HEALTH TALK: Seven silent medical killers

Dr. Victor Emanuel MD

I think it’s fair to say that increasingly in Dominica, we are realizing that some conditions arrive without warning, and some don’t even threaten us, they just go straight ahead and kill us.  Perhaps we can just briefly discuss several of these silent conditions.


This is the type of diabetes which is also called maturity – or adult –onset diabetes, for reasons that the name suggests.  Everyone knows that this is one of the most prevalent diseases in Dominica.  Many people have it and don’t know it, but the symptoms will eventually catch up with you.


•    Extreme thirst
•    Dry mouth
•    Increased urination
•    Blurred vision
•    Weight loss
•    Eating more than usual (polyphagia)

Type 2 Diabetes is related to insulin resistance, when the body is unable to properly use insulin to control blood sugar levels. Or the pancreas may just not be producing enough insulin to deal with the level of sugar (glucose) in your blood.

Any of the symptoms above should prompt you to get your blood or urine checked, especially if you have a family history.

You will want to avoid stroke, amputations, heart attack and other complications that it poses.  Keep in mind that diabetics often get silent heart attacks – without the pain, et cetera.


•    Being overweight or obese
•    Women who developed diabetes during pregnancy
•    Family history


Let’s call this public enemy no.1 for men and women, because it is the leading cause of death in so many places, including here.

Often, the first sign is not crushing chest pain, especially for women. For them, signs may include: bloating, gastrointestinal upset, back pain, arm pain, nausea, and sweating.

When chest pain does occur, it is usually described as a very dull, achy, heaviness, like someone is sitting on your chest.

You may not have chest pain, but instead:
•    Fatigue
•    Perspiration
•    Nausea
•    Shortness of breath


•    Regular exercise
•    Eating a healthy diet
•    Avoid smoking or STOP IT.
75 mg to 150 mg of Aspirin a day can also help.


You may think that this skin cancer is confined to white people, but if memory serves me correctly, the great Robert Nester Marley had this in his toe, and it metastasized (spread) to his brain and did him in.

The thing is, people don’t look at their moles at all and even those that do don’t notice subtle changes.

It is mostly a disease of excessive exposure to the sun in lighter skinned people, but in people of African decent, melanomas may not be in sun-exposed areas.  We find them in the mouth, under the finger- or toe-nails or in the genital areas.  So check yourself monthly at home to look for irregular lesions that are growing and changing.

Look for these ABCD’s in moles:

Asymmetry of moles, where one half is different from another.
Border irregularity; the edges of melanomas are usually ragged and jagged.
Colour, because melanomas often have a variety of colours within the same mole.
Diameter, as melanomas continue to grow.


•    Avoid sun between 10:00a.m. through 4:00p.m.
•    Use a broad-spectrum sunscreen.
•    Wear a hat and clothing with a tight weave to block UV light.


I feel like a broken record talking about this.

Most people with high blood pressure don’t know it because there are usually no symptoms.  Sure, the occasional person will get a headache, or feel dizzy, but usually there is NO SYMPTOM OR SIGN.

It’s important to know that high blood pressure (hypertension) can affect children, young people and adolescents too.


The only way to tell for sure that your blood pressure is high is to have it checked.  Your blood pressure should be 119/79 or lower, according to the American Heart Association, and that is what we go by, folks.

Uncontrolled hypertension can lead to stroke, heart attack, heart failure, or kidney failure.


•    Exercise, especially aerobic, like walking.
•    Stress reduction
•    Don’t SMOKE, quit smoking, and avoid second hand smoking

If lifestyle changes don’t work, medication is the next step.  So make your choice folks, at a time when it can be made.


This is an ‘everywhere, everyone’ disease that is very common.  Yet early symptoms are so subtle that people often don’t recognize them as a problem and then once many people have established disease, they may get no outbreaks and are asymptomatic.  In fact, a large number of people who acquire herpes do so from someone who had no sign or symptom.

If you have recurring symptoms below the belt that are unexplained, you may have herpes (Herpes Simplex II). Painful, recurrent vesicular lesions that break down and leave no scar, is the key.


The best we can do is a cream or ointment for outbreaks, and a tablet for outbreaks and to keep it at bay.  There is no cure. And even when you take tablets to prevent outbreaks, you can still infect a person.

Condom use is yet again of vast importance.


Glaucoma is a painless, gradual loss of vision.  The most common type is primary open-angle glaucoma, and about half the people it affects may be unaware that they have this potentially blinding disease, because of the lack of symptoms.

It generally affects your peripheral vision, constricting it so slowly that you don’t know you’re missing it.


In glaucoma, the optic nerve is damaged.  It can be associated with elevated pressure inside the eye and can lead to visual loss.  It is the no.1 cause of visual loss in Dominica.

Early diagnosis and treatment can preserve your sight.


•    Eye drops
•    Surgery


•    Family history of glaucoma
•    African decent
•    Increasing age
•    Elevated eye pressure


As everyone knows, this is a major risk factor for heart disease, but again without symptoms.  Most people don’t know theirs is high unless they get a blood test as part of their annual physical.


For the purpose of this article, let’s tell you that there is Total Cholesterol,
Good Cholesterol (HDL) and Bad Cholesterol (LDL). LDL and total ones need to be low, the good one (HDL) needs to be high.

LDL should be less than 130. The lower the better. HDL should be 40 or higher, and total should be less than 200, the number above which heart problems start to occur. You may see ranges from the local labs which are more, shall we say, liberal, but Western and international ranges tend to be tougher. I prefer this.

Cholesterol forms plaque in your arteries supplying your heart, narrowing them and obstructing flow of blood.  Without nutrients and oxygen, heart muscles dies; heart attack is the result.


•    Eat foods low in saturated fat and cholesterol
•    Lose weight if you need to
•    Exercise

If these are not working, medicines can help.

See you next week.

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    June 15, 2012

    Thank very much Dr. for this very information. Recently I’ve been conveying this message to alot of my colleagues who if I should say are obessed and rely strickly of fast for for breakfast, lunch and dinner and who do not initiate excercise as part of their day to day activity. This is additional infor I can use to better help them and myself prolong a happier, healthier lifestyle. Thanks much.

  2. June 14, 2012

    keep up the good work DOC
    always looking foward to your column, very informative.Thanks Again.

  3. precious
    June 14, 2012

    thank you for the information Doctor Emanuel:-)

  4. Distured
    June 13, 2012

    Is it a rummor that “herbs” can assist with the treatment of glaucoma? :?:

  5. June 13, 2012

    did’t know Glaucoma and Herpes killed, is this correct info. Glaucoma takes your sight but your are still healthy and alive otherwise, as for Herpes it gives sores but I din’t know it killed you, someone explain please

  6. concerned
    June 13, 2012

    very imformative. tht’s why I make it a point of duty to read Doc Emanuel’s articles. Dominicans, Doc may keep the info coming but if we just read it and let it slide then we are in no way appreciating the Doc’s message. Act on what we learn.

    A medical student and fellow Dominican in NYC

  7. Proud Dominican
    June 13, 2012

    Broken down into terms that allow the lay man to very easily understand the content of this peice. Thank you good Doc.

  8. Grace
    June 13, 2012

    Well said Doc
    just a thought i think that we should do more outreach program espeically in the country where there are people who cannot go to town to see a doc, im just saying ,once again thanks for the infor

  9. Whale Watcher
    June 13, 2012

    Dr. Emanuel, Thanks for taking the time to educate us with this type of information. You truly care!!

    • ideal
      June 13, 2012

      I have to add my thank you for all the info, we need to listen and do all the right things, thank you again

  10. Anonymous
    June 13, 2012

    Well informed and not to difficult to understand

  11. Blessed
    June 13, 2012

    Thank you for the info…God Bless

  12. Viewpoint
    June 13, 2012

    Great stuff Doc!

  13. Anonymous
    June 13, 2012

    Thanks For the Info Doc.

  14. Anonymous
    June 13, 2012

    proper informtion

  15. Chris
    June 13, 2012

    Thanks Doc.

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