A diagnosis of Alzheimer’s disease can be difficult, but getting accurate information and support can help you know what to expect and what to do next. Use this checklist to get started.
Learn about Alzheimer’s disease
Being informed will help you know what to expect as the disease progresses. Here are some resources:
Alzheimer’s Disease Education and Referral (ADEAR) Center: 1-800-438-4380; nia.nih.gov/alzheimers
Prepare or update your will, living will, healthcare power of attorney, and financial power of To find a lawyer, contact your local bar association or the National Academy of Elder Law Attorneys: www.naela.org
Learn about care you may need in the future and how to pay for it: longtermcare.gov
Explore getting help to pay for medicines, housing, transportation, and Visit the National Council on Aging: www.benefitscheckup.org
Get help as needed with day-to-day tasks
Use simple memory aids like a notepad or sticky notes to jot down reminders, a pillbox to keep medications organized, and a calendar to record appointments.
Ask family members or friends or find local services to help with routine tasks, such as cooking, paying bills, transportation, or shopping.
Consider using technology solutions for medication management, safety (e.g., emergency response, door alarms), and other care.
Talk with your doctor if you become confused, get lost, or need lots of help with directions, or if others worry about your driving.
Get a driving evaluation. Ask your doctor for names of driving evaluators, or visit the American Occupational Therapy Association: http://myaota.aota.org/driver_search
Be active! Getting exercise helps people with Alzheimer’s feel better and helps keep their muscles, joints, and heart in good shape. For tips, see nia.nih.gov/Go4Life.
Continue to enjoy visits with family and friends, hobbies, and outings.
If you live alone
Identify someone who can visit you regularly and be an emergency contact.
If you are at risk of falling, order an emergency response system. A special pendant or bracelet lets you summon help if you fall and can’t reach the the phone.
Consider working with an occupational therapist. This person can teach you ways to stay independent. Ask your doctor for more information.
Stick with familiar places, people, and Simplify Your Life.
If you are working
If you have problems performing your job, consider reducing your hours or switching to a less demanding position.
Consult your employer’s HR department or employee assistance program about family leave, disability benefits, and other employee benefits.
Find out if you qualify for Social Security disability benefits through “compassionate allowances.” Visit socialsecurity.gov/compassionateallowances or call 1-800-722-1213.
NIH, National Institute on Aging, Alzheimer’s Disease Education and Referral Center, April 2016
Locally, if you have questions, concerns, a need for help, contact PA HOME CARE of Lancaster at 717-464-2006 or by email to PAHC@pa-homecare.com. We’ll be glad to help.
Though the following deals specifically with people living with Alzheimer’s, these are good tips to follow for anyone with disrupted sleep patterns.
Alzheimer’s disease often affects a person’s sleeping habits. It may be hard to get the person to go to bed and stay there. Someone with Alzheimer’s may sleep a lot or not enough, and may wake up many times during the night.
Here are some tips that may help caregivers manage sleep problems in people with Alzheimer’s disease:
Help the person get exercise each day, limit naps, and make sure the person gets enough rest at night. Being overly tired can increase late-afternoon and nighttime restlessness.
Plan activities that use more energy early in the day. For example, try bathing in the morning or having the largest family meal in the middle of the day.
Set a quiet, peaceful mood in the evening to help the person relax. Keep the lights low, try to reduce the noise levels, and play soothing music if he or she enjoys it.
Try to have the person go to bed at the same time each night. A bedtime routine, such as reading out loud, also may help.
Limit caffeine.
Use nightlights in the bedroom, hall, and bathroom.
Learn more about sleep and Alzheimer’s disease on the NIH website.
Feast your eyes on the pictures below and then break out the pots and pans to make this healthier version of an old family favorite comfort food. The beauty of this recipe is that you can change it up to go even healthier than as shown. Variations include using all cauliflower and no pasta, or substitute quinoa for the pasta and load up on the cauliflower. Even skip the breadcrumbs if you’re trying to limit gluten and carbs. Try adding in other veggies for a great slightly different version, broccoli or tomatoes work great in all mac and cheese dishes. You can even add in chicken or tuna and make a complete meal out of it. Happy Cooking All!
Skillet Cauliflower Mac and Cheese
This easy and extra cheesy mac and cheese dinner gets a healthified veggie bump thanks to caramelized cauliflower added to the velvety cheese pasta to create a whole new take on a comfort food favorite.
Cauliflower comes in several hues these days, so if available, look for the orange cauliflower to match and meld into your cheesy sauce. It helps to avoid the pesky question of, “What IS THIS?” when spied upon the first forkful with a glaring stink-eye. If you can’t find an orange one, regular white cauliflower tastes exactly the same. I like to cut my florets pretty small so they literally melt into the sauce, making it a perfect sneak-attack for picky eaters.
The cauliflower is cooked in a very large skillet, as is the rest of this dish, making for at least one less dish to wash. One more vote for victory.
The garlic is cooked in a bit of butter and then the cauliflower goes in, cooking for 10 minutes or so, until it’s sweetened and caramelized. I add some water at about the half way point to help steam and move the whole cauliflower caramelization process along.
For this mac and cheese recipe I used a combination of Medium Cheddar to really get that cheese-flavor point across the palate, and Colby and Monterey Jack to add to the sauce’s cream factor. Calcium. Protein. They’re naturally added in there too. The cheese is all added to the simple butter, flour and whole milk roux cooked in the same pan as the cauliflower.
Dirty dishes. Who needs ’em?
One of my favorite parts of this mac and cheese, and what pairs so deliciously with the creaminess of the cheese sauce, macaroni, and the tender cauliflower, are the garlicky bread crumbs generously sprinkled on top. The contrast in texture is spot on and instantly addicting.
Since most of the cooking is done before mixing everything together, this dish needs only about 10 minutes in the oven just to melt it all together.
If you’d like make this ahead, just refrigerate before baking and add another 10-15 minutes or so to the timing. This recipe also reheats well in the oven for leftovers through the week. If there are any, that is.
Let the digging-in begin.
Skillet Cauliflower Mac and Cheese
This ultimate comfort food recipe gets a veggie bump with caramelized cauliflower added to this smooth and velvety cheesy pasta for a new family favorite.
Serves: serves 10
Ingredients
1 pound pasta, I used large shells, but you could use elbows, rotini or capatappi
9 tablespoons butter
¼ cup panko breadcrumbs
½ teaspoon garlic salt
2 cloves garlic, pressed or minced
1½ lb. cauliflower, cut into ½-inch florets and roughly chopped into smaller pieces
¼ cup all-purpose flour
½ teaspoon kosher salt
¼ teaspoon white pepper
3 cups whole milk
3 cups Colby and Monterey Jack cheese, shredded
2 cup Medium Cheddar Cheese, shredded
Kosher salt
Instructions
Preheat the oven to 400° F. Bring a large pot of water to a boil, season generously with kosher salt and cook the pasta just until al dente. Drain and place back in the pot or into a large bowl.
While pasta is cooking, in a large, high-sided non-stick skillet over medium high heat, melt 1 tablespoon of butter and add the panko breadcrumbs. Season with the garlic salt and stir the breadcrumbs often until golden, toasted and fragrant. Transfer immediately to a small bowl and set aside.
To roast the cauliflower, in the same skillet, melt 3 tablespoons of butter. Add the garlic and cook for 30 seconds or until fragrant. Add the cauliflower to the pan, reduce the heat to medium and cook for 5 minutes, stirring occasionally, and add ¼ cup water. Cook for another 5-7 minutes or until the cauliflower is softened and caramelized. Season with kosher salt and freshly ground black pepper, then add to the pasta.
To prepare the cheese sauce, wipe the skillet clean and melt the remaining butter in the same skillet over medium heat. Add the flour and whisk to combine, cooking for about 3-4 minutes, until the flour mixture becomes light brown in color. Add the milk while whisking and cook for about 5-8 minutes or until the sauce thickens and coats the back of a spoon, whisking often.
Once the sauce has thickened, turn off the heat and stir in the cheeses until melted. Pour over the pasta and cauliflower and stir to combine, getting the cheese in all of the nooks and crannys of the pasta. Transfer the mac and cheese mixture back to the skillet and sprinkle with the toasted panko crumbs. Bake in the oven for about 5-10 minutes, tenting the top with aluminum foil if the panko crumbs start to become too browned, and serve.
Recently much has been said about “sitting being the new smoking” when it comes to health risks. For our senior population another risk has been well known in anecdotal form, but much less well documented. That is the inherent risk associated with social isolation as it relates to chronic depression. According to the National Institute on Health, frequent feelings of loneliness are linked to higher rates of infection, cognitive decline, cardiovascular disease, depression, morbidity and mortality. This risk is magnified among our older population as they are facing retirement and a perceived loss of self as well as health limitations and possibly disabilities limiting their mobility and ability to do all of the things they want to do.
It doesn’t have to be this way. Older adults, in particular, have shown an ability to thrive with a minimal level of social connectedness. Even a small social network, church activities, volunteering, visits with family, etc. can bring a level of satisfaction much greater than the lack of same can lead to health issues, particularly depression. However, this is not a “one size fits all” resolution. Some folks are happy with little outside contact while others crave more activity. This is the difference between actual social disconnectedness and perceived isolation. One elder who appears to be socially disconnected may, in fact, thrive on a certain level of contented solitude. Another apparently active senior may feel unsupported and not intimate in their relationships and actually perceive themself as isolated. Ask your older loved one the following questions; “How often do you feel that you lack companionship?” “How often do you feel left out?” and “How often do you feel isolated from others?” Their answers will be very telling.
So what do we do? First and foremost, you must know the senior adult that you are concerned about. Not just know who they are and what their physical needs are, but know them as a person. What do they enjoy, who do they enjoy time with, what would a perfect day look like to this individual? Now, how do we get them there? What resources are available to the elder and their family? What is reasonable and sustainable? For instance, if regular family time is what your senior craves, is it possible to have a standing date every week, every month, whatever works for you and your family? If church and activities revolving around church is enjoyable, does the church have transportation available or any kind of outreach program for those at home? If regular exercise is what’s most enjoyable, a walk can do wonders and can be done with a “buddy” for companionship and safety. Senior centers are often a viable option and can best be approached on a temporary basis with enough time allowed for the elder to build friendships and enjoy the socialization. Following are a few more suggestions:
* Courses in the following, often leading to clubs or informal gatherings to do same; Cooking, Crafting, Computer/Internet, Bird-Watching, Gardening, or any other new activity.
* Volunteering; opportunities abound across many areas of need; hospitals, churches, schools, public service organizations, also check with your local United Way.
* Exercise programs geared specifically towards the older adult; check with your local YMCA, Office of Aging, or Senior Centers, as well as Health Clubs in your area.
The possibilities are really endless if approached from a position of what can we do, instead of what the senior is no longer able to do. At PA HOME CARE we are happy to help in any way that we can. We’re available by the hour or by the day and anything in between.
Growing up I knew my grandmother had diabetes, but I never really understood what that meant. I mean I knew she and my grandfather had to watch how much sugar they ate, and had to monitor their sugar levels throughout the day. But wasn’t that just something that the elderly people had to do? Didn’t most people get diabetes when they got older? It wasn’t until my grandmother began to have kidney failure that I began to understand just what was happening in her body, and why.
You see, my grandmother grew up on a farm; they grew most of their food and ate a simple diet. Most of which was farm to table. However, as the times changed, her own family began to grow, and more processed foods became available, her diet changed. My grandmother had five children, four boys and my mom. Feeding a growing family with growing appetites on a budget that didn’t grow as fast as the family required some creativity. At the same time things like Wonder Bread and Bologna and American cheese were readily available, and cheap. Lets not forget Mayonnaise. Mayonnaise makes everything taste better, right? These ingredients were combined to create a staple sandwich in my grandmother’s house when my mom was growing up. Another staple was canned food. Canned food was an affordable way to keep food available without having to worry about it going bad before you can use it. However, these foods are all high in sodium, fat, and sugar. They are also not filled with many nutrients like vitamins and minerals. After a while of eating this way, the body begins to break down. It cannot do what it is supposed to do without the necessary fuel.
As an illustration, lets say you go to the gas station and your car is supposed to take premium gasoline. It has all the ‘nutrients’ your car needs to run smoothly and efficiently. However, instead of premium you decided that the regular is cheaper and more appealing, so you fill up your car. What you may not think about is how after a few weeks and months of feeding your car the wrong type of gasoline, your car begins to run more slowly, and less efficiently. Suddenly, the lights on your dash begin to blink, warning you that if something doesn’t change things will only get worse.
It’s the same with our bodies and food. Our bodies are designed to need certain micronutrients like vitamins and minerals, and macronutrients such as carbs, proteins, and fats. The food naturally available to us is designed to meet those needs. However, the American diet is full of processed foods, which are high in calories but low in nutritional value. So what does that mean? It means that the food we are choosing to eat does not have the vitamins, minerals, and other nutrients our bodies need to run smoothly. Instead, it has high fat and sugar content to make it taste good and last longer. When we choose to put the wrong kinds of foods into our bodies, or too much of a certain category of food in our bodies, the warning lights begin to blink: achy joints, inflammation, fatigue, dull skin, weak hair and nails. These are all signs that our diets are lacking something. And if something doesn’t change, it will get worse. In my grandmother’s case, when she was diagnosed with diabetes, she didn’t really change her diet. She had to go on medication and add things like sugar monitoring to her daily lifestyle, but she didn’t change the one thing that could have helped her the most.
Later, when her kidneys began to fail, she was strongly urged by the doctor to change her diet. She cut back significantly on her sodium intake, and paid closer attention to how much sugar she ate and cooked with. For a woman who’s pies have won contest and whose home was always filled with some combination of cookies and cake or pies, this was not an easy adjustment; but it was necessary. For my grandmother, these changes were too little too late, but that doesn’t have to be my story, or yours. Not all disease is preventable, but if you can help your body be strong enough to fight off what it can, wouldn’t you want to?
Even if you don’t have diabetes, chances are you know someone who does and can appreciate how important diet really is. If diabetes runs in your family, you are doing yourself a great favor to start paying attention to what you eat now, instead of when you have no choice.
Here are a few recipes from the American Diabetes Association website. This website has great tools to help you understand what you are putting in your body with the recipes they provide. When you click on a recipe you would like to try, the website not only provides the ingredient and instructions, but also the nutrition facts. Remember, even if you don’t have diabetes, it is still important for you to be aware of what you are eating. Your body is designed to heal it self and with the right fuel, you can help to delay and prevent disease today.
Quick Gluten Free Recipe:
Apricot Glazed Chicken
Get a sweet taste of spring with this baked chicken recipe! Pair this with brown rice and corn on the cob for the perfect spring/summer meal!
For the complete list of ingredients and instructions, click the link below:
Short on time this week? Throw this in the crock-pot in the morning and by dinner time you have a delicious and nutritious meal! Add your favorite taco toppings like tomatoes, beans, onions, lettuce, salsa, pico de gallo, cheese, or cilantro for a fun family dinner!
For the complete list of ingredients and instructions, click the link below:
This recipe combines stir-fried vegetables and perfectly broiled cod fillets for a mouth-watering dinner in under 30 minutes! Try substituting the cabbage and snow peas for your favorite stir fry vegetables for an Asian inspired dinner that is sure to please the whole family!
For the complete list of ingredients and instructions, click the link below:
Ashley Gonzalez is writing for PA HOME CARE of Lancaster. She lives in northern Pennsylvania with her husband Rich and their two beautiful daughters, Alana and Elise. We look forward to more interesting and thoughtful articles from her. She brings a wealth of personal knowledge as well as a degree in medical studies from Liberty University.
Written By: Anna Almendrala for The Huffington Post
Oscar-winning actress Patty Duke, star of “The Patty Duke Show” and the Broadway play and film “The Miracle Worker,” died of sepsis from a ruptured intestine on Tuesday.
Simple though it may seem, her death announcement is a major milestone for the sepsis awareness movement, said Thomas Heymann, executive director of the Sepsis Alliance. The more people are aware of this condition, Heymann said, the stronger their likelihood of saving their own lives or the lives of their loved ones.
“The fact that they said Patty Duke’s cause of death was sepsis is relatively new,” Heymann said. “It very often would have been left as a complication of surgery or an infection, but it’s not a complication — it’s sepsis.”
Sepsis, a reaction to infection that leads to systemic organ failure, kills more than 258,000 Americans every year, according to the U.S. Centers for Disease Control and Prevention, making it the ninth-leading cause of disease-related deaths in the country. While most people can fully recover from sepsis, some survivors are left with permanent organ damage or missing limbs due to amputation.
Despite these alarming facts, less than half of Americans have even heard of sepsis, according to polls conducted by the Sepsis Alliance in partnership with official polling companies. In a 2015 online survey of 2,000 participants, only 47 percent of Americans were aware of sepsis. Meanwhile, 86 percent knew about Ebola and 76 percent knew about malaria — two diseases that are much rarer in the United States.
People who have sepsis experience organ dysfunction caused by their body’s overreaction to an initial infection, whether viral, bacterial or fungal. This overreaction is overwhelming for the body, and can lead to death. It’s most common in people with compromised immune systems, like the very young, the very old and those with chronic diseases like AIDS, cancer, or diabetes. But people can also develop sepsis from a simple scrape, wound or burn that was not properly cleaned.
Sepsis is also on the rise: It was the primary or secondary cause of 1.6 million hospitalizations in 2009, more than double the sepsis-related hospitalizations in 1993, according to a report from the Agency for Healthcare Research and Quality. And it was the single most expensive reason for hospitalizations in 2009, adding up to nearly $15.4 billion in hospital costs.
Sepsis can hide in plain sight
In one highly publicized, tragic story, a 12-year-old boy named Rory Staunton scraped his arm while playing with friends in 2012 and eventually began vomiting and complaining of pain in his leg. Doctors sent him home with Tylenol, but three days later he died from severe septic shock.
Rory’s case highlights a major difficulty doctors face: Sepsis symptoms can be hard to discern from those of a simple infection that could go away on its own.
What’s more, sepsis is often thought of as a hospital-acquired infection, making doctors more likely to look for it among hospital patients and the chronically ill. But about two-thirds of cases are first documented by the emergency department, which means that they were acquired outside of a hospital setting, explains Dr. Craig Coopersmith, professor of surgery at Emory University School of Medicine and the former president of the Society of Critical Care Medicine.
To avoid deaths by sepsis, Coopersmith has two basic rules for physicians: If a person has an infection, check for organ dysfunction. And if they have organ dysfunction, check for sepsis.
Context also counts for a lot when spotting the signs of sepsis. In addition to symptoms such as high fever, elevated heart rate, or abnormal white blood cell count, a medical history of pneumonia, infection, wounds or urinary tract infections could provide important clues for health care providers, notes a sepsis review published in the journal Nursing Practice.
Other clues, like a patient’s cancer and chemotherapy history — known factors that can suppress the immune system — are stronger clues that an infection could actually be sepsis, notes ABC News.
You could save your own life, simply by knowing what sepsis is
The signs of sepsis can be broken down in a simple acronym, notes the CDC.
S – Shivering, fever, or feeling very cold
E – Extreme pain or general discomfort, as in “worst ever”
P – Pale or discolored skin
S – Sleepy, difficult to wake up or confused
I – “I feel like I might die”
S – Shortness of breath
Once spotted, doctors treat sepsis by addressing the initial infection, supporting the body’s organs and preventing drops in blood pressure and oxygen levels. But time is of the essence when it comes to sepsis treatment. A 2006 study analyzing over 2,000 septic patients found that over six hours, each hour of a delay in treatment was linked to a 7.6 percent decrease in survival, but treatment within the first hour of a documented drop in blood pressure, a tell-tale sign of sepsis, was linked to an 80 percent survival rate.
Because of this, if you suspect you have sepsis — perhaps after a surgery, or because of a prior infection or wound that isn’t healing well — it’s important to actually say the word “sepsis” to your doctors, the CDC says. They advise patients to say, “I am concerned about sepsis,” in order to get the most timely treatment possible for a potential infection complication. Your life could depend on it, says Coopersmith.
“If you get sepsis, you have a higher chance of dying than if you have a heart attack, stroke or trauma,” Coopersmith said. “There is no question that increasing awareness of sepsis would save lives.”
About the writer: Anna Almendrala is a Healthy Living editor for the Huffington Post. She was born in Manila, Philippines and grew up in New Zealand and California. She graduated from U.C. Berkeley in 2006 with a double major in Rhetoric and Spanish and has previously worked for Sojourners and Brave New Films. She lives with her husband in Los Angeles.
Weighty Matters: Obesity has been linked to neurologic problems such as migraine, dementia, and sleep apnea. Experts review the evidence and offer advice for getting weight under control.
Thirty-five percent of Americans tip the scales into the obese category, according to the US Centers for Disease Control and Prevention (CDC). This public health crisis affects rates of heart disease, type 2 diabetes, and some forms of cancer. Recently, that list of health problems has grown longer as scientists have discovered a connection between obesity and neurologic conditions such as obstructive sleep apnea, migraine, depression, Alzheimer’s disease, narcolepsy, and even carpal tunnel syndrome. What’s more, excessive weight has been identified as a risk factor for cognitive decline later in life.
In a 2009 study of 2,798 people published in the Archives of Neurology, researchers from the University of Washington in Seattle reported that people who were obese at midlife had a 39 percent higher risk of developing dementia later in life than people of a normal weight, based on their performance on various neuro-psychiatric tests and magnetic resonance imaging scans. A study published last April inNeurology found that obesity was associated with a higher rate of mild cognitive impairment, delayed logical memory (the ability to recall a narrative story after a time delay), and depression, among 397 older adults who were given a battery of neuropsychological tests.
“Obesity impacts your general health, and your overall health can affect your brain health and function,” says Jennifer Molano, MD, FAAN, an associate professor of neurology and rehabilitation medicine at the University of Cincinnati College of Medicine. “To make sure your brain is healthy, you need to make sure your body is healthy—and weight management is an essential part of that.”
BMI BENCHMARK
These days, a healthy weight is defined as a body mass index (BMI) between 18.5 and 24.9, according to the CDC. An adult who has a BMI between 25 and 29.9 is considered overweight. Obesity is defined as having a BMI of 30 or higher, and extreme obesity (formerly called morbid obesity) is defined as having a BMI of 40 or higher.
The point at which excess weight increases the risk of developing neurologic disorders varies from one condition and individual to another and is based on genetic factors, underlying health conditions, lifestyle factors, and other considerations. But for many disorders, the risk begins to rise precipitously at a BMI of 30, Dr. Molano says. (Your doctor can chart your BMI based on your height and weight, or you can do it yourself at http://bit.ly/BMI-calc.)
EXCESS POUNDS AFFECT SLEEP
TIM POWELL
After years of sleeping poorly and waking up feeling tired in the morning, Tim Powell, who is 6′1” and weighed 288 pounds in October 2013, went to his doctor at his wife’s urging; she suspected he had sleep apnea because of his loud snoring. “I had a general lack of energy and regularly had to catch myself from falling asleep behind the wheel,” recalls Powell, a software project manager and father of five in Salt Lake City. “I remember feeling foggy and not being able to focus.”
After an overnight sleep assessment, Powell was diagnosed with sleep apnea, a potentially serious disorder in which a person repeatedly stops breathing or breathes very shallowly for seconds to minutes at a time, then resumes breathing (often with a loud snort, gasp, or choking sound) throughout the night. Powell’s doctor thought his sleep apnea was caused or exacerbated by his excess weight. Because he didn’t want to rely on a machine or device to keep his airways open while he slept, Powell, now 50, says “that [diagnosis] was the tipping point for me to improve my health.”
SLEEP APNEA AFFECTS WEIGHT
What Powell didn’t know is that his sleep apnea could have been contributing to his excess weight, and vice versa. “People who don’t get enough sleep experience neurochemical changes, including an increase in stress hormones such as cortisol, which can lead to weight gain, elevated blood glucose, and insulin resistance [a precursor to diabetes],” explains Todd J. Swick, MD, FAAN, an assistant clinical professor of neurology at the University of Texas School of Medicine in Houston. In fact, the relationship between obesity and sleep apnea is a tricky two-way street. “The more obese you are, the worse your sleep apnea gets,” Dr. Swick says, “and the worse your sleep apnea gets, the more obese you become.”
With untreated sleep apnea or sleep deprivation of any kind, levels of ghrelin, an appetite-regulating hormone, increase. Elevated ghrelin levels increase appetite, which can lead to weight gain, notes Alon Avidan, MD, MPH, a professor of neurology at the University of California, Los Angeles (UCLA) and director of the UCLA Sleep Disorders Center. “From there, the cycle continues,” with a revved-up appetite causing weight gain, weight gain exacerbating sleep apnea, and so on.
NEUROTRANSMITTERS AND NARCOLEPSY
The basic mechanism linking obesity with obstructive sleep apnea is largely anatomical. “The increased BMI and the effects of gravity make it more likely for the tissues in the back of the throat to collapse, causing the airways to close up while you’re sleeping,” Dr. Molano explains. But, she adds, the relationship between excess weight and other neurologic disorders isn’t so easily explained.
Depending on the condition, various obesity-related physiological factors may be at work. For example, obesity is also a risk factor for narcolepsy, a chronic neurologic disorder that causes severe daytime drowsiness and sudden attacks of sleep during waking hours, Dr. Avidan says. This may be related to levels of a neuropeptide called orexin or hypocretin, which regulates alertness, wakefulness, and appetite. Low levels of orexin are associated with both obesity and narcolepsy. In a 2011 study in the Journal of Sleep Research, for example, investigators measured orexin levels in 70 people with narcolepsy and found that the severity of excessive daytime sleepiness was associated with an orexin deficiency. As far back as 2000, in a study in The Lancet, researchers noted that people with narcolepsy have a higher BMI than the general population.
THE HORMONE CONNECTION
Scientists now know that excess body fat isn’t inert. It’s actually quite active, and depending on its location it can set off a hormonal cascade of detrimental effects. In particular, in people with central or abdominal obesity (the classic apple-shaped pattern), the fat surrounding organs can raise levels of stress hormones such as cortisol, promote systemic inflammation, increase oxidative stress (rust-like damage that’s caused by unstable molecules called free radicals), and create insulin resistance (a reduced response to the hormone insulin, which makes blood sugar rise). Each of these effects can harm the brain and neurologic function.
INFLAMMATION AND MIGRAINE
The underlying pathways connecting obesity with certain neurologic disorders are more complicated in some conditions than in others. The association between migraine and obesity, for instance, may stem partly from the fact that obesity is considered a pro-inflammatory state, explains Teshamae Monteith, MD, chief of the headache division at the University of Miami Miller School of Medicine. This state can increase the number of inflammatory substances in the brain such as calcitonin gene-related peptides, which are linked to an increase in the frequency, severity, and duration of migraine attacks. In addition, “obesity is associated with sympathetic activation of the autonomic nervous system—the fight-or-flight response—which is linked with migraine,” Dr. Monteith says. “It’s also linked to low levels of adiponectin, [a hormone] related to [increased inflammation] and pain.”
A meta-analysis published in the Journal of Headache and Pain in March 2015 found that women who are obese have a 44 percent higher risk of migraine than women whose weight is in the normal range. Additionally, overweight and obese women have, respectively, a 39 percent and 75 percent higher chance of developing chronic migraines than women who are not overweight.
METABOLIC SYNDROME AND ALZHEIMER’S
Evidence suggests that those who develop metabolic syndrome have a higher risk of developing Alzheimer’s disease. The syndrome is characterized by a waist circumference of 40 inches or more for men and 35 inches or more for women plus two of the following: elevated blood pressure (130/85 or higher without taking medication for hypertension), high triglycerides (150 mg/dL or higher), low HDL or “good” cholesterol (below 40 mg/dL for men and below 50 mg/dL for women), and high fasting blood sugar (100 mg/dL or higher).
“Obesity quadruples the risk of developing Alzheimer’s,” says Gary Small, MD, director of the UCLA Longevity Center and coauthor of The Alzheimer’s Prevention Program (Workman Publishing Company, 2011). He cited a 2011 study of 8,534 twins published in Neurologythat found that obesity in midlife was associated with four times the risk of later developing dementia, including Alzheimer’s disease and vascular dementia, compared with a normal BMI. Excess belly fat, in particular, has been linked with an increased risk of late-onset Alzheimer’s disease.
Even without metabolic syndrome, people who have insulin resistance or type 2 diabetes—both of which can stem from being overweight or obese—may be at higher risk for Alzheimer’s disease. This may be due partly to increased inflammation, Dr. Small notes, but a 2015 study in Molecular Aspects of Medicine suggested that type 2 diabetes and Alzheimer’s may share genetic risk factors as well. Indeed, insulin resistance and diabetes have been shown to cause changes in brain structure and function that are seen with Alzheimer’s disease, injuring neurons and causing abnormal growth patterns such as the formation of tau tangles and amyloid plaques, says Dr. Small.
A LINK TO PEDIATRIC MULTIPLE SCLEROSIS
Some research suggests that obesity may be a risk factor for pediatric multiple sclerosis (MS), too. Scientists from Kaiser Permanente Southern California found that obesity was associated with a significantly increased risk of MS among girls between the ages of 11 and 18. The study, published in Neurology in 2013, showed that overweight girls had one and a half times the risk of developing MS compared with their normal-weight peers. Moderately obese girls had 1.8 times the risk, and those who were extremely obese (meaning their weight was off the charts for their age and sex) had nearly four times the risk. The researchers theorized that high estrogen exposure and the low-grade inflammatory state that occurs with obesity may accelerate the onset of MS.
“It has been more difficult to link obesity, independent of cardiovascular risk factors, to the risk of developing MS in adults,” says Dennis N. Bourdette, MD, FAAN, an endowed professor in the department of neurology at Oregon Health & Science University in Portland. “However, obesity appears to increase fatigue in people with MS and compounds other symptoms of MS. So an MS patient who is obese and develops mild leg weakness, for example, will have a lot more problems adapting to that weakness than someone who maintains a normal weight.”
MEDICATION AND WEIGHT GAIN
Certain antiseizure drugs and corticosteroids, as well as antidepressants used to treat certain forms of pain, and beta blockers prescribed for migraines, can cause extra pounds to creep on, either because they decrease metabolic rate or stimulate appetite or both, notes Dr. Monteith. “Not all patients are going to get that effect, but some will,” she says.
Cynthia Fabian, who has epilepsy and sleep apnea related to nocturnal seizures, is one of them. “Depakote [divalproex sodium] has been nothing short of a miracle for me in terms of seizure control, but it hasn’t been without trade-offs. I follow a 1,200-calorie diet and take at least one class at the gym each day just to maintain my nearly 200-pound frame,” says Fabian, 57, a teacher and writer in Venice, FL.
At one point, Fabian switched to topiramate (Topamax), another antiseizure drug. While it helped her drop 60 pounds, it didn’t control her seizures sufficiently. So she went back on divalproex sodium and regained the weight. In her view, the added pounds have been a small price to pay for being able to drive and have a normal, active life. “I remain positive and meditate nearly every day,” she adds. “But it is difficult [for people] to understand how someone who does not eat much still has a larger frame.”
THE WEIGHT LOSS BONUS
People who lose weight often see an improvement in their condition. Case in point: A 2011 study published in Cephalalgia found that when obese premenopausal women with migraine underwent bariatric surgery for weight reduction, the frequency of their episodic migraines dropped from four a month to one a month and their chronic migraine episodes decreased from 16.8 to 8.5 a month. What’s more, the attacks were shorter and the women needed less medication to manage them.
Even habits that facilitate weight loss can improve neurologic disorders linked with obesity. For example, some studies show that exercise can protect against migraine, says Dr. Monteith. A 2011 study of 91 patients with migraine published in Cephalalgia found that exercising for 40 minutes, three times a week, was more effective at reducing migraine attacks than taking topiramate. The forms of exercise that show the most benefit tend to be gentler, such as swimming or cycling, as opposed to jarring, pounding activities such as aerobics or jogging.
LESS WEIGHT, MORE SLEEP
Just as sleep apnea can create an upward spiral of weight gain and worse apnea, weight loss can reverse that cycle and lead to better sleep and, in some cases, a remission of apnea. That was the experience of Tim Powell, the father of five from Salt Lake City. After revamping his diet and eating fewer refined carbohydrates, less sugar, fewer processed foods, and more vegetables, fruits, and healthy fats, and exercising for an hour a day (30 minutes of cardio, 30 minutes of resistance training) five or six days a week, he lost 77 pounds in seven months. His snoring disappeared, along with any signs of sleep apnea, and his blood pressure and cholesterol improved. “I have much more energy,” he reports. “It’s been a huge difference.”
For those who don’t have the energy to lose weight, a continuous positive airway pressure (CPAP) machine that keeps airways open during sleep can help, says Dr. Avidan. When the sleep disorder is well controlled, people may have more energy to make the dietary changes and perform the physical activities that will help them lose weight. Once they start to lose weight, “the pressure on the CPAP machine can be readjusted,” he says.
A TRANSFORMATION
SHELLEY RAFILSON
Even for people who are obese and have more than one neurologic disorder, losing weight can make a tremendous difference. Shelley Rafilson, a singer and writer in Scottsdale, AZ, has severe neuropathy, fibromyalgia, hypothyroidism, and arthritis. While caring for her elderly father, she gained 100 pounds and developed sleep apnea, which took a further toll on her energy, weight, and pain. When she found herself struggling to get off the floor after putting on her father’s shoes, she decided to take action.
A few years ago, Rafilson went on a 1,200-calorie diet, started walking for exercise, and began weighing herself once a week. “I decided it was time to turn my life around, and that’s exactly what I did,” says Rafilson, now 60. It was difficult, she says, but she persevered, and over the span of two years she lost more than 100 pounds, kicked her reliance on pain medications, and wrote and self-published 100 Pounds to Happiness!, a book about her transformation. “I want to help others learn from my experience,” she says.
Her take-home message? Losing weight is worth the effort for an improved quality of life and a future of good health. As Dr. Molano says, “What you do at midlife can have an impact on what happens later in terms of your brain health.”
BMI BREAKDOWN:
These days, a healthy weight is defined less by the numbers on a scale than by body mass index (BMI). According to the US Centers for Disease Control, a BMI of between 18.5 and 24.9 is healthy for adults. A BMI higher than 24.9 breaks down as follows:
25–29: Overweight
30–40: Obese
OVER 40: Extremely obese (formerly called morbidly obese)
LOSING WEIGHT:
Dropping pounds can help you reclaim and protect your health. Many of the negative health effects of obesity can be reversed by losing weight. The challenge, of course, is getting started. We asked several weight-loss experts for advice.
START WITH CALORIES. “Limiting calories is much more effective for initial weight loss than exercising, so don’t worry if your [condition] limits what you can do in terms of physical activity,” says Lawrence Cheskin, MD, director of the Johns Hopkins Weight Management Center in Baltimore. Many weight-loss experts, including Dr. Cheskin, recommend reducing your calorie intake by 500 to 750 calories a day to lose one to one-and-half pounds a week.
AVOID REFINED CARBOHYDRATES. It’s not just the quantity of calories that count; quality matters, too. “Most people consume more carbohydrates than they need,” says Molly Kimball, RD, nutrition program manager of the Ochsner Health System’s Elmwood Fitness Center in New Orleans. She advises cutting down on refined carbohydrates and focusing on eating more fiber and whole grains like quinoa and brown rice, lean protein like skinless poultry and fish, vegetables, and spices and aromatic herbs.
CHOOSE BRAIN FOOD. Consuming antioxidant-rich berries, plums, cherries, apricots, grapes, broccoli, sweet potatoes, bell peppers, spinach, and tomatoes can help protect your brain from harmful free radicals that cause wear and tear on your cells, explains Gary Small, MD, director of the UCLA Longevity Center. The omega-3 fatty acids in fish such as salmon, mackerel, tuna, sardines, and anchovies can reduce harmful inflammation in your body.
EAT SMALLER PORTIONS. Be mindful of the size of your meals. If you don’t prepare your own food, make sure people involved in your care adhere to your nutritional goals, Kimball adds.
ENLIST A BUDDY. Get plenty of sleep and learn to manage stress without turning to food. “It helps if you have a friend for support,” Kimball says. “That buddy system helps keep up motivation.”
SET A CALORIE BUDGET. Pick your target weight, then determine how many calories you need to reach it. If, for example, you want to weigh 150 pounds and have no physical limitations, allow yourself 10 calories for each pound for a total of 1,500 calories per day, says Kimball. (If you exercise more than an hour a day, you may need more calories.) To track your calorie intake, Kimball recommends using a smartphone app like MyFitnessPal. If you have physical limitations or mobility problems, you may need to decrease your daily calorie allotment by 10 to 25 percent while trying to lose weight, depending on the extent of your limitations, Kimball says. If you don’t want to count calories, Kimball recommends limiting starchy carbohydrates of all types, including whole grains, and focusing on lean proteins, vegetables, and small amounts of healthy fats.
HONOR YOUR HUNGER SIGNALS. Get in the habit of listening to your body and paying attention to when you’re truly physically hungry and when you simply have the urge to eat, Kimball suggests. If you’re hungry, you should eat healthy foods but stop eating before you feel completely full. If you have an urge to eat, identify what’s causing it. If it’s loneliness, for example, call a friend. If you’re feeling sad, listen to upbeat music. If you’re tired, take a nap.
INCORPORATE AEROBIC ACTIVITY. Besides helping you burn extra calories during a workout, exercising helps shed body fat, add lean muscle (which will help you burn more calories all day), and increase your cardiovascular fitness, Dr. Cheskin says. If you’re new to exercise and have no physical limitations, start with 10 to 20 minutes a day and build up from there. Eventually, the goal is to do at least 45 minutes of aerobic exercise—such as walking, swimming, bicycling, or using the elliptical machine—most days of the week. “Cardio exercise is good for your heart and vascular health, your mood and stress levels,” Kimball says.
ADD STRENGTH TRAINING. Working out with resistance bands or weights twice a week builds lean muscle, increases your strength, and helps you with activities of daily living. “Increasing lean muscle can raise your resting metabolic rate: One pound of muscle can burn approximately seven calories [per day], so adding 3 to 4 pounds of lean muscle, which is very reasonable within 12 to 14 weeks in a proper strength training program, can increase your ability to burn calories when you aren’t exercising by up to 30 calories a day,” says Pete McCall, MS, a professor of exercise science at Mesa College in San Diego.
ACCOMMODATE PHYSICAL LIMITATIONS. If you have mobility problems, start by doing what you can three times a week and building from there. And consult your neurologist about any possible limitations. “Just getting up and moving for five minutes at a time with two to three 10- to 15-minute intervals throughout the day for activities such as walking, climbing stairs, or simply standing can improve your ability to burn calories,” says McCall. Find an activity you enjoy—whether it’s walking, riding a stationary bicycle, or doing exercises in a pool—and make it a habit. “Start slowly, then increase intensity and frequency,” McCall advises.
WORK WITH A THERAPIST. If you have limited use of your legs or difficulty gripping things, consider teaming up with a physical or occupational therapist who can show you how to use various exercise machines and pieces of equipment. For example, some people may benefit from using a hand cycle, which is powered by the arms instead of the legs, or resistance bands that are attached to a wall or door, or Velcro weights for the wrists or ankles for strength training. “Do anything to move your muscles and get your heart rate up so you can burn more calories,” Kimball says.
Emily Gurnon is Senior Content Editor covering health for Next Avenue. Follow her on Twitter@EmilyGurnon.
I was fortunate to be able to attend the American Society on Aging’s massive Aging in America 2015 conference in Chicago, Ill. last month. One of the most interesting and well-researched presentations I heard was by Lynn Friss Feinberg, senior strategic policy advisor for the AARP Public Policy Institute.
Feinberg has done policy analysis and applied research on family caregiving and long-term services and supports for more than three decades, according to AARP. The following are excerpts from her talk. She began by discussing how caregiving is different today than it was in the past.
Lynn Friss Feinberg:
There is greater complexity today in the caregiving role. Older people have multiple chronic conditions. Families serve as both care coordinators and service providers. They serve as social workers and nurses, without adequate training — many feeling very scared about their role because they don’t know what they’re supposed to be doing to do it right.
People are discharged quicker and sicker from hospitals today, so nearly one-half of family caregivers of adults are carrying out health-related tasks in the home. This is a huge shift from the old days.
So what are these tasks that are so scary?
Managing complex medication schedules is one. Imagine if you are working at your job, but your grandmother came home from the hospital with prescriptions for 16 different medications that had to be taken. And you can’t afford to hire help in the home, so you have to run home periodically during the day to administer those medications.
There is also bandaging and wound care, tube feedings, managing catheters, giving injections and operating medical equipment in the home. As Susan Reinhardt from AARP Public Policy Institute has said, these are tasks that would make nursing students tremble. It’s really scary, and we are not trained to do that.
More WomenWorking and Caregiving
There are more women in the workplace, especially older women, and women today define the provider role as not only taking care of their families but also supporting their families economically. Among 55- to 64-year-olds, women’s labor force participation increased from 41 percent in 1980 to 59 percent in 2012 and is projected to reach 67 percent by 2020.
Another difference is the changing composition of families and households. There is more long-distance caregiving. When I grew up, my grandparents lived right down the street from me. My granddaughters live in California, I live in Maryland; things are not the same. There is increasing diversity, delayed marriage and childbirth, high rates of divorce. The divorce rate of the population 50 and older doubled between 1990 and 2010.
Fewer Adult Children to Help
In addition, there are fewer adult children. The percent of those 85 and older with no adult children is projected to increase from 16 percent today to 21 percent by 2040. So even if you have one of those three great daughters that we all wish for, there’s no guarantee that they’re going to be there when you’re in old-old age.
So who will be caring for whom?
On Changing the Language of Caregiving
If I can do anything in my career now, I would like to change our terminology.
We should definitely retire the term “informal caregiver” from our vocabulary in referring to the care of frail older people by family caregivers and friends. Because family members are traditionally not paid for the help they provide to their loved one, they’re sometimes described as informal. In contrast, health care professionals and social service professionals, as well as direct care workers like home care aides, are generally described as formal caregivers because they’re paid for their services and they’ve also received training.
But the jargon of “informal” devalues the complexity of what family caregivers are doing today — suggesting that the tasks the families undertake are casual, relaxed, easygoing and simple.
Now let me ask you: Is there anything simple and easygoing about providing care to a grandparent with Alzheimer’s disease who has escalating needs and more costly care? Anything casual about an adult daughter having to take her father to use the toilet? The term “informal” disrespects family caregivers by creating an impression that the efforts of family members and friends play only a minor role in long term services and supports and health care.
In reality, it is families that do almost all the coordination, and provide that care, too.
America’s Care Gap
The U.S. is facing a care gap. The future looks unlike the past. We are facing rising demand as our population ages and shrinking families to provide supportive services.
No longer do we have what my grandparents and great grandparents have, which was seven, eight, nine siblings in their families to share the care. Although the family has historically been the major provider of care for older people with long-term services and support needs, the number of potential family caregivers has begun to inch downward.
Today, the caregiver support ratio has begun what will be a steep decline. We’re at the apex right now, then it’s going to go drastically down. In 2010, the support ratio was at its highest; there were 7.2 potential family caregivers for every person over the age of 80. But by now, in 2015, it has started the decline to 6.8 potential family caregivers for every person in the high-risk years of 80 and over.
By 2030, in just 15 years, as the boomers transition from family caregivers themselves into old age, the ratio is projected to decline even more sharply to 4 to 1. And by 2050 when all the boomers are in old age and will need help themselves, it will fall to less than 3 to 1.
These are really worrisome statistics, which brings me to my last point.
Facing Caregiving With Urgency
We need to treat family caregiving with new urgency and make it a priority on the national health care and long-term care agenda, in workplaces too. Family caregiving is one of the least appreciated, but most important, issues our country faces as we all age. But family caregiving is typically viewed as a private family issue and the responsibility of women in particular, and largely overlooked in public policy.
With the looming care gap, it’s time to ask this question: Are we asking families and close friends to do too much?
In my view, the debate should focus less on whether family or the public sector should be responsible for providing care and we should focus more on how family caregivers can be better recognized and supported if they choose to be a caregiver to keep them from burning out. And we should ensure that the choice that a family member makes does not have negative consequences for the individual or the family.
The current heavy reliance on family and friends as I’ve just described is just unsustainable in long-term care.
I want to leave with a quote from a colleague, Jonathan Rauch, who wrote an article in The Atlantic magazine called “Letting Go of My Father” in April 2010. He wrote that what we need “is for our nameless problem to be plucked out of the realm of the personal and brought into full public view, where help can find us.”
Postscript from Kathy Spence of PA HOME CARE of Lancaster:
We have found that most successful plans of care that are established for people in need in their own homes involves a “jigsaw puzzle” of supports. Some of those supports are comprised of family and friends, we call them the family caregivers. Some of those supports are a blending of various non-medical and medical personnel, we call them the professional caregivers. Needs are broken down and tasked out to various members of this support team so that the overall care for the loved one is not too overwhelming for any single individual. However, as with any plan, foreseeing all of the complexities and details in putting together a workable solution can be, in and of itself, daunting. We encourage anybody in this situation to not be silent. Ask for help and guidance. Identify what is easily and conscientiously handed over to someone else to handle for you. You may want to continue going along to doctor’s appointments, so maybe someone else can do the laundry. You may need a medical professional to handle wound care, so maybe a non-medical caregiver can handle bathing and dressing. “Pick the low hanging fruit” (tasks easily identifiable and assigned in their entirety) and move on to the myriad other caregiving responsibilities that all come together to provide a safe and happy season of life, in your loved one’s own home.
In co-operation with Lancaster General Hospital, we’re please to share this important message.
Why get a colonoscopy?
It could save your life…
by Dr. Dale J. Rosenberg
If you could get a test that could prevent cancer from developing, would you say no? Unfortunately, too many Americans are doing exactly that. By not following recommendations for a colonoscopy, you are missing out on a life-saving opportunity.
Colon cancer is the third leading cause of cancer-related deaths, with approximately 140,000 new cases diagnosed in this country every year. Approximately 51,000 people die from the disease annually. A New England Journal of Medicine study indicates colonoscopy could have played a life-saving role in thousands of these deaths.
Colonoscopy saves lives
Experts say the study is the best evidence yet that colonoscopy prevents deaths. Tracking patients for 20 years, the study concluded that colonoscopy cut the death rate from colorectal cancer by 53 percent in people whose physicians removed what are known as adenomatous polyps during the test.
According to federal estimates, however, only 6 in 10 adults are up-to-date in following the screening recommendations. In general, you should start screening for colorectal cancer at age 50—earlier if you have a family history of the disease or signs that you may have a problem.
What is a colonoscopy?
During a colonoscopy, your doctor examines the inside of your intestine by inserting a tube with a tiny camera into your rectum. It’s not the most pleasant of tests. You need to take strong laxatives the day before to clean out your intestine, but during the actual exam, you’ll most likely be sedated so you won’t feel a thing.
If precancerous polyps are spotted, they can be removed immediately. While not every polyp turns into cancer, nearly all colorectal cancers start out as adenomatous polyps.
Before this study, research showed that removing precancerous polyps cut the incidence of colorectal cancer. Now we know that the test saves lives—the most important statistic of any cancer screening. It can also detect at an early stage any cancer that’s present.
Along with cervical and skin cancer, colon cancer is one of the few cancers that a screening test can prevent. But the exam only works if people use it.
Some people are simply embarrassed; others are deterred by the bowel preparation, which is often the toughest part. Cost is another factor if the test is not covered by your insurance plan.
Regardless of whatever misgivings people have about colonoscopy, everyone needs to understand the life-saving potential of this test. And unlike other cancer screenings, you only need a colonoscopy every 10 years if no polyps are detected.
Talk to your doctor about colonoscopy and whether it’s time for you to have this important screening.
You may feel groggy and a bit weak after having this screening done. Most doctors require you to have someone along to drive for you and help you get safely home and comfortable again. PA Home Care can help you in successfully maneuvering this important milestone. Call us today and let’s talk.
In the United States, 1 in 4 women dies from heart disease. In fact, coronary heart disease (CHD)—the most common type of heart disease—is the #1 killer of both men and women in the United States.
Other types of heart disease, such as coronary microvascular disease (MVD) and broken heart syndrome, also pose a risk for women. These disorders, which mainly affect women, are not as well understood as CHD. However, research is ongoing to learn more about coronary MVD and broken heart syndrome.
This article focuses on CHD and its complications. However, it also includes general information about coronary MVD and broken heart syndrome.
Coronary Heart Disease
CHD is a disease in which plaque (plak) builds up on the inner walls of your coronary arteries. These arteries carry oxygen-rich blood to your heart. When plaque builds up in the arteries, the condition is called atherosclerosis (ath-er-o-skler-O-sis).
Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. Over time, plaque can harden or rupture (break open).
Hardened plaque narrows the coronary arteries and reduces the flow of oxygen-rich blood to the heart. This can cause chest pain or discomfort called angina (an-JI-nuh or AN-juh-nuh).
If the plaque ruptures, a blood clot can form on its surface. A large blood clot can mostly or completely block blood flow through a coronary artery. This is the most common cause of a heart attack. Over time, ruptured plaque also hardens and narrows the coronary arteries.
Heart With Muscle Damage and a Blocked Artery
Figure A is an overview of a heart and coronary artery showing damage (dead heart muscle) caused by a heart attack. Figure B is a cross-section of the coronary artery with plaque buildup and a blood clot resulting from plaque rupture.
Plaque also can develop within the walls of the coronary arteries. Tests that show the insides of the coronary arteries may look normal in people who have this pattern of plaque. Studies are under way to see whether this type of plaque buildup occurs more often in women than in men and why.
In addition to angina and heart attack, CHD can cause other serious heart problems. The disease may lead to heart failure, irregular heartbeats called arrhythmias (ah-RITH-me-ahs), and sudden cardiac arrest (SCA).
Coronary Microvascular Disease
Coronary MVD is heart disease that affects the heart’s tiny arteries. This disease is also called cardiac syndrome X or nonobstructive CHD. In coronary MVD, the walls of the heart’s tiny arteries are damaged or diseased.
Coronary Microvascular Disease
Figure A shows the small coronary artery network (microvasculature), containing a normal artery and an artery with coronary MVD. Figure B shows a large coronary artery with plaque buildup.
Women are more likely than men to have coronary MVD. Many researchers think that a drop in estrogen levels during menopause combined with other heart disease risk factors causes coronary MVD.
Although death rates from heart disease have dropped in the last 30 years, they haven’t dropped as much in women as in men. This may be the result of coronary MVD.
Standard tests for CHD are not designed to detect coronary MVD. Thus, test results for women who have coronary MVD may show that they are at low risk for heart disease.
Research is ongoing to learn more about coronary MVD and its causes.
Broken Heart Syndrome
Women are also more likely than men to have a condition called broken heart syndrome. In this recently recognized heart problem, extreme emotional stress can lead to severe (but often short-term) heart muscle failure.
Broken heart syndrome is also called stress-induced cardiomyopathy (KAR-de-o-mi-OP-ah-thee) or takotsubo cardiomyopathy.
Doctors may misdiagnose broken heart syndrome as a heart attack because it has similar symptoms and test results. However, there’s no evidence of blocked heart arteries in broken heart syndrome, and most people have a full and quick recovery.
Researchers are just starting to explore what causes this disorder and how to diagnose and treat it. Often, patients who have broken heart syndrome have previously been healthy.
Outlook
Women tend to have CHD about 10 years later than men. However, CHD remains the #1 killer of women in the United States.
The good news is that you can control many CHD risk factors. CHD risk factors are conditions or habits that raise your risk for CHD and heart attack. These risk factors also can increase the chance that existing CHD will worsen.
Lifestyle changes, medicines, and medical or surgical procedures can help women lower their risk for CHD. Thus, early and ongoing CHD prevention is important.
More information about heart disease in women is available through the National Heart, Lung, and Blood Institute’s The Heart Truth® campaign.
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®The Heart Truth is a registered trademark of the U.S. Department of Health and Human Services.
TIM POWELL
SHELLEY RAFILSON
Consuming antioxidant-rich berries, plums, cherries, apricots, grapes, broccoli, sweet potatoes, bell peppers, spinach, and tomatoes can help protect your brain from harmful free radicals that cause wear and tear on your cells, explains Gary Small, MD, director of the UCLA Longevity Center. The omega-3 fatty acids in fish such as salmon, mackerel, tuna, sardines, and anchovies can reduce harmful inflammation in your body.
Working out with resistance bands or weights twice a week builds lean muscle, increases your strength, and helps you with activities of daily living. “Increasing lean muscle can raise your resting metabolic rate: One pound of muscle can burn approximately seven calories [per day], so adding 3 to 4 pounds of lean muscle, which is very reasonable within 12 to 14 weeks in a proper strength training program, can increase your ability to burn calories when you aren’t exercising by up to 30 calories a day,” says Pete McCall, MS, a professor of exercise science at Mesa College in San Diego.
