Donna - My question is
this. I had a 4 week PCR run. My viral
load had gone from 1,050,000 to 139,000. My
dr said I was a "slow responder" and that
the 4 week viral load was the new standard.
I had hoped that I had misunderstood - but
since then I've done major reading. One
study jumped out at me (most agreed with the
4 week being the new standard :o( ) that
said for geno type 1's, at 4 weeks, if your
viral load is over 100,000, you have less
than a 3% chance of getting SVR. Do you
have any more information on this? I'm
going to stick it out for the 12 week viral
load (so many encouraging words from this
website), but if my chances really are less
than 3%....I am contemplating waiting for
the new meds or at least a clinical trial.
Thanks! Dottie
Hi Dottie
The buzz word for the past
18 months or so has been RVR, Rapid Viral
Response, meaning the viral count is
undetectable at Week 4. I have routinely
checked a PCR at Week 4 for awhile and now
it's pretty much the standard. Each
clinician uses the information differently.
Some studies suggest treatment duration can
be reduced, others predict an increased SVR.
The bottom line, a 4 Week PCR is a guide.
Yes it would be nice if you cleared at this
point, but there is no data to suggest you
won't achieve SVR. The study you're
referring to looked at persons with more
severe disease and I believe the treatment
regimen was sub-optimal.
The 12 Week PCR provides a
clearer picture, because there is more
literature looking at the prognostic
implications. I applaud you for sticking it
out until then. If you are 'almost
undetectable' at week 12, continue for
another 6 weeks. Sometimes tweaking the
regimen can yield better results. Assuming
you clear at Week 18, you should stay on
treatment for a minimum of an additional 36
weeks, preferably 42 weeks more. Again,
this is in light of minimal side effects and
the ability to remain on the maximum dose
with minimal risk. It is imperative
that you don't miss a dose of ribavirin, and
don't delay taking your shot…even a couple
of hours can make a big difference with
weekly Peg- Intron or daily Infergen. Drink
plenty of water, exercise and eat a diet
high in complex carbohydrates and low in
fat. Take Omega-3 fish oil capsules and you
will do fine. Good luck to you.
Keep in touch and God Bless,
Donna Fanelli
From
jenibjones
contradicting information. Those exposed to
'mucosa' from that of known infected person
should be tested??? I read that kissing is
not a major risk factor but the mucosa
is eyes and mouth. Now...tell me why that is
not a threat, kissing some one with possible
gum disease is a threat? There are levels of
gingivitis and periodontal disease, help me
under stand. My common sense tells me unless
you have excellent oral care...you could be
a higher risk person to give the disease to
another...for the record my mouth is very
healthy.
thanks..
may questions left....
Jenibjones,
Hepatitis C is a bloodborne disease; the
virus is transmitted by infected blood. HCV
is not transmitted via any other body fluids
unless those body fluids have been
contaminated with blood. Gingivitis, an
inflammation of the gum tissue surrounding
the teeth, often results in bleeding gums
because the tiny blood vessels rupture as a
result of the inflammation. For the virus to
be transmitted, the infected blood must come
in contact with an open sore or wound and be
carried through the circulation. Unless the
kissing results in trauma, the risk of
transmission is extremely low.
I hope
this helps. God Bless,
Donna Fanelli
considerate2
Thank you all for the replies. I am
going to ask questions as much as i can
once getting to the doctor and i am glad
i have this site. One question i do want
to ask: When a person comes back
positive for Hepetitis B and C, does it
make his chances for survival lower
because he has both verses just having
one.
Hi,
When you
say positive for Herpatitis B and
C, I assume you mean there is a
detectable virus in both. Having
both viruses is more difficult to
treat and depending on the liver's
resistance, survival may be
diminished, but this is very
individual. Both viruses can be
treated together and the Hepatitis B
virus will be treated a lot longer.
The Hepatitis B virus is often
controlled and not "cured", while an
SVR in Hepatitis C is a cure. I
hope I've answered your question.
God Bless,
Donna
General Question
Needle Stick while on the job
If exposed to HCV while four months
pregnant what are the chances of
passing the virus onto my
child.
Overall, the risk of vertical
transmission (transmitting the virus
from mother to child) of HCV is about 3
to 5%, and higher if the mother is
co-infected with HIV.
It has been reported that the
risk of transmission after a needlestick
injury on the job is 4-5%. Do the
math...5% of 5% … the relative risk is
very very low.
God Bless,
Donna Fanelli
From Francias
Here is the first time he posted on
the boards
Hello,
I've been recently diagnosed with
Hepatitis C. According to my test
results the Hep C virus RNA HPA
count is 915133 (A) and the HCV RNA,
ser/plas, PCR is 5.96 iU/mL and
Bilirubin, direct level 0.2. My ALT
level is 118 units/L and the
alkaline phosphatase is 46 units/L.
I have never had blood transfusion
in the past or used any type of
recreational drug with a needle or
even any type of tattooing or
piercing. But I was abusing alcohol
for a long period of time, which
affected my ability to hold
employment because I would drink
700ml of vodka or whiskey plus 3-6
beers on the weekdays and then end
up not showing up for work on
mondays. There would be three to
four days of binge drinking that
would knock me out.
My question and curiosity is the
high levels of ALT is due to
alcohol abuse for approximately
past ten years? could this be
alcohol related Hepatitis C. I have
completely stopped drinking now. But
I'm worried what these numbers
indicate. If someone could please
relate to this please let me know.
Could these results be inaccurate
due to my history of alcohol abuse?
How can I be sure this is not
misdiagnosed?
Second Time he Posted
So here is how I got my diagnosis:
Got a full blood check including
liver. Results show the following:
ALT = 120 units/L
With this I was asked to take
another test for all major liver
disease including hep ABC. The
results for Hep C. was reactive. I
just do not rememeber what the doc
said the kind of test it was. After
which I was asked to again take the
a live panel test but this time with
the quantitative PCR test. The
results was what I listed in my
promary message. I was referred to a
GI because the doc wasn't
knowledgeable in this field and
couldn't answer a lot of my
questions. My appointment in 3 weeks
and I am just outbusted on what is
going on here.
Here were my results for the liver
panel test and notice I do not have
AST?? I guess they didn't bother.
| Name |
Standard Range |
2/29/08 |
3/5/08 |
4/13/08 |
|
ALKALINE PHOSPHATASE |
|
|
49 |
46 |
| ALT |
|
120
H |
125
H |
118
H |
|
BILIRUBIN, TOTAL |
|
|
0.8 |
1.2
H |
Now what does justify me to have Hep
C? I know my VL is pretty high at
approx. 915,000 count. But does it
justify me conclusively I have HCV?
What does my PCR number 5.62 mean???
I canoot figure out how possibly I
could have caught this disease??? I
have an eye surgery 21 years ago and
dental work at a student dentist
facility that possibly could have
mishandled some of their materials.
This was in Paris France...
Well anyways before I go to my GI I
want to learn as much as I can about
HCV as I can. I am with Kaiser in
CA. Do you think they will drop me
if I have this? How much will I be
llooking at spending for treatment
(getting the medicine?).
I guess the next step will be to
figure out my genotype. To begin
with what exact bllood test
competely proves me HCV?
What are the exact steps? What are
treatments available for a high VL
like mine? I mean I feel perfectly
fine thank goodness.
What can I do to lower my VL? Only
medication? How about ALT, Bilirubin
counts?
PLEASE help me understand.
Thanks,
Hi
Francais.
I
don't believe you're focusing on the most
significant part of your story…your
recovery. Your accomplishment empowers you
to manage the remaining chapters.
Congratulations!!
To
answer your questions: your former alcohol
abuse has little to do with contracting the
Hepatitis C virus. You may never know for
sure how and when you contracted the virus,
and the uncertainty should not interfere
with your ability to address the problem. A
misdiagnosis is unlikely, the blood results
speak for themselves. A positive HCV
antibody indicates exposure, and a viral
count shows active disease. Your count of
915,000 is moderate. I have treated
patients with more than 50 million. A high
viral count doesn't mean worse disease and
the reverse is also true.
Your
ALT is elevated, but your bilirubin and alk
phos are in the normal range. It's unclear
as to why you don't have a result for the
AST. All of these values provide a one
dimensional current picture of your
liver function. A more detailed piece of
information can be obtained from a liver
biopsy which actually looks at a small piece
of your liver tissue. It is also important
to learn your genotype. This is the "type"
of Hepatitis C virus you have and basically
denotes the route your virus takes to
replicate itself and can provide more
information about your ability to respond to
current therapy.
No insurance company should
deny paying for your treatment at this
time. If you have a problem, please contact
me personally, and I'll advise you.
Search the Janis and Friends
site. The information is as accurate as it
is up to date. Remember to get vaccinated
against Hepatitis A and Hepatitis B. Keep
in touch, ask questions and praise your
success.
God Bless,
Donna Fanelli |
|
Hi Donna
and anyone else that can add insight to my questions.
can you please give me some info about TELEPREVIR..
does it really work well
will it be FDA approved, and when?
does it cut down on TX time for geno
1a patients
it was suggested somewhere that it is
possible to be UD after only one week of tx. is this
possible?
i realize it will be part of a 'cocktail',
along with peg and riba, i was wondering whether the SX were
worse with teleprevir added to the mix.
please give us as much info as
possible on teleprevir and any other new TX drugs that may
be coming in the future
thank you.......Ron
Hi Ron
( This is a former
posting of mine)
Vertex or Telaprevir
(VX-950) seems to be winning the race as the first protease
inhibitor to come to market. This class of drugs has been
used for years in HIV and is new to Hepatitis C. The
difference in the Hep C population, is these drugs develop
resistance very quickly…in 2-4 weeks. The HCV virus is very
smart in changing it's appearance to continue doing it's
dirty work, thus resulting in mutations and resistance.
PEG/IFN and ribavirin will continue to suppress viral
replication, without the risk of resistance. The
telaparevir will kill the virus and the combo Rx will help
prevent it from coming back by boosting the body's immune
system. It is approaching Phase III and hopefully we will
see it in 2-3 years on the shelves.
More information can be
found on the link below.
http://www.hivandhepatitis.com/hep_c/news/2008/020108_a.html
I hope this helps. God
Bless
Donna Fanelli
I
am a 48 year old female. I was just diagnosed with Hep C 1
month ago. My genotype is 1b, I used intravenous drugs 25
years ago but quit then. liver biopsy results were that I
am between stages 2 & 3. I haven't received treatment yet.
I would really like a estimate on my chances of survival and
how long I have left. Thank You for your
consideration. Dawb Austin
Hi Dawnaust,
It has been
estimated that at your age, it can take 10-12 years
to advance from stage 2 to 3 and less time from 3 to 4.
This time line is quite variable depending on one's
overall state of health and well-being, alcohol
consumption as well as other lifestyle choices.
With a successful
course of therapy, the timeline reverses.
Good Luck and God
Bless,
Donna Fanelli
Hi I am newly
diagnosed about 1 month ago...It has been one heck of a
bumpy ride, to say the least. I have never been high
risk, I did have blood transfusion 5 years ago. It
seems that the doctor does not really want to help. My
alt/ast are elevated to alt 99 ast 49, my viral load is
3.94+e5iu/ml whatever that means. The doctor was so
mean to me in his office I asked him about an biopsy and
being refered he said it does take some time to be
refered to specialist, and 'that i was not dying now'
nice eh? then they proceeded to fax my records to the
wrong person, well anyway I guess I am venting now. My
question is I truely have been given no information in
anything, diet health nothing...We do not have any blood
test in the past in regards to my liver because through
the past years it has been all prenatal. what should I
be telling my doc is a biopsy important should i be
getting my geno typedone? there saying I might not get
in until october i can not wait this long with now
knowing anything...Please help me understand all of
this!!!!
thanks sincerely Terri
Hi Terri,
I'm sorry to hear
you've had so much trouble at a time when you're very in
much in need of TLC. You need to seek out a provider who
will guide you through the process of healing. Seek a
gastroenterology group who treats a large number of HCV
patients. Often those affiliated with large teaching
hospitals have an edge up and groups involved with
research are very forward thinking.
I believe it's
unlikely you contracted HCV from a blood transfusion 5
years ago. Since 1995, the blood supply has undergone
the most sophisticated testing. Other risk factors for
HCV transmission include amateur tattoos, ear piercing,
IV or intra-nasal drugs, hospital worker, or living with
someone infected. You may never know how, but it's
often helpful to know when.
The next step in your
treatment plan should be to obtain a genotype.
Depending on the results, you may not need a liver
biopsy because genotype 2 and 3 (less common) respond
well to only 6 months of treatment.
Eat a diet high in
complex carbohydrates and protein and low in fat. No
alcohol ever, and make sure you get vaccinated against
Hepatitis A and Hepatitis B.
Look at the main
site,
www.janis7hepc.com and
www.hcvadvocate.org. for additional
information.
Good luck and God Bless,
Donna Fanelli
Dear Donna,
Thank you for the reply (I copied it below for
reference). I did make an error in my original message
about the 70-80% - sorry, I can only plead brain fatigue
from trying to research so late at night!
My brother is basically saying that there is no cure, so
he will live as if he is toxic so as not to spread the
disease. Since the percentages are so low for death from
HVC, there is no reason to do the therapy. Since he will
not do therapy, there is no reason to get tested.
I found these figures and it's hard to argue with his
logic:
It currently seems that if 100 people catch hepatitis C:
15-20 people will get rid of it within 2-6 months (much
like we get rid of a flu virus)
60 people will have a long-term infection that may cause
no problems or may cause levels of liver damage ranging
from mild to serious.
20-25 people will have a long-term infection that leads
to serious liver damage after 20 years. Of these people
(i.e., those with serious damage after 20 years):
10-will remain stable and the other 15 will progress to
liver failure or liver cancer after another 5 years
According to an article in Gut 2000;47:131-136, the 5
year rate for progression to hepatocellular cancer is
13.4% and the 5 year rate for progression to death is
15.3%.
Question 1 - is there a compelling argument that he gets
tested if he will not be doing drug treatment?
Question 2 - is he correct in assuming that odds are he
has the more common variety (which is resistant to
therapy) because his test came back with numbers that
were 'very high?'
Question 3 - you mentioned Milk Thistle as a possibility
for managing the disease symptoms. There is a website
liversupport (dot) com that seems to have a lot of
scientific evidence that the brand Maximum Milk Thistle
is better than other brands. It sounds logical to me,
anyway. While I realize that you can't promote one brand
over another, is there any reason to doubt their claims?
The Internet has so many scams that I am pretty
skeptical about anything having to do with herbal
remedies after dealing with my father's esophageal
cancer and my husband's colon cancer.
Also, I did not make it clear that the doctor he saw
works at the health department clinic, which is
apparently the only free clinic in the county. After
dealing with her when he went in to get the test
results, I doubt I can talk him into going back again.
They gave him some HVC phamplets that were so old they
had a phone number for the clinic that had been
discontinued for years on it. I'm trying to talk him
into getting an Internet connection to get more updated
research, but he just keeps going back to his original
argument that he doesn't need to know any more than the
fact that he has it, he will live as though he is
infectious, and that is the end of it. I'm thinking that
he may come around eventually, particularly if I can
present some logical arguments for getting tested, but
it will take time.
Thanks again for your help. You are a godsend!!
geckokl
Hi geckokl
You have referenced
the statistical progression of HCV. The importance of
further testing is to gain insight about your brother's
progression. There are many factors that affect disease
progression and there are many factors that influence
response to treatment.
Prior to making negative
predictions, your brother should learn the facts about
his disease so he can make an informed decision.
There is no
correlation of "the numbers" and genotype. The
"resistant type" is
genotype 1a or 1b, and has a 50
% cure rate with the available treatment. If the virus
clears within the first 12 weeks, those odds are
increased to 70-75%.
.There
are so many products promoted on the Internet and not
one has undergone controlled clinical trials. The
products at GNC, The Vitamin Shoppe and Costco are all
very similar and contain the listed amount of the active
ingredient, silymarin.
Lastly, you can find information about clinical trials
accepting new patients in your area. All treatments,
tests and examinations are at no cost. He may also have
new and more effective treatments available to him. The
two websites are,
www.centerwatch.com and
www.clinicaltrials.gov.
I
hope this is of help to your brother.
God
Bless,
Donna
Fanelli
------------------------------------------------------------------------------------------------------
I
was diagnosed with cirrhosis
in late 2005. I had done two rounds of peg-intron and
one year of daily infergen since 2002. I will often
wonder if I would have still progressed to cirrhosis
that fast if I had refused treatments.
My main question
involves constant abdominal pain that I have had for
over a year now. I was tested by MRA, CT Scan,
ultrasound, 24 hour urine test, gastric emptying test
and finally diagnostic laporascoptic surgery. All came
back normal. Yet I still suffer daily pain of varying
intensities of abdominal pain from the navel down. It
ranges from 3-4.5 up to 7-7.5 on a scale of 1-10. It can
range from mild to severe all in one day.
I have tried about 12
different medications to ease the discomfort. None
worked. I finally saw a pain specialist that prescribed
5 mg oxycodeine. I have to take 4-6 before I get any
relief. I do not get any kind of a high. The only way
that I can tell they're even working is if my pain
eases.
I have developed high
blood pressure and type II diabetes over the last few
years. I am also being treated for depression, anxiety
and bi-polar disorder.
Do any of these
illnesses lend any reason for the abdominal pain? All of
my doctors are at a loss. There has to be some
explanation. I often feel people around me think that I
am exaggerating my pain. That often hurts more than the
pain. It hurts to have your credibilty challenged by
those you respect or care about.
One last thing. I
have been off work on disability for 5 years. I returned
to work on 1/14/08. I am trying desperately to making a
successful return to full-time work. All of the odds are
against me but I am giving it all that I have. Please
wish me luck on this tremendously difficult challenge.
I want to congratulate you
and I pray each day will become easier for you. To
answer your first question, in all likelihood, the two
rounds of treatment were a benefit and may have delayed
your cirrhosis. Regarding your main question, I am
puzzled. It's quite difficult for me to shed light on
your situation without taking a thorough history and
performing a comprehensive exam. I would also want to
know all of your medications, your age, sex, look at
your lab work and evaluate the results of your tests.
Did you have a colonoscopy, and what are your bowel
movements like? When is your pain most intense? Did
the pain begin before or after you started treatment?
These are a few of the hundreds of questions that are
running across my mind.
Feel free to contact me if
you would like to discuss this further.
God Bless,
Donna Fanelli
My question for
Donna,
I would like to know what is the normal dosage for
ribivirin during treatment with pegesys for genotype
2b, My heptimax test was negitive at 4 weeks. I have
had 6 weeks of tx now and would like to drop from
1000 mg to 800 mg. I have read many reports that 800
mg is the norm for my genotype and RVR. I also don't
like the idea of it not being divided unequally, 3
pills morning and two nightly. My weight is lower
and not higher and my pegesys is 180 once a week. My
last liver biopsy was 2/2 two years ago. I don't
drink, smoke, or have other known problems besides
the hep-c.
Thanks for your help,
Hi
Humbled,
Please let me know your weight, as of today. I will
calculate your dose and discuss it with you. Thanks.
Donna
Fanelli
Humbled we
have also emailed your weight per Donnas request.
Hi
Humbled,
Don't
worry about your weight. After treatment, you will
have the opportunity to eat and exercise. Regarding
your ribavirin , I don't see any problem with you
reducing your dose to 800mg at this time. In the
WIN-R tial, there was no difference in SVR in
patients with genotype 2 who received either 800mg
or weight based dosing. I calculate dose by
multiplying Kg. X 13. At 150, your ribavirin should
be 900mg. Considering your genotype, your rapid
response, and liver histology, I truly don't believe
you will compromise your treatment if you reduce
your dose to 800mg. Please make sure you complete
the 24 weeks though. Current thinking is that the
treatment time can be reduced to 18 weeks is some
patients with genotype 2. Unfortunately, we're not
exactly sure who these patients are!
Good
luck to you and God bless.
Donna
Fanelli
General Question:
We hear so much about the
new drugs in trials etc. Many of them are/will be
used with Peg-IFN. Are their any trials without
using interferon? . Their is some good news here at
Jans site. We have a member which was in the Phase 2
Vertex 950 trial . She cleared....so wonderful.
Link to thread
39395.1 This
was very exciting and promising for all of us.
At this point in time, Vertex or Telaprevir (VX-950)
seems to be winning the race as the first protease
inhibitor to come to market. This class of drugs
has been used for years in HIV and is new to
Hepatitis C. The difference in the Hep C
population, is these drugs develop resistance very
quickly…in 2-4 weeks. The HCV virus is very smart
in changing it's appearance to continue doing it's
dirty work, thus resulting in mutations and
resistance. PEG/IFN and ribavirin will continue to
suppress viral replication, without the risk of
resistance. The telaparevir will kill the virus and
the combo Rx will help prevent it from coming back
by boosting the body's immune system. It is
approaching Phase III and hopefully we will see it
in 2-3 years on the shelves.
I found out the other day
that my VL is 3,080,000. My regular doctor has
referred me to the GI. I just don't know what to
expect. I am so afraid of the unknown. I was doing
ok until I got the call from the doctor saying that
they are going to set up the referral. I got the
call this morning telling me that i have an appt.
May 1st. I have a whole month of this before I meet
this new doctor. What should I be asking and what
should I be expecting to happen. Any input would be
wonderful.
Hello Marie,
Please relax, take a deep
breath and don't worry. There's no correlation with
viral count and liver histology. You need to find
out your genotype and then most likely you will
need a liver biopsy. Try to estimate the timing of
when you contracted the virus, and absolutely NO
ALCOHOL!
Look on the Janis site.
The information is comprehensive and
accurate...unlike many other sites. I look forward
to your future questions.
Good Luck and God Bless.
Donna Fanelli
My brother has just been diagnosed. The health
department did not give him a copy of the results of
his test - is this normal? Does he have a right to a
copy his test results? The doctor apparently is not
very nice, but there is no other local alternative,
since my brother does not have insurance. The first
test came back with 'very high numbers' so they do
not want to bother doing more tests which are 'very
expensive.'
My brother is now
refusing to consider treatment because he says it is
not going to help and the treatments are too
expensive/painful. If he doesn't get drug
treatments, but does modify his diet and does not
drink, what can he expect as far as a timeline on
the progression of the disease? What I am trying to
find out is what the average lifespan is if he
doesn't do the drug therapy.
Given the expense
and pain involved with the drugs, and the fact that
it is only 70-80% effective (as near as I can
gather), and the fact that it is so bad that you
automatically qualify for disability, is it worth
it? (I know that this will just be an opinion -
nobody can say for sure, but I need to have
something to go on here...)
Thanks for any
info. I'm blundering around in the dark on this...
Geckokl
Hello Geckokl,
As I always say, I wish I
had a crystal ball. Determining disease progression
involves many variables and is never calculated with
certainty.
Your brother has a right
to his lab results, but from the doctor who ordered
them. The health department cannot share them (as
crazy as that sounds). Have your brother present to
the office/clinic in person and ask for a copy.
It's his right and the law that his request be
accomadated.
Not having insurance is
no excuse to avoid treatment. The drug companies
are very generous, if you can prove need. Also,
there are clinical trials in which all treatments
are at no cost to participants, and there are
clinics/providers who will charge a small fee for
service. Yes, the treatment can be difficult, but
with the right support and access to information,
it's very doable.
You reference the cure
rate as 70-80%. What is your brother's genotype?
Has he had a liver biopsy? These are important
pieces of information in determining response to
treatment and disease progression.
A good diet high in
complex carbohydrates, moderate protein and lower in
fat, is a diet good for your brother and for all
Americans. He may want to consider milk thistle and
omega-3 fish oil. Most important, NO ALCOHOL.
I hope this helps, and I
wish him all the best. Keep us updated.
God Bless,
Donna Fanelli
From Bette:
I have a question for Donna. Actually 2. My GI did
not see any reason to do a bx because my ultrasound
only showed fatty liver. But now I am pretty
positive I want to have one done to be sure. I have
a family history of Liver Cancer. How do I ask for
one to be done? Is my GI the only one who can order
one?
Also I have been told that Cymbalta is hard on my
liver but it works really well for the depression
and the nerve pain from Cryoglobulinemia. Is there
another alternative that works as well?
Thanks for any info you could share.
Bette
Dear Bette,
Thank you for your questions. I
definitely agree with you…you need a liver biopsy,
bottom line.
An abdominal ultrasound provides an image of
the liver via sound waves. It 's a useful first line
test to rule out hepatocellular carcinoma or HCC,
aka, liver cancer. I assume that your ultrasound,
luckily, did not identify any atypical densities or
growths. It most likely identified "echogenic
changes consistent with a fatty liver." It however,
does not indicate a level of scarring, or fibrosis
and the degree of inflammation present. With your
family history of liver cancer you are at risk, and
if you have significant fibrosis, you are at even a
greater risk. My recommendation to you is to find
another provider. If you let me know what city you
live in, I will try to find you someone qualified.
Another option is to ask your PCP to order the
biopsy. Interventional radiologists do most
biopsies. I believe a CAT scan guided biopsy is best
to prevent sampling error, but a radiologist
disputed this with me, so I guess either is fine.
Regarding Cymbalta, Lily did come out with a
warning that it should not be used in the presence
of liver disease. I switched my patients to Effexor.
Both medications are similar in that they target the
same neurotransmitters, seretonin and
norepinepherine. It does help the neuropathic pain
in many patients, though this was never studied in
clinical trials.
I hope this helps. Feel free to follow up
and stay well.
God Bless,
Donna
This is a general
question by Myer
Part 1-
A person has had HCV
for 25 years. Had a biopsy 6 years ago and had no
damage. Had another biopsy this year and it showed
stage one grade one...Geno 1...Age 50... With normal
liver function tests. Is it wise to treat or wait to
treat, if at all? Do we know what the time frame is
that we will progress to stage 2 ? Will we progress?
Hi Myer,
You pose a common dilemma most providers
face at one time or another. Whether or not to
treat a slow progressor is dependent on individual
factors such as family history, the presence of
fatigue or depression, to name a few. A real
generalization regarding progression of fibrosis is
15 years for each stage. However as one ages, the
progression occurs more rapidly. We also know that
in light of minimal fibrosis, response rates
increase. I wish I had a crystal ball. When I
manage a patient like this, provided they have no
significant past medical history or a history of
severe depression, I will recommend treatment. I
start with the first 12 weeks and see how it goes.
If there is a complete viral clearance and treatment
is tolerated relatively well, we go on. There are
other factors I also look at including the presence
of iron, fatty liver, history of alcohol use/abuse.
There is no across the board answer. The decision
to treat and the treatment itself needs to be
tailored to each individual.
Part 2- A person is newly
diagnosed. Contracted HCV in the year 2008 with
either genotype what would be your advice on
treating? I ask this question because of the
problems we are having with the Endoscopy Centers
across the country.
Myer, your second question is also another
tough one out in the debating field. I believe
newly diagnosed persons have the best chance of
response and may not even need the full 24 or 48
weeks of treatment. Again, this decision needs to be
tailored individually with many factors taken into
consideration.
Regarding the endoscopy
centers, I believe most are safe and only a very
limited few don't clean the scopes and the wires the
way they should .
Hi,
I have a question for Donna,
and thank you for this idea.
My husband is on his 11th
shot this Friday. He's in
extreme pain with
arthritis/gout. Is
practically bedridden.
Nurse Practioner says no
RA. I know tx makes bone
pain but is this normal? He
can't move and if he gets up
for too long a time like to
take a bath it's
excruciating to him. Is
there anything he can take
that may help him? And how
long will this last? And can
he develop RA while he's on
treatment? He's genotype 1a
on 48 weeks of tx. V/L
dropped from 600,000 to
350,000 first two weeks.
Waiting to see Thurs. next
V/L. Had to take two shots
of Aronesp when his blood
bottomed out. He's 57. Is
there any foods he needs to
avoid? Not that he's eating
too much now. Thanks for any
help.
D
Hi D,
It's difficult
for me to evaluate this
situation without seeing
your husband and his
labs. PEG IFN can
induce RA because IFN
boosts the immune
system. RA is an
autoimmune disease which
means the body
mistakenly thinks it's
own cells are invaders
and begins to attack.
My advise
initially, encourage
your husband to drink at
least 3-4 liters per day
of water. With the drop
in his hemoglobin (the
red blood cells ability
to carry oxygen), make
sure he had an EKG
and/or stress test prior
to starting treatment.
Also, labs I
would check are
rheumatoid factor, ANA,
uric acid and an anti-CCP
(Cyclic Citrullinated
Peptide Antibody).
It is unusual
for patients to have
such dehibilating pain
while on combination
therapy and other causes
need to be investigator.
Keep me posted.
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Donna J. C. Fanelli, MSN, NP-C, Medical Director of
Primary Health and Wellness Center, LLC, in Milburn,
NJ and Senior Clinical Research Coordinator of
Gastroenterology Research Associates, LLC, in Cedar
Knolls, NJ. She is certified as an Acute Care Nurse
Practitioner, an Adult Nurse Practitioner.
We are very pleased to provide
information in this forum. The information provided
is for general educational purposes only and is
intended to help users learn about health and
diagnosed diseases. As always be sure to discuss
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