An Appointment With...

UAB Cardiologist Alan Gertler, M.D.
By V.R. Miller

UAB cardiologist Alan Gertler, M.D., worked with Sherri Mills to help her control her heart disease.

Sherri Mills was surprised by her first symptoms of heart disease. “It was nothing like Fred Sanford on the 70s TV sitcom, Sanford & Son, where he used to grab his chest and say, ‘This is the Big One,’” she laughs. Not only was Sherri unprepared for the symptoms—she simply didn’t consider herself a candidate for heart disease. “Heart disease is on my father’s side of the family, but as women, we hear so much more about cancer being a killer, not heart disease,” she says

“The fact is, heart disease is the number-one killer of women, leading to more deaths than cancer, lung disease, pneumonia/influenza, diabetes, and accidents combined,” says UAB cardiologist Alan Gertler, M.D. “It’s important that everyone know their risk factors for heart disease,” Dr. Gertler emphasizes, adding that women’s heart symptoms are often misdiagnosed.

Sherri, a healthy, active woman in her 50s who travels each year to Kenya, Africa to oversee a children’s charity, didn’t want to let heart disease slow her down. “We have opportunities to change children’s lives there,” she explains, “but I felt it would be unwise to continue traveling, not knowing what might happen with my heart.”

In this interview with ehealth magazine, Sherri describes her experience with the diagnosis and treatment of her heart disease, and Dr. Gertler explains how her condition is being successfully controlled.

Sherri: “The symptoms began when I was walking the dogs or exercising in the pool; I felt pressure in the upper part of my chest, neck and throat area, like someone’s hand was pushing down on my chest, and I had difficulty breathing.”

After two or three such episodes, Sherri went to her physician. An electrocardiogram revealed no signs of heart damage, but when a stress test showed that Sherri’s heart muscle was not receiving enough oxygen, she was referred to Dr. Gertler.

Sherri with Hannah Wanja, the child Sherri and her husband, Bert Brosowsky, sponsor.

Dr. Gertler: “Sherri’s symptoms were classic, especially since they occurred when she was exercising, and would stop when she rested. It’s important to note that most people describe this feeling as pressure or discomfort, rather than pain. So it can be overlooked, or even mistaken for a different problem.

“Women can be more difficult to diagnose, because symptoms can include extreme fatigue, shortness of breath, lightheadedness and nausea; sometimes symptoms are attributed to depression, anxiety or even indigestion.”

Sherri: “Dr. Gertler gave me treatment options. I could simply take medicines to control the disease and help lower my cholesterol, while he followed my progress closely, or I could go also have a procedure called a coronary arteriogram, to see where the blockage was. I asked him the old standby question, ‘If I were your mother or wife, what would you want me to do?’ He was thoughtful for a moment, then said that since I put it that way, he’d want me to have the coronary arteriogram. I felt that, with our missions in Kenya, it was the only responsible thing to do. I wouldn’t want to need medical treatment so far from home.”

In a coronary arteriogram, or heart catheterization, a tiny tube is inserted in an artery in the leg or arm, then threaded into the coronary artery where dye is injected, enabling the physician to see whether the blood is moving through the vessels as it should, or if there is a narrowing in the vessels.

Dr. Gertler: “Coronary heart disease occurs when coronary artery walls become lined with fatty deposits, narrowing the arteries and restricting the flow
of blood and oxygen to the heart. Diagnostic heart catheterization showed that Sherri had about 50 percent blockage in two arteries, but no need for
angioplasty or heart surgery.

“We feel her coronary heart disease can be controlled by medicine and by modifying her risk factors. Among those risk factors is her post-menopausal status; 10 years post menopause, the rate of death by heart disease among women begins to equal that of men. Her heredity, with her father requiring a bypass in his 60s and her grandmother dying of a heart attack at 65, is a strong factor. Finally, she has a lipid abnormality: her total cholesterol, triglycerides and LDL, or ‘bad’ cholesterol were too high. However, Sherri has an excellent understanding of her condition, and she’s determined to improve it.”

Sherri: “In just four weeks of treatment, my total cholesterol is already down from 287 to 175; they still want my LDL, or ‘bad’ cholesterol a little lower.”

Dr. Gertler: “It’s very important for patients to maintain a diet low in saturated fat, especially animal fat. We tell patients to increase the amount of fruits and vegetables they eat. For Sherri, we also prescribed a type of medicine, called statins, to lower her cholesterol and triglycerides. She has responded very well to these drugs. We’re using beta blockers to slow down her heart rate and decrease the amount of oxygen needed by the heart muscle, and aspirin therapy to decrease the tendency for clots to form is also an important part of her treatment.”

Sherri: “I used to work for the American Heart Association, so I’ve been on a low-fat diet since the 1970s. And I enjoy walking the dogs and exercising in the pool and on the treadmill. If I hadn’t been exercising and pushing myself, I wouldn’t have found out about my condition. It might have progressed for five to ten years more to the point where I needed surgery or had a heart attack.”

Dr. Gertler: “Even people who are apparently in good health need to know their risk factors for heart disease, and modify those they can. Sherri should continue doing well with her medical treatment, regular exercise, appropriate diet, and watching her blood pressure. We’ll see her in six months, unless her symptoms change.”

Sherri is relieved to have caught the symptoms of heart disease in the early stage, so that she can continue doing the things she loves.

Sherri: “My husband and I have a real heart for the Kenyan children— they have so little, but have so much hope. We began by providing for the education of one child, and our charity now cares for 30 children, giving them a brighter future. I look forward to seeing them fulfill their dreams.”