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Stirrings of Concern
On the morning of August 1, 1988, I learned that my mother had died the previous evening. She was 71 years old, having celebrated her birthday six weeks before.
Her death was not a total surprise, but I had seen her only two weeks before and she seemed to be coping. Although she had undergone a very stressful year of dealing with my father's stroke, my siblings and I thought that she was managing well enough. However, she had had blood pressure, cholesterol, and blood sugar issues for nearly three decades. We had seen plenty of signs of her deteriorating health — from breathlessness to fatigue to severe discomfort in her feet. We all thought she was in poor health, and that her future didn't look good, but none of us expected her death that soon or that quickly.
At the funeral my brother (who became a physician) remarked to me that we had inherited some "bad genes" when it came to cardiovascular disease. My mother's father had died of a heart attack at the age of 59; her brother had died of the same condition at the same age. My brother saw our mother's death as more or less a wake-up call — "we all needed to pay a little more attention to our genetic imprinting" was the message he imparted.
To be completely honest, I didn't take his words to heart. At 43 years of age, I felt that I was healthy and active, busy with a teaching career, a marriage, and raising a son. However, it is not as though I hadn't already received some warning signs that I indeed had Familial Hypercholesterolemia (more about that later).
The First Glimpse of the Future
Eight years before my mother's death, I had asked my doctor what the small bumps under my eyes were. He told me they were cholesterol bumps or xanthomas which are "skin lesions caused by the accumulation of fat in macrophage immune cells in the skin and more rarely in the layer of fat under the skin."
My bumps were very small, and only under my eyes. If you go on the internet, you will find photographs of xanthomas which are huge — and also located in many other places. Thankfully, I didn't have a very pronounced or noticeable condition, but I will admit that they bothered me.
Although my bumps were small and apparently minor, my doctor was concerned enough to follow through with blood tests, as well as arranging for me to see a nutritionist. The end result was: Yes, I had xanthomas, but I didn't appear to have anything else wrong. My cholesterol levels were "normal"; although the ratio between HDL and LDL was "off" he did not think it was "of concern." The nutritionist thought my diet was "excellent" and felt I was in no need to change anything. 2
This is the message I received from both my doctor and the nutritionist (from Livestrong.com): "Because cholesterol bumps are not cancerous, they do not pose immediate health risks. However, the condition causing the deposits can have devastating effects on your health. High cholesterol levels, for example, increase your risk for a heart attack. If you develop a xanthoma, always have it checked by a doctor and work to control the conditions causing the deposits."
Essentially, my doctor left me with the impression that I was all right and the cholesterol bumps were an anomaly.
I was just beginning to understand cardiovascular disease and its link to genetics. I have spent the rest of my life trying to figure it out! 3 I didn't know it yet (nor did my doctor), but this condition is inherited.
Familial hypercholesterolemia (FH) is a genetic disorder characterized by high cholesterol levels, specifically very high levels of low-density lipoprotein (LDL, "bad cholesterol"), in the blood and can be a predictor of early cardiovascular disease. Today there is even an online community and organization for those who inherit this condition — there was nothing like it when I was first told about this (not even an internet, of course). (See the website for the FH Foundation here).
Remember: If you have FH, you are not like other people who just lower their cholesterol intake in their food and their blood lipids reach normal levels. People who have FH may exercise and eat a proper diet and still have out-of-range numbers for their blood lipids.
From 35 to 60
So many people told me that I had to exercise and restrict my diet. If I did these things, my blood lipids would fall "in range" of "normal." So, for many years, I paid more attention to my diet and I tried to keep up my exercise. This was not religiously followed, but I was naturally very active. My teaching job meant that I was on my feet a great deal, and my husband and I did many outdoor activities, including walking, hiking, camping, canoeing, and cycling in the summer and cross-country skiing in the winter. I was not a fanatic about exercise, but I did enjoy moving.
It took me years to figure out, however, that having FH meant that what worked for others did not necessarily work for me. Despite my best efforts, I saw little change in my xanthomas or my blood test results — for years.
By the time I was 55, I was being strongly encouraged by my doctor to start using a cholesterol-lowering drug such as Lipitor or Crestor. I resisted that recommendation until I was about 60. At that time, I went on the drug for several years and saw my scores fall in the "normal" category — except for HDL (it was never high enough). Despite daily exercise, a conscientious diet, and medication, I have never achieved a normal HDL reading.
60 and Beyond!
As the years went by, the medical community learned more about FH — and, as a result, so did I. There is no doubt that the arrival of the internet, with its amazing amount of technical information available to everyone, made a difference. As well, new drugs came on the market. More importantly, I learned more about the condition and came to understand what I could and could not control. The odds are fairly high that I will eventually suffer from cardiovascular disease, but I am hopefully maintaining as high a quality of life as possible.
The biggest change in my health occurred when I had menopause at 47 and then began to see new health issues develop, specifically metabolic syndrome, pre-diabetes, and osteoporosis. My concerns grew with these new conditions and I went in search of ways to exercise more.4
I started participating in fitness classes and began to notice a change in my general health. After about a year, I decided to become an instructor — I knew that there would always be a class I could go to! I have been teaching fitness to older adults since the beginning of 2006. The combination of a cholesterol-lowering drug, a careful diet, and exercise on a regular basis — these have made a difference. My blood sugar and cholesterol levels are generally within normal ranges, and I have them tested every three months. I have also been taking medication for my osteoporosis and tests reveal that my bone health is improving. Will I avoid cardiovascular disease? Probably not. But I am hoping that the quality of my life has greatly been improved and that I will live longer than my mother did.
Modern human beings have to work very hard to exercise. We live a very sedentary lifestyle. Driving in our cars to work. Sitting at our desk during the day. Watching TV in the evening. There is no doubt that retirement has given me the time to exercise which I did not have when I was teaching full-time. I have come to believe, however, that we must treat exercise like a prescription from the doctor. We must put it in our calendar and find no reason to avoid it. What we do is not as important as just doing it.
For older adults particularly, there are four areas that need to be addressed:
- cardiovascular exercise (walking, stair climbing, running, dancing, swimming, etc.);
- strength training (using weights to increase muscle tone and endurance);
- balance training (older adults need to be aware of how and why they stay upright and train for it); and,
- maintenance of flexibility (increasing flexibility will probably not happen, but maintaining what you have is well worth the effort).
If you believe that you must become more involved, here are some articles that may help you to decide what kind of activity you wish to do:
- Aging and Activity
- Fitness Instruction for the Older Adult: BCRPA Guidelines
- Fitness Instructors: What They Know and What They Don't Know
- Fitness Principles
- Motivation: How do we stay involved in physical activities?
- Book Review: Which Comes First, Cardio or Weights?
- Book Review: Body by Science
- Book Review: Man's Search for Meaning
- "A new study says....": What you should know about those studies!
- The Aging Process: What to Expect
- The Bitter Gene: Something I Inherited
- Characteristics of a Healthy, Fit Adult: Do you have all of them?
- Genetics and Our Health: How much can we control
- Healthy Eyes: A Guide
I am a BCRPA-certified fitness instructor in Vancouver, BC. I teach four classes at the West End Community Centre in Vancouver, BC, mostly designed for the older adult. The Inevitable Disclaimer: Everything published here expresses only my opinion, based on my training and research. What you do with the information is entirely your own responsibility. I am not liable for any injury you suffer that seems to be related to anything you read here. Always consult your doctor before beginning an exercise program. For other articles, return to the table of contents.
These three dots behave exactly like a footnote. Click on them and you will get more information about the topic. ↩︎
Over the years, tests for these conditions have changed as well. The scores I should "meet" changed many times. ↩︎
It didn't help that science and medicine have continued to develop new tests and information. Over the years, I have been told to pay attention to THAT test result instead of one I had been looking at before. ↩︎
It didn't take long for the term "metabolic syndrome" to come under my radar. This is defined as "a cluster of biochemical and physiological abnormalities associated with the development of cardiovascular disease and type 2 diabetes." Most common conditions include diabetes, high blood pressure, and heart disease. ↩︎