Sunday, July 3, 2011

Starting Medications

It’s just a pill.

Well, in my case, it’s three pills. But still, it is medicine. But why is it imbued with so much emotional debris? That is something I am sorting through as I prepare to go on anti-retroviral treatment at the end of the month.

I have been HIV-positive since March 2007, and I have known since July 17, 2007. I remember, very clearly getting the phone call from my doctor saying I needed to come in right away. It was 3 p.m. in the afternoon and I was meeting with the head of the Lansing Parks Commission about Shakespeare productions we had coming up. He offered to drive me.

When she showed me that paper, I literally went numb. Emotionally and physically. It also triggered off anxiety attacks of epic proportions. Attacks I continue to battle to this day. It was so overwhelming, I could not eat for days. Nothing tasted right. And the idea of being hugged by the loving members of the cast of Julius Caesar -- which I was then directing -- was enough to trigger a panic attack. It took three times the standard does of Lexapro and 10 days to get some emotional stability in my life again so that I could eat. I lost about 15 pounds in the process.

And when I met with the doctors for the first time, I was convinced that I was going to start on the meds right then and there. Why? I was not going to allow the then guidance be my guide because it was structured on a multi-person, multi-year study in which most of the cohort were HIV positive drug or alcohol abusers. The study guidance was created because at 350 of less CD4s that cohort was more likely to experience symptoms which made them more likely to adhere to the strict pill regime necessary to be successful with the medications.

But something funny happened. My blood work was excellent. I had no measurable virus at all. My CD4s were healthy. And this is how it has been for years. So much so, I have come to rely on having healthy CD4s and very low or undetectable virus measures. For four years I have had the tiger by the tail, and was winning the battle.

This year, that has changed. While my blood viral load remains incredibly low (272 3 months ago and 277 in June -- most people who start meds measure their viral loads in tens of thousands or more), by CD4s have crashed. My frontline defenders are so depleted I am at risk of additional infections. It i time to start the medications.

Yet this realization, while rational, has illicited something different by way of emotions. For the first time since I had to normalize the idea that I was HIV positive, I must now normalize the fact that I am infected with a virus that is slowly but surely destroying my immune system. A march which could ultimately kill me if I did not take the chemo-therapy being offered.

And let there be no mistake about it. These medications while certainly life saving, are not a walk in the park. They are heavy duty toxic chemicals with a bevy of horrendous side effects. The medications themselves can be as dangerous and sometimes more so as the virus itself. These are medications that one takes and prepared for requiring access to toilets through out the day. They can cause the pancreas (which regulates insulin and thus blood sugar) to cease working. They can impact the liver, which filters all the waste products from ones blood, by shutting it down completely. They can destroy the nerves on the fringes of the body and they can impact cognitive processes. This is not “taking a pill and everything will be alright” this is scrotched earth warfare -- and the earth of the battlefield is your body.

I don’t now if I am actually ready to start the medication, emotionally anyway. But I will. Because I will be damned if a protien packet surrounding a bit of viral RNA is going to get the best of me.

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