Stacy Phillips

Thank you so much. I appreciate your feedback.

Thank you so much for your feedback. I appreciate both of your comments. Hopefully, women like you and me can continue to bring awareness to this critical topic.

Her alarm goes off, and it's another morning of struggling to get out of bed. After peeling herself out of bed, she shuffles to the bathroom and notices her feet seem even more swollen today than usual. She thinks, "I need to cut back and eat healthier.” Later she is whizzing around the kitchen, making breakfast, pouring coffee, and getting ready to head out the door, and wow, her indigestion is bothering her this morning. She feels so full, and these hot flashes are killing her. She is sweating now, and her jaw is aching; she must have ground her teeth again last night in her sleep. Suddenly, she is so exhausted. Her partner comes in and sees her. "You don't look so good. Are you OK?” "I'm fine. I need a little rest. The weekend can't come soon enough.” Later that morning, while at work, she passes out, and her co-workers call 911. She is transported to the nearest hospital, admitted, and diagnosed with heart disease. These days, women are juggling their schedule between keeping up with children's activities, their partner's activities, and, oh, let's squeeze a career there. As a result, self-care keeps getting further pushed down on the "to do" list. "I just need a good night's sleep" or "I'll rest after XYZ is done" are a few common themes. Unfortunately, this constant struggle of go, go often leads to women ignoring or dismissing vital signs and symptoms of heart disease. Couple this with the fact that many women with heart disease sometimes have vague, dangerous symptoms. Heart disease is the leading cause of death in women in the United States, with some statics showing it kills as many as 1 in 5 women. Despite these scary numbers, only about ½ of women recognize heart disease as the number one killer. Heart disease is 16x more frequent in women than breast cancer. In fact, in recent years, the death rate from heart disease has gone down in men but has slightly increased in women. The rise in the prevalence of diabetes has also contributed to the increase in heart disease in women. Diabetes can not only be a contributing factor to heart disease in women but also further complicate and worsen symptoms of heart disease in women. Risk Factors There are many risk factors for heart disease in women, so women need to be aware of these risk factors. Women need to take an active role in decreasing their risk factors. Risk factors for heart disease in women include: Diabetes Smoking Decrease physical activity Emotional stress and depression Menopause Pregnancy complications Family history Inflammatory diseases such as Lupus and Rheumatoid arthritis Some women can have a genetic predisposition to heart disease, but many of these risk factors can be decreased with better daily life choices. For example, smoking is a huge risk factor that can be eliminated by quitting. Many hospitals and physicians' offices have programs and counselors that help persons quit smoking. Tight control of blood sugars and healthy food choices are other factors that women can control to decrease their heart disease risk. Small diet changes over time can have a significant impact on lowering HGB A1C levels (blood tests used to determine blood glucose levels). Daily meditations, physical activity, and scheduled "time outs" for a bit of peace and quiet can decrease emotional stress. Regular check-ups with your primary physician, including yearly labs to check cholesterol, HGB A1C, thyroid function, and stress hormones, can help mitigate risk factors and identify them early. Symptoms Symptoms of heart disease or a heart attack can be different in women than in men. These differences can result in women often ignoring or dismissing these symptoms. Symptoms of heart disease can occur about ten years later in women than men in part due to the drop in estrogen after menopause. Symptoms of heart disease in women can be: Neck or jaw pain or aching Shoulder or upper back pain Arm pain in one or both arms Sweating Dizziness or lightheadedness Suddenly feel tired or weak Indigestion or nausea Pain or pressure in the chest Feeling full or aching in the upper abdomen Women often overlook these symptoms or try to explain them as something else. "I am just feeling tired today,”; "it's just been a long week,”; or "I ate something that doesn't agree with me" are just a few of the common reasons women will come up with to try to explain these symptoms. Women, especially post-menopausal women, need to educate themselves on the symptoms of heart disease and monitor themselves regularly. Sometimes heart disease in women can present as general fatigue and shortness of breath. They can have swelling in their legs or abdomen. They can have persistent indigestion or nausea that is not relieved by medications. Women often complain of pain or aching in their jaw and arm or armpit. They can have feelings of fullness in their upper abdomen or pressure in their back or lower chest. Women can feel sweaty and think they are having a hot flash. Women need to be an advocate for their health. Women with heart disease are often overlooked or misdiagnosed when they first go to the doctor. Heart disease in women has often been misdiagnosed as thyroid disease, depression, or menopausal symptoms. A woman may also have this diagnosis as well as heart disease. Women need to make sure their practitioners are listening to their symptoms and if women need to make sure they are being heard. An ECG is an easy, non-invasive test that physicians can order that provides a clear electrical picture of the heart. Women should not be afraid to ask for an ECG if they feel their symptoms may be related to heart disease. Women need to keep speaking up until they find answers. References Heart disease in women: Understand symptoms and risk factors Lower Your Risk for the Number 1 Killer of Women Women & Cardiovascular Disease Heart disease in women: Unsuspected? Overlooked? Ignored?

As the prevalence of diabetes in the United States today is growing, so is the number of complications related to diabetes including diabetic foot ulcers. Roughly 15-20% of the 16 million Americans with diabetes will be hospitalized with complications related to foot ulcers. Approximately 85% of diabetes-related lower extremity amputations are preceded by foot ulcers, and the post-amputation mortality rate for these patients can very high. To best treat these patients, nurses must educate themselves on how to recognize, assess, classify, and care for patients with diabetic foot ulcers. Early recognition and classification of diabetic foot ulcers can help prevent toe, foot, or lower extremity amputation. This can be confusing for many nurses because there are multiple classification systems out there for DFUs or diabetic foot ulcers. These systems include the Wagner Diabetic Foot Ulcer Classification System, the University of Texas Diabetic Foot Ulcer Classification System, and the Diabetic Ulcer Severity Score (DUSS) just to name a few. It is important that nurses recognize that they are the gateway to limb and life salvation for many diabetic patients. The Wagner Diabetic Foot Ulcer Classification The Wagner Diabetic Foot Ulcer Grade Classification System is a widely used grading scale for diabetic foot ulcers. It was developed in the 1970s as a treatment guideline to provide direction for the level of surgical intervention. It is easy to use and a good predictor of pending amputation. The Wagner Scale uses 6 grades ranging from 0-5. The scale assesses depth, presence of osteomyelitis (bone infection) and presence and extent of gangrene in the affected limb. Critics of the Wagner Diabetic Foot Ulcer Classification System agree that it does not address all aspects of the diabetic foot ulcer. It does not address the patient's vascular status or the presence and extent of neuropathy in the affected limb. The presence of venous and/or arterial disease must also be addressed for the patient to fully heal their diabetic foot ulcer and neuropathy must be addressed for the prevention of future diabetic foot ulcers. The Six Grades of the Wagner System The Wagner Diabetic Foot Ulcer Classification System uses 6 grades to classify the diabetic wound. Grade 0: There is no open lesion. The skin is intact, but the foot may have deformities, callus build-up or active cellulitis. This grade needs to be reassessed frequently. Grade 1: This includes a superficial ulcer with partial or full tissue loss. Grade 2: This wound extends into the ligament, tendon, or joint capsule and includes soft tissue infection. The muscle, bone and joint are not infected at this level. Grade 3: This wound also extends into the ligament, tendon or joint capsule however the infection has now progressed to osteomyelitis or bone infection, and or joint sepsis. Grade 4: This wound has progressed to gangrene that is localized to the toes or forefoot. Grade 5: This wound has progressed to an ulcer with gangrene involving the entire foot and is often beyond salvage. Why Wagner Classification System Although there is no universally agreed-upon scale for classifying the diabetic foot ulcer, the Wagner Diabetic Foot Ulcer Grade Classification System does give nurses a tool they need to classify and document on the diabetic foot ulcer. Another crucial factor to remember when using the Wagner Diabetic Foot Ulcer Classification System is that Medicare uses its guidelines for reimbursement for Hyperbaric Oxygen Therapy for patients. Patients with a Grade 3 or higher, according to the Wager Diabetic Foot Ulcer Grade Classification System, would qualify for reimbursement of Hyperbaric Oxygen Therapy as a part of their treatment protocol. Hyperbaric Oxygen Therapy has been shown, in conjunction with antibiotic therapy and revascularization of the affected limb, to heal the diabetic foot ulcer and prevent amputation. Nurses are advocates for patients every day and must stay educated on the tools and systems available for the assessment and treatment of patients. The Wagner Diabetic Foot Ulcer Grade Classification System is one of several classification systems used for diabetic foot ulcers today. It is widely accepted and used throughout the United States. Resources Hyperbaric oxygen therapy Hyperbaric oxygen and wound healing Understanding Diabetic Foot Ulcer Classification Systems Diabetic foot ulcers: pathogenesis and management