Expert Guest Chat Log
Topic: The Emotional Side of PH
Date: January 22, 2000
Guest: Dr. Armond Aserinsky, Clinical Psychologist

<Moderator> *** The guidelines for this chat are: ***
<Moderator> *** If you have a question during the chat, please type and send a "?" ***
<Moderator> *** I will then add you to a list of others who have a question. ***
<Moderator> *** I will call on you to state your question when you reach the top of the list. ***
<Moderator> *** Dr. Aserinsky (Armond) will then send a reply to the room. ***
<Moderator> *** I will ask you if you have a "follow-up" question. ***
<Moderator> *** If you have a follow-up, please ask it. ***
<Moderator> *** If not, please state that you do not, I will call on the next person with a question. ***
<Moderator> *** I may need to repeat these instructions as more people enter the room ***
<Moderator> *** This chat will proceed more slowly than our free form chats because... ***
<Moderator> *** The guest speaker may need time to formulate a reply ***
<Moderator> *** Thanks for your patience everyone!!! ***
<Moderator> *** We will open-up the room as "free form" chat once we have finished ***
<Moderator> *** We are making history today. First ever, online, PH expert chat!! ***
<Moderator> *** Are there any questions about the chat guidelines? ***
<Moderator> *** OK, let's begin. If you have a question for Armond, please send a "?"
<dtpchick> ?
<Moderator> Go ahead vickie
<dtpchick> Thanks
<dtpchick> How should one deal with a therapist's assumption that lack of oxygen may be at the root of emotional problems and their expression?
<Armond> Thinking…
<dtpchick> k
<Armond> Does this therapist have experience in dealing with people who have a chronic illness?
<rhonda> Do you know of any nat'l list online that i can visit to get emotional support for PH?
<Moderator> Rhonda, please wait.
<dtpchick> That I don't know, but I doubt it.
<Armond> In that case,
<Armond> The therapist does not "understand" you.
<Moderator> Follow-up Vickie?
<dtpchick> y
<dtpchick> How much help should the patient expect (emotionally) from his/her PH doctor?
<Kathy-Texas> ?
<Armond> In my experience, many physicians prefer to have this aspect of treatment handled by another specialist.
<Moderator> Rhonda, your question?
<dtpchick> thanks
<rhonda> is there a nat'l list where one can get emotional help for PH?
<Armond> None that I am aware of. This is just the kind of thing that we ourselves are going to build from the ground up.
<Moderator> Rhonda, follow-up?
<rhonda> no....thanks
<Moderator> Other questions?
<Kathy-Texas> ?
<dtpchick> Kathy-Texas had one
<dtpchick> :-)
<Moderator> Go Ahead kathy
<Kathy-Texas> Can lack of O2 cause emtional stress
<Armond> YES.
<Armond> The brain is highly sensitive to changes in oxygen level.
<Armond> It is a great strain to try to function fully when one is oxygen deprived.
<Moderator> Kathy, follow-up?
<Kathy-Texas> Can it cause crying for no reason
<Armond> Yes and no....
<Armond> That is, yes it can cause crying
<Armond> But not for 'no reason.'
<Armond> The reason for crying is frustration.
<Moderator> Other questions?
<Kathy-Texas> Thanks Armond. I have no more questions now
<Pat K> ?
<Moderator> Go ahead Pat.
<Pat K> If one is seeing a therapist or looking for one, how will they know they have a therapist that is qualified to treat him/her?
<Armond> In the case of a therapist who is going to deal with a chronic physical disease in a patient
<Pat K> I guess I'm asking what traits or qualifications one should look for
<Armond> it is essential that the therapist have special background.
<Armond> Well....the easiest solution is to start with a psychiatrist since they are medical doctors.
<Armond> They will at least have some basic understanding of the medical issues.
<Moderator> Follow-up Pat?
<Pat K> No, thank you.
<mcats> ?
<Moderator> Go Ahead MCATS
<mcats> how do you deal with an overprotective spouse who is treating you like an invalid.
<Armond> The spouse needs to have some conversations directly with the patient's specialist.
<Armond> He needs a chance to voice his/her worries and to ask questions about the patient's capabilities.
<Moderator> Anyone who has a question, please feel free to send a "?" at any time and I will add you to a list. MCATs, follow-up?
<mcats> no. thank you.
<Moderator> Other questions?
<rhonda> how do you get someone with PH to open up to you when they don't like to talk about "bad things"?
<marty> ?
<Moderator> Armond will address Rhonda's question
<Moderator> Marty, you will be next
<Armond> Rhonda....
<Armond> The question is whose need is being addressed in your question?
<Moderator> Rhonda?
<rhonda> Person with PH
<Armond> So you think that the patient's not talking about the disease is harmful to her?
<rhonda> Is it?
<rhonda> she just found out
<Armond> Not necessarily...
<Armond> it takes people some time to digest an unpleasant fact....
<Armond> so I would say that as long as the patient is following her specialist's orders...
<Armond> she's doing o.k. at this stage of the game.
<Moderator> Marty, your question?
<marty> HOW CAN ONE GET OVER THE FEELING OF ALL THIS
<Armond> That is a good question and a big one.....
<Armond> I'm tempted to ask if you have had a consultation with a person who can treat depression.....
<Armond> It is extremely common in people with serious illnessess.
<Moderator> Marty, follow-up?
<marty> YES
<Moderator> Go Ahead.
<rhonda> do you think a person need therapy after just being diagnosed with PH?
<marty> I AM NOT DEPPRESSED I AM USED TO WORKING 40 HOURS OR MORE A WEEK
<Moderator> Hold on Rhonda.
<Armond> Marty,
<Armond> the word depressed is kind of an umbrella term...
<marty> NOW I DONT WORK AT ALL
<Armond> I didn't mean to imply that you were just down in the dumps and moping...
<Armond> You've had a major change in your life. .....
<Armond> It's like a retirement that you hadn't planned on.
<Moderator> Rhonda, go ahead.
<mcats> ?
<Armond> We'll go back the your question about therapy...
<Moderator> Those that are new, please send a "?" if you have a question for armond.
<Debbie> ?
<Armond> All people who are diagnosed with a serious illness should be considered for some kind of...........
<Armond> Emotional support.....
<Armond> It should be a routine part of the patient's evaluation.
<Moderator> Rhonda, follow-up?
<dtpchick> she's gone
<Moderator> Mcats, your question?
<Moderator> debbie, you will be next.
<mcats> what do you say to peers/co-workers when they tell you it's "all in your head". They don't understand you can still work/do things, just not at the quality/speed you used to.
<Armond> Thinking.....
<Armond> It is a tough question. PH is an invisible disability that affects nearly every organ in the body....
<Armond> including the brain....
<Moderator> mcats, follow-up?
<Armond> More....
<Moderator> Armond is going to eleborate.
<mcats> brain = slow thinking? is that normal? definitely affects work.
<Armond> You will have to educate your co-workers.
<Armond> Yes thinking can be slowed. Have you measured your oxygen saturation while you are working?
<mcats> no. will ask doc. thank you.
<Armond> To elaborate further...
<Armond> One of the most dramatic pieces of 'evidence' that you are different physically from your co-workers....
<Armond> is to use a portable oximeter on yourself and then on others in the room with you.
<Moderator> Debbie, your question?
<Debbie> How can we best provide "therapy" to ourselves, e.g. reduce anxiety in a moment of panic, maintain a positive attitude? Are there techniques you can suggest?
<Armond> Good question...
<Armond> First of all, whatever is worrying you can be 'checked out' with other patients or caregivers through...
<Armond> the listserv or message boards. Sometimes we just need to air out something that is gnawing at us....
<Armond> with someone else in the same boat.
<Moderator> Debbie, follow-up?
<Debbie> yes
<Debbie> I'm thinking more of immediate situations - like being alone driving somewhere and feeling vulnerable all of a sudden, a quasi-panic attack
<Armond> Ohhhhh....
<Armond> Quite different....
<Armond> I think it is a good idea for all PH patients to travel with a cell phone and to know who they can reach...
<Armond> at any moment. Now, with panic attack in a person who is not ill, the approach is somewhat different....
<Armond> but I think the reality of feeling vulnerable cannot be ignored when you have PH.....
<Armond> So, be prepared and you will feel better. Equip your car with anything you will need.....
<Armond> so that you can wait patiently by the side of the road for a tow truck if the car stops running.
<Armond> etc, etc.
<Debbie> There must be a way to simply get oneself under control - calm oneself down. I know I do it somehow when needed, but can't explain it to others. Am hoping you can - but I don't mean to put you on the spot.
<dtpchick> ?
<Moderator> Armond is thinking...
<Armond> Well, Debbie,
<Armond> one can talk to one's self in a kind of firm but kind parental way just saying 'nothing is happening here that is going to result in my immediate demise.'
<Armond> A little humor.
<Moderator> Vickie, your question?
<dtpchick> yes, and it's related
<Moderator> ok.
<Debbie> Humor actually works best for me! Thanks, Armond, and you're absolutely right about the cell phone. It has kept me quite independent!
<dtpchick> Isn't a panic attack a panic attack regardless of the reason? I mean, aren't there treatments for people who experience them in such a way that they are debilitating?
<Moderator> Anyone else with a question, please send a "?"
<Moderator> Armond is thinking...
<Armond> Vickie, there is such a thing as a panic attack. The approach to treatment is to understand the basis of the fear....
<Armond> that induces the panic and then do something about that fear....
<Armond> In some cases, just understanding what is driving the fear will diminish it....
<Armond> In other cases one takes concrete steps to provide oneself with an environment that seems safer and more secure.
<Armond> If, despite all psychological measures....
<Armond> the panic continues, then it may be necessary to employ anti-anxiety medication.
<Moderator> Vickie, follow-up?
<dtpchick> y
<Moderator> Go ahead.
<dtpchick> So then, your advice would be for the person experiencing panic attacks that he/she seek the help of a therapist to address the reason for the fear?
<Armond> Very often the basis of the fear is not apparent to the sufferer....
<Armond> So, yes, it is helpful to have a trained person.
<dtpchick> ok... thanks!
<Moderator> Anyone else with a question for Armond, please send a "?"
<ann> ?
<Moderator> Go ahead Ann.
<ann> I'm not really sure how to put this...
<ann> How do you deal with the fears of a spouse when you're so wrapped up in fear yourself?
<Armond> Ann, the patient cannot provide reassurance to her/his spouse....
<wrighton> ?
<Armond> It is important for the spouse to embark on his/her own program of understanding and mastery of the situation.
<Moderator> Ann, follow-up?
<ann> no - thank armond!
<Moderator> Anyone else with a question for Armond, please send a "?"
<dtpchick> wrighton
<Moderator> Sorry, go ahead Margaret.
<wrighton> I have difficulty expressing strong emotions because I cannot breath and emote. I am avoiding emotional situations but am not sure how to cope with strong emotions should the need arise. Any suggestions?
<Armond> Margaret, this is a special challenge for PH patients. When anyone gets angry or excited, their heart rate rises....
<Armond> ordinarily, this is not a problem....
<Armond> But, when you have PH, the rising heart rate leads to decreased oxygen saturation....
<Armond> One solution is to be sure to get things off your chest (pun intended) a little bit at a time....
<Armond> We often wait until things build up and then we kind-of explode....
<Armond> That is a bad idea for anyone. So, if you practice knowing how you feel at all times, and letting others know, then you will not work yourself into a volcanic state.
<Moderator> Margaret, follow-up?
<jade> ?
<wrighton> Yes
<Moderator> Go ahead Margaret
<Moderator> Jade you will be next
<wrighton> If one of my ailing parents were to die, I know that I would have trouble coping with the extreme emotions. Any suggestions?
<Armond> Margaret, it is good that you are aware that this time is approaching. I think it would be best if you consulted with a psychiatrist who will be able to help you with some medication to keep your feelings moderated.
<Moderator> Jade, go ahead with your question.
<jade> Margaret just asked the question I was going to ask.
<Moderator> Oh, ok.
<Moderator> Anyone else with a question for Armond, please send a "?"
<Moderator> If there are no more questions.....