Advances in Aortic Stenosis

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6 Tips to Manage Anxiety Before Your TAVR Procedure

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6 Tips to Manage Your Anxiety Before Your TAVR Procedure
Susan Strong and her partner, Darryl, after her TAVR procedure.

If you have severe aortic stenosis and find yourself feeling anxious about your diagnosis and your upcoming transcatheter aortic valve replacement (TAVR) procedure, you’re not alone. As someone who went through my own TAVR a few years ago, I know that what you’re feeling is perfectly normal. With aortic stenosis, the heart’s aortic valve doesn’t open fully, so blood can’t flow from your heart out to the rest of your body. Severe aortic stenosis is life-threatening if not treated. While the vast majority of valve replacements are successful, receiving such a frightening diagnosis forces you to face your own mortality, which can be scary, to say the least.

After my diagnosis, and leading up to my TAVR, my anxiety and stress levels were through the roof, and I’ve heard the same from many other patients of all ages. The silver lining of all this? I’ve learned so much about anxiety, and I’ve developed tools I can use to better manage stress in all parts of my life.

Facing Your Own Mortality

Anxiety is our body’s normal reaction to stress and perceived danger. The anxiety you feel after a diagnosis of severe aortic stenosis won’t be resolved within minutes or hours; the stress of your diagnosis can become chronic over the weeks or months between diagnosis and treatment. Facing your own sense of mortality during a time of uncertainty can feel very lonely, and many people don’t admit their feelings and fears to loved ones or their doctors–which can make you feel even more alone.

Even though the risk of mortality is very low with TAVR–and it’s performed so that people with severe aortic stenosis can live longer, fuller lives–I vividly remember lying awake in the hospital the night before my procedure, wondering if it would be my last night on earth. To some, this may seem irrational, but many patients I’ve talked to have felt the same fear. After my diagnosis, I even made a point to meet with a lawyer to update my will, something I’d been putting off for a few years. But once I was told that my heart wasn’t able to do its job, it became a priority.

Another challenge facing patients with severe aortic stenosis is that many of the physical symptoms of valve disease and anxiety overlap, like palpitations, increased heart rate, shortness of breath, and chest tightness. When we experience these symptoms, we may fear our condition is worsening, which creates uneasiness and anxiety, which can create more symptoms… which sounds like the start of a vicious cycle.

If reading this is stressing you out, don’t give up hope. Fortunately, the body’s parasympathetic nervous system can be activated to calm the body, slow breathing and heart rate, relax muscles and return the body to a balanced state. And the good news is we can take specific actions to make that happen, even during chronic stress, in order to find relief from the uncomfortable symptoms of anxiety.

Caring for yourself and taking action are key. First, understand the anxiety you’re experiencing is simply biology, not a character flaw or weakness. Fortunately, there are many strategies you can try to restore your sense of balance and well-being. Here are a few of mine.

1. Talk it out with someone you trust.

You might feel alone with your fear because very few people are comfortable hearing about it. If you do open up, friends, family, and even healthcare providers may be quick to dismiss your feelings, hoping to make you (and themselves) more comfortable. You may keep your fears to yourself, telling yourself you shouldn’t feel anxious. But we don’t have to suffer in silence with anxiety, which typically only makes us feel worse. Talking to a close friend, a therapist, or another patient who has been in a similar situation and understands your fear can bring relief and the realization that you are not alone. It also helps us acknowledge that our current situation is stressful, it’s understandable to feel anxious, and there’s no shame in asking for help.

2. Let your doctor know.

If your stress is impacting your life significantly and you’re having trouble sleeping or experiencing painful muscle tension, stomach pain, trembling, restlessness, or difficulty concentrating, you may benefit from short-term medication to help you manage until your symptoms subside. You don’t have to tough it out. It can also help to more fully understand your TAVR procedure; if you know what to expect, you may find your stress levels decreasing. Don’t be afraid to ask your doctor any questions you have about your aortic stenosis and valve replacement. Before my TAVR, I asked my doctor if I could speak with a patient who had already gone through the procedure, and I was connected with Bill, who’d been in my shoes just a few months earlier. Learning about his experience and how grateful he was for his new lease on life helped me feel confident and soothed many of my fears.

3. Make positive lifestyle changes.

Following a heart-healthy diet that focuses on real foods like vegetables, fruits, whole grains, and lean proteins helps you feel good, both physically and mentally. Reducing or eliminating processed foods, excessive caffeine, alcohol, and sugar also can improve all aspects of your health. Along with diet, prioritizing sleep can make a huge difference in your health and quality of life. Practice good sleep hygiene by going to bed and getting up at the same time every day. Establish a bedtime routine, which includes shutting off electronics an hour or two before bedtime. Allow for 7 to 9 hours of sleep each night. Try keeping a gratitude journal and develop the habit before bedtime of listing three things from the day that gave you joy and a sense of gratitude.

When you notice your thoughts are focused on “what ifs” and worries, do something to “change the channel” mentally. Try a guided meditation from an app on your phone or an online video. One that helped me was titled, “Meditations for a Successful Surgery.” You might read or listen to something inspirational. Ask yourself, “what is soothing to me?” Some ideas could be massage, aromatherapy, a weighted blanket, drawing or coloring, reading, or listening to music. Pick something from your list and commit to focusing only on that one activity for a little while. It takes practice, but after a few tries, stopping your anxious spiral in its tracks will become increasingly easier.

4. Be intentional about calming your anxious thoughts.

When you notice your thoughts are focused on “what ifs” and worries, do something to “change the channel” mentally. Try a guided meditation from an app on your phone or an online video. One that helped me was titled, “Meditations for a Successful Surgery.” You might read or listen to something inspirational. Ask yourself, “what is soothing to me?” Some ideas could be massage, aromatherapy, a weighted blanket, drawing or coloring, reading, or listening to music. Pick something from your list and commit to focusing only on that one activity for a little while. It takes practice, but after a few tries, stopping your anxious spiral in its tracks will become increasingly easier.

5. Enlist your support system for help.

Cafe Gratitude

Severe aortic stenosis can make it difficult to manage routine tasks or exert a lot of effort, so don’t be afraid to ask for help when the stress of your to-do list is mounting. Friends, family members, and neighbors are often happy to assist you, especially when you let them know what you need. And that doesn’t only apply to your everyday tasks; always ask for emotional support when you need it. My partner, Darryl, gave me the greatest gift when I felt most afraid and my mind went round with worries about every possible thing that could go wrong with my TAVR. He gently reminded me of all the ways things could go right: that I would feel strong again and able to breathe better, that I would again enjoy dancing at my Zumba class and taking hikes. He reminded me what it would look like to have my life back. And this is one of those times I don’t mind saying, “Honey, you were right!”

6. Give yourself a break.

Be good to yourself. Give yourself permission to feel what you feel and need what you need. It’s OK to slow down, to say “no,” or leave non-essential tasks undone. Remember to be kind to yourself, just as you are kind to others.

Reducing stress will put you in a much better position for both your TAVR procedure and your recovery. Once you add new stress-busting skills to your routine, coupled with improved quality of life from your new heart valve, you just might find yourself feeling better than ever!

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