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Mayday! the S.S. OCD calling
Jan 11, 2006

Dear Dr. Bob,

All S.O.S.'s to you have failed so far, but i know its because you are a busy man helping people and not because you don't care about certain questions. To tell you the truth, I feel like all these years (yes years) which i have read your forum i begin quoting you when i talk to others about safer sex and all that jazz. I am currently writing you from a small town in Ontario where i am conducting my studies. Unfortunately due to rampant OCD HIV fears, I have a lot of trouble concentrating on school and often find myself scrolling thebody archives late at night while playing some light jazz. I have noticed that you have kept up steadily answering loads of questions and for that good sir I am grateful, as your advice is always rational, many times funny, but most of all caring. You don't find too many doctors who are like you Bob. I often wonder sometimes how life wouldn't have been without OCD haunting me every day. I know that you have mentioned in the archives that HIV has not destroyed your life at all, and you seem to be such a thriving passionate person living bravely with your illness.

I often check out Dr. Gallant's HIV info website at johns hopkins. Have you two ever met? He is pretty damn funny however more sarcastic. I bet you two would be good buddies if your paths did cross. It is so amazing that there is a site like yours. I bet you save lives every day. I donated to your foundation last year and will be ante'ing up again sometime soon when my tuition is payed off. Over the course of the past few years i have undergone 5 specific HIV fears which took me out of commission and basically out of life. I retreated to my parents basement and watched DVD's and dreaded the imminent HIV tests that i forced myself to do after each low risk exposure. I once purchased 10 rapid blood spot tests for home use (unapproved) and did them all in the same day then didn't trust the non-FDA nature of the test and eventually went in for proper ELISA's. All of my HIV fears were brought on by handjobs, and latex condom protected intercourse with females i knew. Each test in the past 5 years has been negative and i am truly grateful for that gift. However, i have been unable to participate much in the "dating game" due to my nagging HIV paranoia. I took a "joe job" doing high profile security in downtown Toronto and eventually dealt with many HIV positive people which assisted me with my fears of contracting the disease. For a while there, i was perfectly content with life and not scared of the virus, as i felt i was well aware of the real modes of transmission and felt well protected. Maybe it was a kind of "exposure" therapy where i was confronted every day with my fear, and learned to deal with it rationally by tossing on latex gloves for medical emergencies, and being super careful searching people when it came to needles and such. I never had a problem and felt that although the work was not appreciated by all (underpaid) and opposed by some (who felt intimidated) I think it was a valuable experience which assisted me in becoming a more sensitive, well adjusted person. The adrenaline flowing all the time made me feel alive, and i recall many laughs with patrons and coworkers who became great friends. Unfortunately when my job ended and it was time to go back to school, i found myself on the couch for a few weeks worrying about stuff. Eventually, I began to obsess about HIV again from a rigorous handjob i received from a girl of unknown status. Then my speck of rationality and reason somewhere in my complex brain reassured me that the exposure (if you could call it that) was pretty damn close to zero risk.

Why is it like this Bob? The constant feeling like i am being chased by this virus and that i am bound to contract it in my life? My Cognitive Behavioral Therapist noted that any worry in my head is just that; inside, and all mental masturbation doesn't change viral transmission probabilities. I find that each day, when i am in the depths of a fear, i obsess for about 12 to thirteen hours per day. To put it into perspective, a thought about HIV infection enters my head about once every 5 minutes or so. I often find that i encounter nightmares where i am having unprotected sex, or being struck with a needle and then i wake up in a sweat. It is highly distressing and incredibly painful during waking hours as the thoughts continue to linger and persist until I can grab on to some sort of reassurance (asking family members, friends, colleagues, doctors, and even total strangers about transmission odds and the likelyhood that I am infected).

To say that the fear is paralyzing is an understatement. When i go to the movies I am bombarded by fears during the previews, that i should not be enjoying myself, as I am infected and must seek help. When i meet a nice girl that i'd like to take on a date, i instantly remind myself that i should pursue anything, as i am incapable of mentally handling a sexual relationship, and that i might infect her anyway.

I find the only time there is solace is very late at night, when i am extremely tired ready to sleep. Then i believe, the brain packs it in for the day and lets me just sit there without any worry. I don't want to depress you with this descriptive account of OCD living, just maybe to help you and your readers understand the way someone with a real bad case of OCD thinks.

When i go to a clinic, i find myself examining the vocabulary of the Dr's and nurses. If they say astronomically low risk, i will ask them what they mean by astronomically. If i am told that my risk is close to zero i constantly think "what if?". It has gotten to the point now that I wonder if it will ever be possible to have a stable relationship and start a family. Occasionally, I have wondered if it would be better to be dead, but then i quickly forget that and think of my family who i love so much and care for deeply and how much sorrow they would feel if i were to pass on prematurely. I know it wouldn't matter to the world, but i know the heartbreak they would feel is worse than anything i have ever gone through so if i ask myself if I've ever been suicidal i'd say definitively "no". I guess we all think about it though in the worst of times. I think my problems began to surface around the time of my beloved Papa's passing. He fought so hard with a form of ALS called Inclusion Body Mytosis from the age of 64-84 and was a gentle soul to the end. I remember how much he wanted to live that when the young intern at the hospital asked him a few days before his death if they could perform an emergency tracheotomy on him he quickly responded "absolutely". This was when he had lost all his muscles in his body, couldn't swallow food, and could not lift a finger. I miss him so much Bob and think about him every day. I am a little choked up writing this but i guess it helps work through whatever it is that is depressing me. Even if you don't even read my letter, i think it has helped me. Sometimes i wonder if there is anything out there in life watching over us. I am really scared sometimes that the only comfort i find is seeing my family and reminicing about the good times we had in life. At one time, i was a happy soul, always making people laugh and enjoying life to the fullest. I am now a shell of that guy, and have resorted to a life of seclusion, avoidance, fear, and anguish.

The meds do help sometimes, but they make you feel listless, take away sex drive, and you gain weight. I find when i take the meds in a high (recommended dose) its hard to feel any emotion at all.

At this point i'm in the process of switching meds and hope it will get a bit better. The marks at school are in the mid-eighties but i can't seem to enjoy academic progress because of the preoccupation with HIV fears. My mom and dad really want me to do well and have supported me so much. I feel so lucky that i was blessed with two loving parents, because without them, i'd almost definately be living on the street. I thank them and my sister all the time for the love and support.

If i can give any advice to people out there dealing with the same kind of issues as me, i would highly reccomend listening to your doctors, taking your meds everyday, and following through with psychiatric/psychological appointments. If you don't you will end up paralyzed with fear like me, unable to do anything.

If you have already posted a reply to my question Bob, please accept my apologies for this stream of consciousness.

If not, i might as well tell you about my latest fears.

----Risk one----(causing great deal of stress) Attended barbershop normally reputable and while he was shaving my neck hair, nicked me ever so slightly with the straight razor. There was a little blood streaming and he used (possibly reused) a styptic pencil which caused it to sting and stopped the small bleeding entirely. I must add i hardly felt the nick. Now the process these guys usually go through is to reuse the razor but stir it in barbicide then wipe it off prior to use. Of course, as it was months ago i can't be 100 percent sure he stirred the cutthroat razor and of course am second guessing. So razor and pencil are both incorporated into the risk. Now, the haircut lasted about 15 minutes, and it was a summer day so fairly muggy in the shop. Also, i did not see a customer in the chair before me so i am assuming there would have been at least 5 minutes of air drying of the razor and pencil prior to me sitting in the chair. I am also assuming of course that someone who sat down before me was HIV or Hep C positive.Have you heard of infections this way? In your incredibly brilliant medical opinion, what is the risk assuming the worst? -----Risk's Two and Three------------ Also, i have had latex condom protected intercourse with two women of unknown status. Both have careers but were having affairs at the time. Furthermore, they insisted on condom use with me and initiated the condom use equally. I know one had a negative test a year prior but not sure about the other. I don't think she has been tested. I noticed no breaks in the condoms, and water checked 90 percent of them afterwards. In total, there were 3 sexcapades with one woman, 4 with the other. I received oral without a condom on one occasion by each woman. Moreover, i washed my genitals with soap and water following the sex. Finally, there may have been a handjob peppered in amongst all those risks that occured prior to my last HIV test.

One month after the barbershop incident i suffered a sore throat, stuffy nose, phlegm, and a week later a localized swollen lymph node behind one ear (not sure why the heck this happened). No fever, or generalized lympadenopathy, no malaise, mylagia, or rash. The head cold like symptoms lasted a week or two until all the snot was horked up and blown out (sorry for the graphics). With this being said, I noticed a patch of reddish skin on the left side of my nose a few weeks after these symptoms and it cleared up on its own in a few days (Sebborheic Dermatitis perhaps???? or dry skin). Am i right to assume what i experienced was not like ARS?

So overall, that is what is causing the latest anxiety and why I am writing, although i think its been theraputic too.

Now Bob, i really hope you are doing well. You always seem to look on the bright side of things and seem to have a busy life. Please give your dog a big hug for me and let Dr. Steve know that i admire him equally, as he is also saving lives. Hope your bro is doing okay and enjoyed the trip to Italy? France?... Maybe someday if you are ever in Toronto I can give you advice on some great restaurants and venues to check out with your pals.

Your wit and kindness puts a smile on my face when im sad and blue doc. Thanks for being there all these years in cyberspace helping out folks such as myself in need of support.

Yours Truly Bill.

Response from Dr. Frascino

Hello Bill,

Let me address your specific concerns first:

1. Risk one, the barbershop nick. HIV risk nonexistent.

2. Risks two and three, latex condom-protected sex. HIV risk nonexistent (assuming the latex condom was sued properly and did not fail).

3. Your symptoms. I agree with your assumption that these symptoms are not suggestive of HIV.

Bill, I also agree with your assessment, "OCD is haunting me every day." Notice you said OCD is haunting you, not HIV! HIV is not your problem, and I believe deep down you know that. You understand that handjobs and latex condom-protected sex are not HIV-transmission risks. Yet the fear of HIV can cause you to take 10 rapid HIV tests the same day!

Your advice to others, "listening to your doctors, taking your meds everyday and following through with psychiatric/psychological appointments," is exactly the advice I would give to you. In addition, I suggest you take this post and my response to your next therapy session and show it to your therapist. There is a very real possibility that your father's illness and death may be involved with your irrational fears. This issue needs to be addressed. I also feel you would benefit from being under the care of a psychiatrist (MD), if you are not currently being treated by one. I don't believe your "life of seclusion, avoidance, fear and anguish" is irreversible. The "happy soul, always making people laugh and enjoying life to the fullest" can make a triumphant return. Work with your doctors. Believe in yourself and a brighter future.

Feel better.

Dr. Bob



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