Doctor's Corner

Hello Ladies. Allow me to introduce myself. I am affectionately known as Dr. E. I will be talking to you all quarterly about various health issues affecting African American Women. I will give you a patient scenario and we will dissect it and determine what changes the patient could make to help improve her lifestyle. This month the topic is Cardiovascular Disease (CD).

August 15th 2003

Hello Ladies,
I know I have been out of commission for a little while, but I'm back to make sure we all are still keeping it real! Just a quick note. if any of you did not attend the Fitness Symposium, it was an awesome experience that you must plan on attending. It was wonderful to feel the energy amongst over three hundred Sistahs together in the name of health and fitness. That being said, let's move on to our next reality check up!
The topic of this month is Diabetes. Patient C is a 39 year old AA woman who presented to my office with complaints of frequent urination, fatigue, and excessive thirst. She was noted to be mildly over weight at 5'7 and weight of 165 pounds. She described that she had been feeling this way for a while but presumed she just was dehydrated. She described to me that her mom and dad both suffered with high blood pressure and diabetes. At that visit we did a finger stick for her glucose (sugar) and it was elevated at over 300mg/dl. The normal range is from 80-120mg/dl. At that visit, we instructed her on the importance of diet and exercise and described that with the appropriate management she may not need to be on medications or insulin. She returned to me six weeks later after attending diabetes classes and receiving lots of information on diet and exercise. She had lost twelve pounds and her sugar was within the normal range at 103mg/dl. I congratulated her and told her to keep up the good work and follow up in two months.
One year later, patient C returns to my office, her weight is slightly up at one hundred fifty-five pounds and her sugars are running in the 200's. She state that she fell off the wagon some but overall despite her efforts her sugars were staying somewhat elevated.

Physical exam: BP=145/95 Blood Sugar=246 Urine=Positive for sugar HemoglobinA1C=9.3

Outcome: She is started on oral medications and her sugars return to good control. Goal Blood Pressure in diabetics is more stringent than the "normal" population. We want her blood pressure to be less than 130/80 consistently, so she is started on a new blood pressure medicine as well and instructed on a low salt diet and exercise. HemoglobinA1C is a number that anyone who is a diabetic should know like their phone number. It is the number which lets us know how well your sugars have been under control for three months. Target range is always UNDER 7.0. (If you have any friends or relatives with diabetes, I challenge you to ask them what theirs is……less than half will likely know.)

Botton E line: Genetics are strong. Do not run from your family history. Sometime no matter how diligent you are, you can develop one of the chronic diseases just because you are predestined to. This means that we must continuously focus on healthy lifestyles so that we can prevent their onset for as long as possible.

· Diabetes is noted in 13% AA versus 7.8% whites, of which the largest proportion is AA women
· One in four AA women develop diabetes after age 55
· Risk of death is 2X higher than people without diabetes
· Risk for stroke is 2-4X higher in people with diabetes

Patient B facts: She in many ways is the product of genetics, which many of us are. She needs to work on being more consistent and finding a partner in diabetes. She needs to learn as much as possible about her disease and know what she can do to prevent the complications. She can beat the odds, she just needs to remain focused.

Ladies, don't go into denial about your genes…..face them head on so that you can prevent them as long as possible.

In good health, until our next office visit.

Dr. E

 

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April 15th 2003
Hello again Ladies. Hope you enjoyed the last reality check and have continued the journey towards healthy lifestyle decisions. The topic of this month is Hypertension(HTN).
Patient B is a 35 years old African American (AA) woman who had been seen two years previously at which time she was informed that she had borderline HTN. She informed me that she wasn't surprised because she had been on medications five years ago, but stopped them after one month because they made her feel funny. She also informed me that her mom and dad both were maintained on medicines for HTN. At that prior visit she was told her weight was too high being 5'4 and 175 pounds. She was advised to restrict her salt intake, exercise, and follow up in two weeks with outside blood pressure readings and a repeat blood pressure evaluation. She never followed up because she was feeling fine. On today's presentation, she was coming in for evaluation of swelling in her legs and feet and occasional shortness of breath with reclining and with moderate levels of exertion.

Physical: Blood Pressure= 196/ 116 Chest X-ray= Enlarged heart.

Outcome: Patient B is hospitalized for control of her blood pressure and has to be maintained on four medications because not only has prolonged elevated blood pressure caused this admission, she now has to cope with a shorter life expectancy with the diagnosis of congestive heart failure.

Bottom E-line: HTN is known as the silent killer. Its effects can take its toll without us having any symptoms. Check your blood pressure sometimes (At least twice a year. See your doctor if it is elevated at all), even at the drug store machines, especially if you have a family history of HTN in mom or dad.

§ AA develop HTN earlier in life, therefore increasing our risks for stroke, heart disease, and kidney complications.
§ In the year 2000, HTN claimed the lives of 5912 AA females versus 4670 AA males.
§ Overall death rate from HTN 46.3% AA males and 40.8% females. Versus in the low 20% for white females.

Patient B facts: She needs to take some responsibility for her health. We cannot call her to make sure she is checking her blood pressure and eating correctly. She should be even more conscientious since her parents have high blood pressure. Genetics are strong ladies. Never stop your medicines unless you have spoken to your doctor about the repercussions of doing so.
§ Goal Blood Pressure is 120/80 (You guys should remember this from last month's presentation)

Take responsibility for your own health so that you don't become patient B whose life expectancy is shorter simply because she didn't.

In good health, until our next office visit.

Dr. E

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March 15th 2003
Patient A is a 47 years old African American woman. She is 5'2 and weighs 195 pounds. She has been working in a sedentary job for twenty years. She cut back on smoking to a half a pack a day, but she's proud because she used to smoke 2 packs per day. She occasionally walks around the block but without any structure or consistency. She has a large family and she cooks for them but she usually tries to separate her food from their high fat diet but sometimes nibbles. She comes to the office today because she has been getting short of breath when she walks up the stairs in her house. She believes it's her weight and her lack of exercise.

Physical: Blood Pressure = 140/98 Cholesterol = 250 Good Cholesterol = 34 Bad Cholesterol = 197.

Outcome: Patient A is hospitalized and has triple bypass surgery because three of her arteries were clogged. She now has to be maintained on 5 medications and is forced to enter a cardiac rehabilitation program.

Patient A facts: She needs to lose weight. She needs to stop smoking. A sedentary job is not an excuse for a sedentary lifestyle. Get your families to eat healthy too.

In good health, until our next office visit.

Dr. E

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