1/
Yesterday in clinic I saw many patients.

All of them living with #HIV.
All Black.
None of them vaccinated for #COVID19.

We engaged in conversations about their reasons for not getting vaccinated.
2/
Some wanted more time to assess the after effects of the vaccine.

Some felt there was no reason to be vaccinated if they could still catch the virus.

Some saw the after effects of the vaccine impact their loved ones more than the virus itself.
3/
I listened to each and every one of their reasons.

While I encouraged them to get the vaccine, I didn't use scare tactics to do so.

I also didn't try to guilt or judge them into compliance.

One thing was clear, however.

None of them were "anti-vaxxers."
4/
None of them were conspiracy theorists.

No one uttered the word "Tuskeegee" during their visit.

What it came down to was a decisional balance.

A weighing of the potential risk of catching the virus vs. the perceived risk and benefits from getting the vaccine.
5/
For some, the perceived threat of catching COVID19 did not outweigh fear of the unknown with a newly developed vaccine.

No matter what the science says.

One 30-year-old patient told me that in the past few months, his mother and father were both diagnosed with COVID19.
6/
He also had a brother who was a recent recipient of an organ transplant and was on immunosuppressants.

But they all live in other states.

For him, that wasn't enough.

I shared with him how I witnessed a dear friend die from COVID19 after turning 40 last year.
7/
For me, that was all I needed to convince me to get the vaccine when it became available.

His mouth dropped and his eyes filled with sorrow.

"I'm sorry about your friend," he said, nodding his head.

"That would make me wanna get it too."
8/
Yesterday in clinic I saw many patients.

I successfully convinced none of them to get the COVID19 vaccine.

Did I feel like a failure on some levels? Sure.

But you know what?

We heard each other.
They still wore masks.
They all understood public health.

We good.

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More from @DMalebranche

7 Jun
1/
I've been seeing a patient living with #HIV who has had right hip pain for 5 months.

He is a 33 year old Black man who hobbles around like he's 90.

He just lost his job.

The pain was so great he couldn't sleep at night and was dozing off during his shift.
2/
No one explained to him what was going on. He got an x-ray at an ER five months ago.

He understood that he had a "ruptured" hip.

Doctors who have seen him have only given him ibuprofen and Aleve for the pain.

Both don't touch it.

He cried during our first office visit.
3/
He could barely get up on the exam room table without excruciating pain.

I couldn't rotate his right hip due to the discomfort it caused him.

We agreed to try a low dose opiate and muscle relaxants as needed.

Our clinic would request the medical records from his ER visit.
Read 10 tweets
4 Jun
1/ "Undetectable = Untransmittable" can be an empowering message for people living with #HIV.

That said, we don't explain to patients that the studies leading to that slogan defined "undetectable" as a viral load less than 200.

Not less than 20, which is the current standard.
2/ So when people are stable on their HIV medications and see their viral load go up to 60, or 100, or 120...

Listen to and address the anxiety they feel, thinking they are not "undetectable" anymore.

Reassure them that they are and you will follow things closely.
3/
As clinicians, we need to do a better job explaining that these small increases in HIV viral load are called "blips."

Blips are common.

A. Doesn't mean the medications have stopped working.
B.. Doesn't always mean you are now "immune" to the meds.

catie.ca/en/positivesid…
Read 6 tweets
18 Apr
I had to send a 26 year old patient to the hospital yesterday after a telehealth visit.

He is living with #HIV

Had lymphoma 5 years ago requiring surgery and chemo

Has syphilis titers that have stayed elevated for 2 years, even after outpatient penicillin treatment.
1/
Now is having fevers, nightsweats, headaches, blurry vision, and unintentional 10 pound weight loss in two weeks.

His T cell count dropped from 200 to 100, even though he is taking his HIV meds and has an undetectable viral load.

I gave him my cell number just in case.
2/
The admitting hospitalist reached out to me this morning.

Him: "Your patient gave me your number. I guess he wanted me to call you with updates."

Me: "No, I gave him my cell phone so you could call me if you needed more information for your clinical decision-making."
3/
Read 7 tweets
25 Mar
Did a follow up call with a patient this morning. Gave her her #HIV lab results:

- T cell count over 1000
- Viral load undetectable

No reaction. It was expected. We spoke about other referrals before concluding .

"Anything else I can help you with?" I asked.

She paused.
1/
"Doc, I have a question, but it's more personal."

"Shoot," I responded, unsure where this was going.

"Do you know anyone in the medical field who is living with HIV? Before my diagnosis I wanted to go into the field but I didn't think I could after that."

My turn to pause.
2/
"You're speaking to one," I said.

I could feel the weight lift from her shoulders through the phone.

"Living with HIV doesn't mean you can't work in the medical field," I continued. "There are many people who are HIV positive and work as doctors, nurses, every position."
3/
Read 5 tweets
6 Mar
A young Black man has been living with #HIV for 4 years.

He is adherent with his meds. The lab report shows he has been undetectable since he started treatment.

He works 16-hour days in a factory and is seen at a busy urban HIV clinic.

He has private insurance.
1/
His last in-person visit with the clinic was in January 2020, right before the #COVID19 pandemic shut the world down.

All was well during that appointment.

His doctor continued his prescription with a year's supply of refills.
2/
He is scheduled a 3 month follow-up telemedicine appointment during the #COVID19 pandemic.

All continues to be well at that visit.

It's April. Flowers are beginning to bloom.

He is given another telemedicine appointment 3 months later.

He misses that one.
3/
Read 10 tweets
21 Nov 20
1/
I went to a local @cvspharmacy today to get my second shot of the Shingrix vaccination.

This is the vaccine that helps protect people over 50 years old from getting the painful reactivation of the childhood chickenpox virus.

Also known as shingles.
2/
The pharmacist was kind. Applied a discount to offset the cost. Gave me the obligatory medical information and consent form to sign.

I did.

He "gently agitated" the vaccine mix in front of me.

To my surprise he came around the counter to give me the shot.
3/
"Which arm?" he asked.

I took my left out of my jacket.

As I turned away from him, I noticed a Black woman staring at me.

Her eyes wide in a mix of horror and surprise.

She was picking up her medications, but got distracted.

I knew exactly what she was thinking.
Read 8 tweets

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