Bleeding Gums

Some people will notice increased gum bleeding during regular brushing. Interferon lowers the platelet count in almost everyone. Reduced platelet count can cause gums to bleed when irritated by brushing. Attending regular follow up appointments during treatment allows for monitoring of platelet and other blood cell counts.

I wanted to share with all of you some information that I thought would be helpful. I had my teeth cleaned about a week ago. They used the baking soda cleaner. Well...if your mouth is already some what dry due to medication and having Hep C and having your teeth cleaned with the baking soda cleaner is hard to deal with. I day or 2 later I got where I could not brush my teeth for my gums hurt so bad and I could not eat because the top of my mouth felt like I had been eating captain crunch with out the milk, and my tongue felt as if I had burned it. The dentist was very kind to pull up some info on HEP C. He highlighted some info that I was not aware of.

HEP C infection can potentially cause a dry mouth and the dryness may be due to inflammation of the glands that produce saliva. Dry mouth can occure when the amount or quality of saliva decreases. Symptoms can include: bad breath, cracked lips, sore mouth and throat, difficulty eating and swallowing which can affect nutrition, mouth ulcers, tooth decay and tooth sensitivity.

I thought this was very educational since not to long ago some one posted something about a sore throat.

I have to share with you a product that is awesome! You can buy it at any drugstore. If they do not have it let the drugstore know and they will order the products. The product cost from 2.99 to 10.00. It is pretty reasonable and it works!

The product is called biotene. They make mouthwash, toothpaste, gum, and a oral gel that does not numb but puts back moisture in your mouth. The product is clinically, allergy and hospital tested. The products are alcohol-free and contain bio-active enzyme protection. The product is to help reduce bacteria, gum irritations due to dry mouth. If you can get moisture back into your mouth it will help with the throat being sore and you becoming horse as well. I bought it all. I have tried it all and I am so glad my dentist introduced this to me. He told me that one of his patients has cancer. The medications and chemo dry her mouth out. She takes a little spray bottle which you can find near hair stuff or tavel in most stores. She fills it 1/2 water and 1/2 of the biotene mouth wash and sprays her mouth on and off all day. I just had to share this with everyone since I am sure that most of us have or had experienced this.
http://dailystrength.org/c/Hepatitis_C/forum/707861-dry-mouth-and-sore-mouth
There is a web address and it is: www.biotene.com and customer service is 1-800-922-5856. I am sure they can also direct you to what stores in your area would have the product. Hope it helps anyone who may be interested in trying,

Brain fog or feeling ‘foggy’ is often described as not being able to think straight, having a shorter attention span or decreased alertness, short term memory problems such as forgetfulness and losing track of thoughts. This should lessen after treatment has finished and within one month, you should feel your normal self again. If it persists, discuss the symptoms with your doctor.

Brain Fog Busters
Alan Franciscus, Editor-in-Chief

“Where are my keys?”  What did I do with that book?”  What time was I supposed to meet John?”  Almost every one – including people living with hepatitis C – forgets where they place things or has missed a meeting because they forgot the day or time of the appointment.  Brain fog is loosely defined as a constellation of symptoms, including difficulty concentrating, memory loss, trouble with retaining information, and a whole range of other cognitive problems.  Along with fatigue, brain fog is one of the most common symptoms people with hepatitis C experience.   

The exact cause of brain fog in people with hepatitis C is poorly understood but there have been some theories put forth that may explain the higher incidence of brain fog in the hepatitis C population.  One theory is that since the hepatitis C virus crosses the blood-brain barrier there may be some low levels of inflammation in the brain that would affect cognitive function. Other experts speculate that the cause of brain fog may be due to the fact that the immune system is over stimulated trying to fight the hepatitis C virus.  This process involves the immune system’s activation of the body’s innate defense system that produces killer cells, and a certain protein called interferon.  The result of the natural production of interferon is that the body goes into an attack mode and this process produces side effects such as fatigue, muscle and joint pain as well as general cognitive dysfunction – this is the same process that occurs when someone catches the common cold or the flu. 

Regardless of the reason, brain fog can affect almost every area of life.  On a personal note, the symptoms of fatigue and brain fog are the symptoms of hepatitis C that eventually led me to seek medical care that resulted in a diagnosis of hepatitis C.   

The ten steps listed below are a variety of measures both scientifically proven and from personal experience that have helped me manage brain fog.  I have found that combining various strategies has greatly improved my memory and reduced the stress of having hepatitis C-related brain fog.  

1. Get a Check Up:  Brain fog can be caused by many conditions, such as depression, acute and chronic pain, diabetes, thyroid disease and many other medical conditions.  Talk with a medical provider to make sure that there is no other mental or physical condition that is causing the brain fog.   

2. Physical Exercise:  One of the best strategies to combat brain fog is exercise. Exercise has been proven to increase blood flow in the brain and aid in the replication of brain cells.  Exercise will also help to reduce the build up of plaque in the blood vessels including those in the brain.  There are many types of exercise to choose from, such as walking, jogging, swimming, etc.; but always talk with a medical provider before beginning any new vigorous exercise program.

3. Exercise the Brain:  Do mental activities that stimulate the brain such as crossword puzzles, reading a book, putting together a jigsaw puzzle, playing memory games, solving mathematical problems, playing chess or any other activity that challenges the brain.   

4. Diet:  It is not surprising that a healthy diet affects every area of the body, including the brain.  A poor diet can lead to obesity, diabetes, increased levels of ‘bad’ cholesterol, as well as many other conditions that can affect the health of the body.  A poor diet can lead to build up of plaque in the veins, and poor circulation. Recently, some studies have suggested that uncontrolled diabetes may contribute to Alzheimer’s.   More studies are needed to confirm the findings, but the link between poor diet and the development of cognitive dysfunction appears to be very solid. 

5. Sleep:  Insomnia can lead to many problems, including brain fog.  It is recommended that people try to get between 8 and 10 hours of sleep every night.   

6. Visualize: This is a very good strategy that has worked well for me.  For instance, when you park your car visualize where you parked it as well as the nearest cross streets.  Another example would be that when you put an item in a certain place, visualize that place.  

7. Permanent Location:  Find a permanent location for things like keys, loose change, or any other item so that they can always be located.  I try to put my keys in the same location in the kitchen so that if I am running out of the door I know exactly where to look without wasting time and becoming frustrated trying to find them.     

8. Daily Planner: Write down every appointment in a spiral bound notebook, daily planner or on a computer and use it to refer to when making appointments.  Every morning after my coffee I check the daily planner so that I am aware of and can plan my daily activities accordingly.  Remember not to overbook and also try to write in time between appointments to rest.    

9. Stress Reduction:  Stress is a killer and nothing will make you more confused and forgetful than being stressed out.  Find activities that help to reduce the stress like walking, meditating, reading a good book, listening to music.  Build these types of activities into your daily routine.    

10. Laugh:  Having brain fog is not funny and it can get the better of you and ruin your life.  If you miss an appointment – apologize and move on.  There is no point in self recriminations especially if you are making every effort to cut down on mistakes.  You will find that life is much easier and enjoyable if you can laugh at your very human mistakes. 

Resources:
CDC Physical Activity for Everyone
http://www.cdc.gov/nccdphp/dnpa/physical
/everyone/recommendations/index.htm

The Original Memory Gym
http://www.memorise.org/

USDA MyPyramid.gov
www.mypyramid.gov

CARDIOVASCULAR ADVERSE EFFECTS

Cardiovascular

WARNING:

Peginterferon must be used with caution in patients with a history of cardiovascular

disease (CV). Those patients with a history of myocardial infarction (MI) and/or previous

or current arrhythmias should be monitored closely. CV adverse experiences, which

include hypotension/hypertension, arrhythmias (including tachycardia: ³150 beats/min),

cardiomyopathy, angina pectoris, and MI have been observed in patients treated with

pegylated interferons with or without ribavirin. Patients who have pre-existing cardiac

abnormalities should have electrocardiograms (EKGs) administered before antiviral

therapy is initiated. Cardiologic consultation should be considered on an individualized

basis.

Fatal and nonfatal MIs have been reported in patients with anemia caused by ribavirin.

Patients should be assessed for underlying cardiac disease before initiation of ribavirin

therapy and should be monitored appropriately during therapy. If there is any

deterioration of CV status, therapy should be suspended or discontinued. Because cardiac

disease may be worsened by drug-induced anemia, patients with a history of significant

or unstable cardiac disease should not use ribavirin.

GENERAL CARDIAC EXCLUSION CRITERIA (ANECDOTAL)

· Cardiologist deems patient an unstable candidate for treatment based on CV status

· Prior anthracycline treatment, mediastinal radiation, or high-dose alkylating agents

resulting in CV compromise

· Congested heart failure (CHF)

· A history of significant or unstable CV disease

PRETREATMENT ASSESSMENT

1. Electrocardiogram (EKG) and/or stress test are indicated for patients with a current or

past history of CV disease. Consider EKG for patients >50 years of age, regardless of

treatment

2. Medical history

3. Past cardiotoxic chemotherapy/medications

4. Past CV history: OBTAIN DOCUMENTATION OF CLEARANCE FROM

CARDIOLOGIST IF POSSIBLE

5. Current cardiac medications (including antidiuretic, potassium supplement)

Side Effects Management Handbook • II. Cardiovascular • p. 2

6. Physical assessment

– Heart rate, rhythm, amplitude

– Abnormalities (murmurs, gallops, extra heart sounds)

– Edema

– Labs: complete blood (CBC), thyroid-stimulating hormone (TSH), chemistry

(SMA), serum triglycerides, and serum lipid levels

RIBAVIRIN DOSE MODIFICATION REQUIREMENTS

For patients with a history of stable CV disease, a permanent dose reduction is required if

the hemoglobin (Hgb) level decreases by ³2 g/dL during any 4-week period. In addition,

if the Hgb remains <12 g/dL after 4 weeks on a reduced dose, the patient should

discontinue ribavirin therapy. Please refer to the section on managing hematologic side

effects for a discussion on the use of erythropoietin (Procrit®, Epogen®) to manage

ribavirin-related anemia.

A. ARRHYTHMIA

Etiologies: Hemolytic anemia, underlying CV condition, interferons,

dehydration, anxiety

Treatment: Symptomatic treatment, repeat EKG, hold treatment

Note: Supraventricular arrhythmias occur rarely and may be correlated

with pre-existing conditions and prior therapy with cardiotoxic

agents. Controlled by modifying the dose or discontinuing treatment,

but may require specific additional therapy.

B. CHEST PAIN

Etiologies: Multiple, including hemolytic anemia (10%), underlying CV

condition

Treatment: Assess and treat symptoms, assess need for lab work (creatine

phosphokinase [CPK], CBC, troponin, etc), hold treatment, repeat

EKG, consider cardiology consultation

C. HYPOTENSION

Etiologies: Multiple

Side Effects Management Handbook • II. Cardiovascular • p. 3

Treatment: May require supportive therapy including fluid replacement to

maintain intravascular volume. Monitor blood pressure,

administration of intravenous (IV) fluids

Note: May occur during or after administration

D. HYPERTENSION

Etiologies: Multiple

Treatment: Monitor blood pressure, initiate treatment if appropriate

E. PERIPHERAL EDEMA

Etiologies: Fluid overload, venous obstruction, heart failure, and capillary leak

Treatment: Monitor electrolytes, elevate extremities, eliminate sports drinks

(such as Gatorade®, POWERade®, 10K®, Allsport®) as hydration

sources due to high sodium content, daily weight measurement,

consider cardiac and renal evaluation

OTHER CONSIDERATIONS

• In patients taking ribavirin, CBC should be monitored at baseline and at weeks 2 and

4 of therapy, then monthly. More frequent monitoring if clinically indicated—for

example, CBC should also be measured at week 1 for patients at high risk.

• Patients with hemoglobinopathies (thalassemia, sickle-cell anemia) should not be

treated with ribavirin therapy

• Interferon treatment may increase serum triglycerides; hypertriglyceridemia-related

diseases are uncommon

Internet Conference Report
Digestive Disease Week (DDW 2004)
May 15 - 20, 2004, New Orleans, Louisiana

Arrhythmias During Pegylated Interferon Alfa-2b (Peg-Intron) and Ribavirin Therapy: Observations from the WIN-R Trial

Interferon has been associated with cardiac arrhythmias. Ribavirin (RBV) causes a dose-dependent hemolytic anemia that may exacerbate underlying cardiac disease.

The objective of the present study was to assess the frequency and clinical presentation of arrhythmias occurring during hepatitis C (HCV) therapy with pegylated interferon (PEGIFN) and RBV.

Using data from the WIN-R Trial, a US multi-center study comparing fixed (800 mg) vs. weight based (800-1400 mg) RBV dosing with peginterferon alfa-2b (Peg-Intron) 1.5 mcg/kg/week, researchers identified patients with arrhythmias reported as serious adverse events (SAE).

Results

4900 patients received at least 1 dose of PEGIFN and RBV. Nine patients had arrhythmias occurring between 2 and 48 weeks of therapy (1 patient was at followup week 2): atrial fibrillation 6, multi-focal atrial tachycardia 1, atrial flutter 1, non-sustained ventricular tachycardia and SVT 1.

Four patients were male, all were Caucasian (mean age 57). Six patients started therapy on 1000-1200 mg of RBV; 3 started on 800 mg. Two patients had RBV dose reduction before the SAE.

Five patients had a prior history of cardiac disease (atrial fibrillation 2, 1st degree AV block 2, surgery to repair Tetrology of Fallot 1).

Based on TSH levels, 8 patients were euthyroid and 1 who developed atrial fibrillation was hyperthyroid.

The mean hemoglobin (Hb) at the time of the SAE was 12.5 gm/dl (n=8). Compared with baseline Hb, there was a mean decrease of 2.7 gm/dl at the time of the SAE. One patient with a history of alcohol abuse was newly diagnosed with cardiomyopathy with an ejection fraction of 20%.

Five patients were treated with medications, 2 were treated with medications and electrical cardioversion, the arrhythmia spontaneously resolved in 1, and the treatment data are not available for 1.

Anti-HCV therapy was discontinued in 3 patients, continued in 2, held for 2 weeks in 1, and therapy was dose reduced in 1.

In 1 patient the SAE was at treatment week 48 and 1 had completed therapy 2 weeks before the SAE.

Conclusions

(1)     Arrhythmias reported as SAEs occurred at a frequency of 0.2% during PEGIFN and RBV therapy in this study;

(2)     Approximately half of patients with arrhythmias during anti-HCV therapy had a history of conduction abnormalities or atrial fibrillation;

(3)     Arrhythmias were not related to severe anemia (Hb <10) in this series; and

(4)     Although one patient with atrial fibrillation had PEGIFN-induced hyperthyroidism, hyperthyroidism does not appear to be the cause of arrhythmias in the majority of these patients.

06/07/04

Reference
F Ahmed and others. Arrhythmias During Pegylated Interferon and Ribavirin Therapy for Chronic Hepatitis C: Observations from the WIN-R Trial. Abstract 1226 (poster). Digestive Disease Week. May 15-20, 2004. New Orleans, LA.

http://www.hivandhepatitis.com/2004icr/ddw2004/docs/0607/060704_b.html