Ms. G is a fifty-nine year-old African-American woman who works as a cook at a local day care in Baton Rouge, LA. Contrary to public opinion, Ms. G has been employed all of her life as a cook and has held her current job for thirteen years. She was referred to me after being evaluated in the emergency room for an elevated blood pressure, elevated blood sugar, and headaches. The emergency room doctor insisted that she seek the services of a primary care physician and get her blood pressure and blood sugar under control, or suffer the repercussions of these health conditions: a heart attack or stroke. Physically, Ms. G is in poor health, but with some lifestyle changes her health outlook could improve. She is a slightly overweight smoker with a strong family history of heart disease and diabetes. Her mother and father died from complications of heart disease, and her younger sister recently died from a massive heart attack.

Her options for treatment were limited to the local charity hospital, which has eliminated the outpatient family practice clinic due to budget cuts. Before the clinic discontinued its services, it required a typical wait of four to six months for a routine appointment. This wait was so prohibitive that she never followed up with a physician for “scheduled visits” after her initial emergency room diagnosis. In addition to simply accessing healthcare, the price tag for health maintenance has grown unreasonable. The average cost for an appointment with a primary care doctor for cash-paying patients including blood work and other tests range from 200 to 400 dollars. I have seen her in my office free of charge.

Prior to her visit at my office, the emergency room had become her primary care doctor and she was very appreciative of seeing a “regular” doctor. Because Ms. G lives just above the poverty level and, as she puts it, “robs Peter to pay Paul,” she has never been able to afford health care insurance. She placed eating, paying the bills, and helping to raise her grandchildren as a priority over her own health. She often says, ‘I gotta live Doc. Maybe I will get some insurance later, but right now, I gotta live.’ Later may just be “too late” for Ms. G. Without medical intervention and a consistent health care program maintained by a physician, her risk for heart disease and stroke are high.

Although Ms. G’s story is sad, it is a very common and frustrating problem for both physicians and patients. There are more than forty million uninsured people that live in the United States, which is twenty- percent of the U. S. population. In 2005, one in five Americans under the age of sixty-five did not have health insurance. This number has continued to increase and their validity was reinforced by a Center for Disease Control (CDC) report released on December 3, 2007 entitled Health in the United States. It showed that one-fifth of Americans could not afford one or more of the following services: medical care, mental health services, prescription medicines, eyeglasses, or dental care.

Since the release of Michael Moore’s controversial and thought provoking documentary, Sicko, which addressed the state of health care in the United States, this topic has spawned much debate. How many people are uninsured in America? Is it forty-seven million or thirty-seven million? Does that include the illegal immigrants? Is universal health care really cost effective? Who is healthier, Michael Moore or Sanjay Gupta? Who cares? One uninsured or under-insured American is one too many!

The face of the uninsured may not be what you think. Though many without health insurance do live significantly below the poverty level, nearly seventy- percent live in homes with at least one full-time worker. Health insurance is either not offered by the employer or the percentage that the worker is asked to pay towards insurance premiums is too expensive. Medicaid and the State Children’s Health Insurance Program have reduced the number of uninsured children under the age of nineteen. Nevertheless, more than eight million children, three-quarters of whom qualify for these programs are still not insured. Young adults between the ages of nineteen and twenty-nine with low income and unstable jobs are the fastest growing population of the uninsured in America.

In a poll by the Henry J. Kaiser Family Foundation, voters rated health care second only to the war in Iraq as the issue they most wanted the presidential candidates to address. Seventy-four percent of voters supported a reform plan that provided health insurance for everyone. The time has come for universal and affordable health care. I don’t have all the answers, but this crisis needs to be addressed and should be of the highest priority for the presidential candidates. These nameless people are their constituents and an integral part of the fabric of this country.

Rani G. Whitfield, M.D. is a board certified family physician with a Certificate of Added Qualification (CAQ) in sports medicine. He practices medicine in his hometown of Baton Rouge, Louisiana. Whitfield is an impassioned advocate for increasing the awareness of health related issues, such as HIV/AIDS, obesity, cardiovascular disease, and substance abuse affecting African American youth. He empowers individuals to change via Hip Hop mediums and is widely known as ‘tha Hip Hop Doc.” Visit his website @ www.h2doc.com.

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There are many reasons for inadequate sleep. Anxiety disorders, use and abuse of certain stimulants such as caffeine, medicines for weight loss or attention deficit disorder, and alcohol abuse to name a few. However, there is one problem that, if not addressed, can be a cause of many health related issues. It’s a disorder that often goes unrecognized because it’s happening while the victim thinks he is resting. This silent killer is called sleep apnea.

It is estimated that there are 18 million people in the United States who are living with diagnosed cases of sleep apnea, but many more are undiagnosed. We all are familiar with NFL legend and hall of fame honoree Reggie White, rapper Pimp C, actor John Candy, comedian Rosie O’Donnell, and best-selling author Anne Rice. Each suffered from this often missed and under-treated disease.

Maybe if more people understood the relationship between sleep apnea, being overweight, and how they all relate to high blood pressure, heart disease, diabetes, and strokes, they would live longer and healthier lives.

Sleep apnea, in its simplest definition, means that a person’s breathing is interrupted while he is attempting to get some z’s. Some individuals will not breathe for 20 – 30 seconds before “coming up” for air. The family and significant others describe the sleep of these individuals with terms like, “loud snoring, restlessness, gasping for air, and sounds of choking.” Most patients complain of daytime fatigue and falling to sleep while at work or driving.

The short term problems are obvious and range from being kicked out of bed by your spouse, losing your job or killing yourself or another driver. The question I’m often asked is, “How does sleep apnea happen, and is it treatable?”

There are two types of sleep apnea: obstructive sleep apnea (OSA) and central sleep apnea (CSA). Obstructive sleep apnea is the most common form and is caused by a blockage of the airways. This usually occurs when the tissues of the neck and throat collapse during sleep. In CSA, there is no airway blockage, but the brain fails to signal the muscles to breathe during sleep.

There can also be a mixed picture where both central and obstructive sleep apnea exist together. Risk factors for sleep apnea include: being male, overweight, being over the age of 40 with enlarged tonsils, having a large neck size (greater that 17” in me and 16” in women) and having a family history of sleep apnea.

When a person with sleep apnea stops breathing, the body has a reflex that will wake them up. The patient does this all through the night and rises the next morning feeling tired and sleepy. During these periods of apnea (which means not breathing) the body is deprived of oxygen to the brain and tissues.

To diagnosis sleep apnea, my patients are referred to an ear, nose and throat (ENT) specialist and sent for a sleep study or polysonogram (PSG). Once the diagnosis is made, conservative treatment options include aggressive weight loss, avoiding sedatives like codeine, alcohol, and sleeping pills, smoking cessation (smoke increases airway swelling), and avoiding sleeping on your back. If attempts at weight loss are unsuccessful, surgical procedures are often considered. A consultation with a board certified surgeon who specializes in bariatric surgery (weight loss surgery) is the only way to go.

One of the most common non-surgical forms of treatment includes wearing a mask at night that will keep the airways open. This treatment is called Continuous Positive Airway Pressure (CPAP). The mask covers the nose and mouth while you sleep, and is connected to a machine that delivers a continuous flow of air, maintaining an open airway. Special dental devices can be designed to keep the airway open as well as the surgical procedures mentioned earlier.

There is even a medication called Provigil that some physicians use to treat the daytime fatigue and tiredness, but this is usually in combination with CPAP and good sleep hygiene. Many people are resistant to using their CPAP machine, and although cumbersome, it could very well save your life.

If you have any of the signs and symptoms above, see your physician right away, improve your sleep, and get back in bed with the one you love.

For more information on sleep apnea, visit http://www.sleepapnea.org.

Dr. Rani Whitfield is a board certified Family Practice and Sports Medicine Physician who lives in Baton Rouge, LA. He is affectionately known as “Tha Hip Hop Doc,” as he uses music and medicine to educate young people on health issues. His dispatches on health and lifestyle can be found regularly on Urban Thought Collective.

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There are many reasons for inadequate sleep. Anxiety disorders, use and abuse of certain stimulants such as caffeine, medicines for weight loss or attention deficit disorder, and alcohol abuse to name a few. However, there is one problem that, if not addressed, can be a cause of many health related issues. It’s a disorder that often goes unrecognized because it’s happening while the victim thinks he is resting. This silent killer is called sleep apnea.

It is estimated that there are 18 million people in the United States who are living with diagnosed cases of sleep apnea, but many more are undiagnosed. We all are familiar with NFL legend and hall of fame honoree Reggie White, rapper Pimp C, actor John Candy, comedian Rosie O’Donnell, and best-selling author Anne Rice. Each suffered from this often missed and under-treated disease.

Maybe if more people understood the relationship between sleep apnea, being overweight, and how they all relate to high blood pressure, heart disease, diabetes, and strokes, they would live longer and healthier lives.

Sleep apnea, in its simplest definition, means that a person’s breathing is interrupted while he is attempting to get some z’s. Some individuals will not breathe for 20 – 30 seconds before “coming up” for air. The family and significant others describe the sleep of these individuals with terms like, “loud snoring, restlessness, gasping for air, and sounds of choking.” Most patients complain of daytime fatigue and falling to sleep while at work or driving.

The short term problems are obvious and range from being kicked out of bed by your spouse, losing your job or killing yourself or another driver. The question I’m often asked is, “How does sleep apnea happen, and is it treatable?”

There are two types of sleep apnea: obstructive sleep apnea (OSA) and central sleep apnea (CSA). Obstructive sleep apnea is the most common form and is caused by a blockage of the airways. This usually occurs when the tissues of the neck and throat collapse during sleep. In CSA, there is no airway blockage, but the brain fails to signal the muscles to breathe during sleep.

There can also be a mixed picture where both central and obstructive sleep apnea exist together. Risk factors for sleep apnea include: being male, overweight, being over the age of 40 with enlarged tonsils, having a large neck size (greater that 17” in me and 16” in women) and having a family history of sleep apnea.

When a person with sleep apnea stops breathing, the body has a reflex that will wake them up. The patient does this all through the night and rises the next morning feeling tired and sleepy. During these periods of apnea (which means not breathing) the body is deprived of oxygen to the brain and tissues.

To diagnosis sleep apnea, my patients are referred to an ear, nose and throat (ENT) specialist and sent for a sleep study or polysonogram (PSG). Once the diagnosis is made, conservative treatment options include aggressive weight loss, avoiding sedatives like codeine, alcohol, and sleeping pills, smoking cessation (smoke increases airway swelling), and avoiding sleeping on your back. If attempts at weight loss are unsuccessful, surgical procedures are often considered. A consultation with a board certified surgeon who specializes in bariatric surgery (weight loss surgery) is the only way to go.

One of the most common non-surgical forms of treatment includes wearing a mask at night that will keep the airways open. This treatment is called Continuous Positive Airway Pressure (CPAP). The mask covers the nose and mouth while you sleep, and is connected to a machine that delivers a continuous flow of air, maintaining an open airway. Special dental devices can be designed to keep the airway open as well as the surgical procedures mentioned earlier.

There is even a medication called Provigil that some physicians use to treat the daytime fatigue and tiredness, but this is usually in combination with CPAP and good sleep hygiene. Many people are resistant to using their CPAP machine, and although cumbersome, it could very well save your life.

If you have any of the signs and symptoms above, see your physician right away, improve your sleep, and get back in bed with the one you love.

For more information on sleep apnea, visit http://www.sleepapnea.org.

Dr. Rani Whitfield is a board certified Family Practice and Sports Medicine Physician who lives in Baton Rouge, LA. He is affectionately known as “Tha Hip Hop Doc,” as he uses music and medicine to educate young people on health issues. His dispatches on health and lifestyle can be found regularly on Urban Thought Collective.

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Did you know that strokes are the third leading cause of death in America, and can lead to disability and even death among its victims? African Americans are twice as likely to die from strokes than Caucasian Americans, and the rate of first strokes among African Americans is almost double that of Caucasians. Although the condition is more common among men, strokes actually kill more women each year.

Well, I have been on a mission to get the message out in 2008, and began to accelerate my efforts in April. I traveled to Buffalo and spoke before 300 people about the PTES messages with R&B artist Darryl Anthony of the singing group “AZ Yet.” Two days later, I was in Manhattan, NY with the one and only BeBe Winans. We completed a media tour together and discussed stroke and its impact on our communities.

BeBe, a really cool brother by the way, lost both his sibling Ronald and good friend Luther Vandross to this dreaded disease. His commitment and dedication to educating the masses is like no other.

One day later, I was in Atlanta, GA at the PTES Power Awards Weekend. The event was filmed and will air on the Word Network soon. Pastors Deborah and Lyle Dukes, Dr. Bobby Jones, and “AZ Yet” were just a few of those honored. I ended my travels discussing PTES messages with the legendary Chuck D on his XM satellite radio show, “On the Real.”

I’m on a roll, so let’s keep it going. My goal is to educate and/or refresh your knowledge on stroke. What is a stroke? What are the risk factors, signs and symptoms? Why are African Americans so disproportionately affected? What are the myths about stroke, and how do we combat this disease?

Here are some truly shocking statistics:

Stroke is the number three killer of Americans in the United States and a leading cause of long-term disability. 110,000 African Americans suffer a stroke each year, resulting in about 18,000 deaths. Even more alarming is the fact that we are twice as likely to have a stroke as white Americans. These numbers only reinforce why it is so important to get the message out about stroke. It is a preventable and treatable disease.

Strokes are also known as “brain attacks,” they occur when blood flow to the brain is suddenly interrupted. They are medically classified under the umbrella of heart disease, which is the number one killer of all Americans regardless of race, gender, or ethnicity.

Risk Factors: The risks factors that we have control over include smoking, high cholesterol, high blood pressure or hypertension, diabetes, physical inactivity, and obesity. The risk factors that we cannot control include age, a family history of stroke, previous stroke, race, and gender. Being active has tremendous benefits, and if coupled with healthy eating and proper rest, one can: control his/her weight, improve cholesterol levels and blood pressure, prevent bone loss, boost energy levels, improve stress levels and improve overall self image. The risk for stroke increases as we get older.

Warning Signs: The warning signs for a stroke include: a sudden numbness or weakness of the face, arm, or leg, especially on one side of the body; sudden confusion, trouble speaking, or understanding; sudden trouble seeing in one or both eyes; sudden trouble walking, dizziness, loss of balance or coordination; and sudden severe headache with no known cause.

The African American Factor: Medicine and research have not clearly delineated why African Americans are more at risk for strokes than other ethnic groups, but we do know that high blood pressure is the number one risk factor for stroke. One in three African Americans has high blood pressure/hypertension. Diabetes also runs rampant in the African American community, and is another major risk factor for this disease. African Americans with sickle cell anemia also run a high risk for strokes. Anybody with risk factors should see a doctor on a regular basis, eat healthy, exercise, and of course, take medicines as prescribed.

Dispelling Myths: There are many myths about stroke that need to be cleared up. Some believe that strokes are unpreventable. That is absolutely not true. Taking charge of your health and establishing a relationship with your doctor is one important step in stroke prevention. Also, you should initiate life style changes like exercising, losing weight, smoking cessation, and controlling your blood pressure and diabetes to reduce your risk of heart disease and stroke.

Another popular myth about strokes is that they cannot be treated, and only happen to the elderly. Wrong again! Strokes can happen to persons young and old, but if the warning signs are recognized, a stroke can be treated.

We can take control of our health! We must learn the risk factors for stroke, see our doctors on a regular basis, learn our family history, exercise, eat healthy, stop smoking, and take our medicines as prescribed to control diabetes and high blood pressure.

We have the power! You have the power! Together we have the power to end stroke!

For more information on strokes visit www.strokeassociation.org or visit my website at www.h2doc.com and shoot me a question at DrRani@h2doc.com.

Dr. Rani Whitfield is a board certified Family Practice and Sports Medicine Physician who lives in Baton Rouge, LA. He is affectionately known as “Tha Hip Hop Doc,” as he uses music and medicine to educate young people on health issues. His dispatches on health and lifestyle can be found regularly on Urban Thought Collective.

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