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Fatigue and AnemiaFatigue and Anemia
           
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Fatigue better, anemia better, now another question for you!!!!
Nov 28, 2002

Hey Handsome, Where you been? When we don't see your witty replies for a few days we all begin to worry about you! So first off tell us you are ok. Next, I must tell you, are indeed a genius. You were correct -- my fatigue was "mutifactorial" as you suggested. And yes, I was indeed anemic. And yes, indeed my anemia was "mutifactorial" as well (also as you predicted when you spoke here). And yes, Procrit has been very helpful for me along with the iron supplements. So you are a genius (as well as being a sexy stud). So now you've improved my fatigue, and fixed my anemia -- why am I still bothering you? Well, I'm feeling so great, I'm back at the gym and starting to get some of those "looks" from some hot gym guys. Obviously, this is not a problem. I'm concerned about my "looks". My cheeks are sunken and I'm considering getting something done about it. I read you went for the Nu-Fill. The other thing I've been hearing about is silicon --- very popular here in LA. What's the real scoop? I only trust you. Did I mention you were a genius? When you coming back to LA or Palm spings to talk? Finally heard from my friends in San Francisco, that the Concerted Effort Concert was amazing this past weekend. Was it videotaped -- if so, how do I get a copy? Thanks again Dr. Bob. An "energetic" fan

Response from Dr. Frascino

Hello Energetic fan,

OK, yes, I'm OK!

I've just been very busy with "A Concerted Effort 2002: A Concert for World AIDS Day." It's our foundation's annual fundraiser here in the San Francisco Bay Area. Videotapes can be ordered from the website, concertedeffort.org.

Me, a "genius?" No, actually I'm a Gemini!

Glad to hear your multifactorial fatigue and anemia are both improved. Yes, Procrit is extremely effective! Getting sexy "looks" from "hot gym guys?" Well, as Martha Stewart would say, "That's a good thing!"

The scoop on sunken cheeks? OK, here's the way I see it. First, the exact cause of HIV-related lipoatrophy (facial wasting) is not known. I think the treatment should be considered "reconstructive, " rather than cosmetic, but many insurance companies don't see it that way. There are no FDA-approved treatments for this condition yet. New-Fill (polyactic acid) is an inert substance that promotes new formation of collagen, a skin protein. It's been used in Europe, Mexico, and South America with excellent results so far. What I like about this product is that it is theoretically the safest, because it should not cause allergic or immunologic reactions. The downside is that it is not FDA-approved for any use in this country. So, it's expensive, and even if your insurance company agrees that treatment of your facial wasting is "reconstructive" rather than "cosmetic," they often won't pay for the treatment. Studies are underway, and we hope the FDA will soon grant approval to this product.

So what's the buzz about silicone? Medical-grade silicones are highly purified substances that contain the element silicone. It's been used for over 40 years in various formulations. A variety of adverse reactions have been reported, including some bizarre immunological reactions. The current buzz is due to a product called "Silikon 1000." It's medical-grade and has FDA approval, but not specifically for HIV facial wasting. That's the catch. And it's a potential big catch, because that means studies have not been done to evaluate the safety or efficacy of this product for this condition. Once a substance is FDA-approved for any indication, a physician can decide to use it for other things as well, but again, the FDA has not sanctioned these uses, so it's "buyer beware!" I've certainly heard of folks in L.A. who have had this done and say they are quite happy with their results so far. Of course, we don't have long-term follow-up yet. The theoretical potential for problems, as I see it, involves the fact that silicone works by causing an inflammatory reaction. This can lead to unpredictable results - inflammatory nodules, over-correction, etc. My personal opinion is that we really don't have enough information yet to recommend this treatment, especially in those of us with altered immune systems. I do hope controlled studies will be done to monitor for adverse reactions and undesirable outcomes.

As for talks/presentations in L.A. and P.S., check with the local AIDS service organizations. Whether or not my presentations are open to the general public depends on who's sponsoring the talk! Also, you might find me lounging poolside at Inn Exile every now and then when I need to relax and recharge my batteries! If you (and I) are in Palm Springs at the same time, perhaps I'll see you at Golds Gym, just around the corner from the Fatburger restaurant off Ramone Street. There's something poetic about the Fatburger and Golds Gym being in the same block. You Palm Springs dudes are just too much fun. Stay well.

Dr. Bob


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