E6 eZ ee THE WASHINGTON POST.TUESDAy, MARCH 3 , 2020
DIANA CummINgs Joe ruBINo“same-aged male peers.” Gulati
told me this is because “the medi-
cal community [has] ignored
women’s hearts and we have not
educated all physicians about
their risk.” reforms, she says,
need to start in medical school,
because “closing these gaps can
save lives.”Get familiar with cPr, and
don’t be squeamish about doing
it. Women who experience cardiac
arrest, when the heart abruptly
stops, are also less likely to survive
these events than men. (About 80
percent of men will die vs. 92
percent of women when cardiac
arrest occurs outside of a hospital.)ventive Cardiovascular medicine
Program at the University of mi-
ami Health System. Three large
trials have showed either “mild or
no cardiovascular risk reduction
but a higher risk for gastrointesti-
nal bleeding that counterbal-
anced any benefits.” on the other
hand, if you’ve already had a
heart attack or stroke, orringer
recommends a daily low-dose as-
pirin to prevent a recurrence.
(Bernie Sanders, call your doc-
tor!)
Don’t waste your money on
fish oil. I’ve got 200 capsules of
fish oil in my medicine cabinet
right now. According to a recent
meta-analysis of many studies,
over-the-counter (oTC) fish oil
“failed to show clear evidence of
cardiovascular risk reduction,”
orringer told me. Part of the
problem is that oTC formulas
don’t contain standardized
amounts of the omega-3 fatty
acids thought to reduce risk. A
study published in the New Eng-
land Journal of medicine last year
showed that a prescription form
of omega-3, icosapent ethyl
(brand name Vascepa), produced
“highly significant additional risk
reduction” for those with cardio-
vascular disease, diabetes or ad-
ditional risk factors, orringer
says. The food and Drug Admin-
istration recently approved icosa-
pent ethyl/Vascepa for certain
at-risk patients. Ask your doctor
whether this is a good option for
you.
Make sure your blood pres-
sure is taken correctly. A t my l ast
annual physical, the nurse took
my blood pressure while chatting
with me and as I sat with my legs
dangling off the exam table.
Wrong and wrong, according to
guidelines revised in 2017. Among
the rules: feet flat on the floor,
legs uncrossed. No talking for at
Heart from e1 least five minutes beforehand; no
coffee, smoking or exercise for at
least 30 minutes. Cuff on bare
skin, not over clothes, with your
arm at heart level and not lower.
If your provider doesn’t follow
these procedures, ask them —
nicely — to try again in accor-
dance with the new guidelines.
Beware daylight saving time.
I had no clue there was a possible
relationship between the begin-
ning of daylight saving time (this
year on march 8) and heart attack
risk. Virend Somers, a mayo Clin-
ic cardiologist, says “the loss of an
hour seems to be associated with
a higher risk of heart attack,
especially on the monday after.”
What to do? Get an extra hour of
sleep if you can on the night the
clocks move ahead, which Somers
says “may theoretically help miti-
gate this issue.”
Younger women need to be
aware of their risk. Counterintu-
itively, younger women are more
likely to die of a heart attack than
anyone else — right after the
attack and up to one year.
American Heart Association
statistics show that 26 percent of
women will die within a year of a
heart attack compared with 19
percent of men. five years after a
heart attack, almost half of wom-
en die, develop heart failure or
have a stroke compared with 36
percent of men.
martha Gulati, chief of cardiol-
ogy at the University of Arizona
College of medicine, told me that
younger (under 55) women “ei-
ther don’t survive their heart at-
tack or they don’t live long after”
it for several reasons.
She explained they are less
aggressively treated, with doctors
less likely to recommend follow-
ups or refer them to cardiac re-
hab. These women are more like-
ly to be rehospitalized after a
heart attack than any other
group, but particularly their
Bystanders are less likely to
perform CPr on women, Gulati
says, because “men are worried
about touching a woman, unsure
how to do CPr on a woman, or
they think they will be sued if they
touch or expose a woman.”
They’re also afraid of hurting a
woman, although Gulati empha-
sized that CPr requires sharp
pressure and “if you don’t break
ribs doing CPr, you probably
aren’t doing it right.” most inju-
ries aren’t serious and heal rela-
tively quickly, Gulati said; consid-
ering the alternative, this is by far
the better outcome. Gulati wants
to see CPr trainings take place on
“woman-equins” not just manne-
quins: “We aren’t t eaching it right
if we don’t have some semblance
to reality.”
Make sure your gynecologist
examines all of you, including
your heart. most gynecologists
take what’s called “the bikini ap-
proach,” focusing on the breast
and reproductive system, while
practically ignoring the rest of the
woman as part of women’s h ealth,
says Nanette Wenger, professor of
cardiology at Emory University
School of medicine and one of the
first doctors to focus on women
and heart disease.
Noel Bairey merz, director of
the Barbra Streisand Women’s
Heart Center at Cedars-Sinai
medical Center, says those annual
exams should include preventive
heart screening as well. That in-
cludes a personal and family his-
tory of heart disease, stroke, hy-
pertension, diabetes and high
cholesterol; bloodwork to mea-
sure triglycerides, cholesterol and
sugar levels; and lifestyle inter-
ventions (including diet, exercise
and tobacco habits). She worries
that gynecologists have “implicit
bias from outdated teaching that
women are ‘protected’ from heart
disease until elderly.”
Bairey merz says studies sug-gest that women who are treated
by female gynecologists tend to
“have better outcomes including
heart disease compared to male
physicians.” B ut she’s q uick to add
that male doctors who work with
female colleagues also had better
patient outcomes when it comes
to heart attacks, “suggesting it is
not the sex of the physician, but
the knowledge and attitude that
can be learned.”
new mothers need to recog-
nize there can be a heart connec-
tion to postpartum deaths.
While bleeding and infection ac-
count for the lion’s share of post-
pregnancy deaths, 40 percent of
those deaths have a cardio con-
nection: general cardiovascular
conditions, embolism, cardiomy-
opathy and preeclampsia/ec-
lampsia. Nandita Scott, co-direc-
tor of the Corrigan Women’s
Heart Health Program at massa-
chusetts General Hospital, says
“more women are entering their
pregnancy less healthy due to a
rise in obesity and cardiovascular
risk factors at y ounger age.” T here
are other risks, of course (more
frequent multiples, increasing
maternal age, more Caesarean
sections), but the heart is key.
“We can reduce the maternal
mortality by increasing aware-
ness among patients and provid-
ers that this is an at-risk situa-
tion,” Scott says.
of course, many tried-and-true
cardiac health recommendations
have not changed: Get enough
exercise and sleep, keep your
weight under control, and eat
well, generally meaning lots of
vegetables and healthy oils while
avoiding red meat and ultrapro-
cessed foods.
The bottom line is that it’s
important to stay informed and
pro-active, as recommendations
about health can change over
time.
[email protected]Updates, t ips on heart disease could be real lifesavers
JAy Petrow“If you don’t break ribs doing CPR, you probably
aren’t doing it right.”
Martha Gulati, chief of cardiology at the university of Arizona College of
medicinetOP: Matthew Simon, right, with brother Jason and their dog. Diagnosed with leukemia in 2015, Matthew discovered that exercise helped ease the fatigue he had during chemotherapy. He started an
organization called Bike to Fight to put stationary bikes in pediatric oncology hospital floors. rIGHt: “It’s much better than walking laps around the unit,” says Bridget Diveley, who underwent treatment at
Johns Hopkins and used bicycles at the hospital. Diveley’s favorite were the virtual reality courses where she raced other people. and while the bike did make her tired, “it also made me feel motivated.”
fatigue from the grueling chemo-
therapy and even elevated his
mood. It was as if he were con-
tributing to his own treatment
plan. “I felt like I was helping
myself stay healthy,” he said.
Simon, now in his second year
at the University of Virginia, dis-
covered something seemingly
counterintuitive: exercising dur-
ing chemotherapy made him feel
less fatigued. Ye t as little as 20
years ago, medical experts pre-
scribed bed rest to conserve ener-
gy for treatment. It wasn’t until
2010 that the American College of
Sports medicine established ex-
ercise guidelines for cancer survi-
vors and patients. Its directive,
updated in 2018, is simple: “avoid
inactivity.” Exercise training, it
said, “is generally safe for cancer
survivors.”
Chemotherapy wreaks havoc
on the body. It causes fatigue,
muscle loss, nausea, pain and
disrupted sleep. Patients can be-
come depressed. But regular ex-
ercise can help minimize these
side effects in cancer patients.
Evidence has shown that a con-
sistent exercise routine can re-
duce cancer-related anxiety and
fatigue, and it can reduce depres-
sive symptoms both during and
after treatment. Doctors are
spreading the word that exercise
improves quality of life and that
patients need to stay moving
after their treatment concludes.
But getting kids to exercise
isn’t always easy, which is why
Simon two years ago started an
organization, Bike to fight, to
cancer from e1 raise money to place Expresso Go
bikes on adolescent and young
adult oncology floors in hospitals
nationwide. The bikes are not
cheap, retailing for about $7,000,
although Interactive fitness, the
company that makes the Go,
gives Simon’s group a discount.
So far, the bikes are being used in
five hospitals, including Johns
Hopkins and Children’s Hospital.
They feature 26-inch screens
with interactive courses and
games that riders play.
The bikes have been a huge hit,
both with patients and their doc-
tors.
The easy availability of exer-
cise “is a way to normalize [young
patients’] lives and a huge psy-
chological benefit. It’s also a way
to improve stamina,” says Pat
Brown, director of the Pediatric
Leukemia Program and associate
professor of oncology at Johns
Hopkins. The bike helps patients
whose sleep cycle is disrupted by
treatment.
“Sleep/wake cycles can be un-
predictable in hospitals, and it’s
discouraging to be awake at 3
a.m. in a hospital bed with noth-
ing to do. The bike is always there
for them,” Brown says.
on the virtual reality courses,
patients compete against other
patients and even against other
Expresso Go users anywhere.
Bridget Diveley, 12, rode the
bike while undergoing treatment
at Hopkins.
“It’s much better than walking
laps around the unit,” she says.
Like many of the patients, Dive-
ley’s favorite were the virtual
reality courses where she raced
other people. And while the bike
did make her tired, “it also made
me feel motivated.”
Another one of the bikes is at
massachusetts General Hospital,
where psychologist Giselle Perez-
Lougee, chair of the Adolescent
and Young Adult (AYA) oncology
Ta sk force, says the exercise the
bike provides is particularly im-
portant to this cancer patientpopulation, which has “an elevat-
ed risk for adverse physical and
emotional health outcomes.
There are many health benefits of
exercise during and after cancer
treatment, but research suggests
that AYAs are not meeting exer-
cise guidelines.” (The National
Cancer Institute defines the AYA
population as ages 15 to 39.)
Besides potentially improving
overall health, exercise can im-
prove self-esteem and confidence
and decrease fatigue, Perez-Lou-
gee says.
At Comer Children’s Hospital
in Chicago, where Simon placed a
bike in the pediatric oncology
unit, physical therapist CatherineKennedy tells her young patients
that opting out of exercise is not
an option. “It’s a way to fight the
tired feeling they can get from
chemo,” she says. for those who
need to be coaxed into exercising,
Kennedy encourages short bursts
of about 10 minutes throughout
the day rather than one long
session so that it’s less daunting.
Any movement, Kennedy says, is
better than no movement.
D octors who treat these cancer
patients hope that exercise will
become a permanent lifestyle
change for their patients — and
for good reason: With advances
in treatment, many cancer pa-
tients are living longer. There is
evidence that exercise can lower
the risk of several cancers and
some recurrences.
At the same time, the in-
creased survival rates are hap-
pening in part because of power-
ful chemotherapy drugs that also
can cause lasting damage to the
cardiovascular system, or cardio-
toxicity.
Heart disease and other long-
term cardiac issues are the big-
gest r isk factors childhood cancer
survivors face after intense che-
motherapy, says Kathy ruble, as-
sistant professor of oncology and
director of the Life Clinic and
Leukemia Survivorship Program
at Johns Hopkins.
“The cardiac mortality rate in
cancer survivors is about 10 times
greater compared to their
healthy siblings and peers,” she
says. “We see cardiotoxicity de-
cades after treatment. But the
good news is that we have de-
cades to change it,” and lifestylechanges are an important part of
that.
When her young patients fin-
ish cancer treatment, ruble sits
down with every family and
stresses the importance of regu-
lar exercise.
“They’re already behind [with
their health], so my job is to find
the secret formula to get these
kids moving again,” she says.
At the Lee Jones Lab at memo-
rial Sloan Kettering Hospital in
New York, researchers are study-
ing the long-term cardiovascular
side effects of chemotherapy.
They are also exploring the bene-
fits of regular exercise on cancer
treatment.
“We know the benefits of exer-
cise on heart disease, so given the
cardiotoxicity of chemotherapy
[on the heart], we hope to apply it
to cancer survivors as well,” exer-
cise scientist Lee Jones says. He
also is interested in looking at
how patients may be able to use
exercise to receive or help them
tolerate stronger — and therefore
possibly more effective — treat-
ment. Jones hopes exercise will
eventually be a regular adjunct to
chemotherapy.
But what exercise aims to im-
prove — energy, self-esteem,
mood and mobility — is often
what makes it difficult to get
started: motivation can be low
when cancer treatments sap your
strength and make you de-
pressed. Enticing patients to
overcome those feelings often
runs up against a mountain of
misinformation.
“Patients are still hearing that
they shouldn’t e xercise,” s ays Alli-son Betof Warner, an oncologist
at memorial Sloan Kettering.
Warner’s goal is to prescribe
exercise to make cancer therapy
work better.
“There’s still this idea that you
should save your energy to fight
the cancer,” s he says, even though
it has been shown that in most
cases exercise while undergoing
treatment is safe.
Betsy o’Donnell, an oncologist
at mass General, says she would
like to see Expresso Go bikes
connected in hospitals across the
country for all cancer patients.
“my dream is a nationwide
social network of cancer patients
who ride the bikes,” she says.
“Then they could take that net-
work home and let it inspire
them. We could have program-
ming just for cancer survivors,
even maybe a class for just, say,
breast cancer survivors.” That
connection would effectively be
one giant support group, helping
to normalize the lives of patients
who are living longer than ever
before.
Simon, meanwhile, is back to
his regular exercise routine.
At U-Va., he tries to make it to
the gym five days a week. He sees
a cardiologist twice a year to
make sure he has not developed
any heart complications from the
chemotherapy he completed in- So far, there are none.
“I exercise for the same rea-
sons I did when I was undergoing
treatment: to relieve stress and
stay healthy,” Simon says. “A nd to
ensure there are no residual side
effects from my treatment.”
[email protected]
Group raises funds to install exercise bikes in hospitals for cancer patients
Betsy O’Donnell, an
oncologist, says she
would like to see
Expresso Go bikes
connected in hospitals
across the country for
all cancer patients.