We need to talk. Did you know that your leading health threat is heart disease? Yes, your heart is more at risk than you might be aware, and chances are that your health care provider may not be talking to you about it. In fact, one it three deaths in women is from heart disease and more women die from heart disease than all cancers combined!  And, in Maryland, 375 out of 100,000 women die from heart disease, 24 more than the national average! (Centers for Disease Control, 2006.) Since 1984 more women than men have died from heart disease every year. Women continue to be misdiagnosed when presenting with signs of heart attack, often don’t receive the same care as men and can die because of it, and have worse health outcomes after heart attack. Leading health experts and WomenHeart: The National Coalition for Women with Heart Disease are working tirelessly to ensure that every woman has information about how to prevent heart disease, and have access to early and accurate diagnosis and proper treatment should they develop heart disease. WomenHeart also provides the only peer led patient support groups in the country to support women living with heart disease. In fact, you have several right here in Maryland. Learn about them in this publication. Also in the issue, learn from women in Maryland living with heart disease about the importance of prevention, early and accurate diagnosis and proper treatment for heart disease; and how and where to get support. Their personal heart stories are inspiring to all women! Ladies, starting today, make a promise to yourself to take care of your heart and become an empowered patient! Together, one heart at a time, we can eradicate heart disease as the leading cause of death in women. And, when you need that extra bit of encouragement or support to do so, visit www.womenheart.org.

In good health,

Carol Allred, Chair, WomenHeart Board of Directors

More common than you may think

42.7 million women are currently living with cardiovascular disease (CVD).1

7.5 million women are currently living with coronary heart disease (CHD).1

More than 3 million women have a history of heart attack.1

Affects more women than men

26% of women vs. 19% of men will die within one year of a first recognized heart

attack

18% of women vs. 8% of men heart attack survivors will be diagnosed with heart

failure within five years.1

Women are less likely to receive appropriate treatment after a heart attack.2

More fatal than any other disease

419,730 deaths in American women are caused by CVD each year. 1

61,511 women die each year from heart attacks.1

Who is at risk?

Cigarette smokers are 2 to 4 times more likely to develop heart disease.4

59% of Caucasian women, almost 78% of African-American women, and 75% Hispanic-

American women are overweight or obese.1

Women with diabetes have a 2.5 increased risk of developing CVD and a 2.2

increased of dying from CVD.1

1 Roger V L, Go A S, Lloyd-Jones D, Benjamin E, et al. Heart Disease and Stroke Statistics 2012 Update: A Report from the American

Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2012; e32-e171.

2 Jackson E, Legato M, Howe M, The American Journal of Cardiology, published online September 19, 2011.

3 Lloyd-Jones D, Adams R, Brown T, et al. Heart Disease and Stroke Statistics 2010 Update: A Report from the American Heart Association Statistics

Committee and Stroke Statistics Subcommittee. Circulation 2010; e1-e170.

4 US Department of Health and Human Services. Fact sheet: health effects of smoking and tobacco use: heart disease. Atlanta, Ga: US

Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic

Disease Prevention and Health Promotion, Office on Smoking and Health; updated December 16, 2010.

818 18th Street, NW • Suite 1000 • Washington, DC 20006 • 202.728.7199 • fax: 202.728.7238 • www.womenheart.org

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Heart disease is the leading cause of death for woman, with approximately 1:4 deaths, and it’s inclusive of most racial backgrounds, including Hispanic, Black, White. It is the second leading cause of death for Asian American women. According to the National Heart Association’s staggering 2011 updates, one American will have a coronary event every 25 seconds and approximately one person per minute will die of an event. No longer can we see this disease as something that exclusively snuffs out our guys or our elderly, since heart disease has become the third leading cause of death for 25-44 year old women and the second leading cause of death for women 45- 64 years of age.  And you know, many times, there’s been no forewarning at all. In fact, studies done back in 2006 found that 36 percent of woman with heart disease never thought they had any risks. Moreover, two-thirds of woman dying of heart disease had no previous symptoms. The worst part is that much of this morbidity and mortality could have been prevented through careful and determined changes to our everyday lifestyle and activities. For instance, with just a 10 percent weight reduction, you can find a 20 percent reduction in developing heart disease.

Some of you ladies may know already the importance of maintaining a healthy weight. And I realize that many of you have tried and tried but STILL can’t seem to get those pounds off no matter what you’ve done in the past. But this February, I challenge you all to muster up just a little more courage and passion to re-dedicate yourself to protecting your heart.

Now really, there’s no one singular way to losing the excessive fat that’s weighing on your heart’s ability to function. What may have worked best for that celebrity you so admire may not be the key to your own success. Our team is prepared to construct a plan that should better suit your personal needs. At Waverly Weight Loss, we also know that at times it can feel just about impossible to stick to a plan and make it work for your needs—but that’s where we can help coach you through it. We will meet one-to-one with you, pour over all your history, and work with you to find that key to a hopeful, healthful future. If you are ready to commit to changing your life’s path, then we promise to help get you to your fitness goals and to maintain your weight loss thereafter.

Green tea was introduced to Japan through Buddhist monks. Chinese monks offered green tea seeds as a gift to Japanese monks who then began growing and harvesting the plant for themselves. The Japanese word for tea is “cha” so all Japanese teas use this as a suffix. For instance there is Sencha, which is the most common Japanese tea, and Matcha, which is green tea grinded into a fine brilliant green powder.

As we discussed in earlier articles, tea leaves go through certain processes when they are harvested that decide the type of tea they will be (white, green, oolong or black). Green tea is heated once it is picked and withered to ensure that the leaves do not ferment.  After the leaves are plucked, they are laid out to wither for about 8 to 24 hours. This lets most of the water evaporate. Then, in order to neutralize the enzymes to prevent oxidation, the leaves are steamed or pan fried. Once heated, the leaves are dried further.  This process allows green tea to stay in a more natural state, which produces its grassy color and taste. 

Since green tea on its own can be slightly bitter, fun flavors like Almond Cookies, Bamboo Sprouts, and Serene Green offer a healthy dose of antioxidants along with great taste. To learn more about green tea or to enjoy a hot pot, stop into either of our two locations—Gypsy’s Tearoom or Cup Tea Bar & Café.

This means, with cardio interval training, you can absolutely expect positive results not only on areas that concern your cardiovascular system but on the overall status of your health as well.

Cardio interval classes, such as “Flirty Girl Fitness” and “Zumba,” are definitely good for the heart. Interval class is a cycle of “repeated segments” withof increased intensity. In this process, there is an interchange period of recuperation. It can be both comprehensive activity and moderate motion. Consequently, the benefits of engaging in this kind of activity can bring you more results that you have ever expected. These are:

1. The threats of heart attack are lessened, if not eliminated

2. Enhanced heart muscle strength and endurance

3. Increased metabolism, increased chance of burning calories

4. Improved lung capacity

5. Helps lessen or eliminate the cases of stress

Interval types of classes such as cardio and strength, cardio and Pilates, Zumba and Flirty Girl Fitness are all great ways to get toned, benefit the heart, and burn calories all at the same time.

It works because it is a form of interval training. It intervals between fast and slow sequences that vary in intensity and can burn as many as 800 calories per class.

You can benefit even if you have never exercised before. You can start strengthening you heart at any age, and decreasing your risk of high blood pressure, heart attack, or stroke.

At Metamorphosis Pilates and Fitness we offer Classical Pilates, Yoga, and cardio classes. All of these exercises carry more oxygen directly to the heart and brain through movement and breathing practice. These are all mind/body movement classes and are extremely beneficial to the body as a whole. Our clientele is a wide variety of ages, gender, fitness levels, and fitness goals. We cater to your personal needs and interests while honoring safety and quality of instruction. Our customers appreciate the personal interest taken in them and the variety of payment options. We never ask you to sign a contract or charge you a membership fee.

Instead, carve out an hour some time this week to pause and reflect about one to three Goals you’d really like to accomplish this year. Decide how important each goal is to you. If a goal is important, then a) make a promise (to yourself) to pursue it, and b) take the first step immediately.

This calls for a mindset shift. We’ve become accustomed to the idea that a “resolution” is something that can be broken. A promise is different. Promises are serious. And if we can’t keep promises to ourselves, then to whom can we keep them? So let’s determine to be a Promise Keeper, instead of a Resolution Breaker this year. 

Did you know that according to the Center for Disease Control, almost all chronic disease is related to unhealthy lifestyles? Coronary heart disease, type 2 diabetes, cancers, hypertension, heart disease, stroke, liver disease, gallbladder disease, sleep apnea, and respiratory problems are all strongly linked to obesity, inactivity, and poor food choices.

So make yourself a promise and a commitment that doing fitness enhancing activities and making good food choices is now part of your life—permanently. Decide that health and fitness is no longer a luxury, but a necessity. We don’t do it because it’s fun (I certainly don’t); we work out and eat better because we have to.

If you want to get healthy, make a promise to pursue fitness and start immediately. My suggestion, of course: do a free consultation with me to assess your fitness level and make a strategic plan to keep your promise of achieving your goals.

The American Heart Association reports that only 13 percent of women view heart disease as a major health threat. Yet it is the number one killer of women over age 25, killing nearly half a million women each year, more than the next four most common causes of death combined. That means that one woman dies of heart disease every minute. Part of the problem is that the symptoms of heart disease and heart attack can be much different for women than for men. And those symptoms can be easily ignored or dismissed as something far less serious. In fact, less than 30 percent of women report having chest pain prior to a heart attack, and over 40 percent had no chest pain even during the attack, according to research by the National Institutes of Health (NIH).

“In general, all of the symptoms of a heart attack that are common in men—including chest tightness, chest pain, shortness of breath, and pain that radiates in the jaw or down the left arm—are also common in women,” says Dr. Hemalatha Naganna, M.D., board certified Cardiologist and Chief of Cardiology at Carroll Heart Center. “However, women can also be prone to more subtle symptoms, such as nausea, heartburn, or other stomach pain, and shortness of breath without any chest pain. Many women seem to think that they aren’t at as high of a risk of having a heart attack as men, when in reality they are.”  

In the NIH study, 95 percent of women had symptoms for a month or more before having a heart attack, but they did not recognize their symptoms as being signs of heart disease. For most women, unusual fatigue was the primary symptom—something easily ignored with the busy lives women lead. Sleep disturbances were the next most common symptom, followed by shortness of breath. Over one-third of women reported indigestion or anxiety in the month before their heart attack as well. And even during a heart attack, most women experienced symptoms easily explained away, with the most common being shortness of breath, weakness, fatigue, back pain, abdominal pain and dizziness.

“All women should know their risk factors when it comes to heart disease, including their family history, their blood pressure, their cholesterol level, and their risk of type-II diabetes,” says Dr. Naganna. “To keep their hearts as healthy as possible, women should exercise regularly, eat a heart-healthy diet, and have regular screenings with their physicians. All women over 40 should see their physicians once a year to have their blood pressure and cholesterol checked to monitor their health. And it’s important for everyone to always discuss any symptoms they might be experiencing or any changes in their health with their physician.”

–Carroll County Hospital

Now gearing up for its seventh session, Lose to Win is a 12-week, semi-annual program that gives participants access to expert guidance on healthy eating, exercise and all-around wellness, while competing for prizes. Participants in the program attend weekly group educational sessions at Martin’s Food Market in Eldersburg. Md., and receive a 12-week membership to the Merritt Athletic Club in Eldersburg with personal training assistance, as well as regular weigh-ins, blood pressure checks, and comprehensive pre- and post-program evaluations to help meet their individual wellness goals.

“The Lose to Win Wellness Challenge is not about dieting, but focuses on making lifestyle changes,” Eileen Overfelt, R.N., B.S.N., manager of The Women’s Place at Carroll Hospital Center, said. “The program has been wildly successful so far. We usually have a waiting list for each session, and the nutritionist at Martin’s has even introduced a follow-up program for participants who want to continue working together beyond their initial 12 weeks.” 

Although prizes are awarded to the individuals who lose the most percentage of body fat at the conclusion of each Lose to Win session, everyone who participates wins the gift of better health. And, while the gift of better health is its own reward, a full makeover donated by Samsara Salon in Eldersburg or Orbital Salon in Westminster, has proven to be the perfect grand prize for the program’s winner. In 2010, Lose to Win participants lost a total of more than 650 pounds, and many significantly reduced their total body fat, cholesterol, triglycerides, and blood sugar as well.

“Each of our participants has different needs, so everyone receives a nutritional consultation that is tailored to their needs and habits,” Lisa Coleman, M.S., R.D., L.D.N., Martin’s in-store nutritionist who leads the weekly meetings, said. “My main goal is to educate; to teach healthy habits and to teach people what to eat instead of focusing too much on what not to eat. There are so many misconceptions out there regarding nutrition; it’s amazing to see how much our participants learn while they’re here.”

The next Lose to Win Wellness Challenge session begins on February 23, and the deadline to register is January 20. Registration is $199, and to be eligible participants must be at least 21 years of age, have at least 20 pounds to lose and have a body mass index (BMI) over 30. They also must commit to exercising at least three times per week at the Merritt Athletic Club in Eldersburg, attend group educational sessions every Thursday afternoon, have blood drawn at Carroll Hospital Center’s Eldersburg Med Lab and obtain a physician’s referral. To learn more or register, visit www.CarrollHospitalCenter.org/lose-to-win.

Instead of the goal being about weight loss, they made it a goal to change their lives, and they lost the weight too. 

They learned about the best foods to eat to target body fat. And they learned a Smart Exercise program that was catered to fit their schedules and goals. With a Smart Exercise and Nutrition Plan you should be able to average three to four inches of body fat loss in the first four to six weeks. That’s not hype, that’s what happens when someone follows a smart plan. Think about what a four-inch loss from your mid-section will do for your self-confidence! This kind of short-term change will really motivate you to stay on a program and in a fit lifestyle. So turn off the infomercials and get educated; make a smart plan and get started.  And if you really want to be serious, make a bold move: do your free consultation with me. We’ll do an assessment of where you are now and make a realistic plan for meeting your goals.

Like many of Dan’s clients, Melonie worked with him for a set period of time that fit her budget. She incorporated what she learned into her life-style.  And like many others, she’s continued her new life-style, and her progress.

In the past, massage was considered a pampering experience. More recently though, people view massage as a preventive measure. Repetitive use of electronic devices such as computers, cell phones, ipads, and video games have caused the diagnosis of blackberry thumbs, carpal tunnel, tendonitis, tennis and golfers elbow, and related diagnoses to increase. Massage on a regular basis keeps the muscles relaxed, reduces pain, and can even prevent some surgeries. Facials can help minimize the aging process. Acupuncture can help with pain management, menopausal symptoms, depression, Lyme disease, and other issues.

Many people say that they carry stress in their shoulders and people complain that their shoulders are up to their ears. When under stress, we tend to take shallow breaths. One of the most underrated exercises is breathing. By inhaling and exhaling deeply and slowly, our body relaxes because the muscles receive the oxygen they require.  

At this time of year, many people resolve to eat healthier and to lose weight. Poor nutrition is the cause of many of our illnesses today. Illnesses caused by poor nutrition can be prevented. Most of us live fast-paced lives and eat on the run. Many of the food choices that we make while on the run aren’t the healthiest. We are encouraged to get 7-13 servings of fruits and vegetable per day. Therapeutic Kneads has a way that can help you bridge the gap between what we eat and what we should eat. Our licensed, registered dietician Lesley Vogel can help you make the appropriate food choices according to your lifestyle and special dietary needs.  

Making positive lifestyle changes, choosing good nutrition, exercising, drinking adequate water, and getting enough sleep are essential for a healthy body. Let Therapeutic Kneads help you keep your resolutions. Call (410) 549-7711 to schedule your appointment with one of our experts who can help make 2012 your best year yet!

The median survival time for all patients with pancreatic cancer is approximately 6 months and the 5-year survival rate—estimated by the Surveillance Epidemiology and End Results Program—is 4 percent, which is the lowest among all types of cancer.

The most common is cancer of the exocrine pancreas that originates in the pancreatic ducts. The ducts are responsible for carrying pancreatic juice to the intestines. This type of pancreatic cancer is called pancreatic adenocarcinoma.

Symptoms

Most patients experience pain, weight loss and/or jaundice.

Pain is present in 80 to 85 percent of patients with locally advanced or advanced disease. The pain is usually felt in the upper abdomen as a dull ache that radiates straight through to the back. It may be intermittent and made worse by eating. Patients often describe that lying in a curled or fetal position improves the pain.

Jaundice is often accompanied by pruritus (itching) and dark urine. Painful jaundice is present in approximately one-half of patients with locally unresectable disease, while painless jaundice is present in approximately one-half of patients with a potentially resectable and curable lesion.

The initial presentation varies according to tumor location. Tumors in the pancreatic body or tail usually present with pain and weight loss, while those in the head of the gland typically present with excess fat in stool, weight loss, and jaundice. The recent onset of atypical diabetes mellitus, a history of recent but unexplained thrombophlebitis (blood clot), or previous attack of pancreatitis are sometimes noted.

Unfortunately, the majority of patients have unresectable disease by the time disease-associated symptoms occur and the diagnosis is made. Several studies have addressed whether earlier detection of nonspecific signs of an evolving pancreatic neoplasm might improve resectability and overall outcomes.

At least three studies have addressed the utility of CT screening for early detection of pancreatic cancer in adults with new-onset diabetes. Two uncovered mainly unresectable tumors, but they selected patients for screening based upon the presence of cancer-related symptoms. A third study from the Mayo Clinic suggested that CT scans done at the time of newly diagnosed diabetes in otherwise asymptomatic patients were more likely to show potentially resectable tumors than scans performed six months later. Whether higher resectability rates translate into higher cure rates was not addressed.

However, CT screening of all older subjects with new onset diabetes in order to discover a small number of pancreatic cancers is not feasible. Identification of those features that differentiate pancreatic cancer-associated diabetes from other cases with new-onset diabetes would help direct efforts to the subset of individuals who would most benefit from screening CT, but these factors have not yet been established. Thus, screening CT scans are not warranted in older otherwise asymptomatic adults with new-onset atypical diabetes.

Physical findings 

An abdominal mass or ascites can be seen as presentation of advanced disease.

The most common sites of metastasis is liver, lung, and peritoneum (serous membrane that forms the lining of the abdominal cavity)

Many patients are in a hypercoagulable state, meaning they are predisposed to get blood clots.

Routine laboratory findings do reveal mild anemia, abnormal liver functions tests.

Tumor markers are not used for screening but for following patients once the diagnosis is made.

Serial monitoring of CA 19-9 levels (once every one to three months [22]) is useful to follow patients after potentially curative surgery and for those who are receiving chemotherapy for advanced disease.

PANCREATIC CANCER STAGING

Once pancreatic cancer is diagnosed, the next step is to determine its stage. Staging is a system used to describe the aggressiveness and spread of a cancer. A pancreatic cancer’s stage is based on:

• The size of the cancer.
• If there are signs of cancer spread outside the pancreas on a physical exam, CT scan or MRI, chest x-ray, or other imaging tests.

The final staging of a pancreatic cancer often depends on what is found during surgery.

Pancreatic cancer stages range from stage I, the earliest stage, to stage IV, which means that the cancer has spread to distant organs, such as the brain. In general, lower stage cancers are less aggressive and require less treatment than do higher stage cancers.

Treatment

Laparoscopy — in some centers, a laparoscopy is recommended before an attempt to remove the cancer surgically to get more information about the location and size of the cancer. During a laparoscopy, the surgeon inserts a thin tube with a camera into small incisions in the belly to see the organs inside the abdomen.

Surgery for tumors in the head of the pancreas — the standard operation for tumors in the head of the pancreas is a Whipple procedure (also called a pancreaticoduodenectomy). In this procedure, the surgeon removes the pancreatic head, the duodenum (first part of the small intestine), part of the jejunum (the next part of the small intestine), the common bile duct, the gallbladder, and part of the stomach. A modification of the Whipple procedure (a pylorus-preserving Whipple procedure) has been developed that preserves the part of the stomach (the pylorus) that is important for stomach emptying.

In the past, complications and deaths following the Whipple procedure were high, and cure rates were less than 10 percent. However, more recent results suggest better outcomes.

Better outcomes are possible in hospitals that perform a large number of Whipple procedures and when the surgeon is experienced with the procedure.

Surgery for tumors in the body or tail of the pancreas — Because tumors in the body or tail of the pancreas do not cause the same symptoms as those in the head of the pancreas, these cancers tend to be discovered at a later stage when they are more advanced.

If the tumor can be removed with surgery, a laparoscopy is usually done first to make sure the cancer has not spread. If surgery is an option, part of the pancreas is removed, usually along with the spleen.

Adjuvant therapy after surgery — Adjuvant (additional) therapy refers to chemotherapy, radiation, or a combination of both that is recommended for people who are thought to be at high risk of having cancer reappear (termed a recurrence or a relapse) after a tumor has been removed surgically.

Even if the tumor has been completely removed, tiny cancer cells may remain in the body and grow, causing relapse after surgery. Adjuvant therapy can prolong survival by eliminating the tiny cancer cells before they have a chance to grow.

In people with stage II or III pancreatic cancer, there are two ways to give adjuvant therapy after surgery for pancreatic cancer:

• Give chemotherapy alone
• Give a combination of chemotherapy and radiation therapy, usually followed by several months of chemotherapy alone. This strategy is called chemo radiotherapy.

In the United States, chemo radiotherapy is recommended for most patients. Outside of the United States, patients are frequently offered chemotherapy alone.

Treatment of locally advanced pancreatic cancer — locally advanced pancreatic cancer is cancer that has not yet spread to distant locations in the body, but has spread into areas around the pancreas. The best treatment of locally advanced pancreatic cancer is not clear, but surgery is not usually possible. Options for treatment include chemotherapy alone or a combination of chemotherapy and radiation therapy (chemo radiotherapy).

Chemo radiotherapy — Chemo radiotherapy often requires a central venous access catheter (often termed a port). This is placed during surgery into one of the large blood vessels in the chest. Chemo radiotherapy also requires a portable chemotherapy pump; this is a small, battery-operated pump that fits into a pack that can be worn around the waist. The pump gives the chemotherapy medicine into the port continuously for five to six weeks.

During this time, the patient is treated with radiation therapy five days per week. The radiation is delivered while the patient lies on a table underneath or in front of the machine. The treatment takes only a few seconds (similar to having an x-ray).

In some cases, the chemotherapy pump is not covered by health insurance. In this case, an oral (pill) form of chemotherapy can be substituted. This treatment is taken as a pill once per day, along with radiation therapy. Radiation therapy is given five days per week. This combination probably works as well as the chemotherapy pump plus radiation therapy, although studies have not been done.

Treatment of stage IV (metastatic) disease — for patients who are initially diagnosed with metastatic pancreatic cancer (stage IV), chemotherapy might be recommended to slow the progress of cancer and to relieve symptoms.

Chemotherapy will not cure the cancer but can prolong the life and improve quality of life. We recommend participation in clinical trials as new breakthrough medicines come down the lane.

END OF LIFE CARE — in many people with pancreatic cancer, the disease cannot be cured. Deciding when to stop treating the cancer can be difficult, and the decision should involve the patient, family, friends, and the healthcare team.

Ending cancer treatment does not mean ending care for the patient. Hospice care is frequently recommended when a person is unlikely to live longer than six months. Hospice care involves treatment of all aspects of a patient and family’s needs, including the physical (e.g., pain relief), psychological, social, and spiritual aspects of suffering. This care may be given at home or in a nursing home or hospice facility, and usually involves multiple care providers, including a physician, registered nurse, nursing aide, a chaplain or religious leader, a social worker, and volunteers.

The following organizations also provide reliable health information.

National Cancer Institute (www.cancer.gov)

American Society of Clinical Oncology (www.cancer.net/portal/site/patient

National Comprehensive Cancer Network (www.nccn.com) 

Mohit Narang, M.D.

Dr. Mohit Narang completed his Hematology/Oncology fellowship at Michigan State University in Lansing, MI. He received his M.B., B.S. at Dayanand Medical College in Ludhiana, India and completed his Internal Medicine Residency at Christ Hospital in Cincinnati, Ohio. He is board certified in Medical Oncology and Internal Medicine. As an active participant in the medical community, Dr. Narang has served as a primary investigator and research assistant on many trials. During Dr. Narang’s fellowship, he was honored with the invitation to attend the Masterclass in Clinical Oncology at Montecatini, Italy by the European School of Oncology. He holds professional memberships with the American Society of Clinical Oncology, American Society of Hematology, as well as the European Society of Medical Oncology.