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Category: Personal

What Are HIV and AIDS?

Published July 9, 2021 by thewriterlyroad_2o62in

What is HIV?

Human immunodeficiency virus (HIV) is a blood-borne virus transmitted through body fluids (i.e., blood, semen, and vaginal secretions). As the name states, HIV infects the cells that help keep our immune system strong. Without a healthy immune system, our bodies are susceptible to a whole host of infections we wouldn’t usually get. It is important to remember that HIV doesn’t only affect a specific segment of society. Anyone can be infected with HIV regardless of their age, sex, race, ethnicity, or sexual orientation (AIDS Healthcare Foundation).

There are only a handful of ways to spread HIV. The first is through anal or vaginal sex. The second is by sharing infected needles or syringes to inject drugs or cookers used to make drugs. Lastly, babies can contract HIV during pregnancy, birth, or if they are breastfed by a mother who has HIV. In rare cases, patients can contract HIV from an organ donation or blood transfusion. This scenario is highly unlikely in the United States because of the thorough testing of organ and blood donors. Regardless of the route of transmission, the disease progression is the same. Many people don’t recognize the initial symptoms of HIV infection because they can be similar to the flu. 

Symptoms can include:

 * Sore throat 

  • Swollen glands 
  • Muscle aches
  • Skin rash
  • Nausea, vomiting, and diarrhea
  • Night sweats

It is not uncommon for patients to experience weight loss with a new HIV infection. If a patient presents with any of these symptoms, the clinician should complete a physical assessment, order blood tests, and obtain a complete medical and sexual history. Blood work would reveal HIV in the blood and a decrease in the white blood cell count. These findings are significant and different from other kinds of infection. 

In most cases, the body will produce more white blood cells to fight a new or growing infection. In the case of HIV, the virus is suppressing the bone marrow’s ability to make white blood cells. Additionally, another cell called a CD4 will also decrease. CD4s are often called “helper cells” because they help the immune system fight various infections; however, HIV prevents the helper cells from doing their job. As the disease progresses, the virus level will rise, and the CD4 cell and white blood cell levels will continue to fall, which further compromises the immune system.

HIV infection has three stages. Stage 1 is known as the acute phase. Some patients may have flu-like symptoms, but others may not have any symptoms at all. Because there is a large amount of HIV virus in the blood during this stage, patients are highly contagious. If a patient has flu-like symptoms with no other explanation, they should have an antigen/antibody test or nucleic acid test (NAT) to determine if they have HIV.

Stage 2 is the chronic phase. Patients still have HIV virus in the blood but at lower levels. However, they are still able to spread the infection to others. “At the end of this phase, the amount of HIV in the blood (called viral load) goes up, and the CD4 cell count goes down. The person may have symptoms as the virus levels increase in the body and the person moves into Stage 3. People who take HIV medicine as prescribed may never move into Stage 3” (Centers for Disease Control). Stage 3 is acquired immunodeficiency syndrome (aids). Although the progression of the disease can vary greatly among patients, stage 2 generally lasts for about ten years.

Clinicians should offer emotional support to a patient newly diagnosed with HIV infection. Significant strides in medications and treatments mean that patients with HIV can live a long and healthy life but there is still no cure, so the diagnosis can be a life-changing event. Clinicians need to be sensitive to the stigma some HIV patients may face with friends, family, and the public, and we should offer other community-based resources if required. These might include referrals to an HIV clinic, a social worker, a therapist, or a support group.

What is AIDS?

Acquired immunodeficiency syndrome (AIDS) is the third stage of HIV infection. At this point, the patient’s immune system is severely compromised, and they are at risk of contracting a variety of illnesses (known as opportunistic infections). 

Some examples of these opportunistic infections are 

*Candidiasis 

  • Cytomegalovirus (CMV) 
  • Herpes simplex virus (HSV) 
  • Lymphoma 
  • Tuberculosis
  • Kaposi’s sarcoma (KS)
  • Invasive cervical cancer 
  • Pneumocystis pneumonia (PCP)

As in the other stages, patients are contagious and can infect their sexual contacts. Even with proper treatment, the general survival period is about two years, although this can vary from patient to patient based on other co-morbidities. Patients are diagnosed with aids when their CD4 count falls below 200 cells per cubic millimeters of blood, or when they develop opportunistic infections.

Patients in the third stage suffer significant disability and physical challenges. The opportunistic infections may also cause multiple emergency room visits and hospital admissions. They may become unable to work, drive a car, or eat enough to maintain their weight. Fungal infections in the mouth may make it difficult to eat. In some cases, parenteral nutrition may be necessary. “Poor nutritional status and HIV infection interact with each other leading to the development of opportunistic infections, malignancies, debilitation and death” (Enwereji et al., 2019). Because patients can also develop a condition called HIV encephalopathy, they can have a cognitive impairment, making it difficult for them to perform their activities of daily living.

Treatment and Medications

As previously stated, there is no cure for HIV and AIDS, but medications and testing are advancing substantially. The main category of drugs currently in use is called antiretroviral therapy (ART). It is not uncommon for patients to be on a multi-drug regimen or “cocktail” of three or more medications to treat the disease. Each category has a different mechanism of action and works on different cells in the body. The multi-drug approach has effectively kept patients free from opportunistic infections, stabilizing or significantly reducing their viral load, and improving their CD4 counts. According to the Mayo Clinic, the classification of drugs is as follows:

  • Non-nucleoside reverse transcriptase inhibitors (NNRTIs) turn off a protein needed by HIV to make copies of itself. Examples include efavirenz (Sustiva), rilpivirine (Edurant), and doravirine (Pifeltro).
  • Nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs) are faulty versions of the building blocks that HIV needs to make copies of itself. Examples include abacavir (Ziagen), tenofovir (Viread), emtricitabine (Emtriva), lamivudine (Epivir) and zidovudine (Retrovir). Combination drugs also are available, such as emtricitabine/tenofovir (Truvada) and emtricitabine/tenofovir alafenamide (Descovy).
  • Protease inhibitors (PIs) inactivate HIV protease, another protein that HIV needs to make copies of itself. Examples include atazanavir (Reyataz), darunavir (Prezista) and lopinavir/ritonavir (Kaletra).
  • Integrase inhibitors work by disabling a protein called integrase, which HIV uses to insert its genetic material into CD4 T cells. Examples include bictegravir sodium/emtricitabine/tenofovir alafenamide fumar (Biktarvy), raltegravir (Isentress) and dolutegravir (Tivicay).
  • Entry or fusion inhibitors block HIV’s entry into CD4 T cells. Examples include enfuvirtide (Fuzeon) and maraviroc (Selzentry).

Like all other medications, side effects are possible. 

Common side effects of ART include: 

  • Bleeding
  • Bone loss 
  • Damage to the kidneys, liver, or pancreas
  • Lactic acidosis 
  • Heart disease
  • Hyperglycemia which can lead to diabetes

Treatment also involves regular blood testing to assess the viral load, white blood cells, and CD4 cells. As much as possible, patients should maintain a strong immune system by avoiding others who are ill, taking medication as prescribed and not missing any doses, eating a well-balanced diet, and minimizing stress.

Another positive step in the treatment and possible prevention of HIV is PrEP, or pre-

exposure prophylaxis. These medications are taken before potential exposure to HIV or if a patient is at high risk of exposure to HIV. PrEP is effective if it is taken regularly. PrEP can reduce the risk of HIV infection from sex up to 90% and in I.V. drug users up to 70% (Medline Plus).

According to the website HIV.gov, there are currently two approved medications for PrEP:

The side effects of PrEP are similar to ART and include:

*Nausea and diarrhea 

*Headache

  • Possible damage to the liver or kidneys
  • Loss of bone density

There is another class of drugs for patients who believe they have been exposed to HIV. These are known as PEP, or post-exposure prophylaxis. PEP may be ordered if a patient feels they were exposed to HIV during sex, after sharing potentially contaminated needles or syringes, and after being sexually assaulted. To be effective, patients must start PEP within 72 hours of exposure, and they must take the drug for 28 days. Just like PrEP, PEP is only effective if taken as prescribed.

Patient Teaching

Like other chronic diseases, patients with HIV and AIDS need ongoing education about the progression, treatment, and management of their illness. Clinicians play a crucial role in helping patients understand symptoms, side effects of medications, the need for regular blood tests, and how to handle and treat opportunistic infections. Teaching should empower the patient in taking their medications as scheduled and report side effects to their provider. Clinicians should strive to build rapport with their patients. In doing so, they stand a good chance of obtaining an accurate and thorough medical and sexual history.

Another critical component of teaching for this patient population is safe sex practices. It cannot be overstated how important it is for patients to understand behaviors that increase their risk of contracting his as well as actions that can decrease their risk. 

Behaviors that increase the risk of contracting HIV are:

 *Sharing needles and syringes 

*Having sexual contact with someone who has a high viral load the presence of another sexually transmitted infection

* Using drugs and alcohol during sexual encounters.

Behaviors that reduce the risk of contracting HIV include:

 *Abstinence 

*Less risky sexual behaviors

*Using condoms and lubricants 

*Reducing the number of sexual partners

*Taking medication to prevent HIV or reduce the viral load 

It is essential that sexual partners have an honest conversation about each other’s sexual practices and whether the relationship will be monogamous. Sexual partners can also agree to only engage in safe sex practices and remain committed to these guidelines during the relationship.

Lastly, partners should always be honest about their HIV status, especially if they plan to engage in sexual activity or become pregnant. Having HIV does not mean that sex or pregnancy is not possible, but extra precautions are needed to reduce the risk of transmission.

Medication Compliance

As researchers and health care providers learn more about antiretroviral therapy, it is clear that strict adherence to the dosing regimen is essential to keep the HIV viral load under control, increase CD4 production, and support the immune system. Clinicians play a pivotal role in ensuring that patients understand their medication regimen and the rationale for strict adherence to its guidelines. As health care providers, we should never assume that patients know what to do to keep themselves healthy. Therefore, assessing the patient’s knowledge level and willingness to follow the medication dosing is crucial to the successful treatment of HIV infection.

Conclusion

The progress made in the battle against HIV and AIDS is nothing short of phenomenal. A disease that at one time would have meant a sure and quick death is now being held at bay by advances in both testing and treatment. If handled properly and conscientiously, HIV patients can expect to live long, quality-filled lives. More than ever, HIV patients can hope that they won’t suffer disability and devastating illness because of the virus. This hope extends to friends, family, and the community as well.

Clinicians can help this patient population by not being afraid to have open conversations about medical and sexual history, medication compliance, and overall health status. Additionally, offering emotional and psychological support will help these patients better navigate their journey of living with the virus. HIV and AIDS once may have been the worst-case scenario for many, but that is not the reality now. We can hope the next phase is a cure.

References

AIDS Healthcare Foundation. What is HIV? HIV Basics. HIV Care. (n.d.). https://HIVcare.org/hiv-basics/?gclid=EAIaIQobChMIgaaX__3x8AIVZz2tBh0WuAUCEAAYASAAEgJ_MvD_BwE

Centers for Disease Control. About HIV. https://www.cdc.gov/HIV/basics/whatisHIV.html

Enwereji, E.E., Ezeama, M.C., Onyemachi, P.E.N. (2019). Basic principles of nutrition, HIV, and aids: making improvements in diet to enhance health. DOI:10.5772/intechopen.84719

HIV: PrEP and PEP. https://medlineplus.gov/HIVprepandpep.html

HIV.gov. What drugs are approved for prEP? https://www.HIVgov/HIV-basics/HIV-prevention/using-HIV-medication-to-reduce-risk/pre-exposure-prophylaxis

Mayo Clinic. HIV/AIDS. https://www.mayoclinic.org/diseases-conditions/HIV-AIDS/diagnosis-treatment/drc-20373531

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Fodder from the Frontlines: Day #7

Published July 24, 2020 by thewriterlyroad_2o62in

Although it was a slow day, the pressure and stress are starting to show. We are all a little too quick to question each other and become defensive over the smallest perceived slight. One nurse who has anxiety has developed a constant eye twitch. Over the weekend, one nurse became agitated when another accidentally bumped into her. She screamed, “Don’t touch me! Don’t touch my stuff!”

Today we began random testing of 10% of the staff to look for positive COVID tests. I volunteered as one of the first to be tested. My anxiety about this virulent virus isn’t unfounded. Two of the complications are renal failure and blood clots. Not only do I have one kidney (I became a living donor in 2015) but I also have a clotting disorder. Contracting this virus could mean a potentially devastating outcome for me.

As I wait for the results, I think about what a positive result would mean. I’d be done working, I would have to stay at home and have my groceries delivered. Can I still sit out on my patio, or walk my dog, Harper? So many questions with blurry answers, and such a new and unfathomable world spinning before our eyes. All three of us who tested are negative. I am so relieved I go to the bathroom and cry.

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Fodder from the Frontlines: Day #6

Published July 24, 2020 by thewriterlyroad_2o62in

t was a busy day but the team handled the flow like a well-oiled machine. We have a system and it’s working. We are processing everyone’s samples while staying safe. Young people are still clearly hanging out with each other and don’t seem to take the threat of this virus seriously. Part of me understands this. At eighteen, I made some profoundly stupid decisions, and no one could tell me I was wrong.

Human beings do not have a fully developed frontal lobe until about age 25. The frontal lobe controls decision making and impulse control, so it’s not surprising the younger ones don’t get how bad COVID can be for everyone. I did a lot of patient teaching today. Some of these kids were offended but I don’t care. A huge part of nursing is helping people comprehend how their actions affect not only themselves but others. I will not stop talking about the right thing to do.

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Fodder from the Frontlines: Day #3

Published July 24, 2020 by thewriterlyroad_2o62in

Day #3 at the COVID clinic. Reality is kicking in. The bridge of my nose is red and inflamed from wearing the N95 mask, and now I have it: “macme.” Acne caused by wearing the mask for so many hours and sweating under it. I was sweating so badly underneath the bodysuit, masks, face shield, and gloves that it ran into my eyes and was dripping off my face.

Luckily, the nurses I work with are awesome and we help each other, no matter what.

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This Time, The Personal is Not Political

Published July 13, 2020 by thewriterlyroad_2o62in

Wear a mask. During the pandemic, all of us have heard this request. The direction seems simple enough, and yet, every day I see people walking around in public with their faces fully visible. They seem not to have a care in the world as they stroll along potentially infecting their fellow humans.

I had an unpleasant conversation last week with a woman in the grocery store. She waltzed right in carrying a young girl on her hip. Neither of them were wearing masks. I was in the checkout line and when she passed I said, “You need to put on a mask.” She ignored me and continued to walk through the store. She came by a second time (headed towards the wrong exit) and I repeated my statement.

She replied, “Mind your own business.”

I said, “This is my business.”

She shouted, “I’m not your fucking business!”

Classy.

Feminist and writer Carol Hanisch wrote an essay titled, “The Personal is Political.” By the time of its publication, the phrase was already commonly used among feminists of the 1960s and ’70s as a way to explain that both personal choices and political policies had an effect on women’s lives in the United States.

However, that feminist rally cry doesn’t apply here.

In the case of this worldwide pandemic, there is nothing political about wearing a mask. The issue is one of safety. Infectious disease doctors like Anthony Fauci tell us that people can be asymptomatic and still spread the virus. This is especially concerning when one considers how many in our community are vulnerable. Children younger than a year, the elderly with chronic health conditions, and those who are immunocompromised are all more likely to die from COVID-19 than the general population. Unfortunately, we are seeing that this virus, just like the ones before it, does not discriminate. Even if you are not in a high-risk group, you can still die.

I have a couple of medical conditions that make this particular virus dangerous for me. I’ve never been in this position before because I’m in good health, but the reality is that if I contract COVID-19 there is a high likelihood I will die. My life literally depends on everyone following the protocols for wearing masks and maintaining social distancing.

Wear a damn mask.

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Where is Here?

Published February 25, 2019 by thewriterlyroad_2o62in

Hello and welcome to my blog. My intention is to write about and discuss the duality in my life and how I reconcile it. I am an artist (writer, singer, dabbler in poetry), and a nurse (blood and guts always included). For years I’ve worked in healthcare while pursuing my creative calling. At times I’ve been happy, but often I’ve been enraged. I perceive it some kind of special injustice that I cannot earn a living as a full-time artist, and I will tell anyone who’ll listen that it’s wrong–it’s just wrong! (add stomping of foot here).

I know that I am not the first artist to feel this way and I will certainly not be the last. The need for a “day job” is the bane and savior of many a talented and aspiring creative. The trick is remembering who you really are. As I sit in yet another work meeting surrounded by people who look like they’ve worked in an office from the time they were born, it is easy to forget. These people are not like me. There is an air of the settled and resigned about them. They know their place in the world and are loath to try to change it.

But that’s not who I want to be.

Besides singing, change is the one constant in my life. I wouldn’t know who I was if I wasn’t continually responding to a shift in my reality. Most of the time I can roll with the punches. But every now and again, life clocks me in the beak and I crumple to the floor like a prizefighter down for the count. It is in these moments that I learn what I’m really made of.

And this is the stuff I want to write about.

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Where Are You?

Published February 25, 2019 by thewriterlyroad_2o62in

Mother’s Day is hard for me. My mother died unexpectedly when I was twenty-three, and each minor and major holiday passing reminds me she’s not here. As Spring rolls into Summer, Mother’s Day and my birthday bring with them a twinge of sadness.

Mother’s Day in May and my birthday in June. My mom’s birthday was one day after mine, on June 5th. We used to celebrate our birthdays together. That made me feel special, as if I had a unique connection to my mom that my siblings didn’t share. If I was born so close to her birthday that must mean something, right? I was a little, albeit pudgy, gift sent as a special treat for her birthday. Last year on your birthday you didn’t have me; this year you do. How cool is that?

I wish we could still celebrate our birthdays together. I wish I could send her a Mother’s Day card thanking her for all she did for me growing up, because I never really appreciated her until after she was gone.

Maybe that’s why Mother’s Day is so hard. I should have told my mom how much she meant to me while she was still alive, and I didn’t. I missed my chance, and now she’s gone forever.

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Mother’s Day Never Gets Easier

Published February 25, 2019 by thewriterlyroad_2o62in
Mother’s Day is hard for me. My mother died unexpectedly when I was twenty-three, and each minor and major holiday passing reminds me she’s not here. As Spring rolls into Summer, Mother’s Day and my birthday bring with them a twinge of sadness.

Mother’s Day in May and my birthday in June. My mom’s birthday was one day after mine, on June 5th. We used to celebrate our birthdays together. That made me feel special, as if I had a unique connection to my mom that my siblings didn’t share. If I was born so close to her birthday that must mean something, right? I was a little, albeit pudgy, gift sent as a special treat for her birthday. Last year on your birthday you didn’t have me; this year you do. How cool is that?

I wish we could still celebrate our birthdays together. I wish I could send her a Mother’s Day card thanking her for all she did for me growing up, because I never really appreciated her until after she was gone.

Maybe that’s why Mother’s Day is so hard. I should have told my mom how much she meant to me while she was still alive, and I didn’t. I missed my chance, and now she’s gone forever.

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Just Choose

Published February 25, 2019 by thewriterlyroad_2o62in

June 15, 2013

I am one week away from a major life change. I am leaving my teaching job in California, packing up some stuff, giving even more stuff away, and heading to Austin, Texas.

When I say this out loud, people look at my quizzically. They aren’t sure they heard me right. Texas? Why on earth would you want to go to Texas when you already live in California? Of course, the thinking goes, EVERYONE wants to live in California. If you don’t want to stay here, you are missing the point.

My answer doesn’t make them feel any better.

When asked why I’m moving to Austin, my answer is: why not? I’m not married and don’t have children. I don’t have any other family living in the area either. Sure, I’m giving up what many would consider a “good” job, but I am a nurse. I have faith I can find a job no matter where I go.

Besides, why do I feel compelled to justify every decision I make? Why isn’t it okay to choose something and go after it? Why is everything a debate?

I need to make it alright to just choose and then just go. I spend so much time agonizing over the alleged “right” or “wrong” decision that I suck all the joy out of a new and exciting adventure.

While I might not know how my move is going to end up or even if I’ll be happy in Austin (I really hope I will be), I do know this: It’s okay to jump. Check the depth of that pond before you swan dive through the air and make sure there aren’t any rocks directly in your path. Beyond that, you just have to let go and make the leap.

The leap makes you free.

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The End of the Shift

Published February 25, 2019 by thewriterlyroad_2o62in

September 15, 2015

Tonight I can write the saddest lines.

To think that I do not have her.

To feel that I have lost her.

To hear the immense night, still more immense without her.

And the verse falls to the soul like dew to the pasture.

–from ‘Tonight I Can Write’ by Pablo Neruda

Yesterday I lost a dear friend.

I’ve known Andrea for over fifteen years. We met and “worked in the trenches” together at an urgent care in San Diego. Later, she became my supervisor in the same urgent care. She never let the title go to her head, though. She was just as down-to-earth, spunky, and kind as ever. She was the supervisor every nurse hopes to have: she supported her nurses and showed us genuine respect.

Andrea was so much more than an amazing nurse. She was a friend to many, a wife to Brian, and a mom to a lovely three-legged dog named Gracie. Andrea was also a long-time diabetic who, after years of suffering with the disease, received the gift of a kidney/pancreas transplant. Despite being cured of diabetes, she continued to work tirelessly and volunteer her time to help raise money and awareness so that, one day, no one would have to live with this debilitating and life-shortening disease.

Her energy was boundless.

Last year, when I decided to become a living donor and give one of my kidneys to my friend David Ybarra, Andrea was my touchstone. She was someone I could speak openly with about my fears and hopes, who truly understood what it meant to share such an amazing and unique gift with another human being. She helped me to navigate successfully the complex and sometimes overwhelming emotions associated with organ donation.

She held me in high esteem, even when I doubted my abilities and felt like a fuck-up. She always reminded me what a wonderful person I am, how smart and capable, how kind, and (with that Wisconsin accent) “Oh my gahd! That voice and that hair!”

Just like with her patients, she saw the good in me and shone a spotlight on the most positive aspects of my personality. During the tough times, she reminded me I would make it through and come out whole on the other side. These are the same qualities embodied in an exceptional friend and nurse.

My shock at her loss is matched only by my belief that the world has lost a vital, bright spirit.

Andrea, even though I told you on more than one occasion how much I appreciated you (and thank goodness I did), I will never be able to thank you enough for everything you meant to me. As a friend and a fellow nurse, you are deeply missed by all of us who loved you and remembered for the countless lives you touched.

Your shift is over. It’s time to go home and rest.

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