It all started with pain and pressure in her chest.
Jan Nermoe was working out at the Perham Area Community Center eight years ago when she experienced her first symptoms of heart disease. Any time she'd start to work up a sweat and get toward her target heart rate, she'd start to feel it.
At first, doctors thought she had exercise-induced asthma, but Jan suspected otherwise. With a family history of heart disease, she was familiar with the signs, and so she requested further tests.
Sure enough, a stress test and angiogram confirmed her suspicions: she had blockages in her heart, and needed two stents put in (stents are tiny mesh tubes that help prop coronary arteries open and prevent a heart attack). She underwent weeks of cardiac rehabilitation, began to feel better, and eventually got back to her normal day-to-day routine.
Jan believed she was lucky; she recognized the warning signs and got the treatment she needed early on.
That was in 2009, when she was 64 years old.
Today, the Otter Tail Lake resident is back in cardiac rehab for what is now the fifth time. Her journey toward heart health has been long and arduous, and is ongoing. She's had repeat, as well as new and worse, heart problems on-and-off since those first stents were put in, requiring the implantation of multiple additional stents, plus a pacemaker to correct an irregular heart rhythm. She also underwent open-heart surgery for a 5-vessel bypass.
Incredibly, in spite of all this, Jan still believes she's lucky. She has a realistic yet optimistic outlook, and is doing everything she can to stay as heart-healthy as possible.
"I just can't let it get me down," she said during an interview at Perham Health's cardiac rehab center last week. "Realistically, I do realize that my life expectancy is not what a normal person my age might have, who doesn't have heart disease. I know I definitely need the pacemaker to live; my heart doesn't beat fast enough to maintain, so the pacemaker works 100 percent of the time. But ... I just want to live my life and move forward and do what I can, while I can."
Jan said she keeps "plugging away," going about life as usual while fitting regular rehab sessions into her weekly schedule, going to her doctor's appointments, taking her medications, staying in tune with her body and remaining watchful of warning signs. For her, as is the case for many women with heart disease, those signs are usually subtle—things like exhaustion, nausea and shortness of breath.
Though there's a persistent misconception that heart disease is a 'man's problem,' it actually kills more women than men each year. Heart disease, which is a broad term that includes stroke and other cardiovascular diseases, is the No. 1 cause of death for both men and women in the United States, deadlier than all forms of cancer combined.
The Heart Foundation states that 1 in 4 deaths are caused by heart disease; for women, that statistic is 1 in 3. Yet only 1 in 5 women believe that heart disease is her greatest health threat. Experts believe heart disease has gone underdiagnosed and undertreated in women because women's early symptoms tend to be different, and less obvious, than men's. A lot of women never feel any chest pain at all.
"Women's symptoms tend to be vague, like tiredness and nausea," said Julie Peters, who leads the cardiac rehab program at Perham Health. "But doctors are getting better at identifying heart disease in women, because they know now that women are 'mysterious.'"
Heart disease has a lot to do with genetics and other factors that are out of a person's control, but there are things people can do to decrease their risk of developing serious problems. Eating a healthy diet and exercising are common-sense actions to start with; it's also important to keep cholesterol and blood pressure low. People who smoke, drink more than one alcoholic beverage a day, use drugs or are obese are at higher risk, as are those with certain other medical conditions like diabetes and depression.
For Jan, heart disease was a hereditary condition that she believes was inevitable for her, though she wishes she would have kept in better shape after retiring.
"I think that this was going to happen, no matter what," she said, "but I think had I kept exercising more regularly, maybe it would have been a little different."
Still, she adds, "There's no sense dwelling on 'I should have done this' or 'I should have done that.' ...I refuse to be an invalid, is what I've told my children. I just look forward and move on with life."
Jan exercises a minimum of three times a week, either at the rehab center or the PACC, and eats a heart-healthy diet. She believes in the power of fitness, and is vigilant about getting to all her rehab sessions and other medical appointments.
"Jan's been through alot, but she works hard," said Perham Health exercise specialist Jacqueline Mattson, who works with Jan at the cardiac rehab center. "She doesn't make any excuses. She's really motivated, and she tries really hard to stay in shape."
"In my head, the more I exercise, the more the blood is forced to flow through those vessels and keep them open," Jan explained. "That's my thinking on it; that keeps me going."
She also pays close attention to what her body might be telling her, and she doesn't ignore any red flags: "I'm very fortunate that I can read my body very well," she said. "I know when something's a little different."
Even when traveling, which Jan still manages to do fairly regularly with her husband, John, she makes sure she always knows where the nearest healthcare center is, just in case. In addition to her heart problems, Jan also suffers from kidney disease and diabetes, "so I deal with a lot of issues," she said, "but I'm thankful for the care I get. The facilities that Perham has, I just think are amazing. The cardiac rehab center and the PACC are phenomenal."
"I'm very fortunate for the care I've had," she reiterated, "because I still can live a pretty normal life, even with a pretty extensive heart history."
February is national Heart Health Month. For more information on heart disease, visit the American Heart Association's website at heart.org, or The Heart Foundation at theheartfoundation.org. Help raise awareness about heart disease in women by participating in National Wear Red Day this Friday, Feb. 3.
What is heart disease?
Heart disease is a term used to describe a wide variety of diseases of the heart and blood vessels, though it's most often used to refer to coronary artery disease, or cardiovascular disease. This is a condition in which plaque, which is made up of fat, cholesterol, calcium and other substances in the blood, builds up inside the coronary arteries that supply blood to the heart. Plaque can grow large enough to reduce or completely block blood flow through an artery, or may rupture, causing a blood clot to form that either blocks the artery or breaks off and travels somewhere else in the body, causing a blockage at another site. When the blockage takes place in a blood vessel that feeds the heart, the result is a heart attack.
Statistics and risk factors
• Heart disease is the No. 1 cause of death in the U.S. for both women and men, claiming more lives than all forms of cancer combined
• Someone has a heart attack every 34 seconds in the U.S.; every 60 seconds, someone in the U.S. dies from a heart disease-related event
• Direct and indirect costs of heart disease total more than $320 billion; that includes health expenditures and lost productivity
• The symptoms of heart disease can be different in women and men, and are often misunderstood
• Common risk factors include: age (heart disease can occur at any age, but four out of five people who die from coronary heart disease are 65 or older); family history; gender (men and women are equally at risk, but women tend to get coronary artery disease an average of 10 years later than men); smoking; excessive drinking; high cholesterol; high blood pressure; physical inactivity (defined as less than 30 minutes of walking or other moderate exercise per day); obesity; drug abuse; diabetes; stress; depression; previous medical history
• Reduce your risk by: getting regular exercise; eating a diet low in salts and saturated fats but high in unsaturated fats; taking fish oil supplements; avoiding smoking; drinking no more than 1 alcoholic beverage per day; avoiding illegal drugs; discussing risk factors with your doctor