Cardiovascular disease — numbers don’t lie The No. 1 killer of Americans centers on heart health issues Nebraska Heart Institute “Historically, heart attacks and other coronary heart diseases have been perceived as a medical problem afflicting men or the elderly,” said Dr.
Rick Heirigs, cardiologist with the Nebraska Heart Institute. “However, statistics are showing that even though we are doing a better job of reducing the mortality for men from heart disease, we
are not as quick to keep up with the risk for women.” Heart disease is the No. 1 killer of Americans. Nearly 500,000 heart attacks occur each year, with men and women each suffering half. “These statistics should be a wake-up Please see LIE, Page 6
Heather Johson / The North Platte Telegraph
Molly Freeze walks on a treadmill at the cardiac rehab department of Great Plains Regional Medical Center. She used the facility to help her bounce back after a heart attack.
Her symptoms were not indication of bronchitis Co-worker’s advice to go to ER turned out to be life saver By HEATHER JOHNSON firstname.lastname@example.org
Molly Freeze is living proof of the dangerous toll stress can take on a body. She almost wasn’t. The North Platte woman had a heart attack in September and sought medical attention on the advice of a co-worker. Had she not, there’s a good chance Freeze, 36, might not have been around to tell the story. “I had been having chest and throat pains all day at work,” Freeze said. “I thought it was just bronchitis, so I was going to go home and go to bed.” It’s a good thing she didn’t.
“My co-worker thought I better go to the emergency room instead,” Freeze said. “She told me I looked gray.” Freeze acted on the suggestion, but declined a wheelchair a nurse offered at the ER entrance. Two seconds later, she changed her mind. “I took the wheelchair,” Freeze said. “My chest pains got worse, and I thought I was going to collapse. They took me immediately to the back of the department for tests. Everything happened so fast, it’s a bit of a blur.” She was hooked up to an electrocardiogram machine when a second heart attack hit. “The nurse went out into the hallway and called for back up for a heart attack in our room,” Freeze said. “I looked at my husband and asked if he was having a heart attack. He said, ‘No, but I think you are.’”
The news caught her off guard. She had been given pain killers, so didn’t feel a thing. “It wasn’t what I thought a heart attack would be,” Freeze said. “I guess I thought it would be kind of like on TV — that I would clutch my chest, fall down and not be able to breathe.” Instead, Freeze only had the initial chest pain. She could breathe, and never felt anything in her arm or back. “What I thought was my throat hurting was actually jaw pain radiating down my neck,” Freeze said. “I hadn’t realized where the pain was coming from because I tried so hard to convince myself I had bronchitis. Next time I think I have bronchitis, I will go to the ER.” A cardiology team whisked Freeze away to a catheterization lab where
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Rotablader is not for removing snow New technology available at GPRMC cardiovascular lab for atherectomy procedure By ANDREW BOTTRELL email@example.com
Great Plains Regional Medical Center is employing a new technology in its cardiovascular laboratory to help patients who aren’t candidates for surgery when doctors find blockages. The lab’s new rotablator machine performs a minimally-invasive procedure called an atherectomy on patients who have total chronic occlusions, which is a completely blocked artery or vein near the heart. The machine acts as a mini drill that Donelle pulverizes Kimberling through the plaque in a blocked artery or vein when surgeons can’t advance a stent through the artery. Donelle Kimberling, director of cardiovascular services at GPRMC, said that it is a last resort proce-
dure for patients who aren’t eligible for surgery. If the surgeon can’t get the stent through the plaque, the patient may be eligible for the rotablator procedure. “Our physicians thought it was important that we offer this service, because it would be a benefit to our patients,” she said. “It’s powered by pressurized nitrogen, That’s what it also uses for the speed of the burr. It’s brass and diamond coated so it can cut through the plaque. We also have a lubricant, which helps it flow easier.” The machine can operate at 200 to 6,000 revolutions per minute, depending on what the surgeon deems necessary during the procedure. The machine breaks up plaque and opens up the artery or vein. “It pulverizes the plaque into smaller pieces than red blood cells,” Kimberling said. The body can then flush the plaque through the system. Kimberling said the
Photos by Andrew Bottrell / The North Platte Telegraph
Above: Nancy Beacon displays the rotablator machine at Great Plains Regional Medical Center. The new machine helps surgeon break up blockages in heart patients who are not eligible for surgery. Right: Closeup photos of instrument that directs the thin rotablader that goes into the arteries and veins to drill through the plaque that has built up in blockage. device also has safety features to protect healthy veins and arteries. “When it hits soft tissue, it deflects off of the soft tissue,” she said. “It knows
Heart disease is a greater risk than cancer in women Nebraska Heart Institute Heart disease affects millions of people each year and it does not discriminate. In terms of total deaths, cardiovascular disease has claimed the lives of more women than men every year since 1984. Yet, many women do not view heart disease as a great risk. Heart disease is the No. 1 killer of women, yet only 8 percent of American women realize that it is a greater risk than cancer.
“Women take care of their family, but often overlook their own well-being,” said Dr. Rebecca Rundlett, cardiologist and medical director of the Women & Heart Disease Program at the Nebraska Heart Institute. “It is important for women to know their risk factors for heart disease, recognize warning signs, and have good communication with their health care provider.” The risk of heart disease in women is serious and often underestimated, and the NHI Women’s Please see WOMEN, Page 5
the difference between the normal wall and the plaque.” The procedure is typically a 24-hour procedure, Kimberling said, and most
patients are able to return to normal activity and work fairly quickly. Because it is minimally-invasive, the recovery time for the procedure is shorter than some other
heart procedures, she said. “With the advancement of technology, with medication, we are better able to care for our patients,” Kimberling said.
High risk factors increase chances for heart attack Smoking, age, high blood pressure, high cholesterol and diabetes all increase chances for heart disease By DIANE WETZEL firstname.lastname@example.org
Think of the lining of the arteries as a freshly-painted, smooth wall. With age, high blood pressure, increased cholesterol and diabetes, the walls start to become sticky. The walls start catching cells instead of allowing them to pass freely. Plaque develops in the lining and the person has an increased risk of a heart attack. “There are certain classical risk factors in heart disease,” said Dr. Arshad Ali, interventional cardiologist at Great Plains Regional Medical Center in
North Platte. “Smoking is one risk factor. Age plays a role and so do high blood pressure, high cholesterol and diabetes.” Being overweight increases the risk of developing Type 2 diabetes and the risks of abnormal cholesterol, he said. All of those factors can make the arterial linings sticky. “All these risk factors have a different kind of role and they interact with each other,” Ali said. Smoking and diabetes are a serious one-two punch when it comes to a risk of developing heart disease. “Normally, the white
blood cells are supposed to flow smoothly [through the arteries],” Ali said. “If the lining is not working very well, it will start capturing those cells and they will stay in the area. Once those white blood cells start going into the cells of the lining of the arteries, they start creating inflammation.” It’s like when you get the flu, he explained. “The reason you feel bad is because you have inflammation in the body. When you have a sore throat, the throat is inflamed,” he said. “That’s what starts happening inside the arteries. They start attracting bad cholesterol.” That’s when plaque begins to build in the arteries. “It becomes a vicious cycle,” Ali said. “You
have to break that cycle by stopping smoking, controlling your blood pressure, controlling diabetes and bringing your cholesterol down with diet change and losing weight.” All of those changes will react in a positive way to break the cycle. Some risk factors for heart disease, such as age and genetics, cannot be controlled. “As people grow older, there is a tendency for the blood pressure to go up,” Ali said. “And our arteries lose their cells and they repair it naturally. Those processes slow down as we age.” If someone has other risk factors, such as a genetic disposition to heart disease, smoking, high blood pressure, high cholesterol, the Please see HEART, Page 6
Diane Wetzel / The North Platte Telegraph
Dr. Arshad Ali, intenventional cardiologist at Great Plains Regional Medical Center, goes over a patient’s chart.
Improve heart function Nebraska Heart Institute Having a diagnosis of congestive heart failure can be a serious condition. However, heart failure can be managed with the right combination of therapy. Many men and women with CHF live a long and satisfying life with treatment. CHF is growing more prevalent. Nearly 5 million people in the
U.S. are living with heart failure and 550,000 new cases are diagnosed each year. Heart failure is typically caused by an underlying medical problem, such as clogged arteries, high blood pressure or a defect in the heart. These medical conditions can, over time, weaken the heart and cause it not to pump efficiently. When
the heart is not pumping properly it can cause retention of fluid, shortness of breath, fatigue and difficulty performing simple activities such as walking and tasks around the house. Patients now have many treatment options available to them to help improve the quality of life. The Nebraska
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Look at heart’s electrical system Why should atrial fib be treated?
Atrial fibrillation prevents top, bottom parts from cooperating Nebraska Heart Institute The upper chambers of the heart — atria — send out signals to the heart’s lower chambers — ventricles — and this is how the heart forms a normal beat. This normal beat allows blood to pump sufficiently throughout your body and is a crucial part of normal circulation. ”Sometimes the atria send out too many signals or erratic signals resulting in the atria not working in conjunction or rhythm with the ventricles,” said Dr. James Wudel, cardiothoracic surgeon with the Nebraska Heart Institute. Atrial fib prevents the top and the bottom parts of the heart from working together. The circulation of blood throughout your body may be reduced as much as 20-30 percent. According to Wudel, this is why some patients may feel tired or weak. Atrial fibrillation is widely known as the most common sustained cardiac arrhythmia. AF affects an estimated 2.5 million patients in the U.S. with approximately 300,000 new cases diagnosed annually. It’s
“Restoring your normal heart rhythm, controlling your heart rate and preventing clots from forming are the goals of treatment,” Wudel said. You may be on medication to maintain normal heart rhythm; these are called anti-arrhythmics. Controlling heart rate is usually done with beta-blockers or calcium channel blockers. Additionally, blood-thinners such as Coumadin are used to prevent clots and strokes. These are the medical options. However, these do not work all the time and many patients have continued symptoms and are unable to tolerate the medications. Fortunately, there are other new and innovative ways to surgically treat atrial fibrillation.
predicted that 5.6 million patients will be diagnosed with AF by the year 2050. The risk of stroke in patients with AF is estimated at seven times greater than patients without AF. Atrial fibrillation is second only to heart failure in terms of cardiac-related hospitalizations.
What causes atrial fib? Atrial fibrillation affects millions of people. Many are older than 65 and have other underlying conditions that put them at a higher risk, such as high blood pressure, hyperthyroidism, lung problems, diabetes, alcoholism or drinking high levels of caffeine. It may, in some cases, occur in otherwise healthy individuals.
Treating atrial fib with surgery
What are the symptoms of atrial fib?
You may benefit from surgery to cure your atrial fibrillation if: n you have symptoms and your medications aren’t working. n you are at risk for forming clots and stroke. n you are having a heart operation already. It may be time to con-
Symptoms include: n Heart palpitations (racing feeling in your chest) n Tiredness n Dizziness n Shortness of breath n Discomfort in your chest Some people have no symptoms at all.
sider a surgical option often referred to as the MAZE procedure, or modified MAZE or surgical ablation. Surgeons at the Nebraska Heart Institute have performed more than 300 surgical procedures for AF. A major part of the surgical procedure for AF includes removal of the left atrial appendage, which is the likely source of stroke in patients with AF. Wudel said that by removing the appendage this dramatically reduces the risk of stroke and may allow discontinuation or reducing the need for Coumadin. The MAZE procedure is a surgical intervention that cures atrial fibrillation by interrupting these extra electrical beats that are fired from the atria of the heart. Traditionally, the MAZE procedure, done by cutting and sewing of the heart, has been very successful. Recently, alternative energy sources have been used to replace cutting and sewing of incisions with linear lines of ablation (lesions) to stop the abnormal impulses. The surgeon uses a highly selective and safe device that creates lesions in the top portion of the heart to stop the conduction of the extra beats, while
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Heart Program is taking action to increase awareness and to educate women on their risk of developing this disease. Although heart disease affects both men and women, there are subtle differences in how a woman’s cardiovascular system displays symptoms. “Women exhibit initial symptoms or experience a coronary event about 10-15 years later in age than men,” Rundlett said. Often, women are more likely to have symptoms but less likely to take it seriously and seek evaluation. One reason why women do not take symptoms seriously is because symptoms of heart disease are often atypical in women. They might experience shortness of breath, fatigue, nausea or discomfort above the waist. Women often think of chest pain as the main indicator of a heart attack. “Sometimes a woman will mention having a dull pain or pressure in her upper back or shoulder area and not necessarily in chest,” Rundlett said. “It is important for women to recognize theses subtle symptoms and seek medical evaluation from their physician.” T raditiona l c a rdio vascu la r risk factors apply to women as wel l as men. Risk fac tors i nclude high blood pressu re a nd cholesterol, tobacco use, fa mi ly histor y of hea r t disease, age a nd diabetes. O f ten, t hese factors have a relatively g reater i mpact a nd a re more per vasive i n women. Factors such as obesity, a sedentary lifestyle, postmeno-
pausal status and possibly markers of inf lammation are emerging as important factors in terms of risk profile and analysis in women. Fortunately, women can benefit immensely from intensive risk factor modification. There is a significant benefit from dietary and exercise lifestyle modifications in women in terms of lowering their risk for primary or secondary coronary events. Women can lower their risk of heart disease by as much as 82 percent by leading a healthy lifestyle. There are several steps women can take towards modifying their lifestyle. They include smoking cessation, regular exercise, a healthy diet, regular blood pressure and cholesterol checks, stress reduction and control of diabetes. According to Rundlett, it is important for women of all ages, especially those with risk factors, to take a healthy approach in their choice of lifestyle. “In our Women’s Heart Program, we work with a woman’s primary care physician in the evaluation and treatment of heart disease and design a heart-healthy lifestyle plan to follow,” Rundlett said. By being familiar with personal risk factors and making healthy changes in diet, physical activity,and other daily habits, women can greatly reduce the risk of developing or lessen the severity of heart disease. “Every woman needs to be aware of her risk factors and take action to reduce those risks,” Rundlett said.
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HEART from Page 4
longer they are exposed to those risks, the more likely they are to develop plaque in the arteries, “There are certain risk factors you can take care of,” Ali said. High cholesterol can be controlled with weight loss, dietary changes and medications. “If you stop smoking, the risk of heart disease over time is diminished,” he said. “After five years of giving up smoking, your risk starts to be almost the same as someone who has not smoked.” Diabetes needs to be controlled to help reduce the risk of heart disease as well. Type 2 diabetes is primarily caused by obesity, Ali said. “Everything is connected,” he said. “If someone is obese, and they are able to lose 3-5 percent of their weight, it decreases the risk associated with any heart problems,” he said. “If someone weights 200 pounds and are classified as obese and they lose just 12 pounds, they can actually decrease
the requirement of drugs they need for high blood pressure, diabetes and that type of thing.” Everything is connected, which is why risk assessment tools are important to clinicians. “We can actually calculate risks by assigning numbers after assessing factors like age, diabetes, smoking, obesity and cholesterol,” Ali said. “You add all the numbers together and that gives you what the risk is going to be.” For a patient whose risk assessment is on the lower side, changes in diet and exercise might be enough. For those with higher risk numbers, diet, exercise and medication may be necessary, “It all adds up,” Ali said. “Having one risk factor is bad, but having two is worse. If you have three risk factors, it is going to be worse than having two.” In his experience, convincing patients to stop smoking is one of the most difficult risk factors to deal with. “After that, it is getting them to change their dietary habits, “he said. Once plaque has developed in the ar-
teries, it is usually there for the duration. “If you have a 70-percent blockage and start taking medication and do everything right, plaque may go down to 6065 percent,” Ali said. “While the percentage in plaque reduction is very small, when you stop smoking and eating right, plaque becomes stable, so it will not rupture or cause a heart attack. It is not the degree of plaque, but primarily the way the plaque behaves. We want the lining to become stable so it will not rupture.” Surgical interventions such as stents and bypass surgeries are damage control, Ali said. “When a patient has a stent, the plaque is pushed outward,” he said. “It’s like having a car wreck and taking your car into a dealership and they repair it. If you are not going to drive better, then the car is going to keep getting wrecked.” Be aware of the risk factors that cause heart disease and take the steps needed to eliminate them, Ali said.
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Heart Institute Heart Improvement Program offers many new drug and device therapies to help treat and alleviate symptoms. “There are several new and very promising drugs and medical devices continually being developed and used by patients in our program,” said Dr. Anuj Jain, cardiologist and medical director of the Nebraska Heart Institute Heart Improvement Program. “Patients have had remarkable improvement in the quality of life and significant increase in the ejection fraction and cardiac output with drug therapies and devices.”
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call,” says Heirigs. “They illustrate the need for men and women to join the fight against heart disease — to take control of their lifestyle and their own healthy well being.”
Risk factors The formula for heart disease is complex with many ingredients. Smoking may increase your chance of developing heart disease by two to four times that of a nonsmoker. Cholesterol, another risk factor for heart disease, contributes to plaque build-up in the arteries, creating a block in blood flow, which can result in a heart attack or stroke. High blood pressure is another contributor to cardiovascular disease, causing the heart to work harder. High blood pressure places undue stress on the heart and arteries. Lack of exercise and obesity are two more factors that may con-
Patients with arrhythmia can benefit from such medical devices. An implantable cardioverter defibrillator is a device used to help prevent sudden cardiac death in patients with life-threatening arrhythmias. This device works by delivering electrical shocks to the heart to eliminate abnormal rhythms. ICDs, such as the Biotronik Tupos LV/ ATx, are unique in that they provide three essential therapies in a single device: Cardiac resynchronization therapy for treating heart failure, atrial therapy for atrial tachyarrhythmia and ICD therapy for ventricular tachyarrhythmia. Surgical options for patients with heart failure continue to expand. “Leaking mitral
valves can be repaired safely in many patients and provide significant symptomatic improvement,” said Dr. James Wudel, cardiothoracic surgeon with the Nebraska Heart Institute. Patients with large amounts of ventricular scar may benefit from surgical remodeling procedures to improve left ventricular function. Additionally, coronary artery bypass remains an excellent therapy in selected patients with viable myocardium and graftable vessels despite poor ventricular function. New surgical devices to control cardiac enlargement as well as less invasive techniques to repair leaking valves may be readily available in the near future.
tribute to heart disease. Inactivity and over eating can indirectly lead to heart disease by increasing blood pressure and cholesterol levels. Women who are postmenopausal are at higher risk for heart disease. Some researchers believe that estrogen, a hormone naturally produced in women, may offer protection against heart disease.
play host to exercise enthusiasts. The American Heart Association reminds us of the three Rs to lowering our risk to heart disease. Take an active part in changing your lifestyle to reduce your risk to heart disease. Recognize the warning signs of heart disease such as chest pain, nausea and shortness of breath. Respond to your body’s call-to-action, thereby limiting the damage that heart disease can cause. According to Heirigs, there are steps we can take to be proactive in the fight against heart disease, such as exercise, diet, know your numbers for cholesterol and blood pressure and, most importantly, see your physician on a regular basis. Whether it’s diet, medication or discussing an exercise plan, your health care team can tailor a program to better cardiovascular health. Education and prevention are the keys to fighting disease. It’s your health, take charge.
Taking charge of your lifestyle Many factors play a role in heart disease. Some of these, such as age and family history, are out of our control. “However, just by making a small change in our behavior, men and women can lower their risk to heart disease,” Heirigs said. In the United States, smoking has declined dramatically during the last three decades. Americans are watching their diet and cholesterol level much closer. And, it’s impossible to find an exercise path or shopping mall that doesn’t
Cholesterol — the good, the bad and the ugly High fat levels give out no warning or symptoms Nebraska Heart Institute Cholesterol can be both good and bad, so it’s important to learn what cholesterol is, how it affects your health and how to manage your blood cholesterol levels. Cholesterol is a type of fat, which is very important for life. It is a vital building block of many substances, including the cell membrane of every cell in our body, digestive bile released by the gall bladder, the sex hormones, Vitamin D (associated with calcium metabolism) and other important substances. Cholesterol can be broken down into three components: low-density lipoproteins (LDL), high-density lipoproteins (HDL) and triglycerides. Levels of each component can be assessed to determine an individual’s risk for heart disease. LDL is known as the bad cholesterol and contributes to plaque formation, which may lead to blockag-
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channeling the normal impulse from the top of the heart to the bottom to form a normal beat. The scar tissue forms where the lesions were made and the abnormal beats are now unable to form. Your heart will
es in the arteries. HDL is considered the good cholesterol because it helps to remove cholesterol from the body. Triglycerides are a source of energy for the body; high triglycerides, especially with low HDL, may indicate a risk. However, according to Dr. Denes Korpas, cardiologist with the Nebraska Heart Institute Lipid & Heart Attack Prevention Program, cholesterol is not all bad. “We have to have some cholesterol, but the liver can make as much as we need. If the level is too high, it is deposited in tissues, specifically the arteries, causing them to narrow and not carry enough blood to vital organs such as the brain or the heart, ” Korpas said. High cholesterol has no warning or symptoms, yet it can cause serious health problems. Hypercholesterolemia, or high blood cholesterol, is a serious risk factor for coronary artery disease. High cholesterol, along with diabetes, obesity, inactivity, smoking, high blood pressure and diet, can all contribute to heart disease. Like high blood pressure, high cholesterol itself is not a disease, but a condition that can lead to some very important consequences, among them heart attack and stroke.
When discussing cholesterol levels, it is more appropriate to realize that there is a spectrum of risk. That is, your level is not normal or abnormal. Rather, the higher the level of cholesterol, the higher the risk of developing a problem. Furthermore, it is important to take into account whether an individual has other risk factors, which make the level of cholesterol more dangerous, if they have already developed blockages. The lower the level, the lower the risk of coronary artery disease and other forms of arteriosclerosis. n Recommended LDL — Cholesterol Levels: Optimal (less than 100) Borderline (100-129) High (greater than or equal to 130) For high-risk patients, the LDL cholesterol should be lowered to 100 mg/dL, and consideration should be given to lowering it to 70 mg/dL. To control your cholesterol, get a cholesterol screening, eat foods low in saturated fat and cholesterol, maintain a healthy weight, exercise regularly and follow all your healthcare professional’s recommendations.
beat normally and provide the body with its needed blood supply. If you are having an open-heart surgery procedure and you are a candidate for surgical treatment of Atrial Fibrillation, the surgeon will be able to access your heart through the same incision.
If you are not having an open-heart procedure, but may be a candidate for surgical treatment of A-fib, you may be a candidate for minimally invasive surgery where your operation will be done with small incisions and without the heartlung machine to cure your atrial fibrillation.
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two stents were placed in her arteries. “I was 100-percent blocked on the right side and 70-percent blocked on the left,” Freeze said. “They put the stents on the right and are hoping lifestyle changes will help the left side.” She spent three days recovering in the intensive care unit. Upon her release, she was given nitroglycerin tablets. Freeze carries them with her all the time and is supposed to place one under her tongue at the first hint of chest pain. She had to do that just six weeks after leaving the hospital. Freeze does not have a family history of heart problems. She did have high cholesterol and high blood pressure and was a Type 2 diabetic, however,
doctors told her it was stress that caused her heart attacks. “I thought I dealt with stress just fine,” Freeze said. “I didn’t think it was bothering me, but obviously it was.” As the general manager at Whiskey Creek, Freeze worked 15- to 16hour days from open to close. When she was home, her phone would ring off the hook with work-related calls. She had no time for relaxation, family or fun. Her heart scare caused her to reevaluate her lifestyle. Freeze quit the manager job to work as a server at Applebee’s. “That has made a world of difference stress-wise,” Freeze said. “I go in, do my job and go home.” She also exercises more. After her discharge from GPRMC, Freeze attended 18 sessions of cardio rehabilitation the hospital
offered. She also went to the hospital three times a week to work out on the exercise equipment. Now, Freeze uses a treadmill at her home, or walks outside. She has also changed her eating habits. “Before, I ate whatever was fast,” Freeze said. “That included lots of fried food. Now, I rarely eat fried food. I eat lots of fresh fruits and veggies and limit myself to 4 ounces of meat per meal.” She cut out pizza, pasta and other carbs and bases her meal choices off a menu from the hospital. “When I found out in March of 2013 that I was diabetic, I set a goal to lose 75 pounds,” Freeze said. “So far, I’ve lost 50 and gone down seven pants sizes. I feel great.” Her husband and father have followed her lead. They eat healthier and exercise as a result of her experiences.