Dr. Bob,

You recently decribed three types of fatigue for a reader. Thank you. The third was as follows: "3. Motivational fatigue, which is defined as a lack of will or desire to engage in emotional or physical activities."

My question is regarding motivational fatique. Besides obvious heath issues related to being an AIDS patient, my main concern lately has been motivational fatigue. My HIV specialist is a great doc, but isn't much help in this area. I'm curious if you have any recommendations in general for combatting this serious problem. My searches online have turned up very little and my gay friendly counselor who means well, isn't helping much either.

Until 2 years ago, I felt like a healthy, smart, attractive, creative, and respectable 30 yo man. Now, I don't really seem to care about much of anything going on in my life - my business, my family, or my partner of 8 years (negative), who despite all, loves me very much. He does not, however, understand that I am not physically, mentally, or emotionally the same person I was even two years ago. I cannot work the long hours in our specialized and demanding business I could before and when my body *is* doing relatively well, my mind is often unable to focus on the tasks at hand (side affects of meds, etc). As a result, I have faced facts and I have become extremely unmotivated and do not know where to go from here. Our business is suffering and so is our relationship. I tried for a while pretending like I was Superman and that could resume my daily grind despite almost dying from an OI after a very unexpected diagnosis of full blown AIDS. I've realized that just isn't realistic but am having trouble coping with this huge and sudden change in my quality of life.

I realize you cannot fix my problems for me online, but I sure could use someone pointing me in the right direction of hope. If you know of any forums, resources, or even books that may help, PLEASE let me know. I realize this isn't a very common situation, but I'm hoping there are others out there who have gone through where I am now, with success. I'm desperate for your help.

Hello,

Actually, your situation is not at all uncommon. Maybe we should call it "the superman syndrome." Living with HIV/AIDS and taking the potent medications required to sustain our lives and "health" is extremely challenging. Honestly, sometimes I doubt even Superman could cope. It would be like his having to function while having to take kryptonite milkshakes twice a day! So, what to do? You've already made one giant step forward. You've realized and accepted that you are not the same physically, mentally or emotionally as you were years ago. However, having "faced the facts," as you state, it seems like you are unsure how to adjust to your new reality going forward. "Quality of life" is still very much possible, but it will require some significant changes in the way you conduct your day-to-day affairs.

Start by having a heart-to-heart with your honey. Show him this post and my response. You need his support to help make the necessary changes to restore your strive-to-thrive spirit. You'll then need to make an appointment with your HIV specialist to discuss the specific issue of quality of life. He should be helpful in getting you to refocus your energies on your health rather than trying to keep up with external demands. Perhaps he'll put you on temporary or permanent disability so you can spend more time optimizing your rest, sleep, nutrition and exercise programs. In addition, you'll need to develop a plan to decrease stress and day-to-day responsibilities. Your "gay friendly counselor who means well" isn't helping; consequently, it may well be time to see an AIDS-knowledgeable compassionate psychiatrist. They are often the best in managing "motivational fatigue" issues. But you'll need a multifaceted approach, involving your HIV specialist and your lover as well.

Things can and will get better, but first a few things have to change.

Good luck.

Dr. Bob