Dr. Loveless will be writing a quarterly article on various topics in Infectious Disease.
We hope you find "Our Blog", not only interesting, but informative.


Thomas J. Loveless, MSN, CRNP, PhD graduated from Thomas Jefferson University College of Nursing in 2002, where he completed his BSN and MSN. He completed his post-masters in Nursing Education and Curriculum design from Thomas Jefferson University College of Nursing in 2006.


He completed his PhD in Nursing from the University of Wisconsin-Milwaukee in 2013.


He is Board Certified as an Adult Primary Care Nurse Practitioner through the American Academy of Nurse Practitioners and has recently been certified by the American Academy of HIV Medicine as a HIV Specialist.


Dr. Loveless has an active practice in caring for and counseling HIV & AIDS patients and those with Sexually Transmitted Diseases.


 

 

Happy Fall Folks


It's time to say hello again, and offer some updated idea sharing for October.


It just so happens that  October is Breast Cancer Awareness month. Let’s start with these important reminders. Breast cancer happens when normal cells in the breast change (and become abnormal) and then grow out of control. It’s the uncontrolled cell growth- the chaos of the cells – that leads to the problem.


Women sometimes discover they have breast cancer because they find a lump in one of their breasts. Breast cancer is the most common female cancer in the United States, the second most common cause of cancer death in women (after lung cancer), and worse yet- the leading cause of death in women ages 45 to 55; this is a tragedy we need to fight against. When found and treated early, breast cancer is most often curable, but early detection and evaluation is the million-dollar tip.


Globally- and it’s a big globe- breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death in women.


Breast cancer is much more common in women than in men. But men can get the breast cancer too! In fact, just today, Beyonce’s father revealed his own battle with breast cancer – it can happen to anyone, any man, and his goal of disclosure was reminding all men to have this important discussion with their health care provider.  His first clue was seeing blood spots on his bed linen and on his shirts.


Breast cancers in men appear to share some of the risk factors associated with postmenopausal breast cancer in women.  In the United States male breast cancer represents between 0.5 and 1 percent of all breast cancers diagnosed each year and accounts for less than 0.5 percent of all cancer diagnoses in men.  But here’s the scary part- most men with breast cancer have no identifiable risk factors.


Here is another important tip: Breast cancer sometimes runs in families and a family history of breast cancer in a first-degree relative is associated with an increased risk of breast cancer among men. One’s mother, father or biologically related sisters and brothers are your first-degree relatives. Approximately 15 to 20 percent of men with breast cancer have a family history of the disease compared with only 7 percent of the general male population.  For women as well, two breast/ovarian cancer genes, BRCA1 and BRCA2, which are inherited, set the stage for many known cases of hereditary breast cancer.


The bottom line here: have this discussion with your health care provider!


Next, the fall is also a time ripe with holidays, both religious and non-religious, and many festive celebrations. That said, I thought it would be fun to share a recent topic of celebration here at IDA. We're celebrating the overall successes in HIV medicine! Only just two years ago, a science thought to be in its infancy - the science of Geriatric-HIV medicine.


Nowadays, we're all quite excited to witness and care for many HIV-infected elderly persons. We need to now tie together the HIV specific risks like chronic inflammation to what might be argued as "HIV-driven" or “HIV-caused" and not overlook the pathophysiology of the aging process that we know emphatically is important- for example-  the immune system is paramount to the aging process- regardless of HIV.


Our priorities flip back and forth: prioritizing goals unique to HIV care- or prioritizing the goals of ensuring that older folks who happen to live with HIV, live well while we manage many co-morbidities and the syndromes of aging.  Even without HIV, we must contend with all the age-related changes including diabetes, cardiovascular disease, osteoporosis, kidney disease, and even chronic obstructive pulmonary disease which are all strongly age-related.  Therefore, it is so critical that all our patients enjoy a therapeutic relationship with their internal medicine primary care providers.  There is so much more to our patients than a diagnosis of HIV.


In any case, all of us here at IDA consider all our geriatric patients as part of a group that may be considered "biologically aged” and because of this - we see these special folks deserving related and cumulative considerations.  The literature is becoming thick with articles about this important topic, and I recently read about a way to manage our very special aging population while never forgetting the importance of ‘mind’, ‘mobility’, ‘medications’, ‘multicomplexity’ (meaning living with multiple diagnoses), and what ‘matters most’.  When it is all said and done, mobility and independence are the cornerstones to living well while aging, regardless of HIV.  Important to us, is what is most important to our patients.


Here is our reason for celebration.  Similar to the trends across the USA and those by the Centers for Disease Control and Prevention (CDC) that reports as of 2016 nearly half of the people in the US that where living with HIV were aged 50 and older- we too have the pride for caring for folks in these age ranges. 


In fact, our recent analysis of our patient population of 436 active patients living with HIV, fall in these ranges: 20’s (30 patients); 30’s (60 patients); 40’s (72 patients); 50’s (158 patients); 60’s (91 patients); 70’s (21 patients); 80’s (2 patients), and finally 90’s (2 patients).  Yes – you read that right – two folks in their nineties.  How fascinating is this to care for so many wonderful folks who have aged well, and lived well; regardless of HIV.  Clearly, the life expectancy of HIV-positive people has increased dramatically, and we here at IDA have the honor of sharing our expertise with you as you share your life stories with us.  For me – after recently meeting a new patient age 93, life stories that reminded me of my father – stories about surviving World War 2 took priority over a diagnosis of HIV.  In fact, HIV was the least of his worries.  What mattered most to this patient was independence, continued living well, and opportunities to keep sharing life stories along the way to anyone who might listen.


And so, it goes – we are celebrating the remarkable journeys so many wonderful people have traveled – so different from 1981 when HIV was first discovered and thought of as a fatal disease.  At that time, none of us ever dreamed we share life stories like these.


So, we now celebrate you – and all we have learned over the years from you- while traveling alongside you, on your journey to wellness.  As you most likely already know - October is HIV Awareness month.  And Sunday, October 20th is the Philadelphia AIDS Walk- find your passion and take part in this huge awareness initiative.


And some final tips to consider while imagining aging into your nineties: don’t forget – it is flu season – get your flu vaccination and pneumonia vaccinations now; make sure your general health maintenance is up to date including mammograms and BRCA gene screening and PAP/GYN evaluations.


As children there were milestones and, yes we have milestones as we age! Reminder for folks celebrating their 50th birthday: to get your Shingrix vaccination to prevent Shingles, schedule your colonoscopy, your DEXA scan and PSA’s for all men.


Another milestone is menopause for women, this is the time that you should start having DEXA scans.


So- stay well folks – stay connected to your health care providers – stay empowered and well informed about what ever ailment you live with – and celebrate living to old age!



See you soon,

Dr. Thomas J. Loveless