PI Perspective #37
January 2004 View PDF En
español
General Health Maintenance Strategies
Have you ever heard someone say, “I don’t want HIV
to take over my life. My life is more than my HIV status?”
Perhaps you’ve had similar feelings or felt overwhelmed with
trying to manage your health. This article provides a different
way of thinking about health than what many people may experience
at a doctor’s office. The goal is to offer a framework for
thinking about a big picture of well-being and provide a path for
developing a long-term strategy to promote and maintain overall
general health.
Studies have looked at similarities among people who are long-term
survivors of HIV and other life-threatening conditions. People who
have spontaneous remissions from serious conditions or improving
outcomes over time are people who are most likely to proactively
address health on all fronts. This doesn’t contradict findings
that people who see an HIV-experienced doctor are more likely to
live longer and healthier lives with HIV infection. Nor does it
disregard that some people might not progress to AIDS as quickly
due to genetic factors, the virulence of the virus they were initially
infected with and other factors. Yes, sometimes outcomes in HIV
infection might just come down to luck. In the biggest picture,
however, people who proactively address health on all fronts have
a tendency to do better than people who do not.
What is health?
What is health and how does someone address health on all fronts?
Is it possible to come up with strategies to address health on all
fronts without it becoming a full time job? Sometimes health crises
arise and managing them can take over a large part of a person’s
life. Part of the goal of a general health maintenance strategy,
however, is finding the right balance. It’s not about health
maintenance interfering with life—it’s about healthy
living.
Project Inform ascribes to a model of health as it concerns the
whole being—a biopsychosocial model of health. This includes
physical (biological), mental (psychological), spiritual and social
health and assumes that each of these areas of health impacts the
others.
At the biological level, health is freedom from disease or injury
and any limitations these might impose. Merely avoiding disease;
having healthy bones, skin and teeth; and staying out of harms way
doesn’t reflect the complexity of our lives. We are more than
the sum of our parts and we can be healthy without being perfect.
As the definition of health expands to include how our whole body
is functioning, a picture of health that includes a mind-body connection
emerges. It doesn’t stop there. Health includes a state of
mind, a peace and harmony with ourselves and our physical and social
environments.
Developing a strategy: building a strong foundation
A general health maintenance strategy addresses the mind, body,
spiritual and social connections of who we are and how we live.
By viewing health this way, the idea of a general health maintenance
strategy being something that overwhelms one’s life begins
to fade away. Through both action and inaction people make choices
daily about their health. You likely have general health strategies
that you are implementing all the time. Taking a moment to look
at what those strategies are, name them, refine them and explore
ways to improve them is the very foundation of health.
No single strategy works best for everyone. Rather, the best answers
are those that fit you best. There are resources, tools and some
basic principals to consider. A good strategy includes goals you
can achieve, is tailored to your needs, fits into your life and
makes you feel better as you implement it. That doesn’t mean
that your strategy is failing if you come down with the common cold
or if you have a bad day. A general health strategy is not something
one achieves or completes, it’s an ongoing process that needs
to be revisited periodically and adjusted as your life changes—as
you change.
Biological health
Your basic biological health is something that a doctor can help
you to understand and develop tailored strategies for promoting
and improving. While people living with HIV often see a doctor four
times each year, many times both HIV specialists and patients can
forget about basic health screening and maintenance. This includes
physical examinations, vaccinations, other preventive health measures
as needed and age appropriate health screening.
For information on what is looked for in a routine physical examination,
what’s meant by age appropriate screening, general recommendations
on vaccinations and a list of special health considerations, call
the Project Inform's National HIV/AIDS Treatment Hotline. Also available is information on standard
tests, vaccines and issues to deal with during a first visit to
a doctor after finding out that you’re living with HIV.
Taking care of your biological health includes more than seeing
a doctor. The following are a few examples:
Nutrition:
The body needs nutrients in order to work effectively. Often when
people are really hungry they’ll get a headache, feel dizzy
or may find themselves in a bad mood. How often and what do you
typically eat in a day? What does good nutrition mean to you and
what can you do to improve your nutrition? Realistic nutritional
goals that fit with your life and lifestyle are key to success.
What this often means is incremental improvements. For example,
if a normal breakfast for you is a cup of coffee and a pastry on
your way out the door, is it be possible also to add a glass of
juice? While it’s great to consult with a nutritionist (especially
one who specializes in HIV), there are probably ways you can improve
on your general nutrition now. For some this means eating more,
for others eating less and for others it’s about eating different
foods. Read more information in these publications from Project
Inform, Nutrition and Weight
Maintenance and Food Safety.
Exercise:
A few pounds of muscle mass (lean body mass) can make a difference
in whether someone recovers from a severe life-threatening infection.
There are many reasons why exercise is good for us, from helping
muscles and bones remain strong to improving the function of our
heart and lungs. Are there ways you can improve how you exercise
or the amount of exercise you get each day? Some people love to
go to the gym and workout; others wouldn’t set foot in a gym
if someone paid them. If you typically don’t set aside any
time for exercise, consider taking a walk for twenty minutes each
morning and/or at the end of the day. Perhaps you’ll never
go to the gym, but you may enjoy going for a hike, bike riding or
simply taking the stairs in your building. What can you do to improve
the kind or quality of exercise you get each day?
Sleep:
When we sleep, our bodies heal. In general it’s recommended
that people get eight hours of sleep each night. The amount of sleep
needed differs to some degree between individuals and can also vary
based on other things going on in a person’s life. When someone
is depressed they might sleep more or have trouble sleeping. Often
when someone is fighting an infection their body demands more rest.
Do you get enough sleep each night? If you are sleeping too much
it is important to figure out why—are you depressed, fighting
an infection, do you have low red blood cell counts (anemia)? If
you are sleeping too little it’s also important to figure
out why—are you depressed, drinking coffee or other caffeinated
beverages too late at night, or is something else going on? If you
find your life is just too busy to find time for sleep, strive for
incremental improvements. If you’re sleeping only five hours
a night, is it possible to make time for five and a half or six
hours?
Relax!
Chemicals produced by the body when people experience stress can
weaken the immune system, leaving cells more susceptible to infection
and crippling the ability of the immune system to rebuild itself.
It’s virtually impossible to completely avoid stress, but
efforts to minimize and manage stress are important to our physical
and mental health. Can you identify things that cause you stress
that you could eliminate from your life? When the things that cause
you stress are unavoidable, are there things you can do to minimize
or manage that stress better? Some find that exercise decreases
stress levels. Getting a massage, taking a hot tub, talking with
friends, laughing, getting out of the house and going to a movie,
spending time with people you love, reading a good book, finding
a good support group and/or finding a good therapist are all possible
ways to decrease and better manage stress. Keep trying different
methods until you find what works best for you and then find ways
to incorporate it into a daily, weekly or monthly routine.
Psychological (mental) health
Each of the issues discussed above, nutrition, exercise, rest and
relaxation can affect mental health. By highlighting this, perhaps
it’s easier to see how health is more than just healthy bones,
teeth and skin, and how it is that our physical, social, spiritual
and mental health are connected. It’s great to seek counsel
and guidance from a therapist who is experienced in dealing with
HIV issues. General mental health ranges from self esteem to addiction
issues, from your emotional outlook to the relationships you have
with other people. The paths to examining these issues and developing
strategies that are right for each individual are varied.
Addiction:
Is addiction a mental or a biological health issue? Some people
are genetically predisposed to alcoholism and other forms of addiction,
because of the way that their body processes (or doesn’t process)
certain chemicals. Regardless of genetic predisposition to alcohol
addiction, there is evidence of chemical changes in the brain that
leaves people alcohol-dependent after consuming alcohol for a long
period of time over days, months and/or years. Addiction comes in
many forms. Alcohol and drug addiction are perhaps the most commonly
spoken of. There are also people with addiction to food, sex, the
internet, video games, gambling, nicotine, shopping and the list
goes on and on. Whatever the case, anyone with an addiction who
is speaking candidly about it can tell you how the addiction interferes
with their life, their relationships and their health. Depending
on the addiction there may be medical interventions, twelve-step
programs, one-on-one therapy options, inpatient programs and harm
reduction programs to explore. In many instances the first step
is recognizing that you have an addiction and then seeking support,
guidance and expert advice on plotting a course of action.
Depression:
Studies show that the most common psychiatric diagnosis among people
living with HIV is depression. As in the general population, some
studies suggest that it is most common among women. Depression can
be caused by chemical imbalances and it can be a side effect of
some medications used to treat HIV and related conditions. Depression
can be caused by HIV infection itself, HIV-related conditions and
even changes in the body (such as menopause and/or decreases in
testosterone production). The key to successful treatment of depression
is identifying the possible causes. Another step is recognizing
depression in the first place. When someone is depressed they may
experience extreme fatigue, sleep disturbances, changes in appetite,
and generally lose an interest and enjoyment in participating in
life. Some of these conditions are interrelated as extreme fatigue
can cause depression, sleep disturbances can also cause fatigue
and depression, not eating well can impact mental and biological
health and be associated with fatigue. Especially when you’re
depressed, finding the strength to pay attention to sleep, nutrition
and exercise is important to avoiding a cycle of ever-worsening
problems. If you experience depression, seeking strategies to deal
with it is critical. For some this might include anti-depressant
medication and for others this might simply involve spending time
with people who they love or doing things they enjoy.
Self esteem and emotional outlook:
Another common theme that unites many people who are long-term survivors
with HIV disease is that they have a philosophy of well-being. Often
they believe that what they are doing today will make a difference
for their tomorrow. They have a hopeful approach to the future.
The road each of us must travel to believe in ourselves and the
value of our voices and choices is unique. For some, a strategy
to improve self esteem and emotional outlook might include seeking
a therapist. For others it might include spiritual soul searching.
For still others it might include going to the gym to improve body
image. For those who feel like they have a positive outlook and
good self esteem, what are you doing to maintain that? A philosophy
of well-being doesn’t mean that when you feel bad you ignore
it or that when you’re angry, depressed or upset that you’re
supposed to think positively. It’s about experiencing those
feelings, working through them and finding a way to embrace them
as part of the picture, but not the whole picture.
Spiritual health
Defining what spirituality means to most people is nearly impossible
because it means something different to every person. For those
who embrace forms of spirituality in their lives, most would contend
a discussion of health without a discussion of spirituality is incomplete.
Others, particularly those who have had negative feelings about
spirituality and religion may be offended by any discussion.
Each person’s path to exploring spiritual health is unique
and very personal. Spirituality is not necessarily religion. A few
examples: for some spirituality is the religion they were raised
with, for others spirituality is founded on a harmony with nature,
a notion of a Higher Power, The Goddess and/or a balance with the
energies of the universe. Spiritual health involves exploring your
spiritual beliefs and examining your life, your actions and inactions,
accordingly. What matters isn’t what your personal spiritual
choices are, but that you’re living your life consistent with
your beliefs.
Social health
Social health is not only having healthy personal relationships
with others, but also includes one’s relationship to their
communities and the health of the community.
While some people enjoy and are energized by social and group activities,
others are not. Social health doesn’t always mean participating
in large group activities or even attending large-scale social events.
It does mean, however, cultivating deep, rewarding and meaningful
relationships and includes contributing to and participating in
community. Social health is about giving and receiving support from
community and loved ones.
The paths to promoting and maintaining social health are varied.
Sometimes it starts with simply sitting down and thinking about
personal relationships, identifying which relationships are most
meaningful and why. Are you happy with your friendships and what
might you do to strengthen those you have and/or cultivate new ones?
Are you being the kind of friend you want to be and do you have
the kinds of people in your life who support you? What kinds of
things can you do to participate in community? Volunteer to help
teach children to read? Write a letter to an elected official advocating
for an issue of importance to your community? Help your neighbor
with his or her groceries?
Discussion
Developing a strategy for good general health provides a strong
foundation upon which to build strategies for dealing with HIV disease.
There is a difference between medications, health and healing. Medications
treat specific biologic conditions, health is an experience and
healing is a process. Medications have their place in an overall
strategy for health, but they are merely one piece of a much larger
puzzle.
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