Surgeon Marc Wallack was seven minutes into his run through Central Park in 2002 when he felt chest pain that he attributed to stress and indigestion. It happened again the next day, and again on a subsequent run. Finally, unable to ignore the telltale warning sign of heart problems, Wallack went to see a cardiologist and was told that all four of his coronary arteries were more than 95 percent blocked. He needed immediate open-heart surgery—a quadruple bypass—which he sailed through successfully from a physical standpoint, but psychologically left him feeling broken. "I woke up from the surgery and wasn't the same person," recalls Wallack, who is vice chair of the department of surgery at New York Medical College. His fears overwhelmed him. "I worried I was never going to operate again, pay my mortgage, support my family; every time I ate I could visualize the plaque going back on my arteries."
And he fantasized about dying, a hallmark of depression, which afflicts one in five patients after heart surgery and one in three heart attack survivors. Wallack knew other colleagues in the same boat; one had to quit his medical practice as a result. And Wallack knew that his depression, if left untreated, would dramatically increase his likelihood of more heart complications. So he and his wife, Fox News anchor Jamie Colby, devised an 8-step comeback plan and detailed it in their recently released book Back to Life After a Heart Crisis. "It was about helping to bring him back amongst the living," says Colby. For Wallack, that meant training for another marathon, which he managed to complete two years after his surgery; for Colby, it meant getting her husband through doctor's appointments, navigating him through career changes, and convincing him to see a therapist. Anyone who has been through heart surgery, Colby says, can benefit from trying the following:
Step 1: Take one night at a time. Most bypass surgery patients experience sleep problems initially, according to surveys, with many finding that the problems become chronic. "I'd close my eyes at night and worry that my heart wasn't going to continue to beat," recalls Wallack. What helped? His wife's reassuring words. "One night we were lying in bed and I had my head on his chest listening to his heart beat," says Colby. "I said, Marc, your heart is so loud, it's beating stronger than I've ever heard it before; I think that helped him." Regular visits to a psychiatrist and prescription sleeping pills (which he now only takes occasionally) also brought better sleep for the first few months. In addition, Wallack used a night-light and slept with the shades open to avoid total darkness, which he associated with death. And he initially took mid-morning naps since his fears didn't plague him during daylight hours as they did at night.
Step 2: Face the pain head-on—both the physical and the emotional. While Wallack took strong painkillers in the days following his surgery, he credits his wife for helping him avoid a potential addiction; she made him stop taking the pills after eight days once his physical pain had subsided. The pills, he writes, "made me high and lifted my severe postoperative depression" but were not safe in the long-term. Instead, he started seeing a therapist and was prescribed antidepressants. His therapist helped him realize that he was actually experiencing post-traumatic stress disorder, common in war veterans and rape victims, but also in those who have been through life-threatening medical experiences. Through counseling, Wallack learned to use his heart attack fears as a way to motivate himself to get healthy through cardiac rehabilitation, stress management, and dietary changes. Colby helped boost her husband's spirits by renting uplifting action movies like Rocky and Rambo and screening gifts and cards sent by well-meaning but sometimes misguided loved ones. One card that she initially hid from him had a depressing message saying: "So sorry you went through this; someday you'll recover."
Step 3: Get out, even if only to the supermarket. It took three weeks for Wallack to leave his New York City apartment after his surgery, and when he finally did he was mistaken for his wife's elderly father because he looked so frail and sickly. Still, he writes, after getting back from that outing, he had confidence to go on another. He recommends preparing by first visualizing the experience and reminding yourself that those first social interactions are bound to be a challenge.
Step 4: Plan for doctor's appointments. Each doctor's visit filled Wallack with fear that he would fail his cardiac stress test or have a scan that would detect new blockages. But after emerging from several without problems, the appointments became easier to bear. He also learned to call his cardiologist whenever he was concerned about a medical issue like his heart beating too rapidly after climbing a flight of stairs. And to keep Wallack's spirits up, Colby accompanied him to his initial appointments and privately asked the doctor to make at least one positive comment during every visit.
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Step 5: Don't ignore the sex issues. Wallack admits that he worried about dying during sex and that he wouldn't have the physical strength to perform. Colby was also scared about her husband's wellbeing and whether she'd feel desire for him in his weak and frail state. The two took things slowly, she writes, starting first with just cuddling and caressing with candlelight and music before trying the real thing. Getting your doctor's OK to have sex after surgery is important, but so too is sharing your fears with your loved one.
Step 6: Learn to trust food again. Doughnuts and fried bacon used to be among Wallack's favorite foods, but now he rarely eats sweets or junk food. His fears of having more heart problems serve as an effective deterrent. Still, he initially had to overcome his worry that any bit of dietary fat, even the small amount in chicken soup, would clog his arteries; in fact, he had no appetite for weeks following his surgery and as a result his weight dropped to 140 pounds on his 6-foot frame. Relaxation exercises like deep breathing helped him get through those first small meals. He also used meal replacements like Ensure to provide extra calories. But what really helped, he said, was simply talking a leisurely walk to his favorite restaurant, which calmed his anxiety and helped rebuild his appetite. Now he visualizes how the nutritious foods he eats—fruits, vegetables, fish—are helping his heart. And whenever he's tempted to eat a hot dog or cheeseburger, he imagines the fat from the food collecting on his blood vessels—a sure-fire way to kill the temptation.
Step 7: Arm yourself against toxic coworkers. Stepping back from a demanding job can be tough following heart surgery, but sometimes it's a necessity. Wallack found he could no longer take the pressures of his 15-hour-a-day schedule or the coworkers who treated him as if he were still sick, questioning his fitness as a surgeon when he returned to the operating room two months after his surgery. He wound up getting fired, which he says turned out to be a blessing because it forced him to take a less demanding position at a hospital closer to home. The cut in salary and prestige scared him at first until his wife sat him down and explained that his job was what he did but wasn't who he was. That little speech, Colby says, helped her husband realize that while he might not have control over his heart, he did have control over how he defined himself.
Step 8: Train for a physical challenge. Always wanted to scuba dive? Climb Kilimanjaro? Do the three-day breast cancer walk? Gearing up for a physical challenge following heart surgery, Wallack says, is a great way to feel alive again. He himself began training for a marathon after he got his doctor's OK following six months of rehabilitation exercise classes. He finished the race two years after his surgery and has done three marathons since. While supportive of her husband, Colby admits that his long races scare her, including the marathon he has planned for Sunday. "I'm always waiting at the finish line with bated breath," she says. But she's also reassured knowing that she played a key role in getting him there.