The Young and Invincible.

The Young and Invincible. Sounds like the title to a soap opera, but actually it’s the attitude that many young adults have about getting sick or injured. Young people think they are invincible and as a result neglect the most important thing that they possess: there health! Listed below are ten medical issues in young adults that I see in my Family Practice that I want to discus with you.

HIV/AIDS
The human immunodeficiency virus (HIV) has become one of the most devastating sexually transmitted diseases ever known to man. Once infected with HIV, the body’s immune system can become weakened and the infected individual will develop the acquired immune deficiency syndrome (AIDS). According to statistics reported by the Centers for Disease Control (CDC): an estimated 38,500 young people (age 13-24) in the United States received a diagnosis of AIDS; African American youth were the largest group of young people affected by HIV, accounting for 56% of all infections; young women, especially of African American and Hispanic decent are at increasing risk. Risk factors for infection with HIV include unprotected sex, multiple sex partners, use of IV drugs, the presence of an undiagnosed sexually transmitted disease, lack of awareness, and poverty. The key is to get tested if you don’t know your status, and if you decide to have sex, Rap It Up!

Obesity
In the past 20 years, there has been a significant increase in over weight and obese individuals in the United States. The Food and Drug Administration (FDA) estimates that almost two-thirds (64%) of all Americans are overweight; almost one third are obese. 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. Today, approximately 17 percent of young people are seriously overweight. One main problem that I see is the decrease in mandatory physical education classes for school aged children. Lack of exercise, poor diets high in fat and calories, and the fast food epidemic are the main reasons for this epidemic. Young people are stuck on computers and hove video games and don’t bike and or play outside as much studies have shown. So get moving! Exercise at least 20-30 minutes most days of the week and eat foods low in calories and fat.

Cervical Cancer
Cervical cancer, a disease of the female reproductive system, is more common in young women. It accounts for 6% of all cancers in women and is caused by the human papilloma virus (HPV) in 90-95% of the cases. The virus is passed from person to person usually by unprotected sex and in most cases the woman has no symptoms. Risk factors for HPV include multiple sex partners, cigarette smoking, and unprotected sex. The key point is that all women who are sexually active need to have a pap smear at least once a year whether you wear condoms or not. Even if you are not sexually active, annual pap smears are still recommended by the age of 18. Cervical cancer can be detected and treated if diagnosed early by pap smears. Talk to your doctor about the vaccine currently in use that may reduce your risk of cervical cancer.

Anabolic Steroids
Barry Bonds is not the first person accused of using steroids and won’t be the last. His situation, however, has brought much needed attention to the topic of steroids. The desire to be competitive and to gain an edge on one’s competitor is natural, however the facts still remain: steroids are illegal and are associated with short and long term effects which can be very damaging to the body. Don’t get it twisted; they do help to build muscle mass, however, with side effects like elevated cholesterol, high blood pressure, balding in men, breast development in men, facial hair in women, and mood swings just to name a few, there is no way I would recommend to anyone using them. The National Institutes of Drug Abuse (NIDA) reported an increase in steroid use among 8th and 10th grade boys in 2000. The primary reasons for using steroids among these young men where to enhance athletic performance and physical appearance. If you want to be the best, work hard and don’t use a substance that is illegal and might permanently damage your body. Also remember, never take or rub a substance on your body if you don’t know what’s in the solution.

Cigarette Smoking
Cigarette smoking is the single most preventable cause of death in the United States. Twenty three percent of high school students and 8% of middle school students in this country are regular smokers. There are more deaths each year from tobacco use than by HIV, drug abuse, alcohol abuse, motor vehicle injuries, suicides, and murders all together. The active ingredient in cigarettes and smokeless tobacco is the very addictive substance called nicotine. Cigarette smoking is associated with cancers of the lung, bladder, and cervix; heart disease; low birth weight babies; sudden infant death syndrome, and chronic obstructive lung disease (COPD). Smoke free facilities are becoming the norm as society is becoming more aware of the harmful side effects of second hand smoke. If you plan on living longer, then you need to stop smoking.

Mental Disorders
Mental health is just as important as physical health and everyone should be comfortable discussing these topics with their doctor. The most common mental health issues seen in my practice are anxiety and depression. Approximately 25% of young adults experience depression by the time they are 24 years old, but very few seek help. This is alarming and depression, if left untreated, can lead to suicide. Anxiety, the most common form of mental disturbance in the U.S., affects approximately 28 million Americans each year. Both anxiety and depression are major problems for society as they can interfere with work, school and family life. They contribute to high rates of substance abuse and alcohol abuse. If you or a loved one has been diagnosed with anxiety or depression, it is important to take your medicines as prescribed and see your doctor and/or therapist on a regular basis.

Suicide
Suicide is the end result of severe depression that is untreated or under-treated. Suicide is common in young adults and the elderly. In general women attempt more suicide than men; men are more “successful” in suicide attempts. Signs of depression include disturbances in sleep, loss of interest in things the person normally does, guilty feelings about a situation or situations, decreased energy, decreased concentration, decreased or increased appetite, abnormal and unintentional weight loss or weight gain, decrease sex drive, and suicidal or homicidal thoughts. These symptoms have to be present for more than two weeks for the diagnosis to be made. The challenge is to recognize these signs and symptoms and to get help for the affected person before a suicide attempt (s) occurs. Suicide is the permanent answer to a temporary problem. If you are someone you love is talking about suicide, get him or her help immediately!

Substance Abuse
Despite what some might try to convince you, drugs of abuse are mind altering and can put you at risk for STD’s, accidents, and time in jail. The trends of abuse have shifted in young adults somewhat from the gateway drugs marijuana and cocaine, to designer drugs such as ecstasy and the date rape drug, GHB. There are more potent forms of marijuana, which make them more addictive, and crystal meth is slowly becoming a drug of choice for many young Americans. The results of substance abuse are quite evident: mental disorders such as depression and anxiety, incarceration, STD’s including HIV, destruction of families, and untimely deaths due to accidental overdose, suicide, or crimes as a result of the drug’s influence. While under the influence of these mind-altering substances, an individual often makes poor decisions and will participate in behaviors that he or she would normally avoid. Education and awareness about the different drugs available and how they affect the body is one of the major ways to decrease abuse.

“Staph” Infections
Community acquired methicillin resistant staphylococcus aureus (CA-MRSA) infections are on the rise! What the hell is that you ask? Well if you have ever had a boil that was hard to treat and it came back to visit you on several occasions requiring multiple doctor visits, drainage by a physician, and sometimes hospitalization and antibiotics through an IV, chances are you had a staph (staff) infection. MRSA was at one time primarily seen in hospital patients with wounds and in individuals with weak immune systems. As a result of antibiotic overuse by physicians to treat simple skin infections and patient noncompliance with medications (not taking them like they are suppose to), these very intelligent bacteria have become resistant to the very basic and inexpensive antibiotics that we have available in our local pharmacies. Staph infections can be very dangerous and are now being associated with pneumonias in healthy individuals. MRSA can kill! If you develop a painful to the touch, red and swollen area on your body that produces pus (drainage), you could have a staph infection. See your doctor right away so that this can be treated quickly and effectively.

Sexual Transmitted Diseases/Sexually Transmitted Infections (STDs/STIs)
Chlamydia, gonorrhea, herpes, HPV, syphilis, and HIV are on the rise again. One out of every 2 Americans will have an STD/STI by the there 25th birthday. The reasons are many and include lack of education and awareness, having unprotected sex, and substance abuse. If a person is infected with one STD/STI, then he or she is at risk of getting another. The concept that oral sex is safe sex or not sex at all is garbage. Herpes, HPV, and gonorrhea can be spread via oral sex. The likely hood of being infected with HIV is very low in someone receiving oral sex compared to the “giver”. However, there is still some risk. Abstinence is still the best way to prevent the spread of sexually transmitted diseases, however, this method is not always practiced. If you choose to have sex protect yourself. Know your HIV status, practice monogamy, wear condoms, and if you perform oral sex learn how to use dental dams. They come in tasty flavors and colors.

This by no means is a comprehensive list of all the potential problems young people encounter, but it’s a great start. Hopefully this will give you a good foundation and help guide your own research regarding the medical issues that I commonly see in my practice.

(c) 2007 Rani Whitfield. This article was published November 2007 by Ozone Magazine.

Women and Steroids

No matter where you go, we are hearing more and more about the use and abuse of steroids in men’s sports. But when multi gold medallist and track super star Marion Jones recently announced that she used steroids after vehemently denying the allegations for years, it sent a shock wave across the country and mixed messages to her friends, family, and fans. This coming on the heels of Barry Bonds record breaking home run season tainted with accusations of steroid use and the recent rumors of talented boxers Sugar Shane Mosley and Jameel McCline’s use of steroids to prepare for there matches. The question most people are asking is why? Why are athletes, especially women athletes, using these illegal and potential harmful substances?

Before I get into the reasons why, let me first explain this class of drugs more correctly called anabolic androgenic steroids (AAS). AAS are the synthetic derivatives of the naturally occurring male hormone testosterone. The ability for steroids to build muscle and strength is the anabolic effect of the drug, while the development of MALE secondary sexual characteristics, like the pitch of someone’s voice and the pattern of body hair describe the androgenic effect of the drugs. AAS have been around since the 1930s to treat a condition in men called hypogonadism in which the testes do not produce a sufficient amount of testosterone for normal male development and sexual function. Other approved medical uses for testosterone include the treatment of impotency, the “wasting” or weight loss seen in persons infected with HIV or cancers, and delayed puberty.

Performance enhancing drugs like AAS 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, however in the “steroid” culture, there is a phrase used by some professional athletes: “If you are not using steroids, then you are not trying hard enough!” This quest for supremacy at the expense of one’s health has taken over and the all-mighty dollar is more important than health, longevity and loved ones. Steroids have been used and proven to build strength and endurance in competitive athletes for decades; however, AAS are illegal and potentially harmful and considered cheating! These are not the messages we want to deliver to young African American athletes.

The reason women use these illegal and potential harmful substances are very similar to the reasons men use them: to improve athletic performance, to become more muscular, to gain weight, to lose weight, to recover faster from fatigue and injury, and/or to increase speed and endurance. Women who are victims of rape or who have been physically abused also use AAS to improve strength and confidence so that they can protect themselves from future attacks. Muscle dysmorphia, also called bigorexia or reverse anorexia nervosa, is a disorder in which a person becomes obsessed with the idea that he or she is not muscular enough, hence uses AAS to “bulk up”.

AAS have become much more complex as proven by the “designer” steroids used by Marion Jones, 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 blood stream they are soaked up my muscle cells and promote the production of protein, which stimulates muscle growth. Athletes will mix different types of AAS to achieve various effects, as there is no accepted medical dosing standard for the use of these drugs for performance enhancement. Side effects of AAS 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 side effects are irreversible and require surgical treatment.

This is a very unfortunate situation and I am truly saddened as Marion Jones was one of my favorite athletes. I hope that she will turn the negative into a positive and begin to educate young athletes on the only way to become successful in competitive sports while at the same time improving their health: hard work and proper nutrition.

For more information on steroids visit www.nida.nih.gov or visit my website at www.h2doc.com, view the Steroid Man, see a comprehensive list of individuals who have been associated with steroids and shoot me a question or comment at DrRani@h2doc.com. It’s Tha Hip Hop Doc, they call me H2D, come on now lets get Hip Hop Healthy. Peace, I’m out! (c) 2007 Rani Whitfield.

Steroids

I love wearing my throwback jersey’s, especially those from the Negro baseball leagues. These jerseys symbolize so many things: pain, suffering, success, fun. But most importantly they represent hard work that the individuals who wore them endured so that other African American players could achieve the American Dream: baseball, hot dogs, apple pie, and Escalade’s!? I wonder how my now 2-year-old daughter will feel about wearing the throwback jersey of the greatest player to ever play the game of baseball, Barry Bonds. Despite his success in this sport, his name and his records have been tainted with the accusations and stench of steroid use and his athletic prowess has come in to question. The “clear and the cream”, substances given to Bonds by his personal trainer who failed to inform him of what they contained, where actually illegal substances used to enhance performance. But why is this steroid thing such a big deal? Why is the home run record that Bonds now holds in question?

Simply stated, steroids are illegal, potentially harmful, banned in most professional sports and college, and is considered cheating. Among athletes on the elite level, some feel that if you are not using steroids, then you are not trying hard enough. Steroids can build muscle and increase an athlete’s speed and strength. That has been proven. The problem is that penalties are placed on athletes found to be using them and if used for long periods of time the side effects can be embarrassing and potentially life threatening. In women, the side effects of steroids include facial and body hair growth, male pattern baldness, deepening of the voice, reduced breast size and menstrual problems. In men, reduced sperm count, impotence, breast growth, and decreased testicle size have all been documented. All individuals who use steroids are at risk for high blood pressure, strokes, high cholesterol, nausea, sleep disturbances, acne, increased aggressiveness, and mood disorders including anxiety and depression. Some of these side effects like the breast development in men and voice changes in women are irreversible. It amazes me that I get continue to get request from athletes in my private practice for steroids.

Hip-hop has had its bout with accusations of steroid use. LL Cool J was rumored to have used steroids to transforms his body into that of a Greek god. He has denied using steroids as well as plastic surgery to improve his physique in his book LL Cool J’s Platinum Workout.

Whether it is to win at any and all cost or to look good and ripped in a shirts, success and vanity out weigh life and longevity in the psyche of steroid users; that is until something bad happens like being banned from your sport, having a heart attack, or not able to “get it up” when the time is right.

The road to success in sports is hard and education on proper nutrition, exercise, and rest is of the utmost importance. Commitment to the sport on all levels is the only way to be successful. Is Barry Bonds guilty; unfortunately some believe he is, despite being the greatest player to ever play the game of baseball. My advice to him and any young athlete is to never take or rub something on your body without knowing exactly what it is that you are taking or rubbing on you. (c) 2007 Rani Whitfield. This article was published October 2007 at http://allhiphop.com/.

Depression and Hip Hop: Are they related?

Images of strength have dominated hip-hop since its inception in the early 1970’s. MC’s often professed superiority over other MC’s with lyrical wizardry and dominance on the microphone. Weakness was not an option, especially outward signs of weakness. However, when it comes to saving your life or the life of someone you love, we have to admit that hip hop artist and those who love hip hop are at risk for one of the most common medical problems seen in the doctors office: Depression. Not that hip-hop itself has any direct relationship to this disease, but you must realize that no one is exempt and we must all be aware of the signs and symptoms of this treatable disease.

The untimely death of hip-hop DJ David “Disco D” Shayman is only a testament to this issue. I never met Disco D and I don’t know all the circumstances surrounding his death, but one thing I can tell you is that depression, left untreated, can lead to loss days of work, destruction of families, and in its worse form, SUICIDE! The old saying that suicide is a permanent solution to a temporary problem is very true. Once a person commits suicide, the opportunity to resolve issues and make amends is gone. Disco D will be missed, and I’m sure he would want those who loved his music to learn more about this problem. So, lets define depression, its signs and symptoms, and options for treatment.

Depression or a depressive disorder is a disease that affects the entire body. It is by no means a sign of weakness and does not have to be prompted by the death of a loved one, divorce, or losing your job, although these situations can be a factor. Depression is an extreme form of sadness that a person cannot pull himself out of or resolve easily with out help. There are several types of depression including major depression, dysthymia, and bipolar disorder. We will focus on major depression. Symptoms of major depression include problems sleeping (insomnia or oversleeping), loss of interest in things one normally does, feelings of guilt, decreased energy, decreased concentration, changes in appetite (not eating at all or overeating), decreased sex drive, and thoughts of suicide. If you have a family history of depression, this also increases your risk of getting the disease. These symptoms usually have to be present consistently for more than two weeks.

In general, women experience depression about twice as often as men, however, men with depression are 4 times more likely to commit suicide than women. There are also studies that show there may be an increased risk of heart disease in both men and women who are depressed.

Once the diagnosis is made, treatment must begin immediately! There are medical problems that can cause depression, such as thyroid disorders and viral infections, but once they are ruled out, the usual course of treatment includes consultation with a psychologist or psychiatrist, medications, and group or one-on-one therapy. Do not let depression take you out of the game. If you or someone you love is exhibiting any of the above signs or symptoms, seek help right away! It could very well save your life. (c) 2007 Rani Whitfield. This article was published October 2007 at http://allhiphop.com.

HIV/AIDS: An Epidemic in the African-American Community

When the media announced that Eric “Easy E” Wright had full blown AIDS in 1995, I grab my Straight Outta Compton CD and head nodded for a few. Four years prior to his announcement, Magic Johnson shocked the world with a similar message… “I have the HIV virus…” It hit me like a rock as my best images of Magic and Eazy E came from the times when they where young and hungry for success. I believed that only gay men got the disease, not realizing that a second cousin moved to California after being diagnosed with an unknown illness and died a lonely death. HIV/AIDS was once thought to be a problem for gay white men only and was defined as the Gay Related Immunodefeciency Disease or GRID. However, ten days after being admitted to the hospital with pneumonia, a common complication of AIDS, Eazy E was dead. The HIV/AIDS epidemic was real and one of gangsta raps pioneers fell prey.

Today, African Americans are facing its greatest health challenge and the numbers reported by the Centers for Disease Control are staggering: African Americans make up only 13% of the United States population, yet we represent 50% of the cases of HIV/AIDS in this country; African American women are the fastest growing population of HIV positive people in the United States; and of the 1.2 million people in the US believed to be infected with HIV, 200-300,000 are unaware they are infected. In the month of October I personally diagnosed eight African American women of child bearing age with HIV- all but one, 25 years old or younger, was incarcerated. This unfortunately comes as no surprise when individuals like Elidor Kersaint (club promoter in Miami), Nikko Briteramos (former college basketball player), and Nushawn Williams (former drug dealer from Brooklyn) have knowingly spread the disease to women.

What was considered a gay white man’s disease has now become one of black and brown brothers and sisters. Debates continue on the origins of the HIV and the emphasis focuses on treatment, not prevention, immunization, or a cure. The bottom line is that the HIV, which is spread by blood and body fluids, is here!

Abstinence, wearing condoms, getting tested, dispelling the myths and educating ourselves about HIV are the only cure. Intravenous drug use (IVDA), promiscuity, men having sex with men (MSM), is the primary modes of infection among African Americans. The southern states have been hit the hardest and my hometown of Baton Rouge ranked number 6 in the country in AIDS cases followed by New Orleans. In 2005, Miami had the highest rates of new AIDS diagnoses in this country. Hip-hop has made several attempts to raise and help eradicate this illness from our communities. When hip-hop was “founded” in the early 1970’s, it was the result of crime and violence that brought about the movement to positively change things. “Coochie Bang” by Queen Latifah and “Go See the Doctor” by Kool Moo Dee, although not specifically addressing HIV, did address condom usage and sexually transmitted diseases. But as you know, the culture has evolved, the game has changed, and the call to do things not necessarily hip-hop is upon us. Rappers, MC’s, and DJ’s have been summoned to speak on politics, injustice, and health. "Hip-hop as a culture is getting a lot of backlash right now for its lyrics, for its public image, and the people are crying out for more responsibility," said KRS-One at the 2007 BET Hip Hop Awards. I applaud Common and Ludacris in their recent efforts to bring more awareness to the issue of HIV/AIDS. We need more of a collaborative effort, however, and I support KRS One for pulling MC’s together to “stop the violence”, but we need some love on the medical battlefield. The messages must be consistent and reinforced on and off the stage. The use of hip-hop as a tool for empowerment has been proven. Lets us use it to educate about health issues as well.

For more information on HIV visit http://www.blackaids.org/. (c) 2007 Rani Whitfield. This article was published October 2007 at http://allhiphop.com.

Sexual Enhancement

In the pursuit of sexual success and fertility, the moon, and everything under it, has been touted as an aphrodisiac by some person or culture. Love potion peddlers stop at nothing to sell their sexual wares. "I'll make you the same promise that my wife made to me," says Theodore Maximillian in the provocative brochure for his "Maxim" product. "I'm going to cure your impotence immediately!" Maxim "acts as a potent aphrodisiac," according to the advertisement.
An aphrodisiac is a food, drink, drug, scent, or device that, promoters claim, can arouse or increase sexual desire, or libido. A broader definition includes products that improve sexual performance. Named after Aphrodite, the Greek goddess of sexual love and beauty, the list of supposed sexual stimulants includes anchovies and adrenaline, licorice and lard, scallops and Spanish fly, and hundreds of other items.

According to the Food and Drug Administration, the reputed sexual effects of so-called aphrodisiacs are based in folklore, not fact. In 1989, the agency declared that there is no scientific proof that any over-the-counter aphrodisiacs work to treat sexual dysfunction.
Countering Cultural Views

FDA's findings clash with a 5,000-year tradition of pursuing sexual betterment through use of plants, drugs and magic. Despite FDA's determination that OTC aphrodisiacs are ineffective--and sometimes even dangerous--people continue the optimistic quest for drug-induced sexual success.

Several principles help demystify some cultural views about aphrodisiacs. Sometimes the reason for an item's legendary reputation is obvious. It's easy to imagine how the sex organs of animals such as goats and rabbits, known for their procreativeness, have achieved their esteemed status as love aids in some cultures.

Chilies, curries, and other spicy foods have been viewed as aphrodisiacs because their physiological effects--a raised heart rate and sometimes sweating--are similar to the physical reactions experienced during sex. And some foods were glorified as aphrodisiacs based on their rarity and mystery. While chocolate was once considered the ultimate aphrodisiac, the reputation wore off as it became commonly available.

Many ancient peoples believed in the so-called "law of similarity," reasoning that an object resembling genitalia may possess sexual powers. Ginseng, rhinoceros horn, and oysters are three classical examples.

The word ginseng means "man root," and the plant's reputation as an aphrodisiac probably arises from its marked similarity to the human body. Ginseng has been looked on as an invigorating and rejuvenating agent for centuries in China, Tibet, Korea, Indochina, and India. The root may have a mild stimulant action, like coffee. There have been some experiments reporting a sexual response in animals treated with ginseng, but there is no evidence that ginseng has an effect on human sexuality.

The similarity of the shape of the rhinoceros horn to the penis is credited for its worldwide reputation as a libido enhancer. The horn contains significant amounts of calcium and phosphorus. The addition of the food to a deficient diet could improve general physical vigor and possibly lead to an increased sexual interest. But in most Americans' diets, which are usually not lacking calcium or phosphorus, the small quantities usually consumed would not affect physical performance.

Because Aphrodite was said to be born from the sea, many types of seafood have reputations as aphrodisiacs. Oysters are particularly esteemed as sex aids, possibly gaining their reputation at a time when their contribution of zinc to the nutritionally deficient diets of the day could improve overall health and so lead to an increased sex drive.

Shortage of Studies
There is no proof that ginseng, rhinoceros horn, or oysters have an effect on human sexual reaction. But might some foods and OTC drugs eventually be proven to affect sexual appetite? Some big obstacles exist to answering this question. The placebo effect is one scientific stumbling block.

"The mind is the most potent aphrodisiac there is," says John Renner, founder of the Consumer Health Information Research Institute (CHIRI). "It's very difficult to evaluate something someone is taking because if you tell them it's an aphrodisiac, the hope of a certain response might actually lead to an additional sexual reaction."

Because the psychological complications are absent in animals, some studies have been done on the effect of certain drugs on animals' sexual activity. One substance that was tested extensively in animals is yohimbine. Obtained from the bark of an African tree, yohimbine has been used for centuries in Africa and West India for its supposed aphrodisiac properties. It supposedly works by stimulating the nerve centers in the spine that control erection. FDA called the res ults of preliminary animal studies "encouraging," but animal studies cannot be relied on to show the effectiveness of the drug in humans.

In people, the only available evidence is anecdotal and subjective. To scientifically measure sexual stimulation, a valid human study would have to be performed in the laboratory, comparing a placebo (an inert pill with no active ingredients) to the test aphrodisiac. Preferably, neither the researchers nor the patients would know who was getting the test substance. Because of cultural taboos, few such studies have been undertaken.

A second obstacle to obtaining proof of aphrodisiac effects is that some drugs may not actually have specific sexual effects, but may change a person's mood and therefore seem to be an aphrodisiac. For example, alcohol has been called a "social lubricant." People drink for many reasons, including to relax, reduce anxiety, gain self-confidence, and overcome depression. Because sexual problems can be caused or worsened by psychological stress, moderate drinking might seem like a sexual enhancer. In fact, it merely lessens inhibitions.

Alcohol is actually a depressant, and so, as the porter in Shakespeare's Macbeth observed, it "provokes the desire, but it takes away the performance." And drinking too much actually decreases desire.

No Quick Fix
Despite the lack of scientific evidence of safety and effectiveness, the fraudulent OTC love potion industry thrives to this day. Marketers use a "blatant snake-oil approach," according to CHIRI's Renner. He estimates that the aphrodisiac sellers, who do much of their business by mail-order, take in revenues in the hundreds of millions of dollars a year.

The FDA sends warning letters to companies that make aphrodisiac claims, stating that the agency may take further regulatory action if the violations continue. "In the health fraud area, when they get a warning letter, most people take their profits and run," says Joel Aronson, director of FDA's division of nontraditional drugs. "They don't want to get into a legal battle with the agency becau se it could involve protracted, expensive litigation."

Aphrodisiac experimentation isn't just a rip-off--it can be deadly. Spanish fly, or cantharides, is probably the most legendary aphrodisiac--and the most dangerous. Made from dried beetle remains, the reported sexual excitement from Spanish fly comes from the irritation to the urogenital tract and a resultant rush of blood to the sex organs. But Spanish fly is a poison that burns the mouth and throat and can lead to genitourinary infections, scarring of the urethra, and even death.

To avoid being taken for their money or their lives, individuals with sexual problems should seek a physician's advice. A lack of sexual energy or ability in men or women could be caused by something as simple as stress or a medication one is taking, or as serious as an underlying condition like diabetes or high blood pressure.

A doctor can diagnose a sexual problem and recommend treatment. If necessary, a doctor can prescribe a drug to treat sexual dysfunction. Testosterone replacement therapy is one prescription option for men whose natural testosterone level is not within the normal range, but its serious potential side effects cal l for a physician's supervision. For those with an impotence problem that isn't caused by low testosterone levels, the new "Caverject" injection may be the answer.

"People will continue to have false hopes of finding easy ways of resolving their problems," says Aronson. And so the hunt for the elusive love drug persists. A universal aphrodisiac may never be found, but experts agree that what's good for your overall health is probably good for your sex life too.

A good diet and a regular exercise program are a more dependable path to better sex than are goats' eyes, deer sperm, and frogs' legs. A good mental state is equally important.
Maybe the wishful search for a cure-all drug should be abandoned in favor of an easier, more reliable mechanism: the erotic stimulation of one's own imagination. To quote renowned sex expert "Dr. Ruth" Westheimer, Ed.D.: "The most important sex organ lies between the ears."
Tamar Nordenberg is a lawyer with the Office of the Director in FDA's Center for Drug Evaluation and Research.

First Impotence Drug
For the 10 million to 20 million American men who suffer from impotence, the Food and Drug Administration's July 6, 1995, approval of Upjohn Company's prescription drug Caverject (alprostadil) may prove to be life-altering. Caverject is the first prescription drug approved for impotence, and is expected to successfully treat 70 to 80 percent of patients.
The drug provides an alternative to devices previously approved by FDA. A vacuum device involves placing a cylinder-like device and attached pump over the penis. By using the pump, blood is drawn into the penis, creating an erection. A constriction band is then placed at the base of the penis to maintain erection. A second treatment option, the penile implant, involves the surgical placement of cylinders in the penis and is available in a variety of designs. (See "Inflatable Penile Implants Under Scrutiny" in the January-February 1994 FDA Consumer.)
FDA approved Caverject to treat impotence caused by neurological, vascular or psychological dysfunction. While psychological factors such as anxiety and depression can lead to sexual dysfunction, more than 85 percent of impotence cases have a physical cause, according to the Impotence Institute of America. A complete physical examination is important so that any underlying condition can be diagnosed and treated. Some common causes of impotence are diabetes, arteriosclerosis (hardening of the arteries), and high blood pressure. Also, impotence has reportedly been caused by 16 of the 200 most commonly prescribed drugs, including drugs for high blood pressure, heart disease, and depression.

Caverject is self-injected into the penis shortly before sexual intercourse. The drug creates an erection by relaxing the smooth muscle tissue and dilating the major artery in the penis, which enhances the blood flow to the penis.

The drug's most common side effect is penile pain. Other side effects include bleeding at the injection site and an unhealthy, prolonged erection of four to six hours. (c) 2007 Rani Whitfield. This article was published October 2007 at http://allhiphop.com/

Steroids: Just Don’t Do It!

At 38 years of age I continue to exercise regularly despite a very busy schedule. While traveling for business, and rarely on vacation, the search for hotels with gyms and nearby training facilities is at the top of my list. I have a very competitive spirit and love to win especially when it comes to sports. What a great accomplishment it would be if I where victorious at the 2008 USA Track and Field Masters 400 meter run I am currently training for? I would do anything to win that race…well just about anything.

Modern sports and the media’s obsession with fame, fortune and the “win at any cost” attitude have created an environment for the abuse of the controlled substances called steroids. Anabolic androgenic steroids (AAS) are the correct name for this class of drugs and many athletes are using them in professional sports today. These substances, once only used by the elite, have spilled over in to mainstream America as we now see weekend warriors and non-athletes using steroids for cosmetic purposes, i.e. weight loss and increased muscle mass. The questions I’m often asked are why people use these illegal and banned substances, what are the benefits of use, and what are the side effects?

AAS are synthetic versions of the male hormone testosterone. The ability for steroids to build muscle and strength is the anabolic effect of the drug, while the development of MALE secondary sexual characteristics, like the pitch of someone’s voice and the pattern of body hair describe the androgenic effect of the drugs. The reported benefits of AAS include: improving athletic performance, increased muscle mass, weight gain, weight loss, faster recovery time from fatigue and injury, and increased speed and endurance. Pills, creams, and needles have been substituted for hard work, nutrition, and adequate rest as ways to gain the edge over the opponent.

In 1997, Sports Illustrated interviewed a group of elite Olympic athletes and one of the questions was: "If you were given a performance enhancing substance and you would not be caught and win, would you take it?” 98% of the athletes responded "Yes". The more chilling question was: "If you were given a performance enhancing substance and you would not be caught, win all competitions for 5 years, then die, would you take it?” More than 70% said, "Yes". Are these the messages we want for our youth?

The side effects of steroid use/abuse described in the medical literature include liver damage, kidney and liver tumors, high blood pressure, strokes, elevated cholesterol, mood disorders, acne, increased aggressiveness, nausea, sleep disturbance, increased body and facial hair, male pattern baldness, breast development in men, reduced sperm count, and decreased testicle size. The user who typically will take ten times or more the recommended medical dose and/or combine them with other substances, like human growth hormone, to enhance the effects of AAS, increases the potential for these health related problems. Furthermore, the integrity of these substances comes in to question as they are often purchased via the Internet, black market, or unregulated pharmacies.

The use of AAS is not only harmful, but it is illegal and considering cheating! We must teach young brothers to place more emphasis on participation and competition not merely winning. Hard work, proper nutrition, combined with hydration and rest are the keys to competitive success. I may not win my event in 2008, but I can promise you I will not use steroids to achieve success. My life and my family are much more important to me.

(c) 2007 Rani Whitfield.

Crack Cocaine

Being affectionately known as “Tha Hip Hop Doc” by the younger generation is an honor and I wear that title with pride. However, “Thug Doc” or “Gangsta Doc” is two other names I am frequently called by the inmates at the East Baton Rouge Parish Prison. Believe it or not, these are terms of endearment and respect as I work at the prison everyday and see many of the inmates, mostly African American, at the two substance abuse clinics where I work as well. The majority of these individuals are African American men who live well below the poverty level and have long histories of substance abuse. The drug of choice for most of them is crack cocaine.

Cocaine is not new to the world as it has been around for hundreds of years. The leaves of the cocoa plant, from which cocaine is derived, where chewed like tobacco by tribes in South America to ease pain, stimulate or suppress appetite, and combat altitude sickness. It was noted by the tribesman that not only could they work longer but they also felt “happy” and euphoric. In the 1880s pure cocaine was used as a local anesthetic for nose, eye, and throat surgeries due to its abilities not only to provide anesthesia, but also to constrict blood vessels and reduce bleeding. And it is true that cocaine was one of several ingredients in the original Coca-Cola only to be removed in 1929 when the harmful side effects of the drug where noted. Some actually thought that cocaine would be the “miracle” drug of the future.

What was thought to be the wonder drug used in elixirs and tonics later became a drug of the rich and famous in the late 1970s. Snorting cocaine was considered to be in vogue and in some social circles were acceptable and fashionable. However, it wasn’t until the mid-1980s that crack cocaine emerged on to the scene. This cheap and relatively easy to make variant of powder cocaine got its name from the crackling sound it makes when it is heated and its vapors smoked. There was nothing in vogue about crack’s introduction to the United States and the initial impact was felt in poor African American communities.

The 2005 National Survey on Drug use and Health (NSDUH) stated that approximately 7.9 million Americans aged 12 or older reported trying crack cocaine at least once during their lifetimes. Adult’s ages 18 to 25 years old have a higher rate of cocaine use than those of other age groups and men have a higher rate of current crack cocaine use than do women. Crack cocaine has a strong correlation with HIV/AIDS, crime, incarceration, and homelessness. The question that I often ask the inmates and individuals in drug rehab is why? Why is this drug becoming an epidemic in our society?

If you only remember one concept from this article, remember that crack cocaine is highly addictive. There are two main forms of cocaine: the hydrochloride salt or powdered form which dissolves in water and can be injected into veins (intravenous use) or snorted (intranasal use); and the freebase form or crack which is when the compound has not been neutralized by an acid to make the hydrochloride salt. Because it is smoked, the user experiences a high in less than 10 seconds that causes an intense and immediate feeling of euphoria, which according to addicts, is indescribable. Crack is inexpensive to both produce and to buy making it the drug of choice for the poor. Even more alarming are the potential medical complications of crack cocaine abuse: high blood pressure, strokes, heart attacks, headaches, hallucinations, addiction, and even sudden death. Substance abuse, in general is linked to illness liked HIV because when one is under the influence of a drug they make poor decisions like having unprotected sex or using IV drugs.

Inpatient and outpatient substance abuse rehab are a must for individuals who have used crack cocaine. As a result of its highly addictive potential, long-term treatment that includes counseling and group therapy are paramount. We must also look at the laws and how individuals are prosecuted once convicted of cocaine use and ingestion. Crack cocaine, despite what some think, continues to be a big problem in our country. Effective drug policies need to be in place and support for the communities under attack by the drug lord are the only remedies for this problem. And in the words of the late Rick James: “Cocaine is a hell of a drug!”



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

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/

Disparities in healthcare

Black America, we have a problem.

Despite what you might think, things are not equal, especially when it comes to health and health care. HIV/AIDS, heart disease, strokes, high blood pressure, colon and rectal cancer, prostate cancer, obesity, and diabetes affect our race at much higher rates than other ethnic/racial groups. Just name a disease and African Americans are probably the most affected population. What’s more alarming is that often despite a good education and quality insurance, stereotyping and biases on behalf of the health care provider can still add up to unequal treatment and sub-par medical care. But its not just African Americans, it’s the poor and uninsured that really get the shaft.

True story : I had a patient who presented to my office with signs and symptoms of a heart disease; a heart attack waiting to happen. One year prior, he had been seen in a local emergency room (ER), diagnosed with “probable” heart disease. After being observed for 23 hours he was sent home without seeing a cardiologist and told to follow up with his primary care doctor. He did not have one. He called the ER and asked what he should do, and they told him not to come to their facility because he did not have insurance. Next he came to my office to discuss his options with me, which were basically none. After our appointment I didn’t hear from him for a while, but later found out that he decided to walk around the hospital grounds until he got sweaty and tired, so that he could walk in the ER complaining of chest pain. They would have to admit him. But what actually happened was after three laps around the hospital, my patient collapsed and was literally having a heart attack. He was the happiest man in the world. He was admitted to the hospital and saw one of the best cardiologists in the city. His blood work showed that he was anemic (low blood count) and because of his age and risk factors a colonoscopy was performed by a very talented gastroenterologist (stomach doctor). However, smiles turned to frowns when he was discharged form the hospital after it was discovered that he could not afford to pay for follow up treatments. He showed up at my office again after this episode, but I never heard from him again after that visit.

This is just one example of the extreme measures the poor and uninsured in America have to take in order to receive medical attention. Sadly, I could tell you many more. Research has shown that minorities are less likely to receive routine medical procedures and quality health care than their white counterparts. So what are some solutions: better doctor-patient relationships; increase the number of minorities among health professionals providing services to minority patients; ensure that both the public and private sector have the same types of coverage; increase patient education and empower patients to better care for themselves.

Racial/ethnic disparities in healthcare are a reality associated with poor medical outcomes and even death, which are unacceptable and should not be tolerated. We, as a community, must learn to take better care of ourselves. Education and awareness about health and health care is essential to the survival of our community.

For more information on disparities in health care visit www.nmhmf.org
(c) 2007. This article was published March 15, 2007 at http://www.eurweb.com/