Dr. Mary Lou Galantino, PT and Dr. David Kietrys, PT are joining me today to discuss lessons they have learned from the HIV pandemic, the long-term COVID-19 pandemic and oncology physical therapy. Rehabilitation is an integral part of recovering from illness and is effective at improving the function of individuals living with disabilities. Due to the many similarities between the current COVID-19 pandemic and the HIV pandemic, this conversation could not have taken place at a better time. 

What does a physical therapist have to do with the care of a person who has HIV?

The short answer is that you treat every patient the same way. You learn everything possible about them that they are willing to tell you, especially about their medical history and their problems and their goals. Next, you identify their impairments. Similarly, you proceed as you would with any other patient by taking standard precautions before developing a treatment plan and implementing it.

What motivated you to present this topic at CSM: The intersection between COVID and HIV?

The group was formed to address the concerns of people with long-term illness and a cancer diagnosis. As a result of getting to be part of this group, Dr. Galantino had the opportunity to write the bylaws in the latter 1980s that was accepted as a special interest group within the oncology section. Due to people living longer and well with HIV disease, her staff believed they could raise awareness and provide solutions so that HIV disease becomes a thing of the past. In light of the fact that we are in the middle of a pandemic, they felt compelled to gather what has been learned from the HIV pandemic and bring that information to the current pandemic. 

The group has a unique perspective, and since we now find ourselves in a new pandemic, their hope is to be able to mitigate what seems to be a global and national pattern of behavior from governments and the public when it comes to basic needs. In the case of pandemics, denial is the first response. Then crisis. Then repeat when the next pandemic comes along. We hope to end this horrible cycle. 

COVID-19 pandemic was in many ways the same as the HIV pandemic. The hope is that if we can continue to have these discussions and not stigmatize these illnesses, like many other chronic illnesses, especially HIV, and COVID, we can make a change. It is important that we create space to discuss them openly and really communicate what we have learned and how to best represent our patients and clients.

The 6 lessons learned from the HIV Pandemic

The first lesson is to anticipate a disability during an after-acute management of COVID-19 and to recognize his episodic nature. The term episodic disability was actually coined by our Canadian colleagues, in particular, Kelly O’Brien, who has led the investigation into how we define episodic disability in the context of HIV. 

Lesson two, we will learn about the possibility that uncertain or worried about the future could play a role in COVID-19-related disabilities. What are the possible side effects? Will I ever be able to smell again? My tastes back? Are there going to be long-term neurological symptoms? There will be fear of the unknown. 

Lesson three, develop a disability and rehabilitation focused response to COVID-19, just as we did in 2016. Now we move on to the international, which I really enjoy, a political declaration on HIV and AIDS, on the fast track to ending the AIDS epidemic by 2030. Then I imagine if we could apply that lesson to COVID-19 in the same way. And then other infectious diseases as well.

The fourth lesson focuses on preparing for the long-term impacts of COVID-19 on key and vulnerable populations, so we can prevent inequality, stigma, and unintended social consequences, ensuring that no one is left behind. 

Lesson five: In addition, by including and focusing on the voices of people living with COVID-19 in all responses to the pandemic, individuals living with this diagnosis can have a meaningful role in the response. 

Lesson six: By focusing on the support networks of community networks, we can ultimately begin to apply similar approaches to what Dr. Galantino and Dr. Kietrys did in terms of our collaborations in HIV research, to the pandemic we are facing now.

What are the effects of exercise and nutrition on the immune system?

Nutrition plays a huge role in your patients’ journey. We cannot ask our patients to extend the calories they do not possess or ask them to exert themselves on different supplements and medications. I think we as professionals are lacking in our knowledge and understanding of nutrition and how it affects our patients’ recovery efforts. I think it is so important that we start to take into account what our patients are using to fuel their bodies, especially in the infectious and chronic disease patient population,

References from Episode:

About Dr. Mary Lou Galantino, PT

Dr. Mary Lou Galantino is a Professor of Physical Therapy at Stockton University, Galloway, NJ, Additionally, she is an Adjunct Scholar and Associate Professor in the Department of Medicine at the University of Pennsylvania where she conducts research on integrative medicine and chronic diseases. Her area of focus of teaching, research and advocacy has been on advancing the care and rehabilitation of those with HIV/AIDS and cancer around the country and the globe with a holistic health approach, as a clinician, yoga instructor and ACSM Wellness Coach. In 1993, she established the HIV SIG of the Oncology Section of the APTA and served as the Research Chair for over a decade. Through her Fulbright Specialist Award in South Africa, Dr. Galantino researches HIV disability and is a visiting professor at the University of Witwatersrand. Dr. Galantino has held several state and national consultative and advisory positions. She is the APTA representative for the Commission on Cancer where she is a member of the Advocacy and Accreditation Committees. In 2017 she was inducted into the National Academies of Practice as a Distinguished Fellow. She has also received numerous university and APTA awards for her teaching and research as well as most notably her Fulbright Award as a Cancer and HIV Rehabilitation Consultant in South Africa. In 2018, she was awarded Catherine Worthingham Fellow of the APTA. She brings passion for interprofessional and community engagement through her students, fellow colleagues and stakeholders at all levels.

About Dr. David Kietrys, PT

David M. Kietrys, PT, PhD, FCPP is an Associate Professor at Rutgers School of Health Professions. His research agenda is focused on non-pharmaceutical interventions to manage chronic pain in persons living with HIV. Recent projects have explored the impact of HIV-related peripheral neuropathy on pain, quality of life, function and disability. His work has been presented at international and national conferences including the World Confederation of Physical Therapy Congress, the Annual Canadian Conference on HIV/AIDS Research, the International Workshop on HIV and Aging, and APTA Combined Sections meetings. He has coauthored several peer-reviewed articles on rehabilitation of individuals with HIV disease as well as chapters on the subject in Neurological Rehabilitation 6th ed. (Umphred), Pathology: Implications for the Physical Therapist 4th ed. (Goodman & Fuller, eds.), and Peripheral nerve injury: An anatomical and physiological approach to pathology and intervention (Carp, ed.). At Rutgers, he helped develop a program for Interprofessional Education for Opioid Assessment, Treatment, and Recovery. He is a member of the Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC) and past Chair and current member of the HIV Special Interest Group of APTA. He provides PT services and education to individuals living with HIV disease in southern New Jersey.

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