If there was a killer stalking the women of America, murdering them at the rate of over 1,000 a day, can you imagine the outcry? Well there is a killer on the loose. Its name is heart disease, and it actually does take over 1,000 of our sisters, mothers, daughters, co-workers, friends, and neighbors every day. I had an encounter with this killer, and survived, barely. But in the last year for which we have statistics, 400,000 women died from some form of heart disease. A woman dies somewhere in the U.S. every minute and a half. Every hour. Every day.
Like any other human ailment, medical science cannot save them all; but here is the most frightening statistic of all: in 64 percent of the cases, a woman’s first encounter with heart disease is sudden death. That’s right, only 36 percent of us even get the chance to survive. Heart disease kills six times as many women as all the cancers. Indeed, according to Dr. Suzanne Steinbaum’s Heart Book, “More women die from heart disease than all forms of cancer, chronic respiratory disease, Alzheimer’s disease, and accidents combined.”
Ask the average woman what is the greatest danger to her health and, according to the latest surveys, more than half of them will say breast cancer. Horrible as this disease is, and brave as its survivors obviously are, your chances of dying from it are one in thirty — for heart disease it is one in three.
Some women die of heart attacks because they don’t even know they are having one. They mistake it for indigestion, take an antacid, and go to bed, hoping to feel better when they wake up. They never do. They think they are developing the flu; the doctor agrees, and they go home and drop dead on the kitchen floor. Pain in the upper back and vomiting does not seem to be a heart problem; the doctor agrees, and they collapse at home and are dead before the ambulance gets there. Deep and mysterious fatigue is chalked up to the party she gave yesterday, but she dies before her husband can get her to the doctor.
She even shows up at the doctor’s office with classic chest pain, which he diagnoses as an anxiety attack, Doesn’t he know that an anxiety attack can be an indication of a severely leaky mitral valve? He sends her home to drop dead in the shower. That’s right, the doctors did not respond properly to a woman’s different symptoms. By her own admission, she can be in denial, and be lucky enough to live to tell about it. “I told myself it was indigestion, medicated myself with antacids, but I knew something was really wrong.” She made it to the hospital in time.
Ask any group of mature women and you will find similar stories; these are just the ones known personally to me. Yet, there does not seem to be the same urgency surrounding the annual Red Dress campaigns that marks the wide distribution of pink ribbons and races for the cure. Can it be because only a little more than a third of us survive to tell the tale? Do we die in such large numbers because our doctors don’t take our symptoms seriously, or don’t recognize them as heart disease until it is too late? Is it because we don’t have enough knowledge to save ourselves? How many women are told they are just getting older, working too hard, or are just too stressed?
Every medical authority, including Dr. Oz, has a checklist for prevention, most of which women know. Yes, she will agree, I should lose some weight, stop smoking, check my blood pressure and cholesterol, eat a diet full of fish and vegetables, and combat stress. But ask her to recite the special symptoms a woman may have if she is having a heart attack, and most women will draw a blank.
Lead researcher in a two-year study of these issues, Dr. Roxanna Mehran of Mount Sinai Medical Center in New York City concluded, “Women take care of their breasts and get mammograms and take care of their bones by getting bone density tests, but they often neglect their hearts.” Presenting results at the American College of Cardiology in 2012, she found that the rate of heart-related death in women ages 35 to 44 is continuing to rise at the rate of 1 percent a year.
Why is this so? According to Renee Sangrigoli, MD, a vibrant young cardiologist at the Heart Institute of Doylestown Hospital in Doylestown, Pennsylvania, and advocate for women’s health, “Women may present differently than men with cardiovascular disease; making the diagnosis for the doctor challenging and frustrating. At times, the symptoms can be so non-specific that they are overlooked even by the patient. Women who develop heart problems are usually older than men. Since they are older, they usually have other medical problems (diabetes, high blood pressure) making them more ill on presentation.”
Is this why the breast cancer campaigns have been able to reach so many women so successfully? Only a third of patients with severe heart problems survive, and most of us are in no shape to race for a cure. And even if you are fortunate, as I was, to have a brilliant surgical team save your life, what then? How do you manage recovery from the massive assault upon you body/mind/spirit in the months and years ahead?
As the survivor of 18 months of misdiagnosis, massive heart failure and seven hours of open heart surgery; as the possessor of a replaced mitral valve, a repaired tricuspid valve, and a triple bypass; I have a very personal interest in the answers to these questions and the urge to share with others what I have learned in the years of my recovery.
In the time I spent putting my life back together I was haunted by the thought that if I had known what my own symptoms meant, I could have insisted that someone send me for heart testing. I was in and out of the offices of six different MDs in five different specialties. All of them are excellent in their fields; all of them had an idea about what might be wrong with me.
Nobody spotted heart disease in a 72-year old woman with high blood pressure and high cholesterol who presented the following symptoms that came and went in mysterious fashion: persistent unexplained severe fatigue, anxiety, also unexplained, heart palpitations, sleeplessness, and throat pain. I noted these symptoms for the first time in March, 2005, in a medical notebook I started to keep. My cardiac train wreck took place December 8, 2006. Three months later, reading a newsletter published by the Friends of the Heart Center at the Doylestown Hospital where my surgery was performed, in an article written by Dr. Sangrigoli, I found the following: “Typical symptoms of heart disease include chest pain, shortness of breath and irregular heartbeats (palpitations). Women’s symptoms may include: shortness of breath and dizziness, flu-like symptoms, nausea, vomiting and sweats, unusual fatigue, pain in upper back, jaw, neck and throat, and feelings of anxiety and malaise.”
I almost dropped the paper on the floor! If I had known what my own symptoms meant, I could have reminded all those doctors what they obviously knew, but were forgetting that they knew.
Nurse-researcher Dr. Jean McSweeney of the University of Arkansas Medical Services interviewed hundreds of heart attack survivors and found that 95 percent of them suspected something was wrong months before the actual attack. She separates the symptoms as early warnings and impending heart attack. In the first instance, get to your doctor; in the second, call 911 and get to the nearest emergency room.
Early (get to your doctor) symptoms include: unusual fatigue, getting winded, mood change or mild anxiety, frequent indigestion, general weakness, chest pain, similar to a pulled muscle, headaches and periods of blurry vision, aching in arms and hands, and throat pain.
Impending (call 911) symptoms include: Overwhelming exhaustion, real shortness of breath, sense of impending doom, terrible heartburn, nausea, vomiting, no strength — like having the flu, crushing chest pain, pain down right or left arm, pain in neck, upper back, throat, jaw, both arms, cold clammy sweat and pale skin.
According to the experts, you may have any combination of these symptoms. My neighbor died because she didn’t know that back pain and vomiting could be heart attack symptoms.
Dr. McSweeney found that the most frequent symptoms during a heart attack in the women she surveyed were shortness of breath, weakness, and fatigue. Acute chest pain was absent in 43 percent of these women during their heart attack.
If the above list sounds like you, get to the nearest hospital Emergency Room for an evaluation.
In A Woman’s Heart, An Owner’s Manual, Drs. John A. Eleferiades and Teresa Caulin-Glaser state, “In recent years study after study have shown that heart disease eludes detection in women, even in the hands of otherwise superbly trained and widely experienced physicians.” Dr. Suzanne Steinbaum states, “Only 40-50 percent of primary care doctors are even aware of the cardiovascular disease prevention guidelines formulated just for women, which weren’t even established until 2002.”
In the Cleveland Clinic Guide to Heart Attacks, Curtis M. Rimmerman agrees. “Incredibly, heart disease kills more women than breast cancer, yet not enough physicians have educated themselves about heart disease in women.” He goes on to state, “Clinicians also fail to recognize (women’s odd symptoms) as possible signs of disease.”
He concludes, “Women must become proactive about educating themselves and their doctors.”
Well intentioned campaigns focus on diet and exercise, which are extremely important. But if doctors are still having a problem connecting the dots, we women have to save ourselves by educating each other. What can you do, starting with yourself?
Dr. Sangrigoli advises, “You can’t change your age, your sex, or your family inheritance. (I obviously inherited the heart of my father, who died of a coronary at 54). You can quit smoking, and take the necessary steps to control your weight, blood pressure, cholesterol, and diabetes.”
In his Heart Disease: An Essential Guide for the Newly Diagnosed, Lawrence Chilnick states, “Despite the grim well-documented stats, the threat of heart disease in women is still not universally understood . . . Some studies have shown that even today, less than 20 percent of physicians in general recognize that more women than men die of heart disease. One reason is that until recently, only 25 percent of the participants in all heart disease related research have been women.”
Clinical trials including women are slowly increasing; but so are fatalities for women in their 40s. In the best of all possible worlds, every doctor, regardless of specialty, would have a poster on the wall of each examining room reminding both patient and doctor to check for heart disease. If we could make stress tests and electrocardiograms as important as mammograms, we might be able to rein in this killer.
In 2004, the American Heart Association and grass roots groups joined to create the Go Red For Women campaigns to educate women of all ages about the risks they face and the preventative measures they can take, if only they knew about them. Too frequently women don’t have the information they need before a heart attack strikes, and, as we have seen, kills them. February each year is Heart Month but once again it does not get nearly the exposure that breast cancer campaigns receive. Both the American Heart Association and Go Red For Women have enormous websites filled with authentic medical information, sources for further learning, stories from survivors, recipes for a heart-healthy diet, advice for lifestyle changes, and even a powerful video called “Just a Little Heart Attack.”
WomenHeart, the National Coalition for Women with Heart Disease, takes a more personal approach. Facilitators, all heart attack survivors, and all trained at the Mayo Clinic, serve as volunteers who organize and host support groups for women all over the country. They also have a website filled with information and support. If you would like to see a support group in your area, contact them at www.womenheart.org.
You do not have to be a heart surgeon to save lives. You just have to be willing to learn about the reality of heart disease in our society and be willing to speak out about what you know. This book is an effort to advance that sharing.
At the center of focus today are the miraculous things medical science and surgery are able to do to save lives — valve replacements, stents, pacemakers, even artificial hearts and human heart replacements. But on either side are, in my opinion, diverse unresolved issues.
On one side is the prevention and detection of heart disease, especially in women, which should be saving more lives than it is currently. The miracles cannot be performed if women are sent home instead to the hospital. On the other side is the slow progress of opening medical minds to the full panoply of healing methods, some thousands of years old, which could be saving more lives than they are currently doing.
The newest thinking has finally identified effects of massive surgery on the body as having the same potential for long-term negative effects as bombs, plane crashes, earthquakes, assaults, wars, and other disasters. The body, though unconscious, remembers the event on a very deep level. It is now recognized that the same symptoms which are referred to as PTSD — Post Traumatic Stress Disorder — can be felt by patients after massive surgical procedures. Some rare doctors/therapists offer recognition and treatment.
How could I not only recover, which my doctors assured me I was doing, and rehab, which I worked at diligently, but how could I heal myself and get my life back? I understood that my days of day-long gardening and large home improvement projects were over. Getting my life back meant to me, a feeling that mind and body, for all the limitations, had fused with my soul and spirit to heal me on mitochondrial and chakra levels.
The biggest thing I learned is this. You are the ultimate healer — not the nurses, not the surgeons, the doctors, the cardiologists; not the pharmacist, not the physical therapist. All of them are the facilitators, those who repair what has gone wrong, and/or assist you in the management of the actions you need to take, or refrain from, to manage the rehabilitation and recovery of your body and mind. You need them to assist you as you re-integrate and re-balance the energy forces which you alone can manage, to become whole and sound again.
What you do with your body can heal, or not heal, your mind; and what you do with your mind, can heal, or not heal, your body. The integration of body, mind, soul and spirit constitutes true healing.
#b#About the author#/b#: On the December midnight when she discovered that she could not breathe, Marylou Kelly Streznewski finally had a good reason to head for the emergency room, after 18 months and five doctors trying to find out what was wrong with her. Seven hours of open heart surgery later, she was in possession of a replaced mitral valve, a repaired tricuspid valve, and a triple bypass.
But even that did not make her an advocate for educating women about the dangers they face from heart disease. It was reading a newsletter three months later that listed the very symptoms from those 18 months. Had she known, she could have insisted that they test her heart. A poet and writer, Streznewski has turned the ordeal into a memoir detailing her road to true healing, discovering integrative medicine modalities.
Streznewski is the author of a non-fiction book, Gifted Grownups: The Mixed Blessing of Extraordinary Potential, a 10-year study of 100 gifted adults; has published short fiction in national publications; and three chapbooks, the latest, Dying with Robert Mitchum, a meditation on war. She is currently at work on her first novel.
As an advocate for educating women about heart disease, Streznewski, who lives in Bucks County, is available to present programs to women’s groups. Contact her at firstname.lastname@example.org.