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Very Concerned-NEEDLESTICK WITH HIV + PATIENT
Aug 6, 2002

Dearest Doctor Bob, I am quite concerned. Let me explain and I am asking you because you are quite knowledgable in this area and i would be so grateful for your feedback sir! I was pricked by a needle that drew blood on an hiv + patient. I think i may be experiencing symtoms. I have tested at 40 days and 60 days negative via DNA PCR. But i need to know when i should test and when i can call off testing if by chance i come back neg. At how many months would you test up to..20 months or so? And would you use a DNA PCR test to verify results? Remember i think i am experiencing symptoms, wierd red marks, buildup of phelgm on throat, new wierd looking pimples that appear at new sites on my face and upper torso each day and some go away others dont. Thank you sir! You are a great man!

Very truly yours,

Scared Sh#tless in Vermont

Response from Dr. Frascino

Hello Insecure and Currently Constipated Law Student!

Thank you for your flattering comments. You lawyer guys really know how to turn on the sweet talk now, don't you? Promise me you won't be an ambulance chaser or "contingency only" medical malpractice lawyer, and I'll answer your questions, OK?

As Perry Mason would say, "Let's review the facts." (By the way, Perry Mason was a popular, good-hearted lawyer on T.V. many, many years ago, long before L.A. Law or Alley McBeal). "Cornerstone Markers" for HIV infection? Absolutely not! Thrush, a fungal infection on the mucous membranes of the mouth, can indicate a suppressed or deficient immune system. However, it can also occur after antibiotics, such as Zithromax, which kills off normal bacteria and allows normal fungi to overgrow, causing the symptoms called thrush. More importantly, your symptoms do not sound like thrush, which is quite easily scraped or brushed off the tongue and mucous membranes. So, what you "think is thrush" is not!

Next, being "stuffed up and having constant mucous coming out of your nose and phlegm coming onto your tongue from the back of your throat" may be annoying and distasteful, but it is not a sign of HIV or a seroconversion-type reaction. Far from a "cornerstone," it isn't even a crumbling old brick! Your doctor friends are probably correct. It sounds a lot like a head cold, sinusitis, or perhaps allergies. Have your doctor or an "ear, nose and throat" specialist take a look. This should be quite easily cleared up with proper diagnosis and treatment.

Next, the red marks on your skin do not in any way resemble the rashes associated with HIV seroconversion, so that knocks that out of consideration as well. What's causing the red marks? I really can't tell without seeing them. No, don't send photos. See a dermatologist if these are bothering you.

Now, the watery stools after you eat. First of all, how do you know what it would feel like to pump 20 pumpkin pies out your behind? No, the "pumpkin pie power pump" is also not indicative of HIV.

Next, the "so nervous that you can't sleep or eat" and the "fatigued" symptoms are probably intimately related. That's just simple cause and effect deductive reasoning and again not related to HIV. So the verdict, my dear friend, is right there in your deposition . . . errr . . . I mean your question! "I have worried myself sick!" That's the only logical answer, and all the facts point to that conclusion.

Now, let's look at the hard physical evidence. Your HIV tests (DNA PCR) were negative at 36 days and 57 days. That's very hard evidence we are not dealing with HIV! What tests should you take? The best screening test would be an HIV antibody test (ELISA) at 6 months. Based on all the information and physical evidence (lab tests), you will be negative. There is absolutely no need for additional DNA or RNA PCRs or to retest at 12 months. Are your 2 negative DNA PCRs pointless? Absolutely not! They are very, very encouraging.

As for other doctors' not wanting to tell you what may be, I strongly doubt that. Medicine and law are very, very different professions. You guys need to keep information secret and spin the facts to your advantage to win cases, even when the evidence is overwhelmingly contradictory (for instance, O.J.!). Physicians, on the other hand, have absolutely no vested interest in getting you to believe something that is untrue, which might delay or alter your treatment to your detriment.

The jury is in, and the verdict is unanimous. You are not HIV infected. Go ahead and get your 6-month HIV ELISA, if you want. It will be negative. Finally, rather than law school, would you rather try medical school?

Don't be like Nathan Lane in "Birdcage" (just can't seem to win). Be like Gregory Peck in "To Kill a Mockingbird" (win with grace and style!)

Stay well! This case is dismissed!

Dr. Bob


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