©iStockphoto.com/annedala Image by: ©iStockphoto.com/annedala
Heart disease and stroke are one of the leading causes of death for Canadian women—and risk factors, symptoms and even treatment might vary by age. Here's what you need to know.
It was Dec. 13, 2014. I was getting ready to go out for dinner when suddenly everything went wrong. I lost coordination, almost like I was drunk. I went numb, as if the local anesthetic that dentists use had been applied to half of my body. My arm went limp, I could barely walk and, out of the blue, I got a raging migraine. At 31 years old, I was in the midst of a transient ischemic attack, often called a ministroke, but I had no idea.
It wasn't until the next day, when I was feeling only slightly better, that I realized something was really wrong. I didn't want to wait for an appointment with my family doctor, so I called Telehealth Ontario, the provincial service that connects callers to a registered nurse via telephone. In the very back of my mind, I wondered if I'd had a stroke—but I was too young, or so I thought. But when I described my symptoms, it became clear that I wasn't too young. In fact, the nurse who took my call was worried enough to send paramedics to my house. Soon, I was in the back of an ambulance, rushing through Toronto's busy streets on the way to the hospital.
Luckily, my stroke was mild, and, in July 2015, I underwent surgery to have a patent foramen ovale closure device inserted to close the hole in my heart. But, to this day, I'm still shocked at how little I knew about the risks associated with stroke and heart disease, or just how common they are. As I soon learned, about 1.6 million Canadians—557,000 of them women over the age of 24—report having cardiovascular disease. And, according to a study looking at factors and behaviours affecting cardiovascular health published in 2013 in the Canadian Medical Association Journal, fewer than one in 10 adult Canadians were in ideal cardiovascular health from 2003 to 2011, which means 90 percent of us are making choices that are increasing our risk for a cardiovascular event. In fact, heart disease and stroke is one of the leading causes of death for Canadian women, and most of us have at least one risk factor.
It's a club that I didn't particularly want to be a part of, but having joined, I began wondering what other women's experiences had been like.
Unlike me, when Victoria resident Carolyn Thomas started having a range of symptoms— crushing chest pain, nausea, weakness, sweating and a persistent ache down her left arm—on her 58th birthday, she immediately thought it could be a heart attack and went straight to the ER. But when she got there and told the doctor on duty about her symptoms, he said it was just acid reflux. "I remember exactly what he said," she recalls. " 'You're in the right demographic for acid reflux. Go home and call your family doctor for a prescription for antacids.' " Embarrassed and apologetic, she did just that. But her symptoms persisted for two more weeks. She eventually went back to the hospital, and this time, she was told she was suffering from what was actually one of the most serious types of heart attacks—a complete blockage of her left anterior descending artery, which is often referred to as the widow-maker.
Since then, she has recovered, but it's far from full—she had to retire early and continues to see a specialist at her regional pain clinic.
Irmine MacKenzie also went to the hospital immediately. It's been 35 years since the New Waterford, N.S., resident lost the use of her left arm and leg after suffering a stroke caused by carotid artery stenosis, narrowing of the arteries that carry blood from the heart to the brain. She was 61 years old and, having just finished eating breakfast with her husband, John, she headed to the kitchen to tackle the dishes. Suddenly, plates started dropping from her hands, shattering as they hit the floor.
After a six-week hospital stay and a three-month stint in a rehabilitation program in Halifax, she eventually learned to walk again. Her ability to manage quite well over the past three decades is clearly a testament to her grit— and maybe some kind words from a stranger. "I won't ever forget the ambulance driver who took me to the rehabilitation centre," she says. "He told me, 'We're taking you by stretcher now, but you'll be walking out of there with a cane.' " Sure enough, that's exactly what she did.
A better understanding
It has now been two years since I suffered my transient ischemic attack, and I feel like I'm still learning about heart health. I now understand the importance of cardiac rehabilitation, for one thing. When I had my stroke, I didn't know this kind of program existed—my cardiologist didn't refer me to one, but having access to dedicated professionals in a safe, encouraging environment could have helped me navigate the health-care system and guided me toward healthier choices.
One thing I found myself, Carolyn and Irmine echoing is how, as women, we must advocate for ourselves in the health-care system, ensuring that our voices are heard and our health is looked after. We need to put ourselves first, without shame or guilt. As Dr. Paula Harvey, director of the cardiovascular research program at Women's College Hospital in Toronto, says, "It comes back to education and partnership with your health provider. Don't be afraid to ask questions and be informed."
Heart health by the decade
Nearly two-thirds of all heart attacks and strokes occur in Canadians 65 or older, but younger Canadians are increasingly at risk. Here's what you need to know at every age.
In your 20s and 30s: Young people with heart-health issues are part of a growing minority. A study published in 2012 out of the University of Cincinnati College of Medicine found that, over a period of 12 years, strokes among people aged 20 to 54 made up an increasingly greater proportion of strokes across all age groups, growing from about 13 percent in 1993–94 to 19 percent in 2005.
Closer to home, the Heart and Stroke Foundation says several studies predict that the rate of strokes among younger adults will double in the next 15 years. The main reason? According to Dr. Tara Sedlak, a cardiologist at Vancouver General Hospital and clinical assistant professor at The University of British Columbia, it comes down to lifestyle—high stress levels, poor eating habits, lack of exercise and smoking. Research bears this out: The University of Cincinnati study suggested that a rise in lifestyle-related risk factors (such as diabetes, obesity and high cholesterol) may contribute to a higher incidence of stroke.
But there is a way to turn the tide: As with other age groups, simple changes such as exercising regularly, quitting smoking and eating healthily could see the rates of cardiovascular disease—and, more specifically, stroke—decrease, says Dr. Paula Harvey, director of the cardiovascular research program at Women's College Hospital in Toronto.
In your 40s and 50s: Cardiovascular disease is less common among younger women, in part because of their higher estrogen levels; the hormone offers some protection to the arteries. But as women approach menopause and their estrogen levels drop, the incidence of stroke and heart attack increases.
Unfortunately, broad knowledge of their increased risk may not protect perimenopausal women from misdiagnosis. According to research by the Canadian Medical Protective Association, which provides advice, legal assistance and risk-management education to 95,000 Canadian physicians, doctors are missing the signs of stroke in patients nearly 10 percent of the time, largely because symptoms are often nonspecific—patients often complained of headache, dizziness, nausea and vomiting.
And women, who have historically been less inclined to advocate for themselves, are particularly at risk. Research out of the University of Leeds in England showed that, between April 2004 and March 2013, 198,534 heart attack patients at National Health Service hospitals in England and Wales were initially misdiagnosed—and most of them were women. During that time, women suffering a heart attack were 50 percent more likely to be misdiagnosed compared to men.
It might be difficult to challenge doctors who tell you nothing's wrong, but Dr. Sedlak encourages women to listen to their bodies and to be firm with health-care providers about what they're experiencing. "If you feel there is a real problem, be persistent," she says.
In your 60s and beyond: Women over 65 have the most strokes of all age groups, but they still have fewer strokes than men the same age. However, a Danish study published in the Journal of the American Heart Association in 2015 found that, after 60, women tend to have more serious strokes than men—and they're more likely to survive, which can have serious repercussions on quality of life.
John Sawdon, the public education and special projects director of the Cardiac Health Foundation of Canada, explains that cardiac rehabilitation programs, which are free with a referral from your doctor, are the perfect next step for recovering cardiac patients of all ages, but they're particularly important for older Canadians, who tend to live more sedentary lives. These programs are supervised by a cardiologist and, after an assessment, are tailored by your cardiac rehab team, which usually includes nurses, physical therapists, kinesiologists and social workers. They can provide exercise training, education on heart-healthy living and stress counselling—all of which can contribute to the health and well-being of people who have heart problems. And they're effective, too: "Research has shown that those completing cardiac rehab live seven years longer than control groups," says Sawdon. It also "reduces incidence of another heart attack by 50 percent."
What's your risk?
Ninety percent of adult Canadians have at least one risk factor for cardiovascular disease. But while factors such as obesity, hypertension, alcohol abuse, family history and ethnicity increase everyone's risk, regardless of gender, the following three are particularly relevant to women.
Smoking: While we all know that smoking is seriously unhealthy, it can be especially damaging to women's cardiovascular health. Smoking when taking the oral contraceptive pill can drastically increase the risk of heart attack and stroke. But quitting can cut your risk within a year.
Diabetes: According to the Canadian Diabetes Association, people with diabetes are at a very high risk of developing cardiovascular disease. In fact, "they may develop heart disease 10 to 15 years earlier than individuals without diabetes."
Mental illness and stress: "Women have a higher frequency of stress-induced heart disease, and women's hearts are affected by stress and depression more than men's," says Dr. David Fitchett, a cardiologist at St. Michael's Hospital in Toronto and associate professor of medicine at the University of Toronto.
Heart health dictionary
Atherosclerosis: When arteries narrow and harden due to plaque buildup.
Cardiomyopathhy: Diseases of the heart muscle, which cause it to become enlarged, thick or rigid.
Cardiovascular disease: A broad term for problems with the heart and blood vessels, often due to atherosclerosis. These conditions can lead to heart attack, angina or stroke.
Heart attack: Also known as a myocardial infarction, these attacks happen when the flow of blood to a section of the heart is blocked, preventing the muscle from getting oxygen.
High blood pressure: Also called hypertension, this is when the long-term force of blood against artery walls is elevated, requiring the heart to work harder, which may eventually lead to heart disease.
Microvascular angina: A disease of the small coronary artery blood vessels. Many angiograms do not view the small blood vessels, so this can be difficult to diagnose.
Spontaneous coronary artery dissection: A tear in the coronary artery wall. Physical or emotional stress appears to play a role. Most cases (around 70 percent) occur in women under 50—and a third of those are pregnant or postpartum women.
Stroke: When the blood supply to a portion of the brain is interrupted. This can happen when a blood vessel carrying oxygen and nutrients to the brain either bursts or is blocked.
Svava Sigbertsdottir, founder of the butt-kicking Viking Workout
UK (by way of Iceland) trainer Svava Sigbertsdottir, founder of the butt-kicking Viking Workout, talks about her workout philosophy and shares simple, equipment-free exercises that you can do at home.
Read on for expert advice on maximizing your enjoyment, staying safe and feeling empowered at every age.
NOT FEELING IT?
Many women mistake a low sex drive for a clinical case of sexual dysfunction— but chances are, the cause is more than medical.
You aren't exactly sure what's up, but even though you love your partner, you just haven't felt like sex lately. You duck his touch, opting to watch Netflix instead. Maybe it's been months, and you're starting to wonder: Is there something wrong?
You can carry on with binge-watching The Crown, because, for most women, there's nothing medically amiss between the sheets. And, if it's any comfort, you're not the only one who's concerned about the possibility of sexual dysfunction. Teesha Morgan, a Vancouver sex therapist, says it's the question patients ask most. But, "almost 100 percent of the time, what they're experiencing is normal," she says. "There are so many things that can affect sexual desire: if you have little kids; if you're on antidepressants; if you take the birth control pill; if you're perimenopausal, postmenopausal or going through menopause...."
Dr. Natalie Rosen, a clinical psychologist and sex therapist in Halifax, says true sexual dysfunction persists for at least six months and is "associated with significant distress for the individual or couple, as judged by a clinician." So, while it may seem as though all of your friends are in the same sexless boat, just 12 to 20 percent of women and 11 percent of men have sexual dysfunction.
But if it's not a medical problem, what's behind your lack of drive? As Morgan says, there are tons of reasons. However, one major cause might be a truism we were hoping to write off: In women, sex drive tends to dip over time. According to a study published in Psychological Medicine last year, which looked at sexual function (desire, satisfaction, ability to achieve orgasm) in more than 2,000 women, those in long-term relationships tended to see a drop in desire. But that doesn't mean you should buy into the clichés about women hating sex; instead, take the opportunity to be more realistic about your expectations—it's OK to have less sex! And take heart: The study also found that the long-partnered women had an easier time achieving orgasm.
So, if you want to have sex like a champion, don't be afraid to try new things: Get it on anywhere but the bedroom or use a sex toy—and make your personal preferences clear. Dr. Laurie Betito, a clinical psychologist in Montreal, suggests that you "liken having sex to going to the gym." Put it in your calendar if you have to! Because, just as with exercise, the more you go, the easier it will be to keep your commitment.
How your smartphone could be messing with your sex life.
No one can be present in the moment if they're waiting to jump on that next ping, so, for God's sake, put down your phone. Experts recommend charging your devices as far from the bedroom as possible. If you really can't let go, at least turn down the volume. And consider trying "mindful intimacy." The wellness buzzword can easily be applied to sexual health; mindfulness is about focusing on the present, and mindful intimacy means being aware of what you are experiencing while you're with your partner. The idea is that couples who practise it can overcome the barriers they've built up and feel more connected to each other and their own individual sexuality. So sign up for a meditation class or use a mindfulness app like Headspace. (Ironic, we know—but apps really are easy and accessible ways to try mindfulness!)
A look at how the newest sexual aids stack up.
Elvie: Remember those squeezing exercises you had to do after giving birth? Pelvic-floor muscles can make all the difference between a meh or mighty sex life, which is why Kegels are a must. But how do you know they're working? This pelvic-floor exerciser monitors your motion in real time thanks to a Bluetooth-enabled smartphone app.
Aphrodisiac marijuana: California-based medical marijuana purveyor Paradigm Cannabis Group markets a strain of weed called Sexxpot that promises to boost mood and libido. Researchers haven't been able to definitively establish a link between weed and libido, but there's anecdotal evidence that some people do benefit from partaking before sex. Trial run?
"Viagara for her": Big Pharma has been trying for years tcome up with a love pill for women, with little success. The most recent, Addyi, hit shelves in the U.S. in 2015, with a resounding thunk. A prescription pill aimed at premenopausal women, it delivers an average of just one-half of an extra satisfying sexual event per month—at a cost of US$900!
BACK IN THE SADDLE
When you've been ill, sex is often the last item on your to-do list—but that doesn't mean it can't move up a notch or two.
Let's be honest: Sex isn't top of mind after you've been sick. Even sneezing and coughing from a cold or flu can drag you down, so it's no wonder something more serious can affect your sex life. But a thriving connection after a medical condition is possible.
First, though, it's important to know it's OK if you're not exactly feeling frisky. "There's psychology related to illness and sexuality," says Dr. Christine Palmay, a family physician in Toronto. "Depression from an illness, sideeffects from medication and body-image concerns can all lead to a lack of interest in sex."
So don't feel pressured to immediately return to your pre-illness state of affairs. Maybe you've had a mastectomy—that can be a huge blow to your femininity. Or you've had a heart attack and are nervous that strenuous sexual activity will cause another one. You can still be intimate. Trade cuddling for intimate touching—get as naked as you both feel comfortable with, then engage in sex talk or remind each other of favourite moves. It will do more for your relationship than sitting side by side watching TV in parallel play.
And you don't have to worry about a subsequent heart attack after all. A study published in the Journal of the American College of Cardiology in 2015 says sex doesn't trigger a heart attack or increase your risk of a repeat. In fact, researchers found it's actually considered "moderate physical activity…and is comparable to climbing two staircases or taking a brisk walk." So putting a little hanky-panky back into your repertoire can't hurt—and it might even help your recovery.
It's also worth noting that lots of women struggle after illness. "Energy levels post chemotherapy tend not to improve for several years. In some cases, women never return to their previous level of functioning," says Dr. Palmay. "So be gentle and patient with yourself." And when you do eventually feel ready, "experiment, be adventurous," she says. "Maybe sex will play a different role in your new life, and that's OK."
YES MEANS YES
Consent isn't just a concept that affects carefree young people. "It's still a consideration in relationships, whether of a casual, short- or longterm nature," says Mary-Jean Malyszka, a registered provisional psychologist and clinical sex therapist in Calgary. But it can be sticky to address. Here are some tips for striking up the conversation.
With your partner: Consent is an ongoing conversation. "If you would like to change the type or degree of sexual activity, check in by asking, 'Is this OK?' or 'How would you feel about…?' " says Malyszka. Or remind your partner to check in with you. And, if you're planning to try something new, consider choosing a code word or action that means "stop immediately," she advises.
With your teens: Explain what consent is, keeping it simple but clear: You are allowed to stop at any point if it doesn't feel right, even if the other person really wants to continue. "You don't need to go into a big explanation. It's all about what you want and don't want for your body, and your partner has to respect that," Malyszka says.
With your parents: This can be an awkward conversation, but, considering the possibility of cognitive decline, an important one. Explain the importance of informed affirmative consent, which means each partner understands exactly what is going to happen and is enthusiastic about trying it.
Sexually transmitted infections are on the rise among older adults. Here's what you need to know.
Remember having "the talk" with your kids about sexually transmitted infections (STIs)? It's time to revisit that conversation— with yourself.
The Public Health Agency of Canada says the national rate of STI infection has been rising steadily since the late '90s, including among older adults. According to the Sexual Health at Midlife Study, a joint project by Trojan and the Sex Information and Education Council of Canada (SIECCAN), the rates of chlamydia, for instance, among Canadians aged 40 to 59 increased by 153 percent between 2003 and 2012.
Dr. Betito has noticed an increasing need to educate even elderly adults. "Seniors' residences are like college dorms. There's often one man for several women, and they don't use condoms because there's no risk of pregnancy," she says. Dr. Palmay has also seen more STIs in her perimenopausal, menopausal and postmenopausal patients. "My senior patients go to Myrtle Beach, have fun in the sun and come back with syphilis, and they're nonchalant about it," she says.
Postmenopausal women are actually more vulnerable to STIs—the lining of the vagina becomes drier with age, which makes it "more likely to tear and become irritated during sex," says Dr. Palmay. "These tears could lead to more susceptibility to STIs."
Blame lack of condom use for the increased health risk—of the 77 percent of respondents in the Trojan/SIECCAN study who had intercourse in their last sexual encounter, only about 28 percent of women said their partner used a condom (see What's Behind the Rise, below, for more info).
"Youth today are taught 'no glove, no love,' but older women didn't grow up with that concept," says Dr. Betito, adding that people who are widowed or recently divorced "don't know how to negotiate condom use with a new partner." She advises women to take charge by carrying condoms and telling their partners they expect safe sex.
WHAT'S BEHIND THE RISE?
Experts say the increasing incidence of STIs among the 40- to 59-year-old cohort can be traced back to three things.
Hookup-specific apps such as Tinder and Bumble: People looking for casual hookups use these apps to find potential sex partners with the swipe of a screen—no sexual history required.
Birth control use over condom use: For the 40-year-olds, birth control may help prevent pregnancy, but the pill doesn't ward off STIs. Condoms are close to 100 percent effective (though you can still contract HPV and herpes through oral sex).
Screening confusion: Not all STIs are diagnosed through blood or urine tests, and not all STIs are part of standard screening. For example, herpes and HPV require their own tests.
If you thought we'd reached the apex of what a condom could be, think again. This is what rubbers could look like in the near future.
The number-one protector against STIs, HIV and, yes, babies, the latex condom has held steady for years. But once you've got thinner condoms, flavoured condoms and condoms bearing Sailor Moon designs, where do you go? To science, that's where. The Bill and Melinda Gates Foundation is backing projects searching for a biodegradable condom that works just as well as the traditional sort, and a model that can also act as a drug-delivery system forSTI prevention. And, if those two aren't enough, behold the Rapidom. It's an applicator that will help a guy get the rubber out of the package and onto his penis in one swift move. Handy (and more likely to prevent user error)!