Doctor's Opinion II

A couple of days ago I wrote to the forum explaining that my Doctor said I had to stop smoking grass for insomnia and anxiety towards treatment. I recieved some excellent advice from fellow Heppers and told my Doc no prob. I was scheduled to start treatment this Friday. I had already purchased the medication, when the nurse called and said that my Doc had decided that I had to wait another six months because I had marijuana in my system. After all the preperation with work,family ect... Decided to wait until same time next year so I can go through treatment in the winter months when business is slower (i'm self employed) and the climate is cooler. Maybe by then the new PI's will be avail. I am geno 2b,stage 1-2 ,inflammation 2 of 4. Evidentally even in a state were medical marijuana is legal the prefered method to treat symptons of this disease is with parmaceuticals.

[spectda]

Personally I would find another doctor and not mention the weed. Perhaps not smoking would be best during treatment though. I don't think the information is clear about the effect on treatment success, but why take a chance.

Good Luck- Dave

[Trish77]

I'm sorry this has occurred.  However, maybe it's for the best. You may have to find another way to treat your insomnia and anxiety anyway.  Daily use of marijuana contributes to an increase in fibrosis.  The pharmaceuticals will actually do you less damage than the marijuana, depending how much you're smoking.  So perhaps this is the opportunity to get adjusted to an alternative and have the time to do it rather than suddenly switch just as you're heading into treatment.  And, as you said, maybe the PI's will be out by then.  Good that you have options being early stage liver damage.  Good luck ongoing, Steve.

Trish

[spectda]

I think you will find limited studies about marijuana, hcv, treatment and its pros and cons.

While there are studies that suggest that daily marijuana use may or does increase the chance of liver fibrosis and progression, I would guess that daily use of many pharmaceuticals could possibly do the same. How many studies have have there been about how daily pharmaceutical use effect liver fibrosis? I would guess that moderate use of any of these drugs would limit any damage you might sustain. I am not presuming to be an expert or a doctor, just my opinion.

I haven't smoked for many years personally, but I still believe that there is no reason for your doctor to deny you treatment. What was his reason for the 6 month time period? Perhaps quitting or moderate use would be a better idea for you at the moment.

I also think that having geno 2 that it would be better to treat with ribavirin and interferon rather then a pi. The results with a pi are marginally better if at all when treating geno 2. If you had been a previous non-responder or relapser, or if you were geno 1 I could understand using a pi. Why risk pi resistance when there is a very good chance that the current drugs will cure you. In a few years when we have cocktails of direct anti viral drugs that are not first generation the issues of resistance may not be a problem,

http://www.aegis.com/news/bar/2006/BR060908.html

http://onlinelibrary.wiley.com/doi/10.1002/hep.20733/full

http://www.hepatitis-central.com/mt/archives/2008/01/risk_of_fibrosi.html

http://www.waitingtoinhale.org/science_news/cannabis_hepc2.pdf

http://www.hepatitis-central.com/mt/archives/2006/09/marijuana_benef.html

Benefits of Medical Marijuana During HCV Treatment

September 18, 2006Printer-friendly version
An unlikely ally has been uncovered for Hepatitis C treatment. Interferon and ribavirin treatment is known to inflict severe side effects resulting in low retention rates. While the link is not yet concrete, medical marijuana appears to reduce those side effects, improving a person's chance of completing treatment.

Study: Pot helps cure hepatitis C

Wednesday, September 13, 2006
Tri-Valley Herald Newspaper
By Josh Richman, STAFF WRITER

Medical marijuana users are more likely to finish hepatitis C treatment and so are more likely to be cured, according to a newly published study conducted in San Francisco and Oakland.

Other studies have shown marijuana relieves symptoms, but medical marijuana advocates said this could be the first to show improved cure rates for a life-threatening illness.

The study is by researchers at the University of California, San Francisco, and the Oakland-based Organization to Achieve Solutions in Substance Abuse (OASIS). It was published in the European Journal of Gastroenterology and Hepatology. It found marijuana users being treated for HCV three times more likely to have a "sustained virological response," meaning the virus can't be detected six months after treatment ends.

HCV treatment with ribavirin and interferon causes severe side effects, so many patients quit the long regimen too early.

Of 71 HCV patients studied, 21 finished with a sustained
virological response: 12 of the 22 cannabis users and nine of the 49 nonusers.

"(M)odest cannabis use may offer symptomatic and virological benefit to some patients... by helping them maintain adherence to the challenging medication regimen," the study concluded.


Good luck!

[Trish77]

""(M)odest cannabis use may offer symptomatic and virological benefit to some patients... by helping them maintain adherence to the challenging medication regimen," the study concluded. "

I also agree that the occasional toke during treatment may be helpful to help people adhere to treatment who might not otherwise. The key is the word "modest".  Daily toking is not modest.  Even at that, an occasional alcoholic drink here and there might help someone adhere to treatment better as well.  But is it wise?  I know one guy who did that and said he probably would not have stuck with it otherwise.  In his case, maybe it was the best route though certainly not something you'd catch anyone recommending.

The fact that daily pharmaceuticals may harm the liver doesn't negate the fact that daily marijuana use also has that potential so I don't get your point in bringing that up.   We're actually very careful about what pharmaceuticals we take while we have HCV and particularly on treatment.  Marijuana is getting the same treatment.  Nobody's picking on marijuana in particular.  That's simply the issue at hand in this particular discussion.  We should be watching everything we ingest for it's impact on the liver .... why wouldn't we apply that same scrutiny to marijuana?

I think there is enough evidence out there on the risk of increasing fibrosis with increase marijuana use, as in daily, that if I was a daily toker, I would certainly cut back on marijuana if I had HCV.  And if I'm toking daily due to anxiety and stress because of HCV, then I think I'd be looking for an alternative.

Maybe his doc wants to see if he can get through treatment without smoking pot daily.  Starting again in six months would certainly give that kind of window to allow Steve to see if he would be able to successfully switch to an alternative.  I think I could understand his doc's decision if it was based on a reasoning like that.

[spectda]

I am sure that you read in both my posts that I was not suggesting anyone smoke pot daily during treatment. I am not defending marijuana use or condemning it. I don't even smoke as I said. Personally I am extremely careful about taking anything during treatment including what food I eat.

I was suggesting that Steve either quit or smoke moderately and that his doctor should not deny him treatment. Do doctors deny people treatment for taking anti-depressants, pain meds, and benzodiazepines? Many of these drugs have warning about liver damage, but we weigh the benefits against the risks

As you said  "We're actually very careful about what pharmaceuticals we take while we have HCV and particularly on treatment." this is very good advice, and I still maintain that the same advice should hold true for marijuana.

It seems to me that comparing the damage alcohol and marijuana cause to the liver does not make sense. How many people develop cirrhosis and have died from advanced liver disease from marijuana use? It is well known that heavy alcohol use has caused end stage liver disease and death in many people.

- Dave

[Diane12855]

I see a lot of people on here stating that pot is a good "natural" way to deal with the sx. Just because something is natural, doesn't mean that it won't hurt you. There are many natural substances that are toxic and even deadly. There are also many pharmaceuticals that are made from natural substances. The important thing is the chemical make up at the point where it enters the body, and the effect it will have at that point

Ex. Eating pot probably has a significantly different effect on the body than smoking it does.

Diane

[Trish77]

"It seems to me that comparing the damage alcohol and marijuana cause to the liver does not make sense."

I wasn't comparing that at all.  I was comparing the use of a little of each to help with adherence to treatment, which seemed to be what you saw as merit of it.  

Steve's doctor isn't denying him treatment, he's delaying it.  Steve seemed to indicate that daily use of marijuana was how he dealt with stress and anxiety, his drug of choice.  You quoted an article that talks about moderate use of marijuana, which is irrelevant in this case.  If Steve's doc only found out just as Steve is going into treatment that his patient relies upon daily marijuana use and it's known to have a negative impact on fibrosis, then perhaps he's within reason to delay treatment until Steve has a better alternative in hand.  No different than if Steve was relying upon a particular pharmaceutical daily and needed to switch.  Maybe this is a red flag for the doc and he's saying let's give this six months of you NOT taking marijuana daily and see how you do and if you can stick with it.

[spectda]

"You quoted an article that talks about moderate use of marijuana, which is irrelevant in this case."

I thought steve being a regular marijuana user that he might find it easier to use it moderately then to quit. I also believe there are as many hepatologists that would treat him while he used marijuana as those that wouldn't.

I don't see moderate alcohol use as an option during treatment, perhaps I am misguided by what I have read and experienced about alcohol.

Again Trish, although you seem to be suggesting that I am a proponent of marijuana use during treatment, I do not see the merit of using marijuana any more then I see the merit of using the other drugs I mentioned. I think if people do not need them it is best to abstain. If they need them, then they have to weigh the gains and risks and make their own decision.

I posted links to studies and articles both in favor of marijuana use during treatment and others that suggest that there is a real risk of increased fibrosis from marijuana use.

[Trinity4]

I understand your point Spectda.  Did you know most antidepressants which in Steve's case could be considered an alternative for Steve in coping with depression, stress and anxiety contribute to fibrosis yet they are highly advocated on this forum, actually for anyone who is experiencing emotional problems.  I suspect marijuana has less of a toxic effect on the liver.  However, marijuana is illegal so it's safer to push the drugs.  I don't smoke pot either but if I needed a coping mechanism I would choose weed over pharmaceuticals.

Trinity

[babs824]

my personal non medical opinion is that if it is important for you to get treatment done soon as u have made plans with work/ family etc. i believe u can find another hepatologist who would treat you. i would play down the regular pot use but talk to him/her of finding a way you can head off the well known psychological effects of tx with ADs before u start. i would start to wean from pot immediately by cutting back. my doc is adamant that it is lots worse for livers than most folks realize. there are some very good ways to mitigate stress with martial arts, meditation or just a good exercise program.add to that a low dose antidepressant and a weekly appt with a therapist might meet your needs is the proper time frame. waiting for pi for those of us with 2b is a waste of time as far as i know. u have lots to ponder but the good fortune of 2b and minimal damage, which is huge. all the best, babs

[nygirl7]

I also think that having geno 2 that it would be better to treat with ribavirin and interferon rather then a pi."

Do we even know if they are going to start out with geno2s being able to use the PIs? As far as I knew it was predominantly a geno1 drug being studied?

Anyway, Steve you are in no rush to treat at stage 1-2 but that being said in a year you could be stage 2-3 and then it would be rather urgent that you start to get attention.  It might be better to try it now,  with your odds and  SOC you should succeed anyway to the point where a geno1 adding a PI would. You should have the same odds anyway and not taking the PI would lead perhaps to less sides.

I would definitely start to wean from the pot. I know you aren't going to like that but nobody in here wants to do that either. You could find another doctor who would not mind I am sure since you are in a 'legal' state.  Perhaps ADs would help you wean off.  It's worth a try anyway.

Remember fibrosis is our enemy just as much as this disease is so you want to try andcut out everything that might lead to it and unfortunately pot is one thing that could.

Just all our opinions in the end no one can decide what is best for you except you.  Good luck.

[blondie717]

I agree. That you should find another doctor. And I wouldnt offer info. about your legal perscription for pot...The problem w/grass is it stays in your system for 30 days? I hear. New pi s wont help you..and geno2 heppers are very curable.  I also agree with nygirl that sooner tx is better for you. why let it get worse. you might try getting meds for 30 days and get some of the weed out of your system. Go with your gut and good luck.

[fretboard]

A true die-hard marijuana smoker!   Even a bit obsessive, funny!  Although I agree and feel that your marijuana smoking should have been overlooked you gotta show some respect to a doctor and the way they want to administer tx.  After all, they hold the keys to the car so to speak.  MJ will always carry a stigma to some ppl and there's really nothing that can be done about that.  I wouldn't have even given a pixx test, I would have just found another doctor if I smoked pot and wanted to continue.  I hope you find the doctor you're looking for.  Besides, I'm sure you learned something from the experience.  good luck

[James10500]

I smoked a lot of pot until I started treatment. I smoked twice on tx at the beginning but it made me feel even more tired.  Then I read about the fibrosis issue's, that made it really easy to not smoke.  So I know where your coming from.  My thought was I need to do everything in my power to ensure success.  And it seems that is what you are doing too.  

Your Doc seems a little Over the top......imho.  Get a new Doc tell him what happened as he may call your old Doc.  It only takes a month to get out of your system anyway.  Pre tx I smoked 4 times a day and was UND week four.  Why wait ? I know it's supposed to move slow but it can at times move fast from my understanding.

Good luck,

J

[Trish77]

"Did you know most antidepressants which in Steve's case could be considered an alternative for Steve in coping with depression, stress and anxiety contribute to fibrosis yet they are highly advocated on this forum, actually for anyone who is experiencing emotional problems. "

That's the first I've heard that anti-depressants that contribute to fibrosis are highly advocated on this forum.  I know the use of anti-depressants as needed while on treatment is highly advocated on this forum, but ones that contribute to fibrosis?  Can you post some examples of those anti-depressants that contribute to fibrosis that are highly advocated here?  I really don't think that's the case.  Anti-depressant use in general *as needed* is advocated, sure.  But ones contributing to fibrosis?  That's a new one on me as I don't recall reading anything about that OR seeing anyone speak up and offer a warning on the fibrosis risk in that regard.  

[Trinity4]

I'm at work, I'll get back with you on that.

[nygirl7]

Since Paxill is extensively metabolized in the liver and can cause abnormal LFTs I have always believed that it would definitely be possible to cause fibrosis.  It's like saying 1+1=2.  That is the reason I stopped taking it after treatment even though I truly wanted to stay on it forever.

Thats all I know.

[nygirl7]

Makes me wonder why my doctor gave it to me I went to check that it was correct and bingo. I bet they all have the same problem. I would think a hit or two off a joint before bed wouldn't even have this much warnings on the label - totally not a real friendly liver drug now is it.

"Paroxetine should be used with caution and dosages restricted to the lower end of the range in patients with clinically significant hepatic impairment."

[Trinity4]

October 17, 2005: The FDA ordered Eli Lilly & Co. to add a warning to the packaging of its antidepressant Cymbalta, that it could cause liver damage.

December 17, 2004: The FDA required that packaging for Strattera carry a new warning advising, “Severe liver damage may progress to liver failure resulting in death or the need for a liver transplant in a small percentage of patients.”51 The drug should be discontinued in patients who develop jaundice (condition that causes yellowness of the skin, eyes and body fluids) or liver injury. The FDA noted, “The labeling warns that severe liver damage may progress to liver failure resulting in death or the need for a liver transplant in a small percentage of patients.”52 Signs of the possible liver problems include jaundice, dark urine, unexplained flu-like symptoms, upper right-side abdominal tenderness and a form of itchy skin known as pruritus (caused by irritation of the sensory nerve endings).

[Trinity4]

http://www.coalitionforpf.org/cpf_news_detailes.php?id=137

Don't see any mention of  'liver' fibrosis specifically in my comment.  

[Trinity4]

Olanzapine and fluoxetine can cause an increase in liver enzymes. Usually, this increase is harmless, although liver damage could occur. Talk with your healthcare provider before taking the medication if you have liver problems.

[Trish77]

""Did you know most antidepressants which in Steve's case could be considered an alternative for Steve in coping with depression, stress and anxiety contribute to fibrosis yet they are highly advocated on this forum, actually for anyone who is experiencing emotional problems. "

I note your subsequent posts, however I wasn't talking about any old anti-depressants.  I was talking about ones advocated "on this forum" I have no doubt that there are anti-depressants and other pharmaceuticals that are not all that great for the liver.  I was more concerned about your comment that the ones  highly advocated for on THIS forum contribute to fibrosis and the potential for confusion.  

Anti-depressants are definitely advocated for as needed on this forum but NOBODY advocates taking anti-depressants blindly and particularly not ones that are bad for the liver.  There's a distinction.  There are a number of people who had hepatologists who wouldn't start treatment without putting their patients on an anti-depressant and there are a number of other folks who found the need for them during treatment due to the well-known mood-altering side effects of interferon and ribavirin.  I would imagine we will continue to advocate for persons to take anti-depressants as needed to help them adhere to treatment and get through their regimen.  I'd hate for anyone to think that we're advocating something that will make their fibrosis worse and thereby making them unnecessarily leery of something that could be vital for them in dealing with side effects that could derail treatment if not treated.  

I think most of the anti-depressants suggested on this forum are suggested by others who also have gone through treatment or are dealing with the impact of their HCV and hopefully cleared by their doctor as being safe enough for their liver.  Having said that.....everyone has the responsibility to ensure that for themselves and clear that with their treating physician.

[Trinity4]

I would advocate antidepressants as much as I would advocate pot.  Frankly, I don't give a damn either way.