Private messsage

Hey Bart:

It is so nice to hear from you and known you are doing well. My private email address has never changed. But, with the new clinic, I also have rob@capitolhillmedical.com.
Please stay in touch and keep in contact. Boy, it is good to hear from you.

Rob

More on Anal Pap Smears for men

Here is a recurring theme in the questions:

"I VERY MUCH appreciate your comments on HPV and anal paps.

Where can we find providers? I live in NC and even Duke does not do them. I had to travel to MD and NY....any one in NC that you know that does them?

Thanks!

Rob Killian MD responds:


Besides travel ( and hey, what does New York have over Seattle?) you could do two things: look at the http://www.glma.org and start calling all gay and lesbian docs on the list in your area and investigate who is up to date and doing these things.

second: you could go to http://www.lapcorp.com and hit the button on the front page and find a lab and ask which doctors in the area are sending in male anal pap smears...

Hope this helps.

But, if you must travel....do not forget the most beautiful city in the world when it is not raining and that is Seattle.

Rob

Blow jobs and HIV

I've recently recieved a blow job from a guy who shortly thereafter found out he was HIV positive. I've read that oral is lower risk, but are there differences in risk between giving and recieving for oral?

Rob Kililan, MD responds:

Every public health study among sex who have sex with other men show that the third most common way to get HIV is by being the receptive oral participant.

there is no myth that one cannot get HIV from Oral Sex.


If this just happened you need to page your doctor on call and begin the HIV medications tonight or go to an emergency room. If more than 72 hours have passed since the incident, please contact your physician and plan on being tested in two to three weeks from exposure.

Rob

Aging, Safe Sex, Heart and Love and Medicine

This question came twice;

"I'm gay and I had a heart valve replacement 4 years ago; due to staph infection.
Since then I take antibiotics prior to medical and dental procedures.
If I don't expose myself to any cuts or open blood sources, use a condom, are there any other precautions I should take? Can I continue to lead a fairly normal sex life? I'm getting my Hep A & B series vaccinations, got pneumonia, flu shot too."

Rob Killian, MD responds:

First do not forget about the Shingles vaccine known as 'Zostavax' or the Gardisil (HPV) Vaccines that now are available.

Second, please no matter what antibiotics you are on, you still have to be aware that HIV, Hepatitis C, and Syphilis are out there. Thus, you need to be sexual, of course, but safely.

If you are using a condom with each sexual encounter than you are doing well. Many other of our entries talk about the eleven STDs out there, but just remember to be wise is choosing who you play with; go fall in love; Don't forget HPV can get through latex condoms or that Syphilis can come from saliva.

Get tested regularly and find yourself a good physician you can rely on when you have more private questions.

Rob

Herpes part one and part two

Here is one of the most valuable issues and yet, potentially controversial for sexually active adults:

"There's this guy I totally want to get with, and he was cool and let me know he has (anal) herpes. Is it safe to rim him? Is it safe to fuck him if he's not having an outbreak? Searching online is weak and only gets me pharmaceutical ads'


Rob Killian, MD responds.....

Everything we knew about herpes two years ago and before has changed. Many of us who treat the GLBT community did not even screen patients unless there was a sore we wanted to either culture or prove was herpes by blood test. But, now we know that every single patient should have at least one screening test if they do not know their status. First, because you can be contagious and not know it; and Second, because there is a link between the "genital" herpes, now known as HSV Type 2 and HIV infection.

Recent changes to what we know is that up to 90%o of those with "herpes type two, the 'genital' herpes, may never have an outbreak but could still be contagious; we also know that those with HSV 2 are more likely to get HIV than other gay men.

Thus, if you do not know you or your partner's status, this is a test that is easily run and then options open up to you

If you have Herpes type two, the 'genital' herpes...meaning you have been exposed....then even without a sore you could be contagious. Thus, first and foremost you need to know your status. You cannot be reinfected. If your partner also has Herpes type two you have nothing to worry about But, if your partner is negative for prior exposure and you show signs of previous exposure, this should lead to a discussion with your understanding doctor and with your partner. Unfortunately, the prevention of exposure, despite expensive medication is only as good as 30-50% protective. That is why our clinic exists or why you must find a knowledgeable gay physician to be your advisor for your health care. And another reason to be open and discussing all of this with your sexual partners.

Now the most controversial of all of this...is that the 'prevention' or 'suppression' medication is only effective 30-50% of the time. So there truly is lots to talk about. Bring it up with one of us at Capitol Hill Medical, your physician, or one of us privately if you cannot talk to you private physician.

(And as a side note, we are not read in seventeen countries and all of the states of the U.S. and all across Canada) We honor you and that.)

Rob

Getting Prepared for your visit with the doctor.....

Here is a repeat question asked in a different way:

"Have yearly checkups and other periodic visits become more streamlined based on age, health, time or other reasons? I feel like over the years my visits to the Doctor are shorter/rushed, and not as in depth. Sometimes I have questions. After what seems to be today’s style of appointment I forget until later, and then it is too late. I am sure what needs to be done is done, and happy unnecessary tasks are not performed.
So is it a sign of the times that with some appointments less is now needed and, or years ago I became accustomed to a Doctor’s specific style and still getting used to newer ways? "

Rob Killian, MD responds:

Yes, of course. First there is the old fashioned 'cook book approach to medicine" If someone gives a 23 year old rectal exam without reason, that doctor is a pervert. But, as you age and based on your past medical and family history, you should have the exam that targets those things that you at most risk for.

Blood testing tells us so much more than a stethascope in many occasions. But, also, good old just feeling around and looking at some tell us a lot to. I have several patients who I feel are HIV positive, but they will not let me test them with their physicals. Some I challenge and some I just watch.

There is a style that each physician adopts.

And, if it works for you great. If it doesn't there are many other physicians out there.

But FIRST (yes, that is all capitalized) You should come to your visit with the doctor prepared.. Write down your questions and worries. Know your family history as best you can. Be prepared to be examined as needed. But, you are the consumer, and as busy as the doctor is be prepared with all of your questions.

Some doctors allow email and questions to be asked after a visit. This is a good practice, because without preparation many forget all that they wanted to discuss.

The Health Care crisis is not just for the consumers. Your primary care doctors are feeling it too. Their expenses keep rising and they spend more and more time advocating behind the scenes for coverage, referral authorizations and medication coverage. Please remember to thank them for this time and effort.

Second: If you forget something make another appointment or contact your physician in a way that you both have worked out.

Third, do not settle for no answer. There may be none available, but a good primary care physician then calls upon experts for help.

Fourth. Most doctors have a plan in place in their heads. We usually do the simple and less expensive things first, but if that fails there is a second or third or fourth option that we will pursue. Do not lose touch and do not give up after only one try to solve a difficult problem.

Make a relationship with your physician. Talk to them. Joke with them. Come to understand their philosophy and DO NOT BE AFRAID to ask questions. This is your health. Your physician is not on a pedestal and unapproachable, but should be your peer, your partner in your healthcare; You are responsible for your health and for communicating your needs. Please of all I ever have or will say remember that. Take ownership of your own health.

Rob

Specific Treatment Questions

Hi:

We have been getting a lot of questions lately about specific side effects and treatment issues ranging from HIV meds to lists of medications and ideas about treatment specific questions about hormone therapy for those who may be transgendered. This blog is not the best forum for such questions.

Making an appointment with your doctor or with one of us is the best. These are personal questions and they should be dealt with privately between your treating medical provider and with you. Not here on a public website.
But, here are some simple suggestions:

1. Write down your question
2. Contact your provider (if they they have email, this is a convenient form of communication)
3. If the issue is complex, making an appointment is always the best for medication and side effect discussions. And sometimes given the time of what a doctor can give on one day you may have to prioritize you needs and make more than one appointment for follow up.

All of us providers at CHM would love to meet you and answer these questions if you feel you are not being served well by your current providers.

Rob Killian, MD