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M. P. Ravindra Nathan
‘WE ARE JAZZED THAT YOU ARE HERE!’
By M. P. RAVINDRA NATHAN, MD, FRCP (LONDON AND CANADA), FACP, FACC

When I told my friends that I was heading out to New Orleans for the March 24-27 annual convention of the American College of Cardiology (ACC), they warned me, “Don’t go there. They are still cleaning up, crime rate is high and there is too much pollution.” I presume they said it with good intentions, looking out for my health and welfare. But I thought, if more than half a million people lived through the worst hurricane to hit USA, the least I can do is to go encourage them in rebuilding the city, by providing a few tourist dollars.

I am glad I did.


The first banner which greets you at the New Orleans International Airport is, “We are jazzed that you are here!” I would see that many more times in other places, a catchphrase for welcome in this city. While waiting for the baggage, a group of musicians entertained us with a mini jazz concert. The amiable shuttle bus driver carrying us delegates added, “We are delighted that you are here; we were worried many of you wouldn’t show up.” Later, Steven Nissen, president of ACC, would echo the same sentiments in his opening plenary session, “Your presence means a lot to the city. We can use every little help as we try to restore New Orleans to its old glory.”

ACC convention is by far the most prestigious of all annual cardiology conventions in the world with a great international presence and registration topping more than 30,000. There are many simultaneous learning sessions, touching on recent advances in this field.

Although I am an avid fan of listening to core curriculum seminars, results of late- breaking clinical trials, discussion of new drugs and procedures for improving cardiovascular care, the symposium I specifically wanted to attend was “Katrina, Lessons Learned.” Since we are approaching hurricane season in Florida, I thought this would be useful. A joint presentation by Oschner Clinic in Baton Rouge and Cleveland Clinic, it gave snapshots of “Surviving Katrina – Pre, Post and Current realities.” The graphic power-point presentations of how the disaster unfolded, how, in spite of advanced planning, so many things went wrong and numerous lives lost, were mind-boggling. An emergency disaster team was prepared ahead of time to take care of hospitalized patients and man the emergency departments but least did they realize that they wouldn’t be going home after 24 hours, the usual pattern in most disasters.

Katrina held New Orleans hostage on Aug. 29, 2005. By early morning, water was 4 feet high and rising rapidly. For many, there was no way to escape. Hugo Mejia, a young heart failure patient waiting for cardiac transplantation, came on the stage to tell us his heart-wrenching evacuation story. He and his wife had to cut through the second-floor roof of his house with crude equipments to be saved by rescuers in a boat. Although a flotilla of boats were quickly assembled after the floodwaters surged, that was not enough to save many. About 1,600 patients from two major hospitals had to be evacuated quickly. The final statistics was staggering: Nearly 2000 lives lost, 780,000 displaced, 200,000 houses lost, 18,000 businesses perished. Only 253,000 of the displaced have returned to the city. I guess bureaucracy is the juggernaut slowing the progress.

Later I went on a tour, “Post Katrina New Orleans.” Our driver, Mike Marino, took us to the 9th Ward, the most affected parish where rebuilding efforts haven’t begun. Yes, the area looked devastated, desolate and gloomy. Skeletons of some of the beautiful houses stood here and there, vestiges of the old glory, silently telling their stories. “There is not enough manpower and resources. So, they are trying to bring workforce from Mexico and Honduras. Many from here have completely relocated, promising never to return. Isn’t that sad?” said Marino.

I asked him about the federal aid and other aspects of the recovery efforts. “We are a nation of laws. So, it wasn’t easy in the beginning. On top of that, the insurance companies won’t pay for floods, but they will pay for fire. Many houses caught fire when the generators were finally repaired and switched on and the power returned,” he said tongue-in-cheek. “The No. 1 lesson in survival,” he reminded us, “is to go and help somebody. Don’t worry about yourself, this will help you heal faster. Everybody needs everybody.” It certainly made sense.

While talking about the increase in the crime rates, he brushed it off saying, “Yes, every city has crime. Of course there is not enough food or jobs here now, so one has to be careful. But the media always exaggerate.” However, the National Guard is staying in the city till July 2007, overlooking the safety of the citizens.

Spring time in the crescent city usually means a lot of celebrations. The upscale part of the city around the World Trade Center and the 5-star hotels is already back on its feet and running. The Ernest N. Morial Convention Center, one of the biggest in the world stretching more than seven city blocks, home to the evacuees during the hurricane, is completely repaired. The French Quarter, always synonymous with jazz festivals, parades, side walk performers, delicious food vendors and a lot of gaiety, is trying to make a come back and regain the charm it had shown over the years. However, the glitter and glamour, music and dance – all were subdued; less number of tourists in the shops, fewer jazz players on the road side. The River Walk was crowded enough, but the business wasn’t brisk. The levy, which broke and exponentially compounded the floods, is still not rebuilt.

Although the general attendance was lower than expected, this was indeed a successful convention with many new arterial imaging tools to assess atherosclerosis exhibited, new drugs introduced, latest clinical trials’ results unveiled and fresh paradigms to improve risk prediction and treat heart diseases with precision presented. The future of heart patients is looking better every year. And let us hope the future of New Orleans, the first European city of USA, also will be bright. (Look for highlights of the convention in the next issue).

Cardiologist Dr. M. P. Ravindra Nathan, director of Hernando Heart Clinic in Brooksville and editor-in-chief of the AAPI Journal, lives in Brooksville.




Payal Patel
ACNE IN TEENAGERS
By PAYAL PATEL, M.D.

Acne is a common problem during the teenage years that affect about 85 percent of children, from ages 9-17 years. It occurs more commonly in boys and can range from mild to severe forms. Acne most commonly affects the face but also can occur on the neck, chest and upper back. Some children may have acne into adulthood. Acne in teenagers should not be taken lightly since it can lead to anxiety and low self-esteem.

Cause:

There are glands on our skin called the sebaceous glands, which produce an oily liquid called sebum to lubricate and protect our skin. During puberty, there is an over- stimulation of these glands caused by hormones, mainly androgens, which can lead to blockage of these glands leading to acne (whiteheads and blackheads). If bacteria called P. Acne get into the pimple, it can worsen the pimple by causing an infection leading to painful red swelling and even pus. This is called nodulocystic acne and can lead to severe scarring.

For females, menstrual cycles can improve as well as worsen acne during certain times during the month. Stress also can worsen acne. Myths related to food such as chocolate, fatty foods, sodas, etc., are dismissed as causes of acne.

Treatments:

Topical treatments such as Benzoyl Peroxide and Retinoids are available as the first line of therapy. This may be combined with topical or oral antibiotics for acne that are more inflammatory or worsening. Also available to girls is birth control pills, which help regulate the hormones and decrease the acne. Oral Isotretinoin (Accutane) is considered for acne that is nodulocystic with scarring and is used more commonly in males because of the risk of fetal malformations if used in a pregnant woman. Therefore, for girls it is important to make sure that she is not pregnant or not planning to get pregnant. Accutane is usually prescribed by a dermatologist who most likely will put a girl on birth control pills to avoid pregnancy-related risk. Other treatments such as laser, etc., are available through a dermatologist whom you can be referred to by your pediatrician.

Tips for home management:

Do wash your face once or twice daily only with an oil-free acne cleanser.

Do not let sweat drip on the forehead when exercising by using a head band to control the sweat.

Do clean your face with a gentle cleanser if you have sweat on your face from exercising or being out in the hot weather.

Do use oil-free non-comedogenic hair products, skin care products, and make up.

Don’t let your hair sit on your forehead, such as bangs or long hair that falls on the face. This will irritate the skin by rubbing the forehead and surrounding areas causing pimples.

Don’t wear tight clothing that will rub against the skin and irritate it.

Don’t scrub your face with a washcloth since this will make pimples worse.

Don’t constantly touch pimples or pick at them, which will introduce bacteria from the skin and make the pimples worse.

Don’t squeeze or try to pop a pimple because it is more likely to lead to scarring.

At the pediatrician:

Your goal as a parent is to determine how bad is your child’s acne and whether it has any impact on your child’s self-esteem. For acne that is mild, trying over-the-counter preparations may be enough. For more moderate to severe forms of acne, it is important to bring it up to the doctor to discuss the ideal management for your child. Follow-up is important for acne that does not improve or is worsening to try a different management or even consider seeing the dermatologist.

Dr. Payal Patel, a board-certified pediatrician with practice location (Lutz Pediatrics 18928 N. Dale Mabry Highway, Lutz, FL 33548) can be reached at (813) 272-0300 or (813) 909-2199 or by e-mail at payalpp@hotmail.com




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