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The Dental Surgeon Living With Sickle Cell (2)
Last week, we read the story of dental surgeon Agboola and today we will be concluding his story. I am sure that a lot of you who read his story last week would have celebrated him. This week, he delves more into some of the struggles he faced because of Sickle Cell. Let's continue his story and find out how he persevered through it all.
Even though I didn't get any prize eventually, and even though I had four resit exams before I graduated, I stayed dogged, consistent, resilient, focused, determined, and persistent amidst those trials before I was qualified to carry that bag that contained the noble degree in Dental Surgery. I was glad and still am.
On my induction day, Mum had to shout "Jesus" (in utmost joy which wasn't explainable with words) as I swore the Hippocratic oath and as I was officially confirmed, publicised, and pronounced Dr. Agboola Emmanuel Tobiloba in the hall. I almost teared up on that day too! However, the journey was not easy.
The story was that of hopelessness, despair, deep depressive moments, and red teary eyes from a heartbreak. A few months before my induction, I had pulmonary tuberculosis (the 24th complication of sickle cell disease I suffered from) and I was diagnosed with some mental health conditions.
I was admitted for 16 days and was placed on analgesics, antibiotics, antidepressants, anti-insomnia, and anti-tuberculosis all in just one hospital admission! My girlfriend whom I intended to marry deserted me in these 16 days of hospital admission! In this state of despair, my final year examination in restorative dentistry was staring at me!
My mum bathed me as a grown-up because I couldn't stand to bathe myself during any severe bone pain sickle cell crisis (VOC). I'd sit on a stool till bathing is finished! I had my siblings and parents, massage my limbs, or body parts where I had these crises on several occasions.
I recall my classmates and dad copied my school notes for me during my secondary school days because Vaso Occlusive Crises (VOC) made me miss school. I was refused admission into the University of Ibadan until my third attempt at writing the University Matriculation Examination (UME), because my marks didn't hit the cut-off of my choice course and my Chemistry result was withheld by WAEC.
On my third attempt, I was temporarily discharged from a hospital admission so I could attend my post-UME interview. A cannula was beneath the sleeve of the shirt and suit I wore that day. I went right back to the hospital bed after my interview. I was discharged a few days later, and I passed my interview. I remember failing four solid courses (Surgery, Pharmacology, Child Oral Health, and Restorative Dentistry) in the university and had resits in these courses, all written just after four different hospital admissions respectively and yet I didn't repeat any class.
In all these seemingly insurmountable die minute brutality, I emerged a dental surgeon! I made tons of friends during this 16-day hospital admission who graced the reception where I was celebrated. It was my turn to be the legend, whose success was to be coveted by junior colleagues that came to celebrate with me. I have long-term memories that I will not forget because of Sickle cell. Yes, I am now a dental surgeon but being admitted into university was an ordeal, to say the least.
Pharmacology resit test was brought to me on the hospital bed, but I refused it. I almost made the university management know officially that I'll quit writing the resit exam in Pharmacology (because I was just discharged from the hospital, and I was not prepared for the resit).
In my line of study, failing a resit exam means repeating the class. A lecturer in this same course who knew I was admitted, encouraged me to go for the exam. I heeded her counsel, wrote the exam and I passed! I had families who supported me with foodstuff, cooked food, cash, and free rides to school (UCH) during my undergraduate years. I am immensely grateful to them.
I would like to encourage other sickle cell patients out there. You are not defined by your experiences in life: ill-health, joblessness, poverty, barrenness, addictions, shackles, expensive mistakes and blunders you may have made, or wrong decisions you have made, and most especially what people call you or say about you.
When there's a strong will to succeed, there'll always be a way out, regardless of the challenges you are going through. Do not give up. Because I didn't give up, and because I experienced a first-hand miracle (breakthrough antidepressants). I presently work at the Federal Medical Centre Makurdi despite all odds and I'm five years and four months old in my profession.
Today, I have practised as a dental surgeon for over five years because I never gave up! I recently got a collaboration offer with an India-based health institution to facilitate how Nigerian Sickle cell patients will benefit from bone marrow transplants at a very affordable rate in India.
Someday, I'll be preparing for some professional exams to get me registered with the General Dental Council in the United Kingdom. I hope to be in the United States someday too, for studies because I will not give up.
If you would like to reach out to the dental surgeon whose story was just shared, kindly message him via his WhatsApp line: +2348020878841
If you would like to get in touch with me about Sickle cell, do so, via email: [email protected]. And do check out my blog: https://www.Dailylivingwithsicklecell.Com/ My book on Sickle Cell – HOW TO LIVE WITH SICKLE CELL and my other books are available for purchase on www.Amazon.Com.
New Medicare Advantage Plans Tailor Benefits To Asian Americans, Latinos, LGBTQ+
By Stephanie StephensKFF Health News
As Medicare Advantage continues to gain popularity among seniors, three Southern California companies are pioneering new types of plans that target cultural and ethnic communities with special offerings and native-language practitioners.
Clever Care Health Plan, based in Huntington Beach, and Alignment Health, based in nearby Orange, both have plans aimed at Asian Americans, with extra benefits including coverage for Eastern medicines and treatments such as cupping and tui na massage. Alignment also has an offering targeting Latinos, while Long Beach-based SCAN Health Plan has a product aimed at the LGBTQ+ community. All of them have launched since 2020.
While many Medicare Advantage providers target various communities with their advertising, this trio of companies appears to be among the first in the nation to create plans with provider networks and benefits designed for specific cultural cohorts. Medicare Advantage is typically cheaper than traditional Medicare but generally requires patients to use in-network providers.
"This fits me better," said Clever Care member Tam Pham, 78, a Vietnamese American from Westminster, California. Speaking to KFF Health News via an interpreter, she said she appreciates the dental care and herbal supplement benefits included in her plan, and especially the access to a Vietnamese-speaking doctor.
"I can always get help when I call, without an interpreter," she said.
Proponents of these new culturally targeted plans say they can offer not only trusted providers who understand their patients' unique context and speak their language but also special products and services designed for their needs. Asian Americans may want coverage for traditional Eastern treatments, while LGBTQ+ patients might be especially concerned with HIV prevention or management, for example.
Health policy researchers note that Medicare Advantage tends to be lucrative for insurers but can be a mixed bag for patients, who often have a limited choice of providers — and that targeted plans would not necessarily solve that problem. Some also worry that the approach could end up being a new vector for discrimination.
"It's strange to think about commodifying and profiting off people's racial and ethnic identities," said Naomi Zewde, an assistant professor at the UCLA Fielding School of Public Health. "We should do so with care and proceed carefully, so as not to be exploitive."
Still, there's plenty of evidence that patients can benefit from care that is targeted to their race, ethnicity, or sexual orientation.
A November 2020 study of almost 118,000 patient surveys, published in JAMA Network Open, underscored the need for a connection between physician and patient, finding that patients with the same racial or ethnic background as their physicians are more likely to rate the latter highly. A 2022 survey of 11,500 people around the world by the pharmaceutical company Sanofi showed a legacy of distrust in healthcare systems among marginalized groups, such as ethnic minorities, LGBTQ+ people, and people with disabilities.
Clever Care, founded by Korean American healthcare executive Myong Lee, aimed from the start to create Medicare Advantage plans for underserved Asian communities, said Peter Winston, the senior vice president and general manager of community and provider development at the company. "When we started enrollments, we realized there is no one 'Asian,' but there is Korean, Chinese, Vietnamese, Filipino, and Japanese," Winston added.
The company has separate customer service lines by language and gives members flexibility on how and where to spend their allowances for benefits like fitness programs.
Winston said the plan began with 500 members in January 2021 and is now up to 14,000 (still very small compared with mainstream plans). Herbal supplement benefit dollars vary by plan, but more than 200 products traditionally used by Asian clients are on offer, with coverage of up to several hundred dollars per quarter.
Sachin Jain, a physician and the CEO of SCAN Group, said its LGBTQ+ plan serves 600 members.
"This is a group of people who, for much of their lives, lived in the shadows," Jain added. "There is an opportunity for us as a company to help affirm them, to provide them with a special set of benefits that address unmet needs."
SCAN has run into bias issues itself, with some of its employees posting hate speech and one longtime provider refusing to participate in the plan, Jain recounted.
Alignment Health offers a plan targeting Asian Americans in six California counties, with benefits such as traditional wellness services, a grocery allowance for Asian stores, nonemergency medical transportation, and even pet care in the event a member has a hospital procedure or emergency and needs to be away from home.
Alignment also has an offering aimed at Latinos, dubbed el Único, in parts of Arizona, Nevada, Texas, Florida, and California. The California product, an HMO co-branded with Rite Aid, is available in six counties, while in Florida and Nevada, it's a so-called special needs plan for Medicare beneficiaries who also qualify for Medicaid. All offer a Spanish-speaking provider network.
Todd Macaluso, the chief growth officer for Alignment, declined to share specific numbers but said California membership in Harmony — its plan tailored to Asian Americans — and el Único together has grown 80% year over year since 2021.
Alignment's marketing efforts, which include visiting places where prospective members may shop or socialize, are about more than just signing up customers, Macaluso said.
"Being present there means we can see what works, what's needed, and build it out. The Medicare-eligible population in Fresno looks very different from one in Ventura."
"Just having materials in the same language is important, as is identifying the caller and routing them properly," Macaluso added.
Blacks, Latinos, and Asians overall are significantly more likely than white beneficiaries to choose Medicare Advantage plans, according to recent research conducted for Better Medicare Alliance, a nonprofit funded by health insurers. (Latino people can be of any race or combination of races.) But it's not clear to what extent that will translate into the growth of targeted networks: Big insurers' Medicare Advantage marketing efforts often target specific racial or ethnic cohorts, but the plans don't usually include any special features for those groups.
Utibe Essien, an assistant professor of medicine at UCLA, noted the historical underserving of the Black community, and that the shortage of Black physicians could make it hard to build a targeted offering for that population. Similarly, many parts of the country don't have a high enough concentration of specific groups to support a dedicated network.
Still, all three companies are optimistic about expansion among groups that haven't always been treated well by the health care system. "If you treat them with respect, and bring care to them the way they expect it, they will come," Winston said.
This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
What's Really In Your Mouthwash? Turkish Study Spills The Minty Truth
In a recent study published in the International Dental Journal, researchers analyze the relative proportions and health benefits of mouthwash components available in the oral care aisles of large retail stores and pharmaceutical outlets in Turkey.
Study: Ingredients in Commercially Available Mouthwashes: A Review. Image Credit: goffkein.Pro / Shutterstock.Com
Most commercial mouthwash products consist of antibacterial, anti-malodor, and antioxidant components that combat the accumulation of dental plaque, which is the primary cause of dental caries and periodontal disease.
However, some mouthwash ingredients, including parabens, sodium lauryl sulfate, and chlorhexidine (CHX), also have side effects, such as allergic reactions, taste-related disturbances, and altered tooth-coloring. Although some studies claim a link between oral cancer and the use of certain mouthwashes, there remains a lack of epidemiologic evidence supporting these claims.
Previous studies have examined the ingredients of commercially available toothpaste in Turkey; however, to date, none have investigated the constituents of mouthwash products sold commercially in Turkey.
About the studyThe present study, conducted between September 2021 and April 2022, is one of the first to comprehensively examine all components in mouthwash brands commercially available in Turkey. The researchers also described the potentially toxic side effects of each of the unique mouthwash ingredients.
Various search engines such as Google Scholar, PubMed, and ScienceDirect were screened to determine the role of each unique mouthwash ingredient and its potential side effects on oral and other body tissues. Subsequently, a list of mouthwashes sold in pharmacies in Istanbul was compiled.
The researchers meticulously collected and organized all mouthwash labels within an archive to help visualize each unique ingredient in mouthwashes. The frequency of occurrence of each mouthwash ingredient was calculated as a percentage. Mouthwash ingredients with similar usage and function were also characterized.
Study findingsThe dental/oral health survey conducted in Turkey in 2021 showed that the incidence of dental disorders in the Turkish population was high. More specifically, the prevalence of caries and bleeding gums was 64% and 16.2% in five-year-old children, respectively.
Furthermore, the incidence of gingival bleeding in the 12 and 35-44 age groups was 48.7% and 70.8%, respectively. Notably, the estimated utilization rate of mouthwash in Turkey is 30%, which is much lower as compared to toothpaste.
Overall, 17 brands sold 45 distinct mouthwash products with 116 unique ingredients in Turkey. The most frequently encountered mouthwash ingredients were aroma, sodium fluoride, sodium saccharin, sorbitol, propylene glycol, poloxamer, glycerin, and menthol.
About 62% of mouthwash products contained sodium fluoride as the active constituent in varying concentrations. While most mouthwashes had 225 parts per million (ppm) or higher concentrations of sodium fluoride, only nine contained less than 225 ppm of sodium fluoride. Notably, the authors could not determine a specific concentration of sodium fluoride in a single gargle.
Although fluoridated mouthwashes remain in the oral cavity for longer durations, rinsing the mouth with water can reduce fluoride retention. Therefore, one should use a combination of fluoride-containing mouthwash and toothpaste to enhance fluoride retention.
These findings raise questions regarding societal awareness of the potential benefits or hazards of fluoride components used in oral care products, including mouthwashes. Thus, future studies are needed to determine fluoride awareness, as excessive ingestion of fluoride compounds could lead to dental and skeletal diseases.
Other active ingredients in mouthwash variants were oxygene, chlorhexidine digluconate (CHX), and zeolite, which were present in three, five, and one products, respectively.
A CHX concentration of less than 0.1% cannot effectively combat dental plaque. However, mouthwashes sold in Turkey consisting of CHX as an active ingredient use CHX concentrations between 0.025-0.2%, thus indicating that these products are not likely to protect against oral diseases.
CHX disrupts the integrity of the bacterial cell membrane to ultimately lead to cell lysis, in addition to inhibiting biofilm formation and maturation. However, several studies have also reported that CHX alters the oral environment, thereby facilitating caries formation that accelerates cardiovascular diseases.
Most mouthwash products sold in Turkey were water or water-alcohol-based. Some mouthwash products included alcohol on their labels; however, whether these products contained ethyl alcohol, which could be a public health concern, was not clear.
Case-control studies claim that alcohol-containing mouthwashes likely increase the risk of oral cancer. Currently, most mouthwash brands using benzyl alcohol adhere to European Union regulations and use less than 1% benzyl alcohol, which is considered a safer ingredient than ethyl alcohol.
In an era where natural components are gaining popularity, many mouthwash products incorporate menthol derived from Mentha arvensis, which has antibacterial, analgesic, and stimulant qualities. However, more clinical studies on herbal mouthwashes containing phytotherapeutic herbs and essential oils are needed.
ConclusionsResearch on the detrimental consequences of the overuse of mouthwashes is scarce. Thus, there is an urgent need for future studies to evaluate the human and environmental health impacts of dental care products, including mouthwashes.
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