As told to Jacquelyne Froeber

October is Breast Cancer Awareness Month.

December is my birthday month. It was also the month I scheduled all my yearly health exams, including my mammogram.

But December 2014 was busy, I guess. (I burned all my journals from that time — but that’s another story.) I don’t remember why I didn’t go for my mammogram, but I didn’t get one until June 2015.

The day after the exam I got a phone call. There was something abnormal in the imaging, and I needed to have a biopsy. I was a nurse, so I knew that wasn’t great news, but I had the biopsy that week and went about my normal routine.

As an on-call hospice nurse, my schedule was pretty consistent. I worked seven days on, seven days off and — most important — I took a nap between 2 p.m. and 4 p.m.

My husband and kids knew not to call me during that time, so when my phone started buzzing during my nap, I was pretty annoyed. It was the provider’s office. “This isn’t a good time to talk,” I said.

“You have breast cancer,” the woman on the phone said.

“OK, can you call me back tomorrow? I’m on call at 5.”

She was startled. But she said OK. I hung up, rolled over and went back to sleep.

I know it sounds strange to just fall back asleep, but my patients depended on me. And I needed that nap. The next day my provider called and I made the time to listen. He said the cancer was small enough for a lumpectomy. So we scheduled the surgery for the following week.

By that Thursday, though, I’d noticed new imaging requests in my patient portal but no one could tell me why they were ordered.

When I finally got the nurse on the phone, I started asking her questions, and she cut me off. “Don’t worry about the tests — I do this all the time,” she said. “All you have to do is show up on Monday.”

I paused and felt the sting of being dismissed. “You may do this every day, but I’m not diagnosed with breast cancer every day,” I said. “And I will call the doctor and let him know why I’m not having the surgery with you. Have a good day.”

I hung up the phone. My mind and heart were racing. I’d just fired my provider! But I couldn’t stay with an office that wouldn’t answer my questions … right? Tears sprang to my eyes.

My husband helped calm me down and we found a different provider. I’d have to wait another month for the lumpectomy — but that was fine with me. During that time, I had the other tests that were ordered, including a PET scan. That scan showed the cancer had spread to the bone.

I had stage 4 breast cancer.

When I heard the news I was shocked. Within a week, I went from “small” cancer and a lumpectomy to plans for a bilateral mastectomy and chemotherapy. I learned that stage 4 — also called metastatic — cancer meant I would need ongoing treatment probably for the rest of my life.

Amid all the confusion and depressing news — there was a bright spot. My daughter had just found out that she was pregnant despite being told she couldn’t have children. The thought of holding my grandchild gave me extra hope that I could get through the surgeries and treatments and also keep my quality of life so I could enjoy time with my family.

The months went on, and after the baby was born, I’d put him on my chest despite the double mastectomy, and we would sleep like babies on my days off of work.

I continued working as much as I could through chemo but it was tough. I felt weak. I couldn’t even drive to work — my husband had to drive me. But I put on my bandana and pushed forward. In 2016, I got the best news: My scans showed no evidence of disease.

In 2017, I felt good enough to move, and my husband, John, and I relocated to a small town in eastern North Carolina. I got a new job as a hospice nurse.

We were only there for about six months when I had a blood clot in my left lung. Then, because of the blood thinners I was on, I had a ministroke. And then one more devastating blow: My provider said I couldn’t work anymore.

I was crushed. I’d been working for almost 40 years. I was the primary breadwinner in our family. Now, I wasn’t going to have income or insurance.

I spent the next seven days looking for financial resources that could help me pay for my medical treatments. I applied for disability — and got it — but it wouldn’t kick in for five months.

Then I came across an organization called Living Beyond Breast Cancer that offered funding and resources for people with metastatic breast cancer. They were hosting an annual conference in Philadelphia, and I decided to go.

At the time, I really didn’t know much about metastatic breast cancer outside of my personal experience. I’d also never met another Black woman with metastatic breast cancer. When I walked into the conference hall, I was blown away by the sheer number of people there. I probably looked like a deer in headlights going from booth to booth, but everyone was so kind and helpful. I got the financial guidance I needed. I heard stories from women who were eight and nine years into their diagnosis and thriving. I bonded with other Black women with metastatic breast cancer. All of it changed my life.

After the conference, I signed up for everything I could do as far as advocacy work for the organization. I traveled all over the U.S. and learned about the disease and new treatments and brought information back to my rural community in North Carolina. I’d learned that breast cancer rates are higher in women who live in rural areas and death rates are higher too compared to the national average. And these numbers are worse for women of color.

Early on, it became clear to me that information regarding Black people and metastatic breast cancer was lacking. But it wasn’t clear why. In 2019, I started working with an epidemiologist, Marina Pomare Kaplan, on a research project and survey that focused on the reasons why Black people weren’t being included in these clinical trials.

Unfortunately, Marina passed away in 2020. I thought that meant our research efforts were done, but a few months later, the Metastatic Breast Cancer Alliance contacted me and wanted to move forward.

We started the BECOME research project based on the research Marina and I had been doing. BECOME stands for Black Experience of Clinical Trials and Opportunities for Meaningful Engagement. And what we found with our survey was a big shocker. The overall reason why Black people weren’t being involved in clinical trials? It was because no one was asking us to participate. No one was having a conversation with us.

From there, I thought, Let’s find a way to get this information to providers. We planned an event the day before the San Antonio Breast Cancer Symposium in 2022, which is basically the biggest breast cancer conference in the world. It was my goal to have 100 people there — or fill half the seats in the room.

But that didn’t happen. The event was so packed I had to grab spare folding chairs. People lined up against the wall to listen to our research.

As I looked out at all the different faces in the room, I was overcome with emotion. I felt so proud to get all these people — providers, pharmaceutical reps, women of color — together in the same room to learn about the importance of including Black people in clinical trials for metastatic breast cancer.

I thought about how far I’d come in my own journey — although I hate to call it a journey. It just doesn’t sound right when you’re talking about being bald and going to chemo. But being a patient advocate helped me help other people when I couldn’t through nursing anymore.

None of us signed up to be in this club. But all of us deserve representation and research to help us live our best lives with metastatic breast cancer.

Resources

BECOME – Black Experience of Clinical Trials and Opportunities for Meaningful Engagement

Living Beyond Breast Cancer

Have a Real Women, Real Stories of your own you want to share? Let us know.

Our Real Women, Real Stories are the authentic experiences of real-life women. The views, opinions and experiences shared in these stories are not endorsed by HealthyWomen and do not necessarily reflect the official policy or position of HealthyWomen.

In the 1970s and ’80s, the smell of piña coladas wafted through the ocean breeze at every U.S. beach. In the summers before the invention of spray-canned sunscreen, my friends and I basted ourselves with tropical-fruit-scented tanning oils in a quest for the perfect tan. We felt smugly confident we were responsibly protecting our skin from the sun’s harmful rays. After all, our Hawaiian Tropic bottles boasted a sun protection factor (SPF) of 2. You don’t have to look too closely at the Polaroid pictures from this time to see that we were effectively and efficiently deep-frying ourselves in oil.

Some of us have paid for our tans (and, to be honest, a few sunburns) with sun-damaged skin. But was our youthful search for the perfect sun-kissed glow also behind the new alarming rates of skin cancer? This year, the American Cancer Society predicts the United States will reach a new, grim milestone: 2 million cancer diagnoses are expected for the first time ever. And the deadliest form of skin cancer, melanoma, is among the most quickly growing types of cancer.

Melanoma is the fifth most common cancer in the U.S., and it’s only getting more common. In fact, melanoma rates have risen by more than 320% in mostly fair-skinned countries since 1975. And in the 10 years from 2013-2023, there was a 27% increase.

So what’s behind this increase?

One study points to the rise in obesity rates as a factor. Obesity is a known risk factor for melanoma because it causes changes in the body, like ongoing inflammation and increased insulin levels, that can lead to cancer. And obesity rates have nearly tripled in women and quadrupled in men since 1975.

More research is needed but some evidence points to environmental factors playing a role as well. Climate change is suspected to be a factor in the rising cases of melanoma, and it’s estimated that a 10% reduction in stratospheric ozone will cause 300,000 additional skin cancer cases.

Indoor tanning bed usage could be another culprit. We can breathe a sigh of relief that indoor tanning usage has decreased in recent years. But the surge in usage in the 1990’s could be accounting for some of the cases we’re seeing today.

With as much progress as we’ve made getting the word out not to tan without protection, new social media trends could be putting this progress at risk. A recent TikTok trend encourages young people to tan during the highest UV indexes, when the sun’s rays are the strongest, which is the most dangerous time to be exposed.

This educational resource was created with support from Merck.

As told to Shannon Shelton Miller

I was thrilled to be pregnant with my first child at 29. Everything went well for about eight months — until the day I went to the restroom and the toilet was full of blood. I immediately called my OB-GYN because I was scared something was wrong with my baby.

At the appointment, he assured me we both were fine. It was probably just
hemorrhoids or my baby was starting to rest on my organs as he grew bigger, leading to some bleeding.

But new symptoms started to show up. I was dizzy, had bad abdominal pains and couldn’t sleep at night. My OB-GYN told me these were all normal during pregnancy. I had never been pregnant before, so I figured that made sense.

2016 (Photo/Michael D Images)

The bleeding and crushing fatigue didn’t stop after I gave birth to my son, Cameron. Once again, I was told this was normal for a new mom. Even as I continued to have vaginal and rectal bleeding months after giving birth, my OB-GYN only suggested changing my birth control method.

When Cameron turned 1, I knew something had to give because the bleeding wasn’t stopping. This time, I went to a primary care physician, who first gave me pills for
irritable bowel syndrome. Just in case that didn’t work, he said, he’d send a referral to a GI specialist.

Weeks later, I had to see the specialist since the pills had done nothing. “You’re way
too young to be sitting in my office,” he said. “What’s going on?” I told him about my symptoms, and he ordered a colonoscopy.

When I woke up in the operating room after that procedure, the doctor and four nurses were there, along with my husband, Derrick. The room seemed too full, and I asked what was happening.

My doctor showed me photos of my colon and told me I had cancer.

“No, I don’t,” I said. We had built a rapport, so I started to laugh a little. “Ok, what’s really going on?”

He kept a straight face. “I would never joke about something like this,” he said. “You definitely have cancer.”

A few weeks later, my mother, my husband and I met with the oncologist. He walked past us, sat down and said, “Well, you have stage 4 cancer and …” He continued to go on, but I didn’t hear anything after that. I just knew it couldn’t be as bad as what I was hearing in my head.

It was. He said I was an exceedingly rare case because of my age and good health. Genetic testing showed nothing. We had no family history of cancer. I was healthy, I played sports, I didn’t grow up eating red meat — I couldn’t understand it.

I didn’t want to think about treatment at that moment. I told my family I wanted to go to the sunflower patch by my house because I’d never been. We picked sunflowers and took photos. It was such a nice day. Afterward, we picked up my son from daycare, and I held him the rest of that day.

The last seven years have been very difficult. I’ve had multiple rounds of chemotherapy and surgeries. After my diagnosis, they removed a foot of my colon, two parts of my liver and my gallbladder. I was very weak and couldn’t walk. My toddler son couldn’t sit on my lap, and I couldn’t pick him up. I couldn’t even hold him by myself.

The cancer was already in my liver when I was diagnosed. And, over time, the cancer spread to my lungs and my lymph nodes. I developed spots all over my body, but one on my heel was noticeably darker, and I asked my oncologist to check it out. It turned out to be precancerous melanoma. I had to have surgery to remove it, and it was incredibly painful because it was on my heel and they couldn’t numb it. They took out a chunk of my heel and I couldn’t walk, drive or do anything for myself for four months. I just was helpless.

2023 (Jommy Photography)

There were some bright moments during that time. I was in remission for most of 2021 and 2022, and 2022 was one of the best years of my life. I got back into working out, doing Pilates, hanging with my friends and playing baseball with my son — it was wonderful. I was even able to go off treatment. But before that Christmas, cancer was found in the lymph nodes in my chest. My doctors wanted me to start treatment before Christmas, and I said I couldn’t. I had to have my perfect Christmas first. I’m glad I did, because it was wonderful.

I started treatment again in January 2023, and I have to continue treatment for the rest of my life. My regimen consists of three days of chemotherapy in the hospital and at home, and then I’m off for three weeks. I still stay busy as a chief administrative officer for a tech-focused startup. I work a lot and travel a lot — I had life goals before I got sick, and I’m determined to do my best to meet those goals. I’m 38 now, Cameron is 8, and I try to enjoy as much time with my family as possible.

I started sharing my story after going to a Colorectal Cancer Alliance event in 2019. At the dinner, they were asking people in the audience to stand up and share their stories. There were actors and dancers on stage who would act out whatever you were saying. It was very cool.

I was nervous, but I stood up and shared my story. People were clapping and coming up to give me a hug. There wasn’t a dry eye in the room.

To this day, no one knows why I developed colon cancer and why it happened during my pregnancy. Was it the rapid generation of cells that took place to grow a new human inside my body? That’s the only link I can think of, because I’m the only person in my family to have it. Because I had no family history or risk factors for colon cancer, I know my young age wasn’t helpful in getting an early diagnosis.

That’s why I always tell people to do your best to advocate for yourself with your healthcare providers because you don’t know what you don’t know. No doctor knows everything. Tell your doctor that you aren’t leaving that office until they look deeper into your issue because it’s your body, and you know best when something is wrong.

This educational resource was created with support from Daiichi Sankyo and Takeda.

Have a Real Women, Real Stories of your own you want to share? Let us know.

Our Real Women, Real Stories are the authentic experiences of real-life women. The views, opinions and experiences shared in these stories are not endorsed by HealthyWomen and do not necessarily reflect the official policy or position of HealthyWomen.

Physical decline associated with aging is not simply the result of getting older. In many respects, it’s a product of becoming less active as we age. Taking it too easy makes aging more debilitating than it needs to be. The human body is much better at repairing and maintaining itself when you keep it well conditioned through a program of regular physical activity, exercise, and good nutrition. This doesn’t change when you move into old age—in fact, the old adage “use it or lose it” is probably more true when you’re in your 60s and beyond than when you’re in your 40s. Slacking off on healthy habits (regular exercise and good nutrition) is the primary factor in age-related problems like excessive muscle loss, deteriorating bone density, declines in strength and aerobic fitness, and increased difficulties with balance and flexibility.

Muscle strength is important for women over 60 because it helps prevent falls, a leading cause of hospitalization. Getting stronger in your 60’s can help you live a longer, healthier life.
Women over 60 should focus on endurance, retaining muscle and bone mass, flexibility and balance. This can help you tone and trim your body, while reducing the risk of falling and injuring yourself. Cross training ensures that you use a variety of exercise types to meet your needs, and reduces the risk of injury — and of boredom.

In a study by Morganti et al., 20 women, all 60 years old, exercised twice a week for one year at 84 percent of one repetition maximum (RM). Performing an intense training regime, the women increased their strength in upper-body, lat pull-down by 77 percent, knee extension by 73.7 percent and double leg press by 35.1 percent. Although 40 to 50 percent of the strength gains were observed during the study’s first three months, improvements in strength were observed over the program’s entire 52 weeks.

If exercise is new to you, start slowly. Always start with warm-up exercises and end with cool-down exercises. Try for a total of ten, fifteen or twenty minutes a day and work up from there. On the other hand if you’ve remained active and continued to exercise through middle age, you probably know your body well enough to recognize your strengths, your natural limitations, and the areas where you should improve to better function in your daily life.

• Focus on the major muscle groups, or try a home fitness program for simplification. In your workout list include biceps curls, triceps extensions, squats, calf raises, overhead press, crunches, bench press, bent-over row and push-ups, modified if necessary.
• Choose a weight for the different workout moves that is comfortable for your current fitness level. If you can’t perform the minimum number of reps for a workout move with 1 lb. weights, perform the move without weights until you develop strength in that muscle or start with a 1 lb. weight and put it down when fatigued, continuing without the weight. Lower-body moves will accommodate heavier weights than upper-body moves for most people unaccustomed to weight-training.
• Practice doing upper body exercises on one leg, keeping your abs drawn in tight to stabilize the spine.
• Utilize core equipment such as stability balls and half-round balls. This unstable movement forces your abs, glutes and hips to engage, training them to coordinate more efficiently. Do some exercises such as shoulder presses, biceps curls and squats standing on the half-round ball. Do abdominal exercises such as crunches and planks on the stability ball. Incorporate at least two balance and core exercises into your workouts for optimal results.
• Engage in weight-training two to three days each week, with at least 24 hours of rest between weight-training workouts. On those “rest” days, engage in cardiovascular exercise such as walking, jogging, aerobics classes or the cardio workouts with a home fitness program.
• Perform your weight-training moves with good form and controlled movement to reduce momentum. Momentum can make weight-training easier and reduce the results you see. Aim for 10 to 12 reps with each move; perform the move slowly up and down. Avoid dropping your arm when training with weights; lower the weight with control.
• Rest for a minute between sets and write down the weight used and number of reps as you complete each set.
• Build muscle in this regimen for about a month; increase the amount of weight if you find some exercises are easier. If heavier weights aren’t available, work through your sets slower for added benefit, pretending the weights weigh twice what they do. Work through your sets, then repeat for a second round.
• Maintain normal breathing patterns while exercising, since breath holding can increase blood pressure.
• Never use a resistance that is so heavy it cannot be lifted at least eight repetitions per set. Heavy resistance can be dangerous and damage the skeletal and joint structures. It is recommended that every set consist of eight to 12 repetitions.
• Don’t over train. Two strength-training sessions per week are the minimum number required to produce positive physiological adaptations. Depending on the circumstances, more sessions may neither be desirable nor productive.
• Given a choice, use machines to strength train, as opposed to free weights. Machines tend to require less skill, and allow individuals to start with lower resistances, increase by smaller increments (this is not true for all strength-training machines), and more easily control the exercise range of motion.

Note:- that the first several strength-training sessions should be closely supervised and monitored by a trained professional who is sensitive to the special needs and capabilities of the older adult.

Disclaimer
The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

September is Pain Awareness Month

Paula* started feeling pain in her shoulder late last year. It started as an ache, but it wasn’t long until routine things like waving to a friend or putting on a sports bra were too painful to do.

She started having problems sleeping and paying attention at work because of the pain.

Paula was eventually diagnosed with a shoulder tear and said some days are worse than others — but the pain is always there. “I don’t remember what it’s like not to have the pain,” she said.

Paula is not alone: About 1 in 5 people living in the U.S. have experienced chronic pain. Research shows women and people assigned female at birth are more likely to have chronic pain than men, and women of color are less likely to be treated for pain compared to white people.

Living with chronic pain can affect all aspects of life and even change the way your brain works.

What is chronic pain?

By definition, chronic pain is pain that lasts for more than three months. It can be constant — like Paula’s — or it can come and go.

There are many causes of chronic pain, including a past illness or injury that’s recovered from but the pain stays. Health conditions like rheumatoid arthritis, osteoarthritis, chronic migraine disease and temporomandibular disorders can be a cause of chronic pain. And some people have chronic pain for unknown reasons without any injuries or past illness.

Regardless of the cause, a growing body of research is showing how chronic pain affects the brain.

Read: After 14 Years of Chronic Pain, I’m Finally Embracing Pain Management >>

How chronic pain changes the brain

“Studies have shown that chronic pain can actually decrease gray matter in the brain,” said Puja Shah, M.D., an interventional pain management specialist and member of HealthyWomen’s Women’s Health Advisory Council.

Gray matter is the tissue in your brain and spinal cord that helps with important things such as learning, memory, emotions and movement — pretty much everything you need to perform everyday activities. So, a decrease in gray matter can lead to problems in related areas.

For example, one study found chronic pain led to a reduction in size and activity in the hippocampus — the part of your brain that is responsible for short- and long- term memory among other other things. Other research shows that chronic pain has a negative effect on the regions responsible for emotions and motivation. These changes can lead to personality shifts and feelings of anger and anxiety.

Chronic pain has also been linked to various health conditions dealing with the brain including:

Chronic pain can also alter areas in the brain responsible for cognitive function. “These alterations can cause difficulties with focus, learning and problem-solving, even when the pain is not at the forefront of that person’s experience,” said Jane Wigginton, M.D., medical science research director at the Center for Brain Health.

The presence of constant pain also has a big impact on mental and emotional health. “The emotional centers of the brain, like the amygdala and regions involved in emotional regulation, become more reactive under the constant pressure of pain,” Wiggington said. “This can lead to increased anxiety, frustration and feelings of hopelessness.”

Over time, chronic pain can reduce the brain’s ability to experience joy and pleasure, which can add to emotional problems.

Chronic pain and depression

The emotional wear paired with constant pain may make people living with chronic pain more vulnerable to mental health conditions like depression.

Chronic pain shares neural pathways with mood and reward systems in the brain, which explains why chronic pain has been linked to depression and substance use disorders.

“Persistent pain can disrupt the balance of neurotransmitters like serotonin and dopamine, which regulate mood, pleasure and motivation. This disruption can lead to feelings of depression, anxiety and a diminished sense of reward, making it more challenging for individuals to find relief or experience joy,” she said.

The fact that chronic pain is an invisible illness can also lend to feelings of loneliness, which can lead to social isolation and depression. Studies show that people living with chronic pain are more vulnerable to social isolation and, in turn, isolation can make symptoms of chronic pain worse.

Stress is another factor that can make chronic pain worse because it accelerates changes in brain function. Basically, the body releases cortisol, also called the “flight or flight” hormone, which can decrease the brain’s ability to manage emotions and pain. “Chronic stress may also make the brain more sensitive to pain signals, increasing both discomfort and emotional strain,” Wigginton said.

Shah said recent studies and advancements in medical imaging have helped put the spotlight on how chronic pain changes the brain. “It also shows that pain in and of itself is a true mind/body disease,” Shah said. “It’s validation that suffering is causing long-term damage.”

Read: Tech Solutions for Chronic Pain >>

Chronic pain in women

There’s still a lot about chronic pain that we don’t know. But, we do know that women and men experience pain differently and women are more sensitive to pain overall compared to men. Wigginton said this is due, in part, to hormonal fluctuations. “These fluctuations, particularly during menstruation, pregnancy and menopause, can heighten pain sensitivity and alter the way the brain processes pain signals,” she said.

Shah noted that chronic pain isn’t necessarily about tolerance — chronic pain is a complex interconnected disease that feels different depending on the person. And there can be stigma surrounding chronic pain that can keep people from getting the help they need.

Read: Breaking Barriers to Pain Treatment >>

“Women are less likely to speak up when experiencing a chronic pain condition,” Shah said. “This is for many reasons, including cultural norms, difficulty in finding the space and time for women to prioritize their self-care and bias in the medical community regarding treatment for men versus women.”

Historically, women have been left out of clinical trials and the conversation surrounding chronic pain despite being more likely to be diagnosed with pain conditions compared to men.

The issue of chronic pain and treatment for chronic pain is personal to Shah. She had migraine attacks for years but said a mind/body approach including medication and aligning her posture has helped her have better control over her migraine attacks.

The first step, she said, is awareness. “Too often we diminish things to be normal when they’re not.”

Both Shah and Wigginton said brain-healthy habits such as reducing stress, practicing mindfulness and getting enough sleep and physical activity can help with the symptoms of chronic pain.

“It’s essential for women to know that they are not powerless in this process,” Wigginton said. “There are multiple pathways to improving brain health and well-being, and by understanding and addressing the brain’s role in pain, women can feel empowered to thrive in their lives, despite the challenges chronic pain may bring.”

World Heart Day is celebrated every year on 29 September to raise awareness about Cardiovascular disease (CVD).

The theme for World Heart Day 2024 is “Use Heart for Action”, focusing on encouraging proactive steps to improve heart health worldwide. This year’s campaign aims to:

• Empower individuals to take better care of their heart health.
• Urge leaders to prioritize cardiovascular health and take it seriously.
• Inspire nations to create or support national plans for cardiovascular health.
• Engage healthcare professionals, patients, and the broader public to drive meaningful change.

The 7 Heart Health Metrics

The Seven health metrics and behavior

that are used to determine if a child’s cardiovascular health is poor, intermediate, or ideal include:

1. Smoking status: According to the Centers for Disease Control (CDC), nearly 25% of high school students use some kind of tobacco product, and nearly 4,000 kids under age 18 try their first cigarette every day. 9 out of 10 smokers had started smoking before they finished high school. This means that if children can stay smoke-free in school, they will probably never smoke. More than 90,000 people die each year from heart diseases caused by smoking. Among young people who would otherwise have a very low risk of heart disease, cigarette smoking may cause as many as 75 percent of the cases of heart disease. And, the longer a person smokes, the higher the risk of heart disease. 
2. Body mass index (BMI): For children and teens, BMI is not a diagnostic tool and is used to screen for potential weight and health-related issues. For example, a child may have a high BMI for their age and sex, but to determine if excess fat is a problem, a healthcare provider would need to perform further assessments. These assessments might include skinfold thickness measurements, evaluations of diet, physical activity, family history, and other appropriate health screenings.
3. Physical activity level: The American Heart Association advises that all children 5 years and older get at least 30 minutes of exercise every day. This should include a mix of moderate- and high-intensity activities. Limit the amount of time spent watching TV, playing video games, or surfing the Internet. Look into organized sports, lessons, or clubs that suit your child’s interests. Most importantly, spend time with your child, and create family outings that involve some type of physical activity (e.g., biking, walking, hiking).
4. Healthy diet score: Eating more calories than they are burning during exercise and daily life. Other causes of obesity may include genetics, aging, gender, lifestyle, and illness. Obesity in children is dangerous because researchers believe that the fat cells we gain as children stay with us as adults. Obese children may have 5 times more fat cells than children of normal weight. Dieting in adulthood will decrease the fat-cell size but not the actual number of fat cells.
5. Total cholesterol: Studies have shown that fatty plaque buildup begins in childhood and progresses into adulthood. This disease process is called atherosclerosis. In time, atherosclerosis leads to heart disease, which is the single biggest cause of death. In some cases, high cholesterol runs in families. This is called familial hypercholesterolemia. About 1% to 2% of children have this condition, and they should have their cholesterol levels checked before they are 5 years old. Other risk factors for high cholesterol include obesity, high blood pressure, and smoking.
6. Blood pressure: High blood pressure is a serious condition in childhood and often goes undetected because it causes no symptoms. Make sure that your child’s blood pressure is checked at his or her yearly check-up. High blood pressure (hypertension) in children is not a congenital heart disease, but it can have a hereditary link. For that reason, children born into families with a history of high blood pressure need to have their blood pressure watched with special care.
7. Fasting blood glucose:  (< 100 mg/dL).

The 3 Key Beneficiaries:

• Humanity
  • Access to treatment and support for CVD varies widely across the world. Over 75% of CVD deaths occur in low-to-middle-income countries, but access can be an issue anywhere. By getting involved with global events such as World Heart Day as well as local activities, we are empowered to spread awareness and help make a difference in the lives of all humankind.
• Nature
  • Air pollution is responsible for 25% of all CVD deaths, taking the lives of 7 million people every year. Whether they are more immediate actions like walking or cycling instead of traveling by car, or longer-term efforts such as supporting clean air legislation, each of us can contribute to a healthier planet in our way.
• Yourself
  • Psychological stress can double the risk of having a heart attack. Exercise, meditation, and getting enough quality sleep help lower stress levels.  By resisting the harmful coping mechanisms and bad habits induced by stress, we can maximize our individual heart health.

Recommended Eating Patterns for Optimum Health

The American Heart Association recommends this eating pattern for families:

• Energy (calories) should be adequate to support growth and development and to reach or maintain a desirable body weight.
• Eat foods low in saturated fat, trans fat, cholesterol, salt (sodium), and added sugars.
• Keep total fat intake between 30 to 35 percent of calories for children 2 to 3 years of age and between 25 to 35 percent of calories for children and adolescents 4 to 18 years of age, with most fats coming from sources of polyunsaturated and monounsaturated fatty acids, such as fish, nuts and vegetable oils.
• Choose a variety of foods to get enough carbohydrates, protein, and other nutrients.
• Eat only enough calories to maintain a healthy weight for your height and build. Kids should be physically active for at least 60 minutes a day.

• Serve whole-grain/high-fiber bread and cereals rather than refined grain products. Look for “whole grain” as the first ingredient on the food label and make at least half your grain servings whole grain.
• Serve a variety of fruits and vegetables daily, while limiting juice intake. Each meal should contain at least 1 fruit or vegetable. Children’s recommended fruit intake ranges from 1 cup/day, between ages 1 and 3, to 2 cups for a 14–to 18-year-old boy. Recommended vegetable intake ranges from ¾ cup a day at age one to 3 cups for a 14–18-year-old boy.
• Introduce and regularly serve fish as an entrée. Avoid commercially fried fish.
• Serve fat-free and low-fat dairy foods. From ages 1–8, children need 2 cups of milk or its equivalent each day. Children ages 9–18 need 3 cups.
• Don’t overfeed. Estimated calories needed by children range from 900/day for a 1-year-old to 1,800 for a 14–18-year-old girl and 2,200 for a 14–18-year-old boy.

This eating pattern supports a child’s normal growth and development. It provides enough total energy and meets or exceeds the recommended daily allowances for all nutrients for children and adolescents, including iron and calcium.

Note that cardiovascular risk factors present during childhood are better predictors of future subclinical CVD development (ie, carotid intima-media thickness or coronary calcification) than cross-sectional comparisons performed during young adulthood.

This is no doubt a Wake-up Call.

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Disclaimer
The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.