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Are we all just crazy?
May 24, 2004

Dearest Dr. Bob:

I'm surprised that it's taken me this long, but I've begun to notice a trend in your recent posts. When you seem convinced that someone has had a conclusive negative test (low-risk exposure with a test after 3 months), instead of addressing what feel like real physiological symptoms, you refer them to a psychologist/counselor instead of another sort of doctor. How is it possible for us (myself included) to have all of these symptoms (swollen glands, headache, white coated tongue, severe fatigue, nausea, fever, etc.) for almost a year with no real physiological basis? How is counseling going to make this all go away, even if we are in your opinion, conclusively negative? It's enough to make you feel crazy. I'm at the point where I can't make it through a full day of work, and the fatigue is getting worse as time goes by. I just don't think it's as simple as you make it sound, and people with real illnesses may end up forgoing treatment they may actually need. I could be wrong, but where do you draw the line? Getting tested more than once after 6 months is obviously unnecessary, but I'm still considering seeing an infectious disease specialist just to rule things out, maybe more blood tests for diseases besides HIV, biopsies of my lymph nodes, etc. Where do I draw the line, and how effective can counseling be in making these symptoms go away? Thanks for your time.

Response from Dr. Frascino

Hello,

I would suggest you go back and read my responses more carefully. My consistent message is that I cannot diagnosis symptoms over the Internet. However, the question frequently posed to me is: "Are my symptoms related to HIV?" By reviewing the potential exposure risks and HIV test results, I can give my expert opinion as to whether HIV is a possibility or can be definitively ruled out. If the questioner appears to have an irrational fixation on HIV disease or difficulty accepting their negative test results, I recommend counseling.

Your question does not give me any details of potential HIV exposures or any HIV test results. However, you do ask, "How is it possible to have all these symptoms for almost a year with no real physical basis?"--- and that's my point exactly. If you've had a variety of symptoms for an extended period of time and no physiological basis can be identified, you should consider a psychological basis. You state that you are "still considering seeing an infectious disease specialist just to rule things out, maybe more blood tests for diseases besides HIV, biopsies of your lymph nodes, etc." OK, fine. You get this second or third opinion and still no physiologic basis is identified. What next? More doctors? More tests? "Rule out" more diseases?

Your last question is an excellent one: "How effective can counseling be in making these symptoms go away?" I'd say, "Why not give it a try and then write back and let us know." Also, check out the numerous testimonials in the archives. I think you'll find them enlightening.

Good luck. Feel better.

Dr. Bob



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