Is it worht it?

I'm doing shot 23 tonight, (out of 24), just got my stat lab back from this morning, ANC IS 600, (lowest so far). Strangely enough, I've managed to hang in there with my ANC better towards the end, last Neup shot was almost 7 weeks ago! My question is, I'm doing my INF shot tonight, if this takes me below 500, which I'm guessing it probably will, is it really worth it to do a Neup shot on Tuesday to take the last INF shot next Friday? (also, I will have to do my blood test on Tuesday, instead of next Friday, because if I check blood next Friday and I'm below 500, I wouldn't take Neup and last INF on same day anyway) I was RVR, GT3.... what do  you think?
Thanks,
Bree

[Trinity4]

Take the Neup.  ANC could very well go below 500 but it could remain where it is.  You never know but either way looks like you need it.  Given you have one more shot after tonight you want to make sure you have a hassle free EOT, in other words no flack from the doctor so  If it were me, I would do one more Neup shot and call it quits.  

Trinity

[iwillbeatthis]

Thanks, as for EOT, I am basically on my own, have been for some time, my (clueless) GI moved, my hemo also left town, I felt comfortable enough with just taking my meds, checking my blood weekly, and going to my GP last month. Thankfully I had a pretty easy tx, considering.

[merryBe]

I agree, you don't want to second guess yourself if you don't succeed, and wonder later if your compliance or lack thereof played a part. You are at the end of a very long race and you need to stretch out your stride, arch your back, and push forward to break that tape across the finish line. You made it this far, just hang in there a few more days.
I think it might be smart to discuss sticking with neupo a little past tx, just to help restore you to normal sooner.

mb

[Trish77]

I'm wondering what your concern is on dropping below 500 ANC with only one INF injection left to go?  

[iwillbeatthis]

well, that is a good question. should I be concerned with dropping below 500 with just one more INF shot to go (after tonight)? maybe not. since I seem to be pretty resilient, maybe I should just (if it goes) let ANC drop below 500 and then watch the blood tests?
I just was hoping I didn't have to take any more Neup. At this point, I'm sick of putting any more crap in my body than I absolutely have to.

[Trish77]

I wouldn't actually be overly concerned with dropping below ANC of 500 with only one more INF shot to go.  It's cold and flu season, so be smart about that and don't expose yourself needlessly.  Your ANC will start to come back up once you're done your INF - the shot stays in your body 7 days only.  I really would not bother with the neupogen when you're not having to concern yourself with dosage reductions/adherence anymore.  Just monitor your blood test results after you're done treatment and see how you're doing.  Just something to consider.

[iwillbeatthis]

I think I am going this route. I am in the sticks, stay on the ranch, send husband to town, no (sick) people around, I think I'll slide into home base without the last Neup.
Thanks,
Bree

[babs824]

sounds like a good plan tho i have no experience in this area. you slide in girl and so glad it is finally almost here for u, hugs, babs

[FlGuy]

At 600 you have room to navigate.  Some docs are not overly conerned at 300. If you have the Neup, you might as well do it. If you need to get an rx filled, I'd forget it and call it a day with the Neup. As for getting labs next Friday (the afternoon before your last shot on Friday night if I'm reading correctly) I don't really see the point.  That is, there will be no need for anymore neup, you could quit the riba if hgb is way low - since you were rvr.  And, since you were rvr and undetected for these 5 months or so a PCR is not going to be informative.  I'd hold off on the pcr until a month after you last shot or riba.  Time for an exit strategy. Tick, tick, tick.

[iwillbeatthis]

Yea, I think so too.... and I'll be sliding in real soon, with you right behind me, glad we were on the same team :) We did a good job, big hug, Bree

[Trinity4]

That would be my strategy too Flguy.  If you have the Neup do it.  ANC is 600, Inf tonight and next Friday night so the ANC could easily drop below 500 within those 2 weeks.  Not to say you'd be in harms way but I'd use the Neup if I had it too and then be done with it.

[iwillbeatthis]

well, I have the Neup, I just would rather not take it. I was going to do my last blood test on the morn of my last INF shot, just because, especially to check ANC. And you don't think I should take 24 week VL test just to make sure I am still UND before I end tx? my last PCR was week 12. If I have the standing order at the lab, shouldn't I just do it? I was going to do PCR on last day of Riba at EOT, then one month after, 3 months after, and 6 months after.

[FlGuy]

A few things. Since you were und at week 3 the chanes of a breakthru at week 24 are waaaay remote.  What would the result tell you?  If undetected (expected and almost certain) the reply would be "of course".  If detected, what would you do with that information?  Run out and get more Peg and Riba and move on to week 25?  If you are insurance covered, that's a hurdle.

I don't think you will have anything to learn with a pcr next Friday.  And, don't you live in the sticks?  Undetected at week 3 is a significant predictor, go with the tea leaves - they are screaming at you !

[iwillbeatthis]

Yes, I live in the sticks lol. and you are right, I was und at week 3 (good memory), and I'm sure I'm still und, and right, if I had a very weird breakthrough, there is nothing I could do.
I hear the screaming tea leaves.

[FlGuy]

And another bonus...since your liver doc and hematologist both abandoned you unless you have other non-hcv medical issues you may have had your last doctor visit for a while.  Since you are holding lab orders for post treatment pcrs (1 month post, 6 monts post) there may be no need to see a doc for a while. Congrats, the end is near.  Oh yeah, tell Arizona I said happy Birthday.  It's coming up soon.

[iwillbeatthis]

I was honestly happy when docs left town, I have really enjoyed not having to go to doctors the second half of tx. No other issues, so it has just been a matter of marking off the calendar. Yep, we are celebrating great Arizona birthday and being done with tx in Feb.
Thanks guy, Bree

[Trish77]

" I was going to do PCR on last day of Riba at EOT, then one month after, 3 months after, and 6 months after. "

Another perespective on whether you do that EOT blood test.  The likelihood of you not being SVR is remote.  If, however, you are DET at Week 4, you may wonder when you became DET.  It is typical to get an EOT PCR done and then the ones that follow.  If it were me, I'd get the EOT one done, simply because it's information to keep subsequent PCR's in context, when you don't know what they will say yet, even though I think you have SVR is looking very good right now.  You can't go back and do it and rather than wish you had, you'll have the information.  It all depends on how much it will matter to you to know if you were DET at EOT if the subsequent PCR results are not what you would have hoped for.

Trish

[frijole]

My last interferon shot was 8/4/2006.  My ANC on 8/7 was 600.  My hemotologist wanted me to boost the ANC if possible and, although I took Neup about every 7 days during tx, I took a shots two days in a row after that test.  My next test was 8/14 and ANC was 700.  Took neup 8/15.  Next test 8/28, ANC 1000 - 8/31 took my last neup.  My ANC remained at 1000 for two months and finally got up to 2000 end of October.

The thing is it takes the whites a while to build back up.  My hemotologist said sometimes ANC never reaches pretreatment levels and it doesn't hurt at all to boost it at the end..  Although I don't think the 600 is too worrisome -- even with neup, my got to 400 and 500 a couple of times -- I would do whatever I could to try to get back to normalcy.  I recommend you take whatever you have left until the rx is gone.

One thing I did notice.  During tx, taking at least 3 shots a week, (INF, PRO, and NEUP) I din't notice the "bone pains."  AFter tx, taking the neupogen by itself, I did notice that effect.  I guess it was masked in tx by all the other nasties.  

Congrats of (almost) finishing tx and good luck with the EOT VL test.
Frijole

[spectda]

I have done a lot of CBCs during treatment because my levels drop so quickly. Within a day or two of taking my weekly injection of neup my anc climbs way above the normal range several times over 10,000 and I mean my anc not my total whites. By the end of the 7 day period my anc is almost always between 250-400.

I did get an ear and throat infection early in treatment when my anc first dropped to 280, but since then I haven't had an issues, I suppose this is because my anc doesn't stay at those levels for long. Also as I am sure you are aware most people with low anc from tx don't get infections although some have had very bad ones.

Personally I think you will be okay whatever you decide especially since it has taken you so long to drop your anc level since your last neup injection. I suppose one never knows over the long term whether the risk of infection is greater then the risk from artificially stimulating your bone marrow.

I know that many of us have taken lots of neup with no apparent issues and that many people might consider neup fairly innocuous.  Obviously the immediate risk is about infection, but I also suspect that messing with our bone marrow has it's risks.

- Dave

[iwillbeatthis]

Trish - you read my mind, I will do EOT PCR just to have that documented. Why leave that piece of the puzzle out of all of this since I have documented everything else so closely throughout tx.

Frijole - I understand what you are saying. I'm just leaning towards letting the resilience of my own body take care of things when I am done with tx. If I had more than one INF shot left, I wouldn't think twice, I'd take the Neup.

Dave- boy I know you know about all this much more than I do. I think one of the main things is that my ANC didn't drop as fast as others have that have had this problem.

My question is if you artificially prop up your ANC with Neupogen, is it really better than letting your body recover on it's own, especially after tx?

[frijole]

No, you don't artifically prop up your ANC with neupogen.  Neupogen assists your own body in manufacturing  neutrophils.  The problem during treatment is that interferon destroys white blood cells.  

"Filgrastim is in a class of medications called colony-stimulating factors. It works by helping the body make more neutrophils."

You have only been on treatment 24 weeks and your ANC did not drop much.  I don't really think it matters much whether you do the shot or not.  If it makes you feel better (mentally) don't do it.

[copyman]

I would do an EOT PCR one week after your last shot. Then at 3 & 6 months.

Good luck with finishing TX and your future SVR.

[iwillbeatthis]

thanks, that is what I am going to do.
almost there.
Bree

[can-do-man]

And end of tx pcr can become very important, not saying it applys in your case but i would not have been able to participate in the trial i was in for relapsers had i not had one in my first tx.

Wishing you the very best going forward.

Cando

[iwillbeatthis]

good point, and thanks.
Bree