Yesterday I was at Whitman-Walker Clinic, which started as a HIV/AIDS clinic in DC and is now mostly primary care for HIV-positive patients (among other things, but the primary care in HIV patients is what we do). Every three months, the patients come in for blood work, including a full chemistry panel, blood count, HIV viral lode, and CD4 count (the white blood cells that HIV attacks). Twice a year they also get blood work for hepatitis B and C and syphilis.
All the patients I saw yesterday are doing very well, as far as their HIV. In fact, for all of them, that was the least of their complaints. One recently had a heart attack, one was recently diagnosed with diabetes and colon cancer, and one fell and hurt his shoulder (there were others, too, but I don't remember if they had any complaints). I wonder if the people who started HIV care thirty years ago imagined that the disease would be so manageable that chronic diseases would be more of a concern than the HIV.
That was yesterday. Today was travel clinic at Ft. Myer. I had four patients, three different trips (the middle two patients were a husband and wife traveling together). Here's where they're going and what I did:
Tanzania:
The first patient is going on a two-week safari in Tanzania. She got a yellow fever vaccine (there's no yellow fever in Tanzania, but there is in Kenya and she has a connecting flight. Tanzania requires official WHO documentation of a yellow fever vaccine for everyone coming from Kenya) and a bunch of other vaccines, including typhoid, meningococcus, hepatitis A and B, polio, and flu. She also got a prescription for doxycycline for malaria prophylaxis (the map above is the malaria map, so you can see that it's everywhere) and prescriptions for Immodium and ciprofloxacin for traveler's diarrhea. I also discussed with her safe food and water, insect avoidance (wear DEET, sleep under mosquito nets, etc), avoiding animals (because they all have rabies), and standard safety information and how to register her trip with the State Department (so they know she's there if anything happens).
Southeast Asia:
The couple traveling together is a retired lieutenant colonel and his wife, going on a two week cruise to Southeast Asia. They needed surprisingly little for their trip. Both needed two shots--typhoid for both, influenza for him and pneumococcal for her--and I gave them prescriptions for traveler's diarrhea, but there's no malaria in any of the cities where they're stopping, so they didn't need anything for that. I did give them some DEET, because there is dengue, and the mosquitoes that carry dengue bite during the day, which is when they're going to be off the ship.
Eritrea:
My final patient was born in Eritrea and lived there until she was 13. This is her first time going back; she's going to visit friends and family for two months. She's mostly going to be in the capital, Asmara, where there is no malaria (the white spot in the middle of the map). Since she is planning on visiting people outside (in the giant red areas), we discussed malaria prophylaxis. There were a few choices: no prophylaxis, a few short courses of prophylaxis just for when she's outside Asmara, or prophylaxis the whole time. She decided on prophylaxis the whole time, so I prescribed mefloquine, since it's only once a week. She also needed a couple of shots--typhoid, flu, and polio. There's no yellow fever in Eritrea, so she didn't need that. I also gave her a few courses of Immodium and cipro in case of diarrhea, and we discussed the standard safety things and travel insurance and whatnot.
Not a bad two days. In other news, I have a couple of presents under my tree, so that makes me happy :)
