Hey Dr. Bob,
I am an underweight man in my mid 30's who has been living with the virus since before '99. I am well educated and want to be impowered to make decisions about my care. My blood work has consistently shown low RBCs and high MCVs and MCHs. Based on these results I believe I have a Vitamin B12 deficiency and have repeatedly tried to initiate a dialogue with my doctor about Vitamin B12 injections but he just won't go there. I supplement myself with 1000 mcg. lozenges under the tongue which I hear is the best was to absorb this elusive vitamin. Why are doctors so difficult to communicate with? At work I am used to making proposals using supporting documentation to bolster my case and have been somewhat successful. I make copies of all the supporting documentation to present to my doctor but he just won't do it. I am frustrated that my efforts are not working. I know I am not the only one to have this problem. I am quite busy and don't have time to doctor shop. What is going on here? Is there a secret handshake or safe word I can utter to get him to do this? Its not like I am asking for Oxycotin. Why the hesitancy?
PS Do you have a boyfriend?
First off there are a variety of potential causes of low RBCs and elevated MCVs and MCHs in HIV pozitoids AZT, for example. The only reason to take supplemental vitamin B12 injections (or the new more convenient vitamin B-12 nasal spray, nascobal) is if you are vitamin B12 deficient. This can be determined with a simple blood test.
A bigger problem is your lack of communication with your HIV specialist. Being involved with your health care decisions is crucial; however, dictating what you want your doctor to do based on your research is not such a good idea. It takes years of medical school and post-doctoral training to become qualified as an HIV/AIDS specialist. You need to work cooperatively with a competent, comprehensive and hopefully compassionate HIV specialist with whom you communicate well, even without the secret handshake or secret code words. You may not have time to doctor shop, but in many ways this might be time well spent. You might check with other "virally enhanced" buddies to see how well they get along with their HIV specialists or check with your local AIDS service organization for a referral. The American Academy of HIV Medicine has a Web site that lists HIV specialists by locale (www.aahivm.org).
Finally, do I have a boyfriend? Absofrickinlutely. Thirteen years and counting. He's heaven on a stick! You can check him out right on this Web site. He's Dr. Steve (the HIV expert who runs The Body's Tratamientos forum). I'm the luckiest guy on the planet.