Surgeries and mental health

Jim Killackey, Staff Writer

Published: May 25, 2008

After four cardiac-arrest episodes in 2007 and this year’s implant of a device to help her heart rhythms, Oklahoma City minister Loyce Newton-Edwards hit a “mental slump” that made getting up each morning a challenge.

She pondered her own mortality and wondered what role — if any — she’d play in the future of her grandchildren.

Her depression worsened until she met psychologist Dr. Chris DuRoy. He and other Oklahoma psychologists and psychiatrists are helping patients before and after surgical procedures — including open-heart surgery, back procedures, organ-transplants, stomach-stapling and even cosmetic surgeries.

At Bone & Joint Hospital in Oklahoma City, one surgeon uses a psychologist to evaluate patients if they are having implants of either a spinal-cord stimulator or a morphine-pain relieving pump.

DuRoy is employed at the Oklahoma Heart Hospital, where Newton-Edwards, 63, associate pastor of the Church of the Open Arms, received an implantable cardioverter defibrillator, or ICD. It gives her heart an electric shock when needed.

“The whole reason that I am here at the Oklahoma Heart Hospital is because of the research that was popping up showing that people who have heart disease or have had heart surgery are at much greater risks to suffer from depression,” DuRoy said.

“Studies also have shown that those who are suffering from depression are more likely to experience some sort of cardiac event like a heart attack or a stroke,” DuRoy said.

All patients admitted to the heart hospital are screened for depression.

With Newton-Edwards, the psychologist helped her procure prescription medications for her depression and fully explained how her ICD worked. He also helped her through her anxieties.

He explained to Newton-Edwards that ICDs play a role in preventing cardiac arrests in high-risk patients like her.

“I don’t go to sleep every night any more wondering if I’ll wake up,” Newton-Edwards said.

Oklahoma City psychiatrist Dr. Murali Krishna was a pioneer in the trend by serving as a consultant to surgeons doing heart-transplant surgeries locally. He worked with patients and their families before, during and after the surgical procedures.

Dr. Stewart Beasley, an Edmond psychologist, now routinely works with patients recovering from open-heart surgery, back surgery, cancer surgery, and weight-loss surgery.

“My experience is that surgery patients are often unprepared for the long period of recovery necessitated by invasive surgical procedures,” Beasley said. “Many become impatient and try to rush the healing process — sometimes leading to a longer recovery period.

“Many experience anxiety and panic attacks. Some experience depression because serious illnesses can result in long periods of inactivity. Patients feel out of control of their body and therefore their life,” Beasley said.

Often, Beasley said, he’s called to the bedside of patients by their primary physician or surgeon.

Sometimes, nursing staff alert the surgeon to signs of depression, anxiety or despair. “Sometimes I’m asked to visit patients in intensive-care units or cardiac intensive-care units where surgical patients were recovering,” he said.

“I was familiar with hospital settings, and it seemed to me that medical staff — including nurses and physicians — saw me as an ally who could assist in areas they didn't feel trained to treat,” said Beasley, who’s on staff at Mercy Health Center, Oklahoma Heart Hospital, and Edmond Medical Center.

Psychologist Dr. Rhonda L. Johnson, assistant clinical professor at the University of Oklahoma Health Sciences Center in Oklahoma City, work primarily with women who have been diagnosed with a gynecologic cancer or breast cancer.

“When I first started this job six years ago, both the patients and the traditional medical team were unsure how to integrate a psychologist into the clinical care setting,” she said.

“Over time, it seems both patients and the physicians appreciate having someone to address the emotional reaction to the diagnosis and treatment.

“I visit patients while they are seeing their doctor, receiving chemotherapy, or if they have to be hospitalized for complications of the disease or its treatment. My care is truly is integrated into their total care,” Johnson said.

Having a psychologist as part of the treatment has become more important as cancer therapies have changed, Johnson said.

“Even seven or eight years ago, when individuals heard the ‘C’ word they immediately thought of end of life. With advances in screening, cancer is found earlier and with improved treatment therapies, there is a growing cohort of cancer survivors,” Johnson said.

“As a group, these survivors have begun asking that their emotional, nutritional, and spiritual needs also be addressed during the time of their cancer treatment and afterward,” she said.

“One of my favorite mantras for those undergoing treatment is ‘Don't let cancer take today.’ The point of all this treatment is to keep cancer from taking time away; if you spend today so depressed or anxious that you didn't interract with your loved ones in the way you want, cancer got this day,” Johnson said.

Medical procedures that may benefit from psychological and psychiatric assistace

— Major back surgery such as spinal fusion. Just as in heart surgery, depression tends to slow down recovery from such procedures and can interfere with obtaining full recovery from surgery.

— Transplant surgery. Most transplant surgeries require a pre-operative psychological evaluation. Patients who have major depression or other emotional disorders may not be good candidates for transplants due to the potential for a poor recovery because of an emotional disorder.

— People who undergo pacemaker or defibrillator implantation for the treatment of congestive heart failure often require psychological or psychiatric intervention because of the anxieties associated with relying a on a battery-operated device to keep you alive; the fear of being shocked by the defibrillator, and the depression associated with living with congestive heart failure.

— Patients who undergo implantation of dorsal column stimulators to manage pain need pre-operative psychological evaluation because some patients may have mental illness such as schizophrenia or bipolar disorder — which may include a component of paranoia that could result in adverse reactions to the surgery. Additionally, a patient’s expectations may be unrealistic for what the surgery might accomplish, and they may have subsequent depression as a result.

— Several cosmetic surgeons utilize psychological evaluation for people undergoing cosmetic surgery. A 15-year study of women who received breast implants shows they have a suicide rate that is 73 percent higher than the general population. The theory is that too many women who have cosmetic surgery to not only change their appearance but to change the way they feel about themselves don’t find satisfaction with the surgery. Unmet expectations can lead to worsening depression or other emotional difficulties.

— Source: Dr. Chris DuRoy, licensed psychologist, Oklahoma Heart Hospital, Oklahoma City.

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