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Fatigue and AnemiaFatigue and Anemia
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low rbc and surgery
Jun 23, 2002

I've decided to have an elective procedure (liposuction)rather than waddling around in misery.My cosult isen't until next week and I was referred by my id doc so I know he'll "do" hiv+ patients.Here's the problem although all my numbers on therapy are really great, my red count isen't it's low (around 3.5 I think with a hemaglobin right at twelve)I'm afraid the doctor is going to say no deal and I'm going to be a "fatty fatty two by four" for eternity!Last year I was a size 2(i'm female)so,unfortunately antivirals gave me alot more than just a lot of cd4s!!!I think somehow in some cruel way the more cd4s you are given back come with a price:inches!!!!So,I'm sure anemic people have surgery everyday,but since this is elective and If I have to do procrit,I'm going to get stuck footing the bill because it would be related to my wanting to have elective surgery(which of course I have to pay for).My id doc doesn't think the mildly reduced red count is low enough to warrant treatment.And that brings me to my biggest rant.....I wish insurance companies would be a little more compassinate when it comes to the whole lipo issue.It would be one thing If I were sitting around tossing back KrispiKremes and KFC all day,but instead it's RUNNING from cardio to resistance SWIMMING LAPS over to Pilates and stairclimbing to yoga while tossing back skinless chicken cooked on the george formen "lean mean grilling machine"and steamed brocoli oh and of course the "cocktail"I'm probably crossing the line here but insurance pays for breast reconstruction after masectomy,and that goes to the whole emotional anguish/pain and suffering/quality of life thing,so I wonder why we can't get a little extra consideration.It's almost like we're being punished.Thanks for letting me vent,and what do you think about the low rbc and surgery,(I'm looking maximun fat sucking potential and no I'm not nuts just very vain.)

Response from Dr. Frascino


From the old withered look of AIDS wasting to "fatty, fatty two-by-four," this damned virus is certainly annoying and stigmatizing. The inconsistencies and unfairness of our medical system is well known to almost anyone who has to cope with a chronic medical condition. I wouldn't look to the insurance companies for extra consideration. They are more interested in "compassionate conservatism." That's having a compassion to conserve all their money under all circumstances.

Having liposuction with a hemoglobin of 12 should not be a problem. That is the lower limit of normal for women. As for maximal fat sucking, the surgeon you see should let you know what to expect. Some of the excess fat induced by the drugs and the disease is "visceral," meaning it's in the organs and therefore not amenable to being sucked out! This can occur particularly in the abdomen. Other affected areas, like the back of the neck and upper back (Buffalo Humps), respond well to liposuction, but the fat may reaccumulate with time.

As for Procrit treatment, keep an eye on your hemoglobin. Has it been trending downward? There are good studies now that clearly indicate that treatment of even mild to moderate anemia in the setting of HIV disease is associated with improved energy, quality of life and even survival. If you drop out of the normal range (below 12 g/dL) and feel fatigued, etc., I'd once again encourage your doctor to consider Procrit. Or get a second opinion from another HIV specialist who might be better versed on this topic and willing to help. Whether or not your "fatty, fatty two-by-four" becomes a "skinny Minnie," I wish you all the best. And if you really are working out that hard and eating George Forman's skinless (tasteless) chicken breast with steamed broccoli, I'd suggest you have at least the occasional Krispi Kreme as you lace up your Nike's for the next marathon. It helps keep the world in balance.

By the way, there is absolutely nothing wrong with wanting to look your best! You go girl!

Stay well,

Dr. Bob

please help me
Hello and thank you

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