Just between women A candid talk by women for women Providence Medical Group

Feb. 28

How can this be? I’m not old enough to have diabetes, hypertension or heart disease Julie Rice, ARNP Rochester Family Medicine

A patient story

A patient story I would like to introduce you to: S.C. 40 year old female

A patient story Medical history:

• Overweight by about 40 pounds

• High blood pressure

• High cholesterol

• Borderline glucose level

A patient story Social History: • Married • Two children • Tobacco: 1 ppd for about 24 years • ETOH: socially • Activity level: sedentary • Employed full time in a sedentary job

A patient story • Early morning she drove to work • Started having some “mild indigestion” on the way • It continued at work so she went outside for a cigarette • Indigestion got worse, and she started to experience upper mid epigastric stomach pain • Told her boss she was going home sick for the day • On the way home started severely sweating and started to have jaw pain • Drove straight to her doctor’s office • EKG showed acute cardiac changes indicating she was actively having a major heart attack • Subsequently had “Coronary Artery Bypass Graft (open heart surgery) for a four vessel repair

A patient story This healthcare scare resulted in sustained major lifestyle changes: • Quit smoking • Lost 45 pounds • Works out 5 days a week Changed entire dietary intake to include: • Low fat / low cholesterol /low salt diet • More fruits and vegetables and salads • Significantly reduced simple carbohydrates (white grains/rice, sugars, and increased complex carbohydrates (brown rice, brown bread) • Lean meats, increased chicken and turkey without bone or skin

A patient story • Continues to take a low dose statin for

cholesterol

• No longer on blood pressure medication

• Has not developed diabetes

• Has since watched her daughter get married

and the birth of two grandchildren

Three diseases which effect women of all ages

Diabetes, hypertension and elevated cholesterol often go undiagnosed because many of the symptoms are silent or seem so harmless.

Diabetes: Stats are staggering •  25.8 million (8.3%) of people in U.S

•  1.9 million new cases of diabetes diagnosed (20 years and older) in 2010

• 215,000 people under 20 have diabetes

• 26.9% of Americans 65+ have diabetes

Signs/Symptoms •  Frequent urination •  Unusual thirst •  Extreme hunger •  Unusual weight loss •  Extreme fatigue and Irritability •  Frequent infections •  Blurred vision •  Cuts/bruises that are slow to heal •  Tingling/numbness in the hands/feet •  Recurring skin, gum, or bladder infections If you have one or more of these diabetes symptoms, see your doctor right away.

How are cholesterol, triglyceride, weight and BP related to diabetes •  People with type 2 diabetes have high rates of cholesterol and triglyceride abnormalities, obesity, and high blood pressure, all of which are major contributors to higher rates of cardiovascular disease

Metabolic syndrome Any three of the following:

• Excess weight around the waist

• High levels of triglycerides

• Low levels of HDL (good cholesterol)

• High blood pressure

•  High fasting blood sugar levels

Especially for women •  Women with diabetes are also more likely to have a heart attack, at a younger age, than women without diabetes

•  Pregnancy brings the risk of gestational diabetes (develops in 18%)

•  1 in 3 women will die of heart disease

•  The risk of depression increases in women with diabetes

•  Women with diabetes have less interest in sex

Heart disease

•  1 in 4 women dies from heart disease (while 1 in 30 die from breast cancer)

Risk factors heart disease

•  Smoking

•  Overweight – BMI greater than 25

•  Hypertension

•  High cholesterol

•  Lack of exercise

Know your numbers

•  BP 120/70 or less •  Glucose less than 100 (fasting) •  Cholesterol less than 200 •  Triglycerides less than 150 •  HDL greater than 45 •  LDL less than 100 •  Exercise 30-60 minutes daily

Questions for your doctor 1.  What is my risk for heart disease? 2.  What is my blood pressure? What does it mean for me, and what do I

need to do about it? 3.  What are my cholesterol numbers? (These include total cholesterol,

LDL or "bad" cholesterol, HDL or "good" cholesterol, and triglycerides.) What do they mean for me, and what do I need to do about them?

4.  What is my "body mass index" and waist measurement? Do they indicate that I need to lose weight for my health?

5.  What is my blood sugar level, and does it mean I'm at risk for diabetes?

6.  What other screening tests for heart disease do I need? How often should I return for checkups for my heart health?

7.  What can you do to help me quit smoking? 8.  How much physical activity do I need to help protect my heart? 9.  What is a heart-healthy eating plan for me? Should I see a registered

dietitian or qualified nutritionist to learn more about healthy eating? 10.  How can I tell if I'm having a heart attack?