Anybody know this Dr.

[Easywriter2222]

Hi Everyone
Hi Mike, Hi Jim

Since I am not responding to treatment and my present Dr. is not being aggressive enough with treatment options I have done a little research regarding increasing my dosage on the Pegasys. Unfortunately my Dr. does not want to take the risk so I am trying to get a referral for a Dr. Bennett Cecil. His web site is www.hepatitisdoctor.com He is out of Louisville Kentucky and that is about 2.5 hours from me. I live in Dayton, Ohio and am having trouble finding an agressive Dr. Does anyone know about Dr. Cecil or does anyone know of Dr.s in the Dayton/Cincinnati area that do offer treatment that includes increased dosages of the Peg-Inferon? I checked with my Insurance Company and they are willing to pay for the medication but I need help finding a Dr. that can take over my treatment. Thanks all. To read my original post it was on Feb 26th 2008. Thanks

[jmjm530]

The drug she probably is referring to is called Telaprevir. The cure rate appears to be around 60% with 24 weeks of treatment.

Right now Telaprevir is still in trial but may be more widely available within the next couple of years. If you end up getting a biopsy and it confirms only stage 1 (F1) damage, you reasonably have time to wait out the trials and revisit the treatment decision when Telaprevir or similar drugs start coming to market.

Treatment-wise, things should only keep getting better as time goes by -- so it's a matter of balancing both current and projected future treatments against the urgency to treat which is based on many variables, including liver damage.

-- Jim

[kynygal]

Yes you are correct. I have genotype 1A. And last yr. I was a F1 on the liver damage. Today when I went to my appointment I did not see Dr. Cecil. It was his asistant that I met with. She was very helpful and explained alot to me and answered all of my questions. She agreed that if everything was still ok, meaning still mild that I should be ok to wait. She confirmed that right now my chances of cure would be about 40%. She told me of a new drug that has been on trial, would be taken along with the other two popular drugs being used now. She said that the new drug will cut the length of time on the meds down to 6 months verses the usual 1 yr.  I am going to check into getting the biopsy done. I am glad that I found this forum. Thanks for all of your help.

[jmjm530]

Given the "40%" figure, I'm assuming you have genotype 1, like most here in the United States.

My guess is that Dr. Cecil's recommendation is based on both a clinical exam, ultrasound,  and bloodwork that probably contained a Fibrosure panel to help evaluate liver damage. I say this because the last time I checked his site (over a year ago) he often used Fibrosure.

Assuming Dr. Cecil wants you to wait on treatment with what is presumed to be non-significant liver damage, I agree with his approach with the caveat that I personally would want a liver biopsy to confirm the amount (of lack of) liver damage. Many doctors just don't consider Fibrosure as accurate enough. Again, if it turns out from biopsy that you don't have signficant liver damage, I agree with Dr. Cecil that you have time to wait.

Also like to add that it's gratifying that Dr. Cecil seems to be taking a Watch n' Wait approach at least with some who demonstrate  little or no liver damage. My previous comments on Dr. Cecil was based on his approach a few years back and other than your post, have no knowledge on how he currently approaches treatment.

-- Jim

[kynygal]

I was diagnosed with Hep C one year ago. It seems that every Dr. here in Kentucky sends everyone to Dr. Cecil. On my 1st visit ,they took blood and set up a ultra sound . When I returned for my 2nd visit. It was confirmed that I do have Hepc but He said that with my type, the treatment available to me at that time would only give me a 40% chance of cure. He suggested that I wait and return this yr. He said new drugs are coming out and that I might even get in on a trial. A recent visit to the ER due to a bad stomache virus, returned a normal liver function. Today is my next appointment with Him. I am sure that all he will do today is check my blood again. I really dont know much about ay of this. Any suggestions will be greatly appreciated. BTW my sister in law in currently in treatmet with him. And yes her does was low and increases. I will keep everyone informed on how this goes. Any ideas on why my liver function enzymes would be getting better instead of worse without treatment?

[SJL]

I have e-mailed Dr. Cecil with several questions and he has always answered me back quickly.If I were closer I would also consult with him. He treats every case individually, as should be done, as none of us have the same side effects, etc. As for his theory of starting therapy with smaller doses and building up, I have to say, I agree with him. The reason I say this is because I am now on Rituxin therapy. On my very 1st. treatment, full blast intraveiniously, my side effects were absolutely horrible. Consensus was that their had been no adverse side effects to the treatment~but, I am here to tell you differently. My treatments at this time are given much slower, but the same dosage and I am doing fine. So, the blast em theory, I have attempted with 3 different interferon treatments, relapsing each time.

I was originally from the Dayton, Ohio area(Fairborn), but of course at that time I did not have the need for a Hepatologist. I do have a sister-in-law who is involved with Kettering Hospital in Springboro/Miamisburg area, and has been with them for 20 + yrs.  I could ask her for a recommendation. How about Ohio State University? I live in New Smyrna Beach, Fl. right now, but I go to Shands Hospital in Gainesville. It is quite a drive, but it is a teaching hospital, which I believe Ohio State University is.I feel that the overall team treatment I receive there, is much more intense~the Doctors very knowledgable~and they are willing and able to direct your treatment, while also providing you with the honest, necessary info., which is needed before you make the decision to treat. I also have a Hepatologist in Lakeland, FL., who actually set up all my appts. at Shands. He also is about the same distance (approx.)2&1/2 hrs. each way. Finding the right medical team is crucial for all of us. If you want me to pursue a recommendation in the Dayton area, I would be glad to make that call? As for new drugs on the horizon, I have been told that they are at least 3-5 yrs. coming. So, it depends on your stats, if you can wait that long.

I wish you the best,
Sandy

[pigeonca]

Dr. Cecil does something very few doctors do, which is to answer questions from people who aren't his patients.  He helped me a great deal in deciding to treat despite an autoimmune disease - even to the point of citing journal articles that might be pertinent to my case.  I think he's a truly caring physician who - if I lived in his area - I would not hesitate to consult.  

I also have a hunch that, as with any other top-notch hepatologist, Dr. Cecil's procedures have changed as new research comes in, and so I would not base my opinion on some article he wrote a number of years ago.

[jmjm530]

Fifth sentence, first paragraph should have read:

The second controversial part of his treatment is that he appears to extend treatment beyond normal protocols, even *extended treatment* protocols and sometimes treats for up to three years.

[jmjm530]

As FlGuy says, some of his approaches are controversial. Specifically, at least the last time I visitied his site, he believes in reverse induction dosing of Peg, meaning starting with less than full-dose and gradually building it up over the first several weeks of treatment. This goes against what is more or less accepted as the "hit it hard, early" approach where full-dose meds are adhered to if at all possible. And, of course it's the antithesis of an induction approach such as double-dosing. The second controversial part of his treatment is that he appears to extend treatment beyond normal protocols, even double-dosing protocols and sometimes treats for up to three years. I know for example that he has recommended stage 3's to treat for two years regardless of liver damage. My opinion, and I've never met the doctor, is that he both undertreats (reverse induction) and overtreats (too long on the drugs). That said, he apparently has had some success with these extended treatments although nothing published that I could find so it would have to be classified as anecdotal. He also has a loyal following, including some members who used to post here. By all accounts he's a very personal, caring and dedicated doctor.

I don't remember most of your stats or history, but pesonally I'd at least try and consult with a liver specialist first (or in addition to Dr. C.) with a less controversial approach. There are many other doctors who are also agressive, and maybe someone can come up with a name in your area. Alternatively, you might want to hop on a plane for a one-time consult and then have that doctor coordinate tx with a local doctor moving forward. I just dont' like the idea of treating for up to three years, regardless of liver damage, especially when there are such promising new drugs in trial. Maybe it made sense a few years ago, but not even sure then except in cases of serious liver damage.

-- Jim

[FlGuy]

Try:

http://www.hepatitisdoctor.com/

Some of his approaches are somewhat contoversial.  You can read more at his site