Elsa Garza, DNP - phaware® interview 297

Elsa Garza, DPN specializes in Pulmonary Medicine and has sub-specialized in Pulmonary Hypertension since 2009. Caring for patients with Pulmonary Hypertension is her passion. 

In this episode, she discusses addressing anxiety or depression that may come with a PAH diagnosis.

My name is Elsa Garza. I'm an acute care nurse practitioner. I currently work out of the pulmonary hypertension office in Chicagoland area.

I actually started working with pulmonary hypertension patients many years ago when I first graduated as a nurse practitioner. I've been working with PH patients since then. These patients are very complex and they require a lot of attention in every aspect, not just in their workup, but also just getting to know them on a personal level and being able to develop a rapport and open communication with them so that you can actually talk to them as more of a human being and really help them understand what's going on.

These patients many times are depressed and have a lot of anxiety, because they're worried about the medications and they're worried about side effects. A lot of these patients are younger, they're still working. They're worried about how they're going to fit in an inhaled therapy four times a day or walk around with an infusion pump, [while trying] to live out their normal daily life activities with friends and family and at work. It takes time for patients to open up to us.

A lot of times the patients tell us that they're feeling anxious or they kind of start showing the signs of isolation. We open up the topic. We talk to them about how important it is to attend support groups. We talk to them about following up with their general practitioner to see if maybe there are any medical therapeutic options for them or if maybe counseling would be appropriate for them. All we can do is do our best to kind of hone in on everything that's going on with the patient and treat them completely overall, holistically, and hope that we will do a good job in doing so.

It really starts with a good relationship and sometimes that in itself is very difficult to build with a patient, because maybe they're brand new to your practice. They're trying to figure out what kind of provider you are. Do they agree with what you're telling them? [Also], they're trying to digest all that information along with do I trust you, do I not trust you, should I get a second opinion? That really goes back to building a good relationship with them. Again, breaking down their barriers. Many patients, we may see that they're getting a little depressed or having some anxiety, but they're not ready to talk about it. I always tell patients we can only help them as much as they let us help them. Building a good relationship is so important.

Typically, the first moment we see the patient, we give them their diagnosis and they go home and they start researching on the internet, and they come back on their follow-up and they say, "I read that this is a fatal diagnosis or that there is no cure and there's only a handful of therapeutic options that we can treat this disease with." The first thing that we say is, "You're right, number one, but number two, there are only a handful of medications that we can treat you with, but it's a lot more than we had 10, 20 years ago." So no, they do not cure this disease, but they definitely improve the quality of life, and that's really what's most important, is making sure that we're doing whatever we can do to improve your quality of life.

Another trigger is typically going from an oral medication or an inhaled medication to something more advanced, whether it's continuous IV or subcutaneous infusions. Usually that just opens up another set of questions. Those are typically the two most common triggers that patients come back with, and it puts them in a very vulnerable position. It really opens up a deeper conversation.

Another example would be when you're being evaluated for a lung transplant. If that is where we are in their disease progression, and we have to indulge into that conversation, we can see it in their face. [They may say], “You told me a couple of years ago I have this progressive pulmonary vascular disease and now you're telling me that I need a lung transplant and that that may be the best option for me?”

It's a very sensitive subject obviously, but we tell them we have to be honest with you and we are really just looking at all options and it doesn't mean that they're a candidate right now or ever will be, but it's something that definitely needs to be addressed and should be addressed, because they have that right. We have to make sure that we do everything possible to help them, to treat them. That's why we're there. We're there to help them and to guide them, and ultimately it's the patient's decision. The patient and the caregiver or family, whoever they want include in their medical decision making helpers or the proxies or supporters.

In summary, when we're dealing with patients with pulmonary arterial hypertension, there are a number of aspects that we look at when we're seeing these patients every day. It doesn't just include medications. It doesn't just include their results of recent exams or testing. It also includes addressing any anxiety or possible depression that may be coming into the picture with these patients, or even with their caregivers. Many times, we get lost in treating the patient, but caregivers need attention, as well. That's why I think support groups are incredibly important for everyone in the PAH picture.

I'm Elsa Garza, and I'm aware that I'm rare.

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