T H E H E A LT H P U B L I C AT I O N C R E AT E D F O R D O C T O R S A N D T H E I R PAT I E N T S Spring 2007
The Official Health Publication of the National Medical Association
Convenient-Care Walk-in clinics at your local pharmacy are convenient, but should they replace your doctor? By Shawn Rhea
ou were perfectly fine when you went to bed last night, but woke up feeling as if your throat was on fire. The glands in your neck are as big as golf balls. A doctor’s visit is definitely in order, but you don’t relish what could be an hours-long wait to see your physician. Then you remember just two blocks away is a pharmacy with a walk-in clinic that treats a range of illnesses, including strep throat and ear and sinus infections. Should you go there – or wait until you can see your doctor?
The next wave Convenient-care clinics are part of a booming trend where drugstore, discount and supermarket chains like CVS, WalMart and ShopRite offer one-stop shopping for medical care. Staffed by nurse practitioners or physician assistants who can write prescriptions, these facilities test for, diagnose and treat a limited variety of common illnesses and conditions. Many also offer immunizations and sports physicals. Patients are typically seen in 15 minutes, and no
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In good hands? But such care is not appropriate for everyone, particularly people who have chronic conditions such as asthma, diabetes and hypertension, which disproportionately affect African-Americans, says National Medical Association President Albert Morris, M.D. “I’m concerned about the collateral damage that can happen (continued on p.3)
INSIDE DEPARTMENTS 4 For Kids’ Sake 9 For Real? 12 What’s My Sign?
FEATURES 7 Missing Men 10
When it’s time to visit the doctor, too few males “man up.”
Black women are more likely to get an aggresive form of breast cancer, but that’s no reason to take it lying down.
The Quiet 4
Each year, more African-Americans develop these little-known – but excruciatingly painful – chronic conditions. Here, what you need to know to get detected early and treated right.
INSIDE THE NMA 14 Cover the Uninsured Week
NMA joins in to help get America’s kids covered.
Members on the Move
Dr. Washington C. Hill, Dr. Wayne J. Riley, Dr. Jeanette E. South-Paul, Dr. Elizabeth Paterson, Dr. Sheryl Heron.
Sudden Cardiac Arrest: Are You at Risk?
COMPLIMENTARY WAITING ROOM COPY
appointment is needed. “These clinics provide convenient care when your primary care physician is closed or when acute (emergency room) care is not really needed,” says Tine Hanson-Turton, executive director of the Convenient Care Association. Insurance is accepted at most, but since the fees run between $45 and $60 per visit (compared to as much as $200 for a physician’s office visit) plus the cost of testing and your prescription (most often generic drugs) if needed, uninsured patients can often afford them. Many clinics have Web sites listing the ailments and services they cover, so patients can ascertain whether they can be treated there, says Michael Howe, president and CEO of CVS Pharmacy’s MinuteClinic chain. “If a patient has a condition we can’t treat, we triage them out to their doctor or the emergency room and we don’t charge them,” Howe explains. “Everything is very clear about what we treat and how much patients pay.”
NMA mobilizes the community for diabetes education.
hen two people establish a business partnership, they each are expected to perform specific tasks. In the same vein, when considering a person’s health management, both the patient and the physician (the medical partner) have duties to perform. Clearly, the physician is expected to be efficient, reliable and accessible. But what about the patient? What responsibilities must a patient fulfill to make the doctor/patient partnership successful? A patient’s responsibility often starts with filling out the medical history form – accurately and completely. This is a critical first step in healthcare maintenance. Unfortunately, patients often race through the medical history document. They ignore some of the questions or deliberately don’t acknowledge certain disorders, perhaps rationalizing that a problem they had many years ago, now resolved, no longer matters. But every bit of information contributes to a patient’s complete medical history and aids the physician in determining a current health assessment. Patients need to understand the importance of providing accurate medical data, including information about previous illnesses, hospitalizations and medications, as well as issues regarding their present health status. Establishing clear communications is essential for an effective doctor/patient relationship. Talking with a physician is no time to be shy. Patients have an important role in
making sure that there is open communication. They must tell it like it is. They do not help their situation if they only partly report what is wrong. They must lay aside any embarrassment or reluctance to tell the truth. They should take full advantage of a visit to a medical provider and describe their symptoms in detail. It is their responsibility to ask questions, take notes, and if desired, bring along a relative or friend for support. Patients should make known their wishes regarding organ donation. This is an important discussion that patients (and physicians) often overlook. To make sure their wishes are known, patients need to discuss end-of-life decisions not only with their families but also with their physicians. Patients also have a responsibility to abide by a prescribed treatment plan. This means complying with the doctor’s orders, keeping appointments, attending therapy sessions, taking the correct dosage of medication and completing whatever regimen has been recommended. Patients commonly stop their medication as soon as they feel better, not realizing that when they do not complete the dosage, their infection or problem may recur. Subsequently, they often have to make a return visit to the doctor’s office or the hospital. When patients do not adhere to a treatment plan, they place their health at risk. Good health care management requires patients’ cooperation. Patients are responsible for
enhancing their health by engaging in positive lifestyle behaviors. Reducing the consumption of high-fat foods, not smoking, exercising consistently, getting ample sleep, following up with regular checkups – all of these are proactive steps that patients can take to demonstrate their commitment to a healthy way of life. Patients who practice healthy behaviors are better equipped to prevent the development of disease or lessen the severity of a disorder. Patients should make careful use of medical resources, especially limited public health services, to enable medical assistance to be readily available for others. While patients are strongly encouraged to seek medical help when needed, running to the emergency room at the first sign of a cold is not the best use of the health care system. Responsible patients are prudent in their use of medical resources. To hold up their end of the doctor/patient partnership, patients must do all they can to protect and fortify their bodies, become informed health consumers and act as effective partners in their own health care. Physicians can advise about what to do, but it is the patients who have the power to do it. Indeed, the proper use of patient power is a lifelong right – and responsibility.
To your good health,
President’s Letter An Official Health Publication of the National Medical Association Medical Editor
Anita Jackson-Kelley, M.D. – Lumberton, NC
M. Natalie Achong, M.D. – Farmington, CT
Hilary Beard – Philadelphia, PA email@example.com
Reese Stone – Montclair, NJ
Alisa Mosley – Washington, DC
NMA Officers President
Albert W. Morris, Jr., M.D. – Memphis, TN
Chair, Board of Trustees
Carolyn Barley Britton, M.D. – New York, NY
Wilma Wooten, M.D., MPH – San Diego, CA
Immediate Past President
Sandra L. Gadson, M.D. – Flossmoor, IL
Nelson L. Adams, III, M.D. – North Miami, FL
Willarda V. Edwards, M.D., MBA – Baltimore, MD
Albert W. Morris, Jr., M.D. President National Medical Association
Speaker, House of Delegates
Michael A. LeNoir, M.D. – Oakland, CA
Vice Speaker, House of Delegates Cedric M. Bright, M.D. – Durham, NC
Secretary, House of Delegates
Rahn K. Bailey, M.D. – Houston, TX
Convenient-Care (continued from p.1) when people don’t get the full complement of services they need,” says Morris. He notes patients with chronic illness or undiagnosed conditions may experience dangerous drug side effects and interactions (such as heightened blood pressure) if treated by a medical professional unfamiliar with the nuances of their medical history. “What happens when someone goes in for care and has a reaction, and the scope of (available) services doesn’t allow the staff to provide care for that?” Morris asks. He’s also concerned that in determining whether they should go to a convenient-care clinic, patients have to self-diagnose their condition, which can be risky. “What someone believes to be bronchitis could actually be pneumonia, and if these clinics aren’t doing chest X-rays, then how
would they know for sure?” But that doesn’t mean such clinics can’t provide appropriate care when used judiciously. Under certain conditions, they may be a better solution than delaying care because you can’t get in to see your regular doctor. Morris suggests following these guidelines: ■ Do call or check the Web site in advance to determine if the clinic’s scope of services matches your health concern. ■ Do go to your doctor if it is your first time experiencing such symptoms, or for sports and other physicals if it’s your first such examination or if you have chronic conditions such as asthma, hypertension or diabetes. ■ Don’t neglect to ask in advance what backup measures the clinic has in place (such as triaging you to or arranging pickup by an area hospital) for your care should something go awry during your visit.
■ Do explain what chronic conditions you have and what, if any, drugs you’re taking so they can consider possible drug interactions or side effects. ■ Don’t consent to treatment before asking whether the clinic accepts your insurance or, if you’re uninsured, the exact fees. ■ Do request a written copy of your diagnosis and prescribed treatment for your records. Also, ask that a copy be sent to your primary care doctor. ■ Do talk to your primary care physician about the clinic’s diagnosis and prescribed treatment before taking any new medication. ■ Don’t replace regular preventative medical care with convenient-care clinic visits. Shawn Rhea is health reporter for the Courier-Post newspaper in southern New Jersey.
Valentine J. Burroughs, M.D., MBA – New York, NY
James G. Bames, DPA – Washington, DC
NMA Public Affairs Committee Chair: M. Natalie Achong, M.D. James Tate, M.D. Nathan Allen, M.D. Theresa Reed, M.D., MPH Deidre Holloway, M.D. Joseph L. Webster Sr., M.D.
NMA Healthy Living is an official publication of the National Medical Association. The ideas and opinions expressed in NMA Healthy Living do not necessarily reflect those of the Association, sponsors, editors or publisher. Copyright 2007. The National Medical Association. All rights reserved. No part of this publication may be reproduced or transmitted without prior written permission of the publisher. For information, please contact the NMA at 1012 10th St., NW, Washington, DC 20001. Or e-mail: NMAHealthy Living@NMAnet.org. Published by:
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For Kids’ Sake
My son’s doctor says he has asthma
but he isn’t experiencing any symptoms. I know my kid better than the doc, so I don’t really trust what the doctor is saying. Has my son outgrown his asthma or does he really need to take his medication?
Breathe Stick with the meds –
By Tamekia Reece
at least for now. It’s possible your son isn’t having symptoms only because the controller medication is working. If he really does have asthma – 6.5 million children in the U.S. do – discontinuing the medicine can be downright dangerous. According to the Asthma and Allergy Foundation of America, asthma is the thirdranking cause of children’s hospitalization, and Blacks are three times more likely to be hospitalized from it.
Children rarely outgrow their asthma. More than likely, what happens is it just becomes more asymptomatic, says Devang Doshi, M.D., director of pediatric pulmonology and director of SPRING 2007 sponsored by
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pediatric allergy and immunology at Beaumont Hospital in Royal Oak, MI. “The thinking is childhood asthma is sometimes triggered by common cold viruses, and as kids get older they get less frequent viral infections; therefore, there are less triggers for the asthma,” he explains.
Or your child may have the symptoms but you’re missing them. “One of the most common symptoms of asthma is nighttime coughing, but when children sleep alone in their own room, parents sometimes don’t hear the coughing,” Dr. Doshi says. Other overlooked symptoms may be frequent colds, a “funny feeling” in the chest, fatigue and limitation of physical activity.
If you’re still not sure whether your son has asthma or not, Dr. Doshi suggests you have the doctor do a pulmonary function test to assess his breathing. Still not convinced? Seek out a second opinion. Ultimately, he’s your child, and you have the right to be sure he isn’t taking medication he doesn’t need.
During the month of May, which is National Asthma Awareness Month, the American College of Allergy, Asthma & Immunology will provide free asthma screenings for children (and adults) through its Nationwide Asthma Screening Program. For more information, click on Patient Education at www.acaai.org.
A vaccine has been created that may help guard your daughter from 4 types of human papillomavirus. Those types may cause 70% of cervical cancer cases and 90% of genital warts cases. GARDASIL will not treat these diseases. GARDASIL works by reaching your daughter before the virus can—by protecting her. GARDASIL is for girls and young women ages 9 to 26. This vaccine is part of your daughter’s recommended vaccination schedule, but only a doctor or healthcare professional can decide if GARDASIL is right for her. GARDASIL is covered by many healthcare plans. So ask your daughter’s doctor or healthcare professional about getting her vaccinated with GARDASIL. She could become one less life affected by cervical cancer.
SELECT SAFETY INFORMATION GARDASIL may not fully protect everyone and does not prevent all types of cervical cancer, so future cervical cancer screenings will be important for your daughter. Anyone who is allergic to the ingredients of GARDASIL should not receive the vaccine, and GARDASIL is not for women who are pregnant. GARDASIL is given as 3 injections over 6 months and can cause pain, swelling, itching, and redness at the injection site, fever, nausea, and dizziness. Please see Patient Information on the next page.
GARDASIL is a registered trademark of Merck & Co., Inc. Copyright © 2007 Merck & Co., Inc. All rights reserved. 20702015(1)(302)-GRD-CON
6 NMA HealthyLiving
Clearing Up the Confusion Does the Pap smear or HPV test detect cervical cancer best?
he Pap smear is still the best tool for detecting cervical cancer in younger women, but, according to researchers,
the same may not be true for women over 40. A study of nearly 10,000 Danish women found that human
Patient Information about GARDASIL® (pronounced “gard-Ah-sill”) Generic name: [Quadrivalent Human Papillomavirus (Types 6, 11, 16, 18) Recombinant Vaccine] Read this information with care before you or your child gets GARDASIL*. You or your child will need 3 doses of the vaccine. It is important to read this leaflet when you receive each dose. This leaflet does not take the place of talking with your health care professional about GARDASIL. What is GARDASIL and what is it used for? GARDASIL is a vaccine (injection/shot) that helps protect against the following diseases caused by Human Papillomavirus (HPV) Types in the vaccine (6, 11, 16, and 18): • Cervical cancer (cancer of the lower end of the uterus or womb). • Abnormal and precancerous cervical lesions. • Abnormal and precancerous vaginal lesions. • Abnormal and precancerous vulvar lesions. • Genital warts. GARDASIL helps prevent these diseases – but it will not treat them. You or your child cannot get these diseases from GARDASIL. What other key information about GARDASIL should I know? • Vaccination does not substitute for routine cervical cancer screening. Females who receive GARDASIL should continue cervical cancer screening. • As with all vaccines, GARDASIL may not fully protect everyone who gets the vaccine. • GARDASIL will not protect against diseases due to non-vaccine HPV types. There are more than 100 HPV types; GARDASIL helps protect against 4 types (6, 11, 16, and 18). These 4 types have been selected for GARDASIL because they cause approximately 70% of cervical cancers and 90% of genital warts. • This vaccine will not protect you against HPV types to which you may have already been exposed. • GARDASIL also will not protect against other diseases that are not caused by HPV. • GARDASIL works best when given before you or your child has any contact with certain types of HPV (i.e., HPV types 6, 11, 16, and 18). Who can receive GARDASIL? GARDASIL is for girls and women 9 through 26 years of age. See “Who should not receive GARDASIL?” below. Who should not receive GARDASIL? Anyone who: • is allergic to any of the ingredients in the vaccine. A list of ingredients can be found at the end of this leaflet. • has an allergic reaction after getting a dose of the vaccine. What should I tell my health care professional before I am vaccinated or my child is vaccinated with GARDASIL? It is very important to tell your health care professional if you or your child: • has had an allergic reaction to the vaccine. • has a bleeding disorder and cannot receive injections in the arm. • has a weakened immune system, for example, due to a genetic defect or HIV infection. • is pregnant or is planning to get pregnant. GARDASIL is not recommended for use in pregnant women. • has any illness with a fever more than 100°F (37.8°C). • takes or plans to take any medicines, even those you can buy over the counter. Your health care professional will decide if you or your child should receive the vaccine. How is GARDASIL given? GARDASIL is given as an injection. You or your child will receive 3 doses of the vaccine. Ideally the doses are given as: • First dose: at a date you and your health care professional choose. • Second dose: 2 months after the first dose. • Third dose: 6 months after the first dose. Make sure that you or your child gets all 3 doses. This allows you or your child to get the full benefits of GARDASIL. If you or your child misses a dose, your health care professional will decide when to give the missed dose. *Registered trademark of MERCK & CO., Inc. Whitehouse Station, NJ 08889, USA COPYRIGHT © 2006 MERCK & CO., Inc. All rights reserved
What are the possible side effects of GARDASIL? As with all vaccines, there may be some side effects with GARDASIL. GARDASIL has been shown to be generally well tolerated in women and girls as young as 9 years of age. The most commonly reported side effects included: • pain, swelling, itching, and redness at the injection site. • fever. • nausea. • dizziness. Difficulty breathing (bronchospasm) has been reported very rarely. If you or your child has any unusual or severe symptoms after receiving GARDASIL, contact your health care professional right away. For a more complete list of side effects, ask your health care professional. What are the ingredients in GARDASIL? The main ingredients are purified inactive proteins that come from HPV Types 6, 11, 16, and 18. It also contains amorphous aluminum hydroxyphosphate sulfate, sodium chloride, L-histidine, polysorbate 80, sodium borate, and water for injection. What are cervical cancer, precancerous lesions, and genital warts? Cancer of the cervix is a serious disease that can be life-threatening. This disease is caused by certain HPV types that can cause the cells in the lining of the cervix to change from normal to precancerous lesions. If these are not treated, they can turn cancerous. Genital warts are caused by certain types of HPV. They often appear as skin-colored growths. They are found on the inside or outside of the genitals. They can hurt, itch, bleed, and cause discomfort. These lesions are usually not precancerous. Sometimes, it takes multiple treatments to eliminate these lesions. What is Human Papillomavirus (HPV)? HPV is a common virus. In 2005, the Centers for Disease Control and Prevention (CDC) estimated that 20 million people in the United States had this virus. There are many different types of HPV; some cause no harm. Others can cause diseases of the genital area. For most people the virus goes away on its own. When the virus does not go away it can develop into cervical cancer, precancerous lesions, or genital warts, depending on the HPV type. See “What other key information about GARDASIL should I know?” Who is at risk for Human Papillomavirus? In 2005, the CDC estimated that at least 50% of sexually active people catch HPV during their lifetime. A male or female of any age who takes part in any kind of sexual activity that involves genital contact is at risk. Many people who have HPV may not show any signs or symptoms. This means that they can pass on the virus to others and not know it. Will GARDASIL help me if I already have Human Papillomavirus? You may benefit from GARDASIL if you already have HPV. This is because most people are not infected with all four types of HPV contained in the vaccine. In clinical trials, individuals with current or past infection with one or more vaccine-related HPV types prior to vaccination were protected from disease caused by the remaining vaccine HPV types. GARDASIL is not intended to be used for treatment for the above mentioned diseases. Talk to your health care professional for more information. This leaflet is a summary of information about GARDASIL. If you would like more information, please talk to your health care professional or visit www.gardasil.com. Issued October 2006 Manufactured and Distributed by: MERCK & CO., INC. Whitehouse Station, NJ 08889, USA 20702015(1)(302)-GRD-CON
papillomavirus (HPV) testing can suss out which older women are at risk for cervical cancer far better than a Pap smear can. HPV, a sexually transmitted disease with some 100 different strains, affects half of all sexually active adults at some point in their lives. Most who become infected will not experience symptoms, and the infection will clear up on its own. But sometimes HPV causes genital warts; other times it causes cervical changes, which may lead to cervical cancer. According to researchers, HPV is particularly frequent and transient in young women, who often test positive for HPV when no real risk of cervical cancer exists. But in older women, HPV infection is rarer and more persistent, putting them at significant risk for the disease even before changes in cervical cells can be detected by a traditional Pap smear. In the study, older women who had positive HPV tests had a 20 percent greater risk of cervical cancer over 10 years than women who did not have HPV. Researchers also found that women who tested positive for HPV often had negative Pap smears – leading them to suggest that the HPV test could be used as an initial screen on its own. Several large studies have been proposed to look at HPV testing as a primary screening method, in place of a Pap test. Still, according to a spokeswoman for the American Cancer Society, it may be some time before experts have enough data to consider changing current recommendations. Screening guidelines leave HPV testing as an option in addition to a Pap test for women age 30 and over. — Seni George
7 NMA HealthyLiving
When it’s time to visit the doctor, too few males “man up.”
By John Head
sit in the waiting room filling out the new patient information form. I’m here at the insistence of my wife, who wants me to get a physical before we move across the country and leave familiar services behind. The doctor is her primary care physician. I’ve never seen him before. The form asks when I’ve been treated for various diseases and allergies. I jot a quick “N/A,” for “not applicable” in the spaces. Then it asks the name of my previous primary care physician. “N/A,” I write, this time meaning “no answer,” because I haven’t had a personal doctor since my mom stopped taking me to the pediatrician. Finally, I’m asked the date of my last routine physical exam. My only honest answer is “CR” – “can’t remember.” Thinking about it, I realize it has been 15 years. Since that time, virtually all of my doctor visits have been to treat sports injuries or other emergency care. I’m a 55year-old African-American man, a classic sufferer of what I’ll call male physician avoidance syndrome. I’m not alone.
Fear of bad news “We see a definite reluctance among men to see a doctor,” says former U.S. Surgeon General David Satcher, M.D., who now heads the National Center for Primary Care at the Morehouse School of Medicine in Atlanta. “Women are much more comfortable using the healthcare system. Yet we know women tend to be healthier than men. They have longer life
expectancy, for example.” Dr. Satcher says maintaining a “macho image” may be one reason men avoid healthcare. A study presented in October at the Annual Scientific Session of the American College of Emergency Physicians shows how some men put doing the “manly thing” over medical care. Researchers at the University of Maryland Medical Center said their three-year survey found that the number of men admitted to emergency rooms increased following major televised sporting events. A previous study found admissions declined while games were on TV. Their conclusion: Men who experience medical problems while watching games such as the NBA playoffs will put off getting help until the games end. TV sports didn’t keep me out of the doctor’s office; fear of bad news did. While results of my physical were generally good – my cholesterol level was a little high – I had gone in filled with dread that some serious problem would be found. Dr. Satcher sees this as emblematic male behavior. One of his own relatives, “casually told me he had a piece of paper he wanted
me to look at,” he says. “It was a report showing he had an elevated PSA [prostate-specific antigen] level. He had had it for six months and hadn’t done anything. After I found out, I was on his case every day to get it checked out.” Dr. Satcher’s relative feared he had cancer and would need surgery. “As it turned out, he had prostate cancer,” Dr. Satcher says, “but it could be treated without surgery. He’s in treatment and doing fine.”
Stepping up Men who dread seeing the doctor because they fear bad news, or for any reason, don’t have to become waiting-room regulars to safeguard their health, according to Matthew McKenna, M.D., who directs the Office of Smoking and Health at the federal Centers for Disease Control and Injury Prevention (CDC). Age-appropriate screening – such as for sexually (continued on p.8) SPRING 2007
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8 NMA HealthyLiving
(continued from p.7) transmitted diseases for younger men and for prostate and colorectal cancer in later years – make more sense, he says. But it’s best if a physician conducting a specific screening also keeps an eye out for other problems. “Take advantage of any visit to the doctor to check other issues,” suggests Dr. McKenna. Rick Williams, a 51-year-old businessman in Oakland, CA, gets an annual physical. But he says contacting his physician whenever he has a medical problem is the key to his health management. “Maintaining good communications with my doctor is paramount,” Williams says. “I try to be proactive.” The father of three says that also means regular cardiovascular exercise and weight training at a gym. And he has tests and screenings during his annual
exam and when specific problems arise. The medical consensus is that men should have annual prostate exams beginning at age 50 – Dr. Satcher suggests that Black men begin at 40. Other routine tests – such as blood pressure and cholesterol – can detect problems early, saving lives. The former surgeon general wants Black men to “step up and take responsibility for the health of their families, their communities and themselves.” He’s working with the civic organization 100 Black Men of Atlanta on an initiative to help. Among the goals: encouraging men to have a primary physician and to include health advice as part of mentoring between Black men and teenagers. African-American men in leadership positions should be healthcare advocates, Dr. Satcher says. John Head is the author of Black Men and Depression: Saving Our Lives, Healing Our Families and Friends.
Word to the Wise
Rates on the rise for this Black-on-Black crime.
A great new book on Black men’s health.
ust look at the statistics on African-American men’s health, and you’ll find that they suffer disproportionately from diabetes, hypertension, cardiovascular disease, HIV/AIDS and other diseases and conditions. Black men are also less likely to take advantage of health services, often having to be urged and sometimes pushed to take care of their health and wellness by the women in their lives. EnterThe Black Woman’s Guide to Black Men’s Health (Warner Wellness, $13.95) by health writer Andrea King Collier and Willarda V. Edwards, M.D. – this is a thorough, informative guide for Black mothers, wives, girlfriends, sisters and daughters who want to take a proactive role in improving the health of the men in their lives. The authors give helpful medical advice on dealing with (and preventing) several health issues, while expertly navigating readers through obtaining the best insurance for their man, tracing his family tree to track his family’s medical history and setting up an easy meal plan and fitness program. There’s no question that Black women will find the book to be an invaluable resource for helping their men live healthier and, most importantly, longer lives. — Elle Pearson
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f you thought that suicide attempts and suicide only happen among White people, think again. In a recent study published in the Journal of the American Medical Association, University of Michigan researchers found that Blacks attempt suicide at the same rates as their White counterparts. The study shows that Black men of Caribbean descent (7.5 percent) and Black women (5 percent) had the highest lifetime risk of suicide among Blacks. Sean Joe, Ph.D., assistant professor at the University of Michigan School of Social Work and one of the investigators, says this rate is higher than was previously thought. “Doctors and family members have to look beyond the old idea that Black Americans aren’t at risk for suicide.” Annelle Primm, M.D., MPH, the American Psychiatric Association’s director of Minority and National Affairs, agrees: “When we characterize psychiatric illness or outcomes like suicide, we cannot paint people of African descent with a single, broad brush.” Make sure you know the warning signs and be prepared to take action. Be on high alert if someone in your life: ● Talks about killing himself and focuses on death. ● Feels worthless or hopeless. ● Says, “It would be better if I wasn’t here” or “I want out.” ● Has a severe bout of depression or deep sadness; goes from extreme sadness to sudden calmness. ● Takes extreme risks, like fast driving. ● Starts giving away things or calls people to say goodbye. Always take these and other warning signs seriously. Immediately encourage the person to seek out help from a mental health professional, and be supportive as the person heads down the road to recovery. — Andrea King Collier
9 NMA HealthyLiving
Word on the street is...
Doctors won’t try to save your life if you’re an organ donor.
But is it true?
N By Seni George
o. Though an organ donor has
essentially signed up to save someone else’s life, her own isn’t any less valuable. Doctors have to hustle to save a donor in a clutch just as they would anyone else. If you don’t find that comforting, keep in mind that if you’re admitted to a hospital you won’t be treated by a transplant physician anyway, since they only work with the transplant candidates and recipients. You’d be seen by the physician who specializes in your particular
emergency. What’s more, contrary to popular belief, organ donation isn’t automatic. Even if you’ve signed a donor card and the organ donor designation on your driver’s license, your family must be consulted before any moves can be made. So if you do decide to become a donor, keep your relatives in the loop and contact your local organ procurement organization for the specific procedures to make sure your wishes are carried out.
Myths aside, it’s particularly important that African-Americans consider organ donation, according to Donate Life America (DLA; www.shareyourlife.org), a nonprofit alliance of national organizations working to inspire people to become organ donors. Because some of the diseases that can lead to organ failure, such as diabetes and hypertension, disproportionately affect people of color, the need for transplants is higher in our communities. Thirtyfive percent of all patients waiting for a kidney transplant are AfricanAmerican, states DLA. Plus, successfully matching donor organs to a recipient calls for genetic similarity, and there’s a better chance of that happening if both parties are of the same ethnic or racial group. Today, the rate of organ donation among AfricanAmericans lags behind the rate of African-Americans who need transplants – and that translates into longer waiting periods or even death for some. For more information on becoming a donor, visit www.organdonor.gov. SPRING 2007
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Health News Breast Cancer:
What You Need to Know
reventing breast cancer is difficult. Though a new study – followed by a flurry of news stories – suggests that staying off hormone replacement therapy may lower the risk, there is no proven way to avoid the disease. Early detection is Black women’s best tool. The American Cancer Society recommends the following guidelines for finding breast cancer early in women without symptoms: ● Mammogram: Women age 40 and older should have a yearly mammogram, a breast X-ray. ● Clinical breast exam (CBE): Women in their 20s and 30s should have a clinical breast exam as part of a regular exam by a health expert, preferably every three years. After age 40, women should have a CBE by a health expert annually. ● Breast awareness and breast self-exam (BSE): BSE is an option for women beginning in their 20s. By examining them regularly, you will get to know how your breasts normally look and feel. Then you can more easily notice changes. The most important thing is to see your doctor right away if you notice any of these changes: a lump or swelling, skin irritation or dimpling, nipple pain or the nipple turning inward, redness or scaliness of the nipple or breast skin, or a discharge other than breast milk. But remember that most of the time these breast changes are not cancer. For more information on breast self-examination, contact the American Cancer Society at www.cancer.org. If you have been diagnosed with breast cancer, seek support. Contact Sisters Network Inc. at www.sistersnetworkinc.org and The Susan G. Komen Breast Cancer Foundation at www.komen.org.
Black women are more likely to get an aggressive form of breast cancer, but that’s no reason to take it lying down. By Linda Villarosa
reast cancer moved into Valarie Jacobs’ life quickly, but she didn’t let it take over. The single mother of two children learned she had the disease two years ago. Not long after being diagnosed, she received the devastating news that she must undergo both chemotherapy and surgery to remove both breasts. Nonetheless, last September, tired from fighting for her life, Jacobs stood in a roomful of Black women and told her story of survival. “I was weak, but having the opportunity to reach out to our community gives me stamina,” says Jacobs, 43, of Somerset, NJ. “I talked about my journey and shared that I am still undergoing treatment. I wanted the women who heard me to be empowered and educated.” Though African-American women are less likely than White women to have breast cancer, when we do get it, the disease is more deadly. In fact, Black women have the highest breast cancer death rates of any racial or ethnic group. Our tumors are generally diagnosed and treated later, making them especially dangerous. More chilling, over the past several years, a number of studies have shown that African-American women are also more frequently diagnosed with an aggressive
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form of breast cancer that resists some kinds of treatment. This type of tumor also occurs at younger ages, often before 35. Last summer, researchers at the University of North Carolina identified a specific, virulent breast cancer tumor that strikes young Black women 10 times more often than either White women or even older Black women. As scientists work to unravel this mystery, AfricanAmerican survivors are fighting back. Though, historically, a breast cancer diagnosis was kept secret, and for many was a source of shame or embarrassment, those attitudes have largely faded. More Black women are speaking openly about surviving using the only tools that they have: courage, honesty and information. “Cancer isn’t a death sentence,” said Jacobs, shortly after sharing her story with Black women at a beauty salon. The event was part of “Mondays at the Beauty Shop,” a program launched by the Susan G. Komen Foundation’s Central and South Jersey affiliate to encourage African-American women to get mammograms. “It’s important that Black women know that you can survive,” Jacobs adds, “and also are given the message about the importance of early detection.”
Health News About a year-and-a-half ago, at 29, Lorie Williams of Holly Springs, NC, found a lump in her right breast while doing a self-exam in the shower. Though she was very afraid, she quickly and forcefully sought medical care, several times insisting that her concerns be taken seriously. The following month she was diagnosed with a fast-growing cancer. In short order, she had surgery, eight months of chemotherapy, more surgery and then 66 days of radiation treatment. Now cancer-free, Williams believes that being proactive saved her life, and that is the message she passes along to her family, friends and co-workers. â€œIf I hadnâ€™t been really diligent about my health, I wouldnâ€™t be here now,â€? says Williams, who has a young child and is pregnant. â€œI am thankful and grateful that God allowed me to be here with my husband and son. So I tell everyone that early detection is the key to survival.â€? In February 2003, Jeanne Lucas, a North Carolina state senator, became very ill during a general assembly meeting. During testing, she was diagnosed with an aggressive tumor in her left breast. She needed months of grueling chemotherapy followed by surgery to remove her lymph nodes, then radiation. Cancer-free for three years, she has spread the word about the importance of breast cancer detection and treatment among her friends, family, sorority sisters and church members. She also tells her personal story at events hosted by Sisters Network Inc., a national organization of African-American breast cancer survivors. â€œThe first thing I tell Black women is that cancer is very serious,â€? says Senator Lucas, 71, who lives in Durham. â€œBut if they get their mammograms, they wonâ€™t have to go through what I went through. I waited too long, like many of us do. I hadnâ€™t had a mammogram in two years, and I didnâ€™t do breast exams regularly. But I was successful on my journey and want to share what I learned.â€? Linda Villarosa, the author of Body and Soul: The Black Womenâ€™s Guide to Physical Health and Emotional Well-Being, is a Brooklyn-based freelance writer.
Do Fibroids Run in the Family? Researchers studying possible genetic connection seek Black, biological sisters with uterine fibroids. By age 50, over 80 percent of African-American women will have uterine fibroids, noncancerous tumors common among women of childbearing age. To determine if thereâ€™s a genetic cause, researchers at the Center for Uterine Fibroids in Boston are recruiting nationwide to enroll Black biological sisters who currently have fibroids or who have had them in the past to participate in a study. These sisters must have the same biological mother and father, complete a consent form and survey and provide a DNA sample by getting their blood drawn or saliva collected by a healthcare provider and mailing it in (the study pays these expenses). If a genetic link is discovered, the goal will be to develop a genetic treatment that could prevent fibroids from forming, says study coordinator Priya Somasundaram, M.D. For more information or to enroll, call 1-800-722-5520 (ask operator to transfer you to 525-4434) or check out www.fibroids.net.â€” Tamekia Reece
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12 NMA HealthyLiving
What’s My Sign?
Do you recognize these signs of
hypothyroid disease? True or False:
Hypothyroidism carries no symptoms.
False: Diagnosing hypothyroidism
A By Rozalynn S. Frazier
common affliction, hypothyroidism – when the thyroid (the butterfly-shaped gland located in the neck) produces too few thyroid hormones (hyperthyroidism is the overproduction of thyroid hormones) – affects nearly eight million Americans yearly without their knowledge. A scary thought since the gland helps every other cell and organ breathe. “It’s one of the hormones necessary for life,” says Memphis endocrinologist Beverly Williams-Cleaves, M.D. What do you know about hypothyroidism? Test your IQ with this quiz.
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can be tricky because many of its symptoms are slow to develop, are common to other conditions and can easily be confused with the effects of stress or overwork. But if you experience sluggishness, cold intolerance, dry skin, dry, brittle hair, muscle cramping or weakness, weight gain, constipation, memory loss, depression, a yellowish tint to the skin and heavy or irregular periods that last more than five to seven days, you could be at risk.
True or False:
Having goiter (an enlarged thyroid gland) proves you have hypothyroidism.
False: Although goiter can signify hypothyroidism, it doesn’t necessarily mean you have it. For example, even though it may still be producing normal amounts of hormones, one part of your thyroid may get bigger if it needs to help another part that has stopped pulling its weight. When goiter develops because of the underproduction of thyroid hormones, that is when hypothyroidism is the culprit.
True or False:
Hypothyroidism can’t kill you.
False: Many complications can arise if hypothyroidism goes untreated, including myxedema coma – the extreme manifestation of hypothyroidism in which a patient exhibits multiple organ abnormalities and progressive mental deterioration – sleep apnea and dementia. Some, including heart failure, can be fatal. True or False:
Not getting enough iodine from foods increases your risk for hypothyroidism.
True: Although rare in the United States because many of our products contain iodine (salt, water and bread, for example), worldwide, it’s the most common cause. For more information, please contact: American Thyroid Association, www.thyroid.org/patients, 1-800THYROID. Thyroid Foundation of America, www.allthyroid.org, 1-800-832-8321.
Health News Doctor to see: Internist, immunologist, pulmonologist, rheumatologist. Treatment: Aspirin or other nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen may reduce joint pain and inflammation. Corticosteroids counter the inflammation of lupus (but can have long-term side effects like weight gain, bruising, high blood pressure, diabetes and osteoporosis), while antimalarial drugs may help in managing joint pain, fatigue and skin rashes. Immunosuppressive medications work to make the immune system less active, but they can eventually cause anemia and increase your cancer risk. What you can do: Get adequate rest; exercise; eat a balanced, healthy diet (minimizing red meat and saturated fats can decrease inflammation); don’t smoke; and limit alcohol consumption (which can affect your kidneys and liver). Since ultraviolet light has been known to cause flare-ups, cover up and wear sunscreen outside. Acupuncture alleviates flare-ups in some people. For more information: Lupus Foundation of America, 202-3491155, www.lupus.org.
Each year, more African-Americans develop these little-known – but excruciatingly painful – chronic conditions. Here, what you need to know to get detected early and treated right. LUPUS What it is: A chronic inflammatory disease that affects skin, joints, blood and kidneys. Normally, the body’s immune system protects it from viruses, bacteria and antigens. But with lupus, the
immune system malfunctions, attacking healthy tissue instead of germs. An estimated 500,000 to 1.5 million Americans have been diagnosed with lupus. Blacks are at increased risk of developing it, but researchers don’t know why.
Symptoms: Signs vary, but often include a rash (often butterflyshaped) on the face; painful or swollen joints; fever; chest pain; lung problems; swollen glands; and extreme fatigue. Symptoms can come and go, so they are often called “flares.”
What it is: A chronic condition characterized by fatigue and muscle, ligament and tendon pain, even under the slightest pressure. The cause is unknown, but doctors speculate that factors such as chemical changes in the brain, injury in the upper spinal region, inadequate sleep and viral or bacterial infection can trigger the condition. An estimated three million to six million Americans suffer from fibromyalgia. Eighty percent are women. Symptoms: Long-term pain in areas, accompanied by stiffness; fatigue; irritable bowel syndrome; headaches; facial pain; and heightened sensitivity. Symptoms never disappear completely. (continued on p.14) SPRING 2007
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Health News The Quiet
(continued from p.13) Doctor to see: Rheumatologist, neurologist, orthopedic surgeon, pain doctor. Treatment: Acetaminophen (Tylenol) may help to ease pain and stiffness, while muscle relaxants at bedtime may help treat muscle spasms. Antidepressants can be used to promote sleep. Regular exercise decreases symptoms over time. What you can do: Avoid emotional stress; relax; get enough sleep; exercise; limit caffeine; and limit daily activities. Yoga has also been known to help relax muscle and reduce tension and fatigue for fibromyalgia sufferers. A chiropractor may help. For more information: National Fibromyalgia Association, 714-9210150, www.fmaware.org.
SARCOIDOSIS What it is: An inflammatory disease that starts in the lungs but can affect any organ including your liver, skin, heart, nervous system and eyes. Doctors believe it results from an abnormal immune response (possibly
overreacting to an unknown toxin, drug or pathogen that enters your body through your airways). The disease often goes away on its own and without treatment, usually within two to three years; however, some have symptoms for a lifetime. Sarcoidosis is most common among adults between 20 and 40. Blacks are particularly at risk, and Black women get it twice as often as Black men. Comedian Bernie Mac has been battling the disease for the past two decades. Symptoms: Many don’t know they have sarcoidosis until it shows up on a routine chest X-ray (which will usually reveal lung inflammation). Common signs include fatigue; fever; weight loss; watery, red eyes; arthritis in ankles, elbows, wrists and hands; small, red bumps on face, buttocks and arms. Doctor to see: Rheumatologist, neurologist, pulmonologist, cardiologist. Treatment: Anti-inflammatory drugs or a corticosteroid called prednisone. What you can do: Don’t smoke, and avoid contact with chemicals, dust and irritants. See your doctor regularly. Melatonin supplements
have been reported to improve breathing, decrease lymph node swelling and normalize blood tests. For more information: American Lung Association, 1-800-LUNGUSA, www.lungusa.org.
MULTIPLE SCLEROSIS (MS) What it is: This difficult-to-diagnose autoimmune/nerve disorder develops when the immune system mistakenly attacks the sheath surrounding nerves in the brain and spinal cord, injuring the sheath and underlying nerves. The damage slows or blocks nerve signals controlling muscle coordination, strength, sensation and vision. MS affects more than 250,000 Americans, including singers Lena Horne, Lola Falana and Tamia, as well as Richard Pryor, who lived with the disease for years before dying from a heart attack. Symptoms: Numbness or weakness of the bottom half of body; tingling or pain in numb areas of body; lack of coordination; blurred or double vision; slurred speech; electricshock sensations with certain head movements; fatigue; bladder and bowel dysfunction; and dizziness.
Doctor to see: Rheumatologist, neurologist. Treatment: Interferon beta-1b (Betaseron) and interferon beta-1a (Avonex, Rebif) help fight viral infection and regulate your immune system. Given intravenously, the chemotherapy drug Mitoxantrone (Novantrone) can treat aggressive forms of relapsing MS, as well as certain forms of progressive MS. Muscle relaxants and corticosteroids are also helpful. Doctors may recommend physical therapy, as well. What you can do: Rest, since fatigue is a common symptom; Eat balanced meals; exercise regularly; and stay out of the heat, which causes extreme muscle weakness. Looking for an alternative measure? Acupuncture has been known to improve fatigue, depression, anxiety and bowel or bladder function, common symptoms of MS. For more information: The National Multiple Sclerosis Society, 1-800-FIGHT-MS, www.nationalmssociety.org. LaShieka P. Hunter lives in Bay Shore, NY.
Inside the NMA National Medical Association Joins Cover the Uninsured Week 2007 to Help Get America’s Kids Covered.
here has never been a more important time for America to come together than for Cover the Uninsured Week to ensure that all of America’s kids get the healthcare coverage they need. Now in its fifth year, Cover the Uninsured Week will take place April 23-29, 2007, in communities across the country. This year, volunteers and groups like National Medical Association (NMA) will focus on covering America’s children and
demonstrating broad, public support for reauthorizing the State Children’s Health Insurance Program (SCHIP). Ten years ago, Congress enacted SCHIP with bipartisan support, making it possible for millions of children to get the care they need. Now SCHIP must be reauthorized by Congress in order to continue. At a time when more than eight million kids are uninsured, Congress needs to fund SCHIP to cover more of America’s uninsured children. Working together, concerned citizens and organizations in communities across America will send a clear and strong message to our nation’s leaders: Our children need healthcare coverage to grow up healthy and reach their full potential. The Week’s diverse network of
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business owners, union members, educators, students, patients, physicians, nurses, faith leaders, etc. in all 50 states and the District of Columbia will host activities highlighting the success of SCHIP, the need for its reauthorization and the importance of covering more of our nation’s uninsured children. Activities also will emphasize the need for all uninsured Americans to have access to healthcare coverage. Activities will include press conferences, community forums, enrollment events, seminars for small businesses, educational events on campus, faith-based activities and more. “National Medical Association believes that America’s leaders must make covering all kids their first
priority,” said Dr. Albert W. Morris, Jr., president, NMA. “We are proud to be a Cover the Uninsured Week National Partner, and we encourage all of our members to get involved by planning or participating in activities in their communities.” Cover the Uninsured Week staff is available to assist organizations and volunteers planning activities. In addition, free planning guides and materials are available for individuals interested in planning events in their communities. For more information on the NMA’s involvement in Cover the Uninsured Week, contact Ivonne Fuller at 202-3471895. Visit www.CoverTheUninsured.org for free guides, materials, updates and additional information.
Patients who receive blood transfusions for Sickle Cell Disease may need toâ€Ś
Blood transfusions help many patients with Sickle Cell Disease. But 10 or more transfusions may overload the body with iron. And Iron Overload can be dangerous. If you receive blood transfusions, ask about iron. And find out how to lighten the load.
For FREE materials and information to share with your doctor, visit
AskAboutIron.com or call 800-215-9847
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Inside the NMA
Members on the Move
Hill appointed Chief of Staff
r. Washington C. Hill, medical director, Labor and Delivery and Maternal-Fetal Medicine, has been appointed chief of staff of the Sarasota Memorial Hospital’s medical staff in Sarasota, FL. Dr. Hill received his undergraduate degree from Rutgers University in New Jersey and completed his medical training at Temple University in Philadelphia. Dr. Hill interned at Walter Reed General Hospital in 1966 and spent the next nine years as a medical officer in the United
States Army with assignments to Beaumont General Hospital in Texas and in Germany. Dr. Hill has a strong interest in education, patient care, teaching and clinical practice. He is a regular participant at conferences that teach perinatal-healthcare providers the management and use of research in caring for highrisk pregnancies. He has helped lead the development of a nationally known Center of Excellence renowned for the care of high-risk pregnancy
r. Wayne J. Riley, the former vice president and vice dean for Health Affairs and Governmental Relations at Baylor College of Medicine in Houston, TX, was named head of Meharry Medical College, one of the nation’s premier medical schools. Dr. Riley is Meharry’s 10th president. “He occupies a very unique role among the nation’s academic medical institutions,” said Milton R. Jones, chairman of the Board of Trustees for Meharry Medical College. “Dr. Riley is a recognized leader in medical education and has the vision and energy to assure our continued national leadership in educating health professionals and biomedical scientists.” Dr. Riley succeeds Dr. John E. Maupin, who led Meharry from 1994 through 2006 and is now president of Morehouse School of Medicine in Atlanta, GA.
r. Jeanette E. South-Paul, chair of Family Medicine at the University of Pittsburgh School of Medicine, was among six physicians that received the 2007 AMA Foundation Excellence in Medicine Award. Dr. South-Paul received the Pride in the Profession Award, which the foundation bestows upon four U.S. physicians who serve underserved groups. From her childhood home atop a rescue mission in Philadelphia, Dr. South-Paul watched as the needy and homeless came for food and help. It’s where Dr. Smith-Paul learned to care for the needy, a lesson she now passes on to medical students who provide free medical care with her at the Matilda Theiss Family Health Center in Pittsburgh. “We’ve got to take care of the uninsured, and we’ve got to keep them close to the minds and hearts of physicians,” said Dr. South-Paul.
Paterson elected to governing board
r. Elizabeth Paterson, a radiologist and former member of NMA’s Board of Trustees from Millcreek, WA, has been elected to the governing board of the Intercultural Cancer Council (ICC) in Houston, TX.
The ICC promotes policies, programs, partnerships and research to eliminate the unequal burden of cancer among racial and ethnic minorities and medically underserved populations in the U.S. and associated territories.
Heron recipient of
2006 Gender Justice Award
r. Sheryl Heron, assistant dean of Medical Education and Student Affairs, Emory University School of Medicine, was awarded the 2006 Gender Justice Award by the Georgia Commission on Family Violence. Dr. Heron works as associate professor in the Department of Emergency Medicine at Emory, where her research focuses on
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College of Obstetricians and Gynecologists, the Southern Medical Association and others.
South-Paul receives AMA Foundation Excellence in Medicine Award
Riley named head
of Meharry Medical College
management. Through the OB/GYN section of the National Mecical Association, Dr. Hill developed a scholarship fund for needy minority medical students, which is supported by corporate sponsors. In 2006, Black Enterprise magazine selected Dr. Hill as one of the “Top 100 Black physicians in the country.” Dr. Hill serves on several national boards and committees including the National Institute of Health, Food and Drug Administration, the American
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preventing violence against women. Dr. Heron’s unique role allows her to reach out to students and practitioners in the medical field to teach how best to understand family violence. Dr. Heron is the immediate past chair of the Emergency Medicine Section at the National Medical Association.
17 NMA HealthyLiving
Inside the NMA
Diabetes Alert! NMA mobilizes the community for diabetes education
he NMA Diabetes Education Program, funded by a five-year cooperative agreement grant from the Centers for Disease Control and Prevention (CDC), continues to make significant strides. Entering the third year of the grant, emphasis of the program is to support community outreach efforts implemented by the coalitions and the national office. To address the prevalence of diabetes in the Black community, the NMA Diabetes Education Program focuses on its core educational objectives: 1) provide outreach, such as screening, community workshops and media campaigns; 2) educate patients on preventative behaviors, as well as healthy disciplines to maintain good health while affected by the disease; and, equally important, 3) educate physicians. The NMA Diabetes Education Program is comprised of coalitions which are designed to provide diabetes education in the community. The coalition sites include Atlanta; Houston; Indianapolis; Los Angeles; Pine Bluff, AK; and the District of Columbia. During the past year, our Los Angeles partner conducted educational outreach at the local NBC health fair. At this event, more than 700 people attended the 50+ Fitness Jamboree where Delores Caffey-Fleming, president of the Auxiliary to the Charles R. Drew Medical Society, and her team provided diabetes education materials. At the 38th Annual Indiana Black Expo, which 18,000 people attended, the Indianapolis Coalition provided diabetes materials, health screenings and blood glucose testing. Much of the NMA Diabetes Education Program is geared toward prevention for the general public, as well as education about selfmanagement for individuals with the disease. Patients who have developed diabetes can develop a series of complications if diabetes is not monitored adequately. It is important to note that 65 percent of all deaths in people with diabetes are directly related to heart disease and stroke. Diabetes is the leading cause of blindness and retinopathy in adults 20-74 years of age, diabetic nephropathy, with 44 percent new
cases occurring in 2002, and other complications such as neuropathy, amputations and dental problems. In the United States, 20.8 million people have diabetes. An estimated 14.6 million people have been diagnosed; unfortunately, 6.2 million (or nearly one-third of the above total) are unaware that they have the disease. For African-Americans, 3.2 million people aged 20 years and older (or 13.3 percent of this population) have diabetes. Even worse, 51 million people ages 40-74 years old have â€œpre-diabetesâ€? or blood sugar levels that are higher than normal, but not yet high enough to be diagnosed as diabetes. By taking small steps in practicing common preventative measures (e.g., healthful eating habits, regular physical activity, weight loss, etc.), diabetes can be prevented or delayed. The risk of developing type 2 diabetes, which accounts for 90 percent to 95 percent of all types of diabetes, increases with the number of risk factors. Common risk factors include over age 45, African-American heritage (as well as Latinos, Native Americans, Asian-Americans and Pacific Islanders), family history of diabetes, diabetes during pregnancy, history of having a baby weighing over 9 lbs., high blood pressure, physical inactivity, overweight or obesity, high cholesterol and high triglycerides. In honor of American Diabetes Alert Day on Monday, March 26, NMA members are encouraged to know their risk for diabetes. The American Heart Association has begun to promote American Diabetes Alert Day. This health observance is an annual, one-day call to action held on the fourth Tuesday of March for people to find out if they are at risk for diabetes. The goal of this day is to raise the awareness that diabetes is serious, you can have diabetes and not even know it, and that taking the Risk Test is an easy way to find out if you are at risk for diabetes. In observance of American Diabetes Alert Day, a tool kit containing selected educational materials from the National Diabetes Education Program (NDEP) and other items will be sent to NMA members and made available on the new Web site at www.nmadiabetes.org. Additionally, a patient tool kit will also be available online. For information or to assist with this initiative contact, firstname.lastname@example.org and visit www.nmanet.org.
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18 NMA HealthyLiving
Inside the NMA
Sudden Cardiac Arrest:
Are You at Risk?
e hear a lot about heart disease. About the
importance of lowering cholesterol. About maintaining heart health through diet, exercise and managing high blood pressure. But we don’t hear very much about a condition called sudden cardiac arrest, or SCA. SCA is one of the nation’s leading causes of death – each year claiming the lives of more Americans than breast cancer, lung cancer and HIV/AIDS combined.1,2,3 Nearly 1,000 people die every day from SCA.4 And most of these deaths – which total approximately 325,000 each year in the United States5 – are preventable. Many people often confuse SCA with a heart attack. Knowing the differences between the two could help save your life or the life of someone you love. “Learning about SCA, its risks and treatment options, as well as being proactive in seeking out appropriate medical care is critically important,” said Albert W. Morris, Jr., M.D., president, National Medical Association. “More lives can be saved if people who are at risk of SCA become better champions of their own health.” The most effective form of treatment for SCA is the delivery of an electrical shock, either with an automated external defibrillator (AED) or with a stopwatch-sized implantable cardioverter-defibrillator (ICD). ICDs are designed to treat dangerously fast heart rhythms. The ICD was introduced in the early 1980s and has been referred to as “an emergency room in the chest.” Today, an ICD is smaller than a cell phone and is implanted in the upper chest. It continuously monitors the electrical conduction system of the heart, watching for dangerous patterns and, when needed, delivering electrical impulses that may range from a tiny pulse like that from a cardiac pacemaker to a full, life-saving shock that can return the heart to normal rhythm. For more information about ICDs, SCA and other heart conditions, please visit www.hearthelp.com. 1
American Heart Association / American Stroke Association. Heart Disease and Stroke Statistics. 2006 Update. 2 American Cancer Society. Cancer Facts and Figures. 2006. 3 Central Intelligence Agency. The World Fact Book – Rank Order – HIV/AIDS – deaths. (Footnotes continued on p.19) SPRING 2007 sponsored by
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Sudden Cardiac Arrest (SCA)
Electrical malfunction of the heart that results in no blood flow to body and brain.
Blockage in a vessel that supplies blood to the heart muscle that may permanently damage part of the heart.
Previous heart attack, heart failure, abnormal heart rhythm, Ejection Fraction* (EF) of ≤ 35%, family history of SCA.
High cholesterol, high blood pressure, obesity, smoking, family history of heart attack.
Racing heartbeat, lightheadedness, dizziness, fainting.
May be accompanied by pressure in the chest, pain radiating to the arm, shortness of breath, sweating, nausea.
SCA is up to 95% fatal if left untreated; approximately 5% of people survive SCA6 because defibrillation was not delivered within six minutes.7,8,9,10
Most people survive a first heart attack.
Implantable cardioverterdefibrillators** (ICDs) are 98% effective in preventing death due to SCA.11
Proper diet, exercise, lowering of cholesterol and blood pressure can help reduce risk.
Successful early defibrillation can lead to quick recovery with no permanent heart damage.
Permanent heart muscle damage often requires long recovery and increases risk of sudden cardiac arrest.
Inside the NMA 4
Zheng, ZJ, Croft, JB, Giles, WH, and *Ejection Fraction (EF): The but are not limited to, infection at the talk to your doctor to see if it is right Mensah, GA. Sudden cardiac death in percentage of blood pumped out of the surgical site and/or sensitivity to the for you. Your physician should discuss the United States, 1989 to 1998. heart during each beat. A healthy heart device material, failure to deliver all potential benefits and risks with you. Circulation. October 30, has an EF between 50%-75%. therapy when it is needed, or receiving Although many patients benefit from 2001:104(18):2158-2163. **Additional Device Information: An extra therapy when it is not needed. the use of this treatment, results may 5 Heart Rhythm Society. Sudden implantable cardioverter-defibrillator After receiving an ICD system, you will vary. For further information, please Cardiac Arrest Key Facts and Statistics. (ICD) system delivers therapies to treat have limitations with magnetic and call the Medtronic toll-free number at 6 Ginsburg, W. Prepare to be shocked: patients with heart rhythm disorders or electromagnetic radiation, electric- or 1-800-551-5544 (7:00 a.m. to 6:00 evolving standard of care in are at significant risk of the who gas-powered appliances and tools in p.m., Monday–Friday, Central Time) or treating sudden cardiac arrest. Am J developing heart rhythm disorders. An which you are allowed to be in contact. see the Medtronic Web site at Emerg Med. May 1998;16(3):315-319. ICD is placed inside your body and Treatment with an ICD system is www.medtronic.com. 7 American Heart Association. works automatically. Risks associated prescribed by your physician. This Statistical fact sheet. Sudden deaths with an ICD system implant include, treatment is not for everyone. Please from cardiac arrest. 8 Pell, JP, Sirel, JM, Marsden, AK, Ford, I, Walker, NL, and VIRAMUNE does not cure HIV or AIDS, and it is not known if it will help you How do I store VIRAMUNE? MEDICATION GUIDE live longer with HIV. People taking VIRAMUNE may still get infections common Store VIRAMUNE at room temperature, between 59° to 86°F (15° to 30°C). Cobbe, SM. Presentation, in people with HIV (opportunistic infections). Therefore, it is very important Throw away VIRAMUNE that is no longer needed or out-of-date. ® that you stay under the care of your doctor. Keep VIRAMUNE and all medicines out of the reach of children. management, and outcome of Viramune (VIH-rah-mune) Who should not take VIRAMUNE? General information about VIRAMUNE • Do not take VIRAMUNE if you are allergic to VIRAMUNE or any of its Medicines are sometimes prescribed for purposes other than those listed out of hospital Tablets ingredients. The active ingredient is nevirapine. Your doctor or pharmacist in a Medication Guide. Do not use VIRAMUNE for a condition for which it can tell you about the inactive ingredients. was not prescribed. Do not give VIRAMUNE to other people, even if they ® cardiopulmonary arrest: have the same condition you have. It may harm them. Viramune Oral Suspension • Do not restart VIRAMUNE after you recover from serious liver or skin comparison by underlying reactions that happened when you took VIRAMUNE. This Medication Guide summarizes the most important information about VIRAMUNE. If you would like more information, talk with your doctor. You Generic name: nevirapine • Do not take VIRAMUNE if you take certain medicines. (See “Can I take other can ask your pharmacist or doctor for information about VIRAMUNE that is aetiology. Heart. August medicines with VIRAMUNE?” for a list of medicines.) written for health professionals, or you can visit www.viramune.com or tablets and oral suspension call 1-800-542-6257 for additional information. 2003;89(8):839-842. • Do not take VIRAMUNE if you are not infected with HIV. 9 Read this Medication Guide before you start taking VIRAMUNE and each What should I tell my doctor before taking VIRAMUNE? de Vreede-Swagemakers, JJ, time you get a refill because there may be new information. This information Before starting VIRAMUNE, tell your doctor about all of your medical Boehringer Ingelheim Pharmaceuticals, Inc. does not take the place of talking with your doctor. You and your doctor conditions, including if you: Gorgels, AP, Dubois-Arbouw, Ridgefield, CT 06877 USA should discuss VIRAMUNE when you start taking your medicine and at regular • have problems with your liver or have had hepatitis checkups. You should stay under a doctor's care while using VIRAMUNE. WI, et al. Out-of-hospital You should consult with your doctor before making any changes to your • are undergoing dialysis medications, except in any of the special circumstances described below • have skin conditions, such as a rash cardiac arrest in the 1990’s: a regarding rash or liver problems. What is the most important information I should know about VIRAMUNE? • are pregnant, planning to become pregnant, or are breast feeding population-based study in the Patients taking VIRAMUNE may develop severe liver disease or skin How should I take VIRAMUNE? reactions that can cause death. The risk of these reactions is greatest • Take the exact amount of VIRAMUNE your doctor prescribes. The usual © Copyright Boehringer Ingelheim Pharmaceuticals, Inc. Maastricht area on incidence, dose for adults is one tablet daily for the first 14 days followed by one during the first 18 weeks of treatment, but these reactions also can tablet twice daily. Starting with one dose a day lowers the chance of 2005, ALL RIGHTS RESERVED occur later. characteristics and survival. rash, which could be serious. Therefore, it is important to strictly follow Biaxin is a trademark of Abbott Laboratories. Diflucan is a trademark of Pfizer, the once daily dose for the first 14 days. Do not start taking VIRAMUNE Inc. Mycobutin is a trademark of Pharmacia & Upjohn Company. Nizoral is a Liver Reactions J Am Coll Cardiol. November twice a day if you have any symptoms of liver problems or skin rash. trademark of Janssen Pharmaceutica. Rifadin, Rifamate and Rifater are Any patient can experience liver problems while taking VIRAMUNE. (See the first section “What is the most important information I should trademarks of Aventis Pharmaceuticals Inc. However, women and patients who have higher CD4 counts when 15, 1997; 30(6):1500-1505. know about VIRAMUNE?”) they begin VIRAMUNE treatment have a greater chance of developing Revised: January 11, 2005 10 liver damage. Women with CD4 counts higher than 250 cells/mm are • The dose of VIRAMUNE for children is based on their age and weight. 10003354/01 10003354/US/1 Zipes, DP, Camm, AJ, at the greatest risk of these events. If you are a woman with CD4 VR-10154 Children’s dosing also starts with once a day for 14 days and then twice OT1801 >250 cells/mm or a man with CD4 >400 cells/mm you should not a day after that. Borggrefe, M, et al. begin taking VIRAMUNE unless you and your doctor have decided that the benefit of doing so outweighs the risk. Liver problems are • You may take VIRAMUNE with water, milk, or soda, with or without food. This Medication Guide has been approved by the US Food and ACC/AHA/ESC 2006 Guidelines often accompanied by a rash. • If you or your child uses VIRAMUNE suspension (liquid), shake it gently Drug Administration. before use. Use an oral dosing syringe or dosing cup to measure the right Patients starting VIRAMUNE with abnormal liver function tests and patients for Management of Patients dose. After drinking the medicine, fill the dosing cup with water and drink with hepatitis B or C have a greater chance of developing further increases in it to make sure you get all the medicine. If the dose is less than 5 mL liver function tests after starting VIRAMUNE and throughout therapy. With Ventricular Arrhythmias (one teaspoon), use the syringe. In rare cases liver problems have led to liver failure and can lead to a liver transplant or death. Therefore, if you develop any of the • Do not miss a dose of VIRAMUNE, because this could make the virus and the Prevention of Sudden harder to treat. If you forget to take VIRAMUNE, take the missed dose right following symptoms of liver problems stop taking VIRAMUNE and away. If it is almost time for your next dose, do not take the missed dose. call your doctor right away: Cardiac Death – Executive Instead, follow your regular dosing schedule by taking the next dose at its • general ill feeling or “flu-like” symptoms regular time. Summary. A Report of the • dark urine (tea colored) • If you stop taking VIRAMUNE for more than 7 days, ask your doctor how much to take before you start taking it again. You may need to start with American College of • tiredness once-a-day dosing. • pale stools (bowel movements) Cardiology/American Heart • If you suspect that you have taken too much VIRAMUNE, contact your local poison control center or emergency room right away. • nausea (feeling sick to your stomach) Association Task Force and the Can I take other medicines with VIRAMUNE? • pain, ache, or sensitivity to touch on your right side below your ribs • VIRAMUNE may change the effect of other medicines, and other medicines • lack of appetite European Society of can change the effect of VIRAMUNE. Tell your doctors and pharmacists about all medicines you take, including non-prescription medicines, vitamins and • yellowing of your skin or whites of your eyes Cardiology Committee for herbal supplements. Your doctor should check you and do blood tests often to check your liver function during the first 18 weeks of therapy. Checks for liver problems • Do not take Nizoral (ketoconazole) or Rifadin /Rifamate /Rifater Practice Guidelines (Writing (rifampin) with VIRAMUNE. should continue regularly during treatment with VIRAMUNE. Committee to Develop • Tell your doctor if you take Biaxin (clarithromycin), Diflucan (fluconazole), Skin Reactions methadone, or Mycobutin (rifabutin). VIRAMUNE may not be right for you, Skin rash is the most common side effect of VIRAMUNE. Most rashes occur or you may need careful monitoring. Guidelines for Management of in the first 6 weeks of treatment. In a small number of patients, rash can be • It is recommended that you not take products containing St. John's wort, serious and result in death. Therefore, if you develop a rash with any of the Patients With Ventricular which can reduce the amount of VIRAMUNE in your body. following symptoms stop using VIRAMUNE and call your doctor right away: • If you take birth control pills, you should not rely on them to prevent • general ill feeling or “flu-like” symptoms Arrhythmias and the pregnancy. They may not work if you take VIRAMUNE. Talk with your • blisters doctor about other types of birth control that you can use. Prevention of Sudden Cardiac • fever What should I avoid while taking VIRAMUNE? Death). J Am Coll Cardiol. Avoid doing things that can spread HIV infection, as VIRAMUNE does not • mouth sores stop you from passing HIV infection to others. Do not share needles, other • muscle or joint aches injection equipment or personal items that can have blood or body fluids September 5, on them, like toothbrushes and razor blades. Always practice safe sex by • swelling of your face using a latex or polyurethane condom to lower the chance of sexual 2006;48(5):1064-1108. contact with semen, vaginal secretions, or blood. • conjunctivitis (red or inflamed eyes, like “pink eye”) 11 Zipes, DP, Roberts, D. The Centers for Disease Control and Prevention advises mothers with HIV not • tiredness to breast feed so they will not pass HIV to the infant through their milk. Ask • any of the symptoms of liver problems discussed above Results of the international your doctor about the best way to feed your infant. If your doctor tells you to stop treatment with VIRAMUNE because What are the possible side effects? study of implantable you have experienced the serious liver or skin reactions described VIRAMUNE can cause serious liver damage and skin reactions that can above, never take VIRAMUNE again. cause death. Any patient can experience such side effects, but some pacemaker cardioverterThese are not all the side effects of VIRAMUNE. (See the section “What are the patients are more at risk than others. (See “What is the most important possible side effects of VIRAMUNE?” for more information.) Tell your doctor if information I should know about VIRAMUNE?” at the beginning of this defibrillators. A comparison of Medication Guide.) you have any side effects from VIRAMUNE. Other common side effects of VIRAMUNE include nausea, fatigue, What is VIRAMUNE? epicardial and endocardial lead VIRAMUNE is a medicine used to treat Human Immunodeficiency Virus (HIV), fever, headache, vomiting, diarrhea, abdominal pain, and myalgia. This list of side effects is not complete. Ask your doctor or pharmacist for the virus that causes AIDS (Acquired Immune Deficiency Syndrome). systems. The Pacemakermore information. VIRAMUNE is a type of anti-HIV medicine called a “non-nucleoside reverse Cardioverter-Defibrillator transcriptase inhibitor” (NNRTI). It works by lowering the amount of HIV in the Changes in body fat have also been seen in some patients taking antiretroviral blood (“viral load”). You must take VIRAMUNE with other anti-HIV medicines. therapy. The changes may include increased amount of fat in the upper back When taken with other anti HIV medicines,VIRAMUNE can reduce viral load and and neck (“buffalo hump”), breast, and around the trunk. Loss of fat from the Investigators. Circulation. July increase the number of CD4 cells (“T cells”). CD4 cells are a type of immune legs, arms, and face may also happen. The cause and long-term health helper cell in the blood. VIRAMUNE may not have these effects in every patient. effects of these conditions are not known at this time. 1, 1995;92(1):59-65. ®
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I N D I C AT I O N A N D I M P O R TA N T S A F E T Y I N F O R M AT I O N F O R V I R A M U N E VIRAMUNE is indicated for use in combination with other antiretroviral agents for the treatment of HIV-1 infection. VIRAMUNE does not cure HIV or AIDS, and has not been shown to reduce the risk of passing HIV to others through sexual contact or blood contamination. VIRAMUNE can cause severe liver disease and skin reactions that can cause death. These reactions occur most often during the first 18 weeks of treatment, but can occur later. Ask your healthcare provider about how to recognize these problems. Stop taking VIRAMUNE and do not restart it if you have these reactions. Call your healthcare provider immediately. Any patient can experience liver problems with VIRAMUNE but women and patients who have higher CD4 counts when they begin VIRAMUNE treatment have a greater risk. Women, including pregnant women, with CD4 cell counts >250 cells/mm3 are at the greatest risk. If you are a woman with CD4 >250 cells/mm3 or a man with CD4 >400 cells/mm3 you should not begin taking VIRAMUNE unless you and your doctor have decided that the benefit of doing so outweighs the risk.
The dose of VIRAMUNE for adults is one 200-mg tablet daily for the first 14 days, followed by one 200-mg tablet twice daily. The 14-day lead-in period is important because it can help reduce your chances of getting a rash. Other side effects that patients have experienced include nausea, fatigue, fever, headache, vomiting, diarrhea, abdominal pain and myalgia. Changes in body fat may occur in patients receiving antiretroviral therapy. Please see Medication Guide for VIRAMUNE on following page for more detail on these side effects and other important information.
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