HEART ATTACKS IN WOMEN

 

Heart attack is the commonest cause of death in women after sixty five. As many women die of heart attack as men at this age. 26.8% of women die of heart disease as compared to all cancers, which is 26.7 %. Sudden grief in women often results in heart attack. I have personally seen two examples of this among my friends. Women’s symptoms of a heart attack are slightly different to men.  They are often resting as opposed to men who are active at the time. They can experience unexplained anxiety, pain in the jaw, back ache, chest discomfort, abdominal pain and even mild flu like symptoms. The reason for these include conditions such as; high blood pressure, diabetes , high (bad) cholesterol(LDL), low (good) cholesterol (HDL), smoking, and high BMI. Even more important than the BMI is abdominal girth as this indicates visceral fat that is the fat inside the body organs. The abdominal girth measured at the level of belly button, should be less than 35 inches, or 89 cms. There can be fast and irregular beating of the heart. There is swelling of the feet if there is associated heart failure. Other conditions that can cause a heart attack are HIV, depression, inflammatory diseases, rheumatoid arthritis, Lupus. Cardiac arrest and aneurysm (Dilated Blood Vessel), high blood pressure during pregnancy and gestational diabetes are also risk factors for heart attacks in women. Women often ignore their symptoms if they are; having chest discomfort or pain, pain in the arm or jaw, sweating, suddenly feeling unwell or fainting. Do not ignore these symptoms. Seek urgent medical help. A dose of Aspirin can be lifesaving. Take it only after you have spoken to your medical adviser. Make sure you are not allergic to it.  For urgent diagnosis an ECG (Electronic heart monitoring) is done. Cardiac Markers are also tested in the blood, they give a good indication of what is happening. Cardiac Markers are repeated to assess the progress. An Ultrasound, chest X-ray, Coronary Angiogram or CT Coronary angiogram is performed to assess the blood vessels of the heart.  Other tests  to assess the general condition such as a full blood examination, inflammatory markers, kidney, liver, thyroid functions and blood electrolytes (Sodium, potassium) are all done. The patients are stabilized, cardiac rhythm is controlled. The final treatment depends on the findings. Either an angioplasty is performed by open heart surgery (changing the blocked blood vessels) or stents are put in the blocked blood vessels. This depends on the severity and degree of blood vessels involved. Both the procedures are very safe. Some researchers believe if early in menopausal life a women takes or given HRT, it is protective against heart attacks in later life. However one cannot be given HRT to protect repeat attacks. In summary it is good to know that, there are lots of solutions for heart attacks. Do not ignore the symptoms if they seem cardiac, as many women get heart attacks as men, after menopause. There is some protection by HRT if one has taken it at the right age, early in menopause. Improve your life style factors. Quit smoking, limited alcohol, watch weight and abdominal girth, regular exercises, cut down your stress levels and be happy. Change of life style factors will take you a long way to protect you from heart attacks.

VEGAN DIETS

 

In our Current world it is becoming popular to try and consume non meat diets. One such diet is called Vegan. It is estimated that in America there are 6.5 million people who are Vegans as opposed to India where the majority are all Vegetarians. The difference is that Vegans do not use any animal products which include milk and milk by products, eggs, fish, or poultry. One well known person in the world who is vegan is Bill Clinton. Using Vegan food is very good for the environment. It takes 100 times more water to produce 1lb of protein from animal than 1lb of protein from plant source. It is good as in some parts of the world we are getting short of water. Vegan diets are useful for weight loss, preventing many diseases, such as heart, diabetes and cancers.  Vegan can get their supply of Vitamin B12 from fortified plant milk and cereals it is important to make sure one gets adequate vitamins from other sources that one cannot get in a Vegan diet. The other vitamin which lacks in a Vegan diet is Vitamin D. For this it is best to sit in the midday sun for about half an hour at least three times a week, to get the UVR rays, as it turns the skin cholesterol to vitamin D. Vitamin D deficiency can cause bone pain, fatigue, muscle weakness, mood changes and even depression. B12 deficiency can also cause this. The other side effects of B12 are red tongue mouth ulcers, tingling and numbness and instability in walking. The other deficiency in a vegan diet is Omega 3. This is very important for body function, cell membranes, hormone production, contraction and relaxation of arteries, blood clotting regulation, decreasing inflammation in the body and heart function.                                                                                                 This can be obtained from flaxseeds, chia seeds and walnuts. These little seeds can be eaten with salads or cereals. The protein sources for vegans are dried peas, chickpeas, kidney, fava, black, and   adzuki beans. These sometimes are hard on GIT and cause bloated feelings and dehydration, it is best to hydrate the beans well when cooking. Eat in proportion. There are some Indian spices when used with lentils and beans help in preventing bloating.

Vegan diets over all, are very useful for individuals, hip pocket and environment; please take care of missing elements such as VitaminB12, Vitamin D, and Omega 3’s.

PREGNANCY IN WOMEN WITH DIABETES

 

Diabetes currently is one of the very serious problems in the world. About 1 in 11 people suffer from diabetes. There are 3 types of diabetes, type1, type 2 and gestational diabetes. The women who are pregnant with diabetes are type 1 or 2. Gestational diabetes is what develops for the first time in pregnancy. Women with diabetes often find it difficult to get pregnant. Uncontrolled diabetes during Pregnancy causes many problems, higher risk of miscarriages, increased foetal abnormalities, macrosomia (big baby) difficult birth, shoulder dystocia, foetal death, and a few others. In view of all this it is very important to have your diabetes under control. Make sure you are taking high doses of folic acid (400mcg daily), for one to two months prior; which helps to prevent foetal abnormalities. Once you get this sorted also make sure your BMI is ok.  This often is not easy but try to exercise regularly.  Find a diabetic specialist, who specialises in pregnancy with diabetes, a dietitian and may be a Physiotherapist. Have a long term glucose test called HbA1c tested it should be 7% if you have type 1 diabetes and 6% if you have type2. In addition you should have all your systems checked that are effected by diabetes, blood pressure, eyes, nerves, and kidneys. It is important to have a pregnancy ultrasound to have precise dates and make sure the pregnancy is normal. An ultra sound is done at 12 weeks, like in any pregnancy, for any genetic abnormalities. An 18 to 20 week ultrasound needs to be done for foetal anatomy and any foetal abnormalities. Maternal blood pressure is watched in women with blood pressure, for mother’s health and adequate foetal growth. In women who have been on Metformin it is discontinued, and replaced with Insulin if required. Women with type 1 diabetes require slightly less insulin in the first trimester. The routine blood tests, full blood examination, blood group, Hepatitis B and C, Syphilis, HIV, latest cervical screening, cervical culture and any other specific tests to the situation are all done.

Regarding the management life style changes are emphasized, regular exercise, stop smoking, no alcohol. Oral antidiabetics are not generally used as they cross the placenta. Women are supposed to maintain and manage their own blood sugars fasting 5.3mmol/L (95mg/dL), one hour 7.8/mmol/L (140mg/dL), two hours 6.7 mmol/L, (120mg/dL). AIC level to be maintained at 6to 6.5 %in type 2 and 7% in type 1 diabetes. This is done every month during pregnancy. It is more important to control blood sugars than A1c. In those women who use the pump, it is also required to test the pre-prandial blood sugar before using the bolus dose of insulin. It is best to leave the insulin management to a diabetic specialist. If the women are getting too many hypoglycaemic episodes, A1c can be relaxed to 7%. A well maintained diabetes prevents preeclampsia.

The most important decision to make in diabetic women is when and how to deliver these women. It is complex in all situations, depending on how well the diabetes is controlled, what facilities are available, what personal are there such as anaesthesiologist, neonatologist and a women’s personal situation. If it is a well controlled diabetes, there are no complications, no foetal compromise, not a big baby, favourable cervix, then it is good to induce at 39 weeks. It is good to have a neonatologist standing by, as babies often require help. Depending on the other factors, induce between 37 to 39 weeks. Never let them be overdue. If there is a situation which require a caesarean section, go ahead and do it.

In the postpartum period the need for insulin decreases so be watchful. Lactation is the best way to feed the babies, they need support as well. They can often get neonatal jaundice. It is important to watch the baby for obesity and diabetes as they grow. In fact this can be transgenerational. Advise all women about contraception.