From the April -- St. Louis Woman's Magazine -- Women's Health section
Gender can play a key role in how symptoms are manifested.
by Breyanna Knoll
CORONARY HEART DISEASES CAUSE THE MOST DEATHS IN AMERICAN WOMEN. According to the American Heart Association, nearly twice as many women die from heart disease, stroke and other cardiovascular diseases than from all forms of cancer.
Heart disease risks change based on gender. Each year 60,000 more women suffer strokes than men, but men have heart attacks more frequently and earlier in life. Gender also changes the symptoms of a heart attack.
"There's lots of data to suggest that women have different symptoms," says Dr. Patricia Cole, an interventional cardiologist at Missouri Baptist Medical Center. "The most common symptoms of a woman having a heart attack are heartburn or nausea."
Heart attack symptoms include discomfort in the center of the chest, pain or discomfort in the upper body, shortness of breath, cold sweats, nausea or lightheadedness.
"A woman may acknowledge the fact that she is nauseous and short of breath but may not understand that it is a heart problem and not a stomach problem," Cole says. "Women tend to come to the ER later - first because they don't recognize the symptoms, and second, women often feel the need to fold the laundry, make lunches and feed the dog before seeking medical attention for themselves. Women feel like they must take care of everything else before they allow themselves to be sick."
Like most health problems, heart disease arises from a combination of risks that can or cannot be altered with lifestyle changes. Older women, women with family histories of heart diseases and women who have had heart attacks before are at higher risk for heart disease.
"Because you can't change these, I tell patients to focus on what they can change," Cole says.
Women can reduce risk factors, like tobacco intake, high cholesterol, high blood pressure, physical inactivity and obesity. And although adults with diabetes have heart disease death rates two to four times higher than adults without diabetes, Cole says she considers diabetes partially modifiable because it can be controlled but not cured.
To take a proactive stance against heart disease, women can make lifestyle changes and discuss the proper tests with their physicians.
"I tell my patients that they need to know their numbers - blood glucose, blood pressure, blood cholesterol and weight," Cole says.
"Being screened for and knowing these four numbers gives a patient an enormous power in making changes to their own health care."
Healthy Eating Pyramid
Portion control and a vegetable-based diet keep women at acceptable weight.
by Breyanna Knoll
A HEALTHY DIET ENCOURAGES WEIGHT LOSS, BOOSTS ENERGY AND STRENGTHENS THE IMMUNE SYSTEM. But understanding the foods in a healthy diet intimidates and confuses many women.
Camilla Kotrba, dietitian with Dietitian Consultant Services, encourages her clients to follow the food pyramid and exercise portion control.
"We do not consider that there are any good or bad foods," she says.
Properly manufactured canned foods offer the same nutritional value, and some snacks provide the daily allotment of grains. Most women choose foods well, she says, but they increase their caloric intake by overestimating portions.
When counting calories overwhelms some women, portion control plates integrate designs that offer guides for serving measurements. Manufacturers present a variety of options from posh, floral designs to plates suitable for children.
Faculty members in the Department of Nutrition at the Harvard School of Public Health say the U.S. government's food pyramid and its twin My Pyramid rely on outdated science and people with business interests in their message. As an alternative to the two traditional pyramids, faculty members built the Healthy Eating Pyramid. The pyramid does not include serving suggestions, but it emphasizes what foods women should eat.
The pyramid includes regular exercise and emphasizes a plant-based diet with vegetables, fruits, whole grains and healthy fats like olive and canola oil. Faculty members recommend cutting back on American staples like red meat, refined grains, potatoes, sugary drinks and salty snacks.
As a realistic approach, the Healthy Eating Pyramid also encourages women to weigh the risks and benefits of moderate alcohol consumption.
The pyramid suggests a multivitamin as a nutritional insurance policy, and Kotrba suggests citruses as a vitamin C source. For vitamin A, women should turn to yellow fruits and vegetables or leafy greens.
"The only thing that I find is a little bit low in people's diets is dairy products," she says.
Kotrba suggests 2 to 3 cups of milk a day for calcium and protein.
Harvard faculty members suggest nondairy sources of calcium like collards, bok choy, fortified soymilk and baked beans.
Pregnancy Fitness
Exercise when you're expecting delivers a variety of benefits.
by Breyanna Knoll
DURING PREGNANCY, SOME MOTHERS FOCUS ON A HEALTHY DIET AND REGULAR EXERCISE because they want to give their baby the healthiest start possible. Aside from offering better nutrition, an exercise routine improves circulation and eases delivery for many women.
Walking and swimming are the best activities to incorporate into a routine because they ease impact on the joints. Pregnancy loosens joints, and exercises like high-impact aerobics might injure them more easily.
The American Pregnancy Association suggests pregnant women never exercise to the point of exhaustion or breathlessness. This shows the mother and baby are not receiving the amount of oxygen they require. As with any exercise routine, listening to your body is an important aspect.
In 2005, Saint Louis University School of Public Health researchers found that only 16 percent of pregnant women and 27 percent of non-pregnant women met the current physical activity recommendation.
Women who dedicate themselves to a regular exercise routine also lose the extra weight after pregnancy because they already have developed the mental stamina a routine requires.
These exercise guidelines also should be followed during pregnancy:
> Wear comfortable exercise footwear that gives strong ankle and arch support.
> Take frequent breaks, and drink plenty of fluids during exercise.
> Avoid exercise in extremely hot weather.
> Avoid rocky terrain or unstable ground when running or cycling.
> Avoid contact sports.
> Avoid lifting weights above your head and using weights that strain the lower back muscles.
> During the second and third trimesters, avoid exercises involving lying flat on your back.
A healthy diet is equally important as exercise, the American Pregnancy Association reports. Pregnant women should eat plenty of fruits, vegetables and complex carbohydrates.
A Message of Hope
Breast cancer survivor Theresa Taylor devotes her days to encouraging others to get screened.
by Shari Scales Finnell
WITH NO FAMILY HISTORY OF BREAST CANCER, THERESA TAYLOR DIDN'T SEE A NEED TO DO SELF-EXAMS. Besides, she was only in her 30s - a demographic not typically considered at high risk for the disease.
Yet, at the age of 36, Taylor happened to notice a lump in her breast.
Instead of feeling alarmed, she initially was puzzled. "My reaction was more along the lines of 'What's this?'" Taylor recalls.
That discovery in 2002 led to a diagnosis of breast cancer -- followed by another diagnosis of cancer in her other breast just two years later.
"As you can imagine, it's pretty devastating," Taylor says. "I have a family. I have kids. You're in shock when you first hear those words, 'You have breast cancer.'
"Since I didn't have a family history of breast cancer I never thought it was something that could happen to me," she adds. "I want people to know that it does happen."
Taylor, now 43, is determined to increase awareness about breast cancer and to serve as a visible reminder that you can survive the disease if diagnosed.
As an outreach coordinator at the Breast HealthCare Center at Missouri Baptist Medical Center, Taylor shares with women the importance of regular mammograms in detecting cancer at an early stage.
"Women so often focus on taking care of their families first before they think of themselves," she says.
"Our outreach provides the opportunity for them to get screened," says Taylor, who talks to women throughout Missouri. "The key is early detection and getting the help you need."
Taylor assures women, especially those who have a family history of breast cancer and are more fearful, that the help is there if they should need it.
"When you're getting a mammogram, you're nervous and more vulnerable," she says. "I'm able to say, 'Hey, I'm a survivor. I got through it; you can get through it, too.'"
Cervical and Ovarian Cancer
Educate yourself on screening methods and risk factors.
by Laura Kruty
CERVICAL CANCER AND OVARIAN CANCER CAN BE EQUALLY FRIGHTENING. But one - cervical cancer - is much easier to detect and treat.
The traditional screening method for cervical cancer is the Pap smear, says Dr. Timothy Philpott, M.D., obstetrician/gynecologist on staff at Missouri Baptist Medical Center. A liquid-based test Philpott uses has the advantage of finding more high-grade dysplasias, or advanced cancerous lesions, he points out.
"Another component is deciding how often, how early and how late patients need (a screening)," Philpott says. The American College of Obstetrics and Gynecology reports women should receive their first Pap test no later than age 21. Some evidence suggests women can stop screening after age 65, he says. Yet, another report says monogamous women can cease screenings after age 35.
Ovarian cancer, on the other hand, is a much more difficult disease to screen, Philpott says. "There is no current good screening test for ovarian cancer."
Because the ovaries aren't easily accessible, doctors must use an ultrasound, X-ray or blood testing. A test called CA-125 is useful in monitoring treatment of patients with ovarian cancer, but not as a screening method because it gives a high number of false positives and false negatives, Philpott says.
In the future, he says, a blood test like that for prostate cancer will be used to draw blood and proteins, which will be tested for risk level.
"It's been reported in articles, but hasn't reached the point of common practice," Philpott says.
Long called "the silent killer" because of a lack of symptoms, Philpott says ovarian cancer does present symptoms, but usually not until later when the cancer is more advanced.
"Stage I is extremely difficult to detect with a pelvic exam," he says.
Symptoms include bloating, abdominal girth and feeling full quickly.
One of the biggest risk factors in ovarian cancer is a family history, Philpott says. It's also important to be educated about the symptoms and to know that although ovarian cancer most often affects women older than 40, it also can happen to younger women.
Risk factors for cervical cancer include a family history, high-risk sexual behaviors, smoking and the presence of HPV. Patients with HIV also are more susceptible, he adds.
Quitting smoking and using condoms can reduce cervical cancer risk, as can the highly publicized Gardasil® vaccine, designed for women ages 9 to 26.
"We're very big proponents of that," Philpott says. Eventually, he says, women older than 26 will be able to receive the vaccine, and - he hopes - men too.
"Men are the carriers of HPV," he says. "It's not FDA approved for males at all. Hopefully, it will be."
Philpott urges women to pay attention to their bodies.
"The most frustrating thing we run into is patients still experience a lot of denial and ignore symptoms they suspect might be a problem," he says. "If you have bleeding after intercourse, that's not normal. It could be a sign of cervical cancer.
"Don't ignore abnormal symptoms."
Screenings
Women should seek mammograms or ultrasounds, depending on their ages.
by Breyanna Knoll
MANY WOMEN HAVE A LONG LIST OF REASONS THEY SHOULD NOT HAVE A MAMMOGRAM. Time constraints, awkwardness and being healthy are just a few reasons they give. Some women even suggest the exposure to radiation will exacerbate any cancer present.
But the American Cancer Society suggests healthy women above age 40 annually screen for breast cancer with a mammogram.
A mammogram is an X-ray that allows radiologists to look at the various tissues in a breast. Any tumor increases vascular activity, and the blood vessels form calcifications in the area.
Though screening mammograms should be completed annually, doctors reserve diagnostic mammograms for examining any masses up close.
Screening mammograms typically are not recommended for women younger than 40, because the breast tissue is so dense that microscopic calcifications can become too difficult to see. Instead, younger women with concerns about breast cancer should have ultrasounds.
Unlike other forms of radiology, mammography only recently began the transition to digital imaging. According to the Food and Drug Administration's studies under the Mammography Quality Standards Act, only 30 percent of institutions used a Full Field Digital Mammography unit in March 2009.
The technology for mammography has transitioned slower than other technologies because of its high-resolution demands.
Staying Ahead
Plan a doctor's visit for routine screenings at the beginning of each year.
by Breyanna Knoll
AS WOMEN BECOME MORE PROACTIVE ABOUT THEIR HEALTH, PREVENTATIVE MEDICINE PLAYS A LARGE ROLE IN HEALTH CARE. Listening to your body and knowing about the proper tests for your age are also important.
The American Cancer Society says chronic constipation, persistent sores, unusual bleeding and lumps in the breast or lymph nodes might not mean cancer, but they could indicate a problem that requires medical attention.
If you have one of these signs, you need to see your physician and be evaluated.
Dr. Deborah Wienski, a medical oncologist at Missouri Baptist Medical Center, says, "The symptoms probably won't go away and likely will worsen."
She stresses the importance of routine screenings. They can help detect some cancers early, often before symptoms appear.
Though doctors recommend some tests later in life, women can begin testing for cervical cancer, high blood pressure, high cholesterol and diabetes in their early 20s.
Mammograms, colonoscopies and bone density tests usually begin after age 40, but certain risk factors, such as family history, might warrant earlier testing.
General practitioners may use the Gail Model to assess breast cancer risk. The Gail Model factors a woman's medical history, reproductive history and the history of breast cancer among her first-degree relatives to estimate her risk of developing invasive breast cancer over specific periods.
The American Cancer Society supports use of the Gail Model by medical professionals, but notes its weakness in underestimating breast cancer risk for women with hereditary syndromes. The Gail Model might not be appropriate for these women.
One of the most exciting developments, Wienski says, is the Gardasil® vaccine for young women ages 26 and younger. The vaccine helps prevent the four types of human papillomavirus known to cause cervical cancer.
It's recommended women start the year by scheduling all health screenings for gynecology, mammograms and dental exams. Women also are advised to list health challenges - smoking, cholesterol, obesity, blood pressure, stress, nutrition or lack of physical activity - and resolve to tackle one challenge that year.
Life-changing Moment
Mary and Dan Byers take the message of healthy living to heart.
by Shari Scales Finnell
THOUGH MARY AND DAN BYERS BOTH HAVE A HISTORY OF HEART DISEASE AND HIGH BLOOD PRESSURE IN THEIR FAMILIES, the couple didn't think much about maintaining healthy lifestyles. During their late 30s, they were focused on the demands of their daily schedules.
That all changed within a matter of weeks. Shortly before Dan's 40th birthday, he complained of feeling pressure - like a brick was sitting on his chest, Mary recalls.
After a series of stress tests and an echocardiogram test, Dan's physician recommended that he see a heart specialist - immediately.
Within days, Dan was in the office of Dr. Allen Soffer, a cardiologist at Missouri Baptist Medical Center.
During that appointment, Soffer told Dan he would need to undergo surgery right away, Mary says.
"It was kind of surreal … like it's not really happening," says Mary, recalling the shocking experience.
On Jan. 28, 1997, Dan underwent heart surgery at Missouri Baptist. The procedure more than likely saved Dan from suffering a massive heart attack, Mary says.
Looking back on the ordeal, Mary doubts her husband would have complained of his symptoms had it not been for the recent death of one of her co-workers at The Solae Company, who had suffered a heart attack.
"Dan probably would have kept ignoring his symptoms," Mary says. "I think he would have thought, I'm just tired. I'm run down. He's not one to complain. He suffers in silence."
Mary says the experience was life changing.
"You constantly hear about all the benefits of healthy living," she says. "You've been preached that, you see it on TV and you read about it in magazines. Once it hits you personally, that's when you realize it does make a difference."
Today, Mary and Dan, both now 52, not only have adopted healthier lifestyles through diet and exercise, they volunteer to share their stories with others in hopes of encouraging them to adopt heart-healthy habits.
They volunteer for the Mended Hearts program at Missouri Baptist and the Healing Heart program at Jefferson Regional Medical Center near their hometown of DeSoto.
Each year, they volunteer at the Missouri Baptist Medical Center Heart Fair and walk with the American Heart Association's Heart Walk, as well as participate in the Get Healthy DeSoto Program.
"It's important to take care of yourself. Exercise, watch your weight and listen to the signs your body gives you," Mary says. "If you're having pain, make sure you don't ignore it. Go see your doctor and get regular checkups.
"It's really important that people take care of themselves - to be healthier longer and be there for their families and just enjoy life."
Relieving Stress
Take time to take care of your mental health.
by Breyanna Knoll
WOMEN OFTEN REFUSE TO TAKE TIME FOR THEIR OWN MENTAL HEALTH. Some mothers can barely squeeze in a shower, let alone a luxurious bubble bath. Yet, that time for themselves might improve their lives overall.
Stress can manifest itself in many forms, sometimes leading to symptoms of illness. People dealing with stress may complain of headaches, problems sleeping, difficulty concentrating and an upset stomach. Other signs include low morale, depression and anxiety, according to the Office on Women's Health of the U.S. Department of Health and Human Services.
The department suggests the following tips for handling your stress:
> Relax. It's important to unwind. Try deep breathing, yoga, meditation, and massage therapy. If you can't do these things, take a few minutes to sit, listen to soothing music or read a book.
> Make time for yourself. No matter how busy you are, you can try to set aside at least 15 minutes each day in your schedule to do something for yourself, like going for a walk.
> Sleep. With enough sleep, you can tackle your problems better and lower your risk for illness. Try to get seven to nine hours of sleep every night.
> Get moving. Physical activity not only helps relieve your tense muscles but helps your mood too.
> Talk to friends. Find someone who will let you talk freely about your problems and feelings without judging you.
> Get help from a professional if you need it. Talk to a therapist who can help you work through stress and find better ways to deal with problems.