Venis T. Wilder, MD

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The Health Impact of Gentrification

Introduction

There is an observed shift occurring in many of our inner cities where traditionally African-American and Hispanic neighborhoods are becoming whiter and wealthier. In Harlem, New York City (NYC), the population of blacks from 2000 to 2010 decreased by approximately 15,000, while the population of whites increased by approximately 10,000, and the median income of the area has increased by 6% [1,2].

Traditionally, gentrification has been discussed using the lens of sociology, urban planning, and geography, as opposed to public health [3]. The economic and social effects of gentrification have been well documented, [4] but there has not been much research reporting the direct health implications of these neighborhood level changes. In this paper, we explore what is currently known in the literature about gentrification and its impact on health.

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Healing or Harassment: Is it OK to Hug a Patient?

Editor's Note: We asked our new physician bloggers to answer the same question.

Venis T Wilder, MD, New York - "Compassion and Connection I often don't have to write a prescription for stress, anxiety or abdominal pain because I have already figured out and provided the desired "treatment" to the patient during the visit. Sometimes all people want is to be heard, to be seen or to be touched by another human. The decision to touch or hug takes a certain level of discernment by the physician. This skill is often referred to as emotional intelligence, and it can enhance one's ability to read the emotional energy of another human being and determine whether touch is appropriate, warranted and welcome. From this information-gathering, a physician can determine whether there are any potential conflicts (such as age, gender, culture, familiarity level, etc.) that would increase the chance that an innocent physical representation of kindness could be misinterpreted. I recently had distinctly different encounters with two male patients on the same day. One patient was upset about a miscarriage he and his wife had just experienced. I opened my arms, and he stepped into my embrace, looking for comfort. An hour later, another patient seemed uncomfortable simply by my proximity to him during a physical exam. His comments of discomfort during his skin examination, referencing the current climate of sexual misconduct allegations, further confirmed my intuition. This is a patient I would likely never hug. It is true that each individual's ability to read people and read situations can vary greatly. Therefore, if unsure, the best thing for a physician to do is to ask the patient for permission. This authentic inquiry can itself demonstrate empathy, compassion and connection. https://www.aafp.org/news/blogs/freshperspectives/entry/20180226fp-hugs.html

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The City Doc has more in common with a rural doc than you know. Read on to find out the similarities in practicing family medicine in the inner city or a small town... http://www.aafp.org/news/blogs/freshperspectives/entry/20171205fp-urbanrural.html

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The City Doc Makeup Video - YouTube

What's in your makeup? Watch my interview with the founder of Sovereignty Beauty , Nethania Abraham, to discuss the ingredients to look for in your makeup

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The CDC reports that some groups at high risk of HIV infection are still not getting tested as often as they should (at least yearly):

29% of men who have sex with men 42% of intravenous drugs users 59% of heterosexual women and men (but especially men as they are less likely to go to the doctor)

For more information click on this link: https://www.cdc.gov/vitalsigns/hiv-testing/index.html

- Venis T. Wilder, M.D. 

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Asthma in the fall

With the falling of the leaves comes the cold weather and the change of season. This is also a time where asthma attacks are more common.  

Asthma is a disease that affects the lungs and can make it hard to take deep breaths. The airways get smaller because of more mucus and swelling.  Also, the muscle in the airways can get tighter.  Because of these changes, less air can get through.  

There are some things – triggers- that can make asthma worse. Some of the most common triggers at this time of year include: cold weather, pollen, and colds (viruses).  Ragweed and mold are common triggers during the fall.

Here are some tips to help avoid having an asthma attack this season:

1. Keep warm.  Make sure you are bundled up to avoid colds and cold air. Putting a scarf over the nose or mouth can help stop cold air from coming into the airways.  

2. Wash clothes worn outside. This is to get rid of the pollen that may stick to clothing throughout the day.  If you notice there is an allergy to the environment,  try to limit the time spent outside.

3. Wash your hands. Cut down on getting a virus by using soap and water or hand sanitizer.

4. Get the flu shot. A virus like flu or even a common cold can result in an asthma attack. Taking the flu shot can help avoid the life-threatening complications of asthma.

5. Take controller medications. There are two types of asthma medications.  The rescue inhaler (albuterol) is used by all people with asthma when they feel short of breath. To prevent frequent asthma attacks, some doctors give patients a medicine to take every day.   These can be inhaled steroids like Flovent or Advair.  Sometimes pills like Singular are given to control asthma made worse with allergies. These medications work, but they can only work if taken consistently.  

If there are any further questions, please contact your doctor.

- The City Doc: Venis T. Wilder, M.D.

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Could Better Coping Skills Curb Rampant Drug Use?

A record number of Americans died of drug overdoses in 2015. Venis Wilder, M.D., ponders how family physicians can help in the latest Fresh Perspectives blog post. http://www.aafp.org/news/blogs/freshperspectives/entry/20171030fp-coping.html

- The City Doc: Venis T. Wilder, M.D.

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My condolences to those affected by the tragic event in Las Vegas, Nevada. Let's find a way to stop the senseless loss of innocent lives...

On an average day 93 Americans are killed with a guns. For every one person killed with guns, two more are injured. America's gun homicide rate is more than 25 times the average of other high-income countries (source: https://everytownresearch.org )

- The City Doc: Venis T. Wilder, MD

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My heart goes out to all of the families affected by Hurricane Harvey in Texas and the rest of the Gulf Coast.  In the aftermath of a hurricane or flood, it is important to take precautions to avoid disease.  Here are some things to do/know:

Keep your hands clean -  Disease outbreaks such as cholera and typhoid are not common in the United States, but other viruses and bacteria can be quickly spread by standing water and less than sanitary conditions.  Therefore, wash your hands frequently (if clean water is available) or use hand sanitizer regularly.

Stay hydrated - Make sure to drink a lot of water (bottled water preferred), especially if you develop diarrhea or an upset stomach. Pedialyte, gatorade, and other oral rehydration solutions can also be helpful.

Pack your medications - This is something that should have been done prior to the emergency, however if you are leaving your home, make sure to pack the medications that you take on a daily basis.  Ain’t nobody got time for more stress!

Use mosquito repellant - Mosquitos can carry disease too, and they love standing water! Therefore, make sure to spray you and your family down consistently.

Throw all spoiled food away - Remember that in power outages, food can become spoiled and not get the refrigeration needed to avoid bacteria from growing. This can be a terrible stomachache waiting to happen.  Avoid it.

Watch out for mold and mildew - Water damage can lead to the growth of mold and mildew that can lead to breathing problems.  This can be especially dangerous for people with asthma or other chronic lung conditions.  It may be best to throw out water-damaged goods, and have your home thoroughly dried out and inspected before moving back in.  

Avoid carbon monoxide poisoning - Don’t forget that alternative forms of energy, like a generator, need to have the fumes deposited outside, not inside.  Make sure you protect your family from this colorless and odorless gas. Also, know the national Poison Control Center # which is 1-800-222-1222.

Seek help - A hurricane is a VERY stressful event.  This can trigger anxiety or feelings of loss of control.  Reach out to your support system to get help in any way that you may need.  There are many people that are waiting to help!

- The City Doc: Venis T. Wilder, MD

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Venis Wilder, M.D., New York, N.Y.

I have not encountered overt racism in my career as a physician. However, I have encountered countless small slights from patients who are not accustomed to a young female physician of color. This has included subtle slights from people of all races, including my own. Unfortunately, systematic racism is powerful like that.

In the office and hospital settings, I have repeatedly encountered raised eyebrows, strained "good for you" comments and coldness that have all added up to a difficult-to-combat, insidious prejudice. It is hard to openly confront these microaggressions because, as the doctor, I could appear combative or confrontational for something seemingly ambivalent but packed with inference. A raised eyebrow suggests there is surprise or a question about my ability. A "good for you" is an unexpected affirmation of my credentials as a physician, as if it were impossible for a black woman to achieve this level of training. And coldness often replaces blatant verbal disrespect because the other is just too obvious.

All of this presents a power struggle that has already been inserted into the room before the true medical interaction begins. It is an unnecessary energy that does not serve the patient or their well-being, and it continues to poison the people of America, preventing us from reaching our highest level of health. It's time to openly address this illness of racism and find a cure for its total eradication. It is literally killing us as we wait.  

- The City Doc

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Seen At 11: From Aches To Anxiety, Practitioners Claim ‘Crystal Light Therapy’ Can Cure What Ails You

From aches and pains to stress and anxiety, could colored lights and cut crystals help cure what ails you?

Watch The City Doc: Venis T. Wilder, MD on CBS News

The City Doc weighs in on ‘Crystal Light Therapy’

“I actually do see it as an adjunct. Someone who is interested learning more or doing more with their energy, or thinking about healing in a different way,”

But she cautioned that the treatment is not for everyone.“There are some things that medications are needed or other types of treatment that is not provided by this type of therapy, so I would check with your doctor first,”

The City Doc: Venis T. Wilder, MD

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The Basic 4#’s of Wellness:

Your Body Mass Index (BMI)

Your Bad Cholesterol (LDL)

Your Sugar (Hemoglobin A1c)

Your Blood pressure (BP)

The BMI is a measurement of your weight to height.  It gives you an idea if you have enough or too much extra fat on your body.  If your BMI > 30, it suggests you are obese.

The LDL is a type of cholesterol that can cause heart disease if there is too much in your body.  If your LDL > 100, consider making some changes to your diet.

Your Hemoglobin A1c is a measurement of how high the sugar in your blood has been in the last 3 months.  If it is high, it can mean you have diabetes or are at risk of having it.  If your Hemoglobin A1c > 6.5, it suggests you have diabetes.

Your BP is a measurement of the pressure in your blood vessels.  If it is too high, it means your heart and other organs have to work harder.  If your BP > 140/90, you may have high blood pressure.

Please consult with your doctor about any of the above numbers in regards to your personal health.

- The City Doc: Venis T. Wilder, MD

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Food insecurity

Food insecurity is associated with some of the most costly and serious health problems in the U.S.  It is a major social determinant of health.

1 out of 6 US households meet the US Department of Agriculture (USDA) definition of a food-insecure household, one in which “access to adequate food is limited by a lack of money or other resources.”

For both kids and adults it can lead to :

Obesity

High blood pressure

Diabetes

Low birth weight

Developmental risk

Poor educational outcomes

Household food insecurity is a strong predictor of higher health care utilization and increased health care costs. Health-related costs of hunger and food insecurity in U.S. in 2014 equaled $160 billion.

Federal nutrition programs (WIC,SNAP, good nutrition programs) are key health interventions and provide support for those experiencing food insecurity or those at-risk for food insecurity.

In 2015, the American Academy of Family Physicians approved a policy to "Promote Food Security for All Children," which addresses the fact that one out of every five U.S. children lacks access to enough food.

Family physicians like pediatricians play an essential role in the recognition of food insecurity, practice-level intervention, and advocacy to decrease food insecurity within our communities.

Dr. Wilder brought forth a resolution to the New York State Academy of Family Physicians in June 2017 to encourage screening and support of such services. It was passed.

She will be taking this to the National Family Medicine Assembly in September.

- The City Doc: Venis T. Wilder, MD

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BIRTH CONTROL

First things, FIRST.  All forms of birth control are not made for every woman.

Do you have a health condition that prevents you from being on certain types or ALL birth control?   Such as Migraines, High Blood Pressure, a History of blood clots, Autoimmune Disease (lupus), etc.

Do you have a family history that increases your risk of having complications?

             Talk to your doctor about your particular options.

GENERAL OPTIONS

Things that studies show don’t work consistently:

Abstinence

Withdrawal (”pulling out”)

Rhythm method

Condoms

More effective options:

Combined oral contraceptive pills (OCPS) or progestin-only pills – Quick start method recommended - which means start as soon as you get the birth control from the pharmacy!

Patch

Nuvaring

Depoprovera (note: shown to cause approx. a 5-7lb weight gain in young black women)

Implanon/Nexplanon

IUD – Progestin IUDs (hormones) vs. Paragard (non-hormonal) – prevents pregnancy > 99% of the time    

Mirena, Skyla, Liletta – has an active hormone which is progestin – can last 3-7 years – side effects: can have spotting, or no periods

Paragard – made of copper – can last 10-12 years – side effects: heavier periods, cramping

Emergency contraception: Plan B – use immediately, up to 5 days after unprotected intercourse. Don’t need a prescription.  If overweight, there is another form called Ella that should be used instead. 

- The City Doc: Venis T. Wilder, MD

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HEALTH TIPS for the Young Woman

Maintain a healthy body mass index (BMI). This decreases risk of chronic diseases and helps maintain a healthy hormonal balance.  Think of your body as a car or cart - how much harder does it have to work if you have extra content on it weighing you down.

Eat Right & Sleep Well & Avoid Toxins. Provide your body with good fuel – water, rest, good food to get the micronutrients you need to have your organs function at top function and you give your body the time and tools to heal itself. Also think about what you are feeding your body - think of food and sleep as medicine. Stay away from drugs, excessive alcohol or tobacco.

Get screened early for illnesses that run in the family. If any diseases run in the family (autoimmune diseases, cancers, heart disease, diabetes, thyroid), tell your doctor so that early screening can be properly initiated.

Safe sex - Condoms and Contraception - Sex and reproduction is a natural part of life…. Have it safely.  Use condoms.  Get checked for STDs annually - HIV, Gonorrhea/Chlamydia.  If you are not interested in becoming pregnant, take the necessary precautions to ensure it doesn’t happen.  If interested in becoming pregnant, take folic acid.

Prevent Human papillomavirus (HPV)- Gardasil vaccine is safe. Recommended from ages 9-26 for everyone including men to prevent transmission of high-risk strains of HPV, which can cause cervical cancer, anal cancer, and genital warts.  Have pap smears to screen for cervical cancer at regular 3-5 year screening guidelines.

Note about chlamydia:  If untreated, it can lead to pelvic inflammatory disease and/or infertility.

Note about cervical cancer:  It disproportionately affects black women, who die of it at rates higher than other communities because of not being routinely screened.

- The City Doc: Venis T. Wilder, MD

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FINDING AND CONNECTING TO YOUR DOCTOR

After going to the pediatrician year after year, there is a decline in young people that consistently go to the doctor. 

It is important to find a doctor you:

relate to

trust

feel comfortable with

feel listened to by

is interested in getting to know you as a person and desire to understand your values

you can build a relationship with to build continuity

How do you find this doctor?

Word of mouth

Insurance carriers - they provide a list of doctors in the network that you can search for by location

Zocdoc - another database of available doctors and appointments. Sometimes doctors may have closed panels... meaning they have reached capacity

BEWARE of the Urgent care:

Use appropriately for acute problems

Doesn't provide the continuity needed - go once (maybe twice) --- but after that you should be looking for a primary care doctor.

What kind of doctor should I have?  

These are the options (Typically choose 1):

Pediatrician - sees kids typically up to age 21

Family medicine - can see everyone in the family and also usually does basic women’s health

Internal medicine -  does primary care for only adults (typically 18+)

OB/GYN - women’s health (including reproductive health and pregnancy care)

Specialist - appropriate only for a particular problem that is beyond the knowledge or expertise of your primary care doctor 

What should I expect from my doctor’s visit?

To be asked questions about acute complaints

To discuss medical history of self and family

To speak about risk factors - alcohol, drugs, smoking, sex

Preventative Health - Vaccines, pap smears

Lab test (if applicable, not always needed)

- The City Doc: Venis T. Wilder, MD