Ask The Doctor
ANTIBIOTICS, NOT SURGERY FOR APPENDICITIS?
A new study confirms that about two thirds of patients can be treated without surgery who have appendicitis. Some of these might have a future attack and surgery might be needed then. This approach has been shown to be safe.
AUGMENTED REALITY DURING BRAIN SURGERY
Neurosurgeons can now put on special glasses that show a dye moving through the blood vessels. This is like a video game! The surgeon can see where the blood flow is poor and take action to improve it to prevent brain damage and a worsening stroke.
HOW TO DECREASE NARCOTICS AFTER SURGERY
A study showed that when the patient was given non-narcotics and lower dose and amounts the patients got off the narcotics more easily after surgery when there was a discussion about how they are using the medications to make sure they are being used properly. Many patients use too low of a dose of the non-narcotics and not as frequently as they can. Also using gabapentin and local anesthetics were helpful in reducing the need for narcotics.
WEIGHT LOSS PILLS WORK?
The newest pill, lorcaserin did help more patients lose 5% of their weight at 1 year if they were also on a lifestyle modification regimen. But is 5% enough to make some changes in their diseases but did they regain it later as what usually happens when the lifestyle changes are not practiced longer. Eat more and exercise less NOW or try it LATER, after a heart attack, stroke, painful joints?
HOME BLOOD PRESSURE KITS WORK WELL
A new study of 2550 patients showed that their blood pressure was controlled more easily and with less clinic visits when the patient had a kit at home. Our Medi-Cal managed care program pays for this and it has been quite helpful. Part of this may be the patient “owning” the diagnosis and actively participating in managing it. If you have hypertension, please ask your clinic to get you a kit.
US LIFE EXPECTANCY HAS DROPPED FROM OPIOID DEATHS
The life expectancy in the US has been getting longer for many years, but lately it went down a little due to the great number of deaths from using narcotics. About 115 people a day die from opioid overdose in the US. Please get naloxone to use for your friend who may overdose on narcotic pills or street drugs. Urge them to get treatment with Suboxone® or Methadone®. We do Suboxone® treatment at our clinics in San Bernardino and Riverside Counties.
VETERANS NOT STORING GUNS SAFELY
A new study showed that 1/3 of veterans do not store their guns safely, putting them and those they live with at risk. Children find guns and use them by mistake or on purpose. Also, veterans are at higher risk for suicide, especially those who have had concussions. Twenty veterans die by suicide a day and 13 of those are by firearms.
PrEP USE INCREASING AND NOT CAUSING RESISTANCE
It is estimated that 1.2 million people should be on PrEP, but only 120,000 (10%) are on it—so more needs to be done, but the number of people on PrEP is increasing rapidly. Tell your friends who don’t use condoms always to get on PrEP. Be aware that other sexually transmitted diseases prevented by condoms are not prevented by PrEP.
Some who don’t take HIV meds regularly cause resistance in the virus and lose control. So the fear of resistance when taking PrEP was real but a new study of patients still on PrEP for years shows this not to be a concern even in those who didn’t take the PrEP regularly, but did catch HIV!
HAVE MUCH HIV RESISTANCE?
Patients who have resistance to antivirals from not taking the meds daily or from having unprotected sex with someone whose virus is not controlled can help their virus develop resistance. We usually do a resistance test and change medications and keep repeating this process and giving them more pills per day, and more times per day with higher risk for side effects for those who don’t change their lives to not miss a daily pill. For those patients with resistance to many medications, there is an antibody that is given intravenously every 2 weeks, Ibalizumab, and when combined with pills, it works well for these patients. This is a hassle, so it is best to not miss the medications, pretty simple.
YOU WILL PAY. SO YOU MUST DECIDE IF YOU WILL PAY NOW OR PAY LATER?
Some things in life cause you to pay now or pay later. In this case you can pay now by adjusting your life to not miss a pill or have more clinic visits with more pills more times a day and an intravenous infusion. Some ignore their HIV status so end up dead or impaired for life, or have a month or two recovering from a serious illness. You can decide to use a condom NOW, use drugs NOW, or come in LATER with a condition that needs treatment, some of which may last your lifetime. It is too bad that when we are immature, we make bad decisions that affect the rest of our lives. “If I could do it over again…………”
Daniel Pearce, D.O., FACOI, AAHIVMS
Clinical Associate Professor of Medicine, Loma Linda University School of Medicine
Adjunct Professor of Internal Medicine and HIV, Touro University California College of Osteopathic Medicine and Midwestern University Arizona College of Osteopathic Medicine
HIV Specialist, Borrego Health (Riverside, San Bernardino, San Jacinto)
Member, Coachella Valley Clinical Research Initiative