Fasting For Lab Tests?

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A study of 209,000 patients found that the fats in the blood were not much different if the patient fasted 1 hour or 16 hours. This finding is contrary to previous opinions. We check the total, bad and good cholesterols and the triglycerides to see if the diet needs to be changed to decrease the heart attack and stroke risk. Of course, to screen for diabetes it is helpful to have a fasting sample. But if the sugar is over 200 anytime, then that makes a diagnosis of diabetes also. We can always recheck the sugar in those few we are concerned about.

Diabetes and high fats are two of the risk factors for strokes and heart attacks; the other 3 are smoking (very strong risk like diabetes), high blood pressure (same as hypertension), and family history of a male having a stroke or certain heart problems before age 55 and a female before age 65.
Cardio (heart) vascular (blood vessels, arteries) problems (clogging, hardening of the arteries) are common in cocaine users. It increases clotting and spasm of the arteries to the brain and heart causing low or no flow.

A new study in Australia showed that it promotes high blood pressure, heart valve stiffness (so the valve doesn’t work well making the heart work harder and tire at a younger age), and causes enlargement of the main heart chamber (meaning it enlarged to try to pump better against the problems caused by cocaine). These findings were in young men who used cocaine once or twice a week. Of course many cocaine users smoke and you are familiar with the added cardiovascular risks of this habit. Some of these heart attacks happened 3 days after the last cocaine use so it is a chronic, slowly growing effect rather than related to having used it very recently. Stop it!

HALF MY FACE FELL
Have you noticed people with half their face not working? Their eye is sagging open and their mouth droops. HIV patients have this more commonly. I had a patient come in today with this for 3 weeks. If he had come in within 24-72 hours of onset, giving him a medicine might have helped it resolve faster.

DIABETES HARDER TO CONTROL IN HIV+ PATIENTS
There was a study that showed that, compared to HIV- patients, HIV+ patients had a poor reduction in their A1C levels (like a 3 month sugar average) after the first year. It seemed to be associated more with using protease inhibitors (such as Kaletra®, Reyataz®, Prezista®)

HEPATITIS C PROMOTES HAVING DIABETES
The effect of Hepatitis C promoting diabetes is stronger than HIV or Hepatitis B promotion of diabetes. Treating Hepatitis C eases the diabetes but diabetes can make Hepatitis C progress to cirrhosis and liver cancer faster. It is important to control both. Please consider getting your Hepatitis C treated by a researcher who has new, more powerful medications. I can provide the list for SoCal upon request.

REGULAR COCAINE USE PROMOTES CARDIOVASCULAR PROBLEMS®, Prezista®) compared with Non-Nucs (such as Atripla®, Viramune®, Complera®).

FLU SHOTS
You are doing yourself and those around you a favor if you get a flu shot. It does not contain a live virus. If you get ill after the shot, you were going to get ill without the shot. There are many cold germs going around and allergies are bothersome this time of year. These are not the flu and the shot won’t protect you from them. The flu usually gives a headache, fever, chills, muscle aches, maybe a sore throat. It doesn’t cause mucus in the sinuses or nose. Only the three or four most deadly flu viruses that might be coming are prevented by the vaccine, not all flus. It is best to get it in October in case the flu season comes early. It ends in March and the vaccine takes a couple of weeks to protect you. I’ve given it as late as February.

GET YOUR INHALER BEFORE YOU NEED IT
This is a time that colds and flus attack since we are crowded together inside buildings instead of in parks during better weather, so more germs are passed around. With the germs and pollens and dusts from wind, asthma can worsen. Make sure you have your inhaler before a Friday night in case of an attack. People die from asthma sometimes.

DEPRESSION TREATMENT ENHANCED BY EXERCISE AND CLOCK THERAPY
A recent article showed that regular exercise (enough to make you breathe fast for about 20 minutes a day) or waking and sleeping on a regular schedule with lights on during the waking time was a great help for treating depression. This makes sense since we know that exercise increases endorphins (your body’s own “morphine”) and that seasonal affective disorder (SAD, a depression) is treated with light in the winter.

Keep those questions coming. Be Safe!
Daniel Pearce, D.O., FACOI, AAHIVS
Associate Clinical Professor of Internal Medicine, Loma Linda University
HIV Specialist, Riverside County Public Health Department
Hepatitis C Specialist and Researcher, Southern California Liver Centers, Riverside
HIV Researcher, Desert AIDS Project

References: Medscape

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