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Author Topic: Question for the experts, I believe this is a new one ..  (Read 8948 times)

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Offline worriedman

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Question for the experts, I believe this is a new one ..
« on: June 04, 2006, 05:53:49 PM »
Dear Ann, Andy, Jonathan,

I have a couple of questions that I believe have not been addressed and I am hoping that you guys can help me out. The scenario is as follows:

I had an encounter with a pro in Latin America and now I am a little worried about it. Before we began, she went into the bathroom and got ready etc. During the encounter I pulled out (I do that to check if the condom is still intact) and I saw some white stuff on it. I asked her if it was an infection, but she said that it was just bacterial cleaning cream that she uses before she has sex. I didn not think much of it and I went on and finished. Afer, as usual, you mind starts to wonder and I was thinking that she douched before the encounter etc. I finished very soon and the condom remained intact. I have heard that nonyoxyl 9 or other creams can increase the chance of contracting HIV. My questions is, does the chances increase only for the women, or both parties, and if my condom remained intact, am I safe and far as getting infected via microscopic tears etc etc. I hope my question makes sense, many thanks in advance.

Offline Ann

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Re: Question for the experts, I believe this is a new one ..
« Reply #1 on: June 04, 2006, 06:52:50 PM »
worried,

Is this the same incident you were worried about in the old forum?

Because if it is, you already tested negative for it. You didn't have a risk of infection - you used a condom.

N9 MIGHT increase the risk to the receptive partner if the spermicide irritates the mucus membranes. It does not increase the risk to the person wearing the condom.

Microscopic holes or tears in condoms are a myth. When a condom breaks, you know about it. You didn't have a risk.

And by the way, we have seen similar questions here before.

Please read through the condom and lube links in my signature line as well as the HIV Transmission Lesson

Keep using condoms and you will avoid hiv infection. It really is that simple.

Ann
Condoms are a girl's best friend

Condom and Lube Info  



"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline worriedman

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Re: Question for the experts, I believe this is a new one ..
« Reply #2 on: June 04, 2006, 06:57:35 PM »
Dear Ann,

Many thanks for you reply. No, it is not the same episode, this is a new episode. I do use condoms regularly, but maybe my guilt of visiting a pro makes me want to make sure that I am doing the right thing. The condom was intact, so I guess I have nothing to worry about.

Again, thanks for taking the time out to answer my question.

Offline worriedman

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Re: Question for the experts, I believe this is a new one ..
« Reply #3 on: June 12, 2006, 10:02:34 AM »
Dear Ann,
I do have a follow up question, and I promise you that this will be the last I use your valuable time. If one had blood on the outside of the condom, and while taking the condom off, accidentally touched the menstrual blood, and then touched ones penis, foreskin to clean it (uncircumsized too), would that be a cause for concern? I am very very thankful in anticipation of your reply, and I hope I can put this matter to rest once and for all.

Thanks and God Bless

Offline jkinatl2

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Re: Question for the experts, I believe this is a new one ..
« Reply #4 on: June 12, 2006, 10:05:10 AM »
<<I do have a follow up question, and I promise you that this will be the last I use your valuable time. If one had blood on the outside of the condom, and while taking the condom off, accidentally touched the menstrual blood, and then touched ones penis, foreskin to clean it (uncircumsized too), would that be a cause for concern?>>

No.

HIV is a very fragile virus, and cannot survive outside the body. Moreover, it begins to lose viability as soon as the environment changes. A condom is excellent protection against HIV, to a degree greater than against syphilis and gonnorrhea and other STDs.

"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline worriedman

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Re: Question for the experts, I believe this is a new one ..
« Reply #5 on: June 12, 2006, 10:34:43 AM »
Thanks J, you are the best.

Offline worriedman

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Hey Jonathan, I was feeling much better, but something HAD to come and screw it up for me. I was worried about these incidents, because I had a condom break while I was having sex with my girlfriend. I was afraid of passing anything to her. Now, she is complaining of a swollen gland on the side of her face. It is not painful, not very large, but it is there. I have felt it myself. IT is not under the jaw but on the sideof her face. She doesnt have any more, just one. She is also in the window period exactly. Since I heard this, I have gone nuts. I find it hard to breathe, concentrate on work, or do anything at all. Please please give me your opinion on this...Is it normal to have ONLY one swollen gland as an ARS symptom and no other symptom? Your answer is appreciated, and I will send a donation to the cause as well. Sorry to bother you, but I dont see any other respite for me rather that wait and got for another test.....many many thanks ....

Offline worriedman

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Re: Question for the experts, I believe this is a new one ..
« Reply #7 on: June 14, 2006, 02:37:35 PM »
I did some more research and found out that it is called the Salivary Gland. To your knowledge, does this look like ARS or early symptoms? Please do not leave me hanging, I really need an answer....Thanks a million !

Offline RapidRod

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Re: Question for the experts, I believe this is a new one ..
« Reply #8 on: June 14, 2006, 02:42:21 PM »
NO, this does not look like ARS. You didn't have a risk to begin with. Swollen or block salivary glands happen all the time it's not unusual

Offline jkinatl2

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Re: Question for the experts, I believe this is a new one ..
« Reply #9 on: June 14, 2006, 02:44:17 PM »
Insofar as ARS goes, it is a systemic illness. ALL lymph glands would be effected.

However, since you claim that she is in the window period, and have been monogamous to one another, then a test at the 13 week period will be sufficient to allay your worries.

WHat, exactly, was her risk to place her in a window period?



"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline worriedman

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Re: Question for the experts, I believe this is a new one ..
« Reply #10 on: June 14, 2006, 02:54:49 PM »
Thanks Rapid and Jonathan!

Jonathan, her risk would be failure of condom with me, had i picked up something. Since the failure, she has had this symptom only and nothing else. I read that the glands in the face are known as salivary gland, and they may be associated with HIV, which is why I am freaking out.

Offline worriedman

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Re: Question for the experts, I believe this is a new one ..
« Reply #11 on: June 14, 2006, 02:57:07 PM »
Jonathan, I also want to add that I was NOT monogamous. I had cheated with prostitues in another country, and seen blood on the condom. The condom however did not break, but I am uncircumsized and did take the condom off with my bare hands, and then proceeded to clean my penis and foreskin.

Offline jkinatl2

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Re: Question for the experts, I believe this is a new one ..
« Reply #12 on: June 14, 2006, 02:57:14 PM »
Wait.. HER risk was from YOU .... but you were protected, so there WAS no risk to you.

Are we dividing by zero here?

"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline jkinatl2

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Re: Question for the experts, I believe this is a new one ..
« Reply #13 on: June 14, 2006, 02:58:00 PM »
No risk, and that sound you hear is me hopping off this thread :)

HIv is not a concern here, and you fried my brain.

:D
"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline worriedman

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Re: Question for the experts, I believe this is a new one ..
« Reply #14 on: June 14, 2006, 03:07:55 PM »
So sorry dear J, I did not mean to do that. It is just that the timing is so freaky for her to get that swollen gland. She never ever had it before in her life on the side of her face. So I am worried about that. And since there was blood, my mind is going back to the incident and trying to recall if i did come in contact with blood in some way some how.

Didnt mean to bug ya ....

Offline jkinatl2

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Re: Question for the experts, I believe this is a new one ..
« Reply #15 on: June 14, 2006, 03:35:04 PM »
Not bugged, just easily confused. YOU had no risk. Therefore your GIRLFRIEND had no risk.

Of course, we are talking HIV here. There are MANY other STDs around, and many of them can be transmitted through skin contact. A full STD panel for any non monogamous couple is always a good idea.

"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline worriedman

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Re: Question for the experts, I believe this is a new one ..
« Reply #16 on: June 20, 2006, 10:34:29 AM »
Dear Jonathan,

I came accross the following excerpt, please let me know your thoughts on this if you can:

Incidence
HIV-associated salivary disease may occur early in HIV disease when CD4 levels are within the normal range. Symptoms may be an early sign of HIV disease progression. A person with swollen salivary glands and dry mouth whose HIV status is unknown may be advised to consider HIV testing.

This condition commonly occurs in children. A survey of 50 children with AIDS found that about 20% had HIV-associated salivary disease.

This has me a bit worried, I just want to cleaify if this happens just around ARS, i am wondering now if the blood did get into my foreskin somehow when I was cleaning and lead to an infection ....

Many thanks ...

Offline worriedman

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Re: Question for the experts, I believe this is a new one ..
« Reply #17 on: June 20, 2006, 10:42:24 AM »
Dear Jonathan,

I came accross the following excerpt, please let me know your thoughts on this if you can:

Incidence
HIV-associated salivary disease may occur early in HIV disease when CD4 levels are within the normal range. Symptoms may be an early sign of HIV disease progression. A person with swollen salivary glands and dry mouth whose HIV status is unknown may be advised to consider HIV testing.

This condition commonly occurs in children. A survey of 50 children with AIDS found that about 20% had HIV-associated salivary disease.

This has me a bit worried, I just want to cleaify if this happens just around ARS, i am wondering now if the blood did get into my foreskin somehow when I was cleaning and lead to an infection ....

Many thanks ...

Offline jkinatl2

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Re: Question for the experts, I believe this is a new one ..
« Reply #18 on: June 20, 2006, 11:10:31 AM »
you still have no risk :)
"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline worriedman

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Re: Question for the experts, I believe this is a new one ..
« Reply #19 on: June 20, 2006, 11:25:39 AM »
God Bless you Sire!
You know when I read the other replies, I wonder why do these people not listen, then when it comes to me, i become one of those people as well:)

So you are saying that if i had to take menstrual blood in my hand and rub it on my foreskin, i still had no risk eh?

I do realize that I have used some of your brain cells, and i continue to use them too. Is there anyting I can do to sort of make it up, maybe a donation wherever you ask ....thanks a mill Jonathan...

Offline jkinatl2

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Re: Question for the experts, I believe this is a new one ..
« Reply #20 on: June 20, 2006, 11:28:35 AM »
Even if you did that, you would make history if you were to be infected via that route.

HIV is almost impossible to get outside of intercourse or sharing an IV drug needle.

"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline worriedman

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Re: Question for the experts, I believe this is a new one ..
« Reply #21 on: June 20, 2006, 11:31:55 AM »
Thanks for your reply, but you forgot to let me know what I can do for you ...or the website ...:)

Offline jkinatl2

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Re: Question for the experts, I believe this is a new one ..
« Reply #22 on: June 20, 2006, 11:43:57 AM »
For me? I'd like a tee shirt. <grin>

For the site? I can't tell you. We used to take donations, but since the merger with Poz.com I dunno how, or if, we do that anymore. I guess we are all big bizzness now, right?

Jonathan
(anxiously awaiting his paycheck :P)

PS: Sire? You must go to the Renaissance Faire too :)
"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline worriedman

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Re: Question for the experts, I believe this is a new one ..
« Reply #23 on: June 20, 2006, 04:49:50 PM »
A T-Shirt, is that it ...DONE!!!! Let me know where to send it please .....Sorry it took so long to reply, but i had to run some errands in the middle ....

Thanks for always answering my questions, how come i havent bunped into you at the faire ....hehe :)

Offline worriedman

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Re: Question for the experts, I believe this is a new one ..
« Reply #24 on: June 22, 2006, 12:58:24 PM »
Dear Experts,

I had a "logical" question, and I was hoping I could continue in the same thread. I hope its not a problem.

The question is as follows: When a person gets infected with a comon cold virus, the body fights it and symptoms follow. Now in the case of a powerful virus like HIV, which infects the whole body, isnt it logical to expect the body to go through some changes initially? If so, then how come so many peolple do not report ANY initial symptoms. Do you guys think it is because they do not notice, or their body just doesnt react???

Thanks in anticipation ...

Offline Ann

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Re: Question for the experts, I believe this is a new one ..
« Reply #25 on: June 22, 2006, 02:03:10 PM »
Worried,

You've done exactly as you're supposed to do - you posted in your own original thread. Thank you.

I suspect some people do not notice anything because they only had very, very mild symptoms but to be perfectly honest, I'm not sure. I don't think anyone really knows the answer to this either. It seems to me that people either get violently ill, or they notice nothing at all - but that's purely going by conversations I've had with other positive people. I want to stress that this is my opinion only. It is not something I've researched and I'm not likely to either - because symptoms are not diagnostic for hiv and therefore mean nothing. Only the appropriate test at the appropriate time will reliably inform anyone of their hiv status.

Hiv is a systemic infection, by virtue of it being an infection of the blood. This means it is an all-over infection and it also is the reason why symptoms (when they happen at all) tend to be very general and not tied to one specific area of the body.

Ann
Condoms are a girl's best friend

Condom and Lube Info  



"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline worriedman

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Re: Question for the experts, I believe this is a new one ..
« Reply #26 on: June 22, 2006, 02:49:20 PM »
Thanks Ann, I am trying to follow all the guidelines of the website. I do know it is a privilige to have access to experts, so i intend to use it properly.

Also, thanks for your answer. It was a frank reply, which is what I was hoping for. Any other opinions from other experts??

Offline worriedman

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Re: Question for the experts, I believe this is a new one ..
« Reply #27 on: June 27, 2006, 08:40:54 AM »
Dear Ann, Andy, Jonathan,

I hope that I am not being a pest, but I read that there is a slight chance of HIV from infected blood splashing in the eyes. There have been documented cases as well. That has got me a little puzzled because if the virus cannot survive outside the host, then how come these cases are happening? And if that is the case then wouldnt menstrual blood on the hand from outside the condom and then on to the foreskin pose a risk, as the foreskin is a mucus membrane as well just like the eye?

Thanks ....

Offline RapidRod

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Re: Question for the experts, I believe this is a new one ..
« Reply #28 on: June 27, 2006, 09:03:35 AM »
That happened as an occupational exposure in a hospital setting. Not in the bedroom or back seat of a car.

Offline worriedman

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Re: Question for the experts, I believe this is a new one ..
« Reply #29 on: June 27, 2006, 09:25:47 AM »
Thanks Rapid ...so no risk?

Offline RapidRod

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Re: Question for the experts, I believe this is a new one ..
« Reply #30 on: June 27, 2006, 09:29:56 AM »
It's not been documented as a risk outside a healthcare setting.

Offline worriedman

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Re: Question for the experts, I believe this is a new one ..
« Reply #31 on: June 27, 2006, 11:00:52 AM »
Would you recommend me to get tested over this exposure ..?

Offline RapidRod

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Re: Question for the experts, I believe this is a new one ..
« Reply #32 on: June 27, 2006, 11:22:17 AM »
No, I would not recommend that you be tested over this matter.

Offline worriedman

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Re: Question for the experts, I believe this is a new one ..
« Reply #33 on: June 27, 2006, 11:45:56 AM »
Thanks a lot Rapid!

Online Andy Velez

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Re: Question for the experts, I believe this is a new one ..
« Reply #34 on: June 27, 2006, 04:08:26 PM »
W, I would recommend you get productively (not frantically) busy in your life. You weren't at risk and now you need to work on getting past all the stuff your mind is so busily giving out. All of course with no basis in HIV science, but it can still be anxiety provoking.

Take a breath and get on with your life. This is not an HIV situation.

Cheers,
Andy Velez

Offline worriedman

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Re: Question for the experts, I believe this is a new one ..
« Reply #35 on: June 28, 2006, 02:01:53 PM »
Hi Andy,

I was taking a break for a day so I didnt see your response, I apologize for not replying earlier.

Thanks a lot for your input, it does make me feel a lot better. You know the funny thing is that I wanted to make sure i wont stress out like this, so i have been trying to be very safe. But I flipped out when my girl got a gland without any reason, no pain, no sore throat etc. It has been there for 2 weeks now and is slightly decreasing so i dont know what to make of it. I guess I have to control my mind again ... ::)

Anyways, thanks for taking the time out.

Offline worriedman

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Re: Question for the experts, I believe this is a new one ..
« Reply #36 on: June 28, 2006, 02:03:44 PM »
Also, Andy if you would be so kind to add to my last question, if I was to rub positive menstrual fluid off the condom, on my foreskin, do you also agree that there is not risk for HIV here?

Online Andy Velez

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Re: Question for the experts, I believe this is a new one ..
« Reply #37 on: June 28, 2006, 06:55:44 PM »
Is this another WHAT IF?

HIV is a fragile virus and even IF the person you were with is HIV+ and IF you rubbed HIV+ menstrual blood INSIDE your foreskin, the likelihood of transmission in that manner is BEYOND unlikely.

You need to find better uses for your time than investing your energy in these scenarios.

Your gf has a swollen gland. Swollen glands happen all the time for all sorts of non-HIV related reasons. There's absolutely nothing in what you have reported which leads me to think you have an HIV problem. No kidding.
Andy Velez

Offline worriedman

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Re: Question for the experts, I believe this is a new one ..
« Reply #38 on: June 29, 2006, 12:52:32 PM »
Dear Andy,

Many many thanks for your reply. I cannot hope for a more definite answer than that. No more questions from me, I will take your advice and stop worrying about this...

Loving Regards.

Offline worriedman

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Re: Question for the experts, Andy I got tested ...
« Reply #39 on: July 20, 2006, 04:33:26 PM »
Dear experts Andy, Ann, Jonathan, Rapid

Many thanks to all of you for helping when I was soooo worried ....

I took your advice and took a few days off from the site and all these thoughts. Andy, I did try to put my time into better things and it helped. I also got tested because i didnt want to have any nagging thoughts. It was negative! I have a question regarding that. At that patricular time I had hurt my back and was on painkillers and muscle relaxants, Vicadin and Skelaxin to be precise. Do you know if that can cause a false-negative? I have read that corticosteroids can cause a false negative, but I am not sure if these medicines are corticosteroids?

Thanks you guys ...

Offline jkinatl2

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Re: Question for the experts, I believe this is a new one ..
« Reply #40 on: July 20, 2006, 04:49:49 PM »
So far as I know, only immunosuppressant therapy given to post-organ-transplant patients and advanced chemo for cancer can delay the production of HIV antibodies.

Seriously, if Vicadin rendered the test inaccurate, half the people who walked into a testing clinic would get false results.

As far as corticosteroid useage goes, that's a tough topic, because it relies on evidence gathered from HIV tests that were obsolete over five years ago. And next year, when refined HIv testing continues, any data gathered this year will be obsolete as well. We can extrapolate based on prior research, but the tests keep getting more and more sensitive, while still maintaining one of the highest rates of accuracy in modern medicine.

More to the point... you seriously, had no RISK.

HIV is not lurking in the shadows or loitering on your condom or your fingers, waiting to jump up and infect you. Statistically it's difficult to establish infection through lubricated unprotected insertive vaginal sex. And you used a condom! And some sort of cream was involved as well, from your description.

Thing is, under no circumstances would most rational people give this a second thought.

The fact that it prompted you to test says less about the risk, real or perceived, and more about what's going on in your head. Now that you have hopefully finished the cycle of testing (which as you know, is it's own roller coaster of crazy) I urge you to address the issues that brought you here. I submit that they are not based in virology nor in epidemiology, but rather in psychology.

In short, I urge you to get over your fear of HIV, however you can. Because as you are aware, facts and rational thought have no power in the world of the crazy. And irrational fear of HIV can destroy a person's life more thoroughly than HIV itself.


"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline worriedman

  • Member
  • Posts: 26
Re: Question for the experts, I believe this is a new one ..
« Reply #41 on: July 20, 2006, 04:58:46 PM »
Hi Jonathan. Thanks for taking the time out again and answering the question. To explain why I was think about this :

 I read a reply by Dr Bob (thebody) to someones question,  and he was talking about how corticosteroids can cause a false negative. And I was out for a week with these pills because of a really bad pinched nerve. So my thoughts went straight to the result wondering if Skelaxin which is a muslce relaxant can cause that or Vicadin, they are quite strong i tell you.....

I really want to get rid of this stress J, which is why i got tested, and I do know that this fear is getting irrational, but I just wanted to be sure ...

Offline jkinatl2

  • Member
  • Posts: 6,007
  • Doo. Dah. Dipp-ity.
Re: Question for the experts, I believe this is a new one ..
« Reply #42 on: July 20, 2006, 05:05:05 PM »
Corticosteroids are not muscle relaxants nor painkillers. Some popular ones include:

Betamethasone (Celestone)
Budesonide (Entocort EC)
Cortisone (Cortone)
Dexamethasone (Decadron)
Hydrocortisone (Cortef)
Methylprednisolone (Medrol)
Prednisolone (Prelone)
Prednisone (Deltasone)
Triamcinolone (Kenacort, Kenalog)

Note, not ALL of these are implicated in the immunosuppression (delayed production of antibodies) which can interfere with an HIV test. And asertaining just how much of any given corticosteriod it takes to mess up a test varies based on a person's immune system, their body weight and general health, etc etc. Again with the chaos theory.

It is generally accepted that it takes a rather large helping of corticosteroid use over time to interfere with the HIV testing window. People who are prescribed long term drugs to deal with the debilitation of lupus or rheumatoid arthritis might experience that sort of immunosuppression.

By the way, you can't possibly claim that you've gone all around the web looking for reeasons not to believe your HIv test and never thought to see whether or not Skelaxin or Vicadin are corticosteroids. Seriously.

You know the answers here. And you know that what you need is not going to be found here. I sincerely hope you find the ability to let this irrational fear of HIV go.

"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline worriedman

  • Member
  • Posts: 26
Re: Question for the experts, I believe this is a new one ..
« Reply #43 on: July 20, 2006, 05:10:35 PM »
Dear Jonathan,

I dont want it to seem that I do not heed your advice ...I Do, and I am thankful for it. I re-read your posting again, slowly and thoroughly, and you take a lot of time out to answer even one question as you have to re acquaint yourself to the question. I do feel selfish right now wasting your time, and maybe I shouldnt have asked this question, I agree with the fact that I gotta sort the head out more than enything else....This was a technical question ........couldnt think of hot to find out if they are corticosteroids or not .....Sorry bout the hassle...:)

 


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