Aa
Thanks HR continued.
SF to JM: You said you think the Fibroscan may not be a useful tool for F2-3
------------------------------------------
Think that was a typo I later corrected. I was talking about *Fibrosure* which is most accurate at the two extremes as opposed to the mid range.
SF: My doc never did any palpitating...my previous one did.
Sounds like my last two girlfriends :)
But seriously, same here. But the last doc that did palpitate said he couldn't feel my liver. I assume that is either very good or I was born without a liver which opens the question exactly what did they end up doing a biopsy on :)
Be well.
-- Jim
SF,
No, never got another biopsy and since I'm SVR, docs do not feel it necessary. As someone at Clincal Options (I think) said, "curiosity" is not a good reason to get a biopsy.
Goofy,
Hey, that's great you have a choice of greener pastures and certainly understand your concern of having a medical security blanket.
I'm self-employed and was able to get a very good health care package that covered all my meds, procedures and doctors -- including PCR's on a weekly basis if I had a script. Lots of out of network benefits as well. Costs close to $1,000 a month but well worth it and if your new job pays more, you still come out ahead. Something to look into if you can set yourself up as an independent contractor at the new job. Or, even not, if the job doesn't offer health insurance, you may qualify for a similar plan. Every state is different, so probably a little research is in order if you haven't already.
No, never got another biopsy and since I'm SVR, docs do not feel it necessary. As someone at Clincal Options (I think) said, "curiosity" is not a good reason to get a biopsy.
Goofy,
Hey, that's great you have a choice of greener pastures and certainly understand your concern of having a medical security blanket.
I'm self-employed and was able to get a very good health care package that covered all my meds, procedures and doctors -- including PCR's on a weekly basis if I had a script. Lots of out of network benefits as well. Costs close to $1,000 a month but well worth it and if your new job pays more, you still come out ahead. Something to look into if you can set yourself up as an independent contractor at the new job. Or, even not, if the job doesn't offer health insurance, you may qualify for a similar plan. Every state is different, so probably a little research is in order if you haven't already.
No liver, huh? Quite a liverhead you had there! I suppose if we had no livers we wouldn't have these problems we do.
My doc wouldn't give me a biopsy, since was tx'ing anyway. I better get something afterwards. I am not living in the dark forever!
Does the Fibroscan have more accuracy with the mid ranges of stages of fibrosis?
Goof; We are looking to replace my Cobra. If you find a good deal around here, let me know. John has a business, so we could go that way. I don't know if you do it that way...
My doc wouldn't give me a biopsy, since was tx'ing anyway. I better get something afterwards. I am not living in the dark forever!
Does the Fibroscan have more accuracy with the mid ranges of stages of fibrosis?
Goof; We are looking to replace my Cobra. If you find a good deal around here, let me know. John has a business, so we could go that way. I don't know if you do it that way...
And I don't mean snakes...I just read that and had a vision of a dancing cobra. I read your post below. You are getting worse health ins. if you leave your present job? If you are passionate about this job, why are you moving? Hope you're not going far away...I like that you are close by.
Sign me up! I, too, would be more than interested in an opportunity to do a Fibroscan in L.A.--if, that is, you accept post-treatment "curiousity" as a medically valid enough reason. A recent Fibrosure test I did indicates a one-stage regression from Stage 3 to Stage 2 after 60 weeks of tx, but given the middle-range weakness of the test, I'd be infinitely grateful for an even more accurate assessment. I'd also like to say thanks so much for your input here at MedHelp and, well, how else to put it but baldly, your _entire_ professional investment in my physical survival.
Califia: that is, you accept post-treatment "curiousity" as a medically valid enough reason.
-------------------------------------------
Since Fibroscan is no more than a high-tech palpitation, i.e measure of liver stiffness :) -- I am hereby volunteering free palpitations to all female members of MH who want a scan, but for whatever reason are turned down by HR. In my case, I do accept "curiosity" as a valid reason. I also accept fear of alien abduction as well as a valid reason as well as Celtophobia (fear of Celts); HOWEVER I do not accept Abluthophobia (fear of bathing) :)
Be well.
-- Jim
-------------------------------------------
Since Fibroscan is no more than a high-tech palpitation, i.e measure of liver stiffness :) -- I am hereby volunteering free palpitations to all female members of MH who want a scan, but for whatever reason are turned down by HR. In my case, I do accept "curiosity" as a valid reason. I also accept fear of alien abduction as well as a valid reason as well as Celtophobia (fear of Celts); HOWEVER I do not accept Abluthophobia (fear of bathing) :)
Be well.
-- Jim
hey, show me some way to get me your email, you show me yours and I'll show you mine...seems we're going to have to book a tourbus to get these LA fibroscans...I get shotgun!!!!
Some one said no livers, when ever I get the flu or bad cold I always say I think the human body should be plastic.
Rev 5 am this morning on discovery channel was a show about russian brides. I think that maybe the answer for all us single men. Replacing are body parts for plastic ones and getting russian brides
Rev 5 am this morning on discovery channel was a show about russian brides. I think that maybe the answer for all us single men. Replacing are body parts for plastic ones and getting russian brides
I think Further will fit everyone ;) Okay, I'll go first. Mine is lindacal at sbcglobal dot net. Send me an email. Maybe we can have a reunion afterwards. Sounds fun to me! Ice Cream, swimming pools....
Jim: Maybe if we can't get those Fibrosure's, you can give them to us...no funny biz though! LOL
Jim: Maybe if we can't get those Fibrosure's, you can give them to us...no funny biz though! LOL
maybe I can get a clarification on the use for this fibroscan once and for all. I keep reading about people wanting the test and signing up for it as if it was going to be available first come first serve, but after my attempt to get one in Boston and getting denied, I wonder what makes one user deny the test and another offer it like hotcakes breakfast.
I was told by the Boston people that because I did not have a biopsy within 6 months, had no hcv infection because I treated, that I did not qualify for the fibroscan. It sounded like folks on tx did not either, so how is it that we can all get one now, with few questions asked?
I was told by the Boston people that because I did not have a biopsy within 6 months, had no hcv infection because I treated, that I did not qualify for the fibroscan. It sounded like folks on tx did not either, so how is it that we can all get one now, with few questions asked?
We aren't sure we can get them yet. HR said to let him know is all, that if it was medically indicated...we MAY be able to get one. I think most of us are excited and want one, not saying we are getting them, for sure. I hope so, that would be great, but it is no sure thing. Hope is alive and some of us are runnin' with it!
I think you're talking about Fibroscan FDA "trial" criteria, which wants you to have a biopsy within X number of months of the scan.
To the best of my knowledge HR is not participating in the trial therefore has different criteria, but you should really hear confirmed that from him.
Second, I had two scans, one during tx and one after. I had them as a private patient, so it's possible that for those like me the criteria was either relaxed or not necessary and they may or may not use my stats in the trial. Don't know, didn't really ask. Just glad I was able to get the scans. I also believe Dr. S in Miami may use the scan on private patients as well, as I don't believe he also is part of the trial but again just a supposition. I think within the next year or two we will be seeing these scans showing up in a lot more places. Hopefully.
-- Jim
To the best of my knowledge HR is not participating in the trial therefore has different criteria, but you should really hear confirmed that from him.
Second, I had two scans, one during tx and one after. I had them as a private patient, so it's possible that for those like me the criteria was either relaxed or not necessary and they may or may not use my stats in the trial. Don't know, didn't really ask. Just glad I was able to get the scans. I also believe Dr. S in Miami may use the scan on private patients as well, as I don't believe he also is part of the trial but again just a supposition. I think within the next year or two we will be seeing these scans showing up in a lot more places. Hopefully.
-- Jim
Great title for a thread! apologies if you've already replied to these questions. It's quite possible I missed the answers in the threads below.
- as noted earlier, HCV's rapid replication and sloppy polymerase would seem to argue against any enduring "senescence" on the part of residual virus. The phylogenetic analysis in Castillo of the 302-bp core sequence should provide good evidence in that regard. Do you think those PCR products are likely to be as reliable as those of the 5' non-coding region?
- the results you mentioned re unreleased intra cell HBV would seem to be another reason to focus on cell rather serum RNA detection. Though PBMC assays seem to be available for research (<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16384611&query_hl=12&itool=pubmed_DocSum">Pugnale'06</a>), they are not available commercially. Why are cell-based assays not routinely done?
- HCV's ability to mutate past whatever roadblocks are put in its path is part of the reason I'm a bit skeptical that, to the disappointment of vertex investors, any of the new HCV-targeted drugs will individually provide a signifcant improvement over ifn/riba (though the effect of simultaneously going after the polymerase(NM283) and the protease (vx-950, SCH 503034) may put a bit more of a squeeze on the virus). However, the fact that HCV is so very picky about its host organism must be an Achilles heel. Though it can quickly sample all the genomic forms that enable it to survive in a host, the host mechanisms are limited and very stable. My pet candidate is the IRES, which is among HCV's most conserved regions. However none of the drug companies seem to be going down that path though the crystal structure is available. Any idea why this is not being pursued?
- do you have any thoughts on the credibility of the <a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=16618405">Pan'06</a> non-hepatic findings and the criticisms raised by Perelson (original thread closed)
- as noted earlier, HCV's rapid replication and sloppy polymerase would seem to argue against any enduring "senescence" on the part of residual virus. The phylogenetic analysis in Castillo of the 302-bp core sequence should provide good evidence in that regard. Do you think those PCR products are likely to be as reliable as those of the 5' non-coding region?
- the results you mentioned re unreleased intra cell HBV would seem to be another reason to focus on cell rather serum RNA detection. Though PBMC assays seem to be available for research (<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16384611&query_hl=12&itool=pubmed_DocSum">Pugnale'06</a>), they are not available commercially. Why are cell-based assays not routinely done?
- HCV's ability to mutate past whatever roadblocks are put in its path is part of the reason I'm a bit skeptical that, to the disappointment of vertex investors, any of the new HCV-targeted drugs will individually provide a signifcant improvement over ifn/riba (though the effect of simultaneously going after the polymerase(NM283) and the protease (vx-950, SCH 503034) may put a bit more of a squeeze on the virus). However, the fact that HCV is so very picky about its host organism must be an Achilles heel. Though it can quickly sample all the genomic forms that enable it to survive in a host, the host mechanisms are limited and very stable. My pet candidate is the IRES, which is among HCV's most conserved regions. However none of the drug companies seem to be going down that path though the crystal structure is available. Any idea why this is not being pursued?
- do you have any thoughts on the credibility of the <a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=16618405">Pan'06</a> non-hepatic findings and the criticisms raised by Perelson (original thread closed)
Parent thread here if interested:
http://www.medhelp.org/forums/Hepatitis/messages/43669.html
http://www.medhelp.org/forums/Hepatitis/messages/43669.html
The scoop is that I need to move on. Or move with the company. So I now have two live offers, and I'm streesing a bit about which to take.
A) Passionate position, fun, interesting, blaah-blah. Little less money, Kaiser HMO, no LTD or Life Ins.
B) Pretty OK position. I could be happy and stay a long time. More money, better bene's over all.
I'm inclined to throw caution to the wind, and go with A.
A) Passionate position, fun, interesting, blaah-blah. Little less money, Kaiser HMO, no LTD or Life Ins.
B) Pretty OK position. I could be happy and stay a long time. More money, better bene's over all.
I'm inclined to throw caution to the wind, and go with A.
Well, I ain't no Russian bride but I do like my walks on the beach! Only thing is, I ain't by the beach no more...I'm working managing the nightshift over here at the Circle K? out her in Gorman? Right out by the Highway 5? You know the spot, right before you get to the Grapevine...You remember I always usedta like to wear spandex in the 80s, well and I still do! though at 5'6 and 245, I should probably try to cover up a little more, but dangit, I do love my spandex!!!! Probably too many Yoohoo's and them machine cheese nachos behing the counter, but for crissake, it gets lonely out here 3 in the mornin!
If you come out soon, we'd love to have ya! Bathroom is out right now, stupid brats firin' off cherry bombs in the toilet again, so you gotta go down to the Mickey D's for that...truckers get mad as h@ll about that but scr@w em! Well, see ya soon Revvie Boy! love to catch up!!!:))
If you come out soon, we'd love to have ya! Bathroom is out right now, stupid brats firin' off cherry bombs in the toilet again, so you gotta go down to the Mickey D's for that...truckers get mad as h@ll about that but scr@w em! Well, see ya soon Revvie Boy! love to catch up!!!:))
Life's too short...take the one you are passionate about. Where is it before I make up my mind ;)
I don't kmow much about Kaiser or CA health plans so really can't comment other than "passion" is often what makes life, life.
-- Jim
-- Jim
Id go for better pay and benes and fulfill my passion with the extra money I made.
I agree passion is important, but Im pretty practical and would take a decent but better paying, better benefits long term situation over the less pay and benefits but more passion and fun setting.
I agree passion is important, but Im pretty practical and would take a decent but better paying, better benefits long term situation over the less pay and benefits but more passion and fun setting.
MEDICAL PROFESSIONAL
Here is the abstract of the PBMc HCV RNA detection/quantification paper that you cite.
Ultrasensitive methods to measure very low levels of hepatitis C virus (HCV) RNA
in biological samples may have diagnostic and prognostic significance and be
useful to evaluate the response to antiviral treatment. A sensitive assay to
quantify HCV RNA in peripheral blood mononuclear cells (PBMCs) was developed and
validated using the iCycler iQ Detection System (Bio-Rad) coupled with TaqMan
chemistry. HCV was co-amplified with the endogenous control
glyceraldehyde-3-phosphate dehydrogenase in a multiplex reaction. Calculated PCR
amplification efficiencies for both target and control genes were used in a
mathematical model for relative quantitation of HCV RNA. A linear relationship
between input RNA and C(T) values over 6 log dilutions was observed for both
HCV- and GAPDH-specific products (R(2) > or = 0.99). As few as 1.5 IU/reaction
could be detected, with high accuracy (CV < or= 3.94%) and reproducibility (CV <
or = 2.20%). Quantitation of HCV RNA levels ranging from 10(3) to 10(7) IU/ml as
measured in 47 plasma samples was highly correlated with values obtained by the
COBAS Amplicor HCV Monitor test, v2.0 (Roche) (R(2) = 0.977). In conclusion,
this assay provides an excellent tool to determine accurately HCV kinetics in
PBMCs during antiviral therapy and to assess the long-term significance of
different patterns of response to treatment.
I placed it here so that you can see for yourself (and I checked the original full length to see if the anser is there- but NO)
WHERE IS THE QUANTITATION OR HCV KINETICS IN PBMC that they are talking about???? All they are saying is that they were measuring the plasma viral load and their method compared well with Amplicor. How much HCV RNa per PBMC?? Thats what this was all about, but no results given.??!!
You are not likely to see any commercial assays for cellular RNA for quite a while.Difficult and clinical use unclear.
Jim, the variability between commercial assays in regard to their intraassay reproducibility that you are referring to is a reality with unpleasant consequences - some do much better than others. We participated several times in comparisons of sensitivity -Eurohep I and II ( saw tremendous differences in lab performances but NGI did super, then, but I do not follow these efforts currently. When tx decisions are bases on these it is bad news.I have not looked at these aspects at NGI for a while, might want to ask our QC department how we are doing here.
Meanwhile all the considerations re the resistance power of HCV against individual component blockage apply as I discussed before.
The 5prime noncoding region is an interesting target but i do not know about efforts in this area. We sure have to be glad for this region of the virus - ootherwise we would have had no PCR for reliable detection.Even that region varies however and I remember vividly the days when I scanned this region to finally come up with one real good invariable pair of primers that made the first commercial assay for HCV and the dramatic growing of NGI possible.
Finally the Pal paper that implies a major contribution of HCV species - more than 50% - from the lymphatic system and not the liver is remarkable and could explain many of the clinical features of Hepatitis C. The news currently are not getting better. While most of these variants might not be very fit, some might sit the treatment out inthe lympahtic system and cause the high rate of relapse. On the other hand SVR is a very stable phenomenon We have to wait for an explanation for that that goes beyond speculation. A guess would be that the small amount of pseudotypes of vastly reduced fitness remaining elicits enough of an immune response to quickly control any viral spread that might occur below detectable levels.
Ultrasensitive methods to measure very low levels of hepatitis C virus (HCV) RNA
in biological samples may have diagnostic and prognostic significance and be
useful to evaluate the response to antiviral treatment. A sensitive assay to
quantify HCV RNA in peripheral blood mononuclear cells (PBMCs) was developed and
validated using the iCycler iQ Detection System (Bio-Rad) coupled with TaqMan
chemistry. HCV was co-amplified with the endogenous control
glyceraldehyde-3-phosphate dehydrogenase in a multiplex reaction. Calculated PCR
amplification efficiencies for both target and control genes were used in a
mathematical model for relative quantitation of HCV RNA. A linear relationship
between input RNA and C(T) values over 6 log dilutions was observed for both
HCV- and GAPDH-specific products (R(2) > or = 0.99). As few as 1.5 IU/reaction
could be detected, with high accuracy (CV < or= 3.94%) and reproducibility (CV <
or = 2.20%). Quantitation of HCV RNA levels ranging from 10(3) to 10(7) IU/ml as
measured in 47 plasma samples was highly correlated with values obtained by the
COBAS Amplicor HCV Monitor test, v2.0 (Roche) (R(2) = 0.977). In conclusion,
this assay provides an excellent tool to determine accurately HCV kinetics in
PBMCs during antiviral therapy and to assess the long-term significance of
different patterns of response to treatment.
I placed it here so that you can see for yourself (and I checked the original full length to see if the anser is there- but NO)
WHERE IS THE QUANTITATION OR HCV KINETICS IN PBMC that they are talking about???? All they are saying is that they were measuring the plasma viral load and their method compared well with Amplicor. How much HCV RNa per PBMC?? Thats what this was all about, but no results given.??!!
You are not likely to see any commercial assays for cellular RNA for quite a while.Difficult and clinical use unclear.
Jim, the variability between commercial assays in regard to their intraassay reproducibility that you are referring to is a reality with unpleasant consequences - some do much better than others. We participated several times in comparisons of sensitivity -Eurohep I and II ( saw tremendous differences in lab performances but NGI did super, then, but I do not follow these efforts currently. When tx decisions are bases on these it is bad news.I have not looked at these aspects at NGI for a while, might want to ask our QC department how we are doing here.
Meanwhile all the considerations re the resistance power of HCV against individual component blockage apply as I discussed before.
The 5prime noncoding region is an interesting target but i do not know about efforts in this area. We sure have to be glad for this region of the virus - ootherwise we would have had no PCR for reliable detection.Even that region varies however and I remember vividly the days when I scanned this region to finally come up with one real good invariable pair of primers that made the first commercial assay for HCV and the dramatic growing of NGI possible.
Finally the Pal paper that implies a major contribution of HCV species - more than 50% - from the lymphatic system and not the liver is remarkable and could explain many of the clinical features of Hepatitis C. The news currently are not getting better. While most of these variants might not be very fit, some might sit the treatment out inthe lympahtic system and cause the high rate of relapse. On the other hand SVR is a very stable phenomenon We have to wait for an explanation for that that goes beyond speculation. A guess would be that the small amount of pseudotypes of vastly reduced fitness remaining elicits enough of an immune response to quickly control any viral spread that might occur below detectable levels.
I had Kaiser for years. Not too bad if you really push for good care, but it takes work. I am sure you can do that Goof! Although, that said I think I picked up Hep C at Kaiser. I at least had septsis. I have heard some horror stories. I had a few GREAT doc's there that I loved though.
Have an Answer?
You are reading content posted in the Hepatitis C Community
Learn about this treatable virus.
Getting tested for this viral infection.
3 key steps to getting on treatment.
4 steps to getting on therapy.
What you need to know about Hep C drugs.
How the drugs might affect you.
These tips may up your chances of a cure.
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
Condoms are the most effective way to prevent HIV and STDs.
PrEP is used by people with high risk to prevent HIV infection.
