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More on anxiety and health.

January 5, 2012

I read a good article about anxiety disorders and health on the Duke Medicine website.  I was seeking articles on the value of stress management in cardiac rehab  and followed links until I got there.  Here’s the link.  In the article, anxiety disorders are defined and explained and treatment options are discussed.  The one downside is that they present patients who have dramatic recoveries in the space of a year or so.  They do not discuss the chronic remitting-relapsing nature of anxiety disorders.  Still, overall a positive portrayal with hopeful treatment options.

Now back to the cardiac rehab issue.  I found a letter to the editor in the Journal of the American College of Cardiology written by Alan Rozanski, MD and James Blumenthal, PhD  that presented a brief review of literature relating to this subject.  In the letter the doctors present evidence of the usefulness of both exercise and stress management training in cardiac rehabilitation.  Dr. Blumenthal is on the staff of the Behavioral Cardiology section of the Duke Medicine Cardiology Department.

I did not know there was a field of Behavioral Cardiology, but am glad to hear it.  I felt my cardiac rehab program was woefully lacking in social support and stress management.  The nurses were wonderful, but the program was structured so that you basically came in and hopped from machine to machine getting blood pressures in between.  There was no real opportunity to talk much with other patients about our experiences, no support group, and the only stress management training was a one hour class offered once a month which was canceled the month I was in the program.  I progressed uneventfully in the exercise and my confidence increased dramatically in the weeks I participated, however I found that anxiety and stress were much bigger problems for me.  The cost of my program was prohibitive for me ($75 a week in copays) as well.  In the end I decided to spend the money on interventions that would help my stress and anxiety: psychotherapy and yoga.  With the money I would spend in a month of cardiac rehab and a little help from my employee assistance program, I was able to buy a month of yoga classes twice a week for both my husband and I and more frequent psychotherapy sessions for myself.  I found this at least as helpful as the cardiac rehab.

I don’t understand why there is such a stark division between physical health care and mental health care.  It is getting better with the requirements for parity in mental health coverage which went into effect last year, though there are still huge loopholes which allow small businesses and businesses which did not previously cover mental health to skate.  I am now caught in a web with an interaction of physical and psychological conditions which are disabling.  Each doctor cares for their piece but rarely communicates with the others.  Now we are playing a keep away game about who fills out paperwork for disability claims.  I’ve spoken to many others who are frustrated with fragmented care.  Recently in an online discussion a friend asked, “Who will speak for me as a whole person?”

That’s just it.  No one speaks for any of us as a whole person, except we ourselves.  The problem is we do not have the expertise to diagnose ourselves or certify our ability to work. So we continue on the merry-go-round between the specialists trying to collect the bits of documentation for each part.

That’s enough to make me anxious.  Here we go again!

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