Rectal douching (an enema) does increase the risk of HIV transmission. The mechanism may be trauma to the rectal lining, opening the gate past the defense of the rectal lining, also some of the liquids have a concentration of chemicals in it which burns away the layer. This lining is super-thin, only 1 cell thick.
Most lubes are damaging to the layer also due to the chemical concentrations. One study found these to be less damaging: Good Clean Love and PRÉ.
But Summer’s Eve may be damaging due to the vinegar (but it is healthy for vaginas which have thicker linings and different acidity).
There are important questions about douching: Are laxatives, suppositories, orFleets enemas dangerous? How about high heat bidets or adding lemon juice to the douche? What kind of damage to that thin layer will more than 1 douche in 24 hours do? Since the data on HIV transmission is on white MSMs, what about the risk to other races and transgender patients?
There is some early work on a medicated douche to prevent HIV. Stay tuned.
PROSTATE CANCER ON THE RISE IN THOSE 20-49
This article looked at the incidence in many countries and the numbers agree that worldwide it is increasing but still quite uncommon. No cause has been found. One wonders if it is in our food or other unknown toxins we are being exposed to. Does eating organic food and charcoal-filtered water prevent it? The guidelines do not mention how to test for it. This group doesn’t see the clinic very often. When the cancer is discovered in this group it is usually more advanced than in older patients since it is uncommon and not looked for unless there are symptoms.
TABLET COMPUTER REPLACES MICROSCOPES
New pathologists (physicians who look at tissues, biopsies, supervise the laboratory) are discovering that they are not using microscopes so much anymore since they have new ways of putting the images on computers. This much easier to work with compared to focusing a microscope: putting a slide on with a drop of oil, focusing and putting the oily slide back, making sure the label and case match.
Also, many pathologists compare images on social media such as Twitter and emails to each other for a second opinion. It is a new generation and the pathology department is keeping up.
AIR AMBULANCES
Are expensive: in 2014 the average air transport cost $30,000 and they crash much more frequently than regular air travel. Sometimes an out-of-network air service is forced to charge much of this to the patient. The pilots and medical personnel are highly trained for dangerous landings and take offs; their insurance costs must be very high too.
HIGH DOSE NALOXONE FOR OPIOID OVERDOSE
Presently we must inject a person who is in a coma with multiple vials of medicine. A new and stronger form was submitted for approval by the FDA, but there were manufacturing problems. The company will most likely resubmit after the corrections and after approval the time to recovery (time is brain!) will be reduced, reducing brain damage from lack of oxygen.
FAST TRACK CITIES HAVE GOOD DROP IN NEW HIV CASES
Those cities which have adopted programs which get the PrEP medications and HIV testing quickly to those who are at higher risk have seen a serious drop in the number of new HIV cases/year. E.g. France saw a drop of 28% inMSMs (men who have sex with men). This was reported at the recent European AIDS Conference.
HOME HIV TESTS FROM THE INTERNET HAVE FOUND MORE CASES
Tests are sent to those who see the offer on a webpage. In those who identified themselves at risk had a higher positivity rate and they referred the test to their social network, increasing the ability to reach at risk groups. It is so much better to get the test soon after becoming positive.
ASTHMA
There are 3 classes of asthma
Intermittent Asthma. The patient doesn’t need inhalers daily. This can range from days to years between need for inhalers. They can use the albuterol inhaler only or have added a steroid inhaler or use an inhaler with a steroid combined with along acting albuterol-like chemical.
Mild Intermittent Asthma.The inhaler us needed more than twice a week and asthma attacks are more common.
Moderate Persistent Asthma. The inhalers are needed daily and there are frequent attacks.
Severe Persistent Asthma. The inhalers are needed daily and flare ups are frequent.
Some people respond to a slower delivery of the medication via a nebulizer machine (producing medicated vapor slowly). This machine prevents the fast heart rate and jitteriness of the albuterol-like inhalers which push the entire dose in very quickly.
The technique of using an inhaler is tricky and showing your provider how you do it will help you find ways to improve your technique and make the dose work harder for you with less side effects. You can also look on YouTube, search for Using a Metered Dose Inhaler CDC.
Keep those questions coming, Be safe!
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®