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!

Habits that used to be worthwhile

I find myself quite often coming to the realization that I am, in fact, grown up, and that time, in fact, is going faster and that, in fact, my metabolism is slowing, and that, in fact, the future that I had been planning for is here, and it isn’t exactly what I thought it would be. I spent many years planning for the so-called future without really realizing that the future would instead be a culmination of many presents, and that if I spent all of my free time planning, instead of developing some skill or talent, I would learn only to plan. And what I have I discovered? I’m good at planning. And that there isn’t any thing wrong with being idle.

Every once in a while it will hit me that I’ve become a full fledged creature of the habits I had, and not the habits I intended to have. I haven’t quite gotten in to the habit of finishing things, and the habit of being relaxed I’ve avoided entirely. What an interesting thing to realize. I hereby plan to spend less time planning, and more time chilling. It’s all too easy to get caught up in organizing abstract things. I need to waste more time, or learn to waste time in a way that contributes to my value/worth/interest as a human being. I’m getting there.

In the meantime, I was sitting a table of people during my last couple of days at Future Builders and a discussion of clothing/style came to be. Many of the people liked the 80s, liked the 50s and 70s, and hated the 1990s. Grunge. Tommy Hilfiger. Plaid. Flat tennis shoes, Swatch watches, Nirvana t-shirts, off-brand cigarettes. Diablo, Warhammer, Magic the Gathering, and anime. Delia*s. AIR shop. And the consensus? Everyone in that room with the exception of myself and one other person hated the 90s. My initial response was to hide my Flik-Flak watch.

I had a Pop-sickle t-shirt, a yellow web belt, and lime green Tommy shoes back in the day. I had red pleather pants and white leopard print jeans. I wasn’t stylish, but I wasn’t too out of touch, either. I enjoyed 90s style, and still do, but it’s toned down. I’ve become practical. I’ve grown up. I've started wearing dresses.

Update

Today I had work at a Boys and Girls club close to Nic and I's old house. We did a group presentation and it lasted about an hour. Fairly typical. It went pretty well. Future Builders is ordering some more tests so that we will be able to resume testing soon.
Nic and I also confirmed that we will be going to work at Heifer Ranch in the fall! We will be in Rutland, MA, working as educators. We will also be getting up early in the morning to milk cows and feed chickens. In addition, we will have to invest in some water/snow proof workboots upon arrival... =) We will be there from August 25th until December 17th.
Yay!

Good and bad things

Unfortunately, Nic and I were deferred from the Peace Corps for three months because Nic was recently injured. This means that we will not be going to Benin, and because there are not very many departures in the winter, we will likely not be going to any country with the Peace Corps until the spring. Initially, I suffered a lot of grieving and heartache. I was not at all happy about the fact that I would be idling. I am not the type of person that handles the waiting game very well; I like to have my future events relatively structured and planned. I like knowing that I will have a job in two months, etc. However, Nic and I decided that we should open our ears and eyes to jobs that we can dedicate ourselves to for several months.
In the meantime, I am working for Future Builders, Inc, a non-profit organization that does HIV/AIDS outreach. The group functions largely on grants, and actually, our focus groups right now for HIV/AIDS testing/counseling is the homeless and youth. As a huge perk, we Future Builder volunteers were trained by the Health Department to be certified HIV testers/counselors. We're certified, and have little certificates that we can show off in the event that we would need to, or someone doubts our words. Right now, though, these certificates are at Future Builders. One of the best things about the job is getting to talk to people; people have some incredible, smart, cool, quirky, painful, sad, and angering stories to tell about their lives. It is amazing how strong some people are.
And, after Future Builders, Nic and I would like to go to Heifer Ranch. We have applied for Education positions and right now are going through the formalities. We are waiting on some forms that we have to fax back in so that we can get a background check, and then there is some stuff we have to sign, and, finally, we need to buy plane tickets. I get paid on Thursday/Friday, and, if ticket prices stay close to the same to what they are, that check should cover my ticket and at least part of Nic's. We'll see. I hate worrying about money, but I spend a lot of time doing it. It seems hopeful and exciting. I am not going to get too excited just yet about the Heifer job, because I fell in love with Benin and then was not able to go. I am going to wait until I've got the confirmation in writing and on the phone that we're good to go, and until we have the plane tickets in our hands and our bags packed, before I truly get excited.
But believe me, when I get excited about this, I plan on jumping for joy. I am going to learn so much.
And! We will be there during harvest season!