after 20 to 30 minutes, repeat the exercise as often as necessary during the night.

• Set the alarm to get out of bed every morning, no matter the amount of hours you have slept.

MAINTAIN GOOD SLEEP HABITS

• Don’t eat or read or watch television in bed and don’t work in the bedroom to avoid associating your bedroom with these activities instead of sleep.

• Avoid using electronic devices (iPad, iPhone, computer) at least one hour before going to bed because the spectrum of blue light they emit inhibits the release of melatonin (the sleep-inducing hormone) in the brain and postpones sleep.

• If you haven’t slept during the night, it is preferable to avoid daytime naps.

• Only go to bed for either “S”: Sleep and Sex.

Build your ability to tolerate things that are irritating, unpleasant, ambiguous, uncertain and unfamiliar.

Here are a few mantras to help you build a tolerant attitude:

• Nothing is forever; everything goes away.

• Reality may sometimes be difficult, but I feel up for the challenge.

• It’s normal that things aren’t easy, but I’ll just do the work to overcome these challenges.

• I keep in mind that what is ideal is often unattainable and that’s ok.

• I allow myself to be frustrated when I can’t have or do what I want, and then, I move on to other things.

• We do what we can, not always what we want.

BUILD YOUR TOLERANCE LEVEL

• Take the time to learn about your heart disease and how to manage it. It is part of you, your life experience, and it takes time to fully understand it.

• Learn to adapt the fact that your heart disease has changed your life and your plans.

• Aside from any negative challenges it has caused, has your disease helped you:

- See life differently?

- Make positive changes?

- Be a better man?

LEARN HOW TO MANAGE YOUR HEART DISEASE

Being present and living each moment to the fullest takes practice

• Have a cup of coffee and pay attention to the feel, taste and smell: feel its warmth, smell its aroma, focus on its taste.

• Go for a walk: observe the trees, the colours, the textures of the ground, pay attention to the different sounds and smells, etc.

• Take the time to enjoy a meal: eat slowly, pay attention to the tastes, aromas, textures, and temperature of the food, etc.

• Every hour, stop for a few moments and pay attention to your body and what you are feeling so you can calm your thoughts and center yourself before going back to what you were doing.

Train yourself to be present and fully conscious in every moment of your life. It’s easy to be preoccupied by the past or worried about the future, but that’s when we miss out on all the good things the ‘now’ has to offer.

When feeling anxious, you may worry about the future: “What will happen if...?” “What will happen to me if...?” When you feel depressed, your thoughts may transport you back to the past: “I shouldn’t have done X. Therefore, it’s my fault...”

Focusing your awareness on the present moment helps us to relax here and now, and be in control of our life.

LIVE IN THE HERE AND NOW

The goal of relaxing is to ease physical and emotional tensions, worries, stress and anxiety.

• Relaxation techniques may also help reduce physical ailments including neck stiffness, upset stomach, headaches, pain, etc. It also promotes sleep and your sense of control and ability to prioritize self-care while managing anxiety and stress.

• Some men prefer more physical techniques like deep breathing exercises and progressive muscle techniques, while others use approaches to calm the mind like meditation and mental imagery.

LEARN TO RELAX

AN EXAMPLE OF A PROGRESSIVE MUSCLE RELAXATION TECHNIQUEPrepare to relax: sit or lie down, wear comfortable clothing, take off your shoes, and close your eyes

Start at your feet and systematically work your way upwards (or downward if you prefer). Take deep breaths and focus on the tension you feel with each muscle contraction. Then focus on the sensation of relaxation upon release of those contractions.

FOOT Curl your toes downwards.*

FOOT AND LOWER LEGTense your calf muscles while pulling your toes towards you.*

THE WHOLE LEGContract your thigh and calf muscles at the same time.*

HANDMake a fist with your hand.*42

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* Repeat on the other side.

Repeat the tension-releasing cycle twice  – or as many times as needed – by focusing as much as possible on the muscle group you are working on.

For more information, visit: www.cci.health.wa.gov.au/docs/ACF3C8D.pdf

THE WHOLE RIGHT ARMFlex your biceps by lifting your forearm to your shoulder to “flexing your muscles” while making a fist.*

BUTTOCKSSqueeze your buttock muscles.

ABDOMENSuck in your stomach muscles.

CHESTContract your chest by taking a deep breath.

NECK AND SHOULDERSBring your shoulders up towards your ears.

MOUTHOpen your mouth wide enough to stretch the joints of the jaw.

EYESClose your eyes and squeeze tightly.

FOREHEADRaise your eyebrows as high as they will go.

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* Repeat on the other side.

You can’t control everything in life, but you can control your self-talk (that little inner voice, you know – the one that talks to you in your head). When you’re going through difficult times, that inner voice (your thoughts) plays an important role.

Don’t judge yourself harshly: it increases suffering and has negative effects. Avoid telling yourself: “I should not feel like this.” Instead, say: “It’s OK to feel this way. Now, what would be a good and healthy way to manage this situation?”

CUT YOURSELF A BREAK

SELF-COMPASSION IS A POWERFUL ANTIDOTE

Examples of self-compassion statements:

• I’m not perfect but I do the best I can.

• It’s normal to feel down, frustrated, worried, and depressed, and I give myself the permission to experience these emotions.

• It’s normal to have difficulty coping with the changes that result from a cardiac event.

• It takes time and work to adapt to all the changes.

• I am a good man after all!

Social support takes a team including your spouse, family, and friends. It has been proven that social support:• Helps men feel stronger and better equipped to meet health-related

challenges

• Promotes health

• Helps cope with difficult and painful memories, and uncomfortable emotions

• Helps protect against mental health issues

• Helps reduce the risk of other cardiac events

BUILD YOUR SUPPORT NETWORK

Thinking realistically is different than positive thinking. Thinking realistically means exploring all aspects of a given situation (positive, negative, and neutral) before drawing conclusions. There is a positive, negative, and neutral side to any situation. The reality is not good or bad; it is what it is. In other words, realistic thinking requires analyzing yourself, those around you, and the world you live in a more balanced and measured way.

Most of the time, we are not aware of your own thoughts. However, our thoughts (or how you perceive a situation) greatly influence how you feel, and how you act or react.

Say you go for a walk and you see a dog coming towards you. If you think it’s a dangerous dog that will bite you, you will logically be afraid. On the contrary, if you think it’s a cute and friendly dog, you will more likely feel calm.

Often, we mistake our thoughts for reality even when a thought is nothing more than an idea. For example, just because you think you might have a heart attack, doesn’t mean that you will. You may take for granted that your thoughts are real facts when you should consider them as hypotheses instead (simply ONE way of seeing things, but there are others).

THINK REALISTICALLY

To think realistically:Pay attention to the changes that occur in relation to the intensity of your anxiety, sadness, or other discomfort level. When you feel that your anxiety, depression or sense of discomfort is intensifying, it’s time to ask yourself the following questions:

“What am I thinking about right now?”

“ What makes me feel worried, depressed, or uncomfortable?”

“What do I fear will happen?”

“What unpleasant event do I think will happen?”

When you experience negative emotions, it can be helpful to pay attention to your thoughts and ask yourself questions such as:

• What would I tell a friend if he was having such thoughts?

• Am I 100% certain that... will happen?

• How many times has this happened in the past?

• Is this event so important that my future depends on it? What is the worst thing that could happen?

• If what I fear happens, how would I be able to manage the situation?

• Do I only rely on how I feel or on real facts?

• Do I confuse a possibility with a certainty? It’s possible, but it’s not certain.

• Is this irritating or a real disaster?

ARE YOU STILL STRESSED, DEPRESSED, ANXIOUS, OR IRRITABLE?You’ve tried these techniques...But they’re not working?Do you need help?

TALK to a friend, someone close to you, or a healthcare professional.THEY CAN HELP.

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Mind the Heart is funded by the MOVEMBER FOUNDATION

For information, please contact:Rana (National Research Coordinator) Email: rana.sughayar@umoncton.ca Tel.: 506-858-4721

Mireille (Ontario and Quebec)Email: cae@montfort.on.ca Tel.: 613-746-4621 ext. 6469

Lise (New Brunswick) Email: lise.gallant@umoncton.ca Tel.: 506-858-4574

START YOUR RECOVERY TODAY! Mind the Heart is a free program. Call now to get back in the game!www.mindtheheart.ca