1. Living Positively with a Heart Condition By Shelton Kartun www.anger.co.za

2. 1. Understanding Grief and Loss 2. Responding and adapting to Change 3. Strategies for dealing with Stress 1. Understanding Grief and Loss 2. Responding and adapting to Change 3. Strategies for dealing with Stress

3. Grief and Loss  Grief follows loss and is the response to it.  Loss is the emotional suffering you feel when something or someone you love is taken away from you.  Everyone grieves differently and it depends on your perception of the loss.  Symptoms of grief include shock, disbelief, sadness, guilt, anger, fear, depression and physical symptoms.

4. Losses Primary  Loss of one’s health  Loss of one’s work role  Loss of someone Secondary = less obvious  Loss of independence  Loss of being productive  Loss of lifestyle  Changed appearance  Lower self esteem

5. Change  We have a tendency to resist change.  It creates stress.  It makes a whole range of emotions surface which include insecurity, anxiety, fear, panic, disappointment, anger, upset, unstable, confusion etc.  We can perceive it as positive or negative.  We can respond to it as we do in grief.

6. 5 stages of Grief or Change

7. Grief and Health  Immune System compromised WBC.  Type of heart failure but NOT heart attack.  Depression.  Cancer Risks.  Insomnia  Loss of appetite  High BP and heart problems in general  Fatigue

8. From helplessness to hopefulness  Accept your emotions.  Express your feelings.  Allow time for what YOU need.  Involve and share with family.  Don’t escape into loneliness.  Keep in touch with friends.  Join a support group.  Seek a professional counsellor.  Be nice to yourself and take care.  Grow as a person. In Chinese crisis = opportunity.

9. What is Stress? Physical Stress vs. Emotional Stress? “When you perceive that the demands on you exceed the personal and social resources you are able to mobilize” i.e. I don’t feel I’m coping at the moment

10. Emotional Stress & Heart Disease  People without spouses live shorter  Major life changes – losses, deaths, moves  Those quick to anger or have hostility

11. Emotional Stress & Heart Disease  Those chronically stressed more likely to smoke / drink / exercise less  Adrenalin surges... Blood clotting HA’s  More evidence now it promotes CAD.  The TYPE of emotional stress is important, as is the type of individual (In control or not?)

12. Personality Types Type A  Impatient, Angry, Hostile  Are at higher risk for CAD  Create Stress  More adrenalin Type B  Patient, calm, serene  Lower risk for CAD

13. Stress & Heart Disease  1 in 7 males.... Heart problems <60yrs  2 of 5 adults.... High BP  Release of fatty acids & glucose which converts to fat and cholesterol raising BP by clogging arteries.  Results in chronic hypertension.  With smoking/ caffeine heart rate increases 38 beats per minute.  Slower repair and healing if chronically stressed.  Stress=> Cardiovascular, muscular, respiratory, skin, sexual, GIT, eating disorders and substance abuse.  Stress.... Heart Disease..... Heart Attack

14. How Does Stress Affect Us  Physically?  Emotionally?  Mentally?  Behaviourally?

15. Recognising Destructive Stress  Physical Checklist Cold hands/feet, dry throat, perspiring, back pain, headache, nail biting, skin conditions, muscle tension, sitting tensely, dizziness, aches & pains, grinding teeth, clenched jaw, indigestion, difficulty sleeping, racing heart, tinnitus, tiredness, exhaustion, trembling, weight changes, tummy upset, stooped posture. Cold hands/feet, dry throat, perspiring, back pain, headache, nail biting, skin conditions, muscle tension, sitting tensely, dizziness, aches & pains, grinding teeth, clenched jaw, indigestion, difficulty sleeping, racing heart, tinnitus, tiredness, exhaustion, trembling, weight changes, tummy upset, stooped posture.

16. Recognising Destructive Stress  Emotional Checklist Anger, anxiety, crying, depression, feeling powerless, mood swings, irritability, loneliness, negative thinking, nervousness, sadness Anger, anxiety, crying, depression, feeling powerless, mood swings, irritability, loneliness, negative thinking, nervousness, sadness

17. Recognising Destructive Stress  Mental Checklist Constant worry, difficulty deciding, forgetful, can’t concentrate, lack creativity, lost humour, poor memory Constant worry, difficulty deciding, forgetful, can’t concentrate, lack creativity, lost humour, poor memory

18. Recognising Destructive Stress  Behaviour Checklist Short tempered, withdrawn, minor accidents, achieving less, more mistakes, changes in concentration, eating, sleeping, sex drive, use of medication, more alcohol, cigarettes, tea, coffee, bossiness, compulsive eating, critical, impulsive, relationship withdrawal, job changes. Short tempered, withdrawn, minor accidents, achieving less, more mistakes, changes in concentration, eating, sleeping, sex drive, use of medication, more alcohol, cigarettes, tea, coffee, bossiness, compulsive eating, critical, impulsive, relationship withdrawal, job changes.

19. Stressors Think about your stressors and create a list of what they are when you can so you can determine which things you can change to reduce your stress levels.

20. Stressors  Illness  Death  Relationship problems  Work overload  New job  Unemployment  Retirement  Loss  Crowds  Relocation  Daily hassles  Legal problems  Finances  Perfectionism  Change

21. What Can I Change? CHANGEABLES What stressors are in our control to modify? UNCHANGEABLES What stressor are not in our control to modify?

22. Emotions and Stress  There is a dynamic relationship between your emotional state and your stress levels.  Control your emotional health and you automatically control your stress.

23. Tools and Tips  Time management  Planning & Organisation  Relaxation  Avoid unknowns  Acceptance

24. Tools and Tips  Environmental eg. Commuting, Workplace  Exercise  Diet  Habits  Outlook  Boundaries

25. Stress Management Tips  Walking or swimming  Vitamin supplements and anti-oxidants  Yoga, pilates, meditation  Relaxing Baths  Aromatherapy, massage  Time Out  Move into forgiveness, communication, gratitude and understanding

26. Stress Management Tips  Use a support network eg family  Avoid addictions eg alcohol, smoking, drugs  Build skills  Reduce excess weight  Set and pursue realistic goals  Practice tolerance, flexibility, adaptability

27. Stress Management Tips  Get enough sleep  Recognise what you can change  Use positive affirmations  Don’t try and please everyone  See stress as something that you can cope with  Learn to say NO

28. Stress Management Tips  Sooth tired eyes  Massage tense muscles eg shoulders, neck  Do muscle relaxation  Drink plenty water and avoid cold-drinks and too much tea and coffee  Follow a well-balanced healthy eating plan  Moderate, gentle exercise

29. Stress Management Tips  Practice Mindfulness – take your time and observe  Attend to your spiritual needs  Take short, grounding 5 min breaks throughout the day  Relax with friends  Make regular contact with nature  Deep breathing

30. The Power of Your Thoughts THOUGHTS AFFECT FEELINGS AND BEHAVIOURS THOUGHT FEELING BEHAVIOUR

31. Common Stressful Statements  It will never work  I don’t have time  I tried it and it did not work  There’s too much to do  I feel terrible  I just don’t know what to do

32. Stress that Motivates  Using motivational rather than stressful self-talk will get you through the day. We CAN change our belief systems!  Stressful Self Talk = There is nothing I can do!  Motivational Self Talk = There is always something I can do!

33. What we say makes the difference! Make the choice!  I always have choices  There is always something that I can do  I turn problems into opportunities  I keep myself in a good mood  I finish fully and I feel good  I am making a solid contribution in my job  This is a good day

34. Thriving on Stress  See change as a challenge rather than a threat  Commit yourself to handling the situation  Start believing that you have some degree of control over the situation  Take responsibility for discovering your solutions  Be willing to talk about it  Celebrate success, however small it might be. “The Longest Journey Starts with Just One Step” (Tao Te Ching)

35. Relaxation – the learned skill  Deep breathing  Progressive muscle relaxation  Guided imagery  Meditation, yoga, pilates  Music and hobbies  Biofeedback  Pampering – massages, baths etc

36. Quick Stress Buster 1. Sit comfortably with eyes closed. 2. Take slow deep breaths in for a count of 5 and out for a count of 5. 3. After 20 breaths open your eyes and re-adjust.

37. Risk Factors  Non-controllable Family history of CHD males<50; females<60 Family history of CHD males<50; females<60 Men 55+; women 65+ Men 55+; women 65+ Post menopausal women/ no ovaries Post menopausal women/ no ovaries Chronic Kidney Disease Chronic Kidney Disease  Controllable Smoking/ Drinking High cholesterol Obesity/ Lack of exercise Hypertension Diabetes  Atherosclerosis Metabolic syndrome Increased C-reactive Protein CRP Psychological stress

38. Conclusion In conclusion, living with heart disease is a challenge, and presents with significant medical and psycho-social impacts. Heart disease of any form has a profound impact on a person's lifestyle, and it can often be hard for a person to change their lifestyle in response to a health problem. Nonetheless, it is still possible to enjoy a high quality of life and standard of living with appropriate medical advice and the support of family and friends. Thank you Shelton Kartun In conclusion, living with heart disease is a challenge, and presents with significant medical and psycho-social impacts. Heart disease of any form has a profound impact on a person's lifestyle, and it can often be hard for a person to change their lifestyle in response to a health problem. Nonetheless, it is still possible to enjoy a high quality of life and standard of living with appropriate medical advice and the support of family and friends. Thank you Shelton Kartun

39. Contact Details Website: www.anger.co.za Email: info@anger.co.za TEL: 021 554 3661 FAX: 086 610 6540 The Centre covers all of SA and offers stress, conflict and anger management to individuals, couples and Organisations. The Director of the Centre is Shelton Kartun B.Sc (Hons) DMS M.ASC M.BAAM