January 23, 2010

January 23, 2010
Mental health

Welcome to another day in my life. Today is Saturday and it is a beautiful weekend here in south Florida. I hope you are having a safe and great start to your weekend also.

Today was the memorial service for my friend, Michael Childers, who passed away recently after a long battle with HIV/AIDS and cancer. Unfortunately due to health problems, I was unable to drive to Jacksonville for the service so I went for a walk and thought about all our great times together instead. I heard from several friend that it was a beautiful services. Lutheran Social Services provided the food for after the memorial.

Going through health problems and being a long term survivor of HIV and AIDS, I have had problems with depression a couple of times over the past 30 years. One thing people with HIV and AIDS need to pay close attention to is their mental health. So as a continuation on this series of blogs about wellness, I would like to talk about mental health today.

Part of every routine visit to your provider should include an assessment of your mental health. Hidden psychiatric concerns such as depression, anxiety, addiction, and other issues can be easily missed.

As a patient, you should feel comfortable discussing anything with your provider, and that includes how you are feeling, not just "medical" concerns. If you're a medical provider, you should make it a point to bring these subjects up as a part of the review of systems. Unrecognized mental health problems often lead to serious consequences such as missing doses of medications, missing appointments, reduced quality of life, relapse into substance abuse, and even suicide.

Many patients are what I like to call "doctor pleasers." These are the ones who come to the office and when the doctor asks, "How are you doing?" they sit forward, look their doctor in the eye, smile, and say, "Great, doc!" They do not want to complain about anything because they do not want to let their doctor down or burden them with their problems.

This is unfortunate because it is their job to be burdened. Sure, it makes the visit a lot faster and a lot less work for the doctor, but that should not be the goal of a provider patient encounter. As a patient, make sure you get your money's worth at every visit.

Prevention with positives

Every HIV positive patient should have a complete assessment of their vaccination history. In addition to all the childhood vaccines, HIV positive people should have up to date tetanus, pneumococcal, hepatitis A and B, and MMR (measles/mumps/ rubella). Further, annual TB screening with a PPD or quantiferon testing should be performed. If you have had a positive TB test in the past, your provider will order an annual screening chest X-ray. If you are a female, ask your provider about the new HPV vaccine. Some providers may also be considering this vaccine for men although there is not yet a formally approved indication in males. In select cases, vaccines for varicella zoster or meningococcal may be appropriate.

In serodiscordant couples (one partner is HIV positive and the other is HIV negative) safer sex with barrier precautions such as condoms and dental dams is essential. This is not only to protect the HIV negative partner but for the positive partner as well. There are plenty of other sexually transmittable diseases out there that can be spread through unprotected sex. The list is long and includes syphilis, hepatitis A, B, and C, herpes, genital warts, gonorrhea, Chlamydia, LGV, and others. Either partner can spread these diseases to the other. In some cases, an STD may manifest in an unusual or more severe form, and be more difficult to treat, in an HIV positive person.

In couples where both parties are HIV positive, all of the above applies. In addition, I am often asked whether HIV can be re-transmitted between people who already have it. The simplest answer is yes. While this occurrence is presumed to be rare, it has been documented. The most serious concern in these cases is when one person transmits a strain of drug resistant virus to their partner. The recipient may or may not have the same resistant strain and this may have serious implications in treatment.

Lastly, your provider should also be performing all the other age appropriate preventative screening measures their HIV negative patients receive. This means Pap smears, prostate exams, cholesterol checks, blood pressure screening, colonoscopies, and more. If you are not sure if you are due for these tests, ask.

Remember you are your best advocate. You need to ask questions, let your providers and case managers know what you need and when you need it. Be honest! They are there to help you. Not to judge you.

Until we meet again; here's wishing you health, hope and happiness.

big bear hug,

Daddy Dab