Donna Mendes, a vascular surgeon practicing in Upper Manhattan for 20 years, has a diverse patient population. Working with local residents, she noticed that the incidence of peripheral arterial disease -- blockages of blood vessels away from the heart -- seemed greater and more severe in her African American patients. This prompted Mendes, P&S'77, the first African American female vascular surgeon certified by the American Board of Surgery, to focus her latest clinical research on the impact of race on vascular disease.
"The amputation rate from peripheral arterial disease was found to be two to four times higher in African Americans beginning as young as age 25," explains Mendes, an assistant clinical professor of surgery at the College of Physicians & Surgeons, chief of vascular surgery at St. Luke's Roosevelt, Uptown and senior vascular surgeon at St. Luke's Roosevelt. "The severity of the disease in African Americans is worse and amputation rates are higher." In the same manner that cardiac surgeons perform cardiac bypass to prevent a heart attack, vascular surgeons perform bypass surgery to prevent amputation.
She continues, "We don't know why there are differences. Is it because the disease is so advanced [at the time of detection]? Is it socio-economic issues? Is access to specialists not available or is there a genetic cause? We have to investigate more, but the answer is that it is probably multi-factorial."
As part of that investigation, Mendes is participating in the Upper Manhattan Health Initiative, a program being developed by Columbia University Medical Center (CUMC), St. Luke's Roosevelt, Mount Sinai and North General Hospital, to reduce the number of amputations through early identification of the disease, education and modification of risk factors. Doctors will chart and monitor patients with amputations, or with one or more of the risk factors for vascular disease, and work to aggressively modify their risk factors. Risks include smoking, hypertension, elevated cholesterol, diabetes and family history. Patients also will participate in education groups to help them adjust their behavior. The hope is that the measures will help prevent amputation. For patients who have already undergone one amputation, a second is often more severe.
"If we can alter the risk factors, we hope to be able to decrease the number of amputations," explains Mendes. "We want to aggressively change patients' thinking and educate them to make more healthy choices [such as diet and exercise] to decrease cholesterol and control blood pressure. People can stop smoking, correct diabetes and become more active so that the disease does not become as advanced."
Mendes practices what she preaches. She exercises regularly with a trainer, plays tennis every Sunday morning and has a treadmill in her home.
In the operating room, Mendes performs bypass surgery on the legs to help blood flow more smoothly. She also conducts procedures to remove plaque from the neck vessels to prevent stroke and surgery to prevent aneurysms, which occur when blood vessels balloon and burst.
"Education is so important to me," Mendes says. "A lot of people don't understand that what happens with the heart vessels also happens with the other vessels in the body. I want to let people know that the same blockages occur elsewhere with the same serious consequences -- stroke when the neck vessels are blocked and gangrene when the leg vessels are blocked."
Through her work on the board of the Association of Black Cardiologists in the summer of 2003, Mendes participated in an outreach campaign with poet Maya Angelou. They joined five generations of women from one family to discuss ways for African American women to maintain cardiovascular health. Videos of that discussion were distributed across the country through cardiologists, churches and beauty salons.
In another outreach endeavor, Mendes recently joined Links, an international organization that assists women in various fields who are in need of mentoring, exposure or friendship. She participated in an event at Macy's in Brooklyn where several Links members talked to women about health issues such as diabetes, nutrition and vascular disease.
Mendes also reaches out to young women aspiring to become health care professionals. Three young women she mentored at St. Luke's Roosevelt went on to become vascular surgeons themselves.
"I have to make sure others can follow [this path] if they like," she says. "If a young girl wants to work with me or follow me, I encourage them. I think it is so important that they see that you can work in this field and maintain a sense of balance and normalcy in your life."