[Question #1127] Follow Up to1009

51 months ago
Doctors, I wasn't expecting to be posting here again, never mind so soon but a follow up with my primary care doc still has me agitated over 10 days late. I can't post the entire conversation due to length. I was following up as I just had a Colonoscopy / Endoscopy done.  Those result were normal as were biopsies. He asked how I was and I told him still dealing with some muscle aches but biggest concern is feeling cold / chills. Gave example it was 90 degrees, I was outside doing yard work for an hour drenched in sweat breeze blows on me I feel a chill. I never have a fever when this happens (or at all since encounter) but it has been happening a lot lately. He suggested sine we were past 6 months I should do another HIV test. This threw me as in the beginning he indicated I didn't even need a test. I explained to him my test were negative and during proper test windows, also how I had consulted on this site. He said we have tested everything for me 2 CBC workups, MRI of brain, Thyroid, testosterone, cortisol etc. All those test were normal. I questioned why he was ok with those tests being normal and not my STD test, he really didn't give me a good answer.  I'm posting here as I want to make sure everything I'm saying to him is correct next time I visit.

1. My 4th Gen Test plus RNA at 34 days is conclusive and in fact that combination would of been at 20 days according to what I have read on this forum is that this combination is used to test all blood used in transfusion.

2. My 2nd test 4th gen test at 84 days is further proof. Also it was done at Quest Labs I don't know the name of the test but it is a 4th Gen Duo test with Reflex. My understanding is Quest as to be FDA approved to give these test so there is not one place that is better than the other.

3. My cold / chills feeling are not a symptom of HIV. I explain to him that it feels like having a permanent sunburn and only occurs above the waist and below the neck. Further at 6+ months I wouldn't be showing signs
51 months ago
4. These symptoms I discuss were going on during my tests and if they were due to HIV my test would of been positive.

Finally statistically it is almost impossible from everything I have read here for me to have it. Condoms were used  and didn't break, plus negative tests plus just egeranl statistics. I'm not sure what he was trying to do but it irritated me enough I'm posting here again so I can show him this reply at my next appointment.
Edward W. Hook M.D.
Edward W. Hook M.D.
51 months ago

Welcome back to our forum.  I can completely understand your frustration and agree with your summary.  I can offer no explanation for why your doctor feels the need to retest for HIV.  I have reviewed your original interaction with Dr. Handsfield and agree with all that he said.  The exposure you described in your original post was a virtually no risk exposure in terms of HIV risk and since then using some of the most reliable tests in all of medicine, you have proven (twice) that you did not acquire HIV from the exposure you described to us.   Repeat testing for HIV at this time is a waste of time and money, not to mention an unnecessary reminder of an event that you already appear to regret.  I completely understand your frustration and think that your doctor owes you and explanation.

I would add that  a recently described problem with medicine today is the tendency to over test patients who lack a good reason for testing. This practice is not only a waste of resources but since there are no perfect tests, over testing is now related to the phenomenon of "incidentalomas" in which tests show an unexpected (and falsely positive) result which then lead to further testing and, on some occasions, not only costs but complications from unnecessary procedures or therapy, not to mention unneeded anxiety.  I suggest ou talk this through with your doctor.  EWH

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51 months ago
Thank you and just for clarification for when I speak top him again. Feeling cold / anxious or as he calls it chills without fever is not a symptom of any STD correct?  Honestly since every test I've done is normal I was expecting him to diagnose me with anxiety and you're correct I regret the incident more than I can express. 
Edward W. Hook M.D.
Edward W. Hook M.D.
51 months ago
Feeling cold (sometimes referred to as feeling feverish or having chills) is NOT a sigh of any typical STI which would be present at this time,  EWH
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51 months ago
Thanks Dr. Hook I will save any other questions until I see my doctor next week.
He has certainly caused my anxiety to return because of this,.
51 months ago
Dr. Hook, I decided to talk to my PCP today still no good answers but these were the 3 main takeaways. Your comments would be appreciated. 1. At the hospital they test at 3 & 6 months and 1 year he said. 2. He is not versed in 4th gen test windows, he is unclear how a result in conclusive at 28 days, asked me to confirm. 3. He started to mention a type 0, then said probably not a concern. Based on my current anxiety level I decided not to look this up but will await your comments.

Since this is my last question and my PCP has set me back to stage 1 from an anxiety stand point I ask for some leeway in these questions.

- In your last reply you stated "is NOT a sigh of any typical STI which would be present at this time" the wording caught me as strange, does this mean it would be at a certain time? I don't really consider these chills I just feel cold a lot. They went away for 3 weeks at one point. My understanding is even this was one symptom of ARS it would not present itself at 6.5 months and usually is a set of symptoms.

- Based on Dr. Handsfield response I began unprotected sex with my wife. Do I need to be concerned? Her safety is my primary concern in all of this.

- I can't even comprehend the odds that he could be right. Condom sex is safe sex for HIV,  two negative tests plus general statistics. I told him the odds would be near impossible. Would you agree

- I believe I may need to find a new PCP, how do I talk to them about this so they can treat my other symptoms and not have to deal with this again?

Finally I appreciate all the help you both have provided, I want to go back to how I felt after Dr. Handfields post but I feel like my anxiety / fear are back in full force from a routine office visit. I'm doing my best to deal with this but to confirm your opinion is my issues are not STD related and I can attack them with that certainty in mind. 

Thank you again for such a valuable service.
51 months ago
Good morning I was experiencing weird issues with the web site last night so I just want to make sure my last question was seen by Dr. Hook. 

Thanks
Edward W. Hook M.D.
Edward W. Hook M.D.
51 months ago

As I have said and as Dr. Handsfield said before, there is no need for concern and the fact that your PCP is not familiar with the nuances of HIV testing does not change this.  You asked for expert opinion and you got it, plus an explanation more than once.   Your PCP and his hospital are being overly conservative and may not be appreciative of the damage that such approaches to for persons with anxiety issues such as you.

Similarly, you should not be overly concerned with an autotype-mediated typographical error such as typing the word sigh instead of sign.  Feeling cold is just not indicative of HIV infection or other STIs.  Fears that these sensations could be the ARS in the setting of your negative tests is illogical and at this time, scientifically implausible.

My assessment is not going to change, nor is our assessment that your possible exposure so long ago is NOT a reason to worry about unprotected sex with your wife. 

I hope these final comments are helpful.  I will not comment on your relationship with your PCP.  I suspect he is trying to do right by you- whether that works for you or not is up to you.   

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