Today was our second soccer/futsal game with the team that I help coach, San Fransico. I woke up early (8am) and took the usual combi to the shelter/orphanage. Usually with traffic it takes me an hour to get there so I plug in my iPod and listen to Coffee Break Spanish and jot notes in my a notebook.
I arrived shortly after 9 and all the boys were yelling "Gringa, gringa es aqui!" "The American is here!" The private combi/van was supposed to show up at 9:30 to take us (me, Eduardo and his wife, and the 8 boys) to the game but by 10 I was getting a little worried. The kids were starting to get restless and kick soccer balls at each other and over the orphanage wall so that they would have to tell the security guard to open the 15 foot black metal door and they could have a chance to run away. It never works and I think they lose more balls that way.
Anyway, the combi arrived and it took us another hour to get to the orphanage where we were playing (for our 11am game). Good thing I got up so early! So I live in a posh area of Lima. All of our roads are paved and our houses have roofs. The area we went to for the game was in the north of Lima. We turned off the highway onto a dirt road with lots of burning trash, super skinny dogs, bodegas (convenience stores) with gates shut, lots of street venders selling fruits and vegetables, and little three wheel buggies transporting mother's and children around the neighborhood. The brick buildings that surrounded us looked like they were never finished being built but they were and people lived there. Their clothes hung from clothes lines on the roofs and an occasional satellite dish meant someone could watch the Premier league futbol (or maybe American Football, who knows) on their TV tonight.
The orphanage walled in but once we drove inside it was much nicer than I expected based on the surrounding area. A dozen small houses with lots of grass and trees a central futsal field. We played 5 versus 5 futsal on a cement court that was about the size of a tennis court. We lost the game 3-6 after hitting the post no less than 8 times and giving up three goals on turnovers by passing back after a kick-in (John Leaney would not be happy as he always told us, "Always throw it down the line."). The kids were pretty upset but got over it once we got back in the combi and they could look at all the pretty girls on the street and drink their Coca Cola - both are a treat when you are locked inside an orphanage all the time.
In work news...
I have been very very busy working on a few data analysis projects. Not only am I learning Spanish but I'm learning Stata and SPSS syntax. AH!
On a high note, I just found out I'm going to Tumbes for a few weeks in October (after I get back from Buenos Aires with 6 American girl friends) to work on a field project there. I will be helping collect anthropomorphic measurements on children as part of an El Nino study but more importantly I am going to be learning how to set up my own project in Tumbes, work with locals on data collection, and get to know this very rural town where NO ONE will speak English (except of course for the three other gringos who are there working on pig slaughtering and chronic obstructive respiratory disease studies).
Why Tumbes? You might ask. Well a number of years ago a researcher from Peru did a great job setting up an epidemiological study on neurocystercercosis and has been collecting census information on the area. It's a great size, we have data on everyone who is born and who dies, who moves in and out, and ever have all their animals accounted for. Tumbes is located on the beach and the ocean is warm and the sun is hot. It will be nice to get out of Lima for a bit. I can't wait!
Saturday, September 26, 2009
Wednesday, September 23, 2009
Know your cardiovascular disease risk
I came across some interesting articles in my overwhelming literature search on what is known and not known about CVD in Latin America.
For busy physicians, there are four challenges in regard to a patient's CVD risk (Cooney et al. JACC 2009): 1) How do I identify people who are at increased risk of a cardiovascular event? 2) How do I weight the individual effects of all the causative risk factors when assessing a person’s risk? 3) How do I stratify that risk to determine who needs lifestyle advice and who needs additional medical therapy? 4) How do I ensure that I am not overmedicalizing those persons who are at low risk of an event?
There are various risk scoring systems that doctors use to answer these questions. The most well known is the Framingham risk score but it is unknown if it is a valid scoring system for different ethnic populations, say in Peru. That's one of my projects here.
So, do you know your CVD risk? Framingham and other risk calculators have been developed based on people who are at risk for events and emphasize secondary prevention after disease has developed. For young people (<45 year) your Framingham risk will be low unless you have a genetic profile that predisposes you to CVD (high cholesterol or triglycerides) but primary prevention and modification of risk factors at this early stage is where we have the greatest opportunity for prevention of CVD and subclinical disease. The earlier the better.
Did you know that it is recommended to exercise at least 2 hours per week? That's it. That's only 30 minutes 4 times a day or 10 minutes 2-3 times per day. How many of us actually get 2 pathetic hours per week? How much time do you spend watching the Twins or Viking (or Packers) games? How much time do you spend in your car? The elephant in the room in the healthcare reform debates is our culture of inactivity and eating poorly. Walking 2 hours per week can lower your blood pressure more than popping a pill and it can decrease your risk of CVD and stroke by 25% not to mention it can help you lose weight.
Below are current recommendations based in risk and age. See where you fit and take the first step in lowering your risk now! It may be cutting down on smoking, it may be going for a walk or a longer walk but we can all do something to lower our risk and put me out of a job! :)
For busy physicians, there are four challenges in regard to a patient's CVD risk (Cooney et al. JACC 2009): 1) How do I identify people who are at increased risk of a cardiovascular event? 2) How do I weight the individual effects of all the causative risk factors when assessing a person’s risk? 3) How do I stratify that risk to determine who needs lifestyle advice and who needs additional medical therapy? 4) How do I ensure that I am not overmedicalizing those persons who are at low risk of an event?
There are various risk scoring systems that doctors use to answer these questions. The most well known is the Framingham risk score but it is unknown if it is a valid scoring system for different ethnic populations, say in Peru. That's one of my projects here.
So, do you know your CVD risk? Framingham and other risk calculators have been developed based on people who are at risk for events and emphasize secondary prevention after disease has developed. For young people (<45 year) your Framingham risk will be low unless you have a genetic profile that predisposes you to CVD (high cholesterol or triglycerides) but primary prevention and modification of risk factors at this early stage is where we have the greatest opportunity for prevention of CVD and subclinical disease. The earlier the better.
Did you know that it is recommended to exercise at least 2 hours per week? That's it. That's only 30 minutes 4 times a day or 10 minutes 2-3 times per day. How many of us actually get 2 pathetic hours per week? How much time do you spend watching the Twins or Viking (or Packers) games? How much time do you spend in your car? The elephant in the room in the healthcare reform debates is our culture of inactivity and eating poorly. Walking 2 hours per week can lower your blood pressure more than popping a pill and it can decrease your risk of CVD and stroke by 25% not to mention it can help you lose weight.
Below are current recommendations based in risk and age. See where you fit and take the first step in lowering your risk now! It may be cutting down on smoking, it may be going for a walk or a longer walk but we can all do something to lower our risk and put me out of a job! :)
Sunday, September 20, 2009
Work update
Hola de Peru! I have been working a lot lately; lots of meetings with various people including my advisor here, Dr Jaime Miranda, the program director at NHLBI, Dr Cristina Rabadan-Diehl, and the Executive Director of UnitedHealth Group (based in MN) and former BMJ editor-in-chief, Richard Smith, and attending a conference on hypertension (in Spanish) so I'm sorry if my frequent (and fun) posts have fallen behind.
My Spanish comprehension is getting much better but I find that I talk to the gringos in English a lot and so my speaking ability is vastly behind. Unfortunately, my wonderful Spanish teacher, Rosalie, is moving to Spain to start a Master's program and is leaving me :( For one of our last classes we went to see the Cuerpo Humano (BodyWorlds) exhibit that was here and I learned a lot of medical vocabulary and taught her a thing or two about the body and diseases.
Research Projects
Here's a quick run-down of the projects I'm working on. There is a potential for this to turn into a two-year assignment as there is a lot of work to do and only one of me (and Antonio the statistician I work with) to do it.
Study 1. PREVENCION (a Spanish acronym) study looked at the prevalence of cardiovascular disease (CVD) risk factors in a cross-sectional sample of the adult population of Arequipa, the second largest city in Peru. The primary investigators are Dr Julio Chirinos and his mother Dr Josefina Medina. I got IRB approval from University of Washington last week to do data analysis and write manuscripts about the normal variance of hemodynamics in this population and specifically where prehypertensives and hypertensives fall based on healthy normotensive curves. We are using measurements from impedence cardiography (something in know little about) but need to train myself in so we can use this technology for study #2 in the spring. I hope to submit an abstract to the World Conference of Cardiology by the end of this month for the Conference in Beijing, China in June 2010.
Study 2. PERU-MIGRANT (PEru's Rural to Urban MIGRANTs) study was designed to investigate the magnitude of differences between rural-to-urban migrant and non-migrant groups in specific CVD risk factors. We will be continuing field work in Tumbes, which is near Ecuador, in the mountains region of Ayacucho, and in an urban area San Juan de Miraflores. The study was Dr Jaime Miranda's PhD work and is the basis for the NHLBI and UnitedHealth Group's Center for Excellence. We will be screening an additional 2000 people for CVD and 1000 for COPD starting in March.
Study 3. LASO (Latin America Study of Obesity) study combines over 12 databases, including the two listed above, to look at epidemiological trends in Latin America. I have not submitted a project proposal yet to LASO but if I run out of things to do with studies 1 and 2 (unlikely) then I always have this one.
My Spanish comprehension is getting much better but I find that I talk to the gringos in English a lot and so my speaking ability is vastly behind. Unfortunately, my wonderful Spanish teacher, Rosalie, is moving to Spain to start a Master's program and is leaving me :( For one of our last classes we went to see the Cuerpo Humano (BodyWorlds) exhibit that was here and I learned a lot of medical vocabulary and taught her a thing or two about the body and diseases.
Research Projects
Here's a quick run-down of the projects I'm working on. There is a potential for this to turn into a two-year assignment as there is a lot of work to do and only one of me (and Antonio the statistician I work with) to do it.
Study 1. PREVENCION (a Spanish acronym) study looked at the prevalence of cardiovascular disease (CVD) risk factors in a cross-sectional sample of the adult population of Arequipa, the second largest city in Peru. The primary investigators are Dr Julio Chirinos and his mother Dr Josefina Medina. I got IRB approval from University of Washington last week to do data analysis and write manuscripts about the normal variance of hemodynamics in this population and specifically where prehypertensives and hypertensives fall based on healthy normotensive curves. We are using measurements from impedence cardiography (something in know little about) but need to train myself in so we can use this technology for study #2 in the spring. I hope to submit an abstract to the World Conference of Cardiology by the end of this month for the Conference in Beijing, China in June 2010.
Study 2. PERU-MIGRANT (PEru's Rural to Urban MIGRANTs) study was designed to investigate the magnitude of differences between rural-to-urban migrant and non-migrant groups in specific CVD risk factors. We will be continuing field work in Tumbes, which is near Ecuador, in the mountains region of Ayacucho, and in an urban area San Juan de Miraflores. The study was Dr Jaime Miranda's PhD work and is the basis for the NHLBI and UnitedHealth Group's Center for Excellence. We will be screening an additional 2000 people for CVD and 1000 for COPD starting in March.
Study 3. LASO (Latin America Study of Obesity) study combines over 12 databases, including the two listed above, to look at epidemiological trends in Latin America. I have not submitted a project proposal yet to LASO but if I run out of things to do with studies 1 and 2 (unlikely) then I always have this one.
Tuesday, September 15, 2009
Dr. Katherine Luke
This was an email I received a few days ago about a wonderful person who I've only met twice but will remember always for her bright smile and amazing personality. She was recently diagnosed with a rare form of breast cancer - the same terrible form that my dear friend and former soccer coach's wife, Carrie Leaney, also suffered from. Katherine will be dearly missed by many as a friend, mother, and wife but her spirit will live on in her memories and through her beautiful children. If you so desire, please consider contributing to her children's educational trust fund.
-
Dr. Katherine Luke, a graduate of Macalester College and a recent PhD in the Joint Doctoral Program in Social Work and Sociology at the University of Michigan, passed away unexpectedly on the morning of Saturday, September 12. Katherine shone personally and intellectually, leaving an indelible mark in the hearts of the many friends and colleagues who loved, respected, and admired her.
Two weeks ago, Katherine was diagnosed with inflammatory breast cancer, an aggressive and rare cancer. After finding out the cancer was quite advanced and had metastasized to other organs, Katherine began chemotherapy on Friday, September 11. This Saturday morning, Katherine passed away.
A memorial service and celebration of Katherine’s life will be held at the First Unitarian Universalist Congregation in Ann Arbor today, September 15th, at 2pm. All are welcome to attend to honor our amazing friend. The First Unitarian Universalist Congregation is located at 4001 Ann Arbor Saline Road in Ann Arbor, MI, 48103.
Anyone who had the opportunity to know Katherine knows that her children, Nicholas and Alexandra, were the absolute light of her life. Her husband Michael Pryplesh, mother Ginger Luke, and stepfather Don Cherry, have communicated to us that the best way to honor Katherine would be to create a loving network of support for her children—showing them how much they are loved and valued every day of their lives—not just today, but tomorrow, in five years, and when they’re twenty or thirty years old.
Future logistics for continued day-to-day support for the family will come in part via the Helping Hands site: Helping Hands. You can register on the site to receive updates as they become available on ways in which help can be provided.
If you have any photographs of Katherine, the family has asked that you please post them to the website above (or email them to zakiyal@umich.edu) so that that they may be included in the service.
In lieu of flowers, the family requests that donations be made to an educational trust fund established for Katherine and Mike’s two children, Nicky and Ali.
Donations to this fund can be made via check to: Ginger Luke and Don Cherry, 5202 Bradley Blvd., 5202 Bradley Blvd., Bethesda, MD, 20814.
Your love, support, and prayers for Mike, Nicky, Ali, Ginger, and Don during this terrible time, are greatly appreciated,
Sincerely,
The friends and family of the Luke-Pryplesh Clan
Tuesday, September 08, 2009
Arequipa and La Punta
Arequipa
A view of the main plaza in Arequipa with the Cathedral lit up at night.
Romina and I flew to Arequipa in the Southern Highlands of Peru on Friday in order to meet with Dr. Josefina Medina, a cardiologist and the principal investigator on the PREVENCION study. We departed the plane with a view of the full moon rising over the picturesque and dormant volcano, Misti. Dr. Medina is the sweetest Arequipenan woman that I have ever met and was very excited to show me all the technology that she has in her cardiology office. Thank goodness for Romina, my friend and translator, as my Spanish is improving but not sufficient to understand scientific meeting by myself. I was very impressed by Dr. Medina’s computer skills and by the wide array of cardiovascular prevention techniques that she uses in her clinic, including echocardiography, arterial pulse wave, sphygmography, and others.
La Punta
After our meeting we took a taxi on a winding mountain road with sheer cliffs down past Mollendo to La Punta, a small town on the beach where Romina’s family is from. We stayed at the Punta del Sur, the largest building in town besides the church. It didn’t take long for the gringos to become the talk of the town. Her uncle is a very prominent figure in the town and owns a lot of farm land and recently built the very nice hotel with solar panels for hot water which was a big bonus.
He drove us around in the back of his Toyota pickup truck up to the giant “Jesus Blanco” for a panoramic view of the beach and fertile green valley.
It was a stark contrast to the desert and dry brown mountains that we drove along.
Then, he took us along the beach and through his never-ending farms where he employs over 70 women to pick crops. Rice is his biggest crop and a close second are artichokes (photo below) since the value of sugar cane has dropped recently and export demands for artichokes have soared in the past few years. Next time you eat an artichoke heart, look at where it came from.
Next we went to the chicken coop where he keeps his prized roosters for cock fights.
There was even a cock ring where he trains these beautiful birds.
Photo of Josh and Tio (uncle) with the beautiful roosters.
Then he drove us through the valley to his prized possession – his bull. At nearly one ton it is an impressive animal and surprisingly friendly. He gave us kisses and let us rub his nose.
Later we went to lunch at this delicious restaurant with great views of the valley and river running though it where they catch fresh fish and crawfish. It was delicious until all of the gringos got sick the next day in which case I can only assume it was lunch.
Back to Arequipa
We returned to Arequipa and toured the city during the day. Since it is 7,800ft (2300m) above sea level, we undoubtedly felt a little altitude sickness upon our return and didn’t sleep much.
The city is nestled in the valley between towering, snow-capped mountains and it’s beautiful! The sky is always blue, the sun is always shining, the roof dogs are always barking, and the neighbor’s roosters are waking you up at sunrise. It’s weather and topography are similar to Arizona and nearby are the two deepest canyons in the world - Colca and Cotahuasi – that I will hike by the end of this year.
This colonial city is build of white volcanic rock, called sillar, and has largely withheld the test of time and numerous earthquakes. The Catedral de Arequipa is the largest building in town and forms one side of the popular Plaza de Armas. It was built in the 1544 and was reconstructed in 1844 after suffering much damage from fires and earthquakes. Recently, in 2001, a cathedral tower fell after a earthquake but has been restored. The streets are narrow and many are for pedestrians only and are lined with small tiendas (stores), cafes, and restaurants, while other restaurants have balconies that overlook the Catedral, Plaza and its central fountain.
Nearby is the Monastario de Santa Catalina (St. Catherine‘s Convent) that was established in 1580 shortly after the Spanish conquest. My proper name is Catherine Ann, after my great grandmother Catherine Youngquist and I believe she was named after this saint. I might start telling people my name is Catalina since when I say “Katie” everyone says “Que?” since it’s not a common name here.
At its peak, over 200 nuns and their servants lived in this city and since the nuns took vows of isolation it because a city-within-a-city. Currently 20 nuns still reside in a private part of the convent and the rest has been open to the public for 40 years. The narrow streets are beautifully painted with reds, blues, and whites, and flowers and fruit trees line the courtyards and streets. The nuns are famous for their baking and I enjoyed a delicious alfadore in the café after wandering this tranquil little city for over an hour.
I met my friends for another delicious meal at Tradicion – rocotta rellena (stuffed red peppers) and queso helado (yummy fresh ice cream) while a very talented band played traditional Peruvian music.
On our last night there were fireworks on this large bamboo structure in the main plaza but before the lit the big structure a man holding a bamboo toy on a stick with fireworks was in the street. My friend Jenni got caught on fire from sparks flying.
Romina and I about to board the plane back to Lima after a wonderful long weekend. I miss it already!
A view of the main plaza in Arequipa with the Cathedral lit up at night.
Romina and I flew to Arequipa in the Southern Highlands of Peru on Friday in order to meet with Dr. Josefina Medina, a cardiologist and the principal investigator on the PREVENCION study. We departed the plane with a view of the full moon rising over the picturesque and dormant volcano, Misti. Dr. Medina is the sweetest Arequipenan woman that I have ever met and was very excited to show me all the technology that she has in her cardiology office. Thank goodness for Romina, my friend and translator, as my Spanish is improving but not sufficient to understand scientific meeting by myself. I was very impressed by Dr. Medina’s computer skills and by the wide array of cardiovascular prevention techniques that she uses in her clinic, including echocardiography, arterial pulse wave, sphygmography, and others.
La Punta
After our meeting we took a taxi on a winding mountain road with sheer cliffs down past Mollendo to La Punta, a small town on the beach where Romina’s family is from. We stayed at the Punta del Sur, the largest building in town besides the church. It didn’t take long for the gringos to become the talk of the town. Her uncle is a very prominent figure in the town and owns a lot of farm land and recently built the very nice hotel with solar panels for hot water which was a big bonus.
He drove us around in the back of his Toyota pickup truck up to the giant “Jesus Blanco” for a panoramic view of the beach and fertile green valley. It was a stark contrast to the desert and dry brown mountains that we drove along.
Then, he took us along the beach and through his never-ending farms where he employs over 70 women to pick crops. Rice is his biggest crop and a close second are artichokes (photo below) since the value of sugar cane has dropped recently and export demands for artichokes have soared in the past few years. Next time you eat an artichoke heart, look at where it came from.
Next we went to the chicken coop where he keeps his prized roosters for cock fights.
There was even a cock ring where he trains these beautiful birds.
Photo of Josh and Tio (uncle) with the beautiful roosters.
Then he drove us through the valley to his prized possession – his bull. At nearly one ton it is an impressive animal and surprisingly friendly. He gave us kisses and let us rub his nose.
Later we went to lunch at this delicious restaurant with great views of the valley and river running though it where they catch fresh fish and crawfish. It was delicious until all of the gringos got sick the next day in which case I can only assume it was lunch.
Back to Arequipa
We returned to Arequipa and toured the city during the day. Since it is 7,800ft (2300m) above sea level, we undoubtedly felt a little altitude sickness upon our return and didn’t sleep much.
The city is nestled in the valley between towering, snow-capped mountains and it’s beautiful! The sky is always blue, the sun is always shining, the roof dogs are always barking, and the neighbor’s roosters are waking you up at sunrise. It’s weather and topography are similar to Arizona and nearby are the two deepest canyons in the world - Colca and Cotahuasi – that I will hike by the end of this year.
This colonial city is build of white volcanic rock, called sillar, and has largely withheld the test of time and numerous earthquakes. The Catedral de Arequipa is the largest building in town and forms one side of the popular Plaza de Armas. It was built in the 1544 and was reconstructed in 1844 after suffering much damage from fires and earthquakes. Recently, in 2001, a cathedral tower fell after a earthquake but has been restored. The streets are narrow and many are for pedestrians only and are lined with small tiendas (stores), cafes, and restaurants, while other restaurants have balconies that overlook the Catedral, Plaza and its central fountain.
Nearby is the Monastario de Santa Catalina (St. Catherine‘s Convent) that was established in 1580 shortly after the Spanish conquest. My proper name is Catherine Ann, after my great grandmother Catherine Youngquist and I believe she was named after this saint. I might start telling people my name is Catalina since when I say “Katie” everyone says “Que?” since it’s not a common name here.
At its peak, over 200 nuns and their servants lived in this city and since the nuns took vows of isolation it because a city-within-a-city. Currently 20 nuns still reside in a private part of the convent and the rest has been open to the public for 40 years. The narrow streets are beautifully painted with reds, blues, and whites, and flowers and fruit trees line the courtyards and streets. The nuns are famous for their baking and I enjoyed a delicious alfadore in the café after wandering this tranquil little city for over an hour.
I met my friends for another delicious meal at Tradicion – rocotta rellena (stuffed red peppers) and queso helado (yummy fresh ice cream) while a very talented band played traditional Peruvian music. 
On our last night there were fireworks on this large bamboo structure in the main plaza but before the lit the big structure a man holding a bamboo toy on a stick with fireworks was in the street. My friend Jenni got caught on fire from sparks flying.
Romina and I about to board the plane back to Lima after a wonderful long weekend. I miss it already!
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