Tag Archives: diagnosis

Jodi Saso’s 
Heart for Running

February 18, 2014 by
Photography by Bill Sitzmann

For many avid runners, qualifying for the Boston Marathon is considered the pinnacle of their running career. For 35-year-old Jodi Saso, completing the Boston Marathon was that and so much more.

Not only did it mark a major feat in her running career, but Saso crossed the finish line just 10 weeks after undergoing major heart surgery. Completing the marathon was a personal confirmation that she had risen above her heart condition and could continue “life as usual,” despite this unexpected setback.

“I didn’t want to be a victim of my circumstances and lay around feeling sorry for myself,” says Saso. “It was all about determination and not wanting to live that life. I figured I had one shot to do this, and I wasn’t going to let my surgery get in the way.”

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This is all even more amazing when you consider the fact that Saso had taken up running just several years ago when she decided she need to do something to get herself and her dog into shape. The pounds began to fall off, running became easier, and it wasn’t long before Saso had developed a new passion.

Saso found running to be a natural fit, and before long, she had started training for marathons. By 2012, she had run eight marathons in one year in addition to several half marathons and a 50-mile run. She was hooked and breaking her own records with each race. Saso felt wonderful physically and emotionally.

But an annual check-up with her doctor told her otherwise.

When Saso was very young, her pediatrician suspected that she might have Marfan syndrome, a rare genetic disorder that affects the connective tissue. The most serious complications of Marfan are defects of the heart valve and aorta. However, Saso never received a firm diagnosis. When she began seeing a new family practitioner in her late 20s, he too suspected Marfan syndrome and recommended they monitor her heart on a regular basis. A heart echo performed at her 2012 visit revealed an aortic aneurysm—a stretched and bulging section in the wall of the aorta.

“When the aorta becomes stretched, there is a big risk of the aorta dissecting or tearing or, even worse, rupturing and causing death,” says Traci Jurrens, MD, cardiologist at Nebraska Methodist Hospital, who performed the echocardiogram. “Jodi’s aorta had reached the threshold for repair.”

Because of the difficulty of the procedure, most cardiac surgeons replace both the valve and aorta during surgery, which requires lifelong anticoagulation with the blood-thinning drug called Coumadin, explains Dr. Jurrens. Coumadin can have a host of side effects, including easy bruising and bleeding.

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“Since she was so young, we determined that it would be worthwhile for Saso to go to the Mayo Clinic, where cardiac surgeons were able to perform the surgery without removing her own valve,” notes Dr. Jurrens.

Saso’s surgery was scheduled for Jan. 31, 2013. The timing could not have been worse. She had qualified for the Boston Marathon the spring before. The run was scheduled for April 15, just 10 weeks after her surgery. It was a dream she was not willing to let go so easily. “I asked my doctors if there was any way that I could still run the race,” she says. “They were doubtful, but they said it was contingent upon how the surgery and recovery went.”

Following surgery, Saso says she was in so much pain that she thought she would never leave the hospital. “Before I left the hospital, they told me that I had to walk the entire floor six times a day,” she says. “That first day, I could barely walk 10 feet.”

But that’s when Saso’s determination kicked in. “My goal was to run the Boston, and I was going to do everything I could to make that happen.” By day three, she was off pain medications. By day five, she was doing two laps instead of one six times a day and was released from the hospital to go home.

Encouraged by her quick recovery, Saso was on a fast track from then on, she says. By two weeks, Dr. Jurrens had released Saso to return to work. Four weeks after surgery, Saso finished an entire stress test—Dr. Jurrens’ first patient to do that. Jurrens cleared her to run the Boston as long as she promised to run it over four hours.

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Donning a T-shirt that read, “I had open heart surgery 10 weeks ago. Let’s do this!” Saso proudly crossed the finish line in 4:08:15.

“I felt amazing,” she says. Luck continued to be on Saso’s side. Having mistakenly booked her return flight extremely close to the race finish time, she had no time to hang out and celebrate. Instead, she left the race immediately to catch her flight. A short time later, she heard about the 2013 Boston bombings. “Someone was looking over me,” she says.

“Jodi has done remarkably,” says Dr. Jurrens. “It is quite a difficult procedure, but Jodi had excellent results. Because Jodi was in such great shape, she was able to get through surgery very well. In general, great functional capacity prior to surgery predicts better recovery from cardiac surgery. That being said, we really do not know what is safe for Jodi in regard to running, and we do discourage excessive exercise. But running is Jodi’s life, and she is going to make her own decision in regard to running.”

Saso completed five marathons in 2013 but says she is planning to slow down the pace for her own health benefits. “I’m going to do just two marathons a year in the future,” she says. “I want to be smart about this, and I really don’t want to have surgery again.”

The pace may be slower, but her determination to live life as usual is stronger than ever, says Saso. She recites one of her favorite quotes, which she says she applies both to running and life: “The body does not want you to do this. As you run, it tells you to stop, but the mind must be strong. You can always go too far for your body. You must handle the pain with strategy…it is not age. It is not diet. It is the will to succeed. Let’s do this!”

Endometriosis

December 13, 2013 by

If you’ve experienced extended pelvic pain, you’re not alone. As many as 15 to 20 percent of women between the ages of 18 and 50 will experience chronic pelvic pain that lasts six months or more. Pelvic pain can have many causes and sometimes it’s difficult to find a specific cause.

It is estimated that approximately 70 percent of these women will have endometriosis, a painful disorder in which tissue that normally lines the inside of your uterus—the endometrium—grows outside the uterus, or anywhere else where it’s not supposed to grow. It usually grows on the ovaries, the fallopian tubes, the outer wall of the uterus, the intestines, or other organs in the abdomen or pelvis.

“The problem with endometriosis is that it can be difficult to diagnose.”
—Ginny Ripley, family practitioner at Nebraska Methodist Health System

The condition becomes troublesome when the displaced tissue continues to act as it normally would if it was inside the uterus and continues to thicken, break down, and bleed with each menstrual cycle. However, because the tissue is outside of the uterus, the blood cannot flow outside of the body. The displaced tissue can build up around the affected area and can become irritated, resulting in scar tissue, adhesions, or fluid-filled sacs called cysts. For women in their childbearing years, the adhesions may block the fallopian tubes and cause infertility.

“The problem with endometriosis is that it can be difficult to diagnose,” says Ginny Ripley, family practitioner at Nebraska Methodist Health System. “It doesn’t show up in ultrasounds or CAT scans, so the only definitive way to get a diagnosis is through surgery. Surprisingly, we’ve found that the severity of a woman’s symptoms do not correlate to the severity of the condition.”

So while some women with extensive endometriosis may have no symptoms at all, others may experience painful periods, heavy periods or bleeding, pelvic pain during ovulation, and pain during bowel movements or urination. The pain is usually located in the abdomen, lower back, or pelvic areas. Many women don’t realize they have endometriosis until they go to the doctor because they can’t get pregnant, or if they have a procedure for another problem. It is estimated that 20 to 40 percent of women who are infertile have endometriosis.

Because of the difficulty in diagnosing endometriosis, it is often a matter of ruling out other causes first before arriving at a diagnosis of endometriosis, notes Dr. Ripley. Other common causes of pelvic pain include fibroids, chronic pelvic inflammatory disease caused by long-term infection, pelvic congestion syndrome, an ovarian remnant, irritable bowel syndrome, interstitial cystitis, and musculoskeletal factors.

The type of treatment a woman receives will depend on the severity of symptoms and whether or not she is planning to become pregnant. Several treatments have to be tried before it is determined what works best. Many women can be treated successfully with anti-inflammatories or a combination of anti-inflammatories and oral  contraceptives and/or hormone therapy. Anti-inflammatories help reduce bleeding and pain. Birth control pills and hormone therapy help shrink the endometrial tissue by lowering hormone levels and help suppress the growth of additional endometrial implants—but they also prevent pregnancy.

“While the tissue growth may come back, it often cleans up the area long enough to allow a woman to conceive.”
—Katherine Finney, M.D., obstetrician/gynecologist University of Nebraska Medical Center

In more severe cases in which all other options have been exhausted, surgery may be recommended to remove the extra tissue growth, says Katherine Finney, M.D., obstetrician/gynecologist at the University of Nebraska Medical Center. Surgery is performed laparoscopically. This means that the doctor places a small, lighted tube through a small incision in your belly and looks for signs of displaced endometrial tissue. The tissue can then be removed or destroyed through heat or cauterization.

“While the tissue growth may come back, it often cleans up the area long enough to allow a woman to conceive,” says Dr. Finney. “Rates of conceiving are higher after surgery, but some women may still need fertility treatments to help as well.”

If pregnancy is not a goal, medications, such as hormone therapy, can be taken following surgery to prevent the growth of new or returning endometriosis, says Dr. Finney.

For women with severe pain due to endometriosis, a hysterectomy may be considered as a last option; however, this is rarely needed anymore. “We do far fewer hysterectomies today than we have in the past because we have so many other effective options,” says Dr. Ripley.

Some women may not require treatment, as they have no or only mild symptoms, while others can have notable symptoms due to pain and/or infertility issues. Treatment is typically based on symptoms. If you are near menopause, you may want to consider managing your symptoms with medications rather than surgically. Once you stop having periods, endometriosis will usually stop causing you problems, notes Dr. Finney. In rare cases, post-menopausal women will still experience continued pain, in which case their physician should evaluate them to determine if they are a candidate for surgery.

ADHD

September 24, 2013 by

One of the most common neurobehavioral disorders found among children is Attention-Deficit/Hyperactivity Disorder (ADHD), according to the Centers for Disease Control and Prevention (CDC). And rates are on the rise.

Dr. Ashley Harlow, psychologist at Children’s Hospital & Medical Center, believes that this spike in diagnoses is due to a combination of factors. “Parents, teachers, and [health care] providers are more aware of the signs and symptoms and, therefore, are investigating this diagnosis as a possibility,” he says.

Because ADHD is so prevalent, there is concern that children are being misdiagnosed.

Misdiagnosis can go many ways, explains Dr. Harlow. “I think misdiagnosis is a problem, although I think it is important to consider misdiagnosis as both diagnosing another condition as ADHD and diagnosing ADHD as another condition.

“I see kids who have been diagnosed with ADHD because they do not like their teacher, they do not listen to their parents, or they do not follow through on what their parents tell them to do,” says Dr. Harlow. “These behaviors do not necessarily indicate ADHD.”

Also complicating the issue are instances where children have ADHD and are instead diagnosed with another disorder, like Autism Spectrum Disorder, or when high-school and college students use ADHD medication to support studying. “In these cases of students seeking study aids, misdiagnosis might occur because of misrepresentation of the symptoms by the patient,” adds Dr. Harlow.

Dr. Harlow says that visible signs of ADHD can include behaviors like “difficulty sitting still in the classroom, disorganization in completing homework or turning it in, making careless mistakes, staring off into space, interacting with peers in immature ways, or starting chores but not finishing them.”

Many children may demonstrate these behaviors, so Dr. Harlow advises careful consideration before jumping to conclusions. “[Health care] providers, in consultation with families, work to determine if enough symptoms are present and impairment is at a level to warrant a clinical diagnosis.”

The CDC states that “children with ADHD do not grow out of these behaviors. The symptoms continue and can cause difficulty at school, at home, or with friends.” Therefore, it is important to treat children who are afflicted with ADHD.

Treatment of ADHD focuses on reducing the impact of the symptoms, not eliminating them. “It is important to remember that ADHD is a neurologically based disorder, and so improving behavior likely means learning to manage symptoms rather than removing the symptoms entirely,” explains Dr. Harlow.

He recommends a combination of medical and behavioral health interventions, including setting up the environment (classroom or home) to be predictable and organized for the child and to make consequences immediate and consistent.

Children’s Hospital & Medical Center offers free parent education sessions related to topics surrounding ADHD. For more information, visit ChildrensOmaha.org/BehavioralHealth.

Getting Through the Emotional 
and Physical Challenges of Breast Cancer

Photography by Bill Sitzmann

Even when it’s over, it’s not over, says one cancer survivor, who recently completed her treatment. The emotional turmoil and lingering fear of what’s going to happen next—Am I really cured? Will it come back?—continue to haunt many breast cancer survivors during and well beyond the treatment process.

The fear was so overwhelming for 39-year-old Melissa Holm that she decided to have a double mastectomy. This was despite her doctor’s assurance that the cancer cells were limited to her right breast and the chance of the cancer spreading to the other breast was very slim.

“I didn’t want to live with that fear for the rest of my life,” says Holm, a mother of two young girls and a boy. “I just wanted them to take everything and start from scratch. I know others who have had a lumpectomy, and they worry before every appointment. My diagnosis came after a year of watching. I didn’t want to continue that waiting game.”

“The number of women choosing double mastectomy over a lumpectomy has doubled from about 3 percent to nearly 6 percent over the last 10 years,” says Margaret Block, M.D., a medical oncologist at Nebraska Cancer Specialists. “We don’t really know why, but a lot of it may stem from the fear and anxiety following a cancer diagnosis.”

The fear and shock of a cancer diagnosis can be overwhelming, notes Patti Higginbotham, APRN, AOCN, nurse practitioner with the Alegent Creighton Health Breast Health Center. “The first thought of 90 percent of women is that they are going to die.”

Even after getting through the initial shock, women still have to endure another year or more of treatment, which may include surgery, chemotherapy, radiation therapy, and breast reconstructive surgery.

“The number of women choosing double mastectomy over a lumpectomy has doubled from about 3 percent to nearly 6 percent over the last 10 years.” – Margaret Block, M.D., medical oncologist, Nebraska Cancer Specialists

For Holm, dealing with the loss of her breasts and then her hair were two of the biggest emotional challenges during treatment. “You go through a period where you don’t even feel like a woman anymore,” she says.

Then, there was the constant fatigue, malaise, and missing out on her children’s events, like plays, basketball and volleyball games, and school meetings. “I slept a lot on the weekends following chemotherapy,” recalls Holm. “My children barely saw me the entire weekend. Thankfully, my husband was there to take charge of the kids, but still care for me. He was my rock.”

While a cancer diagnosis is never easy, there are several steps women can take to help ease the physical and emotional impact of a breast cancer diagnosis, cancer experts say.

One of the most important of these is the support of family and friends. “Women who try to do it alone usually don’t do as well physically or emotionally,” says Higginbotham. “Part of our makeup as women is that we need to talk about it. If you don’t have someone that you can lean on, we encourage women to seek support through a cancer support group, our social worker, nurse navigators, or other members of our staff. It’s also very important that you have a health care person you can connect with. If you don’t have that partnership, then maybe you have the wrong provider.”

“I couldn’t have made it without the support of family and friends,” notes Holm. “There is strength in numbers. They gave me strength through some of the most difficult times. I had to lean on so many people. I couldn’t have made it without all of their help.”

“Women who are informed and have the facts also do better and make better decisions,” says Block. “Faster is not always better. Once you get the diagnosis, you need to take some time to get through the initial shock and then ask questions and do some research. Otherwise, women tend to make decisions based on emotions rather than facts.”

“…we’ve found that physical activity will help with the emotional [and] the physical side effects.” – Patti Higginbotham, APRN, AOCN, nurse practitioner, Alegent Creighton Health Breast Health Center

“We encourage women to stay engaged throughout the entire process,” adds Higginbotham. “Ask a lot of questions, let us know if you are having side effects, ask what you can do for yourself, and seek support.”

Exercise, sleep, and good nutrition can also help with physical healing. “I remember the days when we suggested to women to take a leave of absence from work and to rest as much as they can,” says Higginbotham. “We’ve done a complete 360 since then. Now, we tell women to keep working if they want and to start exercising after surgery, as we’ve found that physical activity will help with the emotional [and] the physical side effects.”

Depression and anxiety are also “side effects” of breast cancer that should be discussed with your provider. “Women shouldn’t be afraid to seek additional help if they have a significant amount of depression and anxiety,” says Dr. Block.  “Sometimes, an anti-depressant can help a woman get through a really difficult time. While most women experience depression and anxiety following a cancer diagnosis, studies show that depression diminishes after treatment and recovery. Anxiety, however, can sometimes continue to linger.”

Life is getting back to normal for Holm. She completed breast reconstruction in late 2012 and says she is now focusing on turning her experience into a positive one by reaching out to others.

“I have volunteered to be a spokesperson for cancer survivors,” she says. “That regular interaction with other women and encouraging them to get mammograms or talking to women who are in the midst of treatment gives me strength.”

And she hopes to pass on some of that strength to others. “I’ve become a stronger person than I thought I was,” she says. “I have become more confident. I want to give other women hope—to let them know it isn’t easy, but you take one day at a time and count your blessings as you go.”

Concussions and Young Athletes

August 16, 2013 by

Here’s a question for parents—Can you describe a concussion? It’s more than a headache or a momentary blackout. Doctors consider it a traumatic brain injury, ranging from mild to severe, caused by a blow or jolt to the head. With young athletes back on the field, Kody Moffatt, M.D., a pediatrician and sports medicine specialist at Children’s Hospital & Medical Center, wants parents, coaches, and trainers to know the signs.

“We know much more about concussions today than we did even a year or two ago. A concussion in a child or teenager is different than in an adult. The impact on the developing brain can be a real problem,” says Dr. Moffatt.

Football poses a risk, particularly when players tackle with their heads down.

“I tell parents that football, in general, is a safe sport as long as young people don’t lead with the head,” he explains. “Coaches in our area have been really good about teaching young, developing players to use the shoulder or chest as the first point of contact.”

Symptoms of a concussion are as individual as children themselves. Visible signs of a suspected concussion are:

  • Loss of consciousness
  • Slow to get up
  • Unsteady on feet, falling over, or trouble balancing
  • Dazed or blank look
  • Confused, not able to remember plays or events

Dr. Moffatt says athletes with a suspected concussion should not return to the field. They need to see a doctor. Immediate emergency care should be provided when the player is vomiting, has a seizure, experiences neck pain, is increasingly confused, or is unable to stay awake.

Nationally and across all levels of play, from professional to recreational leagues, the emphasis has been on “return to play.” This focus surrounds the safe return to the game following diagnosis and treatment. This fall, “return to learn” will receive increased attention, too.

“Before young athletes are returning to play, we need to get them back in the classroom symptom-free and able to learn like they did before the concussion,” says Dr. Moffatt. “We have to keep in mind that we’re dealing with a brain injury. This can result in learning problems that impact a student athlete’s academic performance.”

The new Sports Medicine Clinic at Children’s Hospital & Medical Center will work with student athletes, their families, and teachers to customize a “return to learn” plan. Dr. Moffatt considers it to be an important part of the recovery process.

“Return to learn is a significant step, in my mind. We’re considering cognitive function and how we help the brain heal,” he says. “We’ll work with schools to help kids get back on track in the classroom.”

The Sports Medicine Clinic at Children’s Hospital & Medical Center is open to families by appointment. No physician referral is needed. To make an appointment, call 402-955-PLAY (7529). For more information, visit ChildrensOmaha.org/SportsMedicine.

Passionate about pediatric sports medicine, Dr. Kody Moffatt is a highly regarded, well-known expert in the field. An athletic trainer turned pediatrician, he holds a Master of Science degree in orthopaedic surgery and is a Fellow in the American College of Sports Medicine. Dr. Moffatt helps shape sports medicine policy on a state and national level as an advisor to the American Academy of Pediatrics and the Nebraska High School Activities Association.

From Patients to Caregivers

February 25, 2013 by
Photography by Bill Sitzmann

Margaret Ludwick spends her days sitting in a wheelchair at a senior care center in Elkhorn. She never speaks. The only expressive motion involves her hands—she constantly puts her long, tapered fingers together like a church steeple. Her big blue eyes stare straight ahead but focus on nothing. No one can reach her anymore, not her daughters, not her husband.

Alzheimer’s, the most common form of dementia in adults 65 and over, robs even the most intelligent people of their brain and eventually destroys their body. There is no cure. There is no pill to prevent it. There’s not even a test to definitively diagnose it. Effective treatments have proven as elusive as the disease, itself.

“We do have medications that may help with symptoms in some patients, especially in the early stages of Alzheimer’s,” says Dr. Daniel Murman, a specialist in geriatric neurology at The Nebraska Medical Center. “But they don’t truly slow down the disease process.”

According to researchers, the number of Americans living with Alzheimer’s will triple in the next 40 years, which means 13.8 million will have the disease by 2050 (Chicago Health and Aging Project research as reported by nbcnews.com).

Awareness of symptoms is crucial for early intervention.

“Memory loss and changes in behavior are not a normal part of aging,” stresses Deborah Conley, a clinical nurse specialist in gerontology at Methodist Health Systems who teaches other nurses and caregivers about Alzheimer’s. “I would urge family members to take [their loved one] to a family physician first, seek as much information as possible, and start making your plans.” An assessment that includes the person’s medical history, brain imaging, and a neurological exam can result in a diagnosis that’s about 85 percent accurate for Alzheimer’s.

Ludwick, a registered nurse, who worked at Immanuel Hospital for years, never received an extensive workup.

 “I would urge family members to take [their loved one] to a family physician first, seek as much information as possible, and start making your plans.” – Deborah Conley, clinical nurse specialist in gerontology at Methodist Health Systems

“I first noticed something was wrong about 15 years ago, when Mom was 70,” explains Ludwick’s daughter, Jean Jetter of Omaha. “It was the day I moved into my new house. Mom put things in odd places, like a box labeled ‘kitchen’ would wind up in the bedroom. And she stood smack in the middle of the doorway as the movers tried to carry large pieces of furniture inside, and she just stared at them.”

As Ludwick’s behavior grew worse, Jetter begged her father, Thomas, to get her mother help.

“He didn’t want to hear it. He kept saying, ‘This will get better.’ He had medical and financial Power of Attorney. Dad worked full-time, and she was home alone. This went on for eight years.”

Ludwick’s steady decline rendered her unable to fix a meal or even peel a banana. She lost control of bodily functions. After she was found wandering the neighborhood on several occasions, Jetter was finally able to call Adult Protective Services and get her mother into an adult daycare program. After breaking a hip two years ago, Ludwick arrived at the Life Care Center of Elkhorn.

“This is such a sad, but not unfamiliar case,” says Conley, who began working with Alzheimer’s patients in the mid-’70s. “Even in 2013, people do not know what to do, where to turn.”

Dr. Murman adds, “There is still a stigma attached to Alzheimer’s. People don’t like to hear the ‘A’ word. But it’s much better to be open and specific about it.”

A specific diagnosis may rule out Alzheimer’s.

“Depression can mimic the symptoms of Alzheimer’s…symptoms like mistrust, hallucinations, apathy, social isolation,” explains Dr. Arun Sharma, a geriatric psychiatrist with Alegent Creighton Health. “But we can treat that. We can treat depression.”

Dr. Sharma helped establish a 22-bed, short-term residential facility called Heritage Center at Immanuel Hospital to better diagnose the reasons for a person’s memory loss. Once a patient is stabilized and receives a proper care plan, they can return home. The more doctors learn, the faster a cure will come.

“I see something exciting in the next five to 10 years,” says Dr. Sharma. “If we identify and isolate the protein believed responsible for Alzheimer’s, perhaps we can do a blood test to catch the disease early.”

 “There is still a stigma attached to Alzheimer’s. People don’t like to hear the ‘A’ word. But it’s much better to be open and specific about it.” – Dr. Daniel Murman, specialist in geriatric neurology at The Nebraska Medical Center

But what about a cure? With 78 million Baby Boomers coming down the pike—10,000 of them turning 65 each day—this country faces an epidemic. And what about the psychological, financial, and emotional toll on the caregivers, who are very often family members? They, too, feel isolated.

“It was an impossible situation for me. I couldn’t get her the help she needed,” says Jetter, who bore the brunt of the family crisis since her married sister lives in Dallas. “Now that Mom is at [the nursing home], I can take a breather and concentrate on Dad, who also has mental issues.”

In recent weeks, her father, Thomas, has been admitted as a permanent resident of Life Care Center of Elkhorn as well.

What about her own family?

“I have no one. No husband, no boyfriend. I mean, what boyfriend would put up with all this?” asks Jean, who’s been shuttling between one parent and the other for years, all the while trying to run her own business. The situation has obviously taken a huge personal toll.

Conley has two words for anyone facing similar circumstances: Alzheimer’s Association. The Midlands chapter has support groups, tons of information, and can gently guide the adult child or spouse. They even have a 24/7 hotline: 800-272-3900.

For anyone dealing with Alzheimer’s, that number could become a lifeline.

Bipolar Disease

November 25, 2012 by

“My husband didn’t know if he was going to come home to Cruella Deville or Dolly Levi from Hello Dolly.” That’s how Jane Pauley, broadcast journalist and former co-host of the TV morning show Today, described her battle with bi-polar disease in a interview on Healthy Minds, produced by New York Public Radio. “Who knows what provokes it, but it was like a swarm of bees that wants a target,” she says.

Being diagnosed with bipolar disease was a shock, recalls Pauley, but getting a diagnosis and subsequent treatment, however, allowed her to regain some normalcy in her life again.

Bipolar disease is a serious mental illness that is associated with extreme mood swings from mania to depression. “It is one of the most serious illnesses we deal with because of the disruptive nature of the disease,” says Sharon Hammer, M.D., psychiatrist at the University of Nebraska Medical Center (UNMC). “It is more serous than depression or schizophrenia because it can lead to risky behaviors, such as drug and alcohol abuse, damaged relationships, and suicide. And because of the impulsive nature of the disease, there is often no time to intervene.”

The average onset of bipolar disease tends to occur in older teenagers and young adults ages 20 to 25 years old. “Many women may start to experience symptoms of depression in their teenage years followed by their first manic episode in college,” says Hammer. “This is a very risky time because the college years are often mixed with stress, sleep deprivation, and alcohol use, which are all triggers for episodes.”

“It is one of the most serious illnesses we deal with because of the disruptive nature of the disease.” – Sharon Hammer, M.D., psychiatrist at UNMC

Women with bipolar disease typically spend about 80 percent of the time in depression and 20 percent in mania. Episodes of mania are characterized by abnormal elevated moods that include irritability, being easily agitated, impulsivity, racing thoughts, and insomnia.

Many women tend to be in denial and don’t start taking it seriously until they have children, notes Hammer. Even then, it is often misdiagnosed as depression or anxiety due to the extended depressive states associated with the condition, and the fact that women are twice as likely to have depression than men. In fact, bipolar disease is the most under-diagnosed mental illness and the most challenging to diagnose, notes Hammer.

Misdiagnosis can create more problems because medications used for depression and anxiety are different than those used to treat bipolar disease and can make the condition worse.

In addition, untreated bipolar disease tends to gain momentum and become more malignant with time, says P.J. Malin, M.D., a psychiatrist with Alegent Creighton Clinic and an associate professor of psychiatry at Creighton University School of Medicine. “It can be very disruptive to other parts of your life. Approximately 60 percent of people with bipolar disease will develop substance abuse problems, and it carries a 15 to 20 percent suicide rate.

“Early treatment of the disease can help prevent the disease from getting more aggressive. Untreated bipolar disease, on the other hand, lowers one’s life expectancy by 10 years.”

If you are being treated for depression and are not responding to depression medications or you are experiencing negative or an unusual response, it is important to communicate this with your provider, adds Malin.

“Early treatment of the disease can help prevent the disease from getting more aggressive.” – P.J. Malin, M.D., psychiatrist with Alegent Creighton Clinic

You can also do your own test by taking the Mood Disorders Questionnaire (MDQ) online, which provides fairly accurate results and can help you and your clinician determine whether you are bipolar, notes Hammer.

Environmental factors and heredity appear to be the major risk factors for bipolar disease, says Malin. “There are different theories as to how the environment plays a role, but they include: obstetric complications, intra-utero viral infections, use of hallucinogenic drugs, and traumatic life events, such as the death of family or friends or abuse.”

Treatment typically involves a combination of medications and counseling that may be necessary over a person’s lifetime. “Counseling is huge for long-term success and stabilization,” says Robin Houser, a counselor for Nebraska Methodist Hospital’s employee assistance program, Bestcare EAP. “Bipolar disease is a lifetime problem, and counseling can help people learn coping techniques and avoid unhealthy thinking and unhealthy patterns of behavior. A lot of people think that once they have become stabilized that they don’t need medications or counseling anymore, but that’s when we’ll start seeing imbalances and manic episodes occur again.”

Women with bipolar disease are very sensitive to stress, lack of sleep, and environmental and seasonal changes, all of which can trigger an episode, notes Hammer. Practicing healthy lifestyle habits like getting regular exercise, adequate sleep, managing stress, and light therapy during the winter months can help keep the disease stabilized.

 “Counseling is huge for long-term success and stabilization.” – Robin Houser, counselor for Nebraska Methodist Hospital

Postpartum is also a common time to experience recurrences, probably because of sleep deprivation, says Hammer. There are medications that are safe to use during pregnancy, which are important to take to prevent a relapse. If a woman stops her medications during pregnancy, it can take up to six months to get the symptoms under control again, says Hammer.

“Newer medications as a whole have fewer side effects,” she says, “but it’s important that you are matched with the medication that works best for you and has the fewest side effects.

“Patients who are being followed and treated by a trained health care professional can function vey well and live a normal life.”