"The Heart of a Woman" Continues

As promised, here is more of the saga ... Some of this is on Mt. Sinai's website for both the hospital and the American Heart Association. They work tirelessly to provide information on women and heart disease, hoping for a growing audience. Now that I have figuried out the blogspot system, I hope to make a contribution, too. Thanks for your responses...

The Elusive Symptoms: Knowledge is Power

The saga had probably begun at least two months before the more obvious signs to come.
I was with a friend at a shopping mall, and just didn't feel right. I felt pressure in my chest and a sense of discomfort best described as what many women call “a dark cloud hanging over me”, typically appearing during a battle with a significant other, a spouse in my case. We had insurmountable problems and I was coming to realize that the marriage could not possibly survive. To my friend, it seemed that I was describing the symptoms typical of anxiety or panic attacks, totally believable but totally out of character. The only “somatic”, or physical, reaction I ever connected to stress was that vice grip on the back of one's neck that turns into a whopping stress headache. I could only guess that I was not handling the combination of my practice, our business and the problems in our relationship well and that this was to be my newest reaction. But I had no pain down my arm, no sweating, no dizziness, just a peculiar and fleeting feeling in my upper chest. I had no idea that the warning signs, and, more importantly, the symptoms of an actual heart attack could be so varied, as we are at last learning they are especially in women. It can be a terrible, even life-threatening mistake to self-diagnose. Neither is it about blaming the victim for not knowing better. Physicians themselves have encountered similar experiences, even with their vast knowledge bases, and how often do we hear that someone left the doctor's office with a seemingly clean bill of health, only to die of a massive coronary practically on the office steps? We do not want to feel vulnerable, helpless, on the brink. According to the theory of Alfred Adler, we instinctively strive for "superiority", not over others, but for ourselves, in a kind of self-competition to improve. Predictability and trust in your own body are rattled through disease, so questioning and knowledge become powerful and necessary. You may be puzzled, frustrated, exhausted, but whatever has happened to you that you surely did not plan offers you a chance to survive. Do not allow yourself to be seduced into self-pity or inaction; for example, learn to wink at yourself when you realize that fatigue has never been defined the way it is now, one of my unrecognized symptoms! Bad news can signal many things, including the possibility of becoming more of who we can be, but first, the initial alarm needs to be heard resoundingly. In re-examining the way you are living your life, you may choose to make changes or you may come to realize that your current strategies will not let you down, despite your difficulty. I had to remind myself to consciously and conscientiously apply what I knew: again the less reliable than usual voice in my head was advising me to maximize what works and eliminate what does not. Don't rely on "wishes", have a plan; be in collusion with yourself to prepare for the best outcome possible, using knowledge, thoughtfulness, pride of accomplishment. Thank yourself in advance for your cooperation, as in a business letter requesting something you need. I had been given the gift of survival; now it would be up to me whether or not I could reach the pinnacle, the point of glory achieved by some, that of thriving.
That feeling of diffuse pressure across my chest recurred about two weeks later, same friend, same mall, but this time coupled with what I would later be able to describe as difficulty breathing comfortably. We concurred once again that I was just more unhappy than I could admit, accounting for why the fallout was way beyond just a sore neck. This conclusion was based more on ignorance than on denial, since the symptom seemed easy to pass off using the psychology with which I was familiar and had long espoused. Several weeks later, while playing tennis three days before my husband and I were due to leave for vacation, I had a pain that was completely foreign. It was strong, located on the left side of my chest, but disappeared quickly. When it recurred, I decided not to simply ignore it. Streams of memories about my father's sudden death filled my mind, and I sat down. Again, it resolved immediately, but left me feeling vulnerable and wondering how much significance it represented. When I returned to the court the next day and it recurred, I found my way to the bench next to my friend, and told her what had happened, with tears welling up in my eyes. She was concerned, even though it once again abated quickly, but neither of us could believe that it was heart-related. No-more-tennis-today was my self-prescribed resolution, but while walking the half-block from my car after tennis, carrying heavy packages, the pain returned. This time it was not nearly as brief: it lasted about a minute and left me more than nominally frightened. Now there was the whisper of an inner voice telling me to get past this, cut out the coddling. How many people react this way out of self-protection, actually causing the reverse result?
On the following day, I was completing preparations to leave for vacation which involved transferring cat litter from a large to a smaller vessel to ease the path for my cat sitter. Suddenly, the pinpoint pain just at the center of my hear hit anew. This time it was considerably more forceful, but stubbornness prevailed and I tried to finish the task. Within a minute or two, I knew that something was really wrong; the pain was not disappearing, but instead growing in intensity. I dropped onto my bed and grabbed for the phone to call the same friend who had been with me on each of the tennis days, announcing with as much composure as I could muster that I thought I was having a heart attack - no denial in this moment, just plain terror.
I wish I had known that for many women, symptoms vary both in kind and in intensity, often masked by our own desire not to give in to the early, seemingly small signs. We prefer to march on and we have been kept ignorant, too.
Until recently, the studies and their conclusions involved only men, so we have been in the dark. I duly noted my symptoms, but they were not recognizable to me as heart-related, singly or as a package. I suppose that if I could have known or even suspected that I had a clogged artery during that first moment of pain on the tennis court and marched myself to a cardiologist, I might have averted the "myocardial infarctions" or MI's (medical-ease for heart attacks) and subsequent permanent damage. My age and history might have prompted a responsible physician to order tests that could have altered the course of my "disease".
I later learned that the type of myocardial infarction that I had, permanently felled most people and was referred to as “the widow maker”, again referring to men. Remarkably, I had not succumbed, but I had lost 30% of the heart muscle and was in for a long, arduous battle to regain enough energy to remain active and feel more or less healthy.
Once there is more data out there, which we have finally begun to demand, it can be expected that women will be more likely to act upon the information elicited by our bodies. My entire history spanned a mere three days, plus two incidents easily ascribed to the problems I was facing. I lacked both the medical wisdom and the ability to accept that anything major was brewing. I have learned since that this reaction is typical of many strong, independent, intelligent people. Denial and resistance, although natural, do not promote acceptance and often inhibit reality-seeking through education.
Soon after the string of MI’s, waiting in my cardiologist's office, I noticed a chart that notes the "3 E's" of rehabilitation: education, exercise and emotional support. Blinders, self-deception and ignorance create a lack of mobilization, paralysis and an inability to take control. Crisis provides choices. You must be willing to take responsibility for yourself, even if it means knowing on whom to rely during times when you may lack clarity of thought and be too weak to be decisive. All of this presumes that you have a life plan, filled with realistic goals and incorporating others who enhance your life. If this is not quite true, you have a multitude of useful, necessary, life-giving tasks to learn and put into practice. Maya Angelou's eloquent simplicity sums up the stages of eventual growth beautifully: "When you know better, you do better". Do not fight against your own evolution. The more you know, the more you grow.