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Episode 16 Transcript

Healthcare & Self Care During Coronavirus Pandemic

Erin Everett: Well, welcome back Michelle. Thanks again for coming on. We enjoyed having you the first time and we’re so excited to chat today and you know, get your thoughts and feelings and everything that’s going on.

Michelle Sariev: Well, thank you. I’m so happy to be back.

Erin Everett: Yeah, so in today’s episode, I think it’d be really important for us, especially as providers, but also, people living in dealing with this new COVID stress to kind of check in and talk about how much life has changed and maybe like how we can be there for other people, maybe some self care things and then also give some insight on to people who are scared, maybe living with chronic illnesses such as those living with HIV.

Erin Everett: I know I recorded an episode touching on COVID and Coronavirus, somewhat recently, but that was actually back when we weren’t really sure what was going to happen. I don’t think anyone, maybe it was a little bit of denial on my part, but I was hoping it wouldn’t be lasting this long and it’s still, we’re not really sure how long we’re all going to be quarantining and staying in a sheltering in place and things like that. It’s just really insane. I’m not sure how to really process all the information myself sometimes. I mean, how are you managing everything in?

Michelle Sariev: Yeah, it’s really interesting. I mean, just one month ago we were still considering how we were going to work out having patients coming into the office and even we were talking about still even doing wellness visits, I guess it was a little bit over a month ago. Really, I mean, it was like everything changed really, really every night it seemed like we went from sort of having the debate in our office, to pretty much everybody going almost all telemedicine and then trying to figure out how we were going to get people in for labs and just how to figure all of that out.

Michelle Sariev: And throughout this whole time, and feeling like everything changed overnight. It has been really, really good to reach out to colleagues like you, and others just to hear how they’re doing, how they’re managing it. And it seems like everybody’s kind of doing it a little bit differently. But I think the common thing is that we all do feel a little chaotic and crazy, but we’re also all really committed to, I think that the sort of recurring theme or thought is that we’re here for our patients and within and a resource for patients.

Michelle Sariev: And so, I’ve sort of felt this urge and need to like educate myself as much as possible about COVID. And what I found is that there really is not very much out there A, and B, that it’s changing every single day. I think we’ve had to learn to be flexible on a whole new level, which is really hard for clinicians. Sometimes we like to have very black and white guidelines and protocols and procedures and stuff. And so, that I think has been kind of tough.

Erin Everett: Yeah, definitely. It’s definitely been a moving target. I mean, and as much I’m with you, I want to stay up to date. I mean, you know, last time I talked to my listeners we were incorporating Telehealth. Now we’re 100% Telehealth for the most part we’re having patients come in who need injections or antibiotics and things like that or injection training. But we’re not doing any labs in house, unless someone’s really vulnerable.

Erin Everett: We’re really trying not to draw labs in general. So yeah, I’ve been trying to keep myself educated because now I’m still seeing the same amount of patients, but we’re doing it virtually and a lot of them are like, “How are you? What’s going on? What’s changed? You know, what is going on with Coronavirus? Like looking to me as their one ‘legit source.’ So, I’m trying to make sure that I am reading like good quality information.

Erin Everett: But like you said, it’s changing every day. And then there gets to a point where I have to mentally say, “Okay, I can’t hear about coronavirus one more time. Today I just need to be Erin.” I’m just going to go home. I’m going to be mom, I’m going to be wife, I’m going to take the kids and the dog for a walk, and I don’t want to hear about coronavirus, which is hard to do because for the first time in our lives we’re walking around and we’re seeing people in face masks.

Erin Everett: We’re seeing the fear in people’s faces. I’m walking around my neighborhood, people are dodging to the other side of the street because, we don’t know why they’re doing what they’ve been told, which is awesome. They’re trying to maintain a six foot distance. So even when we try our hardest to switch off from coronavirus and pandemic, and sheltering in place, it’s sometimes really hard to ignore cause it’s just still so in your face.

Erin Everett: So, I mean, all that to say it’s been weird and I think it’s been creating a lot of strange feelings with people. I mean, I have patients telling me that they’re exhausted and they don’t know why. And having stress dreams, those types of things. But also, like you said, checking in with other providers and seeing how their practice has changed. I have, colleagues who have been furloughed who are healthcare providers, like nurse practitioners like us, which is sucks, and it’s also a little bit mind boggling because I’m then left wondering, “Well, what does that look like for them and future practice?”

Erin Everett: And is it because there’s a lack of patients to be seen, or is it a lack of adaptability? I mean, all these things, just like a constantly racing through my head because I’m like, “Where were those patients now going for that care?

Michelle Sariev: How did it add to the phones were constantly ringing. There were not enough hours in the day to see all the people. Now, all of a sudden people are getting furloughed. There’s like nobody there. I wonder the exact same thing. I mean, I think a part of it is that people utilize some offices like ours, like primary care offices, internal medicine officers utilize those things. Sometimes for a cold. And this started happening I think early on when we started deciding not to see any respiratory illnesses in office and we are really managing a lot more of that over the phone or over the and to try to make sure and keep sick folks out of the office when we were still having some other people come in.

Michelle Sariev: And it’s interesting because really with most respiratory illnesses, right, we can totally reduce this on our own. Oftentimes I think people do come in maybe and we do have visits with them. Maybe, I think about and I know we’re going to talk about HIV and a minute, but I think about HIV patients and how, I still have a lot of people who come every three months for their followup visit. And that’s what they like to do. Despite the fact that the guidelines say that they don’t have to come that often.

Michelle Sariev: But that’s what people’s comfort level. And so, sometimes we have full schedules with maybe appointments that could have been handled otherwise. So, I’ve been thinking also about how is this going to change the face of primary care and chronic care management in general. I think it will be really interesting to see what happens with that and hopefully it will be changes for the better and we can utilize telemedicine whenever appropriate, and we can get some better and more solid laws, some better and more accessible practice laws and things like that. I’m hoping good things will come out of this. But yeah, I am a little sort of flabbergasted by the fact that primary care offices are physical. I know that-

Erin Everett: Because this people are still out there, They’re needing care, but the practices are closing or laying off their employees. So it’s not necessarily that the patients don’t need to be seen anymore, but now they cannot be seen. And so, I worry about people who are social distancing and sheltering in place at home alone. And what that looks like. You know? So I think it is really reassuring that both of our practices is incorporated telemedicine and we’re doing it really well.

Erin Everett: Meaning that it’s in a timely fashion, and we’re making sure patients are aware about it because there’s been a lot of patients who’ve actually reported back feeling very comforted by the fact that we’re doing telemedicine and like, Oh my gosh, such a relief. I wasn’t sure if I was going to be able to keep this appointment with you because of everything that’s been going on. So, that’s another thing too. It’s like, I want to make sure that people know that while their current practice, for whatever reason, wherever they’re attending, if their practice is unable to see them, there are other offices out there accepting new patients and via Telemedicine.

Erin Everett: And even if it’s with the intention to just manage your character in the pandemic because you want to go back to your other provider, that’s amazing. But just to know that you haven’t been abandoned, we’re here. We’re here if you need us. Scary enough, you know?

Michelle Sariev: Absolutely. And I see our role as one of the most important things right now is making sure that people who have other conditions keep their medications, get the check-ins that they need to have to keep them out of the acute care settings. I mean that is number one thing that we can do right now as primary care providers. So, I really hope that the word gets out there that there are places that people can go.

Erin Everett: Yeah, and that’s why I think it’s sometimes the three month follow ups are so important because even if you’re not doing anything earth shattering or major with the patient’s treatment plan, it’s a great point to check in and say, okay, let me put my own like medical needs to the forefront for the next 15, 20 minutes, however long you spend with your patient. Prioritize that and make sure we’re reiterating the importance of that.

Erin Everett: So, that’s another reason why I think it’s great that we could still do those via virtual visits because maybe that dialysis patient is not monitoring their intake as much because it’s stressful, they don’t have their provider checking in with them. They’re at home by themselves. They’re going to the dialysis visits, but they know they’re probably drinking a little bit too much more fluid. They’re off their low phosphorus diet or whatever it is. But to have those routine check-ins is just another like little gut check. Okay. I got to keep my health in mind, life doesn’t just stop because coronavirus is here.

Michelle Sariev: Absolutely. Absolutely. Which speaks to the fact that as healthcare providers, we are so much more than just diagnosing, treating, monitoring labs. I mean, it really is about having a cam relationship with the patient and rapport and partner people and their health. And so, I think it’s… And Telemedicine is a great way to continue that for sure.

Erin Everett: Yeah.

Michelle Sariev: It has been good.

Erin Everett: Yeah. I, we definitely plan on keeping Telemedicine as part of our practice moving forward. To what degree? We’re not really sure. It’s also gonna depend on what the patients want. Of course, we’re all excited to get patients back in the office because having that interaction with your patient, being able to listen to them, it helps continue that rapport you have with them. But it’s also been very interesting sitting on sitting in front of a computer for however many hours a day. I’m not used to being, having a sedentary job.

Erin Everett: So that’s been really interesting, and then like having eye fatigue from staring at a computer screen because you’re doing these virtual visits, it’s really strange. All uncharted waters.

Michelle Sariev: Yeah. So going back to the self care thing. I’m with the walks. So important. I’ve been taking so many walks and even I’m at work now, for my lunch break I take a walk around to the park or whatever by my office and it’s been really fun. We’ve met so many people in our neighborhood that we didn’t know. People have been walking down our street that don’t normally walk down our street.

Michelle Sariev: There’s a guy in our neighborhood who stands out on his porch and if you walk by his house, he’ll say, “May I read you a poem?” And he reads you a poem. Kind of lost because it’s just like a moment where it’s not about COVID. You’re right. It does it all encompassing. I mean, have you found like watching TV or watching movies, you’re like, “What are you doing in such a big crowd?” It’s like I’m still like, “Oh my gosh, it’s just like took over my brain, social distancing.”

Michelle Sariev: So it’ll be really interesting to see, that happened very fast. So, it’ll be interesting to see how we get back to the world or how things sort of slowly… It looks like it’s going to be pretty slowly and come back into at least somewhat of an open sort of place.

Erin Everett: People ask me how long I think this is gonna go on for and I’m not really sure what to say. What have you been telling patients just like a loose guideline?

Michelle Sariev: So, I’m watching the projections for peaks and all of that, flattening of the curve and I’m watching that as well as the CDC guidance for ambulatory care clinics pretty closely. So, now there’s been this, they were saying I think May 8th was going to be peak, but now they’ve backtracked it and said that we already had our peak so things change every single day. But on Friday or Thursday, last time I was in the office I was telling people all since the peak is going to be around May 8th because it was at that time.

Michelle Sariev: I think at least for the first two weeks in May, it’s kind of continue to imagine we’re going to have strict stay at home orders, place recommendations. And so, I’m just kind of doing it in segments. And I guess I’m talking in terms of how to schedule patients and people who need to come into the office versus who could just do a Telemedicine visit. But like if patients are just asking in general, I’m basically saying we should be prepared for some pretty strict social distancing to go probably through the summer.

Michelle Sariev: I’m guessing like August-ish, it’ll depend on what happens with schools and the decisions that the schools make that’s going to be really, I think that’s going to be a deciding factor.

Erin Everett: Yeah, I mean as far as the fall?

Michelle Sariev: There was that, I heard on this one report they were saying that there’s been a suggestion that schools may experiment and be like, we can go back for two weeks and kind of see what happens because we know so little about kids and how much of this they have. And so if we don’t have good testing by then, I think it just all depends on so many factors that we just don’t have answers to right now. So in lieu of trying to give false reassurance, I say we should probably plan on through the summer.

Erin Everett: Yeah, I think that’s pretty reasonable, especially until we have a vaccine. I think things are probably going to be cycling between a little bit of freedom and then back to like strict social distancing to help prevent like recurrences and more peaking. But I feel like as far as them saying the peak was supposed to be May 8th and now they’re backpedaling on that. I have noticed personally we’re seeing a lot less patients with COVID like symptoms than we were even like last week or the week before.

Erin Everett: I don’t know if that’s because people are just like not calling us as much and they’re just going to get their own testing, but before anybody with any kind of respiratory or GI issue is calling us, wondering if they had COVID, and probably a lot of them did. So, it does make me wonder if the cases are down as a whole or again if they’re skipping us and going to the drive through clinics or the urgent cares that are now offering the testing.

Michelle Sariev: Right, right. This is also for a condition that we have like zero data on, it’s a time of unprecedented information that’s available to the public, general public. So I think a lot of people know my patient panel is in general, pretty, I would say this is a generalization, but I would say has a higher health literacy than some areas, I mean we live in an urban educated, I’m in a private practice. Of course, many of my patients are insured.

Michelle Sariev: And so, I think that there is a piece of it where people are sort of, I think a lot of my patients feel like they’re leaving space for people who really are like, I can handle this. That’s kind of what I was trying to say earlier when we’re not, we’re not getting as many calls from people who can manage things at home. So, I think there’s a little bit of that because actually last week I had more COVID calls.

Erin Everett: Oh really?

Michelle Sariev: Then I did the week before. Yeah. So, it is interesting. I know that just talking to colleagues at the hospitals, it sounds like it’s pretty manageable still in our hospitals. So, I think there’s also a piece that is, especially here in Atlanta, we did a really good job of social distance. I think what happened down in Albany really scared a lot of people in Georgia. And I think that, I think just by some of the slower action of our political folks, I think a lot of people hunkered down and a lot of the restaurants like sprung into action and did-

Erin Everett: Yeah sure, they didn’t. We weren’t really met with a lot of resistance on that.

Michelle Sariev: Yeah. So, I think that probably has a piece of it, but I think the fact is we just really don’t know what’s going to happen.

Erin Everett: One thing that I’ve been counseling my patients on is like self care techniques and things like that. Do you have any pearls for people who are listening on how they can be?

Michelle Sariev: For self care?

Erin Everett: Yeah, for self care. Like how can they be checking in on themselves and then other people, I mean, I know the spiel that I’ve been giving people, but I’m just curious, what kind of information you’re providing for your patients.

Michelle Sariev: Yeah, with each visit, I’m just kind of checking in on that, and just asking, “How’s your mental health?” And just addressing it period. I think that a lot of people don’t get asked that question often times. And so, just checking in and also allowing a space for grieving and sort of addressing that and addressing the fact that we are all sort of grieving the loss of what our normal life was.

Michelle Sariev: Also, opening up space for people who are doing okay with this and saying, “No, it’s okay is you’re actually kind of enjoying the quiet time.” You know, some people are calling this the great clause and it’s actually a positive thing for some people. So, trying to focus in on that. And then, I do a lot of educating about how important it is to exercise right now. Get out, take walks.

Michelle Sariev: I mean in here in Atlanta we couldn’t be at a better time of year to have more time to take breaks because it’s gorgeous out there. So, I’m talking about that. I think this is a great time for arts and music. There’s so much free stuff right now on the web. So people who have good internet access we’re very those of us who do have the internet access are so privileged right now. And I do want to kind of say that I’ve thought about social determinants of health so much with this because it really is a privilege to be able to work from home or do telemedicine or have internet.

Michelle Sariev: And man, is that not more evident than now? So, I really my heart out to those folks who don’t have that access. I’m encouraging people to journal.

Erin Everett: That’s a big one now.

Michelle Sariev: We’ve never had a time in history like this. I mean this is our defining moment in history. So, I’m definitely encouraging that as well.

Erin Everett: Yeah. I’m not sure if you get the updates too from your local politicians, but Renitta Shannon sends out an email, I think a weekly updating District 84 on what’s been going on with coronavirus. But to your point, I was just circling back to your social determinants of health. You know, she mentioned actually in her email about how more hit the African American community had been from coronavirus.

Erin Everett: And I think that has a lot to do with what you’re talking about, which would be access to good information, internet access, and things like that when you’re looking at populations of low SES status who don’t have access to those things, or who maybe can’t work from home. So they’re still having to leave their homes and go to work risk exposure, but then also to may not have the means to get care early on in the course of illness. So just to circle back to that, that is definitely a very important thing.

Michelle Sariev: I had a statistic, it may have been Cuomo’s press conference today. He was saying that 40% of essential workers are people of color. And I’m not sure if that’s just in New York or in the United States, but that is a huge number. And so, 40% of people can’t stay home. And those are people of color. And so yeah, I mean it’s just really, really crazy.

Erin Everett: So there’s a lot of factors to be considered there. But yeah, so back to the self care things. I think those are really good recommendations. I know a few of my favorite musicians are doing live streaming shows on Instagram and things like that. But outside of that, I think the other important thing is, when this all first started, everyone ran out and stocked up. Well, I think a lot of people did.

Erin Everett: And probably on more convenience, and packaged foods and non-perishables, which I think is a great idea with amount of uncertainty ahead of us. However, now that we know that there’s going to be, and I think we always did know, but we were scared that there’s going to be accessed to grocery items continually. I think that’s really important for people to be focusing on the nutrition right now. I mean there’s like nothing worse than being stressed and exhausted, maybe not sleeping well, but then also not even fueling your body in a great way. Like maybe over consumption of like salty and processed foods that are also going to cause you to maybe have more fatigue, swelling, and that kind of thing. And so, if people can really focus on nutrition, what it can lead to is a nice distraction of maybe cooking new recipes and like socializing within their home, within their people that they’re social distancing with and trying new things but also feeling their body.

Erin Everett: Because, if you can eat right and eat healthily in a balanced diet, you’re also strengthening your immune systems. I think that is something too that I’ve been trying to counsel patients on as well. It’s like don’t get stuck in the rut of ramen noodle every night, you know?

Michelle Sariev: Yeah, absolutely. Because the first thing that we go to when we want comfort food is carbs. And so, there’s no shame, and things in moderation. But I totally agree with you. It is so imperative that we really try to keep healthy. You know, I try to check in with people about drinking as well, and forms of substance abuse, just like kind of checking in about that and making sure that people are not just holing up and you know self-medicating.

Erin Everett: Right, right. Because, I think we’ve definitely seen an increase. I mean there’s obviously an increase in alcohol consumption. We see all the memes and everything floating around on Facebook. I don’t know if you have a TikTok? I’m kind of obsessed with TikTok now, but there’s been a lot of funny videos of people drinking alcohol and they’re like I’m not the only one drinking all day. Right?

Erin Everett: Well, that’s all funny but I think it’s really important that we’re out of our routine. You know a lot of people are ahead of their routine. They’re, they’re able to sleep later cause they’re working from home. And then so maybe going to bed on time is not like such an issue. And so, they’re more likely to over invite in the evenings or during the day. And so that’s fine for like a week or so. But this is going to go on for a long time. So, I think it’s really important, like you said, to like reset those habits because it’s just going to exacerbate our stress, and at the end of it not do us any favors really.

Erin Everett: Hey guys, on a more serious note, I understand that coronavirus has changed a lot of things for a lot of different people in many different ways. It’s a scary, uncertain time. So if you find yourself struggling or you need help, please feel free to reach out. We’re still seeing new patients every day, and we’re here for you. There’s no need to feel alone and isolated when you don’t have to walk this journey alone. Also, feel free to post and let us know how you’re doing. You can post on my Instagram page, let us know how coronavirus has impacted you for the good, the bad, the ugly. Everybody has their own version of their silver linings during this time. We just have to support each other, focus on the positives, and learn to focus on things we cannot control and try not to worry about things that we cannot control.

Erin Everett: And to control the things that we can, like making sure we’re eating well, getting enough sleep, those types of things. So feel free to reach out and if you want to make a personal comment that you don’t feel like posting on social media, feel free to email me if you have any questions, concerns, or if anything that we can do to help you.

Erin Everett: The other thing I think is important too to mention is not only have medical offices like ours gone to Telehealth platforms, but a lot of mental health care providers have already been doing Telemedicine and so now they’re just continuing it. So, that’s still an option. Like maybe people didn’t have the need, I think everybody needs a therapist, but maybe they didn’t acknowledge the need to engage in a relationship with a mental health care provider. So if people are feeling that way now, there’s definitely a lot of resources out there for you to establish care with a mental health care provider. And I usually refer to psychologytoday.com so that way you can search for providers who are doing virtual visits, who are in network with your health insurance if that’s important to you.

Erin Everett: But also you’re able to see reviews and look at all their specialties. So, for those of us who are allies are in the LGBTQ community, as could probably be more important for you to find a mental health care specialist that is also LGBTQ friendly or is familiar with nontraditional couples, and those types of things so that you can receive the mental health care that you need. I think it’s announced no better time to do that.

Michelle Sariev: Absolutely. And if I could, I would love to give a shout out and endorsement to Mara Collins who, I don’t know if you’ve got this, but she’s doing that COVID-19 support group.

Erin Everett: Please tell us more about that. That’s amazing.

Michelle Sariev: So it’s an online mental health support group for all impacted by the COVID-19 crisis. The support group is queer and trans us centered and the intent is to build collective resilience. They discussed self care and community care practices to help our collective nervous system function better during uncertain times. Group therapy and support and mutual aid, allowing space for folks to share their resilience.

Michelle Sariev: So it’s Mara Collins who is a therapist and Sonali Siddique, I’m sorry if I mispronounced her last name. And she’s a Mago communication coach. And this meeting is on Mondays from 5 to 7:00 PM Eastern standard time. It’s via zoom, and if you’re on Facebook I know you can find information about it with if you just search Mara Collins her page.

Erin Everett: Yeah. And whatever information you have, I’ll put on the description of the podcast so people can easily click and link to it. That sounds really interesting. I think really helpful. And Mark Hollins is a very well recognized mental health care provider in the LGBTQ community and is also local to Atlanta and does a lot of work on advocacy as well. So, that would be a really helpful group. I can imagine so.

Erin Everett: One thing that I think is really important that we talk about is those who might be experiencing a little bit more fear. And you highlighted this earlier, Michelle, when I was talking to you, are those patients living with HIV and that those patients who have been impacted by HIV in some regard, whether they’ve lost a partner friend, whatever to HIV, back when the epidemic occurred there back in the 80s, this can be very triggering for them.

Erin Everett: You’ve brought that to my attention and that’s a really good valid point that I think we should discuss but also kind of give some guidance on patients who are living with HIV. Do they need to be more scared? I’ve touched on this briefly before but I think we can probably revisit it, because it is a scary time and I know it’s plaguing some of those folks.

Michelle Sariev: Absolutely. That is definitely a question that is coming up over and over again. Like am I at increased risk if I’m living with HIV. I think you talked about this in your first one about how quickly, as long as the CD4 count is good, viral is undetectable, folks are on meds, same risk factors. Now, that being said, if people are living with HIV and have other chronic conditions like diabetes, hypertension, pulmonary disease, then yes, they are at increased risk for severe COVID-19.

Michelle Sariev: But in general, the biggest most important thing is that people stay on their medications right now, and keep their HIV infection under control. And that remains the case. I mean, I’m checking in on that every day. There is a case report, I think I left it at my office, but I believe it’s out of Wuhan, and it was on one person. So it’s an end of one. And a base report obviously. And it was someone who was co-infected with HIV and hepatitis C, and had a delayed antibody response to deal with the Coronavirus. And so, that was suggesting that it took them a little bit longer to fight the virus I believe, is kind of the conclusion that they were coming to. But in general, I don’t think that we’re seeing any big signals that just HIV infection alone affects. And that being said, we’re just not seeing those yet. We don’t have any data about it at all.

Erin Everett: I would love to actually see some data on how many patients who have HIV, who have been co-infected with coronavirus. I’d love to see how many there actually are.

Michelle Sariev: There’s a database for that. Actually, you can access it through AAHIVM. So, if any providers out there listening, if you have any folks living with HIV who also test positive for COVID-19 there is a database, I think it’s called, I don’t remember what it’s called but I guess we can look it up later, and they’re just kind of keeping track of folks and it’s HIPAA compliant. The way that they’re gathering the data thing so that that way we’ll have that data.

Erin Everett: Okay. Well, that’s good because since we’re studying certain antiretrovirals for the treatment of coronavirus, it’d be kind of curious to see if some people were less likely to get it because of their regimen.

Michelle Sariev: Yeah, that’s a very common question I get as well. A lot of people talking about asking, if people who are on PrEP, if that’s protective and you know the longest short of it right now that we just don’t know.

Erin Everett: Oh yeah, we don’t have enough information, but I’m sure all of these things will be studied afterwards and we’ll come out with some really good information on that. I also read that about the antibody response, which also made me wonder then if someone has been exposed to Coronavirus and you’re living with HIV, if perhaps you should be extra cautious before going back around people in case you have a delayed symptom onset as well. So, you might find that you’re in the clear, okay, well I had an exposure but I haven’t developed any symptoms. But if the antibody response takes longer, it may also take longer for them to even show their first sign of illness.

Michelle Sariev: Right, right. Yeah, and I think that was the case with this person.

Erin Everett: Yeah.

Michelle Sariev: I think that’s an important point.

Erin Everett: Well, that’s good. So, that’s pretty much like what I had been telling patients too. You know, it doesn’t seem to be the virus itself. HIV is not seemingly to place patients at additional risk. It’s all about immune functioning in general. And so that’s why we base on CD4 count. And some other ways you can boost your CD4 count without obviously you’re already on your medication would be, taking vitamin C.

Erin Everett: I always recommend that for everybody, vitamin C and zinc and I actually joke at work that the feds leaked my secret because that’s something that I recommend all the time and I have seen really positive gains on immune functioning. People who live with HIV or don’t taking, you know, vitamin C and zinc together does help reduce viral replication of cold and flu viruses in general, but also helps maintain a healthy immune system along with proper sleep hygiene, hydration and stress management, which we touched on briefly earlier.

Erin Everett: So those are all really important things for anybody in the community is listening. But particularly those who are living with HIV, because this could be, again, stressful and triggering, maybe taking them back to the days they were first diagnosed, depending on what year that was and the losses they endured during that time. And so, that could obviously lead some people down the road of self-medication and mismanagement of their stress and maladaptive coping skills.

Michelle Sariev: I think it’s really interesting as well that Fauci is playing such a prominent role this time around because he lived through the AIDS crisis in the 80s, became very familiar with his name and especially the activist and the providers, and then also Dr. Birx. It’s so interesting that HIV providers or the medical faces of this in the political realm of the Coronavirus. And I think that that in along with the fact that this is becoming rapidly more and more politicized as a disease is very similar to the way that HIV and AIDS was back in the day. And actually still is, as we all know. And I just, and I think that there’s so many things that are different about the two viruses for sure, but there are so many similarities on a very sort of, like you said, triggering love.

Michelle Sariev: And so I worry that people are probably kind of having some feels about it and, and it’s probably taken them back and actually, it was, I mean, for the gay male community, it was way more catastrophic than what we’re dealing with now, in a much smaller level. And so, I really definitely want to make sure and check in with all those folks. I think the providers who went through it before, they are probably remembering what it felt like to be dealing with a virus that they knew nothing about.

Michelle Sariev: So that’s really, I mean how it feels as relatively younger provider I guess. It’s maddening sometimes. And so for those folks, especially infectious disease folks who are now going through this a second time in life is gotta be really, really mind blowing.

Erin Everett: Yeah. Yeah. I absolutely agree. And it’s very strange in the fact that like Corona virus, some people may have mild symptoms and not really even notice that they have it and then other people of course are losing their lives to it, which is a little similar to HIV AIDS. Some people lived with HIV for a long time before they developed AIDS, and had no idea they had it until they developed AIDS. But several years had passed, and they were lucky that their treatment options had improved whereas other people were diagnosed because they rapidly started declining and they died right away before they could even get any treatment. So, it is kind of nutty in that regard as far as like the uncertainty and the trauma surrounding that. I think it’s really creepy.

Michelle Sariev: It is. It is creepy.

Erin Everett: I’m really hoping that we get more solid information on how to manage coronavirus here soon. Because like you said before, it is just an ever changing thing and it seems to be a lot of like mixed information and you’re really having to kind of like detangle everything to figure out what’s important and what you’re going to relay to your patients.

Michelle Sariev: One other thing I do want to say for sure is that just in case there’s any providers who might be unaware that really all across the board, all the recommendations are to be giving 90 day supplies of medications and advocating for that. Whether insurance companies typically pay for that or not. We’ve re to be trying to advocate for that. And I was just seeing on the Academy of HIV Medicine’s website that they have been assured that there’s not going to be any sort of supply issues with any of the ARVs. So that really, really reassuring. So we do have folks in the advocacy world who are making sure to keep an eye on that, and so, patients don’t need to worry about running out, and providers need to not hesitate to give those 90 day supplies and now maybe hold off on doing labs, especially if they’ve been done within the last six months.

Erin Everett: Right.

Michelle Sariev: You know, it’ll be okay to wait, two to three months or maybe even longer. So, I had to mention that.

Erin Everett: Yeah, especially if someone’s been stable, their counts have been stable, they’ve been undetectable for a long time. I definitely think it makes sense now if you’re monitoring other issues like renal function and things like that, then you know you have to just use your best judgment there. But in general, like you said, a lot of people can skip their blood work this time around.

Erin Everett: The other thing that is really important for people know who are listening is that if you’ve lost your health insurance now, maybe the first time that you’ve had to utilize the Ryan White programs or the advancing access to your Gilead. If you’ve been for a load and lost your health care benefit, there’s still ways for you to get your HIV medication. So, it’s really important that you reach out to your providers before you run out of meds. There’s no reason for you to come off of your medications due to lack of insurance.

Michelle Sariev: That’s a great point. Thank you so much for bringing that up. And also for PrEP. There’s time resources for prep, even if you don’t have, if you’ve lost your insurance.

Erin Everett: I agree. I’ve already had to transition some people over to the advancing access program for prep. You know, even though we’re social distancing and things like that, there’s other things that potentially continually expose them and need them to stay on their prep medication. But yeah. So, that’s all good. And so just to summarize, it’s really important that during this time of uncertainty and pandemic that we’re focusing on our health and hygiene.

Erin Everett: Our health hygiene, making sure that we’re sleeping well, eating well, those types of things. And if you’re really just not doing a very good job at that, that’s okay, don’t beat yourself up. Really focus on positive self talk. And if you feel like you’re really still not doing a good job, then don’t hesitate to reach out to a healthcare provider like myself or Michelle and even a mental health care specialists that can help you through this hard time.

Erin Everett: If you’ve never needed help before and now is the first time, that’s okay. It doesn’t mean you fail. I think it’s really important for people to remember that.

Michelle Sariev: Absolutely.

Erin Everett: Yeah. Do you have any other thoughts or things you wanted to share today, Michelle?

Michelle Sariev: I think I really appreciated the opportunity to do this. It’s been some good self care for me and I love being able to get out there and reach folks and hopefully maybe give some information that might be new to them, but also just kind of sort of support and that kind of feeling of we’re going to get through this out there in the universe. And yeah, I appreciated that. That was awesome.

Erin Everett: Michelle, is your practice still accepting new patients via Telemedicine?

Michelle Sariev: Yes, absolutely we are. Yup. Yup.

Erin Everett: I See. So both Michelle’s practice and my practice are accepting new patients. So if you feel abandoned by your previous provider or you just can’t get in touch with them, maybe they didn’t have the means to adapt to the ever changing conditions right now. Never fear help is here.

Michelle Sariev: Thank you. Yeah, people can just contact the front desk at my office and we can get the paperwork and get them all set up on our Telemedicine platform, no problem.

Erin Everett: Well cool. Well everybody makes sure you stay fierce, stay safe and live your truth. Thanks for listening. I’m not sure if y’all have had a chance to check out my episode on HIV. It’s a useful topic. A lot of people ask me questions about HIV treatment prevention and the first signs and symptoms of HIV, so any questions you have will most likely be answered with that episode. So don’t forget to check it out and leave a rating and review, so that that information can also reach other listeners. Without the reviews, it’s only able to reach other listeners because I don’t go up on the ranks in the podcast platforms. And the whole purpose of this show is to reach listeners so they have access to good quality information. There’s a lot of misinformation out there. So, it’s my job to play Myth Buster. So, give us a share, let your friends know about it, and take a listen and give me any feedback. Or if you have any questions that weren’t answered, let me know.