Caving and anti-nauseating

Days three and four: Without a doubt Combivir is causing ongoing nausea, headaches, and muscle aches. They were so bad today that I couldn't nap- I already have some problems with muscle aches in my back, and they have just been exaggerated by side effects. I also have been pretty tired but this could be as a result of either traveling or meds; it's uncertain which. Due to ongoing nausea and a general sensation of blah, I decided to start taking the anti-nausea meds, which I initially was uncertain about taking. Here's what I'm on:

Ondansetron, 4mg orally dissolving tabs, taken 3 times a day in 8 mg doses.

Ondansetron is a serotonin antagonist with a chemical formula of C18H19N3O. Serotonin, most popularly known as the brain's happy happy joy joy chemical, can actually make you vomit your guts out. Here's how (short version): If your digestive system is content, certain cells in your guts, known as enterochromaffin cells, will release serotonin in response to the presence of food. Normally, this serotonin will be absorbed; however, if your guts are filled with bacteria/chemotherapied/stuffed full of anti-retroviral meds, your body will release more serotonin than the body can absorb, and this will activate certain serotonin receptors in the central nervous system, known as 5HT3 receptors, which will cause you to vomit. The anti-nausea med that I am on blocks 5HT3 receptors, meaning that the excess serotonin produced in my body is never detected by my brain. Conclusion: I don't get nauseated and don't throw up, at least for a few hours after taking these meds!
Here's what it looks like:

It's interesting taking the same type of medication that a person undergoing chemotherapy might take, as several members of my family have undergone chemotherapy; it's a strange way to relate to someone (hey- we took the same meds! Wow!), but I am glad for any ability to have more compassion for those around me, even if it is bonding over the funny taste or (in)effectiveness of a particular medicine. This particular med also has several uses outside of nausea relief, which I personally to find pretty interesting and quite unexpected, as these tiny white pills seemed innocuous enough.

Here are some additional (occasionally off-label and controversial) uses of ondansetron:

1)Treatment for alcoholics. Ondansetron has been shown to significantly reduce alcohol cravings, esp. by alcoholics.

Ondansetron: All-American.
2)Bulimia treatment. Ondansetron use reduces urges in young women to binge. Here's a short study about it: Study here!

3)Relief of tardive dyskinesia. Tardive dyskinesia, notoriously hard to treat, results in uncontrolled repetitive movements of the human body, similar to a twitch. Tardive dykinesia is usually induced by long term (or high dose) antipsychotic drug use. After 4 weeks of use, patients that participated in the study received a significant reduction in symptoms of tardive dykinesia.

4)Relief of schizophrenia symptoms. Ondansetron acts on 5-HT3 receptors, which are the same receptors that are involved in development of cognitive impairment associated with schizophrenia and schizophrenia itself. Thus ondansetron may relieve some of the symptoms associated with schizophrenia and the cognitive impairment affiliated with it.

(P.S. Even though I myself am not a paranoid schizophrenic, my handle all through junior high and high school in all chat rooms/icq/irc/Palace/virtual interaction was “Paranoid Schizophrenic Duck Girl.” I went by P.S.D.G. for short. The name came from a comic book featuring Daffy Duck in a therapy session. I cut this comic out of a newspaper and carried it around for years- I only lost it when moving around a lot during college. I still hope to come across it in my stuff one day.)

5)Relief of opiate withdrawal symptoms. Once again, ondansetron acts on 5-HT3 receptors which are associated with the withdrawal symptoms of opiates, although ondansetron itself does not reduce cravings. However, it is the only drug out there right now that can potentially treat withdrawal symptoms that does not itself pose a risk of addiction. For example, a heroin addict treated with methadone may just become addicted to methadone. Let's be honest here- I have dealt with friends that have skipped the other opiate addictions and became addicted to methadone directly. But ondansetron? Not addictive at all because it does not get you high- it just takes away the vomiting.

And all that is just for starters! Turns out this drug has been targeted in many rudimentary studies, and much of the potential use for ondansetron has yet to be fully fleshed out. The future is bright!

Accidental adventures in anti-retrovirals

Well, it’s official- my mom’s worst nightmare about my Peace Corps service has happened! I’ve gone and gotten myself stabbed with a dirty needle in a hospital in West Africa, and now I have to take HIV prophylaxis. What do you know! I remember when I was first applying and was pushing really hard to be placed in Francophone Africa, and hearing all kinds of reactions, a chunk of which directly related to potential HIV exposure. I with full confidence told everyone I would neither get stabbed by any dirty needles nor have sex with any HIV positive people, yet here I am, stabbed!

Don’t freak out, Mom! I am HIV negative and will stay that way, and here’s why! I am taking proper preventative action and will be completing my 30 day course of meds- Ivy Renfro, HIV free and content with that- but I do want to take full advantage of this experience, so I am going to blog about it! I am taking a fixed dose of 150 mg of lamivudine and 300 mg of zidovudine, marketed commercially as COMBIVIR tablets, twice a day for 30 days.

So, what happened? I was working at the Eye Clinic in Ourosogie at the Ourosogie Hospital, sponsored by the NGO Right to Sight and Health based out of US. Basically, a group of American doctors and nurses come to Senegal to perform cataract surgeries, distribute glasses, and teach local doctors improved cataract surgery techniques. A woman needed to be taken to her hospital room. Myself, Nic, and her son were put in charge of taking her to her hospital room. The woman was really woozy, scared, and spaced out, so after walking several yards with her, Nic rushed ahead to grab a wheelchair. There was a bit of trash on the wheelchair, which I thoughtlessly brushed aside with my left hand, which I pulled up to discover was bleeding everywhere thanks to a stab with a dirty needle. Oops! I went and rushed to stick my hand in a vat of alcohol (die everything die), then, with Nic’s counseling, I called med, who called me back and said “RUN TO DAKAR, RUN BABY RUN.”

Back in America in my previous life, I spent 8 weeks serving as an HIV/AIDS counselor in Arkansas via an organization called Future Builders. This experience has shaped much about my perception of medicine and sexual health, in collaboration with a six-month experience as a "movie person" during my employment with Cupid’s. So I was trained by the Arkansas Department of Health (and my old boss at Cupid’s) to speak frankly about everyone’s fetishes, genitals, sexual practices, and diseases without giggling, hesitating, or judging. To be honest, both of these jobs were easy in some ways for me because I do not judge people’s sexualities anyway, but receiving training confirming that I should have an open heart and open mind is quite frankly refreshing. Now, I have HIV positive friends that I hug, I have had scares, had tests, had conversations, and asked lots and lots of questions. I have tested and counseled teenage girls, little boys, college students and homeless women. However, I have never been able to attest in any serious way to what it feels like to be on anti-retrovirals. When it came to legitimate post-exposure treatment, or lifetime treatment options, I was at a loss for words. I was taught to say that the anti-retrovirals make you sick, make you feel awful- and I was taught to say this partially as what I interpreted to be a scare tactic, and partially as a testimate to reality. Some people are aware that they are HIV positive but chose to avoid anti-retrovirals due to the fact that they make you feel like total shit for a while. Others have no problems with them, and take them willingly. For all HIV- positive parties involved, they are lifesaving pills at some point in time in one's life. I am the type of person that likes to have some experience with what I am telling people, however, I am NOT the type of person to take anti-retrovirals for a while just to talk about it.

I am, however, the type of person that is going to celebrate this unusual accident by fully embracing and taking advantage of this 30-day adventure in anti-retrovirals. Ready, folks? Lots of journaling for me.

Day 1: After a 12ish hour car ride from Ourosogie to Dakar, most of which I slept through due to the fact that anxiety about Heb C and HIV and a 3 hour long Bright Eyes listen-a-thon kept me most of the night, I arrive at the med office. Dr. Ulle takes tubes of my blood to take to a lab. I get an HIV test and a liver panel, and am given a bag of pills. I am taking a combination of lamivudine and zidovudine, standard anti-retrovirals. I will be starting an anti-nausea medicine, but I have not taken one yet. I am waiting to see what is going to happen to my body before I start them. However, judging by how these last two doses have gone, I will be starting my anti-nausea medicine here in a few hours. So I took my first dose after a dinner of French fries and schwarma, and things were fine for about 45 minutes. I was settled into a long facebook chat with a good friend from back home when I was hit by this wall of pain and dizziness. It started with mild cramping in my left side that made me pause and think, “man, so much for fries…” and then it took over my body, leaving me totally floored. Nausea radiated out of my intestines and towards all directions in my body, my feet, arms, and head alike. A pounding headache blossomed like a rose in what felt instant, and I had to stop what I was doing. Muscles that I rarely use ached and burned and made me acutely aware of them. All of this happened at once. The wave came and went, parts of the wave lingered- the cramps, the headache, and the mild muscle aches. I went to sleep with the residual cramping, headache, and aches.

Day 2: So about two hours ago I took my second dose of anti-retrovirals, and sure enough, within about half an hour to forty five minutes, the same purging wave of nausea and headache came over me, and my body wanted to drain itself of itself. Shaking hands, blossoming headache, evacuating guts. The headache and muscle aches from yesterday did not go away, and today’s episode seems to have amplified what lingers. We will see what the evening brings. The meds I am on are commonly prescribed anti-retroviral medications and are frequently given to HIV positive mothers to prevent the transmission of HIV to their unborn child, and they are given in lower doses to children born of seropositive (HIV positive) mothers to prevent them becoming seropositive due to bodily fluid exposure during childbirth. So why is this entire disaster kind of a good thing? I am very interested in pediatrics and obstetrics/gynecology as a medical professional, and without a doubt want to work with underserved/marginalized populations (and I mean it, we are talking the homeless, drug addicts, child runaways, and troublemakers). As such, I do anticipate at some point in my medical career I will be in the situation where I will need to talk to a seropositive pregnant woman about her options for keeping her baby safe during pregnancy and delivery. Although I anticipate that by the time I am settled into a medical career, these meds will have shifted and changed some, I will be able to speak frankly, honestly, and realistically about what it feels like to take this medicines, how you can manage a life while on them, and what helped me cope with the issues associated with the medicines for the brief period of time that I was on them. I will also be able to attest to whether or not side effect subdue over time at least in a 30 day period, but as of right now, these side effects totally blow.

First things first, how does this drug even work?

Here comes the science!

Well, COMBIVIR is a nucleoside/nucleotide reverse transcriptase inhibitor (NRTI). What?! Long story short, the HIV virus gets into your cells, copies its own genetic material into your cell’s DNA, and then our body’s DNA becomes an unwitting copy machine for the HIV virus. Smart virus, eh? The genetic material carried by HIV that jumps into our cells (specifically those little suckers called CD4) is in the form of RNA, or ribonucleic acid, which looks like this:

RNA and its BFF DNA, posing for the camera. Thanks, learner.org, for this great photo! Science is sexy, isn’t it?

So basically, NRTIs contain busted-up non-functioning versions of the building materials used to convert RNA to DNA, and the HIV virus picks up these broken building materials and tries to use them to create DNA. HIV, even Bob Dylan is face-palming at how hard modern medicine is owning you, but I’m celebrating, because thanks to HIV’s tendency to use these these faulty versions of DNA building materials, the HIV virus cannot transmit it’s genetic material into my cells. This means my CD4 cells will not become unwitting copy machines for HIV.

Thanks to deviant artist Ayame Lawliet for creating something that truly expresses how HIV feels right now.

Now, this led me to wonder, what do these chemicals that travel through my body and fight crime look like? Well, lamivudine looks like this: And it has a molecular for

umula of C8H11N3O3S, with a molecular weight of 229.3, and is an off-white crystalline solid. Beautiful, ain’t it? Zidovudine looks like this:

With a molecular formula of C10H13N5O4, and molecular weight of 267.24, it is a white or beige crystalline solid. Alright, who is ready to make this stuff at home?! Any takers? Anyone? (Disclaimer: I DO NOT PROMOTE DIY ANTI RETROVIRALS. Seriously. This is not stuff to mess with.)

However, I am including an alternatively organized periodic table for you science heads out there to take a look at and think about while you contemplate what is racing through my body. Science rules. So does wikipedia commons, provider of this great image. Love y’all!