The burning question in minds of men and women during and immediately after a heart attack is, “Will I be able to go back to work?” “Will I be able to take care of my family?” It is difficult, if not impossible, for your doctor to tell you exactly what you will be able to do when you eventually leave the hospital, but if you understand the problem involved you may be able to help yourself.We must go back to the basic fact that your heart is a pump designed to pump blood. This muscular structure in a young adult has a phenomenal reserve capacity. On demand it may be able to pump seven or eight times as much blood per minute as it does when you are asleep. In other words, during extreme exercise your heart may be able to deliver 30 quarts of blood per minute to your body compared to the four quarts per minute that may be pumped during complete rest. As the years pass, the body ages and we are all aware that we no longer have, for example, the muscular strength that we had when we were twenty years old, nor at age sixty do we have the sense of sight or smell that we had when we were twenty years old.In a similar way the reserve capacity of your heart may be diminished by the process of aging. A person at age fifty may have a reserve capacity of five times, or possibly six times, the resting level of blood flow. We have stated previously that the result of a coronary thrombosis or myocardial infarction is the death of heart muscle. There is less heart muscle to pump the blood after a myocardial infarction than there was before the incident. The reserve capacity of the heart must, therefore, be diminished. This is the determining factor that will decide what you will or will not be able to do after your heart attack. If enough functioning muscle remains, you may be able to do practically the same things that you were able to do before your heart attack. This, of course, is particularly true if you had a large reserve capacity.The primary symptoms that you may recognize if you exceed your reserve capacity will probably be chest pain in the form of angina pectoris, fatigue, or shortness of breath on exertion. It is essential that the person who has recovered from a heart attack understand the factors that increase the demands upon the heart if he is to avoid difficulty and make the most of his physical impairment. The main factors that result in increased heart work are exercise, eating, emotional excitement, and extremes of temperature. Let us examine each of these in detail.When you exercise, as for example, taking a walk or hammering a nail, the muscles of your legs and arms are active and are doing work. This work demands increased food and oxygen to nourish the muscles of your legs and arms. Food and oxygen are carried to the muscles by blood that is pumped by your heart. Exercise, therefore, increases the work of the heart.The process of eating, and in particular digesting food, requires increased blood flow to the stomach and intestines. When food enters your stomach, the muscles of the stomach contract to mix the food with digestive juices and to propel the food to the intestinal tract. The intestinal tract also contracts to mix the food and to propel it further along. Great quantities of stomach acid and various digestive juices are poured into the intestinal tract to aid in digestion of the consumed food. These juices are produced by glands all of which depend upon blood for their raw materials. The production of digestive juices and the action of the intestinal muscles, therefore, require increased blood flow which must be supplied by the heart.A state of excitement or tension, anger, rage, or fear also results in increased heart work because these situations stimulate the adrenal glands, which produce adrenaline. The adrenaline circulates throughout the body and prepares the body for an emergency such as a fight or a flight (running away). The action of adrenaline upon the heart is to increase the rate of heart contraction and the work of the heart. A person who is frightened or angry, therefore, may have a heart that is working just as hard as if the man were actually running at full speed down the street.*12/309/5*

Meditation is frequently suggested as an aid in achieving and maintaining sobriety. Any number of approaches are available to those wishing to try it, and many treatment centers include an introduction to one or more. Although meditation has different goals depending on the type practiced, the process of reaching a meditative state is somewhat similar to relaxation. A fairly relaxed state is necessary before meditation can begin. Some schools of meditation use techniques quite similar to relaxation methods as a lead-in to the meditation period. In yoga, physical exercises are coupled with mental suggestions as a precursor. Studies have shown that altered physiological states accompany meditation or deep relaxation. Altered breathing patterns and different brain-wave patterns are examples. These changes are independent of the type of meditation practiced. The real physical response in part accounts for the feelings of well-being after meditation periods. Those who practice meditation find it, on the whole, a rewarding experience. Many also find in the experience some form of inspiration or spiritual help. Several highly advertised schools of meditation are receiving attention these days. You might investigate those that are available for clients who express an interest in meditation.A word of caution is needed here. Alcoholics tend to go overboard. Meditation should never be a substitute for their other prescribed treatment. Also, there are extremists in every area of life, and meditation is no exception to exploitation. That is why some personal knowledge of what is available, who is using it, and how it affects those who do use it is necessary before advising your alcoholic client to try it. Meditation is only helpful if it alleviates the alcoholic’s anxiety and allows him to continue learning how to function better in the world, not out of it.What is a meditation?Perhaps a meditation is a daydream, a daydream of the soul as the beloved and God, the lover, their meeting in the tryst of prayer, their yearning for one another after parting; a daydream of their being united again.Or perhaps a meditation is the becoming aware of the human soul of its loneliness and the anticipation of its being united with the One who transcends the All and is able to come past one’s own defenses.Or perhaps, again, it is a standing back with the whole of the cosmos before one’s mind’s eye as one’s heart is being filled with the sheer joy of seeing the balances of the All and one’s own self as part of it.Or perhaps a searching into one’s own motives, values, and wishes, with the light of the Torah against the background of the past.*142\331\2*

Tension headaches are caused by a tightening of the muscles at the back of the neck with consequent tension of the scalp. The pain can be felt at the back of the neck, over the top of the head, or over the forehead, and is often described as a ‘vice round the head’. The tension of the muscles is in itself painful, but associated constriction of the arteries to the muscles makes the pain considerably worse. The electromyograph (a machine which picks up electrical activity in muscle) can prove that active muscle contraction occurs during this form of headache.Patient G.H., a 45-year-old housewife, said:For the past nine months, I have suffered from almost continuous headaches. It is as if I have a heavy weight on the top of my head and I notice it as soon as I wake in the morning. It lasts all day but it does not keep me awake at night although it is there when I wake up in the morning. I do not feel sick and have no trouble with my eyes. Sometimes I feel a tight band around my head and usually the back of my neck feels stiff.This is a typical tension or muscle-contraction headache. In the case of G.H., direct questioning revealed that the headaches had started after her husband had told her he was contemplating divorce but had not yet decided to leave the conjugal home. These sorts of headaches could be due to depression, coupled as they were with feelings of lack of wanting to do anything, and early morning waking.Anxiety-depressive headaches are commoner than typical migraine but the two types often occur at different times in the same sufferer.
*6/152/5*

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