Ask the Doctor

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I NEED MY NORCO

People have real pain and seek relief. Providers are under the increasingly watchful eye of their supervisors, medical groups, and insurance companies and the State to make sure they are not over prescribing controlled substances. According to the Medline Plus medical encyclopedia, a very helpful web service, dependence is needing a drug to function normally and stopping it causes withdrawal. Addiction is a set of behaviors one uses to get more controlled substances which can be used to get high or to sell. There has been much abuse and a great number of deaths these last few years from prescribed controlled substances. We are to first try other medications which do not have these problems. For pain that is not neuropathy, the controlled substances, in general are superior to the others. Pain specialists and primary care providers many times will have you review and sign a Pain Contract so that you understand the rules such as agreeing to having only 1 provider, 1 pharmacy, random drug screens, no other substances allowed. We run a report from the State telling us which controlled substances you have used and which providers and pharmacies you went to. Some providers use these as a way to get you out of their practice. Is the consequence of breaching the contract to lose that provider forever, or to never get pain medications from them?  The poor don’t have many options in finding a provider to work with on their pain.

I have seen many become slower mentally and physically on controlled substances and when they finally come off, they feel more energetic and mentally quicker.  We all wish there were better medications for pain.

Check out the webpage, Medline Plus medical encyclopedia. It is a trustworthy source of information regarding your health.

 

SHAKE HANDS WITH THE DOCTOR?

Studies show that there are germs on the ties and hands of providers and that can be passed to patients. It is known that if a hospital pushes handwashing and measures the improvement, that there are less infections of the hospitalized patients. Bathroom sink handles and door handles have germs on them, but so do all surfaces that you touch so why pick out the bathroom door handle, rather than the next handle you touch? On the other hand if a child has a pet (germs), that child is at less risk of asthma and some other diseases. If a child is delivered by Cesarian section, or not breast fed, their body’s bacteria may not be the same as if they were treated the normal way and this may lead to a risk of chronic diseases such as obesity and colitis.  Patients want the provider to shake their hand. A clinical outcome of a study would be, e.g., to list the types and number of infections. A theoretical outcome would be that there are germs found on this surface (which could possibly lead to an infection); this is what most of these studies show.

How do we make sense and strike a balance between friendliness, germs, and infections?  My read is that: 1) We should expose children to normal germs, 2) I’m not sure about adults needing to be as sterile as possible, 3) We should avoid serious germs when there is a substantial risk of contracting them, 4) Health care providers should wash or use sanitizer on their hands between patients, 5) I shake hands upon first meeting the patient, and if the patient seems to want this.  I do touch my patients during the exam.

OTHER NEWS

An African study showed that one could possibly delay treatment of HIV until after the TB is treated for 6 months if the CD4 was more than 220.

The mediterranean diet with extra olive oil or extra nuts were superior in preventing heart attacks and strokes compared to a regular low fat diet in a recently published study.  The mediterranean diet consists of much fruits and vegetables, beans and nuts, healthy grains, fish, olive oil, small amounts of meat and dairy, and red wine.

A new study finds that people with diabetes are significantly more likely to die from suicides, accidents, and homicides compared to the general population.  These unnatural causes of death may be related to falls from neuropathy, or fainting from low blood sugar or poor decisions from high blood sugar.

Vitamin D is a hot topic lately. A low level is associated with hypertension, diabetes, myocardial infarction, and stroke. A recent study found that low Vitamin D levels were not associated with hardening of the brain arteries or decline in mental function.

A tenofovir vaginal ring has shown to prevent transmission of monkey HIV so they are planning on studying it in humans. Good news!

PTSD and Major Depression have been found to be helped by electroconvulsive therapy.  It also reduced the overall death rate and suicide rate. Forget what you saw in movies, that’s Hollywood. The patient is seen by a specialist, sedated, given low voltage shocks to the head. When they wake up, they have no memory of what happened. I know it sounds barbaric, but it really helps get people closer to normal functioning.

Keep those questions coming. Be Safe!

 

Daniel Pearce, D.O., FACOI, AAHIVS
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
Researcher, Veterans Administration Hospital, Loma Linda
HIV Specialist, Riverside County Public Health Department
Hepatitis C Specialist and Researcher, Southern California Liver Centers, Riverside

 

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