Why It’s More Critical Than Ever to Support Mental Health and How Insurers Can Help
Around noon on January 6th, I got out of my car and strode into the Bone & Joint Institute at Hartford Hospital.
Wait! Did I say “strode?” Actually, it was more like “walked guardedly, trying not to provoke my arthritic left hip into another flareup.” That’s because I was going into that bright, shiny new building in Connecticut’s capital city to get a bright, shiny new artificial hip that would let me walk and move comfortably and confidently again. In my mind’s eye, I was visualizing a positive outcome to that surgery, and it included a picture of me striding purposefully and effortlessly across the landscape.
What my pre-op positive visualization didn’t contemplate, however, was that the path to recovery often involves some unexpected twists and turns. And that’s especially the case if there are co-morbidities involved. (“Co-morbidity” is medical speak for something else that’s wrong with you besides what you’re hoping the doctor can fix.)
How my recovery from surgery took an unexpected turn
I’ll spare you most of the details, but here’s what happened: Because I have a history of deep vein thrombosis (a potentially fatal form of a blood clot), my surgeon recommended a type of anesthesia less likely to lead to post-operative clot development. But this form of anesthesia carries the risk of enlarging the prostate (in patients who have one). And if the prostate is already enlarged (as is the case with the majority of men in their sixties or older), this can lead to problems with urinary retention. Big problems as I learned about a week after my surgery.
I wound up having to go to the emergency room to have a catheter placed. They drew out over 2,000 milliliters of fluid from my bladder — more than half a gallon.
My primary care doctor connected me with a urologist, who put me on medications to tame the grip my swollen prostate was exerting on my bladder outlet. Over the next several weeks I was a regular visitor to his office.
My urology appointments followed a familiar pattern:
• catheter comes out in the morning
• go back in the afternoon for a bladder scan
• learn that I’m still retaining large amounts of fluid
• catheter goes back in
• tweak the medication dosage, and
• schedule a follow-up in another week, or two weeks, or four weeks.
This was the story of my life from mid-January until mid-April. And it was definitely not an outcome I envisioned going into the surgery.
The disability / mental health connection
I recommend you check out this article in the Journal of Occupational and Environmental Medicine. It’s the outgrowth of a research project completed by The Council for Disability Awareness’ Research Committee with The CDA member company MDGuidelines. Fraser Gaspar, PhD, was the lead author.
One of the key study findings I found sobering — especially in the wake of my recent post-surgical experience — is this one:
“The odds of developing a new-onset depression and/or anxiety within a year [of a work leave due to an injury or non-mental health illness] was 4.21 times higher (95% CI: 4.14–4.27) in individuals with a work leave compared to those without.”
In other words, a physical disability leave puts you at substantially higher risk of developing anxiety and/or depression.
I can see how that might be. Your routines are upended. You’re limited in what you can do. You’re cut off from your social support network. And that’s just for a “normal” post-op experience. Throw in a bunch of complications and the disorienting effect gets magnified.
I have to say, on more than one occasion over the past couple months, I felt myself coming close to the brink of outright depression — or else at the verge of getting caught up in a whirlwind of worry. But somehow, I beat the odds. How did that happen?
There were several reasons why I didn’t go over the edge into full-blown depression and/or anxiety:
It helps to have job flexibility
Even before the pandemic drove large portions of the workforce into remote-work mode, I had a job that wasn’t tied to a specific office location. That was very helpful in my post-surgical return to work. It also helped — a lot — that my work is basically project-driven. As long as you can produce an agreed-upon deliverable by a particular date and time, then it doesn’t matter what time of day you do your work. And, finally, I was already working part-time as part of a phased transition to retirement. (I turned 70 last year.) So returning to part-time work wasn’t as big a challenge as returning full-time would have been.
Work is therapeutic
I was able to get back to work about two weeks after my surgery. I soon found that having the structure of work — regular check-in calls, meeting deadlines for deliverables, etc. — was extremely helpful, if not therapeutic, in dealing with my complicated recovery.
Social connections are vital
I made a point of calling different people — family, neighbors, church friends, old college roommates — on a regular basis. It pulled me out of my circumstances and out of myself. The outward focus was important in keeping me mentally healthy. And guess what? Work is an important source of social connection, too.
Serenity now!
Over the years, I’ve had several friends who were active in various recovery programs. They all talked about the importance of the Serenity Prayer, where you ask for courage to change the things you can, serenity to accept the things you can’t, and wisdom to know the difference.
This kind of perspective on life is something all of us can benefit from, not just those involved in recovery. Some problems just can’t be solved, and instead of obsessing over the unfairness of that, we can learn to live with what just is — and maybe, just maybe, even see something to be grateful for in any given situation. I learned not to rail on about the unfairness of having to wear a catheter, and instead to be grateful that there was this technology that could help me do what I otherwise couldn’t do on my own.
In summary….
I hope this short account gives you a better sense of why we at The CDA talk about work and disability in the larger context of people’s lives. A disability event involves more than a specific diagnosis or surgical procedure, and its impact isn’t limited to your finances.
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