Integrative Infectious Diseases

11/29/2019

Kombucha
Fermenting tea with a mixture of yeasts and bacteria results in this lightly fizzy flavorful drink which is a convenient source of prebiotics (nutrients for good microbes) and probiotics (actual good microbes) that promote gut health and digestion.
I recommend it- along with other measures- to protect gut microbiome, especially when exposed to antibiotics.
All these benefits depend on the purity of the product ofcourse which is difficult to measure. So you can imagine my smile when I found the Kiwi brand that does it RIGHT! No dilution. No artificial sweeteners. NOT from concentrate. No cutting corners. Pure stuff and so so tasty!
I have been drinking this stuff since I got here and today I met the couple behind the brand and their amazing story !
Food here is so delicious and (mostly) natural. I wish I could take it all back home with me.

05/31/2019

Happy to attend my first NZ conference about HIV clinical update. Meeting the Australasian HIV clinicians and sharing our experiences highlights how important it is to collaborate on a Global level.
Take home points : We need more studies with women (Including Transgender women) and further research in concepts like microbial gut translocation and "inflam-aging" !!
It was very nice to share my experience practicing in NZ with US colleague and Guest speaker ultimate role-model-woman-in- medicine, Dr. Judith Currier .

05/21/2019

Had my doubts about this one.....
I bet quitting sugar, improving the microbiome by eating mainly fresh vegetables and improving collateral circulation by adding 20 mins/day of any form of exercise would have MORE than a "modest" benefit.

“There is very little data to justify how these drugs are being used and why they should be in the top 10 in sales,” a researcher said.

05/13/2019

Thank you to the peer reviews that made it possible for me to make this list second year in a row.

Continuing to grow my professional skills, this year in New Zealand, with the goal to provide quality care for all my patients and be the best doctor I can be.

05/07/2019

Day 1 at the Sexual health Clinic in New Zealand!

As I learn the landscape of HIV / STI in my new environment I see several differences
Incidence is quite low. Rates among heterosexual in some areas higher than MSM community. Meds are limited and doctors need special permission to prescribe them, but they are funded and available. This is true for PreP as well, making it difficult for primary care docs to start Prevention antivirals.
Emphasis on nutrition,stress control and social connection/family for better health outcome.

What's not different?
1)STIGMA.
2)ADHERENCE BARRIERS to keeping with daily treatment.
3)Rising rates of STD's including Gonococcal and Syphilis cases.
4) Patients asking when is the cure coming?

It was very nice to be able to share my experience with the patients when they asked "about all those new meds in America". As dysfunctional as our health system is we really are very fortunate in some regards.

Looking forward to collaborating with such knowledgeable colleagues in bringing quality care to patients living with this disease on the other side of the world.

04/24/2019

OH HOW I MISSED THIS!.... Even the smell of the lab is soothing for me..There's something about seeing the culprit under the microscope. We ID docs ALWAYS nag about cultures and the reason is that you get SO much information this way. It's invaluable to solving a case!
This is Streptococcus pnemoniae. First slide in blood then CSF- cerebrospinal fluid! Two of the places it should NEVER be in!! This is the feared infection with this bacterium and the reason why doctors recommend the "pneumonia shot". It's not to prevent 'pneumonia' alone (which can occur for many other reasons) , as much as the devastating effects of the Pneumococcus!
This infection is more likely and much worse in "elderly "immunocompromised * those with chronic health issues (diabetes, lung diseases, etc).
There are two different vaccines- each interacting differently with your immune system and offering different strains protection. Good news is immunity lasts several years so you don't need vaccine doses very often.
If you fall in one of the categories listed, please please please demand your shot!

Conozcan el Neumococo- una bacteria devastadora cuando infecta la sangre y líquido cefaloraquideo. Esto ocurre en personas immunocomprometidas, enfermedades crónicas y mayores de 60 años. Afortunadamente existe una vacuna! Importante aplicarse la vacuna conocida como "vacuna de neumonía"

04/12/2019

While NYC deals with C.auris, I am seeing different species I had only seen in old textbooks. Candida pulcherrima.
This yeast described in 1901 by Lindner is named after Pulcherrimin the red pigment produced by it in special growth conditions.
There is a lot of talk about "Candida" in wellness sites but as Infectious disease doctors in a hospital, the candida we see is quite different. It's acute, life threatening and an EMERGENCY!
The conditions leading to this acute infection are heavy immunosuppression from chemotherapy or drugs used to prevent transplant rejection, intravenous feeding when people can't eat through the normal route, having indwelling catheters in place, prolonged exposure to BROAD intravenous antibiotics.
The good side is that the two syndromes don't overlap. Having dysbiosis doesn't lead to this life threatening infection generally because the conditions are very different.

I think these differences are why many clinicians brush off the "overgrowth" associated with dysbiosis described by so many people in the office setting.
I find they are both real entities but the management for the two is night and day.
I love being able to treat both because the science does cross-pollinate.

&

04/10/2019

Ms. or Dr. ?

I learned something new that I had to share and I don't think I'll ever get used to! 😆👍🏻

Male surgeons are always addressed as Mr in the United Kingdom (& Ireland, Australia and New Zealand)

The reason is historical. Before 1800 physicians were doctors who possessed a university medical degree (an MD); surgeons seldom had any formal qualifications, they learned from observing as apprentices.

The growth of voluntary hospitals in the 18th century and the founding of the Royal College of Surgeons of London in 1800, brought new stature to surgeons who now had a formal qualification with letters after their name (the MRCS).

Surgeons became so proud to be distinguished from physicians that the title of Mr became a badge of honour.

it's not an it's a .

03/30/2019

Wishing all my colleagues the best day- in admiration of all you have sacrificed to get here and all you continue doing everyday for the health of humanity.
Tomorrow I start a new role in a hospital in New Zealand. I will be welcomed with a ritual practiced by the Maori culture named powhiri, intended to detect friend from foe.
Medicine for me has opened so many doors, allowed me to live in other countries and care for so many peoples from all cultures. I know burnout is real but we still have the best job on the planet!

💕

03/27/2019

Good morning from Auckland!!! I made it to NZ soil yesterday after an extremely smooth 13hour flight (of which I slept 10!). I had an interview with the medical board here in Auckland and received my registrar number which is assigned for life. (In case I return to practice here someday). Once my documents are received and signed off by the medical board, I may begin seeing patients, hopefully Monday!
Is this really happening?? Someone pinch me. 😲

03/23/2019

Do you know what are the big 3 harbingers of HIV infection? STI's such as Chlamydia, Gonorrhea and Syphilis serve as indicators of a person's risk of acquiring HIV. Having one of these STI's is a warning sign and should be a perfect opportunity to intervene with a full HIV prevention package which includes education & antiretroviral medication.
..wrapping up one final HIV conference in L.A. this weekend. So much information gives me hope that the US is in a good position towards ETE -- ending the epidemic with it's 3 pillars 1) test and treat. 2) Prophylaxis with antivirals and 3) Cluster- busting. (Diagnosis of acute cases to break the clusters that arise around new infections which are the most Infectious).

Stay tuned for the "treatment" posts tomorrow!