SAN DIEGO, CA - JULY 22: (Top L-R) James Frain, Sonequa Martin-Green, Jason Isaacs, Mary Wiseman and Shazad Latif (Bottom) Anthony Rapp and Doug Jones from CBS’ ‘Star Trek: Discovery’ pose for a portrait during Comic-Con 2017 at Hard Rock Hotel San Diego

don’t forget the feet

Today I had a patient who was a little…off.
She couldn’t tell me what year it is.
She didn’t even know how to count backwards from 10.

I thought to myself, “She’s 70. Maybe there’s a history of cognitive decline?”

So while she sat and wondered about which day of the week it is, I quickly looked through her chart. But I found nothing. Nothing about memory lapses. Nothing about disorientation. Nothing about short-term memory issues. Nothing.

I preceded to do a full head-to-toe physical. When all I had left to do was the feet, I hesitated. I usually don’t skip the feet. But for this poor woman who sat there mumbling to herself and nodding off, I wondered if I should make an exception. The woman had enough trouble getting out of a chair, let alone pulling on socks and lacing her shoes. 

But I knelt down and placed my hands on her shoes. “Ma’am, is it okay if I take off your shoes and check the bloodflow in your feet?”

She nodded and returned to mumbling to herself.

After I got the laces undone and the shoes off, I carefully pulled back the socks. 

Then when I examined the soles of her feet, I found this:

Few rashes appear on the soles of the feet.
Syphilis is one of them.

Syphilis can lie dormant for decades.
Sometimes when it reappears, it can affect the eyes (occular syphilis).
Other times, it can affect the brain (neurosyphilis), leading to dementia and behavioral disturbances.

I helped the woman put on her socks, and I tied her shoelaces. Then I left the room and reported to my preceptor. Once I mentioned the sudden cognitive decline and rash on the feet, my preceptor immediately searched the patient’s records at all local hospitals for bloodwork.

Then we found it.
A positive RPR dating back a few decades, indicating that at some point the woman tested positive for syphilis. Looking through her records, she never received treatment.

We spent most of the following hour scrambling for an emergency infectious disease consult, and it did create some chaos for the remainder of our scheduled patients. But we managed, and now the poor woman is receiving treatment.

So, friendly reminder:

Don’t. Forget. The Feet.

What People Living With HIV Want You To Know

“Once I began my medication I realized that not only was it very manageable but a relief, not having to worry about my health every minute of the day.”

“Most people don’t know the difference between HIV and AIDS. They assume that I have AIDS and I’m really really sick or that I have to take a bunch of pills every day. Most people don’t understand how far we’ve come with the science and that by taking one pill a day, I can live a happy, healthy life.”

“I deserve to be happy and healthy. And I am.”

“My life is fairly normal other than my status,” Elder said. “I sleep, wake up, workout, eat breakfast, go to work, attend comedy shows, kick back with friends, read books, laugh at cat videos, stargaze, hook up, date… I just happen to take a pill every morning that those who are negative do not. This pill allows me to live a long a fulfilling life and allows me to protect others from HIV.”

“People live in fear of disclosure, which creates isolation in their treatment, which fosters depression because living in secret with a chronic illness and fear being judged … it’s just not an environment that’s conducive for living with this disease.”

“I’ve lived openly with HIV ever since I found out I had it…I told everyone, even strangers, and kids were pretty decent about it, but adults sometimes were not.”

“I’m not glad I have it. But I am happy that I do know my status. Now that I know my status, I’m doing whatever it takes to protect myself and others.”

“The biggest way [HIV] manifests in my life is when something that is unrelated to HIV happens to me and I have to see a doctor. The doctors always bring it back to HIV. That kind of stuff will drive you crazy because, in the medical space, everything relates to the HIV and it shouldn’t.”

What People Living With HIV Want You To Know

via attn

To those who chose to reject someone simply because they disclosed their herpes status

You are entitled to leave if you want. But keep this in mind:

80-90% of the population has herpes. Of those, 85% of people who have herpes have no idea. Of those who are aware they have herpes only half will actually tell you.

So, when you reject someone who is honest enough to tell you they have herpes because you don’t want to take that risk, just remember you are, in fact, taking a much larger risk with all the other people out there who may not know their status or be honest. Statistically speaking you are safer with someone who knows their status and is honest with you than with anyone else. And even those who claim they get tested regularly, herpes is not included in most STD panels unless you specifically ask.

So just keep that in mind when making your decision.

Liam Payne Becomes Record Third One Direction Member to Top Pop Songs Chart, Dethroning Niall Horan
Payne's "Strip That Down" follows Horan's "Slow Hands" to No. 1, after Zayn led in 2016 with "Pillowtalk." One Direction is the first act with three soloists each with Pop Songs No. 1s.

One Direction becomes the first group to spin off three soloists each with No. 1s on Billboard’s Pop Songs radio airplay chart, as Liam Payne’s “Strip That Down,” featuring Quavo, rises 2-1 on the latest tally, dated Oct. 14. (Both Payne and Quavo make their first trip to the top of the chart.)

Payne directly replaces Niall Horan’s “Slow Hands,” which topped the chart dated Oct. 7. The two 1D members follow former member Zayn, who led the list for two weeks in May 2016 with “Pillowtalk.”

(The Pop Songs chart, which began in 1992, measures total weekly plays, as tabulated by Nielsen Music, among its reporting panel of 164 mainstream top 40 stations.)

Only one other group features even two soloists each with Pop Songs No. 1s: Destiny’s Child, as Beyonce has earned six solo leaders and Kelly Rowland has scored one. As a group, Destiny’s Child collected two Pop Songs No. 1s: “Jumpin’, Jumpin’ ” and “Independent Women Part 1.”

Meanwhile, with Payne succeeding Horan, it’s the first time that two members of the same group have reigned back-to-back on Pop Songs. (Honorable mention to Maroon 5, whose “Moves Like Jagger,” featuring Christina Aguilera, led for six weeks in 2011 before being dethroned by “Stereo Hearts” by Gym Class Heroes featuring Maroon 5 lead singer Adam Levine, for three weeks.)

Beyond Zayn, Horan and Payne, the other two members of One Direction have yet to lead Pop Songs: Harry Styles reached a No. 12 high with “Sign of the Times” in April and Louis Tomlinson peaked at No. 25 three weeks ago with “Back to You,” featuring Bebe Rexha and Digital Farm Animals. One Direction has not hit No. 1 on Pop Songs, either; its debut entry, “What Makes You Beautiful,” rose highest, to No. 3 in 2012.

On the all-genre airplay, streaming and sales-based Billboard Hot 100, Payne’s “Strip” has hit a No. 10 peak to date. Check back later today for highlights of the new, Oct. 14-dated Hot 100’s top 10. All charts will update tomorrow (Oct. 3) on Billboard.com