The Heart Brain connection

For all of the time I've known Rich, he has struggled with depression. 

Yesterday I was talking to a nurse from cardiology who wanted to discuss the Holter Heart Monitor versus the Medtronics Loop Implant that Rich had.

His stress test had come up with some 'abnormalities' and so his PCP had ordered a Holter Monitor for him.

The Medtronics Implant recording any A-fib incidents. This could have been the causes of his stroke and TIA's.

The Holter would look for PVC's or Premature Ventricular Contractions. 

I told the nurse that he'd worn one in 2015 and the last echo was done either then or in 2012 when he was having so many problems with his anti depressants medications.

She confirmed that he had PVC's in 2015 and also an echo done then. She had seen that they had been done previously also.

I hung up the phone after our discussion. Rich would get the monitor and they'd try and figure out how often he had PVC's.  I did a bit of research as a pattern started to form in the back of my head.

Every time Rich's anti depressants stopped working for him, he had more fatigue, dizziness, and had been pointed in the direction of cardiologists who did tests added meds because his blood pressure would fluctuate wildly,...did more tests, and generally could not figure out what the issue was.

What happens to the body during a period of severe depression?

Any stress or anxiety sends the blood pressure through the roof, causes heart flutters, dizziness, and sometimes confusion.

The brain is the master of the body organs. When the brain cannot function properly the heart and other organs cannot function properly.

Every single time 1998, 2002, 2012, and now 2018 there has been a pattern. The doctors of the physical being don't connect with the mental health doctors and vise versa. 

Rich's statement, "I can't do anything, I feel weak, a bit dizzy, and feel like I will tip over."

When the depression meds slow down and stop working the anxiety builds. It is slow and insidious. 

Put it all together and the pattern works.

I will say that the VA facility we go to have excellent doctors. Some of the very best! However.

Most of the PCP docs and the psychiatric or psychologists rotate out of the VA every few years. There are no doctors that have been through even one full cycle of depression recovery and the pitfalls with Rich. 

I've been there since 1996 and have seen a pattern develop over the years.

We fight the heart, dizziness, fatigue, mental stress issue with the physical doctors. Nothing seems to work as he declines.

The mental health doctors talk and try to adjust the current mental health medications.

Rich spirals downward until there is a crisis. 

Rich is admitted through the ER.

Rich's 'team' changes his meds and monitor him.

Rich is discharged to home. Much better and out of that dark place. 

We all feel relieved.

We skate on a fine line holding off that dark place of depression for a while until it slowly creeps up again and takes hold.

The cycle starts again.

There is a heart - brain connection. It is there.

The Link Between Depression and Physical Symptoms

Look at the studies regarding dementia and strokes. There are studies also that research depression and its physical manifestations.

Treat only the physical symptoms and the mental issues do not go away.

Testing, testing...

Monday morning was a stress test. Working with a person who has severe depression is and can be very frustrating.

I got him up early so I could get him to take a shower.
"I can't, I have to lay down."
This is where it gets frustrating.
I put my hands on my hips and feel the anger grow. I get a bit snarky, "So why do you need to lay down? Are you dizzy, tired, out of breath..." I take his 02 levels and they are fine.
In my mind that says it is the depression talking. He needs to move, he needs to keep moving.
So I become the bad guy. "Your 02 levels are fine, your blood pressure is good. Do you need me to get the shower chair and help you? Are you dizzy, why do you need to lay down."

I can't help myself here. I am trying to get him ready for a doctor's appointment. I tried all day yesterday to get him to shower and he was too tired. Yet he could watch the streaming on the small flat screen TV for 3 hrs.

He gets angry with me, gives me the look, and goes to lay down. I stand in the bedroom door and fume. I look at the clock, he needs to shower.

That is how the mornings go with appointments at the VA. Nudge, push, push, nudge, frustration and stress at just making the appointment on time in Madison which is 89 miles away.

The stress test came back 'abnormal'. That is all the tech would say. Cardiology called yesterday morning and scheduled an echocardiogram. I wonder how abnormal is really was if the echo is scheduled nearly a month away.

As is our normal routine when not rushing to get ready for an appointment, I left hay out for Rich to feed Bob and Thor. I reminded him that I had an appointment with the manager for his mother's apartment lease.
I contacted the attorney who will be her guardian to get some guidance and told him that I'd bring him lunch back from The Corners Restaurant.

When I returned home, he had his boots on, but was sleeping. I woke him up.
I gave him his burger and fries and then asked how feeding the donkeys went.

"I was too tired," came the answer.

I was quiet for a bit while I made copies of the POA paperwork and arranged some papers for him to sign regarding his mother's paperwork for elderly housing. The lease would not have to be signed until she had the new guardian in effect. That was a huge relief.

Finally I said, "Oh. Okay. I guess that is why they brayed when I drove in. They are hungry."
I got a nasty look and he sighed. "I better go feed them since somebody wants to play psychiatrist and tell me what to do."

I stack my copies of paperwork and shrug.
He stops at the door, "Is it hot out?"
Snarky remarks want to fly past my lips...but I press them closed and then say, "Well it isn't too bad."

He feeds the donkeys and comes in with a huge sigh. "There, don't I look cured! Don't I feel awesome? Don't I want to just run up and down and be fine? Oh look I am all better!"

Picture these words with aphasia and it actually is more drawn out and difficult. But I get the jist. He is angry at being made to move against his will. He wants to just go to bed, which he does for the rest of the afternoon.

I gather up items to go to the forest and go fencing. In my back pack I throw some toys. I won't have time for it,....but you never know.

We ... he argues with me again later after I draw out a map of how I am fencing. I tell him to get on the 4 wheeler and I'll show him.
"Quit trying to be the stupid doctor, I just need meds to make my head better. If my head is better I'll be better. Just stop it."

I let him blurt it all out and listen. I want to say to him that since he has gone out to feed the donkeys daily he has improved. He has anger which is better than two weeks ago when he had no emotion. He takes it out on me of course and I sit there and want to point out the good things that are small baby steps. He won't hear any of it.

I finally tell him that I'm going out to the garden. I leave and am there until nearly dusk.
Surprisingly he does come out of the house and onto the porch. He pulls up a chair and we are friends again as we quietly snap green beans.

Oh yes.
I did have a moment or two for some silliness.
And it makes me laugh.

Toys given to me by neighbors and other kids....
why not? We all need to smile and laugh.

Testing? He tests my patience. It is a good thing I have a LOT of it.