Maxy sez : The Healing Power of Friendships Grows With Age

Friends can be health superheroes by saving you from loneliness and lengthening your life.
By Kathleen Doheny     Medically Reviewed by Justin Laube, MD

Having a few good friends — or many — has always been golden. And as you age, those friendships may become even more important.

If you're in your sixties or beyond, friendships aren't just the social glue and glitz of life: As you get older, good friendships can dispel loneliness, improve your health, boost your sense of well-being, and even add to your years.

Friends Aren't Just for Fun: They Can Be Lifesaving, Too

Loneliness stemming from having too few friends doesn't just potentially spiral you into a state of depression: It could even shorten your lifespan.

For adults over 60, loneliness seems to increase the risk of dying earlier, according to a 2012 study in JAMA Internal Medicine that followed more than 1,600 men and women enrolled in the University of Michigan Health and Retirement Study.

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Researchers defined loneliness as lacking companionship and having feelings of isolation or not belonging. Those who reported loneliness were nearly one-and-a-half times more likely to die during the six-year follow up. In addition, people who were lonely were less likely to be able to do simple daily tasks and activities, such as walking around the block, dressing and showering, and carrying objects as light as 10 pounds.

Friendships Keep Your Brain Sharp

If you're not the type to have many friends, be assured that quality may be more important than quantity, says Rosemary Blieszner, PhD, alumni distinguished professor at Virginia Polytechnic Institute and State University in Blacksburg, and an expert in human development and aging. If you have at least one person who understands you — a friend you feel you can tell anything — that's enough to contribute to your feelings of well-being, she says.

Other research suggests that the feeling or perception of loneliness, rather than isolation, may be the thing that increases risk of cognitive problems like dementia later on. Researchers from the Netherlands tested which had a greater impact on the risk for getting dementia: social isolation (defined as living alone, being unmarried, or without social support), and feelings of loneliness. The Dutch team found that those who felt lonely were about 1.6 times more likely to get dementia, while those who were socially isolated but not lonely had no higher risk than others, according to the 2012 study published in the Journal of Neurology, Neuropsychology & Psychiatry.


Social interaction, regardless of how many friends are ideal for you, helps keep your thinking and cognitive skills sharp, Dr. Blieszner says. "People who are socially isolated and not stimulated are the ones who tend to have lower cognitive ability in old age."

Besides keeping your mind sharp, friends can help with your physical health, too. "Friends encourage you to eat well, to get your check-ups and exercise, and to go to the health club or play with your dog," Blieszner says.

"There can be a connection between the health habits you're making and how that might be influenced by friends," she says. If they're healthy and encourage you, you gain benefits.

Friendships May Change With Age

As the years go by, not everything stays the same. These three facts about friendships, and how they (and you) may change with age, can be helpful in navigating twists and turns along the way:

You may become more tolerant of quirks. If you've got long-time friends, Blieszner finds, you're likely to hang onto them. "Older people seem to be more tolerant of idiosyncrasies," she says. Suppose a friend has an annoying habit, like eating with her mouth full. Younger people might ditch that friend quickly, she finds, but older adults may be more likely to look at the whole picture, reasoning that the friend has many redeeming qualities.

You can expect to be dumped, or to dump. Norman Abeles, PhD, professor emeritus of psychology at Michigan State University in East Lansing and a former president of the American Psychological Association, tells older adults to be aware that the friends who met your needs in your thirties, forties, or fifties may have different interests and needs now. "The other person may outgrow you," Dr. Abeles says. And that's okay. After all, you can draw on your by-now honed skills at developing friends. "You don't necessarily have to have all-lifetime friendships," he says.

Friendship is a two-way street. "It's important to maintain friends, but it doesn't have to be equal all the time," says Abeles. He warns against becoming overly invested without getting enough in return. Likewise, he says, it's crucial not to lean too much on one friend. "Reciprocity is a very important factor," he says. A big difference in the balance of give-and-take in the friendship is not ideal. "You can't be waiting for the other person to call you and they don't call you. Have a scope of friends," he recommends. "Don't depend on just one or two."

Maxy sez : Blood Sugar Testing: Questions and Answers

By Beth W Orenstein        Reviewed by Lindsey Marcellin, MD, MPH
Monitoring your blood sugar levels daily allows you and your doctor to know how well you're controlling your diabetes. These tips can make blood sugar testing more manageable.
If you have diabetes, regularly testing your blood sugar levels will let you know how well you’re controlling the condition and whether your doctor needs to make adjustments in your medications or treatment plan.

“Testing gives us an objective idea of how you’re doing,” says Sunshine Shahinian, RN, a diabetes educator at the Rancho Los Amigos National Rehabilitation Center in Downey, Calif. “If you don’t test, we may not have the opportunity to intervene if you’re not controlling your blood sugar well.”

As essential as glucose testing is to tracking your blood sugar levels, it can be a daunting and confusing habit to develop. Here are answers to common questions about blood sugar testing questions.

Q: What’s the best time to check my blood sugar levels?

A: Work with your doctor to determine when and how often you should test your blood sugar. Your testing schedule will depend on your medications, mealtimes, and how well you're controlling your condition.

Shahinian recommends varying your daily testing times. One day check it after you get up and before lunch. The next day, do it after breakfast and after lunch. The following day, test before lunch and before dinner. “Vary it so we know how you’re doing throughout the day and so we can do something about it if your numbers are off,” she explains.

You’ll also want to test your blood sugar whenever you have symptoms of high blood sugar. These include dry mouth, increased thirst, blurry vision, frequent urination, and dry skin.

Q: Should I use the same finger every time?

A: Try to use different fingers and test sites because your fingers can get sore if you prick them in the same spot every time. You have more nerves in the center, or pads, of your fingers, so you may want to use the sides. Establishing a pattern of which day you use which fingers will help you remember to use different test sites.

Q: Can I get the blood sample from somewhere other than my fingers?

A: It’s best to use your fingers because any changes in your blood glucose levels will appear most readily in the blood from your fingers, Shahinian says. However, some blood glucose meters can be used on other parts of the body, such as the palm, forearm, or thigh. Read the instructions to see where your device can be used, or ask what your doctor recommends.

Q: How do I prepare for blood sugar testing?

A: Wash your hands with warm, soapy water. Washing serves two purposes: It cleans the test site, which reduces the risk for infection, and the warm water brings more blood to your fingers. Dry your hands well before testing.

Another way to bring blood to your fingers is to dangle and shake your hands below your heart. You can also massage your finger, pushing blood toward the tip. Shahinian recommends not using rubbing alcohol to clean the test site because it can dry your skin. “You’re less likely to test if your fingers are dry and hurt,” she says.

Q: How much blood do I need?

A: “Try to get just enough,” Shahinian says. Most meters today require only a small drop of blood. Usually a quick prick works fine. If you lance your finger, you may bleed too much.

Q: Where can I learn how to test properly?

If you’re unsure about how to do a proper test, ask the caregivers in your doctor’s office to show you what to do. Don’t be afraid to speak up. It’s important that you use the proper technique so the results are accurate.

Q: What do I do with the results?

A: Keep a record of the results and the time of each testing. You should also make notes about what you ate or did before you tested and if you were experiencing any symptoms at the time. This will help you identify trends for when your blood sugar is high or low.

Q: When should I talk with my doctor about the results?

A: One high reading is nothing to be alarmed about. But when the readings are high or low for consecutive testings, you need to pay attention.

“If your blood sugar is higher than your target level for at least two consecutive days, let your doctor know,” Shahinian says. “You could have an infection, or you could need to adjust your medication.” Everyone is different, so you and your doctor need to decide what your individual target level is.

Also talk with your doctor if your blood sugar levels fall below 70 mg/dL for two or three consecutive readings or if you have more than one low blood sugar reaction in a week that you can’t explain.

With guidance and experience, you’ll get the hang of blood sugar testing. Work with your healthcare team until you’re comfortable with the process on your own. Making regular blood sugar testing a priority is an important part of managing your condition.

Maxy sez :Stress and Your Diet

                                               Maxy    &  Tonka
By Diana Rodriguez           Reviewed by Pat F. Bass III, MD, MPH

1  .  When you're feeling tense, there are many ways to manage and, in fact, reduce stress levels. Your diet and nutrition choices can make your stress levels go up or down. Certain foods provide comfort and actually increase levels of hormones in the body that naturally fight stress. Other types of foods and beverages can reduce stress by lowering the levels of hormones that trigger it.

2 .    Have a Cup of Soothing Comfort
Sometimes, it's the effect of a food or drink that can help reduce stress, not necessarily its nutrients. A warm cup of tea can actually calm many people, says Sandra Meyerowitz, MPH, RD, LD, online nutrition coach and owner of Nutrition Works in Louisville, Ky. There's the soothing effect of sipping a warm drink, regardless of the flavor — but certain herbs, like lavender and chamomile, have been shown to have a relaxing effect on their own, Meyerowitz says.

3 .    Indulge in Dark Chocolate
Dark chocolate in the diet can reduce stress in two ways — its chemical impact and its emotional impact. Chocolate feels like such an indulgence that it can be a real treat to simply savor a piece of it, and that feeling alone can help to reduce stress, says Meyerowitz. Dark chocolate, which is also rich in antioxidants, can also help to reduce stress by lowering levels of stress hormones in the body, according to a Swiss study in which participants ate about 1.5 ounces per day for two weeks. Just avoid excess calories in your diet by not overindulging in chocolate, advises Meyerowitz.

4  .    Choose Carbohydrates
Carbohydrates have been found to increase levels of serotonin, a chemical in the body that can boost mood and reduce stress. Once serotonin levels are increased, people under stress experience improved cognitive function, meaning they can concentrate and work better. Meyerowitz notes the comforting effect of carbohydrates in the diet that can reduce stress — savoring a bowl of pasta or macaroni and cheese feels soothing and can help you to relax. Just make sure to choose healthy carbohydrates like sweet potatoes and whole-grains for better nutrition, and limit fat-laden, calorie-dense toppings.

5 .  Enjoy Avocados
Avocados are not only delicious mashed into guacamole or sliced onto a salad — they're also packed with omega-3 fatty acids. These healthy essential acids are known to reduce stress and anxiety, boost concentration, and improve mood. Meyerowitz emphasizes the importance of getting the right amount of omega-3 fatty acids in the diet for overall health, in addition to the benefit of helping to reduce stress.

6  .   Eat Fatty Fish
Fatty fish are also a good source of omega-3 fatty acids and an excellent way to use diet and nutrition to reduce stress because they also offer a major benefit to cardiovascular health. Omega-3 fatty acids and fatty fish have also been found to ease depression, because the chemicals improve communication between nerve cells. Fatty fish include tuna, halibut, salmon, herring, mackerel, sardines, and lake trout.

7 . Make a Mug of Warm Milk
A centuries-old home remedy for getting a better night’s sleep, warm milk helps because it has a relaxing effect on the body. Calcium-rich foods are an essential part of a healthy diet for bone health, but they also help with stress reduction. Milk and other dairy foods with calcium and added vitamin D can help muscles relax and stabilize mood — one study even found that they can also ease symptoms of premenstrual syndrome.

8  .     Grab a Handful of Nuts
Nuts are full of vitamins, including B vitamins, and healthy fatty acids as well. According to Meyerowitz, B vitamins are an important part of a healthy diet and can help to reduce stress. Almonds, pistachios, and walnuts can even help lower blood pressure levels. According to one study, pistachios in particular were found to have a role in reducing stress levels. Just remember to limit servings to just a handful a day to avoid excess calories.

9  . Get More Vitamin C
Some studies have found that high levels of vitamin C help ease stress levels. One double-blind study reported on the value of taking 3,000 milligrams of vitamin C in a slow-release formula to reduce stress and levels of the stress-related hormone cortisol. Another study looked at the stress reduction effects of taking a supplement containing 1,000 mg of C, plus B vitamins, calcium, and magnesium. Eating citrus fruits, including oranges, grapefruits, and strawberries is a good start, but you would need a supplement to reach such high levels of these nutrients.

Maxy sez : Is Anxiety Hereditary?

The tendency to develop an anxiety disorder might stem from your genes but your life experiences and environment play a role, too.
By Madeline R. Vann, MPH        Medically Reviewed by Anxiety disorders can have both genetic and environmental roots.Photo Credit: Ian Simpson/Alamy
Key Takeaways
You might have inherited the tendency to develop an anxiety disorder from your parents or other close relatives.

Anxiety disorders can also be caused or triggered by traumatic events or other aspects of your environment and life experience.

If you have an anxiety disorder, you might notice signs of the same condition when you look through your family tree. Or you might not.

Unlike some personal traits like eye color and facial features, anxiety in the family isn't always easy to see through the generations. Anxiety disorders include a variety of conditions, such as panic disorder, obsessive-compulsive disorder (OCD), social anxiety, post-traumatic stress disorder, and generalized anxiety disorder.

The search for specific genes related to anxiety disorders is in the preliminary phase. Consider this: Researchers analyzed the genetic make-up of 1,065 families — some of whom had OCD — and found that the gene in question was not associated with the disease. However, in their May 2014 issue of Molecular Psychiatry paper, they drew upon other research to conclude that there still may be a link between our DNA code and the  occurrence of OCD, but these ideas still needed to be researched.

The Link Between Genetics and Anxiety

For most people, genetic risk for anxiety is less likely to be an on/off switch than a complicated mix of genes that can put you at risk for developing anxiety. Even then your anxiety disorder might be different from your relative’s in important ways.

“Individuals inherit a predisposition to being an anxious person, [and] about 30 to 40 percent of the variability is related to genetic factors,” explains psychologist Amy Przeworski, PhD, an assistant professor in the department of psychological sciences at Case Western Reserve University in Cleveland.

A genetic predisposition to anxiety could start young. Studies have shown that when anxiety develops before age 20, close relatives are more likely to have anxiety as well. A study published in the June 2013 issue of the Journal of Anxiety Disorders underscored that certain anxiety traits correlated with panic disorder are evident by the age of 8.

Researchers have tried to better understand the genetics behind anxiety disorders by looking at whether relatives have the same anxiety disorder. They have found that people are at significantly greater risk for panic disorder if they have a twin who has it and at somewhat greater risk for panic disorder if a first-degree relative, such as a parent or sibling, has it.

Studies show that the risk of anxiety tends to run in families, but the role of genetic influence versus the influence of the family environment remains unclear, conclude researchers in an article published in the June 2011 issue of the Journal of Korean Medical Science.

As it stands now, experts believe the genes involved may modify your emotional responses in a way that might lead to anxiety. If two people have a similar mix of genes, whether they develop anxiety or not, could depend on their experiences or environmental risk factors.

Environmental Risk Factors for Anxiety
Some of the environmental risk factors that can trigger anxiety include abuse of all kinds, traumatic events, stressful life events, difficult family relationships, lack of a strong social support system, low-income status, and poor overall health. Research has also suggested that when anxiety develops despite an environment that has none or few of these risk factors; it’s probably due to underlying genetic risk.

Anxiety Treatment Strategies

The good news is that anxiety treatment, which could include medications and cognitive behavioral therapy, appears to be just as effective for people with a genetic history as for those without, Przeworski says. At least to date, research into the genetic roots of anxiety hasn’t revealed any treatment strategies that might work better than cognitive behavioral therapy.

Maxy sez: No Pelvic Exam? Why You Should Care 'Down There'

 author-avatar By Lauren Streicher, MD
Your pelvis, or at least the health of your pelvis, is under attack with the new "no-pelvic exam" advice. And it's time to fight back.

A little background: Every year, millions of women make that annual trek to their gynecologist, internist, or family doctor, and reluctantly climb into the stirrups and put up with a less than comfortable, sometimes humiliating exam. No one likes it, but from my point of view, it's clearly worth the brief discomfort and possible embarrassment to make sure that all is well in gyne-land.

But not every professional medical organization is in agreement about the value of routinely checking out the vulva, vagina, and pelvic organs. In 2014, the American College of Physicians (internists, not gynecologists) issued a statement that there was no value in an annual pelvic exam unless someone had a specific complaint. But common sense will tell you that “no complaint” does not mean “no problem.”

Signs and Symptoms Seen in a Pelvic Exam Matter

Many women may not recognize that their vulvar itching could be the first sign of vulvar cancer. Most women assume that there's no treatment for painful sex and vaginal dryness, so they don’t bother to mention it. In still other cases, a woman may assume her urinary incontinence is an inevitable consequence of aging and frequent the diaper aisle instead of getting appropriate treatment.

And most disturbing, a serious condition such as vaginal cancer may have no symptoms but be easily detectable by a gynecologist via a simple speculum examination of the vaginal walls.

You can’t treat something if you don't know it's there, and it's been well established that being asymptomatic is NOT the same as being healthy.

The No-Pelvic Exam Statement by the USPSTF

June 2016, the U.S. Preventive Services Task Force (USPSTF) released a statement that questions the value of routine gynecologic exams. But here’s the astonishing part: The authors of the report looked at only four — that’s right, four — conditions:

Ovarian cancer
Bacterial vaginosis, a common vaginal infection
Trichomoniasis, a sexually transmitted disease
Genital herpes
They inexplicably concluded that since there was no benefit to a pelvic exam in diagnosing these specific conditions, an annual pelvic exam need not be performed for otherwise healthy women. This argument is so outrageous, so flawed, and so beyond the most basic logic that I am embarrassed for them.

For starters, it has already been well established in the medical literature that ovarian cancer isn't detected on annual exams. Genital herpes is diagnosed only if it's active, and bacterial vaginosis and trichomoniasis are detected only if a specific screen is performed. In other words, it's not news that these particular four conditions are not generally going to be diagnosed during an annual exam. Any gynecologist will tell you that these conditions are not the reason for the exam!

Ovarian cancer, bacterial vaginosis, trichomoniasis, and genital herpes don't even represent a fraction of the sorts of conditions a gynecologist screens for during your pelvic exam.

The Value of the Pelvic Exam After Menopause

The executive committee of the North American Menopause Society (NAMS) has come out publicly and stated, on July 1, that they “strongly disagree with the conclusion of the USPSTF draft evidence review, particularly as it applies to postmenopausal women.” And while it might be “reasonable to recommend against the pelvic exam for diagnosing those four conditions, there is no scientific basis for extrapolating beyond those four specific conditions to the myriad of conditions that affect women.”

It appears that women are perilously close to losing the right to a complete exam, with consequences that may not be evident for years.

But there's something you can do that may change this recommendation.

Public Comments on the Pelvic Exam Are Open

The USPSTF has declared that this statement is only a draft and that they are willing to “hear public input” prior to making a final recommendation. Quite frankly, it’s pretty frightening that this recommendation will be based on public opinion as opposed to solid science. What’s next, a public “vote" on whether taking blood pressure is important?

In any event, you have until July 25 to go to the USPSTF site and read the report yourself, and to then leave a comment if you disagree with this recommendation.

You may want to tell the USPSTF about a condition that was diagnosed that you had no idea you had until it was discovered on a pelvic exam. Or you may want to explain that your annual gynecologic exam is your opportunity to discuss “below the belt” issues, such as incontinence or sexual function — or that it's your opportunity to simply be reassured that everything is normal instead of treating your genitalia like some kind of no-fly zone that's only examined or treated if you have excruciating pain, a zoo-like odor, or bleeding requiring a change of pad every 10 minutes.

Or you may simply want to tell the USPSTF that you are offended that, once again, women’s heath is marginalized by encouraging doctors and insurance companies to forego this critical part of your annual exam. And while you're at it, ask for “proof” that listening to your lungs and heart, a screen performed by every internist, is an effective way to reduce mortality and improve quality of life.

Important: The views and opinions expressed in this article are those of the author and not Everyday Health. 

Maxy sez :7 Unusual Signs of Type 2 Diabetes

By Amy Gorin, MS, RDN      Reviewed by Erin Palinski-Wade, RD, CDE, LDN
1 .  Strange Symptoms That May Signal Diabetes
When you have type 2 diabetes, it’s important to be diagnosed as early as possible, since untreated symptoms can lead to dangerous — and sometimes irreversible — damage to the eyes, nerves, and kidneys. Common symptoms include fatigue, lethargy, confusion, nausea, and increased urination, says David Bradley, MD, assistant professor of endocrinology, diabetes, and metabolism at the Ohio State University Wexner Medical Center in Columbus. But those aren’t the only signs that may signal type 2 diabetes — there are several more unusual symptoms that many people don’t commonly associate with the disease. It’s important to be aware of them, especially if you have a family history of diabetes: If one or both parents has type 2, then you have an increased chance of developing the disease yourself.

So that you know what to be on the lookout for, we consulted the experts, who told us about seven unusual symptoms of diabetes. If you experience one or more of them, consult your doctor as soon as possible.

2 .  Blurry Vision

If you’re having trouble reading street signs, your glasses may not be the problem. Although later-stage diabetes can cause permanent eye damage, blurry vision that arises in the early stages of the disease may be reversible. “A person with diabetes may experience blurred vision because of fluid level fluctuations that cause the eye to swell,” says Erika Villanueva, MD, an endocrinologist and clinical instructor of Medicine at NYU Langone Medical Center in New York City. High blood-sugar levels cause fluid levels in some tissues to drop, including the lenses of your eyes.

3 . Your Skin Looks and Feels Weird

When blood-sugar levels are heightened, the kidneys eliminate excess sugar through the urine, which results in increased urination and loss of fluid. “The subsequent dehydration causes increased thirst, and may cause itchy skin,” says Dr. Villanueva. You might also notice darkening in the body’s folds and creases (such as the armpits, groin, and neck). These velvety patches are caused by insulin resistance. Extra insulin circulating in the body may trigger skin cells to rapidly .

4 .  A Wound That Won’t Heal

A slow-to-heal cut or bug bite can be a red flag for diabetes. Hyperglycemia (aka high blood sugar) decreases the amount of oxygen that can be delivered to wounds through the bloodstream, slowing the healing process and lowering the immune system. “I had a client who was diagnosed with diabetes after she had a mosquito bite that turned into a sore that wouldn't heal,” says Rachael Hartley, RD, CDE, a dietitian in private practice in Columbia, South Carolina. This effect on 

5 .  Frequent Yeast Infections or Jock Itch

Yeast thrives on glucose, and blood levels of glucose are consistently elevated in a person with diabetes, notes Villanueva. This is why women with diabetes are prone to chronic yeast infections, and men are more likely to develop jock itch. Yeast can grow in other areas, too — creating itchy rashes in skin folds, such as under the breasts, and between fingers and toes.

6 .  Problems in the Bedroom

Diabetes can cause a decrease in sexual function in both men and women. Men may experience erectile dysfunction, while women may have vaginal dryness and problems with arousal. This is because high blood-sugar levels can damage blood vessels and nerves that you need to work properly for sexual response, explains Hope Scott Paul, MS, a Certified Diabetes Educator in Murrysville, Pennsylvania. Nerves control the body’s response to sexual stimuli, signaling an increase in blood flow to the genitals; damage to these areas contributes to sexual 

7 .  Restless Sleep

Diabetes doesn’t only lead to dangerous spikes in blood sugar, but can cause dips — known as hypoglycemia — as well. Nighttime hypoglycemia may cause nighttime sweats, as well as vivid dreams. “I’ve heard these described as horrible nightmares,” says Paul. If hypoglycemia is suspected, it’s important to test blood-sugar levels and follow the 15/15 rule if numbers are low: Experts recommend having a 15-gram serving of carbohydrates, such as 4 ounces of fruit juice or 2 tablespoons of raisins, then waiting 15 minutes before retesting numbers. Those with diabetes may need to consult a doctor immediately, as dangerously low blood-sugar levels can lead to serious complications, and can even be life threatening if not addressed properly.

And if you're a frequent napper, the habit could be increasing your risk for developing diabetes. 2015 research published in Diabetologia found that regularly taking a nap an hour or longer raises risk of type 2 diabetes by 46 percent.

Maxy sez: A Silent Threat to Women’s Hearts That Many Don't Recognize

 Many women are in the dark about the insidious blockage of blood flow to the heart called coronary artery disease.
By Jennifer J. Brown, PhD
Heart disease is the leading cause of death for Americans, killing more women and men each year than all types of cancer combined. The latest data from the American Heart Association (AHA) indicates that cardiovascular disease causes one death every minute among U.S. women, or 398,035 deaths yearly.

The biggest villain of all the heart conditions is coronary artery disease. Also called hardening of the arteries or atherosclerosis, it's caused by a buildup of plaque — cholesterol, inflammatory cells, and calcium — that sticks to blood vessel walls, explains the American College of Cardiology. But many women — and too often their doctors — don’t recognize women's symptoms of heart disease.

“Quite honestly, we need to do the same thing for heart health that we’ve done with breast cancer,” says Beth Battaglino, RN, CEO of the nonprofit HealthyWomen and a nurse at Riverview Medical Center in Red Bank, New Jersey.

Battaglino and HealthyWomen are working on a patient advocacy and education site called Spread the Word, which aims to get women talking with other women about heart disease. Spread the Word partners include Nurse Practitioners in Women's Health, Society for Women's Health Research, Coalition of Labor Union Women, and the cardiovascular genomic diagnostic company CardioDx of Redwood City, California, which manufactures gene tests for heart disease.

Are You at Risk for This Quiet Killer?
If you are a woman with silent coronary artery disease (CAD), you may not realize that the arteries leading to your heart can get partially blocked by plaque buildup. But this situation can cause a heart attack as heart tissue dies and is starved of a nutrient-rich blood supply.

“Women do not understand it’s the No. 1 killer,” says Battaglino about heart disease. “Give them the tools to find out about the risk. Women will share their stories.”

Battaglino was inspired to get involved in patient advocacy for women because she was impressed by Violet Bowen-Hugh, MD, a champion for women’s health who began the nonprofit national women’s health resource center that's now called HealthyWomen. “In 1988, a female ob-gyn from West Virginia founded our organization. She believed all women need to be educated, regardless of their socio-economic background, to make educated decisions about their own health," Battaglino says.

You or a woman you love could easily mistake the pain of coronary artery disease for a pulled muscle.
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Now, Battaglino hopes that more women will join the conversation about heart disease online and become their own advocates in the doctor’s office.

“Write a blog post. Go on social media. Share what you learned with friends and family,” she urges. “If we don’t take care of ourselves, we won’t be there to take care of  those we love.”

Heart Symptoms in Women vs. Men

Women can all too easily overlook the more subtle symptoms of a heart condition like atherosclerosis — including arm or back pain. Often, the condition remains undiagnosed until after a heart attack or heart failure from arterial blockage, notes the National Heart, Lung, and Blood Institute.

“Symptoms present (show up) so differently in women than in men,” explains Battaglino. In women, coronary artery disease may mimic other common, less deadly ailments. Whereas a man is more likely to feel the typical effects of angina — sharp chest pain — women need to be looking out for other possible symptoms, she says.

Women’s symptoms of coronary artery disease can include:

Feeling tightness in your jawUpper back pain
Upper arm pain
Upper abdominal pain
Throat pain
Stomach pain
Sudden weakness or fatigue
You, or a woman you love, could easily mistake the pain of coronary artery disease for a pulled muscle. Gut pains might seem like simple indigestion. Even sudden-onset fatigue is too often explained away by women who don't realize it could be heart related.

“Many women are often tired, and so could easily dismiss that. But it could be a sign of coronary artery disease,” says Battaglino.

When to Have the Heart-Health Conversation? 

You don’t have to wait until a cardiologist diagnoses you with heart disease — at yor annual well-woman checkup, you can become your own patient advocate. Take advantage of the opportunity to find out more about how your heart is working.

“It’s so important to have the conversation about heart health when you visit the ob-gyn or your primary care provider," says Battaglino. "If they tell you your blood pressure is a little high, for example, ask, what does that mean?” This way, you can understand what your heart is telling you in the results of routine, but vital, heart-health tests like blood pressure.

RELATED: 10-Step Do-It-Yourself Heart Makeover

When you get to the few precious minutes you have with your doctor, tell them about any symptoms that could point to heart disease. “You want to bring up anything that’s bothering you, like indigestion, pain in the upper arm, back, or neck, or tightness in the  jaw. Remember, women present (show symptoms) differently than men,” Battaglino says.

She suggests writing down the questions you want to ask before you go in. This is good advice not only for yourself, but also for family members who may be getting ready for their annual primary care visit.

Battaglino says, “As a daughter, I want to be sure I’m letting my mom know, too, to have that conversation.”

The best way to get the most you can out of your visit is to prepare. Get the education and tools that can help you understand your heart and signs of heart disease from online heart-health resources, and share them with the women in your life.

Women Heart
Remember, women present (show symptoms) differently than men,” Battaglino says.

She suggests writing down the questions you want to ask before you go in. This is good advice not only for yourself, but also for family members who may be getting ready for their annual primary care visit.

Battaglino says, “As a daughter, I want to be sure I’m letting my mom know, too, to have that conversation.”

The best way to get the most you can out of your visit is to prepare. Get the education and tools that can help you understand your heart and signs of heart disease from online heart-health resources, and share them with the women in your life.


While you’re with your healthcare provider, be sure to talk about how you might be able to cut your risk for heart disease. Important factors include a healthy diet, regular exercise, and curtailing any exposure to smoke — be it cigarettes, e-cigarettes, or secondhand smoke.

While you’re there, remember to check that you're current with all your vaccines. If you’re a smoker, you may want to get the pneumonia vaccine, Battaglino points out. And if you’re not sure whether or not you were vaccinated against measles — which has reappeared in the United States — ask your doctor about getting your MMR vaccine. If you have a heart condition, you may be at  greater risk for infection and complications, which can be severe.

Battaglino says about her patients, “They can have blood drawn and have titers [antibody levels] taken to find out if they need a [measles] booster or not.”

Heart Test Facts to Know

If your visit to primary care turns up a possible heart condition, be proactive and ask for a cardiac referral.

“You’d go to primary care, then you’d see a cardiologist, and based on that you’d see about tests. Understand the testing that’s available to you,” says Battaglino.

Getting the right tests just might put you on the path to avoiding a potentially fatal heart attack. Heart tests have different benefits and health risks. Here are some of the heart tests that might come up, what they identify, and, for some, their radiation exposure risks:

CAD Blood Test This sensitive genetic test may be considered to identify which genes are active. (The test is manufactured by CardioDx.)

Exercise Stress Test An ECG (electrocardiogram), with or without imaging of the heart with an echocardiogram, is done while you walk on a treadmill or pedal a stationary bicycle. This test can identify blood flow limiting coronary artery disease.

CT Coronary Calcium Scan Also called the Agatston score, this heart scan shows areas where plaque has built up inside your blood vessels even before symptoms appear. It exposes you to radiation of about 3 millisieverts (mSv, a measure of radiation dose).

CT Coronary Angiogram Another heart scan, this is one that identifies narrowing of individual coronary arteries. But note that it exposes you to significantly more radiation than a calcium scan — 12 mSv.

Nuclear Stress Test This combines an ECG, small amounts of intravenous radioactive dye, and heart scans that include radiation exposure of about 10 to 24 mSv. For comparison, a mammogram exposes you to about 0.4 mSv, and a dental exam to 0.005 mSv. This test can identify regions of the heart that have diminished blood flow during exercise or drug-induced stress.

Don't be afraid to ask questions if you don't know what the tests involve. According to Andrew Einstein, MD, PhD, associate professor of medicine at Columbia University Medical Center in New Your City, two questions you should always ask about your heart test are:

1. Is there a good clinical reason I’m getting this test?

2. Do you modify the test for each specific patient?

The answer to the first question should, of course, be yes. And Dr. Einstein points out that it's important that some tests be adjusted to suit the person, because a woman may need lower radiation doses based on her weight, the size of her heart, or her age.

The best practice is to minimize your exposure to radiation, because you may be scheduled for several X-ray screening tests in a year by different doctors. Both your referring physician and the doctor who actually does the tests should discuss the risks of radiation exposure with you, according to the AHA.