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Early ARS symptoms - maybe not so early...
Dec 25, 2009

Dr. Bob:

It's me again, your friendly neighborhood train wreck, writing to you with another update. I was going to title this post " ... - wish I understood French" since as you can see I have been a bit obsessive about following your posts, and I saw the last one you responded to in French.

However, I changed the title as you can see because of a particularly bad episode last night. In fact, I was hoping not to post another comment/update until after the holidays (at least Xmas) but I'm afraid this thing has gotten me so wrapped up, its pretty much all I think about.

As a brief recap, I'm the guy who got the massage with the rub and tug at the end and who after got home found some small scratches on the back of his hand that looked like they had just been bleeding (maybe from the massage). Of course that caused all kinds of worries about the possibilities of transmission. I know you've been trying to tell me its a no risk proposition, but I guess my mind (at least part of it) is just not listening despite your best advice.

Further, I've been having some "symptoms", but worst is a chest cold that just developed in the last week or so (We're at about two weeks since my exposure). Previously, it was just more of an irritation and scratchiness then sore. However, last night, I began coughing a lot, and at that point the throat actually became sore. Because its one of the conditions of ARS and we're close to the 2-3 week period, I instantly freaked out. Today, I feel better, with most of the soreness gone and a little coughing, but the irritation mostly comes at night anyway (maybe because its colder?) but last night was really bad.

To top it off, I've also been having ear problems that I am now suspecting might be caused by enlarged lymph nodes in my neck rather than an actual ear infection. I seem to feel them at least on one side and maybe both sides of my throat (although since I'm not a doctor, its hard for me to be sure). While I've had this ear irritation/infection before the incident, it seems to have worsened since then, again leading me to believe that maybe enlarged lymph nodes are now causing the problem. I've also been checking my groin and underarms regularly, but don't seem to notice any enlarged nodes although I've had a slight twitch in my groin from time to time and my arms ache every once in awhile.

As you might have guessed, this is not the first time I've put myself in a situation like this, but what's worse is that although I had some of the same worries and concerns, I still put myself in this type of situation again. So if it turns out I actually caught something from this, no matter how unlikely, then I will really go off the deep end.

What makes matters worse is I have a beautiful wife and children, and for me to do something like this repeatedly is abhorrent (to myself at least). Of course a little too late for that now. I actually 'fessed up to my wife after the last incident, and she somehow forgave me, including my irrational behavior afterwards from the fear of catching something, but despite the fear I now go back and do it again. She probably already suspects something based on the last incident, since it was not too long ago, and I've been behaving weird again. I don't think we can survive another one of these if I tell her, although I am still contemplating doing so.

Bottom line is I am just a screw-up, and need to try to put my life back together, along with getting some professional help. I hope this is just a cold, but if its something more, than maybe I deserve it for all my past sins and mistakes.

Can you believe all this from a few tiny scratches? Anyway, thanks for being there, doc, if anything to listen to our rambling nonsensical ways.

Peace out.

Response from Dr. Frascino

Hello Friendly Neighborhood Train Wreck,

With each of your daily posts (yes, I read them, even though I did not post them), I get a clearer picture of your problem. That problem is not virological (HIV), but rather psychological (guilt, irrational fear, anxiety). On some level, I think you too realize this, as evidenced by your comment: "I know you've been trying to tell me it's a no risk proposition, but I guess my mind (at least part of it) is just not listening despite your best advice." BINGO! I absolutely agree! It's your mind that is the real problem here!

Your totally unwarranted and completely irrational fears of being HIV infected are also tremendously magnified by guilt. Again, just reread what you wrote: "What makes matters worse is I have a beautiful wife and children, and for me to do something like this repeatedly is abhorrent." Further complicating the issue is the fact you've done this a number of times in the past.

One of your final statements is key: ". . . I need to try to put my life back together along with getting some professional help." Once again, you and I are in complete agreement. You need professional help and you need it now.

My advice is simple and straightforward:

1. Level with your wife again. As you stated, she probably already knows anyway, plus it's the right thing to do. Advise her you will get psychotherapy (counseling) and offer couples counseling if she would like to be present for the sessions.

2. Get the counseling you need!

3. Even though your HIV risk is nonexistent and there is no medical indication for HIV testing, if getting a definitive three-month test will help you put your irrational fears permanently to rest, it may be worth the effort psychologically.

Good luck.

Dr. Bob

Early ARS Symptoms - additional follow-up Dec 19, 2009

Dr. Bob:

Sorry for this additional email from my post yesterday in response to the original email you answered on the 16th (and wanting to thank you and wish you holiday greetings).

I was hoping the last follow-up email would be it, but did want to mention that last night my ear was bothering me again and I think I started developing a sore throat, but only on the side where my ear was bothering me. As I mentioned before, I'm hoping that the sore throat is related to it, although I haven't seen it as a usual symptom. I'm going to try and check it out today.

You might recall from my earlier follow up that although I said there was no blood from the scratches, I should have clarified that there was blood but it had dried up when I saw it when I got home from the massage, but it looked fresh enough that I thought it likely I got it during the massage. The cuts were tiny, 1-2 mm, and it looked more as if I had scraped my hand.

I know your assessment might not change at all despite a small cut that bled on my hand and the addition of a sore throat as a symptom (although still no fever) since it is technically early for ARS symptoms to begin showing, but again I'd just thought I'd throw it out there.

I'll put in in an easy question form in the event you do feel like answering. 1) Would the fact that my scratch was bleeding at the time change your assessment of the risk (again massessuese was fully clothed and I did not touch her fluids - unless it was through clothes - and did not notice any blood on her hands, although I was not looking for it specifically) 2) Would this sore throat, plus the other "symptoms" I have still be considered too early and not consistent with ARS? 3) testing is still not needed or warranted.

In any case, this gives me the chance to thank you again and wish you happy holidays.

Response from Dr. Frascino

Hi,

1. My assessment, as anticipated, remains completely unchanged!

2. Yes.

3. Correct!

Stop worrying. You are just fine and dandy, OK?

Happy Healthy Holidays!

Dr. Bob

Early ARS symptoms? Dec 16, 2009

Dr. Bob:

I submitted this question before but thought I'd take a different angle because of recent developments. Went to a massage parlor late last week and got a full body massage, and then at the end she gave me a handjob. The masseuse was clothed during the entire massage and I never touched her skin (except maybe for an ankle, or something minor like that).

I wouldn't even be worrying about this except after I left and went home, I found a few tiny scratches on the back of my hand not more than a few millemeters long. They weren'y bleeding but looked fresh leading me to believe the massage might have caused it.

I know this is essentially a no-risk situation for me, but I've also been getting a few "symptoms"that made me doubt myself. My arms have been sore leading me to believe that I have sore lymph nodes in my armpits (although how can you tell exactly?) Also I've had an irritation in my groin, although it comes and goes with one side usually bothering me more. Also, it doesn't always seem consistent, and I've had it for a few weeks. Finally, I think I've had a sore lymph node in my neck for a few weeks as well, but only on one side, which I've tried to reason has to do with an possible ear infection for me.

However, the night before last I had a bout with diahrrea although it seems only to have been a one-time occurence. I also woke up twice during the night with night sweats, although they were not somewhat mild and not drenching (hair was sweaty but not shirt)

Then last night, I was nauseous (sp?) and ended up throwing up, but then a little bit later was able to eat without any repeat occurrence or feeling of nausea. I had a big lunch before and so was hoping that I ate too much or just had something that didn't settle right with me, or perhaps I just caught a simple stomach virus from the night before when I had the diahrrea.

Again, I wouldn't be worried with any one of these occurences. However, having them all about the same time and checking the archives and noting the "symptoms" for ARS from previous posts, it has me worried a little worried.

So I guess my questions would be: (1) the risk for this type of situation is essentially nonexistent (using your words), correct? (2)even if there were a risk, its too early for me to begin exhibiting ARS symptoms and/or (3) the symptoms are not consistent with ARS, correct? (4) would you even recommend testing for something like this?

I'm sorry to keep pelting you with questions since I know you're busy but these last few things I mentioned have made me worry. You're a great help and I've already made a donation.

Response from Dr. Frascino

Hello,

"I know this is essentially a no-risk situation . . . ." I absolutely agree, except you can leave off the "essentially" part!

Your "symptoms" are not at all worrisome for HIV acute retroviral syndrome (ARS).

To address your specific questions:

1. Nonexistent! Period.

2. ARS symptoms generally become manifest two to three weeks after primary HIV infection.

3. Correct.

4. Nope!

Thanks for your tax-deductible donation to The Robert James Frascino AIDS Foundation (www.concertedeffort.org). It's warmly appreciated.

Happy Health Holidays. Stop worrying!

Dr. Bob



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