ARKANSAS, USA — Sarah Steinsiek grew up in small-town Arkansas watching her mother, Ruthie Hare, join all sorts of fitness groups. Naturally slim, Ruthie especially loved aerobics and calisthenics.
She had another motivation, too. She knew it would help ward off the heart disease that had plagued nearly every member of her family.
Yet there was one healthy step she couldn't take. Ruthie kept smoking cigarettes, despite knowing the risks.
One day when Sarah was 8 and her brother, TJ, was 6, Ruthie said she didn't feel well. She had pain in her arms and chest. She lowered herself into a recliner, hoping the sensations would go away.
When they didn't, she recognized the symptoms experienced by her parents and several siblings. She told her children: "I think I'm having a heart attack."
Sarah called 911.
Her mother had indeed had a heart attack. She was 39.
From there, Ruthie worked to improve her health. She started to focus more on nutrition, stopped drinking, and did her best to give up cigarettes. She tried cessation programs, pills, patches, and hypnosis. They all worked, but only for a while.
She developed other health issues as well: gastrointestinal issues, circulatory problems, fibromyalgia, and peripheral artery disease, where fatty deposits and calcium build up in the walls of the arteries.
As much as Sarah feared for her mother's health, she started smoking at age 14. A chubby child, she thought it would help keep her weight down. She also wanted to look cool and fit in with her friends at school.
Like her mom, Sarah became a fan of cardio activities. While her mom did it mostly for heart health, Sarah's motivation was keeping her weight down. She wanted to be thin, which to her meant attractive. She ran regularly and counted calories.
As Sarah continued to smoke, her mother finally stopped for good. But her health never improved. She started having blood clots and mini-strokes.
In December 2014, Ruthie died from a coronary embolism, a blood clot in her heart. She was 53.
That week, Sarah, then 23 and sick with grief, smoked a carton of cigarettes, twice her usual amount.
A few months later, Sarah had her own health scare, including high blood pressure and a fast heart rate. Doctors thought they could be stress-related.
Maybe, Sarah thought. But maybe it was also her body's way of telling her to clean up her lifestyle. That, she knew, would be the best way to honor her mother, a beautiful soul and a loving mom.
Sarah, now 33, has made great progress.
She quit smoking, although it hasn't been easy. Now living in Calhoun, Louisiana, she's a district training manager at a large retail chain. She's especially proud of being smoke-free because about half the people she's around are smokers.
She's also become more comfortable with her body.
While maintaining a strict diet helped her lose 60 pounds and improve her cholesterol and blood pressure, she knew that plan wasn't sustainable. However, she became so interested in nutrition that she began studying it formally. She hopes to get a degree in it.
"I wanted to do it for my own benefit, but also so I could use my training to help others someday," she said.
She also started working with a personal trainer to work on her strength and mobility. Her favorite activity is hiking, especially in the Arkansas mountains.
Sarah's brother, TJ, calls his sister "a role model and an inspiration." He lives with their older half-brother, Corey, in San Antonio. They're both trying to quit smoking and keep active by shooting hoops.
Corey, who has a different mother, is impressed that Sarah's lifestyle change "seems less about her weight and more about how it makes her heart healthy, makes her brain healthy and makes her whole being feel better."
Every year since her mom passed, Sarah has commemorated her mom's birthday in a special way. She calls that day – March 19 – "Ruthie Day."
"I always ask everyone to do one random, selfless act of kindness, just like my mom did every day," she said. "Like she always said, we never know what each person is going through."
And now that she's cleaned up her lifestyle, Sarah hopes to enjoy many more Ruthie Days.
"I want to see my friends and families grow up and see their children grow up," she said. "I want to do and see as much as I can on this beautiful earth for as long as I can. I know all too well that I only have one life, and I want to take care of it."