Health

I was 14 years old when I went from flat-chested girl to voluptuous woman—almost overnight. Every girls dream, right? Not really. Having a D cup in your teens and a DD in your 20s is not so much fun.

Besides being uncomfortable naked and in a bathing suit, my neck and shoulders were killing me. And my belief that I looked OK in clothes was shot to pieces one day in my late 20s when I reviewed a taped segment of myself (I was an on-air TV reporter) and saw that I looked like I had two huge grapefruits under my sweater. I was horrified and never appeared on-screen again in anything but a business suit.

Life could have gone on like this—with me enduring the pain in my neck and rib cage, being tired of the sweat that accumulated at night between the two mounds of heavy skin while I tried to sleep, and strapping on several sports bras before every jog—if my mother hadnt met a woman whod had breast-reduction surgery. Id considered reduction mammoplasty, sure, but I really couldnt afford it. (The average cost is $6,000-plus, according to plastic surgery organizations.) But the woman my mother told me about had the surgery and loved it, and her insurance paid for it.

I had no idea my top-heaviness was a medical condition that might be covered. But I was about to find that out. Heres my journey and what you need to know.

The approval process
Insurance companies need to be convinced that breast reduction is medically necessary. And convincing them requires more than just a doctors recommendation. You need real proof. To get it, I went to see an aesthetic-and-reconstructive plastic surgeon. After a quick examination, he told me what I already knew. My breasts were large for my frame, one was a good deal larger than the other, and I had the typical indentation marks on the top of each shoulder where bra straps had pressed into my skin for years. In his opinion, I was a good candidate.

The next step was harder. I had to be photographed from the neck down, and the pictures were sent to my insurer. A panel of doctors would determine if a reduction was appropriate and, most important, if my bill would be paid.

Insurance companies typically make the call by relying on a set of charts that consider height, weight, and the amount of removable tissue in each breast, accord­ing to Amy S. Colwell, MD, a specialist in aesthetic-and-reconstructive breast surgery at Massachusetts General Hospital in Boston. The surgery is covered 90 percent of the time when the tissue to be removed meets insurers standard criteria. (It weighs between 400 grams to 2,000 grams, or about 1 to 4 pounds.) Women with DD, DDD, and H cups usually qualify. But Dr. Colwell says the criteria of different insurers can be fuzzy, and a recent study in Plastic and Reconstructive Surgery found that insurers breast-reduction rules arent always based on medical science.

Weeks passed as I waited to hear what a panel of strangers had decided about my naked body. When the call finally came, I was shocked and thrilled all at the same time: The insurance company had approved my surgery, and I would probably go from an overflowing DD to a B. At 5-foot-4 and 130 pounds, I thought that sounded a little bit small, but I knew I needed the surgery. And now, finally, at 30 years old, I could afford it. The cost? My small deductible of $150.

There are several ways to perform a breast reduction. In my case, tissue was removed from the bottom of each breast, and my nipples were moved up without disconnecting them from the blood flow, allowing me to quickly regain sensation. “Nobodys leavin till theyre even,” was my surgeons motto in the operating room.

What about the risks? They include infection, wound breakdown, scarring, and the need for re-operating. Studies suggest that 10 to 50% of women undergoing a reduction may have some complications. But the healthier you are, experts say, the more likely surgery will be a success. Dr. Colwell says most women are extremely satisfied.

With mild pain medication and a full week of rest, recovery was easier than I had anticipated. Early on, I had feeling in one breast but not the other. With time, sensation returned to both, just as the doc said it would.

Two years later, the scars around my nipple and the lower-middle section
of each breast are barely visible. The scars underneath each breast are light-colored and hidden by the natural shape of perky boobs. Because theyre around and below the nipple, they dont show in bikini tops or plunging necklines. To be honest, I love the scars. They are a reminder that I took control of a part of my body that was out of control.

Although it takes months for breasts to take on their permanent shape after a reduction, I quickly looked and felt different. The weight on my neck and rib cage was gone, and, for the first time in a long time, I felt proportional. And my bra size? I turned out to be a perfect 34D. (Once in surgery, my doctor was able to meet the weight-removal requirements set by the insurance company and still leave me with breasts that felt right to me.)

Now that Im out of the Big Bra Club and feel great, Im on a mission to convert other women whose large breasts are a health issue. They need to know that feeling top-heavy, uncomfortable, and embarrassed isnt just a part of life that they need put up with. They need to know its not normal to have to search constantly for a bra that fits or to have backbreaking pain. And although a reduction can limit a womans ability to breast-feed, its unlikely to affect mammograms. Ultimately, these women need to know that big-breast problems can be fixed. For good.

I cant claim to be objective about this rousing endorsement for the brand new book Whole Green Catalog, which makes its debut in bookstores September 1. But even if I hadnt written WGCs chapter on natural healing, Id still praise it profusely.

Going green is a buzz phrase thats totally become mainstream. I know this because just the other day, while shopping at my local Waldbaums supermarket, I discovered their store brand, Green Way. These natural, USDA-certified organic products (some 150 different ones, according to the Waldbaums website) sell for about the same price as their nonorganic counterparts.

Clearly, Waldbaums listened to their customers and responded to their demand for more earth-friendly stuff. I used to travel to the other side of town to seek out natural and organic products. Now Im happy to find the basics right at my neighborhood grocery.

Going green: Keeping it real
Normally, the gulf between having the desire to go green and making it an actual lifestyle commitment is harder to cross. There are so many questions: Which is greener, organic strawberries from across the country or nonorganic ones grown upstate? What about eco-friendly cleaning products? Should you buy them even if theyre made by a company that makes products containing toxins? You know youre supposed to recycle, but what should you do with your light bulbs, your old paint cans, or your dead car battery?

Thats where the Whole Green Catalog becomes indispensable. Its 20 chapters tell you everything you need to know about how to green-clean your house, eat well, choose eco-friendly clothing, garden organically, travel with a smaller carbon footprint, and much more.

The natural healing chapter profiles 50 supplements, mostly herbal, which can figure significantly into a wellness program that might help you use fewer pharmaceuticals. Whats more, all are made by companies who make a significant effort to do right by our planet.

I particularly love the eco-technology chapter, which helps you buy a greener PC, hooks you up with a more earth-friendly printer, and plugs you into a product that lets you track the amount of energy various household machines are consuming.

Fitness freaks will love the sports and recreation chapter, with its variety of green gear—including sustainably produced skate and snowboards, a carbon-neutral air mattress, and even biodegradable sneakers. How cool is that?

One minute Elizabeth Baska was wrapping Christmas gifts … “and suddenly I couldnt breathe,” says the Seattle mom, who was 36 at the time.

Just as she had done during a similar episode two years earlier, she called 911. And, once again, the paramedics who came diagnosed the incident as an anxiety attack. But this time, Baskas symptoms continued to worsen, so the emergency personnel gave her an EKG—and determined that she was having a heart attack. “If I were a man, I think everyone would have been quicker to realize that it was my heart,” says Baska, who now takes pulse-slowing medications to keep her safe. “I never considered the possibility because I didnt think women needed to worry about heart attacks.”

The truth is, more than 450,000 American women die from heart disease each year. For two decades, it has killed more women than men, and the gap is actually widening as mens heart attack death rates improve faster than womens. Yet only a third of women in the United States consider themselves at risk for heart disease, according to a 2006 poll.

“Most women worry far more about breast cancer than heart disease,” says Elsa-Grace V. Giardina, MD, cardi­ologist and director of the Center for Womens Health at New York Presbyterian Hospital and Health Editorial Advisory Board member. “But for every woman who dies from breast cancer, 10 die from heart attacks.”

There have been advances: Heart disease deaths in women actually declined between 2003 and 2004. But the lifetime risk of dying of cardiovascular disease (CVD) is still nearly one in three for women. And thats why the American Heart Association (AHA) recently released new guidelines underscoring the impor­tance of healthy lifestyles in women of all ages to reduce the long-term risks of heart and blood vessel diseases.

Next Page: Forget most of what you already know about heart attacks [ pagebreak ]For starters, you need to forget most of what you already know about heart attacks. The conventional wisdom has long been based on the male experience, but doctors are now realizing that heart disease can be very different for women—from symptoms to diagnostic tests to effective treatments.

Heart_WhyDying225.jpg and left arm numbness. But thats not always the case for women,” explains cardiologist Nieca Gold­berg, MD, associate professor of med­icine at the New York University School of Medicine and director of the NYU Womens Heart Program. “Women commonly experience different symp­toms, such as shortness of breath, fatigue, pressure in the abdomen, and jaw pain.” And these are often misidentified as stomach ailments or anxiety attacks, so the early warning signs go unheeded.

Even when doctors suspect heart disease and order an angiography or angiogram (a diagnostic X-ray of the heart and its blood vessels), they often dont see problems, something that has long baffled them. But findings of a 10-year study by the National Institutes of Health—the Womens Ischemia Syndrome Evaluation (WISE) completed in 2006—appear to unravel the mystery.

WISE researchers discovered that two-thirds of the study participants with chest pain had “clear” angiograms, but half of those women had a condition called coronary microvascular sydrome, in which plaque coats small arteries in the heart rather than building to clumps in larger vessels.

“Instead of discrete obstructions, the plaque is evenly distributed throughout the blood vessels, so its pretty much invisible on the angiogram,” says Dr. Goldberg, who's also an AHA spokeswoman.

Next Page: Vessels become more narrow and rigid [ pagebreak ]Nonetheless, the vessels become more narrow and rigid, and less permeable. This, in turn, chokes off the flow of blood and oxygen to the heart muscle (a condition called ischemia), leading to chest pain and potentially a heart attack. Researchers estimate that as many as three million women have the syndrome, sometimes referred to as small-vessel heart disease.

The medical tests used in the WISE study to identify the syndrome are not yet widely available, but one common procedure can spot it: a nuclear stress test, in which thallium is injected into the bloodstream. Using a special camera, physicians then observe how well the radioactive material moves through the blood vessels supplying the heart.

“For years cardiologists thought that stress tests didnt work well for women because, after they turned up problems, the angiogram would come up clear,” Dr. Goldberg explains. “Now we know that the angiogram can sometimes be inaccurate for women.”

Thats why, no matter what the angio­gram shows, a poor result on the nuclear stress test calls for treatment. But standard procedures, such as angioplasty and bypass surgery, arent always the answer. Angioplasty uses an inflatable balloon to open clogged arteries and a mesh tube called a stent to keep them open. And bypass surgery involves grafting blood vessels from other parts of the body, such as the arms and legs, onto the heart to bypass clogs.

With small-vessel heart disease, there are no discrete clogs to clear or bypass; the problem lies in smaller blood vessels coated with plaque. A better solution—and, happily, a much less invasive one—is drug therapy to reduce blood cholesterol (and therefore plaque), to thin the blood (improving flow), and, in some cases, to limit the pace of the heart (easing its burden). Reducing other heart disease risk factors, such as poor diet and lack of exercise, is also effective.

Next Page: Risk factors for women are nearly identical to men [ pagebreak ]

Heart_CalltoArms225.jpg . But the same hazards are often underappreciated by women and their physicians. Eighty percent of doctors erroneously believe that heart disease kills more men than women, according to a 2005 national study of physician awareness published in the AHA journal Circulation. In the same study, doctors were given patient profiles in which risk levels were the same but the gender of the patients differed. When asked to assess each patients health, the doctors tended to assign a lower cardiovascular risk to women than to men who had the very same risk factors—and tended to recommend less-aggressive treatments.

The upshot is that women need to be strong advocates for their own cardiovascular care, says cadiologist Goldberg. If youre having symptoms and your physician suspects only indigestion or anxiety, insist on additional testing. If a stress test or another procedure indicates problems but no blockage shows up on an angiogram, demand treatment anyway—preventive care and a follow-up plan, at least. “If your doctor isnt taking your symptoms seriously, find one who will,” Dr. Goldberg says.

Thats what Gayle Nix did. And it probably saved her life. When she was in her late 40s, the Live Oak, Fla., mom began feeling pressure in her chest, as well as pain in her back and jaw. “My doctors told me it might be indigestion or stress,” she says. “But I kept pushing for more tests.”

Even after an angiogram showed no blockage and doctors gave Nixs heart a clean bill of health, she didnt stop visiting doctors offices whenever her symptoms reappeared. Finally, she was referred to the University of Floridas Division of Cardiovascular Medicine, which happened to be conducting the WISE study—and she was diagnosed with coronary microvascular syndrome.

After a course of blood thinners and some pointers about eating right, Nixs symptoms have all but disappeared. “I got myself a treadmill, and I learned how to broil instead of frying everything like I used to,” says the now-active 62-year-old grandmother. “And I feel great.”