Common Health Problems Workshopby Paula

"Common Health Problems, the Shelter and You" was the title of a 'Health Care for the Homeless' all day workshop held October 2. This workshop was designed to benefit homeless services workers and homeless residents by educating them about some of the more typical health problems in our community.

Included are summaries of the various workshops given that day. The information is not to be taken as medical advice. If you have one of these conditions or think you may have been exposed to a contagious disease, you should definitely get your medical advice from a doctor and not from this article.

Diabetes
The first workshop was about Diabetes presented by Dr. Keith Andrews. Diabetes mellitus means abnormal metabolism of carbohydrates (sugar and starches). There is Type 1 diabetes (shortage of insulin) and Type II (insulin resistance - more genetically related). Also related are hyperglycemia (high blood sugar), and gestational, drug related and pancreatic diseases. Insulin hormone is made by the pancreas and it pushes sugar in cells and then scoots the rest of the sugar out.
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There has been a dramatic increase in the risk of diabetes among people born in the last 10 years. Some antipsychotic drugs heighten risks. There's slightly higher risk among males compared to females. The highest risk ethnic populations in the U.S. are African-American, Hispanic, Asian, and Native American. Quitting smoking reduces risk by 50%. The most important risk factor is Obesity, higher risk among apple shaped bodies vs. pear shaped obesity.
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Those diagnosed with diabetes should have their vision and kidneys checked by the doctor regularly, and have sores checked immediately. They should guard against nerve damage and be careful with foot care, examining them daily. Their sugar levels should be carefully regulated.
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Dr. Keith Andrews

Hypertension
Dr. McKee gave a presentation on hypertension (high blood pressure), which is the result of persistent high arterial pressure. It makes it more difficult for blood to travel from the heart to major organs and can do damage to the vessels and arteries of the heart, brain, kidneys and eyes. Hypertension can cause the walls of the heart to thicken causing heart failure, strokes, vision problems, plaque, hardening of the arteries, and kidney problems.
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Blood pressure is read measuring the maximum (systolic pressure - when heart is pumping) over the minimum (diastolic pressure - when heart is resting). For example, normal blood pressure is 120/80 while 140/90 is high. Factors that increase the chance of high blood pressure are diet (high salt and/or fat intake or excess alcohol); lack of physical activities; being overweight; a family history; pregnancy, and being over the age of 40. African-Americans have an inherited higher risk; also, some psychiatric medications will raise blood pressure. Measures for controlling blood pressure are loosing weight, a diet with less fat, avoiding salt and caffeine. People with hypertension should also eat more fiber, get regular exercise, stop smoking, learn to relax, and take medications with regular medical checkups.

HIV/STDs
HIV and STDs "101" was the title of the third workshop, presented by Karen McDonald from the Dept. of Health and Human Services. Sexually transmitted diseases (STDs) are passed by transfer of infected fluids or from direct contact with a lesion, sore or infected tissue through oral, anal, and vaginal, and sometimes other contact. Sometimes STDs have symptoms and some don't. Some can be cured and some can't. The bacterial STDs are Chlamydia, Gonorrhea, Syphilis, and Trichomoniasis. (These can be cured but can re-infect). Currently, Sacramento has the second highest rate of Chlamydia in California and Gonorrhea is fourth highest rate. Viral STDs are Human Papilloma Virus (HPV), Genital Herpes, Hepatitis B and HIV.
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Human Immunodeficiency Virus (HIV) infects T cells (a type of white blood cell that fights infections). The virus reproduces very quickly, infecting more cells and impairing the immune system. It becomes AIDs when life-threatening complications occur. People get HIV from unprotected sex with an HIV positive person, sharing needles and body piercing and tattoos. Sexual transmission is highest with anal sex, but it also transmits through vaginal and oral sex if there are micro tears on the tissue. Prevention includes abstinence from sex and IV drug use (sharing needles), and using condoms or dental dams during sex (with non-oil lubrication to prevent rips). Check expiration dates on condoms, don't leave in the heat or wallet, and if put on the wrong way, throw it out and use another. Another preventive measure is to avoid alcohol and drugs because they are conducive to risky behavior. They now have a rapid test for HIV that only takes 20 minutes and you can take that test at the Clinic at 1500 C Street (this clinic allows anonymous testing). HIV tests measure the amount of antibodies, which takes 2 weeks to 6 months to appear, so HIV would not test positive if it was contracted within that period.
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Asthma
The Asthma workshop was presented by Priya Patel, the lead pharmacist with the Sacramento County DHHS Pharmacy. Asthma is the third leading cause of preventable hospitalizations in the United States (500,000 hospitalizations and 5,000 deaths a year). It is a chronic inflammatory disorder of the airways, inflaming or swelling the lining of the airways or bronchial tubes. The surrounding muscles become tight, which makes the airways narrower. It also produces a thick mucus. The exact causes are unknown, though it does run in families. Triggers are environmental conditions (such as heat or cold), allergens, irritants (such as smoke), medical conditions (such as colds), and exercise. Treatment includes infection and environmental control and medication. Drug treatment uses a quick relief inhaler and long term control (used daily and not effective for episodes already in progress). Ms. Patel demonstrated the methods for using inhalers and peak flow meters.

Hepatitis A, B & C.
'Hepa' means liver and 'itis' means inflammation (Latin medical terminology). The most common cause of hepatitis is alcohol. Although there are over 100 causes, when it is caused by a virus it is named "hepatitis" followed by the letter (such as "a", "b" or "c"). The liver filters toxics in the blood, recycles hemoglobin and makes key proteins.
Hepatitis A (HAV) is spread by putting in the mouth anything that has come in contact with stools, so washing hands is very important, though water or food can be contaminated in areas of poor sanitation. There is a vaccine for HAV or immune globulin is given after exposure.
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Hepatitis B (HBV) is transmitted through direct blood to blood contact, unprotected sex, un-sterile needles and from a women to her newborn during delivery. It is 100 times more infectious than HIV, and if a person is infectious it is determined through a blood test. Only one out of ten adults will get rid of the virus after a few months; some people who get Hepatitis B never recover. There is a vaccination for HBV and it is important for infants to get vaccinated because they may be at greater risk. There is also a treatment to prevent severe liver disease.
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Hepatitis C (HCV) is spread by blood to blood contact and can live in dry blood for up to 4 days. About 25% of Hepatitis C patients will clear the virus on their own. 41% of incarcerated people are infected with HCV. HCV is not passed through sex unless there is blood present. Sometimes there are no symptoms. There is no vaccine but treatment works for many people. To prevent infection don't share needles, don't touch anyone's blood or objects that might have blood on it, use bleach to clean blood spills and use condoms.
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Vicky Carlson, HCH Nurse