HIV

Unintended consequences

Unintended consequences 

None of this promiscuity, however, was without other unintended yet completely innocent consequences. At least two of us ended up with a case of HPV or genital warts.

The farmer’s daughter also had oral cold sores, otherwise known euphemistically at that time as “the kissing disease,” but better known now to be the Herpes Type 1 virus…which she was good enough to share with me. Call it by any other name; it’s still just a  sexually transmitted salivary venereal disease of the oral vermicular.

The problem with venereal disease is that like any highly communicable disorder, even the common cold, it spreads by geometric multiplication. It is only linear, for example, if a man goes to a prostitute or a mistress, gets something he then gives to his faithful wife, in which case the train stops at that terminal. Usually so does the marriage. But this was an era when the worst of the STDs was still not enough to kill you and, in most cases, was easily curable. If not, they were simply common “ho-hum” nuisances with little or no attached social stigma. Even the cold sore did not have a known etiology, much less knowledge of how easily it could be transmitted. At the same time a wart was simply that: a wart. So what?

But if the 1960s had been the era of not so free love, it was soon supplanted by the 1970s being the era of crass, casual promiscuity. Nobody knew then that HPV is associated with causing cervical cancer. At the same time nobody really paid much attention to any of the STDs until the early 1980s when having Herpes Type 2 or the genital variety became a widely advertised social stigma, a stigma soon to be dwarfed by the appearance of the potentially lethal HIV virus. HPV and HSV should have been a warning that viral VD was replacing bacterial VD and that unlike bacteria, viruses not only do not respond to antibiotics, but also have a nasty knack of being able to permanently insert themselves into the human genome.

That fact, along with the sudden appearance of the super venereal viruses helped to usher in the 1980s as an era of renewed sexual sobriety and gave great credence to Talmudic scholars who in pointing to the traditional religious proscriptions against fornication had warned the world for centuries as they autistically rocked back and forth in their libraries. Or in taking it directly to the Wailing Wall, they might perseverate as they autistically beat their heads with the holy books or beatific bricks:

  • I told ya so, I told ya so, I told ya so, I told ya so.

I only got “the clap,” once, from a very promiscuous nurse when I was a Resident. She had let it be known that she was on a mission to screw every house officer in the hospital, to wit every house officer in the hospital seemed more than willing to sign on to help her accomplish this odyssey. When it abruptly became symptomatic, I knew at once why they called gonorrhea “the clap.” Whenever I tried to pee, without any premonitory warning it was so horribly painful it I stood straight up on my toes like a ballerina on point, only then to segue immediately into a crude version of Flamenco. I was clomping around in my clogs, holding my hands high over my head, slapping my palms together, clenching my teeth and whining through a sheepish grimace. It also left me with a residual urethral stricture that to this day sometimes causes me to pee with a forked stream reminiscent of the forked tongue lies I had told to put myself in this payback circumstance I so well deserved in the first place.

The Urologist who treated me found the whole thing professionally amusing, adding that if all I got was a stricture, I should consider myself to be lucky and then refused to fix it. He said the cure could be worse than a problem that would serve as a permanent reminder of my wayward habits anyway.

  • White man pee with forked stream. Ha, ha.

You would think that would have taught me the lesson that even nice people can get VD…but no. By the time I had married for the second time in my late fifties and estimate I had sex with perhaps fifty or so “nice” women, one of whom was even “nice” enough to generously share her type 2 genital variety of herpes. It may sound like promiscuity, but for the most part, except for a few insane or widely scattered sexual benders in the 1970s and 1980s, most of my relationships would still be categorized as sequentially monogamous. Some short. Some long. But always in a faithful sequence.

Magic Johnson and Long John Holmes, the former having survived HIV and the later who died of it, who each admitted to having sex with 3000 women or more, would come to serve society as more permanent reminders, as well as being unfortunate yet unwilling icons, of the Golden Age of Sexual Promiscuity.

My brother once told me I was lucky that my dick hadn’t developed gangrene and fallen off. His statement harbored a combination of satire, envy, and truth as well as a premonitory HIV vision of a deadly future to come.

He said:

  • Watch out, Al. If you keep this up you’re going to come down with a bad case of the Faccala.
  • The Faccala? What the hell is that?
  • It’s a VD you can get when you indiscriminately fuck the fish in the fish tank. It started in Rome in 49 B.C. That’s why the Italians dry the things out and salt ‘em down before they eat them at Christmas. “

Don’t give a dose

To the one you love most

(Social Proverb)

 

 

 

 

The Epitome of Promiscuity

The Epitome of Promiscuity

 I had the opportunity to take care of a famous Broadway producer, who in his seventies required open-heart surgery and a simultaneous aortic valve replacement.

At some point after full recuperation he presented to my office in a panic because the twenty-five-year-old man he had been living with was diagnosed with AIDS. He was also dying of a rapidly accelerated, aggressive strain of the virus; at a time before modern anti-viral drugs had become available.

I do not make value judgments on sexual preferences, but certainly found it curious that May-December relationships are not exclusively limited to old rich codgers and young blond bimbos, so I suppose then that logic dictates: why not be gender neutral on this issue, too?

My producer was upset on multiple levels including the fact of his genuine feelings for his young lover and his obvious fear that he too could have become infected. He lamented:

  • I told him over and over again he would get himself in trouble if he kept having all those random sexual encounters with the young bucks.

Obviously jealousy was not an issue in this relationship, either.

Interestingly, and perhaps miraculously the first HIV test came back negative. However, because the virus can be latent, he wanted to come in every six months to be tested.

HIV testing requires a special medical form that ensures patient confidentiality by coding a personal identification number instead of by the patient’s name. The code number is then kept in the medical record to match up with the number coming back on the final report.

As I got to know his proclivities better, it became apparent to me that this person was himself not only homosexual but was also bisexual and probably somewhat promiscuously indiscriminating himself. In recounting some of his many and varied sexual escapades I could not help but react sarcastically one day by asking him if had ever screwed door knobs or animals.

He said:

  • No. But that’s an interesting thought.

Although he truthfully was a very nice, generous person, because he was so sexually jaded I nevertheless politely declined an invitation to visit him at his winter home in Puerto Rico out of fear for my own safety and  certain still intact virginal orifices. Yes, I would consider a visit but only if I could only be that proverbially vicarious fly on the wall.

After about three years, he remained HIV negative, but insisted on continuing biannual testing. At that point, the medical form for blood testing changed to include a new litany of queries to be checked off. After the usual demographics I came down to the section requiring a statement as to sexual persuasion, so I asked him how I should classify him, wanted to know if I should label him heterosexual, bisexual or homosexual.

  • Why, none of those. I’m none of those.
  • What do you mean? You have to be something.
  • The medical form is wrong, completely wrong. They need to make it over.
  • And why is that, pray tell?
  • Because they should add a new box that simply says ‘Sexual.’ That’s what I am. Just sexual.

I said: “OK,” then checked off all three boxes, while immediately visualizing him on a sodomizing romp through a men’s bathhouse, a whorehouse and then a barnyard, I concluded by asking him to please not further elaborate.  

He never did test positive for HIV, but died of natural causes many years later.

 

bye-bye-birdie

 

 

Some guys have all the luck

Some guys have all the pain

Some guys get all the breaks

Some guys do nothing but complain

(Rod Stewart)

 

Poster Graphic www.ahishacres.com

Immunizations

 

Tetanus and Immunizations

Ancient folklore has it that there were four incurable conditions in medicine: scabies, rabies, babies, and tabes dorsalis.. We’ve come a long way since then.

 

Salk vaccine

 

There is a very troublesome organized campaign in the United States that targets parents in an attempt to convince them to stop vaccinating their children. The information spread by these groups is misleading as well as seriously dangerous to the health of the nation as well as the rest of the world.

We are so fortunate to live in an era where certain bacterial and viral illnesses can be prevented by vaccination or immunization that we have forgotten how harmful these deadly organisms actually are. Physicians all too often do get to see cases of common illnesses such as hepatitis, but it is a real eye opener when a doctor has the non-privilege of seeing one of the rare ones. If the anti-vaccine groups had to participate in the care of any of the devastating consequences of vaccine preventable diseases, perhaps they would change their minds.

These insular minded advocates do not have to see liver failure following an infection with Hepatitis B. They do not have to see the forty-year old school teacher die from congestive heart failure following the influenza attack that destroyed his cardiac muscle cells. They do not have to see the congenital heart defect in the baby born to a mother who had Rubella during the pregnancy. They did not have to manage Jim Henson’s case when he died of a pneumonia caused by the common and ordinary pneumococcal bacterium. They have not seen the crippling effects of the few living individuals from pre-vaccine days that were fortunate enough not to die from polio but were nonetheless permanently crippled by it. Perhaps FDR doesn’t come to mind either.

The list goes on and on.

These advocacy groups always cite the rare case of the person who had a serious complication from a vaccination only to then utilize inductive reasoning which generates a hysterical perception in the general population that this vaccination is dangerous for everyone.

One of my favorite predictable gripes is the patient who comes to the office and states:

  • So I got my flu shot and I got the flu anyway. What’s the point?
  • Influenza is not the only virus that can give you a cold. When you were sick did you get tested for influenza?
  • No.
  • Then how do you know that it was the flu?
  • I just know. So next year I’d rather just take the flu and skip the shot.

That’s when the little man in the front of my brain says:

  • You really are a stupid ignoramus. Ask any of  those 18 million souls who died in 1919 what they might think about a shot that could have saved their lives.

But the real words come out as:

  • Why don’t we discuss it again next year?

Anti-vaccination advocates also come up with ridiculous personal theories such as the one currently in vogue that the mercury (thimerosol) in the Mumps-Measles-Rubella (MMR) vaccine is responsible for childhood autism. This one is worse than simply fomenting generalized hysteria because the concept causes parents to shun vaccination schedules; generates litigation and is predicated entirely on false science. Based on real and credible CDC scientific evidence, this propaganda has been debunked only to become yet one more example of one of America’s new favorite pastimes: blame seeking. In fact new theories are emerging that make more sense. For example, autism may be a maternal -fetal antibody phenomenon, similar to Rh incompatibility.

False science is so seriously dangerous because it presents as fact a series of deductions made without true scientific proof. For example, the false science of racial genetics and characteristics perpetrated by Heinrich Himmler in the 1930s convinced the German people by a series of pseudo-scientific measurements and salacious proofs that Jews were an inferior race: Why? It’s because their skulls look different, of course. The Aryan movement in modern America does the same thing reference to Afro-Americans: their brains are smaller.

Another recent example of medical false science was the inductive misinformation that silicone breast implants caused collagen vascular diseases; such as Lupus. This resulted in multi-million dollar law suits, wasted court time and the temporary withdrawal of the product from the market; leaving some women who legitimately required this type of prosthesis for breast reconstruction with less desirable alternatives. It was all a colossal waste of time and money; but only in America. European countries paid it lip service and didn’t give the controversy the light of day.

But even in the case of the MMR vaccine, and despite more scientifically convincing evidence that autism probably has a genetic basis, as well as the fact that some autistic children are really mislabeled mentally retarded; being able to convince these ignorant stalwarts to the contrary is virtually impossible. Or, as they say in Texas, do not let the truth ever interfere with a good story.

My eyes were opened for good after having to treat a case of Tetanus. Prior to seeing this disease in the flesh it was something a Resident House Officer would only read about and have to consider as part of a board review scenario.

This particular situation occurred in a middle aged white female woman who was doing window box gardening and happened to get a splinter in the web space between two fingers. It then got infected, resulting in a small pustule. But inside the little pustule the Clostridium bacteria had already set up shop and had done its dirty work before she came to the emergency room to have the abscess incised and the offending splinter removed.

Simple case, yes?

Not until she came back two days later complaining of hypersensitive skin and very non-specific neuralgic symptoms. If not for a very astute Infectious Disease Fellow she would have been sent home. But much to everyone’s surprise and veiled skepticism he had her admitted for observation. I said:

  • So why did I get this case? There’s nothing wrong with her.
  • Because I think she might have Tetanus
  • Get out. That’s ridiculous. Nobody gets Tetanus anymore.
  • Well she might have it
  • Tell me why? This is nothing but dumping  a shitty case on me.
  • Well, my opinion is based on her history as well as the fact that she told me she was never vaccinated.
  • So what history is that?
  • A very recent foreign body infection followed by hyperirritability, acute skin sensitivity and the fact that her husband says when he touches her she starts to twitch, then yells at him and says: “Get away from me. Stop touching me.” That is coupled by the fact that they have a good relationship and he says she has never in her life ever talked to him like that.
  • Yeah, right. Maybe it’s just menopuase or something.
  • Just admit her for observation; get Neurology over here; and every fifteen minutes or so just brush her skin with your fingertips. You’ll find out soon enough.
  • What a drag.

After about two more hours of bedside testing I placed a frantic call to the I.D. resident and said:

  • Get your ass over here right now. I just touched her and she went into a seizure.
  • What did it look like?
  • She screamed; arched up; clenched her fists; hyper-extended half her muscles and hyper flexed all the rest. The spasm was so intense I thought she was going to break her back.
  • So I was right all along, yes? And when was the last time you saw a Grand mal seizure ever look like that?
  • Never. So please, just get your ass over here right now because I have absolutely no idea what to do next.

She had Tetanus all right. But calling it Tetanus was euphemistic for what this horrific disease was really all about. Just blowing on her ear would cause so much involuntary total body muscle spasm I thought she would not only break her back, but would also beak every other bone in her body including her neck. And that was not to mention the horrifying screams that went before the spasms.

The treatment requires intubation, artificial ventilation and total body muscular paralysis with intravenous curare. The clinical conundrum here is that the disease then has to run its course over a period of several weeks, during which time other drugs are required in order to sedate the conscious brain. Because the patient is completely paralyzed there is then absolutely no way of knowing how awake the patients’ brain might be. Think about that. You are completely paralyzed, unable to move or to communicate, yet your brain is aware of everything that is going on around you.

The case dragged on for three or four weeks, in the middle of which the patient developed pneumonia and then a bleeding ulcer requiring urgent surgical intervention. Unbelievably, she survived and after a period of intense physical therapy was able to walk out of the hospital. That case made a believer out of me, even to the point that despite the last Tetanus booster I had; which put me to bed for three days with worst “flu” like reaction I had ever experienced; I would still take the shot again over the deadly disease itself.

During the time I was at St. Luke’s there was actually one other case of Tetanus that had occurred in a heroin addict secondary to infected skin-popping abscesses. Fortunately, I did not get the case, which nonetheless had a curious footnote. His “friends” were a collection of fairly unsavory fellow addicts who visited his bedside on a regular basis. One day however, the visitations suddenly stopped; but was curiously and coincidentally linked to the disappearance of several vials of curare that had been left in the patient’s cubicle. No one involved in the care was at all upset by the prospect of these junkies having gone out on the street and shot themselves up with something that would get them higher than they had ever been in their entire lives: all the way up to the level of the Pearly Gates.

The police would not even investigate a dead junkie with a needle still in his vein.

One really disturbing thing about vaccinations is the fact that the CDC has declared Smallpox to be eradicated from planet Earth; along with an opinion that vaccination for this virus is no longer necessary. This agency also believes that it owns the only remaining repository of the virus and that because it is hidden safely inside its freezer vaults, has even discussed the idea of destroying the remaining cultures. If I ran the CDC, I would not be so cock sure about this. We are living in the infancy of an era of genetic engineering that raises the possible specter of microbiologists having the potential ability to manufacture killer microbes earmarked for germ warfare.

A new global outbreak of Smallpox would have the potential to kill off ninety percent of the world’s non-immunized population, bringing new meaning to the aphoristic medieval curse that could possibly be adopted by a terrorist:

  • May the Pox be upon you; your family; and all your family’s family.

We now have vaccines for the following diseases:

Smallpox, Polio, Measles, Mumps, Pertussis, Tetanus, German measles, meningococcal meningitis, pneumococcal pneumonia, Zoster, influenza, Hepatitis A and B, Anthrax, Yellow fever and genital HPV. In the very near future we may also have vaccines for Hepatitis C, the worst of the nasty triumvirate that includes A and B, as well as for HIV and Herpes.

When I was a child I developed mumps, measles, chicken pox and German measles. None of these diseases were pleasant. The Mumps was complicated by a mild case of cerebritis causing me to hallucinate about wild animals attacking our house.It’s only too bad I did not see the Virgin Mary in the back yard, instead of a Grizzly bear, or we might have been able to translate that vision into a fortune by selling the rain water that always seemed to cascade off the hill behind our house and filled up our basement. Lourdes in our cellar.

Perhaps the disease did leave me with a small degree of permanent brain damage that I can blame for my I.Q. being only slightly above average but not genius; just like the people who blame MMR for autism. But I was fortunate if the only complication I got from the mumps was to be attacked by an imaginary Grizzly bear, because sometimes these supposedly simple viruses can do a lot worse. And when they do kill, there is nothing at all imaginary about the death.

There was only one other case I ever encountered that highlights the fact that as science has become more sophisticated, some homeopathic theorists have paradoxically thrown us back to the Stone Ages. A nurse I worked with, for holistic reasons, did not believe in tonsillectomies, and despite the fact that her daughter repeatedly developed Streptococcal pharyngitis, refused to let her have them removed. Beta-streptococcus is known to be responsible for causing Rheumatic fever, a disease that eventually attacks and causes serious scarring to cardiac heart valves. Treating the infection with penicillin easily prevents this consequence.

Then to make matters worse, after a number of prior infections and courses of antibiotics, this mother decided that too many antibiotic treatments could also be harmful. Instead of treating a subsequent Beta strep infection then, she had her daughter pray over lighted candles. The outcome was predictable as the poor girl developed acute Rheumatic Fever, spent two weeks in the hospital; followed by permanent rheumatic scarring of her Mitral valve. As far as I am concerned, this is a case of child abuse.

When I was a child I was fortunate that despite the fact of nay-sayers warning it could actually cause polio, my mother was proactive enough ignore them and pushed me to the head of the line for the Salk vaccine. Even people in the 1700’s were smart enough to know that if they rubbed their skin with exudate from someone else’s Small pox lesion; that they might get an attenuated or abbreviated form of the disease themselves.

At this point in my life, I remain a true believer, have received every vaccine available on the market and look forward to being the first in line to get the next one that comes out of pharmaceutical research and development. These miracles of medical intervention prevent not only the serious common consequences of the diseases that they abort, but also save millions of lives.To those nay sayers who still believe that vaccinations are passé, dangerous or unnecessary, I then facetiously say:

May the Pox never be upon you, your children, or your children’s children.

Tetanus

 Tetanus

Soldier dying of Tetanus   Painting by Sir Charles Bell