Guiding and Helping Hands

Afaque Akhtar, a medical doctor specializing in internal medicine, can rightly be described as a citizen of the world.
Born and raised in Karachi, Pakistan, he was attracted early on to the healing arts, was named student of the year at Superior Science College, and earned an Internship Excellence Certificate as he moved along the path leading to board certification in internal medicine.
Along the way, he completed fellowship training in hospice and palliative care.
When he found his way to America, he was engaged as a hospitalist in internal medicine—working exclusively in hospital settings, in numerous locations, including hospitals in South Carolina, Tennessee, and Ohio—all the while expanding his training in various aspects of his specialty.
Five years ago, he set up his own practice—Premier Health Center—in Fuquay Varina, offering medical expertise to patients from age 18. And it is a practice with a difference. “Some of my patients are limited to nursing homes, so I often go to them,” he notes. “When needed, I also make home visits. My goal is simple. I want to offer my patients every aspect of internal medicine—which is a very broad field—that can be useful and beneficial for them.”

Health & Healing: Is self-medication a critical issue in your practice?

Dr. Akhtar: It’s true that many of my patients are accustomed to self-medicating, and over time I convince them that their medications should be supervised by a physician. Too often, they develop complications—their kidneys are failing, their liver is failing—because they are failing to medicate properly, with physician direction and oversight.
Diabetes, for example, is a difficult and challenging problem for many of my patients. It is a syndrome that can affect all parts of the body, from eyes to toes. It can make you blind, it can cause heart attack, it can cause your cholesterol to go up, it can cause or contribute to kidney failure—and you can lose your legs through amputation with the complications of diabetes.
Obviously, effectively managing diabetes from the very earliest stages is critically important. We want to avoid complications whenever it is possible to do so. And the simple truth is that, with the proper medications, good supervision, and positive lifestyle changes, the patient with diabetes can lead a good life for a long time with minimum complications.

H&H: What are other issues you commonly encounter?

Dr. Akhtar: With very little reflection, I can think of a great many patients who have walked similar paths to better health.
For example: in the recent past, I worked with a 45-year-old man who, when he came to me, was about 100 pounds overweight. He was complaining of a number of different medical problems, such as persistent and fairly intense heartburn, and restless sleep. He was experiencing high levels of fatigue, with very little motivation to engage in life. He was also depressed and had anger problems. Life was not a happy, pleasant experience for him when he first walked through my door.
Despite all of this, he was reasonably satisfied with his professional life—but he still complained. He wanted life to be more abundant and more pleasant.
He had been to many different physicians, and everyone was giving him sleep medications. I fairly quickly came to agree that poor quality of sleep was a significant issue, and after appropriate testing, we understood that he was, indeed, suffering with sleep apnea.
The condition was causing him to wake up periodically during the night, and this lack of restful sleep translated into depression, anger, and scattered thinking during his waking hours. And through all of this, he kept eating and kept gaining weight. Family relationships were pretty intense. His heartburn continued to worsen.
Effectively treating his sleep apnea—with faithful use of a C-PAP device—was the key to a different lifestyle for this patient. Slowly, he was motivated to do some exercise, and he began to lose weight. His quality of life began to shift and improve, and his depression is lifting. His blood pressure is coming down.
He understands that there is a good deal of work remaining to be done, but he also knows there is a path to much better quality of life for him and for his entire family.
It’s important to talk about the quality of our sleep—it is such a vitally important part of life. Everyone, without exception, needs quality sleep. At least one-third of our life is spent sleeping. If we do not have good quality of sleep, it affects everything we do.
We regularly address the issue of quality of sleep in this practice, and encourage our patients to have sleep studies when indicated. Daytime sleepiness is the number one indicator of the possibility—perhaps even the likelihood—that there is a sleep disorder that needs attention.
Once your sleep is better, your day will be better. It will help free you from having anxiety, depression, and fatigue, and give you the motivation to do what needs to be done in your life. We work with our patients to address this issue in an effective, professional way.

H&H: There is a growing awareness in the media of addiction problems; is this an issue you encounter?

Dr. Akhtar: Yes. Addiction is another key issue that I address in my practice—opioid addiction, alcohol addiction, tobacco addiction—they are a curse in the lives of many, especially my more youthful patients.
Addiction is often at times a key issue related to medications a patient may be taking—medications that are considered essential in treating other health conditions. As needed, we use different tools—such as psychotherapy, for example—to keep such issues in balance. There is always an effective path—and it is our job to find it and apply it, on behalf of our patients.