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

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

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

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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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,

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?

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

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

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

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

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

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

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

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,

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

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

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

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

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

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

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.

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

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

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

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

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

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

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.

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.

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

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

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

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

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

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

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

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

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

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

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

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

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,

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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,

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,

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.

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

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

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?

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

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

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.

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

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

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

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

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

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,

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

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

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

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

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

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

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,

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

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

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

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

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

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

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

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

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

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.

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

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.

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

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.

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

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

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

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

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

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.

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

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,

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.

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

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

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.

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

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

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.