Tag Archives: South asian heart center

Doctors Open Doors To Sick Punjabi Truckers

The doctor leaned over Jitamber Singh Bedi and inserted the needle of the injection into his eyeball. Jitamber had a blockage in his vein that was causing his eyesight to cloud up. Vision problems are a side effect of diabetes. Like eighty-eight percent of truck drivers, Jitamber Singh Bedi too had Type 2 diabetes. 

In order to operate a commercial vehicle on the road, a driver must be able to prove they are maintaining stable blood sugars. Jitamber medical exam report is part of his driving record. It is filed electronically by the Medical Examiner (ME) with the US Department of Transportation (DOT) bi-annually. Any drop in health indices would mean he loses his license or at best, gets recertified every year. 

Over half of all long haul truck drivers suffer from hypertension and/or diabetes. These comorbidities put them at a higher risk for COVID.

“Sedentary lifestyle and erratic sleep gets you, if bad food on the road doesn’t,” says Jitamber Singh Bedi. “Sitting for ten hours a day for ten days at a stretch, the truck driver is a sitting duck for diseases like diabetes. And when they do take a break it is easy to pull out a cigarette.”

“At every rest stop I ended up smoking,” says Jitamber. 

Irregular eating habits and dehydration further strain the system. Jitamber is always worried about taking restroom breaks and therefore restricts the intake of fluids and food which can lead to the taxi cab syndrome. The inability of drivers to relieve themselves regularly throughout the workday leads to voiding dysfunction, infertility, urolithiasis, bladder cancer, and urinary infections as compared with nonprofessional drivers wrote Alon Y Mass, MD, David S Goldfarb, MD, and Ojas Shah, MD. from the Department of Urology, NYU Langone Medical Center. Paid by the mile, every restroom stop costs precious time.

“Sssssslow suicide behind the wheel,” says Jitamber, “with the pandemic that could take a quick turn for the worst.”

Jitamber graduated from Mayo College, where he went to school with the sons of India’s upper classes, princes, and nobles. After immigrating to the US, he worked for ten years as the Assistant Manager, Special Reporter and Editor for India Post, a California publication. Jitamber started driving a truck in the US in 2012.  

Jitamber & his wife Lisa

He still maintains his A1 license to drive a truck and is married to Lisa, a librarian at the county library. Jitamber is on his wife’s medical plan. Kaiser is their health insurer. Kaiser, a California company, has agreements with other providers to provide coverage all over the US thinks Jitamber. He does not really know how his health insurance will play out if he falls sick on the road.

Raman Dhillon of the North American Punjabi Trucking Association (NAPTA) has negotiated a health plan that truckers can buy into. Portability of insurance plans from one state to the other has been a bottleneck to seamless healthcare access. NAPTA wants to ensure that the trucker has access to pharmacy anywhere and medication can be prescribed to and picked up by the driver from the pharmacy closest to him. 

President Trump’s Emergency Order in the face of the COVID pandemic opened up anywhere anytime access to healthcare.

Anywhere Anytime Access 

Of the 1.5 million truck drivers on US highways, says the Punjab Truck Association, about 150,000 Punjabis are working in the trucking industry. The South Asian gene makes the Punjabi drivers more vulnerable to acute myocardial infarction (MI). Studies by UCSF, Stanford and El Camino hospital’s South Asia Heart Center, show that heart disease strikes South Asians at a younger age and more malignantly than the general population. “South Asians represent approximately 17 percent of the world’s population – yet they account for 60 percent of the world’s heart disease patients,” says Anita Sathe of the South Asian Heart Center which runs a program to help South Asians manage their heart risk.

The ability to access and monitor healthcare on the road is crucial to the health of Punjabi truckers.

COVID-19 opened the door for truckers to access technology-based ubiquitous healthcare. Under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act, the incorporation of telemedicine into routine medical care on a temporary and emergency basis, has lightened the burden on truckers. The waiver has loosened former requirements that the patient and provider be in the same state or that the patient must be in physician shortage areas to access telemedicine; so a doctor in New York now can be reimbursed for consulting with a patient out of California. 

The rule that a new patient could not use telehealth and must have an established relationship with the doctor has been relaxed as have some of the HIPAA requirements like data transfer and storage. The new criteria allow the use of tablets or smartphones, so a driver can call a nearby doctor from his smartphone. However, all calls must be video calls;  audio-only calls may not be made. 

“From March 6, 2020, a range of providers, such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers, offered telehealth to all patients,” says Apexon Healthcare executive Siva Sundar. “Meeting the doctor through zoom or Facetime has become the norm for everyone during the quarantine.” 

Telemedicine and walk-in medical clinics located at truck stops and Pilot and Flying J Travel Centers proliferated with the advent of COVID. For the sake of the truckers, these new rules must outlast the pandemic and become the new normal. 

Checking For Sugar On The Road

Jitamber Singh Bedi would find it useful to wear body sensors that alert him, his family, and his doctor to potentially serious changes in his health status. 

Continuous glucose monitoring devices to monitor the driver’s blood sugar – motivates healthy behaviors says Rajeev Sehgal, Jitamber’s classmate from Mayo College, who has been wearing the Dexcom 6 device for over 6 months. “In the same way that wearing a Fitbit can be motivational for meeting daily fitness goals, real-time monitoring of blood sugar levels might reinforce good behaviors around eating and exercise,” he says. 

The tiny sensor he wears on his stomach sends real-time reading of his blood sugar levels to his phone every 5 minutes.  “It is extremely comfortable to wear. I can swim with it. I change the device every ten days,” says Sehgal who highly advocates its use by drivers. The device allows quick remedial actions for timely diabetes management and the information can be kept private or shared with family members when the driver is on the road.

If the sensor indicates high sugar and blood pressure levels, the trucker can consult with a doctor by teleconference over Facetime. If they’ve embarked on a trip without getting a refill or forgetting to pack their meds Telemedicine can get them their meds at a pharmacy close to where they are. 

“At present, the sensor is prescribed and covered by insurance for people who have uncontrolled type 2 diabetes but it should be authorized for truck drivers who are managing their diabetes,” says Sehgal. 

Monitoring blood sugar levels on the go will allow the trucker to take immediate remedial action. A brisk walk could fix a spike in blood sugar levels following a sugary lunch or in case of a drop in sugar levels, a quick pop of sugar will prevent deterioration in vision like the one Jitamber had to face. A year ago he noticed he couldn’t read street signs. Retinal vein occlusion and macular edema caused big brown blobs to float in front of his eyes. After a series of shots at regular intervals, Dr. An Ngoc Huynh, MD at Kaiser Irwindale California declared his vision to be 20:25.

“The main thing I want to better understand is, how different things I do affect my glucose levels,” says Jitamber. “I will track my blood sugar levels to see how it responds to food, sleep, and exercise. Fasting, exercise, stress, or sleep can be tweaked to get the marker to the right place. Precision in targeting our health issues can prevent shots in eyeballs,” said Jitamber.

Read other articles in this series:

Road Warrior

Punjabi Truckers Find A Warm Welcome At US Highway Dhabas

Ritu Marwah wrote this series while participating in the USC Center for Health Journalism‘s California Fellowship.

 

Gala For Heart Health A Success

On Saturday, March 17, 2018, more than 320 philanthropists, physicians, and community leaders came together for the Scarlet Ball, an annual gala to benefit the South Asian Heart Center at El Camino Hospital. The fundraising event, which was held at the Dolce Hayes Mansion in San Jose, raised more than $348,000 to support the Center’s work.

A commendation letter from the 19th Surgeon General of the United States Vivek H. Murthy, MD, MBA, was shared at the event recognizing the South Asian Heart Center staff, volunteers, and supporters for their lofty vision of working to improve the health of the South Asian community. Dr. Murthy stated, “You saw that heart disease was disproportionately affecting South Asians, leading to heart attacks, disability, and lives lost. You also recognized that many of these tragic events could have been prevented if only evidence-based prevention measures had been brought to the community in a culturally appropriate manner. Admirably, you took it upon yourself to build an institution that would close the gap between what our community had and what it needed to prevent disease and save lives.”

Congressmember Ro Khanna and Assemblymember Ash Kalra attended the event, and presented the South Asian Heart Center with certificates of recognition for outstanding work in reducing heart disease and diabetes among South Asians.

Since opening its doors in 2006, the South Asian Heart Center has dedicated its resources to increasing awareness and prevention of diabetes and heart attacks in South Asians, and research to improve risk prediction and reduction in this vulnerable population. To date, the Center has enrolled more than 7,800 participants in its culturally appropriate AIM to PreventTM and STOP-DTM programs, educated more than 3,000 physicians, reached out to more than 80,000 community members, published its findings in peer-reviewed journals, and opened satellite offices in Fremont and Los Gatos.

“The four little secrets that have helped us improve health outcomes for our participants are Meditation, Exercise, Diet, and Sleep – what we call our MEDSTM lifestyle platform. This enabling platform forms the basis of the Center’s education curriculum, expert lifestyle counseling, and personalized health coaching to help stop diabetes and halt heart attacks,” says Ashish Mathur, executive director of the South Asian Heart Center at El Camino Hospital. “Through the ideal daily practice of MEDS, we’ve seen 68% of our participants lose weight, 62% improve their cholesterol ratio, and 71% improve their HbA1c.”

Building off the importance of developing a healthy lifestyle, keynote speaker Munjal Shah, a successful entrepreneur and South Asian Heart Center participant, shared his story of determination to get healthy. After Shah sold his company Like.com to Google in 2010, he had a heart attack scare. He modified his diet and lost 40 pounds and through the process, realized he had a passion for digital health and healthy living. Shah now focuses his entrepreneurial energies in this direction and co-founded Health IQ in 2013. As part of his keynote, Shah quizzed the Scarlet Ball attendees on how much they knew about aspects of a healthy lifestyle and challenged them to evaluate their health literacy.

The gala also featured a live auction, heart-healthy cuisine by Chef Vittal Shetty of Jalsa Catering, entertainment, and dancing.

About El Camino Hospital
El Camino Hospital is an acute-care, 443-bed, nonprofit and locally governed organization with campuses in Mountain View and Los Gatos, California. Key medical specialties include cancer, heart and vascular, men’s health, mental health and addictions, neuroscience, orthopedic and spine, senior health, urology, and women’s health. Additional community-based services include the South Asian Heart Center and Chinese Health Initiative. The South Asian Heart Center’s mission is to reduce the high incidence of diabetes and heart attacks in Indians and South Asians through culturally tailored, science-based, and lifestyle-focused services. To learn more visit www.elcaminohospital.org.

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Heart Health Month: Diabetes and the Heart

As a child growing up in India, it was common to hear elders on both my mother’s and father’s sides talk about their diabetes and their high blood pressure. I used to overhear conversations about stents, angioplasty, and blockages during family get-togethers. My father took pride in helping his friends measure their blood pressure. At the time, I hardly knew what any of these terms meant; I never imagined that I would have to deal with some of these conditions myself. I had always thought of these problems as problems related to older people, and assumed that they were of no concern to a man in his 30s or 40s. However, fate necessitated that I learn and understand all these terms intimately.

I did not realize at the time, but the very first signs of my predisposition to diabetes surfaced in my mid-twenties during a free employee health checkup when lipid panel results revealed that I had elevated triglycerides, a possible sign of metabolic syndrome. A primary care doctor I consulted simply put me on cholesterol-lowering medication and advised me to take it for life. I remember thinking “It is just one small pill, which is nothing compared to the large number of pills my father takes on a daily basis. My affliction must be pretty minor.” Starting on a plan for “medication for life”should have given me pause, given that both my parents were diabetic, but it did not. My life at that time did not indicate illness in any discernible way. I was young, active, excited to be married and to be parenting a beautiful new baby. I had a great job and life was good.

Seven years later at my annual health checkup, I mentioned to my doctor that my eyes were having trouble focusing in the mornings. He asked me to get blood work done. Results showed elevated A1c which is a measure a of a person’s average blood glucose levels over the past few months. I was officially diagnosed with diabetes! My diagnosis should not have come as a shock. After all, diabetes was in my genes. Yet, I found myself pulling over to the side of the road to catch my breath when I heard the news from my doctor’s office. Images of my father struggling with his insulin injections and the mounds of pills that he had been taking for half of his life swirled through my head, and I was shattered. How could I have type 2 diabetes at the age of 33? I was put on prescription medication that soon caused episodes of hypoglycemia. My concerned wife convinced me to get help from an endocrinologist who helped with medication management and I was able to regain some control over my life.

That was ten years ago. Over the course of a decade, as work and stress  increased, I could not maintain a regular fitness regimen and exercised sporadically. I continued to gain weight and my A1c slowly began to rise. Long hours at a demanding high tech job, plus family responsibilities sent stress levels through the roof. There was no special diet except a superficial avoidance of sugar and sweet treats. I was on the typical Indian “rice and chapati-centric” meal plan. It was the perfect storm and my diabetes flourished.

I knew I needed to get control of my diabetes and invest in my health, not only for myself, but also for the sake of my wife and daughters. I made a commitment to see an endocrinologist every three months and a cardiologist once every year. Still I could not keep my A1c in check. Two years ago, my medication was increased to the maximum allowable dosage. I was exercising regularly and felt strong and energetic, but my blood test results still did not show any signs of improvement. In desperation, I turned to the Internet and the library for help. I read all there was to read on pre-diabetes, insulin resistance, and type 2 diabetes I learned more about the importance of diet and exercise for those with this metabolic disease. I read about insulin and how it works, about cortisol, ghrelin and glucagon. I even read a few books on diabetes management. I gained significantly in knowledge, but could not put all the disparate information together into a regimen that I could maintain. I tried techniques like intermittent fasting, a diet avoiding sweets completely and another diet with less than 100g of carbs per day. These had good short term results, but I just could not sustain these diets in the long term. . I was overwhelmed and frustrated.

It was at this time that my cardiologist recommended the South Asian Heart Center at El Camino Hospital. At first, I enrolled in the Center’s AIM to PreventTM program and learned about the specifics of my personal condition. I was happy to find experts who presented information about type 2 diabetes in a way that I could understand, accept and utilize. The program helped me understand my diet and choose my foods mindfully. Last year when the Center launched a new program called STOP-D to stop diabetes before it starts, I was among the first to register.  STOP-D, a structured, culturally adapted program based on proven national diabetes prevention curriculum was just what I needed. I learned the science through webinars and workshops led by experts, and benefited from personalized lifestyle coaching. My peers and I shared recipes and achievements, and motivated each other to stick to the program. I not only focused on the obvious – exercise and diet – but also meditation and sleep, which turned out to be just as important. In the one year on STOP-D, I have picked up actionable tips and tools on diet and exercise, stress reduction and more that have become part of my daily life.  

I grew to appreciate vegetables, even salad, and stopped eating a lot of  rice. My eating habits now are very different  from the diet that I grew up with  in Hyderabad, India. I have a sweet tooth and I soon devised ways to avoid temptations in the office lunch room. I discovered that not only the quantity, but the quality of food and my interaction with food matters a lot. My heart health coach constantly encouraged me by setting up little challenges to take me to the next level.  

The Center’s focus on sleep led me to investigate the reasons for my inadequate sleep patterns.  I now use a machine to treat my sleep apnea and am getting a full night’s sleep for the first time in years.  I used to think that meditation is quackery but my coach gently wore down my resistance.  I tried it and was amazed to find it clarified my thought process, helping me decompress and think through challenging choices.

Over the course of this program, and with the support of my family, I have learned to exercise sustainably, eat right, and reduce stress with proper sleep and regular meditation. I’ve lost weight and my A1c level has dropped from 6.8 to a pre-diabetic level of 5.7.  Now I understand that, for me, as for so many others, that medication alone is not enough.  I needed a structured lifestyle program too.  I am glad I made this investment in my health so I can take care of my family, now and in the future.  

Sajjad Lateef a 44 year old father of two, is a technical product manager at Illumio in Sunnyvale, California.