47 WEEKS VERSES 48?

I am really confused now.  My doctor called me yesterday about my bloodwork that I did on April 1st and said everything was fine.  My white blood cells were 1.7 which was normal for me threw this whole treatment.  Neutrophils were at 700 so she said I did not have to worry.  She said I will see you on May 8th which is a Monday and if you want your last shot could be May 5th instead of May 12th.  She said that 1 week of treatment would not make a difference in the outcome (47 weeks verses 48).  What do you guys think?  I mean it sounds good to end 1 week early but I have been thinking about it all night and should I chance it?  At first I was excited to end 1 week early but now I am scared to?  Why would she tell me that?  Does she know what she is talking about? I am really confused?  I have time to think about it but I would really like your input on this. I am a geno 1a and cleared at 4 weeks, 1,500,000 when I started.  Thanks  Sheila

[Algernon]

I'm one of those rare forum members who is always trying to figure out how to stop early...but

I just saw my doc (I'm 3a, HI VL) and he was telling me about brand new studies showing that 16 weeks might be sufficient.  I asked if I could stop a couple of weeks early!!  He said, I wouldn't do it.  Go the whole 24.

I doubt that one week would matter either direction.  Might as well do the last week (unless you have killer sides) just for closure.

[Mister beagle bailey]

I agree with all, what's 1 more week?  you came this far and to me it doesn't make sense to stop a week early.

I would finish the 24 weeks.  I'm a 2B and I plan to do the same.

Beagle

[Moniker]

Unless the side effects are really bad for you, why not do all 48 weeks? I think it's your choice. Myself, I'd rather do the whole treatment as  was originally planned. In a few weeks it'll be finished either way, but you'll be able to tell yourself you did the whole thing as best you could.
Bob

[NYgirl]

I agree and I'd tell you I would just feel more comfortable doing the entire treatment for my peace of mind.  It really probably doesn't make one bit of difference if you are one week short but mentally if I were to relapse I know I would be POSITIVE it was that one week and I'd beat myself up so much it wouldn't be worth it.

She's probably just trying to be nice.  I'd ask if I could come in the following week and finish up then...at 48.  

Good luck you re almost done wooo hooo!

[amommy]

I guess I am in the minority on this.  At what point in your tx did you clear the virus?  And, have you been 100% compliant throughout?  If you cleared early on in tx and you have been compliant all along, I'd forego the last shot and not even think twice about it.  If that virus isn't dead and gone, one week isn't going to make a darn bit of difference.  And, if it IS dead and gone forever (which it IS) then one week isn't going to make a darn bit of difference.  I do not believe anything "magical" happens at week 48 that would be any different than week 47 in most cases.  Of course this is purely my personal opinion, and should not be considered as anything other than that!  Also, excuse the brain fog, but didn't you have an issue where you needed to go back to work?  And stopping one week early would give you one extra week to recover before going back?  Something I would definitely take into consideration.  All that said, going to 48 wouldn't be a big deal either, but I can most definitely understand stopping at 47.  Good luck and let us know what you decide!

[jmjm530]

Why break treatment protocol without a good reason? Why stress yourself out by worrying whether or not you did the right thing? Why stop one week short after investing 47 weeks of your time and energy? Whatever you decide, just make sure you're totally comfortable with the decision, irrespective of what your doctor suggests.

-- Jim

[Mister beagle bailey]

all day my right ankle has been swollen for no reason.  I have been puting ice packs on and off all night.
Any feed back would help.

Thanks,

beagle

[dyce]

Ha dude, ya stated earlier that ya was workin , on the racecar, powerwashing the house etc., maybe ya twisted it a little and didn't realize it. When I was in the army I unknowingly did something to my ankel on a march , well when I got back to the barricks I felt pressure in the boot and when I took it off it swelled up like a baloon. Didn't even know I did anything to it,go figure. Try elevaten it and put some ice on it, maybe that'll help.

Dyce

[Mister beagle bailey]

Thanks dude, I've been putting ice on and off tonight.  You have a point I may not even know I hurt it till I saw the swollen ankle.  I did however remember it itching all day in the area where it's swollen.

How are you doing?  Hope your sxs are mild.

Beagle

[dyce]

I'm good tonite, actually felt human today. I got 1 of my hound pups out of the kennel and stated some training, gettin sumthin done. You be careful guy!

Dyce

[amommy]

Hope your ankle is feeling better.  Sounds like you may have twisted something without even knowing it.  Or, is it possible you were bit/stung by something?  Is it red? or just swollen?  Does it hurt to walk on?  I have lots of questions and no answers for you!  I really hope that with some good rest tonight it is feeling better tomorrow!  Take it easy, keep those feet up :)

[Mister beagle bailey]

Dyce-- Glad your feeling good today, hope it stays thet way.

amommy-- I think you and dyce are right. May have done something without knowing.  However it doesn't hurt and will see how I am in the morning.  


Thanks to you both for your help.

Beagle

[fishdoc]

Hey, if your platelets are low, wouldn't you bruise easily? As in a slight twist might cause swelling and discomfort greater than normal.   Just can't sleep, so thought I would solve the worlds problemss.....;)  take care

[friole]

dodger -- Sheila - it's almost funny - a couple of weeks ago you were wanting to quit early, and now when the doc suggests it you are getting cold feet.  I would hang in there for the last shot.  Why in heck they picked 48 weeks is beyond me.  Why not a whole year -- 52?  But since that is the standard, in this case, I would go with it.  How did you do back at work on Monday with that long day?  Are you working more than 3 a week now?

beagle -- I sometimes wonder if sensitivity is diminished on tx.  I am constantly finding new bruises and scratches that I cannot pinpoint.  Altho my platelets are not particularly low, I certainly bruise more often.  do the RICE -- rest, ice, compression and elevation -- and it should get better.

[OnAPrettyPoison]

Dodger, I would try to hang in for that one more week if you can.  I have a friend in "real life" who treated for HCV with the peg and the rebetol.  She was so tired of it at week 47 she squirted out the last shot (and didn't tell the doctor) but she just had her 2 year PCR and is still clear.  She had also cleared the virus at the 12 week pcr, so she well could have treated 36 weeks beyond clear.  Hang in there, I know it is really tough.

[Mister beagle bailey]

Thanks guys, have been doing the ice, etc., still no change this morning.  Being it did itch before the swelling started I wonder if I was bit by something.

Beagle

[PKCO]

48 weeks is not engraved in stone. It is a recommendation, not a directive. Ninety percent of the virus is killed in the first week. I wouldn't fret over it for one second. Your doc is right.
The 80/80/80 rule has never been discredited. (80% of dose strength, 80% of on-time compliance, and 80% of intended tx length). The difference between this and full compliance,dosing,strength, etc., is insignificant. This data is from the same folks who gave you the 48 week "recommendation".

Best regards,
PK

[Mister beagle bailey]

not to my beagle bailey

How are you doing?

Bob

[Mister beagle bailey]

sorry you had a problem sleeping.  Do you take any thing to help you sleep? I take lunesta and it helps a lot.

Beagle

[OnAPrettyPoison]

Hate your ankle is swollen!  Have you taken any Ibuprofen or another NSAID anti-inflamatory?  That could help with the swelling.  I agree with Fishdoc, I somehow end up with more little bruises/tiny cuts that kind of get infected than I ever did before treatment.  I think it kind of goes with the territory since our blood is so out of whack.  Low hgb, platelets, white blood cells, and the rest of it.  You might have overdone with that power burst you got being back home in sunny Florida!  Warmth and sunshine always makes me feel better.  Didn't you have bad storms yesterday?

[NYgirl]

I take Ambien - aside from the sleep walking and sleep eating and having sex while I'm asleep it's just great!  hahahahaha

Seriously no I've not had any of those side effects that have been in the news lately - except sleep eating which I have ALWAYS done. I just love waking up in a bed full of Oreo crumbs it seems ;-)

Ambien has saved my sanity during tx - not sleeping was so horrible it was almost impossible to deal with.

[fishdoc]

Last night was pretty much a first, I take a bennie, sometimes two (benadryl) but last night, just wasnt cuttin it...could it have been sleeping 13 hours two  nights in a row, with a couple of naps thrown in????  nawww, must have been the coke at lunch...

[NYgirl]

I drink a cup of tea every night at about 8pm to relax me LOL.  I don't think caffeine ever really bothered me until treatment but now that dayum Riba just makes it impossible for me to sleep (I can't FALL asleep and then if I do I wake right back up).

Have you thought about having him write script just for "those" nights when you can't possibly sleep?  I take mine evry night but there is no reason that you have to you know what I mean jellybean?

[Algernon]

Beagle,
If your ankle feels warm or looks pink, go to the doctor ASAP for a possible infection under the skin.

This actually happened to me once long ago.  It can be serious and we are more susceptible to infection while on treatment.

You're probably fine but if it is infection, it probably hurts like the dickens.

[Mister beagle bailey]

The ankle is not red, no cuts and no bruises,  When I go back to NY tomorrow will call the doc.
yes we had bad storms last night, but it's sunny today, wish I could walk.

Hope all is having a great day.

Beagle

[fishdoc]

good point, I have an appointment next month, having a security blanket in the med cabinet is  a good thing...

[bobbyullc]

quit kicking the dog.
bobby

[jmjm530]

I agree that that 48 weeks is not in stone, however it is the number most of the trials/studies used and therefore that's where our tx data is generated from.

While most of the virus is killed early -- actually within 24 hours  of the first peg shot -- but after that virus is killed, the remaining virus starts replicating again in a cycle that continues until all of the virus is gone. Unfortunatly, we don't have sensitive enough tests to know exactly when that is, so we have to estimate the amount of time to treat based on clinical studies. That's why treatment takes so long with these current drugs.

The 80/80/80 rule is more of a guideline and according to many should not be used as an excuse to reduce drugs or shorten treatment. 100% adherence is still the safest recommendation with riba probably being more important early on and Peg later in treatment.

"...the 80/80/80 rule is controvesial because it has not been studied in well designed prospective clinical trials. Another concern is that (it) may ber sending the wrong message about treatment adherence since it sets a lower threshold for taking medications 100% of the time or as close to 100% as possible -- *especially* during the first twelve weeks of therapy..."

Full text: http://tinyurl.com/r8wz7

[FlGuy]

I've been meaning to ask you...I think that you said that you had diabetes and are doing tx now. How far into tx are you and have you seen any changes to the blood sugar levels?  As I said in an earlier post I had insulin-required diabetes.  A follow-up endo visit last week confims all now in order, AIC at 6.3. And that's after gourging myself with lot of food (good, varied diet)post tx. Have you had the diabetes longer than hcv?

[timedog]

to anwser your question I have dad hep c for about 17 years or so. I only started treatment now for reasons to long to go into here. I was diagnosed with type 2 diabetes about 6 months ago. I am about to start week 5 of treatment for hep c and so far it has not effected my blood sugar level at all.

I will say the one odd thing, which maybe because of the diabetes, is that my appatitite is pretty large so if I thought I was going to loose any weight from tx i don't think that is going to happen.

[FlGuy]

Good luck as you go onward.  May be I'm just an oddity of tx. But all blood sugar dropped to normal at week 12 when I had a non-detect pcr and hasn't bliped since.  When you do blood work, or a pcr down the road a bit have your doc also order an A1C too.  No telling what hcv, or tx for that matter, can result in.  Good luck.

[GoofyDad]

Based on my understanding of the 80-80-80 rule (gleened from a paper by Dr. R. Gish) it's useful in demonstrating the importance of 80% complince against lesser compliance rates. It was not evaluated against 100% compliance, and as Jim said, it doesn't stand as a justification for intentionally cutting back on  meds.

On the question of 47 vs 48 - I think it's back to Risk (cost) vs. Reward (benenfit).

I think it's relatively unlikely that that single 48th week is going to tip the balance, so if for some reason it is a vaslty more difficult week, one could probably justify skipping it. Like if you were going to loose a job opportunity, or had hightened risk if injury from the meds.  

[timedog]

This brings up the question 24 versus 48 why?