Ask The Doctor Nov

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ANIMAL EXPOSURE IS GOOD FOR YOUR HEALTH

A study showed that there was more allergic-type diseases in Amish (who have farm animal contact on small family farms) compared to Hutterites (who use machines and touch animals less). Both religious communities are isolated from the outside world.  The Amish had dramatically less asthma and rashes than the Hutterites. Skin testing of house dust was more reactive in the Hutterites. There were similar animals on the farm. The Amish children had fewer allergic antibodies and cells in the blood.

This is another confirmation that the hygiene hypothesis is valid: if we are too clean and avoid germs, we will suffer more allergic symptoms. So it is probably not a bad idea if our kids eat a little dirt and have pets. Use less Purell®?

 

1 MILLION SEXUALLY TRANSMITTED DISEASES DAILY!

According to WHO estimates. A few months ago we were alerted to treat Gonorrhea with 2 antibiotics instead of just one.  Chlamydia and Syphilis have brewing resistance also. I so appreciate my patients not demanding antibiotics for routine, allergic or viral sinusitis, sore throats, colds, flus, and bronchitis. Antibiotics only treat bacteria and they are not the usual causes of these problems.

 

HEART VALVE INFECTIONS UP

With the higher use of narcotics for pain relief and then some patients seeking the same feeling, there is an increase of injection drug abuse. Bacteria get injected with the drugs and they settle on the heart valve, destroying it slowly causing heart failure. Usually the patient needs 6-8 weeks of intravenous antibiotics to cure the infection. Some need a heart valve replacement since the old one is so chewed up.

 

ARE YOU ON STRONG ENOUGH CHOLESTEROL MEDICINE?

If your cholesterol is high, most studies and guidelines recommend a strong medication (strong against cholesterol but not against you!) such as atorvastatin rather than a weak one such as simvastatin or pravastatin.

 

GALLSTONES A RISK FOR HEART DISEASE?

A survey of many large databases found that there was an association between having gall stones and later having heart disease. The higher risk persisted even when they discounted the effects of obesity, hypertension, diabetes, and high cholesterol—all risks for heart disease by themselves.

 

EARLY MENOPAUSE A HEART ATTACK AND STROKE RISK

Women who have menopause younger than age 45 had increased risk for cardiovascular events.  Perhaps they should be monitored more closely for blood pressure and cholesterol and, of course, be advised strongly to stop smoking. Talk with your mothers, aunts, girl friends.

 

HIV+DEPRESSION=BAD FOR YOUR HART

Depression and HIV are both small risks for heart attacks but together they cause a large risk. This is from a large study.

 

CLINICAL TRIALS ARE BEING REVIEWED MORE CLOSELY

A recent journal article describing the trial of a heart treatment was retracted quickly by the officials at a major journal after it was published. The reasons were that the trial was described as a random selection of patients, but it truly wasn’t. In addition, the rules state that such a trial should be posted on a central website, clinicaltrials.gov, before starting the trial. This posting helps all researchers know if they are duplicating a trial so that they can spend their efforts on a modification of the trial. The medical literature is commenting more lately on making sure that good scientific methods are used in conducting and reporting research.  We all applaud this movement since we want the best, most accurate information to treat our patients.

 

DAILY BLOOD DRAWS IN THE HOSPITAL AT 5AM?

If you have been hospitalized, you will remember the nice person waking you up daily to draw your blood. There is a new move to limit the number of daily labs for those patients not in the intensive care unit (ICU).  There is the counter pressure of the providers being busy and not being able to tailor the orders to each patient.

 

HIV+ WOMEN FORCED TO BE STERILIZED IN UGANDA

There were some abuses like this in the United States more than 50 years ago, but this has happened lately in Africa. The women were sterilized without their consent. Maybe a relative signed the consent. Sometimes there is a language barrier. When they try to have children, they are unsuccessful. An infertility workup shows that they have been sterilized, much to their surprise! Sometimes their records are released from the hospital to confirm the procedure happened. A women’s rights organization investigated and found that 20 of 744 women surveyed had the procedure forced or without consent. If an HIV+ pregnant woman has her virus controlled, it is very rare to have an HIV+ baby.

 

MORE OR LESS ANTIVIRALS

Again, a four drug regimen did not prove superior to a triple. There is some preliminary evidence that a strong 2 drug regimen may work well in those with an initial viral load below 100K.

 

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 University Health System, Public Health

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

 

REFERENCES: Medscape®

 

 

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