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    Archive for January, 2017
    Lawyers and Heart Disease
    Monday, January 23rd, 2017

    ♫ Oh but workin’ too hard can give you a heart attack
    You oughta know by now… ♫

                Music, Lyrics and recorded by: Billy Joel.


    In December 2014, Edward Greenspan, one of Canada’s most famous criminal defence lawyers, died at age 70 from heart failure, ironically while on holiday. He is not alone. Many lawyers will be diagnosed this year with heart disease, heart attacks, high blood pressure, atrial fibrillation, pulmonary embolisms and strokes and some will die. Globally, cardiovascular disease is the leading cause of death and claims more lives than all forms of cancer, combined.

    Lawyers are particularly susceptible to stress-related illnesses, including heart disease, “because of the unique interplay of the legal profession and lawyer personality” (per the ABA Journal). It is no secret that the legal profession has to deal with stress, depression and a degree of hostility. This, unfortunately, is a particularly lethal combination.

    Lawyers have the highest rate of depression among 100 professions (Sells, The Sole of Law: Understanding Lawyers and the Law (1994) at 94.)

    Edward C. Suarez, Ph.D., of Duke University, says a recent study, “. . . suggests the possibility that men who are . . . hostile and exhibit depressive symptoms, even in the mild to moderate range, are at heightened risk for cardiac events.”

    Dan Lukasik, a personal injury lawyers asks, given the “clear connection between lawyer hostility, depression and the heightened risk for a cardiac event, what can lawyers do about it?”

    One of the first things we can do as a profession is to curtail uncivil behavior and over-aggressiveness. While we live in an adversarial system, neither our clients, the legal system, or the public are well-served by this approach and it causes undue stress and toil for all concerned.

    Another thing that we can do is curtail long work hours. The cure for overwork is not time management, or less holidays or not taking vacations or even weekends off; it is improving our work conditions such that our minds and our bodies have an adequate time to rest and rebound from the stresses of the day.

    Take time to exercise, maintain good nutrition, good weight control and not smoking are four things that all of us can do, right now. An added incidental benefit will be a lower exposure to substance abuse triggers.

    In Stress Management for Lawyers – How to Increase Personal and Professional Satisfaction in the Law“, 3rd ed, by Amriam Elwork, Ph. D, the author puts forth many concrete suggestions to reduce stress. One suggestion is by shifting our point of view of a stressful situation we can control our emotional response and look to generate solutions rather than generating anxiety and depression.

    A very interesting aspect of Dr. Elwork’s book is his suggestion to be true to your values. He lists seven areas of people’s lives where values are important: finance, work, character, growth, relationships, society and religious faith. He then asks if you are living true to your values in these seven areas.

    Do we recognize the signs of overwork and stress in ourselves that can lead to a heart attack?  We ought to know by now…

    What are the signs and symptoms of types of heart conditions?


    Atrial Fibrillation (known as AFib) (according to is where the smaller vessels of your heart are being activated in a chaotic electric pattern in excess of 400 beats per minute, as compared to 60-100 coordinated beats in a normal heart.

    Signs and Symptoms of Atrial Fibrillation

    • Heart palpitations (feeling that your heart is racing or fluttering)
    • Awareness that the heart is beating.
    • Chest pain, pressure, or discomfort.
    • Abdominal pain.
    • Shortness of breath.
    • Fatigue or lack of energy.
    • Exercise intolerance.

    AFib raises your risk for stroke, since the chaotic rhythm may case blood clots to form inside the heart and then travel to your brain.


    Congestive Heart Failure symptoms (according to

    Heart failure signs and symptoms may include:

    • Shortness of breath (dyspnea) when you exert yourself or when you lie down
    • Fatigue and weakness
    • Swelling (edema) in your legs, ankles and feet
    • Rapid or irregular heartbeat
    • Reduced ability to exercise
    • Persistent cough or wheezing with white or pink blood-tinged phlegm
    • Increased need to urinate at night
    • Swelling of your abdomen (ascites)
    • Sudden weight gain from fluid retention
    • Lack of appetite and nausea
    • Difficulty concentrating or decreased alertness
    • Sudden, severe shortness of breath and coughing up pink, foamy mucus
    • Chest pain if your heart failure is caused by a heart attack


    Pulmonary Edema’s signs and symptoms (per

    Signs and symptoms may include:

    • Difficulty breathing
    • Coughing up blood
    • Excessive sweating
    • Anxiety
    • Pale skin
    • Pink frothy sputum (which may be coughed up)
    • Nocturia (getting up at night frequently to urinate)
    • Swollen ankles (ankle edema), there may also be general swelling in the legs
    • Orthopnea – the patient becomes breathless when lying down flat
    • Paroxysmal nocturnal dyspnea – episodes of severe sudden breathlessness at night.

    If left untreated this can lead to coma and then death – usually due to hypoxia (oxygen deprivation).


    High Blood Pressure (HBP):  According to the American Heart Association, “The truth is that HPB is largely a symptomless condition. If you ignore your blood pressure because you think symptoms will alert you to the problem, you are taking a dangerous chance with your life”


    Heart Attack:  The signs and symptoms of a heart attack (per: are:

    1. Chest discomfort, manifest as pain, fullness, and/or squeezing sensation of the chest
    2. Jaw pain, toothache, headache
    3. Shortness of breath
    4. Nausea
    5. Vomiting
    6. Upper middle abdomen discomfort
    7. Sweating
    8. Heartburn and/or indigestion
    9. Arm pain (commonly in the left)
    10. Upper back pain
    11. General malaise
    12. No symptoms.

    One cannot overemphasize the importance of seeking prompt medical attention in the presence of symptoms that suggest a heart attack.

    (originally published in BarTalk, a publication of the BC Branch of the Canadian Bar Association).

    Posted in Adding Value, Change Management, Firm Governance, Issues facing Law Firms, personal focus and renewal, Tips, Trends | Permalink | 4 Comments »