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Fatigue instead of hay fever
Apr 22, 2007

Doctor,

I have not had my cd4 count in a long time because I do not have insurance. My last cd4 count was 16.9%. I am not on any medication. My rather trivial "problem" is that now I experience only fatigue when before I would have had hay fever.

I have had no fall allergies during the last two fall seasons, no cold air induced symptoms during the last two winter seasons, no summer symptoms from artificial cold air. My only symptom is fatigue mainly in the spring on a few really windy days when everybody else is sneezing. This would be a relief after so many years of taking antihistamines/decongestants, but I happened to read an article that said sneezing, etc. was a healthy immune response and just feeling tired or aching indicates an immune system that isn't strong enough to successfully launch an attack. Is this true?

Also, I have had a small white bump on my face for about 6 months; an extremely small "baby" white bump has recently appeared next to it. I only very rarely get a pimple which always disappears within a few days so I don't bother to pop them. I kept waiting for this whitehead(?) to disappear, but I am now wondering if it could be something else. Can a regular pimple or whitehead last this long?

I have been considering going to the doctor to be evaluated, but am too embarrassed because I am sure I could not afford all the tests (that's why I stopped going). I guess that I am basically a loser, but I would really appreciate any insight you could provide. Thanks.

Response from Dr. Frascino

Hello,

It is true repetitive sneezing can be a symptom of an allergic reaction to, for instance, seasonal pollens, animal dander, molds, dust mites, your in-laws, etc. However, you can also sneeze as part of a common cold and that is not an allergic response. Similarly, being tired cannot automatically be linked to a weak immune system. For instance, if I stay up late watching reruns of Alberto Gonzales being skewered by the Senate Judiciary Committee and only get two hours of sleep before getting up tomorrow morning, I'll be tired all day, but my immune system would not be the cause (Alberto's deliciously bumbling performance and Dubya's comment, "you're doing a great job, Alberto," would be!)

Regarding your six-month-old white bump and new "baby" bump, I agree this does not sound like a pimple. I can't diagnose what it is over the Internet. (It could be molluscum contagiosum or a small wart or any of a number of other conditions.)

All that aside, I'm very concerned that you are HIV positive and have not seen a physician in some time, because you have no health insurance! This is another indication of how shameful it is for the richest country in the world to have 47,000,000 of its citizens without any health insurance! I urge you to contact your local AIDS service organization (just Google AIDS service organization and the name of your town or city) and ask them for advice. They may well have a benefits counselor or staff who can help direct you to a free clinic or subsidized health care service in your area. Don't wait! You've waited for too long already.

Good luck.

Dr. Bob


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