Hostility and Cardiac Rehabilitation: In reply

Abstract

In our recent publications demonstrating marked benefits on reducing levels of hostility1Lavie CJ Milani RV Effects of cardiac rehabilitation and exercise training programs on coronary patients with high levels of hostility.Mayo Clm Proc. 1999; 74: 959-966PubMed Google Scholar as well as other adverse behavioral characteristics (especially depression and high levels of psychological distress2Milani RV Lavie CJ Cassidy MM Effects of cardiac rehabilitation and exercise training programs on depression in patients after major coronary events.Am Heart J. 1996; 132: 726-732Abstract Full Text PDF PubMed Scopus (197) Google Scholar, 3Milani RV Lavie CJ Prevalence and effecls of cardiac rehabilitation on depression in the elderly with coronary heart disease.Am J Cardiol. 1998; 81: 1233-1236Abstract Full Text Full Text PDF PubMed Scopus (113) Google Scholar, 4Lavie CJ Milani RV Cassidy MM Gilliland YE Effects of cardiac rehabilitation and exercise training programs in women with depression.Am J Cardiol. 1999; 83: 1480-1483Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar, 5Milani RV Lavie CJ Behavioral differences and effects of cardiac rehabilitation in diabetic patients following cardiac events.Am J Med. 1996; 100: 517-523Abstract Full Text PDF PubMed Scopus (88) Google Scholar, 6Lavie CJ Milani RV Cardiac rehabilitation programs markedly improve high-risk profiles in coronary patients with high psychological distress [abstract].Circulation. 1999; 100: I-825Google Scholar we used nonspecific therapy with cardiac rehabilitation and exercise training. We agree with Mr Fogel that more specific psychological treatment aimed directly at reducing high levels of behavioral abnormalities, particularly in patients with more adverse profiles or persistently abnormal profiles after cardiac rehabilitation and exercise training, would likely result in more dramatic improvements than we have noted with our nonspecific and general treatment. Obviously, the benefits of these additional and more costly treatments will need to be proven and shown to be cost-effective before additional therapies become acceptable to clinicians, who have largely been slow to accept the importance of various forms of psychological distress on medical illnesses and, especially, cardiovascular diseases. Lyme Disease and PseudotumorMayo Clinic ProceedingsVol. 75Issue 3PreviewTo the Editor. I was surprised, after reading the November 1999 Residents’ Clinic,1 that Lyme disease was not included in the differential diagnosis of increased intracranial pressure, especially since Minnesota is an endemic area for this tick-borne illness. Lyme disease may have protean neurologic manifestations, including pseudotumor; this association was first described in 1985.2 Since then, I have treated 4 children, between 8 and 14 years old, with increased intracranial pressure secondary to Lyme disease. Full-Text PDF Fibromyalgia and Pain Management: In replyMayo Clinic ProceedingsVol. 75Issue 3PreviewIn reply: I am sure Dr Sartin's letter embodies many of the concerns and prejudices of other physicians involved in treating patients with chronic pain problems. My article does not conclude that all fibromyalgia patients should be treated with narcotics. To quote: “Opiates are seldom the first choice of analgesics in chronic pain states, but they should not be withheld if less powerful analgesics have failed.”1 Full-Text PDF