HIV and AIDS patients find exercise improves their health

NEVER AN ATHLETE -- simply from lack of interest, not lack of innate ability -- Travis Tanner at first did not realize the magnitude of the challenge that lay ahead.

Still, a challenge was exactly what Tanner, 29, sought. He had just come out of a darkness so intense that he could hardly bring himself to leave his midtown Sacramento apartment. His life had been in a downward spiral since February 2003 when he tested positive for HIV.

Drug addiction and depression, however, gave way in the past year to a renewed interest in work and college. And Tanner was ready to try something else, something healthier. So when he saw a flier in January for the NorCal AIDS Challenge, a four-day, 325-mile charity cycling event that begins Thursday, he thought, why not?

On a borrowed bike, he hit the American River trail one day four months ago, full of hope.

"I could only go 10 miles before being winded," he recalls. "But I started getting better right away."

Now, he's doing 100-mile rides with relative ease, lifting weights regularly at a gym and talking about hill-climbing like an experienced cyclist.

"This is definitely the best shape I've ever been in," says Tanner, whose lithe body shows distinct muscle definition. "And it's ironic because I got so sick when I first became (HIV) positive and now I'm the healthiest I've ever felt."

Such a refrain is not unusual among HIV and AIDS patients. In the decade since protease inhibitor medications have helped manage the virus, many patients have either begun exercise regimens or resumed endurance training with a vengeance.

Mounting evidence suggests that exercise not only provides a boost to well-being, but also can help the immune system fight off illness and AIDS-wasting disease by increasing muscle mass and improving heart and lung endurance.

In addition, a study in 2006 by Massachusetts General Hospital found that exercise manages symptoms of "metabolic syndrome," which increases the risk of heart disease and diabetes. Reports say as many as 45 percent of HIV-positive patients have metabolic syndrome.

And a 2005 Columbia University study found that moderate exercise, in combination with anti-retroviral drugs, led to improved nervous-system function and circulation in HIV patients.

Psychological benefits, too

Such preliminary reports are heartening to people living with HIV. Even so, many say that they would be exercising even if it showed no healthful indications.

"For me, the effects are more psychological than biochemical," says Bob Katz, a member of the Positive Pedalers, an HIV-positive cycling club in California with a membership of around 275, mostly in the Bay Area and Los Angeles. "Having a sense of self-worth, feeling comfortable in your body, is something exercising will do.

"We (HIV patients) need to be able to pay attention to what our bodies are telling us. There's nothing like physical exercise to make you aware of what's going on in your body."

Dr. Archana Maniar, an infectious disease specialist and assistant professor at UC Davis, agrees that HIV patients are no different from noninfected people -- they need proper exercise.

"With the advent of anti-retrovirals, patients are living long enough to get the diseases everybody else gets -- diabetes, hypertension, cardiovascular disease, strokes," Maniar says. "From that standpoint, exercise promotes their general wellness and increases their chances of avoiding those things.

"Some HIV patients are concerned about being prone to complications if they exercise a lot, and I tell them that listening to their body is the key, just like for anyone else."

A few HIV-positive endurance athletes say they have never let the disease limit their activity.

Perhaps the most noteworthy is Ric Munoz, 50, a Los Angeles marathoner featured in a widely aired 1995 Nike TV ad. It showed him running through the Malibu hills and ends with this message: "Eighty miles every week. Ten marathons a year. HIV positive. Just do it!"

And Munoz has done it, over and over. He tested positive for HIV in 1987, four years after he started running. He remembers telling the physician who gave him the news that he was a marathoner and he had no plans to give it up. This was, remember, before any enhanced drug regimens were developed.

"If he had objected to that, I would've found another doctor," Munoz says.

All these years later, Munoz is still running. He completed last month's Boston Marathon in 3 hours, 22 minutes, a time he wasn't happy with. He's training now for a 56-mile ultramarathon in South Africa.

Over the years, Munoz says, running as much as 80 miles a week hasn't affected his health and does not adversely interact with the "drug cocktail" he takes.

"I always thought it was a genetic thing, the way some folks are better able to fight HIV," he says.

Ten years ago, deep into his running career, Munoz chose to stop all medication. That experiment lasted for three years.

"My doctor said, 'I'm not going to force you to take it, but I can guarantee at some point, you'll come down with an opportunistic infection,' " Munoz recalls. "And I did. It was cryptosporidiosis (an intestinal infection). But even when I wasn't on medication and my T cells were dropping, that didn't affect my (marathon) performance."

Once he returned to his drug regimen, Munoz says, the condition went away. Since then, he boasts, he's running nearly as much as ever and "I've built T cells up to undetectable range."

One runner is unsure

Not all HIV athletes have been as fortunate.

Larry Teeter, a 48-year-old AIDS patient and a biomedical researcher at the Baylor College of Medicine in Houston, has run 108 races of marathon length or longer, including the Western States 100 endurance event in 2004.

All this, despite losing vision in his right eye as a result of AIDS-related CMV retinitis in 1994 and, in 2005, suffering from avascular necrosis -- bone deterioration due to lack of blood supply -- in his right hip.

For years, Teeter ran with an IV catheter poking out of his chest. (Now, he takes anti-retrovirals orally.) And his hip degeneration was corrected after surgery in 2005.

Teeter says he has seen the ravages of the disease take a toll on his body. And he says he's not sure whether his exercise routine has hastened a decline. He just knows he doesn't want to stop doing it.

"Certainly the muscle mass is there for the legs, but I have a loss of body fat and facial wasting that's characteristic for (HIV patients)," he says. "And there are some studies that suggest marathon or longer events might be detrimental to your (cell) count."

But that's countered by Richard Brodsky, an HIV-positive New York man who runs a marathon each month. Brodsky says his cell count has been "900, higher than they've ever been." But Brodsky also has brain cancer, which he says his doctors have determined is not related to his HIV status.

Exercising keeps him alive, he says.

"A lot of it just has to do with, pardon the pun, being positive about it," Brodsky says. "When I run, I tend not to get colds or any of the opportunistic infections. Some days, it feels like the HIV isn't even there."

For Tanner, the Sacramento cyclist, extreme endurance events probably won't become a habit. But he says he definitely will continue exercising after the four-day AIDS ride.

"It makes me feel better about myself," Tanner says. "When I go on a ride, the first few miles I'm thinking, 'Uh, why am I doing this?' Then I go through what I call the wall and I get into this zone -- just me and the bike. It's kind of meditative, you know?"

Prescription Drug Addiction Has Unlikely Victims

Lia Johnson sat shackled in a vacant, windowless room in the bowels of the Abingdon regional jail one afternoon in March.

The young mother was handcuffed and zipped into an orange jumpsuit. Between her and the cool, spring breeze outside were two armed guards, a long hallway and two sets of fortified doors.

"This is the last place I ever thought I would be," said the blue-eyed, 38-year-old former nurse.

Johnson had never been in trouble with the law. Just two years ago, she was a full-time nurse, mother of a young son and a productive member of society.

Today, she is the new face of drug addiction in America and in Southwest Virginia. Johnson is college educated, middle class and employed, which currently is a similar demographic of the American population addicted to prescription drugs, according to research by Martha J. Wunsch, associate professor at Virginia College of Osteopathic Medicine.

'Equal opportunity' addiction

Southwest Virginia was a rural epicenter of addiction when the use of the narcotic painkiller OxyContin exploded around 2000. The drug was nicknamed "hillbilly heroin" because its use was concentrated in rural communities such as Virginia's coal mining counties, where it eased the chronic pain of some of those who labored in the mines, said Lisa Williams, director of a treatment program at Highlands Community Services in Abingdon.

In the years since, prescription pills have become the drugs of choice -- in some circles earning a new nickname, "equal opportunity."

It seems no one is immune.

A new drug, suboxone, has emerged in the last couple of years, and some say it offers hope to the addicted, only 3 percent of whom beat their addiction, said Marsha Miller, spokeswoman at Highlands.

Johnson, from Saltville, Va., was a nurse at Johnston Memorial Hospital in Abingdon when she injured her back lifting a patient in 2001. Opting against expensive surgery, Johnson managed her pain with prescription painkillers -- five milligram doses of hydrocodone per day.

In 2006, her close cousin was killed in a car crash, and Johnson realized the opiates helped with her emotional grief, as well as her physical pain.

"I started taking it every day," she said. "It numbed me."

Johnson's life spiraled out of control in the months that followed. It wasn't long before she was taking 40 to 45 pills a day.

"Trying to get pills consumed almost all of my time. When I would get a new script, I would already be worrying about running out and where I was going to get my next," she said.

One day, out of pills and on the cusp of withdrawal, Johnson crossed the line. She called a pharmacy and pretended to be a nurse at her physician's office, so she could prescribe herself a bottle of painkillers. From that point, her crimes escalated.

"When you feel like you're going to die if you don't get something, you justify it in your mind," she said.

Searching for the bottom

Johnson's life spun out of control in a matter of months. Before long, she was calling in prescriptions at various pharmacies throughout Smyth and Washington counties to support her habit.

She knew she needed help. But her insurance didn't cover substance-abuse treatment, she said, and every effort to find help led to a dead end. She called about 15 facilities, and the cheapest she could find still cost $8,000, "and that was just one week of detox," she said.

About five months into her addiction, Johnson went to a Marion pharmacy to pick up a prescription she called in for one of her former patients. She was working as a home health-care provider at the time and as her addiction progressed, she began calling in prescriptions for patients who didn't need painkillers and then picked them up for her own use. The patient whose name she used on July 23, 2007, had recently died, but she didn't know it.

She waited at the pharmacy as the clock's minute hand orbited the hour. With each tick she became more sure that something was wrong.

When she finally left, pills in hand, two Marion police cruisers were parked beside her car.

"Somebody will have to help me now," she said she thought with relief.

Johnson pleaded guilty to 32 counts of prescription fraud in Smyth and Washington counties and was allowed to complete outpatient therapy before reporting to jail on Jan. 28. After being caught by police, she had two weeks before entering a detox program in Lebanon, Va.

"I probably used more than I ever had," she said of those two weeks.

Detox lasted six days.

It didn't work.

It was then -- after police confronted her, after she pleaded guilty and confessed to her family and following detox -- that she hit rock bottom.

It happened about a week after being released from the treatment center. Johnson called a fellow patient she had met there -- who had told her he could get some pills -- and she arranged her first illicit street drug deal.

She gave the dealer the last of her money, and he promised to meet her shortly with the pills. He never showed.

That night, Johnson endured withdrawal for what she hopes was the last time.

Withdrawal, she said, is one of the most agonizing, unbearable experiences a person can go through. It lasts for weeks, unrelenting.

"I would hurt all over, runny nose, sneezing, coughing, horrible anxiety, elevated blood pressure and heart rate, chest pain, anorexia, nausea, diarrhea, night sweats, horrible insomnia -- I didn't sleep at all in withdrawal -- and cravings. You can't think of anything but the pills. Nothing. Because you know that all that misery will end as soon as you get some pills," she said.

It's the threat of withdrawal that keeps people using, she said.

By morning, scared she might kill herself, Johnson went to an emergency room at one of the hospitals where she used to work. Her former manager was in the waiting room when she arrived.

"That was rock bottom, when I went to the ER where I worked and told them I was going to kill myself if I didn't get help," she said.

Recovery rewards

After more than 10 hours in the hospital ER, Johnson was taken by police to the Southwest Virginia Mental Health Institute, where a doctor immediately started her on suboxone.

"For the first time since active addiction I had hope," she said. " ... I felt like myself for the first time in years."

Johnson spent 27 days in the hospital, paid for by a state grant. She was introduced to a 12-step program, and upon her release she continued with meetings three nights a week, along with intensive outpatient therapy at Highlands Community Services.

"The way I maintained on a daily basis was to surrender to God's will every single morning," she said.

She stopped suboxone the day before she reported to jail. She said she experienced no withdrawal or cravings, "it was just like any other day."

Johnson got out of jail on April 16. Her boyfriend of eight years, who is the father of her 6-year-old son, picked her up and took her out to eat. Then he drove her to their son's school.

"He ran into my arms and tears started rolling down his little cheeks. I didn't expect that much emotion from a 6-year-old," she said. " ... We stood and cried in the elementary school parking lot for I don't know how long. It was a very special moment."

Johnson has now been clean for nine months.

"I appreciate my bed and my bathroom. I appreciate hearing the birds and watching the lightning. I appreciate all the people who love me," she said.

"I don't want to take anything for granted."

Johnson doesn't know what the future holds. She is legally restricted from working as a nurse for five years, a fact that upsets her. She said she was good at her job and loved her work.

She says she has no desire to ever take another pain pill.

"My biggest lesson would probably be: Never say never. I fooled myself into thinking I would never be an addict. I just didn't think it could happen to me. I felt that I was a good person and things like that didn't happen to good people," she said. "I also learned that addiction is a disease ... not a moral deficiency."

Calais: Addiction focus of summit workshop

"What is Addiction" is the focus of a five-hour summit workshop on Wednesday, May 14, at Washington County Community College.

The workshop starts at 4 p.m. and will be held in the assembly room at the college.

The Washington County Drug Action Team based out of Machias is the sponsor of the event. The team is composed of several groups including Neighbors Against Drug Abuse and the Weed and Seed program in Calais.

The public is invited, along with members of the area medical group.

Among the presenters will be Michael Edwards, director of research and evaluation at Healthways-Regional Medical Center at Lubec. Edwards will open the workshop with a talk on addiction and the brain.

Psychologist Marjorie Withers, who serves as chairwoman of Community Caring Collaborative, a Washington County-based system of services for at-risk infants, developmentally delayed infants, toddlers, preschoolers and their parents, will focus on the generational heritage of addiction.

Dr. Marc Kaplan, who understands the effects of medicines applicable to alleviate the need for drug addiction, will talk about medical issues of addictions.

Washington County Sheriff Donald Smith will talk not only about addiction problems related to people who are in jail, but also about the impact of addictions throughout Washington County.

Denise Altvater, who is chairwoman of the Criminal Justice Commission at Pleasant Point, will talk about her knowledge and experience with families directly involved with addiction issues. Her talk is titled "The Social Effects of Addiction."

Mary Ann Ogonowski, a certified social worker who is a case manager with the Women's Project of the Department of Health and Human Services, will talk about "Addiction Issues That Face and Matter to Case Managers."

Each presentation will be followed by a brief question-and-answer session. "The presenters are well-qualified experts within our county who serve our communities and their residents," the group said in a prepared release. "The workshop will conclude with group discussions to answer questions and begin to take steps toward a countywide community resolution."

There is no cost and dinner will be provided.

New Medication Shows Promise In Addiction Treatment

Prescription drug addiction continues to rage nationwide and across the region, despite state and federal intervention.

In 2006, nonmedical use of prescription painkillers drew the highest number of new users, or "initiates," than any other illicit drug, with 2.2 million users, according to the 2006 National Survey on Drug Use and Health.

And according to the U.S. Drug Enforcement Administration, there are nearly 7 million Americans abusing such drugs today -- more than the number of those using cocaine, heroin, hallucinogens, ecstasy and inhalants combined.

Despite the alarming statistics, many insurance companies don't cover substance-abuse treatment. In fact, Medicaid in Virginia didn't cover the cost for anyone but pregnant women until last July.

Lisa Williams, director of the suboxone treatment program at Highlands Community Services in Abingdon, said one of the most difficult obstacles in combating prescription drug abuse is the availability of the drugs and the lack of viable treatment options.

Until 2005, methadone was the only treatment for opiate addicts, but it has a number of drawbacks. First, it can only be distributed at clinics, which in rural areas such as Southwest Virginia can be far away. Second, methadone gives its user a feeling of euphoria that mirrors the effect of an opiate, and the more methadone you take, the greater the high.

And perhaps the most telling drawback is the spike in methadone overdose deaths in the western district of Virginia. According to the state medical examiner's office, there were 264 fatalities in 2006 from drug overdoses, 70 because of methadone. It's the leading cause of fatal overdoses in the state.

Suboxone was introduced in the U.S. in 2005 as an alternative to methadone. Like methadone, the drug works to placate withdrawal symptoms and cravings in opiate addicts.

But, Williams said, the drug is superior in several ways. Because it does not give its user a feeling of euphoria, it has little potential for abuse. It simply satiates the cravings. It also has a "ceiling effect," which means exceeding the prescribed dose does not increase the patient's relief.

Suboxone also can be prescribed by certified physicians across the country, which makes the treatment more convenient in rural communities.

But there are drawbacks. Strict criteria govern the treatment. In order to start on the drug, a patient must be in a specific phase of withdrawal and cannot be taking certain other drugs that interact poorly with suboxone. Also, only certified physicians can administer the drug, and they are limited in the number of patients they can treat.

Williams said those enrolled in her program have an astonishing 87 percent success rate at beating their addiction.

But some say the drug may not be all it's cracked up to be. Suboxone is the most expensive drug per milligram on the black market today, said Richard Stallard, head of the Southwest Virginia Drug Task Force. An 8-milligram pill sells for $25 to $30 on the street, which means 80 milligrams -- the average dosage of OxyContin -- would cost more than $400, he said.

"There have been several suboxone arrests. I am not saying that it doesn't work when used properly," he said. " ... But to say it has no potential for abuse is totally wrong. No one is going to spend $30 on a pill that don't make you feel good when you use it."

Stallard said he started seeing the drug on the street about two years ago.

"Not many weeks go by in this area that there is not a suboxone purchased by undercovers [police]," he said. "I was here when oxy came in the mid-'90s. It started slow and then got big. Suboxone has some similarities."

Coffee, pastries and hope on menu at new library cafe

Ronald Wimes was homeless and battling drug addiction.

"That's like a circle that goes down and down and down," he recalled yesterday. "It's everything that comes with homelessness -- the rain, the cold, eating in soup lines and just despair, loneliness and a lot of pain.

"I needed help. I had nothing. I had a desire, and that was the biggest piece to wanting change."

He found Project HOME, a Philadelphia nonprofit agency that deals with poverty and homelessness.

Yesterday Wimes, 47, started his first day of work as lead host at the HOME Page Cafe, a wireless-Internet cafe in the lobby of the Central Library on the Ben Franklin Parkway.

The cafe, a collaboration among the Free Library of Philadelphia, Project HOME and Bank of America, officially opened yesterday morning with a ribbon-cutting ceremony and speeches from project organizers and cafe employees.

The cafe will employ 10 formerly homeless Philadelphians and five teens from Project HOME's Harold A. Honickman Youth Entrepreneur Program. Employees will earn $8.75 an hour.

"Public libraries and homelessness are often in conflict," said Sister Mary Scullion, executive director and co-founder of Project HOME. "Those that have no home often take refuge here and sometimes people are afraid. Philadelphia has found a way to take a step forward in providing a solution to this very real tension."

Mayor Nutter and project participants cut the ribbon with a giant pair of scissors.

"This is an incredible example of the creativity we should be replicating all over the city," Nutter said.

The spacious cafe was financed partly by a $200,000 grant from the Bank of America Charitable Foundation.

The cafe serves Starbucks coffee, baked goods from Metropolitan Bakery, and sandwiches and salads from Project HOME's Back Home Cafe and Catering, situated at the group's main office at 15th Street and Fairmount Avenue.

Wimes began his recovery a year ago by moving into Project HOME's St. Elizabeth's Recovery and Resistance community at 1850 N. Croskey St., in North Philadelphia.

"I would never imagine I'd be standing here, an employee of the HOME Page Cafe and lead host," Wimes told the crowd. "I would never imagine that."

Wimes said that his position as lead host, which is full-time with benefits, is similar to a supervisor who oversees employees and manages the cafe's inventory -- areas of responsibility he never could have contemplated before.

"First of all, I wasn't lead nothing," Wimes said. "Nobody wanted to be around me, so it's a big jump in the experience of life. I've never been a supervisor or anything like that."

Another host, Jeanne Brophy, 33, also was once homeless, but has lived in Project HOME's Kairos House at Broad and Jefferson streets for 15 months.

Brophy said that she hopes to increase her hours at the cafe so that she can continue her education; she'd like to study computer technology.

"Working with these guys is awesome," Brophy said, while rushing to refill coffee carafes. "It's just incredible."

The cafe also will employ a full-time manager and a full-time "job coach." These employees will hold daily training sessions on topics including punctuality, appearance and job performance.

For Wimes, customer service is a priority.

"It's about reaching out to people, man," he said. "I've got a new sense of self-respect and respect for people. The way I was helped and served go into my customer service."

Once the cafe is self-supporting, Project HOME hopes to create a profit-sharing program for employees.

The partnership is one of many working programs that Project HOME has in the city.

Among others are: providing restroom attendants at the Central Library as well as the Back Home Cafe & Catering and Our Daily Threads Thrift Store, at Project HOME's main office.

"We celebrate today another step forward, actualizing our commitment to end homelessness in our city," Scullion said.

"By taking action, we can end this very human crisis."

'Just say no' doesn't work

Tony Gizzie speaks out against harm reduction as a strategy in fighting drug addiction. Harm reduction is a proven strategy that helps many people who drink or use drugs. I am a member of Parent Action on Drugs, a community group that, like the Centre for Addiction and Mental Health and Toronto Public Health, has successfully delivered programs based on harm reduction. They've all done so because it works.

In the U.S., the "Just Say No to Drugs" strategy did not stop youth from drinking and taking drugs. Should we just continue to preach abstinence as the only solution?

Teaching people they should not drink and drive is harm reduction. Educating youth that condom use will prevent not only pregnancy but also disease is harm reduction. Giving people options to the heavy use of alcohol is harm reduction - like showing a daily drinker that he or she can cut back to three days a week and be healthier.

Making people aware, giving them options and helping them change their behaviour - whether it's stopping, cutting back or adding new strategies to their lives - is harm reduction.

It is not a cop-out, as Gizzie implies. It's a proven solution that helps thousands of people who drink or take drugs, and helps society around them.

Nancy Miller, Toronto

Commentaries like the one written by Tony Gizzie, a banker from Oakville, are precisely the reason why harm-reduction programs fail. Such programs for intravenous drug use have been shown to be effective in reducing the burden of drug abuse in countries all over the world, including Canada.

However, many of these programs are threatened by knee-jerk appeals to the "common sense" of people with no experience treating or living with substance abuse. Gizzie referred to Alcoholics Anonymous and its policy of complete withdrawal, but he neglected to mention that many alcoholics return to normal drinking patterns later in life. He also failed to mention the enormous societal cost of treating drug addiction and the fact that for the vast majority of addicts, abstinence does not work.

"Harm reduction" applies to the society that no longer has to shoulder the immense economic, social and health burden of complications due to unsafe drug use.

It is this kind of "up by your bootstraps" thinking that shuts down progressive social programs, or prevents them from starting in the first place. I would implore the Toronto Star and Gizzie to leave the arguments on harm reduction to people who know more about it.

Ian Cromwell, Toronto

In Canada, the application of the harm-reduction approach in substance-abuse treatment has become accepted public-health policy. It is part of any professional program that seeks to assist any person who has become addicted to drugs. Self-help programs such as Alcoholics Anonymous and its offshoots, which focus on a spiritual force to recovery, can also be part of successful treatment programs.

Tony Gizzie obviously has not done his homework before stating his beliefs. There is no strong evidence that an AA approach is superior to harm reduction in any time frame for all addicts. There is no evidence that the AA immediate-abstinence approach will help all addicts or substance abusers. And there is no evidence that AA reduces overall social and health costs to the individual and society.

Non-judgmental harm reduction has been accepted in Canada and around the world as a smart strategy for the individual and society.

Man get six years for possession of drugs

A "TALENTED golfer" with a possible future as a professional has been given a six-year sentence after being caught storing cocaine valued at €27,300 in his rented house in Swords to repay a €2,500 drug debt.

Joseph Deegon (21) was due to undergo training that would have allowed him to teach golf and play as a professional.

Deegon, of Howth Road, Raheny, pleaded guilty at Dublin Circuit Criminal Court to possession on March 9th, 2003 of the drugs for sale or supply at Parklands, Northwoods, Swords.

Judge Katherine Delahunt said she believed "special and exceptional circumstances" were evident in this case to allow her depart from the 10-year mandatory minimum sentence applicable to this offence.

She noted Deegon's admissions to gardai, his early guilty plea and the fact he had a drug addiction at the time. Judge Delahunt imposed a six-year sentence with the final three years suspended on conditions.

Sgt Denis O'Callaghan testified that while searching the house on foot of confidential information they found cocaine valued at €27,300 in the bedroom and drug paraphernalia, such as a weighing scales, plastic bags and a mixer, lidocaine.

Sgt O'Callaghan said Deegon admitted responsibility and told gardai he was holding the cocaine to repay a drug debt to a third party whom he could not name as he feared for his own safety.

Sgt O'Callaghan said Deegon had 14 previous convictions, one of which was a drug offence and the remainder for road traffic offences.He agreed that Deegon had "legitimate fears" for the safety of himself and his family and had paid off the €2,500 drug debt with a bank loan.