Ask The Doctor
PREVENTING HEART ATTACKS AND STROKES
If you have hypertension, even if controlled, then you are at higher risk of these events. Make sure it is controlled. A major study gave a low dose of an anti-hypertensive medication and it lowered the heart attack risk from 5% over about 6 years to 3.6%. you may think that isn’t much, but the more years you take the medication, we assume, the better the protection. These statins keep having confirmation in study after study of having more benefit than just lowering the cholesterol.
Of course living a healthy lifestyle has the best prevention benefit.
ATTENTION SPAN
A study from the University of Indiana found that small children had short attention spans later in life if their parents didn’t pay FULL attention to them. Children learn more by what you do than what you say.
How long you can concentrate on a problem or person or issue is an important trait that can influence your success. Have you ever talked to a child whose mind seemed to be wandering? If you are with small children and you are on your phone or not paying attention to them then they will have short attention spans (like you?). You think you are being a good uncle, godfather, or dad by spending “quality” time with them, but you may be barely fitting them into your busy life. Be thoughtful about your priorities?
ACNE
Yes, I know some of you have it into your late twenties or even later, as do some of my patients. HIV patients seem to have acne later than others. The usual approach is benzoyl peroxide first—the highest concentration you can stand without “burning” your skin, i.e. make it too red. No need to scrub those granules really hard. Next is an antibiotic solution like erythromycin or clindamycin. Next is combine the two. If that doesn’t work, then try an antibiotic daily (women will need a different one than doxycycline since it can cause birth defects). Next is combine 2-3 of these treatments. If this doesn’t work then consider Retin-A® cream. Next combine 2-4 of these treatments. Lastly is Accutane® pills—it can cause severe birth defects so contraception is a must.
MARIJUANA MAY HELP AND HURT HEART ATTACK PATIENTS
In a database study they found that those who listed using marijuana had a lower chance of death in the hospital after a heart attack, but a longer time on the breathing machine. Database studies help us focus on making a real trial to see if this is a good idea
A HEART SHOCKER IN YOUR CHEST
There is a device that is put in peoples’ chest that shocks the heart out of a lethal rhythm. It looks like a pacemaker and has the same wiring to your body, etc. Sometimes a pacemaker has this additional function. When it shocks to reset your natural pacemaker to save your life, it is quite a jolt and scares people.
What if you are at the end of life and treatment for your other diseases won’t work and you are just being kept comfortable. As you are getting more tired and sleepy closer to death you heart might go into one of these fatal rhythms and the shocker goes off, startling you and your family? Don’t forget to ask your doctor to deactivate it (turn it off)!
REPLACING YOUR VALVE WITHOUT A KNIFE?
One of the most important 4 heart valves is the Aortic. There is a new technique that doesn’t involve opening your chest. Ouch!—This will hurt for about 2 months. The new technique is through entering an artery with a group of catheters (tubes) and threading them a little past the valve into the heart. The patients did well.
CAN YOU CATCH OR SPREAD DISEASE FROM VISITING A PATIENT IN THE HOSPITAL?
New guidelines say that you should wash your hands before entering their room. If they have resistant Staph and you already have had contact with them before they were admitted, maybe you don’t need to dress up unless you are visiting another patient in the hospital. If they are on isolation from diarrhea, then you may have to dress up. You don’t want that or to spread it to others.
If they have a pneumonia then you should wear a plain mask. But if you live with them, then you are already exposed as you are with resistant Staph so maybe you don’t need a mask.
If you have an infection, do not go to work or the hospital if there is a risk of transmission.
Be Safe! Wear protection. Keep those questions coming.
Daniel Pearce, D.O., FACOI
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: My notes from CROI, Medscape®