Sue Detisch - Healthy Habits, Healthy Heart
Bio: Sue Detisch, a writer, retired high school English teacher, married for nearly 50 years, a mother of three daughters and four very young grandchildren cherishes each new day and all the wondrous knowledge, beauty, and life each brings to her, with fresh renewal, since her heart attack in December 2017.
Life is a dime on its edge. Nobody knows this better than a heart-attack survivor. It was unthinkable that a heart attack should happen to me. But it did. My doctor said, “I’m not sure if there is anything I could have done to thwart your attack,” but now that it has happened I have a choice to make. I can either wallow in the muck of depression that frequently follows a trauma, or live deliberately: renewed, challenged, exuberant, and full of purpose. That said, I feel I have a responsibility to tell other women who mistakenly believe that coronary disease is mostly gender specific to men, the truth is more women die from heart attacks than men.
Arm yourself with information and be proactive!
When my doctor said she didn’t know what should have done differently, I thought about things I could have done. Above all, I should have listened to my body’s warnings. It warned me that something was not quite right. I dismissed my instincts. I brushed off fatigue, sleep problems, anxiety, and indigestion. I could easily excuse these: no red flags.
I was unaware that over the years fatty deposits, called plaque, had been forming in my arteries. This plaque had narrowed my arteries and reduced the blood flow to my heart. It wasn’t surprising that I was caught unprepared: There can be no symptoms at all when the blockage is less than 50 percent.
I was raised on a dairy-heavy diet with cream, cheese, and butter. These were my choice “comfort foods,” to which I would return for baking and entertaining my entire life. I was vaguely aware that heart disease ran in my mother’s family. But it was easy for me to deny the potential impact of heredity on my life: “Predisposition isn’t always destiny.” However, I attempted to eliminate some risk factors many years ago. I quit smoking and drinking alcohol. I modified my intake of red meat and carbohydrate-laden foods and reduced my intake of refined sugar and salt. I exercised. With these changes, I grew complacent that I’d taken the necessary steps to prevent heart disease. I thought it wouldn’t happen to me. I am a woman and weren’t heart attacks more of a male domain issue than female?
This is a misconception. “Women have gained equality in this disease, making it the number one killer of women in the United States.1 According to renowned La Jolla Cardiologist Mimi Guarneri, M.D., FACC, five hundred thousand women die yearly from heart disease―a figure that exceeds the next seven causes of death combined”
It’s easy to be fooled by stereotypes and presumptions of who might be at risk. Heart attacks are indiscriminate in their choice of victims, and heart disease can be a silent killer. There are some mitigating reasons for the astonishing number of female deaths, including age. Although age is not always a factor, the drop in estrogen during menopause could be a significant risk. Diabetes puts women at greater risk than men. And emotions are also a risk factor. Mayo Clinic lists mental stress, depression, and “Broken Heart Syndrome,” (takotsubo cardiomyopathy) as some.
Women are more apt to dismiss their symptoms than men. One reason for this is that symptoms can be vague. Symptoms can occur while resting or even sleeping. Most women describe them as subtle and widespread discomfort, although some may experience the crushing chest pain typically associated with heart attack. Symptoms are possibly a squeezing pressure or fullness in the chest area, discomfort in one or both arms, the back, neck, jaw, or stomach. There might be shortness of breath, without chest discomfort. Victims may break out in a cold sweat, feel nauseated, or light-headed. Common complaints masking heart disease can be unusual fatigue, difficulty sleeping, indigestion, and anxiety. Many women delay seeking emergency medical treatment, but if they wait too long, it may be too late. Time is essential in having the needed angioplasty done to open up blocked arteries and restore the healthy flow of blood to the heart muscle.
Another reason that the mortality rate is higher for women according to Dr. Mimi Guarneri is ”Women are far less likely than men to receive basic medical care that could significantly reduce their heart attack and stroke risk. Many physicians order fewer tests for women and prescribe fewer preventative measures such as daily aspirin, diet, and cholesterol and blood-pressure-lowering medications” Women need to be self-advocates. Nobody knows her body better than the body’s owner.
A Unique Christmas Present
Like many other women survivors before my heart attack in December, I lived under an umbrella of denial, false security, and blissful ignorance.
It was mid-afternoon on Friday, December 22nd, three days before Christmas. My house dazzled with holiday brilliance. It was clean and ready for family and guests. Mulling spices infused the air. Food was bought, prepared, and stored, ready to serve. Worn-out ornaments were replaced by new ones on my Christmas tree. It sparkled with lights, ribbon, and crystal icicles. At its top was a cute Santa topper to delight my grandchildren.
Mid-day, I felt a discomfort in my upper chest, upper back, and throat: a complaint I’d never felt before. It was at once too painful to ignore and too indeterminate to identify. Neither passing time nor attempts at resting helped. I called out to my husband for help. “I think I’m having a heart attack,” I admitted. “You’re too healthy,” he protested. Finally, as the symptoms 5 persisted, he suggested an ambulance. I begged for him to drive me: “No sirens for me, please!” It was fortunate that I arrived at the nearest hospital emergency room in the nick of time.
The EKG alerted the cardiologist. I was immediately carted into an examining room. My pulse suddenly dropped dangerously low, and cardiologists filled the room. A catheter was inserted into the carotid artery in my neck. Dopamine was administered into my IV to raise my pulse rate. Chilled intravenous solution was pumped into my veins for therapeutic hypothermia. Nevertheless, I began to lose consciousness. Voices became muted blurs. I sensed my gurney being pushed through the corridors to the catheter laboratory. Several hours later, after two stents were inserted into two of my antral arteries, fresh blood once again began to flow into my heart. I was lucky. Fortunately, I got help in time by a team of skilled cardiac physicians, and my loving family surrounded me.
Listen to What Your Heart is Telling You!
If I had listened to the warnings my body was giving me as long ago as last June, I might have enjoyed Christmas with my family.
My husband and I visited Banff, in the Canadian Rocky Mountains early summer last year when snow blanketed the mountains, but a glorious spring bouquet of wildflowers carpeted the ground. This national park is situated nearly five thousand feet above sea level. Soon after arriving, we took the two-mile Lake Agnus Tea House Hike, which begins by turquoise Lake Louise at the famous Fairmont Chateau Hotel. The hike is rated, “moderate” a two-hour climb of about thirteen-hundred feet on a switchback trail. Below, the surreal Lake Louise diminishes in size, until finally, it disappears from view. The trail passes by tumultuous falls, rocky streams, and dense woods.
I felt confident about my ability to take the Tea House Hike. Although I am a seventy-three-year old woman, I regularly chart five to six-mile walks along sandy ocean beaches near my home in San Diego, California. A moderate hike like the Tea House Hike seemed to pose no problem.
But, surprisingly every thirty yards or so I needed to stop to catch my breath. My husband patiently waited for me to catch up to him. Each time as I huffed and puffed to join him, he looked at me quizzically: “Are you all right?” He wondered. “Must be the altitude,” I explained. When we arrived at the Tea House, another hiker approached me. Smilingly, he congratulated me. “I’m glad to see you made it!” Two others saw what I denied myself by not letting my heart speak. It was warning me.
Until recently it was believed that the brain is the catalyst for rushing the many emotions we feel to the rest of our body. More recently, however, the heart is considered an organ of great intelligence, “…with its nervous system, decision-making powers, and connections to the brain. It also has its logic that tunes it into the senses that are transformed into nerve impulses that permeate the brain. It has been called, “The Little Brain,” because it acts independently of the cranial brain: to learn, remember, even sense, and feel.8 Does it intuit? Victims have been noted after their heart attacks to recall premonitions of death or despair. In my case, I had trouble sleeping. I’d become afraid to go to sleep.
The American Heart Association has done a good job of educating women of changes they can make in their lifestyles that will help avoid coronary heart disease. To live a pro-active life, one would quit smoking and take control of high blood pressure, high cholesterol, and diabetes. She would stay physically active and maintain a healthy weight. She would eat a low-fat, low-salt diet, rich in fruits, vegetables, and whole grains. Finally, she would reduce and manage stress.i Coronary disease may be emotional and spiritual as well as physical, according to Doctor Guarneri. Other than the more recognizable risk factors, others might include social, psychological, and spiritual issues. Specifically, cardiologists are looking at isolation, depression, and hostility.
Chronic depression “stands beside high blood pressure and elevated cholesterol as a major risk factor for heart disease. Those with heart disease who are depressed have an increased risk of death after a heart attack compared with those who are not depressed—four times as likely.” Type-A women can carry feelings of cynicism and hostility that tend to raise their stress hormones. High-stress hormones result in higher cholesterol and blood sugar levels: risk factors for heart disease. These women may feel pushed, competitive, goal-directed, and sometimes, isolated, and hostile. In many cases, the mask of hostility covers emotional pain. Depression, anxiety, a sense of low self-efficacy can be predictors of major illness, including heart disease. Mothers have a particular kind of stress. They are caregivers. Not only do they tend to their family’s tender responsibilities, but they also keep the near-impossible task of scheduling and running children to their myriad after-school activities. They supervise their household, act as a control point for communication; are moderators, tutors, ministers, and coaches. Many mothers do all this (and more), and still find time for careers, professions, or jobs. There is no wonder that there is no time left for a rest, taking care of their health care and mental well-being. What time is there to consider what would happen to their personal universe if they should suddenly disappear?
My daughter called me just now. Winter break has ended, and she is due to return to her teaching job tomorrow. “I don’t want to go back,” she said, her voice muffled, holding back tears.
“Why not?” I asked, feeling very disappointed. She is a resource specialist for her middle school. She has been nominated for city-wide “teacher of the year,” dynamic in the classroom, and had been very enthusiastic about working with her special-needs students. She is ambitious, and she is an achiever. When I reinforced these talents to her, she admitted to me that she did recognize them in herself, but…she was struggling with the politics. I let her talk. I listened to what she had to say, validated her feeling, and empathized with her. Then I reminded her that she had just finished three weeks of being very busy after a semester of the hard work of teaching. During the winter break, she occupied her elementary-aged children, caught up with housekeeping chores she’d put off while working, and put Christmas magic into her home. And she’d had to deal with a sick mother who was recovering from a heart attack.
We discussed her frustrations for a while, and she asked my advice. I told her that I felt her source of energy had become depleted. “You are simply exhausted,” I said. It was time for her to recharge her batteries, recognize her inner beauty and character strengths. “Do some positive reaffirming, take some time for yourself―now, today,” I suggested. “Go into your room, shut the door, and let someone else take care of your kids while you take some me-time.” 9 But, I felt a sudden grip of fear. Didn’t my daughter’s behaviors reflect my own? And might they not be destructive behaviors that might put her on the path of future coronary heart disease (distress, frustration, and hostility)?
Hopefully, she found some help in coming to me and venting. I listened, validated her, and tried to support her. As someone said, the “I” in isolation causes illness; the “We” in wellness heals. Perhaps in knowing that she has a team backing her by her family and solid spousal support, she will feel reinforced and pull on our loving strength for her own.
Seventeenth Century poet John Donne recognized that “No man is an island.” Now in the Twenty-first Century, through the miracle of technology, humans can connect to anyone, anywhere, at any time. Paradoxically many complain of feeling lonely and isolated. They see themselves as separate souls, ‘islands of consciousness confronting an alien world." Many struggle with issues of loneliness. Loneliness and despair can increase inflammation throughout the body, heighten levels of stress hormones, and create an increased risk of heart attacks and strokes.
Contrarily, social interaction improves the production of genes that produce antibodies that fight infection. According to Psychology Today,13 healthy people share similar attributes. They focus on quality over quantity. While social media may provide a seeming abundance of “friends,” a few good friends are hard to find and a treasure to keep. People with healthy social tools tend to seek face-to-face relationships rather than depending on telephones and the internet.
They share personal bits of information, and they listen to others responsively by asking questions about what they hear. The heart that beats within your chest is much more than merely a blood pump. It holds treasures of memories, feelings, joy, sorrow, grief, and hopefulness. It is an organ to listen to, care for, and understand. It will tell us when we work too hard, when we struggle with issues of despair, when we need to talk to a good friend, or when we should take time for ourselves to refurbish and renew. The heart also will tell us when we are joyous, contented, and hopeful. Focusing on spiritual, emotional, and physical self-care may help us avoid an attack. Being aware of warning signals to keep in mind might keep us forearmed. In the busy life of a woman, nobody needs to take time to listen to what her heart is telling her then she does. So busy giving care to others, she needs to take time to care for herself. A healthy heart needs healthy habits. https://www.mayoclinic.org
1 Mayo Clinic, “Heart Diseases in Women: Understand Symptoms and Risk Factors.” https://www.mayoclinic.org/diseases-conditions/heart-disease/in-depth/heart-disease/art-20046167
2 Guarneri, Mimi, M.D., FACC The Heart Speaks, A Touchstone Book, Simon & Schuster, New York, 2007. (page 175)
3 Mayo Clinic, “Broken Heart Syndrome,” https://www.mayoclinic.org/diseases-conditions/broken-heart-syndrome/symptoms-causes/syc-20354617
4 Guarneri, Mimi, M.D., FACC. The Heart Speaks, Simon and Schuster 2007. Page176
5 Guarneri, Mimi,, M.D., FACC. Ibid (pg 176); Jean McSweeney et al., “Women’s Early Warning Symptoms of Acute Myocardial Infarction,” Circulation 108 (2003);2619
6 McSweeney, Jean, et al. “Women’s Early Warning Symptoms of Acute Myocardial Infarction,” Circulation 108 (2003):2619.
7 Guarneri, Mimi, M.D., FACC, ibid (page 156); J.I. and B.C. Lacey, “Two-way Communication Between the Heart and Brain: Significance of Time Within the Cardiac Cycle,” American Psychologist (February 1978): 99-103.
8 Guarneri,Mimi, M.D., FACC, ibid (page 156); J. A. Armour and J. Ardell, eds.,, Neurocardiology, (New York); Oxford University Press, 1994
9 Guarneri, Mimi, M.D., FACC ibid (page 92); A. Appels, “Depression and Coronary Heart Disease: Observations and Questions,” Journal of Psychosomatic Research 43 (November 1997): 443.52; review
10 Guarneri, Mimi, M.D.Facc ibid, page 93
11 Guarneri, Mimi, M.D., FACC. Ibid (180); Alan Watts; Myself: A Case of Modern Identity. San Anselmo, CA; Audio Wisdom, 1973.
12 Underground Health Reporter: “Social Isolation may be the Most Serious Health Hazard of the Twenty-first Century,” http://undergroundhealthreporter.com/social-isolation-hazards/