The Gift and the Curse...

In life, our intentions, credentials, and even abilities will be continuously tested.  In my opinion, the occurrence of such actions or behavior is never the problem, the manner in which one responds to such events are the true display of character and motive.  I started this blog with the intentions of sharing my experiences (positive and negative) and obstacles related to being a woman and being diagnosed with Crohn's disease.   In my experiences, living with such an autoimmune disease can be debilitating, frustrating, painful, emotional, and even lonely at times.  This myriad of sensitivity is not only the weight of the individual diagnosed with such a condition, it is shared by the friends, family, co-workers, etc. whose lives are intertwined with the diagnosed individuals.  As with any illness or condition, one's life and daily actitivities can only be suppressed to the extent that they allow, and I believe whole heartedly that the degree of suppression is determined by the amount of understandable information, as well as support made available to the public in a form that is easily digested.  In my case, I have experience in living with Crohn's disease, and I have created a platform of which to share my experiences = "The Gift".  In hopes, that someone, somewhere in need of information or support for Crohn's disease will have the opportunity to stumble upon my blog...just so they know that they are NEVER alone.

However, in sharing my experiences I purposefully place myself on a public platform because of the 1% chance that I may be able to help someone.  As we all know, public platforms can be damaging to one's character and name similar to bullies or like stepping out on a limb at a teenage slumber party admitting to stuffing your bra...LOL!  Whichever the case, my name and experiences are linked on a public platform for my audience to proceed as they wish = "The Curse".  So, as I began this blog I asked myself a number of questions...

• will people think I'm weird,
• how will this affect my career,
• how will this affect my life and relationships, and
• how do I really feel about placing myself on display for the sake of helping others that I don't even know?

Annndddd, as you can see...this blog is up and running...which brings me back to character and motive.  This blog is one of my contributions to the health care of others.  This is my attempt at bringing you into my world, and allowing everyone the opportunity to see what it's like to have an autoimmune disease and to be a woman.  I pray that the majority of my audience utilizes this blog in a positive manner.  The facts still remain that I am a Woman that has been diagnosed with Crohn's disease.  Notice, it does not read "I am Crohn's disease that has been diagnosed with Woman".  My point is, being diagnosed with Crohn's disease or any other condition does not EVER define one's capabilities, credentials, or enable any form of discrimination.  In addition, one should NEVER feel obligated to "water-down" the many elements (illnesses, experiences, etc.) that creates uniqueness and individuality.  Nor should anyone have to succumb to "closed-lip-syndrome" with regards to their diagnosed illnesses in order to reinforce or confirm their abilities to carry out responsibilities clearly incorporated in accredited credentials.   

Just to be clear, if this blog has the smallest probability of helping one person...it is worth any amount of negativity that placing my experiences on a public platform could provoke.  I hope this blog inspires everyone to share their experiences in saving and enriching lives despite the never ending attempts of a select few to discredit and/or dictate character, motives, and credentials.  My husband always tells me..."You succeed and surpass many, the more you become comfortable with your condition, and begin to own it".  So, as an extension of my husband...I say...no matter what your situation may be "own it", because it's yours...besides it wouldn't look as good if owned by someone else ;)

Thank you, to everyone for continuing to read and support my blog...you are greatly appreciated and NEVER alone!!

A Warning Bowel Movement Before Your "Period"...Who Freakin Knew???!!!

I'm sure this topic may be a bit weird or uncomfortable for many to address, Hoooowever...when it happens to me I'm always concerned about the probability of it happening to another woman, and if she then feels as if she can't express concern or question it because she's the "only one" or its "not proper" to discuss.  If you have been reading my blog AT ALL, you know that my purpose is to discuss and post about such topics because they are natural, normal, they do happen on a daily basis, and we MUST discuss them in order to familiarize ourselves with the anomalies of our body!  And most importantly, not having these discussions enables feelings of isolation, loneliness, insufficiency, and irrelevance that can be harbored as depression and anxiety issues in women, which we ultimately run the risk of passing on to younger women.

I decided to write this post because, over the years I have noticed an obvious relationship between the day I start mensing and horrible crampy bowel movements.  Since I have had a hormone free IUD, I have noticed very difficult, cramping, can't keep still bowel movements the day of mensing (bleeding).  These bowel movements are so painful that I have to use labor breathing techniques, stomach rubbing, and rocking to cope with the pain...afterwards I feel as if my entire bowel tract has been emptied and I'm exhausted and must take a nap.  AND upon waking from my nap... menstrual mensing (bleeding) has begun! Initially, I was thinking that the bowel pain, and discomfort that I was experiencing was related to my Crohn's disease, but in all reality it appears to be related to a non-steroid hormone in our body called prostaglandin!

So What Is Prostaglandin?
Prostaglandins are non-steroid hormones that are very potent and present in very small amounts (Shier, Butler, & Lewis, 2007, p. 495).  They are not stored in cells but are synthesized just before they are released (Shier, Butler, & Lewis, 2007, p. 495).  Different prostaglandins have different functions, but this post is going to focus on one prostaglandin in particular that is named PG4.  This particular prostaglandin has the ability to contract smooth muscle in the walls of the uterus, causing menstrual cramps and labor contractions (Shier, Butler, & Lewis, 2007, p. 495).

Translation to Painful/Urgent BMs at the Start of Menses...
When our endometrium is stimulated by estrogen and progesterone, the production of prostaglandin is increased.  When the endometrium begins to shed or when mensing (bleeding) begins the actual break-down of the endometrium causes the release of prostaglandin (Lewis, Heitkemper, Dirksen, O'Brien, & Bucher, 2007, p. 1386).  The prostaglandin in our reproductive organs causes contractions and constriction of our uterus to expel the complete uterine lining.  In some women, the release and amount of prostaglandin can be very excessive causing the non-steroid hormone to travel to the bowel regions, at which point it causes contractions and constrictions of the bowels...which leads to the urge to have a bowel movement and/or painful, cramping bowel movements within 12-24 hours before the onset of your menses (bleeding).  In addition, this same excessive prostaglandin release is the cause of primary abdominal pain or discomfort (dysmenorrhea) associated with menstrual flow.

Other Symptoms
Other symptoms of excess prostaglandin release can include

• lower abdominal pain that is sharp, radiating to your lower back and upper thighs
• abdominal pain can be accompanied with nausea, diarrhea, loose stools, fatigue, headache, and light headedness (Lewis, Heitkemper, Dirksen, O'Brien, & Bucher, 2007, p. 1386).

How to Feel Better

I'm not sure there is much that can be done about the urgent, very painful, cramping bowel movements.  I just thought it would nice for you to know that those "horribly crampy, smelly bowl movements"  that you may experience between 12 hours and 2 days of your period starting...are not in your head and that there is a legit reason for them...NO REASON TO BE ASHAMED ;)  However, with regards to painful menstrual cramping you can use:

• heat (apply to lower abdomen or back)
• regular exercise (can reduce prostaglandin production),
• proper nutritional habits,
• avoiding constipation,
• eliminating stress and fatigue, 
• drug therapy( such as NSAIDs, Naproxen, Ibuprofen, etc..) - remember that these medications should be started at the first signs of bleeding, and continued for every 4-8 hours to maintain a sufficient amount of the drug in your system to minimize prostaglandin release (Lewis, Heitkemper, Dirksen, O'Brien, & Bucher, 2007, p. 1387).
• lying down for a short period,
• drinking hot beverages (herbal teas), and
• taking warm tub baths.

Educate Yourself

Make sure to keep track of your menstrual symptoms and moods through out your cycle, with some sort of application (I've named a few in a previous post).  This way you can better prepare for rough days, and pick up changes or alterations that can be discussed with your health care providers.  The more aware you are of your body and its responses or lack thereof, the better prepared you can be to address the issue.

I hope this post helps with deciphering between bowel issues related to Crohn's and  bowel issues related to menstruation.  I also hope this post resonates with someone...sometimes all it takes is one person to mention an issue for others to relate.  So, I hope this post is relatable ;)  Feel free to share and comment.  Until next time ;)

References:

Lewis, S., Heitkemper, M., Dirksen, S., O'Brien, P., & Bucher, L. (2007). Medical Surgical Nursing Assessment and Management of Clinical Problems (Seventh ed.). St. Louis, Missouri, USA: Mosby Elsevier.

Shier, D., Butler, J., & Lewis, R. (2007). Hole's Human Anatomy & Physiology (11th ed.). Boston: McGraw-Hill.

Since We Can't Avoid You...Hello, Endometriosis!

Endometriosis seems to be a topic that I can't get around discussing as it's a huge contributor to a number of infertility issues as well as chronic pelvic pain issues in women.  Not to mention how living with this disease, and not receiving proper medical care has mentally scarred a number of women, and ruined a number of marriages, relationships and career opportunities.  Endometriosis takes its name from one of the layers of the uterus named the "endometrium".  The endometrium along with the myometrium, and the perimetrium make up the wall of the uterus.

The Layers of the Uterus Wall.  (www.urologyhealth.org, 2014)

The three layers combined creates a thick wall where the:

• Endometrium - is the inner mucosal layer, and is covered with columnar epithelium and contains abundant tubular glands.

Columnar Epithelium Shape of the Endometrium. (www.occc.edu)

Tubular Glands Shape of the Endometrium.  (www.flylib.com)

• Myometrium - is the very thick, middle, muscular layer that consists of bundles of smooth muscle fibers in longitudinal, circular, and spiral patterns and is interlaced with connective tissues.

Myometrium View Under a Microscope. (www.occc.org)

• Perimetrium - consists of an outer serosal layer, which covers the body of the uterus and part of the cervix.

Microscopic View of Uterus Layers.  (http://legacy.owensboro.kctcs.edu/)

Each layer of the uterus wall has its own responsibilities to fulfill during our monthly menstrual cycles.  For example, during menses (bleeding) the endometrial tissue sloughs off for excretion when a fertilized egg is not implanted into the uterus lining.  Next, a new phase of the menstrual cycle begins when the endometrial layer grows thicker, and the endometrial blood vessels and secreting glands develop in preparation for the implantation of a fertilized egg.  When a fertilized egg fails to implant, the endometrium degenerates and sloughs off as menses (bleeding) in order to start the menstrual cycle all over again (Gould & Dyer, 2011, pp. 622-623).  This process seems pretty straight forward, until somehow the endometrial tissue becomes displaced or migrates to other body parts, where it makes its new home and binds to internal body organs other than the uterus!  The presence of endometrial tissue outside of the uterus on structures such as the ovaries, ligaments, or colon is classified as "endometriosis".  The most common areas where endometriosis is found are:

• The fallopian tubes,
• Ligaments that support the uterus,
• The internal area between the vagina and the rectum,
• Outer surface of the uterus, and
• In the lining of the pelvic cavity (www.hopkinsmedicine.org)

Occasionally endometrial implants can also be found on:

• intestines,
• rectum,
• bladder,
• vagina,
• cervix,
• vulva, and
• abdominal surgery scars (www.hopkinsmedicine.org).

I think we would be able to handle having an extra patch or two of tissue located on or near internal organs as long as the tissue didn't interfere with our bodies functions.  However, this isn't just any tissue it's endometrial tissue that has a primary function to grow/proliferate, become thick and nutrient filled in order to support and nourish a fertilized egg.  And since we are dealing with reproductive organ tissue...hormones dictate the behavior of this endometrial tissue.  The interesting part is that, our hormones will continue to cycle through their balancing act (menstrual cycle) every month, and since our menstrual cycle hormones dictate the proliferation of the endometrial tissue...it will continue to proliferate and slough off REGARDLESS of its location.  So, in other words...no matter which part of our body the endometrial tissue decides to use for implantation, when our hormones start their balancing dance the misplaced endometrial tissue will grow during certain stages of our menstrual cycle, and will ultimately degenerate, shed, and bleed.

The Process of the Endometrium Changing According to Menstrual Cycle Hormones. (www.aviva.co.uk)

The Process of the Endometrium Changing According to Menstrual Cycle Hormones. (www.hopkinsmedicine.org)

The problem with this is that our uterus is made to accommodate the proliferation of the endometrium, and our vagina is made to accommodate the excretion of the sloughing and bleeding endometrium layer.  BUT...no other organ or body cavity is built to handle these demands of the endometrial tissue.  So when the endometrial tissue is displaced or migrates, there is no place for the shedding and bleeding to exit the body.  Therefore, the stagnant blood will begin to irritate the tissues surrounding it, causing local inflammation and pain.  This inflammation and pain will occur every month, with every menstrual cycle hormone change leading to a build up of fibrous tissues in the areas of the displaced endometrial tissue with results that may play out as seen below.

Endometriosis Causing Infertility. (Gould & Dyer, 2011, pp. 626)

What Causes the Migration of Endometrial Tissue
Research has yet to prove what causes the endometrial tissue to become displaced.  However there are a number of theories, such as:

• retrograde flow of endometrial cells from the uterine cavity, through the Fallopian tubes, into the pelvic cavity during menstruation deposits viable tissue, which implant on the peritoneal surface, but to debunk this theory 90% of women have retrograde flow during menses but only 0.5 to 5% of reproductive age women develop endometriosis (Child & Tan, 2001, p. 1736), another theory is that
• endometrial tissue can be transported to distant sites via lymphatic and vascular channels, which explains rare cases of extra-abdominal endometriosis, and newer research proposes that the 
• concentrations of macrophages, leptin, tumor necrosis factor-α , and interleukin-6 often are higher in the abdominal fluid of women with endometriosis, which may add to the development of displaced endometrial tissue (Schrager, Falleroni, & Edgoose, 2013, pp. 107-108).

The Symptoms of Endometriosis
This disease is very interesting in that some women can experience debilitating pain, while others can be asymptomatic.  In other words, the amount of pain or number of symptoms a woman may experience are not indicative of the severity of the disease.

The Most Common Symptoms of Endometriosis.  (www.hopkinsmedicine.org, 2015)

I find the list of symptoms above really interesting because, some of them are symptoms we have been taught to accept as "normal" menstruation pain.  So, I can only imagine the difficulties women with endometriosis must endure in order to have family and/or medical professionals "hear" their valid complaints.  In fact, receiving effective medical care for endometriosis is suspected to be one of the reasons for girls and/or women not getting medical care in a timely fashion.  It has been reported that most women experience their initial symptoms between the ages of 10-16 years of age, and due to experienced doctors not believing their symptoms, in addition to their parents being unsympathetic, leads women to experience symptoms for close to 4 years before seeking medical attention (Cox, Henderson, Anderson, Cagliarini, & Ski, 2003, p. 5).

Why Women Don't Get Help for Endometriosis.  (Cox, Henderson, Anderson, Cagliarini, & Ski, 2003, p. 5)

Living with endometriosis can be a very difficult path, and at times leaving women feeling hopeless and alone.  Sometime physical symptoms of endometriosis are attributed to "being a woman" and may not be recognized as being out of the ordinary (Denny, Women’s experience of endometriosis Elaine, 2003, p. 644).  Having endometriosis affects the lives of women in a number of ways.

Affects of Endometriosis.  (Cox, Henderson, Anderson, Cagliarini, & Ski, 2003, p. 5)

The Significance of Endometriosis

• Endometriosis is the second most common gynecological condition, affecting approximately 10% of women during their menstruating years,
• It is one of the leading causes of infertility in women over the age of 25, and
• It is believed that close to 30%-40% of infertile women have some degree of endometriosis 
  (Cox, Henderson, Anderson, Cagliarini, & Ski, 2003, p. 2).
• Studies have indicated that approximately 20% of women will have a recurrence of their symptoms of endometriosis within 12 months of being treated, regardless of the treatment type, and 50% will have a recurrence within 5 years 
  (Cox, Henderson, Anderson, Cagliarini, & Ski, 2003, p. 3-4).
• It is estimated that 40% of women attending infertility clinics are doing so as a result of endometriosis (Kaatz, Solari-Twadell, Cameron, & Schultz, 2009, p. 221).
• The length of time from onset of symptoms to diagnosis of endometriosis can be 8 to 11 years (Kaatz, Solari-Twadell, Cameron, & Schultz, 2009, p. 221).
• In the United States from 1990 to 1998, endometriosis was the third most common gynecologic diagnosis noted in the hospital discharge records of reproductive-age women, 15–44 years (Mao & Anastasi, 2010, p. 110).
• Endometriosis is a risk factor for the development of severe pelvic infection especially following IVF treatments. Furthermore, pelvic infection in women with endometriosis tends to be more serious and resistant to antibiotic treatment, frequently requiring surgical intervention  
  (Elizur, et al., 2014, p. 164).
• Women with rectovaginal endometriosis are at high risk of placenta praevia. However, apart
  from placenta praevia, severe forms of endometriosis are not associated with other obstetric complications (Vercellini, Parazzini, Pietropaolo, Cipriani, Frattaruolo, & Fedelea, 2012, p. 1542).

According to a number of studies, general practitioners and/or specialists may not be as up to date or experienced with endometriosis (Cox, Henderson, Anderson, Cagliarini, & Ski, 2003, p. 6).  A number of participants from an endometriosis study reported having the following issues,

Issues Endometriosis Patients Have Experienced with Doctors.  (Cox, Henderson, Anderson, Cagliarini, & Ski, 2003, p. 6)

Diagnosing Endometriosis

Tools for Diagnosing Endometriosis.  (Seth, 2015, p. 9)

Making the Pain and Life Experiences a Reality
For many women it's difficult to put their pain, and discomfort related to endometriosis into words.  Here are a few quotes that stood out to me.

• "It's either suicide or fight to control the pain"
• "The pain was a crippling disabling pain. It felt like my insides were coming out of my body at times. My legs used to feel like they were lumps of iron. Pain in my lower back. I only remember feeling pain throughout the month, not often free of it, but it was worse at period time normally the first week"
• "a gnawing pain that would keep me awake",
• "crippling disability",
• "it feels to me like I’m sitting on a knitting needle",
• "I had my first period when I was about to turn 13. Ah I felt sickly but I wasn’t in pain, the second one I was in pain. And I was in pain the entire time of the period like a whole week and that continued till late 1994 I had glandular fever and from then on I was in pain 24/7 no matter what was happening. And I didn’t get diagnosed until 1999. I had a lap (laparoscopy) and diathermy; I was diagnosed as stage 4. And the operation was a complete failure. I was in more pain after it than before it and that was right from the word go… I had another lap with another surgeon, was pain free for about three and a half months and then the pain came back as normal…. I was on natural therapies for four months. And was pain free for that time and then all of a sudden I’m in pain again",
• "They really couldn’t see anything wrong but decided it had to be irritable bowels. We were sitting back in the doctors surgery my husband had come with me and he actually saw an article while we were sitting in the doctors surgery and it was just like out of a magazine I think it could have been – I don’t know what it was, just a magazine and we read it right there and then and then the symptoms, and that’s when we asked and he (the doctor) said oh yeah it could be",
• "All we can offer you is this the conceptive pill or you get pregnant and breast feed for the next 20 years’. And he was joking and I laughed at the time but I realize afterwards that it’s just not funny. And for a start heaps of women with endo (endometriosis) can’t get pregnant anyway",
• "You know you go into everything feeling positive so you start taking this drug feeling this is going to be it. You pick a particular surgery and you think right I will do this and it will be better, you wake up and you feel dreadful and you think okay that’s fine and it will pass. After two months you start feeling as bad as you did before and after three months you are as bad as you were before and you think what’s the point of doing it. I hate going under anesthetics, I hate the feeling and yet I put myself through it and nothing works",
• "… basically all of the doctors just look at you and say ‘we are sorry, but there is no cure’"  
  (Seear, 2009, p. 197).
• "When it’s at its worst is when the last thing that you remember before you fall asleep is that you’re in pain, and before you’re even aware you are awake, you are aware you’re in pain" (Denny, Women’s experience of endometriosis Elaine, 2003, p. 644).

Is Endometriosis More Prevalent in Certain Ethnicities?
According to research, endometriosis may not be more prevalent in a certain ethnicity, but certain ethnicities may be less likely to report health concerns related to menstruation and pain, as "from an early age, women learned negative images of menstruation, associated with bleeding and pain... the stigmatization of menstruating women as discreditable is associated with concealment and a consequent reluctance to disclose the symptoms of endometriosis" (Denny, Culley, Papadopoulos, & Apenteng, 2011, p. 169).  One participant of Indian descent was reluctant to speak with her doctor about menstruation pain for fear of it reaching her husband and/or in-laws "For example, if my in-laws know or are related to my doctor I would not be physically able to say look this is my problem because they would know. Even though I would hope the doctor would not tell them in my mind I would know that what if they find out" (Denny, Culley, Papadopoulos, & Apenteng, 2011, p. 174).  Pakistani women were embarrassed to discuss their menstrual pain issues with their male doctors "We know lots of girls that just wouldn’t go to the doctor’s and talk about a problem, because it’s so embarrassing, especially if it’s a male doctor. ‘‘I can’t tell a bloke about this’’, and hope the pain will go away" (Denny, Culley, Papadopoulos, & Apenteng, 2011, p. 174).

Caribbean and African ethnicities may seem to have more diagnoses of endometriosis in recent years because older generations were not willing to discuss painful menstrual cycles, or painful sex with health care providers, as it was considered a private subject to them (Denny, Culley, Papadopoulos, & Apenteng, 2011, p. 174).  The manner in which endometriosis was discovered in this ethnicity was through seeking medical help for the possibility of being infertile.  In addition, research has shown that black populations have lower rates of endometriosis and Oriental populations have higher rates than whites (Denny & Mann, 2007, p. 1112).

Know Your Risk
According to a number of sources a few things can place you at risk for developing endometriosis.

Risk Factors for Endometriosis.  (Schrager, Falleroni, & Edgoose, 2013, pp. 108)

Treating Endometriosis
The approach to treating endometriosis is to completely remove or minimize the displaced endometrial tissue.

Options for Treating Endometriosis.  (Seth, 2015, p. 9)

Getting Better

The key to this disease as it is for many other diseases, is to know your body.  We have to be in tune with our bodies in order to properly advocate our needs.

Things to Keep in Mind on Your Path to Wellness.  (Cox, Henderson, Anderson, Cagliarini, & Ski, 2003, pp. 7-8)

Resources for Women with Endometriosis
Connecting with others that may be affected by endometriosis can help with developing an additional support system.  These resources can also assist in establishing awareness of endometriosis.

• The Endometriosis Association
• Endo-Online
• Endometriosis Global Forum
• Endometriosis Research Center
• Center for Endometriosis Care
• National Library of Medicine
• NationalWomen’s Health Information Center
• National Institute of Child Health and Human Development
• Mayo Clinic (Mao & Anastasi, 2010, p. 114)

This is a large amount of information to digest, but educating each other and enabling awareness is one way to start the conversation with health care providers, friends, and family members.  As patients we should always be able to communicate our needs to health care providers without being dismissed, or made to feel as if "it's all in our heads".  I hope this post gives someone that extra push or support to continue their journey for effective health care and pain management.  Feel free to share and comment.  Until next time ;) 

________________________________________________________________________________

References

Child, T. J., & Tan, a. S. (2001). Endometriosis Aetiology, Pathogenesis and Treatment. THERAPY IN PRACTICE , 61, 1735-1750.

Cox, H., Henderson, L., Anderson, N., Cagliarini, G., & Ski, C. (2003). Focus group study of endometriosis: Struggle, loss and the medical merry-go-round. International Journal of Nursing Practice , 9, 2-9.

Denny, E. (2003). Women’s experience of endometriosis Elaine. Journal of Advanced Nursing, 46 (6), 641-648.

Denny, E., & Mann, C. H. (2007). A clinical overview of endometriosis: a misunderstood disease. British Journal of Nursing , 16 (18), 1112-1116.

Denny, E., Culley, L., Papadopoulos, I., & Apenteng, P. (2011). From womanhood to endometriosis: findings from focus groups with women from different ethnic groups. Diversity in Health and Care, 8, 167-180.

ELIZUR, S. E., LEBOVITZ, O., WEINTRAUB, A. Y., EISENBERG, V. H., SEIDMAN, D. S., GOLDENBERG, M., et al. (2014). Pelvic inflammatory disease in women with endometriosis is more severe than in those without. Australian and New Zealand Journal of Obstetrics and Gynaecology , 54, 162-165.

Gould, B. E., & Dyer, R. M. (2011). Pathophysiology for the Health Professions. St. Louis, Missouri, USA: Saunders Elsevier.

Huntington, A., & Gilmour, J. A. (2005). A life shaped by pain: women and endometriosis. Journal of Clinical Nursing , 14, 1124-1132.

Kaatz, J., Solari-Twadell, P. A., Cameron, J., & Schultz, R. (2009). Coping With Endometriosis. JOGNN , 39, 220-226.

Mao, A. J., & Anastasi, J. K. (2010). Diagnosis and management of endometriosis: The role of the advanced practice nurse in primary care. Journal of the American Academy of Nurse Practitioners , 22, 109-116.

SCHRAGER, S., FALLERONI, J., & EDGOOSE, J. (2013). Evaluation and Treatment of Endometriosis. American Family Physician , 87 (2), 107-113.

Seear, K. (2009). The third shift: Health, work and expertise among women with endometriosis. Health Sociology Review , 18 (2), 194-206.

Seth, N. (2015, April, May, June). Endometriosis: A Culprit for Chronic Pelvic Pain. New Hampshire Nursing News , 9.

Vercellini, P., Parazzini, F., Pietropaolo, G., Cipriani, S., Frattaruolo, M., & Fedelea, L. (2012, August 20). Pregnancy outcome in women with peritoneal, ovarian and rectovaginal endometriosis: a retrospective cohort study. BJOG , 1538-1542.

Stroke vs. Heart Attack...Do You Know the Difference?

After writing my last post about heart disease or cardiovascular disease, I realized that I hear many people use the words stroke and heart attack interchangeably, as if they are the same.  But in all reality, a stroke has to deal with your brain (tissue damage to your brain), while a heart attack has to deal with your heart (tissue damage to your heart)...which sounds pretty simple...but it gets a little more complicated and simplified in that strokes and heart attacks are both usually caused by a process called "Atherosclerosis".

So...What is Atherosclerosis?
Atherosclerosis is the process of one's large arteries (the vessels that carry blood from the heart to all of our other organs) becoming narrow due to the accumulation of cholesterol plaque and/or thrombus (blood clots).  So imagine, a water hose being connected to your house in order to transfer water from the water tank to any place within your yard.  Now, depending on where you live your water supply may have a number of chemicals or organic particles that are normal for your home location.  Due to a number of factors like the material of the hose you use, the length of the hose, the force of which your water supply flows through the hose (I could go on and on with listing the factors) all contribute to a build up of elements along the inside of the hose that decreases the internal diameter of the hose, and affects the passage of the water traveling through the hose.  Over time, the build up within the hose gets thicker and your water doesn't make it to its destination as fast or as forceful as it once did.  This ultimately leads to the hose becoming completely blocked causing it to burst or causing the water to flow backwards.  At any rate...you need a new hose!

This same idea can be applied to our arteries in that blood that has circulated through our body in order to supply our organs with nutrients and oxygen, returns to the right side of our heart, the right side of our heart then sends the blood (that has little to no oxygen remaining in it) to our lungs where oxygen is added and the newly oxygenated blood is then pumped to the left side of our heart.  At the end, the left side of our heart pumps the newly oxygenated blood into our body circulation to delivery nutrients and oxygen to our entire body.  Sooooo, by the time the blood has completed an entire body circulation cycle it reaches the right side of our heart to start the oxygenation cycle all over again.

Blood flow through the heart. (www.yournursingtutor.com, 2015)

So, your arteries are the hoses and your heart is the water tank, and due to a number of individual factors such as genetics, diet, exercise, etc. your arteries begin to accumulate build up that narrows the passage way of your blood (oxygen, nutrients, etc.) circulation through your body.

Narrowing of Artery, Atherosclerosis.  (National Heart, Lung, and Blood Institute, 2014)

Stages of Atherosclerosis. (www.dreamstime.com, 2015)

Stages of Atherosclerosis. (www.3deducation.com, 2015)

As soon as atherosclerosis begins it becomes open season for complications throughout your body.  This is the reason behind preventative health measures such eating healthy, exercising, etc., as these actions help minimize the risks for atherosclerosis that we can control.

The Infamous "Heart Attack"
In the medical world heart attacks can be referred to as "Myocardial Infarction" or an MI (total blockage of an artery), or "Angina Pectoris" (partial blockage of an artery) and they occur when a coronary (related to the arteries that supply and surround the heart) artery becomes blocked, leading to prolonged restriction of blood supply to tissue, cell death, and infarction (tissue death due to lack of oxygen) to the heart wall (Gould & Dyer, 2011, pp. 287-290).

Warning Signs of Heart Attack. (Gould & Dyer, 2011, pp. 291)

If you experience ANY of the above symptoms, IMMEDIATELY call 9-1-1, as the size of the blockage, the location of the blockage, as well as the amount of passed since symptom onset; determine the severity of damage done to your body.  Also, if blood supply can be restored within the first 20-30 minutes, irreversible damage may be prevented (Gould & Dyer, 2011, pp. 291).  If action is not taken fast enough the area of tissue death tends to increase or spread.  The faster you seek medical help, the better chances of survival!

The Infamous "Stroke"
In the medical world strokes can be referred to as "Cerebrovascular Accident" or a CVA (total blockage of an artery) and they occur when carotid (related to the arteries that supply oxygen-rich blood to your face, scalp, and neck) or cerebral (related to the arteries that supply oxygen-rich blood to the cerebrum of your brain) arteries become blocked, leading to tissue death, irreversible nerve cell damage, and empty cavities in the brain.  The causes of strokes are thrombus, embolus, or hemorrhage.

Types of Strokes. (Gould & Dyer, 2011, pp. 487)

Atherosclerosis in Carotid Artery. (National Heart, Lung, and Blood Institute, 2010)

The symptoms of a stroke are as follows:

Warning Signs of Stroke. (Gould & Dyer, 2011, pp. 488)

The Common Link...
Even though strokes and heart attacks are not the same, their common factor is atherosclerosis!  So, why not just minimize your chances of getting atherosclerosis??!!  SCORE!!!!!!! Well...to drizzle on this parade...both stroke and heart attack have other predisposing factors that can not be mitigated AND there are predisposing factors of atherosclerosis.  Hooooowwwwever, there are more modifiable factors for atherosclerosis than non-modifiable factors!

Modifiable and Non-Modifiable Factors of Atherosclerosis. (Gould & Dyer, 2011, pp. 287-288)

Now that I have overloaded you with so much information, I think it's fair to say that preventing negative obstacles is key with respect to anything we treasure in life.  If there is a small possibility that I can plan ahead and prevent health issues prior to experiencing the negative external symptoms, then in my mind I have won a small battle.  Unfortunately, in most cases by the time we experience external symptoms, the internal damage has already been done.  So, just keep this information in mind the next time you are presented with a "red or blue pill"...yes...I love The Matrix ;)  Feel free to comment and share this post.  Until next time!

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References

Gould, B. E., & Dyer, R. M. (2011). Pathophysiology for the Health Professions. St. Louis, Missouri, USA: Saunders Elsevier.

National Heart, Lung, and Blood Institute. (2014, April 4). Explore Atherosclerosis. Retrieved May 1, 2015, from National Heart, Lung, and Blood Institute: http://www.nhlbi.nih.gov/health/health-topics/topics/atherosclerosis

National Heart, Lung, and Blood Institute. (2010, November 1). Explore Carotid Artery Disease. Retrieved May 1, 2015, from National Heart, Lung, and Blood Institute: http://www.nhlbi.nih.gov/health/health-topics/topics/catd

www.3deducation.com. (2015, January 1). www.3deducation.com. Retrieved May 3, 2015, from www.3deducation.com: www.3deducation.com

www.dreamstime.com. (2015, February 12). www.dreamstime.com. Retrieved May 3, 2015, from www.dreamstime.com: www.dreamstime.com

Yournursingtutor.com. (2015). Yournursingtutor.com. Retrieved May 1, 2015, from Yournursingtutor.com: https://www.pinterest.com/source/yournursingtutor.com/

Wearing Your Heart on Your Shoulder

Do you wear your heart on your shoulder?!!!?????  I'm kind of being silly, but not really...I ask this question in relation to your heart health versus your emotional health.  In the past few months I have lost a number of exceptional women in my life due to heart disease, or cardiovascular disease (CVD), and the statistics in addition to the need for educating women about our vulnerability to this disease has inspired this post.  

In my opinion, it's important for us to take notes on our bodies and its response to our daily activities, interactions, and stress levels.  I'm not saying you need to meditate, participate in yoga, see a therapist, etc....I'm just suggesting that when something about your body feels "off" make a mental note of it and maybe even have a seat and live in the "offness" you feel to be able to describe to it to a medical professional.  The more moments we take to listen to our bodies and educate ourselves about them; provides us with more tools to utilize when our bodies are responding in unusual patterns.

For International Women’s Day the World Health Organization (WHO) presented 10 illnesses that were significant to women and their health.  Those 10 health issues were:

World Health Organization (WHO) 10 Health Issues of Women. (Bustreo, 2015)

In researching more, I found an additional list of health concerns related to women, which listed the top 5 female health issues as:

1. Heart disease 
2. Breast cancer
3. Osteoporosis
4. Depression
5. Autoimmune diseases (Zamora, 2015)

For the sake of not overloading you with ALL of the health concerns for women, I’m going to address cardiovascular disease (CVD) in women in this post, as it is one of our top health issues and causes of death.  Just to put things into perspective, 

• In 2006, 26% of women died from CVD, which is equivalent to more than 1 out of every 4 women you may know dying from CVD (Moran & Walsh, 2013).
• If we fast-forward to more recent years, statistics show that CVD is responsible for 29% of deaths in women  (Bustreo, 2015).  
• About 5.8% of all white women, 7.6% of all black women, and 5.6% of mexican-american women have coronary artery disease (CDC, 2015).

In talking about what may make noticing CVD symptoms difficult for women...the short of it is that CVD symptoms present very differently in women than they do in men AND our CVD symptoms are NOT usually presented as the “classical/standard” symptoms.  But just as a general rule of thumb, any symptoms that appear as

• pain, pressure or discomfort in the chest, neck, jaw, upper stomach, or back,
• feeling weak light-headed or faint,
• pain or discomfort in arms or shoulder,
• shortness of breath, and 
• nausea (Centers for Disease Control and Prevention, 2015)

that can appear while resting, at the start of physical activity, or during periods of high stress.  These are significant signs that should prompt you to seek medical advice and/or call 9-1-1.

In our case, the female body already has so many functions playing the balancing dance that CVD symptoms could be very subtle or even absent…which definitely makes me and should make you uneasy!  But, studies have shown that a large percentage of women experience

• fatigue,
• sleep disturbance, and
• shortness of breath

prior to experiencing a heart attack (Moran & Walsh, 2013).  After reading this, I instantly thought...I experience at least two of those three on a weekly basis...which would make me a prime candidate for ignoring such indicative signs.  The more disappointing research shows that close to two-thirds or 64% of women who die suddenly from CVD had absolutely NO symptoms (Moran & Walsh, 2013).  With that in mind, we need to pay close attention to our body with respect to symptoms or feelings of being “off or icky” that may appear and disappear spontaneously.  If and when you ever feel chest discomfort, or any of the symptoms listed above, it is EXTREMELY important that we seek medical advice, and if you suspect that you or someone near you is having a heart attack INSTANTLY call 9-1-1.  NEVER brush off or ignore any of the above symptoms as indigestion or stress (which is what I might I have the tendency to do...considering life doesn't really slow down!) as the faster you seek medical assistance the larger your chances are of surviving.

Just a Few Facts…

• Heart disease is the leading cause of death for African American and White women in the United States (Centers for Disease Control and Prevention, 2015).
• Illness symptoms can be broken down by:

CVD and Related Symptoms. (CDC, 2015)

Your Risks for Being Affected by CVD...

CVD Risk Factors. (CDC, 2015)

How to Limit or Minimize Your Risk...

By educating ourselves and listening to our bodies, we can reduce our chances of heart disease by:

Minimizing CVD Risk Factors. (CDC, 2015)

There are a number of initiatives at work to educate on CVD, check out these links below for more information:

• State Public Health Actions to Prevent and Control Diabetes, Heart Disease, Obesity and Associated Risk Factors and Promote School Health
• Million Hearts
• WISEWOMAN
• The American Heart Association
• The Heart, Lung, and Blood Institute

Also, I wanted to point out that none of the listed symptoms related to CVD had an age stamp attached, which is VERY significant, as women of any age as well as those at a "healthy" weight with unhealthy fat proportions can be affected in large numbers.  Hopefully this post will help someone along their journey to optimal health.  Please feel free to comment or re-post.  Until next time ;)

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References:

Bustreo, F. (2015 8-March). Promoting health through the life-course. Retrieved 2015 13-May from World Health Organization (WHO): http://www.who.int/life-course/news/2015-intl-womens-day/en/

Centers for Disease Control and Prevention. (2015 30-April). Division for Heart Disease and Stroke Prevention. Retrieved 2015 1-May from Centers for Disease Control and Prevention: http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_women_heart.htm

Centers for Disease Control and Prevention. (2015 19-February). Heart Disease. Retrieved 2015 1-May from Centers for Disease Control and Prevention: http://www.cdc.gov/heartdisease/signs_symptoms.htm

Moran, B., & Walsh, T. (2013 February/March). Cardiovascular Disease in Women. Nursing for Women's Health , 63-67.

Zamora, D. (2015). Women's Health. Retrieved 2015 1-May from WebMD: http://www.webmd.com/women/features/5-top-female-health-concern