OKORONKWO MEDICAL CLINIC

Ask any African, or a Nigerian in particular, why he or she is overweight or obese, and the answer will be ‘…it is evidence of good living’. This is quite contrary to popular belief and current medical evidence.

Diagnoses and Health Consequences:

Obesity is defined as a body mass index (BMI) of greater than 30 Kg/m2. Body Mass Index is equal to kilograms of body weight divided by the square of the height in meters (kg/m2). Overweight is defined as a BMI from 25.0 to 29.9 kg/m2. In certain ethnic groups, the elderly, athletes and children, BMI may not be the best predictor of weight-related health problems. Obesity is associated with increased all-cause mortality and increased risk for serious medical conditions. These include type 2 diabetes, dyslipidemia (cholesterol problems) hypertension, Pulmonary diseases like sleep apnea (breathing problems), cardiovascular disease, cancer, gastrointestinal disease, kidney disease, endocrine (hormonal) problems, infertility, obstetrics and gynecological problems. People who are obese may experience social stigmatization. It is difficult to loose weight and maintain weight loss. A loss of 5% body weight can substantially reduce the risks associated with obesity and lead to improvement in health outcomes.

Screening and Prevention:

In people of all ages, monitored food intake and increased levels of activity, particularly walking and other forms of exercise, are associated with less future weight gain and should be encouraged. Even during infancy and early childhood, risk factors for obesity may be present, and some of them may be modifiable. Women can make certain efforts to lower the risk that their children will become overweight, including maintaining normal weight gain during pregnancy, not smoking, and extending duration of breastfeeding. Parents can encourage certain healthy habits in their children by making sure that they eat breakfast, limit their intake of high sugar foods such as soft drinks and fruit drinks, reducing their time spent in such sedentary activities as watching television, and encouraging adequate sleep.

Some drugs (steroids, antidepressants, anti-psychotic medications, etc) are associated with weight gain. Clinicians may be able to substitute medications that produce less weight gain to help patients avoid becoming overweight.

Treatment:

Individuals should assess whether they are ready to make lifestyle changes to set attainable weight-loss goals. Weight losses of 5% to 10% are more realistically attainable and are still associated with proven health benefits. Behavior therapy is one of the cornerstones of treatment for obesity. People who are successful in losing weight and maintaining weight loss tend to monitor their behavior, eat less, increase their physical activity, and practice positive thinking and techniques to reduce stress. Other strategies include keeping food diary, to learn to monitor eating behavior by recording what is eaten, determining the setting in which to eat, and identifying the situation that trigger eating. To lose weight, a person must consume fewer calories by eating less food than the body needs for resting metabolic rate and daily activities. Many diet plans are available for overweight individuals. These are grouped as low-glycemic-index diet, low-fat diet, low-energy-density diet, low-carbohydrate diet, etc. Commercial weight-loss programs include Overeaters Anonymous, TOPS (Take Off Pounds Sensibly), Weight Watchers, Jenny Craig, Herbalife, OPTIFAST, LA Health, and e-Diets. Only a few studies have demonstrated their effectiveness. Whatever diet type, eating at regular intervals throughout the day is important.

 Exercise offers a strategy for balancing energy intake and expenditure, whether as a primary treatment for weight loss or for preventing patients from regaining weight. People who are trying to lose weight should increase their walking or other comparable activities to 30 to 60 minutes, 5 or more days a week. Exercise alone is not adequate as a primary treatment for weight loss, because it takes a lot of exercise to lose weight. A person who wishes to lose 1 pound per week through exercise needs to walk approximately 5 miles per day, 7 days per week, in order to achieve a deficit of 3500 Kilocalories. For persons wanting to monitor their exercise, inexpensive pedometers can be worn on the belt. A mile is about 2000 steps.

Physicians occasionally consider drug treatment for obesity in patients with a BMI greater than 30 Kg/m2 and no associated diseases or with a BMI greater than 27 kg/m2 if there are associated health problems like diabetes, osteoarthritis, hypertension, dyslipidemia, or cardiovascular disease. The US Food and Drug Administration (FDA) has approved several drugs for treatment of obesity. Examples are sibutramine and orlistat for induction and maintenance of weight loss. Sympathomimetics Amines like phentamines, diethylpropion, benzphetamine and phendimetrazine are approved for use only for twelve weeks.

Surgical treatment for obesity is considered if BMI is greater than 40 Kg/m2 or a BMI greater than 35 Kg/m2 with serious comorbid conditions, such as sleep apnea, diabetes or arthritis. Some of the surgical procedures to treat obesity, known as bariatric surgery are gastric bypass, gastroplasty, pancreaticobiliary bypass, stomach banding, and liposuction. You should be aware of the various adverse effects associated with surgical intervention for obesity.

Discuss with your physician to ascertain attainable weight-loss goals and determine which therapy is best suited for you. Treatment for obesity include behavior modification strategies, counseling, reduced food intake, increased physical activity, drug therapy, and bariatric surgery. Seek specialist referral and second opinion when necessary. ‘Evidence for good living’.

Uchenna A. Okoronkwo II, M.D.

Annals of Internal Medicine. Vol. 149, No. 7

American College of Physicians - ITC

MKSAP

The African Association Ibo Union Soccer Tournament and Festival for 2007 has come and gone and San Francisco Stars are the tournament champions. Congratulations!

Twelve teams participated this year and each one of them came prepared to carry the Champion’s Cup. The margin of error was very small, and the best team won.

The individual players were skillful and talented. This was a showcase of soccer artistry. St. Louis All Stars and Leone Stars of LA played well but it was not their day. Afriscope United did not measure up to their potential. Oakland Insurgents, the most improved team, was determined but luck was not on their side. The 2006 Champions, Pure Riddims of Oakland, started well with the initial 6-0 knock out of St. Louis, but fizzled out towards the end. Cambay Lions, Nembo Stars, Togo, and Sierra Leone, to their credit, showed up.

The highlight of the tournament was the finals and championship game between SFO Stars (Nigeria) and Lone Stars (Liberia). The game started well with both teams equally matched. At the half, it was SFO Stars 1 and Lone Stars 0.

Fifteen minutes into the second half the game suddenly changed. The Frisco Boys summoned energy from who knows where and started moving at dizzying speed. Attempts by the Loners to match the SFO speed was to no avail. No legs. The goals poured in under the chorus of eh!, eh!!, eh!!!. SFO Stars had maintained the three necessities of skills, luck and endurance to become the champions.

The final score: SFO Stars 4, Lone Stars 0.

The Champion’s Cup presentation was made to the Champions by Mrs. Grace Bessong, wife of Mr. Gabriel Bessong. Mr. Bessong was Afriscope Coach who untimely passed into the lord in December of 2006, after a brief illness.

The music and dancing continued. Players proudly wore their shinning medals around their necks. There was appreciation and gratitude all over as the sun faded away and the cool breeze picked up. The participants slowly dispersed and the field laid in an ocean of green grass as if nothing had happened, waiting for another year to come alive again.

CHOLESTEROL – The Good, The Bad and The Ugly.

Cholesterol is important because it is one the risk factors for coronary artery disease, which leads to acute coronary syndrome or heart attack. There are different types of cholesterol and how much you have of a particular type may determine the state of your coronary health. Total blood/plasma cholesterol level should be less than 200mg/dl. There are three numbers (among many others) to track: 1. Low Density Lipoprotein (LDL), 2. High Density Lipoprotein (HDL) and 3. Triglycerides.

LDL or "bad" cholesterol - this number should be less than 130mg/dl or less than 100mg/dl if you have other coronary risk factors like diabetes.

HDL or "good" cholesterol - this number should be higher than 45mg/dl and the more the better.

TRIGLYCERIDE or "ugly" cholesterol - this number should be lower than 150mg/dl.

LDL levels are increased by diets high in saturated fats and cholesterol, mainly because of decreased LDL receptor-mediated catabolism. Human populations on high saturated fat/high cholesterol diets have elevated LDL cholesterol levels. They have significantly more coronary artery disease (CAD) due to atherosclerosis (clogging of the heart blood vessels) than populations on low saturated fat/low cholesterol diets. The most common cause of LDL excess is increased production. Elevated LDL cholesterol level is an independent risk factor for premature CAD in our society. Lowering LDL cholesterol with either diet and exercise (lifestyle modification) or diet, exercise and drug therapy, have been shown in prospective studies to reduce heart disease prospectively. Other studies indicate that aggressive lipid modification (LDL lowering) can result in stabilization and regression of existing coronary atherosclerosis.

HDL is synthesized in both the liver and the intestine. It acts as the scavenger and picks up bad cholesterol from tissues and delivers it to the liver directly or transfers it to other lipoproteins (chylomicrons or VLDL remnants) that are then taken up by the liver. In the liver, cholesterol can either be excreted directly into bile, be converted to bile acids, or be reutilized in lipoprotein production. The most common cause of low HDL is enhanced catabolism, often associated with high triglycerides (hypertriglyceridemia). Decreased or low HDL cholesterol level is an independent risk factor for premature CAD. Women tend to have higher HDL levels than men and hence a lower risk for CAD (? estrogen effect). Isolated deficiency of HDL cholesterol (below the tenth percentile of normal) can be genetic in nature and is known as familial hypoalphalipoproteinemia. This disorder is found in approximately 5% of patients with premature CAD.

TRIGLYCERIDE is the direct result of fatty diet. Dietary fats are packaged by the intestine into triglyceride-rich ‘chylomicrons’ to enter the blood stream and by lipolysis broken down into triglyceride and chylomicron remnants. These remnants are taken up by the liver to synthesize Very Low Density Lipoprotein (VLDL), which is converted to Low Density Lipoprotein (LDL)-The Bad.

Hypertriglyceridemia remains a potentially important coronary risk factor. Many studies have explained the relation between high triglycerides and CAD as due to the association of hypertriglyceridemia with low HDL cholesterol, obesity, diabetes and sedentary lifestyle. Elevated triglyceride have not been clearly shown to be an independent risk factor for CAD, but have been shown to be a risk factor for pancreatitis, especially with values greater than one thousand (>1000 mg/dl). This is due to deposition of triglyceride in the pancreas. Patients who present with severe hypertriglyceridemia in childhood or early adulthood and who are not obese, often have a deficiency of the enzyme lipoprotein lipase or its activator protein (apoC-II), resulting in markedly impaired removal of triglyceride. The most common of these disorders is familial hypertriglyceridemia (greater than 250 mg/dl), an autosomal dominant disorder in which obesity, glucose intolerance, hyperuricemia(causes gout), and HDL deficiency are often present. The cholesterol levels cannot be accurately calculated if the triglyceride level is 400 mg/dl or above, which is why it is required to get a fasting blood sample. The following formula is used: LDL C = TC – HDL C – TG/5* (*valid if TG<400)

C = Cholesterol; TC = Total cholesterol; TG = Triglycerides.

The National Cholesterol Education Panel-Adult Treatment Panel (NCEP-ATP) develops guidelines for the diagnosis and treatment of cholesterol (Lipid) disorders. The cornerstone of the treatment of lipid disorders is diet therapy. Excellent patient dietary pamphlets are available from the American Heart Association and the NCEP. Decreasing caloric intake and increasing exercise level is very helpful in treating elevated lipid levels, especially in persons who are overweight. In most cases, diet therapy should be tried for at least six months prior to initiating drug therapy.

Cholesterol (lipid) lowering medications can be divided into two general classes: drugs effective in lowering LDL cholesterol (>15% reduction)-the BAD; and drugs effective in lowering triglyceride levels (>15% reduction)-the UGLY. There are three classes of drugs to consider: a. anion exchange resins (cholestyramine and cholestipol); b. nicotinic acid (niacin); c. hydroxymethylglutaryl coenzyme A (HMGCoA) reductase inhibitors (lovastatin, pravastatin, simvastatin and other statins).

Discuss with your physician to determine which drug is best for you.

In the US, coronary artery disease (CAD) accounts for over 10 million physician office visits and one half million deaths each year. Aggressive lipid modification can result in stabilization and regression of existing coronary atherosclerosis. Remember, each 1% reduction in serum cholesterol concentration yields approximately a 2% reduction in risk of mortality from coronary heart disease.

Courtesy-MKSAP 1X (ACP)

Mazi Uchenna A. Okoronkwo II, M.D.

OKORONKWO MEDICAL CLINIC

DIABETES.

Millions of people have diabetes. It is a serious health problem, but with proper care you can learn to manage your diabetes and lead a full and active life. Scientists don’t know what causes diabetes.  One possible cause is that people with diabetes may be missing a certain gene that protects against diabetes.  Others have speculated derangement in immune system. What we know is that certain risk factors increase your chance of getting diabetes. Diabetes risk factors include being overweight, high blood pressure and family history.  When you eat, some of your food is broken down into glucose (sugar). Glucose is carried by the blood to the body cells. Insulin, made by the pancreas, helps glucose move from your blood into the cells, where it is used to produce energy which is needed for healthy living. Insulin lowers blood glucose levels by helping glucose move from the bloodstream into the cells. With diabetes, the body does not make any insulin, enough insulin or the insulin does not work right. Hence, the balance between blood glucose and blood insulin is disrupted.

There are two major types of diabetes, type 1 or juvenile and type 2 or adult onset. In type 1 diabetes, the pancreas (the organ that makes insulin) does not work right. The cells that produce insulin are damaged or destroyed, so the body makes little or no insulin. Type 1 diabetes usually occurs in children or young adults. In type 2 diabetes, the body makes some insulin but not enough. Or the insulin the body makes does not work right. Only type 2 is preventable and is more common in overweight older adults. Young people can also have type 2 diabetes. It can also occur during pregnancy, and it can be caused by certain illnesses.

The most common signs and symptoms of diabetes are: 1. Urinating a lot. 2. Feeling thirsty often. 3. Losing weight without trying. 4. Feeling hungry a lot. 5. Having blurry vision. 6.Tingling or numbness in hands or feet. 7. Tired all the time. 8. Sexual problems. 9. Wounds that won’t heal. 10. Have infection often. 11. Have very dry skin.

When any of these signs and symptoms occur, do not delay getting checked to rule out diabetes.

People who don’t produce insulin or make enough insulin need to take insulin injections or diabetes pills to keep their insulin and blood glucose in balance. Some people can manage their diabetes with a diet and exercise plan developed with their healthcare provider. Everyone is different, which is why it is important to individualize diabetes treatment plan in other to properly manage one’s diabetes. A typical plan includes:  1. A meal plan, 2. An exercise plan, 3. Instruction on how and when to check blood glucose, 4. Determine personal blood glucose target range, 5. If taking insulin, the types, dosages, and timing of doses, 6.If taking pills, the types, dosages, and timing of doses, 7. Other health care goals like weight reduction, stop smoking etc, 8. Maintain regular health checkups with your health care provider.

It is important to be well educated about diabetes and with these lifestyle changes be able to maintain good blood sugar control in other to help prevent complications like: A. Heart disease. B. Stroke. C. High blood pressure. D. Eye problems. E. Kidney damage. F. Nerve damage. G. Infections.

‘Knowledge is power’. With knowledge you can help keep well with diabetes.

OKORONKWO MEDICAL CLINIC

TESTICULAR CANCER:

Testicles are male reproductive organs that produce and store sperm. They also produce testosterone, a hormone that causes such male traits as facial hair and lower voice pitch. Testicles are smooth, oval shaped and somewhat firm to touch. They are below the penis in a sac of skin called the scrotum. The testicles normally descend into the scrotum before birth. Parents should have their infant sons examined by a doctor to be sure that the testicles have properly descended. If they have not, this can be easily corrected with surgery.

Testicular cancer is the most common type of cancer in men ages 20 to 35. It accounts for about one percent of all cancers, hence resulting in many people not having heard about this type of cancer. It is mostly a disease of young men. It can occur anytime after age 15, and less common in middle-aged and older men. White men are four times more likely to develop testicular cancer than black men.

Two groups of men have a greater risk of developing testicular cancer- those whose testicles have not descended into the scrotum and those whose testicles descended after age 6. It is 3 to 17 times more likely to develop in these men.

The most common symptom of testicular cancer is a small, painless lump in a testicle or slightly enlarged testicle. It is important for men to become familiar with the size and feeling of their normal testicles, so that they can detect changes if they occur. Other possible symptoms include a feeling of heaviness in the scrotum, a dull ache in the lower stomach or groin, a change in the way a testicle feels, or a sudden accumulation of blood or fluid in the scrotum. These symptoms can also be caused by infection or other conditions that are not cancer.

A simple procedure called testicular self-exam (TSE) can increase the chances of finding a tumor early. Men should perform TSE once a month-after a warm bath or shower.  The heat causes the scrotal skin to relax, making it easier to find anything unusual. TSE is simple and takes only a few minutes. Examine each testicle gently with both hands. Feel for any abnormal lumps-about the size of a pea-on the front or the sides of the testicle. These lumps are usually painless.

If you do feel a lump, you should contact your doctor immediately. The lump may be due to an infection, and a doctor can decide the proper treatment. If the lump is not an infection, it is likely to be a cancer.

Fifteen years ago, testicular cancer was often fatal because it spread quickly to vital organs such as the lungs. Today, due to advances in treatment, testicular cancer is one of the most curable cancers, especially if detected and treated promptly. Testicular cancer almost always occurs in only one testicle, and the other testicle is all that is needed for full sexual function.

Routine TSE are important, but they cannot substitute for a doctor’s exam. And remember that testicular cancer is highly curable, especially when detected and treated early.

Courtesy: INH               Mazi Uchenna A. Okoronkwo II, M.D.

OKORONKWO MEDICAL CLINIC 

BREAST CANCER:

Breast cancer is the most common type of cancer among American women. Each year in the US, more than 175,000 women learn they have breast cancer. Two-thirds of them will be over 50 years old. Breast cancer also occurs in young women and in about 900 men a year. The average woman has about 11 percent chance of developing breast cancer during her life time.

Only about 20% of biopsied breast lumps are cancerous, and if cancer is found early, there are choices for treatment. Hence understanding the need for, and practicing breast exams will help increase the chances of detecting breast cancer in its early stages. With prompt treatment, the outlook is good. Most women treated for early breast cancer will be free from breast cancer for the rest of their lives.

Doctors do not know how to prevent breast cancer. However, the chances of detecting breast cancer in its early stages can be increased by following the three steps of the National Cancer Institute’s early detection guidelines.

1. Mammography: Beginning at age 40,all women should be encouraged to have a mammography every 1 to 2 years until age 50. After 50, mammography should be done annually.
2. Physical Breast Exam: This is a must by a health care professional. This exam may be uncomfortable for both you and the doctor or Nurse Practitioner. Request for a standby nurse and ask for it.
3. Breast Self Exam: Women should do breast self-examination monthly. Breasts come in all sizes and shapes, as women do. Your own breast will change throughout your life. Your monthly menstrual cycle and menopause, childbirth, breastfeeding, age, weight changes, and birth control pills or other hormones may change the shape, size, and feel of your breasts. It is important to learn what is normal for you and familiarize yourself with all parts of your breast and under your armpit.

If you discover anything unusual during your exam, such as a lump, a discharge from the nipple, or dimpling or puckering of the skin, you should see a doctor immediately. Remember 80% of biopsied breast lump are NOT cancer.

The above three steps used together, offer you the best chance of finding breast cancer early.

 If you are over 45 years old and do not have insurance, have not had mammography because you cannot afford it, call my office at (510) 569-7326 and ask how you can enroll in the Breast Cancer Early Detection Program (BCEDP).

Courtesy: NIH             Mazi Uchenna A. Okoronkwo II, M.D.

HIGH BLOOD PRESSURE:

What is Blood Pressure: This is the force the heart sees or experiences as it does it’s work, which is pump blood to all parts of the body every second of the day. For the heart to pump blood it has to squeeze (contract) and relax (expand). It is during relaxation (diastole) that the heart collects the blood that it distributes to the rest of the body when it contracts (systole). It is the force of this contraction over force of relaxation that we call blood pressure (BP). The average normal BP is 120/80, measured in millimeters of mercury (mmHg).

The blood vessels (the arteries) and the organs at the end of each set of blood vessels (end organs) bear the brunt of this force. These are: the brain, eyes, heart, lungs, kidneys and other small vessels.

 When blood pressure is too high, the heart is working harder than it should. Once developed, high BP lasts a lifetime. It is a dangerous condition, which often has no warning signs or symptoms, known as the silent killer. If not controlled, it can lead to brain attack (stroke), eye (glaucoma and blindness), heart attack, kidney disease and indirectly to lung disease.

High BP affects about 50 million adult Americans. It is especially common among African Americans and Ibos, who tend to develop it earlier and more often than whites. Conditions that predispose one to get high BP are lifestyle, maleness, age, hereditary, and unknown.

High blood pressure can be controlled by the following steps: loose weight, if overweight; exercise regularly; eat healthy and choosing food low in salt; limit alcohol intake; and when diagnosed and medication prescribed, take medication as prescribed. If you have been diagnosed with high BP, see your doctor regularly, at least 3 to 4 times yearly. All the above can prevent high BP except taking pills.

Remember, even slight elevations of blood pressure above the optimal of 120/80 or less are unhealthy. The higher the blood pressure above normal, the greater the health risk. As we say, prevention is better than cure. 

Mazi Uchenna A. Okoronkwo II, M.D.

Hello fellow Ibos,

Over the course of time I have contacted you individually regarding the established cultural organization ‘Ibo Union Of Northern California Inc.’ The Idea came to mind because of the dismal situation in which we have found ourselves. It was the great poet and Nobel price laureate William Butler Yeats who lamented, and later emphasized by author Chinua Achebe:

                                  Turning and turning in the widening gyre

                                  The Falcon cannot hear the Falconer

                                  Things fall apart

                                  The center cannot hold…………..you know the rest

We have all watched the slow disintegration of the Ibo society where it is every one to one’s tent. Previous attempt to unite the Ibos in Northern California had resulted in unnecessary infighting and political bickering. As Ibos we have become our own worst enemy. Shamelessly immersed in fruitless exuberance and self-adulation. However, we still have a lot of good people who can make a difference if encouraged and given a chance.

As most of us may have realized, there is no going back to the fatherland. Our future and that of our children lie in this great nation called the United States of America. Thus fulfilling the age-long tenet of ‘ubi bene, ibi patria’-‘where I live, there is my fatherland’. It will be very sad to leave our children in this hemisphere without a tribe. We are the Ibos and belong to the Ibo Nation. We must join together to leave a lasting legacy for our progenies. We must, irrespective of minor differences, work together as caretakers for something tangible that we hope to leave behind as we exit this existence. There will be difficulties and bumpy roads ahead, but together we shall prevail, working together with commonality of purpose and uniformity of consistency.

Our motto: United we stand above politics for the good of the Ibos.

Our mission: To facilitate and enhance the assimilation of all Ibos and Ibo related persons in the United States of America into the American society in order to achieve the ‘American Dream’ through Education, Health and Socio-Economic development.

We are registered with the state of California as a non-profit corporation operating exclusively for public purposes within the meaning of section 501( C )3 of the Internal Revenue code. We are in the process of applying for Tax Exempt status. Every Advisory Board member has been chosen because of his or her expertise or interest in a particular field. This is a beginning. Let it be a labor of love. I welcome you all.

                    Mazi Uchenna A. Okoronkwo II, M.D.

                                        Director