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Nancy Reagan, First Lady with Many Causes
 
Nancy Reagan was a film actress and First Lady from 1981 to 1989 as the wife of Ronald Reagan, the 40th President of the United States. She started the "Just Say No" campaign against drugs that led to 12,000 anti-drug youth clubs, and in October 1988, she spoke to the United Nations General Assembly and called on the international community to enforce laws against recreational drug use. 
 
She signed with MGM Studios in 1949, but in 1951, during the McCarthy era, she was blacklisted as an alleged communist sympathizer.  She requested a meeting with the actor Ronald Reagan who was then president of the Screen Actors Guild.   Reagan proved that she had been confused with another actress with the same name.   Their meeting was well timed: he had just divorced actress Jane Wyman. They fell in love, dated for three years and married in 1952 when she became pregnant. 
 
In 1987, at age 66, she was diagnosed with breast cancer and had her entire breast removed, instead of the much less extensive lumpectomy that was conventional at that time.   She influenced many women to get mammograms and because she was the First Lady, many women afflicted with breast cancer also opted to have mastectomies.   
 
She is perhaps best remembered for her courageous role as spokesperson and primary caregiver during her husband's 10 year battle with Alzheimer's disease.  Caring for him wore her out physically and emotionally and she became much less active.  She died of heart failure at age 94.
 
Early Years and Education
Anne Frances Robbins was born in 1921 in Queens, New York to a father who was a car salesman and a mother who was an aspiring actress.  When she was six, her parents divorced and sent her to be raised by an aunt and uncle in Bethesda, Maryland.  Her aunt frequently took Nancy to New York to see her mother performing.  Her mother married a famous Chicago neurosurgeon named Loyal Davis and in 1931, at age 10, Nancy moved to Chicago to live with them.  In 1935 she was formally adopted by Dr. Davis  and her new name became Nancy Davis.   She went to the Girls Latin School in Chicago and to Smith College, where she majored in drama and earned her BA degree in 1943, at age 22.
 


 

Her Career and Causes
After college, she took odd jobs as a sales clerk in Marshall Fields department store in Chicago and as a nurse's aide.  In 1949, at age 28, she moved to Hollywood and signed with MGM Studios.  She worked in a few films and then met and dated Ronald Reagan.  After three years of dating, she became pregnant and they married on March 4, 1952.  They starred together in Hellcats of the Navy, a 1957 movie about a World War II submarine.  
 


 

When Ronald Reagan decided to seek political office, she became a strong helpful cog in all his campaigns.  From 1967 to 1975  he was Governor of California, so she led a campaign to aid Vietnam veterans.  When Reagan was elected President in 1980, she led a campaign to prevent drug abuse, particularly among young people. She also actively supported her husband in starting negotiations with the Soviet Union that lead to the end of the Cold War.  In 1987, she hosted a state dinner for Mikhail and Raisa Gorbachev.  After dinner, pianist Van Cliburn played "Moscow Nights" and both Mikhail and Raisa sang joyously along.  She hosted 56 state dinners over eight years, compared to six by George and Laura Bush.   "For eight years, I was sleeping with the president, and if that doesn’t give you special access, I don’t know what does,”
 
Just Say No
In 1982, a schoolgirl asked her what she should do if someone offered her drugs. Nancy Reagan responded "Just say no."  To promote drug abstinence, she traveled more than 250,000 miles, visited drug abuse prevention programs and drug rehabilitation centers, appeared on television shows, recorded public service announcements and wrote guest articles.
 


 

Her Breast Cancer
In 1987, she was diagnosed with breast cancer and chose mastectomy, major surgery to have her entire breast removed, rather than the  simpler lumpectomy.  I have not seen her medical records but I found several news reports stating that she had a type of breast cancer called Disseminated Carcinoma In Situ (DCIS) which we now learn is probably a pre-cancer.   Her cancer was only seven millimeters in diameter, about the smallest doctors can detect on a mammogram.
 
Because of her, many women became more aware of breast cancer and went out and had mammograms.  In the three months following the removal her breast, there was a 25 percent increase in women opting to have their entire breasts removed for this condition (DCIS).   Four months later, the percentage of women opting to have their entire breasts removed returned to the normal lower percentage (JAMA. 1998;279(10):762-766).  See my report on Ductal Carcinoma in Situ (DCIS)   
 
Ronald Reagan's Alzheimer's Disease
Upon leaving the White House, the couple returned to California, where they purchased a home in the Bel Air neighborhood of Los Angeles.  In 1994, her husband was diagnosed with Alzheimer’s disease.  She became his primary caregiver and cared for him until his death in 2004 at age 93.  During this period she worked actively with the National Alzheimer's Association and the Ronald and Nancy Reagan Research Institute in Chicago, Illinois, searching for better treatments for Alzheimer's disease and raising public awareness.  This was her final and perhaps most important cause.  The Reagan's close friend, Charlton Heston, called their marriage "the greatest love affair in the history of the American Presidency." 
 
Final Years and Death
In 2008, at age 87, she fell and was hospitalized for two days. In 2012 she fell and broke several ribs. On March 6, 2016, she died of congestive heart failure at her home in Bel Air.  At 94, she was the second-longest-living First Lady of the United States, after Bess Truman (97).  Ronald Reagan was the second-longest-living President, after Gerald Ford; they were both 93 but Ford lived five-and-a-half weeks longer than Reagan.
 
Congestive Heart Failure
Heart failure is the most common cause of death in elderly people who have no other diseases or health problems.   Nancy Reagan had no obvious risk factors for heart disease, and she had stayed slim and active throughout her life.  However, being the primary caregiver and watching her husband suffer from dementia for ten years wore her out and slowed her down.  
 
Congestive heart failure means that the heart is not strong enough to pump the blood that returns to it, so the blood backs up, filling the lungs with fluid to make the person short of breath, and filling the legs and feet with fluid which causes swelling and pain.  
 
Aging weakens all muscles in the body, including the heart muscle.  The primary stimulus for blood to circulate through your body comes from your skeletal muscles, not your heart. When you move your muscles, primarily the large muscles in your legs, they squeeze the veins near them which increases the amount of blood that returns to your heart. Then the leg muscles relax and the veins near them fill with blood. Your heart is a big muscular balloon. The extra blood pumped by the leg muscles fills the heart causing the heart to beat faster and with more force. This helps to explain why strong skeletal muscles are so important for heart health.  
 
Unfortunately, congestive heart failure is a vicious circle because the weaker your heart gets, the less you move around so the skeletal muscles continue to get weaker.  Discomfort and pain sap your energy so you lose interest in your daily activities and move even less.  The American Heart Association recommends that all older people have a heart disease prevention program that includes safe exercise and treatment of depression, social isolation  and other psychosocial issues (Circulation, 2002; 105: 1735-1743).  However, it takes energy and determination to keep moving.  Sometimes the person just decides that enough is enough.  More on Congestive Heart Failure
 


 

July 6, 1921 – March 6, 2016
March 13th, 2016
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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