Understanding the Pap Smear

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

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

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!!

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?

1. 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.
2. 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.
3. 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.
4. 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.
5. 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.
6. 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%.
7. 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.
8. 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.
9. 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?

"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

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

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

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!

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

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!