Ask The Doctor

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GETTING THINGS DONE WITH MUSIC

A former intern of mine writes a column on Medscape in which he describes the boost to work that music can give. He states that classical music puts him to sleep and that Rock or Country music distracts him with the lyrics. He and others find that video game music makes him work faster and more accurately. After all, video game music is there to help you focus on the game and not let your mind wander off it to your spouse, kids, parents, pets, food, full bladder, fires, emergencies!

MARIJUANA GOOD OR BAD?

Be careful when reading studies about the harms of marijuana. Most of the studies are done in animals, on plates, test tubes, or on computer information. There wasn’t enough money before to do the best kind of trials: large, multicentered, randomized, placebo controlled, double-blinded trials.  All the money for decades went to proving how bad marijuana was rather than its benefits, so of course, they were going to find harms. Are these harms rare, minor, or theoretical?

The one harm that makes sense to me is that the developing brain till the age of 24 or so is very susceptible to chemicals and ­­­they may cause permanent damage and dependence. When you compare marijuana to alcohol or other substances, it is clear that no one (or nearly no one) dies from a marijuana overdose and no one is violent on it (unless it is laced with other drugs like PCP, LSD, methamphetamine, cocaine, etc).

It is about time that some money is going to quality (i.e. expensive) research on the benefits, such as Colorado’s cannabis research fund.

Will the new president change the enforcement rules?

DO YOU REALLY HAVE ASTHMA ALL THESE YEARS?

There was a large study getting much press: checking people who continued their inhalers into adulthood after being diagnosed as having asthma as a child. They found that a good number outgrew their asthma and didn’t need the inhalers. So if you don’t seem to get much of a benefit from your inhaler, then ask your provider to check if you have asthma. A simple Peak Flow Meter that many insurances pay for can help you measure the maximum force of air when you exhale. Do this when feeling like your asthma may be acting up, before inhaler use and 10 minutes after. If you show your provider the numbers then you should feel comfortable that you do or don’t have asthma. If the numbers are not that helpful, you may need a formal breathing test in a pulmonary lab. They usually ask you to breathe into a tube with and without giving you an inhaler-like medication. They also yell at you to make sure you are trying hard enough (like a Super Bowl coach) because they want the very best measurement of your lung function.

RELAXED BLOOD PRESSURE TARGETS FOR THOSE >60

The latest guidelines by the family and internal medicine physician groups say that keeping the blood pressure top reading less than 150 is better than 140. They weigh the risks and benefits. The lower target may cause dizziness and falls resulting in fractures in a few.  The higher target does a good enough job in preventing heart attacks and strokes. There wasn’t clear information to guide them till the latest studies came out with their results.

WHITE COAT HYPERTENSION

Many patients have higher blood pressure in the clinic than they do in the rest of their lives. Why take a medication for the rest of your years if you only have high blood pressure an hour every three months? Many are anxious when they are at the clinic, and some don’t know it. We ask that you get your blood pressure checked at a pharmacy or borrow a machine from a friend or relative, write the blood pressures down, taken on 3 different days and call those into the office so we know whether you need treatment or not, or need to lower or raise your blood pressure medications. IEHP in the Inland Empire pays for home blood pressure machines if the person has suspected White Coat Hypertension or regular hypertension so they can treat well those who truly need it.

STARTING ANTIVIRALS EARLY IN HIV PREVENTS PNEUMONIA IN THOSE WITH HIGH CD4s

The famous START trial shows that for those with more than 500 CD4s, starting antivirals early prevented half the pneumonias that happened in the late start group. Only 2% of the people had pneumonias overall. This is another reason not to delay starting medications.

Be Safe! Wear protection. Get tested. Keep those questions coming.

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

HIV Specialist, Assistant TB Physician, Riverside County Public Health Department

Hepatitis C Specialist and Researcher, Southern California Liver Centers, Riverside

Researcher, Inland Empire Liver Foundation and Clinical & Translational Research Center

REFERENCES: Medscape®

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