Happy, Healthy'and HIV-positive?

[In years past when people found out they were HIV-positive, many assumed it was an automatic death sentence. They went on with their daily lives, though. Some even felt a renewed vigor and sense of life as their mortality was 'realized.' But most did not worry about the types of health afflictions that would have challenged them as they grew older. And grow older many, many have. The first generation of women and men with HIV has reached the age where they are more likely to become sick from diseases not related to HIV. Now they are forced to take an overall view of their bodies, their health. Are you ready for the reality of taking care of yourself for the long run?] Larry Peterson has a problem. 'I thought HIV was going to kill me. I guess I was wrong,' he says while holding back tears. 'I just found out that I have late-stage prostate cancer, and the doctor claims that it's not related to my 'plus sign.''' A year earlier the 43-year-old commodities broker had detected a tinge of blood in his stool but brushed it aside after the problem seemed to go away. 'If only I would have had this checked out when I first noticed the problem,' he adds with frustration in his voice. Sarah Reynolds, a 38-year-old HIV-positive hotel worker, has a similar problem. 'I am scheduled for an angioplasty next week because my doc says I have a blockage in my heart,' she reports with noticeable shortness of breath. 'It made me feel bad when the cardiac specialist told me that the procedure might have been avoided had I paid attention to the symptoms, like being short of breath and tired all of the time. I guess I was focusing in too much on my CD4 count and keeping my viral load in check, and not looking at the rest of my health. When you are dealing with HIV, it's easy to get caught up in the numbers game.' Peterson's and Reynolds's predicaments point to a growing realization for people living longer with HIV disease'neglecting other potential health concerns as one naturally grows older. 'There is a tendency for HIV-positive people to think that once they get their HIV under control, they don't have to monitor other aspects of their health,' says Tom Barrett, MD, an HIV treatment specialist at Howard Brown Health Center in Chicago and a faculty member at Northwestern University. 'This is a false and even dangerous belief system because HIV-positive individuals are indeed susceptible to the same illnesses as the rest of the population. I try to get that message across to all of my patients so that we can avoid future health-related problems.' Focusing on the Big Picture Stressing a concept that he calls 'total wellness,' Barrett says, 'At Howard Brown, we have a men's and women's program that serves to educate patients about common health risks and disease prevention'which, in my opinion, is vitally important. Many service providers now seem to be heading in that direction because there is a feeling that people are neglecting other aspects of their health.' That's the case at Northstar Health Center in Chicago, where HIV primary care specialist Kaleo Staszkow, MD, says, 'Our clinic attempts to address a total wellness approach. HIV treatment is trending toward this direction because, thankfully, people who respond well to the antiretroviral medications are living longer. It is for this reason that we emphasize to our patients to 'watch your health' and expose them to information about common illness not related to HIV.' Staszkow, who has been treating HIV patients since 1999, adds, 'You know, it's a shame to see people getting sick from the non'HIV-related stuff'especially when it is possibly preventable.' He provides an example: 'Not too long ago a female patient in her mid 30s visited me to discuss several small lumps on her right breast. After examining her I asked how long she had noticed the problem. I was shocked to learn that she had felt the lumps nearly nine months earlier but never bothered to bring the issue to anyone's attention!' Staszkow adds, 'Sadly, she died a year and a half later.' He goes on to offer other troubling examples: 'I have seen male patients who have suffered heart attacks but never discussed their symptoms with me until the damage was done, and I have seen female patients with syphilis who neglected to report the warning signs, such as the telltale rash on the bottom of the feet.' Speaking with a tone of dismay, Staszkow concludes, 'Keep in mind that many of these patients had undetectable viral loads and high CD4 counts, which goes to show you that people living with HIV really do need to approach their health holistically and not focus in on just having HIV.' Intervention Creates Prevention One of the people helping to amplify the message of total wellness is Stan Sloan, executive director of Chicago House, an AIDS service organization. 'We are trying to address the physical, emotional, and spiritual needs of our clients, with the goal of keeping them healthy,' he says. 'In 1998 we closed our hospice program because of a decline in need for this kind of service'which was great because it served as the perfect metaphor that people were getting better. However, it was also during this time period that we realized the nature of HIV was changing, and Chicago House needed to change with it.' Pointing to an example of this change, Sloan cites a new wellness initiative that the agency launched this year. 'We have a program called Prevention With Positives, which encourages clients to examine all areas of their health and to set up a wellness plan with their case manager. An example of a goal might be to exercise more or to get a vaccine for hepatitis. The nice thing about this program is that the client gets to choose the goals based on lifestyle, which empowers them to take control over their total health and prevent future illnesses.' Commenting on the success of the program so far, Sloan says, 'The overwhelming response from clients has been positive. I'd like to think that we are helping to offset problems down the road for the people that we serve.' How to Get It Done So what do Barrett, Staszkow, and Sloan collectively recommend to people living with HIV as part of a total wellness mosaic? Here are five major considerations: (1) Inform your doctor of any changes in your health. This is perhaps the easiest way to prevent serious illness. Report to your doctor any changes in your health, including fatigue, skin rashes, pain that will not go away, shortness of breath, or anything that seems out of the ordinary. Also report any lumps that appear on any part of the body. Women should specifically consider giving themselves a selfexamination to screen for breast cancer. To obtain more information about this easy-to-complete test, contact the Y-ME Breast Cancer Organization toll-free at (800) 221-2141. (2) Get an annual physical exam. This is another way to ensure you stay well. Make sure that you schedule an annual physical and have your doctor check your blood pressure and cholesterol levels. Women should receive a yearly Pap smear to check for cervical cancer, and men should be screened for prostate cancer. Depending on your age, you might also want to talk to your doctor about colon cancer screening. Also, be sure to ask your doctor if you need new vaccinations, including those for influenza and hepatitis. In addition, you should remind your doctor of your family history regarding illnesses such as heart disease and stroke. Last, it is also a good idea to be checked for diabetes. (3) Consider consulting a nutritionist. Whether you are HIV-positive or not, eating well is an important component to overall good health. A nutritionist can help you to develop good eating habits with goals of your choice, such as heart disease prevention or weight loss or gain. When speaking to your nutritionist, be honest about your eating habits so that she or he can help you create changes in your diet that you can live with. (4) Keep your mental health in check. According to researchers at the University of Wisconsin-Madison, depression may be linked to the onset of physical illnesses. If you are feeling blue, be sure to let your doctor know so that he or she can check for depression. Myriad treatments exist today for this common condition, including therapy, medications, or both. (5) Develop an exercise program. A moderate exercise program might be taking a 30- to 45-minute walk four to five times a week. It might also be spending three days a week in the gym. In either case, a moderate exercise program produces many health benefits, including weight loss or gain, cardiac benefits, and a boost to your self-image. If you have never exercised before, consider hiring a trainer who is knowledgeable about HIV. An excellent resource for finding a trainer in your area is the American Council on Exercise, which can be reached toll-free at (800) 825-3636. Make the Plan Just for You For people like Larry Peterson and Sarah Reynolds, their situations might have been avoided had they monitored their health more closely. This does not have to happen to you'especially if your mind-set has been that a diagnosis of HIV disease was a death sentence. Work with your doctor or case manager to develop your own customized health plan and create your own mosaic of wellness. Keep in mind that many illnesses are totally preventable or, at a minimum, treatable if they are caught early enough. Remember to keep in mind that HIV might be part of you, but it does not define you. This means looking at your total health and doing what is necessary to keep yourself well. By following these five tips, you will be well on your way to living happier and living longer.