December 10, 2024 • 45 mins
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)
Join the Newsletter for almost weekly content for this podcast and other heart related news.
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.
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:01):
We are not a heart, right? We're not our lungs, we're not our liver.
We are human beings, right, who have lots of things, right?
We have a body, we have health, we have family, we had a
job, we have things we like, things we
enjoy, we have physical needs, right? If we think about our sexual
health. So there's lots of things that make us a human. So
(00:24):
fixing a heart is part of it. And it's great if
you're able to fix your heart, but what comes with it.
Welcome to Open Heart Surgery with Boots,
a podcast for heart patients by me, a
heart patient. Join me as I take you on a journey through
the intricacies of the human heart, revealing
(00:46):
the triumphs and challenges of those who
undergo the life changing event of heart
surgery. We're not just exploring medical procedures,
we're delving into the human experience.
Be sure you hit subscribe and also
leave a review. That means the world to
(01:09):
me and I read every single one. Also, if you
have a story to share or want to hear something that I haven't
covered on this program, you can send me an email which is
linked in the show notes. But without further delay, let's
get to this week's episode. Welcome back
to another episode of Open Heart Surgery with Boots.
(01:32):
If you've been along with me for a few weeks now, I have
been re interviewing a few heart
patients that were some of the original
friends I've made through this podcast and a series
called Hope for the Holidays. If you haven't gone back and listened to
those, I highly recommend it. It is really amazing
(01:54):
the perspective we heart patients gain through our
experience and then once we kind of let things
percolate and cook and
ferment, it's amazing like a couple of years
and for me it's four years how like our perspective continues
to shift and grow. So I do recommend you listeners
(02:16):
going back and checking that out. And to round out the
series, I am so excited to welcome today Dr.
Laura Suarez from the Mayo Clinic and I want to tell you real
quickly how I got to meet Dr. Suarez. So I was
at the Mayo Clinic in October 2024 of
this year for Women Heart. It was my second time
(02:38):
participating in the Science and Leadership Symposium. I am something
called a heart champion and basically
what we do is we are advocates for
women with heart disease across the United States
and we get to mentor and help
educate people in our communities. I'm using my podcast as
(03:01):
my platform and Dr. Suarez was there
and gave an incredible talk on cardiac
psychiatry. Am I saying that right Dr. Suarez.
Yeah, yeah, yeah. So it was amazing.
And I thought to myself, if only I had had her in my
life four years ago when I was facing my open
(03:23):
heart surgery. So I, like, quickly ran up to
you, Dr. Suarez, like a fan girl afterwards, and gave you my
business card and invited you onto the podcast and you
very, very graciously said yes. And amongst
all your incredible things that you do, and if
I may just real quick brag about you, I am looking
(03:46):
at your incredible bio. It's amazing
what you do in your days. I have so many
questions about it. But you're a board certified
consultation liaison psychiatrist, which
I'm going to want to hear about that, what that means in a second with
expertise and the impact of psychiatric
(04:06):
illness in the adjustment and trajectory of
patients with chronic medical illnesses, mainly
psychocardiology. And that's just amazing to
me. And I have so many things I want to unpack with you there.
And you originally come to us from Bogota, Colombia,
correct? Correct. But then you've done so many
(04:29):
incredible things between then and now at the Mayo
Clinic, and the things that you research, you
are. Your clinical focus is on the treatment of
patients with medical conditions and comorbid
psychiatric illnesses, with a primary focus on patients
with cardiovascular disease. I
(04:51):
cannot thank you enough because I talk to so
many patients who struggle, and I see it in,
like, Reddit platforms and on Facebook
platforms, and I just couldn't believe that
it took me four years and going to the Mayo Clinic
and hearing what. I mean, I did Hear you in 2023 in the
(05:12):
virtual Science and Leadership Symposium, but I don't know if I was
ready to let that sink in yet. It's just, it's just such
a big topic, and I just cannot wait for you to educate us on
the nuts and bolts and then we'll get our hands dirty as
we dig into all the great things that you do. So, welcome. Yeah,
well, thank you so much for the invitation. It's really a great pleasure to be
(05:34):
here. So what is
the consultation liaison? What does that mean? I've never heard
of that. Yeah. So consultation liaison, previously known as
psychosomatic medicine, is the area within psychiatry that
focuses on the overlap of psychiatric and medical illnesses.
So we. It's a subspecialty training, a
(05:57):
fellowship training, and what we do is really
focus on the management of psychiatric illness. And when
I say psychiatric illness, it can be kind of an array
of things, I would say depressive disorders, anxiety disorders,
trauma, psychosis, like schizophrenia,
bipolar disorder, among other, you know, things
(06:18):
in those patients who have Medical illness. So within consultation
liaison, there's more sub, sub specialties, right? So
there are patients, there are psychiatrists who focus on,
for example, psychiatric illness and HIV or
psychiatric illness and dementias or
psychiatric illness and neurological disorders
(06:41):
or Parkinson's disease. The practice of
psychiatric medicine in the hospital, right, There are all different
subspecialties, but for me, really, it was
cardiology. So I started my
psychocardiology adventure over 10 years
ago when I started doing research in patients with cardiovascular
(07:01):
disease. And that really made me
really excited to say, boy, there's so much to unpack and
so much to do that this is the field I really want
to focus on. So I did my training on consultation liaison,
giving myself experience to manage all sorts of patients with medical,
chronic ill illnesses, you know, diabetes, surgical,
(07:24):
medical patients, hospitalized outpatients.
And because of the time I've been doing this work in cardiology,
now I have the luxury of having a practice with
cardiovascular disease patients. I mean, what was like the moment
that you knew cardiovascular disease or cardiology
was your passion? Is it your passion?
(07:46):
Is that ver to say? Yeah, I think that's fair to say. So I
think a couple things. So if we think about, for example, cardiac illness, I mean,
it's the number one cause of death, I would say,
worldwide, it touches so many people.
And what we've learned is it's not a one problem,
right? There's so many contributions to cardiac illness, and actually there's
(08:08):
a lot of environmental problems, and that includes psychological
health, you know, our behaviors, you know, how much we exercise, how easy
is for us to a healthy diet, why do we drink sometimes
or smoke or how do we cope when we're
stressed, not to say stress alone. And part of my research
back then was that how to help people engage in those healthy
(08:29):
behaviors. What can we do to improve
the ability to stay on task in those healthy
behaviors? And I thought that was quite interesting because we always think
about just do it, you know, and. And
truthfully, it's easier said than done. And then I started to think,
well, there's so many layers to that, right? It's not only
(08:52):
doing it, but how can I adjust and change all my life and
all, all I have to be able to do this, to do this kind
of diet, or to exercise regularly. And then
as a woman and thinking about, you know, especially young women with younger
kids, boy, how can you, like, adjust even to that and
be able to maintain your role as a mom, as a wife
(09:15):
or with your children? And last thing is cardiac patients
who have cardiac illness sometimes develop symptoms that are chronic. You know, I
think particularly about heart failure patients who
have chronic illnesses who come into the hospital
often with cardiovascular symptoms whose quality of life is
this poor and yet we haven't developed anything to
(09:38):
support them. Right. I mean, there are some things that we're starting to do.
But if I was thinking about, you know, patients with cancer
or, you know, patients with other chronic illnesses that have a lot
of things surrounding them, and my sense was,
why are we not developing programs or
establish multidisciplinary care teams to care for these patients
(10:00):
who struggle for their whole lives? So. So all of those
things really made me be part of that
process and get into this line of
work. Wow. Yeah, I just as like
a personal side note. So I'm just think like there's just so much I want
to unpack in all of that, you know, I just
(10:21):
shared. It's been four years for me since my congenital heart disease
diagnoses. And for those new here, I was diagnosed
at the height of COVID which made it so much more fun. June of
2020. And then I had my surgery
January of 2021. And through this podcast
I met a cardiac dietitian. And we actually,
(10:44):
she and I just did a whole series in October
because she changed my life. And she and I
started working together just this. May I bring this up
because I've always considered myself very healthy. I
haven't had a drink in 14 years. I've never smok, eat
organic. I work out. And I'm like the epitome of like
(11:06):
health. Right. So when I meet her and she
starts educate and I had her on the podcast months ago
and she just blew my mind. I had no idea the
role of nutrition in cardiolo in my cardiac health because I
wasn't told that by my cardiologist or my surgeon, which
is just mind blowing to me. And it was
(11:28):
amazing. Here I am right, like picture of health
and I'm doing that in air quotes right now because I really
wasn't. I thought I was. And it, it
was really incredible to me how long it took me
to make the changes that she was
suggesting. All science based it, it, it. She is
(11:50):
really. Her name is Michelle Rothenstein and she just has,
like I said, done nothing but improve my life. And
I am continuously amazed at how many months it
took to start instituting these changes. I needed my mental health
therapist to help and so I just want to normalize.
Yes, you're right. It takes so much
(12:12):
willingness to reflect and the
courage to say, oh, actually I Haven't been
making the right changes. I haven't been. And having the
grace to. Giving ourselves the grace to
accept that maybe the choices we've been making were more
(12:33):
coping than help than, like, for our health. Right.
Which, I mean, coping is a way to help our health because it helps our
nervous system, but at least that's how. Correct me if I'm
reflecting incorrectly, but, yeah, I just
want to normalize that. Oh, my gosh. It's hard.
Yeah. Oh, absolutely. And I want to touch on that because I
(12:56):
think that's actually a very important point, is we are not a
heart. Right. We're not our lungs, we're not our liver. We are human
beings. Right. Who have lots of things. Right. We have a
body, we have health, we have family, we had a job.
We have things we like, things we enjoy.
We have physical needs. Right. If we think about our sexual health, so.
(13:18):
So there's lots of things that make us a human. So fixing a
heart is. Is a part of it, and it's a great. If you're able to
fix your heart, but what comes with it, right. If fixing
your heart means that you have to quit your job, that maybe it was
your passion, or that you cannot run around with your kids
anymore, right. What. What does that mean? Or that you cannot
(13:40):
eat your favorite meal anymore. So all of that really impacts who
we are. And we have to sort of think that when illness and
this type of illness that make us face mortality, we have to
sort of reinvent ourselves. Right. How do I be
the person I want to be, knowing that I cannot do the things I'm used
to do and that it's not easy
(14:02):
there. You have to grieve. Yeah. So that's the first
thing I think, is we have to first understand that this is
grieving, losing health. It's part of grieving. And we have to go
through the process of that until we accept it. But it's important to recognize
and sort of be okay with feeling that way. So when you
say normalizing, I think, yeah, we have to accept that there's an emotional response to
(14:24):
what's going on, and it has to be. And we cannot put
it aside. And sometimes your cardiologist might not be able to recognize
it, but I want to invite people to be okay with feeling,
you know, with having an emotional response, maybe being angry,
because that's part of the process of acceptance, and that's where it's
important to. To. To do that. And the other thing, as you mentioned, you
(14:47):
know, before you being a healthy person, and doing everything you need to do
to be healthy. We always forget about sometimes that psychological
piece. So I often see patients who are doing everything right
again, air quotes. But they're angry. They, they
have stress in their lives, they are depressed. They might not
be enjoying what they do. They might have a history of trauma
(15:10):
as a child or a difficult upbringing. And all of those things
really compound and actually impact the way we do things and how our body
reacts. We have one body again, so our brain and our body are
connected and there's a lot of influences. And I'll just give a quick
example with heart dis, when we get excited, our
heart races. And when we're
(15:32):
happy, our heart races. When we're worried, sometimes actually
get diarrhea or our GI tummy. And those
things helps us understand that there is a connection between our
brain and our mind and our body and how we need to really
appreciate that connection and how to work as a whole as opposed
to dividing, you know, our brain and our heart.
(15:54):
Yes, and I can attest to that. I mean, I just, my
husband just had shoulder surgery yesterday
and I, my heart was skipping
and it's been doing so great. But the day before my
heart was skipping and it was racing. And then yesterday
it was like all over the place and having a party in my chest.
(16:17):
And then we had like this big winter storm that hit, of course. And
then we get stuck in the car for five hours on our way home from
shoulder surgery. And it is just amazing how that
has affected me physically. You know, I have all the self care skills and I
got acupuncture today and everything's calmed down. But
yes, it is amazing how I became like the skipping record
(16:40):
for 48 hours for shoulder surgery for my husband. Right.
And, and I just, now I have the awareness of it and I just talk
to my heart and I put my hands on my chest and I take deep
breaths and make warm tea and you know, can comfort
it. But before I had this awareness, it would be so
scary. Yeah, I think that that's the other thing is
(17:01):
sometimes even you have those symptoms and it's
scary and you don't know what to do. And now sometimes
realizing that there might be a component of anxiety or stress give
gives you permission to do something about it. And that
actually is helpful because you have some tools you can use and maybe you
need to still go and see your cardiologist and do that, but you
(17:24):
now have other things that you can do and perhaps decrease, you know,
the severity of the symptoms. Right, right, exactly. And
probably four years ago, I would have run to the ER because I didn't
understand. And in the communities that
I am part of and like Reddit and some Facebook support
groups, you know, I see people posting, is this
(17:46):
normal? Should I go to the er? And it's. I mean,
I. Obviously, I'm not a doctor, I can't give medical advice, but I
can see myself reflected in those questions, you
know, four years ago. Right. And so that
brings me to the next thing I wanted to talk about, which
is, I mean, we. We could talk all day. This is so amazing. I'm just
(18:08):
so excited you're here. How, like I said, I had not
heard of you and the type of you. Right.
So how. It doesn't seem like what
you do is commonplace across the United States. Am
I correct on that? Yeah, so. So there's actually
a number of groups working on understanding
(18:30):
the overlap between psychological, psychiatric illness, psychological
health and cardiovascular illness. Now, what I think it's
a lot of this work is research. So we do a lot of research and
investigative work in learning about the connections.
And I would say in the early 2000s, there was
a huge load of information about
(18:52):
there is reality with this connection. Actually, depression and
depressive symptoms have been strongly associated
with worsening of cardiac symptomatology and even
development of new events that really actually put
this idea as a risk factor. Even the American Heart association
embraced the fact that we need to really identify depressive
(19:14):
symptoms. What I've noticed happened is we do the
research, we identify the problem, we kind of get it
out there, but then it's hard for us to move to the practice.
And in part it's because we're still learning and we're still working. And
part of my kind of argument, or
when I wanted to become
(19:36):
more be able to practice this, I said, well,
we cannot wait until we know it all, because it's going to take some time.
So we need to do two things. We need to go out there
and start doing what we know how to do, help
patients, help cardiologists in this area,
and then at the same time learn from our patients so we can continue to
(19:58):
do research and develop treatments. Because
there's a lot still to learn. But I think that's what I
wanted to do. I would say there's a few groups, I
think one in the east coast, there's a group in Canada
who've done more of that practical work, kind of that translational work of
from research to practice. But. And
(20:21):
psychology and psychotherapy has actually evolved
some more. There's more of those psychologists doing that kind of mental health
work in cardiology. So I think that's sort of picked
up more than us in psychiatry working with patients.
But hopefully it will continue to evolve. I see, for example,
a lot of the trainees and medical students who are actually interested
(20:43):
in learning about this. So eventually this can become more of
a standard of care, actually, than just a one
off. Incredible. That warms my
heart. Pun totally intended. What?
Like, do you have a part. Is a portion of your
job educating, like getting the word out? Like,
(21:05):
hey, this is what we're doing at Mayo? Because I didn't y'all
mention at Science and Leadership that there's like a 20 year lag
between like the research and then when it's kind of like
the rubber meets the road to help patients on a more
national scale or global scale.
Yeah, I think, you know, at May, of course, we've started to develop this
(21:27):
program and helping other departments and
specialists to really think about the importance of
psychological health and mental health. And then we do. The other part
of our work is really trying to fight stigma because one of
the big problems that we struggle with in psychiatry and psychology is
that there's a lot of stigma for mental illness. So
(21:49):
people are embarrassed and are afraid of saying they might be depressed
or that they have an anxiety disorder. And it's sort of better
to just bottle things up and don't share anything and kind of go
with the flow. And we're starting to see more
spaces for mental health, you know, care. I think if we
incorporate psychiatric care in the standard of care practice
(22:12):
where cardiologists, GI docs, primary care
providers do that work, I think that normalizes it.
Insurance companies have started to also help us covering
mental health needs because that's a big barrier. Right. If you need to go to
a therapist and you have to do out of pocket weekly for
12 weeks, I mean, that's. That's pretty daunting. So I think
(22:33):
we're starting to see more of that openness to
mental health. And again, I will emphasize is the. Is that really
understanding of that. It's one body.
Right. One. The brain and the body are connected and just
natural. There's going to be some exchange and that's starting to
become more common and opening those spaces for
(22:55):
patients and for providers certainly too. Right,
right. Okay, so what's your
advice then for my. For all the
listeners out there like myself, who
are in front of their local cardiologists and
I'm like, give us some basic vocabulary
(23:16):
questions, statements to help us
advocate for ourselves. And, I mean, I
love my cardiologist. She really is incredible.
And I feel like I've won the lottery with her, but she's
one person, and I. Before I let you speak, I
just want to share one other thing. I had a naturopath on
(23:38):
a while back that actually specializes in the
MTHFR mutation. It was a
fascinating conversation, and something she said
really just hit me in the
right, necessary ways, which is we can't
expect any one medical
(23:58):
provider to hold all the answers, to
hold all the knowledge. Right. And I
realized that I had been kind of expecting
that of my cardiologist. And so it's like, we've got.
We really have to build these teams behind us. But,
yeah, that's just a side note, but I do think it applies to
(24:20):
what I just asked of you. Like, how do we. Yeah, we just. And I
also. I swear I'm going to let you talk in a second, but
I've had several patients or listeners tell me that
they've learned how to advocate because of this
podcast. And so this is your teachable moment of
help us help ourselves when we sit down with our
(24:42):
cardiologists. I think that's really important. And
I would say multidisciplinary treatment approach.
Right? Having a group of people who helps you in the different
areas is actually most helpful. We cannot
know it all. And really, the best way to help
patients is by actually connecting and collaborating with our
(25:04):
colleagues. And that's when you think about my subspecialty,
which has the word liaison. That's really what that means.
How can I connect, collaborate with my
colleagues and help the patient move to where they need to
go, as opposed to me doing everything. With that said, I
would say first, you have to accept that you are having
(25:27):
maybe some emotional concerns or some
difficulties with your kind of, I would call it, emotional
world. So if you feel like you're crying more
often than not, or you're not able to really engage and
enjoy the things you used to enjoy, and I would say that this is not
a physical problem. A lot of the patients do have physical symptoms that don't
(25:49):
let them engage. But if you feel like you can do it physically, but you
cannot really get the motivation, that should be for you, like a red flag
that there may be some psychological component to it. And what I
would say is that's an opportunity for you to say to your
doctor, there's something that's not physical, that it's
impacting my ability to engage in life. And I would
(26:12):
Appreciate, you know, either a referral or your guidance
in how to manage that. If you think about anxiety, anxiety is
tremendously common, right? And anxiety is normal to a degree. We
all have anxiety to be able to do our life. But when you feel
like anxiety is really taking over your life, where you sit down
and watch a movie, your brain is going right, is
(26:34):
nonstop. You're, you're concerned about your health
24, 7, someone is talking to you and your brain is
somewhere else worrying about your health. You're maybe
searching online constantly about your symptoms, you're checking your Apple
watch constantly for your heart rate, and that's taking you away
from life. That's another red flag to say, boy,
(26:56):
I may be worrying excessively and I need to ask
and see what guidance to get. Those are two major
problems that are really common when patients have cardiovascular disease.
Certainly if you know and you've had a difficult upbringing, that
you've had any exposure to trauma or to life threatening
experiences, and perhaps you start having nightmares,
(27:19):
flashbacks, and you know, it's often that some patients don't ever
have any symptoms until they have a cardiac surgery. And after
surgery, things happen. And
that would be a red flag again to say, boy, I never had
these thoughts, I never had my sleep get disrupted with nightmares.
I need to ask and see if I can get guidance for it.
(27:41):
So I think those are areas and part of it, it
starts with you accepting that there may be something beyond your physical
health, trusting your family members. Sometimes, you know, family would
say, boy, you, you're different, you're not as joyful,
you, you don't listen to when we're talking. And then maybe that
should resonate and give you some indication to get the help
(28:03):
you need. Certainly if you're engaging in alcohol use more
than the normal, or smoking or
any unhealthy behavior, that was not something you used to do. That
also should tell you, why am I doing this? Maybe I'm trying to
cope for some problems that I don't know. And then can I
help get the help you need? Stress is a buzzword, but I think stress
(28:26):
is normal. We all get stressed. But if the stress gets to the point where
you again, cannot function, cannot enjoy, that's another
area that should prompt you to talk to your doctor. And again, don't
expect the cardiologist to necessarily treat you, but at least put it out
there so that person can help you get to the person
or the team that can help you with those symptoms. Right?
(28:48):
And as we were mentioning a few minutes ago, it's Important
to treat well, just because we all deserve to have a
great quality of life. Right, Number one. But number two, it affects
your heart, it affects your whole body. So, you know, there's many
reasons to advocate for yourself. And we
deserve good health, we deserve happiness, we deserve
(29:11):
joy, peace, we deserve to
advocate for our health. We are in the driver's seat of our
healthcare. And I would add that the fact that you've
had a cardiac event or have cardiac illness should not
take you completely away from having an enjoyable,
meaningful life. And sometimes pain and
(29:33):
physical health does takes us away from that. So thinking that
you could certainly regain the meaning of life despite of having an
illness, but you may need someone to help you in the process of
adjusting to that. What do I need to reinvent
myself to get that meaning back? But don't feel like because you're
ill, sort of. That's it. I should feel this way.
(29:58):
My whole body just relaxed when you said that. I mean, my
surgeon told me to go live my best life at my six
week follow up after my open heart surgery, which
was awesome. And I, I continue to
replay that in my mind. He was just so thrilled for my
outcome. But I don't know if it's
(30:20):
commonplace for heart patients to be given their
permission to thrive. Not
that they're being told not to thrive, but to
set the intention of you're going to go out now
and kick ass. I mean, that was the
whole point of my podcast, was I kept talking to people
(30:42):
who weren't necessarily thriving and felt alone. And I felt
like one of the lucky ones who was doing well. And I mean, I feel
like I've had to claw my way to get to where I'm at four years,
but I'm living a really beautiful life that I never thought
possible. But there's a lot of people out there who, yeah,
like, stay in that victim mindset. I definitely was in the
(31:04):
victim mindset for a while. I got mad. You know, I went through all the
stages of grief. But even just hearing you say it again,
like, we can have amazing lives, like,
that's my spin on it. Like I still needed to hear that
again today. Yeah. And I would say the survivorship
mind actually helps recovery. Okay. I've never heard
(31:27):
that say more. And there's actually some work about
being a survivor versus being a victim. What I would say is
that takes time to get there. Don't feel like it's easy
to become, have that sense of survivorship, but it
takes some time and that's when that's Another reason to ask
for help is if you feel like that victimhood has become
(31:49):
really part of who you are and it's really hard to get out of your
physical symptoms. They're sort of the, your new identity
and driving your life. That's something that I always say,
well, that there might be something else that we're missing. And then that's
another reason to get some psychological support.
Incredible. Before we wind down here,
(32:13):
I wanted to give you the opportunity to shout
from the mountaintop for two reasons.
One thing you wish all patients knew,
and then one thing you wish all cardiologists
knew. Okay, so I think I will
start with patients and I would say two things. The first
(32:36):
is knowing that this
is hard, right. And I will speak about
self compassion because I think oftentimes we forget about
that and we get into the mode, almost autopilot of
doing all the things they tell us to do to recover, but we forget
about the process of that and how difficult some of those
(32:58):
things could be. So I think the recognition
that this might be a hard part of your life
and that we need to always have some self compassion, be kind to
ourselves, be concerned and get the support you need. Which is
the second thing that I'll add kind of
thing about support is you're not alone. Even
(33:20):
if you're, if you feel like you're alone because maybe your healthcare team
doesn't get you or you don't get the help you need, there's a
lot of other resources and people who can help you.
Primary care providers are very well
trained and actually manage a lot of our patients with psychiatric
illness. So they are a great resource. There's a great
(33:42):
number of psychotherapists and psychologists that can also guide
you. And although there's not enough psychiatrists, as
many as we would like, I think there's also enough of us to help
you. So always remember that you're not alone.
You can ask for help. And I think important is to recognize you need help
because then that becomes a barrier and then be able
(34:04):
to do that with kindness and with
compassion. Now, for cardiologists,
the one thing I would like to know is that untreated
psychological and psychiatric illness impacts
cardiovascular outcomes. So someone
who has severe depressive symptoms or depression
(34:25):
and has cardiac events, we know that they have a higher risk
of having more cardiac events. And there is a
connection, both biologically within our bodies that connects
depression, anxiety and cardiovascular disease. As it is
environmental, right? People tend to eat unhealthier,
tend to do poor coping skills like smoking and Drinking,
(34:47):
they are more sedentary. I've done some work before,
and optimism, for example, helps patients be more active.
And if you think about when we wake up and we're feeling
tired or more pessimistic, it's really hard to get into the
treadmill and do some running as opposed to feeling really excited.
So the negative affect really impacts the way we do and connect
(35:09):
with our bodies. So it's important to recognize that
if this illness is present and is not treated or
addressed in the way it should, getting cardiac illness
under control is going to be very difficult. And that we.
I personally advocate for multidisciplinary approach. So not feeling
like they have to be the people treating, you know, symptoms
(35:33):
they might not be comfortable treating, but that we can work together to
give best to our patients.
That's. I chill. Sounds incredible for the listener
out there who's really struggling to make these, like,
initial changes that, you know, might have
some unhelpful coping strategies. Is that
(35:56):
a nice way? Is that a good way of wording that? No, I like
that. Okay. What do you want to say to them right now?
I think that, again, it's part of the process, and change is really
hard. I. I always think about how we. We have
habits. Our brain is very good about learning habits, and we
oftentimes live our life in autopilot. So if you think about
(36:17):
stress, and let's think that every time, for
example, we get home, the way we. We sort
of reconnect is by watching TV and eating
a bowl of cereal. And we've been doing that for five years.
The brain learns that habit. So every time we open
our door, the brain is going to immediately recognize that it's
(36:40):
time for a couch and cereal. So it's something that we.
It's automatic. So. So part of the idea is
we need to change those habits with good habits.
But that takes time, right? Because, of course, we've
had years in the making of having these bad habits. So the first thing
is understanding that it's going to take time and effort to make those
(37:02):
changes, but that our brain learns as they learn bad habits, it learns good
habits. The other thing is that we sometimes put
ourselves, give ourselves big goals, too
big. I'm going to run a mile and a half, five days a week. If
you haven't exercised for a while, that's probably too much. So
I always like to talk about something called smart
(37:24):
goals, which helps us really, what I would
summarize as baby steps, right? Having
really small steps to get us where we need to be.
And if you think about you needing to do
multiple things at once, well, pick one because you're not going to be able to
change all of them and start small. And
(37:47):
when I say small is if it exercises going to be your goal,
the first thing would be to take your shoes out and leave them out.
That might be just the beginning. And then from there you can
start right now you put your shoes on and maybe you watch the same
TV and the same serial, but with the tennis shoes
on. And then as you go, you know, you keep increasing that
(38:09):
goal into more exercise or
more specific to exercise. And in that way
you're going to be more successful at making the change. And
also it's going to feel less sort of
difficult because when you put big goals on yourself and
you're not able to accomplish them, it really feels like a failure.
(38:30):
Yeah, so sort of it's that defeat defeated sense
of why try if I never make it?
But perhaps it's because your goals are too, too big. And then the last thing
I would say is that sometimes we need accountability because again, our
brains and our bodies are used to the way we live. So we need to
really have that accountability to be able to exercise change. So
(38:53):
maybe it is my son who's going to take me out with the tennis shoes
or it is my dog who's going to make me walk or maybe my friend
will call me every time I get from work and instead of me sitting on
the couch, I'm going to go to their house and walk. So
that support is important because being and doing things alone
tend to be more difficult. Right.
(39:15):
And I can attest to the small
incremental changes because that's what I did with my, the cardiac
dietitian. We just started with breakfast
and I did that for a month and then we
layered in dinner and lunch was last. It
took months and it was, it was all of a sudden, I thought
(39:37):
it was going to take forever at the start of it. And then we
all know how fast time goes by and now it's,
now it's like nothing. It's just this automatic more healthy choices
when I go to the refrigerator. So I just, you know, just as a
side note of like, yep, I get that. Start with the tennis
shoes, start with the, with the breakfast.
(39:59):
It's. This has been great. Anything else that
we haven't covered that you are just wanting to talk about?
Well, the last thing I would say kind of from that is
recognizing what also is getting in the way. And sometimes it's
psychiatric illness. So if you're depressed, your
ability to get up and do things is going to be
(40:21):
diminished. When you're depressed, you're going to be craving
carbs, not carrots. Right. So if we
don't treat that, it's going to be really hard, even
if it's a small goal. So make sure that as you put those baby
steps in, you also recognize what are other things that are getting in the
way, so you get all the help that you need. I would say that treating
(40:44):
psychiatric illness is doable, is safe in patients with cardiac
illness. So sometimes there's a lot of fear,
but I would say that it can be very successful, and
it's just giving yourself the opportunity to at least understand what
treating psychiatric illness and psychological stress
means. Thank you so much. You kind of froze there. Probably. Probably
(41:06):
because I'm on the side of a mountain in Idaho.
Definitely has nothing to do with Rochester. I could tell you that.
Yes. And. And I will say, you know, I broke my leg
a year ago, almost a year ago, and I did get sad because it
was a really sad event. I was very sad. So
(41:26):
I've had. I had all kinds of things I had to undo,
and I was craving carbs. That is very real.
Oh, yeah. Yes, it was. It was a very sad
event. So. Well, Dr. Suarez, thank
you so much for your time today. If people
would like to find you, what is the best way. I
(41:48):
can put it in the show notes, but would you like to verbalize to us
the best way to connect with you? Actually, do you want to be connected
with. Should ask you that. Yeah.
So I don't have any. Any kind of public
presence. I'm not so huge into social media, so
that's. That makes it challenging in terms of finding me, you know, publicly.
(42:11):
I'm part of the, of course, psychiatrist psychology department at Mayo
Clinic. And of course, this podcast is something
I do personally and independent of the clinic. But if you. If you
get care. If you have that, that's. And the place I
work, I collaborate. You know, the Academy of Consultation
Liaison Psychiatry is the group of
(42:33):
psychiatrists who get together once a year and exchange ideas. So I do
collaborate with a number of other practitioners around the country
who are doing this line of work. So I would say I
would ask your doctor about, you know, the possibility of a
psychocardiologist or a consultation liaison psychiatrist.
And if there's any way you could get to me, you know,
(42:56):
I'll be happy to help you.
And I have had the benefit of going to the Mayo
Clinic, and it really is as a patient and it really
is unlike anything I've ever experienced as far as just
feeling cared for and seen and heard.
So thank you for being a part of it. Thank you for today.
(43:19):
I can hardly wait for this episode to hit the airwaves.
And thank you from my heart to yours for everything
you're doing for us for weak cardiac patients
nationwide, worldwide. Yeah, well this was
really wonderful. I appreciate the invitation and the space to really share
this line of work which as you said, it's not many
(43:41):
people know about. I will. I would say that it's cardiac psychiatry, but
also you can find it as psychocardiology in Europe and Australia.
That's the term they use the most. So if you want to learn a little
bit about those two terms will get you some information.
But so excited to be here. Thank you. Yes, thank you.
So you've heard it here today listeners. Thanks again for
(44:02):
joining us as we wrap up Hope for the Holidays.
I deeply hope that the series
has fed you, has given you hope and
inspiration and things to think about as you head into
the holiday season. I for one am not a huge fan
of the holiday season, so I'm also doing this for myself.
(44:24):
This is my own self care of surrounding myself
with people who are joyful and
wise minded and are thriving despite
circumstances they've been dealt. So I hope that this has
been helpful and I would love to know if it has. You can send me
an email that's in the show notes. You can always connect with me over social
(44:47):
media. Please consider joining our Patreon. We meet up
once a month on Zoom and it has been amazing
to see other heart patients come together and
form a community through this podcast. So in case
no one's told you today, you are loved, you matter and your
heart is your best friend. Be sure to come back next week for
(45:09):
a couple of reruns of the most downloaded
episodes of 2024 and then
2025 is already looking really
amazing for this podcast, so I can't wait to keep
bringing the heart patients and healthcare providers to you every week
through open heart surgery with Boots. I love.
We are not a heart, right? We're not our lungs, we're not our liver.
We are human beings, right, who have lots of things, right?
We have a body, we have health, we have family, we had a
job, we have things we like, things we
enjoy, we have physical needs, right? If we think about our sexual
health. So there's lots of things that make us a human. So
(00:24):
fixing a heart is part of it. And it's great if
you're able to fix your heart, but what comes with it.
Welcome to Open Heart Surgery with Boots,
a podcast for heart patients by me, a
heart patient. Join me as I take you on a journey through
the intricacies of the human heart, revealing
(00:46):
the triumphs and challenges of those who
undergo the life changing event of heart
surgery. We're not just exploring medical procedures,
we're delving into the human experience.
Be sure you hit subscribe and also
leave a review. That means the world to
(01:09):
me and I read every single one. Also, if you
have a story to share or want to hear something that I haven't
covered on this program, you can send me an email which is
linked in the show notes. But without further delay, let's
get to this week's episode. Welcome back
to another episode of Open Heart Surgery with Boots.
(01:32):
If you've been along with me for a few weeks now, I have
been re interviewing a few heart
patients that were some of the original
friends I've made through this podcast and a series
called Hope for the Holidays. If you haven't gone back and listened to
those, I highly recommend it. It is really amazing
(01:54):
the perspective we heart patients gain through our
experience and then once we kind of let things
percolate and cook and
ferment, it's amazing like a couple of years
and for me it's four years how like our perspective continues
to shift and grow. So I do recommend you listeners
(02:16):
going back and checking that out. And to round out the
series, I am so excited to welcome today Dr.
Laura Suarez from the Mayo Clinic and I want to tell you real
quickly how I got to meet Dr. Suarez. So I was
at the Mayo Clinic in October 2024 of
this year for Women Heart. It was my second time
(02:38):
participating in the Science and Leadership Symposium. I am something
called a heart champion and basically
what we do is we are advocates for
women with heart disease across the United States
and we get to mentor and help
educate people in our communities. I'm using my podcast as
(03:01):
my platform and Dr. Suarez was there
and gave an incredible talk on cardiac
psychiatry. Am I saying that right Dr. Suarez.
Yeah, yeah, yeah. So it was amazing.
And I thought to myself, if only I had had her in my
life four years ago when I was facing my open
(03:23):
heart surgery. So I, like, quickly ran up to
you, Dr. Suarez, like a fan girl afterwards, and gave you my
business card and invited you onto the podcast and you
very, very graciously said yes. And amongst
all your incredible things that you do, and if
I may just real quick brag about you, I am looking
(03:46):
at your incredible bio. It's amazing
what you do in your days. I have so many
questions about it. But you're a board certified
consultation liaison psychiatrist, which
I'm going to want to hear about that, what that means in a second with
expertise and the impact of psychiatric
(04:06):
illness in the adjustment and trajectory of
patients with chronic medical illnesses, mainly
psychocardiology. And that's just amazing to
me. And I have so many things I want to unpack with you there.
And you originally come to us from Bogota, Colombia,
correct? Correct. But then you've done so many
(04:29):
incredible things between then and now at the Mayo
Clinic, and the things that you research, you
are. Your clinical focus is on the treatment of
patients with medical conditions and comorbid
psychiatric illnesses, with a primary focus on patients
with cardiovascular disease. I
(04:51):
cannot thank you enough because I talk to so
many patients who struggle, and I see it in,
like, Reddit platforms and on Facebook
platforms, and I just couldn't believe that
it took me four years and going to the Mayo Clinic
and hearing what. I mean, I did Hear you in 2023 in the
(05:12):
virtual Science and Leadership Symposium, but I don't know if I was
ready to let that sink in yet. It's just, it's just such
a big topic, and I just cannot wait for you to educate us on
the nuts and bolts and then we'll get our hands dirty as
we dig into all the great things that you do. So, welcome. Yeah,
well, thank you so much for the invitation. It's really a great pleasure to be
(05:34):
here. So what is
the consultation liaison? What does that mean? I've never heard
of that. Yeah. So consultation liaison, previously known as
psychosomatic medicine, is the area within psychiatry that
focuses on the overlap of psychiatric and medical illnesses.
So we. It's a subspecialty training, a
(05:57):
fellowship training, and what we do is really
focus on the management of psychiatric illness. And when
I say psychiatric illness, it can be kind of an array
of things, I would say depressive disorders, anxiety disorders,
trauma, psychosis, like schizophrenia,
bipolar disorder, among other, you know, things
(06:18):
in those patients who have Medical illness. So within consultation
liaison, there's more sub, sub specialties, right? So
there are patients, there are psychiatrists who focus on,
for example, psychiatric illness and HIV or
psychiatric illness and dementias or
psychiatric illness and neurological disorders
(06:41):
or Parkinson's disease. The practice of
psychiatric medicine in the hospital, right, There are all different
subspecialties, but for me, really, it was
cardiology. So I started my
psychocardiology adventure over 10 years
ago when I started doing research in patients with cardiovascular
(07:01):
disease. And that really made me
really excited to say, boy, there's so much to unpack and
so much to do that this is the field I really want
to focus on. So I did my training on consultation liaison,
giving myself experience to manage all sorts of patients with medical,
chronic ill illnesses, you know, diabetes, surgical,
(07:24):
medical patients, hospitalized outpatients.
And because of the time I've been doing this work in cardiology,
now I have the luxury of having a practice with
cardiovascular disease patients. I mean, what was like the moment
that you knew cardiovascular disease or cardiology
was your passion? Is it your passion?
(07:46):
Is that ver to say? Yeah, I think that's fair to say. So I
think a couple things. So if we think about, for example, cardiac illness, I mean,
it's the number one cause of death, I would say,
worldwide, it touches so many people.
And what we've learned is it's not a one problem,
right? There's so many contributions to cardiac illness, and actually there's
(08:08):
a lot of environmental problems, and that includes psychological
health, you know, our behaviors, you know, how much we exercise, how easy
is for us to a healthy diet, why do we drink sometimes
or smoke or how do we cope when we're
stressed, not to say stress alone. And part of my research
back then was that how to help people engage in those healthy
(08:29):
behaviors. What can we do to improve
the ability to stay on task in those healthy
behaviors? And I thought that was quite interesting because we always think
about just do it, you know, and. And
truthfully, it's easier said than done. And then I started to think,
well, there's so many layers to that, right? It's not only
(08:52):
doing it, but how can I adjust and change all my life and
all, all I have to be able to do this, to do this kind
of diet, or to exercise regularly. And then
as a woman and thinking about, you know, especially young women with younger
kids, boy, how can you, like, adjust even to that and
be able to maintain your role as a mom, as a wife
(09:15):
or with your children? And last thing is cardiac patients
who have cardiac illness sometimes develop symptoms that are chronic. You know, I
think particularly about heart failure patients who
have chronic illnesses who come into the hospital
often with cardiovascular symptoms whose quality of life is
this poor and yet we haven't developed anything to
(09:38):
support them. Right. I mean, there are some things that we're starting to do.
But if I was thinking about, you know, patients with cancer
or, you know, patients with other chronic illnesses that have a lot
of things surrounding them, and my sense was,
why are we not developing programs or
establish multidisciplinary care teams to care for these patients
(10:00):
who struggle for their whole lives? So. So all of those
things really made me be part of that
process and get into this line of
work. Wow. Yeah, I just as like
a personal side note. So I'm just think like there's just so much I want
to unpack in all of that, you know, I just
(10:21):
shared. It's been four years for me since my congenital heart disease
diagnoses. And for those new here, I was diagnosed
at the height of COVID which made it so much more fun. June of
2020. And then I had my surgery
January of 2021. And through this podcast
I met a cardiac dietitian. And we actually,
(10:44):
she and I just did a whole series in October
because she changed my life. And she and I
started working together just this. May I bring this up
because I've always considered myself very healthy. I
haven't had a drink in 14 years. I've never smok, eat
organic. I work out. And I'm like the epitome of like
(11:06):
health. Right. So when I meet her and she
starts educate and I had her on the podcast months ago
and she just blew my mind. I had no idea the
role of nutrition in cardiolo in my cardiac health because I
wasn't told that by my cardiologist or my surgeon, which
is just mind blowing to me. And it was
(11:28):
amazing. Here I am right, like picture of health
and I'm doing that in air quotes right now because I really
wasn't. I thought I was. And it, it
was really incredible to me how long it took me
to make the changes that she was
suggesting. All science based it, it, it. She is
(11:50):
really. Her name is Michelle Rothenstein and she just has,
like I said, done nothing but improve my life. And
I am continuously amazed at how many months it
took to start instituting these changes. I needed my mental health
therapist to help and so I just want to normalize.
Yes, you're right. It takes so much
(12:12):
willingness to reflect and the
courage to say, oh, actually I Haven't been
making the right changes. I haven't been. And having the
grace to. Giving ourselves the grace to
accept that maybe the choices we've been making were more
(12:33):
coping than help than, like, for our health. Right.
Which, I mean, coping is a way to help our health because it helps our
nervous system, but at least that's how. Correct me if I'm
reflecting incorrectly, but, yeah, I just
want to normalize that. Oh, my gosh. It's hard.
Yeah. Oh, absolutely. And I want to touch on that because I
(12:56):
think that's actually a very important point, is we are not a
heart. Right. We're not our lungs, we're not our liver. We are human
beings. Right. Who have lots of things. Right. We have a
body, we have health, we have family, we had a job.
We have things we like, things we enjoy.
We have physical needs. Right. If we think about our sexual health, so.
(13:18):
So there's lots of things that make us a human. So fixing a
heart is. Is a part of it, and it's a great. If you're able to
fix your heart, but what comes with it, right. If fixing
your heart means that you have to quit your job, that maybe it was
your passion, or that you cannot run around with your kids
anymore, right. What. What does that mean? Or that you cannot
(13:40):
eat your favorite meal anymore. So all of that really impacts who
we are. And we have to sort of think that when illness and
this type of illness that make us face mortality, we have to
sort of reinvent ourselves. Right. How do I be
the person I want to be, knowing that I cannot do the things I'm used
to do and that it's not easy
(14:02):
there. You have to grieve. Yeah. So that's the first
thing I think, is we have to first understand that this is
grieving, losing health. It's part of grieving. And we have to go
through the process of that until we accept it. But it's important to recognize
and sort of be okay with feeling that way. So when you
say normalizing, I think, yeah, we have to accept that there's an emotional response to
(14:24):
what's going on, and it has to be. And we cannot put
it aside. And sometimes your cardiologist might not be able to recognize
it, but I want to invite people to be okay with feeling,
you know, with having an emotional response, maybe being angry,
because that's part of the process of acceptance, and that's where it's
important to. To. To do that. And the other thing, as you mentioned, you
(14:47):
know, before you being a healthy person, and doing everything you need to do
to be healthy. We always forget about sometimes that psychological
piece. So I often see patients who are doing everything right
again, air quotes. But they're angry. They, they
have stress in their lives, they are depressed. They might not
be enjoying what they do. They might have a history of trauma
(15:10):
as a child or a difficult upbringing. And all of those things
really compound and actually impact the way we do things and how our body
reacts. We have one body again, so our brain and our body are
connected and there's a lot of influences. And I'll just give a quick
example with heart dis, when we get excited, our
heart races. And when we're
(15:32):
happy, our heart races. When we're worried, sometimes actually
get diarrhea or our GI tummy. And those
things helps us understand that there is a connection between our
brain and our mind and our body and how we need to really
appreciate that connection and how to work as a whole as opposed
to dividing, you know, our brain and our heart.
(15:54):
Yes, and I can attest to that. I mean, I just, my
husband just had shoulder surgery yesterday
and I, my heart was skipping
and it's been doing so great. But the day before my
heart was skipping and it was racing. And then yesterday
it was like all over the place and having a party in my chest.
(16:17):
And then we had like this big winter storm that hit, of course. And
then we get stuck in the car for five hours on our way home from
shoulder surgery. And it is just amazing how that
has affected me physically. You know, I have all the self care skills and I
got acupuncture today and everything's calmed down. But
yes, it is amazing how I became like the skipping record
(16:40):
for 48 hours for shoulder surgery for my husband. Right.
And, and I just, now I have the awareness of it and I just talk
to my heart and I put my hands on my chest and I take deep
breaths and make warm tea and you know, can comfort
it. But before I had this awareness, it would be so
scary. Yeah, I think that that's the other thing is
(17:01):
sometimes even you have those symptoms and it's
scary and you don't know what to do. And now sometimes
realizing that there might be a component of anxiety or stress give
gives you permission to do something about it. And that
actually is helpful because you have some tools you can use and maybe you
need to still go and see your cardiologist and do that, but you
(17:24):
now have other things that you can do and perhaps decrease, you know,
the severity of the symptoms. Right, right, exactly. And
probably four years ago, I would have run to the ER because I didn't
understand. And in the communities that
I am part of and like Reddit and some Facebook support
groups, you know, I see people posting, is this
(17:46):
normal? Should I go to the er? And it's. I mean,
I. Obviously, I'm not a doctor, I can't give medical advice, but I
can see myself reflected in those questions, you
know, four years ago. Right. And so that
brings me to the next thing I wanted to talk about, which
is, I mean, we. We could talk all day. This is so amazing. I'm just
(18:08):
so excited you're here. How, like I said, I had not
heard of you and the type of you. Right.
So how. It doesn't seem like what
you do is commonplace across the United States. Am
I correct on that? Yeah, so. So there's actually
a number of groups working on understanding
(18:30):
the overlap between psychological, psychiatric illness, psychological
health and cardiovascular illness. Now, what I think it's
a lot of this work is research. So we do a lot of research and
investigative work in learning about the connections.
And I would say in the early 2000s, there was
a huge load of information about
(18:52):
there is reality with this connection. Actually, depression and
depressive symptoms have been strongly associated
with worsening of cardiac symptomatology and even
development of new events that really actually put
this idea as a risk factor. Even the American Heart association
embraced the fact that we need to really identify depressive
(19:14):
symptoms. What I've noticed happened is we do the
research, we identify the problem, we kind of get it
out there, but then it's hard for us to move to the practice.
And in part it's because we're still learning and we're still working. And
part of my kind of argument, or
when I wanted to become
(19:36):
more be able to practice this, I said, well,
we cannot wait until we know it all, because it's going to take some time.
So we need to do two things. We need to go out there
and start doing what we know how to do, help
patients, help cardiologists in this area,
and then at the same time learn from our patients so we can continue to
(19:58):
do research and develop treatments. Because
there's a lot still to learn. But I think that's what I
wanted to do. I would say there's a few groups, I
think one in the east coast, there's a group in Canada
who've done more of that practical work, kind of that translational work of
from research to practice. But. And
(20:21):
psychology and psychotherapy has actually evolved
some more. There's more of those psychologists doing that kind of mental health
work in cardiology. So I think that's sort of picked
up more than us in psychiatry working with patients.
But hopefully it will continue to evolve. I see, for example,
a lot of the trainees and medical students who are actually interested
(20:43):
in learning about this. So eventually this can become more of
a standard of care, actually, than just a one
off. Incredible. That warms my
heart. Pun totally intended. What?
Like, do you have a part. Is a portion of your
job educating, like getting the word out? Like,
(21:05):
hey, this is what we're doing at Mayo? Because I didn't y'all
mention at Science and Leadership that there's like a 20 year lag
between like the research and then when it's kind of like
the rubber meets the road to help patients on a more
national scale or global scale.
Yeah, I think, you know, at May, of course, we've started to develop this
(21:27):
program and helping other departments and
specialists to really think about the importance of
psychological health and mental health. And then we do. The other part
of our work is really trying to fight stigma because one of
the big problems that we struggle with in psychiatry and psychology is
that there's a lot of stigma for mental illness. So
(21:49):
people are embarrassed and are afraid of saying they might be depressed
or that they have an anxiety disorder. And it's sort of better
to just bottle things up and don't share anything and kind of go
with the flow. And we're starting to see more
spaces for mental health, you know, care. I think if we
incorporate psychiatric care in the standard of care practice
(22:12):
where cardiologists, GI docs, primary care
providers do that work, I think that normalizes it.
Insurance companies have started to also help us covering
mental health needs because that's a big barrier. Right. If you need to go to
a therapist and you have to do out of pocket weekly for
12 weeks, I mean, that's. That's pretty daunting. So I think
(22:33):
we're starting to see more of that openness to
mental health. And again, I will emphasize is the. Is that really
understanding of that. It's one body.
Right. One. The brain and the body are connected and just
natural. There's going to be some exchange and that's starting to
become more common and opening those spaces for
(22:55):
patients and for providers certainly too. Right,
right. Okay, so what's your
advice then for my. For all the
listeners out there like myself, who
are in front of their local cardiologists and
I'm like, give us some basic vocabulary
(23:16):
questions, statements to help us
advocate for ourselves. And, I mean, I
love my cardiologist. She really is incredible.
And I feel like I've won the lottery with her, but she's
one person, and I. Before I let you speak, I
just want to share one other thing. I had a naturopath on
(23:38):
a while back that actually specializes in the
MTHFR mutation. It was a
fascinating conversation, and something she said
really just hit me in the
right, necessary ways, which is we can't
expect any one medical
(23:58):
provider to hold all the answers, to
hold all the knowledge. Right. And I
realized that I had been kind of expecting
that of my cardiologist. And so it's like, we've got.
We really have to build these teams behind us. But,
yeah, that's just a side note, but I do think it applies to
(24:20):
what I just asked of you. Like, how do we. Yeah, we just. And I
also. I swear I'm going to let you talk in a second, but
I've had several patients or listeners tell me that
they've learned how to advocate because of this
podcast. And so this is your teachable moment of
help us help ourselves when we sit down with our
(24:42):
cardiologists. I think that's really important. And
I would say multidisciplinary treatment approach.
Right? Having a group of people who helps you in the different
areas is actually most helpful. We cannot
know it all. And really, the best way to help
patients is by actually connecting and collaborating with our
(25:04):
colleagues. And that's when you think about my subspecialty,
which has the word liaison. That's really what that means.
How can I connect, collaborate with my
colleagues and help the patient move to where they need to
go, as opposed to me doing everything. With that said, I
would say first, you have to accept that you are having
(25:27):
maybe some emotional concerns or some
difficulties with your kind of, I would call it, emotional
world. So if you feel like you're crying more
often than not, or you're not able to really engage and
enjoy the things you used to enjoy, and I would say that this is not
a physical problem. A lot of the patients do have physical symptoms that don't
(25:49):
let them engage. But if you feel like you can do it physically, but you
cannot really get the motivation, that should be for you, like a red flag
that there may be some psychological component to it. And what I
would say is that's an opportunity for you to say to your
doctor, there's something that's not physical, that it's
impacting my ability to engage in life. And I would
(26:12):
Appreciate, you know, either a referral or your guidance
in how to manage that. If you think about anxiety, anxiety is
tremendously common, right? And anxiety is normal to a degree. We
all have anxiety to be able to do our life. But when you feel
like anxiety is really taking over your life, where you sit down
and watch a movie, your brain is going right, is
(26:34):
nonstop. You're, you're concerned about your health
24, 7, someone is talking to you and your brain is
somewhere else worrying about your health. You're maybe
searching online constantly about your symptoms, you're checking your Apple
watch constantly for your heart rate, and that's taking you away
from life. That's another red flag to say, boy,
(26:56):
I may be worrying excessively and I need to ask
and see what guidance to get. Those are two major
problems that are really common when patients have cardiovascular disease.
Certainly if you know and you've had a difficult upbringing, that
you've had any exposure to trauma or to life threatening
experiences, and perhaps you start having nightmares,
(27:19):
flashbacks, and you know, it's often that some patients don't ever
have any symptoms until they have a cardiac surgery. And after
surgery, things happen. And
that would be a red flag again to say, boy, I never had
these thoughts, I never had my sleep get disrupted with nightmares.
I need to ask and see if I can get guidance for it.
(27:41):
So I think those are areas and part of it, it
starts with you accepting that there may be something beyond your physical
health, trusting your family members. Sometimes, you know, family would
say, boy, you, you're different, you're not as joyful,
you, you don't listen to when we're talking. And then maybe that
should resonate and give you some indication to get the help
(28:03):
you need. Certainly if you're engaging in alcohol use more
than the normal, or smoking or
any unhealthy behavior, that was not something you used to do. That
also should tell you, why am I doing this? Maybe I'm trying to
cope for some problems that I don't know. And then can I
help get the help you need? Stress is a buzzword, but I think stress
(28:26):
is normal. We all get stressed. But if the stress gets to the point where
you again, cannot function, cannot enjoy, that's another
area that should prompt you to talk to your doctor. And again, don't
expect the cardiologist to necessarily treat you, but at least put it out
there so that person can help you get to the person
or the team that can help you with those symptoms. Right?
(28:48):
And as we were mentioning a few minutes ago, it's Important
to treat well, just because we all deserve to have a
great quality of life. Right, Number one. But number two, it affects
your heart, it affects your whole body. So, you know, there's many
reasons to advocate for yourself. And we
deserve good health, we deserve happiness, we deserve
(29:11):
joy, peace, we deserve to
advocate for our health. We are in the driver's seat of our
healthcare. And I would add that the fact that you've
had a cardiac event or have cardiac illness should not
take you completely away from having an enjoyable,
meaningful life. And sometimes pain and
(29:33):
physical health does takes us away from that. So thinking that
you could certainly regain the meaning of life despite of having an
illness, but you may need someone to help you in the process of
adjusting to that. What do I need to reinvent
myself to get that meaning back? But don't feel like because you're
ill, sort of. That's it. I should feel this way.
(29:58):
My whole body just relaxed when you said that. I mean, my
surgeon told me to go live my best life at my six
week follow up after my open heart surgery, which
was awesome. And I, I continue to
replay that in my mind. He was just so thrilled for my
outcome. But I don't know if it's
(30:20):
commonplace for heart patients to be given their
permission to thrive. Not
that they're being told not to thrive, but to
set the intention of you're going to go out now
and kick ass. I mean, that was the
whole point of my podcast, was I kept talking to people
(30:42):
who weren't necessarily thriving and felt alone. And I felt
like one of the lucky ones who was doing well. And I mean, I feel
like I've had to claw my way to get to where I'm at four years,
but I'm living a really beautiful life that I never thought
possible. But there's a lot of people out there who, yeah,
like, stay in that victim mindset. I definitely was in the
(31:04):
victim mindset for a while. I got mad. You know, I went through all the
stages of grief. But even just hearing you say it again,
like, we can have amazing lives, like,
that's my spin on it. Like I still needed to hear that
again today. Yeah. And I would say the survivorship
mind actually helps recovery. Okay. I've never heard
(31:27):
that say more. And there's actually some work about
being a survivor versus being a victim. What I would say is
that takes time to get there. Don't feel like it's easy
to become, have that sense of survivorship, but it
takes some time and that's when that's Another reason to ask
for help is if you feel like that victimhood has become
(31:49):
really part of who you are and it's really hard to get out of your
physical symptoms. They're sort of the, your new identity
and driving your life. That's something that I always say,
well, that there might be something else that we're missing. And then that's
another reason to get some psychological support.
Incredible. Before we wind down here,
(32:13):
I wanted to give you the opportunity to shout
from the mountaintop for two reasons.
One thing you wish all patients knew,
and then one thing you wish all cardiologists
knew. Okay, so I think I will
start with patients and I would say two things. The first
(32:36):
is knowing that this
is hard, right. And I will speak about
self compassion because I think oftentimes we forget about
that and we get into the mode, almost autopilot of
doing all the things they tell us to do to recover, but we forget
about the process of that and how difficult some of those
(32:58):
things could be. So I think the recognition
that this might be a hard part of your life
and that we need to always have some self compassion, be kind to
ourselves, be concerned and get the support you need. Which is
the second thing that I'll add kind of
thing about support is you're not alone. Even
(33:20):
if you're, if you feel like you're alone because maybe your healthcare team
doesn't get you or you don't get the help you need, there's a
lot of other resources and people who can help you.
Primary care providers are very well
trained and actually manage a lot of our patients with psychiatric
illness. So they are a great resource. There's a great
(33:42):
number of psychotherapists and psychologists that can also guide
you. And although there's not enough psychiatrists, as
many as we would like, I think there's also enough of us to help
you. So always remember that you're not alone.
You can ask for help. And I think important is to recognize you need help
because then that becomes a barrier and then be able
(34:04):
to do that with kindness and with
compassion. Now, for cardiologists,
the one thing I would like to know is that untreated
psychological and psychiatric illness impacts
cardiovascular outcomes. So someone
who has severe depressive symptoms or depression
(34:25):
and has cardiac events, we know that they have a higher risk
of having more cardiac events. And there is a
connection, both biologically within our bodies that connects
depression, anxiety and cardiovascular disease. As it is
environmental, right? People tend to eat unhealthier,
tend to do poor coping skills like smoking and Drinking,
(34:47):
they are more sedentary. I've done some work before,
and optimism, for example, helps patients be more active.
And if you think about when we wake up and we're feeling
tired or more pessimistic, it's really hard to get into the
treadmill and do some running as opposed to feeling really excited.
So the negative affect really impacts the way we do and connect
(35:09):
with our bodies. So it's important to recognize that
if this illness is present and is not treated or
addressed in the way it should, getting cardiac illness
under control is going to be very difficult. And that we.
I personally advocate for multidisciplinary approach. So not feeling
like they have to be the people treating, you know, symptoms
(35:33):
they might not be comfortable treating, but that we can work together to
give best to our patients.
That's. I chill. Sounds incredible for the listener
out there who's really struggling to make these, like,
initial changes that, you know, might have
some unhelpful coping strategies. Is that
(35:56):
a nice way? Is that a good way of wording that? No, I like
that. Okay. What do you want to say to them right now?
I think that, again, it's part of the process, and change is really
hard. I. I always think about how we. We have
habits. Our brain is very good about learning habits, and we
oftentimes live our life in autopilot. So if you think about
(36:17):
stress, and let's think that every time, for
example, we get home, the way we. We sort
of reconnect is by watching TV and eating
a bowl of cereal. And we've been doing that for five years.
The brain learns that habit. So every time we open
our door, the brain is going to immediately recognize that it's
(36:40):
time for a couch and cereal. So it's something that we.
It's automatic. So. So part of the idea is
we need to change those habits with good habits.
But that takes time, right? Because, of course, we've
had years in the making of having these bad habits. So the first thing
is understanding that it's going to take time and effort to make those
(37:02):
changes, but that our brain learns as they learn bad habits, it learns good
habits. The other thing is that we sometimes put
ourselves, give ourselves big goals, too
big. I'm going to run a mile and a half, five days a week. If
you haven't exercised for a while, that's probably too much. So
I always like to talk about something called smart
(37:24):
goals, which helps us really, what I would
summarize as baby steps, right? Having
really small steps to get us where we need to be.
And if you think about you needing to do
multiple things at once, well, pick one because you're not going to be able to
change all of them and start small. And
(37:47):
when I say small is if it exercises going to be your goal,
the first thing would be to take your shoes out and leave them out.
That might be just the beginning. And then from there you can
start right now you put your shoes on and maybe you watch the same
TV and the same serial, but with the tennis shoes
on. And then as you go, you know, you keep increasing that
(38:09):
goal into more exercise or
more specific to exercise. And in that way
you're going to be more successful at making the change. And
also it's going to feel less sort of
difficult because when you put big goals on yourself and
you're not able to accomplish them, it really feels like a failure.
(38:30):
Yeah, so sort of it's that defeat defeated sense
of why try if I never make it?
But perhaps it's because your goals are too, too big. And then the last thing
I would say is that sometimes we need accountability because again, our
brains and our bodies are used to the way we live. So we need to
really have that accountability to be able to exercise change. So
(38:53):
maybe it is my son who's going to take me out with the tennis shoes
or it is my dog who's going to make me walk or maybe my friend
will call me every time I get from work and instead of me sitting on
the couch, I'm going to go to their house and walk. So
that support is important because being and doing things alone
tend to be more difficult. Right.
(39:15):
And I can attest to the small
incremental changes because that's what I did with my, the cardiac
dietitian. We just started with breakfast
and I did that for a month and then we
layered in dinner and lunch was last. It
took months and it was, it was all of a sudden, I thought
(39:37):
it was going to take forever at the start of it. And then we
all know how fast time goes by and now it's,
now it's like nothing. It's just this automatic more healthy choices
when I go to the refrigerator. So I just, you know, just as a
side note of like, yep, I get that. Start with the tennis
shoes, start with the, with the breakfast.
(39:59):
It's. This has been great. Anything else that
we haven't covered that you are just wanting to talk about?
Well, the last thing I would say kind of from that is
recognizing what also is getting in the way. And sometimes it's
psychiatric illness. So if you're depressed, your
ability to get up and do things is going to be
(40:21):
diminished. When you're depressed, you're going to be craving
carbs, not carrots. Right. So if we
don't treat that, it's going to be really hard, even
if it's a small goal. So make sure that as you put those baby
steps in, you also recognize what are other things that are getting in the
way, so you get all the help that you need. I would say that treating
(40:44):
psychiatric illness is doable, is safe in patients with cardiac
illness. So sometimes there's a lot of fear,
but I would say that it can be very successful, and
it's just giving yourself the opportunity to at least understand what
treating psychiatric illness and psychological stress
means. Thank you so much. You kind of froze there. Probably. Probably
(41:06):
because I'm on the side of a mountain in Idaho.
Definitely has nothing to do with Rochester. I could tell you that.
Yes. And. And I will say, you know, I broke my leg
a year ago, almost a year ago, and I did get sad because it
was a really sad event. I was very sad. So
(41:26):
I've had. I had all kinds of things I had to undo,
and I was craving carbs. That is very real.
Oh, yeah. Yes, it was. It was a very sad
event. So. Well, Dr. Suarez, thank
you so much for your time today. If people
would like to find you, what is the best way. I
(41:48):
can put it in the show notes, but would you like to verbalize to us
the best way to connect with you? Actually, do you want to be connected
with. Should ask you that. Yeah.
So I don't have any. Any kind of public
presence. I'm not so huge into social media, so
that's. That makes it challenging in terms of finding me, you know, publicly.
(42:11):
I'm part of the, of course, psychiatrist psychology department at Mayo
Clinic. And of course, this podcast is something
I do personally and independent of the clinic. But if you. If you
get care. If you have that, that's. And the place I
work, I collaborate. You know, the Academy of Consultation
Liaison Psychiatry is the group of
(42:33):
psychiatrists who get together once a year and exchange ideas. So I do
collaborate with a number of other practitioners around the country
who are doing this line of work. So I would say I
would ask your doctor about, you know, the possibility of a
psychocardiologist or a consultation liaison psychiatrist.
And if there's any way you could get to me, you know,
(42:56):
I'll be happy to help you.
And I have had the benefit of going to the Mayo
Clinic, and it really is as a patient and it really
is unlike anything I've ever experienced as far as just
feeling cared for and seen and heard.
So thank you for being a part of it. Thank you for today.
(43:19):
I can hardly wait for this episode to hit the airwaves.
And thank you from my heart to yours for everything
you're doing for us for weak cardiac patients
nationwide, worldwide. Yeah, well this was
really wonderful. I appreciate the invitation and the space to really share
this line of work which as you said, it's not many
(43:41):
people know about. I will. I would say that it's cardiac psychiatry, but
also you can find it as psychocardiology in Europe and Australia.
That's the term they use the most. So if you want to learn a little
bit about those two terms will get you some information.
But so excited to be here. Thank you. Yes, thank you.
So you've heard it here today listeners. Thanks again for
(44:02):
joining us as we wrap up Hope for the Holidays.
I deeply hope that the series
has fed you, has given you hope and
inspiration and things to think about as you head into
the holiday season. I for one am not a huge fan
of the holiday season, so I'm also doing this for myself.
(44:24):
This is my own self care of surrounding myself
with people who are joyful and
wise minded and are thriving despite
circumstances they've been dealt. So I hope that this has
been helpful and I would love to know if it has. You can send me
an email that's in the show notes. You can always connect with me over social
(44:47):
media. Please consider joining our Patreon. We meet up
once a month on Zoom and it has been amazing
to see other heart patients come together and
form a community through this podcast. So in case
no one's told you today, you are loved, you matter and your
heart is your best friend. Be sure to come back next week for
(45:09):
a couple of reruns of the most downloaded
episodes of 2024 and then
2025 is already looking really
amazing for this podcast, so I can't wait to keep
bringing the heart patients and healthcare providers to you every week
through open heart surgery with Boots. I love.
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