Preaching What She Practices
Nurse educator Marcie Gonzalez Wilson of Austin, Texas, has a passion for educating her community in being heart healthy. At age 65, she has no thought of retiring. The day we spoke, she was putting together a bilingual program educating Hispanic elementary school students about heart health using handouts that their parents must read and sign. It’s another way to get valuable information to a vulnerable community.
Her own parents would have benefited from such a program because both had atrial fibrillation (AFib), which Marcie inherited from them. Her father, who also had diabetes, lost both legs to blood clots caused by his fluttering heart. “I can’t tell you how many cardioversions they did on him,” she said. “He just never got a normal rhythm.”
After nursing school, she went to work on a cardiac stepdown unit, where heart surgery patients go when they leave cardiac intensive care. She also became a new mother at age 30. It was around this time that she first felt the flutter of AFib. A few years later, the family moved to New York, and Marcie went to work at a VA hospital. The episodes, which had been sporadic, became more frequent; but she mentioned them to a doctor and tests were run. Nothing abnormal. For the next few years, she went about her business, wondering about these strange feelings: “Sometimes, I would have it for two or three days, almost straight, and I would be so tired that I couldn’t even get out of bed. Then I wouldn’t have it again for months,” she said. “Or I would go into bursts of it happening, and then it would be okay after an hour or so.” Several times, she wore a Holter monitor, the best technology at the time for recording heart rhythm, but it never picked up anything.
Then one day at work at the VA hospital, Marcie felt rapid palpitations and began sweating. “I told one of the nurses, ‘This is happening again. I feel so bad.’ He started taking my pulse and said, ‘Girl, I can’t even feel your pulse, it’s going so fast.’ I told him, ‘I think I’m going to pass out.’” And then she did. While she was still on the floor, they did an EKG, and she finally had proof that like her mom and dad before her, she had atrial fibrillation.
She continued to have sporadic episodes, despite taking heart-rhythm medication. Over the next dozen years, the episodes grew more frequent and were more intense. She moved back to Austin and married a healthcare executive who insisted that she visit a cardiologist, and soon after she had a catheter ablation at age 45. This returned her to a normal rhythm.
Marcie has since made some important lifestyle changes. She avoids wine and caffeine because they trigger her irregular heartbeat. “Right away, I feel my pulse change and I feel like I’m going to pass out,” she said.
Another trigger is cheese, which has caused her to transform some of her family recipes to be heart friendlier. “Lard is definitely out, and I eat a lot more fresh fruits and vegetables,” she said. And she doesn’t go all day without eating like she used to when she worked in hospitals.
“Nurses are the worst, because you go all day not eating and then you go home and eat everything and anything,” she said. “I’m taking much better care of myself that way. And I stay away from salty items, anything that’s going to increase my blood pressure.”
She takes high blood pressure medication and monitors her numbers. She also walks two miles a day and keeps her weight in check.
Marcie is a cardiovascular disease and stroke community outreach coordinator for the Seton Healthcare Family in Austin, where she sits on the board of directors, and runs a stroke support group. She also served on the national advisory committee for the American Stroke Association. She spends most of her time out in her community visiting senior centers, churches and civic organizations, educating people about risk factors for stroke and heart attack. She teaches people the importance of keeping control of high blood pressure, diabetes and cholesterol levels. And she maintains an active Facebook page and encourages people with heart disease to participate in the MyAFibExperience online support community. She also stresses the importance of regular exercise and healthy eating, and has started walking clubs at local schools. In other words, Marcie gets to preach what she practices.
She is busy full time with her outreach, and she is passionate about it, because she knows how harmful untreated atrial fibrillation can be. She has firsthand experience. “I can’t tell you how many seniors I’ve talked to who say they have it, and it’s like not a big deal to them,” she said. “But people need to realize it is a big deal, and you need to get serious about it.”
Evaluating Stroke Risk
Doctors are always figuring a risk/benefit ratio regarding any course of treatment. In evaluating stroke risk for patients with AFib, doctors use a scoring system known as CHADS-VASc. This is an acronym where each letter stands for a potential risk factor of having a stroke:
C — congestive heart failure;
H — hypertension;
A — age 75 or older;
D — diabetes;
S — a prior stroke, TIA or thromboembolism;
V — vascular disease like heart attack, coronary or peripheral artery disease;
A — age 65-74;
Sc — gender category (female sex).
Patients get 1 point for each category, except they get 2 points for being over 75 or having had a previous stroke. Female gender earns 1 point. The higher the score, the higher the risk. “So, if your CHADS-VASc score is 0 or 1, you’re at relatively low risk for a stroke, and we may not use anticoagulation in those atrial fibrillation patients,” said cardiologist Allen Solomon, professor of medicine at The George Washington University School of Medicine & Health Sciences. “But if you have at least 2 points, then your risk is elevated to where the benefits of anticoagulation outweigh the risks, and all physicians would feel that you need to be on anticoagulation to prevent a stroke. You can calculate the annual risk of having a stroke by your CHADS-VASc score. If you have a score of 2, you have about a 2 percent annual risk of having a stroke; if your score is 4, your annual risk is about 4 percent.”
Solomon hastened to point out that this risk is not cumulative — 2 percent over 10 years does not produce a 20 percent risk. “Each year you have a 2 percent risk,” he said. “But even though for an individual patient that might seem like a fairly low number, for doctors who take care of hundreds of people with atrial fibrillation, we can’t afford to have 4 percent of our patients have a stroke, so we have to mitigate that risk with treatment.”
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