Sunday, October 27, 2013

Then, I Had Pneumonia

I thought after TB, I would be healthy once more. I said, I will re-gain my lost weight, and will start working out again.

While working out at the gym, I started to notice shortness of breath, especially when doing squats. I reported this to my pulmonologist, but he said I was just adjusting from my long rest from the gym. But, each week, my breathing problem was getting worse. My doc then asked me to have a pulmonary function test. That test showed that my lung capacity was very low for my age. So, my doc concluded I had asthma. Since I was kinda suspecting I may have HIV because of my ePTB, and I knew that pneumonia is a common illness for people with HIV, I kept asking my pulmonologist "Doc, di naman to pneumonia no?" (doc, this is not pneumonia, right?) I asked him that question in 2 of my consultations. But he said it's not. I guess it's because he's not hearing a wheezing sound from his stethoscope, and based on my X-ray 2 months back, my lungs were clear. So I believed him. I had asthma, and not pneumonia. I was glad it's not pneumonia, because if it were, I would already believe I had HIV.  

I took the asthma meds that he prescribed. But my condition didn't improve at all. Alas, it was even worsening. After two weeks, it was such an effort to walk from my car to the elevator. And, it was a struggle to climb a 10-step stairs. When I went to the airport one time, I was losing breath when I got my luggage from the conveyor belt. And it was so difficult to quickly cross the street to make it before the pedestrian light turns red. When my breathing became unbearable, such that walking 10 steps was causing me to grasp for air, I went back to my doctor. When he saw my acute condition, he didn't let me go home anymore, and ordered my hospital admission. While in the hospital, he continued giving me asthma meds. They took another X-ray. This time, it showed I also had pneumonia. My doctor concluded it was just community-acquired pneumonia, and gave me antibiotics. Well, my condition slightly improved, but it was really not significant. I was discharged, as my doctor thought my asthma and pneumonia would improve at home anyway, with home meds. Days passed. the expected improvement didn't come. I went back to my doctor 4 days after my discharge, with my new X-ray result. My X-ray showed my pneumonia progressed further. And clinically, my breathing was worse. He then prescribed a stronger antibiotics (azithromycin and another one). He also asked me to have a sputum test, to check if my pneumonia was caused by the PCP fungus. I had the test on the same day, but results will be out in 3-5 days. I went home, with hope that the new antibiotics would now work.

At home, my breathing was not improving at all. It was actually worsening each day. I started to research about the different types of pneumonia. There's community-acquired, hospital-acquired, bacterial, and the dreaded PCP. The first two are the common types, while PCP is a major AIDS-defining illness. Only people with very weak immune system can get PCP. So, this means that a positive PCP test for guys my age is almost 99% synonymous with a positive HIV diagnosis. Now, I'm scared to death. The first 2 antibiotics for pneumonia (which I assumed was for community-acquired and bacterial pneumonia) didn't work. I already knew I would most likely be positive for PCP. For days at home, I had been thinking and reading about HIV, as I was now 70% certain I was positive. 4 more days passed, still my breathing was worsening. When a 10-step walk made me look like I was having an asthma attack, I went back to see my doctor. Too bad, he was on leave that day. So, I decided to go to ER instead. They checked my heart rate, it was about 145 beats per minute (normal should be less than 100). And may oxygen level was ranging from 75-93 I think (normal should be 98-100%). So it was indeed a medical emergency. The ER doctor asked me about my personal lifestyle - I knew it was to profile my HIV risk. I even remember I asked that ER doctor directly, doc... do you think it's HIV? Then he backed out a bit... "Ay, hindi, hindi naman ganon. Don't worry!" I knew he didn't mean that DON'T WORRY thing. Then, they contacted my pulmonologist and also asked for an infectious disease specialist (IDS) from the hospital to attend to me. Finally, I was in my hospital bed with my oxygen mask to aid my breathing. 

I was scared, coz I knew it would only take a few days before they tell me I'm positive. And most of all, I was too scared coz I didn't want my family to know. Well, I was actually prepared to know my HIV status, but I wasn't ready to tell my family. But how would I hide it, when I was in my hospital bed??? 

The following day, different specialists came in, one at a time, most of them asking about my lifestyle, to know my HIV risk. To let them know that I'm not the hysterical patient, I remember telling my doctors: Doc I know that I am at risk of HIV. When my PCP result comes out positive, does it mean I'm HIV positive? The doctor said straight out, Yes. So I said, in that case, can you just keep this from my family? Try not to discuss about my illness when there are other people in the room. Due to doctor's confidentiality, they had no choice but to do agree to my request. 

More tests were done. ECG, X-ray, arterial blood gas, CBC, etc. I was too worried, all alone in my bed, keeping the thought of HIV to myself. I texted my best friend, and told him I could be positive. The following day, the HMO representative came. She told me that the HMO would no longer shoulder my hospital bills (unless I could show them a negative HIV test). So I just said, in that case, please remove the HMO's doctor as one of my attending physicians as she would be redundant. 

On my third day, my best friend visited me. Incidentally, the PCP test result also came out. I asked him to get the result. I waited. Knowing my friend, I told myself, if he texted me before he gets back to my room, I'm sure PCP is negative. But if he got back to my room without sending a text message, then that's it. Minutes passed, no SMS! Then he knocked. Sigh, it was my friend, with a serious face. He gave me my result. Alas... I was positive for PCP!!! And I know this means I'm positive for HIV!!! But, I kept my composure and calmness. No crying and hysteria, just a minute of silence. Then, I  started to talk to my friend (we couldn't talk much about the result because I had a companion in my room). After 30 minutes, he left. I started to think and read more about HIV from the internet. Then I started to think about ways on how to hide it from my family. I thought: I need to talk to all my doctors. I'll ask them not to disclose my HIV status anything to my family; I need to ask my best friend to withdraw money from my bank and pay for my hospital bill so my family won't know that my HMO is not covering my hospitalization, etc. etc. Acceptance on my HIV status was easy to me coz I've read so much about HIV, but disclosing to my family was a torture!

That night, my friend texted, trying to check how I was. I said I was OK (and I really was). What was bothering me was my family. Then he said, at this point, try not to stress yourself. Just think about yourself. Get well. Be selfish. Don't think of others, how they would feel. Just think about yourself and get well. So, better just tell your family. With you in your hospital bed grasping for air, you will have their sympathy. Stop stressing yourself! You need to get well. You need to overcome this disease. 

That struck me. The stress of planning a way to hide was just overwhelming. There's no way I can hide it while I'm on my hospital bed. They'll ask endless questions! Then I cried. This was the first drop of tears that came out of my eyes after I knew my status. I thought: now I have a tag. I AM POSITIVE. I know HIV is not a death sentence, but HIV is still HIV. It still has a a social stigma. Sadly, I am now tagged as HIV POSITIVE! The same tag that Sarah Jane Salazar, Magic Johnson and Wango Gallaga have. Tears came out, but only for 2 minutes. Then I said I'm gonna be OK! And my friend's text convinced me. I can't hide my status to my family. So I decided I'm gonna tell them I'm positive.  

I tried to mutter enough courage. I tried to write what to say, in a way that would make them understand that I'm not dying. The next day, my family visited me. After hours of nervousness, this is it. I'm gonna tell them. So I told them, exactly how I planned to tell them. No hysterical crying. Just a drop of tears or 2 from our eyes. Then, we prayed together. When they left, I was totally relieved! I felt so much peace. Finally... it was over. Now, I can focus on getting well. 

A few more days in the hospital, still there was no breathing improvement. One of the fellows asked me if I would agree to have a tube inserted in my nose (or mouth?) in case my breathing further deteriorates. Since I'm young, they wanted to be aggressive in their treatment, and wanted my consent in case we came to that situation. I said yes. Then I got even more scared this time. One nurse even said that I would be transferred to ICU. Now, this is serious! I was advised to have a complete bed rest, with minimal movements, so as not to further strain my lung muscles. I can't leave my bed this time, not even go to a bed-side poop chair. I started praying hard this time. I didn't want to die. 

Luckily, my prayers were answered. After a day, my breathing slightly improved. My x-ray result showed a slightly reduced lung infection. I no longer needed to be transferred to ICU. Then, my IDS doctor wanted to have my HIV test already, so they could start my HIV meds. I refused, as I didn't want my HMO to have access to my official HIV test result. Since my bill was getting high in that expensive hospital, and my doctor estimated that I would stay for at least one more week there, I decided to transfer to PGH. My IDS doctor referred me to her IDS colleague at PGH. She also said that PGH also has an HIV treatment hub. 

After a long process of hospital transfer, I finally was at PGH. Hey, PGH was not bad at all.
Yes, the building, corridor and elevators were kinda old and crowded. But its private room was comfortable. It was a lot bigger than my room in the private hospital. It was newly renovated and had complete amenities (aircon, TV, ref, toilet). Food was worse though. But what the heck. This hospital will cost 75% less, and most of all, has the best doctors in the country. They are consultants, and mostly professors at UP. OK... at PGH, I agreed to have my HIV and CD4 tests simultaneously. After 1 week of treatment at PGH, my breathing became almost normal. I was discharged, and continued oral meds at home. When I got home, I didn't go directly to my room. I was still afraid to climb the stairs, for fear that like my last discharge, I would still feel shortness of breath when climbing the stairs. After 30 minutes of resting in the living room, I decided to go up. Step 1, 2, 3... 9 and 10!  BINGO! No more shortness of breath! Finally, pneumonia was over! I thanked God for the healing. 

I continued my oral meds for PCP at home. My breathing was improving each day. After 1 or maybe 2 weeks, I went back to see my HIV doctor for follow-up. My HIV confirmatory test result was not yet out, but my CD4 result was. Sadly, it was low... VERY LOW! It was only 15 (A CD4 count of less than 200 is AIDS case; the lowest CD4 a person can get is 0). Though my confirmatory test was not yet out, my HIV doctor enrolled me already to SAGIP (PGH's HIV hub) due to my very low CD4, so I could start taking my HIV meds. Right after my check-up, I went straight to SAGIP. It was a small room at PGH. The doctor at SAGIP, who also attended to me while I was confined started to ask me personal questions for record purposes. Then, I was given my first free set of HIV meds (also known as ARV, ART, or HAART) consisting of Lamivudine, Zidovudine and Efavirenz.  She advised me on when to take those meds, and the possible numerous side effects. I went home and took my first dose of ARV that night. I said, this finally ends my chapter on pneumonia!