Working: What's the impact of heart disease on your career and vice versa?

Sometimes if the prognosis is poor and the risk of recurrence high, return to work may be inappropriate. In other cases a change in career or employer may be required (or desired).

I had a very demanding job with many pressures when I got heart disease. As I was recuperating, I did a lot of soul searching. One of my cardiologists told me that a high percentage of those who returned to the same stressful environment subsequently left their jobs because they became ill again.

I was aware that research showed that chronic job strain after a first heart attack could double the risk of suffering a second one. I was afraid if I returned to the same job I would end up sick again very quickly.

Ultimately I did return to the same job (in July 2005) and things are going well, but I made quite a few changes (and I've stuck to them).

• I stopped putting in 10 and 12 hour days.
• I stopped taking work home in the evenings and on weekends.
• I started taking my lunch breaks.
• I started delegating more.
• I learned that I can't do everything.

Think about what habits you may need to change and discuss them with the person you report to.

How soon can you return to work (RTW)?

This varies from person-to-person and the type of job you have. You will need to discuss this with your doctor. The longer you are off sick, the harder it is to return. Plus if your cardiac event occurred on the job, you may find it more difficult to be back in the same environment.

Some general guidelines:

• After angioplasty: 1 - 4 weeks
• After a heart attack: 4 - 6 weeks
• After cardiac surgery: 3 months

For patients with a strenuous job or complications, additional time and testing may be needed before a RTW.

For insurance purposes, many companies require a letter from your doctor stating when you can return and what you can or cannot do. If your job requires a license (for example: truck drivers, pilots), medical clearance will likely be required from your cardiologist.

Another thing to consider is the physical requirements of your job. Are you required to

• do heavy lifting and carrying
• do pulling and pushing
• do shoveling
• use heavy tools or equipment
• do other physically demanding duties

and if so, in what quantity and frequency?

The effects of your work environment will be considered:

• are you seated or standing
• are your duties performed in extreme temperatures
• are you exposed to fumes
• do you do shift work

Stress on the job is a known risk factor. Will you be facing stress from:

• deadlines
• supervision
• workload
• toxic coworkers

Another consideration is a gradual RTW. Many insurance plans will support a gradual return starting with part time as this has been proven to be a very successful way to ease people back into the labor force.

It worked very well for me - allowing me to ease myself back into the daily routine. Develop a written schedule to help you and your employer. Your doctor, your disability case manager, and/or your employer can assist you with this.

Be realistic - You may need to neglect household chores or social activities for a little while in order to conserve your energy. (When I first started back part time, I attended in the morning and napped in the afternoon!)

A change in career

You may want or need to change your occupation if

• your job involved a lot of physical demands
• your job was unrewarding/unfulfilling
• your work environment was toxic or extremely stressful

Is there something else you've always wanted to do, or love to do, that can provide you with an income? In order to change careers, will you need retraining or further education? Is that feasible? How will it affect your financial situation? Are you willing to adapt?

Barriers to a successful RTW include

Attitude of the employer

• fear of employee's further illness
• failure to consider rehabilitation, redeployment, or retraining
• lack of understanding of the medical condition and its impact (I was very worried that my employer would, over time, expect me to return to my previous obsessive levels because I look and sound the same - my heart disease isn't visible. Fortunately, that hasn't happened.)

• fear of future illness
• lack of motivation/understanding of the illness
• benefits of the “sick role” - it's easier to stay on disability than to RTW

A Decision to NOT return to work?

After a cardiac event, your priorities may shift:

• Work may become less important.
• Health and family may become more important.

Are you eligible for a pension? If so, it might make sense to retire.

Will your condition prevent you from a successful RTW? Will you be able to access disability income replacement?

Does your work environment contribute to your heart disease?

A study of self reported job related illness showed that record numbers of employees felt their illness was caused by or made worse by their jobs. (Jones JR, Huxtable CS, Hodgson JT. Self reported work related illness in Great Britain)

There's no doubt many people are spending longer hours at work. Increased demands and deadlines and an increasing pace are becoming the norm. Technology has made it almost impossible to escape from the pressures of work.

Stress in the work place can take a toll on your heart. See our tips on stress management.

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