* PHILIPPINE LADY ASKS WHY SHE HAS DEVELOPED CONSTANT EAR NOISE? 

"Roshin?  May i ask what is this nuisance noise in my ears? If you try to cover your ears with your fingers that is the kind of noise i hear even my ears are not covered Its disturbing Thank you.. I really wish that we could talk. Sometimes im thinking perhaps im near to die? Please help me about this.  Thank you." (Eve, Philippines)

Hi Eve,

With regards to your question, "I would like to ask what is this noise in my ears that wont stop its annoying," I believe, after our conversation on Facebook (Nov 15, 2016), the ear noise, that is bothering you, is medication induced.  You asked me  "to close your ears with your two fingers and thats axactly the sound buzzing in my head."   Your description of the ear noise has many possible etiologies, and based on your reply to my questions, I ruled out many of the potential causes, arriving at the conclusion that the medicine, Idezar, you are taking for your hypertension, may be the most likely explanation for your ear noise. 

How did I arrive to this conclusion?  You stated, " I notice this noise maybe 2 weeks ago and sonetimes its quite disturbing."  You also said, "I remember then when im still a child but im not sure if my mother or father had some problem also in ear noise and put a whole pepper or ginger in the ear hole.  The sound i hear is like when you are in the forest and you hear some insects sounds. Or somewhat like try to cover your ears with your fingers its like that."

You said, "The doctor prescribe it, The idezar only 150mg,  to me for hypertention."   You said your blood pressure readings this past month have been " 130/80 120/80 120/70"  and " Maybe 5 timea 140/90."  However, you also told me that you take "75mg on and off" not "150 mg once a day."  When I asked why you do not take a 150 mg tablet as prescribed by your doctor, you said " Im only taking 75 mg a day bcos i dont feel good taking 150mg.  I feel a little dizzy. I feel my heart hold my breath." 

Furthermore, when I asked was your blood pressure normal when you took the 150 mg medication as prescribed, you replied, " Yes.. even i dont take it i feel im ok.. only the sound and some shaking."  You said "Sometimes i feel my body is trembling.  I feel my hands shakes my legs something like that." 

I believe the trembling might be due to your blood sugar levels fluctuating from normal.  In fact,  you mentioned,      "Im sorry.. i thought its only maybe my over dieting. My food intake is not the same. I reduce sugar intake, from rice and other."   Fluctuations in blood sugar can cause dizziness and trembling. 

Most importantly, all my questions regarding other causes of ear noise [such as trauma, ear infection, respiratory illness, throat pain, cardiovascular disease, occupation, circulatory problems, anemia, allergies, an underactive thyroid gland, intracranial hypertension (also called pseudotumor cerebri), Meniere's Disease,  and diabetes] allowed the final conclusion that not being compliant with the dosing of Idezar is causing your ear noise.   Hypertension causes ear noise (referred to as tinnitis).  Thus, when you take 75 mg of Idezar, instead of 150 mg as prescribed, your blood pressure rises, and this is why " Maybe 5 timea 140/90" readings occurred.  A blood pressure greater than or equal to 140/90 is Stage I hypertension, a serious condition that must be controlled before worse complications occur. 

What do I recommend for you?  Visit your doctor, and mention that when taking the 150 mg Idezar,  " i dont feel good."  Your doctor should be able to easily change your blood pressure medication to a different hypertensive medicine that will not cause you adverse side effects.  You should also ask your doctor to check your blood sugar levels, and prescribe appropriate medication, as needed, to keep sugar levels in the normal range. 

The two hours we spent visiting on Facebook was well worth the time.  I believe these suggested conservative measures may easily remedy the present medical concerns you have expressed.  Thank you for question(s) and trust in me.  God Bless you and God Bless the Philippines.  Stay in touch.

Respectfully,

Dr. Roshin

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* PHILIPPINE MAN QUESTIONS HIS ANTI HIV VIRUS MEDICATION REGIMEN?

"hello doc.  how are u?  can i call?  just a shortwhile pls.  I WISH TO CALL U COZ I HAVE SOME IMPORTANT QUERIES"  (Mr SPinoy, Philippines)

Dear Mr. SPinoy,

I am glad we were able to chat on Facebook video, this past weekend, November 11, 2016, concerning your antiretroviral therapy (called HAART).  You mentioned that your HAART therapy consists of Aluvia with Efavirenz.  Aluvia is a combination pill of Lopinovir/Ritonavir, and Efavirenz is a non-nucleotide reverse transcriptase inhibitor medicine (NNRTI).   Your inquiry was whether this was the correct medication regimen to continue to take for combating the HIV virus. 

Latest HAART guidelines suggest that if a patient has a CD4 count less than 500, that person could be placed on one of the following three medication regimens.

1) 2 NRTI (nucleoside reverse transcriptase inhibitor)  +  1 PI (protease inhibitor)

2) 2 NRTI + Efavirenz

3) 2 NRTI + 2 PI

NRTI medications include the following not limited to Zidovudine (also called AZT), Didanosine, Stavudine, Lamivudine, Tenofovir), and NNRTI medicines include  Efavirenz, Nevirapine, Doravirine, Etravirine, and Delavirdine.  PI (Protease Inhibitors) are not limited to the following which include simeprevir, lopinovir, ritonavir, boceprevir, darunavir, telaprevir, fasamprenavir, indinavir, saquinavir. 

When I asked what your latest CD4 count and viral load were, you said you will "recheck these levels in December 2016".  You also mentioned that "my Cd4 count go up 100 points since last time."   Although the updated guidelines would  change your HAART therapy, my recommendation is for you to stay on the Aluvia + Efavirenz combination treatment.  Why, you might be wondering?  To become healthier and contain AIDs (Acquired  Immune Deficiency Syndrome) side effects, a physician wants the patient's CD4 count to increase and the viral load to decrease.  Thus, as long as your CD4 count continues to increase and the viral load continues to decrease, STAY on this  antiretroviral therapy regimen.  Furthermore, you mentioned "not having" any adverse symptoms, such as rash, confusion, neurologic conditions...etc., from your present medications; thus, you should  STAY on this HAART protocol.  Your medications are making you healthier and providing you a longer life. 

In the end, visit with your doctor, seek counsel, and make a decision that is best for you.  I am humbled by your trust in my opinion.  God Bless you and God Bless the Philippines.

Respectfully,

Dr. Roshin

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" WHY INTEGRITY MATTERS IN OUR CHOSEN LEADERS." 

Dear Readers,

With just under a week until the 2016 national Presidential elections, I wish to offer a perspective concerning  the importance of integrity in our chosen leaders. 

The President of the United States is considered by people and heads of state alike as the leader of the free world, and that individual must exemplify strong character, morals, a positive, peaceful vision, and most importantly, integrity.    Why is integrity the value I consider the most important in a leader?

Our leaders have virtually no control over events ongoing on the planet.  We choose a leader who we feel will best afford the most conscientious, decision at any moment of potential crisis.  Part of making a resolute decision weighs heavily on whether the information and intelligence we receive has integrity, the leaders on the global stage are trustworthy and their words echo integrity, and is the chosen leader free of any potential conflicts of interests, thus, allowing his/her final decision to carry merit, i.e. integrity, free of any bias or prejudice.

In my opinion, regardless of party, our Presidents have lacked integrity, and the consequences have been profound to our country and the world.

Bill Clinton, in his second term as former US President, lied under oath (1999-2000).  Thus, the message sent to our country and world was the following: if you lie and can get away with your lie, do it.  Immediately after Bill Clinton was not held accountable for perjury, US companies (1999-2007) falsified their annual growth reports, showing profits that never existed.   Thus, the stock market soared to unprecedented levels, allowing politicians, companies, and knowledgeable people to make quick money based on lies.  The fabrication and falsifying of profit reports resulted in the global, earthquake economic collapse of 2007-2008.  Millions of hard working Americans lost their life savings and pensions while the politicians were virtually untouched by the consequences of their decisions. 

George W. Bush, the former 43rd President of the United States, continued the lying started by Bill Clinton, by stating weapons of mass destruction existed in Iraq.  As we know today,  after 9/11, our country initially declared war on the Taliban in Afghanistan; but, we were diverted to Iraq, after President Bush stated Saddam Hussein posed a significant threat to our country due to his (Saddam) possession of weapons of mass destruction.    We began a "shock and awe" campaign that killed hundreds of thousands of innocent Iraqi people.   Since there were no weapons of mass destruction in Iraq, ask yourself, what have been the consequences of this lie?   Increased terror and the largest debt  in our country's history are the undeniable results of this weapons of mass destruction lie.  After all, killing innocent people, has increased resentment and animosity towards our country, and the net result is the profound increase in terror events, global and domestic.  The culmination of economic lies and wartime lies have resulted in the largest debt burden placed on our country's citizens.  Most importantly,  in my opinion, there is a direct link between lies, orchestrated by our Presidents, and the lack of peace in the world.    

If Hillary Clinton becomes the next President of the United States, children in our country and around the world will learn that Bill Clinton, lied under oath; but he still reaped the benefits of his lying by having the honor of becoming the first "First Man" of the United States.  Lying is the gift that keeps on giving to these career politicians.

Thus, upon voting Tuesday November 8, 2016, vote your conscience placing front and center the importance of integrity in our leaders.  Has the time arrived to vote all career politicians, at the local, state, and federal  levels, out of office?   As a person who supports business and the free enterprise market system, I write from a deep concern for the direction of our country, and in my opinion, failure in the integrity of our "leaders".   In 2016, all  establishment "leaders" must go, in other words, all career politicians should be voted out of office.  

Respectfully,

Dr. Roshin

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