Women & Heart Disease
Interview of Cathy Luginbull
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Ms. Cathy Luginbill: My name is Cathy Luginbill. I am a clinical nurse specialist. I work at Alta Bates Summit Medical Center and I'm in charge of the Alta Bates Summit Cardiovascular Rehab Programs. Women need to be aware that heart disease is the number one killer of women. It kills more women than any other disease process in the world. It kills six times more women than breast cancer. It kills 13 times more women than all sorts of other cancers combined. It is the number one killer of women in the United States.
The symptoms of heart disease in women are different in many times than men. Women do not classically, most women do not classically get the, sort of the mid-chest pain or I think men describe it often as an elephant sitting on their chest. Women may have other symptoms and actually more women have such symptoms as shortness of breath. They may feel nauseous or vomiting. They can have indigestion, dizziness, fatigue, sweating and then some women also do get what we call angina. We sort of like the word angina more than the word chest pain because angina also can refer to heart pain that shows up in the neck, the throat, the jaw, the shoulder, the left arm, the back of the neck. And when we say chest pain to a person, they say, well, no, I don't have any chest pain. So we like to use the word angina.
The problem is, is that many of those symptoms are symptoms that women would experience just walking down the street, she may think that the shortness of breath is because she's tired that day or it's a little bit of a hill or the nausea and vomiting maybe she's got a touch of the flu and that's what makes the diagnosis of heart disease in women more challenging for the medical community and for the woman trying to identify whether she's got a problem or not. If a woman always gets some shortness of breath or she's starting to always get a little nausea or sweating with low level activity, that's a warning sign. But unfortunately they may say, well, I'm just getting older or the pain in their jaw of their neck, they may think they've got some sort of a dental problem or arthritic problem or the shoulder pain and the arm pain may be, again, some sort of an arthritic or strained muscular problem, rather than one associated with the heart. That makes it much more difficult and that may be one reason that women are under-diagnosed and under-treated. At Alta Bates Summit, we've been very involved in the education of the physicians, the emergency room and the healthcare community in letting them know that the women's symptoms are what we call atypical. That it means that it's not what we normally think of.
Prevention in heart disease for women is pretty much the same as it is for men. There's things that we call risk factors and there are three risk factors that are not modifiable.
- We can't modify our age, as much as we'd like to.
- We can't modify our family history and
- we can't modify our race or our ethnic background.
We used to put gender as a non-modifiable risk factor, but now we recognize that the gender is not as much of a -- different genders are not a difference in risk factors. Both men and women are getting more heart disease. So just being a male doesn't indicate that a man is going to have heart disease earlier or not going to have heart disease more than women. So those are the non-modifiable risk factors.
But going onto those risk factors, the risk factors that are modifiable, meaning we can do something about it, probably the number one most important modifiable risk factor is smoking or tobacco use. And the tobacco use, I think nobody is surprised in knowing that tobacco of any kind is bad to use. Unfortunately, women seem to have a higher or a more negative response to tobacco in the area of heart disease. Women who smoke have a different kind of disease process occurring in their arteries and it's more difficult to diagnose, difficult to determine the severity of it and it is that the tobacco disease process occurs in women much younger, even in the ages of 30 and 40. Quit smoking. I know it's easy to say. It's hard to do; and yet it's probably the number one thing that women can do to make their health much better.
More exercise regular, aerobic activity, meaning using as many of the large muscles, the legs and the arms as possible. Swimming, biking, elliptical (where they use the cross-trainers), but, you know, walking is one of the best things that we can do for ourselves. And certainly in the Bay Area we have wonderful areas to hike. We don't have weather that keeps us from being able to go out for six months out of the year, either because it's too hot or it's too cold. With the exception of some rain and most of us don't melt; we can walk 12 months a year here.
Of course, watching the dietary intake of low saturated fats, staying away from trans fats is another important part. Keeping diabetes under control is -- or avoiding diabetes - is another major risk factor modification. We know that diabetes is an epidemic in our country. We're starting to see kids in their early 8 to 12 years of age having diabetes and we're seeing that impact coming into cardiac rehab and into the cath lab here at Alta Bates Summit. We're having people who have been diabetics for 10 to 12 years coming in for their heart procedures at the age of 35, 40, 45.
Women who have diabetes have smaller, more fragile arteries in their heart and it makes the process of fixing it a little bit more challenging to the cardiologist and the surgeons. Women that have good control of their blood glucose levels can avoid cardiac procedures.
I have a wonderful story about, I'll call her a young woman because she's only 52 who actually is a professional in the healthcare area. And for the last three months she had been noticing increasing shortness of breath and her, what we call “GERD” or stomach problems was getting a little worse. So she was taking more of her stomach medicine and she realized that it was -- she was more tired. She had been getting more short of breath, but she realized she had put on more weight, her blood pressure was up a little bit, she was under a lot of stress at work. So her doctor, she saw a doctor, she was just thinking for her stomach and the doctor listened to her symptoms of the shortness of breath, the fatigue, the stomach problems causing her actually to lose a little weight because she wasn't hungry and ordered a special treadmill test for her. The test was one done here at Alta Bates campus and it was a test where she not only walked on a treadmill but we gave her a special isotope so that we could see the heart images a little bit better. Those are, that type of test as far as superior in women in detecting heart disease. During her treadmill test, her EKG showed some very significant changes and within 24 hours this wonderful woman had four stents that was put in -- that were put in over at Summit Medical Center campus. And she recognizes now that the symptoms of shortness of breath, increased fatigue, that what she was calling stomach pain or the nausea were all classic symptoms in women for heart disease. She's now exercising in our cardio rehab program with us three times a week and is becoming a strong advocate for other professional women with whom she works and is telling them that they need to watch out for these particular symptoms. So it's a wonderful success story.
What's most important for women to know about heart disease is that it occurs in women starting under the age of 50. It is important to know that women experience and manifest symptoms of heart disease differently than men. One of the strongest factors that women have going for them is that we are very in tune with our bodies and if we feel that there's something wrong, we need to insist to our medical care practitioner that something is wrong.
Another very important aspect of heart disease in women is that we can do something about it. We can prevent it. We can stop a process of heart disease by being aggressive in our own healthcare. We don't need to have a physician tell us we need to stop smoking. That is something we can do. We don't need to have a physician tell us we need to lose weight or need to eat more in a more healthy fashion. We don't need to have a physician tell us that we need to learn how to relax and take care of ourselves. But we also have to be a partner with our physician in making sure that blood pressure and cholesterol is under control; that the diabetic medications are appropriate; and that we need to have physicians be a partner with our physicians in our healthcare and that all coordinates into a healthy approach to our own daily activities.
When a woman hits 50, her risk of heart disease and dying of heart disease escalates dramatically and even more importantly, women in their fifties and sixties are diagnosed with and die more often of heart disease than men. Too many people feel that death and dying of heart disease, especially in the early years is something relegated to men, but unfortunately death and dying of heart disease in women of 50 and over is an area where women dominate.
You know, we are caregivers to the family and the problem is that the caregiver often does not have anybody to give care to them. And it's what I call the "honey, what's for lunch syndrome." When a man has bypass surgery, he comes home from the hospital. His wife drives him home and she says, honey, I'm going to make sure that, you know, your medications are out every day. I've got these great books. We're going to change your diet. I'm going to make sure you get to your doctor's office and to the cardiac rehab. We're going to get through this. You know, I love you, it's wonderful, we're going to get through this. The wife comes home from bypass surgery and the husband says, “oh, honey, I am so sorry this happened, what's for lunch?” And unfortunately, that's a fact. I mean, it's shown on studies. You know, the women, we've put ourselves a little bit into this category of caregiver, but we've also, because we're caregivers, the human race has survived.
After heart attacks, more women die within 30 days of hospitalization than men. Almost three times more women die of hospitalization, after hospitalization for a heart attack and classically we see that they don't get the same medications. We do know that women are usually sicker when they're seen in the emergency room than men.
Interviewer: Because they're coming in later?
Ms. Luginbill: They're coming in later. They're being under-diagnosed. I can't tell you how much work we've done in the ERs here and at Summit and it has really paid off. It was not uncommon ten years ago for a woman to come in with chest pain or nausea and they might run an EKG and they might not and they give them - and this wasn't just here, it was all over- they'd give them Maalox or, you know, protonics for their stomach or Valium and then send them home.
Interviewer: How can a woman go about convincing her husband or partner to take on a little more of that role of a caregiver?
Ms. Luginbill: One thing that we do in cardiac rehab is our educational programs, we want their spouses to come with them. And sometimes we've seen that -- we've seen that occasionally it's the first time that the spouse has really realized that there's something that they need to do also. If the spouse smokes, we do everything we can to get the spouse to stop. They have to understand that their actions directly impact their wife or significant other. But it's hard to undo behaviors that have been part of their lives for 30 years, 20 years, 60 years.
It has to be an educational effort by not just the physician but by the other professionals that are taking care of the woman. And it may be hard for the woman to say. I'll tell you, it's very hard for women to say “I need to be given this; I need somebody to take care of me.” We don't give ourselves permission to do that, so part of the educational process too is to make sure that the woman understands what her medical and emotional/physical needs are. That's not easy to do.
(Recording Ends)
- INTERVIEW CONCLUDED -Go to the Women's Health Audio Web Page
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