by Carolyn Thomas ♥ @HeartSisters
Five months after my heart attack, I attended the 2008 WomenHeart Science & Leadership patient advocacy training at Mayo Clinic – the first Canadian heart patient ever accepted. I learned so much from my 44 American heart sisters – ages 31 to 71 – who also attended that year, and of course from our rock-star faculty of female cardiologists from Mayo and beyond, brilliantly led by the one and only founder of the Mayo Women’s Heart Clinic, Dr. Sharonne Hayes.♥ When I returned home and started writing and speaking about what I’d just learned at Mayo, my public relations friends teased me: “This is what happens when a PR person survives a heart attack: you just keep writing, speaking and looking stuff up – because that’s all you know how to do!” And they were so right! Here’s my annual overview of what I’ve been learning while writing some of the most-read posts this past year: .
1. Sharing our health struggles: too much, or not enough? In January of 2023, Harvard researchers launched a new book about their multi-generation Harvard Study of Adult Development: The Good Life: Lessons from the World’s Longest Scientific Study of Happiness. One of their key points was the importance of talking about our serious health issues when we’re struggling.
But what I learned about this study is that it began in 1938, so like basically all academic research back then, THERE WERE NO WOMEN in the study for decades. So Harvard’s recommendation (“Talk about what you’re struggling with!”) might be more applicable to men than to women. Maybe their book title should be “The Good Life: Lessons FOR MEN”. Meanwhile, there is no legal requirement to disclose every personal detail of every personal health problem update if you don’t want to. Read the rest of the post to see what other social scientists say about this.
2. Struggle care: a new way to look at housework: I am still laughing at the hilarious reader comments this post inspired! It’s based on the wonderful work of Texas psychologist KC Davis – whom I only learned about this past year. She reminds us that routine household chores called “care tasks” can suddenly seem insurmountable in the face of certain life changes – like having a baby, or a divorce, or being diagnosed with heart disease. I learned some truly helpful tips which KC calls the Six Pillars of Struggle Care to use when fretting over why the housework isn’t doing itself. And then my readers jumped in with their astute theories on WHY we fret over housework in the first place (spoiler alert: it was your mother!)
In this post, I told my own story of sorting out the trunk of my car – a task I’d been meaning to do since 2017. As I explained: “I wish I were the kind of person who drives around with a clean, empty trunk like so many people do – but clearly I am NOT. I did, however, find a baby stroller and a favourite umbrella in there that I thought I’d lost!” KC also reminds women that “Good Enough is Perfect!” I’m going to go embroider that one on a pillow. . .
3. Sweating: the neglected cardiac symptom: This was a surprisingly popular Heart Sisters post this past year, and I learned that it’s likely because it addresses a common yet often overlooked cardiac symptom in women. In fact, the top three most commonly reported cardiac symptoms in both women and men are chest pain, shortness of breath and sweating! In this post, I quoted Dr. Catherine Ryan at the University of Illinois in Chicago, who explains why we tend to sweat during a cardiac event, and then warns: “Breaking out into a sweat for no apparent reason is one thing that you cannot explain away!” – as many women often try to do with other heart symptoms at first – like shortness of breath (I’m just out of shape?), nausea (something I ate?), fatigue (all women are tired!), and even chest pain (a pulled muscle?)
4. Medical Minimizer or Medical Maximizer: which one are you? This post’s popularity has as its core an often-heard complaint from our physicians: “Why don’t my patients take their medications that I prescribe for them?” I started this post with a quote I love from Boston cardiologist Dr. Lisa Rosenbaum from The New England Journal of Medicine:
“I wanted to believe that if my patients knew what I know, they’d take their medications. But what I’ve learned is that if I felt the way they feel, I’d understand why they don’t.”
I also quoted the 2012 book, Your Medical Mind by Drs. Jerome Groopman and Pamela Harzband, in which I learned more about this concept of Medical Maximizers vs. Medical Minimizers. They wrote that “each of us has a medical mind, a highly individual approach to weighing the risks and benefits of treatments. Are you a minimalist or a maximalist, a believer or a doubter, do you look for natural healing or the latest technology?” The answer to those questions can explain a lot!
5. Women’s heart disease: is it time to hang up the Red Dress? This post addressed a topic we don’t want to talk about, but we must. We know, for example, that the last American Heart Association awareness survey on women and heart disease revealed shockingly awful results, as the AHA itself admitted:
“Women’s awareness of heart disease – our #1 killer – is actually worse now than the results of our last awareness survey 10 years ago. Almost half of women we surveyed did NOT know that chest pain is a cardiac symptom!“
No matter how you slice and dice these and other stunning survey results I mentioned in this post, I learned that it’s no longer possible to pretend, after decades of massive awareness-raising campaigns and Wear Red for Women events and wearing little Red Dress lapel pins every February, that what we’ve been doing is working. We can’t light up downtown buildings in red and actually believe that a red spotlight is somehow educating women about heart health. Unlike the U.S., here in Canada, even our national Red Dress Day has nothing to do with heart disease! Instead, it’s the official National Day of Awareness for Missing and Murdered Indigenous Women and Girls, observed every May 5th. I also quoted Florida researchers who warn that adding more info/more facts/more stats/more data will NOT change poor results of awareness-raising campaigns: “People who are simply given more information are unlikely to change their beliefs or behavior.”
6. Cardiac arrest: when it happens in the bathroom: Did you know that over 10 per cent of all sudden cardiac arrest deaths are linked to constipation-related straining on the toilet? I just learned this in 2023. I also learned that sitting on a modern toilet seat is also behind most bowel-emptying problems – compared to the simple squatting posture that has been historically used worldwide long before the invention of pedestal flush toilets a century ago. As a privileged Canadian urban-type woman, I’m not keen on squatting, personally, but I do mention several preventive recommendations in this post that I learned might help to avoid constipation and related straining, and the best one was this: “Resting both feet up on a footstool while you’re sitting on the toilet will keep your knees above the level of your hips, and can help to mimic a squatting posture and reduce straining.” WHO KNEW?!?! Japanese researchers also warned: “Physicians caring for patients with cardiovascular disease should acknowledge constipation and related straining during bowel movements as an important cardiovascular risk, and pro-actively intervene to prevent it.”
7. Finally, I’d love to mention something I wrote this year not for my Heart Sisters readers, but for the physicians who read the British Medical Journal. It was called “Heart Failure: It’s Time to Finally Change the F-word“. The BMJ invited me to submit a patient opinion piece on this topic in early spring. But somewhere between early spring and mid-December when it was published in BMJ Open Heart, this manuscript had somehow morphed from a patient essay to an official Editorial.
Here’s what I learned about writing an Editorial for a major medical journal: patients are rarely if ever invited to write them! I have no medical experience, no graduate degrees, nothing but that Mayo training street cred and a personal history of being misdiagnosed in mid-heart attack. The big difference to me is that articles here on my site are read and shared mostly by women with heart disease, but articles in medical journals are read and shared mostly by clinicians (who will, let’s face it, be the ones who decide to change or not change the hurtful name of heart FAILURE). And I also learned that medical journal Editorials follow the same required steps as academic researchers who publish their scientific papers, e.g. editors, peer review, and lots of tech challenges. And that’s also how I learned how valuable a good Editorial Assistant can be! Thank you, Christine Janssen-Seijkens at BMJ Open Heart!
To all learners, and especially to all of my readers from 190 countries around the world, I wish a “Happy New Year” to you wherever you are. May you have a safe, peaceful and heart-healthy year ahead in 2024. ♥
Image: Coco and Wifi, Pixabay
♥
NOTE FROM CAROLYN: Have you read my book A Woman’s Guide to Living with Heart Disease? You can ask for it at your public library or favourite bookshops (please support your local independent bookseller!) or order it online (paperback, hardcover or e-book) at Amazon – or order it directly from my publisher Johns Hopkins University Press (use their code HTWN to save 30% off the list price when you order).
Q: What other topics related to the future of women’s heart health would you like to see here in 2024 Heart Sisters posts?
Heart Sisters 
Hi Carolyn, I am so grateful to you for your book and all of your articles – they have helped me tremendously.
Today is my 1st Heart-iversary and it’s been a roller coaster of emotions, but I am so grateful to be here and to have had all the love and support over the past year.
It’s been quite a healing journey and that is a work in progress both physically and mentally. I wish you a year ahead that feels safe, serene and full of joy and hope.
Kathleen
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Hello Kathleen – Happy 1st Anniversary! – and thank you so much for your kind comment.
Many people have told me that they view this first year milestone as a kind of turning point (we’re no longer that scared, overwhelmed freshly-diagnosed new patient in a frightening hospital, but we’re also not quite yet over the milestone of looking back at that cardiac event as a long-ago experience of a distant past. By now, you’re likely a real expert in being a “work in progress” as you say – but progress is the key word, day by day. You probably have learned more than you ever thought you’d want to even know about heart disease (particularly those mental/psychosocial bits!) I often say that heart disease did not matter AT ALL to me – until it happened to me! And after that, it mattered a whole lot!
I hope that you too will enjoy the year ahead, feeling better day by day. ❤️
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Thanks Carolyn – as you say it’s about day by day progress and keeping moving forward.
I was thinking about your question about future topics… I am curious and starting to read about the heart and lung connection. I’ve had a longstanding cough on and off which pre-dates my heart attack so that is being followed up on (which I had to push for) but I want to learn more for myself.
An out of range BNP test recently has me curious about these various tests.
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Thanks for that suggestion, Kathleen. Getting an out-of-range test result is always a bit scary.
Just a thought about your longstanding cough (remember: I’m NOT a physician so cannot offer medical advice!) First, I’m glad this cough is being followed up – there are several reasons behind chronic coughing (if the lungs become congested, coughing is often the body’s natural response to an airway blockage, cuing you to clear bronchial passages by coughing to help relieve congestion).
But a question: are you taking an ACE-inhibitor drug for blood pressure by any chance? A severe dry barking cough is a known side effect. I had this cough for four years before changing GPs. My new GP heard me cough during my first appointment with her (so did everybody within a 2-block radius, I’m sure!) and I said, oh, I’m NOT SICK, that’s just ‘normal’ for me. She immediately noted from my medical records that I was taking Lisinopril and suggested we change that to a different drug that would be equally effective at managing BP – minus the horrible coughing! The cough stopped within the first week and has never come back.
It wasn’t a ‘normal’ cough at all (truly, it was embarrassing more than anything else – sounded like I was coughing up a lung!) but I didn’t clue into the lung connection at all at the time.
Thanks for the heart/lung connection idea – I’ll add that to my future blog list of topics!
Take care. . . ❤️
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Thanks Carolyn, glad you were able to get your cough sorted out! I am on a low dose ACE inhibitor for artery protection vs BP – as mine is on the low side.
The cough pre-dates any meds by many years. I just put up with it for a long time as ‘part of me’. It’s since my heart attack I’m wondering if there is more to the story and a possible heart / lung connection, so I’m thankful it’s getting checked out. Better late than never!
Take care!
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Hi Kathleen – I think so much of medicine is ruling out what the problem is NOT, as you are now doing with this cough issue. You’ve inspired me now to look into this heart/lung connection. And so many body parts are inter-connected, it wouldn’t surprise me if we learn all kinds of new developments in the connection between those important organs.
Thanks again for your thoughts on this! ❤️
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I look forward to reading your excellent articles here in Northern Ireland. I wish you and yours a very wonderful 2024. Thank you for all the work you do to raise awareness of women’s heart health.
I had a silent heart attack in April, maybe a future article on this type would be helpful. I had all the symptoms: clammy, blurred vision etc but no chest pain, nor did it show up on the ambulance heart tracer. I did have a bad ache in my throat.
Finally after blood tests, a heart attack was confirmed. Having 3 stents already over the years, I had all tests done but was told I had a inside fur coat, joking was the young doctor? On being told if I was younger I would be offered a bypass, but too risky at my 82 years, and I agree. I am on medication now and feeling the restraints of it all daily.
I do try to keep positive and have now learnt the lesson of patience, but sometimes I just yearn for those days when I was able to run and dance 💃 and be me again.
Sorry for the long epistle, it helps me to write it out of my system. 😅
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Hello Brenda, and thank you for your kind words. I was just thinking about silent heart attacks the other day, so your response is very timely! I’ll put that topic on my 2024 list, for sure – although I’ve written over 900 (!) posts here since 2009, I’ve not written specifically about that one.
I believe that yearning for the ‘good old days’ is quite common after a serious diagnosis. Researchers call that the “loss of self” (for example, we “observe our former self-images crumbling away without the simultaneous development of equally valued new ones.” You have been adapting, however, as you describe staying positive and being patient – both skills that will help every day.
Take care, and Happy New Year to you. . . ❤️
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Thankyou for another great article. I’m a yoga teacher interested in women’s health, especially after my mum had open heart surgery 20 months ago and seeing the devastating impact it had on her at 78 years old.
I love your campaigning, especially over the F-word. I have seen this in my local clinic and will be directing them to your book.
With love,
Kate
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Hello Kate and thanks very much for your nice note.
There’s nothing quite like witnessing your own mum go through major heart surgery and recuperation to inspire an interest in finding out more about our #1 killer. The heart patient is surrounded 24/7 by doctors and nurses whose only job is to make sure the patient is recovering well, while many times the family or close friends can feel just as upset (and even worse, helpless) – but all attention is, not surprisingly, targeted at the patient. I hope your mum and the rest of your family are doing much better now.
Happy New Year to you. . . ❤️
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Dear Carolyn,
Thank you for your dedication, perseverance and genuine love of knowledge and people!
Finding your column in my mailbox every Sunday makes me smile.
I first discovered Heart Sisters through your article on crushing fatigue and I have enjoyed it ever since.
When you asked about topics for 2024, I’d love to hear if you find research on the consistently inconsistent aspects of cardiac symptoms… that seems to be my latest conundrum.
Why do I get short of breath one day while getting dressed and not another day? Why can’t I get out of my recliner for 3 days and then go on errands with great energy the next? I’ve tracked, diet, blood sugar, sleep, medications, heart rate, rhythm and BP…. None of them are the culprit!
I have come to the place of accepting that “it is what it is” and just getting on with it rather than fretting.
But as a lover of human physiology I DO wander what the heck is going on!
Onward and Upward!
Happy New Year!
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Hello Jill – Thanks so much for your kind words. Just as you look forward to finding my columns on Sunday morning, I look forward to your thoughtful and wise comments in response to almost all of them! Thank you for that heart connection we share.
Your questions are 100% on point. I too find that these”consistently inconsistent” symptoms are puzzling – especially when trying to make plans for future outings. It seems that I used to be able to accurately predict a “good” time of day (to meet friends for coffee, for example) until the day arrives and I can immediately tell that this is just not going to happen! Symptoms are rarely straightforward (e.g. people living with stable angina – pain on exertion, pain eases with rest – can predict that if they run up the stairs, they WILL feel chest pain).
I now generally say NO to all invitations for evening outings because it’s “normal” for me to be in my jammies by 7 – but sometimes I’ll be visiting my little grandson and feeling surprisingly perky at 7! I also have a 3-generation photo of me, my mother and daughter taken as we were celebrating my mother’s 80th birthday, the day before I was hospitalized with a “widow maker” heart attack. I’m happily smiling for the photographer – even though I was having severe cardiac symptoms. Didn’t want to make a fuss on her birthday, ruin the party… I like your ‘it is what it is” philosophy.
Your suggestion to see more on this topic in future blog posts is a good one. I suspect this “inconsistency” of symptoms = especially in women! – is what often contributes to diagnostic error.
Happy 2024 to you, too. ❤️
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Thank you for sharing your own inconsistencies. . . I give my best effort to not feeling “lazy, crazy or stupid” but it always helps to hear there is another person that shares my conundrum.
Recently I’ve had days when I perk up at 4pm and then fade at 7pm LOL
Quite the enigma!
❤️🤝❤️
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Hey! You could actually make dinner plans on those ‘perky from 4-7pm’ days!!! I dream of that! ❤️
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Happy New Year Carolyn! Thanks for all your articles throughout the year.
I look forward to them every Sunday, I have your book, and of course I’ve had a heart attack in 2020. My first and hopefully last! I’m 76.
You have helped me, educated me, (I’m not a trained medical person), and most of all I feel encouraged by your articles that I somehow have tools to guide me on this journey.
I hope this all makes sense.
Thank-you!❤️
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Hello Nola,
Thanks so much for your kind words – which DO make perfect sense to me! I love hearing that the “tools” I write about here and in my book have helped you.
Happy New Year to you, too. ❤️
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