LIVING WITH AIDS: DIET OF MEDICATION FRUSTRATING, COSTLY

The Wednesday morning before Ted Fedler's AIDS clinic appointment wasn't so good.

He battled insomnia all night, then woke up to persistent diarrhea, aches all over his body and an upset stomach. There were 15 different medications to take, which meant Fedler had to eat a few crackers and drink lots of water. It made the problems worse.

Long after healthy people were out of their homes and at work, Fedler was trying to pull himself together enough for the two-hour drive for health care. About three mornings a week go that way.

"I've been taking all the pills since 1989, so it's habitual," Fedler said. "But I get fed up with it at times."

Fedler, 47, tested positive for the Human Immunodeficiency Virus in June 1989 and had full-blown Acquired Immune Deficiency Syndrome by November 1990.

When Fedler tested positive, he had a T-cell count of 287. Doctors use T-cells, a class of white blood cells, to determine how well the immune system is working. By January 1994, Fedler's count was zero. His bone marrow quit producing any white cells in October.

He doesn't know why, with no immune system at all, he has stayed relatively healthy for a person with AIDS. Some PWAs, people with AIDS, die within weeks of their first opportunistic infection, others live several years.

Most of the time, Fedler can function like any other person with a measure of good health. Other days and weeks are horrible as one nightmarish complication after another sets in.

He spent the last holiday season at the John Cochran Veterans Administration Medical Center in St. Louis. Fedler went in Dec. 21 and got out Jan. 6 with just a few days at home in between. He had developed lesions in his throat and esophagus. The pain was unbearable, he couldn't eat, his condition worsened. His friends braced themselves for the worst.

The right combination of medication, and perhaps an incredible desire to live, saved Fedler.

Now he checks in at the VA in St. Louis once a month. The treatment is free, thanks to a 1 1/2-year stint in the Navy. He even receives a small mileage reimbursement.

Because Fedler can't work as a police officer anymore, the government also picks up the tab for his medication, which can cost up to $192 a day depending on what he must take.

But nothing can compensate for the hardship of lengthy travel. Only one doctor in Cape Girardeau sees HIV patients, but he doesn't have as much training or equipment as some physicians in St. Louis or Memphis. People like Fedler generally have to make long, painful journeys for care.

"It's so frustrating," Fedler said. "I have always been one who went from 6 a.m. to 1 a.m. with no problem. My body just won't do that anymore. There is constant pain -- side effects from all the medication. It never leaves anymore."

The last clinic he went to was Feb. 22. A VA receptionist barely glanced up at Fedler as he told him to put his identification card down and have a seat in the waiting room. Unfortunately, the waiting room is filled with people who have communicable diseases, which are deadly to Fedler.

"I don't come here for the social outlet," Fedler said. "I come for the services. I'm very satisfied with what the VA has provided. It was the first system in the nation to address HIV and AIDS."

He saw Dr. Carl Fichtenbaum, who discussed the results of Fedler's recent CAT scan. Things looked so good that Fichtenbaum wants to see his patient every two months instead of every month.

After checking Fedler's blood pressure and feeling a nodule on his arm, the doctor was ready to send him on his way.

"I think Ted is doing fantastic," he said. "He takes excellent care of himself. He is in the advanced stages of this disease, and he knows that, but he is doing very well.

"I don't have a crystal ball, but I would venture a guess that we can probably expect Ted to have another couple of years. Five years would be very, very optimistic."

The Cost of AIDS

This is a list of the medications Ted Fedler takes in his fight against AIDS and their cost per use. The combinations are different for each case.

D4T - 20 mg. - twice daily - $2.20 per use

Slows the progression of the Human Immunodeficiency Virus.

Acyclovir - 200 mg. - four times daily - $1.14

Reduces herpes lesion developed due to AIDS.

Dapsone - 25 mg. - twice daily - $.23

Prevents pneumocystic pneumonia, which may be fatal to people with AIDS.

Fluconazole - 100 mg. - twice daily - $6.30

Prevents thrush, known as oral candidiasis.

Prednisone - 10 mg. - twice daily - $.10

Heals lesions in the throat and esophagus.

Sucralafate - 1 gram - four times daily - $.66

Coats the esophagus and stomach.

Prozac - 20 mg. - once daily - $1.84

Helps relieve AIDS-related depression.

Hydroxyzine - 25 mg. - once daily - $.16

Prevents AIDS-related insomnia.

Neupogen - 1 ml. - three times weekly - $150

Activates bone marrow to produce white blood cells.

Multivitamin - n/a - once daily - $.18

Supplements a healthy diet.

Ibuprofen - 600 mg. - four times daily - $.09

Helps relieve pain.

Tylenol 3 - 30 mg. - twice daily - $.22

Helps relieve pain.

Rifabutin - n/a - twice daily - $3.71

May prevent night sweats, general wasting away.

Clarithromycin - n/a - twice daily - $2.97

May prevent general wasting away.

Nystatin - n/a - three times daily - $.04

Heals herpes lesions.

Anti-diarrheal pills - n/a - three times daily - $.25

Prevents runny stool and dehydration.