Michael Antil, M.D. |
If you are overweight, the pancreas has to work
harder. If it becomes unable to make enough insulin
to keep up, then you have diabetes.
According to Michael Antil, M.D., an internal
medicine specialist with Pinehurst Medical Clinic,
excess body fat creates a resistance to insulin.
“Your pancreas may work just fine, spitting out
plenty of insulin, but all the fat is keeping it from
getting into your muscles and doing its job,” he says.
The most serious—and not uncommon—complications
of diabetes are blindness, kidney failure,
heart attack, stroke and nerve damage that can lead
to the amputation of feet and legs.
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Lifestyle
changes—eating
healthier and
exercising—are
often the most
effective ways
to treat type 2
diabetes and to
prevent the disease
from occurring in
the first place |
In addition to the daily insulin shots that some
patients need, there are a number of medications to
treat diabetes. Some drugs stimulate the pancreas to
produce more insulin, some stimulate the muscles
to take up sugar faster, and others reduce the liver’s
production of sugar.
Lifestyle changes—eating healthier and exercising—are often the most effective ways to treat
type 2 diabetes and to prevent the disease from
occurring in the first place. A simple blood sugar test can show if someone is in the early stages of
developing diabetes.
“If they are, we can reverse that,” Dr. Antil says.
“It’s much easier to help someone prevent diabetes
than it is to deal with all the complications after the
fact.”
Are you eating your liver to death?
An increasingly common liver problem, one
that primary care physicians now see almost daily,
is called “fatty liver disease.” Overweight people
whose diets are high in fat and low in fiber can
have fat deposits in their liver that interfere with
its normal function. Too much fat can even lead to
liver failure.
“Fifteen years ago, if you saw elevated liver enzyme
numbers (in a patient’s blood test), you would
immediately suspect hepatitis,” Dr. Antil says. “Of
course, we still check for hepatitis and ask about
alcohol abuse; but more and more, the problem is
plain old fatty liver, and it’s caused by a very poor
diet and not enough exercise. If your diet is bad
enough, you can eat your liver to death.”
The treatment for fatty liver disease?
“Eat a healthier diet, exercise and lose weight,”
says Dr. Antil. “This is a problem we can catch early
and reverse by educating patients about what they
are doing to themselves. That’s one of the things I
like about primary care.”
ABCs of hepatitis
It used to be that if someone said “liver disease,”
the first thing you might have thought of was hepatitis.
Well, it’s still around and, depending on the
type, it’s still very serious.
There are three main types of infectious hepatitis,
each caused by a different virus and spread
most often through contact with blood or other
body fluids. Symptoms of all three types can
include jaundice, fever, loss of appetite, fatigue,
joint and abdominal pain, diarrhea and nausea. A
blood test is the only way to diagnose hepatitis.
Hepatitis A is the least serious form of the disease.
There is no treatment for it, but it isn’t chronic and
if you have it once you can’t get it again.
Vaccines can prevent both hepatitis A and B.
People with chronic hepatitis B infection are
at much greater risk of liver failure and liver
cancer. Certain antiviral drugs are effective in
about 40 percent of people with hepatitis B.
Most people who become infected with hepatitis
C develop chronic infection, and most of those will
have chronic liver disease. They are at especially
high risk for liver failure and cancer.
Liver failure caused by hepatitis C is the leading
reason for liver transplants.
There is no vaccine against hepatitis C. Drug
treatment can eliminate the virus in about half of
infected patients.
These stones can be galling
Gallstones are the most common problem
related to the gallbladder and bile ducts, the tiny
tubes that carry bile from the bladder to the small
intestine. The stones are composed mostly of
cholesterol and calcium salts.
No one knows exactly what causes gallstones,
but a high-fat, low-fiber diet may be a contributing
factor. As many as one in five Americans
over 40 have gallstones, but most people never
have symptoms.
Gallstones aren’t a problem unless they cause
inflammation or obstruction. If a stone becomes
lodged in the bile duct or at the point where the
duct leaves the gallbladder, it can cause severe pain.
In most cases, the stone either slips back into the
gallbladder or passes through the bile duct and into
the intestine.
A gallstone that gets stuck can cause inflammation
and infection, with symptoms that
include intense pain, fever and vomiting. The
treatment in nearly every case is surgical removal
of the gallbladder. The digestive system
usually adjusts quickly and is able to function
well without the gallbladder.
 Scott Hees, D.O.
|
Ultrasound is the primary tool for detecting
troublesome gallstones, says Scott Hees, D.O., a
radiologist at FirstHealth Richmond Memorial
Hospital.
“Ultrasound is our best means to identify
gallstones, as well as to show thickening of the
gallbladder wall or fluid around the gallbladder,
which could indicate acute inflammation,” he
says. “The common bile duct can also be evaluated
with ultrasound, but sometimes may not
be well seen due to shadows from bowel gas. In
the cases where the common bile duct cannot
be seen by ultrasound, MRI with specific sequences
designed to highlight the common bile
duct (called an MRCP or Magnetic Resonance
Cholangiopancreatography) is often used as a
non-invasive tool to better evaluate the duct for
stones, tumor or abnormal narrowing.”
| Diabetes Self-Management |
There is no cure for diabetes
and, for a lot of people
who have it, keeping it under
control isn’t easy. Depending
on the severity, it can require
frequent monitoring, precision
medication, strict dietary management
and proper exercise.
Dealing with all of that—and sticking with it—can
be a challenge, which is
why FirstHealth offers the
Diabetes Self-Management
Program.
“We have both one-on-one
counseling and group classes
to help patients understand
their diabetes,” says Melissa
Herman, R.D., a registered
dietitian and manager of
Diabetes Self-Management
Program. “Patients meet with
a nurse and a dietitian, who
assess how well they are doing.
Then we work with them to develop goals and
help them manage
their disease better.
The classes go into
a lot of detail about
self-care practices
such as meal planning,
exercise,
taking their medication
and preventing
complications.”
 It was a good lesson for
Roy Timbs, a historic interpreter
at Lee County’s House
in the Horseshoe. Timbs is
only 32, but was diagnosed
with Type 2 diabetes last
year and quickly learned that
his weight—256 pounds at
its greatest—and weakness
for soft drinks and candy
bars were a big part of his
problem.
The Diabetes Self-Management
staff convinced him to give up the sweets,
eat more sensibly,
exercise and stay
compliant with his
medications. The
result, says Phyllis
Simmons, R.N., a
certified diabetes
educator, was a
“360-degree turnaround”
in Timbs’
condition.
“We try to make patients
feel empowered so they take
responsibility for what they
do and how they do it,” she
says.
“My health in general is a
lot better,” Timbs says.
One of the biggest obstacles
to effective diabetes
management, Herman says, is
patients’ lack of understanding
that diabetes is a progressive
disease. “So, if they don’t feel bad,
they are less likely to take
the initiative to take care of
themselves,” she says. “Too
often, patients don’t get serious
about it until they start
being diagnosed with serious
complications, and many of
those complications can’t be
reversed.”
The Diabetes Self-Management
Program isn’t an alternative
to a physician’s care.
Rather, it helps patients follow
their physician’s advice.
“We also have a lot of
patients who hear about
our program and ask to be
referred,” Herman says.
For more information about
FirstHealth’s Diabetes Self-Management Program, call
255-3668 in Moore County
or toll-free (800) 364-0499. |
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