Natalie Cole's perspective on Hep C - Geno 1

[granitekonig]

Copy and paste into your address bar:

http://images.google.com/imgres?imgurl=http://storage.people.com/jpgs/20080922/20080922-750-119.jpg&imgrefurl=http://www.people.com/people/archive/article/0,,20230571,00.html&usg=__PGKKiKELMWz9Sj92gjw4WHhbvaw=&h=992&w=750&sz=96&hl=en&start=20&um=1&tbnid=wdUdNk1JxZNVOM:&tbnh=149&tbnw=113&prev=/images%3Fq%3Dbefore%2Bafter%2Btreatment%2Bhep%26um%3D1%26hl%3Den%26sa%3DN

[Trinity4]

For the record, she isn't on treatment anymore.  They stopped the interferon too.


Yahoo! Buzz Digg Newsvine Reddit FacebookWhat's this?By Kelley L. Carter, USA TODAY
LOS ANGELES — Natalie Cole was worried she'd be forgettable.
The singer had known for months that something wasn't quite right physically. It wasn't until she was sprawled out on the floor of her New York hotel room last month, barely breathing, that she was forced to figure out what was ailing her. She was in the middle of a heavy schedule of appearances to promote her new album, Still Unforgettable, which like 1991's Unforgettable … With Love features a virtual duet (Walkin' My Baby Back Home) with her late father, Nat King Cole.

After Cole, 58, checked into a hospital for tests, doctors told her she had fluid in her lungs and 10% kidney function.

"I could have been dead," the eight-time Grammy winner says, sitting in the living room of her high rise dressed in charcoal gray slacks and a matching sweater set, her hair cropped and her face made up. "The volume of work that I've had before, I can't do it. Instead of 90-minute shows, maybe I'll only do 60. Instead of dancing around the stage, maybe I'll just walk elegantly."

The most recent health scare came on the heels of her announcement in July that she had been diagnosed with hepatitis C (a liver virus), probably the result of years of intravenous heroin use in the '70s and '80s.

FIND MORE STORIES IN: New York | Grammy | Maria | Yellow Pages | Nat King Cole | Natalie Cole | Still Unforgettable | Tena Clark | Unforgettable With Love
To treat it, she was receiving weekly injections of interferon (a drug also used with cancer patients), which was rough on her body. She lost her appetite, hair and 15 pounds. At the same time, she was finishing her album and gearing up for a tour, later canceled.

Days after the album's release, she was told she needed dialysis three days a week. Since getting out of the hospital, she's stopped taking interferon, but the dialysis continues for now.

In more than three decades of friendship, says her former personal assistant Benita Hill Johnson, Cole has never had worse than a head cold.

"Natalie thinks that she can't be defeated in anything," Hill Johnson says. "Her biggest disappointment is that she's going to have to slow down."

Cole is hoping to get her doctor's approval to do a few concerts here and there; she's itching to get back on the road, even if that means dramatically changing her set.

"I'm getting stronger every day. As much as I don't like dialysis, it absolutely is giving me the strength and the endurance that I need, so I'm happy for that," Cole says. She pauses to kiss goodbye to her mother, Maria, who says she needs to look into her daughter's eyes to see that she's healthy.

Cole doesn't love the idea of getting dialysis while traveling for work, "but it is what it is, you know?"

It'll be a different life on the road, but those who know her best doubt that fans will notice the difference.

Given where Cole is now, "I don't know that people expect Natalie to run across a stage," says Tena Clark, her album's executive producer. "Her voice is still gorgeous. Natalie could sing the Yellow Pages and people would sit there on the edge of their seats."

[alagirl]

I laughed that one.  I was a pretty intolerant patient.  In many ways, I'm sure ;)

[jmjm530]

Because mono, while more effective than mono in the general HCV population, is not as effective as combo when doses are titrated whether based on serum riba levels or "on patient tolerance" (more readily available :) ) as stated in the guidelines above.

[jmjm530]

Here's another article (actually guidelines) from MedScape supporting the use of ribavirin in patients with kidney problems. Free registration required.
http://www.medscape.com/viewarticle/572657
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Guidelines for Hepatitis C in Chronic Kidney Disease Issued
Release Date: April 8, 2008

From the study highlight section:

"...As in the general population, HCV-infected patients with CKD stages I and II should receive combined antiviral treatment with use of pegylated IFN and ribavirin, with ribavirin dose titrated based on patient tolerance..."

[alagirl]

That's what I meant, what you said.  I think what I really meant to ask though is, if monotherapy is effective in dialysis patients, why not use that more conservative treatment - or, because I'm being too lazy to look it up and see, is there evidence they have a much larger chance of SVR with the combo tx than monotherapy, even considering their increased ability to benefit from monotherapy (over someone who doesn't have CKD).  I just worded it badly.

I am doing well - I appreciate it.  Really recovered.  If only my bank account would recover this way.

[jmjm530]

If you check the literature I think you will see that monotherapy is not more effective than combo with dialysis patients but that mono therapy is more effective in dialysis patients than in non-dialsysis patients. This is different and does not mean that riba should be ruled out with people who have kidney problems.

Good to see you posting again and hope you're doing well.

-- Jim

[alagirl]

Sorry, Jim, didn't see the study you posted prior to commenting.  Just curious as to why they use the riba with CKD if they can effectively use monotherapy.  Anyway.  I agree there is data out there that suggests that people with CKD can be treated.

[alagirl]

Here's the kind of weird thing to me.  I thought that in CKD patients, they typically used monotherapy and not riba since monotherapy seems to be more effective in people on dialysis...

[granitekonig]

Smooches, pumpkin. ;)

[jmjm530]

Thank you GK.

[jmjm530]

Let's not make this personal. You clearly stated that people with kidney problems cannot take ribavirin and this is not correct information. More than that, it could discourage someone in that position from treating.

As I mentioned previously, many with kidney problems can treat with ribavirin, its just that weight based may be more problamatic than with the general population.

Here is a teaching capsule from the Clinical Care Options Web Site that support what I've said. There are numerous other papers out there as well. Free registration required for the site. The link follows at the bottom. If you have a study or paper that contradicts this, please post.

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HCV Genotype 1/4 Patients With Poor Renal Function May Benefit From Ribavirin Dosing Based on GFR, Not Weight

Posting Date: April 15, 2007

    * German multicenter, open-label, observational study[1]

Summary of Key Conclusions

    * Dosing according to glomerular filtration rate (GFR) may be preferable to weight-based ribavirin among ribavirin-treated HCV genotype 1/4 patients with poor renal function
    * Poor renal function (low GFR) associated with
          o Lower sustained virologic response (SVR) rates
          o More adverse events
          o Possibly due to nonoptimal ribavirin dosing
    * GFR varied according to sex, age, and genotype but not according to weight or body mass index (BMI)
    * Further studies needed to determine if adjusting ribavirin according to GFR would improve treatment response


http://www.clinicaloptions.com/Hepatitis/Conference%20Coverage/Barcelona%202007/Tracks/Updates%20in%20HCV/Capsules/656.aspx

###

[granitekonig]

"arguing with you is getting boring"

Jim wasn't arguing with you. His post made sense and expounding on your point.

[alagirl]

kidney problems can be a side effect of chronic hep c

[CoWriter]

Arguing with you is getting boring.

Co

[jmjm530]

People with kidney problems *can* take riba, just not at the normal doses. There have been several papers on this in the last few years.

Lindahl, the Swedish researcher, and others have talked about dosing ribavirn based on serum riba levels as well as kidney function as opposed to weight based which docs here seem to stubbornly stick to. If she had impaired kidney function and was put on weight based riba, then this could account for her problems.

-- Jim

[CoWriter]

She must have had the kidney problem before starting tx.  That's probably why they took her off the Ribavirin.  People with kidney problems can't take Riba.  

Co

[annieCinMD]

The last I heard she needs a kidney. I wonder if that is a side effect of the treatment?  Hearing that almost made me reconsider treatment. I decided to stop dating while I'm on treatment, too.  I have enough on my plate with a full time job, part time college classes and being a single parent. It's good to hear celebrities speak out with their stories. So many people just don't know about this disease and they are prejudicial as a result.

[Trinity4]

Latest info I heard was that she was taken off of tx due to kidney failure and is on dialysis treatments 3 times wk.  Her son may give her one of his kidneys.  Also read where the kidney problem existed prior to starting treatment but was exacerbated by the treatment.
Trinity

[Marc1955]

It sounds to me like she wasn't prepared very well for the treatment. That may not have been her doctor's fault. She may be the sort of driven person who dives into things without adequate preparation. Just about everyone on this board seems to better manage the process.

[granitekonig]

For those who have problems with the link:
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After battling a drug addiction in the '80s, Natalie Cole, the daughter of legend Nat King Cole, led a sober and healthy life, becoming a "workout fanatic" when not racking up Grammys between world tours. But a series of blood tests in April revealed a shocker: She had hepatitis C, which had been dormant for decades. "Nothing could have prepared me for this—nothing," says Cole, 58, who was told she contracted the degenerative liver disease from sharing dirty needles. "I had to make peace with my past, because I can't change it," says the singer, who released a new album of pop standards, Still Unforgettable, Sept. 9. Cole shared her story with PEOPLE's Marisa Laudadio.

In her 2000 memoir, Angel on My Shoulder, Cole wrote that drugs "were a culmination of not having resolved things"—including her father's death when she was 15. She was also molested as a child. She hit bottom in the early '80s.

I was a heroin addict, sharing needles with the crowd I was with. At the time I was having fun. I didn't know. Then, 25 years later after a routine blood test, my doctor tells me, "You have hepatitis C." My life crumbled before my eyes. I never had symptoms. I didn't know anything about it. Would I still have a career? Was I going to die? How long did I have? I was devastated. I had to let it sink in for six weeks while they ran more tests.

It's important to wallow and grieve when you have a health issue. I don't think you really get the best stuff out of life until you've had the worst stuff. But I was upset with the Lord: I was like, "How could you?" But I got over it. I said, "Well, I know you haven't brought me this far to leave me."

Cole's doctor started her on a standard 48-week course of treatment, with chemotherapy-like injections and an antiviral drug, Ribavirin.

Nothing my doctor could have done could prepare me for this. It's debilitating. I give myself a weekly injection of chemotherapy in my thigh. When I started in May, I thought I was dying. I couldn't get out of bed for three weeks—literally. I was nauseous every day. I lost 15 lbs. from not eating. And chemo dehydrates you. I looked like a scarecrow. It would take a 300-lb. man to his knees.

I had some concerts this summer. I remember standing in my dressing room in Tokyo, naked, looking in the mirror. I was pathetic: so skinny, with an IV hanging from the wardrobe rack, trying to get hydrated to go onstage. I was in bad shape.

My support system—my sisters, my close friends of 30 years and my son Robbie—had never seen me like this. I was depressed. My doctor warned me I might even think of suicide. I never did. But I understand why people do. It's a hopeless emotion. Imagine having a 24-hour flu. Now imagine that times 10, every single day, for a year or longer.

The side effects were so severe that she stopped the Ribavirin after a month. But Cole's body responded quickly; the virus is now undetectable. Her treatment will continue until the end of the year, in hopes that she'll be cured.

I'm lucky—some people are in treatment for years. But I'm still emerging from the depression. You have to make yourself do things, like just going to the store or having lunch with a friend. Even that takes so much out of you. And of course there's always vanity. You've got to have a friend take you to the hairdresser and get your nails done. Even if you're leaning over the table sick. Vanity trumps all!

But my hair's starting to fall out, so I'm getting ready to cut it all off. Seventeen years ago, when Unforgettable ... with Love came out, I cut it off too. I'm looking forward to it. It's one less thing to deal with. It's freeing.

As long as she's in treatment, Cole—who's been married three times—says dating is the last thing on her mind.

I can't see putting a man through this. I'd make a horrible girlfriend. This is a very emotional, unstable time for someone with hepatitis. Then you add my celebrity life, and not many guys could deal with this. I definitely am open to love again. I just can't imagine how or where it will come from.

Cole's new album, Still Unforgettable, includes a new duet with her father, "Walkin' My Baby Back Home." Producing a new project and thinking about her father has helped her cope.

My dad was so much fun. I just wish he could be here. That's the hardest part of this. I think of him every time I sing. My father led by example. He wasn't much of a talker—he walked life. That means a lot to me.

I'm committed to working. I'm a fighter, not a chump. The timing is intense. The album is special to me, and here I am sick. But you know the saying: These are the best of times and the worst of times. So we'll barrel through. If I have to, I'll kick butt sitting down.

You shouldn't have regrets. I'd say instead that I've learned a lot of lessons. Yes, I could have handled some things better. But they've also made me who I am today. I like myself so much more than I did even five years ago. I can't think of anything I wish I hadn't done, even with this hepatitis. I'm almost 60—but I'm still growing.


More From This ArticleWhat Is Hepatitis C?
Hepatitis C is a virus affecting the liver. "It's transmitted by exposure to blood, commonly through intravenous drug abuse, blood transfusions, tattoos and possibly nasal cocaine use," explains Cole's physician, Dr. Graham Woolf, an associate clinical professor of medicine at UCLA/Cedars-Sinai Medical Center. It can also be contracted by sharing items like razors or toothbrushes. About 200 million people worldwide, including 4 million in the U.S., have hepatitis C. Left untreated, it can cause inflammation or cirrhosis—and at worst, cancer or liver failure. Patients with Cole's viral strain—the most common—have a 40-50 percent chance of successful treatment, he adds. "Natalie's attitude is fantastic," says Dr. Woolf. "She has a good chance of being cured."