Aa
Need some advice
I am going to discuss my bx with my Gastro-enterolgist(?)in a couple of days. I have genotype 1b and my vl is 2.4mil. After raeding many posts here and much research on the internet the chances for SVR for HCV genotype 1 are 50-50 or less. This does not seem good. Since this may be the case, would it be a good idea for me to pursue a group test where the shelf life is much longer than the pegalated interferone of today. I would only need to take a shot every 2-4 weeks, because this brand of interferone stays bilogically longer in the system. I understand people are given this new tx when they don't clear after 48-72 weeks with pegalated interferone/ribi. I know there may be some risks invovled, but I would be willing to take a chance. The SVR rate is higher with this new tx for genotype 1's. Please let me know if this is worth discussing with my Dr.
Thanks all.
CIGASO.
Thanks all.
CIGASO.
I am just glad you have the time to spend here and still do all of this research. Seems like everytime I visit there are always several threads with your input. How do you do it??
Regarding the ALT quotient. It seems to me that using the absolute value of ALT, whether in the normal range or outside of it, as a predictor of liver damage and efficacy of treatment does not make sense. However, using the relative value of AST/ALT as a marker for liver damage does. I have spoken to several doctors about this and gotten several different viewpoints. The most common one is that a high AST/ALT ratio called the De Titus quotient can be used as a starting point that points to a more significant level of liver damage. I would like to see more data on this and if you can dig some up it would be most appreciated.
I have never heard of the ALT/ULN ratio which....is not suprising. Seems like the world is full of things I don't know and what I do would barely fill a thimble. I will try to read more about it.
Best to you and thanks again for the research,
Steve
Regarding the ALT quotient. It seems to me that using the absolute value of ALT, whether in the normal range or outside of it, as a predictor of liver damage and efficacy of treatment does not make sense. However, using the relative value of AST/ALT as a marker for liver damage does. I have spoken to several doctors about this and gotten several different viewpoints. The most common one is that a high AST/ALT ratio called the De Titus quotient can be used as a starting point that points to a more significant level of liver damage. I would like to see more data on this and if you can dig some up it would be most appreciated.
I have never heard of the ALT/ULN ratio which....is not suprising. Seems like the world is full of things I don't know and what I do would barely fill a thimble. I will try to read more about it.
Best to you and thanks again for the research,
Steve
haha I have to totally agree with Southernboy as you always offer valuable information and research and I know sometimes when you list these items,,,,,haha Me,,,,Will want you to decipher for me,,,,I know you are the messenger of the info but you have such a way about you,,,,,That always explains everything so well and makes each person feel so much better about themselves and their own situation. You really do have a talent and I pray after your SVR,,,,that you will continue to help people at the boards,,,Which I'm sure you will...
Thank you for the kind words. The same can also be said for you. You've always provided great help and insight to the folks here.
As far as the ALT quotient goes, I believe that what you have found (the ratio of AST to ALT, or De Titus quotient) is actually a different creature than the ALT quotient.
For example, look at this study entitiled <a href="http://www.janis7hepc.com/pegintron7.htm">Histological benefit of peginterferon alfa-2a (40KD) (PEGASYS}) monotherapy in patients with advanced fibrosis or cirrhosis due to chronic hepatitis C</a> that's posted on the Janis & Friends site. If you scroll down a bit more than halfway you'll come to "Table 1.Demographic and clinical characteristics at baseline in patients with paired biopsies" (though for some unknown reason, Table 1 follows after tables 2 & 3). In this table they use ALT quotient and define it at the bottom of the table: "ALT quotient defined as the baseline ALT value divided by the ULN ..." (where ULN stands for 'Upper Limit of Normal').
That's what I've seen used in a few studies and at a few different sites as far defining ALT quotient goes (though the other sites have defined ULN in the 50-60 range, whereas here they use an example of 30). So that's the example I've been following - baseline ALT/ULN (and I use a ULN figure of 52, which I saw used at two different sites).
When I was first diagnosed back in 1992, my gastro told me that ALT could be an indicator of possible liver damage (in fact, he used it to gauge my response to the mono interferon). Since then, the medical community view these days seems to be that there is no correlation between ALT level and actual liver damage. For example, think of the estimated 30% of all Hep C patients who have normalized ALT's (which if were are to believe the figures of 4,000,000 cases in the US, would give a figure of 1,200,000). You can be assured that their 1,200,000 bx's would show the whole range of damage possibilities, despite having normal ALT readings. Could ALT be a better indicator of current ongoing inflammation as opposed to actual progression or a certain level of damage? That seems to make pretty good sense to me (though I have no data of any kind to back that up with).
It does seem to stand logic on it's head that a patient with greater levels of inflammation would stand a better chance of SVR.
Take good care.
TnHepGuy
As far as the ALT quotient goes, I believe that what you have found (the ratio of AST to ALT, or De Titus quotient) is actually a different creature than the ALT quotient.
For example, look at this study entitiled <a href="http://www.janis7hepc.com/pegintron7.htm">Histological benefit of peginterferon alfa-2a (40KD) (PEGASYS}) monotherapy in patients with advanced fibrosis or cirrhosis due to chronic hepatitis C</a> that's posted on the Janis & Friends site. If you scroll down a bit more than halfway you'll come to "Table 1.Demographic and clinical characteristics at baseline in patients with paired biopsies" (though for some unknown reason, Table 1 follows after tables 2 & 3). In this table they use ALT quotient and define it at the bottom of the table: "ALT quotient defined as the baseline ALT value divided by the ULN ..." (where ULN stands for 'Upper Limit of Normal').
That's what I've seen used in a few studies and at a few different sites as far defining ALT quotient goes (though the other sites have defined ULN in the 50-60 range, whereas here they use an example of 30). So that's the example I've been following - baseline ALT/ULN (and I use a ULN figure of 52, which I saw used at two different sites).
When I was first diagnosed back in 1992, my gastro told me that ALT could be an indicator of possible liver damage (in fact, he used it to gauge my response to the mono interferon). Since then, the medical community view these days seems to be that there is no correlation between ALT level and actual liver damage. For example, think of the estimated 30% of all Hep C patients who have normalized ALT's (which if were are to believe the figures of 4,000,000 cases in the US, would give a figure of 1,200,000). You can be assured that their 1,200,000 bx's would show the whole range of damage possibilities, despite having normal ALT readings. Could ALT be a better indicator of current ongoing inflammation as opposed to actual progression or a certain level of damage? That seems to make pretty good sense to me (though I have no data of any kind to back that up with).
It does seem to stand logic on it's head that a patient with greater levels of inflammation would stand a better chance of SVR.
Take good care.
TnHepGuy
Hi and thanks for all the help you provide to the people here. Your insight and research are most appreciated.
Here is some info that may throw some light on the ALT quotient being discussed above.
"Aspartate aminotransferase (AST, SGOT) are a group of enzymes that are involved in the metabolism of amino acids. Isoenzymes of AST are present in the cytoplasm and the mitochondria of cells. Severe tissue damage and even a mild degree of liver tissue injury results in the release of these isoenzymes.
In viral hepatitis and other forms of liver disease associated with hepatic necrosis, levels of serum AST are elevated even before the clinical signs and symptoms of disease, such as jaundice appear. Moderately increased levels of AST activity may also be observed in extrahepatic cholestasis. Levels observed in cirrhosis vary with the status of the cirrhotic process. Elevations also occur in patients with primary or metastatic carcinoma of the liver. AST levels are also elevated in other conditions such as myocardial infarction, progressive muscular dystrophy, pulmonary embolism, acute pancreatitis, crushed muscle injuries, gangrene, and hemolytic disease."
"Alanine Aminotransferase (ALT, SGPT) are a group of enzymes involved in the metabolism of amino acids. ALT is found primarily in the liver, although significant amounts are also present in the kidney. ALT is thought to be predominantly nonmitochondrial. The chief application of a determination of this serum enzyme is in the diagnosis of hepatocellular disease. It has been postulated that, in mild hepatocellular injury, when the hepatocyte but not the mitochondrial membrane is damaged, cytoplasmic ALT and AST are released into the serum."
"With more severe hepatocellular injury, mitochondrial membrane damage may result in the release of mitochondrial AST, elevating the AST/ALT ratio. Since ALT is found primarily in the liver, in patients with myocardial infarction, elevations of the serum levels of ALT are only slight or absent.
The ratio of AST to ALT, or De Titus quotient, is normally 1 or slightly more. An abnormal AST/ALT ratio can be used in diagnosing a variety of conditions such as alcoholic liver disease, viral hepatitis, and metastatic carcinoma of the liver."
Thus, a higher ALT quotient can be an indicator of more severe liver disease and we know that there is less efficacy with interferon treatment when there is more liver damage.
Best to you and thanks again for all the help.
Here is some info that may throw some light on the ALT quotient being discussed above.
"Aspartate aminotransferase (AST, SGOT) are a group of enzymes that are involved in the metabolism of amino acids. Isoenzymes of AST are present in the cytoplasm and the mitochondria of cells. Severe tissue damage and even a mild degree of liver tissue injury results in the release of these isoenzymes.
In viral hepatitis and other forms of liver disease associated with hepatic necrosis, levels of serum AST are elevated even before the clinical signs and symptoms of disease, such as jaundice appear. Moderately increased levels of AST activity may also be observed in extrahepatic cholestasis. Levels observed in cirrhosis vary with the status of the cirrhotic process. Elevations also occur in patients with primary or metastatic carcinoma of the liver. AST levels are also elevated in other conditions such as myocardial infarction, progressive muscular dystrophy, pulmonary embolism, acute pancreatitis, crushed muscle injuries, gangrene, and hemolytic disease."
"Alanine Aminotransferase (ALT, SGPT) are a group of enzymes involved in the metabolism of amino acids. ALT is found primarily in the liver, although significant amounts are also present in the kidney. ALT is thought to be predominantly nonmitochondrial. The chief application of a determination of this serum enzyme is in the diagnosis of hepatocellular disease. It has been postulated that, in mild hepatocellular injury, when the hepatocyte but not the mitochondrial membrane is damaged, cytoplasmic ALT and AST are released into the serum."
"With more severe hepatocellular injury, mitochondrial membrane damage may result in the release of mitochondrial AST, elevating the AST/ALT ratio. Since ALT is found primarily in the liver, in patients with myocardial infarction, elevations of the serum levels of ALT are only slight or absent.
The ratio of AST to ALT, or De Titus quotient, is normally 1 or slightly more. An abnormal AST/ALT ratio can be used in diagnosing a variety of conditions such as alcoholic liver disease, viral hepatitis, and metastatic carcinoma of the liver."
Thus, a higher ALT quotient can be an indicator of more severe liver disease and we know that there is less efficacy with interferon treatment when there is more liver damage.
Best to you and thanks again for all the help.
Hi again,
I don't know if the Albuferon retains full potency. I would imagine this is one of the things they need to investigate and there is not enough data on efficacy to know. This same question has been raised about the peg interferons and the consensus seems to be that they lose some potency, but more then make up for it by maintaining higher concentrations in the body. They do know that the Albuferon molocule itself is maintained in the body for long periods of time, up to 30 days.
There is another company working on a long acting interferon but it is still in the preclinical stages. This is Flamel Technologies, a French biotech which is combining interferon alpha 2b with their proprietary Medusa delivery technology. They are calling the result Interferon Alpha 2b XL. One of the things they are striving for is a long lasting interferon that retains full potency.
Let me know what else you find out and if you have any other questions I would be happy to answer them. Please be patient as I usually don't visit here that often unless in the middle of a discussion like this one.
Best,
Steve
I don't know if the Albuferon retains full potency. I would imagine this is one of the things they need to investigate and there is not enough data on efficacy to know. This same question has been raised about the peg interferons and the consensus seems to be that they lose some potency, but more then make up for it by maintaining higher concentrations in the body. They do know that the Albuferon molocule itself is maintained in the body for long periods of time, up to 30 days.
There is another company working on a long acting interferon but it is still in the preclinical stages. This is Flamel Technologies, a French biotech which is combining interferon alpha 2b with their proprietary Medusa delivery technology. They are calling the result Interferon Alpha 2b XL. One of the things they are striving for is a long lasting interferon that retains full potency.
Let me know what else you find out and if you have any other questions I would be happy to answer them. Please be patient as I usually don't visit here that often unless in the middle of a discussion like this one.
Best,
Steve
You have been given the best advice and knowledge there is, but I want to add- make sure that your Dr. will step in w/ procrit and/or nueupogen rather than lower dosage. Best, best of luck to you. Joni
I live about 120 miles from a Mayo clinic. Tnhepguy brought up a good point. Does Albuferon retain it's potency? I will talk to my Dr. tomorrow and see if he knows anything about this test. I will have many more questions Friday.
Thanks,
cigaso
Thanks,
cigaso
Hey there,
I think I can help a little with information on Albuferon. I have been a participant in a clinical trial using this for about 8 weeks now. These trials are set up as dose testing and contain 3 arms, a low level dose and a higher level dose administered every 2 weeks are the first two arms. The third is a higher level dose administered once a month. All these doses including the lower every 2 weeks one are higher then the ranges given by TnHepGuy. Support drugs such as Neupogen and Procrit are included in the protocol. I have not heard any results yet but my docs at the Mayo clinic are hopeful. This is the first long term trial using Albuferon and is designed to go on for 48 weeks. Previous to this the longest anybody had been on this interferon was 1 month (two doses) at a level of around half the lowest level being tested. Let me know if you would like any more information.
One thing I can tell you, the sx are a breeze. This is my third time on tx. Peg/riba combo the first time and daily infergen/gamma interferon/riba combo the second time. The sx with Albuferon are a cakewalk.
Best to you and all,
Steve
I think I can help a little with information on Albuferon. I have been a participant in a clinical trial using this for about 8 weeks now. These trials are set up as dose testing and contain 3 arms, a low level dose and a higher level dose administered every 2 weeks are the first two arms. The third is a higher level dose administered once a month. All these doses including the lower every 2 weeks one are higher then the ranges given by TnHepGuy. Support drugs such as Neupogen and Procrit are included in the protocol. I have not heard any results yet but my docs at the Mayo clinic are hopeful. This is the first long term trial using Albuferon and is designed to go on for 48 weeks. Previous to this the longest anybody had been on this interferon was 1 month (two doses) at a level of around half the lowest level being tested. Let me know if you would like any more information.
One thing I can tell you, the sx are a breeze. This is my third time on tx. Peg/riba combo the first time and daily infergen/gamma interferon/riba combo the second time. The sx with Albuferon are a cakewalk.
Best to you and all,
Steve
Forgot to mention, all arms are combo with weight based riba and all meds, visits, tests and other related medical services are paid for by Human Genome Sciences.
Steve
Steve
Hi Mike,
Thanks, and right back at you. Although I don't post much I try to keep myself updated and have watched your struggle and progress for several years now. Can't tell you how happy I am to see you doing better. Also wanted to thank you for all the info and support you have provided to so many people over the years. Although it is not often expressed, we really, really do appreciate it.
Best,
Steve
Thanks, and right back at you. Although I don't post much I try to keep myself updated and have watched your struggle and progress for several years now. Can't tell you how happy I am to see you doing better. Also wanted to thank you for all the info and support you have provided to so many people over the years. Although it is not often expressed, we really, really do appreciate it.
Best,
Steve
I will take advantage of Chevy's intro and post the latest happenings:
On Wednesday, since I have been feeling run down this week, I decided to call Quest and ask if all the results were back, after a positive answer that included the PCR results, I decided I did not want to drive back home with bad news fresh in my mind.
I hate driving on the Long Island Expressway, always have, the monthly drive to the GI has been a torture; 1-2 hrs RT, in a road cluttered with 18 wheelers and maniacs(besides me).
I called the GI and told them I wanted the results before my appt today, as I did not want to endanger anyone on the road. The recept. stated that Bernstein does not want results given if the appt is within a week and it was up to the NP to decide if she would.
I kept dreading to drive on bad news so I called back to reschedule a week from today and requested the PCR results mailed if need be.
I just got a call back from the NP; 5 wk (12/30) post tx test:
Undetectable still. I am one step closer, but not out of the woods, I know.
72 wks of peg and riba+two 1/2 peg, many forgotten ribas, lowered riba for months, 1a, low vl, detectable at 12 wks, stage one damage; and negative after 5 wks.
I could have been a negative after 48 wks, but who truly knows and why take the chance?
I know all, or most, of you are happy with me, but I ask that you save the congrats for the 3, or better yet, 6 month PCR! I don't want to jinx it too much with too many congrats, pretty please?
On Wednesday, since I have been feeling run down this week, I decided to call Quest and ask if all the results were back, after a positive answer that included the PCR results, I decided I did not want to drive back home with bad news fresh in my mind.
I hate driving on the Long Island Expressway, always have, the monthly drive to the GI has been a torture; 1-2 hrs RT, in a road cluttered with 18 wheelers and maniacs(besides me).
I called the GI and told them I wanted the results before my appt today, as I did not want to endanger anyone on the road. The recept. stated that Bernstein does not want results given if the appt is within a week and it was up to the NP to decide if she would.
I kept dreading to drive on bad news so I called back to reschedule a week from today and requested the PCR results mailed if need be.
I just got a call back from the NP; 5 wk (12/30) post tx test:
Undetectable still. I am one step closer, but not out of the woods, I know.
72 wks of peg and riba+two 1/2 peg, many forgotten ribas, lowered riba for months, 1a, low vl, detectable at 12 wks, stage one damage; and negative after 5 wks.
I could have been a negative after 48 wks, but who truly knows and why take the chance?
I know all, or most, of you are happy with me, but I ask that you save the congrats for the 3, or better yet, 6 month PCR! I don't want to jinx it too much with too many congrats, pretty please?
I will take advantage of Chevy's intro and post the latest happenings:
On Wednesday, since I have been feeling run down this week, I decided to call Quest and ask if all the results were back, after a positive answer that included the PCR results, I decided I did not want to drive back home with bad news fresh in my mind.
I hate driving on the Long Island Expressway, always have, the monthly drive to the GI has been a torture; 1-2 hrs RT, in a road cluttered with 18 wheelers and maniacs(besides me).
I called the GI and told them I wanted the results before my appt today, as I did not want to endanger anyone on the road. The recept. stated that Bernstein does not want results given if the appt is within a week and it was up to the NP to decide if she would.
I kept dreading to drive on bad news so I called back to reschedule a week from today and requested the PCR results mailed if need be.
I just got a call back from the NP; 5 wk (12/30) post tx test:
Undetectable still. I am one step closer, but not out of the woods, I know.
72 wks of peg and riba+two 1/2 peg, many forgotten ribas, lowered riba for months, 1a, low vl, detectable at 12 wks, stage one damage; and negative after 5 wks.
I could have been a negative after 48 wks, but who truly knows and why take the chance?
I know all, or most, of you are happy with me, but I ask that you save the congrats for the 3, or better yet, 6 month PCR! I don't want to jinx it too much with too many congrats, pretty please?
Need a shot of Expresso, see ya after lunch!
On Wednesday, since I have been feeling run down this week, I decided to call Quest and ask if all the results were back, after a positive answer that included the PCR results, I decided I did not want to drive back home with bad news fresh in my mind.
I hate driving on the Long Island Expressway, always have, the monthly drive to the GI has been a torture; 1-2 hrs RT, in a road cluttered with 18 wheelers and maniacs(besides me).
I called the GI and told them I wanted the results before my appt today, as I did not want to endanger anyone on the road. The recept. stated that Bernstein does not want results given if the appt is within a week and it was up to the NP to decide if she would.
I kept dreading to drive on bad news so I called back to reschedule a week from today and requested the PCR results mailed if need be.
I just got a call back from the NP; 5 wk (12/30) post tx test:
Undetectable still. I am one step closer, but not out of the woods, I know.
72 wks of peg and riba+two 1/2 peg, many forgotten ribas, lowered riba for months, 1a, low vl, detectable at 12 wks, stage one damage; and negative after 5 wks.
I could have been a negative after 48 wks, but who truly knows and why take the chance?
I know all, or most, of you are happy with me, but I ask that you save the congrats for the 3, or better yet, 6 month PCR! I don't want to jinx it too much with too many congrats, pretty please?
Need a shot of Expresso, see ya after lunch!
sorry, I thought I hit the 'stop' button on time, the window was still visible, fast posting!
Ok,,,,if you insist,,,I will keep it toned down and save the big whoo hoo for 3 month mark. But a small yippee should be acknowledged....LOL
That is wonderful,,,,honestly,,,,so many say if virus is coming back,,,,will show up first 4 weeks,,,,but since we are still keeping it low key,,,,We will save for 7 more weeks!
That is wonderful,,,,honestly,,,,so many say if virus is coming back,,,,will show up first 4 weeks,,,,but since we are still keeping it low key,,,,We will save for 7 more weeks!
We drive the LIE too, and with test results/drs appts lingering it can be quite a drive...but you seem to be on the right road!
Good heavens. you could have been, more than likely, celebrating your 3rd yr SVR-cured!
how sick do you wnat to get? I was transfused and recieved hep c in 1967. I was finally dx in 2001-late Sept 2001 AFTER MY LIVER FAILED. How sick is that? B/c of ammonia levels., i was in a coma in icu 9-12-2001. b/c of low platletts I almost bled to death, and lost the sight in one eye. every little thing became major-fast.
I'm a 2b who was sent home to die b/a dif doc put me into a study for end stage liver disease, Schering supplied all the meds and I cleared the virus in 18 days. that was 2 1/2 yrs ago.
I fin 24wks, had mild sides and now am healthier than I've been in 25yrs. and i'm about your age.
Why wait? you could be done by your busy season and you doctor is an idiot. You have a chronic, progressive fatal disease and a cure just waiting.
go figure
how sick do you wnat to get? I was transfused and recieved hep c in 1967. I was finally dx in 2001-late Sept 2001 AFTER MY LIVER FAILED. How sick is that? B/c of ammonia levels., i was in a coma in icu 9-12-2001. b/c of low platletts I almost bled to death, and lost the sight in one eye. every little thing became major-fast.
I'm a 2b who was sent home to die b/a dif doc put me into a study for end stage liver disease, Schering supplied all the meds and I cleared the virus in 18 days. that was 2 1/2 yrs ago.
I fin 24wks, had mild sides and now am healthier than I've been in 25yrs. and i'm about your age.
Why wait? you could be done by your busy season and you doctor is an idiot. You have a chronic, progressive fatal disease and a cure just waiting.
go figure
Thanks for refreshing my memory on your stats. Hopefully, it will help me keep my eye on the prize while I
Thank you for the kind words.
Though it seems to stand logic on it's head, a higher ALT quotient is a positive predictor when it comes to SVR. Though this <a href="http://www.natap.org/2004/EASL/easl_17.htm">SVR Calculator Model</a> is based upon studies involving geno 1's, it discusses (and uses) the ALT quotient as a factor. And under their "PROBABILITY OF ACHIEVING A SUSTAINED VIROLOGIC RESPONSE" sub-section they predict that for their definition of a 'standard patient', who has an ALT quotient of 2.0 (that is, a starting ALT level of 104), the SVR odds are 52%. For the same theorectical patient who has an ALT quotient of 1.0 (that is, a starting ALT level of 52), the SVR odds drop to 45%. Take that same patient and make the ALT quotient 4.0 (that is, a starting ALT level of 208), and the SVR odds jump up to 64%.
Is an ALT quotient much to think about? Nope. Just one of many factors that the researchers have looked at in trying to determine who may or may not achieve SVR, and overall odds.
Some other questions to ask your doc when you visit include:
- how often will I be having regular lab work done during tx?
- how will I be receiving the results? phone? mail? in-person?
- who will I be meeting with during the course of my tx? You (the doctor)? nurse practioner? nurse?
- how often will I be meeting in-office with this person?
- if I have questions about my tx between visits, who should I direct them to? How quickly can I expect my calls to be returned?
- what medicines do you rx for tx-related sleep issues?
- how often will my TSH (Thyroid Stimulating Hormone) be tested during tx?
TnHepGuy
Though it seems to stand logic on it's head, a higher ALT quotient is a positive predictor when it comes to SVR. Though this <a href="http://www.natap.org/2004/EASL/easl_17.htm">SVR Calculator Model</a> is based upon studies involving geno 1's, it discusses (and uses) the ALT quotient as a factor. And under their "PROBABILITY OF ACHIEVING A SUSTAINED VIROLOGIC RESPONSE" sub-section they predict that for their definition of a 'standard patient', who has an ALT quotient of 2.0 (that is, a starting ALT level of 104), the SVR odds are 52%. For the same theorectical patient who has an ALT quotient of 1.0 (that is, a starting ALT level of 52), the SVR odds drop to 45%. Take that same patient and make the ALT quotient 4.0 (that is, a starting ALT level of 208), and the SVR odds jump up to 64%.
Is an ALT quotient much to think about? Nope. Just one of many factors that the researchers have looked at in trying to determine who may or may not achieve SVR, and overall odds.
Some other questions to ask your doc when you visit include:
- how often will I be having regular lab work done during tx?
- how will I be receiving the results? phone? mail? in-person?
- who will I be meeting with during the course of my tx? You (the doctor)? nurse practioner? nurse?
- how often will I be meeting in-office with this person?
- if I have questions about my tx between visits, who should I direct them to? How quickly can I expect my calls to be returned?
- what medicines do you rx for tx-related sleep issues?
- how often will my TSH (Thyroid Stimulating Hormone) be tested during tx?
TnHepGuy
The Alt quotient continues to sound mysterious (anything with the word "quotient" in it will always be mysterious to me) but I'm glad it appears to be a positive indicator.
The list of questions are a treasure. I assumed that a TSH would be part of the blood test given last Nov., as it has been included in the previous blood tests and seemed logical for them to test the thyroid prior to treatment. Wrong. I also have 2 sisters and a daughter that are hypothyroid, so I really wanted to know. I will make sure to get a TSH when I see the dr. next. My blood test in 2003, the dr didn't even ask for a viral load! Seems like the patient needs to go over a checklist to make sure the doctor is asking for all the tests they should.
I am not optimistic about the arrangements for communication in this clinic. I was told it takes 2 weeks for labs to make it into the chart and a doctor to call. It was the young disinterested intern who called with the blood test results. The real dr called with the biopsy results. Obviously, I would prefer to have the test results in my hand when I talk to him--I don't have the opportunity to look at it, think about it and ask thoughtful questions (let alone consult with my experts at the forum!) I will push for what I'm sure would be "special treatment", but I have the feeling the clinic has its procedures for processing us, and it will be more difficult than dealing with with a private physician. I hope that this doctor (the only hepatologist in the Tampa Bay area)is worth putting up with this clinic.
Another question: am I correct in the understanding that, if I only have to go the 24 weeks, that I am likely to escape some of the sides? That was a suggestion I read somewhere along the line, and it makes sense. But the realities of this disease and treatment often don't make sense. I guess I am pursuing a vain attempt to see into the future on treatment, and I've already been told THERE ARE NO PREDICTORS.
It's been an illuminating day. Thank you so much.
The list of questions are a treasure. I assumed that a TSH would be part of the blood test given last Nov., as it has been included in the previous blood tests and seemed logical for them to test the thyroid prior to treatment. Wrong. I also have 2 sisters and a daughter that are hypothyroid, so I really wanted to know. I will make sure to get a TSH when I see the dr. next. My blood test in 2003, the dr didn't even ask for a viral load! Seems like the patient needs to go over a checklist to make sure the doctor is asking for all the tests they should.
I am not optimistic about the arrangements for communication in this clinic. I was told it takes 2 weeks for labs to make it into the chart and a doctor to call. It was the young disinterested intern who called with the blood test results. The real dr called with the biopsy results. Obviously, I would prefer to have the test results in my hand when I talk to him--I don't have the opportunity to look at it, think about it and ask thoughtful questions (let alone consult with my experts at the forum!) I will push for what I'm sure would be "special treatment", but I have the feeling the clinic has its procedures for processing us, and it will be more difficult than dealing with with a private physician. I hope that this doctor (the only hepatologist in the Tampa Bay area)is worth putting up with this clinic.
Another question: am I correct in the understanding that, if I only have to go the 24 weeks, that I am likely to escape some of the sides? That was a suggestion I read somewhere along the line, and it makes sense. But the realities of this disease and treatment often don't make sense. I guess I am pursuing a vain attempt to see into the future on treatment, and I've already been told THERE ARE NO PREDICTORS.
It's been an illuminating day. Thank you so much.
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.
