Re: Critical question (follow up)
Feb 21, 2010
Hello Dr. Bob,
Thank you so much for your always uplifting answers. Just receiving a reply from you makes me uplifted and happy. Indeed what Bernard Shaw said is enlightening, I'm still grasping the full meaning. One thing I think it entails is how to start an activity where I give and not receive. Something of service to the community around me. I'm up to something and will keep you posted once I have it all figured out.
A small note: actually it is my psychiatrist who prescribed the mentioned medications not my HIV specialist. The reason I asked you is that I think the interaction between Sertraline and Lamictal is not known to my doctor, I have printed the scientific articles concerning the topic and I will bring it to his attention during my next visit in 2 weeks. But it is your own opinion that I was after, I believe that the intuition of a professional like you about the data is so important (never min your answer being boring, it never is!!) :-)
As for the pseudo-straight dudes, it is clear they are not lawn dart straight as you say :-) what bugs me most about them is their internal struggle which they try to hide, but I can so clearly see. It is good to be at peace with oneself, I feel sorry for them, with compassion not with repulsiveness. You know what I mean :-)
All the best and lots of love!
Response from Dr. Frascino
Thanks for your thanks! Bringing the information to your psychiatrist is a good idea. As I mentioned, the drug-drug interactions are complex, can be dose related and can have other factors involved as well. I didn't think my response would bore you, but rather the other readers of the forum!
The pseudo-straight dudes do indeed have internal struggles. Remember, coming out is a process, and some of these guys are so far in the closet they are hiding behind mohair sweaters, platform shoes and jackets with Nehru collars. Personally, I think closets are health hazards!
Be well. Let me know what your psychiatrist decides, OK?
Critical question Feb 19, 2010
Hello Dr. Bob,
It has been a while since I asked a question. It might not be the right place to ask, but your advise is always excellent, so I might ask here since the mental health forum is no more.
I have HIV since 2005, and currently taking boosted Tilzir and Truvada. I also have bipolar and ADHD. For both I'm on Lamictal, amisulpride and concerta (low dose). For a few months now I have been suffering from a persistent depression and finally talked about it with my doctor who decided to put me on Zoloft (low dose) and take a cautious approach to see if this works and that it won't throw me into mania like I suffered before on SSRIs prior to taking a mood stabilizer. She also (my doctor) increased my Lamictal dose to counter the Sertraline effects, but I have doubts about the dose increase.
There have been scattered reports online on interactions between Sertraline and Lamotrigin causing the former to increase the blood levels of the latter, significantly. I failed to find credible resources on the issue though. Do you think I should increase the lamictal dose, or is the suspected boosting effect of sertraline (25mg) enough under the current dose (300mg Lamictal)?
If this question is hard for you to give a definitive answer on, just let me know and I will try to find an answer elsewhere.
Finally, I still look up to you and value you as a person so highly. My aspiration is to someday be able to live with HIV so positively as you do! I'm perfectly fine despite the current depression, but I look at you and say "hell, that lad must be constantly on crack" :-) love you doc!
btw, why on earth do seemingly straight men find me attractive? I look seriously manly, wtf is going on?!!!! Last incident, a work colleague who has a girlfriend and is theoretically heterosexual, attacked me with a french kiss in a party!!!! wtf! I'm bisexual so thats welcomed, but is there something wrong with straight men these days? is it too much hormones in chicken? :-))
to all bisexuals out there, I used to have safe sex with men and unsafe sex with women, and never failed to do so. When that long term girlfriend called me to say she was HIV positive and have been for at least 4 years, I got tested and voila! a girl has given me HIV and not a man :-) So to all you idiots out there, it is never safe to have unsafe sex!
Response from Dr. Frascino
As you have discovered from your initial research, there are indeed some drug-drug interactions for your current combination of medications. Without knowing your exact dosages and a bit more about what other prescription and nonprescription drugs you are taking, it's difficult for me to give you a very specific response. I started to elaborate on the potential drug-drug interactions and their consequences; however, the response was getting too long, detailed (and boring). Plus, not all of it would apply to you. So I came up with a better idea. You should see a psychiatrist (M.D.). I know your depression, bipolar disorder and ADHD may be in reasonably good control at this time, however, I'm suggesting you see a psychiatrist primarily because they are best at juggling these drugs. You basically need a psycho-pharmacologist! A good shrink would be best. He may need to look up interactions with your antiretrovirals, but that's far easier than an HIV specialist trying to manage a handful of psychotropic drugs.
Next, as for being positive about being positive, well, I take my cues from George Bernard Shaw. (See below.)
Next, why are seemingly straight men hitting on you? That's easy. First, these seemingly straight dudes aren't really as straight as a lawn dart. Second, you're a "seriously manly" hottie!! Woof!
Finally, thank you for sharing the story of how HIV found you. It's an important lesson that far too many guys fail to learn until they too wind up virally enhanced.
Be well M. And thanks for your kind comments!
A reality you and i face everyday (BEING POSITIVE ABOUT BEING POSITIVE) Jan 2, 2009
Dr Bob, From the forum i have found that you are a person who has taken hiv and life in the same stride and lived it to the full! I am proud of you and i am sure so are many of the readers! But i was diagnosed just recently, a week before and i am an immigrant student who just got a job in engineering industry in the midst of this terrible economy! How do i make sense of everything? I mean first of all i need to convince myself that i didnt let my parents down by spending half a grand on education and now that i have a job to start in this poor economy, i also have a disease to deal with! How do i convince myself?What do i tell myself? How do i face myself in the mirror? And ofcourse what do i do to make sure that i go on living as the rest of us do without suffering since i think thats the most fitting reply to the world, "that i can live life just like you without being hindered by a stupid disease"?
Thank you and wish you a very happy new yr, Andy(not my real name)
Response from Dr. Frascino
"We" are not alone. Remember there are over 33,000,000 of us currently on this planet cohabitating with this unwanted intruder. Each of us has our own unique story of how HIV screwed up our life's plans.
1. How do you make sense of everything? Well, not everything "makes sense." Remember life, love, sex and illness are all essentially unscheduled events! Using a game of cares as an analogy: You may not be able to change the hand you've been dealt; however, how you choose to play the cards is totally up to you. I'd suggest you begin by reading the information in the "Just Diagnosed" chapter that can be found on The Body's homepage under the Quick links heading. Take control of your situation. Don't let your situation control you. (See below.)
2. Regarding your parents, this is not their problem. It's yours. Certainly they will be disappointed and probably scared. You need to gain control and perspective on your new reality before you'll be able to give others a proper perspective on being "virally enhanced."
3. How do you face yourself in the mirror? I'd suggest doing so with open eyes, a clear head, and an optimistic attitude.
4. Focus on living well with HIV, not on being ill or suffering with HIV. Get informed. Work with a knowledgeable and compassionate HIV physician specialist. Build a strong support system. Read through the information on this site and in the archives of this forum. There you will find many courageous and inspiring testimonials.
I'm here if you need me, OK?
Be well! (I mean that!)
What is your secret? Jul 10, 2005
Dear Dr. Bob, Can you tell me how you keep such a positive attitude? Your upbeat attitude shows in your answers on this website. I have been positive 13 yrs. and have gone from very bad health to right now my viral load under 200 and cd4 201. These numbers are better than I have ever had, but I still feel awful and have many bad health issues going on. I cannot work which I hate and recently I have become hateful to my partner, family and everyone around me. I had unsafe sex one time 13 yrs ago due to a breakup with my partner after 7 yrs and became infected. We are together now and July will be our 22 anniversary. He does not have hiv. I was tested before we got back together. I also have the support of my entire family and all my friends. What is wrong with me? I do not want to fight this anymore. Don't worry I am not going to do anything stupid to hurt myself. I am just ready to stop treatment altogether. I have read you bio and know how you got hiv and just wondered how you are so upbeat. You should sell the secret. You were helping someone and got infected and I was upset about my break-up and got drunk and got it. I guess I have not gotten over my guilt or should I have a swift kick in the butt and be told to get over it. I have taken up enough of your time, but would appreciate your answer. You are a wonderful person for all you do for people. Thank you and bless you.
Response from Dr. Frascino
How do I stay positive about being positive??? Hmmm . . . well, I truly believe life is not measured by the number of breaths we take, but by the moments that take our breath away. I guess I've been lucky enough to have had (and continue to have) more than my fair share of those moments. I don't have a "secret," but rather a philosophy on life. I'll post a couple of responses from the archives in which I've addressed this question, OK? Interestingly, the first two I pulled up both use one of my favorite George Bernard Shaw quotes. I guess it bears repeating.
I wish you peace and health.
I love your smile. Apr 18, 2005
Hey Doc. I had a question to ask you about insertive oral but i have read through the archives enough to realize you have said all you need to say about this. Anyway i couldn't help but wonder how you keep such a great disposition on life. I mean come on dude you seem happy and funny all of the time. I think the main thing i have learned from you is that no matter what happens keep on keeping on and dont let life get you down until your 6 feet under.You have changed my perception of role models from athletes to people who have to face maybe the harshest disease ever. I hope you are around for a long time and continue to let that vivid personality of yours shine.PS i am not gay but you are my man. Holler at your boy>
Response from Dr. Frascino
I see no reason to holler. Rather, I'll just give a quote from George Bernard Shaw that reflects my positive attitude on being positively positive.
"This is the true joy in life, the being used for a purpose recognized by yourself as a mighty one. The being a force of nature instead of a feverish, selfish little clod of ailments and grievances complaining that the world will not devote itself to making you happy . . . . Life is no brief candle for me. It is a sort of splendid torch which I have got hold of for the moment, and I want to make it burn as brightly as possible before handing it on to future generations."
-- George Bernard Shaw
Dr. Bob, What about you? Sep 6, 2004
Hello Dr. Bob,
I want to start by simply saying thank you for all of the work that you do each day on this site. You bring so much comfort and knowledge to people. You are a very compassionate and caring man.
Perhaps it doesn't surprise you that we (your devote fans) are just as caring and concerned about you. Some of us can't help but wonder how you are doing with this disease. What is your status in terms of viral load and CD4? How do you find strength each day to go on? and what can we do for you to help you with this very trying time in your life?
You do not have to answer this if you do not want to. We just simply want to know about someone we love. And I mean that Dr. Bob.
Your Friend Always William
Response from Dr. Frascino
What a pleasure to read a question that isn't self-centered and related to a lap dance from a bisexual cross-dressing transsexual Mormon midget! There were so many of those types of questions coming in from New York City last week ahhh, the fools and fanatics of the GOP Convention!!!
The best word for my viral load and CD4 count at the moment would be "stable." How am I doing with the disease? Well, according to the statistics at the time the virus found me in January of 1991, I shouldn't even be here, so I'd say I'm doing quite well. Sure, at times I feel as though I'm living on borrowed time. As I've said before, I really do believe we measure life in the wrong dimension. A life shouldn't be measured merely in length, but rather in depth. In many ways, perhaps because of HIV and the depth of my experiences, I've never felt more alive.
I won't say that cohabitating with HIV is easy. It's not. The drugs that keep me alive are science's classic double-edged sword causing not only great benefits but also some not-so-great side effects. At times I can be so exhausted I need to take a nap before going to bed. Once asleep, I can sometimes have my very own version of a "wet dream," a drenching night sweat that has, on occasion, made me wonder if I should wear a lifejacket and flippers to bed. At times I look at our linen closet and refrigerator, and see that it's now decorated in "nouveau pharmacy" style. Mack trucks deliver my medications in Godzilla-sized containers. Like so many other virally enhanced folks, I've had my fair share of HIV-related complications, but I see no point in dwelling on them. In life, as in playing cards, you can't choose the cards you are dealt, but you can definitely choose how to play these cares. Perhaps that's the real secret of living well on borrowed time. I also freely admit having Steve (Dr. Steve in The Body's Tratamientos Forum) to share life, love, sex, and other unscheduled events makes me the luckiest guy on the planet.
Here is my two-rule manifesto for living well with HIV:
1. "This is the true joy in life, the being used for a purpose recognized by yourself as a mighty one. The being a force of nature instead of a feverish, selfish little clod of ailments and grievances complaining that the world will not devote itself to making you happy . . . . Life is no brief candle for me. It is a sort of splendid torch which I have got hold of for the moment, and I want to make it burn as brightly as possible before handing it on to future generations." George Bernard Shaw
2. Always remember the wise advice of rule number 1.
Thanks for your concern and friendship, William. I find that compassion and generosity, when freely given to those in need, is returned a thousand fold.
Stay well, William.
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