Internal medicine, sexual health, and HIV physician. Public health and health equity advocate. Writer. Activist. Human being. He/him/his
May 21, 2022 • 10 tweets • 3 min read
1/ I spoke with a former academic colleague today who had texted me a few days back for some advice but I forgot to call her back.
We didn't always see eye to eye when we worked together, but we always respected one other.
2/ She was reaching out because her son had recently invited her in and told her of his attraction to other men.
He also told her that he had just had his first sexual experience, and the condom had broke.
He's only 20 years old.
Feb 19, 2022 • 16 tweets • 3 min read
A 🧵
I had a talk with a dear friend this morning. I've known him for over 30 years.
He is struggling with the reality of his father's aging and increasingly burdensome medical conditions.
His father is a 82-year old immigrant from the Caribbean.
Like my father was.
1/
In recent months, my friend has watched him struggle with routine tasks.
Air or car travel is cumbersome.
His feet swell, making ambulating tough at times without a wheelchair.
Breathing is difficult due to deconditioning.
He would rather stay at home then go out.
2/
Sep 3, 2021 • 8 tweets • 2 min read
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.
Jun 7, 2021 • 10 tweets • 3 min read
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.
Jun 4, 2021 • 6 tweets • 2 min read
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.
Apr 18, 2021 • 7 tweets • 2 min read
I had to send a 26 year old patient to the hospital yesterday after a telehealth visit.
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/
Mar 25, 2021 • 5 tweets • 2 min read
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/
Mar 6, 2021 • 10 tweets • 3 min read
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/
Nov 21, 2020 • 8 tweets • 3 min read
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.
Aug 29, 2020 • 11 tweets • 6 min read
1/ Chadwick Boseman died from colon cancer at 43.
I am sad that this talented brother lost his earthly life to this disease at such a young age.
Most of us don't know the details of the screening, diagnosis, and treatment journey he endured. #ColonCancer #SaturdayThoughts2/ What I do know is that according to the @AmericanCancer, colon cancer screening is recommended starting at age 45.
I also know that Black people suffer disproportionate health inequities related to colon cancer compared to other races/ethnicities.
Jul 29, 2020 • 5 tweets • 2 min read
1/ I am leaving academic medicine for the 2nd time in my life.
I am walking away from the combination of job duties I love most:
Service
Teaching
Research
I didn’t leave because I felt disrespected or unacknowledged as a Black faculty member.
That was the 1st time.
2/ I left this time because I had to.
I had to stop putting everyone else first while throwing myself under the bus.
I had to refrain from running into brick walls that I knew were not moving or capable of being toppled over.
I had to accept that my healing is important too.
Mar 31, 2020 • 7 tweets • 4 min read
1/ I know a lot of folks living with HIV are worried about coronavirus.
It's understandable. Everything is crazy right now.
We are learning more about it daily.
We are hearing stories about people getting sick and dying.
It's ok to be anxious and nervous about it.
2/ It's already enough living with HIV. Any fever, sniffle, or rash can cause panic and concern.
It's scary. All of it.
But you know what?
We know a good amount about COVID-19. There are good resources where you can empower yourself.
1/What bothers me the most about medical providers today is not that they aren't intelligent. They most certainly are.
It's that they lack a sense of urgency with patients even when the facts are RIGHT IN FRONT OF THEM. Here are some examples:
2/ An 87 year old man with high blood pressure and heart disease has leg pain and non-healing leg ulcers.
Tests show 2 of 3 leg arteries are 100% blocked. The pain is so bad he sleeps sitting up.
He is told to follow up as an outpatient to get ultrasound and cardiac clearance.
Dec 29, 2019 • 6 tweets • 3 min read
1/ A dear friend called me yesterday to talk how he had anal sex without a condom 24 hours earlier. He wanted advice on if he should be worried.
He used phrases like:
"I did something stupid"
"I know I'm being paranoid"
"I know I'm a hypochondriac"
2/ I asked if he had enjoyed the sexual and intimate experience he had - his first in 9 months of self-imposed celibacy.
"Hell yeah!" he responded. "It was nice."
I asked about his HIV status.
He was negative. The sexual partner said he was negative when asked directly.
