April 15, 2025 • 31 mins
Heart disease is the leading cause of death among American women, yet it frequently remains unrecognized, undiagnosed, and untreated.
In this episode of The Visibility Gap, Dr. Jen Ashton introduces you to Tiffany Storrs who shares her story of an unexpected bradycardia diagnosis and her struggle for validation by medical professionals.
Later, Dr. Alana Biggers and Dr. Margaret Rutherford delve into the emotional, physical, and systemic burdens of this critical health concern.
All Cigna Healthcare products and services are provided exclusively by or through operating subsidiaries of The Cigna Group. © 2025 Cigna Healthcare
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SPEAKER_02 (00:00):
Welcome to the Visibility Gap.
I'm Dr.
Jen Ashton.
Today we're talking about thenumber one killer of women in
America, heart disease.
It often goes under-recognized,under-diagnosed, and
under-treated.
But why?
(00:20):
For one, heart disease manifestsdifferently in women than it
does in men.
On top of that, symptoms arefrequently overlooked, Thank
you.
Thank you.
Thank you.
Thank you.
(00:47):
Heart disease has left its markon countless lives, and this
conversation is both a tributeto those affected and a beacon
of hope, offering actionableinsights that could protect so
many others.
So let's dive in.
We'll talk to some experts tohelp us understand the
emotional, physical, and overallsystemic strain of this silent
(01:08):
killer and what companies can dobetter.
Tiffany, thank you so much forbeing here to share your story.
I've heard a lot of unbelievablestories about women and heart
disease, but yours really jumpedout at me.
(01:30):
Yours started following yourpregnancy.
I would love it if you couldtake us through what your health
was like.
Let's start with your pregnancy.
SPEAKER_00 (01:42):
I grew up with great health for the first 30 years of
my life.
It wasn't till my husband and Istarted to try to start building
our own family that we realizedwe ran into some fertility
issues.
So after four years of tryingand being told, oh, just have a
(02:03):
glass of wine or you thinkyou're over processing it,
you're overthinking it, justrelax.
That didn't work.
Another four years went by andwe decided to see a fertility
specialist.
And thank goodness we didbecause that was where we really
needed to go.
Everything had been well upuntil that point.
(02:23):
And then life took an extremehard left for me.
Just two weeks postpartum afterthe birth of my daughter, I lost
all my hearing on one side.
And on top of that, I was beingdoubted that I was losing my
hearing.
In that time frame, quicklylooked for hearing aids.
(02:46):
I did a survival sign languageclass, anything to get up to
speed and acclimate.
And then since it had took somany years to conceive our
first, we started trying rightagain.
So we saw the fertilityspecialist and we did get
pregnant again.
And after the birth of mysecond, I lost, I went
(03:07):
bilaterally deaf.
I lost everything on the otherside as well.
So the timing was so bittersweetthat it correlated directly
after the birth of each child.
So at that point, I wascompletely deaf, a new mom,
trying to figure out why, andmore importantly, just how to
(03:29):
move forward.
And in that case, a cochlearimplant was the best sound
solution long term because ofhow profoundly deaf I had
become.
SPEAKER_02 (03:42):
You're a new mom and literally can't hear your infant
crying.
SPEAKER_00 (03:49):
It was horrific timing in terms of all the joys
that I had anticipated for solong.
And then I'm unable, like it'sunable to hear them.
It was just ripped away from me.
Two
SPEAKER_02 (04:05):
babies, two in diapers, completely deaf, going
for cochlear implants to rectifyyour sudden death.
dramatic hearing loss.
And incidentally, during thatprocedure, it's discovered that
you have profound bradycardia.
Which, as
SPEAKER_00 (04:25):
you know, is a very slow heart rate.
At the time, resting heart rate,30.
SPEAKER_02 (04:33):
Wow.
But for context, normal is 60 to100.
60 to 100.
Well-trained athletes can be inthe low 50s.
30 is a different category.
SPEAKER_00 (04:47):
And at the time, I was told it was attributed to my
very active lifestyle, which Ido indeed have.
I work out almost every day.
And yes, I like to considermyself healthy and fit.
And then Dr.
Jin and I also had to qualifythat because at the point, the
(05:08):
first cardiologist was saying,you've got a Lance Armstrong
heart.
That's great.
You're doing really well.
You look great.
It's fine if you're LanceArmstrong and winning six Tour
de France.
I didn't feel like LanceArmstrong.
I felt like I was living withthe flu every day.
I was tired.
(05:29):
So you were symptomatic.
SPEAKER_02 (05:30):
You were having symptoms, which is important.
So you're diagnosed with thisheart condition, this
arrhythmia.
Yes.
What comes next.
SPEAKER_00 (05:40):
And I'm told to go home, that I look very healthy,
that I've got this great LanceArmstrong heart.
Go right again.
Except it got progressive.
The bradycardia worsened.
And I insisted that I wasn'tfeeling right.
I really wasn't.
I went and got a second opinion.
(06:00):
And I'm grateful I did.
I did a Holter monitoring.
And that showed a little bit.
The mishap with that form oftesting is that it's very
short-term.
Two weeks is not long enough, Ifeel, to make a long-term heart
diagnosis.
It didn't capture theinformation that was true to my
(06:23):
heart and my heart's rhythm, atleast not for me.
Maybe other people have moresuccess with it, but...
I was sent home again.
Oh, it looks fine, just verylow.
And it was dipping into the 20seven at night.
So resting 30, nocturnally 20s.
And I was still complaining.
I just felt so bad.
I'm so tired
SPEAKER_02 (06:44):
at this point.
This is now what period of timehas elapsed that you've been
going through all this?
SPEAKER_00 (06:50):
About a year.
One
SPEAKER_02 (06:53):
year.
Yes.
(07:18):
was just not seeing you, was nothearing you, was not there for
you.
SPEAKER_00 (07:22):
Absolutely, especially at first when I
hadn't educated myself enoughabout the topic.
But I was questioned by mycardiologist if everything was
okay at home.
Was I having any maritalproblems?
Stress can trigger things.
How's my electrolyte level?
And behind the scenes, I wasfading away Literally.
(07:47):
So then the syncope startedhappening and I would pass out.
Which is fainting, right?
My children had found me beforeon the kitchen floor.
I would be rushed to theemergency room, being given
atropine, epi, you name it.
And it was during those hospitaltrips, which there was at least
(08:08):
five before the pacemaker wasinserted.
I would be Wow.
(08:36):
Ambulance comes to the house.
Everyone knows what's going on.
Neighbors would text, everythingokay again?
We see the ambulance thereagain.
Is Tiffany okay?
This was becoming normal.
And finally, a nurse in the ERsays, Tiffany, what are you
doing here again?
Like, what are
SPEAKER_02 (08:54):
you doing here again?
You had been to the emergencyroom so often that the nurse
knew you by name.
SPEAKER_00 (08:59):
Yes.
And she's like, yep, your bloodshows well.
elevated protein levels, proteinenzymes, you definitely had a
cardiac event.
ECG shows that, and I'm like,will somebody please take care
of me?
And so finally I go straightfrom the ER, like I'm not
(09:21):
released until, I think this wason this last final episode on
Saturday or Sunday, and I washeld there until the
cardiologist was in office onMonday.
And finally, He got on board,said, yeah, she's going to die.
This will take her if we don'timplant her.
(09:43):
But what was the holdup?
Like, I just don't understand.
In my gut, in the pit of mystomach, I knew I needed
something more.
I was passing out.
And one time even I had a, thankGod, nothing happened to me or
anyone else.
But I was feeling sick.
(10:03):
dizzy in my car.
I called 911.
I feel like I'm about to passout.
I said, just pull over.
I didn't even hear the rest ofit.
I was found on the side of theroad, car still in drive.
It was almost unbelievable tothink that I had just been
walking around like this andpeople, I kept saying like, you
guys have the information.
(10:24):
So finally a surgical Heartdevice was implanted in me like
one month before pacemaker.
It was designed to stay in forthree years to get the big, big
picture.
It only took like three days.
And they're like, get it out.
Get her in the OR.
How's your health today?
My health is great.
(10:44):
My health
SPEAKER_02 (10:45):
is great.
I feel reborn.
I mean, you know the databecause you're so active.
You're such an advocate in thisspace now that is powerful.
Very clear and it's verydisturbing.
A woman with the same symptoms,the same cardiac symptoms as a
man will wait longer in anemergency room setting for
(11:05):
treatment and will receive lessaggressive treatment than a man
with the same symptoms and thesame condition.
So the need for awareness,education, destigmatizing,
advocacy could not be greaterthan than it is right now.
And I really want to applaud youfor the work you're doing.
(11:27):
Tiffany, thank you so much forsharing your story.
I know that people learned somuch on so many different levels
from it.
Your heart Thank you.
What an incredibly powerfulstory.
(11:56):
I mean, to help us make sense ofwhat we've just heard, we have
an incredibly amazing andesteemed expert panel joining
us.
Dr.
Margaret Rutherford is aclinical psychologist with over
three decades of experience.
Welcome, Margaret.
(12:16):
Thank you so much.
And Dr.
Alana Biggers is an internalmedicine physician and public
health researcher dedicated toadvancing health equity and
improving chronic diseaseoutcomes.
She's an associate professor atthe University of Illinois
(12:36):
College of Medicine in Chicagoand special Thank you so much,
Alana, for being here.
Thank you.
Men versus women outcomes, theyare night and day different.
(13:00):
And women are suffering anddying as a result of it.
A woman with chest pain or signsof heart disease or a heart
attack who presents to anemergency room takes longer to
be seen.
When diagnosed with a heartattack, gets less aggressive
treatment than a man with thesame diagnosis and has a higher
(13:22):
risk of death following a heartattack than a man.
Why?
SPEAKER_01 (13:26):
Why?
That's a big question.
Why?
Unfortunately, there is ahistory in medicine where there
are gender biases.
You know, stemming, well, youknow, in terms of research,
we're not in clinical trials.
There was the FDA actuallybanned women from being in
clinical trials who were ofchild birthing age until 1993.
(13:52):
So there is a lag behind in theresearch on women in general.
So we just don't know.
You know, there's a lot ofresearch out there that we just
don't know.
Can I
SPEAKER_03 (14:02):
ask the two of you what
SPEAKER_02 (14:04):
reason was given for that?
Pregnancy concerns, medical,legal concerns about pregnancy.
But also it was, believe it ornot, a relatively new diagnosis
or discovery in science thatwomen and men are different on a
cellular level.
Every single cell is differentorganically.
(14:25):
Man versus woman.
So you can't say, well, thismedication has been tested in
men, therefore it must work inwomen, or this disease in men
looks like this, so therefore itmust look like the same in
women.
We know now that that's nottrue, and now we're playing
(14:52):
catch-up.
Okay.
SPEAKER_01 (14:57):
Absolutely.
There was a 2022 study thattalked about women differences
in heart disease, but they alsonoted there were differences in
communities of color, inparticular, Black African
American communities, too.
They're also less likely to getto the cath lab.
They're more likely to wait inthe waiting room.
(15:18):
They're less likely to get theaggressive treatments, too.
So there are areas where we needto play, as you said, catch up.
And
SPEAKER_02 (15:26):
it's not...
We should be clear.
It's not just that there's somejudgmental healthcare providers,
researchers, or cliniciansfailing to recognize heart
disease in women.
That may be the case, but it'salso even amongst women doctors.
Yeah.
Wow.
(16:07):
in men, that's not the case.
It's not the same pathology inwomen.
So women can have relativelyclean or clear coronary arteries
and still have symptoms ofischemia or heart attack.
So it's really, yeah, it's thesame organ, but we have to
almost look at it like acompletely different illness
(16:28):
when you're talking about womenversus men.
But Margaret, I want to ask youropinion on something that
Tiffany said, which I thoughtwas so powerful.
When she was asked, as she washaving repetitive symptoms, is
everything okay at home?
Are you, maybe you're anxious.
I cringed when I heard that.
(16:51):
I mean, first of all, good toask, right?
That's important to ask.
But I almost got the feelingthat it was the default
assumption that Like you needattention.
SPEAKER_03 (17:02):
You come to the ER for attention.
I understand that.
Pat you on the knee kind ofthing.
And it is, yeah, it's egregious.
I mean, I agree with you forsomeone to say, I want to make
sure that, you know, if thiswould be the place to tell me if
you're being abused in some wayor if you are up against
(17:23):
circumstances that areoverwhelming at home, maybe
that's playing out in yourphysical being.
But at the same time, even– Imean, I'm not a medical doctor.
From what she was saying, it'sso striking to me that she was
ignored.
SPEAKER_02 (17:41):
I
SPEAKER_03 (17:41):
want to ask
SPEAKER_02 (17:41):
you about another concept of multiple truths,
which is she got a diagnosis, soshe knew it was real.
But the subsequent anxiety orfear that comes along with a
diagnosis, while at the sametime also she– expressed relief.
(18:02):
Oh, finally, I've beenvalidated.
I have a diagnosis.
What's your advice for someonewhen they have actually had
something happen that may or maynot be traumatic, it's real,
medical event, and then theyhave subsequent fear or anxiety,
in many cases appropriately so,after that?
SPEAKER_03 (18:23):
You just said my answer, which was...
We have tended to think ofanxiety as something that you
must get rid of.
That's a terrible kind ofemotion.
And yet some anxiety is verynormal.
And protective.
And protective and part of thegrieving process and part of the
ability to sort of begin toweave this into the reality of
(18:45):
your life.
And that takes some energy andtakes some...
Again, and facing, challengingthat anxiety and said, okay, so
now you're a part of my life.
How can I, use the term before,regulate you rather than you
overwhelming me?
So journaling, talking tofriends about it, joining
(19:10):
support groups, all that kind ofthing can be very helpful
because you realize other peopleare just as anxious as I am.
Alana,
SPEAKER_02 (19:18):
so much of your research is in health equity and
health disparities.
Do you think, if you were togive us a report card right now,
women and heart disease, what'sour grade?
See,
SPEAKER_01 (19:32):
maybe?
I would agree with you.
Yeah.
SPEAKER_02 (19:36):
What can be done better?
What
SPEAKER_01 (19:44):
can we improve upon?
(20:07):
some type of professionaldevelopment that, you know,
people in my generation andolder need in that regard.
So there are people who get it,and unfortunately, there are
people who not necessarily, theydon't get it.
So raising awareness in thatgroup is helpful, like the Go
Red for Women campaign, too.
SPEAKER_02 (20:27):
By the way, this was a coincidence that I was wearing
this.
But you're right.
Go Red for Women has done anincredible job in increasing
awareness.
So you talked about what can bedone in terms of medical
education and in health care.
What about in the workplace?
What can be done to bridge thisgap, specifically when you talk
about women and heart disease?
SPEAKER_01 (20:47):
I want to say also awareness campaigns, you know,
having health fairs, again,where you're, you know, checking
blood pressures on people.
I've had a number of patientscome in to me who said, I was
at, you know, this workplacehealth fair.
They checked my blood pressureand it was high.
And it was the first time thatanyone's ever told me that.
So, doc, what do I do?
(21:09):
So just create an environmentwhere, you know, health is a
priority.
I think that is important.
what is needed and actuallypromoting that throughout your,
you know, with your employeesand they'll appreciate
SPEAKER_02 (21:25):
that.
So,
SPEAKER_00 (21:26):
yeah.
SPEAKER_02 (21:26):
You may have heard the saying, Margaret, in medical
school, a very common sayingthat we're taught a lot is when
we study pediatrics, there's asaying, children are not little
adults.
And I would say now, Women arenot small men.
Yes, exactly.
So when you look specifically atheart disease...
(21:47):
Let's do a little bit of a minimed school on what are the tests
or are there special tests thatyou recommend to your patients
who are women that they shouldbe asking for or know about when
it comes to their heart health?
SPEAKER_01 (22:17):
Okay, what's that?
It's inflammation marker.
You know everything has a letterin medicine.
Yeah, exactly.
That's an inflammation marker inyour body.
And the combination of thosethree can actually predict in
the future your cardiovascularrisk, not just men, but in women
as well.
And,
SPEAKER_02 (22:35):
you know, I think the other thing that so few
women...
or even, sadly, providers knowabout, or workplace health
resources, is the connection nowbetween a woman's reproductive
health, OBGYN conditions, andrisk factors for heart disease.
And in OBGYN, we consider anumber of pregnancy
(22:59):
complications, literally failedstress tests for heart disease.
High blood pressure duringpregnancy, gestational diabetes,
a placental abruption, a pretermbirth, all of those things are
usually siloed, right?
Because you have young,generally healthy women who may
(23:20):
be seeing their healthcareprovider, their OBGYN, their
midwife, who just is thinkingpregnancy, pregnancy, pregnancy,
pregnancy.
and they don't think five, 10,20 years down the road, those
pregnancy complications are riskfactors for heart disease at an
earlier age as well as in thefuture, as well as some GYN
(23:41):
conditions like polycysticovarian syndrome, metabolic
syndrome.
So I think from my specialty,OBGYN, one hand has to talk to
the other.
And we have to stop waiting forwomen to become statistics and
become much more proactive.
And we know the statistics, notto be grim.
(24:02):
One out of three women willbecome a statistic for heart
disease.
There are three of us sittinghere.
I have heart disease, so thereyou go.
And by the way, everyone thinksit won't be them.
Everyone thinks, well, not me.
But the good news is 80% ofheart disease is preventable.
But as you say, it starts withthat awareness, which is so
(24:25):
important.
I think you bring up
SPEAKER_03 (24:27):
such an interesting point that I'll just give you a
quick example.
I went to my last cardiologyappointment and I had
interviewed someone that was ahormone replacement,
bioidentical hormone replacementspecialist.
And I was asking him somequestions about it.
And he looked at me and he Oh,we leave hormones up to the
OBGYNs.
(24:49):
And I thought...
Wrong answer.
What?
And so, you know, I do thinkI...
I love that in my part of thecountry, one of the members of
the Walton family has startedthis medical school that's going
to be holistic, that's not goingto be so siloed.
At least that's the promise, andthe training will be different.
(25:12):
Again, I'm not in yourprofession, but I think it's
such a good thing.
Direction to go and let'sinclude mental health in there.
SPEAKER_02 (25:20):
How about that?
That would be what a novelconcept.
Yeah, that would be amazing.
What about, you know, we heardin Tiffany's story, obviously,
the emotional, the physical tollthat this has taken on her.
there's a real financial toll toindividuals, to women in
particular, both in theworkforce and in their family
(25:42):
unit, medical bills, lost daysof work, sick time, et cetera,
et cetera.
Do you think that's justsomething people are not aware
of or they don't want to facethat reality or don't want to
talk about it?
I
SPEAKER_01 (25:54):
feel like they're probably not aware of it.
I feel like You know, you're notin it until you're in it.
And then once it becomes areality, it's like, whoa.
You know, when you start off,you're like, oh, I have health
insurance.
This will be fine.
You know, and then people getsick and then they see their
health insurance.
The bills still come, you know,deductibles, et cetera.
(26:16):
But then it's like you said, thelost productivity, the home life
is affected, all of thosethings.
That's
SPEAKER_03 (26:22):
what I was going to say.
And the loss of time with thosetwo children,
SPEAKER_00 (26:25):
you know,
SPEAKER_03 (26:25):
and her having to, you know, Do you feel, Margaret,
like
SPEAKER_02 (26:35):
there's something more loaded or charged with
heart issues and mental health?
SPEAKER_03 (26:42):
Yes.
because actually what is fairlygeneral knowledge, and this is
not going to come as anysurprise to the two of you, but
it is very common to deal withdepression and anxiety with
heart disease and brain issues,neurological problems.
You know, they're so primal tous being able to function in
(27:03):
life.
And so, yes, I mean, there is amuch heavier load when you've
got something wrong with yourheart or your brain.
And I see that a lot withpeople.
They'll have heart issues andthey'll get depressed or highly
anxious.
And I don't see as much of theneurological simply because of
the nature of my practice, butI've seen a good deal of the
(27:24):
cardiological problems.
And of course, most
SPEAKER_02 (27:27):
people have heard of broken heart syndrome, which is
an actual medical entity.
But I think it speaks to justhow important the heart is To
our overall well-being, and I'mnot talking just physically, but
again, really connecting thedots holistically, you know, for
(27:49):
so much of Tiffany's journey,she literally was, ironically,
she couldn't hear, but she wasnot seen.
She felt invisible along herjourney in getting a diagnosis
and even being validated forwhat she was going through and
how terrifying it was.
that was for her.
(28:10):
You said you would hope that thehealthcare providers would be
questioning themselves andsaying, what did I miss?
What could I do differently?
But that onus of responsibilityis pretty obvious on the
healthcare professionals withthe body of knowledge.
What would your advice be tosomeone going through a heart
issue who doesn't feelvalidated, who doesn't feel seen
(28:32):
the way that they need to?
Keep on going
SPEAKER_03 (28:35):
to other professionals.
I mean, get a second opinion.
Get a third opinion.
Get a fourth opinion if you needit.
Now, is that costly?
Yes.
And time-consuming.
And time-consuming.
And, you know, again, you'redealing with your heart.
And so, you know, what kind oftime do you have?
I mean, she said she was down to20 beats a minute.
Yeah.
(28:56):
And so, you know, it's sofrightening.
It's ridiculous.
But I do think that it's findingsomeone who does listen to you
is so important.
I think therapy is the same way.
Some therapists will just kindof pat you on the knee and go,
oh, well, that sounds terrible.
See you next week.
Rather than actually listeningto you and trying to understand
(29:17):
the impact of what you'refeeling on your life outside of
a therapy session.
SPEAKER_01 (29:22):
And unfortunately, it's not an isolated incident
with her story, Eve.
I mean, there are studies thatsay that anywhere I've read,
20%, even in the UK, they said80% of women reported that they
felt dismissed by their healthcare provider.
So this is something that is abigger problem.
The majority.
Yeah.
SPEAKER_02 (29:41):
And we should mention this is not necessarily
directed or blamed at malehealth care providers.
They could feel unseen, unheard.
unvalidated even sadly by otherwomen healthcare professionals.
So I think Tiffany's story, wow,I mean, so powerful.
So many people.
younger women, younger womenwith heart disease, younger
(30:04):
women after pregnancy, healthcare providers all have
something to learn from herstory.
And you can tell she
SPEAKER_03 (30:13):
still feels it very, very deeply.
I mean, the hurt done to her andthe invisibility, to use your
word, and just the peoplelooking at her and saying, well,
you know, this is in your heador...
Are you, how is it at home?
You know, it was just such adismissal of what was going on
SPEAKER_02 (30:33):
with her.
It took a lot of bravery for herto just relive that.
But thank you both so much foryour insights and for the
thoughtful questions.
I think sometimes Complicatedissues don't always have a
simple answer.
Sometimes the smart thing isreally to raise questions.
And I really appreciate thequestions you both brought to
(30:54):
this discussion.
It was so helpful.
So thank you.
Thank you.
We hope this episode of TheVisibility Gap has helped you
and your loved ones feel seenand empowered.
If you found it valuable, pleasedon't forget to share it, like
it, and subscribe to stayconnected with us.
Your support truly makes all thedifference.
UNKNOWN (31:15):
Thank you.
you
Welcome to the Visibility Gap.
I'm Dr.
Jen Ashton.
Today we're talking about thenumber one killer of women in
America, heart disease.
It often goes under-recognized,under-diagnosed, and
under-treated.
But why?
(00:20):
For one, heart disease manifestsdifferently in women than it
does in men.
On top of that, symptoms arefrequently overlooked, Thank
you.
Thank you.
Thank you.
Thank you.
(00:47):
Heart disease has left its markon countless lives, and this
conversation is both a tributeto those affected and a beacon
of hope, offering actionableinsights that could protect so
many others.
So let's dive in.
We'll talk to some experts tohelp us understand the
emotional, physical, and overallsystemic strain of this silent
(01:08):
killer and what companies can dobetter.
Tiffany, thank you so much forbeing here to share your story.
I've heard a lot of unbelievablestories about women and heart
disease, but yours really jumpedout at me.
(01:30):
Yours started following yourpregnancy.
I would love it if you couldtake us through what your health
was like.
Let's start with your pregnancy.
SPEAKER_00 (01:42):
I grew up with great health for the first 30 years of
my life.
It wasn't till my husband and Istarted to try to start building
our own family that we realizedwe ran into some fertility
issues.
So after four years of tryingand being told, oh, just have a
(02:03):
glass of wine or you thinkyou're over processing it,
you're overthinking it, justrelax.
That didn't work.
Another four years went by andwe decided to see a fertility
specialist.
And thank goodness we didbecause that was where we really
needed to go.
Everything had been well upuntil that point.
(02:23):
And then life took an extremehard left for me.
Just two weeks postpartum afterthe birth of my daughter, I lost
all my hearing on one side.
And on top of that, I was beingdoubted that I was losing my
hearing.
In that time frame, quicklylooked for hearing aids.
(02:46):
I did a survival sign languageclass, anything to get up to
speed and acclimate.
And then since it had took somany years to conceive our
first, we started trying rightagain.
So we saw the fertilityspecialist and we did get
pregnant again.
And after the birth of mysecond, I lost, I went
(03:07):
bilaterally deaf.
I lost everything on the otherside as well.
So the timing was so bittersweetthat it correlated directly
after the birth of each child.
So at that point, I wascompletely deaf, a new mom,
trying to figure out why, andmore importantly, just how to
(03:29):
move forward.
And in that case, a cochlearimplant was the best sound
solution long term because ofhow profoundly deaf I had
become.
SPEAKER_02 (03:42):
You're a new mom and literally can't hear your infant
crying.
SPEAKER_00 (03:49):
It was horrific timing in terms of all the joys
that I had anticipated for solong.
And then I'm unable, like it'sunable to hear them.
It was just ripped away from me.
Two
SPEAKER_02 (04:05):
babies, two in diapers, completely deaf, going
for cochlear implants to rectifyyour sudden death.
dramatic hearing loss.
And incidentally, during thatprocedure, it's discovered that
you have profound bradycardia.
Which, as
SPEAKER_00 (04:25):
you know, is a very slow heart rate.
At the time, resting heart rate,30.
SPEAKER_02 (04:33):
Wow.
But for context, normal is 60 to100.
60 to 100.
Well-trained athletes can be inthe low 50s.
30 is a different category.
SPEAKER_00 (04:47):
And at the time, I was told it was attributed to my
very active lifestyle, which Ido indeed have.
I work out almost every day.
And yes, I like to considermyself healthy and fit.
And then Dr.
Jin and I also had to qualifythat because at the point, the
(05:08):
first cardiologist was saying,you've got a Lance Armstrong
heart.
That's great.
You're doing really well.
You look great.
It's fine if you're LanceArmstrong and winning six Tour
de France.
I didn't feel like LanceArmstrong.
I felt like I was living withthe flu every day.
I was tired.
(05:29):
So you were symptomatic.
SPEAKER_02 (05:30):
You were having symptoms, which is important.
So you're diagnosed with thisheart condition, this
arrhythmia.
Yes.
What comes next.
SPEAKER_00 (05:40):
And I'm told to go home, that I look very healthy,
that I've got this great LanceArmstrong heart.
Go right again.
Except it got progressive.
The bradycardia worsened.
And I insisted that I wasn'tfeeling right.
I really wasn't.
I went and got a second opinion.
(06:00):
And I'm grateful I did.
I did a Holter monitoring.
And that showed a little bit.
The mishap with that form oftesting is that it's very
short-term.
Two weeks is not long enough, Ifeel, to make a long-term heart
diagnosis.
It didn't capture theinformation that was true to my
(06:23):
heart and my heart's rhythm, atleast not for me.
Maybe other people have moresuccess with it, but...
I was sent home again.
Oh, it looks fine, just verylow.
And it was dipping into the 20seven at night.
So resting 30, nocturnally 20s.
And I was still complaining.
I just felt so bad.
I'm so tired
SPEAKER_02 (06:44):
at this point.
This is now what period of timehas elapsed that you've been
going through all this?
SPEAKER_00 (06:50):
About a year.
One
SPEAKER_02 (06:53):
year.
Yes.
(07:18):
was just not seeing you, was nothearing you, was not there for
you.
SPEAKER_00 (07:22):
Absolutely, especially at first when I
hadn't educated myself enoughabout the topic.
But I was questioned by mycardiologist if everything was
okay at home.
Was I having any maritalproblems?
Stress can trigger things.
How's my electrolyte level?
And behind the scenes, I wasfading away Literally.
(07:47):
So then the syncope startedhappening and I would pass out.
Which is fainting, right?
My children had found me beforeon the kitchen floor.
I would be rushed to theemergency room, being given
atropine, epi, you name it.
And it was during those hospitaltrips, which there was at least
(08:08):
five before the pacemaker wasinserted.
I would be Wow.
(08:36):
Ambulance comes to the house.
Everyone knows what's going on.
Neighbors would text, everythingokay again?
We see the ambulance thereagain.
Is Tiffany okay?
This was becoming normal.
And finally, a nurse in the ERsays, Tiffany, what are you
doing here again?
Like, what are
SPEAKER_02 (08:54):
you doing here again?
You had been to the emergencyroom so often that the nurse
knew you by name.
SPEAKER_00 (08:59):
Yes.
And she's like, yep, your bloodshows well.
elevated protein levels, proteinenzymes, you definitely had a
cardiac event.
ECG shows that, and I'm like,will somebody please take care
of me?
And so finally I go straightfrom the ER, like I'm not
(09:21):
released until, I think this wason this last final episode on
Saturday or Sunday, and I washeld there until the
cardiologist was in office onMonday.
And finally, He got on board,said, yeah, she's going to die.
This will take her if we don'timplant her.
(09:43):
But what was the holdup?
Like, I just don't understand.
In my gut, in the pit of mystomach, I knew I needed
something more.
I was passing out.
And one time even I had a, thankGod, nothing happened to me or
anyone else.
But I was feeling sick.
(10:03):
dizzy in my car.
I called 911.
I feel like I'm about to passout.
I said, just pull over.
I didn't even hear the rest ofit.
I was found on the side of theroad, car still in drive.
It was almost unbelievable tothink that I had just been
walking around like this andpeople, I kept saying like, you
guys have the information.
(10:24):
So finally a surgical Heartdevice was implanted in me like
one month before pacemaker.
It was designed to stay in forthree years to get the big, big
picture.
It only took like three days.
And they're like, get it out.
Get her in the OR.
How's your health today?
My health is great.
(10:44):
My health
SPEAKER_02 (10:45):
is great.
I feel reborn.
I mean, you know the databecause you're so active.
You're such an advocate in thisspace now that is powerful.
Very clear and it's verydisturbing.
A woman with the same symptoms,the same cardiac symptoms as a
man will wait longer in anemergency room setting for
(11:05):
treatment and will receive lessaggressive treatment than a man
with the same symptoms and thesame condition.
So the need for awareness,education, destigmatizing,
advocacy could not be greaterthan than it is right now.
And I really want to applaud youfor the work you're doing.
(11:27):
Tiffany, thank you so much forsharing your story.
I know that people learned somuch on so many different levels
from it.
Your heart Thank you.
What an incredibly powerfulstory.
(11:56):
I mean, to help us make sense ofwhat we've just heard, we have
an incredibly amazing andesteemed expert panel joining
us.
Dr.
Margaret Rutherford is aclinical psychologist with over
three decades of experience.
Welcome, Margaret.
(12:16):
Thank you so much.
And Dr.
Alana Biggers is an internalmedicine physician and public
health researcher dedicated toadvancing health equity and
improving chronic diseaseoutcomes.
She's an associate professor atthe University of Illinois
(12:36):
College of Medicine in Chicagoand special Thank you so much,
Alana, for being here.
Thank you.
Men versus women outcomes, theyare night and day different.
(13:00):
And women are suffering anddying as a result of it.
A woman with chest pain or signsof heart disease or a heart
attack who presents to anemergency room takes longer to
be seen.
When diagnosed with a heartattack, gets less aggressive
treatment than a man with thesame diagnosis and has a higher
(13:22):
risk of death following a heartattack than a man.
Why?
SPEAKER_01 (13:26):
Why?
That's a big question.
Why?
Unfortunately, there is ahistory in medicine where there
are gender biases.
You know, stemming, well, youknow, in terms of research,
we're not in clinical trials.
There was the FDA actuallybanned women from being in
clinical trials who were ofchild birthing age until 1993.
(13:52):
So there is a lag behind in theresearch on women in general.
So we just don't know.
You know, there's a lot ofresearch out there that we just
don't know.
Can I
SPEAKER_03 (14:02):
ask the two of you what
SPEAKER_02 (14:04):
reason was given for that?
Pregnancy concerns, medical,legal concerns about pregnancy.
But also it was, believe it ornot, a relatively new diagnosis
or discovery in science thatwomen and men are different on a
cellular level.
Every single cell is differentorganically.
(14:25):
Man versus woman.
So you can't say, well, thismedication has been tested in
men, therefore it must work inwomen, or this disease in men
looks like this, so therefore itmust look like the same in
women.
We know now that that's nottrue, and now we're playing
(14:52):
catch-up.
Okay.
SPEAKER_01 (14:57):
Absolutely.
There was a 2022 study thattalked about women differences
in heart disease, but they alsonoted there were differences in
communities of color, inparticular, Black African
American communities, too.
They're also less likely to getto the cath lab.
They're more likely to wait inthe waiting room.
(15:18):
They're less likely to get theaggressive treatments, too.
So there are areas where we needto play, as you said, catch up.
And
SPEAKER_02 (15:26):
it's not...
We should be clear.
It's not just that there's somejudgmental healthcare providers,
researchers, or cliniciansfailing to recognize heart
disease in women.
That may be the case, but it'salso even amongst women doctors.
Yeah.
Wow.
(16:07):
in men, that's not the case.
It's not the same pathology inwomen.
So women can have relativelyclean or clear coronary arteries
and still have symptoms ofischemia or heart attack.
So it's really, yeah, it's thesame organ, but we have to
almost look at it like acompletely different illness
(16:28):
when you're talking about womenversus men.
But Margaret, I want to ask youropinion on something that
Tiffany said, which I thoughtwas so powerful.
When she was asked, as she washaving repetitive symptoms, is
everything okay at home?
Are you, maybe you're anxious.
I cringed when I heard that.
(16:51):
I mean, first of all, good toask, right?
That's important to ask.
But I almost got the feelingthat it was the default
assumption that Like you needattention.
SPEAKER_03 (17:02):
You come to the ER for attention.
I understand that.
Pat you on the knee kind ofthing.
And it is, yeah, it's egregious.
I mean, I agree with you forsomeone to say, I want to make
sure that, you know, if thiswould be the place to tell me if
you're being abused in some wayor if you are up against
(17:23):
circumstances that areoverwhelming at home, maybe
that's playing out in yourphysical being.
But at the same time, even– Imean, I'm not a medical doctor.
From what she was saying, it'sso striking to me that she was
ignored.
SPEAKER_02 (17:41):
I
SPEAKER_03 (17:41):
want to ask
SPEAKER_02 (17:41):
you about another concept of multiple truths,
which is she got a diagnosis, soshe knew it was real.
But the subsequent anxiety orfear that comes along with a
diagnosis, while at the sametime also she– expressed relief.
(18:02):
Oh, finally, I've beenvalidated.
I have a diagnosis.
What's your advice for someonewhen they have actually had
something happen that may or maynot be traumatic, it's real,
medical event, and then theyhave subsequent fear or anxiety,
in many cases appropriately so,after that?
SPEAKER_03 (18:23):
You just said my answer, which was...
We have tended to think ofanxiety as something that you
must get rid of.
That's a terrible kind ofemotion.
And yet some anxiety is verynormal.
And protective.
And protective and part of thegrieving process and part of the
ability to sort of begin toweave this into the reality of
(18:45):
your life.
And that takes some energy andtakes some...
Again, and facing, challengingthat anxiety and said, okay, so
now you're a part of my life.
How can I, use the term before,regulate you rather than you
overwhelming me?
So journaling, talking tofriends about it, joining
(19:10):
support groups, all that kind ofthing can be very helpful
because you realize other peopleare just as anxious as I am.
Alana,
SPEAKER_02 (19:18):
so much of your research is in health equity and
health disparities.
Do you think, if you were togive us a report card right now,
women and heart disease, what'sour grade?
See,
SPEAKER_01 (19:32):
maybe?
I would agree with you.
Yeah.
SPEAKER_02 (19:36):
What can be done better?
What
SPEAKER_01 (19:44):
can we improve upon?
(20:07):
some type of professionaldevelopment that, you know,
people in my generation andolder need in that regard.
So there are people who get it,and unfortunately, there are
people who not necessarily, theydon't get it.
So raising awareness in thatgroup is helpful, like the Go
Red for Women campaign, too.
SPEAKER_02 (20:27):
By the way, this was a coincidence that I was wearing
this.
But you're right.
Go Red for Women has done anincredible job in increasing
awareness.
So you talked about what can bedone in terms of medical
education and in health care.
What about in the workplace?
What can be done to bridge thisgap, specifically when you talk
about women and heart disease?
SPEAKER_01 (20:47):
I want to say also awareness campaigns, you know,
having health fairs, again,where you're, you know, checking
blood pressures on people.
I've had a number of patientscome in to me who said, I was
at, you know, this workplacehealth fair.
They checked my blood pressureand it was high.
And it was the first time thatanyone's ever told me that.
So, doc, what do I do?
(21:09):
So just create an environmentwhere, you know, health is a
priority.
I think that is important.
what is needed and actuallypromoting that throughout your,
you know, with your employeesand they'll appreciate
SPEAKER_02 (21:25):
that.
So,
SPEAKER_00 (21:26):
yeah.
SPEAKER_02 (21:26):
You may have heard the saying, Margaret, in medical
school, a very common sayingthat we're taught a lot is when
we study pediatrics, there's asaying, children are not little
adults.
And I would say now, Women arenot small men.
Yes, exactly.
So when you look specifically atheart disease...
(21:47):
Let's do a little bit of a minimed school on what are the tests
or are there special tests thatyou recommend to your patients
who are women that they shouldbe asking for or know about when
it comes to their heart health?
SPEAKER_01 (22:17):
Okay, what's that?
It's inflammation marker.
You know everything has a letterin medicine.
Yeah, exactly.
That's an inflammation marker inyour body.
And the combination of thosethree can actually predict in
the future your cardiovascularrisk, not just men, but in women
as well.
And,
SPEAKER_02 (22:35):
you know, I think the other thing that so few
women...
or even, sadly, providers knowabout, or workplace health
resources, is the connection nowbetween a woman's reproductive
health, OBGYN conditions, andrisk factors for heart disease.
And in OBGYN, we consider anumber of pregnancy
(22:59):
complications, literally failedstress tests for heart disease.
High blood pressure duringpregnancy, gestational diabetes,
a placental abruption, a pretermbirth, all of those things are
usually siloed, right?
Because you have young,generally healthy women who may
(23:20):
be seeing their healthcareprovider, their OBGYN, their
midwife, who just is thinkingpregnancy, pregnancy, pregnancy,
pregnancy.
and they don't think five, 10,20 years down the road, those
pregnancy complications are riskfactors for heart disease at an
earlier age as well as in thefuture, as well as some GYN
(23:41):
conditions like polycysticovarian syndrome, metabolic
syndrome.
So I think from my specialty,OBGYN, one hand has to talk to
the other.
And we have to stop waiting forwomen to become statistics and
become much more proactive.
And we know the statistics, notto be grim.
(24:02):
One out of three women willbecome a statistic for heart
disease.
There are three of us sittinghere.
I have heart disease, so thereyou go.
And by the way, everyone thinksit won't be them.
Everyone thinks, well, not me.
But the good news is 80% ofheart disease is preventable.
But as you say, it starts withthat awareness, which is so
(24:25):
important.
I think you bring up
SPEAKER_03 (24:27):
such an interesting point that I'll just give you a
quick example.
I went to my last cardiologyappointment and I had
interviewed someone that was ahormone replacement,
bioidentical hormone replacementspecialist.
And I was asking him somequestions about it.
And he looked at me and he Oh,we leave hormones up to the
OBGYNs.
(24:49):
And I thought...
Wrong answer.
What?
And so, you know, I do thinkI...
I love that in my part of thecountry, one of the members of
the Walton family has startedthis medical school that's going
to be holistic, that's not goingto be so siloed.
At least that's the promise, andthe training will be different.
(25:12):
Again, I'm not in yourprofession, but I think it's
such a good thing.
Direction to go and let'sinclude mental health in there.
SPEAKER_02 (25:20):
How about that?
That would be what a novelconcept.
Yeah, that would be amazing.
What about, you know, we heardin Tiffany's story, obviously,
the emotional, the physical tollthat this has taken on her.
there's a real financial toll toindividuals, to women in
particular, both in theworkforce and in their family
(25:42):
unit, medical bills, lost daysof work, sick time, et cetera,
et cetera.
Do you think that's justsomething people are not aware
of or they don't want to facethat reality or don't want to
talk about it?
I
SPEAKER_01 (25:54):
feel like they're probably not aware of it.
I feel like You know, you're notin it until you're in it.
And then once it becomes areality, it's like, whoa.
You know, when you start off,you're like, oh, I have health
insurance.
This will be fine.
You know, and then people getsick and then they see their
health insurance.
The bills still come, you know,deductibles, et cetera.
(26:16):
But then it's like you said, thelost productivity, the home life
is affected, all of thosethings.
That's
SPEAKER_03 (26:22):
what I was going to say.
And the loss of time with thosetwo children,
SPEAKER_00 (26:25):
you know,
SPEAKER_03 (26:25):
and her having to, you know, Do you feel, Margaret,
like
SPEAKER_02 (26:35):
there's something more loaded or charged with
heart issues and mental health?
SPEAKER_03 (26:42):
Yes.
because actually what is fairlygeneral knowledge, and this is
not going to come as anysurprise to the two of you, but
it is very common to deal withdepression and anxiety with
heart disease and brain issues,neurological problems.
You know, they're so primal tous being able to function in
(27:03):
life.
And so, yes, I mean, there is amuch heavier load when you've
got something wrong with yourheart or your brain.
And I see that a lot withpeople.
They'll have heart issues andthey'll get depressed or highly
anxious.
And I don't see as much of theneurological simply because of
the nature of my practice, butI've seen a good deal of the
(27:24):
cardiological problems.
And of course, most
SPEAKER_02 (27:27):
people have heard of broken heart syndrome, which is
an actual medical entity.
But I think it speaks to justhow important the heart is To
our overall well-being, and I'mnot talking just physically, but
again, really connecting thedots holistically, you know, for
(27:49):
so much of Tiffany's journey,she literally was, ironically,
she couldn't hear, but she wasnot seen.
She felt invisible along herjourney in getting a diagnosis
and even being validated forwhat she was going through and
how terrifying it was.
that was for her.
(28:10):
You said you would hope that thehealthcare providers would be
questioning themselves andsaying, what did I miss?
What could I do differently?
But that onus of responsibilityis pretty obvious on the
healthcare professionals withthe body of knowledge.
What would your advice be tosomeone going through a heart
issue who doesn't feelvalidated, who doesn't feel seen
(28:32):
the way that they need to?
Keep on going
SPEAKER_03 (28:35):
to other professionals.
I mean, get a second opinion.
Get a third opinion.
Get a fourth opinion if you needit.
Now, is that costly?
Yes.
And time-consuming.
And time-consuming.
And, you know, again, you'redealing with your heart.
And so, you know, what kind oftime do you have?
I mean, she said she was down to20 beats a minute.
Yeah.
(28:56):
And so, you know, it's sofrightening.
It's ridiculous.
But I do think that it's findingsomeone who does listen to you
is so important.
I think therapy is the same way.
Some therapists will just kindof pat you on the knee and go,
oh, well, that sounds terrible.
See you next week.
Rather than actually listeningto you and trying to understand
(29:17):
the impact of what you'refeeling on your life outside of
a therapy session.
SPEAKER_01 (29:22):
And unfortunately, it's not an isolated incident
with her story, Eve.
I mean, there are studies thatsay that anywhere I've read,
20%, even in the UK, they said80% of women reported that they
felt dismissed by their healthcare provider.
So this is something that is abigger problem.
The majority.
Yeah.
SPEAKER_02 (29:41):
And we should mention this is not necessarily
directed or blamed at malehealth care providers.
They could feel unseen, unheard.
unvalidated even sadly by otherwomen healthcare professionals.
So I think Tiffany's story, wow,I mean, so powerful.
So many people.
younger women, younger womenwith heart disease, younger
(30:04):
women after pregnancy, healthcare providers all have
something to learn from herstory.
And you can tell she
SPEAKER_03 (30:13):
still feels it very, very deeply.
I mean, the hurt done to her andthe invisibility, to use your
word, and just the peoplelooking at her and saying, well,
you know, this is in your heador...
Are you, how is it at home?
You know, it was just such adismissal of what was going on
SPEAKER_02 (30:33):
with her.
It took a lot of bravery for herto just relive that.
But thank you both so much foryour insights and for the
thoughtful questions.
I think sometimes Complicatedissues don't always have a
simple answer.
Sometimes the smart thing isreally to raise questions.
And I really appreciate thequestions you both brought to
(30:54):
this discussion.
It was so helpful.
So thank you.
Thank you.
We hope this episode of TheVisibility Gap has helped you
and your loved ones feel seenand empowered.
If you found it valuable, pleasedon't forget to share it, like
it, and subscribe to stayconnected with us.
Your support truly makes all thedifference.
UNKNOWN (31:15):
Thank you.
you
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