As the manager of guest services at MeritCare, Jan Wigen sees sick people daily. As a healthy, non-smoking, woman in her early 50s, Jan, unlike many of the guests she serves, has the appearance of a healthy woman. What lurked beneath that picture of health were symptoms that she might tend to overlook or pass off as another less threatening issue.
Jan has a family history of heart disease, both her mother and grandmother died of heart attacks. She was attentive to her heart health and monitored her lab work. "None of the blood panel or labs were bad – the numbers were in great shape; my triglycerides were great. I knew I should lose some weight and exercise more, but I was fine," recalls Jan.
Jan also knew that women's heart issues don't always appear in the same ways as men's, so she decided to seek the advice of a doctor who would be most appropriate for her age and health history.
Jan selected Dr. Jennifer Raum, internal medicine doctor at MeritCare. "Women underestimate the risk that they have for heart disease," Dr. Raum says. "They think it's a man's disease, and they are more concerned about things like breast cancer."
Dr. Raum continues, "Heart disease is the number one killer of men and women. Typically in men, heart disease starts earlier. And maybe that's why women don't own this disease. Since with women, it tends to start later on in life."
Easy to Overlook
Jan had a lot of fatigue and sometimes shortness of breath, but she passed it off. Jan says, "I work long days. I move around and get tired, but that was because I should be in better shape." That wasn't the only warning sign. "I also had heartburn. What others think of as chest pain, to me was heartburn," Jan says. "I just didn't pay attention to the warning signs. I said, 'I am not sick, I should be fine.'"
Jan was already on medication that seemed to be controlling some symptoms, but by the time she saw Dr. Raum again a few months later, she was complaining of new symptoms, including more intense chest discomfort. Dr. Raum was concerned over these issues that Jan had explained away.
Dr. Raum explains, "At that point, I needed to know that it wasn't her heart causing her problems. It could have been heartburn, anxiety, or a pulled muscle. All sorts of things can cause chest pressure. With women, the heart is something we always have to consider. I've had patients with symptoms of heart burn and I send them for a stress test, and sure enough they have heart disease. It can really masquerade as a lot of different diagnoses."
Dr. Raum cautions that Jan's story is all too common. She says, "Jan does not look like a woman who has heart disease. She's fit, and when she was having these symptoms and seeing herself in the mirror, I am sure she didn't think about having heart disease."
Incredible Teamwork
With Jan's warning signs progressing, Dr. Raum decided that Jan again needed to see her cardiologist for further testing. At Dr. Raum's request, Jan had gone to see MeritCare Heart Center cardiologist Dr. David Clardy over a year ago, but the tests at that time were inconclusive. This time though, Dr. Clardy recommended an angiogram, which is an X-ray test that uses a special dye and camera to take pictures of the blood flow in an artery.
Dr Clardy says, "We found that her blockages had worsened." Jan had very small coronary arteries (the vessels that supply blood to the heart), so placing a stent to open them up was not a possibility. Rather, Dr. Clardy consulted MeritCare heart surgeon Dr. Roxanne Newman. After looking at her angiogram, which showed significant blockage in three arteries, Dr. Newman determined that Jan needed triple bypass heart surgery.
Jan says, "I didn't even think of a second opinion for the heart surgery. I happen to know Dr. Newman is one of the best in the nation." Having such a resource so close to home impressed Jan. "To me, that's the most amazing part," she says.
Within just a few days Jan's surgery was complete. In fact, within a matter of days, Jan's care had been completely coordinated from internal medicine to the heart center. Plus, all of her medical needs were met in one location.
Dr. Raum continues, "Jan's case is a great example of how smoothly things can work in our health system. Jan came to me, her doctor, with vague concerns she was quite happily ignoring, which I picked up on. I made a phone call, and the very next day she was in to the cardiologist having an angiogram, which showed significant worsening of her heart disease, and within a few more days, she has heart surgery. It's very efficient."
For Jan, the entire process was made less scary because of the quality of the doctors and the overall care at MeritCare. She says, "I remember lying in that bed being grateful that I could have that kind of a surgery in this community and not have to be in another community with my family not being accessible. I was confident that I had a top-notch surgeon; I had doctors with the knowledge and understanding of what was happening and what they needed to do to diagnose and treat my problem."
Her problem, luckily, was caught early, and Jan now is back to serving guests.
Heart-Healthy Tips:
- Have regular check ups with your doctor because knowing your blood pressure and cholesterol and discussing healthy weight, eating, and lifestyle habits are all important ways to protect your overall health.
- Don't smoke.
- Get regular exercise, which is great for cardiovascular health. Be physically active. Park your car at the end of the lot, take the stairs. Try to find ways to make yourself active.
- Eat a healthy diet with fresh fruits and vegetables – avoid too much red meat.
- Know your family history. It doesn't mean that you will absolutely have heart disease, but it means that you have to be more cautious.
- Know the symptoms, but also understand that in women, especially, symptoms are not necessarily text book. If you have recurring issues, such as fatigue, shortness of breath, or chest pain that seems to be around or near your heart, make an appointment with your family doctor or internist.