Dr. Rosenstock’s Reflections on HIV Long‐Term Survivors Day

I started practicing infectious disease in October of 1981. I’d chosen the perfect specialty for a young, over‐confident military doctor. Infections were fascinating problems to solve, and they usually had solutions. Every case seemed like a winnable battle, after which I’d triumphantly send a cured patient off to live life to the fullest. Needless to say, 1981 threw us all a curve ball.

 

It’s almost a cliché to say now, but if you weren’t there when the AIDS crisis hit, it’s impossible to understand what it was like. It was a stunning time of loss for LGBTQ communities, and a period of intense uncertainty for healthcare providers. My long‐time nurse, Mary Burns, and I lost two to three patients per week in those early days, almost all of them gay men. We saw their loving partners step up and become part of their care teams. We saw their intense devotion through unimaginable anguish, during a time when their relationships weren’t recognized in life or death. It was beautiful and horrific to witness. Their names will echo through our practice forever.

 

Our dying patients taught us about dignity, chosen family, altruism and forgiveness. They laid bare the consequences of stigma and hatred. They acted up against stigma, silence and healthcare bureaucracy. My remarkable nurses and medical assistants became family to our patients and to each other. We were united in our grief and in our shared commitment to fight alongside our patients.

 

In the mid‐1990s, the pace of death slowed with the advent of effective treatment, and we eventually had time to catch our breath and refocus on treating HIV as a chronic illness. So many of those caring partners held on just long enough to reap the benefits of all the studies they’d participated in. One of our patients had lost 59 friends and was awaiting his own demise when protease inhibitors came along. He’s still with us today. Our patients became People Living With HIV, and I grew up to be a doctor who saw people first, infections second. My patients led me to the realization that I loved being able to get to know their whole stories.

 

To my patients who are long‐term survivors of HIV: Thank you. Thank you for staying here with us despite the stigma, the grief, the survivor’s guilt, and the insensitivity of so many care providers. Thank you for putting your bodies on the line in the early days to test new treatments; for your tireless, unapologetic political activism. Thank you for being a beacon of hope for the newly‐diagnosed, and for helping to build a medical system that would serve your communities best. It’s been the honor of a lifetime to care for you at every appointment.

 

Dr. Joel Rosenstock, CMO

Dr. Joel Rosenstock, CMO 

Peripheral Artery Disease

Peripheral Artery Disease (PAD) is caused by build up of plaque in the arteries bringing blood to your extremities, organs and brain.  The plaque is formed by cholesterol, calcium, platelets, and fibrosis tissue which are all found in the blood.  After an artery is damaged the body begins healing by forming plaque at the damaged site.

The plaque will harden over time and result in narrowed arteries which obstructs blood flow. The plaque can break off the artery wall and form clots or obstruction of the artery resulting in decreased flow of blood to important tissues. PAD can cause a variety of symptoms ranging from skin changes to organ failure. Knowing and addressing your risk factors can help prevent this significant health problem.

The American College of Cardiology and the American Heart Association have identified groups with increased risk.

  • Over age 70 years old
  • Age 50 to 70 with history of tobacco use
  • Age 40 to 50 with Diabetes Mellitus and at least one additional risk factor (male, African American, family history of atherogenesis, tobacco use, elevated cholesterol, and hypertension)
  • Abnormal lower extremity pulse examination
  • Known Arteriosclerosis

Your healthcare provider will diagnose PAD by comparing blood pressure in arms & legs, usually via ultrasound and physical exam and blood tests.

Prevention of PAD continues to be the best intervention. The US preventive health taskforce recommends smoking cessation, a heart healthy diet, management of elevated cholesterol, and controlling diabetes and/or hypertension.  All of these strategies reduce your risk of this common and significant problem.  Discuss your risk with your health care provider at your next annual exam.

David Stahura, DO

David Stahura, DO

Penicillin Allergies

Penicillin is one the of the most commonly used antibiotics.  About 1 in 10 patients have a penicillin allergy recorded in their medical records. Many allergies are diagnosed in childhood and may be a rash caused by a viral infection versus a true allergy. Penicillin allergies tend to fade away for about 80% of people over a 10‐year span. Most patients with a penicillin allergy recorded with their medical record can tolerate penicillin‐like antibiotics.

Penicillins are among the safest antibiotics. Having an unverified penicillin allergy may result in other antibiotics being used to treat infections, which could result in treatment failures, healthcare‐associated infections (like Clostridium difficile), and adverse side effects.

Penicillin allergies can be evaluated by your physician evaluating a thorough history of the reactions.  Skin testing for a penicillin allergy is the usual next step in evaluation. If no reaction occurs, the first dose of penicillin can be used in the future.  It is important to remember that allergic reactions can occur anytime, so being cautious is always appropriate.

If you have a history of penicillin allergy, ask your physician how you can be evaluated.

David Stahura, DO

David Stahura, DO

Ref: American Academy of Allergy Immunology

www.aaaai.org

Support and Social Groups Available at AbsoluteCARE

Support Group
Please check out the updated list of support and social groups currently offered to our members. We hope you’re interested in joining us! If you have any questions or concerns, contact Emily Brown, our director of community engagement, at ebrown@absolutecare.com or 404–994-4234.

Peers of Georgia

A monthly support group for People Living with HIV and their families, friends and supporters. People who are not members of AbsoluteCARE are welcome!

Meeting Times: 4th Wednesdays 12:00PM-1:30PM

Facilitator and Contact: Please contact Freda Jones at 404–231-4431 x3132 or freda.jones@oakhurst.org.

One Roof 

One Roof is an HIV peer support group open to all AbsoluteCARE members living with HIV. Our different backgrounds and experiences will remind us that under this One Roof we can inspire each other.

Meeting Times: Every first and third Tuesday at 5:30PM – 7:00PM, with our first meeting on March 19th, 2019.

Staff Facilitator and Contact: Please contact Jonathan at 678–666-3278 or jspuhler@absolutecare.com

Life With(out) Substance

Life With(out) Substance is an unique, open‐minded, and affirming substance use peer support group open to all AbsoluteCARE members with past or present substance use. Our focus will be on life, and how substance use affects it, at all levels, and what recovery looks like for individuals, relationships, and communities.

Meeting Times: Life With(out) Substance meets every second and fourth Thursday at 5:30PM – 7:00PM, with our first meeting on March 28th, 2019.

Staff Facilitator and Contact: Please contact Jonathan at 678–666-3278 or jspuhler@absolutecare.com

#SheMatters Women’s Health Happy Hour

#SheMatters is a casual, fun happy hour for women living with HIV and their allies to discuss various health and social topics in a relaxed environment. People who are not AbsoluteCARE members are welcome to attend!

Meeting Times: Every 3rd Thursday, 6:30pm to 8:30pm

Facilitator and Contact: Please contact Freda Jones at 404–231-4431 x3132 or freda.jones@oakhurst.org.

Come As You Are

Come As You Are is a social group for gracefully aging (35+) gay men living with HIV who are members of AbsoluteCARE. We meet monthly and our activities include pot‐lucks and fine dining, bowling and escape rooms, museums and festivals, and more. All are welcome; cost and transportation sponsorship is available for any in need, and is anonymous.

Meeting Times: Once per month; variable depending on activities and interests.

Staff Facilitator and Contact: Please contact Jonathan at 678–666-3278 or jspuhler@absolutecare.com to join!

Monthly HIV Lunch & Learns

These monthly lunch and learns are an opportunity for patients and community members living with HIV to learn about different aspects of living with HIV.

Meeting Times: 2nd Wednesday at 12:00pm-1:30pm

Facilitator and Contact: Please contact Freda Jones at 404–231-4431 x3132 or freda.jones@oakhurst.org.

Sue Westgate Receives Dean’s Teaching Award

Congratulations to Susan, our National Director of Behavioral Health, for receiving the Dean’s Teaching Award at University of MD, School of Social Work for a graduate class taught this past fall. Her course was titled, “Working With Individuals with Chronic and Life‐Threatening Illness”. The Dean’s Teaching Award is given based upon student satisfaction and student overall recommendation of the instructor.

We are so fortunate to have Sue as part of the AbsoluteCARE team. Well done!

Weight Loss Surgery Options

There are multiple types of surgery for people who struggle with excess weight. These surgeries are now much less invasive and much safer than back in the 90s. Hundreds of thousands of these surgeries are done each year and follow up over 5–15 years has shown sustained weight loss of 25–30% of body weight. Plus, the risk of serious complications is very low, like that of a gall bladder surgery. The improvement in heart and brain health, diabetes, blood pressure, cholesterol, and even risk of cancer, is significant.

The most common surgery involves cutting the stomach to a “sleeve” that is shaped like a banana. It reduces hunger and makes people feel full so they lose weight. A couple months after the operation, they go back to eating normal food but smaller amounts of it. The other common operation is bypass and that is more effective, but has slightly more complications. It is still very safe and preferred for those who are very obese.

Consult with your healthcare provider to determine if you’re a candidate for weight loss surgery.

 

Anuj Malik, MD
Board Certified in Obesity Medicine

Beginning Hormone Therapy for Gender Transition

Hormone therapy (HRT) can have positive and important impacts on a transgender person’s quality of life. First, you need to make the decision that you are truly ready to start your hormone therapy. Once you start, some changes cannot be undone. One question to ask is how will HRT impact my life? If you make the decision that HRT is right for you, the next step is finding a healthcare provider (HCP) to prescribe your HRT and monitor your therapy. It is important to find an HCP you feel comfortable with and one who has experience in prescribing HRT for gender transition.

Your HCP will perform a physical assessment prior to starting your HRT and may also request a mental health assessment. HCPs have a responsibility to be sure you are making an informed decision and that you meet the physical and mental standards for eligibility and readiness for HRT. Following the mental health assessment, the mental health professional will then make recommendations to your provider. Your HCP will then do the physical exam, order baseline laboratory testing, and discuss the process of initiation of your HRT. Once complete, your HCP will make recommendations on dosages and frequency of your HRT and how you will be monitored during your transition. Ongoing care will include follow up appointments with your HCP to monitor your hormone levels and the effectiveness of your therapy. You may also be followed by your mental health provider in certain circumstances.

Remember, HRT is a lifelong commitment and requires monitoring to optimize your transition and your overall health. Finding the appropriate HCP is an important first step to building a happier, healthier quality of life for you!

If you’re interested in scheduling an appointment to discuss beginning HRT, please give us a call at 404.231.4431.

 

Terry Hackworth, NP‐C

Should You Get the New Shingles Vaccine?

Shingles or Herpes Zoster is a condition that causes pain and a blistering rash over specific parts of the body. It occurs in people who have had “chicken pox” in the past. When a person recovers from “chicken pox” the virus can remain dormant in the body.

If the virus reactivates it can cause Shingles. Postherpetic neuralgia is a result of Shingles and can become a chronic pain problem impacting quality of life. Shingles can be treated with paid medication and antiviral medication, but is preventable by vaccination.

There are two types of vaccinations for Shingles. Zoster Live vaccine and Recombinant Zoster vaccine. The Live vaccine has been available since 2008 but is only about 50% effective against Shingles. It has been indicated for people older than 60 years old, as they are more likely to experience Herpetic Neuralgia.  In the fall of 2017, Recombinant Zoster vaccine became available. It is recommended for patients over the age of 50 and is greater than 90% effective in preventing Shingles and Neuralgia, which is significant improvement over the previous version available. It is not a live vaccine, so it should also be safer than the older vaccine. The Recombinant vaccine requires a series of two injections, given 2–6 weeks apart.

All adults over 50 years old should be vaccinated against Shingles. If you have never had “chicken pox”, you should receive a Varicella vaccine instead of a Shingles vaccine. Your health care provider can test you to determine the correct action if there is a question as to which vaccine is appropriate. Currently it is recommended that anyone over 50 years old who has received the Live Shingle vaccine be revaccinated with the new Recombinant Shingle vaccine (Shingrix).

Please be sure to discuss Shingles vaccine options with your healthcare provider if you qualify.

 

Dr. David Stahura, DO

Do you Wheeze more in the Spring and Fall?

Most of us look forward to spring after hibernating indoors all winter. We enjoy getting out and walking about, enjoying the blooming flowers and budding trees. But if you have asthma or allergies (or both), spring pollen season can take a toll on your lungs. The same goes for ragweed in the fall. Seasonal pollens in the spring and fall can trigger asthma symptoms by increasing airway inflammation causing someone to wheeze more during these peak seasons.

If seasonal pollen is a trigger for your asthma, it is best to stay indoors when pollen levels are high, particularly during the morning hours. Keep windows closed to prevent pollens getting into your home or car. When you have been outside, take a shower and wash your clothes to remove residual pollens once you are back indoors. Most importantly, always remember to carry your rescue inhaler with you should it become difficult for you to breath or you start to wheeze while enjoying the outdoors.

 

Allene Harrison, NP‐C

When is a PAP Necessary?

A Papanicolaou (PAP) test is a screening tool for prevention of cancer. Cervical cancer occurs in the bottom part of the uterus in women. The main symptom is abnormal vaginal bleeding but very often in early stages there are no symptoms. For this reason, screening is important.

Papanicolaou smear (PAP) and the Human papillomavirus (HPV) test are the routine screenings for cervical cancer. These tests are performed by obtaining cells from the cervix using a small brush or spatula during a vaginal exam in the health providers office. It is a quick and painless exam.

The benefit to testing is early detection of cancer as it is generally curable in the early stages. The evidence of benefit is significant in women between the ages of 21 — 65 years old. Potential harms of screening are from false positive test results and over testing, but this is far outweighed by the significant benefits. These recommendations apply to women between age 21 — 65 that have not had a previous cervical cancer diagnosis and are not immune‐compromised.

Currently cervical cancer screening is recommended in women aged 21 — 65 years. For women 21–30, screening should be a PAP test every 3 years. For women 30–65 screening can be done by PAP every 3 years or by PAP test and HPV test every 5 years.

For women less than 21 years or older than 65 years the benefit of screening is unclear and needs to be individualized with your health care provider.

Dr. David Stahura, DO