HEALTH

Understanding the Pap Smear

2010-06-01T10:37:00.001-07:00

What Is A Pap Smear?

A pap smear is a screening test for cervical cancer. Screening tests are examinations done to detect the development of a disease or cancer in its early stages. Often, these tests are done when there are no symptoms of illness. In the case of cervical cancer, the pap smear is used to detect abnormal cells on the cervix that have the potential to turn into cancerous cells.

The pap smear is performed during a regular office visit. Your provider will use a wooden scraper and/or a small brush to collect a sample of cells from the cervix. These cells are placed on a slide and sent to a laboratory to check for abnormalities.

Who Should Have Pap Smears?

All women who are 18 years or older, or who are sexually active should have regular pap smears. Initially your provider will do them every year. Once you have several consecutive pap smears that are normal, your doctor may decrease the frequency to every 2-3 years.

Women who have had an abnormal pap smear in the past may need to have more frequent pap smears. Women who have had a total hysterectomy (uterus and cervix removed) for non-cancerous reasons may not need to have pap smears. On the other hand, women who have had their uterus and cervix removed because of cancer (or who have risk factors for developing cancer) will need to continue to have pap smears.

How can I prepare for a Pap Smear?

If you know you are going to have a pap smear, you should avoid douching for 48 hours before the test. In addition, you should avoid using vaginal creams one week before the test, and abstain from sexual intercourse for 24 hours in advance. It is best to schedule the pap test for a time when you are not having your menstrual cycle.

What does a Pap Smear tell you?

Once your pap smear is completed, the laboratory will evaluate the cells to determine if they are normal or not. The laboratory uses a system developed by the National Cancer Institute to classify the pap test. This classification helps doctors plan treatment.

Normal: Only normal cells were seen on your pap test.
Atypical squamous cells of undetermined significance (ASCUS): Abnormal cells were found in the cells of the outer cervix.
Atypical glandular cells of undetermined significance (AGUS): Abnormal cells found in the cells lining the inner cervix.
Squamous intraepithelial lesions (SIL): The cervical cells show mild or severe changes that may progress to cancer.
Cancer: The cells show abnormalities consistent with cancer.

I Have An Abnormal Pap Smear, What Can I Expect Next?

If your pap test comes back abnormal, your doctor will ask you to come in for further testing. This may consist of having a repeat pap smear in a few weeks or a few months.

You may be asked to come in for a colposcopy. This is a procedure done in the clinic where the doctor takes biopsies of abnormal areas on the cervix. The abnormal areas are visualized by use of a microscope after applying acetic acid (vinegar) to your cervix. The acetic acid will stain abnormal cells on the cervix which the doctor can then biopsy.

These biopsies are sent to the laboratory for an evaluation, looking for the presence of cancer. Depending on these results, your doctor will either have you return for a repeat pap smear at a later time, or have you come back for more extensive biopsies.

What can I do to help prevent cervical cancer?

Cervical cancer is one of the only types of cancer that is preventable. You should see your doctor annually for a pap smear and exam. Women who have never had a pap test or who have not had one for several years have a higher-than-average risk of developing cervical cancer.

Other preventable risk factors for developing cervical cancer include multiple sexual partners, HIV infection, HPV infection (genital warts) and smoking. Condom use will help decrease many of these infectious risk factors from contributing to the development of cervical cancer.

Empowerment Points

A pap smear is a screening test used to detect the early stages of cervical cancer.
You should have a pap smear annually unless your doctor advises otherwise.
Avoid douching, intercourse or the use of vaginal creams before your pap smear.
An abnormal pap smear does not mean you have cancer.
If you have an abnormal pap smear you may need to repeat your pap smear or have biopsies of your cervix taken.

Disparities in Children's Oral Health and Access to Care

2010-06-01T10:29:00.001-07:00

The oral health of Americans has improved in recent years, yet considerable gaps in the provision of dental care remain, according to the U.S. Surgeon General's Report in 2000. The report states that oral health is essential to the general health and well-being of all Americans. There is a silent epidemic of oral diseases affecting our most vulnerable citizens: poor children, the elderly, and many members of racial and ethnic minority groups. The report served as a wake-up call against this silence and a call to action for health professionals, policymakers, community leaders, insurance companies, the public and private business.
During the 2004-2005 school year, the Dental Health Foundation surveyed more than 2?,000 California children in kindergarten or third grade in nearly 200 randomly selected schools located across the state.2 They found that by the third grade, more than 70 percent of the children had a history of tooth decay; at any given moment, more than a quarter of the children had untreated tooth decay; and some 4 percent of the kids were sitting in the classroom in pain or suffering from an abscess. The problem is worse for the poor, Hispanics, other ethnic minorities, and for the uninsured. Barriers to dental care, including parental financial difficulties or a lack of dental insurance, can have a profound impact on their children's dental health. About one-third of low-income children have untreated decay compared to about one-fifth of higher income children.
Oral diseases are cumulative and progressive over time and can affect lives in many ways. Oral diseases can limit the foods one eats, affects one's appearance, and cause significant pain and discomfort. Oral health is also an integral part of overall health and may lead to systemic diseases (click here to read the entire article)

Menopause

2010-06-01T10:28:00.001-07:00

What is Menopause?
Menopause is the medical term for the end of a woman’s menstrual periods. It is often called the "change of life" and marks the transition between a woman’s childbearing years and her non-childbearing years. Menopause is a natural part of aging and occurs as a result of the gradual loss of estrogen, a hormone produced in the ovaries. During a period known as "perimenopause," estrogen production declines and women often develop irregular periods, hot flashes, mood swings and fatigue. These symptoms often develop 3 to 5 years before a woman’s last period. Menopause is diagnosed when a woman has been without a period for one year.

The average age of menopause is 51 but varies from person to person. Cigarette smoking has been shown to accelerate the onset of menopause by 1-2 years. A variety of factors that affect ovarian function may cause premature menopause.

Menopause in African American Women

Menopause affects all women regardless of race or socioeconomic background. However, recent studies have shown that the experience of menopause is different among racial groups. African Americans have more estrogen related symptoms (hot flashes, night sweats, vaginal dryness, urine leakage) than all other ethnic groups. Additionally, African Americans are less likely to have somatic symptoms (headaches, difficulty sleeping, racing heart, stiffness and soreness in joints) than all other ethnic groups.

What are the Signs and Symptoms of Menopause?

Menopause is a very individualized experience. Some women find the "change" extremely bothersome while others notice little difference. Research has proven, however, that low estrogen levels are responsible for a variety of uncomfortable symptoms, which will be outlined below.

Hot Flashes: Hot flashes are the most common symptom of menopause, affecting more than 60 percent of menopausal women. A hot flash is a sudden; often fleeting sensation ranging from warmth to intense heat that usually begins in the face or upper chest and spreads over the body. These flashes usually last from 30 seconds to several minutes, and are often accompanied by a rapid heart rate and feelings of anxiety. Hot flashes usually occur spontaneously but can be triggered by hot, humid weather, confining spaces or ingestion of caffeine, alcohol or spicy foods. Stress and tension may also increase the frequency and severity of flashes.

Irregular Menstrual Periods: Episodes of heavy bleeding and/or of infrequent cycles. Cycles may be longer or shorter. Irregular menstrual cycles may occur 2-8 years before the end of your periods. However, not all cases of irregular bleeding are caused by menopause. Discussion with your physician will determine if further evaluation is necessary.

Mood Changes: many women report an increased level of anxiety and irritability as the "change" occurs.

Vaginal Dryness: results from lack of vaginal lubrication. This is caused by a deficiency of estrogen and may contribute to a decrease in sexual satisfaction.

Complications of Menopause

We have already discussed many of the changes a woman goes through during menopause. It is important to realize that there are long-term complications linked to the decreased levels of estrogen that accompany menopause. We will discuss the most important ones below.

Osteoporosis: (thinning of the bones) Deficiency of estrogen results in loss of bone mass. A decrease in bone mass may lead to curvature of the spine, fractures of the vertebrae, loss of height and pain.

Cardiovascular Disease: Many studies have shown that the risk of cardiovascular disease, including heart attacks and strokes, are increased in postmenopausal women. This is thought to be caused by estrogen related changes in levels of cholesterol and other blood lipids (fats).

Vaginal/Urinary Changes: vaginal tissues and tissues of the bladder are estrogen sensitive. Without estrogen, these tissues start to degenerate, resulting in symptoms of vaginal dryness, painful intercourse, painful urination and incontinence.

How can you be evaluated for Menopause?

Menopause is diagnosed primarily by its symptoms. If a woman who is almost 50 years old or older stops menstruating completely, a presumptive diagnosis of menopause can be made without further testing. Diagnosis is slightly different in a younger woman who has signs and symptoms of menopause. Special hormonal blood tests may be necessary to confirm the diagnosis. Your doctor will be happy to discuss this with you further.

Treatment Options

Hormone Replacement Therapy (HRT): As stated earlier, many of the symptoms and complications of menopause occur as the result of a deficiency in estrogen. Most women will eventually need to decide whether or not to take hormone replacement therapy (HRT). HRT can have beneficial effects for many women, but it is not for everyone. For further information, go to our section on hormone replacement therapy.

Calcium supplementation for prevention of osteoporosis. Postmenopausal women on HRT should take 1,000 mg of calcium daily. Women not on HRT should take 1,500 mg of calcium daily. Ask your physician regarding other bone sparing medications including vitamin D, and phosphorous containing medications.

Nutrition: Eating a reasonable diet will help you throughout and after menopause. Choose foods low in fat, saturated fat and cholesterol. Eat fruits, vegetables and whole grain cereal products, especially those high in vitamin c and carotene. Eat very little salt-cured and smoked foods such as sausages, smoked fish and ham, bacon and hot dogs. Avoid food and drinks containing processed sugar.

Exercise: Regular exercise benefits the heart and bones, helps regulate weight and contributes to a sense of overall well-being and improvement in mood. Weight bearing exercises such as walking and running help to increase bone mass. Moderate exercise preserves bone mass in the spine, helping reduce the risk of fractures. Consult your doctor before starting a rigorous exercise program. He or she will help you decide which types of exercises are best for you. An exercise program should start slowly and build up to more strenuous activities.

Empowerment Points

Menopause should be considered a naturally occurring event in all women’s lives. It is a time of transition. It is not an end to life or of normalcy!

Symptoms of menopause can include hot flashes, irregular menstrual periods, mood changes, disrupted sleep, vaginal dryness and changes in urinary continence.

Making lifestyle changes such as improving your diet and exercise can make a significant difference in menopausal symptoms.

Do not be afraid to talk with your doctor regarding your concerns about menopause. There are many therapies that may help.

Medicare Prescription Coverage is Changing: What You Need to Know!!

2010-06-01T10:27:00.001-07:00

Starting in January of 2006, Medicare beneficiaries are entitled to a new prescription drug benefit. It is called Medicare Part D and it is new. Since Medicare is working with health care organizations and private companies to offer this benefit, the actual details for individual plans are greatly varied.

What Choices do I have?

Senior citizens will have to decide whether to enroll in Part D and select the policy that best meets their needs. Since health care organizations, such as Kaiser Permanente and private companies, such as Aetna are setting up the plans with Medicare, consumers will have lots of decisions to make. Some plans may use only certain pharmacies and others may cover only certain drugs. The costs are also going to vary significantly depending on which plan you choose. Therefore, it is important to pick one that meets your needs.

What steps do I have to take?

Making the right choice will require extensive research of your current prescription benefit to determine if it meets your needs for the rest of 2006. If it does, you can continue with this coverage until the next open enrollment for Medicare Part D which will be in November, 2006.

Even if you believe your current prescription coverage is adequate, by May 15, 2006 each Medicare recipient must decide between a stand-alone prescription drug plan or an integrated Medicare Advantage Prescription Drug Plan. A stand alone prescription drug plan may be offered by your current HMO's plan, and thus you may decide not to join a Medicare Part D plan and simply save yourself the monthly premiums which will be about $32.00 per month.

Be aware that different insurance plans cover different medications. You may you’re your providers’ drug lists (known as their formulary) by visiting either their web site or the cms.gov site. The federal government requires approved Medicare Part D providers to disclose their drug formularies to the public and are required to provide beneficiaries with a copy to view themselves. However, every therapeutic category of prescription drugs will be covered under the Medicare Part D prescription drug plans.

If you choose a Medicare Advantage Prescription Drug plan be aware that enrollment is voluntary, but there is a penalty, of 1% per month that you are late, if you decide to enroll in Part D after the May 15, 2006 cutoff.

Understand the costs. The Part D standard benefit design costs about $32 per month in premiums and has a $250 deductible which means that you have to pay for the first $250 worth of drugs that you buy.

Appreciate that for the next $2000 in drug costs, Medicare Part D will pay 75% of the drug cost and the patient will have to pay for the remaining 25%.

Be aware that if your drug expenses in a given year range from $2250 to $5100, the patient pays 100% of these costs. This is being called “the donut hole” because there is a gap in Medicare Part D coverage with some plans.

Understand that many insurers are offering $0 deductible plans and plans with low co-pays as well as plans that fill in the donut hole to some extent.

Know where to get more information from the government. You can call 1-800-MEDICARE (1-800-633-4227) You can also call the Elder Care Locator at 1-800-677-1116 or visit www.eldercare.gov. You can also contact the Social Security Administration at 1-800-772-1213 or www.ssa.gov/prescriptionhelp for people with limited incomes and resources.

Living With Lupus: Why Is This Diagnosis So Elusive?

2010-06-01T10:26:00.001-07:00

"Everyday, I am grateful to be living, but I realize that I have to limit some of my activities especially the time I spend outside," says Reverend Shirley Humphrey who is a young African American minister living with Lupus. Reverend Humphrey initially thought her fatigue was just part of the stress and exhaustion that comes with a busy ministry, book tours and speaking engagements. That wasn't the case.
In 2005, Reverend Humphrey was at her annual medical check-up when her physician pressed her about any other symptoms she might be experiencing. Based on her responses, Shirley's physician decided to order several tests for immune dysfunction. That's when further evaluation revealed a laboratory profile that was consistent with a diagnosis of Lupus.
Systemic lupus erythematosus (SLE), or lupus, is a chronic, inflammatory, autoimmune disease that mainly affects women of child-bearing age. Its symptoms range from unexplained fever, swollen joints, and skin rashes to severe organ damage of the kidneys, lungs, or central nervous system. African American women are three times as likely as Caucasian women to get lupus. African American women tend to develop lupus at a younger age and have more severe symptoms than Caucasian women.
Signs and Symptoms of Lupus
Patients with lupus frequently complain of fatigue (80-100%). Fever and weight loss also occurs in more than 60% of patients. Currently, there is no single laboratory test that can determine whether a person has lupus or not. To assist the physician in the diagnosis of lupus, the American College of Rheumatology issued a list of 11 symptoms or signs that help distinguish lupus from other diseases.

Sympton	Description
Malar Rash	Rash over the cheeks
Discoid Rash	Red raised patches
Photosensitivity	Reaction to sunlight, resulting in the development of or increase in skin rash
Oral Ulcers	Ulcers in the nose or mouth, usually painless
Arthritis	Nonerosive arthritis involving two or more peripheral joints (arthritis in which the bones around the joints do not become destroyed)
Serositis	Pleuritis or pericarditis (inflammation of the lining of the lung or heart)
Renal Disorder	Excessive protein in the urine (greater than 0.5 gm/day or 3+ on test sticks) and/or cellular casts (abnormal elements the urine, derived from red and/or white cells and/or kidney tubule cells)
Neurologic Disorder	Seizures (convulsions) and/or psychosis in the absence of drugs or metabolic disturbances which are known to cause such effects
Hematologic Disorder	Hemolytic anemia or leukopenia (white blood count below 4,000 cells per cubic millimeter) or lymphopenia (less than 1,500 lymphocytes per cubic millimeter) or thrombocytopenia (less than 100,000 platelets per cubic millimeter). The leukopenia and lymphopenia must be detected on two or more occasions. The thrombocytopenia must be detected in the absence of drugs known to induce it.
Antinuclear Antibody	Positive test for antinuclear antibodies (ANA) in the absence of drugs known to induce it.
Immunologic Disorder	Positive anti-double stranded anti-DNA test, positive anti-Sm test, positive antiphospholipid antibody such as anticardiolipin, or false positive syphilis test (VDRL).

Medical Evaluation and Diagnosis
If you have any of these symptoms or findings, you should make an appointment to see your doctor. The diagnosis of lupus can by difficult to make based on the fact that patients may present with only one of the above findings and not meet the strict diagnostic criteria. Occasionally your doctor may refer you to a rheumatologist who is a doctor that specializes in autoimmune disorders such as lupus.
The most useful laboratory tests identify auto-antibodies in the blood. Examples of such tests include: ANA (antinuclear antibody), anti-DNA, anti-Smith, and anti-Ro. Your doctor may choose to order some or all of these tests depending on your condition.
The Role of Genetics
A study conducted in 2003 by the Medical University of South Carolina's Gary Gilkeson, M.D., and his colleagues showed that two variant forms of a gene that promotes the formation of nitric oxide-a molecule involved in blood vessel dynamics and nerve transmission-may be a risk factor for the rheumatic disease lupus in African American women. These same gene forms have been associated with improved outcomes in some African patients with malaria.

Treatment
There is no cure for lupus, but there are treatments that can help ease your symptoms.. The goal of both the patient and the physician is to control acute severe flare-ups and develop a maintenance regimen that will suppress the symptoms.
There are several groups of medicines used to control the symptoms of lupus:

NSAIDS: non-steroidal anti-inflammatory drugs are a class of drugs that decrease inflammation. Usually these are used in patients with joint pain, fever, and swelling. Because of different dosages and side effects, it is important to consult your doctor prior to using this class of medication.
Corticosteroids: This class of medications remains the mainstay of treatment. These work by rapidly suppressing inflammation. These are very potent drugs, and your doctor will prescribe the lowest effective dose. Prednisone is the most common corticosteroid used.
Immunosuppressants: This class of medications is reserved for patients with kidney and central nervous system lupus. They work by blocking the production of some immune cells.
Other: Methotrexate, intravenous gamma globulin and anti-malarials are other medications your doctor may recommend if multiple organs are involved.

Empowerment Points

Most patients with lupus can lead normal, active healthy lives.
The key to managing lupus is to recognize symptoms and to treat flare ups as soon as possible.
It is important to work closely with your doctor, and to never stop or alter your medications without first talking with your physician.
Research continues for new treatments, improving quality of life, and prevention and cure.

Living With Diabetes

2010-06-01T10:25:00.003-07:00

Living with Diabetes brings various challenges along the way. For adults and especially for children, the initial steps to adjusting for this diagnosis take time and most importantly education.

Maybe you've just been diagnosed and or you've had diabetes for years. When one is trying to exercise, go out with friends, travel and adjust to work, school or the demands of family, diabetes can "get in the way. "But don't worry. We're here to help."

Accepting the Diagnosis

This is often a key first step. A diagnosis of diabetes can send shock waves through your entire family. It will take some time for you and your family to adjust to all of the associated emotions. There are support groups and regular meetings at almost every local hospital. In addition, organizations such as the American Diabetes Association, can be a wealth of information.
Traveling

It is important to take into consideration the best times to travel and to prepare for delays, so that you are not "stuck without your medication." In addition, we recommend a medical id bracelet. Countless times, diabetics have passed while traveling or out in the company of strangers. This can also happen even when you are close to home or at a sporting event or at a concert and no one knows what to do. When a first responder knows to look at a medical id bracelet, this can provide invaluable information. (To obtain a MedicAlert identification tag, please call 1-800-432-5378.)

Exercise

Blood sugar can vary immensely throughout the day in relationship to several factors including the time of the last meal, insulin levels and even exercise. The body requires extra energy, usually in the form of glucose during exercise. This can lower blood glucose levels immensely.

The benefits of exercise on diabetes are huge. In a recent study of Hispanic men and women, 16 weeks of strength training produced dramatic improvements in glucose control that are comparable to taking diabetes medication. Therefore, aerobic exercise can help decrease the risk of type 2 diabetes and helps those with diabetes to better manage their blood glucose levels. Examples of aerobic exercise include swimming, walking or bicycling. Remember to discuss your plans with your physician or Endocrinologist so that you don't develop hypoglycemia unexpectedly during your favorite exercise routine. For example, depending on the time of exercise, you may have to reduce your dose of either long-acting insulin or short-acting insulin.
The American Diabetes Association offers these basic guidelines for exercising:

Learn the effects of various types of exercise on your blood sugars.
Do not exercise if your blood sugar is greater than 250 mg/dL (milligrams per deciliter) and your ketones positive. This is an indication that you already may have a lack of insulin and exercise will only cause a greater rise in your glucose levels. Hydrate yourself and adjust your insulin as necessary, contact your health care provider.
Use caution when exercising if your sugars are greater than 300 mg/dL without evidence of ketones, exercise may help decrease your sugars, but it's possible they will increase instead. Hydrate well prior to and after exercise and keep track of your sugars and ketones.
Have carbohydrate-based foods available for exercise and for the period following exercise. Add carbohydrates to your meals if you plan on doing exercise, adjust you insulin dose appropriately in anticipation of exercise.

To learn more about exercising visit the American Diabetes Association article at http://www.diabetes.org/weightloss-and-exercise/exercise/overview.jsp

Living Well With HIV

2010-06-01T10:25:00.001-07:00

The Human Immunodeficiency Virus (HIV) first made it appearance in the US in 1981. Current estimates are that there are more than 1 million people living with HIV/AIDS in the US.
In the early 80’s, someone diagnosed with HIV/AIDS was basically given a death sentence. The death rate from this disease was staggering. This stayed the case for the next two decades, with little change. Now in this the 21st century, HIV/AIDS appears to becoming more of a manageable chronic disease, in which individuals are living longer and healthier lives in spite of this disease. In fact, some medical experts say that HIV/AIDS patients have a better chance of dying from a non-HIV/AIDS related illness such as heart disease or cancer.
There are several reasons for this new perspective on living with HIV/AIDS. According to the Centers for Disease Control, the number of people living with HIV/AIDS is increasing, as effective new drug therapies keep HIV-infected persons healthy longer and dramatically reduce the death rate. These medications are more affordable, accessible and most importantly, more effective than past medications. This anti-retroviral drug therapy works, by focus on providing maximum suppression of symptoms related to HIV/AIDS for a long as possible. Consequently, there can be an increase in an individual’s T-lymphocyte of T-Cell count, which is crucial in slowing downs the progression of HIV/AIDS. These improvements have been largely responsible for changing the status of this disease to that of being more manageable.
Another aspect of manageability of this disease is the fact that many more individuals are being tested for this disease and by doing so individuals are being diagnosed earlier and are getting into treatment at a much earlier time in the disease process. Receiving treatment means being able to utilize the medication therapy earlier as well.
Empowerment Points
People diagnosed with HIV/AIDS are living longer and more productive lives now, more than at any other time since the identification of this disease. A positive attitude and a willingness to live are also impacting this new approach to living with this disease. Individuals are planning families, planning successful careers and pursuing their dreams.
The future looks encouraging as work continues towards finding a vaccine for this medical condition. As this works continues, so too will the improvements in the quality of life of individuals living with HIV/AIDS.

Keloids

2010-06-01T10:24:00.002-07:00

What Are Keloids?

A keloid is the term given to the prominent, irregular scar tissue, which sometimes forms after a person has suffered a small cut or a scratch in the skin. Usually, a “bump” appears at the site of the injury. The bump becomes larger and over time a full-blown (and often unsightly) keloid develops. It is important to point out that sometimes keloids develop spontaneously, without injury to the skin.

The cause of keloids is genetic and we are unlikely to be able to prevent keloids until gene therapy develops in this century. Now there exists in the US and Paris a research project to map out every gene in the human body. This project, known as the Human Genome Project, will hopefully identify the gene that codes for keloids. Once found, we would have the potential to turn off the gene responsible for keloid formation!

Blacks and Keloids

Most often, keloids are found in people of African descent. I have also seen keloids in Indians and Chinese, and more rarely in Whites. Keloids tend to run in families. If your parents or siblings have keloids, you are more likely to have them as well.

Keloids have been noted in Africans throughout history. One of the theories that has been postulated for the predominance of keloids in Blacks is the fact that when keloids are developed they become insensitive to pain. In Africa, men would put scars on their bodies in order to develop keloids. The keloids would then become a sort of natural armor, giving some protection. This “scarification” of the body would also take place at particular times of the year, in accordance with local customs. Most of this knowledge is historically interesting and has been lost to us in the west!

Prevention of Keloids

One of the most important things that one can do to prevent the formation of keloids is to properly care for skin abrasions and cuts. It is important to remember that any cut that is deep enough to require stitches (sutures) should be stitched promptly. Many people will put a dressing over the cut and allow it to remain open. In these cases, a keloid is likely to develop and/or the site if injury will become infected. It is important for doctors to carefully suture the wound and to avoid damage to the surrounding skin in the suturing process.

Treatment Options

Keloids are never life threatening. Rather, they are cosmetic and cosmetic only. One’s appearance is important, however, and keloids are problematic from this perspective.

The treatment of keloids will vary. Some people believe that if the keloid is cut out all will be well. Many times, however, the keloid will return larger than it was before. Doctors have, therefore, developed several ways to treat keloids:

1. Injection of the keloid with steroid solutions. Steroids have the effect of causing tissues to become atrophic (thin). This is a known side effect of steroids that we are using to our advantage when we inject the keloids with the steroid solution.

2. Surgery of the keloid with use of steroid injections. In this case, we still inject the keloid for several weeks prior to the surgery. Then, we surgically remove the keloid material and the wound is carefully sutured. Steroids are again injected and continued for several weeks thereafter.

3. Surgery of the keloid followed by radiation therapy. In this case, patients receive superficial radiation to the affected area. This may be a good option in some cases.

4. Lately, there has been the development of pressure to treat keloids. Scientists have developed a type of sheeting called silastic gel which is applied to the keloid and kept in place with tape. The silastic gel is applied at night for several months and it flattens the keloid.

5. Additionally, a newer therapy involving tape impregnated with steroids has been used. The tape is applied to the keloid and the steroid is slowly released. Overtime, the keloid thins.

Empowerment Points

Keloids are very common in Black people throughout the world.
Keloids usually occur after a person has suffered a cut or scratch to the skin.
The resulting scar tissue is thickened and often unsightly.
There are a variety of treatment options available and your dermatologist will be happy to discuss them with you.

Treating keloids can be challenging, but good results can be obtained!

Hysterectomy: Making It Plain!

2010-06-01T10:24:00.000-07:00

Medical “lingo” is a different dialect than many of us are use to. In fact, many medical terms are derived from Latin. It is easy to become confused with the language that doctors and other health care providers use, especially if you are not in the health care field or have not had any experience with the illness your doctor is referring to. Sometimes it is hard for us to admit to our doctors that we do not understand what they are saying. At other times, it is the lack of explanation from the doctor that adds to our confusion. In either case, it is important to understand the illness that you have and the treatment options available in order to feel that you are receiving proper care.

I have received many questions regarding hysterectomy; this article will give you a better understanding of the different types of hysterectomy and the ways it can be performed. First however, it is important to understand the female anatomy.

Anatomy

The female organs consist of the uterus, fallopian tubes, ovaries, cervix and vagina. The uterus is made of two parts, the body and the cervix. The cervix is the lowermost portion of the uterus that is visible through the vagina. The fallopian tubes are attached to either side of the fundus (the superior-most portion of the body of the uterus). This is where the egg travels to get fertilized by the sperm. Right outside the fallopian tubes (but not attached to the fallopian tubes) are the ovaries. The ovaries contain eggs and produce hormones necessary for ovulation and menstruation. These hormones also help protect other organs outside of the female organs such as the heart, bones, bladder and brain. When the ovaries no longer produce these hormones in sufficient amounts, menopause occurs.

What is Hysterectomy and When Is It Necessary?

Hysterectomy is the surgical removal of the uterus. It does not necessarily mean that the ovaries or fallopian tubes will be removed. These organs can, however, be removed at the same time as a hysterectomy is being performed.

A hysterectomy may be performed as part of treatment for fibroids, endometriosis or chronic pelvic pain, for bleeding problems, for uterine prolapse (uterus is “falling” out through the vagina) and for cancer of the uterus, ovaries or cervix.

Types of Hysterectomy

There are two types of hysterectomy: Total (complete) and Subtotal (supracervical). Total or complete hysterectomy involves removing the uterus and the cervix. Subtotal or supracervical hysterectomy involves removing the uterus without the cervix. In this case, the cervix remains in place and yearly pap smears are still needed to screen for cervical cancer.

Having one type of procedure over another is a personal decision except in certain cases. If you are having your hysterectomy because of cancer, the cervix is removed to prevent the cancer from spreading to this organ.

Many people (doctors and patients) feel that leaving the cervix in adds better support to the vagina and results in less sexual dysfunction after hysterectomy. However, there has been no study to definitively show that having a supracervical hysterectomy will prevent these problems from occurring. Some women who are ambivalent about having a hysterectomy feel more comfortable knowing that their cervix is left in place.

Some doctors advocate total hysterectomy in an effort to decrease the chance of developing cervical cancer at a later time. However, with proper screening for cervical cancer (pap smear), abnormalities of the cervix can be detected prior to developing cervical cancer.

How is the Hysterectomy Done?

There are two main approaches to removing the uterus: through the abdomen or through the vagina.

The abdominal approach is used when a supracervical hysterectomy is being performed, in cases where the uterus is too large to come through the vagina, in cases where the physician suspects there will be a lot of scaring around the uterus and in many cancer cases. (Scarring occurs from prior abdominal or pelvic surgery, prior infections of the tubes or ovaries, ruptured appendix, or from endometriosis).

The advantage of having an abdominal hysterectomy is mostly for the physician. This will allow for the most exposure and access to the pelvic organs. This is especially necessary in cancer patients to evaluate how much the cancer has spread.

A vaginal hysterectomy can be performed with or without the use of a camera placed in the abdominal cavity for assistance. Because the procedure is carried out through the vagina, the recovery time is significantly shorter for the patient compared with an abdominal hysterectomy. And at some hospitals, this procedure is done on an outpatient basis (same day procedure).

However, not all patients are good candidates for this procedure. As stated earlier this procedure is limited to the reason for the hysterectomy, size of the uterus, and amount of scarring present.

Should I leave my ovaries in?

This is a difficult decision and outside of needing to have them removed in the cases of cancer or severe endometriosis, the decision is best made after a thorough discussion with your doctor.

Having your ovaries removed means you will be in menopause and will have all the manifestations of menopause if you do not take hormone replacement (hot flushes, bone loss etc.). With this in mind, if you are not close to menopause it is probably better to leave them in so you will still have all the benefits of hormone production from your ovaries. If you are in menopause or very close to it (average age is 51) then some would advocate taking your ovaries out. The rational is that they are minimally functioning at this point, but still susceptible to ovarian cancer. And, since you are having pelvic surgery you should have them removed to decrease your chance of getting ovarian cancer later and requiring another surgery. Keep in mind, the overall chance for a woman to develop ovarian cancer is 1/70.

Empowerment Points

Hysterectomy is the surgical removal of the uterus, with or without the cervix.

Some people feel leaving the cervix in place allows for better vaginal support and less sexual dysfunction.

The method of hysterectomy, vaginal vs. abdominal, is dependent on the reason for the hysterectomy, size of the uterus, and amount of abdominal/pelvic scarring thought to be present.

Whether the ovaries should be removed at the time of hysterectomy should be based on a discussion with your physician. In some cases it is necessary such as cancer, in other cases it is a personal decision.

Take it upon yourself to discuss your options with your doctor.

High Blood Pressure (Hypertension) Enemy #1 in the African American Community

2010-06-01T10:23:00.001-07:00

Hypertension in the African American Community

If you are like most people, you or someone you know has high blood pressure. For a variety of reasons, the unfortunate truth is that the prevalence of hypertension in African Americans is among the highest in the world. This fact makes hypertension one of our primary targets in the campaign to improve health and wellness.

Poorly controlled hypertension can lead to a variety of serious health problems including strokes, heart disease and kidney failure. African Americans suffer from the complications of hypertension at alarmingly high rates. Often, we do not receive treatment until the blood pressure has been elevated for many years and has already began to damage organs in the body.

Compared to Whites, African Americans develop hypertension at an earlier age and are more prone to have substantially elevated pressures. Data reveal that compared to the general population, African Americans have:

A 80% higher death rate associated with strokes due to hypertension.
A 50% higher death rate associated with heart disease due to hypertension.
A 320% higher death rate associated with end-stage kidney disease.

Quick Refresher: The Basics of Our Circulatory System

Our circulatory system consists of several components that act in harmony to transport nutrients and oxygen to our tissues and remove waste products. Let’s quickly review the key components.

Blood	A fluid made up of blood cells and plasma that circulates throughout the body. Blood caries a variety of substances (oxygen and waste products) that are transported between various organs and tissues.
Heart	Muscular organ that pumps oxygen poor (deoxygenated) blood into the lungs and pumps the newly oxygenated blood out to the body.
Vessels	Vessels are arteries and veins and can be thought of as the “tubing” which carries blood throughout our bodies. For the most part, arteries are the blood vessels that carry oxygen rich blood to our organs and tissues. Veins carry the oxygen poor blood back to the heart.
Lungs	Responsible for the oxygenation of our blood.

What is Blood Pressure?

Blood pressure refers to the pressure blood exerts against the walls of the main arteries in our bodies. The systolic pressure is the pressure in the vessels when the heart is pumping. The diastolic pressure is the pressure of the blood between heartbeats (when the heart is at rest). When you see or are told of a blood pressure of 120/80 or 120 over 80…the systolic pressure is120 and the diastolic pressure is 80.

What Defines Hypertension?

Hypertension is defined as an average systolic blood pressure of 140 mm Hg (millimeters of mercury) or higher and/or an average diastolic blood pressure of 90 mm Hg or higher. It is important to point out that blood pressure readings can be different at varying times of the day and can be elevated with stress or anxiety. Therefore, the determination of a person being labeled as “hypertensive” is usually based on the average of three blood pressure readings taken on different days. The following chart is adapted form the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI).

Category	Systolic (mm Hg)		Diastolic (mm Hg)
Optimal	<120	And	<80
Normal	<130	And	<85
High Normal	130-139	Or	85-89
Hypertension Stage 1	140-159	Or	90-99
Hypertension Stage 2	160-179	Or	100-109
Hypertension Stage 3	>=180	Or	>=110

Hypertension and Diabetes Mellitus

Controlling blood pressure is extremely important in diabetic patients with hypertension. Properly controlling blood pressure helps to prevent damage to the kidneys and can help to control the development of diabetic nephropathy (diabetes related kidney disease).

The goal for diabetic patients with hypertension is to keep the blood pressure below 130/85 mm Hg. A combination of anti-hypertensive medications and lifestyle changes (especially weight loss) should be used to reach this blood pressure goal.

Hypertension Associated with Birth Control Pills

Many women taking birth control pills experience a small increase in blood pressure, but the pressure usually remains in the normal range. Hypertension has been reported to be 2-3 times more common in women taking birth control pills and is most evident in obese and older women. Women over 35 years of age who smoke are advised against taking birth control pills as they are at an increased risk of developing hypertension.

Hypertension and Kidney Disease

The early detection of kidney damage from hypertension is very important. Your doctor can order blood tests that can determine whether or not there is evidence of damage. Blood pressure should be controlled to levels of 130/85 mm Hg or lower. The goal here is to prevent advanced or “end-stage” kidney failure requiring the need for dialysis.

Evaluation and Diagnosis

The initial screening for hypertension is fairly simple and straightforward. All you need to do is have your blood pressure measured with a cuff that is placed around your arm and then inflated (technically it is called a sphygmomanometer). As a basic rule, if the average of three blood pressure readings (on different days) is over 140/90 mm Hg it can be concluded that you have hypertension.

The exact cause of hypertension in most cases is not known. In the medical community this is referred to as “essential” hypertension. A combination of genetics, diet, and lifestyle certainly play a large role in the development of high blood pressure. It is very important to point out that if you develop hypertension at a young age or the hypertension develops suddenly, your doctor should carefully evaluate you for causes of hypertension that are potentially reversible. You may need special studies that will evaluate the vessels that supply blood to your kidneys and for other potential disorders in your endocrine system.

Treatment

Lifestyle Changes

For most individuals, the first step in treating hypertension is to make lifestyle changes. This means losing weight, increasing the amount of exercise you get, and changing your diet. Our accompanying article Controlling Hypertension Throughout Our Life Cycle discusses these lifestyle changes in more detail. In general, decreasing the sodium (salt) in your diet, eating more fruits and vegetables, and getting more aerobic exercise can help to lower your blood pressure. It will take some effort on your part!

Anti-Hypertensive Medications

If the lifestyle changes mentioned above are unable to control your blood pressure, your doctor may prescribe medication(s). There are a variety of different medications available and your doctor will prescribe the medication that is best for you. Some medications are better for people with diabetes, heart disease, kidney disease, etc. If you cannot tolerate a certain medication because of adverse side effects, there are other options.

Many people are often opposed to “taking a pill every day.” Please, please, please remember that taking a pill every day can be a much better option than developing a stroke, heart attack, or needing to have kidney dialysis because your blood pressure ran out of control for too long.

Empowerment Points

Hypertension (high blood pressure) is often asymptomatic but over time it leads to a variety of health problems including heart disease, strokes, and kidney failure.
The prevalence of hypertension in African Americans is among the highest in the world.
Have your blood pressure checked and if it is elevated discuss treatment options with your doctor.
The only way that we can beat hypertension is to confront it head on—make lifestyle changes and take your medication if your doctor prescribes it!

African-American Women, Menopause, and Hormone Therapy - The Facts

2010-06-01T10:22:00.003-07:00

Menopause is a natural change in a women's life and this seems very clear to African American women. The Study of Women's Health Across the Nation (SWAN) found that African-American women view menopause more positively than white or Asian women. Although this is good news the bad news is, as a result, African American women may be less likely to discuss menopause related symptoms with their doctor. African American women should discuss their menopausal symptoms with their doctor- there is so much to know and so much has changed over the years for treating menopause especially the use of Hormone Therapy (HT).
The Women's Health Initiative and Hormone Therapy
The Women's Health Initiative (WHI), a 15-year study involving over 161,000 women that focuses on strategies for preventing heart disease, breast and colorectal cancer and fracture in postmenopausal women, has made some strong clinically valid claims about hormone therapy. Results from the WHI Trial found that Hormone Therapy (HT) which has long been the medical treatment of choice for managing menopausal symptoms could be harmful for women. The facts from the WHI study are very clear, HT is not for everyone. HT is linked to stroke, breast cancer and heart disease for some women. To empower women to make the right choices about HT and management of menopausal symptoms it is critical to understand what menopause is, it's symptoms, and treatment that can be used safely based on one's personal health history and risk status.
What is Menopause?
Menopause (also called the "change of life") is a normal part of a woman's aging. Menopause marks the time period when women are no longer able to conceive children. For some women the time it begins is usually at age 47, with the final menstrual period usually around age 51. However, some women experience it earlier. Menopause occurs over a period of time because the levels of a hormone called estrogen, which is produced by the ovaries, begin slowly decrease. Menopause is typically completed when a woman has not had a period for 12 months in a row.
Menopause will occur immediately, for example, if a woman has both ovaries removed (sometimes done as part of a hysterectomy). This is called "surgical" menopause. Another way women might enter menopause is if her ovaries are damaged by cancer treatment.
What are the Symptoms of Menopause?
The symptoms of menopause include:

Hot flashes
Night sweats, or perspiring excessively,
Sleep difficulties
Vaginal dryness.

Treating Menopause
Menopause is a natural process for women as they age and treating it is unique for each woman affected. Treatment can begin with a healthier lifestyle that includes, eating a healthy diet and exercising. Some women may not need any special treatment for menopause. But some women may have menopause symptoms that need treatment. Several treatments are available so it is best to talk about the treatments with your doctor so you can choose what's best for you. There is no one treatment that is good for all women. Sometimes menopause symptoms go away over time without treatment. Some women may consider alternative treatments or hormone therapy (HT). If a woman is considering HT it must be used properly, under the supervision of a doctor. Hormone therapy is the only therapy that is approved by the government for treating more difficult hot flashes and vaginal dryness. However, according to the WHI, hormone therapy should not be taken to prevent heart disease. These products are approved therapies for relief from moderate to severe hot flashes and symptoms. The Food and Drug Administration (FDA) recommends that hormone therapy be used at the lowest doses for the shortest duration needed to achieve treatment goals. Postmenopausal women who use or are considering using hormone therapy should discuss the possible benefits and risks to them with their physicians.
Estrogen-alone and Breast Cancer
Long-term use of hormone therapy (10 years or more) has been associated with a more than 50% increase in breast cancer risk among black women, states, Lynn Rosenberg, Sc.D., of the Slone Epidemiology Center at Boston University. Dr. Rosenberg reported in the Archives of Internal Medicine that previous studies included mainly white women, and few examined hormone use and breast cancer risk in black women specifically. The study included more than 23,000 black women ages 40 or older enrolled in the Black Women's Health Study, which started in 1995. Data on hormone use, breast cancer risk factors, and the occurrence of breast cancer were collected via questionnaires administered every two years through 2003.
Results of the Women's Health Initiative, reported in the Journal of the American Medical Association in 2004, indicated an 81% increase in breast cancer risk for women on long-term estrogen combined with progestin. The study found no increased risk associated with estrogen alone. Other studies, most notably the Million Women Study, which presented results in The Lancet in 2003, found an elevated breast cancer risk associated with estrogen alone as well.
Prior to the release of the latest findings, hormone therapy had been the common treatment in the United States for treating menopausal symptoms. It was believed that hormone therapy relieved hot flashes and vaginal dryness and prevented many postmenopausal conditions, such as osteoporosis and heart disease. However, in July 2002, the Women's Health released a report that hormone replacement therapy actually caused more health risks than benefits for women in the clinical trial. As a result doctors stopped routine prescriptions for HT treatment.
What Options Exist for Women?
There are safer options for treating heart disease, osteoporosis, and the symptoms of menopause. The options include:

Follow a heart-healthy lifestyle- Women's risks of heart disease increase with age which can be right at the time menopause has begun. So follow a heart healthy lifestyle which includes not smoking, eating a variety of foods low in saturated fat and cholesterol, limiting salt and alcohol intake, maintaining a healthy weight, and being physically active. Sometimes, drugs also are needed to control high blood pressure, high blood cholesterol, or diabetes. For those who already have heart disease, adhere to your medications, maintain a healthier lifestyle and maintain your doctor appointments
Keep your bones strong- The risk of osteoporosis increases as women get older. To help prevent osteoporosis, include calcium and vitamin D in your diet and make sure you get some exposure to sunlight to help the body make vitamin D. Also, do weight-bearing exercises. Osteoporosis is treated by stopping bone loss which women can indeed do through lifestyle changes and sometimes medication.
Talk to Your Doctor about Alternatives Therapies for Treating Menopausal Symptoms- Alternative therapies can include botanical products that contain or act like estrogens. Examples of botanicals are soy and herbs, such as black cohosh. According to the WHI, research has stated conflicting results on the safety and effectiveness of botanical products. Lifestyle changes can offer some relief from hot flashes and other menopausal symptoms, especially those that are mildly to moderately bad. For instance, dress to avoid being too warm; reduce stress; avoid spicy foods, alcohol, and caffeine; get enough sleep; and be physically active.

Empowerment Points
Each woman should discuss her risk-benefit concern with her physician to make the best decision prior to starting HT. Every woman taking HT needs to routinely reevaluate her prescription with her physician and decide, based on individual risk factors and symptoms, to continue therapy or consider alternative treatments.

HIV/AIDS Facts You Can't Ignore

2010-06-01T10:22:00.001-07:00

AIDS and African American Women

African American communities are feeling the damaging effect of an epidemic of AIDS and other sexually transmitted diseases (STDs). At issue is our lifestyle. Although a number of AIDS cases can be attributed to Injection Drug Use (IDU), too many of us – whether gay, straight, male or female – continue to have unprotected sex with multiple partners or people we barely know.

African Americans make up 13 percent of the population, yet we now account for 50% of all AIDS cases reported to the CDC from 1981 through 2005 The AIDS rate among Black women is four times as high as that among Latina and white women ^(6,1). According to the CDC’s June 2007 revised HIV/AIDS Surveillance Report ⁽¹⁾, Black women account for 66% of new AIDS cases among women while white and Latina women each account for 16% of new AIDS cases. Furthermore, Black women represented more than a third (35%) of AIDS Cases diagnosed among Blacks (women and men combined) in 2005, by comparison, white women represented only 15% of AIDS cases diagnosed among whites (men and women combined) ⁽⁶⁾. Sadly, Black teens (aged 13 – 19) accounted for 69% of new AIDS cases reported amongst all teens in 2005.” ⁽⁶⁾. Today Black women make up more than half of all women who have died of AIDS.

What is HIV?

HIV is the abbreviation for human immunodeficiency virus. HIV is the virus (infection) that causes AIDS (acquired immunodeficiency syndrome), a disease that can destroy one’s life. Human immunodeficiency virus infection occurs when infected cells in blood, semen, or other body fluids are spread from one person to another.
HIV infection attacks and breaks down the body’s immune system which normally produces white blood cells and antibodies that fight against viruses and bacteria. The infection-fighting cells are called CD4+T-cell lymphocytes. When the T-cell lymphocytes are destroyed, the body’s immune system is no longer able to effectively protect the body against diseases. The infected person is more open or susceptible to illnesses that usually do not affect healthy persons.

What is AIDS?

AIDS is a late stage of HIV infection, and is present when the body becomes overpowered by one or more opportunistic infections. These opportunistic infections ultimately cause death because the body cannot defend itself against them.

The AIDS definition developed by the CDC includes the following conditions:

a person must be HIV positive, AND
have a CD4 (T-cell) count below 200 OR one or more opportunistic infections.

A positive HIV test result does not mean that a person has AIDS. A diagnosis of AIDS is made by a physician using the above clinical criteria.

How Can You Become Infected?

Women, because of the structure of the female genital tract, run a higher risk of contracting the AIDS virus from a man than men do from women. That’s why the disease is increasingly transmitted through heterosexual activity and is claiming the lives of African American women at such an alarming rate. Common ways of acquiring HIV infection are:

Having unprotected (without a condom) sex with someone who has HIV.
Sharing needles and/or syringes used in IDU (injection drug use).
A pregnant woman with HIV can give it to her baby during childbirth (this is now a much rarer occurrence given the fact that women can take medications before the birth to reduce the risk of transmission).
Blood transfusions. Since 1985, however, people have seldom received HIV from an infusion of blood or blood-products because better safeguards are practiced against such occurrences.

Common Questions and Answers

Can I become infected with HIV from "French" or open-mouth kissing?
There is the potential for infection with blood during "French Kissing" if either partner has gum disease or there are other conditions when blood is present.
Can I become infected with HIV from oral sex?
It can happen, but not as likely as infection through anal or vaginal sex. Condoms and other health protective barriers should be used to prevent contact with body fluids.
Can birth control pills prevent a person from getting HIV infection?
No. Birth control pills do not protect against HIV infection or other STDs.
I have anal sex with my boyfriend so I won’t get pregnant. Is this a safeguard against AIDS?
No. Anal Intercourse with an infected partner is one of the most common ways that HIV is contracted. Anal sex is very risky whether you are male or female.

Empowerment Points

AIDS is now the leading cause of death for African American women, aged 25 to 44 years of age.
You can decrease your chances of infection with HIV and other STDs (sexually transmitted diseases) by using a latex condom correctly every time you have sex.
Teenagers should learn that alcohol and drugs can cause them to make decisions and do things that can put them at risk for HIV, AIDS, and other STDs.
AIDS is claiming and destroying the lives of millions of people. We need to be wise and informed about HIV, AIDS, and STDs for our own sakes and for those we care about.
If you or your partner can’t or won’t discuss safe sex, then you should not have sex with that person. After all, it is your health and life at risk.

Hepatitis C

2010-06-01T10:21:00.002-07:00

What is Hepatitis C?

The term “hepatitis” refers to the inflammation of the liver which is caused by viruses, toxic substances, or immune system abnormalities. You may have heard people talk about Hepatitis A, B, C etc; this refers to the infectious form of hepatitis which is caused by viruses. There are a number of viruses that cause hepatitis and the most well described forms of hepatitis include Hepatitis A, Hepatitis B, Hepatitis C, Hepatitis D, and Hepatitis E.

Hepatitis C is a worldwide epidemic and there are approximately 170 million infected individuals. In the United States, about 4 million people have been infected with the virus. Hepatitis C is an important cause of chronic and often debilitating liver disease and accounts for an estimated 8,000-10,000 deaths each year in the United States.

Why is Hepatitis C An Important Medical Problem?

Hepatitis C has the potential to be a very serious medical problem because most people who become infected carry the virus for the rest of their lives. Most of these individuals have some mild, chronic liver damage but fortunately do not feel ill. Approximately 20% of individuals infected with Hepatitis C have a much worse experience with the disease and go on to develop cirrhosis (scarring of the liver) and liver failure. A small percentage of these patients will also develop liver cancer. Without a doubt, Hepatitis C is an important medical disease which we should all be aware of.

How is Hepatitis C Spread From One Person to Another?

The Hepatitis C virus is found in the blood of persons who have the disease. The virus is spread in the infected blood and has primarily been seen in intravenous drug abusers and in individuals who received blood transfusions prior to 1992. Hepatitis C can be spread sexually, but this form of transmission is fairly rare.

Hepatitis C is not spread by sneezing, hugging, coughing, or other forms of “casual” contact.

Who is at High Risk For Being Infected With Hepatitis C?

Any one can become infected with Hepatitis C, but the following individuals are at particularly high risk:

Individuals with a history of injection drug use.
Individuals with a history of receiving blood transfusions or blood products prior to 1992.
People who received an organ transplant prior to 1992.
End stage kidney patients on chronic hemodialysis.
Individuals with greater than one abnormal liver function test and no other obvious cause.
Health care workers after an occupational exposure to Hepatitis C infected blood.
Children born to Hepatitis C positive mothers.

Signs and Symptoms

Many individuals with chronic Hepatitis C have no symptoms of liver disease. Some of the symptoms that have been reported include:

Fatigue (extreme tiredness)
Mild abdominal discomfort
Decreased appetite
Nausea
Joint and muscle pains.

Medical Evaluation and Diagnosis

Many doctors routinely screen for Hepatitis C in patients who are considered at “high risk” for having the disease (please see the section “Who Is at Risk for Being Infected with Hepatitis C”). The screening consists of a simple blood test which looks for the presence of antibodies to the virus.

Sometimes, doctors test for the presence of Hepatitis C infection after routine tests of liver function remain persistently elevated. While the test for the presence of antibodies toward the Hepatitis C virus is usually the first step in terms of laboratory testing for the virus, there are more sophisticated blood tests that your doctor may order (if necessary).

If the test results reveal that you have been infected with the Hepatitis C virus, additional studies of your blood and even a liver biopsy may be needed to determine whether or not you are in need of medical treatment.

Treatment

In previous years, the treatment options available for treating chronic Hepatitis C were limited and the success rates were not very impressive. Things are a little better today, and researchers are actively looking for new and exciting approaches to treating this disease. The mainstay of treatment for chronic Hepatitis C at this time is a combination therapy using the anti-viral medications Interferon and Ribavirin. This combination of medications works effectively for about 30-40 out of every 100 people infected with the Hepatitis C virus.

It is important to note that these medications have significant side effects and some patients will not be able to tolerate them.

Side effects of Interferon include:

flu-like symptoms
depression with suicidal thoughts
thyroid disease
decreased white blood cells and platelets in the blood.

Side effects of Ribavirin include:

anemia
nausea
and this medication can cause birth defects and should not be taken by pregnant women.

Prognosis

Overall, the majority of individuals infected with Hepatitis C do quite well and live a full, healthy life. Some individuals, however, will develop cirrhosis, liver failure, and/or liver cancer. If you have Hepatitis C, a thorough evaluation by your physician will help you to manage your disease effectively and devise the best treatment plan for you.

Empowerment Points

Hepatitis C is a liver disease caused by a virus that is found in the blood.
Most people who have Hepatitis C carry the virus with them for life.
The majority of people with this disease do quite well, although they may have some mild, chronic liver disease.
Approximately 20% of individuals will develop cirrhosis and serious liver disease.
About 5% of Hepatitis C infected individuals will develop liver cancer.
There is treatment for Hepatitis C with anti-viral medications.
Remember, knowledge is power!

Heart Disease

2010-06-01T10:21:00.000-07:00

What Is Heart Disease?

“Heart Disease” is a term that can refer to a variety of ailments ranging from heart attacks, chest pain (angina), congestive heart failure (CHF), arrhythmias (irregular, fast, or slow heart beat), and etc. For the purposes of this article, we will discuss Coronary Artery Disease (CAD) which is the number one killer of both men and women in the United States.

What Is Coronary Artery Disease?

CAD is caused by the progressive thickening of the inside walls of the coronary arteries, the small blood vessels that supply blood to the heart muscle. This thickening, referred to as arteriosclerosis, narrows the space through which blood can flow and decreases the supply of oxygen and nutrients to the heart. A heart attack occurs when there is complete blockage of blood flow to a portion of the heart muscle.

Heart Disease and African American Women

According to noted cardiologist Dr. Richard Allen Williams, “heart disease has long been considered a disorder which principally affects men in our society; consideration of the occurrence of heart attacks in females has been largely been an afterthought.”

We now know that every woman should be concerned about heart disease. It is the number one killer of American women and it is estimated that 370,000 women in the United States die from heart disease each year.

Dr. Williams notes that African American women are especially affected by CAD in a negative manner. They have a higher mortality and morbidity than African American men and White women under the age of 55. In the age group 25-44, African American women have 2.5 times the coronary heart disease mortality risk of white women.

Symptoms

The symptoms of CAD vary from individual to individual. Symptoms can include:
Chest pain (angina)
Shortness of breath with exertion (may be an early sign of CAD).
Chest heaviness, tightness, or pressure.

Are You At Risk?

Risk factors are habits or traits that make a person more likely to develop a disease. The more risk factors you have, the greater your risk for development of disease. Heart disease risk factors include:

Cigarette smoking
High Blood Pressure
High Cholesterol
Overweight
Physical Inactivity
Diabetes
Family history of heart disease

Dr. Williams points out that cigarette smoking and obesity represent risk factors which have been documented to increase cardiovascular disease in black women. Diabetes is of particular concern in black women as a risk factor; the death rate among black diabetics is 2.5 times higher that in diabetic whites.

What Can I Do?

Making lifestyle changes to reduce your risk factors for heart disease is one of the best thing you can do to improve the “health” of your heart. Consider taking the following steps:

Make an appointment with your doctor for a physical exam (if you have not had one recently).
Discuss your risk factors for heart disease with your doctor.
Make a plan to reduce any risk factors that you may have.
Continue (or start) to get regular aerobic exercise.
Eat a sensible, balanced diet.

Hair and Scalp Dehydration (HSD)

2010-06-01T10:20:00.001-07:00

Dry Environments will cause your hair to dry out.
Many African Americans suffer from hair and scalp dehydration during the winter months. Have you ever noticed how dry and “ashy” your hands and feet are in the winter or during whether changes? Well there is a reason for these changes: the air is so dry that moisture is pulled from whatever is moist- in this case your skin, and your hair and scalp are suffering right along with the rest of the body. Under such circumstances, Hair and Scalp Dehydration can develop. HSD is a developed disorder that occurs when the hair and scalp is depleted of its natural moisture. This occurs in two ways: first, lack of the appropriate natural moisture to offset the sudden change in the climate or the environment that the hair and scalp is exposed to; second, using hair products that have a high pH, high protein, or high alcohol content. In extreme cases HDS will cause chronic scalp itch and flakes and hair breakage. During the winter months your hair goes through several traumatic and dehydrating dry changes in the course of a single day. You may have never thought about this, but if you live in a part of the country or world where the air is always dry or the winters are cold and dry, your hair and scalp has suffered from a form of HSD.
The Average Winter Day can Cause Winter Hair and Scalp Dehydration.

Lets start with a cold winter morning. Most of us keep our house nice and toasty (dry heat) then we go outside (dry cold) to get in the car and turn on the heater (dry heat). We get to work and walk (dry cold) inside the warm building (dry heat). That is five different drying situations that your hair just went through. In my clinic, I hear women complain about dry hair, scalp itch and flakes more during the winter months than any other time of the year. The reason for this phenomenon is because of the dehydrating changes that the scalp and hair goes through on the average winter day.
One of my more current studies shows that one cause for HSD is what I have coined as transition weather. This is the time of year between seasons, like at the end of winter and the beginning of spring. During this transitional time, we may experience cold mornings and warm evenings.

Ways to prevent Hair and Scalp Dehydration (HSD)
Simple changes making big differences.
The key is to be prepared; most of us will use lotion on our body during the dry months and never make the connection to our hair and scalp. Your hair and scalp, like your skin, benefits from adding moisture. Changes like dry flaking and itching scalp will cause some to use dandruff shampoos. Others with dry brittle hair often turn to moisturizing shampoos. Neither of these specialty shampoos are helpful, and will actually cause HDS to become more chronic.
Changes you can take to avoid HDS

Deep moisture condition your hair twice a week.
Apply a small amount of moisturizer each day to your hair
In extreme cases and coarse hair textures, after applying moisture, apply oil on top to seal in the hydration.
Stay away from shampoos that have fillers, such as moisturizing shampoos, because they cause a filmy build-up that can be drying
Only use clarifying shampoos that have a pH between 4.5 to 5.5, the hair and scalp’s natural pH.
Apply oil not grease to your scalp

Grow Natural or Go Straight?

2010-06-01T10:19:00.001-07:00

At the start of each New Year, many black women ask this very question; "should I grow natural or go straight?"
Most black women have a naturally kinky hair type, a feature that we were born with. However, many black women have resolved to change this natural trait. For many years, there has been a growing difference of opinion as to why some women want to change the natural state of their hair and whether this is right or wrong. In an effort to solve this dilemma, I will discuss some of the most common explanations.

For decades, many black women have been forced to choose sides in a metaphorical battle between kinky and straight hair types. Whether we recognize it or not, black women are divided into two sides: one side which we shall call the "Natural Hair Movement" and the other side which we shall call "Unnatural, Straight Hair Movement." Within these two groups, there are a plethora of reasons for choosing to stay natural or go straight. For instance, some in the natural hair movement say "to be black is to be natural and we should not change and conform to the look of another race." Others, choosing to stay natural proclaim, "If I straighten my hair, it will fall out." These are just two examples of the variety of reasons for choosing to go natural.

On the other hand, an overwhelming percentage of the members of the unnatural, straight hair movement, exclaim, "I wear my hair straight because I don't like my hair natural!" as they cover their mouths saying, "Oops, did I say that out loud?"
Many black women are forced to make the choice: natural or straight? There seems to be an easy answer: just do what you want and you will be happy. Unfortunately, this state of blissfulness is short lived.
Many women whom I have counseled about their hair ask this same question: "should I stay natural or should I go straight?" My answer is always the same. "Yes." And no, I am not riding both sides of the fence. I truly believe that, regardless of the reason, it is and should always be a women's choice to wear her hair kinky or straight. With that being said, I also believe that once she has made her choice, she should act responsibly. In other words, if a choice is to be made, a woman should accept the responsibility of her choice by caring for her hair accordingly. Never make a choice that you are not willing to care for.
Unfortunately, at some point most sisters find themselves unhappy with their choice no matter whether they chose natural or straight..

The reasons for this despondency are that many women:

Don't understand the choice that they have made
Don't understand how to manage the choice that they have made
Don't understand how to properly care for the choice that they have made

Let's take a look at the two choices… Natural and then Straight.
Natural Hair
We were born with natural hair (hence the term: natural), however we still don't understand our natural hair. Natural hair requires "care steps" to be taken in order to manage the spiral tresses.

You must cleanse and clarify with shampoo and stabilize with a protein and moisturizing conditioner, at least weekly, so that your scalp won't be prone to disorders and your hair won't become polluted.
You must moisturize your natural hair each day in order to prevent a dehydrated hair and scalp.
You must groom your natural hair each day so that your natural hair will not web together or matt, even if you have locks or twist styles.

Straight Hair
Many women choose the option to mechanically or chemically straighten their hair. While this is a very viable option, many women forget that their hair is not naturally straight, causing so many of them to suffer with hair loss and other problems. Remember, when you change your hair from kinky to straight, you must protect and preserve it by following some simple rules:

Pressed/ Flat Ironed Hair

Only use heated tools on clean and conditioned hair.
Always use a moisturizer when straightening your kinky hair.
Only use one heated tool when straightening your kinky hair.
Always monitor the heated tool, ensuring that the temperature stays below 300 degrees.
Oil your hair and scalp, as needed, in order to seal in moisture.

Relaxed hair

Never relax damaged hair or receive a relaxer if your scalp is damaged.
Never allow less than 8 to 10 weeks time between relaxers.
"Wet Set" your hair and stay, heated tools your last choice in styling
When choosing heated tools, also always monitor the heated tool ensuring that the temperature stays below 300 degrees.
Moisturize your hair to prevent hair dehydration.
Oil your hair and scalp, as needed, in order to seal in moisture.

At the end of the day, we will always have strong opinions about black women and their hair, but the choice is yours. Just remember: God made your hair and God makes no mistakes. Learn to respect and love your hair in its natural state, before you alter it.

The Flu

2010-06-01T10:10:00.001-07:00

It's that time of year again when you may be concerned about getting the flu, a contagious respiratory illness caused by influenza viruses. Each year, you may find yourself wondering if this is the year you will get the flu, or if you had it last year, you wonder if you will get it again this year? You may also wonder if you should get vaccinated against getting the flu. Well, to help answer your questions you should start with understanding your risk for complications from the flu. According to the Centers for Disease Control, every year in the United States:

5% to 20% of the population gets the flu;
more than 200,000 people are hospitalized from flu complications, and;
36,000 people die from flu.

These facts make it critical to understand your risk for serious problems if you get the flu. Certain groups of the population are at higher risk.
Who Should Get a Flu Shot, and When?
According to the CDC, the following groups of individuals should be vaccinated:

People at high risk for complications from the flu, including:
- Children aged 6 months until their 5th birthday,
- Pregnant women,
- People 50 years of age and older,
- People of any age with certain chronic medical conditions, and
- People who live in nursing homes and other long term care facilities.
People who live with or care for those at high risk for complications from flu, including:
- Household contacts of persons at high risk for complications from the flu
- Household contacts and out of home caregivers of children less than 6 months of age (these children are too young to be vaccinated)
- Health care workers.
Anyone who wants to decrease their risk of influenza.

Who Should Not be Vaccinated?
The CDC advises that the following individuals should not get a flu shot before talking to their doctors:
People who have a severe allergy to chicken eggs.
Those who have had a severe reaction to the flu shot in the past.
People who previously developed Guillan-Barre syndrome (GBS) within 6 weeks after getting the flu shot.
Children less than 6 months of age (influenza vaccine is not approved for use in this age group).
People who have a moderate or severe illness with a fever should wait to get vaccinated until their symptoms subside.
Types of Flu Vaccinations
There are two types of vaccines:

The "flu shot" - an inactivated vaccine (containing killed virus) that is given with a needle.
The nasal-spray flu vaccine - a vaccine made with live, weakened flu viruses that do not cause the flu (sometimes called LAIV for "Live Attenuated Influenza Vaccine"). LAIV is approved for use in healthy people 5 years to 49 years of age who are not pregnant.

Empowerment Points
The flu vaccination is the most effective way to prevent the flu. Talk to your doctor about your need for a flu vaccination today.

Fibroids

2010-06-01T10:06:00.001-07:00

What are Fibroids?

Fibroids are growths (tumors) that develop from the smooth muscle layer of the uterus. They are the most common growths of the uterus and female pelvic organs. One study found that approximately 50% of women have them. Most often they are benign. Very rarely they can become cancerous (less than 0.5% of the time).

The growth of fibroids is dependent on estrogen production. This is the reason why fibroids have the potential to enlarge during pregnancy (when increased levels of estrogen are present) as well as to regress after menopause (when there is decreased levels of estrogen). They can be multiple or exist as a single large growth. They can be located on the surface of the uterus, in the wall of the uterus, or in the uterine cavity.

Most fibroids do not cause any symptoms and many women are unaware that they have them. When they do cause symptoms, it ranges from abnormal bleeding to pelvic pressure.

Fibroids in African American women

Fibroids are more common in African American women than in women of other racial groups. One study showed that fibroids are three times more common in African American women than in Caucasian women. Additionally, fibroids tend to be larger and occur at an earlier age in African Americans. It is unclear as to why such differences exists.

What are the signs and symptoms of fibroids?

Abnormal menstrual cycle

Abnormally heavy menstrual bleeding.

Abnormally heavy menstrual periods that come more frequent than your normal cycle (less than every 28-30 days).

2. Pelvic pain/pressure

Painful menstrual periods.

Pain during or after sexual intercourse.

Pressure on the bladder which can cause frequent urination.

Acute or severe pelvic pain from twisting of the fibroid on its stalk, or from degeneration of the fibroid.

Complications of fibroids

The most common complication is heavy bleeding which can lead to anemia. The anemia can be so severe as to necessitate blood transfusions, and/or an emergency surgery such as a hysterectomy.

Very infrequently, fibroids may be a cause of infertility and/or pregnancy loss.

How can you be evaluated for fibroids?

Fibroids can be diagnosed during a physical exam by your doctor. He or she can often feel an enlarged, irregular uterus. Your doctor may use other tests (ultrasound, hysterogram) to help confirm the diagnosis, and/or to determine the best treatment option for you.

Treatment options

There are many options for the treatment of fibroids. Treatment options will vary based on your symptoms, age, and desire to conceive. Further discussion with your doctor will help you decide which treatment is best for you.

Motrin or other anti-inflammatory medications may be prescribed for pain.
Birth Control Pills help to regulate the menstrual cycle, control heavy bleeding, and alleviate some of the pain and pressure.
Lupron: another type of hormone that may aid in shrinking the fibroids and stopping bleeding.
Ablation: a surgical procedure in which the lining of the uterus is destroyed to prevent further bleeding.
Uterine artery embolization: a procedure that destroys the blood supply to the fibroids thus causing them to shrink (resulting in less bleeding).
Myomectomy: a surgical procedure to remove the fibroids and to leave the uterus otherwise intact..
Hysterectomy: a surgical procedure that removes the uterus, and thus, the fibroids.

Empowerment Points

Fibroids are the most common growth (or tumor) of the female reproductive tract.
Many women who have them are unaware of them.
The most common symptoms are irregular bleeding and pelvic pain or pressure.
Initial management consists of medical therapy. If this is unsuccessful, there are many surgical options available, including options to preserve the uterus. Discussion with your doctor will help decide the best management for you.

Excessive Hair Growth (Hirsutism): What You Should Know

2010-06-01T10:05:00.000-07:00

What Is Hirsutism?

Hirsutism is excessive hair growth that generally occurs in the midline of the body (upper lip, chin, chest, and abdomen). When this is associated with recession of hairline, deepening of the voice, loss of female body shape, and the development of male pattern pubic hair it is called virulism.

Many women have what they perceive to be excess hair growth. In reality, the pattern of hair growth may be normal. Ethnic variations due exist; African Americans are less susceptible to hirsutism because they have fewer hair follicles per surface area than Caucasians.

Normal Hair Pattern and Growth

There are 2 types of hair on the body: (1) vellus hairs which are short, fine and colorless and (2) terminal hairs which are long, coarse, colored and, in certain areas of the body, responsive to hormonal influence (androgens).

The adrenal gland and the ovary normally make androgens (male hormones). In normal amounts, androgens cause acne and the appearance of terminal hair on the extremities, armpits and pubic area at the time of puberty.

In women with excessive hair growth, the hair follicles are sensitive to androgens which may cause hairs to change from vellus to terminal hairs. Once a vellus hair becomes a terminal hair, it usually does not change back. If a woman’s androgen level is very high, she may experience male pattern balding, decreased breast size, and a deepening of her voice.

Causes of Hirsutism/ Virulism

Both hirsutism and virulism are caused by excess androgen secretion or increase sensitivity of the hair follicle to normal levels of androgens. Additionally, some medications that have similar characteristics as androgens may cause excessive hair growth. The following are the most common causes of hirsutism:

Causes of Hirsutism

Familial/Ethnic	Increased sensitivity of the hair follicle to androgens causes excessive hair growth. This can be hereditary.
Polycystic Ovarian Syndrome (PCO)	Excess androgen production from multiple cysts on the ovaries leads to excess hair production. PCO is also associated with abnormal menstrual cycles, insulin resistance and other metabolic abnormalities.
Menopause	Estrogen production is decreased but the continued androgen production leads to an increase in the number of terminal hairs.
Ovarian/Adrenal Tumors	These tumors produce androgens and can cause hirsutism. May also be associated with male pattern balding, deepening of the voice, and enlargement of the clitoris.
Late-Onset Adrenal Hyperplasia	May be associated with irregular periods, severe hirsutism, and defeminization.
Cushing Syndrome	Excess cortisol (an adrenal hormone) production can cause hirsutism, obesity, high blood pressure, easy bruising, and purple stretch marks.

Evaluation and Treatment

Initial evaluation consists of a complete history and physical exam. Often, this is enough to establish a diagnosis. The diagnosis is confirmed with further laboratory testing and possible radiological studies.

Treatment depends on the cause. If a tumor or metabolic disorder is found, these disease processes are treated. If these causes are ruled out, treatment depends on the patient’s desire. Options for treatment include medical therapy and cosmetic-based hair removal.

Medical therapy is successful in preventing new hair growth but does not affect existing hair. Existing hair must be managed by cosmetic therapy.

There are several medications used to treat hirsutism:

1. Birth control pills: the most commonly used medication in treatment for hirsutism. These pills prevent ovarian androgen production.

2. Spironolactone: blocks the effect of androgens on the hair follicle. Often used together with birth control pills.

3. Others: ketoconazole, flutamide, and steroids.

Cosmetic therapy is almost always combined with medical therapy and should be initiated six months after medical therapy is begun. Temporary techniques include shaving, waxing, and use of depilatory agents. Permanent techniques include electrolysis and shaving. Laser technology is a new approach to consider. A dermatologist experienced in treating black skin will be helpful in advising you.

Once a treatment has proven to be effective, it is continued indefinitely. Because it is usually not possible to cure the hormonal problem causing the excess hair growth, hirsutism will return if medical treatment is stopped.

Empowerment Points:

Hirsutism is the excessive growth of long, coarse hair on the face, chest, lower abdomen, back, upper arms or upper legs of women.
Hirsutism has a variety of causes, most of which relate to excess androgen (male hormone) production.
This is a chronic condition, most commonly hereditary or familial.
Hirsutism may rarely be caused by tumors producing excess androgens. A physician should investigate if excess hair growth develops over a short period of time.
Treatment is available, you should not feel embarrassed, uncomfortable or self-conscious about your excessive hair growth.
Treatment consists of medical as well as cosmetic therapies.

Endometriosis

2010-06-01T10:04:00.000-07:00

What is Endometriosis?

The inside of a woman’s uterus is lined by tissue known as the endometrium. Each month, this tissue is shed during the menstrual period. The term “endometriosis” refers to the abnormal growth of endometrial tissue outside of the uterus. This “misplaced” endometrial tissue is most commonly found in the ovaries, on the fallopian tubes, and around the ligaments that support the uterus. Uncommonly, it can be found in or around the intestines, bladder, vagina, or even the rectum.

Endometriosis in African American women

Endometriosis affects approximately 10% of women of reproductive age, and there does not appear to be a strong racial prevalence. Characteristics of women with endometriosis include women who have never been pregnant, infertile women, women with regular menstrual cycles less than 27 days in length, and those with prolonged menstrual bleeding of 8 or more days.

What are the signs and symptoms of Endometriosis?

* Pelvic pain

* Excessive menstrual cramps: This pain usually begins prior to a woman’s period and may be felt in the abdomen or lower back.

* Pain during or after intercourse: It is typically worse around the time of the period.

* Low back pain.

The symptoms of endometriosis vary; some women have severe pelvic pain, whereas others have no symptoms at all. There is poor correlation between the degree of pain and extent of the disease; that is, some patients with severe disease may have no pain, whereas some patients with mild disease may have excruciating pain.
Complications of Endometriosis

In addition to pelvic pain, the scar tissue that develops from endometriosis may form on the fallopian tube and/or on the ovary, blocking the release of the egg and its passage through the tube toward the uterus. This, in turn, will inhibit a woman’s ability to conceive, causing infertility.

How can you be evaluated for endometriosis?
Diagnosis is based on evaluation of your history, and a complete physical exam, including a pelvic exam. However, diagnosis can only be proven by laparoscopy. Laparoscopy is a surgical procedure in which a laparoscope (camera) is inserted into the abdominal cavity through a small incision. The laparoscope will allow the physician to identify the location, and extent of the endometriosis. This method also allows the physician to rule out other conditions with similar symptoms.

Treatment Options

Principles of management for women with symptoms of endometriosis include:

1. Recognizing that it is a chronic disorder.

2. Discussing treatment options with your doctor.

3. Planning long term therapy based on your age, presenting symptoms, severity of disease, and desire to have kids.

Medical Management

When mild to moderate pain is the principal symptom, medical therapy is recommended in most cases. Management is directed at suppressing a woman’s level of estrogen, the hormone which stimulates the endometrial growths. Examples of medications which help to decrease levels of estrongen in the body include:

1. Low dose birth control pills.

2. Progestins such as provera.

3. Danazol (a weak androgen that produces a low estrogen environment).

4. Depo-Lupron (a medication which inhibits ovarian production of estrogen).

Surgical Management

Surgical treatment falls into two categories: conservative and non-conservative management.

Conservative surgical treatment is designed to preserve the ability of a woman to become pregnant and bear children in the future. This involves removing selected areas of endometriotic tissue, commonly through a laproscope (a camera placed through small incisions in the abdomen).

Nonconservative surgical treatment is undertaken to relieve a woman of severe pain after all other options have failed. This can include removing the uterus and both ovaries; or removal of both ovaries and fallopian tubes. In either case, a woman must accept the fact that she will not be able to have children in the future. This definitive surgery offers the best chance for sustained relief.

Empowerment Points

1. Endometriosis is the growth of endometrial tissue outside of the uterus.

2. Endometriosis affects many women regardless of race or economic status.

3. Symptoms include chronic pelvic pain, pain during sexual intercourse, and pain associated with monthly periods.

4. There are many different treatment options and you should not opt to suffer in pain.

5. Medical therapy is usually initiated as a first line of therapy and may include birth control pills, or other hormonal treatments.

6. Surgical therapy is reserved for women with moderate to severe symptoms or in women who have failed medical therapy.

7. Optimal treatment can be achieved with an open, honest discussion with you health care provider.

The Link Between Diabetes and Cardiovascular Disease

2010-06-01T10:02:00.002-07:00

What Is The Link Between Diabetes and Cardiovascular Disease (CVD)?

We know that CVD is a major complication and a leading cause of premature death among people with diabetes. Here are some facts that emphasize the link between diabetes and CVD.

About 75% of people with diabetes die from heart disease or stroke.
Adults with diabetes are 2 to 4 times more likely to have heart disease or suffer a stroke than people without diabetes.
Heart attacks occur at an earlier age in people with diabetes. Deaths from heart disease in women with diabetes have increased 23 percent over the past 30 years compared to a 27 percent decrease in women without diabetes.

Why The Increased Risk of CVD For People With Diabetes?

People with diabetes have high rates of hypertension, high cholesterol and obesity, all three of which lead to increased rates of CVD.
97% of adults with Type 2 diabetes have one or more lipid (cholesterol) abnormalities.
About 70% of people with diabetes also have high blood pressure.
“Sticky” blood platelets contribute to clotting problems and poor blood flow in people with diabetes.
Smoking doubles the risk for CVD in people with diabetes.

Who Is At Highest Risk For Premature Death or Disability Due to Diabetes and CVD?

People with a family history of diabetes.
Overweight and obese people.
Certain ethnic groups African Americans, Hispanic/Latino Americans, American Indians, and Asian/Pacific Islanders.
Older people.

What Are The Therapy Goals For Optimal Diabetes Management?

If you have diabetes, three of the most important parameters for you to control are your blood glucose (sugar), your blood pressure, and your cholesterol. We refer to these as the ABCs of diabetes..Let’s take a look.

A stands for Hemoglobin A1c, a test that measures how well your diabetes has been controlled over the last 3 months. The ideal level is less than 7 %.
B is for blod pressure…goal is less than 130/80 mmHg.
C is for cholesterol… goal is for LDL cholesterol less than 100.

What Should People With Diabetes Do to Lower Their CVD Risk?

Many studies have shown that tight control of diabetes lowers the risk of complications from the disease. Management approaches include lifestyle changes such as eating a healthy diet, weight management, and increased physical activity. Medications prescribed by your doctor may also play an important role in management. Here are five recommendations:

Participate with your health care team in treatment decisions, set individual lifestyle goals, become more educated about diabetes and actively manage the disease.
Control your blood glucose and pressure to reduce the risk for eye, kidney, and nerve disease.
Control your blood pressure and cholesterol to reduce the risk of CVD.
If you smoke, quit!!
Ask your medical provider about aspirin therapy for CVD prevention.

Depression

2010-06-01T10:02:00.000-07:00

Depression in African American WomenMental health professionals estimate that clinical depression affects 17-20 million Americans a year. Untreated depression is second only to heart disease in causing lost work days in America, and it is the No. 1 cause of suicide. Depression strikes women –favoring no single ethnic group – at twice the rate of men. The good news is that once identified, more than 80 percent of people with depression are successfully treated. But many African-American women do not get treatment, often because of a widespread belief in the African-American community that depression is evidence of personal weakness, not a legitimate health problem. Recognizing the need to increase awareness in our community, Delta Sigma Theta Sorority Inc. and the National Black Nurses Association are partners in the national Campaign on Clinical Depression.

What is Clinical Depression?Clinical depression is a treatable illness that can strike anyone at any age. It can be caused by one or a combination of triggers including biological factors, genetics, difficult life events, negative thinking patterns, physical health problems and some medications. People suffering from depression may not feel hopeful or happy about anything in life, may cry a lot and withdraw from friends and family, be forgetful, anxious and worried, and have recurring thoughts of death and/or suicide. Clinical depression is not a "mood" that someone can "snap out of."

What are the Signs and Symptoms of Clinical Depression?An evaluation for clinical depression is recommended if you experience five or more of the following symptoms for longer than two weeks, or if the symptoms are severe enough to interfere with your daily routine:

* A persistent sad, anxious or "empty" mood
* Sleeping too little or sleeping too much
* Reduced appetite and weight loss, or increased appetite and weight gain (weight gain is more likely to occur among African-American women suffering from depression)
* Loss of interest or pleasure in activities once enjoyed
* Restlessness or irritability
* Persistent physical symptoms that don't respond to treatment (such as headaches, chronic pain, or constipation and other digestive disorders)
* Difficulty concentrating, remembering, or making decisions
* Fatigue or loss of energy
* Feeling guilty, hopeless or worthless
* Thoughts of death or suicide

How can you get help for clinical depression?A good first step is to talk to your doctor or to a qualified mental health professional. You also may be able to get help through your company’s employee assistance program (EAP), a pastoral counselor, guidance counselor or local mental health association. Since people with clinical depression often do not have the motivation or energy to seek treatment for themselves, it is often necessary for friends and family to help them seek treatment.

Treatment OptionsThe most commonly used treatments for clinical depression are antidepressant medications, psychotherapy or a combination of the two.
Medication The symptoms of depression are caused by imbalances in chemicals in the brain and other parts of the body that influence things like mood, sleep, and how much energy we have. Antidepressant medications correct these imbalances. The two most common types are selective serotonin reuptake inhibitors such as Prozac and tricyclic antidepressants such as Elavil. While antidepressant medications have been shown to be extremely effective, many can cause side effects, some of which are temporary. Since different medications affect individuals differently, you and your doctor may need to try more than one before you find the right one or combination.
PsychotherapyFor some cases of depression, talking with a trained mental health professional can help teach people how to better handle problems, change negative styles of thinking, and how to change relationships that can cause or worsen clinical depression. Short-term therapy that lasts just 10-20 weeks often is all it takes.

Empowerment Points 1.
You Can Make a Difference!

Lifestyle factors including diet and exercise can impact depression. Regular exercise such as walking, running, swimming, or other aerobic activity causes the brain to produce more of the chemicals that combat depression. Exercise also can make you look better, which in turn raises self-esteem and decreases depression. Increasing the amount of Vitamin B3 (niacin) in the diet also has been found to bring relief from depression. Good dietary sources of niacin include oily fish such as salmon; chicken; dried peas and beans; whole grains; and seeds.
2.
Reach Out for Help

Building and maintaining a strong support network of friends and relatives can help prevent and aid recovery from clinical depression. Calling the national Campaign on Clinical Depression’s hotline at (800) 228-1114 can put you in touch support groups and other resources. Seeking help from a spiritual source also has proven helpful for many. People with a strong spiritual faith have a lower risk for depression.
3.
If You Have Already Been Diagnosed With Clinical Depression

Be informed and voice all of your questions and concerns about your treatment to your health care provider. Make treatment a partnership. By working with your doctor or other mental health professional, you can find the best treatment, with the fewest side effects, for you.

Contraception

2010-06-01T10:01:00.001-07:00

Importance of Contraception

Did you know that approximately 45% of unplanned pregnancies are attributable to the lack of any contraception being used. A surprisingly high 55% of unplanned pregnancies are a result of ineffective birth control? Effective and well-planned birth control is essential to preventing unplanned pregnancies and is vital in protecting yourself from exposure to sexually transmitted diseases (STDs).

Contraception and African American Women

Today’s African American woman is setting and achieving goals in record numbers. Talented sisters are excelling in education, business, the arts, sports, and almost any other endeavor that one can think of. Child bearing is also a goal that many of us share and balancing our personal and professional lives with respect to this goal is important. Hopefully, we will be able to have children when we are best able to give them the love, emotional, spiritual, and financial support that they deserve.

Recent data from the National Center for Health Statistics indicates that we have work to do in our communities with respect to education about pregnancy and contraception. Data reveal that despite a decline of 21% from 1991-96, the birth rate for African American adolescents was still twice that of White Americans. Increased knowledge and awareness is the first step in improving these numbers!

Methods of Contraception

There are many methods of contraception. One may be better suited for your lifestyle than another, or you may choose to use a combination of methods. An open discussion with your doctor and your partner will help you choose which method or methods might be best for you. Remember that abstinence is also an option!

Non-hormonal (Natural) Contraception

Type	How Used	Advantage	Disadvantage	Failure Rate
Coitus Interruptus (Withdraw)	Withdraw of the penis from the vagina before ejaculation.	Convenient, no cost.	Dependent on the male, requires discipline and motivation. Provides no protection from STDs.	14%-27%
Natural Family Planning	Avoiding intercourse during a woman’s fertile period.	No cost.	Can be a complex method. No protection from STDs.	14%-27%

Barrier Methods

Type	How Used	Advantage	Disadvantage	Failure Rate
Condoms (Latex, Polyurethane, or Lamb skin). Latex is best, polyurethane for people with latex allergy.	Condom holds sperm, preventing its deposition into the vagina. Female condoms are also available.	Protection against STDs including gonorrhea, herpes, chlamydia, and HIV.	Motivation is essential. May decrease sensation for some. A new condom should be used each time.	Approx. 12%
Diaphragm (A circular spring covered with latex rubber. Fits in the vagina, covering the cervix.)	Used in combination with a spermicide. Can be inserted before intercourse and left in place 8 hours after intercourse.	Some protection against STDs, tubal infertility, and cervical cancer.	Must insert before each episode of intercourse, spermicide must be reinserted with repeated intercourse. Fitting is required.	12%-39%
Cervical Cap (Similar to the diaphragm but much smaller. Only covers the cervix.)	Used with spermicide, placed over the cervix prior to sex. Can be left in place as long as 72 hours.	Non- hormonal method.	Fitting required. May dislodge during or after intercourse.	Higher failure rate than with the diaphragm.

Intrauterine Devices (IUDs): What Are They?

Intrauterine Devices (IUDs) are devices placed in the uterus to prevent pregnancy. IUDs interfere with the passage of sperm through the uterine cavity, preventing fertilization. There is also a minor action in preventing the fertilized egg from implantation in the uterus.

How Are IUDs Used?

A doctor in an office setting inserts IUDs. There are two types of IUDs commonly used, the Copper T (Paraguard) or Progestasert (progesterone containing). The Copper T can be left in place for 10 years. Progestasert must be changed annually.

Health Concerns

Risk of Infection:

In the past IUDs were associated with significantly increased rates of infections such as Pelvic Inflammatory Disease (PID). A PID is an infection involving the uterus, fallopian tubes, and/or the ovaries. Today’s IUDs do not pose the same rates of infection as those of the past. Currently, the risk of developing Pelvic Inflammatory Disease (PID) is increased during the first 20 days after insertion. Thereafter, the risk of developing PID is the same as in the general population (those without IUDs). It is important to report to any signs of infection to your doctor (fevers, vaginal pain or discharge, abdominal pain, etc.)

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IUDs are moresuccessful at preventing uterine pregnancies than ectopicpregnancies(inectopic pregnancies, the fertilized egg implants outsideof the uterus). If you become pregnant using an IUD, it isimportant to be evaluated for the presence of an ectopic pregnancy.

Who Should Not Use IUDs?

If you have a history of Pelvic Inflammatory Disease,multiple sexual partners, a large fibroid uterus, copper allergy (for theCopperTIUD), or chronic immune suppression, then IUDs are probably not the best method of contraception for you.

Advantages/DisadvantagesIUDs area highly effective method of birth control, but women can experienceincreased menstrual flow and cramping during their periods.

Failure Rate:
2.5%-4.5%

Hormonal Contraception

Type	How Used	Advantage	Disadvantage	Side Effects	Failure Rate
Oral Contraceptives (The Pill) Several different pills to choose from.	Combination pills: 21 day packs—take pills for 21 days and then have 7 day break (at which time your period occurs. 28 day pack-take a pill each day, pills 22-28 are without hormone.	Very Effective. Reduces ovarian cancer, endometrial cancer, ectopic pregnancy, functional ovarian cysts and can decrease discomfort of periods.	Motivation is essential, as you must take daily pills. Cost may be prohibitive for some. Does not protect from STDs. Fertility may be delayed 3-6 months after discontinuation.	Variable. Some experience nausea, breast tenderness, weight gain, and mood changes. Symptoms usually decrease after three months of use.	0.1%-3%. Women with blood clotting disorders, heart disease, strokes, active liver disease, known or suspected breast cancer, and smokers over 35 should not take the pill
Depo-Provera	A synthetic hormone injected every 3 months	Very effective and convenient.	3-8 pound weight gain over several years. Irregular bleeding. (sometimes heavy, sometimes spotting.) After use for 1 year, 50% of women no longer have periods.	Irregular menstrual cycle, headache, abdominal discomfort, acne, nervousness.	0.3%-0.4%
Norplant	A synthetic hormone released from capsules inserted into the arm.	Very effective, protects against pregnancy for 5 years.	Requires surgical insertion and removal. Cost may be prohibitive.	Irregular bleeding, headache, acne, weight gain, facial hair.	0.2%-1.1%

Surgical Contraception

Tubal Ligation is a surgical procedure involving cutting, tying, banding, clipping or burning the fallopian tubes.

* Timing: can be done immediately after delivery, during cesarean section, or anytime thereafter.
* Benefits: decreased risk of ovarian cancer.
* Advantage: high efficacy, convenient form of birth control (after the procedure).
* Disadvantage: It is a surgical procedure that, for the most part, is permanent.
* Reversal: dependent upon amount of tube remaining after initial procedure. Success rates vary from 30 - 75%.
* Failure Rate: 0.8 - 2%

Empowerment Points

* Deciding what method of birth control is right for you is not a simple decision. You need to know what is available and what is the best method for you based on your lifestyle.
* An open discussion with your doctor and partner can help decide which method is best for you.
* No matter what method you use, you should always practice measures that will protect you from sexually transmitted diseases.
* The only sure way not to get pregnant, AND not to get a sexually transmitted disease it not to have sex (abstinence).

Congestive Heart Failure

2010-06-01T10:00:00.003-07:00

What is Congestive Heart Failure?
Most women rarely think about their hearts until one of two things happen: It gets broken (and we’ve all been there) or it stops working as it should. Congestive Heart Failure, also called CHF, is a term used to describe the condition when the heart can no longer effectively pump blood and oxygen. Subsequently, fluid builds up in various parts of the body.

Each time your heart beats, two separate processes are happening- it contracts to push blood forward, then it relaxes to allow itself to fill with more blood, then the process repeats itself over and over (about 115,000 times a day!) In people with CHF, the problem can be due to the heart not contracting well, also called “pump” failure, or it can be due to the heart not relaxing completely, or it can be due to a combination of the two. In either case, CHF is a serious condition that is progressive and potentially fatal. And like most life-threatening conditions, African-Americans die sooner and more often due to this illness.
What are the signs of CHF?
The signs and symptoms of CHF can range from very mild to very disabling. There can be swelling of the feet and legs (also called edema), difficulty breathing or catching your breath (called dyspnea), fatigue, weakness, or difficulty breathing while lying on your back. This is called orthopnea, and it is usually a symptom of advanced heart failure. You may notice that it is necessary to sleep on more pillows in order to breath. There may also be attacks of severe shortness of breath that awaken you from sleep and can be very frightening. The attacks are often associated with coughing and wheezing, and are sometimes called “cardiac asthma”. What are the causes of CHF?
There are many potential causes of congestive heart failure. The major causes, especially among African-American women, are hypertension and heart attacks. Long-standing, poorly controlled high blood pressure causes the heart to get stiff, therefore it doesn’t relax as it should and fluid can start to buildup. Heart attacks cause portions of heart muscle to die, and if a large enough part of heart muscle is dead, blood is not pumped to the rest of the body efficiently.

Some other causes of congestive heart failure include problems with the heart valves (such as aortic stenosis), long-standing irregularities in heart rhythm (called “arrhythmias”), and heavy alcohol use. For women, there is also a more rare but not uncommon cause of CHF called “postpartum cardiomyopathy”. This heart condition occurs after giving birth, and results in the heart loosing its pumping ability. Unfortunately, this type of heart disease is often rapidly progressive, with heart transplantation being the only long-term cure.

In a minority of cases, there is no identifiable cause of heart failure, called “idiopathic” (which means nobody knows). It is thought that certain viruses may play a role in its development. Certain drugs (such as chemotherapy medicines) and uncontrolled hyperthyroidism are less frequent causes of CHF.
How do you know if you have CHF?
If you are experiencing any of the above symptoms, you should see your doctor right away. Your physician will take a history, perform a physical exam, and evaluate your risk factors for heart disease. If you smoke, have high blood pressure, consume large amounts of alcohol on a regular basis, or have had a history of heart attacks, you are at increased risk for congestive heart failure. Diabetes is also a major risk factor in the development of CHF. Your doctor may wish to order an echocardiogram, which is the best way to look at the heart and determine if it is pumping effectively. (It is similar to the ultrasound used to look at babies in the womb). It is important to remember that other processes can cause symptoms that resemble CHF, such as lung disease, and sometimes distinguishing the two may be difficult. That is why it is so important to see your doctor regularly and at the first sign of symptoms.
How is CHF treated?
Treatment of CHF has advanced over the past decade, however, in the majority of cases, the goal is to slow progression of the disease. Few therapies offer a cure. If you have been told you have CHF, there are several medications you should ask your doctor about. These include medications called ACE Inhibitors, Angiotensin Receptor Blockers (ARBs), beta-blockers, digoxin, diuretics (which help the body get rid of excess water), and spironolactone. Aspirin and a cholesterol lowering medicine may also be needed if you are risk for heart attacks. What these medicines do is beyond the scope of this article, but it is important to initiate a discussion with your physician so that as a team, you and your doctor can determine the best and most effective course of treatment.

If the cause of the heart failure is a problem with a heart valve, a valve replacement surgery may be an option. For selected patients with a history of heart attacks, bypass surgery may help prevent further weakening of the heart. The ultimate cure for severe heart failure is heart transplantation, however this option is often limited due to the age of the patient (usually, transplants are not done on people over the age of 60) or other medical conditions that make transplantation excessively dangerous.
What can you do to prevent CHF?
Since once heart muscle is weakened or destroyed, there is usually no way to recover normal function, the key is to prevent heart failure. Here are the vital ways to keep your heart healthy, and if you are already diagnosed with CHF, how to slow or stop its progression:

1. STOP SMOKING! If you do not smoke, DON’T START! Smoking is the number one preventable cause of heart disease.

2. Control your blood pressure. If you have high blood pressure, take your medications every day. Your blood pressure goal is the top number (called “systolic pressure”) less than 130, and the bottom number (called “diastolic pressure”) less than 80. If your blood pressure does not reach these goals, additional therapy is necessary.

3. If you have diabetes, strict, aggressive control of your blood sugars will help prevent heart disease.

4. LOOSE WEIGHT. Discuss your weight goals with your doctor. Obesity increases the likelihood of developing high blood pressure, diabetes, and heart attacks.

5. EXERCISE. This not only helps in weight loss, but also naturally lowers blood pressure and cholesterol.

6. Drink alcohol only in moderation.

7. Take all medications prescribed by your doctor every day. Know your medicines and why you are taking them. Do not hesitate to ask questions if you are unsure about your health issues. ALWAYS consult with your doctor before taking over-the-counter or herbal medicines, as they can worsen heart failure or interact with your medications.

8. Limit salt intake. Discuss with your doctor the daily amount of salt that is right for you.

Remember that as women, you do not have to be victims of any illness or disease. Accepting responsibility and educating yourself are the first steps to taking control of your bodies and your health.

Love Thyself Series: Colon Cancer Screening

2010-06-01T10:00:00.001-07:00

In North America and Western Europe, the second leading cause of death due to cancer is colorectal cancer (CRC). The disease progresses slowly taking up to 10 years for the normal lining of the colon to change to cancer. Since the disease progression can take up to 10 years, this affords the chance to use procedures for screening in an effort to detect polyps. Polyps are growths that begin in the colon and rectum and are considered to be the most common precursors to colon cancer. The size and appearance of the polyps may vary. When polyps are small, they have the appearance of a wart and as they grow the appearance changes to that of a mushroom with a stalk. The polyps found in the rectum and colon are usually benign (non malignant) and exhibit no symptoms. Without screening, detecting colorectal cancer can be is almost impossible because most people are usually asymptomatic. In this article I will focus on the signs and symptoms of colorectal cancer in addition to the procedures used for screening to detect polyps that are the precursors to colon cancer.
Symptoms
Most people with CRC are asymptomatic or experience non-specific symptoms until the cancer becomes advanced. The most common symptoms of cancer or precancerous polyps are blood in the stool, a change in bowel habits, and pain to the abdomen which is much less common. Symptoms also can include fatigue, weakness and iron deficiency anemia. If detected and removed in the premalignant or early stages, the development or spread of the cancer is prevented. Without screening, detecting CRC in its early stages can be difficult. Current evidence shows that screening individuals who are asymptomatic or of average risk reduces the mortality rate for CRC, because cancers can be prevented if polyps can be removed. Early detection is imperative in the prevention of CRC.
Sigmoidoscopy and Colonoscopy
According to the American Cancer Society, a screening flexible sigmoidoscopy should be done at age 50 for individuals without a family history of colon cancer. This procedure has been proven to decrease the mortality and incidence rate of colon cancer. If patients have a first-degree relative of age 60 years or less that have had CRC, a more intensive screening may be needed such as a colonoscopy or a barium enema x-ray. The flexible sigmoidoscopy examines the lower 1/3 of the colon where 2/3 of polyps or cancers occur. This test takes approximately 3 to 5 minutes and requires no sedation. This procedure can cause a little discomfort, but it reduces the chances of developing CRC. According to an article written by a board certified gastroenterologist, a flexible sigmoidoscopy can detect approximately 65%-75% of polyps and 40%-50% of CRC.
A colonoscopy is considered to be the most conclusive test for colon cancer screening. The procedure is performed by a board certified gastroenterologist; utilizes a longer version of the sigmoidoscopy instrument. It is a flexible fiberoptic tube that is used to visualize the entire colon. Prior to the procedure the patient is given valium and a narcotic. There are some risks associated with the procedure and they are discussed with the physician prior to the exam. The current indications for a colonoscopy include: a positive test of blood found in stool, a poly (adenomatous) found on flexible sigmoidoscopy exam greater than 5mm, family history of 2 relatives with colon cancer or one first degree relative with colon cancer 60 years or less, unexplained diarrhea, and occasionally for some types of abdominal pain.
According to Rao and Goodin, the third most common cause of cancer deaths in women is CRC. The rate of colon cancer remains high for African Americans compared to other ethnic groups. The probable cause of this disparity is attributed to lack of quality healthcare in the lower socioeconomic communities. Since CRC is so slow growing, screening and early detection is imperative. If detected early through one of the screening exams, CRC can be prevented. One should check with his or her primary physician to determine which screening method is appropriate.

HEALTH

Understanding the Pap Smear

Disparities in Children's Oral Health and Access to Care

Menopause

Medicare Prescription Coverage is Changing: What You Need to Know!!

Living With Lupus: Why Is This Diagnosis So Elusive?

Living With Diabetes

Living Well With HIV

Keloids

Hysterectomy: Making It Plain!

High Blood Pressure (Hypertension) Enemy #1 in the African American Community

Hypertension in the African American Community

Quick Refresher: The Basics of Our Circulatory System

What Defines Hypertension?

Evaluation and Diagnosis

Treatment

African-American Women, Menopause, and Hormone Therapy - The Facts

HIV/AIDS Facts You Can't Ignore

Hepatitis C

Heart Disease

Hair and Scalp Dehydration (HSD)

Grow Natural or Go Straight?

The Flu

Fibroids

Excessive Hair Growth (Hirsutism): What You Should Know

What Is Hirsutism?

Normal Hair Pattern and Growth

Causes of Hirsutism/ Virulism

Familial/Ethnic

Polycystic Ovarian Syndrome (PCO)

Menopause

Ovarian/Adrenal Tumors

Late-Onset Adrenal Hyperplasia

Cushing Syndrome

Evaluation and Treatment

Endometriosis

The Link Between Diabetes and Cardiovascular Disease

Depression

Contraception

Congestive Heart Failure

Love Thyself Series: Colon Cancer Screening