Some mental health professionals—psychiatrists, psychologists, social workers, psychiatric nurses, counselors—deal primarily with people affected by HIV infection. Psychiatrists are physicians who have specialized in psychiatry—that is, in disorders of mood and thinking; psychiatrists can prescribe medication. Psychologists have doctoral degrees, either a Ph.D. or an Ed.D., in psychology; psychologists can test and diagnose. Social workers have master’s degrees plus supervised training. Psychiatric nurses have master’s degrees plus supervised training. And counselors can be pastors or others who counsel people. All these professionals should be certified by the certifying boards of their respective professions. The certifying boards for counselors are variable, some good, some not so good, and as a result, counselors are not as tightly monitored as the other mental health professionals. To overgeneralize, these professionals offer two kinds of therapy—talk therapy and medical therapy. All of them offer talk therapy. They can help you express and understand and resolve painful feelings, analyze and solve problems with other people, gain a sense of who you are as a whole person. They will work with problems that range from the specific and practical to the fundamental and philosophical. You can say anything to them. Psychiatrists alone can also offer medical therapy, drugs that restore sleep, appetite, and mood. Probably the best advice is to begin with talk therapy, but you will want to ask the professional to refer you for medical therapy if necessary. The professional who is unwilling to do this is best avoided. If you do not know who the mental health professionals are, begin by asking the medical professionals—doctors, nurses, physician’s assistants—you do know. If they cannot help, they will surely refer you to someone who can. Local AIDS-advocacy groups, the gay community, local mental health associations, and state mental health agencies all have lists of qualified, experienced mental health professionals.*235\191\2*
One patient I recommended calcitonin to was a Middle Eastern woman just reaching menopause. A DEXA scan showed Maya’s bone density to already be 15 percent below ideal levels in her spine and 12 percent lower than I would have liked to see at the hip. Her NTX level was still in the normal range, but at the high end of it (41), indicating a risk of fracture mildly higher than her bone density alone would predict. She was an avid exerciser, and was glad to learn how much that contributed to protecting bones. She was determined to go through menopause as “naturally” as possible, and didn’t want HRT for this reason. But she was concerned enough about her bones to consider other prescription treatments if she could avoid side effects and not raise her risk of any other condition. Calcitonin appealed to her since it is “natural” in the sense that the pills are made from salmon; the substance is also produced in the human body and has no known side effects other than nasal irritation in one in ten people who use it (it comes in a nasal spray).To aid and abet calcitonin to the best of her ability, Maya adopted a diet rich in plant estrogens, upping the amount of tofu and other soy products she ate. She started taking the recommended doses of calcium and vitamin D supplements, along with a multivitamin and other supplements similar to those described in Chapter 6. She kept up her regular exercise program, with a renewed focus on strength training.One year later, her bone scan showed her vertebrae to now be 13 percent above expected, though her hip was still 4 percent below ideal levels. She was among the fortunate 90 percent of patients who experience no side effects from calcitonin, so she continues to take it every day. I expect that when she comes back for her next scan in about two years, she’ll have rebuilt all her bones to the level of a healthy 30-year-old woman—or even better*155\228\2*
This recommendation does not mean you must eliminate sweets, desserts, and alcohol from your diet. However, they are a major source of calories (because they usually contain large amounts of fat or sugar) and contribute very few other beneficial nutrients to your over all diet.People who have high levels of tryglycerides (a type of fat in the blood that contributes to atherosclerosis) a usually decrease their triglyceride level by:Losing weight and then maintaining a desirable body weightCutting back significantly on significantly and sugar-containing foods. The sugar in beverages, such as sweetened soft drinks or sweetened coffee or tea, can add up quickly. Even reducing the amount of fruit and fruit juice, because they naturally contain sugar, may help lower triglyceridesDrinking less alcoholIncreasing the amount of exercise *302\252\8*