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1st Doctor visit

I had my 1st doctor visit last week and I was a bit confused by what he said.  He said he wanted to start treatment in January after he runs a bunch of blood tests to make sure I don't have any other liver issues.  I asked about waiting for the new drugs and his response was that he did not like the side effects of and thought I should try this 1st.  I never had a liver biopsy, but he seemed to think that being young (37), healthy (average weight), low viral load (190000) and my CAT scan (uneventful), that my chances were more like 65% of clearing the virus.  He said I should be UND at week 4.  If I'm not, then he would do the liver biopsy.  Does this make sense to anyone?  
BTW- he thought it was definitely possible that I got it from Rhogam in 1993 or 2007, I had no idea that was a blood product.  Apparently there have been reported cases from both those time periods in the US (just my luck).

Anyway any thoughts would be helpful.
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1225178 tn?1318980604
I lied... sorry. I just reread the above posts and read where your doctor would think you had failed at tx if you aren't UND by your 4th week. There are MANY people on this forum who weren't UND by week 4 but who achieved SVR. I didn't even get my UND until week 12, and have been every since.

Diane
Helpful - 0
1225178 tn?1318980604
Just one last thought from me anyhow.... I'm 1a too. I'll be taking my 31st shot tomorrow. I have to tell you... when I reached my 24th shot, the fact that in the future when the PIs come out, I would have been taking my last shot instead of only being half way through tx really weighed heavily on me for a day or two. If you aren't having symptoms, and if your biopsy comes back stage 2 or lower, you may want to take these thoughts quite seriously.

Diane
Helpful - 0
Avatar universal
You might also ask your doctor to run your IL28B test.  The result of this will give you a much better indication of your percentage of responding to SOC.  

Also, there is a blood test - I think this link may help: http://www.medicalnewstoday.com/articles/153004.php, that could get you some info on your liver without bx.  I had both tests done and they were in sync.
Helpful - 0
Avatar universal
You might also ask your doctor to run your IL28B test.  The result of this will give you a much better indication of your percentage of responding to SOC.  

Also, there is a blood test - I think this link may help: http://www.medicalnewstoday.com/articles/153004.php, that could get you some info on your liver without bx.  I had both tests done and they were is sync.
Helpful - 0
419309 tn?1326503291
Sounds like your doctor is being more than forthcoming about what he wants, but I surely hope he's willing to work with you to do what YOU want.

I have heard of docs using guidelines like age (young) and viral load (low) as 'indications' to treat, but at this juncture in time, with increased success rates and shorter treatment durations possibly becoming available soon to genotype 1s, my thinking is that if you are not in agreement with what your doctor is recommending (and I think there IS good reason for you to question his call), I'd say push for the biopsy -- more information means a better decision making base.

And definitely organize your thoughts on paper before you get face to face with the doc.   It's useful to make a list of things in priority order so that if time runs short you can ask the pressing questions first.  Hope that helps, and good luck. ~eureka
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Avatar universal
Thanks for all the info.  This site is invaluable.  I stepped away from Hep C land for a bit when I was dealing with an unrelated vascular issue.  Now I am back in the zone.  

My primary tested for genotype (1a) and my vascular surgeon did the CAT scan looking for something else but aware of my Hep C status so he included my abdomen which was pretty cool of him.

I feel like I turn into a blabbering idiot whenever I get to a doctors office and then I forget things....writing them down next time.  But the way I see it, is that if he thinks that I'm sooo healthy as too be 65% curable (sarcasm) when the rest of the 1as are 45%, then I can definitely wait.  There is no doubt these meds are all going to kick my *** as I seem to have strong immune responses to almost anything foreign in my body...I am so screwed..lol   The point for me and I'm sure others is that if at all possible I'd like to only do this once.  
Helpful - 0
1225178 tn?1318980604
One warning before you talk to your doctor again. Don't tell him some people on the internet disagree with him. For some reason, many doctors quit listening to you once you mention the internet. Just tell him that people who have been through treatment and people who are in treatment now... in your "support group" told you this.

Diane
Helpful - 0
Avatar universal
Did your doctor tell you your Genotype?  That at least tells you how long you'd need to treat if you were to do so.

Personally, I'd go for a biopsy prior to treatment.  Different schools of thought about that here but I find that kind of information useful to help me determine a) how urgent it is to treat now and b) if I'm going ahead with treatment, it helps me make decisions as I go along with accurate information about my existing state of liver damage kept in mind.

As for side effects, well as others have said you wouldn't be avoiding the worst of the side effects since you'd still be doing ribavirin and interferon.  Side effects from the PI's are manageable for the most part although there are cases where they've been bad enough to make someone withdraw however same can be said of interferon and ribavirin.  That's not true *as a given*.   So I don't quite concur ... or concur at all .. with what he's saying.
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Avatar universal
I think he meant that he would do the biopsy once I failed the treatment.  From what I read on here, it seems I should wait.  This was my 1st appointment and I was totally caught off guard by his response.  My next one is in January and I am going to press the issue.  If he resists , then I need to change doctors.  It's a shame, he 's really nice and kinda cute..lol  Introduced himself by his 1st name.
Helpful - 0
Avatar universal
Interferon reduces platelets which lowers the bloods ability to clot.  I haven't ever heard of a doctor performing biopsy during antiviral therapy because one of the concerns is excessive bleeding under normal circumstances.

You really should question your doctor and his insistence to treat now.  The side effects with the protease inhibitors can be managed much like those with the current standard of care.   Even with a low viral load starting out there is no guarantee you will be UND at 4 weeks.  For genotype 1, the odds of SVR with a 48 week course of interferon and ribavirin are around 45%.  With a protease inhibitor added to the mix, the treatment duration time will most likely be shorter and the odds increase to 75%.  Something to think about.

Trinity  
Helpful - 0
Avatar universal
I am a 1a.  He is a gastro, but with a focus on Hepatology.  There were no hepatologists in my network, so I had to do the next best thing.  He would do the biopsy once treatment had been abandoned.  That and the side effect issue was news to me from what I've seen on this site.
Helpful - 0
1225178 tn?1318980604
I wondered about Rhogam too. I had it in 1988, 1996, and 1999.

I never heard of a doctor doing a biopsy after starting tx. The sides of the new drugs are also possible sides for Interferon and Ribavirin... So I don't get his reasoning for that. Do you know what genotype you have yet? Some are easier to clear than others.

What kind of doctor is this anyhow?

Diane
Helpful - 0
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