Men's Health Review and STIs

Shamika Brooks has been practicing nursing for more than 12 years and has been a nurse practitioner since 2015 when she graduated with a Master of Science in Nursing from Maryville University in St. Louis, Missouri. She currently works as an advanced practice clinician providing preventive, primary care, palliative, and acute care to adult & geriatric residents living in a long term care setting. Shamika is a certified Family Nurse Practitioner licensed in the state of Texas and Washington state. Her previous position was as a nurse practitioner at Parkland hospital in Dallas, Texas providing primary care, urgent care, and specialty care to those living with HIV/AIDS. Her duties also include being a member of the inpatient infectious disease consult service at Parkland and also being certified by the American Academy of HIV Medicine as an HIV specialist. In her spare time, she enjoys mentoring and educating new graduate and student nurse practitioners in her current role as preceptor and graduate clinical faculty at University of Texas at Arlington online accelerated FNP program.

0:00:00.1 Professor Walden: Okay. Alright guys, we are live and in color, and it’s happening. I’m gonna wait a few minutes and let everybody kind of hop on and jump in, because I know that you guys are probably putting kids to bed, doing dinner, things like that, so we’re gonna let you guys go ahead and get situated. So with that being said, hopefully everyone is well, and everyone’s doing good. I do wanna point out that we have a mental health survey that has went out, and so we’re kind of checking in to see how everyone is doing. And if you could fill that out, get your friends to fill that out, that would be great, okay? So we will go from there, okay? Alright, so we are going to get started. And as always, you are always welcome to watch the replay as well. So no worries if you join in late, we’re just gonna get started. So I am super-excited. I have been stalking this young lady for a while, and we finally have gotten in contact with each other. It’s really hard to find an infectious disease NP, someone who specializes in those things. And she has graciously agreed to grace us with her presence, so I’m excited to listen in along with you guys.

0:01:37.8 Professor Walden: So this is Shamika. So Shamika Brooks has been practicing nursing for more than 12 years and has been a nurse practitioner since 2015, so she’s an OG in this when she graduated with a Master’s of Science in Nursing from Maryville University in St. Louis, Missouri. She currently works as an advanced practice clinician providing preventative, primary care, palliative and acute care to adult and geriatric residents living in a long-term care setting. Shamika is a Certified Family Nurse Practitioner licensed in the state of Texas and Washington State. Her previous position was as a nurse practitioner at Parkland Hospital in Dallas, Texas. She provided primary care, urgent care and specialty care to those living with HIV and AIDS. Her duties also include being a member of the Inpatient Infectious Disease Consult Service at Parkland and also being certified by the American Academy of HIV Medicine as an HIV specialist. In her spare time, she enjoys mentoring and educating new graduate and student nurse practitioners in her current role as a preceptor and graduate clinical faculty at the University of Texas at Arlington Online Accelerated FNP Program. So that being said, let’s bring Shamika on. Hello.

0:02:58.7 Shamika Brooks: Hello, everyone.

0:03:00.9 Professor Walden: Fantastic. We are super-excited to have you. I’m just excited to hear. I would love for you, even kind of as an intro, just telling the folks, again, a little bit about how you got into infectious diseases, ’cause I think that’s something that we just don’t talk about. We know all the normal things done, right? Respiratory, ER, we know all of those things. But really kind of tell them how you got there and what you learned, and then we can jump right into your program. But I will sit back and listen as you talk right now.

0:03:39.4 Shamika Brooks: Okay. So my schooling for my FNP program was a distance learning program, so I was responsible for finding all my preceptors in the State of Texas. And so I intentionally got a job as a case manager at Parkland, because I knew that I wanted to get my preceptorship there, because it’s the county hospital, you’re gonna see anything and everything, right? So by chance, I was looking for my internal medicine preceptor hours, and a lady reached out to me via email internally, and she was like, “Hey, I can give you all the hours that you need. It’s primary care, but all of our patients live with HIV,” and I was like, “Interesting.” I was just happy to get the hours and at a quality site. So I will tell you this, and I hope nobody’s eating, or got the kids or somebody watching, but I’m such a nerd. But so the first day of clinical that I was there at the site, we went into a room, and brace yourself, okay? This gentleman had come in with some signs and symptoms of discharge, and it was rectal discharge. And I had never known that STIs and STDs, how they can affect, it blew my mind, that’s all I’m gonna say, I’m not gonna go into any more detail. But it blew my mind, and I was hooked from that day on. And so I was so grateful to be able to secure a position in that clinic after I graduated. I made such an impression, ’cause I just loved it, I just thought it was just the greatest thing.

0:05:26.3 Professor Walden: That’s awesome. Yeah. No, and this also goes to show you your clinicals, your clinicals can turn into a job. And I try to tell people that all the time, and they’re like, “But I don’t know.” And I’m like, “No, no, no, even if you did not enjoy it, play your cards right, because they know someone who is looking for someone.”

0:05:48.1 Shamika Brooks: Yes.

0:05:48.7 Professor Walden: And that’s pretty amazing, so I’m…

0:05:50.9 Shamika Brooks: It was great, it was great. I’m forever grateful to her, ’cause she set me on my path.

0:05:55.0 Professor Walden: Oh, that’s awesome. Alright, so today you are going to talk to us about shingles, which I have been telling everyone who has been listening to me that all the things are back this year. So whereas last year or the year before, we didn’t know what happened to flu, we didn’t know what happened to RSD, we didn’t know what happened to shingles, it just kinda all disappeared. Everything is back in full effect this year, so we decided to start right with this one. And so I’m just gonna pull up your PowerPoint, and I’ll let you take it away.

0:06:31.2 Shamika Brooks: Okay. So let me see. Alright. So, I kinda told you guys who I was. And I had a prior certification as a HRB specialist in the HRB Academy of Medicine. We talked about my ID consult service. And then another fact is, I was a brief clinic owner as a nurse practitioner in the state of Texas for about a year and the pandemic kinda derailed my plans, so we had to shut down. But during the time that I had the clinic, I actually tested over 100 people for COVID, so it was a great experience. And of course, I’m still adjunct faculty at UTA. Okay. So, one of the major things that I learned in my role working at the County Hospital and the IV consult service, that Academic Medicine has a whole another level of terminology. And me being a nurse, I’m thinking, I’m coming in, I’m like, “Okay, I can understand this.” But they had a whole another language and it was a huge learning curve for me as I was trying to learn my job. So, one of the terms… I’m sorry, having a technical difficulty. Okay. So, seroconversion. Seroconversion generally is the time between exposure to a virus and when antibodies show up in your blood. And I know this has been a big topic of conversation with SARS-CoV-2 and the people in one camp are championing natural immunity versus vaccination.

0:08:13.6 Shamika Brooks: And the data that I found that was out there was showing that the antibodies usually show up in the blood 7-14 days after a positive PCR test, but the amount of time that the antibodies remain is up for discussion and debate. So, there’s still more information that needs to be learned from that, and so I’m sure we’ll get more information in the future. Visceral involvement, and this is where the soft internal organs of the body are involved, including the heart, the lungs, organs of the digestive track, reproductive and circulatory systems. Okay. And disseminated infection. This is, for example, I think when infection extends beyond the origin or nightest of infection, it involves the blood stream and it seeds other areas of the body. Methicillin resistant staph aureus is a pathogen that is very assiduous for doing this. That’s why infection as these doctors treat it very aggressively, because the bacteria itself is sticky. So, it’ll stick to bones, it’ll stick to the valves of the heart, so that’s one disease that is treated very aggressively.

0:09:43.1 Shamika Brooks: Okay. Next is tropism, and this is the ability of a given virus to productively infect a particular cell. So, there’s certain receptors on the cell that the virus will attach to and insert itself on, so that was one term that I wasn’t familiar with until this, my role. Okay. So, let’s talk about some myths and facts. And we’re gonna cover all of these in the presentation. So, stress can trigger a shingles outbreak, is that true or false? You can’t get shingles more than once. Do you believe that’s true or false? And then symptoms always leave after a few days with shingles. Is that true or false? Chickenpox and shingles are the same illness, is that true or false? Open blisters can spread chickenpox. Is that true or false? Open shingles blisters. And shingles are a rare phenomenon. Do you believe that to be true or false? And lastly, only older people can get shingles, is that true or false? So now, we’re going to look at the VZV life cycle. So VZV, varicella zoster virus, which is the virus that causes chickenpox infects the human host when virus particles reach mucosal epithelial sites of entry. Local replication is followed by spread to tonsils and other regional lymphoid tissues, where the VZV virus gains access to the T cells.

0:11:35.6 Shamika Brooks: Infected T cells then deliver the virus to continuous sites of replication, and then VZV establishes latency in the dorsal root ganglion. Reactivation from the latency, which is the same shingles, enables a second phase of replication to occur in the skin, which typically causes lesions in the dermatome where it had innervated the dorsal root ganglion. This next picture down here is looking at how the virus has entry into the cell. So, these VZV particles will attach to the cell membrane and fuse and come inside the cell, and then basically not to have your eyes gloss over into virology, it just turns the cell into a virus making factory. And it just creates more particles that go throughout the rest of the bloodstream and infect as many cells as they can. And so the varicella zoster virus is a DNA virus, so it’s double-stranded, and then when we talk about other viruses like HIV, they are RNA viruses and they are single-stranded, so the main difference is the DNA replication takes place in the nucleus for DNA viruses, and in the RNA replication takes place in the cytoplasm.

0:13:10.4 Shamika Brooks: Okay, so let’s talk about some epidemiology, anyone who has had a natural infection with wild-type varicella zoster virus, or has had a vaccination can develop herpes zoster. I, for one, was born in ’85, I’m a 90s kid, so I remember distinctly having chickenpox as a child. So children who get the varicella vaccine have a lower risk of herpes zoster compared with children who were infected with the wild-type. Many people do not remember having chickenpox, however, approximately 99.5% of the people born before 1980 in the US have been affected with wild-type virus. As a result, almost all older adults in the United States are at risk for herpes zoster, and so the varicella vaccine contains a live attenuated virus, which causes latent infection, and then, in my clinical practice dealing with my patients with HIV, they had to have a certain CD4 cell count, meaning their immune system was functioning properly before we would even consider a live vaccine for them. Alright, so when you encounter herpes or someone with herpes zoster virus, shingles, in your clinical practice, most commonly, they’ll have a rash and one or two adjacent dermatomes, which is localized, you can see this diagram here that’s colored, it breaks down to characterization of the different dermatome types.

0:14:45.3 Shamika Brooks: The rash most commonly appears on the trunk or along the thoracic dermatome, and the rash does not usually cross the midline. So the rash, I’ve never had the shingles personally, but from my clinical practice and experience, the rash is usually very painful, itchy or tingly, and these symptoms may precede the rash onset by several days, and I had a particular case when I was a new graduate, of a lady that presented in clinic and she had some upper posterior back pain, it was very tingly and itchy, and the amount of pain that she was describing was out of proportion to what I could physically assess on her body, and so there was no other differential that I could think of remotely that would explain it, so shingles was on my differential, so I went ahead and treated her empirically with valacyclovir, and I gave her gabapentin ’cause she was in so much pain and shoot true enough, the rash did show up a few days later. So the symptoms may precede rash onset by several days, and some people may also develop headache, photophobia and malaise in the prodromal phase, and we’ll talk about some neurological complications that can happen with shingles as well.

0:16:05.6 Shamika Brooks: So the rash develops into a cluster of vesicles, new vesicles continue to form over three to five days and progressively dry or crust over. They usually heal within two to four weeks, but there can be permanent pigmentation changes and scarring on the skin, and I’ve seen this a lot with my patients who were living with HIV, they had a lot of scarring from a shingles infection. Okay, so people with active herpes zoster lesions can spread primary varicella infection and cause varicella in people who have never had varicella or who have never received the vaccine. Once varicella resolve, these people are then at risk for herpes zoster. Active herpes zoster lesions are infectious through direct contact with vesicular fluid until they dry and crust over. So people with active herpes zoster lesions, you want to have them cover the lesions and avoid contact with susceptible people in their household or in their occupational setting until their lesions have dried and crusted over. Okay, so we’re gonna talk about those who are high risk for complication. So we have an example here, we have a 56-year-old female with leukemia on chemotherapy. She is on a medication that can suppress her immune system, do you think she is at high risk for complications? True or false?

0:17:46.9 Shamika Brooks: Next, you have a 32-year-old male with new diagnosis of HIV, would you think he would be someone who is at high risk for complications with shingles? True or false? And next, we have a 64-year-old with renal transplants on immunosuppressant medication, do you think this individual would be high risk for complication? True or false? And in my professional opinion, all of these examples here are at increased high risk for complication. So the reason why VZV reactivates and causes herpes zoster is not fully understood. A person’s risk for herpes zoster increases as their VZV specific cell mediated immunity declines. This decline in immunity can result from increasing age as well as from other medical conditions or medications that suppress a person’s immune system. So let’s talk about diagnosis. When lesions are atypical or difficult to distinguish, which I’m gonna show you a slide here in a minute. From those, you may wanna do some additional testing. You can have swabs of the vesicular fluid from a fresh lesion or a tissue biopsy that can be submitted for viral culture or PCR testing. Additionally, scabs maybe an adequate specimen for PCR testing. And PCR, what it does is they put it in the machine and it just amplifies the DNA from the sample so it can pick up a minute trace of the infectious pathogen and be able to diagnose it very, very accurately.

0:19:30.4 Shamika Brooks: So PCR lesions is the most sensitive and specific method for diagnosis of VZV infections. And like I said, the patients that I dealt with, they had a lot of complications and visceral involvement of infections, so we sent a lot of samples for histopathology and we would send PCR on blood and other fluids such as cerebrospinal fluid or ophthalmology might send it on vitreous humour. And these can help aid the diagnosis of VZV infections like I said in visceral organs. So a titer, you mostly are familiar with that because we have to get those titers when we get a new job or we’re going to school. So it’s a laboratory test that measures the presence or an amount of antibodies in the blood. A titer may be used to prove immunity to the disease, so the blood sample is taken and if the test is positive, the individual has immunity to the disease. And like I said, we send histopathology if we’re concerned about visceral involvement of different organs. Alright, so this is a case here of someone that comes to your clinic and in this particular situation, it may not be readily apparent to you that this individual may have a herpes zoster infection. So the rash like we said, typically presents in one or two contiguous dermatomes on the thorax or the face and it does not typically cross the midline of the body.

0:21:08.8 Shamika Brooks: And in my clinical practice, when I was rounding with the infectious disease attendees, if it crossed the midline, they considered it a disseminated infection. So a patient might have a few scattered lesions outside of their sharply demarcated and localised rash in about 32% of immunocompetent patients, however, if they have more than 20 lesions as identified outside the discreet area of cutaneous involvement, a diagnosis of disseminated herpes zoster can be made. And this can occur in about 2% of the general population but about 15-30% in cases of those who are immunocompromised. So once disseminated disease is identified, a concern is raised for possible unknown immunocompromised state as well as other significant complications. So this is someone that you want to send to the hospital because they need further work up to determine what is causing their immunocompromised state or what other complications could they have. And in this individual, they’re gonna require IV formulation of treatment.

0:22:24.0 Shamika Brooks: Okay. So, this is a common presentation that I’ve seen in my patients that presented with herpes zoster living with HIV. And so when herpes zoster involves the nasal ciliary branch of the trigeminal nerve, the eye can be affected causing herpes zoster ophthalmicus, resulting in keratitis which is inflammation of the cornea or anterior Uveitis, which is inflammation of the iris and interior ciliary body or both. And vesicles on the tip of the nose, which is the Hutchinson sign, are a clue that the nasal ciliary branch is involved. Okay, and so when you see this Hutchinson sign, and the patient is at risk for acute retinal necrosis or PORN, which is the acronym for progressive outer retinal necrosis, and these are variants of necrotizing retinopathy caused by VZV. So the complication of VZV can be loss of their eyesight. And progressive outer retinal necrosis typically occurs in immunocompromised patients and almost exclusively in patients with AIDS, with CD4 count less than 100. So you may not ever come across this, but it’s just something for you to think about when you see someone present with this presentation. You kinda wanna do a deeper dive into their history and find out if they are on immunosuppressant medication, all those types of things. This can be an emergency for them.

0:23:57.5 Shamika Brooks: And so when someone comes and presents to me here in a presentation like this, I’m going to try to get them an urgent ophthalmology consult the same day or I will send them to the ER because my concern is I don’t want them to lose their eyesight, so I want ophthalmology to look at them. And in some cases, it may not be available readily but you can go ahead and start them on oral anti-viral treatment. But my recommendation, in my professional experience, that you wanna send them to the ER if you can’t get an urgent ophthalmology consult because you wanna make sure that they are not having retinal necrosis. Okay, so let’s talk about some more complications that can happen with shingles. And I hope I’m not freaking you guys out and making you scared when you go into practice thinking all of these differentials in your mind. It’s just I want you to have that next layer when you do start practising to be able to identify, “Okay, this could be something more serious than just a typical herpes zoster uncomplicated infection.” So, Postherpetic neuralgia is the most common complication of herpes zoster, and it’s gonna involve pain that persist in the area where the rash was for more than 90 days after the rash onset.

0:25:23.8 Shamika Brooks: And Postherpetic neuralgia can last for weeks or months and occasionally, for years after the infection. And I’ve had a lot of my patients that had continued pain even after the rash had resolved and gone. So, the treatment that I put them on was Gabapentin. And the individual will be on Gabapentin for a long time to help control the pain. And we talked about the eye complications that can happen from herpes zoster. And then, of course, you can get bacterial super infection of the lesions, with any skin or continuous infection that can happen. And then, cranial and peripheral nerve palsies can happen as well. And then, here we have visceral involvement. So, they can have VZV pneumonitis, VZV hepatitis. We talked about acute retinal necrosis and Meningoencephalitis. And I kid you not, I literally think that every, every patient that came in that was living with HIV and their CD4 cell count was low, and they were at risk for AIDS, if they had any neurological symptoms, everybody was getting a lumbar puncture. And I got to the point where I was able to evaluate CSF fluid and kinda get an idea, is this true infection, or are they okay? So, it was a great learning experience.

0:26:50.4 Shamika Brooks: So, you wanna be mindful of that if they come in with headache and any other neurological involvement. You want to get them evaluated in the ER as soon as possible. Okay. So, herpes zoster treatment is valacyclovir one gram PO three times a day, or you can use Famciclovir. I never use Famciclovir, but that is one option for treatment. And then, we have oral acyclovir 800 milligrams five times a day. I’m telling you right now, I could not depend on my patients to take a medication five times a day. So, my go-to medication for it was valacyclovir, but if you do send them to the hospital and they have a complicated case, they’re gonna be put on IV acyclovir in the hospital setting. And duration of treatment is about five to seven days. I treated all of my patients for seven days, so that’s just the standard duration of treatment. Okay. So, prevention is gonna be great for you in your practice. So, the recommendation is for immuno-competent adults 50 years and older, they should get two doses of Shingrix two to six months apart. And so, Shingrix provides strong protection against herpes zoster and Postherpetic neuralgia. Two doses of Shingrix are more than 90% effective at preventing herpes zoster and Postherpetic neuralgia.

0:28:23.7 Shamika Brooks: Protection stays about 85% for at least the first four years after vaccination. And Shingrix is an inactivated recombinant vaccine. So, it’s not a live virus vaccination. Okay. So, let’s talk about some myths and facts. We’re gonna recap those. So, stress can trigger an outbreak of shingles, and that is true. A lot of young people that I would evaluate in presenting with shingles, most oftentimes I would ask them, “Have you been under a lot of stress lately?” And they’ll tell me, “Yeah, life is stressful.” And so this can trigger a herpes shingles outbreak. And it’s false. You can not get it more than once. You can, trust me, get it more than once. And then, the symptoms don’t always leave after a few days. We talked about the complication of Postherpetic neuralgia. And so, these individuals can have pain well into months and even years after their infection. So that’s false. Chickenpox and shingles are the same illness. No, they’re caused by the same virus, but they’re not the same illness, so that’s false. And then, open herpes zoster blisters can spread chickenpox, and that’s true. So, if you are someone who has never had varicella zoster or chickenpox, you can get infected if you touch a herpes singles blister or come in contact with one.

0:30:01.6 Shamika Brooks: And shingles are not a rare phenomenon. I would say that that is false. And the fact that only older people can get shingles, that is false as well. And where does the virus lay dormant? In the dorsal basal ganglia. Alright. So, let’s kind of go over some scenarios that may present to you in clinic. So, you have a 72-year-old female who presents in clinic. She’s completed therapy with oral valacyclovir two weeks ago for herpes zoster. Lesions are crested over, but she still has significant pain. What do you do? So, in this case, you’re gonna diagnose her with Postherpetic neuralgia. And I would try her on a course of Gabapentin to see if that would help to alleviate some of her pain. And next, you have a 56-year-old male who presents to the clinic with new onset of a painful rash around his right eye and on the bridge of his nose. He does report some tearing and right eye discomfort. What do you do? You wanna get an urgent ophthalmology consult, or he’s gonna go to the ER, in my professional opinion, to have ophthalmology evaluate him there because loss of eyesight can be very traumatic and distressing for patients. And you don’t want that to be a complication of their shingles infection.

0:31:34.8 Shamika Brooks: Okay. So, here are some of my clinical hurdles. Pain can be present before a rash develops. So, you wanna keep shingles in the back of your mind for your differential. If someone comes in with pain out of proportion to what you are seeing on your physical exam, keep that as a differential. And refer to ophthalmology for any concern about eye involvement because we know that there could be complications of retinal necrosis when it comes to eye involvement of the shingles infection. So, make sure you refer them. And if the lesions are extensive, where there’s plenty of more lesions or it crosses the midline of the spine infection, it’s in multiple dermatomes, you can consider this disseminated. I will refer them to the emergency room for evaluation because we wanna find out what is the underlying cause, ’cause they have some immunocompromised state or unknown complication that we’re not aware of. So, you want them to be worked up and evaluated further. And of course, the easy thing is uncomplicated zoster can be treated outpatient with oral medication. And you wanna encourage vaccination in your patients 50 years of age and over.

0:32:55.7 Shamika Brooks: Okay, guys that is my presentation on shingles. I hope you learned something from me. And I hope I didn’t scare you and make things too complicated. I just want to be able to give you that next level to think about when you are evaluating someone that is presenting with a condition that you are concerned about that they could be shingles. So, I appreciate you guys listening to my presentation. I don’t know if there are any questions. I might have gone too fast.

0:33:31.7 Professor Walden: We were all sitting here going true, false, no. Going to the ER, a lot of the things, it’s very familiar because it’s what we study for boards, right?

0:33:45.9 Shamika Brooks: Right.

0:33:46.5 Professor Walden: And you kind of saying things, it just reaffirmed like, alright, we really did learn the right things to say and to do if someone presents. So, one of the things that I definitely kinda wanted to come back to, it’s because you said when you were a New NP, you had someone present with shingles and you weren’t quite sure what it was, but the pain and the area just wasn’t matching. I wanted to absolutely say, same.

0:34:19.1 Christina: That happened to you too.

0:34:23.2 Professor Walden: I was probably about two weeks in. And I’ll never forget, I asked my MD, I was like you gotta come look at her because she’s in pain. She doesn’t want anything to touch her ’cause she was sitting like this. Like lifting up her shirt. And I was like, “I don’t see anything. And I don’t know what is happening.” And she ended up coming back two days later. And you could start to see the vesicles. And I was like, “There it is.”

0:34:52.2 Christina: And that stuck with me from that moment on. I was like, “Okay.”

0:34:57.5 Professor Walden: Yes. Same. So, guys, when she says the pain does not match the area and kind of what the patient is complaining about, and it is in that general gengria area, yes, please make sure that you are paying attention because that has to be a differential because that is exactly how it presents. It is exactly it. Someone had a question. And so, they’d like some insight on HIV. She says the clinic where they’re at wants them to treat insured patients. And they have a clinic that focuses without insurance. She said, can I contact to you? She needs some pearls. She needs some pearls of wisdom.

0:35:41.5 Shamika Brooks: Yes, sure I love HIV. And yes, you as a primary general FNP, whatever your certification is, you can treat them. It’s not that difficult. So, I can help you with that.

0:35:55.9 Professor Walden: Yeah. Wonderful, wonderful. So, I’m sure Christina is gonna be very excited about that. She was like, “No, I need you. I need help.”

0:36:05.3 Shamika Brooks: Yes. Yes. And if anybody wants to get into HIV, you know, the way I got into it, someone brought me in, but you can volunteer in Ryan White facilities, and because the HIV treatment the providers who have been treating it for years, they’re aging out. And they don’t have enough replacement, new younger providers into the profession. So, they’re trying to really champion that.

0:36:31.8 Professor Walden: That’s a really good idea though. I’m from LA, and so obviously, it was a very big deal out there. I went to USC. It’s not where I got my nursing degree or anything, but I very much remember just being in school, and doing volunteer activities, and going down the street because that’s where it was down the street to the Ryan White facility and volunteering there. So, that is wonderful to hear that they are looking for volunteers ’cause I also used to volunteer at the school and give HIV tests.

0:37:04.9 Shamika Brooks: That’s so cool.

0:37:06.9 Professor Walden: All before the Healthcare. Before I used it. So, I’ve always loved HIV AIDS. It’s for me, it’s a fascinating disease.

0:37:16.0 Shamika Brooks: It’s very fascinating.

0:37:17.7 Professor Walden: Yeah, Oh, that’s good to hear. So, I’m making notes for myself.

0:37:23.0 Shamika Brooks: Definitely.

0:37:25.0 Professor Walden: So, what will do Christina and pretty much for everyone else will put in all of her handles and lean so that you can get in contact with her. And so, when you get in contact with her just, hey, I was on the NP collective when you talked, so she knows it’s you. And I’m sure she’ll just let you fire questions at her.

0:37:44.5 Christina: Yes.

0:37:45.5 Professor Walden: Awesome.

0:37:46.6 Christina: Contact me.

0:37:48.8 Professor Walden: Awesome. I think the other thing that I wanted to kind of hone in on is when you started talking about what affects the eyes. So, talk a little bit more about that because I’ve also had that presentation as well.

0:38:09.7 Shamika Brooks: So basically, like I said, if you have someone comes in with a shingles presentation and it’s involving any part of the eye area, I don’t even try to guess if it’s a trigeminal nerve or whatever it is. Because loss of eyesight is distressing. I don’t want my patients to lose their eyesight and have further complications, so my recommendation at my… I was lucky because we can get urgent ophthalmology consult the same day, but a lot of places don’t have that resource that they would need, so I would recommend sending them to the ER to get further treatment.

0:38:43.7 Professor Walden: So that is a good point because again, when I’m lecturing, and I’m lecturing for boards, one of the things that I always say is, no one loses their eyesight, if it has anything involving the eyes, don’t be afraid to be like, “I don’t know. It’s not my wheelhouse.”

0:39:00.5 Shamika Brooks: Right.

0:39:01.8 Professor Walden: Send them right on out.

0:39:03.8 Shamika Brooks: Yes, you wanna protect the patient and protect your license, too.

0:39:06.1 Professor Walden: Yes. Yes.

0:39:08.1 Shamika Brooks: That’s it, no one loses their eyesight.

0:39:10.6 Professor Walden: That is right. We pay too much money, and we work too hard. That is very true. So just kind of in that presentation, I have that presentation as well, the young lady, diabetic, not HIV positive or anything that I knew of, but very, very brittle diabetic, and she came in and it was like right there. As soon as she walked in, I was like… I cursed y’all. Y’all know I love Jesus, but I still curse a little. And in my head, I was like, “I know exactly what this is.” And I’m literally begging her to go to the ER, and again, I’m not a free clinic, so the thought of going to an ER for folks, all they can think is money, bills, they don’t want anything to do with it, and I am, “Please, you’ve got to go,” and I am documenting like crazy.

0:40:02.5 Shamika Brooks: Yes. And I think there’s a form they can sign, too, if they go against it. It’s just having to protect yourself.

0:40:09.9 Professor Walden: So that’s probably the most important thing, even if your patient says, no, yes, whatever, you make sure you document it because I did not want that coming back on to me. I wrote all over that chart recommended, urged, encouraged patient to go to the ER. I don’t think she did.

0:40:28.4 Shamika Brooks: Hey, you did what you could do, right?

0:40:31.3 Professor Walden: I did what I could do. I did what I could do. But no, this is exciting. So I, as usual, being who I am, I absolutely have taken what you said and I have created some little clips, and that means a little bit of homework to kind of reinforce for everyone, and you can just take it at your leisure, you guys. It’s no pressure to do it tomorrow or anything. I’m not grading it or anything, but it is to reinforce what Shamika has told us because these are things that we need to have ingrained. We’re also going to give you a fact sheet, so that can be found in your portal as well, so that you can download that. And also her PowerPoint. So her PowerPoint had very good diagrams, which makes sense as to why the disease process lies dormant where it lies dormant. So that was the connection that happened for me today. So take a look at it at your leisure, especially if you are seeing these type of patients. I know also that we have one other person who is watching live that does the long-term care or did. We haven’t had a conversation. So you might probably get some info, some questions about that as well as we throw your information in there.

0:41:51.8 Professor Walden: So you guys, please use the network that we’re creating for you and reach out, and again, ’cause as I grow my network, you grow your network, we’re all in this together, and it’s too small of an industry for us just not to be paying attention to each other.

0:42:07.5 Shamika Brooks: Alright. ‘Cause the physicians do it all the time, they’ll call so and so. Yeah, they have a network.

0:42:12.7 Professor Walden: They got to get real good at it ’cause you’re right, they do it all the time. And they don’t hesitate. It is not a competition.

0:42:18.9 Shamika Brooks: No, no, no, you’re not an island. You’re not alone, so please reach out to me if you need the assistance.

0:42:25.3 Professor Walden: Fantastic. So thank you so much for coming. So let’s wrap this up, guys. ‘Cause you guys know that I am always super protective of your time and we are nailing it. So this was absolutely fantastic. This was one of the first lives of 2022, and we’ve got so much more coming for you, so I hope that you will join us, but I hope that this was helpful for you. And again, like I said, as all the things are starting to return back, we’re starting to see all of the illnesses and disease processes kind of come back to fruition now. Hopefully, this was helpful to you, ’cause I know a lot of us are treating geriatric patients in particular. So this is very, very helpful. But with that being said, we have our new Slack channel, so reach out if you guys need anything, we’re always available in the Facebook group as well. Don’t hesitate. We will be uploading all of the things to your portal. If you’ve missed out on this, don’t worry, you can always catch the replay, alright? And with that being said, if there are no more questions, which I don’t see anyone typing anything, I will see you guys soon, and again, see you in the Slack channels. Bye.