ABCs of HIV for National Youth HIV & AIDS Awareness Day

Today, April 10, 2016, is National Youth HIV & AIDS Awareness Day. Why do we need a YOUTH awareness day? Because in 2014, nearly 10,000 young adults were newly diagnosed with HIV (age 13-24 years, 9731 cases). And that is only young people who got TESTED and therefore were DIAGNOSED. Nearly half of young people already living with HIV are UNAWARE that they are infected. In honor of this HIV Awareness Day, here are my quick HIV ABCs:

• A: ALL people ages 15-64 should be tested for HIV at least once, regardless of risk factors. Why?Widespread testing will help identify the estimated 1 in 8 people living with HIV infection who do not know their are infected, and now with our highly accurate rapid testing, false positives are extremely rare.
• B: BISEXUAL- meaning remember that HIV occurs in BOTH genders, as well as emphasizing the fact that HIV is most prevalent in gay, bisexual and other males who have sex with men (but not all MSM identify as gay or bisexual.) Nearly 20% of the 44,000 new HIV diagnoses in the US during 2014 were female, and the vast majority (87%) were infected through heterosexual sex. 
• C: CONDOMS- "Safe Sex" means using condoms consistently and correctly, for all forms of penetrative intimacy. To be specific, use condoms for oral, anal and vaginal sex. (While oral sex is low risk for HIV transmission, other STIs such as gonorrhea and herpes simplex are easily transmitted this way.) Condoms do not make you bullet-proof, but they work extremely well -up to 98% decrease in transmission of HIV.

BOTTOM LINE: HIV has not disappeared, and many who are infected do not know. GET TESTED!

STD Awareness Month 2016 "Talk. Test. Treat"

"TALK. TEST. TREAT."

Perfect theme for the CDC's 2016 STD Awareness Month! We can't have AWARENESS if no one is talking about these diseases. And because these diseases are mostly SILENT, you can't have AWARENESS that you have an STD unless you TEST for it.

The Bad News: 

• Sexually transmitted infections affect over 20 MILLION Americans every year, and young people ages 15-24 make up over HALF of these cases. 
• Chlamydia, gonorrhea and syphilis are on the rise for the first time in a decade.
• Gonorrhea is more difficult to treat because it has become very resistant to antibiotics
• Curable bacterial STDs, if not diagnosed and treated in a timely fashion, can have lasting impact by causing chronic pelvic pain or even infertility. 
• Young people are the least likely to get tested and treated for numerous reasons, including ignorance that their non-intercourse sexual activities can transmit STDs, fear and embarrassment of telling their parents, inability to pay for or access healthcare on their own.

The GOOD News:

• Many of these infections are preventable, and testing is easier than ever (no pelvic exam required in most cases- only a urine test for gonorrhea and chlamydia, and a blood test for HIV and syphilis). 
• Gardasil vaccine prevents the vast majority of genital warts and HPV-related cancers.
• Hepatitis B vaccine prevents Hep-B related cirrhosis and liver cancer.
• Proper and consistent condom use greatly reduces transmission of most STDs.

I have found that sharing stories (with accurate medical information) is a powerful tool for teaching about sexually transmitted infections. Check out the newly released second edition of Seductive Delusions: how everyday people catch STIs.

BOTTOM LINE: TALK.TEST.TREAT  and learn how you can help spread KNOWLEDGE and stop the spread of DISEASE.

Pre-Gaming with ADD Meds...A Dangerous Party Plan

Binge drinking in college students is not exactly breaking news.  My patients repeatedly explain "if you can't handle five shots of vodka, you are pretty lame".  They toss back multiple shots, have beers, then top off with mixed drinks. Hit the replay button once or twice, and the weekend is over. On Monday morning, they head back to class, seeming none-the-worse for wear beyond a headache.  How is this possible? Especially for adolescents who are only STARTING to drink, how exactly can they tolerate this volume of alcohol?  I started asking...and heard the same answer, over and over. "Well, to be honest, I pre-game with my ADD meds". 

PRE-GAME? Yes. Young people have figured out that when they take a prescription stimulant right before going out to party, they can "hold" more liquor. The stimulant takes away the typical buzzed, relaxed sedation of the first few drinks. Many have told me they "feel absolutely nothing at all from the alcohol...till I reach a certain number of shots, then suddenly I go from sober to super buzzed, and then either puke or pass out."

At first this confused me...wasn't the POINT of their drinking to catch that buzz in order to feel more social or confident? It seems counterintuitive. But if the peer pressure now is not only to drink, but to show you are so comfortable with drinking that it doesn't affect you- then this plan makes total sense. Except that this plan is so very dangerous, which makes it terrifying instead.

Unfortunately, not "feeling" the effects of alcohol does not mean that the alcohol is less potent within your brain, liver, bloodstream or nerves. This practice makes it far too easy to reach ALCOHOL POISONING levels, because you have turned off all your body's warning signs. Short term, you can hit toxic levels of alcohol that make you stop breathing. Or enough to "just" pass out...but then throw up and choke on your vomit. Long term, you are taking the HOV lane to end-stage alcohol complications because although you may only drink on weekends, you are getting huge quantities in at one time. And socially, this practice is normalizing binge drinking, because everyone sees their friends routinely drinking numerous drinks without it seeming to affect them.

A recent Cochrane meta-analysis Social norms information for alcohol misuse in university and college students examined 70 studies, including nearly 45,000 students. The premise was that college students have an inflated misperception of how much their peers are drinking, and therefore educating them about the true social norms may reduce alcohol-related consumption and subsequent problems. Although there were some significant effects, the "substantive meaningful benefits" were not enough to recommend policy changes.

As a side note, many students are taking ADD meds they have borrowed or purchased from a friend, which is not only illegal but magnifies their medical risk.

Yes, binge drinking in college has been around for a very long time, and thankfully the majority give up this habit when they hit the real world- if they survive their risky behavior. Note that a standard screening question for alcohol abuse is "have you had more than 4 drinks in one day during the last year?" 

Wondering how many drinks it would take for YOU to get alcohol poisoning? Check out one of my favorite resources: Aware, Awake, Alive

BOTTOM LINE: Doctors, parents and teens ALL need to know the dangers of "pre-gaming" with ADD meds. 

Drug Abuse from YOUR Medicine Cabinet

Prescription drug abuse is at an all time high- no pun intended. Sadly, studies have found that 1 in 5 high school students say they have taken a prescription drug without a prescription. What are they taking? Pain killers, stimulants, and anxiety medications. Specifically, the most common drugs are OxyContin, Vicodin,  Percocet (narcotic pain pills), Ritalin & Adderall (ADD stimulant drugs), and Xanax (called "bars" because of the shape-an anti-anxiety sedative like valium.)

Many people have a false sense of security using prescription medications to catch a buzz, especially adolescents. The prescription element seems to be a stamp of safety for them (similar to "organic" equals "better"-but I digress). Frankly, it terrifies me to hear of kids swapping any prescription medications, particularly ones as potent as these. Add in that these pills are often combined with alcohol, and you now have a recipe to take your breath away- literally. Both narcotics and alcohol can suppress your drive to breathe, and they are additive when taken together.  Accidental overdose is a frighteningly common cause of death for teenagers, and inappropriately used prescription drugs are a major culprit. When I prescribe codeine cough syrup (which is the most common reason I prescribe narcotics this time of year), I always remind my patients that this "cough" medicine is a narcotic, and NARCOTICS + ALCOHOL = DEATH.

Another common pairing of prescription medications and alcohol is "Pre-gaming" with ADD meds, with the intent of revving up with the stimulant so they can "handle" their liquor better...which is a fast track to alcohol poisoning.

What can parents do about this alarming trend?
Number one, TALK to your teen. Ask (in a non-threatening, conversational tone) if they are aware of anyone borrowing prescription medications from friends. Let them know this is DANGEROUS and ILLEGAL. Please throw in the fact that it is a FELONY to buy or sell prescription drugs, and that charge is a one way ticket the wrong direction. The truth is that there is a ton of "altruistic" sharing of medications in college, and that sharing often becomes buying and selling between friends. Kids want the stimulants to help them pull an all-nighter, and that seems like a good and worthy cause to them (although numerous studies have proven all-nighters don't help grades.) Students also want these drugs to lose weight, or "hold their liquor", or  to use as an escape. Acknowledging these issues up front can lead to a more productive conversation, and talking with your teen at least lets them know you are aware of this risky behavior in general.

Next step? Take a close look at your medication cabinet. Throw away expired drugs, and keep close inventory of any potentially abused medications. If your kid is on ADD meds, make sure they are taking them as prescribed. Finally, if you realize that you are using prescription drugs inappropriately, it's time for a difficult conversation with your physician. You can't abuse it if we don't prescribe it, so this is a problem we need to tackle together, and there are solutions beyond simply cutting you off.

BOTTOM LINE: Prescription drug abuse is out of control. Learn the facts and protect and educate your teens. Get more info at the National Institute on Drug Abuse.

STILL Coughing? Will Anything Help?

Is your cough driving you (and everyone around you) nuts? If your purse, coat or pant pockets are overflowing with empty cough drop wrappers and tissues, than you've dealt with that cough on your own long enough. Whether the original culprit was a common cold, the flu, or "just" seasonal allergies, coughs can take on a life of their own as our lungs gear up mucus production and airway spasm. My rule of thumb is that lingering coughs should be on a clear decrescendo- getting slowly but steadily better each day. If your cough is getting worse by increasing in frequency, intensity (like those fits of coughing hard enough to make you leak urine), or preventing sleep, then it's time to let a doctor listen to your lungs and take a full look at you.

But what can be done for a cough that wont go away? Do I need antibiotics?
The vast majority of persistent coughs do NOT need an antibiotic, because they are typically a left over reaction from a respiratory virus.  However, if you are a week or more into your symptoms and things seem to be improving, but then suddenly you feel a ton worse and develop chills, sweats and fever as your cough worsens, this might be a bacterial infection setting up shop AFTER the virus cleared the way past your body's defenses.- possibly even pneumonia. For this scenario, yes, you often do need an antibiotic. More commonly, though, frustrating coughs are the result of developing  some over-reactive airways and therefore, you may benefit from inhalers or other asthma-style medications. Not uncommonly we prescribe a very brief course of oral steroids (prednisone) for someone who develops wheezing and airway spasm after a viral respiratory infections.

But I don't HAVE asthma- so why am I coughing? People who did not grow up with the diagnosis of asthma can still have an asthma response to a respiratory tract infection or seasonal allergies- we call this "reactive airways disease". Your lungs make extra mucus and have more inflammation,  together causes airway spasm- audible to the examiner and sometimes to the patient themselves as a "wheeze". The asthma inhalers or breathing treatments through a nebulizer (machines that deliver the asthma medication as a fine mist that is inhaled through a mask or mouthpiece) work to pop open those airways, stopping the wheeze that was caused from the airway spasming shut in areas. That relief is temporary, however, because it fixes the problem and not the cause. The steroids are the real "fix" because they decrease the inflammatory response that started the whole cycle.

What else might my doctor give me?
There are a variety of cough suppressant combinations that include dextromethorphan, which is in most over the counter cough and cold products. Some persistent coughs without the reactive airway component will respond to a prescription cough suppressant called benzoate (brand name tessalon perles.) Additionally, a prescription narcotic cough syrup may help you sleep at night and reduce the nighttime exacerbations. Finally, your doctor can remind you of some traditional home remedies such as cool mist humidifiers and topical menthol products that may help your symptoms. Finally, sometimes a cough comes from other sources, such as acid reflux or sinus drainage, which require different treatments.

BOTTOM LINE: See your doctor to evaluate coughs that get worse after a respiratory illness, or that wont go away- don't expect antibiotics, but know there are other treatment options!!

Flu Vaccine- NOT TOO LATE!

* The "C" in the flu tests pictured above is for "control"

Friends, family, colleagues and everyone else- FLU SEASON was mild to begin with, but now we are really gearing up. Pictured above are two positive flu tests from one morning this week (two of many). The extra good news is that so far I have not seen anyone with the flu who was vaccinated, though certainly that can happen. Remember that seasonal influenza causes thousands of hospitalizations and deaths every year in the United States, and the flu vaccine is our best method to prevent or at least reduce the severity of the flu.

This year, we hit a home run on the strains in the vaccine, as we have a very good match between the vaccine and the current strains. Yesterday's CDC press release notes that the overall effectiveness of this years vaccine is 60%. While that number might not sound super impressive, reducing the total healthcare burden of people needing to seek care for flu symptoms by 60% is huge in our total population! Also, keep in mind that if you receive the vaccine but in your case it is not fully effective so you still get the flu, your symptoms should be less severe, and your infection is likely to resolve more quickly. I'm posting this today, though, not for adamant anti-flu vaccine holdouts, but for the well-intentioned stragglers that simply never got around to getting the vaccine. Please, it's not too late- GO GET VACCINATED!

CDC data shows happily that only two states- Arizona and Oklahoma- are having HIGH levels of flu-like illnesses right now. Texas, along with Arkansas, Connecticut, Florida, Hawaii, Illinois, Maryland, Nevada, New Jersey and New Mexico are close behind with "moderate" levels, which is no surprise with what I am seeing in my patients.

Remember- not all flu looks the same. Fevers can be high or minimal. Headaches, sore throats, muscle aches, cough, runny nose and fatigue are common. Stomach symptoms with nausea, vomiting or diarrhea can occur independently or with the other symptoms.

When should you go to the doctor? If you are MISERABLE- feeling like a truck hit you, rather than a common cold or allergies causing upper respiratory symptoms, then go sooner rather than later, because if you do have the flu, the anti-flu medications are maximally effective when started within 2 days of symptoms beginning.

Does everyone need medication if they have the flu? No. Most otherwise healthy young people can manage without anti-viral medications, but they may certainly benefit from a cough suppressant or decongestant.

Why bother testing for flu? There are several reasons, partly for you, the patient, and partly for public health/your family. If a college student living in close quarters in a dorm has the flu, for example, we would rather they not infect their roommate and classmates. Knowing they have the flu helps us advise them on when to return to class, or perhaps help parents who live nearby to decide to whisk them home for a few days of chicken soup and true rest. Remember, if a flu test is POSITIVE- you've got the flu. If it is NEGATIVE...you still might have the flu. (For more explanation, see Was My Rapid Flu Test Accurate?)

BOTTOM LINE: Flu season is still here and it is NOT too late to get vaccinated!

Got RED? WEAR IT FRIDAY, 2/5/16

Don't wait for Valentine's Day next week to wear RED- pull it out tonight to wear on Friday, February 5, 2016. The American Heart Association has set aside the first Friday in February to call attention to cardiovascular disease in WOMEN. Did you know that one in three deaths in women are caused by heart attacks and strokes? This is not to minimize the deaths and struggles from cancers, but to create awareness about the incredibly high frequency of these diseases in women, and therefore encourage more women to take positive steps to improve their health. The best news is that the  vast majority heart attacks and strokes can be PREVENTED when people recognize, modify and treat their risk factors. So...let's start with basics:

What is a "heart attack"? The heart is ultimately just a muscle, and like every other muscle, it needs a unique blood supply to provide the nourishment it needs to work. Although the heart muscle's  job is to move blood by pumping it, that blood being moved to the body is not the same blood that feeds the heart muscle itself. Instead, there are smaller blood vessels (called coronary arteries) that carry the specific blood that supplies the heart muscle. If one of these small arteries gets a clot or blockage that obstructs the blood flow, then the area of heart muscle that requires that blood supply will have the "attack" because it is not getting the fuel it needs, so that portion of the muscle can be hurt or destroyed. If the fuel line in your car were clogged, then your engine would have an "attack" because it wasn't getting fuel. Similarly, a stroke is when an area of the brain has it's blood supply cut off by a clot. 

What can you do to decrease your risk of a heart attack or stroke?

1. Quit smoking (always number one on my wish list for patients to improve their health!)

2. Know your numbers- what is your BLOOD PRESSURE? your CHOLESTEROL? your BMI?

3. Move MORE- whatever your baseline activity is, kick it up a notch!

Rather than focusing on losing twenty pounds,  running a marathon, or getting off all your blood pressure medications in one month, pick a few small changes that you can easily incorporate into your life as a permanent change.  

1. Consider starting these changes by scheduling a physical with your family doctor to learn your "numbers" to help prioritize your lifestyle changes.

2. Commit to one vegetarian meal per week (if that is not already part of your standard food rotation). If you are vegetarian, look at what you eat and add in new fruits or vegetables in different colors than you typically consume.

3. If you are inactive, start walking 10-15 minutes per day. If you walk a mile per day, kick it up to a mile and a half. If you walk or jog a couple miles per day already, alternate with an exercise bike or swimming. The point here is that WHATEVER you are doing, take it up ONE notch.

BOTTOM LINE: Wear RED this Friday, 2/5/16, serving as a reminder to you and the people you love to prioritize learning your own personal risk for heart attacks and strokes- then start making changes to prevent these diseases!