From The Tennessean

Feb. 5, 2017

Judy Cox ignored all the signs. When she started noticing her shortness of breath when she ascended long flights of stairs, she attributed it to the extra pounds she’d picked up in middle age. When she began noticing a heavy feeling in her chest, she ignored that, too, assuming that she was just exhausted from juggling a busy career with family and church and, as she says, burning the candle at both ends.

As a real estate broker and 26-year co-owner with her husband of Wilson County-based C&D Realty and Cox’s Construction, exhaustion likely played a role in Cox’s symptoms. It didn’t tell the whole story, however, and one morning nearly 13 years ago, she couldn’t ignore her symptoms anymore.

There was work to be done: A closing, several open houses, some condos to show in Mt. Juliet. Yet Cox was feeling a nagging sensation in her abdomen — a stomach bug, she thought — that threatened to upend her entire schedule. By lunchtime the nagging had turned into a crippling headache and nausea, so she decided to go to the emergency room.

An ER nurse, who happened to be a high school classmate of Cox, took one look at her longtime friend’s pale, graying face, and she immediately had a diagnosis. Cox was having a heart attack.

“Two and a half hours after entering the hospital, I woke up from surgery with a pacemaker,” Cox says. “It was that quick.” 

Mixed signals

In retrospect, Cox had no idea that her nausea and headache were heart attack symptoms. She wasn’t aware of a family history of heart disease, and she didn’t smoke. And those assumptions, says Timothy Houle, clinical director at Marathon Health’s Averitt Express Wellness Clinic in Nashville, can prove costly.

“The biggest misconception is that heart disease only affects people who have obvious risk factors, like obesity, smoking or high cholesterol,” Houle says. “Heart disease can affect anyone, and the way in which risk factors affect an individual may have to do with their genetics, as well, so family history plays a role. The best thing to do is not assume you have no risk and find out what factors you should be concerned about with your doctor.”

Meeting with a doctor can also provide clarity on any symptoms that could be heart related but that, as in Cox’s case, may be masquerading as something else.

“Most people are aware of chest discomfort on the left side of the chest which can be associated with shortness of breath, jaw pain, left arm pain, nausea, dizziness and sweating,” says Dr. Sharmin Basher,  assistant professor of medicine, general and preventive cardiology at the Vanderbilt Heart and Vascular Institute. “What people should also be aware of is that women can oftentimes experience a different kind of discomfort, including GI distress, stomach discomfort, chest pressure, nausea and vomiting, back pain and shortness of breath.”

Houle agrees, noting that early signs of heart disease can actually mimic other conditions. “Things like fatigue, weakness, shortness of breath, difficulty breathing at night or chest and stomach symptoms are often misconstrued as heart burn or dyspepsia, but could suggest heart disease,” he says.

Thirteen years after her life-threatening heart attack, Cox wears her survivor badge and takes seriously her responsibility to educate others on heart disease risk factors and symptoms. Her No. 1 directive for heart health? Make an appointment with your doctor. Now.

“Don’t be afraid to go find out,” says Cox. “Even if the doctor ends up saying you just have indigestion or you need to work out more, go get checked.”


An ounce of prevention

Thanks to a commitment to healthy eating and exercise (she swims three mornings per week), Cox is confident that she won’t end up in the ER again. She also knows that had she made those lifestyle changes earlier, she may have never had a heart attack in the first place.

But while eating right and exercising appear to be relatively simple directives, limited financial resources can make them difficult to achieve.

In 2011, Tash Weddle launched The New Beginnings Center at the urging of Chris McCarthy, the former CEO of Nashville Area Habitat for Humanity. Weddle had worked as a strength coach for college athletes for 17 years, and McCarthy believed she could have a positive impact on the health and wellness of Nashville’s low-income population.

“There are many factors that contribute to the fact that lower income individuals have a 50 percent higher risk of heart disease,” Weddle says. “Access to health care may be an issue for some. But other factors that are more likely the issue are smoking, high blood pressure, high cholesterol, diabetes and being overweight or obese. All of these conditions are caused by lifestyle choices, and those living in poverty tend to lack the education on how to eat, exercise and live a healthy life. They also have more stress and less time to take care of themselves.”

Today the New Beginnings Center provides low-income women with the education, coaching and accountability they need to be successful. Every three months, 40 women begin a 12-week coaching program that is modeled on behavior change — not a temporary diet. And for women with a household income of 150 percent or less of the low-income limits determined by the United States Department of Housing and Urban Development, all costs are covered.

Participants meet two to three times a week to learn about nutrition basics; they participate in a workout that is individualized and designed to meet each attendee at her current fitness level; and they also go through various life coaching exercises. “We do vision boards and personal mission statements, and we discuss things like how to handle stress,” says Weddle.

Weddle says that, on average, participants achieve 7 percent weight loss in the first 12 weeks of the program (those who attend regularly for 12 weeks have the option of continuing to attend classes and work out for the remainder of the year), and 50 percent of the women eliminate or decrease their medication dosages. Blood pressure meds are usually the first to go.

"Considering that 75 percent of all disease is preventable through lifestyle behaviors, there’s a lot a person can do to prevent heart disease,” says Weddle. “No one should think that they are immune to the effects of heart disease, because it affects so many. Don’t wait until there’s a diagnosis or worse. Be proactive and live the healthiest life possible, because we only get one body.”

Topics: News Coverage, In the News