Anthology of Medical Diseases

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The followings are the many Books that Dr. Alcena has written
1. The Status of Health of Blacks in the States of America- A Prescription for Improvement (1994)
2. The Third World Tropical Diet, Health Maintenance, and Medical Management Program (1994)
3. African ...
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The followings are the many Books that Dr. Alcena has written
1. The Status of Health of Blacks in the States of America- A Prescription for Improvement (1994)
2. The Third World Tropical Diet, Health Maintenance, and Medical Management Program (1994)
3. African American Health Book (1994)
4. AIDS the Expending Epidemic, What the Public Needs to know: A Multi Cultural Overview (1994)
5. African American Women's Health Book (2001)
6. Women's Health and Wellness for the Millennium (2002)
7. Men's Health and Wellness for the New Millennium (2007)
8. The Best of Women's Health (2008)
9. Health Care Disparity in the United States: An Urgent Call for Universal
Health Insurance & A Public Health Insurance Plan (2009)
10. Triumph and Tragedies of Haiti and Its People (2010)
11. Health Care Disparity in the United States of America. (2011)
13. The Tragic History of Haiti (2011)
14. Black people and medical diseases 2012
15. The most common medical diseases seen in black people and how best to diagnosed and treat
16. Black people and medical diseases the root causes of health care disparity
17. African Americans and medical diseases An American Health Care Crisis That is Crying
For Help and Actions 2013
18. Anthology of Medical Diseases 2013
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Product Details

  • ISBN-13: 9781491822609
  • Publisher: AuthorHouse
  • Publication date: 10/26/2013
  • Pages: 764
  • Sales rank: 1,063,961
  • Product dimensions: 8.25 (w) x 11.00 (h) x 1.52 (d)

Read an Excerpt


By Valiere Alcena


Copyright © 2013 Valiere Alcena, MD., M.A.C.P.
All rights reserved.
ISBN: 978-1-4918-2260-9



World wide the incidence of high cholesterol is the highest in Europe (54% for both sexes), Americas (48% for both sexes), Africa 22.6%, and Asia 29.0 %. Source: WHO

Approximately 106,700 million individuals in the U.S. have high cholesterol: 50,800,000 males and 55,900,000 females have high cholesterol; 47.9% white males and 49.7% white females have high cholesterol; 44.8 black males and 42.1 black females have high cholesterol. Seven million children/adolescents in the U.S. have high cholesterol.

High cholesterol is one of the leading risk factors for coronary artery heart disease. The different types of abnormal lipids that can be found in the blood of people are:

1. Hyperlipidemia

2. High cholesterol

3. High triglycerides/high cholesterol

4. High low-density cholesterol (LDL)

5. Low high-density cholesterol (HDL)

6. High cholesterol/LDL ratio

7. High VLDL cholesterol

All these abnormal lipids are genetically transmitted from parents to their children to one degree or another.

According to a recent report that appeared in the New England Journal of Medicine, Vol. 342 No. 12 (March 23, 2000), four new markers of inflammation were found to be predictors of future development of coronary heart disease. These are hs-CRP, serum amyloid A., interleukin-6, and sICAM-1. According to the authors, the hs-CRP was the most sensitive predictor when found to be elevated.

Hyperlipidemia (too much fat in the blood) is, generally speaking, a genetically transmitted disease. If a person's mother or father has too much fat in his or her blood, this trait is likely to be transmitted to his or her children, resulting in hyperlipidemia, which can lead to the development of coronary heart disease resulting in heart attack and possible early death. Hyperlipidemia is categorized as:

1. High blood cholesterol

2. High blood triglycerides

3. High low-density lipoprotein

4. Low high-density lipoprotein

5. Cholesterol/HDL ratio, which is LDL/HDL, greater than 7.13.

In a man, if the LDL/HDL ratio is greater than 7.13, that is a high risk factor. In a woman, if the LDL/HDL ratio is greater than 5.57, that is a high risk factor.

Each one of these different components of hyperlipidemia represents an independent risk factor when abnormal, resulting in coronary heart disease.

Normal blood cholesterol is from 130 to 200 mg/dl. A normal blood triglyceride level is 60-150 mg/dl. Normal HDL is 35-80 mg/dl. Normal LDL is less than 130 mg/ dl. Normal cholesterol/HDL is less than 3.4. Normal LDL/HDL is less than 2.8 these ratios are for men. In women, normal cholesterol /HDL ratio is less than 3.27 and the LDL/HDL less than 2.34.

Most people believe that blood cholesterol level is the only thing that matters when addressing abnormal fat levels in the blood. This is wrong because a person may have perfectly normal total blood cholesterol and yet have significant hyperlipidemia, predisposing that person to coronary artery disease. One must be aware that the quick cholesterol test may be misleading if normal. Normal blood cholesterol by itself is not enough to tell if a person has abnormal genetically transmitted lipid. There are five basic cholesterols in the blood:

1. Total cholesterol

2. High-density lipoprotein (HDL)

3. LDL cholesterol

4. Triglycerides

5. VLDL (Very low-density lipoprotein)

HDL is the cholesterol that takes the regular cholesterol from the blood, carries it into the bowel and the colon, mixes it with stool, and carries it out of the body. If the HDL is low—less than 45 mg/dl—then there is not enough of it in the blood to complex with bad cholesterol to remove it from the body. This is a genetic abnormality transmitted from parents to children. More appropriately, these lipid abnormalities are called hyperlipoproteinemias. When both the fasting total cholesterol and the LDL are elevated, this is type 2a hypercholesterolemia.

When the fasting total cholesterol, the LDL cholesterol, and the triglycerides are elevated, this is type 2b hypercholesterolemia. When the total cholesterol is high and when the level of triglycerides is very high, that is type 3 hyperlipidemia. When the triglycerides are very high and the VLDL is high, that is type 4 hyperlipidemia. High chylomicrons, high VLDL, high triglycerides, and cholesterol manifest type 5 hyperlipidemia.

Type 1 hyperlipoproteinenemia is manifested by high chylomicrons.

Secondary hyperlipoproteinemia is seen in association with several medical conditions, such as diabetes mellitus, hypothyroidism, uremia, and nephrotic syndrome, alcoholism with acute or chronic pancreatitis, ingestion of oral contraceptive, etc.

First, high triglycerides and VLDL may be evident on the skin and under the eyes as deposits (xantomas). Second, VLDL, triglycerides, and high cholesterol may be high in diabetic women who develop ketoacidosis. Third, high triglycerides, high cholesterol, diabetes mellitus, and hypertension may be present persistently in obese people (Syndrome X).

The use of birth control pills or ingestion of any estrogen-containing pills can raise the level of VLDL and triglycerides. One of the dangers of taking estrogen-containing pills is the possibility of high level of lipids. It is important to know the lipid level in a person before he or she starts taking estrogen pills. If a woman has an elevated lipid level, estrogen-containing medication may be harmful to her health by increasing the blood lipid further, predisposing her to heart attack, stroke, phlebitis, pulmonary embolism, etc.

Alcohol abuse is also associated with elevated lipids in the blood, such as triglycerides and, in particular, a high level of very-low-density lipoprotein and chylomicrons. In addition, Type 5 hyperlipidemia and sometimes Type 4 hyperlipidemia may be associated with increased alcohol abuse. Type 5 hyperlipidemia may cause acute pancreatitis, which is a very serious medical condition and if left untreated can be fatal.

Hyperlipidemia causes coronary artery disease because in a high lipid state, lipid is deposited within the lumen of coronary arteries, causing gradual narrowing of these vessels and resulting in coronary occlusive heart disease. When the vessels around the heart become narrowed, the condition called angina pectoris frequently develops. Angina pectoris is manifested by chest pain because of lack of oxygen delivery to the heart muscle.

As just stated, the pain occurs when tissue is deprived of oxygen, causing a series of substances, called kinins, to be secreted in and around that tissue, which causes the burning pain to occur. A good example of what kinins are is what one develops in a blister in one's finger or toe. If one bursts the blister right away, the liquid that forms within it causes a burning sensation to occur in the finger or toe because this liquid contains kinins.

High lipoprotein A is also associated with coronary heart disease. A high level of homocysteine level is also associated with coronary heart disease. Both these conditions are genetically transmitted and can cause thrombosis to occur anywhere in the body.

When one is having a heart attack, what happens frequently is that the clot forms acutely because of the plaque within the vessels that cracks or a fissure within the vessel that develops, resulting in the crack. The result is that bleeding occurs acutely within that vessel, causing a clot to develop. The clot closes the vessel, acutely cutting off blood flow to the part of the heart muscle for which this vessel is responsible for delivering oxygen, and the result is an acute heart attack. The muscle that is damaged may die acutely due to lack of flow of blood to that muscle.

Cardiac dysrhythmias can develop, resulting in all sorts of rhythm disturbances such as atrial arrhythmias, ventricular tachycardia and ventricular fibrillation, etc., which can lead to the death of the individual who just had the heart attack. If a person presents to the emergency room with acute chest pain and a physician administers tPA acutely to dissolve the clot based on the symptoms and the EKG findings, the death of the involved muscle can be prevented.

This can frequently result in the survival of the patient by preventing the heart attack from occurring. It is safe to say that from the time that the patient presents with the symptoms up to several hours later, in certain circumstances, the tPA can still be of value if administered.

In 2011, coronary artery disease claimed the lives of of 7.5 million people in the world and 425,425 people in the United States. There is a high rate of cardiovascular-associated deaths in people due to the following factors: Sources: WHO and CDC

1. High blood pressure

2. Obesity

3. High lipids in the blood

4. Smoking

5. Diabetes mellitus

6. Poor diet with too much fat, carbohydrates, and salt. Two-third of people is obese/overweight in the United States and obesity is a major risk factor for coronary artery disease.

7. Genetic predisposition, gender, stress, poverty, poor education, poor economic status, marital problems, raising children and caring for a family, etc.

All these factors together play a major role in the causation of an increased rate of coronary artery disease.

The following is a list of some factors that can decrease the incidence of coronary occlusive disease secondary to high lipids:

1. Maintainance of an ideal weight.

2. Regular exercise.

3. Non-abuse of alcohol.

4. A diet of plenty fruits and vegetables.

5. Preparation of foods only with vegetable oils.

6. Avoidance of butter.

7. Use of skim milk.

8. Removal of the skin from the chicken to remove as much fat as possible.

9. Use of margarine that is low in fat.

10. Avoidance of red meat as much as possible.

11. Decreased ingestion of pork, bacon, cheese, sausages, egg yolk, all foods that are too rich in fat.

12. Avoidance of too much simple carbohydrate-containing foods because simple carbohydrates are converted into fat in the liver, which ultimately results in fat deposition in the tissues in the human body resulting in obesity.

13. Decreased consumption of foods with a high sugar content such as cakes and pies.

14. Avoidance of fast foods as much as possible because they contain too many fat and simple carbohydrates.

15. Minimization of the ingestion of high cholesterol foods such as lobster, crabs, shrimps, and oysters by individuals who already have high cholesterol.

16. Avoidance of cooking foods with coconut oil because coconut is too rich in cholesterol.

17. Eating foods with high fiber, such as collard greens when prepared without ham, hocks, hock tails, and bacon. Vegetable oil, a little bit of hot sauce, and a little bit of wine make the greens taste just as good.

18. Eating foods with complex carbohydrates, such as yams, plantain, sweet potato, green bananas, and pasta. These foods are very high in cellulose which turns into fiber which is good for the body. These foods also contain good vitamins and satisfy hunger. Yet, they will not result in gain weight because the human body is not capable of breaking down complex carbohydrates. People in the underdeveloped world eat these types of food and they, by and large, do not suffer from the same degree of obesity as people in the United States. The incidence of high lipids is quite low in the underdeveloped world because a lot of vegetables and fruits are consumed instead of fast foods frequently consumed in the so-called "developed world". Fat-containing foods that are a great part of the diet in the United States and other developed countries predispose their inhabitants to all sorts of diseases such as cancer, coronary artery disease, and diabetes.

19. Using vegetable oils and olive oil that contain polyunsaturated fat in cooking.

20. Sparing use of mayonnaise which is very rich in cholesterol.

Treatments of hyperlipidemia:

The rate limiting enzyme that controls the synthesis of cholesterol in the liver is 3-Hydroxy-Methyl-glutaric—Co enzyme A (HMG-CoA). Once this enzyme is blocked, LDL receptors increase, preventing the re-absorption of cholesterol from the blood.

The medications in use to treat high cholesterol are called Statins and they include:

1. Zocor

2. Lipitor

3. Lescol

4. Mevacor

5. Crestor

6. Niacin

7. Pravastatin

8. Livalo

Some of the most important parts of the treatment of high cholesterol, high triglycerides and hyperlipidemia in general are diet, exercise and weight loss. However, once the cholesterol reaches a level at which the diet is not sufficient, then the clinical thing to do is to provide the patient with medication.

Medications in use to treat high triglycerides are:

1. Lopid (gemfibrozil)

2. Tricor (fenofibrate)

3. Cholestyramine

4. Colestipol (bile acid rasins)

5. Trilipix

6. Lipofen

The usual dose of Cholestyramine is 8-12 grams 2 or 3 times per day by mouth. The usual dose of Colestipol is 10-15 grams 2 or 3 times per day by mouth. Lopid (gemfibrozil) decreases triglycerides and VLDL (very low-density lipoprotein) and increases HDL. The usual dose of Lopid is 600 mg by mouth 2 times per day. The usual dose of Tricor is 145 mg or 43 mg daily by mouth.

The usual dose of Trilipix is 135 mg by mouth nightly and the usual dose of Lipofen is150 mg by mouth nightly.

It is important that these fat-lowering medications and, in particular, the Statin be taken one half hour after dinner every night and the reason is that fat is circadian, which means there is more fat in the blood at night. The more fat there is in the blood at the time the Statin is being taken, the better the chance of removing the most fat from the bloodstream.

It is important to realize that these medications work best when given in the evening because cholesterol works via the circadian system. That is to say, that cholesterol level is highest in the evening in the body. The usual doses of these medications are 10-20 mg a half hour after dinner nightly for Lovastatin, 10-40 mg for Provestatin, and 5-20 mg for Simvastatin. The maximum dose of Lovastatin can go as high as 80 mg daily, Provestatin as much as 40 mg and the Simvastatin as high as 40 mg. These medications are quite expensive, but they are very effective in bringing down the total cholesterol, LDL, and triglycerides and raising the HDL, thereby decreasing incidence of coronary disease and arterial occlusive disease all over the body.

All these medications, and in particular the HMG CoA reductase inhibitors, can cause mild liver function test abnormality and for that reason it is important to monitor the liver function tests every six weeks to two months. It is very important to emphasize that these medications must be used in conjunction with a low-fat, low simple-carbohydrate diet along with a good exercise program.

Another known side effect of these medications is muscle and joint pain. This occurs because of muscle breakdown and secondary inflammation. In some cases, this can lead to rhabdomyolysis, which, if not recognized quickly and treated, can lead to kidney failure. If these symptoms are persistent and severe, the medication ought to be stopped and the patient's doctor contacted.

The test to do to confirm this problem is serum CPK. When muscles are swollen, the CPK level in the blood goes up. Niacin is also a very good medication to treat high cholesterol. The usual starting dose is 500 mg at bedtime. The maximum dose of Niacin is 2000 mg at bedtime. Niacin has many side effects and prominent among them are flushing and diarrhea, etc.

Along the same line, it has been shown that drinking one or two glasses of wine at night, either red or white, with dinner, increases the level of the HDL (the good cholesterol). It is not advisable that people drink or abuse alcohol, but these studies clearly show that moderate ingestion of alcohol, in particular red wine, seems to have a significant advantage in increasing the level of the HDL cholesterol.

Diet plays a major role in the prevention of obesity and the prevention and control of hypertension. Diet also plays a major role in both preventing and controlling the levels of cholesterol and triglycerides in the blood. The so-called soul food that blacks like to eat so much is a legacy of slavery that began 500 hundred years ago in the United States.

However, soul foods have too much fat, simple carbohydrates, and salt, and are too spicy. These foods taste good, but they are unhealthy. Therefore, it is fine to eat them every now and then; but when a person eats them on a daily basis, it increases his or her chances of becoming obese and raising his and her blood pressure and cholesterol.

A combination of obesity, high blood pressure, and high level of fat in the blood is responsible in part for the high incidence of coronary artery disease and deaths of people in the United States. To prevent this high occurrence of coronary artery disease and deaths, the diet of most people must clearly be modified. Diet is very ethnic in its origin. People of different ethnic backgrounds have different tastes for different foods, and that is fine, except that one has to understand that everything has to be done in moderation.


Excerpted from ANTHOLOGY OF MEDICAL DISEASES by Valiere Alcena. Copyright © 2013 Valiere Alcena, MD., M.A.C.P.. Excerpted by permission of AuthorHouse.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

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Table of Contents




Chapter 1 High Cholesterol, 1,

Chapter 2 Obesity, 9,

Chapter 3 Diabetes Mellitus, 19,

Chapter 4 Heart Diseases, 37,

Chapter 5 Cancer, 87,

Chapter 6 Kidney Diseases, 171,

Chapter 7 Genital And Urinary Tract Diseases In Men, 194,

Chapter 8 Prostate And Bladder Diseases, 209,

Chapter 9 Gynecological And Obstetrical Diseases, 225,

Chapter 10 Gastrointestinal Diseases, 265,

Chapter 11 Sprue /Gluten Enteropathy/Celiac Disease, 291,

Chapter 12 Tropical Sprue, 295,

Chapter 13 Diarrheal Diseases/Food Poisoning, 298,

Chapter 14 Staphylococcus Gastroenteritis, 302,

Chapter 15 Ecoli Gastroenteritis, 304,

Chapter 16 Shigella Gastroenteritis, 306,

Chapter 17 Campylobacter Gastroenteritis, 308,

Chapter 18 Samonella Gastroenteritis, 312,

Chapter 19 Typhoid Fever, 316,

Chapter 20 Listeria Gastroenteritis, 319,

Chapter 21 Giardia Lamblia Gastroenteritis, 322,

Chapter 22 Cryptosporidium Gastroenteritis, 324,

Chapter 23 Entamoeba Histolytica Gastroenteritis, 327,

Chapter 24 Yersinia Enterocolitica, 330,

Chapter 25 Clostridium Difficile Diarrheal Disease/Gastroenteritis, 332,

Chapter 26 Viral Gastroenteritis, 336,

Chapter 27 Cholera, 339,

Chapter 28 Constipation, 343,

Chapter 29 Hemorrhoids, 346,

Chapter 30 Diverticulosis, 348,

Chapter 31 Diverticulitis, 350,

Chapter 32 Anemia, 353,

Chapter 33 Iron Deficiency Anemia, 362,

Chapter 34 Sickle Cell Anemia, 369,

Chapter 35 Thalassemia, 387,

Chapter 36 Autoimmune Hemolytic Anemia, 392,

Chapter 37 Nonimmune Hemolytic Anemia, 396,

Chapter 38 Cirrhosis Of The Liver And Hemolytic Anemia, 398,

Chapter 39 Thrombotic Thrombocytopinic Purpura, 399,

Chapter 40 Hereditary Spherocytosis, 401,

Chapter 41 Megaloblastic anemias, 404,

Chapter 42 Folic acid deficiency, 411,

Chapter 43 Anemia of chronic diseases/inflammatory diseases, 413,

Chapter 44 Hemochromatosis/Iron Overload, 416,

Chapter 45 Aids, 421,

Chapter 46 Osteoporosis, 449,

Chapter 47 Osteoarthritis Arthritis, 458,

Chapter 48 Rheumatoid Arthritis, 470,

Chapter 49 Systemic Lupus Erythematosus, 478,

Chapter 50 Mixed Connective Tissue Diseases/Overlap Syndrome, 486,

Chapter 51 Gout, 494,

Chapter 52 Fibromyalgia, 498,

Chapter 53 Psoriatric Arthritis, 500,

Chapter 54 Sarcoidosis, 502,

Chapter 55 Eye Diseases, 507,

Chapter 56 Hypertension, 523,

Chapter 57 Stroke, 547,

Chapter 58 Depression, 568,

Chapter 59 Alcoholism, 585,

Chapter 60 Drug Addiction, 609,

Chapter 61 Viral Hepatitis, 630,

Chapter 62 Hepatitis B, 633,

Chapter 63 Hepatitis C, 637,

Chapter 64 Cirrhosis Of The Liver, 641,

Chapter 65 The Common Cold, 645,

Chapter 66 Allergic Rhinitis (Hay Fever), 650,

Chapter 67 Influenza (The Flu), 653,

Chapter 68 Sinusitis, 656,

Chapter 69 Asthma, 660,

Chapter 70 Emphysema/Copd, 668,

Chapter 71 Pneumonia, 680,

Chapter 72 Sarcoidosis, 686,

Chapter 73 Thrombophilia, 690,

Chapter 74 Deep Vein Thrombophlebitis, 692,

Chapter 75 Pulmonary Embolism, 695,

Chapter 76 Pulmonary Hypertension, 700,

Chapter 77 Tuberculosis, 703,

Chapter 78 Malaria, 707,

Chapter 79 Dengue Fever, 710,

Chapter 80 Parasitic Infestation, 712,

Chapter 81 Tick Borne Diseases, 716,

Chapter 82 Headache And Migraine, 719,

Chapter 83 Thyroid Diseases, 732,

Chapter 84 Hyperparathyroid Disaeses, 739,

Chapter 85 Multiple Sclerosis, 743,

Chapter 86 Psoriasis, 746,

About the Author, 749,

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