Neupogen at 5 weeks

[friole]

Had my appointment with the hemotologist this afternoon.  I have been feeling rundown and was expecting her to suggest Procrit pretty soon.  Instead, she said she (and the GI) are more concerned about the ANC (Absolute Nuetrphils Count) going down than the hemoglobin. My ANC was at .8 today.  The range is 2.0 - 8.0.  Pretreatment I was 2.8.  She would like to see it up to 1.5.  I think JmJm said the norm was to rx at .5, but she wants to start Monday.  So now I need to look thru all the archives on WBC and Neupogen.  Have read the Janis7 info already.  Any comments and suggestions would be appreciated.

My Hemoglobin has dropped to 11.2 (pretreatment 14.6) but she is not worried about that yet.  Mainly she wants to get that WBC up to prevent infections.  I liked this doc a lot.  Very caring and informed.  I am glad she is on my team
Kathy

[jmjm530]

Cathy,

Unless there's something about your condition that is unusual, I think your doc is pulling the gun on Neupogen too soon.

While some docs prescribe neupogen at <.75, my doc doesn't intervene until ANC is below <.5

Almost all the papers I've read do not find any relationship between low ANC and the kind of infections that are commonly associted with low WBC. Apparently, it's a different story when the low numbers are caused by tx.

In my case, my ANC was hanging around 1.3 for the first 15 weeks of treatment. Then one week it dropped to .8 and I called my doctors in a minor panic. They said not to worry. Next week ANC jumped back up to 1.2  
This apparently is pretty common on treatment.

Regarding the Procrit, you've had a pretty big hemoglobin drop in a short while, so I'd definitely think you need Procrit if you're feeling like you have to drag yourself around.

Maybe you can reason with her or get a second opinion. She sounds a litte "old school" on both issues.

-- Jim

[IwillBeatHCV]

Hello

My ANC dropped to .88 on my 8th week blood tests. So I guess If my doctor is not concerned yet, I guess I shouldn't be either? And can I ask one question: what exactly is the ANC count??

[LvdByGod]

WHAT ARE THE SIDE EFFECTS AND OR DANGERS OF TAKING PROCRIT...DR SUGGESTED IT TO ME AT LAST VISIT BUT I TURNED IT DOWN CAUSE I'VE BEEN AT THE SAME LEVEL FOR ALMOST 2 YEARS NOW ON TX AND FIGURED I'VE DONE OK SO WHY ADD A NEW DRUG NOW?

[snook_man]

My Nuetrophils have lingered between 600 and 900 since week 8. Dr will not interven unless it drops below 500.
Dr is jumping the gun..

[jmjm530]

Like others have said, you'll have to clarify "dormant". Either you have the virus or you don't. When was the last time you were tested for viral load and what were the results?

As far as statins are concerned, in most cases they're fine as long as you're not taking them while on treatment and control the dosing. My docs want me to go on them as soon as treatment is over. Any very minimal risk of liver damage is more than offset by the advantages to the cardiovascular system. Of course, I'll probably monitor my liver enzymes more often once I start the statins.

-- Jim

[jmjm530]

Like others have said, you'll have to clarify "dormant". Either you have the virus or you don't. When was the last time you were tested for viral load and what were the results?

As far as statins are concerned, in most cases they're fine as long as you're not taking them while on treatment and control the dosing. My docs want me to go on them as soon as treatment is over. Any very minimal risk of liver damage is more than offset by the advantages to the cardiovascular system. Of course, I'll probably monitor my liver enzymes more often once I start the statins.

-- Jim

[jmjm530]

Sorry for the duplicate post in the wrong thread. I think I'll blame that on the new computer virus going around. :)

[Lynne5477]

I, too, find it a little strange your dr would be ordering the Neupogen with your ANC only at .8.  I started at 4.5 pre-tx and dropped to 2.0 at end of wk 1.......then down to .7 at wk 24, back up a little after that.  But, like most everyone else's dr, mine wasn't getting concerned til it dropped to .5 or below.
My dr said that chemo patients go even lower and they seem to do okay.  She was more concerned with the Hgb dropping.

What was your WBC count?  The lowest mine got was 1.6 and that was the same time as the low ANC.  Could it be that your WBC has also dropped significantly?  I think the dr's look at both these counts (WBC and ANC) before intervening with the Neupogen.

Good luck to you.

[IwillBeatHCV]

Some one please answer my question...:-)

[jmjm530]

If your doctor isn't concerned with .88 ANC, you shouldn't either.
Definition: http://www.medterms.com/script/main/art.asp?articlekey=20219

[friole]

Iwillbeat - ANC is your Absolute Neutrophil Count.  It is calculated (according to info on the Janis7hepc sight) by multiplying the white blood cell (WBC) count by the percentage of bands and segmented neutrophils" Now don't ask me what the heck that means, but the ANC is the number that the docs watch more closely than the WBC. Neupogen helps the bone marrow manufacture WBCs.

Okay, so I was snowed by this doctor and now I am wondering.  Perhaps this is the deal - the only hemotologists in town are associated with the oncology department at the hospital.  I think she primarily regulates the blood work for kemotherapy patients.  She did say she had a lot of experience with Interferon, although used for other things.  She said she was not too familiar with the interferon-ribaviron combo.  At the time I did not translate that to be "I have no hep C patients" but now I do.  Now I wonder if the risk of infection is much greater with cancer patients and it is critical to keep the ANC up at 1500 (1.5).  Is is not so critical with hep c patients?

So what is the down side of building up your WBC with Neupogen?  Just adding a drug you don't need and possibly achey (achy) bones.  I feel like this doctor would be receptive to studies.

Jim, my WBC was 2.2 today (range is 4.8 - 10.8)
Didn't anybody start Neopogen at .8?
Kathy

[IwillBeatHCV]

Thank you...

[What Next]

Just had my first visit to the infectious des doctor today. Blood work drawn to find out my type and my viral load. My question is how much to all these drugs she is talking about? Her inital diagnosis is Chronic Hep C . Ultra Sound tommorow and Liver Biopsy is being scheduled. I have no Rx coverage is there any foundations that might be able to help. I do not qualify for any state programs because of my husband income but poop all are bills take all our money now. Anyone have any sugeestion?

[nyhepc]

my wbc a week ago was 2.1 and ANC was 798...started on neupogen 2 days ago. haven't seen the lab yet from 8/15 but know the wbc was 2.3, don't know the ANC. no rise in hgb or hct, so still no tx drugs....going on 2.5 weeks now. am sure whatever ground i gained in the 5.5 weeks i treated is lost.  appt with new doc is 10/3...will muddle thru til then. but i don't mind the neupogen...whatever it takes to get me back on tx

[Laika]

My hgb was 11.2 at about 20 wks.  That was the lowest it got.  I think if I would have acted interested, my dr would have put me on procrit at that point.  But I only had 4 more wks of treatment, and it takes 2 wks to feel better from the procrit, so the dr and I both just thought why bother. I was dragging around, but was able to function.

My dr has extensive hep C experience.  He has mentioned that "they used to think" that it was very dangerous to let the ANC's get too low with hep C patients, but over time have discovered that it is not.  Of course they need to be closely monitored, but no need to jump in with neupogen at higher levels.  Sorry, I don't remember numbers too well.

What I'm trying to say is I do trust my dr's experience and knowledge, and it looks like his comments have been on track with other postings here.  Also, that even though your hgb is not extremely low, it may be more of an issue.  The way I understand it, most drs intervene with procrit at 10, but if the patient is having a lot of low-hgb symptoms and trouble functioning, they intervene sooner.

Laika

[jmjm530]

Cathy,

It does appear your doctor's chemo background is influencing her decisions. Numerous papers suggest that (unlike with cancer patients) inteferon-induced low ANC (neutropenia) is not associated with serious infection. http://tinyurl.com/8btj7

Possibly show her this study (or others) and maybe you can hold hold off a week or two and see if your ANC rebounds. It often does. Neupogen is normally given when ANC is 750 or 500, depending on the doctor, although the more agressive treaters use the 500 number.

But I'm really more concerned about the anemia. You've had a big drop in just a few weeks which is equally as important as your absolute hemoglobin number. If you're feeling very tired, weak, etc. I'd really push on the Procrit now.

You seem to like your doctor so maybe you can work with her. If not, you can always find another. Just don't let go of one until you have someone else you like. Not a lot of good ones out there.

-- Jim

[friole]

My brain is full.  I am trying to absorb all of this.  Forgot my Riba last night and remembered at 10:00- took it then.  Forgot my Riba this morning and had to drive back home from work to go get it.  LOL - I have been so conscientious for 5 weeks I haven't missed it, and now two times!  ANd duh, I wish I know how to do a spellcheck on this forum.  Chemotherapy - jeesh!

Lots to think about here, lots to respond to

NYhep - I am most interested in what is happening to you.  Your WBC and ANC stats are almost identical to mine and you were just put on Neupogen.  I have probably read the threads, but can't recall now - did you get pulled from treatment for low RBC and WBC and are trying to get that under control to begin peg-copeg again?  What type doc put you on the Neupogen and does he/she have a lot of hep c knowledge? What was the reasoning?

Snook and Jmjm - you both seem to have top of the line hepatologists.  They all recommend waiting until <.5. Laika, Lynne, Iwillbeat - your docs say the same thing.  <.5.  My doc wants to do the first Neupogen and see what the tests read.  She is hopeful I can take a half dose, maybe once a week.  I am still thinking the more WBCs the better but I am going to discuss it further with the doc.


Jmjm - thanks for the article - I will get that and the info on the Janis7 sight to my doc.  I am wondering this though -- I know you suffer from sinuitis and psoriasis (or other skin problems?) and wonder if Neupogen would build up the WBC to fight some of that. There are so many side effects from treatment, it seems the more WBC the better.  
Laika and others - Laika ,your hbg is identical to mine this week.  I have tired days, but am not weak and overall do not feel beat down yet.  Although this doc did not seem to lean towards Procrit, I think she will work with me on it.  I walk 3 mi most mornings.  I am going to use that as my gauge - if I find myself breathless or tired half way through, I think I need Procrit.  Also, if my hgb hits 10 I will ask for it.

Lvdbygod - you snuck a question in there that hasn't been answered -- hope you see this.  You say your doc wants you to take Procrit but your counts have been stable.  WHat are those counts?  I think it quite possible for this anemia to affect our quality of life slowly, so that we don't realize it could be any different than it is.  Perhaps you should try the Procrit and see how it affects you.

I thank you all for your responses.

[nyhepc]

doc pulled me off tx when hgb was 9.9, hct 28.1, wbc 1.8, anc 936. yes, i was symptomatic for anemia. after 1 week off tx, values were hgb 10.5, hct 31.1, wbc 2.1, anc 798. and there they've stayed since. i would assume he started me on the neupogen because the values didn't rebound as quickly as he would have liked.  if you all remember, i've had nothing but problems with this guy. he is NOT aggressive, his staff doesn't follow thru...and he talks to me like i'm an idiot. little does he know...he's on marked time!!!! :)))  have another cbc on monday followed by an office visit. we shall see what that will bring

[friole]

Well, good luck.  I hope you find somebody better. It is a shame they didn't use the Procrit and Neupogen.  I don't suppose they ordered a PCR either (after they pulled you). Gosh it is hard to find the right people.  Sometimes I wonder if I am the only person in my town treating.  I am trying to avoid going out of town for treatment but that may have to change.
Kathy

[nyhepc]

have appt with Lauren's dr.  he HAS to be better!!!! let me give you one more example of his philosophy.  i was expressing concern that being off tx this long would affect long-term outcome. his statement to me:  "anybody who can maintain therapeutic dosage will clear at the end. it is up to you to be able to maintain therapeutic dosage."  do you wonder where i found this guy?  he is a highly recommended GI doc. i think hep c just isn't his forte'

[chellski]

i have no rx insurance and i get my meds free thru roche diag., the makers of the pegasis/copagus combo.  my doctor made the initial call and i had to fill out questionare to make sure i qualified..ask your doctor to check or get an 800# from him to call roche yourself.  they ship meds every month..
good luck! and keep in touch!
<3 michelle

[dodger1]

I am still waiting for my doctor to call me back from Monday when I insisted on Procrit.  When I started treatment my hemoglobin was at a 14.7 then 2 weeks later 12.7 then 4 weeks later I am at a 9.0.  I feel terrible.  She told me when I could not move in the morning to go to work she would prescribe it.  Why dont these doctors want to give this out??  My white blood cells are at a 1.8.  Can you take neupogen and Procrit at the same time????

[What Next]

Thanks for the info about RX help I will ask the doctor a/s/a/p
She did say it was going to be pegius and co pegius

[friole]

Your hemoglobin was dropped so much, you surely need Procrit.  I have been doing a lot of reading since my hemotologist suggest the Neupogen, and seems adverse to the Procrit. The research definitely shows that hep c patients can tolerate lower ANC than chemotherapy patients. WHat is your ANC?

My doc, as I said up top, wants to put me on the Neupogen ASAP and is very hesitant to do the Procrit. She admits to not knowing anything about the Ribiviron and therein is the problem.  I truly believe now that she is treating me as a chemotherapy patient, not a hep c patient.  Could that be your problem too?  I have copied a lot of stuff off the internet to give to her on both the WBC and RBC issues and hope she will work with me or transfer me to another doc with hep c experience.

As far as taking both, there are quite a few members of this forum that take both.

[friole]

I am waiting for the doc to call today.  I did take her a lot of things I copied off the internet suggesting we wait and see a bit, but if she still wants me to, my first shot will be Monday. Like you said, it can't hurt to build up those white blood counts.  Besides, I am around my 4&5 year old grandkids a lot, and you know how many things they carry from the daycare and school.

[friole]

Thanks, Scott.  The hemotologist wants to shoot for 1500 ANC.  She is hoping one shot a week will do it, or even taking half of the 300ml dose once a week (and, she said, putting the rest back in the fridg and using it next time).  If I don't hear from her in 1 hr & 45 minutes, I will be doing the shot Monday. Her office said she is going out of town today at 2:00.  I will call and talk to her nurse after she is gone to set up my "shot lesson."
Kathy

[friole]

Got a reprive for this week.  I will talk to the doc Monday, but she is okay with my not starting Neupogen until I have next week's blood work done.    The prescription has been ordered by my pharmacy though so it will be in hand.  
Thank you everyone

[friole]

Before this goes to archive I wanted to report.  I did not take the Neupogen shot on Monday, and had blood work on Tuesday.  My ANC was up to 1.2 (up from .8 one week ago).  I don't know what the doc will recommend - she still has not called me back.  The rx for the Neopogen is at the pharmacy and I will have to pick it up.  I am guessing it will sit in my fridge until I do, in fact, need it.  With winter coming on, I just may.
Kathy