What is a time of joy for many women was my darkest hour.
I’m going to admit to something ugly: growing up, I never bothered to really think about heart health or feel in danger of heart disease. To my knowledge, there is no history of it in my family, and for a while there I had a very narrowly stereotypical image in my mind that heart attacks were something that happened exclusively to old people, ignorantly content with my hackneyed mental image of an old white man theatrically clutching his chest.
Then, about 6 years ago, I had a change in health coverage and found myself having a regular checkup with a new doctor. He seemed to linger with the stethoscope for a bit, then double-checked the questionnaires in my chart. He said he wanted me to see a cardiologist with such seriousness that I had to check the mirror to make sure he was seeing actual Pia and I hadn’t done a Quantum Leap into someone else’s body.
The doctor said he wanted to err on the side of caution, but that something didn’t sound right and he felt the “math was off” when he factored in my pulse, heart rate, size, and whatever he heard in my chest. Um, okaaayyyyy… of all of the potentially iffy news to get from a doctor, I never thought my heart would even enter the conversation.
But there it was, coughing and sputtering into the stethoscope of the subsequent specialist I saw. The consensus is that my heart had been weakened by years of alternating between anorexic and bulimic behaviors. Whoa. I made another appointment to have even more detailed testing.
As an informed disordered eater, I knew that heart failure is a potentially deadly risk of eating disorders, but I had been overweight to begin with, so I convinced myself that the risk was diminished for me. A clinical diagnosis of anorexia includes falling below certain weight guidelines that I didn’t come close to, and unfortunately we know that a medical degree does not make one immune to weight bias, so I saw a number of doctors who would rather congratulate my swift weight loss than ask too many questions or take a second listen to a funky heartbeat.
Add to this that I was very good at hiding my ED, and I was in and out of doctors’ offices for years without anyone giving my heart health a second thought. So when I found myself with a more attentive doctor deciphering my EKG results for me, I had to come clean. By that point I was already in ED recovery, although I had replaced some of my restrictive and elimination eating behaviors with compulsive exercise, which was compounding the problem.
My resting heart rate became abnormally low, to compensate for how hard I was pushing it and for how long, and without proper fuel. My already low blood pressure had plummeted and I felt the effects constantly. Still, until the doctor cared enough to check and re-check, I was ready to let it coast. I had grown up dancing and hey, who doesn’t get lightheaded and pass out throughout the day, amirite?
Turns out that in the United States, African-Americans constitute the largest percentage of deaths due to heart disease; just under 25%. Oh. Stroke or heart disease kills one in three women, and heart disease is the number one cause of death in both men and women. What was that malarkey I was saying about an old white man clutching his chest?
This black woman had to get more informed, and I want to spread the word. February has lots on its shoulders; there’s the weighty responsibility of Black History Month and the peripheral glitz of awards season. It is also National Heart Health Month, and today is National Wear Red Day to promote awareness.
There are millions of people who did not have to come late to the threat of heart disease; people living with it and who have lost loved ones to it. While my privileged ass was essentially doing this to myself with no family history, about 36,000 babies are born with congenital heart defects a year in the US.
Although I have the opposite of hypertension, one of the most commonly recognized risk factors for heart disease, the final cardiologist I saw hypothesized that I might have suffered a silent ischemia, or “silent heart attack,” at some point.
What. Are. You. Talking. About. WILLIS?!
In the simplest of oversimplified terms, I made my heart work overtime too often and for too long, and the wear and tear made itself known. Still, I got off very lucky. I haven’t had any surgical procedures, and I do my best to pay attention moving forward. It may take me longer to catch my breath once I’ve lost it, and when palpitations happen I don’t just immediately write them off as anxiety.
I feel like so many of us do the most, living with a certain amount of stress and anxiety and sleeplessness that may feel like a personal status quo but could be adversely affecting our hearts. The staggering heart disease and stroke mortality rates don’t just come out of thin air, and the effects can be cumulative.
I spoke more about this with Dr. Suzanne Steinbaum, who runs the Women’s Heart Health Division at Lenox Hill Hospital in NYC. She told me, “My personal passion is to really have younger women understand what happens when we don’t take care of ourselves; that there are potential ramifications.” The absolute opposite of sounding holier-than-thou, Dr. Steinbaum cheerily added that in her younger years, “My whole thing was living on jellybeans and coffee for a couple of years.”
I once wrote about an exercise experience form an emotional perspective. I began by saying “The heart is made of muscle…” and aimed to get all metaphorically jiggy about strength and tears and whatnot. This is kind of the flipside; I know I have to pay attention to emotional stressors and manage my own depression and anxiety at times, but -- is it too cheesy to say that as we work on healing our emotional wounds we have to also remember our actual physical hearts beating in our chests? Well, bring on the Velveeta, because we really can’t forget that they’re connected.
I hate that many of the heart health messages I see in the media can look at first like they’re fat-shaming weight loss ads. This is not a question of pounds on the scale; it’s an actual question of life or death and a reminder that heart health is a specific thing that needs specific attention. In my case, if we were to measure by conventional mainstream standards, my outsides were in the best shape of my life while my insides were crumbling to bits.
When I told Dr. Steinbaum that I see too much scolding going on for my taste, she took it a step further. She said that even though heart disease kills more women than cancer, in her experience women don’t talk about it openly as much as other illnesses and diseases. She said she sees a lot of what she calls the Blame Game: patients saying, “If I only exercised more, If I only ate better…” and from the other side, there can be that scolding, that sense of, “You didn’t do the right thing, so you have heart disease.” She continued, “It’s so unfair, because this is a lifestyle disease. This isn’t just about food. This isn’t just about exercising. This is about how you live, your family history, how much sleep you’re getting; your entire series of choices.”
I promise I don’t want to scare you. I know it’s overwhelming, but such is the nature of matters of the heart. What I’m saying is to please pay attention and please check your hearts and don’t stay uninformed about heart health for as long as I did.
Dr. Steinbaum told me that she wrote her Heart Book “because this is a book that I wish someone gave me when I was 20 years old. Heart disease can take decades to develop, so the earlier we do something about it, the better we can prevent the outcome.”
My heart health unawareness might have been extreme, but an unfortunate side effect of the stereotypical image of the older male heart patient is that women are less likely to pay attention to possible symptoms or go to an ER in the case of a possible heart attack. And if we do make it there, medical professionals may be “challenged to respond to women's milder symptoms, acting with insufficient guidelines,” to quote this study.
We have to get in the mix and be counted; for prevention, for treatment if need be, and for increased understanding of when and why we’re at risk. Dr. Steinbaum continued: “Women sometimes have more subtle symptoms: palpitations, shortness of breath, jaw pain, back pain, nausea, vomiting, flu-like symptoms, sleep disturbances…if one day you aren’t able to do what you usually do because it’s just too exhausting, think about your heart.”
At this point I let out a nervous laugh because that could be almost all of us at any given time. But that’s the point. Here’s yet another reason to take a close look at how we’re living and see how we can be better to ourselves, remembering that that’s not a one-size-fits-all answer.