Sunday, October 11, 2009

HIV, Will you get me? Not with the help of ARV's.

So I'm taking ARV's.


Sounds like the latest gas-guzzling 4X4 from Pajero.
Or some super-cool new street drug that with one hit can send you on a round trip through the milky way, with a stopover in Heaven and possible delays in Hell.

But, nope.

ARV's are way cooler than that.

They are anti-retroviral drugs!

They can prevent the contraction of HIV, when a doctor exposes herself to it while she is taking blood, very diligently and gently and with gloves on, from her HIV positive patient who moved during the procedure resulting in the bloody needle piercing her thumb.

No biggy.

This is only like the fourth freaking time this has happened to me.

The first time was when I was a fourth year medical student doing my paediatrics rotation. The poor paediatrics registrar was struggling to gain intravenous access on a very sick neonate with veins smaller than the cannula diameter. I was helping her hold the neonate still while she attempted the procedure for the 20th time. After failing, for the 20th time, and understandably frustrated, she threw the needle into the sharps bin. Except that it didn't make it into the yellow sharps container. Instead I watched, in slow motion, as it did a spectacular somersault through the air and embedded itself, rather painfully, in my thigh.

I was distraught, and upset and got loads of sympathy from family and friends.
I started the ARV's immediately and sweated through the ensuing 28 days, petrified of sero-converting to HIV, and ultimately testing HIV negative. Phew!

That was five years and three similar events ago.

This time I didn't even tell my colleagues until someone saw me squeezing out the blood from my wound. It was near the end of the afternoon shift and I was completely disinterested in myself and my patients. (horror)
But my concerned colleagues forced me to go and open up a hospital folder, have my blood taken and start the ARV's.

So now I'm taking them. twice a day.

These drugs are brilliant, but can result in nasty side effects such as:

Skin Rashes
Bone marrow Suppression
Lactic Acidosis


Luckily I have only suffered mild nausea and muscle pains thus far.

Oh, and I've also suffered at the hands of Dr MB's torturous pranks.

After behaving very sweetly, and drawing my blood very gently, and phoning the laboratory for my initial test results before starting the ARV's...he then stole one of my personal patient stickers from my file, and stuck it into the front room's patient log book along with this made up diagnosis for all to see:

Patient: Dr S

Working diagnosis: Retained foreign body, +/- ?sex toy??


I eventually got my own back though with this entry into the logbook:

Patient: Dr MB

Working diagnosis: ?Haemaphrodite. Vaginal Bleeding, Grade IV prolapsed rectum and dysmorphic buried penis.

Overkill? Maybe.
But that's my style.
I'm ruthless with my retaliations.

I guess that's one way of making fun of a ridiculous situation.

With almost every second patient that we see being HIV positive, it's inevitable that one of us will be accidentally exposed to the virus while trying to treat patients.

It's so common that I don't think I've met one doctor who hasn't been on post-HIV-exposure prophylactic ARV's.

Which is why I keep reminding my husband that he could have married a prostitute, as both doctors and ladies of the night run the risk of contracting HIV from their professions.


MAGUS said...

tat was cool..i'm myself a medico(final yr)n can imagine ur plight!!! once even i had a needle stick injury wid an unidentifiable needle .gosh cldnt sleep for nyts aftr tat!

Spark Star said...

good god!! that was some retaliation!!!! hahaha

Muammil said...

Have you eaten all the vowels off your keyboard? I can't think of any other reason one would decide to simply not use them...

@Dr S
Pajero = one model line produced by Mitsubishi...

MAGUS said...

well thr r a lot f consonants wich r missing 2!lol..

hope its nt tat difficult 2 undrstnd..:)

Muammil said...

I don't even know where to start. Seriously.

femail doc said...

OMG, I would freak out if an HIV+ needle embedded itself in any part of me. Your fourth round of ARVs? What a crazy world you practice in, I only need visit here now and again to quit my bellyaching over any part of my practice.

Ketan said...

Fortunately, I've never had to face this situation up till now!

You're sure squeezing your finger is part of the protocol? I think first thing to be done is to wash away the part with as much soap and water as possible!

I hope with your experiencing only mild side-effects, the potency and bio
availability of your pills is not suspect! ;) Just joking!

And wish you all the best!

Stupidosaur said...

noOne of the reasons I did not go to medicine was that I am not so selfless to risk dangerous diseases for humans or reptiles. Of course there were other reasons too.


Stay well.

Its wonderful that there are things like ARV that prevent HIV contraction.

In 12th Science, I did hear of AZT (a particular kind of ARV i guess) which was touted as miracle cure for HIV when discovered. But then turned out to be very toxic to liver or kidney or something.

That time I was just wondering if ( somewhat like dialysis) we could bring the blood out, treat it with this substance which would beat the living/non living threshold daylight out of the virus, then neutralize this medicine substance and put the blood back in. Liver/Kidney/Such other vital organ totally bypassed!

Of course since even slightest body fluid can still hold loads of this virus, it will still be sticking around all over inside the body. That we can take care of with safer milder doses of ARVs.

Of course the basic premise of this blabber is that once contracted the infection, we cant do much because larger doses of ARV themselves would kill patient before the actual virus can. So we need to 'optimize' between virus and drug hazard. This would keep the virus thriving (though in lesser quantities than without the drug) and then it will get chance to mutate into resistant strain over time.

Instead if we bring the infected blood out of the body, and give the virus a full bam!biff!pow! dose of the drug,outside, without fearing side effects, then patient's system might get cleaned better, and survival prolonged a lot more!

Of course I don't know what we would do with the virus thats already inside the T4 host cells, nicely busy dividing. Maybe by some 'nanotechnology' we can identify and filter those too after bringing the blood out.

I don't know how crazy or practical or easy or difficult or useful or useless this idea is. But its definitely an alternative 'technique' that as far as I have heard, has never been tried out. Maybe research can be done in this direction apart from trying to make vaccines and more effective & less toxic drugs (the techniques that are being pursued)

Anyways its just one of the midday/midnight/anytime dreams that I used to get lulled into during class 12. Your ARV mention brought it all back and I just dumped it.

Now hopefully some researcher will be bloghopping medical blogs and read this and save the world ;)


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