Mashkikiwinini: A health article - Just what does that mean?

By Dr. Arne Vainio
News From Indian Country 4-08

I was asked to write a health related article. I’ve been thinking hard about this, and it turns out I don’t really even know what that means. I thought all of these articles were health related. Every patient I see brings to mind issues to address, some serious, some less so. In every visit, I hope to be helpful, to try to guide health decisions and give choices that are worth making. Do I help everyone who comes to see me? Not always.

Can I help someone who chronically weighs over 250 pounds and has back and knee pain? I see this on a regular basis. I try to highlight the fact that the cartilage in our knees, hips and back does the same job as the springs in a pickup truck. If you overload the truck all the time, the springs wear out. You can get new springs or a new truck, but it turns out to be much harder with living tissue. As a people, we need to lose weight. That goes for me, too. I have been able to lose 17 pounds in the Diabetes Prevention Program at our clinic on the Fond du Lac Reservation. This was not easy, and keeping it off has proven to be as tough as losing the weight in the first place.

Can I help someone with diabetes who never checks their sugars or watches their diet? Again, this is a tough problem and one I see on a regular basis. If you’ve been following the articles to date, you know that diabetes affects every system in our bodies. Uncontrolled diabetes causes damage to nerves and blood vessels, this is the reason for foot ulcers, kidney problems and eye problems. High sugars attract bacteria and also make our immune systems not work as well. This is a setup for foot infections and eventual amputations. I watched my mother go through several amputations and a kidney transplant. She was strong and had a fighting spirit equal to any I’ve seen, but in the end it wasn’t enough. The medicines we have now were not available to her when she was first diagnosed. I really think she would still be around as a grandmother if this were the case. Checking sugars and watching your diet is a drag and a burden, but the alternative is much, much worse. I never want to see anyone follow my mother’s path.

What about someone with known heart or lung disease and an ongoing smoking habit? Cigarettes have been called coffin nails, cancer sticks and other names for a reason. Every cigarette does damage to already damaged tissue, every cigarette makes blood cells react so they don’t go through blood vessels as well. Our lungs are full of little air sacs called alveoli. These are microscopic, but are clustered like a sponge or like hollow grapes. Each alveolus has blood vessels surrounding it. The veins around an alveolus give off carbon dioxide for us to breathe out and the arteries around the alveolus pick up oxygen to carry to the rest of the body. This is really a pretty nice system. Instead of putting tobacco into our bodies, we should be putting it outside for whoever designed this system in the first place. If you were able to take those alveoli and lay them out flat, they would have a total surface area about the size of a tennis court. That’s a lot of area for air exchange. Smoking breaks down those alveoli until they’re big open holes with almost no surface area. You can see these on a chest x-ray; I see them all the time. You can never get the alveoli back, but you can prevent further damage. Preventing our kids from smoking in the first place is the best answer. Remember, they want to be just like you. If you can’t quit for you, do it for them.

What about alcohol? It’s been said that a daily glass of wine or a glass of beer is good for your heart. So it would follow that a lot of them would be better, right? Not even close. Alcohol in larger doses is a direct central nervous system depressant and is a direct poison to the heart and bone marrow. Alcohol affects a protein that takes fat out of the liver. This causes the liver to get full of fat and it actually expands at first and can be felt on an exam in the office. Blood tests for the liver will usually be elevated at this point, but not always. We really are overdesigned to withstand the damage we inflict on ourselves and we can do a lot of damage before it can be picked up.

I often tell my patients that if Henry Ford built cars that could repair themselves like we can, we would still be driving black 1920s Model A’s. With continued alcohol use, the liver starts to die off and becomes hard and scarred. This is called cirrhosis of the liver, and this damage is not repairable. What happens if you lose 10 percent of your liver function? In reality, nothing. What about another 10 percent? Again, nothing. 10 more? Nothing. In fact, we can lose about 70 percent of our liver function and still be OK. But once you get beyond that, not much can be done to avoid an unpleasant death. Where does cirrhosis fit into my family? It took my grandmother and two of my aunts. My aunt Harriet was only 27 when she died. I really don’t even remember her, I got her age by doing the math on her tombstone. Not much of a legacy, is it?

What about drugs? Meth? Cocaine? Prescription narcotic drug abuse? Again, I see this all too often. The health issues list is longer, but it’s all I had space for in a single article.

How do we stop this?

By working together. All of us. Clinic wellness and diabetes prevention programs, dieticians, exercise trainers and CD counseling are a good start. In addition, we need to get our traditional ways back, we need to honor the sacrifices of our ancestors. We need to protect and teach our children how to survive in a world full of perils our ancestors never even dreamed of. Approach an elder, any elder. Ask them about their childhood and what their parents taught them. Most important? Listen to the answer. Ask another question. We’re losing our elders every day, and their knowledge is irreplaceable. It’s getting late, but it’s not too late yet.