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.