Dear Carol, I happen to be an MD by training and my partner is on Fuzeon. Since he's not terribly comfortable injecting himself, and since I don't mind doing so, I've been giving him his injections BID for the last couple of years. He's never had an injection site reaction when I administer the shot. When he tries to do it himself, he inevitably has a problem. I am doing NOTHING out of the standard procedure for giving a sub q injection. I don't bother heating the solution. I draw it up, find a pinch of fat, and shoot it in. Then I normally massage the area with the alcohol wipe I used to cleanse the skin before injecting. Again, nothing heroic by any means. I've shown my partner how to do this himself and while I have access to his "love handles" and the fat under his arms, he does not. But he does have ample access to the fat on his belly and upper thighs. Same density of fatty layer (I already thought of that one and checked with calipers to ascertian the thickness of the fatpad in that area.)

I've injected this man several hundred times and never had a reaction. He does it once and gets one. I've made him inject as fast or as slowly as I do. I have taught him how to choose an appropriate spot. I also have shown him how to go in on a 45 degree angle rather than a 90degree angle that some people try to manage. He's learned my technique. I let him practice on me with sterile saline so he could "get the feel" of it.

Can you come up with any ideas of what's different? I cannot see anything myself, but sometimes "fresh eyes' can see more than I can after years of this. Also, I've wondered if it's some bizzare manifestation of a real co-dependant relationship on his part? Maybe he's pulling up these horrid red spots psychologically because he's afraid that I won't be there to take care of him?

Yes, I know that's stretching it a bit... but I'm really frustrated by this situation. I don't mind doing this for him, but I do feel guilty if I'm not home to inject him for a couple of days because I know he's going to have a painful bump or rash. I knew he was a little nuts, but this (if it's indeed psychological) is more than just the standard amout of crazy in my opinion.

M in NYC

Dear M, It seems to me that you are comfortable with the injection technique and he is not. You can't help but wonder if his stress level is not contributing to the reactions. I am not sure physiologically if there is some type of stress-induced reaction going on.

My suggestion is to apply ice to the site before and after the injection. Also use a hand-held massager for at least 5 minutes after the injection. The nodules form if the Fuzeon is not absorbed. Biopsy of nodules showed that there were crystals of the Fuzeon causing the problem. Site rotation is very important. Your partner may need to give the injections regularly to improve his technique and reduce the physiological reaction.

As medical people we want to take care of the ones we love. I understand your feelings. I hope I provided you with some answers. Carol