WHAT’S GOING TO HAPPEN TO MY BRAIN (HIV+) AS I GET OLDER?

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A study showed that those with HIV are at higher risk of mental decline if they had poor kidney function (eGFR <50, ask you provider). Less strong association was having no more education than high school, having HIV at least 15 years, and a high spinal fluid protein level. The kidney function is concerning since the risks for that are: diabetes, hypertension, obesity, African-American genes, HIV and one HIV medication–tenofovir which is in many medications. I have many patients on it, but many of us HIV specialists monitor the kidney function at least every 6 months and switch out the tenofovir when the eGFR drops below 70.

PAIN PILLS HARDER TO GET?
With the rise of opiate overdose deaths in the US, laws are still getting stricter. Providers are being watched and sentenced to jail. Now pharmacists are being watched. I am getting more calls from pharmacists when I give an opioid pain prescription. For those in pain where only opioids help, there are more hassles and barriers. But we must stop the deaths. We are doing that by referring more patients to physical therapy and pain specialists, who many times can find other ways to relieve the pain to lower or eliminate the opioids. The common cycle is: bad painopioidswithdrawalstreet heroin mixed with more lethal opioidsdeath. “But Dr. I can’t function unless I have my Norco®,” I hear. It would be wonderful if we had medicine as powerful as but safer than an opioid to help those in severe pain. In the meantime, we have our best alternative: this complex treatment and legal structure to help more and harm less.

BRAIN FOOD
A large study found that children were smarter in many categories if they had a habit of eating leafy vegetables. A slice of white lettuce on a hamburger is not enough! This has been found true for adults too. Dark lettuce, kale, chard, mustard greens, Asian greens are examples. Our bodies are made to work best if given the right fuel. Taking a vitamin pill has been shown to be unhelpful or harmful if there is not a specific deficiency. At least five portions (size of a deck of cards) per day of fruits and vegetables are required for maximum health.

IS SMOKING 1 CIGARETTE A DAY REALLY THAT BAD.
Those who smoke 1-10 cigarettes a day have an 85% higher risk of early death. So yes, one cigarette is bad. We have free counselors to help with the psychological addiction at 800-45NOFUME and 800-NO BUTTS. We have Chantix, Zyban, and Nicotine (patches, lozenges, gum, spray) to help with the physical addiction.

POISON PACKAGES
Food poisoning is common when people don’t clean the cutting board after cutting meat and then cutting up raw food. But packaged food you buy is rarely infected. There were a large number of packaged food outbreaks in 2016. All you can do is be alert to the news. Here is a list of 2016 scares in certain places with certain products: powdered instant meal supplement, eating raw (cookie, cake, etc) dough (uncooked eggs can carry germs), frozen vegetables, sprouts, and not washing hands after touching animals raised in the back yard or farm,.

HEALTHY FATS
Good fats prevent heart disease and bad fats promote it. Good fats are: corn, soy, and peanut oils. OK oils are: canola, avocado, olive oil.
Most fast foods contain unhealthy fats since that type of fat or grease doesn’t spoil much and can be used over and over again. If bacteria find it poisonous, humans should realize that it isn’t nutritious for them either. Examples are: palm, and coconut oils, and animal fats like butter and fatty meats.

LESS PEOPLE SHOWING UP LATE WITH HIV
In a World Health Organization study, 5 countries had less people showing up at the hospital gravely ill with HIV and more of them getting tested before they got sick—which may take as little as a year of being positive. Get tested every 6 months if you are having unsafe sex. Live in reality. Reality bites those living in a fantasy.

CANCER HIGHER WITH HEP C/HIV
A study showed that those with Hepatitis C and HIV have a higher incidence of cancers of many types. So, it is important to get both treated. Even though the Hep C treatment is about $40.000, Californians have a good situation in that many can get treated. The Republican health bill may drop us back to county insurance status and we will lose all the many benefits of Medi-Cal, which pays for mid to late Hep C in all, and any stage if HIV+. Take the benefit now! In Riverside County we are working on getting Hep C treatment for a patient with only county insurance and it has taken months with no firm sense of success soon, she is not happy.

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 University Healthcare System, Public Health (Department) Member, Coachella Valley Clinical Research Initiative

REFERENCES: Medscape®

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