My new pill: Efavirenz

So it has been five days since I started drinking my new medicine, Efavirenz. Which side effects include insomnia, sleep deprivation, depression, vivid dreams, paranoia, mania and suicidal thoughts, dizziness, impaired concentration, confusion and anxiety... All of which I've already been through in the past, so I guess this will be just a breeze to me. Although on my first day, I really felt the dizziness effect, I was so dizzy that I couldn't even stand, that was within the first few hours of drinking my first pill. Then the next day, when I was about to go to work, I can still feel the side-effect of the drug, which was dizziness, it went on until I arrived at work and while I was working. As the days go by, the dizziness effect started to be tolerable, or because I have been expecting it to happen so I am already mentally prepared for it. However, the other day, I was on my way home and I was caught outside within the time I need to take Efavirenz, so I did. I felt so dizzy that while I was walking up the stairs of my building, I almost fell and it took me almost 10 minutes to arrive at my unit. That's why I need to be home before the time I take that pill. So far, no vivid dreams, but I am anticipating it. That's why I watch a lot of anime before I go to sleep.

Do you remember or know the feeling of getting so drunk that you cannot almost text right and your speech is slurred? You're so drunk that your motor skills get affected so much you cannot walk right? That is how Efavirenz affects me. Well, it gets better everyday, tolerable.

I take Efavirenz once a day together with Lamivudine/Zidovudine which is taken twice a day. I still feel weak these days, or it is because of me being overweight. During my stay in the H4 Ward during my confinement, my lungs were discovered to be already inflamed due to smoking and being already too sensitive to irritants, well I haven't been smoking since I took my first ARV pill which was more than a month ago. Also, my heart is already weak, so I have to minimize my bad fat intake and start doing mild cardio workouts. People living with HIV must take care on working out not to stress themselves too much and the workouts must be on a progressive process so that the body won't be surprised with the sudden activity. Last time I tried doing cardio during my ARV trial, I got sick. I can feel my body weaken, perhaps because of all the toxicity of the pills I have been taking. Well, I just have to live with it.

Confined in San Lazaro Hospital H4 Ward (part 2)

Part 1 here 

DAY 3 - Sunday, my 3rd night in the hospital, was very emotional for me. Dad's wife showed concern by coming to the hospital to see me, which she rarely does, well, she rarely see me anyway; this time she did. Anne's entire family came to the hospital to visit me, all of them cooked something for me. Angel, went to visit me with a bag full of cheesecakes and beef tenderloin in mushroom sauce. Anne's ex-boyfriend's family and friends came to see me too; which was very unexpected and we were all wondering how did they find out. We had a little feast on my bed that day, it went on until early evening. Every caught up with one another and Angel met Anne's family for the first time. It was a wonderful night indeed. I was very full, and sleepy after all that eating. Angel stayed after everyone went home. He stayed and we talked for a while, all the while he held my hand and showed me how much he cared and how he dearly misses me. I missed him too.

DAY 4 - Monday, early morning, Fred (one of my exes), came by to see me before he gets his blood extracted for his 3rd CD4 count. He bought someone along with him, a friend of his whom I met in one of his birthday parties in the past, he is also a PLHIV now. After Fred went to the SACCL clinic for his blood extraction, doctors came to do their rounds. One of the more tenured doctor ordered Wiggly#1 and #2 to be transferred to the male ward because they have fever, while Rico, and Marsha to be transferred to the female ward. The goals is to have all patients with fever in one room and those without to another. Good thing I didn't have any fever on that day anymore. So there we were; me, Rico, Marsha, bikiniboy and the female OFW all in one room. Rico and bikiniboy were already close, so as Rico and Marsha. I asked dad to bring my Monopoly board game so I can play with my roommates to get rid of boredom. So we did play monopoly; Rico, Marsha, bikiniboy, and Rico's older brother. We started late afternoon and until the early evening, we played on bikiniboy's bed while we drag our IV stands along. Everyone was so excited and noisy that some of the nurses had to come by to our room to hush us down. My dad had to interrupt us several times because we weren't eating at all; we were so all into the game. So we had our dinner (food ration) together using bikiniboy's table and everyone sat and ate together. After eating, it was already 8 PM, just in time for everyone's medicines. My dad went home, and after a while the nurse came by to inject diphenhydramine on my IV tube. At first, as the drug goes into my veins and I felt a jolt of pain in my arms, but I felt all light and funny after a short while, and I dozed off.

THE CHARACTERS I MET

Rico - an OFW, he said he thinks he got the virus while he was in the middle east and doing sidelines as boy-for-pay because he needed the extra money. He entered some bikini open contests locally, that's where he met bikiniboy. The two had a thing in the past. He also told me that he is seeing someone lately and that guy doesn't know he is a carrier. I told him to better tell the guy as soon as he can before things get too deep. I told him that if the guy accepts as what he is right now, that he must be truly sincere in his intentions. So Rico did tell the guy the same day I told him so. The guy he is seeing went to visit him in the hospital and they talked. So after a while, Rico introduced the guy to us as his boyfriend, the two were all flirting inside our room. Rico then asked his new boyfriend what if he gets infected because the condom broke? His boyfriend told him it is okay to be infected by him because he loves him so much. Okay wait..! I thought I did not hear that statement correctly! Yes I did, that is just fuckin' stupid! Why would anyone be so foolish to have a mindset like that? It is okay to be infected by the one you love? Don't you love your own life? Fine, it may be selfless, but didn't he already see what are we going through? That same mindset, I think, is one very careless way to be infected and die! 

Bikiniboy - Is from the province. we call him "contesera" because he joins one bikini contest after another, and that is all he does. His mom sells food in construction sites and on the streets and they have a little sari-sari store. He has several siblings and his ex-boyfriend who is also a PLHIV lives with them; who watches over the store and his siblings. He has pretty eyes, and that's it. You don't want to hear him talk because of his provincial accent and annoying high pitched voice, but he's nice.

Wiggly#1 - A young lad from the province, he's around 21 or 22, I think, I can vaguely remember his age. He was fragile looking because he was so thin and his skin became dark because of the ARVs. He has a sharp nose and deep set eyes, he has the facial features that would have that piercing look. He's almost as tall as me. His parents never knew he has HIV until the day he got sick. So sick he almost couldn't walk anymore and has several infections including UTI. Wiggly#1 often gets fever attacks during the early evening and at dawn. He chills so much it scares the hell out of out me. They even need a lamp to warm him up and wrap up in plastic bags to make him sweat then wrap him in several layers of blankets. As the days go by I notice his eyes turn yellow, and the nurses told them that an option to be transfered to the ICU was open for wiggly#1, I saw tears of devastation came out from his mom's eyes.

Wiggly#2 - 20 years old, a very bright boy. All he does when he was not having fever attacks was to read books, not novels, but science books. I have the impression that this boy is a geek. I got to talk to his mom one day and she said his son finished college ahead of his peers, he was a scholar from highschool through college and was a teacher by profession. He was one of the youngest teachers to ever taught in the school (name not to be mentioned anymore). He had to quit teaching when he got sick, he was planning to be a professor one day, because all he wanted was to teach; his mother told me. The mother only knew of his condition when he got so sick, but wiggly#2 already knew he has HIV way back, he just kept it all by himself and he never asked for treatment, until it got worse.

Wiggly#3 - 25 years old, from the outsourcing industry who quit his job because he cannot work anymore, he's just too sick. His mother only knew of his condition when he got hospitalized. Wiggly#3 never knew he has HIV until he was confined to a hospital near their place and the doctors don't know what to do anymore, so they asked him if he wants to have an HIV test, because the medicines weren't working at all. He tested positive, he was then asked to transfer to San Lazaro Hospital. There, they found out he only has a CD4 count of 10. He's the middle child amongst 7 siblings, his mom is the one with him in the hospital. He has pneumonia, his fever almost never goes away, and he is already becoming all skin and bones.

The female OFW - She's pregnant with a baby she never wanted. She was working in Malaysia when she was raped. It was how she got the virus and got pregnant. All the while, her relatives thought she was still in Malaysia, working. She's in hiding right now, because she can't face her family in her present condition. Her husband is taking care of her as she recovers.

Alexis - Was already in the H4 ward for two years. He was already skin and bones when I saw him, and he looked so fragile that a mere touch might seem to break him apart. He always sleep on his side facing the wall. He always wears a sando and pair of boxers. They say that he was confined for 9 months the first time, it was then he knew he has HIV, he began to lose his sight until he got completely blind, one complication of HIV. He is back in the hospital because he was bleeding through his stool. his mom and nephew diligently watches over him. I saw Alexis' face for the first time while I was talking to his mom. He almost just a skull, he obviously has nice facial features in spite of all the wasting that occurred. He has a dominant jaw line and high cheekbones with a very sharp bridged nose. I wanted to look at his eyes, but I was too scared to do so.

Marsha - I got his attention when I played Donna Cruz's hit "Kapag Tumibok Ang Puso". He just stood up and went dancing to the exact dance steps of that song! I was laughing my ass off while watching him, he was so full of energy! After he danced, he grabbed a broom and started cleaning the whole room. He was still in the male ward when I first met him. He is just so full of life, he's so funny that he makes everyone burst out laughing. He is the only one who can make wiggly#3 laugh so hard he almost fell out of his bed laughing. He has the typical "pa-girl" type attitude and lines that makes everyone around him light-up and laugh. He is no longer a cross dresser anymore 'though. He has a sister who is a tomboy, so the two of them literally switched genders. He is also strong, in every sense of the word. With his IV still attached to his wrist, he cleans the room, cleans the rest room, if there's no water in the restroom, he gets water from outside all by himself. He was even able to fix the female ward's ceiling with a hammer. When he transferred from the male ward to the female ward where I was at, he even carried the wall fan from his old bed to his new bed, and he installed it all by himself. Marsha, was already there for two months because of a fungi in his brain. He had a Lumbar Tab procedure done to get spinal fluids to be cultured and find out if the medicines were able to eliminate the fungi. The lumbar tap procedure was done in the ward and everybody watched, including me of course. It was scary, the doctor drilled a hole to his spine! and we all saw how the clear spinal fluid was dripping into a small glass bottle. After the procedure, Marsha was told not to move and eat for 8 hours. We were all worried. After several hours, Marsha was very quiet, we were worried, until... He talked in a husky voice and requested for Donna Cruz's Kapag Tumibok Ang Puso to be played, so I did. While I was playing the requested song in full volume through my phone, he was dancing along to the song while he was lying in bed and with his eyes closed! We all smiled and said "he's okay and back to normal". After a while he yelled for the nurse and said "Pabilisin niyo ang oras! nagugutom na ako!" We all laughed and said, welcome back Marsha, you are indeed fine and well. The said procedure is so dangerous that he is the only living survivor of it, it was already his second lumbar tab procedure. The others who underwent such a procedure weren't able to survive, after it; they just stopped taking, responding, functioning, and they eventually die.

THE EXPERIENCE

The male ward where the wiggly boys are, is what I call the fever ward; because everyone in there have severe fever. During late nights, that room seemed to be a greenhouse with yellow lights focused on giant cocoons of wiggling worms. All of them are shivering in their beds at the same time they seem to have a choreographed dance number. They seem to do a wiggle dance every night, they all looked like giant worms wrapped in cocoons 'though. They may look funny, but they are dangerously ill.

The picture below was taken by me after bikiniboy cleaned our restroom, because before, we have to cross to the other room just to use the restroom. Bikiniboy then decided to just open up the locked restroom in our room (the female ward) that says "Out of order" and check out why it is out of order. I had a Lysol cleaner with me and Rico asked his older brother to buy muriatic acid. Bikiniboy spent more than an hour cleaning the restroom, and he found out that the only thing wrong there was the faucet. So we asked for the plumber to come over and fix it, he was able to, but the water just wouldn't flow as fast as in the other restrooms. We just have to live with it. We have the cleanest restroom in the whole H4 ward 'though. So because we have the cleanest restroom in the whole ward, Marsha did not want just anyone to use it. So he posted a sign as you see in the picture below.
I had a great time in the hospital. The female OFW, Rico, Bikiniboy, and Marsha and me... We all ate together, laugh together, play cards together, share our stories with each other. I've met a lot of interesting characters, and seen different faces of HIV that I only see in photographs. I saw different Opportunistic Infections, specially the scary ones. I met the nicest nurses and had a great laugh with Marsha's antics! The female ward eventually became the Becky Ward! Our usual routine was breakfast, shower, then sleep, lunch, sleep, afternoon monopoly and card games, dinner, meds, sleep. Sometimes Anne's dad, Angel, or Rico's mom or brother would bring lots of food to share with everyone, so we give away our food rations to the other "bantays" who cannot afford to eat. On most nights, since the female ward became the becky ward, nurses would often go to our room to hush us down. There was even one incident that we were so noisy that the guard came to our room and told us the the noisy ones will be escorted outside the ward... Yeah right! Whatever! Female OFW never went out of her bed except when going to the rest room, but when we were already becoming noisy and were having fun, she joined in and started walking around too! She too became so noisy the nurses had to tell her to quiet down. Everyone in the room got well, so well, that me, Rico, and bikiniboy got discharged on the same day. While female OFW was told she needs only one last blood transfusion and she will be released. Marsha on the other hand needs to stay because he needs to wait for the results of his spinal fluid culture.

I technically spent 6 days in the H4 ward. It was an experience worth remembering, but I don't want to be confined ever again.

Thank you so much to everyone who visited, gave food, brought books, made me laugh, bought laptops and MP3s players, and those who pleasantly surprised me. I appreciate all your efforts, thank you so much!

Confined in San Lazaro Hospital H4 Ward (part 1)

It was August 3, morning, Wednesday. I was on my way to San Lazaro from work, when I started to feel unusually tired. When I arrived in San Lazaro to have some lab work done, I was already feeling weak, so weak that I could barely walk far. I decided to go to the H4 ward to have a temperature check or perhaps an impromptu check-up, but all my vital signs were normal, so the nurses told me to go home and take a rest; so I did. In the train, I was so weak I can barely hold tight on the metal bars for support or even on the over head bars. Good thing I was able to find myself a seat. I was able to go home safely that day. A few hours after I arrived home, my fever shot up to 40 degrees. I called up the ward to tell them what happened and what to do. They told me to take paracetamol tablets. The next day was my check-up; so I'll have everything checked on that day.

Check-up day came, August 4, 2011. I was feeling a bit better, dad drove me to the hospital that morning. My fever was intermittently high on some hours and I have to take paracetamol for it to go down. I was inside the car the whole time because I was so weak to even sit on the plastic chairs in front of the ward. When it was my turn to be checked, the doctor asked me if I wanted to be confined, I said no. Although he warned me that anytime that I feel something else aside from the fever, I need to be confined right away, the doctor also told me to observe anything unusual so we can determine what causes the fever.

August 5, 2011, I woke up in the morning and saw my arms with bright red spots. I told my dad who then just arrived from the market. He told me to pack my things, I am going to be admitted. While we were in the car, I started informing people that matters that I am going to be confined. Everybody responded with well wishes. I was soon to know who will visit. When we arrived at the hospital, the doctors were on lunch, so we have to wait a couple of minutes more. My fever started to get high again so I was shivering at the ward's lobby, I laid myself down on one of the benches and slept. My name was called after some time, and a wheelchair was waiting for me to take me to the doctor's office. I told the doctor I am ready to be admitted, so the doctor arranged all the needed documents. A bed in the female ward was prepared for me along with other male patients who were just kids. The only female patient in that room was a pregnant girl. we'll call her Female OFW.

DAY 1 - It was my first time to be confined in a public hospital. This is better than nothing at all, I cannot afford to to be in the pay-ward anyway. I was put in the female ward, with only 1 female patient and with three males; all three were in their early twenties. The room was around 50 square feet with green walls and screened windows. There were 5 beds that were made of old hospital metal frames and some foams already have cracked because of age. My bed was the one with the cracked foam and was at the very end of the row of beds. At my right was a kid with both of his parents at his side who frequently has severe fever attacks at night, let's call him wiggly#1. On my left is a small space where some stuff are stored a bit further down and was Female OFW's bed, and at the foot of my bed is bikiniboy, the twenty something provincial lad who was confined because his body reacted violently to Nevirapine. At my far right was a twenty year old someone from somewhere in NCR, let's call him wiggly#2. While my dad was at the mall shopping for supplies I need. A friend from work who lives nearby was the first one to visit me with her boyfriend. We had a little chitchat and we caught up with some stuff at work and about her kid. She helped me settle down some of my stuff I brought with me. My dad came back in the room late afternoon and my friend and her boyfriend had to go, we had fun catching up. My mom came late afternoon and I told her to have dinner with my dad. While the two were away I was left alone on my bed, half asleep, when the mother of wiggly#2 told me that I was bleeding. I looked at my hand and saw a fountain of smooth flowing blood gushing out of my wrist. My IV tube went out, thus, the bleeding. The blood was gushing out so fast that almost half of the bed-sheet got wet of blood. Infairness, I was at awe on how much blood gushed out and how beautiful the flow was that I almost did not bother to stop it from bleeding. The next thing I knew was that my hand was full of fresh, warm blood, and so as the sheets. The nurse came and and immediately wore his gloves, took the paper towels at my stainless steel desk and stopped it from bleeding. Half of my bed was full of paper towels because I have to pat it dry. My IV tube was then transfered to my right wrist. Anne, my best friend was the one who was with me on my first night in the hospital. I asked my dad to go home and take a rest. Anne was very diligent on checking my temperature and wiping my back and changing my clothes. I never knew she would do it, not until that day. She bought DVDs and a player with her. So after watching a flick, we slept. She was not able to slept soundly because I kept on coughing and moving around all night and I was sweating like a roasting pig with my pink-rashed skin.

DAY 2 - More visitors came by to greet and bring food. Anne's dad dropped by and brought food during lunch time. I also was able to get to know more patients as I my fever goes down and I was able to walk around inside the ward. I was able to talk to a mom of a mid-20-something boy who has a CD4 count of 10, let's call him wiggly#3. Who struck me the most was Alexis, more of him later. Rico, was a former OFW, he was confined at the same day I was and because of high grade fever. There was Marsha, a loud, flamboyant, and very funny gay guy who was already there for more than two months because of a fungi infection in his brain; because of HIV. Wiggly#3, Alexis, Marsha, and Rico were at the room opposite to the female ward, that's the male ward, with a brighter atmosphere and big windows with plenty of fresh air circulating. Marsha, is so loud that he screams when he is in pain or wants attention from everyone. I noticed him when he was yelling... "ANG SAKIT... ANG SAKEEET SAKEEET... NG ULO KO!'. All the nurses came running to his bed and I came to the door of their room to see what the commotion was about. He asked the nurses if there is are pain relievers he can drink to ease his headache, he said "Nurse, may gamot ba?" ...all the nurses said was "wala kaming kumot Marsha eh, wala nang extra". Marsha said, "Aanhin ko ang kumot, kelangan ko ng gamot! Jusko"! I walked back to my bed with a grin on my face. Night of day two, I asked my dad to go home. I am strong enough to take care of myself anyway, even if I have an IV inserted on my wrist. I don't need someone to watch over me at night. So he went home that night and I chatted with the other patients until bed time came.

Part 2 here

My 10th day of ARV trial treatment: The side effects

It has been 10 days since I took my first three pills of ARVs. My cocktail is Nevirapine (200mg) + Lamivudine(150mg)/Zidovudine(300mg). I have been following a very strict hypoallergenic diet, strictly no smoking, and complete sleep all the time. No physical manifestations of the side effects so far, no rashes, no skin redness, etc. There were however some mild side effects that I experienced, like: fatigue, and increased food intake.

I experienced fatigue when I decided to jog for half a kilometer last week. I don't usually get so tired for such an activity, but this is different. After going home from my jog, then taking a shower, resting, etc. I went to bed and woke up late in the afternoon. I can barely get up, I felt so exhausted, my body felt so heavy and tired, I tried standing but my knees seemed too weak. I just stayed in bed all day and had food delivered. I almost crawled just to answer the door when the food delivery guy came. The next day, the same feeling lingered. Although not as worse as the previous day, but I still felt tired and so weak. I can only stand for a few minutes, although I managed to prepare meals for myself. I can get up, and walk around my condo, but I end up on my bed within a few minutes. Next day again, I felt great! I feel energized, like I rested for more than a day. When I went to SLH for my check-up, I told the doctors what happened, and they said it is part of the side effects, I shouldn't have forced myself to jog in the first place; because that activity triggered the side effect.

Nevirapine is only supposed to be taken once a day, everyday at 8am; then after 14 days, it will be taken twice a day, 1 pill at 8 PM and again at 8 AM. Last Friday, while I was in the train on my way to work, while I was listening to the radio through my phone. I wondered, "did I forget something, it's 8:20 PM and I should have taken something". I looked at my phone and for a second or two I realized that the alarm failed! I unzipped my bag and look for the pill container that has Nevirapine, I found the small pink plastic container, opened it up, took a pill and popped it in my mouth as quickly as I can and drank water. After I swallowed the pill, I realized that nothing was wrong, that pill was supposed to be drank the next day at 8 AM not 8 PM. My next pill is at 9 PM, there was no alarm to go off in the first place. So there, since that day moving forward, I have been taking Nevirapine twice a day, no physical side effects so far. So instead of 14 days trial for that pill, it was cut short to 7. I haven't told my doctors yet. Based on what I found out online, the reason why there is a 14 day for Nevirapine is because of its fatal skin rash side effect and to give the body, specially the liver time to adjust to the toxicity. I will report this incident to my doctors this week. It's just common sense, if I accidentally doubled the dosage within the trail period but it will doubled afterwards, I might as well go on with it. Instead of doubling the dose on one day then going back to the normal trial dosage. Its like bringing battle tanks to fight the enemy then withdrawing it and replaced by armed foot soldiers; such lowering of dosage might lead to treatment failure.

For the past two days, I have been awfully drowsy every after lunch at work. Yesterday, after eating lunch (packed lunch) which was not so heavy at all. I felt so sleepy that I just can't help but to tell my teammate that I will be sleeping for a bit. Earlier, I felt so drowsy that I accidentally slept at my workstation. I am yet to know what is causing these incidents. I am never like this at work, not when I have enough sleep.

My first day on ARVs: The beginning of a lifetime.

July 15, 2011, Tuesday. Today is my first day of taking ARVs. I was supposed to finish my shift at 7 AM, but because I have to finish a lot of stuff and I am on Vacation leave for a week, I have to make sure all things are good and everything have been properly endorsed. So I stayed at work until brunch time. It was 7 AM, my phone alarmed telling me it's time to eat. I wandered in our pantry, only to find out it was full of foods that I am not supposed to eat. The nearby McDonald's is definitely a no no because of all the processed meat. I went to Starbucks to check out the sandwiches, all have cheeses in them. I moved on to Seattle's best, all have cheeses in them too! Yesterday I ate there and ordered a pesto pasta and asked the attendant to make sure not to put parmesan on the dish. I then went to two 711s to buy some siopao, and there was none, I was able to buy siopao and a piece of banana from the 3rd 711 store two blocks away from our office building. It took me 20 minutes just to look for something to buy for breakfast or dinner, whatever.

8 AM, my phone alarmed again, I was sitting at my workstation; it's time for Nevirapine. Good thing my water bottle was ready, I took my bag and peeked inside to look for the bottle, I carefully opened it, took a pill and felt it rolling on my fingers. As I felt its texture and played around with it for a little bit, its path on my fingers left a fine white powder. The pill was coarse, rough, big, and fragile. It felt like that I can break it into pieces with just little effort. I popped it in my mouth and gulped a mouthful of water. I felt it go down in me, and I waited for any effect to be felt. almost an hour has gone by, and I was very paranoid.

9 AM, it's time for Lamivudine/Zidovudine. it's a two in one pill, two medicines in one medium sized white pill, that is a little smaller than Nevirapine, and it is smoother and it felt smooth to touch. After gulping it down with water. I waited, and waited. Until I was ready to go home, I felt nothing. I waited a bit outside our office building, sat there for while looking at the sun soaked busy street full of passing taxi cabs, luxury cars, and the hurrying day workers in tight and well pressed office attire. Another hour passed by again, and still, I felt nothing.

I was on my home, in the bus, I felt this rumbling in my stomach. I was hungry. Moments later, I found myself in the cool and long aisles of SM Fairview, doing a little bit of shopping.I ate hungrily at Mang Inasal, I ordered pork barbecue and did not bother to even fix the sauce for it. I had two and a half cups of rice. I was so full, and I went home.

At home, I unpacked all the stuff that I bought, tidied up the plastic bags, took a shower, slept. My dad came knocking on the door around past 4 PM. Asked a few questions on how I was doing, and offered to accompany me to the market, I said not now, I'm very sleepy. We talked for a bit and he went home. I slept again.

My phone alarmed, it was already 7PM, I have to eat. I went down to the nearby canteen and I found porkchops, fried. I ordered a piece and two cups of rice. I went back to my condo, watched cable, then my phone alarmed, it was 9 PM, time for another pill. As I wait for any effects, I went to browse a few stuff online and even checked some important emails and replied to a few correspondents.

As of this writing, it is already 12:04 AM, July 16, Saturday. It has been 16 hours since my first pill, and I still feel nothing significantly noticeable or new. I have a few itchy spots here and there, no redness, no bumps; so it might just be the heat.

HIV/AIDS Management: preparing for ARV treatment (part 3)

Tuesday, July 12, 2011, H4 Ward San Lazaro Hospital, Manila. It was the final day of the ARV treatment counseling. My dad, Jay, and I were all waiting patiently at the ward's entrance. My name was called at around 2 PM, I was the first patient to be counseled. At the table near the back of the doctor's clinic area, awaits 4 doctors. 2 dermatologists; one dermatologist looks like an Indian while the other one is an old Chinese mestizo, the doctor who counseled me who is infectious disease specialist was there, and one of the most tenured doctor in H4 ward who is also an infectious disease specialist took the lead; all were waiting for me. Papers were preparedly piled, booklets as well as handouts. I introduced myself, Jay, and my dad to the lead doctor and we all sat at the other end of the table, me sitting next to the lead doctor. The doctor then told me that this is the final stage of the counseling and we will review what I have learned during the first two sessions, making sure that I already fully understand the processes of HIV treatment. Below are the questions and what I answered as well as few of the discussions.

Lead doctor: What are ARVs for?
Me: They are medicines that inhibit the replication of HIV viruses inside the CD4 cells. There are what we call protease inhibitors and others that blocks the virus from getting the cell's DNA, stopping the virus from replicating itself.
Lead doctor: What are CD4 cells and what they do?
Me: CD4 cells are helper cells, a kind of antibody that tells other antibodies that there are invading bodies inside the system.
Lead doctor: What are the relevance between CD4 cells and HIV?
Me: The HIV virus needs the CD4 cells for it to multiply, as they go inside the cell and replicate, the CD4 cell dies. It goes on and on, repeating the process.
Lead doctor: Name three types of ARVs and one significant side effect of each.
Me: Nevirapine - rashes that may lead to Steven Johnson disease; Efavirenz - dizziness, Lamivudine/Zidovudine - anemia.
Lead doctor: How long are you required to undergo treatment?
Me: For a lifetime.
Lead doctor: What are the purposes of taking ARVs?
Me: To prolong a patient's life, to raise up my CD4 level, to lower a patient's viral load down to undetectable.
Dermatologist 2: What are difference between adherence and conformance?
Me: Conformance is doing what is needed as directed or conforming to what is needed to be done. Adherence is doing what is needed on time.
Dermatologist 2: What are the intervals in-between and taking each type of pill?
Me: 12 hour intervals between each dosage and 1 hour apart for each type.
Dermatologist 2: Name the ARVs and when you are supposed to take it.
Me: Nevirapine once a day at 8pm, Lamivudine/Zidovudine twice a day every 12 hours, so that will be 9pm and 9am.
Dermatologist 2: If you are 30 minutes late in taking your medicines are you going to double the dosage?
Me; No.
Dermatologist 2: Nevirapine will be increased to what dosage and when?
Me: Twice a day 12 hours apart, 8pm and 8am after two weeks of no violent side effects.
Dermatologist 2: Are you depressed?
Me: During the first few weeks of diagnosis of course I was, but I am okay now.
Dermatologist 1: What will be the trigger for you to be confined here?
Me: If there will be rashes or diarrhea or any severe side effect.
Dermatologist 1: Is it okay for you to be confined here?
Me: No.
Dermatologist 2: Are you sexually active?
Me: Not at all.
Dermatologist 2: Were you sexually active?
Me: Not even.
Dermatologist 1: Does your partner know?
Me: When I had one, yes.
Lead doctor: Do you practice safe sex?
Me: I haven't had sex for along time, I'm not active at all, if ever I do, of course I will.
Dermatologist 1: What diet are you practicing, if any?
Me: Yes I am, the hypoallergenic diet, and I was hoping rice would be on the list.
Dermatologist 2: You are overweight. Once you have settled to a particular combination of medicines your next goal is to lose unwanted weight. You are two times prone to heart diseases compared to uninfected obese individuals. Right now, you watch what you eat, be extra careful. No smoking nor drinking.
Me: Is it okay to take glutathione?
Dermatologist 1: For what?
Me: To clean my liver before I take my first pill. I do believe that the medicines are already toxic and may stress the liver.
Dermatologist 1: Its effects aren't clinically proven, so we don't recommend you do it.
Dermatologist 2: If you want to take care of your liver, stop smoking and stop drinking.
Lead doctor: Also, no multivitamins for now and nothing of any type of food and herbal supplements.
Lead doctor: If your CD4 goes up as high as 1000, are you supposed to stop ARVs and why?
Me: No, because the ARV's purpose is to set a block for the HIV and the CD4 cells. If I stop taking ARVs that block or wall will be stopped, enabling the virus to get a hold of a CD4 cell and start replicating again.
Lead doctor: What will happen if you stop taking ARVs at any given time?
Me: The virus might or will develop resistance to the medicines and I may have or will need to take the 2nd line of ARVs.

Those were some of the questions and discussions during the last part of the counseling. I felt like I was in a panel interview or I was a student presenting a report to a panel of professors with my friend and dad as audiences. I was kind of nervous answering their questions, afraid that I may answer a wrong one. I even felt that I was graded! Dermatologist 2, was very strong in his statements and has a strong command of words. Dermatologist 1, was the quiet type, the counselor doctor was quiet the whole time, the lead doctor, she was already my doctor in my previous visits, she has a very strong character.

After the almost hour long discussion and reviews, the lead doctor prepared the papers for enrollment, my enrollment for ARVs, she said delightfully "alright, you are indeed ready to be enrolled". Then dermatologist 2 said "I think you more than ready, you are happy". I replied, "I am very much ready and being happy is my choice. I am even excited to start the treatment!". There were a couple of papers to sign and Jay and my dad has to sign as well, as witnesses. I was given a booklet that looks like a bank passbook, it will record the ARVs I get from the pharmacy. After we signed the papers the lead doctor told us to proceed to the pharmacy and get the medicines. I shook her hand as well as the other doctors and thank them for a wonderful discussion. The three of us then headed out of the ward to get my medicines then off to a late lunch at SM San Lazaro.


Part 1

Part 2

HIV/AIDS Management: preparing for ARV treatment (part 2)

Tuesday, July 05, 2011. I brought my friend Jay to the H4 ward in San Lazaro Hospital as a requirement by my doctor to have another treatment partner aside from my dad. Jay was very supporting and asked questions regarding my treatment and the what nots as well as the what tos. I deeply appreciate his efforts on doing so and coming with me to the hospital.

All my lab results turned out well, except that my blood sugar level was a bit high, so no more extra rice for me. The rest of the lab results were good, including Hepatitis B and Syphilis that turned out non-reactive.

The second session of the counseling was more detailed, because the doctor had to discuss all the medicines from 1st line to the 3rd line one by one, their possible side effects and what to do with each one. Whether I will be needed to be rushed to the hospital or just to let it wait until a particular side effect clears. We also discussed how long I will be doing my weekly check-ups once I start my trial stage of treatment. The weekly check-ups will be once a week, every Thursdays for one to two months. I have to be on leave from work for two weeks so that everything will be observed and anything that may happen will be noticed and will be taken cared of. The pills were also shown to us, the intervals of taking each one were discussed and what the pills look like. The first line of medicines are Lamividine/Zidovidine and Nevirapine.

I also have to be careful on what I eat. The importance of me going on a hypoallergenic diet was also discussed again, just to make sure I understood its importance in the treatment, which I must strictly adhere to. It is important for me to go on a hypoallergenic diet to find out the causes of allergy if ever I will have or may develop one. Also, no more raw foods for me, either vegetables or animals. So goodbye sushi, sashimi, and most types of maki, no rare and medium-rare steaks; hoping all of this is just for now. No more street foods too. All avoidance to certain types of food to be done to prevent me from getting any parasites, fungi, or additional viruses.

Exercise is a must but must be done in moderation, because I cannot get tired. Amount of sleep was also discussed, I must have at least 6 hours of sleep, but it is important to have full 8 hours. It was also reiterated in the discussion that lack of sleep and stress can significantly damage the immune system. The doctor also suggest that I get vaccinated before I start on ARV treatment, making sure I get additional protection.

With a CD4 count of only 295, all measures must be done to protect my already weak immune system. Strict compliance to medical advices is a must.


Part 1

Part 3

HIV/AIDS Management: preparing for ARV treatment (part 1)

First week of June, was my 3rd blood extraction for my 3rd CD4 test. 3rd week of June, I got the result and my CD4 is already at 295 from the previous count of 386. To be diagnosed as someone with AIDS, a person living with HIV must have a CD4 of 200 and below and have at least one Opportunistic Infection (e.g. Pneumonia, TB, etc.). I am already nearing the point of having a CD4 count of 200, plus I am very much prone to Pneumonia, so I am going to start taking ARVs real soon.

Yesterday (June 28, 2011), me and my dad went to San Lazaro Hospital for our ARV counseling as well as to work on my lab tests. I had a long list of lab tests that even the medical technicians at the hospital's lab department were surprised on how much tests my doctor requested. Well those were done and I will get them by next week, Tuesday. Yesterday, the counseling session between me, my dad, and my doctor; started. Topics that were discussed was what ARVs are for, the importance of, the side effects, the benefits and why people living with HIV needs them. My dad was obviously interested on the topics discussed and did ask some questions that I never thought of. Like my sleeping habits, food intake and if there are any food that I cannot eat, and is it okay if I live alone? While I asked about my weight issues and my plans about it.

Regarding my weight, The doctor said to maintain my weight even at my chubbiness level. Any weight loss will be checked if it has any connection to the medicines I will be taking or to the side effects or to the new diet I will be practicing. The doctor also said that I must be happy I have this much fat, most patients are craving to have such built. Regarding food and diet, my doctor has put me on a strict hypoallergenic diet so that when I start taking ARVs and if side effects start to appear, they can immediately rule out food as a cause.

I was also given handouts about ARVs which contain data like the suggested times I need to take them, the intervals between, the side effects and how to deal with them. All are in Tagalog.

About my dad's question about me living alone, the doctor suggests I bring a friend next time who can look after me when my dad is away. Even though my dad lives only 20 minutes away(drive) from my place, and he can always visit and check on me on a daily basis my doctor suggested to have a friend as a backup to check on me whenever needed. I volunteered a very close friend (of more than a decade) of mine as my dad's backup, Jay. The doctor repeatedly said how important it is to have a dependable treatment partner, someone who will monitor my vital stats, every body changes that may happen, and anything that can be related to the cocktail of drugs I will be taking; and someone who will make sure I will take my medicines on time. So, those people are my dad and Jay.

So that's the end of the first ARV counseling session. The second will be next Tuesday and Jay will be with us on that one. Also, next Tuesday, I will be getting the lab results. All 14 of them.


Part 2

Part 3