CAN YOU HEAR ME NOW?

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Many sporting events or entertainment events have very loud sounds, sometimes up to 150 decibels. A loud restaurant has about 80 decibels. These loud noise exposures can cause permanent hearing damage. Take a break and walk away occasionally and wear either ear plugs or ear muffs to protect your ears. Get your hearing checked at your clinic if you or those close to you think you might have a problem since it can worsen faster once it starts!  People with poor hearing are frequently dissatisfied with hearing aids and live a life of depression and isolation.

ARE YOU WALKING SLOWER?

A survey of older adults found that those who walked slowly or those whose speed decreased over time were at risk for dementia coming on soon. This was an independent measure from thinking tests, so if you just look at a person’s walking speed and not their thinking ability, you might be able to predict dementia is coming soon. I don’t think speeding up can help postpone dementia, it may be too late, but if you are living an unhealthy lifestyle (including not exercising/speed-walking), then you are already at risk for early dementia.

PAs and NPs (mid-level providers) PERFORM AS WELL A PHYSICIAN

One study that compared diabetic control numbers of these three types of providers showed all three had similar scores and outcomes.  That is reassuring since much of primary care and some specialty care is provided by these mid-level clinicians.  Ideally these providers would refer to their supervising physician or a specialist when the clinical picture warrants this move; this is the same rule for physicians: when the diagnosis or treatment is not sufficiently clear, then a referral to a specialist should be considered.  These providers also work for specialists such as dermatologists, psychiatry, psychology, chest surgery, neurology, pain.

ANIMAL BITES: 3-6 MILLION A YEAR IN THE U.S.

386,000 require emergency treatment.  A patient of mine was dragging his finger along a chain linked fence and with no warning a dog clamped down on his finger.  The dog had to be waiting and be fast!

AEROBIC EXERCISE AND WEIGHT (RESISTANCE) EXERCISE HELP PREVENT HEART DISEASE.

A new study from Peru found that resistance exercise was quite important for preventing strokes and heart attacks. This is just one study and not of high quality but causes us to pause. Aerobic exercise (speed-walking, cycling, jogging, elliptical trainer, stair climbing, rowing, swimming) is thought to be the most benefit, but this study causes us to have doubts. Most authorities recommend both.

CLOSING DIALYSIS SHUNT HELPS THE HEART AFTER KIDNEY TRANSPLANT

To dialyze patients, a vein and artery are joined, typically in the arm to stick needles in to get pressurized arterial blood, filter it, and then pump it back into the vein. Without resistance between arteries and veins (usually there are many branches to tiny capillaries) the heart chambers stretch and lose muscle. After a transplant the shunt is not needed so if they tie it off, then the heart pressures lower and the heart can repair itself some.  This may result in longer life and better energy on top of what having a real human kidney can do.

ANCIENT PATIENTS SURVIVE LONGER IF CHOLESTEROL NORMALIZED

Japanese patients age 75-104, had less strokes and heart attacks when their high cholesterol was reduced by a medication over 5 years.  I’m glad they studied them since most studies don’t let patients this old into them. Someday I hope to be healthy and ancient!

NEW CELLPHONE ATTACHMENT FOR HIV TESTS

Using micro-technology and Nano-technology, an attachment to a cellphone can detect HIV for about $5. This was developed in Massachusetts and hopefully will be rolled out world-wide.

ABORTION GAG RULE HAS CLOSED MANY CLINICS

The new rule by the Trump administration has caused many clinics to close and caused much confusion which has kept many out of health care around the world. This rule doesn’t allow discussion of abortion.

PrEP FAILURES WHEN RESISTANCE VIRUS IS TRANSMITTED.

There are now a few cases where the HIV+ person has resistant virus and transmits it to a person who is HIV-  even though that person has been on PrEP.  This makes sense. This is rare. So far there is no HIV resistance to abstinence, monogamy, or a condom!

TWO DRUG COMBO AS GOOD AS TRIPLE

For many years we have found that three antivirals were needed to effectively treat HIV. But now with such powerful and tolerable medications in the Integrase Inhibitor family, a new study showed that combining lamivudine with dolutegravir and not a third drug worked as well as a triple combination medication.  There is already a double combination: Juluca® but one of the ingredients needs to be taken with food and can’t be taken with some acid reflux medications.

With the Rapid Start philosophy of starting medication right after diagnosis, we aren’t able to get the lab tests back soon enough to see if the double combination is a good idea. E.g. the resistance test (genotype) takes 3-4 weeks to come back.  So in a Rapid Start we will be using a triple combination and then consider a switch to a double.

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


REFERENCES: Medscape®

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