At the end of every art class, Rita Owens sang a little ditty to her high school students. While it was just three words -- "Clean up, please" -- a lot was packed into her delivery.
Her tone was that of a loving mother and, in a sense, she was. Owens cared for these students so much that she ran an after-school program that helped steer kids in the right direction in life.
By making a joyful request instead of barking out an order, Owens showed clever leadership. Her sweet approach proved an effective way of getting the class to put away their colors, papers and other materials.
So her daughter, entertainer Queen Latifah, knew something was wrong when she called Owens' classroom one afternoon and heard her mom deliver that trademark tune with "a little less of a song to it -- not the same brightness."
"I could hear her being more short-tempered with her students," Latifah said. "She had a lot of patience, so if she was short, it was very noticeable. I also noticed she was more fatigued. I could tell she wasn't feeling well."
Owens was an energetic woman who didn't smoke or drink, and was never overweight. To her loved ones, this change in her personality was more of a curiosity than a major concern.
Until the day she passed out at school.
Latifah was in the hospital when the doctor delivered Owens' diagnosis: Heart failure.
It's a frightful phrase for anyone. For Latifah, it was magnified because about a year before her grandmother died from it. As this doctor discussed which medicines Owens should take, Latifah recognized several as being the same ones her grandmother had taken.
"But my mom was in her 50s!" Latifah told the doctor. "She's too young for this. What does it mean? She's going to be OK, isn't she?"
Although no one could say so on that day, today we can. It's been 11 years and Owens is still going strong. So strong that she and Latifah are working with my organization, the American Heart Association, to spread the word that patients can "Rise Above Heart Failure," and to help teach them how.
"Heart failure" may not be what you think it is.
Many believe the term is synonymous with a heart attack. Or that it means a heart is about to stop -- as in, fail to beat anymore.
Actually, the failure is that the heart is unable to do its usual job (pumping blood to the rest of the body) at its usual rate. An inefficient heart can lead to problems elsewhere in the body.
Heart failure (also called congestive heart failure) is chronic and progressive. It's also way too common.
Nearly 6 million Americans -- about equal to the combined populations of Los Angeles and Houston -- live with it; another roughly 870,000 new cases are reported each year. This makes heart failure one of the most common types of heart disease, which is itself the most common killer of Americans.
While I don't like dwelling on those details, it's important to understand the severity of this condition. It also adds to our resolve as we talk about reversing these trends.
Last week, the American Heart Association announced a goal of reducing hospitalizations from heart failure by 10 percent in 2020.
We aim to do this, in part, through "Rise Above Heart Failure," a campaign that seeks to make a difference through awareness, education and support. It is supported nationally by Novartis Pharmaceuticals Corporation.
The goal is empowering Americans to better understand heart failure so they can take steps to prevent it, or to detect it early. And if they or a loved one is diagnosed with heart failure, or is already dealing with it, this knowledge can help manage and treat it.
Let's start right now with a brief overview.
What causes heart failure?
Heart failure is triggered by conditions that either directly damage a heart or cause damage indirectly by making it work too hard. Indirect causes include the usual lifestyle factors that increase your risk of heart attack and stroke: smoking; being overweight; eating foods high in fat, sodium and cholesterol; and physical inactivity. Also at higher risk of developing heart failure are people with diabetes, high blood pressure, hardening of the arteries, obesity and metabolic syndrome.
What are the symptoms?
The most common are shortness of breath, persistent coughing or wheezing, swelling of the feet and ankles, fatigue, lack of appetite or nausea, confusion or increased heart rate.
What can be done about it?
A physician can set an individualized treatment plan. The basics involve medicines and lifestyle changes, such as exercise and following a low-sodium diet. There are also support networks for patients and caregivers.
There are good reasons to be optimistic that we can make a difference. The best reasons are the success stories -- the people like Owens.
Owens has been a model patient, from taking medication to making lifestyle changes, such as following a low-sodium diet.
She received an implantable defibrillator to protect her heart from going into cardiac arrest. She also uses oxygen to help with a lung problem, one she believes stems from her heart condition. (She also has sleep apnea; a sleep study following her heart failure diagnosis showed that she stopped breathing more than 100 times in a night. Think of the added strain that put on her heart.)
Latifah and her siblings dote on Owens, providing all the personal attention they can. They also realize that they, too, are at risk.
A key component of Rise Above Heart Failure is encouraging people to make small changes that can make a big difference. More than just a spokeswoman, Latifah is leading by example.
"We as a family have all started eating better," Latifah said. "We eat less fat, especially less saturated fats, less sugar and less sodium. I very rarely add salt to my food. I was already heading in that direction, but I've become more cognizant of what I eat.
"I'm also trying to maintain a healthier lifestyle in general -- exercise more, rest more, sleep better, just taking care of myself and keeping my stress down. I'm trying to avoid all the things that contribute to heart problems."
Those changes make sense. Anyone can make them ... anyone who is serious about rising above heart failure.
"We're sharing our story to get these messages out, to help people prevent heart failure and avoid being hospitalized as frequently," Latifah said. "We want people to live longer, healthier lives."
Photos of Latifah, Owens by Amy Ploss-Samson, Figure 8 Studio
Wouldn't it be great if you could do something relatively easy to improve yourself, and your family?
Now let's scale it up. What if that same action could help your neighborhood? Your city? Your state?
Whoa, now it's starting to get intimidating ... and, hopefully, intriguing.
Here's the deal: Tuesday is World Heart Day, and this year's theme is creating healthy heart environments. While this might sound like a lofty challenge best suited for people with deep pockets and powerful connections, it truly requires nothing more than being inspired.
If you're willing to merely invest some time and effort, everything else is in place to help you make a difference in your life and the lives of those around you.
It's already happening in communities around the country -- such as Dayton, Ohio, where Dr. Mary Chace is helping lead the charge.
The premise is simple:
The concept is called "shared use," a name that's perfect because we all learned about sharing in school. It is even more perfect when you line up a few other facts.
Let's start with the most obvious, that schools are paid for by taxpayers.
Then there's the cruel reality about Americans: Most of us weigh more than we should and exercise less than we should. Surely it's not a coincidence.
Put it all together and you and your family could partake in fun, healthy activities at a nearby place built and/or maintained by your taxes.
Nothing is ever as easy as it seems, and there are some challenges any grassroots campaign might face. There's good news about that, too: Easy-to-follow toolkits are a few keystrokes and mouse clicks away thanks to people like Chace.
"We'd drop 40 or 50 cents in a box to pay the monitor who was there to watch over things," she said. "We spent all day there playing volleyball, dodgeball and basketball."
Chace's fondness for those days may have led to her career choices. She earned degrees in health-fitness and biology, a Ph.D. focused on exercise and wellness education and a Master of Public Health in Health Education. She's now an assistant professor in the Kinesiology and Health Departments at Wright State University, and the director of the school's public health education program.
And, in perhaps her most important role, she's the mom of a ninth-grade daughter.
Put it all together and you have someone who is personally and professionally motivated to make a difference. She also believes the saying that "knowledge is not enough; it's your responsibility to speak up and make change." So in addition to studying shared use, she's taken action.
I'm proud to say that one of the many ways she contributes is through the American Heart Association's Ohio Advocacy Committee. She's provided leadership and strategic guidance for many issues, such as testifying to state legislators and being a spokesperson for a variety of issues.
Her expertise will soon be evident in a scientific paper about to be published in the Journal of Physical Activity and Health. It is called "Opening the Doors to Health," and it's based on several years of researching how schools across Ohio were sharing their facilities with their communities for physical activity outside the school day.
"The doors were open to some extent, but the majority were informal agreements, not written down," she said. "We need to make it sustainable and part of the regular daily life for people."
So let's go back tour initial three-step approach, with Chace's insight on each:
"The hard part is getting started -- that first step of saying `Yes, we want to do something,'" Chace said. "Nobody is expecting schools to do this alone. We know their primary job is educating children. But if they've got the resources that we've all paid for, it just makes sense. Let's work together.
"It's got to happen from the grassroots up. People need to push for it. Sometimes it just takes a parent or community member going to school board and asking them. Be patient, though. It might take time."
Chace's research showed that a primary barrier was concerns over liability. Since then, Ohio has passed a law resolving that. Solutions exist for states without such legislation.
Voices for Healthy Kids -- a joint initiative of the American Heart Association and the Robert Wood Johnson Foundation that works to help all children grow up at a healthy weight -- is among the organizations that provide a how-to toolkit featuring all the necessary paperwork, and more.
"Nobody has to reinvent the wheel; the hard work has been done," Chace said. "Just Google 'shared use toolkit' and you'll find it all."
Another concern is cost -- paying for oversight and maintenance, plus utilities and other unforeseen expenses.
Harkening back to the gym coin box of her youth, Chace said: "Nobody is expecting schools to incur a lot of costs or extra staff time. It makes sense for them to charge a nominal fee. Those are things that can be worked out. That's what a shared-use agreement does. And it should be in writing and posted somewhere for everyone to see."
Another potential barrier is coaches who've bought expensive equipment for their players and don't want to share it. This could especially be true when the funds came not from taxpayers but from boosters.
Chace found little evidence of it. In fact, quite the opposite was true -- many coaches, principals and superintendents were visionary enough to realize they could expand their base of supporters by welcoming in their neighbors.
"Most schools really want to find new opportunities to engage their communities; they just haven't thought of this as a way," she said. "Whether a person's kid goes to that school or not, using those facilities makes them feel connected to the school. They're more likely to contribute when the lacrosse team is selling things to pay for new uniforms or the civics club is holding a car wash to raise money for a trip to Washington, D.C."
"Once there's a spark, it's up to each community to find out what people have a passion for," Chace said. "It's going to be different in each community. You also have to think about the activities that might be the best fit for a certain target group. The best scenario is multiple generations doing an activity together. Imagine a grandma playing badminton with middle schoolers."
The next step is finding people to make it happen.
While some community members may have expertise in certain areas, there are other win-win solutions available.
"Right here at my college we have a lot of sports science majors who would love to create programs, leagues or classes in the community. That's their passion," she said. "And that's just one example."
Technology makes this easier than ever.
In addition to old-school methods such as signs and posters, write-ups in the local newspaper and stories on TV and radio, there are also new-school tactics such as email, Facebook, Twitter and more.
Schools can tap into their social networks. Take advantage of neighborhood associations.
The key is getting the communication going. Chace also recommends keeping conversations going with school leaders.
"Shoot a quick email to the superintendent to say you appreciate using the track," she said. "Let them know it's being used and that they are helping make a difference."
There's something else important to know. There are many variations of "shared use."
While the details could fill another column (or several), Chace offered these:
And while schools have been our main focus, Chace also emphasized that there are other options you can tap into to bring this concept to your community. Any business or church with a gym, large meeting room or even a big outdoor space could be options.
"I'm a true believer that exercise doesn't have to be done in a formal setting -- it can be any green space," she said. "Most communities have what we need. So ask yourself, 'How can I connect the pieces in my community that are already there to make the healthy choice the easy choice?'"
All it takes is a spark. Here's hoping World Heart Day 2015 can ignite you create a healthy heart environment.
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The first time in any situation can trigger all sorts of emotions. It can be exhilarating and exciting one minute, intimidating, nerve-wracking and overwhelming the next minute. Make it a situation you've been anticipating and those reactions can be even more extreme.
Now consider everything that surrounded Cullen Timmons' first day of working a rotation in the emergency room at Emory University Hospital in Atlanta.
He fell in love with science in middle school, even more in high school. He came to a bit of a crossroads in college when he worked in a lab and knew it wasn't right for him. He took the MCAT anyway and wound up at a great medical school. He soon realized medicine truly was his calling. Further affirmation came when he discovered his niche: not in a lab, obviously, but in the wonderfully unpredictable world of the ER.
So here he was in August 2014, with three years of medical school down and one to go, starting a trial run of his future.
That first day was a disaster. Timmons spent most of it sweating profusely and excusing himself to go throw up.
Understandable, right? This was a huge moment in both his career and his life.
As it turns out, his body was signaling that his life was in jeopardy. And if Timmons hadn't been a medical student, he probably would be dead right now.
He also told them about his other symptoms: a sharp pain that emanated from his chest to his arm and jaw.
Everyone recognized the classic symptoms of a heart attack. Yet in their ER training, they'd also been taught to factor in the patient's age (26), physical condition (top notch, as verified by a variety of tests he'd undergone throughout med school) and family history of heart problems (none). They agreed that the logical conclusion was something innocuous -- a poor reaction to stress or severe acid reflux, something Timmons had endured once or twice before.
Within days, Timmons felt confident that's all it was.
Back at University of Virginia's medical school, Timmons' final year was filled with electives. One he wanted to take was a two-week class called Advanced Physical Diagnosis.
Only, he didn't get in.
His roommate did.
Something came up and the roomie had to drop the course. Timmons snagged his pal's spot and found himself honing his stethoscope skills alongside two peers and Dr. Eugene Corbett.
Holding his stethoscope, Timmons remembered something: While at Emory, he'd detected a "really, really faint" murmur -- a swish after the second beat -- in his own heart. He'd never heard it any other time he'd listened to his heart, but it had seemed so minor that he'd put it out of his mind.
This time, Timmons heard the murmur a little louder.
"It could be something serious," Dr. Corbett said.
Timmons thought more about his recent health and came up with a few red flags.
He liked to go running and knew he'd been moving slower lately. Pain shot through his shoulder every now and then. His vision had become blurry.
Then again, he was still young, in good condition and had no family history of heart disease. Plus, all these things seemed attributable to the stress of a final-year med student trying to land a residency.
Dr. Corbett suggested they treat this as a teaching moment -- a chance to see how accurate their listening skills were compared to the results of an echocardiogram, a test that uses ultrasound waves to show what's happening with a heart. Coincidentally, he and Dr. Max Luna had been planning a comparison like this for the class.
Now, that lesson would take place sooner than expected.
Timmons had just finished an ultrasound course, so he had a good idea of what he was seeing.
Yet when his aorta appeared on the screen, it seemed way too big. What was supposed to look like a banana was more like a coffee cup.
"What's that?" Timmons said.
"We'll come back to that," Dr. Luna said.
Timmons went into the exam thinking he may have had a relatively common mutation involving his aortic valve. If so, he would've needed a new one, but probably not for many years, until problems became severe and frequent.
The exam showed something far worse.
His aorta had torn, probably on that first day in the Emory ER. The tear had gotten worse, causing a thoracic aortic aneurysm, a weakened artery wall in his aorta.
"I knew it was going to mean open-heart surgery," Timmons said. "And pretty quickly."
Imagine the ensuing phone call home:
Hi, Mom and Dad, I just helped make a potentially life-saving diagnosis of someone with a heart problem for the first time. And, uh, that patient is me.
Timmons explained that while it was a serious condition and a serious procedure, he was fortunate to have it discovered and should be fine following the operation. Amazingly, his sister is an aneurysm researcher, so she was able to navigate the family through it all.
The surgery was last Nov. 10, less than two weeks after the echocardiogram.
"Everyone in the room was looking at (his aneurysm) and just holding their breath," said Dr. Irving Kron, who performed the surgery. "This thing was a time bomb. It would not have been unusual for him to have dropped dead in a couple of weeks."
Being young and healthy, Timmons bounced back quickly.
Within months, he was working in the OR on an anesthesia rotation when he saw the same cardiothoracic team that had worked on him operating on someone else.
"So," he said, "I ducked in."
This was his first up-close look at a cardiac bypass machine -- a device that oxygenates the body while the heart is stopped so it can be operated on. Realizing he'd been hooked up to that device just a few months before was jarring. He was awed by the technology, the science and the expertise of everyone involved.
"It was amazing to watch, and certainly humbling," he said.
It also was pretty cool being able to thank the team, and to show them what a great job they'd done.
In March, he also showed his appreciation for the lifesaving research and advancements funded by the American Heart Association by sharing his story at the Heart Ball in Charlottesville, Virginia. The AHA funds more cardiovascular research than any organization outside the federal government, having invested more than $3.7 billion, including upwards of $100 million annually since 1996.
As he recovered, Timmons also pursued his residency. Those interviews had to be doozies.
He landed a three-year stint at Vanderbilt University Medical Center in Nashville, which he started July 1.
He launches his career with fascinating insight on what it's like to be a patient, something he thinks would benefit every new doctor.
"You see good habits you want to emulate, like the importance of communication and understanding how important empathy is," he said.
Timmons laughs off the notion that he's perhaps already made the best diagnosis of his career.
"The whole experience of facing your mortality certainly lights a fire under you," he said. "The scar under my scrubs is a good reminder to never take anything for granted."
Looking back, the white cheeks might've been the first clue.
Even when Gianna Schupler danced -- sometimes going for three or four hours straight -- her cheeks never turned beet red. That happened to the other girls, but never Gianna.
If anything, her usually pale complexion became paler -- "white as a ghost," she called it.
Nobody thought anything of it.
Not after the first time she passed out, at age 11. Or even the second.
It took four episodes before doctors uncovered that she'd been born with a rare heart problem. So at 14, she underwent open-heart surgery to correct it.
When Gianna awoke, her first words were, "Can I dance?"
And that's where the story of this teenager from Long Island, New York, really gets interesting.
As a first-grader, Gianna gave up soccer because it left her too dirty. Her mom suggested she try dancing. So Gianna tagged along to a friend's class.
Gianna had never been to that studio. The only person she knew there was her pal. Still, she felt right at home.
She tried all forms of dance -- lyrical, jazz, hip-hop -- yet tap became her thing. Others noticed how good she was, making Gianna like it even more.
Competitions began in fourth grade, solos in fifth grade. She loved it all.
Gianna switched studios in sixth grade, moving from an old-school, Broadway-esque style of tap to what she calls a hardcore percussion, "pure street" variety. She won her first crown that year, and that's when it dawned on her: "Wow, I could get somewhere with this if I keep practicing and pushing myself."
Gianna was in fifth grade the first time she passed out. It happened after a strenuous routine at the end of a 3-hour class.
Tests were inconclusive. Maybe she'd just been dehydrated.
It happened again in sixth grade, this time during a cardiovascular fitness test at school. Then again a few months later during a special performance: a duet with a 12th grader who'd spent her "senior wish" on dancing with Gianna.
She felt the telltale signs soon enough to avoid losing consciousness. Still, it was enough to crush her vow to "keep practicing and pushing myself."
For about two years, Gianna held back.
While she continued dancing and even added ballet, she never gave her all. And, sure enough, there were no more spells.
Were they connected? Or had she outgrown her problem?
She decided to find out on March 1, 2014.
"If you go full out today and it doesn't happen, it'll never happen again," she told herself.
She went so hard over 1.5 hours of ballet that she began to sweat -- something that almost never happened. Then she went to the dance studio and flung herself through an hour of tapping.
That's when the feeling hit. She stopped, walked to her water bottles, put her knees to her chest and passed out.
By this point, hospitals didn't faze Gianna.
Quite the opposite, she focused on the fun parts: the snacks, the big drinking jug she could take home and nurses so attentive that it was like flying in first class.
She went to a different hospital this time, and doctors took a different approach. They ran a new test that turned up something peculiar. They wouldn't let her check out until they resolved it.
They hooked her up to an IV that filled her veins with a liquid that would show up better on a CAT scan. Doctors then watched that liquid travel through her right coronary artery. On its way to her left coronary artery, the liquid made a wrong turn.
This explained why every time her heart rate went up, blood and oxygen became scarce.
That lack of blood and oxygen also explained her pale skin.
Gianna considered the diagnosis a relief.
"No more passing out, no more being scared to dance," she said. "No more blood tests and IVs to figure out what it is."
Yes, that was the plan. But first she had to endure open-heart surgery.
Gianna asked to wait a few months, until after school and competition season. She was overruled.
The surgery went well. She threw herself into recovery with the aim of getting back on the dance floor.
Then came even more motivation: Gianna's dance teacher reminded her that she'd already qualified for the Starbound National Dance Competition in mid-July.
That was still four months away.
In mid-May, Gianna underwent a stress test. Her mom was so sure she wouldn't pass it that she made a deal: If Gianna did pass, she could compete at Nationals.
Gianna passed all right, and the race was on.
Back in the studio, she remembered every step.
As she progressed, Gianna encountered some strange sensations.
The first was a thumping in her veins.
Healthy people know that happens when you work out. Gianna's unhealthy heart had never beat hard enough for her to feel that.
Then there was the time she finished dancing and looking in a mirror.
"My cheeks were all red and I started freaking out," she said. "Everyone else was like, `That's supposed to happen!' But it had never happened to me before.
"Little things like that make me happiest."
Gianna had been to nationals twice before. She'd never won, but always went home happy. She loved competing and the camaraderie of spending a week in Atlantic City, New Jersey, with her teammates and their families.
After all she'd been through, being there last July was a victory in itself.
Standing backstage before her tap solo, Gianna felt a burst of confidence knowing her heart could handle what she was about to do. To celebrate, she started a new pre-competition ritual: She kissed her right hand and ran it up her scar, then did it twice more.
What followed was the greatest performance of her life. That's no hyperbole. The first time she watched the video she thought, "Oh my gosh, I've never tapped like that before. I had a hunger for it. I was there to prove that I'm OK."
The judges agreed.
She won Miss Teen Starbound 2014.
A few days later, she competed in another Nationals event, the Miss Star of Hope, which benefits a charity for children battling cancer. All the performers open their routines by explaining why they've entered this event.
So Gianna told her story.
"I saw the judges' jaws drop in their seats," she said. "They were like, `This girl already won a title and she just had open-heart surgery?!'"
While the audience buzzed over her revelation, Gianna remained focused on the suffering kids.
It may be anti-climactic to note she won that crown.
"Miss Star of Hope is not as big as Miss Teen Starbound, but it meant more to me," she said. "When I won that, it was like: `This is complete.' I felt pure pride."
Over the last year, Gianna's health has continued to improve. She's also become more comfortable with her scar and the fact she's a survivor of a congenital heart defect.
In February, her story was featured at the American Heart Association's Go Red For Women Luncheon on Long Island. Her story has been told in her local media and she's had a surprise visit from Val Chmerkovskiy, the professional dancer who won the most recent "Dancing With the Stars" competition along with his partner Rumer Willis. Chmerkovskiy even talked of trying to get Gianna on the show.
This week, Gianna is back in Atlantic City defending her title as Miss Teen Starbound.
She qualified for Nationals using the same routine as last year's winner. It's retired now, replaced by a new routine. She learned it in June and after just two classes deemed it ready for the big stage.
She is not, however, competing again for Miss Star of Hope.
"I want to give someone else a chance to show why they are dancing," she said.
Still too young to drive a car, Gianna is a champion in so many ways. Part of that is being too humble to admit it.
Here's hoping the blush in her cheeks gives her away.
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