Please dont go to the Dominican Republic!

Its Mothers Day and I finally got the chance to write about a subject that has been troubling me for years. If you are thinking about a trip to the Caribbean please don’t go to the Dominican Republic. I know the rock bottom pricing is amazing and tempting but you should understand that your tourist dollar is promoting modern day slavery. I do not intend to get into a long dissertation on the subject but hopefully it will stimulate your interest to read about the subject some more. All the hard back breaking work of construction and sugar cane harvesting in the Dominican Republic is done by people of Haitian descent. There is a documentary called “Black Sugar” you may wish to watch. I haven’t watched it myself because I know it will just upset me and besides, I have been there, many times both as a tourist and as a Health Care Volunteer. On my last visit a gentleman who was the administrator for ILAC, a center run for US students by the Catholic church, proudly took us to his farm and showed off his farm workers. “Haitians are like dogs” he said. He certainly housed them as if they were. He happily told my husband to demonstrate the point that since Dominican girls are not allowed to sleep with Haitians and there is a relative shortage of Haitian women he hires a Haitian prostitute to ‘service’ his workers. He said they would form a line outside the hut and you could hear the person inside shouting ”Next!”. I didnt think this was a particularly appropriate story to tell in front of a lady but then again perhaps he did not view me as such. If you are of Haitian descent no matter how many generations before you cannot obtain Dominican citizenship. This means you have no passport and are trapped inside the country with no opportunity for an education or health care. I offered to pay for a Health Canter for the people in a batey (ghetto for Haitians) in Santo Domingo and the staff of ILAC told me it would be a waste of time because all doctors are paid by the government and they would not send a doctor there regularly. They told me instead to use the money to build a school for Dominican children because “Haitians don’t appreciate an education”. Even the United Nations has not been able to convince the Dominicans to change. Last year the Dominican High Court stripped more than 200,000 Haitians of any claim to citizenship making them legally stateless and denying their children the right to receive education, health care or any basic human rights. Many Haitians were actually kidnapped and taken to the Dominican Republic to work, if they run away they are beaten and returned. Sound familiar? It is convenient for those of us who are comfortable and free, to ignore the plight of those human beings who are basically slaves. Can you really lounge on the beach and raise that Pina Colada with a clear conscience, pretending you don’t know just because you got a deal?

Hair, Skin and Nails

Hair tends to be less lustrous as we get older, Nails more brittle and Skin more saggy. Is there a common thread? Of course, not just the obvious generic aging syndrome but also deficiencies that we can actually point to (and replace). Here are some basic tips: Use an antimicrobial shampoo before you use the fancy, nice smelling, super conditioning stuff. make sure the producte you use dont cause build up. Consider massaging coconut oil into the scalp before washing, leave on for a minimum of 20 minutes. Get the supplements on our list for whichever is problematic for you, hair, skin, nails or all of the above. If you notice rapid aging check for hormone imbalances, thyroid etc and vitamin deficiencies. Maintain your internal anti-oxidant levels and of course use the Stop-Aging Skin therapy twice a day. This would be a good time to stock up on maintenance items for the New Year, if you were registered for today's seminar because of the 10% discount. Yours in health Dr. Nadu A. Tuakli

PREVENTION, CONTROL AND CURE OF ARTHRITIS Have you ever heard that there is nothing that can be done about Arthritis? Its not true! An Aunt of mine was having a terrible time earlier this year with bad arthritis of her spine causing so much pain she couldn’t move. Unfortunately she is not in the States and I could not get to her. She told me she was hospitalized and was put through the ‘usual’ paces. MRI’s, Spinal taps and injections, pain medications and anti-inflammatories and then the usual ‘nothing can be done’. My first thought was: that’s a lot of money, time, energy and pain to end up with “nothing”. My second was : Of course something can be done, they are just staying with the same old paradigm. One of the most magnificent things about the body is its ability to heal itself, those of us who practice traditional medicine just need to learn to tap into that ability. If we do, the sky is the limit, we will even ‘find’ the cure for cancer! As always prevention is better than cure but what do you do if you are already afflicted? I have read 9 books on Arthritis over the past month (I am happy to share the titles with anyone who is interested) and I am so excited about the information I was going to discuss it this afternoon at my ‘Skin” seminar! Not that arthritis and skin are not related because they are, but it certainly is a stretch on the ‘looking great for the holidays’ theme! (By the way for those of you who keep asking me ‘when is your next seminar’, arranging a huge seminar like the last one is really time consuming so I will be doing mini-seminars at my office and sharing new information periodically.) So why the excitement? I do believe that arthritis can be prevented, contained and cured! But not by managing it the way we are taught in medical school. i.e take anti-inflammatories to decrease the inflammation while your joints get worse and you suffer from the side effects. Oh, and then when it completely breaks down replace the joint with an artificial one. I now believe that the non pharmaceutical measures you can take are much more powerful than drugs for the treatment and prevention of arthritis. These do not suppress the symptoms while the disease gets worse, they stop it. So here’s a summary of what may be needed: Oral Hygiene measures. Dietary changes. Healthy Oils Supplements Vitamins Exercises Maintain a healthy weight Antimicrobials when indicated Allergy testing Balance your Hormones Nothing invasive! If you have an interest in generating a personalized program for arthritis treatment then please feel free to schedule a consultation. If you have arthritis personally or in your family I would strongly encourage you to do so SOONER than later. (Those of you who signed up for today’s seminar will be mailed the supplement sheet we prepared for today). Yours in health Dr. Tuakli

Dont discount doing a pap smear

A patient said to me last week “I do believe you saved my life for the second time Dr. Tuakli” And I thought Wow! You know what, she is right. People thank me for saving their lives from time to time and not to sound cavalier but I often think that it is nice to hear but I was just doing my job. Any qualified physician could have been credited with doing the same thing. But this time was different and very stark. This 50 something year old lady has been in my practice for perhaps 3 or 4 years. She has a variety of medical issues that we have been working on and from time to time I would suggest she have a pap. She had told me previously that she had been told that she didn’t need one because she had had a hysterectomy. Interestingly enough whenever I probed further she never seemed sure about exactly what had been done. Was the uterus completely gone including the cervix? How about the ovaries? Why was the surgery done in the first place? It never ceases to amaze me how many times I ask those questions and the answer is “I don’t know”, particularly in over 40 year old women. I eventually convinced her that it would be a good idea to just do a routine check up even though she had no symptoms and so I did a pap. As soon as I started her pap I knew from the look of the lesion in her vagina that it was cancerous. Putting cells on a slide and sending it to the lab quite frankly was a formality and I had her schedule an appointment with a gynecology oncologist pending the results. She told me when she came in last week that the specialist walked into the room and the first thing he said to her was “What is a women your age doing still getting pap smears?!” (I wont be referring any more patients to him). The arrogance dissolved when he saw the cytology report and the patient has since had the appropriate surgery. So why do I tell this cautionary tale? Well, for one thing, the current guidelines imply that she did not need a pap smear, simply based on her age. Secondly, I think that many women are walking around thinking that because they have had a hysterectomy they are immune to genital cancers. Thirdly, standard recommendations are just that, written for the common good but not by someone who knows you. Do not take them as gospel. You could argue that this is the exception to the rule and that is probably true but it also means that someone’s mother and sister will still be alive 3 years from now and she also managed to avoid the trauma of cancer therapy that would have resulted had she found it later. In medicine it is not always easy to argue with “official recommendations” and specialists who don’t know the patients. I believe that I taught myself something with this case, not everything has to be rational, and care must be individualized regardless. I am a strong believer in learning from past experience even if its not written anywhere. I derive no satisfaction from my patient being diagnosed with cancer but I am sure glad I followed my gut. When in doubt get a pap, it sure beats the alternative!

If you do get a high PSA level it might be worth doing another test

As I mentioned before there is a lot of controversy about the PSA test. But what happens if you get an abnormally high PSA, should you automatically move to the next step of treatment? There is the old saying that more men die with Prostate cancer than die from it. No one wants the cure to be worse than the disease. So the good news is that there is a new genetic test that can help assess how aggressive a prostate cancer might be. This may be a useful adjunct if you are unfortunate enough to do a PSA and end up with a high value. This test is not in common usage yet but it is becoming more common.

A test for cancer............... do you want it?

There is a test for cancer you want it right? Eh...... Maybe! I had heard that the US preventive task force had recommended that we stop doing PSA Tests a couple of years ago. Despite the fact that I was personally affiliated with the very first task force in 1989 thru my residency at Johns Hopkins I really did not pay much attention to the recommendation . In 1989 when the government commissioned the first task force we residents were given unlimited library resources to research every article ever written on whatever subject we were assigned. A friend of mine researched the effect of dietary fat on cancer development, my subject was malignant melanoma. At that time the task force was unheard of and preventive medicine was not a field that many people were interested in. The first book was released without a lot of fanfare and controversy but now it is a quotable reference and considered the 'last word' on preventive measures. Despite this I paid minimal attention to their recommendations, maybe because having seen the inside I was less than impressed, that and the fact that some of the recent recommendations they made didn't seem to make sense to me. For example, a few years ago they changed the recommendations for mammogram screening, I was called by a reporter from Goodhousekeeping magazine for their breast cancer awareness month she wanted to know how the new recommendations were going to change my routine practice. I told her "not at all" because I have seen too many women in their 40's diagnosed with breast cancer to recommend starting mammograms at 50. So when the recommendations regarding PSA came out, I thought it was the same thing. If there was a test that could pick up cancer in the early stages why would we not want it? Why not indeed. I did not change my views until earlier this year. In March I attended a session on the use of PSA and prostate cancer at Temple University. On stage was a Family Physician,a regular Urologist, an Oncologist and a Reconstructive Urologist. The only person who thought that doing PSAs was a good idea was the 'regular' urologist. The first guy had tables of all the complications of treatment for prostate cancer and studies that showed no difference in mortality in patients who had the test and those who didn't. The most shocking was the reconstructive guy who simply declared "I clean up the mess left by urologists who unnecessarily treat the prostate cancer. Oh, you know, urinary incontinence, erectile dysfunction, pain and so on!" I have since thought about two patients I have had in my practice, the first one was a guy I did the test on when it first came out. I always remember having to call him on Xmas eve with the news because I was leaving the country. He was 39 at the time (earlier than the recommended age for screening). He started with a PSA of 16 (normal being under 4), several years and many procedures later the number continued to climb. He was one of only two men I have ever sent for a mastectomy (side effect from the treatment). The primary could never be found but his number just kept going up, eventually a year before his death it was found spread to his nervous system. He always said if he knew then what he knew 10 years later he never would have had the surgery or the hormonal therapy. He said the cure was way worse than the disease. Another gentleman who's PSA I checked around the same time had a level of almost 5, he and his wife were moving to Gettysburg, Pennsylvania, I gravely advised them to get it rechecked when he found a new doctor, they did not. They showed back up in my office almost a decade later saying they had not been seeing any doctor but he had to have a level done 3 weeks before for life insurance and it was 54. I moved into overdrive, immediately repeated the level (it was 65), got him a same day appointment with a urologist and shuttled him into treatment. He is doing well, having chosen some minimally invasive modalities. I wonder what the outcome would have been if we had detected the cancer earlier. Would we have improved the quality of his life over the past 12 years or would modern medicine have hastened its demise? I do know I wish I had found the first patient's elevated PSA much later, even though at the time I thought I was being diligent. For news about the updates on Prostate Cancer diagnosis see the next blog. Be Well!

How does Gun Violence affect your health?

What do guns have to do with health? Actually a lot. Health is measured in two ways: Mortality (Duration of Life) and Morbidity (Degree of Illness) both of which are being severely impacted by Gun Violence. I actually started this blog a while ago but the events in the Navy Yard today caused me to resurrect it. Are we not yet tired of this violence and the thing that begets it : Uncontrolled Access to weapons? There are age groups were gun violence is the leading cause of death and young people have more to fear from Gun Violence than actual diseases we can be immunized against. The incidence of gun related suicide is directly related to ease of gun access.I'm not a politician and I am not trying to be one but let's get real, look at the numbers, Gun Control has become a Public Health issue and is working its way to the top of the list. Soon we will be more concerned about stopping a bullet than getting cancer. Nail me to the stake if you have to but as a Public Health professional allow me to say what needs to be said. More important PLEASE stop and educate yourself on the situation and be glad it wasn't someone in your family who got killed this year. However would you not rather act before it hits closer to home? I was initially moved to write this blog earlier this year when I read about a University of Maryland student who got killed by another student over some frivolous incident. The first thing that came to mind was: "Yet another parent who thought they had finally got their kid in college, only to turn around and they are gone in a puff of smoke" (How many since Virginia Tech?) Just food for thought. Please Be Well, Oh, and stay alive !