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hey's Alabama Gal! (ALABAMA GAL, 2011)
Feb 6, 2011

Just checking in and needing your support. No need for me telling details once again...just could use your support again....encouraging words......just wanting to know that you are still in my corner. Thanks.

Response from Dr. Frascino

Hey "Bama Babe,"

Of course I'm in your corner. As for encouraging words, well, not sure what you need, so I'll just repost my previous responses and you can pick and choose whatever reassurance you need from those, OK?

Be well!

Dr. Bob

Hey's Alabama's been awhile! Jun 16, 2010

Hope you are doing well! Since you have been so helpful and supportive of me in the past......I want to ask you what your thoughts are rather then ask a different expert here. :) As you may remember I am Bi-polar II, have a number of other less severe illnesses and have been on HAART since April 2009-Atripla (my numbers are decent now thank God!).

I have been taking Trazodone for the depression part of Bi-polar for about 13 yrs and have been taking the mood stabilizer Lamictal for about 6.5 yrs.......I seemed to be doing really well on those meds. With severe stress due to family relationships and living in poverty for the last 7 yrs it has been a difficult ride. With the stress of those 'living' things to deal with my depression has greatly increased. After starting the first HAART med ever last year (the 'living' stuff increased at the same time as well)....I have noticed my depression becoming more and more severe and more severe suicidal thoughts have increased significantly (even going as far as writing suicide notes and making plans-but then better thinking kicks in.....and I tell myself 'if I feel the same way tomorrow I will do it'........but I awake with a better spirit-until the next time...which are becoming more and more frequent). I attributed them to the more difficult 'living' things......due to my deep depression after starting Atripla I have been in alcoholic relapse-drinking at what do I expect right? I am under infrequent county mental health 'treatment' (for years. infrequent visits due to their schedules not mine and IMHO-they are so inadequate..... I know I need to get sober again. It seems to be a vicious circle-depression and living stuff leads me to the bottle. The Atripla has worsened my depression.......blah blah blah

I have made every call there is for help to get sober (AA works-I was sober for nearly 11 yrs......but it isn't working for me now). My mental health 'professionals' know I'm in deep trouble......they pass me off to AA and the disasterious HIV/Aids clinic here......the HIV/Aids clinic here passes me off to the mental health 'professionals'. There is no detox/treatment for poverty people here (Medicare/Medicaid)...not even outpatient help.......believe me I've made the calls, done in person interviews, pleaded my case.

Yesterday, another Bi-polar II/HIV+ friend did research on Atripla........and as far as we can tell.......Atripla can be very wrong for people with severe mental illness. Since my CD4 count and viral load has gotten awhole lot better......the HIV/Aids clinic does not want to change the med.

Long story.......I know.......I know.......but again, you have been so helpful and supportive in the past.........I am turning to you for help. I feel depleted.......

Thank you for any help/advice you can offer me.

Response from Dr. Frascino

Hey Alabama Gal,

Sorry to hear you are having such a difficult time! I agree with your friend's research. Atripla should be avoided in people with severe depression (you qualify!). Since you are now apparently doing well HIV-wise, there should be absolutely no reason the HIV specialists couldn't switch to a regimen that doesn't contain Sustiva. (That's the culprit in your three-in-one drug Atripla that can cause all the problems.) So a new antiretroviral regimen should be your first step.

Second step should be 12 steps! Yep, back to AA. Get a good sponsor who will work with you and keep you out of the bottle!

Third, on one of your infrequent visits to the "mental health" professionals, try to snag a psychiatrist (M.D.) and ask if your bipolar meds need adjusting. Also, advise him of your suicidal ideation. You can even show him this post and my response if it will help or make things easier for you.

You've come this far. Now is not the time to give up. Let's get through this together and both be here for the cure, OK?

Good luck.

Dr. Bob

Pro-Active from Alabama Gal Apr 21, 2009

Hey honey.yep it's Alabama gal! How are ya? I wanted to tell you that although I have been struggling with accepting what is......I have been recognized as a dynomite public speaker. Last month I was speaking to 8 State Representatives and 5 Senators re: matching State Funds. Did you know that although the Feds offer 6 million dollars in funding for meds/testing/education/prevention/treatment for various HIV/Aids affected patients and their families....unless our state matches the funding we will lose what isn't matched. This means people needing Aids saving meds on waiting lists and sub-standard care. I have become pro-active and a public speaker. I have begun this new venue with educating new HIV moms, I will be in Memphis next week advocating education and prevention. I am proud to say that I am 'doing something'.

There is nothing like getting out of self to help another to save one's own sanity!

Thanks for your undying love and passion for those of who suffer........


Response from Dr. Frascino

Hi Alabama Gal,

BRAVO! Actually if we all just did our part, we could stop HIV cold in its tracks! Thanks for doing your part.

Keep up the great work!

Dr. Bob

Hey it's Alabama gal with a question and opinion.........go figure :) Mar 11, 2009

I just asked my question under separate cover........I hope you answer always answer my questions.I think we are in love from a distance, living in different worlds with different partners and different perspectives on life....

anywho..... lol

The doc that just wrote in concerned about his needle stick exposure and subsequent questions/concerns/misinformation about his HIV tests....scares the bejeebies out of me.

Pulezze tell me that universitys and teaching hospitals are not turning out insufficeintly trained docs? Like that just doesn't happen! It's sick, it's sad, it's scary and so potentially dangerous.

Who can the layman trust if peeps like this are being turned out to treat us?

Keeping you in my thoughts always my friend, your dweeb friend from Bama, tho a Calif lol

Response from Dr. Frascino

Hey there Bama-Babe,

I certainly advocate for additional HIV/AIDS instruction and experience for our doctors-in-training in the U.S. I should point out that I get questions from the entire cyber-universe. Consequently the questioner you refer to may not be from the U.S.

By the way, he did write back with additional information. He took PEP and is being evaluated appropriately.

Ciao Bella. (And don't tell anyone else about our secret forbidden love affair!)

Dr. Bob

Thought I had asked the questions I had...but one more please Oct 16, 2008

Yep, it's Alabama Gal again...

I was dx after I had spent 3 mos with a pos (unbeknownst to me). After he and I parted ways his sister in law called me to suggest 'btw, you knew he was HIV pos right?' I preacehd to my daughters to be safe, always use a condom because I believed that older adults would be honest and not intentionally infect. At any rate, I was tested within a week after the breakup and two weeks later I went for my results...

So, finally here's my question :)

I do not understand nor think it would be of benefit for me to know all the lab lingo...meaning the percentages, sero-conversion, CD$ and CD 8, whether my doc did the Elisa and Western...blah blah.

I know how to protect myself and others now. I keep on top of my labs, meaning I see my clinic reguarly/lab tests, know what my CD4/VL is.

Do I, as in 'DO I' need to know all the terminology...

I kind of think if I was all so consumed with this and that and the other I could be one of those that manifests 'symptoms' purely because I know 'too much'? Is it ok for me to 'just know that I have been pos for nearly 8 yrs, not on HAART yet, know my VL and CD4 count and how not to spread it to others nor put myself in any other jeparody as in HEP C, or other STD?'

Is it ok to just know the basics and not try to play doc on myself?

Personally I think knowing just the basics has eleviated alot of unneccessary worry.

And your thoughts?

Response from Dr. Frascino

Hey Alabama Gal,

You "believed older adults would be honest"??? Hmm . . . honesty is not the first thing that comes to mind when I think of "older" adults, like Bush, Cheney, Rumsfeld and McCain!

Regarding your question, there really should be no correlation between knowing the basics (or much more than the basics) and playing doctor on oneself! I strongly advise against playing doctor on oneself, even if one happens to be a real doctor! However, I do strongly advocate all HIVers learn as much as possible about HIV, HIV monitoring tests, antiretroviral therapy, prevention, transmission and safer sexual techniques. This allows the "virally enhanced" individual to play an active role in their health and health care decisions working in concert with their HIV specialist. Understanding HIV actually decreases worry! You don't have to become an expert. That's what you have your HIV specialist for! And you don't have to learn everything right away. I'd suggest you begin with the chapter entitled "Just Diagnosed," which can be easily accessed on The Body's homepage under the Quick Links heading. You might also try reading Poz magazine.

Dr. Bob

Probably not a biggie... (WHEN TO START TREATMENT 2008) Oct 16, 2008

Hey Dr Bob it's Alabama gal! Funny, I read so many people's concerns here about being 'sure they must have HIV because they had risky exposure and now have 'all the symptoms-sore throat, swollen glands etc' Since I had not one clue that a women of my age with a man of the same age 'could be carrying such a devastating disease as to pass it to me'...I HAD no symptoms! lol

Ok fast forward (that was just an observation from the worry warts of this board...)

My labs in May were fairly 'bad'. I am not on HAART yet but when I went back for my results the PA said she could put me on HAART if I wanted to start. I asked the pertinent questions...'if I delay will it cause me more harm?' She said it was up to me but that she felt I could delay for awhile if I wanted to. Going to Calif for a reunion etc I didn't want to be suffering any side effects while there trying to have a good time for my parents anniversary. In Aug I had labs again and at the 3 weeks results appt my CD4 had risen a little so again I was told it was my choice to start HAART. I delined...for now. New labs on Oct 6th and will return for results on Nov 5th or something.

BUT......I have been sick on and off, mostly sick for the past 3-4 months. I mean really sick.flu going into broncitis. Two weeks ago I just had to go to a dr I was so sick for over two weeks prior. DX was Broncitis, Broncial Spasms, Asthma and Carotidenia. I just seem to be sick all the time. At my next lab result visit should I bite the bullet and go on HAART? I just hate that 'they' have left it up to me to make the decision.

My CD4 is VL is really good at 15,000...they say.

I am not looking forward to starting a life long regiment of drugs but......I don't want to be sick all the time either.

Any suggestions/help would be appreciated!

Take care-you're hero of mine!

Response from Dr. Frascino


Your testimonial of not having any symptoms, yet being HIV positive, is a very important one for the readers of this forum. I constantly stress that the reason to worry about or test for HIV is related to risk exposure, not whether symptoms are present.

As for your specific question, I would strongly recommend you begin HAART. The current treatment guidelines recommend beginning treatment when the CD4 count falls to 350. You have been closer to 250 for the past six months. As you approach 200, your risk for opportunistic infections, such as PCP (pneumocystis carinii pneumonia), increases dramatically. I'll reprint some information below about when to start treatment.

Good luck!

Dr. Bob

cd4 counts (WHEN TO START TREATMENT) Oct 2, 2008

Doctor, i've notice over the years (in fact over the course of a few short months), you've recommended med treatment at higher and higher cd4 counts. First, it was 200, then 250,... now, all of a sudden you're telling people that medical consensus says a whopping 350! What gives you the right to simply just keep rounding up and up and up, when you are advising people.

Other doctors here assure the reader that even if the person starts meds late, they can eventually get a good response.

If you're gonna say 350, cite your source,... and i hope its more than just a lone wacko doc you heard at a symposium in Mexico.

Expand Response >>

It's me....!!!! Aug 10, 2008

Yep Alabama Girl...and doing great thank You! Really mean have been a great source of support to me! I have a problem with my family. I am an older adult and have old aged parents and middle aged daughters. They seem totally uninterested in HIV/Aids and deliberately stick their heads in the sand when it comes to my status. My friends are pretty much in the same frame of mind. My concern is that if everybody sticks their head in the sand...saying it's not happening to me so it's of no concern......then we are in a very precarious position as a nation. To say or even think 'that is you and not me' is opening us all up to being suspectible to this disease...whether it is the disease itself or the lacksidasical general feeling for the one infected. I can not understand why my disease is not considered a 'family disease' such as alcoholism-it does or should affect the entire family in some way. I am never asked how I'm doing. I am never engaged in conversation about the disease-whether it is how it affects me personally, affects them as my loved ones who may one day have to deal with my Aids related death..or how the members of my family, any family could contract it as well under their certain circumstances-young, single, promiscuous...

Well, it appears I just needed to vent..not much for fodder I suppose.

I just returned from my family reunion and have seen the power of denial first hand...again. *sigh*

I will be seeing my HIV clinic in Sept where I will again have the option to start meds if I want to. I do not feel confident in 'leaving it up to me-the novice'. Where is the ultimate professional advice here? Maybe if they asked if I want to live a bit longer the choice would be obvious......but it's always been an 'iffie' sort of treatment choice left to me.

Gads......I am filled up to here with family dynamics and my thinking (and speech/writing skills) are alot to to be desired. I hope that you can sense I am once again....down in the fricking dumps due to no one understanding me "Wah Wah'...I know-you don't have to say it! lol

How are you my good man? I presume psychologically more sound then I am at this point! lol

Response from Dr. Frascino

Hello Alabama Gal,

I'm presently in Mexico City attending the International AIDS Conference. The apathy toward HIV/AIDS and denialism you discuss is rampant worldwide. After listening to the presentations here, I say it's epidemic in proportion! We are trying to confront these issues globally. However, I believe it's essential to think globally and act locally! In other words, why the hell are you waiting for your clueless and insensitive family to ask you about HIV/AIDS? Why not just talk about it nonstop to all of them until they get the message? Give it a try. You'd be amazed how effective this technique can be! Try it; you'll like it! (They'll hate it, but you'll like it and it will ultimately be good for them!)

Dr. Bob

Delaying starting meds Jun 20, 2008

Guess who? It's your Alabama Gal! lol

Quick question: Tomorrow is when I'll discover what my resistance is and which meds to begin on. I'm going to Calif for my parents 50th and family union at the end of July thru first week of Aug. Realizing that there is an adjustment period to starting any medication for any your opinion do you feel it would be a vaiable decision to put off starting meds until I return back home? I fear that any side effects and anxiety over med schedules etc might dampen the spirit to which I wish to have during this fun and exciting vacation. Could putting off begining treatment for a few weeks be a choice I can feel comfortable with? 6 weeks ago stats...Vl 10,000...and CD4 246...and a definite sudden decline with percent.

Keep supporting me Dr. make my world go from twisting/twirley to somewhat sane!

Thank you...answer as soon as you are able...time is not my allie at this particular time. I want to go on my trip without feeling I am neglecting what is best for me...yet I want to be able to enjoy it as if what is can wait with no logistical problems.1

Too much to ask? So what...I'm asking!! lol

Response from Dr. Frascino

Hi Alabama Gal,

While I doubt there would be any significant negative consequences to your waiting to begin your regimen until after your vacation, I really don't believe there is any real reason to wait. You have a full month to adjust to your mediations before heading to California. That should be plenty of time. Besides, many of the newer regimens are much more convenient to take and better tolerated than the older ones. In fact, you may even feel significantly better on your medications! Consequently, my vote would be to get started now and enjoy your California getaway with the comforting thought that your medications are doing some serious ass-kicking of your HIV infection!

Safe travels. Bon voyage!

Dr. Bob

You'll laugh at this! Jun 9, 2008

Yep, it's me again-the 56 yr old woman from that is funny in got admit! Tired of me yet? I hope not...sincerely...

Just a much information as this site gives, all of the answers to questions etc etc...I am suddenly getting overwhelmed with all of the knowledge and resources found here! I mean...I've been pos for about 7 yrs...and soon to start on meds and freaked out about it (Delayed Grieving was my last post to you)...and now I ran across a question about HIV-1 and HIV-2... Sometimes it is too much info no? I mean, for me, as much as I want to know...sometimes I get to knowing too much and it scares me or confuses me. Do I really need to know everything about everything? Is it enough to know that I have been pos for 7 yrs, that my Aids Clinic in Alabama is far from 'up on current', and that I will soon start meds? Rather then knowing which monkey spread this HIV-1 or HIV-2 to me?


Just overwhelmed sometimes by all the info...maybe sometimes it is just too much info for our own good?

Keep up your so genuine support of matter how weirded out I seem...your support means so much to me as I have little if at all here.

Humor me ok?

Bless you and hope all the best for you and anyone else having to deal with this disease...

Response from Dr. Frascino

Hey Alabama-Gal,

The information can be confusing, but in general I feel information is power. Don't feel you have to learn everything immediately. Take your time and learn a little bit each day. Start with "the basics" and build up from there. Being well informed is an excellent way to cope with the challenges of cohabitating with HIV. Plus, you can help keep the staff at your HIV clinic current.

Be well!

Dr. Bob

Your support is awesome! Jun 9, 2008

Dr Bob...I can not express enough of how much your answers to all of my questions and your support of me has helped me trudge through this journey! Yep...I am the 56 yr old woman from Alabama that you have continued to answer All of my questions (I think I have asked 5 questions thus far and you have answered all of them-thank you, thank you so very much!)...and am so grateful that you are in my corner! You can not know how much this means to me! Your last line in your last response to me was 'Let's get through this together, ok?'

I need this! Thank you!!!!!!

Response from Dr. Frascino

Hi Alabama-Gal,

Now you've done it! You've just announced to the gazillions of readers of this forum that I've answered all five of your questions. I can just hear the anxious wrecks now madly (figuratively and literally) typing away on their keyboards complaining (IN ALL CAPITAL LETTERS) that I have not answered even one of their very important concerns, even though they have submitted hundreds of them every hour on the hour for the past 90 days. Oh well . . . thanks for the thanks!

Dr. Bob

unprotected sex 7 years ago please help?????will donate
How do I deal with the constant fatigue

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