P.H.A.T or Fat?

“Doc, I just don’t understand”, said Patient X, one of my long-time patients. “My blood pressure is okay, I’m taking my medicine as prescribed and my blood work is normal. Look at my weight. It’s almost the same as last visit. Did you check my thyroid? I think my hormones are all out of order. I need that weight loss pill. Those television potions that I spent hundreds of dollars on aren’t working to rid me of my cellulite and baby fat. My knees are aching, I get short of breath walking up and down the stairs. I snore all the time, and I’m always tired. I’m going to start exercising this week, I promise. Doc, can you help a sister out with some of those weight loss pills? I need to lose 30 pounds this month for my daughters wedding, class reunion, cruise… These guy where looking at me and said I was P.H.A.T.” Or did they mean fat?

“Patient X” has the same story each visit and despite being a regular and loyal client, taking charge of her life has taken a back burner to quick fixes for weight loss. She’s probably one of the nicest people I have ever met; however she seems to be in denial when it comes to her health and the hard cold facts. Her blood pressure was elevated at 130/85 (normal is 120/80 or less), her cholesterol and fasting blood sugar was also mildly elevated, and wrapped around her waist was an excess of fat that had increased by several inches over the last year creating a cute, but deadly “jiggle” as she walked. My patient, Patient X, has what we call the metabolic syndrome, which is a group of risk factors found in one person. The risk factors for the metabolic syndrome include an increased waist circumference, elevated cholesterol (specifically the triglycerides), a low HDL (the good cholesterol), elevated blood pressure (130/85 or greater), and an elevated fasting blood sugar (greater than 100 mg/dl). It is estimated that over 50 million Americans have the metabolic syndrome and one of the dominant underlying factors is abdominal obesity (excess fat around the stomach).

The disease obesity, which can be simply defined as excess in body fat, is not the same as being overweight. “A person who is overweight is running a definite health risk, but an obese person is loudly and insistently asking for trouble”, says Stacy Mitchell, M.D. co-author of Livin’ Large: African American Sisters Confront Obesity. Overweight and obesity are labels for ranges of weight that are greater that what is considered healthy for a given height. When discussing adults, the Body Mass Index or BMI determines overweight/obesity. In my practice, I consider the BMI a vital sign as it helps me to assess my patient’s risk for obesity and the diseases that come along with it. So by simply taking one’s height, weight, and waist circumference, not only can your doctor determine your BMI and risk for obesity, he/she can also gain some insight on your risk for heart disease, the number one killer of all Americans.

In the past 20 years there has been a significant increase in obesity in the United States and African American’s are under attack. Obesity does not discriminate as the Food and Drug Administration (FDA) estimates that almost two-thirds of (64%) of all Americans are overweight; almost one-third are obese. Conservative estimates by the Centers for Disease Control (CDC) show that 65% of African American women and 33% of African American men are overweight. Childhood obesity is on the rise and we are now seeing shocking increases in diabetes, heart disease, and hypertension in this previously active and healthy population. Overweight/obese individuals are at risk for developing many conditions including diabetes, heart disease, strokes, high blood pressure, arthritis, hypothyroidism, high cholesterol, sleep apnea, gall bladder problems, gout, cancer of the kidney, endometrium (lining of the uterus), breast, colon and rectum, esophagus, prostate and gall bladder; depression, anxiety, etc… Obesity is now considered the second most preventable cause of death in the United States, preceded only by smoking. Four hundred thousand deaths a year are estimated to be associated with obesity.

There are treatment options for this disease; however, we must first accept that there is a problem, especially in the African-American community. While some medications have been approved for treatment (orlistat and sirbutamine) and there are surgical options, which are reserved for extreme cases, proper diet and nutrition coupled with regular and consistent exercise and modification of behaviors associated with overeating is the mainstay of treatment.

She’s P.H.A.T (pretty, hot, and tempting), “big boned”, full figured, pleasing plump, or thick! That can be a compliment to some ladies, but it could also mean she’s fat, obese, or overweight depending on the messenger. Remember, being overweight/obese is not an issue of aesthetics. “You can be overweight and still stop traffic”, says Teri Mitchell who also co-authored Livin’ Large. The reality is it’s still unhealthy. For more information on obesity visit http://www.cdc.gov/, pick up the book Livin’ Large by Teri and Stacy Mitchell.

(c) 2007 Rani Whitfield. This article was published September 2007 at www/eurweb.com

Alcohol: Is it Good or Bad For You?

Despite what most people thing alcohol is the second most commonly abused legal drug in the United States after tobacco. There has been some debate over whether alcohol is good or bad for those who do drink. The difference between what’s “good versus bad” is in the amount and frequency that one drinks. To date, there has been no universally accepted standard drinking definition. Alcohol abuse is a major cause of preventable death in the United States. Heavy drinking can damage the liver and heart, cross the placenta and harm and unborn child, increase the chance of developing certain cancers, plays a role in depression and violence, and is a major cause of problems with relationships. The assumed benefits, if one drinks in moderation, include improving cholesterol, reducing one’s risk of heart disease, potentially protecting against type 2 diabetes and preventing gallstones.

But before we get all excited about the rum and cola you had last night, lets take a look at the numbers: 14 million Americans meet the criteria for alcohol abuse or alcoholism; alcohol plays a role in 1 in 4 cases of violent crime; more than 16,000 people die each year in automobile accidents in which alcohol was involved; alcohol abuse costs more than $180 billion dollars a year. Alcoholism cuts across gender, race, and nationality in the United States. 17.6 million people, about 1 in 12 adults, abuse alcohol or are alcohol dependent. In general, more men than women abuse alcohol and problems are highest among young adults age 18-29 and lowest among adults ages 65 and older. There is research that shows that the risk for developing alcoholism runs in families; however, lifestyle plays a major role as well.

Ethanol, the active ingredient in alcoholic beverages can affect the body in many ways. It is classified as a sedative significantly impairs judgment the more you consume. Long-term users of ethanol are often defined as problem drinkers or alcoholics. Alcoholics are both physically and psychologically dependent on the drug, while problem drinkers are only psychologically dependent. Heavy and binge drinking overtime can cause inflammation of the liver called hepatitis and eventually lead to scarring of the liver called cirrhosis. Cardiomyopathy, an enlarged and poorly functioning heart, is also a major long-term side effect. Cancers that have been linked to alcohol abuse include those of the mouth, throat, esophagus, colon, and breast. Certain individuals should never drink and they include pregnant mothers, recovering alcoholics, those with diseases of the liver, and individuals taking medicines that interact with alcohol. As mentioned earlier, ethanol can cross the placenta and put an unborn child at risk for Fetal Alcohol Syndrome. These children are born with facial deformities, abnormal behavior, and mental retardation, just to name a few.

In most cases, alcoholics deny that they have a drinking problem. Signs and symptoms of alcoholism include binge drinking; drinking alone; nausea, sweating, shaking, and seizures if some one is coming off a binge drinking session; depressed mood, irritability, and legal problems. Unfortunately, there is no cure for alcoholism, but the good news is that it is treatable. Treatment programs use a combination of both counseling and medications to help people stop drinking. The bottom line is that if you don’t already drink, there is no reason to start. You can get similar if not better benefits for your heart by exercising and eating a healthy low fat diet. If you already drink alcohol, do so in moderation. Men should drink no more than two drinks a day and women no more than one. Women have less total body water than men, so therefore it takes less alcohol to have an effect on women. The principles of good health for the most part have not changed. A good diet, regular exercise, and seeing your doctor on a regular basis is the key to longevity. If you don’t already drink, don’t start. If you do, do so in moderation and remember to never drink and drive.

For more information on alcohol visit www.niaa.nih.gov. (c) 2007 Rani Whitfield. This article was published September 2007 at www.eurweb.com

Drugs of Abuse Steroids:Fact or Fiction

By the time you read this article, Barry Bonds may have already broken the home run record. On July 20, 1976 Hank Aaron hit the last and final homerun of his very successful, yet tumultuous career in the Major Leagues. Much like his predecessors, Satchel Paige, Jackie Robinson, Willie Mays, and many others African American players during that era, he played the game under extreme racism, scrutiny, and ridicule because he was African American and because he seized the home run record of America’s white hero, Babe Ruth. So we should be applauding the efforts of the African American Barry Bonds, right? He has great hand-eye coordination, he is the winner of eight Gold Glove Awards, he was the Most Outstanding Player in Baseball in 1993, and he holds the record for the most home runs in a single season- 73! Something, however, “just ain’t right”, and the accusations of his use of anabolic androgenic steroid (steroids or AAS) to help achieve these goals have not only tarnished his image, but the image of successful African American athletes.

Performance enhancing drugs like steroids are not new to the arena of sports. They date back to the early Olympic Game’s, which started in Greece and has now evolved into a multimillion-dollar industry due to marketing and advertising. As early as 1969, journalist Bill Gilbert was quoted in Sports Illustrated as saying, “The pill, capsule, vial, and needle have become fixtures of the locker room as athletes increasingly turn to drugs in the hope of improving performance.” The desire to win and to gain the edge over one’s opponent is innate. Who could argue with a young man or woman whose business contract becomes more lucrative if he/she can out run or out bench press more than his/her competition? The facts, however, still remain: steroids are illegal and are associated with short and long term side effects, some of which are very damaging to the body. The question I am often asked is why do athletes use steroids.

Anabolic (tissue or muscle building) androgenic (the development of masculine characteristics) steroids or AAS are the man made or synthetic versions of the male hormone testosterone. Testosterone, a hormone found in men and in women in much smaller amounts, is responsible for the development of males during puberty. The original purpose for the use of steroids by physicians included: replacement of the hormone in men born with low levels; treating individuals who suffered injuries during war; treating those who are malnourished, such as HIV and cancer patients. There are also veterinarian uses for these drugs to treat certain medical problems in cows and horses. When used properly, these medicines can be very successful in treating illnesses and definitely have a place in the medical arena.

Unfortunately, there is a phrase used by some professional athletes: “If you are not using steroids, then you are not trying hard enough!” The quest for supremacy at the expense of one’s health has taken over and the all-mighty dollar is more important than longevity and loved ones. Steroids have been used and proven to build strength and endurance in competitive athletes for decades. Weight gain, weight loss, increased speed, increased strength, and physical appearances are all reasons for the use of these illegal concoctions. Steroids have become much more complex as proven by the “designer” steroids, some of which are undetectable with the latest technology in urine, blood, or hair samples. Steroids are administered in many ways including pills, needles, patches, or creams. Once in the system they are soaked up my muscle cells from the blood stream. Once inside the muscle cells they promote the production of protein, which stimulates muscle growth. Athletes often take doses two to three times the normal amount of steroids required on weekly basis. They mix or stack different types of steroids to achieve various effects: more muscle mass, decreased weight, leaner appearance, etc…. None of these “protocols” used by the athlete have been tested on humans and at best are experimental.

Side effects of steroid use/abuse include high blood pressure, strokes, elevated cholesterol, nausea, sleep disturbances, acne, increased aggressiveness, and mood disorders including anxiety and depression. Women can experience reduced breast size, increased body and facial hair, a deeper voice, and menstrual problems. In men, reduced sperm count; impotence, breast growth, and decreased testicular size have all been documented. Some of these are irreversible and require surgical treatment.

It still amazes me, however, that I get request frequently for these drugs to improve performance. To win at any and all cost is the main reason. A poll taken in 1995 of 198 sprinters, swimmers, power lifters, and other Olympians and aspiring Olympians asked if the athletes would take a performance-enhancing substance if they knew it would help them win there event and they would not be caught- 195 out of 198 said yes. The poll went further to ask if under the same conditions they would take the substance knowing that in five years they may die- 80% still said yes!

Educating our youth on proper nutrition, exercise, and the consequences of steroid use/abuse is the key. Commitment to the sport on all levels is the only way to be successful. Steroids are illegal, potentially harmful, and are viewed as cheating. Is Barry Bonds guilty; unfortunately many believe that he is, despite being one of the most talented individuals to ever play the game of baseball and one of my personal favorites. My advice to him is to never take or rub something on his body without doing a little research. I surely will celebrate the day he breaks the record, but for some, his success will always be in question.


For more information on steroids visit (www.nida.nih.gov) or visit my website (www.h2doc.com), view the Steroid Man, and shoot me a question at DrRani@h2doc.com. (c) 2007 Rani Whitfield. This article was published September 2007 at http://www.eurweb.com/

Breast Cancer and Robin Roberts

When “Good Morning America” anchor Robin Roberts announced she had been diagnosed with breast cancer, I had mixed emotions. On one hand, I hated the fact that she had to deal with this dreaded disease; but on the other hand, who better than Robin Roberts to speak out about and educate our community on the most common cancer found in women today? In October of 1985 the first National Breast Cancer Awareness Month program (NBCAM) took place. This week-long event, sponsored by the two founding members, the American Academy of Family Physicians and Cancer Care Inc., used media and brochures before a U.S. Congressional committee to spread the word about the need for access to mammography and the importance of early detection and treatment of breast cancer. A valiant effort this was, but the personal testimonies and survivors of the disease is what gives us hope and I applaud Ms. Roberts for her courage.

So what is breast cancer? In the breast there are living cells. Everyday these cells divide, grow and die. Sometimes these cells grow out of control and can form a lump or a mass in the breast called tumors. Breast tumors, in general, are classified as benign or malignant/cancerous. Benign tumors pose little health risk once removed and they are not cancer causing. Malignant tumors are abnormal cells that if undetected can invade nearby tissue and spread to other parts of the body. Approximately 212,000 new cases of breast cancer are expected to occur among women in the United States during 2007. Approximately 1700 men, yes that’s right MEN, will be diagnosed and roughly 460 will die from breast cancer in 2007. Breast cancer is the most common cancer in African American women and the second leading cause of death among African American women, exceeded only by lung cancer. Unfortunately, African American women have higher breast cancer death rates than women of any other racial or ethnic population.

Those at risk for breast cancer include: females, women of Ashkenazi Jewish heritage (ancestors from Central or Eastern Europe), African American Women, those who are getting older, individuals with a family history of breast cancer, having a previous personal history of breast cancer, first period before age 12, late menopause (after age 55), a woman that has never had children or has her first child after age 30, women who are obese, those who don’t exercise, those of high socioeconomic status, drinking alcohol and those who do no breast-feed.

The symptoms of breast cancer can be vague, but include a lump or hard painless knot in the breast; swelling, warmth, redness or darkening of the breast; change in breast size or shape; dimpling or puckering of the skin of the breast; itchy, scaly, sore or rash on the nipple; bloody nipple discharge; a nipple that retracts. If you have any of these signs or symptoms you should see your doctor right away. Remember, if detected early breast cancer can be treated.

There are two different stages of testing for breast cancer: screening and diagnostic. Screening test, like the mammograms look for signs of disease in women without symptoms. Mammograms should be done at least once between the ages of 35-40 in women without risk factors and annually after age 40. For women with increased risk factors or a previous history of breast cancer, mammography is done more frequently. Diagnostic test, such as MRI’s, bone scans, ultrasounds, biopsies and blood test are done once breast cancer is suspected or diagnosed. In depth treatment options are beyond the scope of this article, but do include radiation therapy, chemotherapy, and or surgery. Treatment options are determined by the type and stage of breast cancer.

So join Robin Roberts and others in the fight against breast cancer. For more information on breast cancer visit these sites: The Susan G. Komen Breast Cancer Foundation (http://www.komen.org/) 800 I’m AWARE; National Cancer Institute (http://www.cancer.gov/) 800 4 CANCER; American Cancer Society (http://www.cancer.org/) 800 ACS 2345. You can also visit my web site (www.h2doc.com) and shoot me a question at drrani@h2doc.com.

Oh, and by the way, here are a few people you may have heard of that have been affected by breast cancer:

Richard Roundtree (Actor-Shaft, yeah I’m talking bout Shaft, shut yo’ mouth)
Anastacia (Singer)
Diahann Carroll (Actress)
Ruby Dee (Actress)
Nikki Giovanni (Professor and poet)
Cecilia De La Hoya (Mother of boxer Oscar De La Hoya)
Shirley Graham Dubois (Author, playwright, composer, activist and wife of W.E.B. Dubois)
Robin Roberts (Anchor Woman for Good Morning America)

(c) 2007 Rani Whitfield. This article was published August 26 2007 at http://www.eurweb.com/

Glaucoma

It really wasn’t the “in thing” at the time. I was having trouble seeing and hated sitting at the front of the classroom, but that was the only way I could see the chalkboard. My teacher spoke with my parents and before you knew it, the once cool 7th grade class president was converted in to “a nerd”- I had to start wearing glasses. I was not a happy camper, but I have to admit that seeing clearer was very rewarding. My sister helped me to pick out some cool specs and before you know it I was “cute” again. My jump shot improved and I could sit further back in the classroom and I of course regained my “cool” status. Our vision is a blessing and the gift of sight should never be taken lightly. That’s why routine eye examinations are a must for African Americans so that we can detect diseases like glaucoma.

Glaucoma, a leading cause of blindness in African Americans, is a major cause of loss vision. It is often referred to as a silent epidemic because in the earlier stages, there are really no signs or symptoms. As the disease progresses, peripheral vision begins to decline and those affected will report squinting or turning the head to focus; but there is no pain present in most cases. So let us jump right in and learn more about the diseases of the eye we call glaucoma and what can be done to treat and or prevent them.

Glaucoma is actually a group of eye diseases that damage the optic nerve, which is the bundle of nerve fibers that carries information from the eye to the brain helping us to see. This nerve can be damaged by increased pressure in the eye, which occurs in glaucoma. There are two main types of glaucoma: open angle glaucoma, which is the most common form (about 95%), and closed angle glaucoma. It is estimated that about 66 million people suffer from glaucoma worldwide; of those approximately, 7 million are suffering from blindness. In the United States, it is estimated that by the year 2020, 3 million Americans will have the disease. Currently in the U.S., glaucoma affects 2.2 million people age 40 and older, with one hundred and twenty thousand being blind. African Americans are affected 3 to 4 times more than Caucasians and experience blindness four times more frequently. African Americans between the ages of 45 and 64 are fifteen times more likely to become blind when compared to Caucasians. The reasons for this disparity is unknown, however knowing the risk factors for the disease and having routine eye examinations can significantly reduce the number of cases of blindness and give those affected an opportunity to receive adequate treatment.

The major risk factors for glaucoma include: being African American, age between 35 and 40, and having a family history of the disease. There are some other risk factors for glaucoma including diabetes, severe nearsightedness, previous eye injuries/trauma, and prolonged steroid use. The key is increasing our awareness of this devastating disease and stressing the importance of being tested. We should all know about famous R&B singer Ray Charles who at age 7 went blind as a result of glaucoma. Some of you may also be familiar with Kirby Puckett, former Minnesota Twins and National Baseball Hall of Famer who woke up at age 36 with no vision in his right eye. These eyes could have potentially been saved with early detection and treatment.

Is HIV/AIDS a terminal illness?

This is a very good question and would have been a lot easier to answer in the late 1980s and early 90s. Before I answer, let me first define “terminal illness”. There are many definitions for a terminal illness, but the most accepted definition is an illness that is incurable and will result in death in a certain time period. This definition is commonly used by hospice agencies and helps to determine the patient’s eligibility for services. In the case of an HIV infected person in the 80s and 90s, treatment options where limited and many died from complications of AIDS. Since the introduction of Highly Active Antiretroviral Therapy (HAART), which is the use of multiple medications to treat HIV/AIDS, this disease has evolved from a terminal illness to a chronic illness and individuals are living longer lives.

With that being said, HIV/AIDS is a terminal illness if one does not have access to care and/or is non compliant with his or her medical therapy. HIV/AIDS patients who do receive adequate treatment and have access to care can live a normal lifespan. (c) 2007 Rani Whitfield. This article was published July 2007 at http://aolblackvoices.com

Prostate Cancer

Real Men Get It Checked!

Spring of 2004 was a busy time for me as I was preparing for the United States Medical Licensing Exam, Part I and completing my 2nd year of medical school. The phone call came from my mother and was of no surprise. She often called to check on me to see if I needed anything; I always needed something. But this phone call was unique and I could hear in her voice concern, worry, and a touch of fear: “Your dad has been diagnosed with cancer!” Huh? Say what? The man, who helped her to raise four kids, joined the military, graduated with honors from both undergraduate school and graduate school earning a doctorate in education, and turned down an opportunity to play pro football to teach; this could not be. But it was a reality, however, and at the age of 59, my father took on the battle of the most common non-skin cancer in America: Prostate Cancer!

In 2007 it is estimated that more than 218,000 men will be diagnosed with prostate cancer and more than 27,000 will actually die from the disease. There are approximately 2 million American men living with prostate cancer, unfortunately African American men are affected disproportionately. African American men are 56% more likely to develop prostate cancer compared to Caucasian men, and are 2.5 times as likely to die from the disease. The reasons for this disparity is unknown, but one thing we do know is that prostate cancer is the “male disease” and there is no reason why a man with risk factors or a family history of prostate cancer should not get his prostate checked. Real Men Get It Checked!

Fear of needles is a common problem encountered in physician offices, but when the idea of a digital rectal exam (DRE) is suggested to some men they break out running! The DRE combined with a simple blood test called a prostate-specific antigen (PSA) test are what we doctors use to detect prostate cancer. If the PSA is elevated and/or the prostate exam is abnormal, a biopsy of the prostate is usually performed to determine if cancer is actually present. Once the diagnosis is made, the different treatment options are then discussed.

The question is who should be tested? The American Cancer Society recommends that men begin testing (DRE and PSA) annually at age 45 for high risk populations which include African American men and men with strong family history of prostate cancer. Men at even higher risk, which would include those with more than one first-degree relative affected at an early age, could begin testing at age 40.

Primary risk factors for prostate cancer include being African American, family history of the disease, and older age. As men get older, the prostate, which is a reproductive organ increases in size and may cause symptoms of an enlarged prostate called benign prostatic-hypertrophy (BPH). Signs of BPH include waking up frequently at night to urinate; sudden or strong urge to urinate; straining to urinate; a weak urinary stream; dribbling after finishing urinating; feeling like the bladder has not completely emptied; pain or burning while urinating. These can also be symptoms of prostate cancer, but in most cases, there are no symptoms at all and that’s why early detection and screening is so important.

Some studies have shown that diets higher in fat intake are associated with an increased risk of prostate cancer. Thirty to 40 percent of the calories in American diets are made up of fat compared to Japanese diets that consist of only 15% fat. The incidence of prostate cancer and the death rates are significantly lower in Japan than those in the United States. Diets high in vegetables may lower the risk of this disease and there is also evidence that lycopene (an antioxidant found in tomatoes and tomato-based products), selenium (a trace element), and vitamin E may also reduce the risk.

Once the diagnosis if confirmed by, which is a grading scale used to determine how aggressive the cancer might be, is assigned, the different treatment options are discussed with the patient and the urologist (one who specializes in diseases of the urinary system and prostate). An in-depth discussion on treatment options is beyond the scope of this article, but there are multiple options including surgical, radiation therapy, hormone therapy, chemotherapy, and even observation (active surveillance). An intimate discussion between the patient and the surgeon must take place to decide what option would be best.

My father has done well and not only survived his bout with prostate cancer, but has remained cancer free since undergoing surgery almost 11 years ago. Since that time he has two brothers who have been diagnosed with the disease; and yes I got it checked. My daughter depends on her father and I have to do whatever necessary to prevent illness to watch her grow old. So I say to all those brothers who are too busy to see the doctor, feel as if it can not happen to them, or who are afraid of the digital rectal exam: your life and that of your family depends upon you and your decisions…REAL MEN GET IT CHECKED!

For more information on prostate cancer visit www.cancer.org

Stroke

The month of May is American Stroke Month, which is the 3rd leading cause of death in America that can lead to disability and even death among its victims. African Americans are twice as likely to die from strokes than Caucasian Americans and the rate of first strokes among African Americans is almost double that of Caucasians. Although the condition is more common among men, strokes actually kill more women each year. So what’s up? What is a stroke, what are the risk factors, signs and symptoms? Why are African Americans so disproportionately affected? What are the myths about stroke and how do we combat this disease? Ready? Let’s roll!

What is a Stroke: Strokes are also known as “brain attacks,” occur when blood flow to the brain is suddenly interrupted. They are medically classified under the umbrella of heart disease, which is the number one killer of all Americans regardless of race, gender, or ethnicity. There are two major causes of stroke: ischemic (is-keem-ik) and hemorrhagic. Ischemic strokes are the most common types of stroke and are caused by blockages in an artery that supplies blood to the brain. These blockages result from cholesterol deposits that narrow the arteries; a blood clot forming in an artery (thrombus); and from clots originating somewhere else and lodging in an artery (embolus). Hemorrhagic strokes occur when a blood vessel in the brain weakens and burst, allowing blood to spill out into the very restricted space between the brain and the skull. In both types of stroke, the blood flow is decreased and some part of the brain is damaged. The ability to walk, talk, speak, swallow, and even breathe normally can be affected.

Risk Factors: Some stroke risk factors are preventable and others are not. The risks factors that we have control over include smoking, high cholesterol, high blood pressure or hypertension, diabetes, physical inactivity, and obesity. The risk factors that we cannot control include age, a family history of stroke, race, and gender. Being active has tremendous benefits, and if coupled with health eating and proper rest one can: control his/her weight, improve cholesterol levels and blood pressure, prevent bone loss, boost energy levels, improve stress levels and improve overall self image. The risk for stroke increases as we get older. African American men develop heart disease and develop it earlier, but women close that gap after age 55. Also remember that if a family member, especially your parents, brothers, or sisters have heart disease, you are at increased risk as well. So know your family history. Even though you cannot control that, it will help you and your doctor to make better choices about the way you live.

Warning Signs: The warning signs for a stroke include: a sudden numbness or weakness of the face, arm, or leg, especially on one side of the body; sudden confusion, trouble speaking, or understanding; sudden trouble seeing in one or both eyes; sudden trouble walking, dizziness, loss of balance or coordination; and sudden severe headache with no known cause. It is recommended that anyone experiencing these signs should see their doctor immediately.

The African American Factor: Medicine and research have not clearly delineated why African Americans are more at risk than other ethnic groups, but we do know that high blood pressure is the number one risk factor for stroke. One in three African Americans has high blood pressure/hypertension. Diabetes also runs rampant in the African American community and is another major risk factor for this disease. African Americans with sickle cell anemia also run a high risk for strokes. Anybody with risk factors should see a doctor on a regular basis, eat healthy, exercise, and of course take medicines as prescribed.

Dispelling Myths: There are many myths about stroke that need to be cleared up. Some believe that strokes are unpreventable. That is absolutely not true. Taking charge of your health and establishing a relationship with your doctor is one important step in stroke prevention. Also life style changes like exercising, losing weight, smoking cessation, and controlling your blood pressure and diabetes. Another popular myths about strokes is that they cannot be treated and only happen to the elderly. Wrong again! Strokes can happen to persons young and old, but if the warning signs are recognized, a stroke can be treated. There are also those that believe that once a stroke has occurred, there are only a few months of recovery. This is also not true. Stroke recovery continues throughout life and it is possible to regain bodily function when working in conjunction with your primary care doctor, specialist (such as neurologist and physiatrist) and a treatment team that include speech therapist, occupational therapist, physical therapist, and social workers.

We can take control of our health! We must learn the risk factors for stroke, see our doctors on a regular basis, learn our family history, exercise, eat healthy, stop smoking, and take our medicines as prescribed to control diabetes and high blood pressure. We have the power! You have the power! Together we have the power to end stroke!

For more information on strokes visit http://www.americanheart.org/, http://www.strokeassociation.org/. (c) 2006 Rani Whitfield. This article was published May 2007 at http://www.eurweb.com/

HIV/AIDS

African Americans are well represented in many areas these days. We are leaders in business and education, have ownership in both the private and public sector, dominate sports (now with head coaches and franchise owners), have lead roles in cinema, and only comprise 13% of the United States population. Even in small numbers we have found a way to make our presence known and have a positive impact on society. So how is it that we make up only 13% of the US population, yet we account for approximately half of the more than one million people estimated to be living with the Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS)? Since the “discovery” of HIV/AIDS in the early 1980’s, 40% of all deaths among people with HIV/AIDS in the US have been among African Americans. Highly active antiretroviral therapy (HAART), an intricate, sometimes difficult, but effective treatment regimen is expensive, but has expanded the lifespan of people infected with the virus. This has also created the environment for HIV transmission as some individuals still continue to participate in unsafe practices despite known infection.

Let us look at the numbers collected by the Centers For Disease Control and Prevention (CDC) over the last 4 years (2001-2005). This data is based on information from 33 states with long-term, confidential name-based HIV reporting. African American women are the fastest growing population of HIV-positive people in the US, however, African American men continue to bear the greatest burden of HIV infection. In 2005, the rate of HIV diagnosis among African American men was seven times higher than that of Caucasian men, and more than twice that of African American women. Infection rates among African American women were more than 20 times that of white women. In our young African American brothers and sister, defined by the CDC as ages 13-24, we accounted for 61% of the HIV/AIDS diagnoses. Another shocking statistic is that there are 200-300,000 people in this country who are HIV positive and have not been tested. They are unaware of their infection, and for one reason or another have yet to be tested. Barriers to testing include poverty, lack of education and awareness, denial, and the social stigma placed on individuals that are diagnosed. Once considered a gay-white man’s disease, HIV/AIDS has become the greatest crisis facing African American men, women and young people today!

Transmission of HIV has been clearly identified and the major modes of infection are by unprotected sex, sharing needles with someone who is infected, blood transfusions (very rare now), and babies born to HIV infected mom’s during birth or through breast feeding after birth. I include substance abuse as a major risk factor because when someone is under the influence, the chance for him or her to indulge in risky behaviors increases. Health care workers and sometimes the patients are at risk of transmission and thus universal precautions and safety are a must in the hospitals and physician offices. HIV cannot be spread by casual contact (i.e. hugging, casual kissing, shaking hands). Dispelling these myths will decrease some of the negative attitudes and stigmata placed on individuals who are HIV positive.

There is some good news however. Even in the storm of rising HIV disease, there is no indication that the overall rate of infections in African Americans is increasing. Mother to child transmission has been significantly reduced, and there also has been increase use of condoms among young people and a decrease in risky sexual behavior.

In my opinion, there is nothing “positive” about being HIV positive. Once this diagnosis is handed to someone, his or her entire life changes. Negative attitudes, beliefs, and actions are directed at those living with HIV/AIDS despite the mode of transmission. Consider the 1980’s when blood transfusions where a major route of transmission. Now we have the unsuspecting mother/girlfriend/lover whose partner brings the virus into what was believed to be a monogamous relationship; or the unborn child who is infected by an HIV positive mom. Men having sex with men (MSM- the undercover brother or the down low brother) is getting more attention than the other common means of infection among African American men which are IV drug abuse and having unprotected sex with a woman who is HIV positive. For women, the most common ways of getting infected include having unprotected sex with an infected male and IV drug abuse. If you are unaware of your partner’s risk factors, have a sexual transmitted disease (STD), live below the poverty level, or have been incarcerated, your risk of HIV is higher.

Max Robinson, Eric “Easy E” Wright, and Arthur Ashe are not here anymore to be celebrity leaders, advocates, and spokes persons’ against this disease. All died from the complications of AIDS, but did live long enough to speak out against HIV. Magic Johnson is carrying the torch by himself in this celebrity role, but there are other organizations and individuals stepping up and speaking out. On December 1st of 2006, World AIDS Day, author/editor Gil Robertson, IV released his book Not In My Family: AIDS in the African American Community. This collection of powerful polemics, essays, and personal stories speaks to the lack of discussion and the denial in our community when it comes to addressing HIV/AIDS. You can read the words of Rev. Calvin Butts, Hill Harper, Jesse Jackson, Jr., Patti LaBelle, Mo’Nique, Sheryl Lee Randolph, and Dr. Jocelyn Elders, Rev. Al Sharpton, and Omar Tyree just to name a few. The CDC has several programs that are addressing HIV/AIDS across the nation including programs specifically targeting incarcerated men, gay and bisexual men, emergency rooms, and labor and delivery departments. The AIDS Drug Assistance Program (ADAP) spoke before congress in March of this year to address the lack of prescription coverage for the uninsured and underinsured. Individuals have died because they could not get/afford their medication. Whitney Breaux, sophomore at Louisiana State University and Miss Teen Louisiana has made over 100 hundred appearances educating teens and young adults on the ills of HIV. Phil Wilson, Executive Director of the Black AIDS Institute has an educational website that is constantly updated and addresses all realms of the disease. Phil is also a contributor to Not In My Family. I have personally seen the effects of HIV/AIDS on the south as southern states have been hit the hardest. Baton Rouge, my birth place and home suffers from the sixth highest AIDS case rate in the nation. Many HIV/AIDS residents, primarily African American, displaced by hurricane Katrina, have attempted to return to New Orleans or surrounding areas to find the necessities of housing, employment, and healthcare stable and fragmented. It was a “no brainier” when asked by Gil to contribute to his book.

More must be done to effectively address the impact of HIV/AIDS among African Americans men, women, and young people. Although prevention efforts have grown substantially over time and important progress has been made, major unmet needs remain. If this disease is killing “US”, then “US” needs to fight. ADAP, the CDC, Not In My Family, The Black AIDS Institute, and Whitney Breaux cannot fight this battle alone. It will take a nation wide effort.

© 2007 Rani Whitfield.

Strokes

We are under attack!

Well, our brains are for sure, and if African Americans don’t wake up we will ultimately perish from the disease that directly attacks the brain—STROKES! The month of May is Stroke Awareness Month and with the “stroke” of my keyboard I will give you the Power to End Stroke! Strokes are the third leading cause of death among Americans and a leading cause of disability and lost days of work among adults. They are more common among men, but kill more women each year. Strokes come under the umbrella of heart disease, which is the number one killer of all Americans no matter what race, gender, or ethnicity. Heart disease, which encompasses diseases of the heart and blood vessels, claims the lives of over 96,000 African Americans each year and account for 33% of all deaths among blacks in the United States. African Americans are twice as likely to die from strokes than Caucasian Americans and the rate of first strokes in African Americans is almost double that of Caucasians. So what’s up? What is a stroke, what are the risk factors, and what are the signs and symptoms? Why are African Americans so disproportionately affected? What are the myths about stroke and how do we combat this disease? Ready? Let’s roll!

Strokes, also called “brain attacks”, occur when blood flow to the brain is suddenly interrupted. In other words, no flow-no go. There are two major causes of stroke: ischemic (is-keem-ik) and hemorrhagic. Ischemic strokes are the most common types of stroke and are caused by blockages in an artery that supplies blood to the brain. These blockages result from cholesterol deposits that narrow the arteries; a blood clot forming in an artery (thrombus); and from clots originating somewhere else and lodging in an artery (embolus). Hemorrhagic strokes occur when a blood vessel in the brain weakens and burst, allowing blood to spill out into the very restricted space between the brain and the skull. In both types of stroke, the blood flow is decreased and some part of the brain is damaged. The ability to walk, talk, speak, swallow, and even breathe normally can be affected.

Risk factors, which are the things that increase your chances of having a stroke, include things that we can and things we cannot control. The risks factors that we have control over are smoking, high cholesterol, high blood pressure or hypertension, diabetes, physical inactivity, and obesity. The risk factors that we cannot control include age, a family history of heart disease/stroke, race, and gender. Being active has tremendous benefits, and if coupled with health eating and proper rest one can: control his/her weight, improve cholesterol levels and blood pressure, prevent bone loss, boost energy levels, improve stress levels and improve overall self image. The risk for stroke increases as we get older. African American men develop heart disease and develop it earlier, but women close that gap after age 55. Also remember that if a family member, especially your parents, brothers, or sisters have heart disease, you are at increased risk as well. So know your family history. Even though you cannot control that, it will help you and your physician make better choices about the way you should live.

Everyone, including family and friends, should know the warning signs of stroke. By knowing them you can significantly reduced the long-term effects of a stroke and possibly save someone’s life. The warning signs include: a sudden numbness or weakness of the face, arm, or leg, especially on one side of the body; sudden confusion, trouble speaking, or understanding; sudden trouble seeing in one or both eyes; sudden trouble walking, dizziness, loss of balance or coordination; and sudden severe headache with no known cause.

Medicine and research have not clearly delineated why African Americans are more at risk than other ethnic groups, but we do know that high blood pressure is the number one risk factor for stroke. One in three African Americans has high blood pressure/hypertension. Diabetes also runs rampant in the African American community and is also a major risk factor for strokes. There is also a special population of African Americans, those with sickle cell anemia, who run a high risk of stroke. All patients with risk factors should see a doctor on a regular basis, eat healthy, exercise, and of course take there medicines as prescribed.

The myths about stroke need to be stated and cleared up now. Some believe that strokes are unpreventable. That is absolutely not true. Taking charge of your health and establishing a relationship with your doctor is one important step in stroke prevention, along with life style modifications like exercising, losing weight, smoking cessation, and controlling your blood pressure and diabetes. Some also feel that strokes cannot be treated and that they only happen to the elderly. Wrong again! Strokes can happen to the young and old, and if the warning signs are recognized, a stroke can be treated with very little disability. There are also those that believe that once a stroke has occurred, there are only a few months of recovery. This is also not true. Stroke recovery continues throughout life and it is possible to regain bodily function when working in conjunction with your primary care doctor, specialist (such as neurologist and physiatrist) and the treatment team that include speech therapist, occupational therapist, physical therapist, and social workers.

We can take control of our health! We must learn the risk factors for heart disease and stroke, see our doctors on a regular basis, learn our family history, exercise, eat healthy, stop smoking, and take our medicines as prescribed to control diabetes and high blood pressure. We have the power! You have the power! Together we have the power to end stroke!

For more information on disparities in health care visit www.americanheart.org, www.strokeassociation.org

© 2007 Rani Whitfield. Published April 2007 at http://www.eurweb.com/