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Nobody isn't hoping that you do not succed - quite the opposite in fact everyone hopes to God that you SVR but pretending that the data says it's OK to be obese and do treatment = same or better odds is just not true.
The FACTS are the FACTS. Just like I knew not being clear by week 12 gave me harder odds - I accepted it and did what I had to do. but nobody ever pretended that my odds were similar or better than a regular geno1 at all and neither did I.
However I knew people were hoping even harder for me to succeed so it filled the gap. Still it was a difficult decision knowing that my odds were worse and one I had to make on my own, for myself. Just as you did. But nobody didn't encourage me just because my odds were higher for failure and thats what you are implying.
Negative predictors are just a part of the equation the rest rests on faith and determination.
I have respect for your preserverance during treatment. I think it took determination and guts to go the whole 72 weeks. I'm not putting you down. Why do you feel its ok to put me down.
No one is trying to dash any one's hopes here. If someone starts treatment with a high BMI, so be it. It is a personal choice and to my knowledge there are no studies supporting a high BMI is a positive predictor. The message is beware, look at the data that is presented and make a choice according to your own convictions. That isn't discouraging people, it's giving them the opportunity to take a long hard look at themselves and the data and what they are comfortable with.
Cutting edge specialists and researchers from around the world have all concluded the same thing about high BMI and treatment so it's not a matter of validation if a person chooses to start treatment with a high BMI.
When the facts are given and the patient chooses to treat regardless of negative predictors it's irrelevant at that point. It's up to the individual to encourage themselves whether others agree or disagree.
I never said BMI is a positive predicator.
Geesh.
What they did not tell me was WHY.
I would strongly suggest you look at the possibilty that metabolic syndromes, endocrine deficiency, diebetes etc play a part in treatment due to the effect they have on tissue repair, overall organ/gland response to chemo, and higher blood sugar levels affecting the amount of Interferon in the system and it's and abiltity to do it's job at reduced levels due to body chemistry.
The person who first clued me as to WHY of all this is so was Cowriter...see her journals.
http://www.medhelp.org/personal_pages/user/568322
the bottom line is that even mild insulin resistance (type 2 diebetes), even a fasting glucose that is say 10 or 20 points above normal, can reduce the chances of a cure by 10% or more. Since many with mild IR don't treat for it, this lowers the chances of the group. This is because higher blood sugar means insulin resistance, means more insulin is produced to compensate, and insulin interferes with Interferon.
The higher the untreated IR, the lower the cure rate. Same with Type 1, because then you are introducing injectable insulin to compensate for not enough, and again insulin interferes.
I'd strongly suggest you see an endocrinologist to see if your glands are still working, most of mine were not and varied from 50 down to 20% of normal output. Correct for these conditions first and it will be easier to take weight off, as well as give you a greater chance of treating successfully.
mb
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
And I have to add something I found on another website, just because:
Doctor: "I’ve got your test results and some bad news. You have Hep C and Alzheimer’s."
Patient: "Boy, am I lucky! I was afraid I had Hep C!"
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
(Okay, now I'm getting back to work. I mean it this time.)
I just finished SOC a month ago and so far so good as far as UND.
Actually many doctors will not treat someone obese until they lose weight. Besides hurting your chances of clearing the virus it can be especially dangerous to a heavier person, heart problem, blood pressure, etc. Several studies show that a lower BMI is one of the main factors in acheiving SVR. if i was overweight the only way I would treat is lose weight or if absolutely necessary take weight based ribavirin. There have been some obese people on this forum that have taken as much as 2000 mg of ribavirin and still did not clear.
Personally I worked on putting on some weight before starting tx, because I was afraid to become too skinny and weak. Thank God I was able to put on about 4 kilos, because I did loose too much weight. Also I had low iron and low hgb. I wanted to be as healthy before starting tx and I worked on getting that up too.
I don't think it is about encouraging or not encouraging people to do treatment. People here want to encourage people to treat with the possibility of the best outcome.
It is sad when people treat and don't make it. For the people who treat and for everyone else watching. It is heart breaking and that why people want to give good advice.
It would be a disservice to tell people with high BMI that they do not need to concern themselves with the challenges of being high BMI because of how things went with you, agreed? It gives hope to those who decide to treat in spite of the challenges that it can be done - same as it gives hope to those who MUST stop treatment early to know that there are others who stopped treatment early but SVR'd regardless. That does not mean that it then is okay for everyone to stop treatment early because it turned out okay for some people.
I think you are possibly confusing talking in realities with not being supportive. My hepatologists told me to try to lose 20 pounds before I started treatment. They knew I was going to treat regardless but they still told me what would give me better odds. It's vitally important that we talk in realities here. When someone comes on this board still in the consideration stage or haven't started treatment yet, you will often see posts that contain truths about what their challenges are. We want to ensure people have all the information they need before they start treatment. Once they've started or have absolutely finalized that decision, then we're with them 100%. Just the same, you will still not find too much candycoating here as people go through their treatment either. These drugs are too harsh and the outcome is too important to do anything other than talk in realities and truth. People can tailor their treatment and be more diligent if they know *exactly* what their potential challenges are.
I didn't even know you WERE high BMI and I have been around more or less for pretty much your whole treatment - I'm not sure what was said to you that you didn't feel supported and, again, I'm wondering taking people speaking in realities as not being encouraging?
I don't see anyone saying this Kathy... People are suggesting that one address the problem of overweight, before starting treatment. The reason people are suggesting this is that according to research, studies, knowledgeable doctors/experts who have treated thousands of patients, one will have a much better chance of achieving SVR.
Still.....
I think that the people who post and answer the thread are also attempting to provide some help for people with high BMI. Information is power.
By providing some info and data it can help people seek corrections which could improve their chances of clearing. Surely that should be considered support.
Some people only have so many chances to treat. *Might* some information and data on response help people either attempt to lose weight, check into metformin, review with their doctor to make sure that the doctor is up to speed on the odds and dosing? (sadly, not all are)
Unfortunately once one has started TX it is difficult to make mid course corrections, either in adding IR drugs, losing weight, embarking on exercise or shopping for a more informed doctor. For people who breakthrough or relapse they may have spent months of TX, at great expense (emotional, financial, possible physical detriment).
I'm not sure that it's any easier for null responders or slow responders.
Embarking on TX sometimes seems to me to be as big a decision as buying a car or buying a house. It may be even more important and it's impact further reaching. Maybe it's up there with marriage. ; )
What harm in having all the information available before one decides?
Your intention is to help and you do. The people who have provided some feedback also have the same intentions as you; they want to help.
I consider it help.
All information and experience is good IMHO. It's why bulletins boards help those who use them.
.....my 2 cents
Willy
And please keep in mind that you have not "beat the odds" yet. You have not SVR'd yet so I would not get up on that high horse just yet. Everyone is different but I actually like the approach of being humble and grateful of the support offered on this forum. Not to post how members are insensitive to fat people. That is just wrong.
I will continue to tell overweight people to lose weight before treating and will provide them with links to studies that back it up. Bottom line is treatment is a personal decision that someone has to make on their own. NOT what is said on an internet forum!
Good luck
Being overweight is NOT a problem for some people who are treating.
Let me repeat that, because it is not being heard:
Being overweight is not a problem for some people who are treating.
One more time:
Being overweight is NOT a problem for some people who are treating.
Does anybody out there here that??? Can anyone respond that they've heard that message without adding a "yes, but..." disclaimer?? It's hard to do, folks. It takes a whole bunch of maturity and understanding.
Here's another one:
Being overweight does NOT mean that person is unhealthy or has IR.
Being overweight does NOT mean that person is unhealthy or has IR.
Being overweight does NOT mean that person is unhealthy or has IR.
Stop the stereotypes people! Stop making ignorant assumptions. You are being really offensive. I am overweight. I have a high BMI. I do NOT have diabetes. I am NOT insulin resistant. I do NOT have high cholesterol. My hepatologists have encouraged me to treat and have NOT indicated that weight is an issue. I AM offended by reading posts by people who just don't get it. Kathy does NOT have diabetes and she is NOT IR. She sees medical experts so please stop trying to give her medical advice. Some people are trying to practice here w/out a license. I don't think people should respond so adamantly about studies unless they've taken at least three courses on statistics and research and how to interpret the literature. Their lack of knowledge is clear. I'm sorry that this will come across as offensive to some, but I don't know how else to state it.
I've heard many "yes, butt" statements on this thread. Shame of those of you who just couldn't be supportive. How sad. Give me a break. No wonder I've heard from several people that have decided to leave this forum. They do not feel it's safe here nor do they feel supported. If you really want to be supportive of someone, you will ask that person what it means to feel supported, instead of cramming down their throats what you think they need.
Sigh,...
Consider the possibility that you are projecting your own issues onto others here. You can repeat your arguments all you wish, but the members here are capable of drawing their own conclusions, however deficient you may assume our educations to be.
As for cramming down peoples' throats what you think, that appears to be what you are attempting to do.
Wow. You must know more than my current doctor, previous doctor, and last two hepatologist, because they all would disagree w/you. All stated in one way or another that I am a very healthy person, other than having Hep C. Glad to hear such incredible wisdom and intellect exists on this thread.
"Consider the possibility that you are projecting your own issues onto others here." Do you think that might also be what's happening w/you? Would you be willing to put your defenses aside to at least consider that possibility?
"...to imply that we are incapable of understanding someone of your supposed intellect is offensive" Okay, whatever I said must certainly have come across offensive if that's how it was received. Boy, I most certainly did not intend that to be the message and I do apologize. I reacted out of frustration. Perhaps the reality is that I feel others are acting on a level of intellect alone and forgetting to keep in touch with the basic human quality that is so intrinsic to mental, spiritual, physical, AND intellectual health. Perhaps I was wrong - I hope so. I was frustrated at not being heard on a very basic and simplistic level. I also was trying to support Kathy as I don't believe she was supported. Yes, some people disagree w/me. Others agree w/me. Doesn't matter who agrees w/whom. My experience is what it is. It's my reality and my truth. Kathy's experience is what it is. It is her reality and her truth. No scientific research will be able to refute that.
No cramming down throats here. I came in support of the original poster. And you???
I can imagen many people how suffers from overweight has been treated real bad ever since childhood because of that.
I also can imagen in due to that, you who are overweighted could use a little exra encouragement because you have been patronized maybe all your life.
If thats the message I can buy it that specially since I know touchy most of us can get on the meds.
I also know how very difficult it is to lose weight and I can imagen you have tryed that
time after time and failed.
So Kathy if you were UND at a test made 4 weeks post and your not stage 4
I would say your almost there congrats.
ca
If thats the message I can buy it , specially since I know how touchy most of us can get on the meds.
I haven't seen anyone saying that someone who is overweight cannot treat. There are ALOT of overweight people treating on this forum. The thing is, these drugs are pretty brutal and can be. So I suppose the approach is taken to give it the best shot you can the first time out in hopes that you don't have to do it again. It is responsible for us to tell the truth and say that best case scenario is to lose weight if you can and to be honest that, statistically, chances are improved if a person's BMI is at a "normal" level and it's also responsible for us to discuss what challenges someone faces or what strategies they'd need to implement if they choose to go ahead with treatment, to mitigate the known risks - higher ribavirin, get IR testing prior - not everyone with high BMI has IR but it's a higher risk group for that so it makes sense to test for that and be aware of all your risk factors, yes?
For some people, losing weight is a piece of cake. For others, not so much. I went at my treatment like a warrior woman but I didn't lose a single pound of the 20 pounds my doctors recommended that I lose before I start treatment. I have always struggled with my weight. Now some on here would be appalled with that, that I couldn't or didn't do a simple thing like drop 20 pounds when my life was at stake, so to speak and when I was going into treatment. Well, it might just go to show how tough that is to lose weight. Tough to quit smoking, tough to lose weight...I've never been a smoker but I do try to appreciate how tough it is to quit. Sometimes I wish people would understand how hard it is to lose weight. I do okay, I'm pretty active - play squash and whatnot - my beautiful, intelligent daughter is quite overweight and it bothers me how society treats that. They don't see her at all, they just see her weight - at least until they take the time to get to know her and some don't. But I digress here.
I have to say that you bringing up this topic makes me think about how it might cause someone to despair a bit to be told they had better odds if they lose weight because, for a significant number of people, that's much easier said than done. If it were that easy, we'd all be doing it. So - I do agree that a certain amount of sensitivity and understanding is required when discussing treatment options with someone who is high BMI.
.
I hope you're not feeling attacked on THIS thread. I admire your courage in speaking up and it's good to bring up topics like this.
Great discussion Kathy and valuable one. Now THAT is what this forum is for.
Trish
Okay .. .a bit of fairness here. We're a bunch of people coming together who don't know each other from Adam and we ARE trying our best to support each other and I think on the WHOLE, it's a damn good place to come for support. This place is not as "fuzzy bunny" as some people like to make it out to be, granted. There is some nasty sh!t that goes down here sometimes. But on the whole, the group of people here try their best to be supportive in whatever ways they know how - and I think the approach that is generally taken here is to speak in truth and reality with some attempt to temper it with a measure of compassion and understanding. There IS alot of truth-telling here, however and I think that's a valuable commodity.
Nobody means to be UNsupportive. It's too much to ask that we're all perfectly cognizant of what support means to each individual who comes on here. Sometimes we're going to drop the ball and that's unfortunate. However, what it comes down to is that support is up to that person individually to seek out. I never felt that the forum was responsible for being my support system. If I came here on a day looking for support and it wasn't available, I didn't get upset about it. Each person here has their own lives to live and it's up to ME to support ME first and foremost. It was up to ME to put my support system in place and if this place was not meeting my needs it was not the fault of anyone here at the forum, it was that the individual that I am does not find my needs met in THIS place and I am free to move on. There is another Hep C forum that I found while on treatment and I chose to "hang" on THIS one because the atmosphere on that one wasn't to my liking as an individual.
I'm lucky to have found *incredible* support here .. I've also been attacked for my viewpoints and as a person. Some people move on, some people stay. This place is far from perfect. But it's still one of the best places I know for someone on treatment.
"You should not take heart in the idea that if you are only overweight you are OK," said Dr. Robert Kushner, a professor of medicine at Northwestern University who specializes in nutrition and diet.
"Given time, there is a high likelihood you will be obese because people gain weight as they age in this country," Kushner said in a telephone interview.
He said many studies have shown that as one starts gaining weight, health risks develop. "We've done very well at medicating people to keep the medical complications at bay, which allows people to live longer," he said.
The study, conducted by Katherine Flegal of the U.S. Centers for Disease Control and Prevention, looked at specific causes of deaths in relation to body mass index, a ratio of height and weight.
A BMI of 25 to less than 30 is considered overweight, while a BMI of 30 or greater is considered obese.
The study did find significant risks linked to obesity, including a higher risk of death from heart disease, diabetes and kidney disease, and several cancers that have been linked with obesity, such as breast, colon and pancreatic cancer.
"I have to say that you bringing up this topic makes me think about how it might cause someone to despair a bit to be told they had better odds if they lose weight because, for a significant number of people, that's much easier said than done. If it were that easy, we'd all be doing it. So - I do agree that a certain amount of sensitivity and understanding is required when discussing treatment options with someone who is high BMI."
Can we all do this? Studies aren't absolute. Can we get a little past them as being absolutes and start to see a bigger picture.
Denise
I did find it interesting that people are so quick to defend studies but not when it comes to supporting people w/higher BMI. There are studies that indicate healthy people are out there with a high bmi. Kathy, you are obviously one of them and that's why tx is working. Now that being said, I do agree that being overweight is not ideal for most people. And yes, there's all sorts of links to higher risk groups for those who are overweight. I'm not refuting that. Not at all. I did get quite defensive here, partly because I'm wore down from people's comments that automatically assume people w/high bmi are unhealthy. You see, it's not about the warm fuzzy feelings I hoped to get. It's about hoping to be treated without the stereotypes.
Trish: This is not my sole support system, obviously. I'd be in big trouble if it was. I really appreciated reading your comments to Kathy. Thanks for sharing something so personal. And thanks for being positive and adding something really valuable to this thread.
Good luck Kathy, isn't that what this is all about. Acceptance regardless? Go yea forth and do great things.
Be well, SVR and live a happy with or out without the poundage, it just doesn't matter.
All the Best
Dabdees
All the Best to you too!
Kathy
No it's not ideal for ANYBODY. PERIOD.
"Being overweight does mean that a person is unhealthy. Further, you are not the only person here with an education, and to imply that we are incapable of understanding someone of your supposed intellect is offensive. "
AMEN!
300,000 people die each year from obesity - it is not healthy. Approximately 25,000 people die each year from cirrhosis - they are not healthy. Both high BMI and cirrhosis are known negative predictors for SVR.
However, even with these FACTS you repeatedly seem to want to call everyone on this forum stupid because we believe in science and studies and hard data.
That's quite amusing because some of the smartest people on the internet are on this forum. It's too bad your are too prejudiced in your own infirmity to realize it but I hope it does not prevent others from seeing it or paying attention to any of the rubbish that goes along with it.
But also, lets look at both sides. How many people have a high BMI who are living healthy? What are those stats? I think Rocker might disagree w/your statement that being overweight isn't ideal for anybody. Did you read his recent posts? He's considered "overweight" according to the charts. I'm guessing if his body weight matched the charts, he wouldn't be at his healthiest.
Anyway, he doesn't fit in the category, 'cause he is big boned and weight trains every day. So most of his 'overweight' is solid muscle.
"When we start to pay attention to how we talk to another person,
we may find that we use the words always or never.
For example, if we say things like:
Women always get emotional
Men never understand women.
People of ____ race (fill in blank), never work hard.
Employees always waste time in meetings.
This almost certainly brings out the defenses in the other person.
It brings in generalizations and hurts those who definitely don't fit those categorizations.
In essence, you are saying that your thought or opinion is absolutely correct and there is no room for argument.
Others can then feel threatened or angry at your statements.
There own beliefs and attitude are now put on the line for debate and scrutiny.
They may feel attacked by your statement and stop listening to anything that you may say, which ultimately stops communication.
Using words like some or sometimes keeps the doors of communication open. It enables you to have a discussion about your thoughts and solutions to be worked out. Moreover, that's when success comes in."
relevant.
And I looked at your profil to see that you wasn´t stage 4 and I perhaps made a blunder when I wrote about that. Should have looked before I wrote my first comment.!
http://healthhabits.files.wordpress.com/2008/11/love-handles-vs-visceral-fat.jpg
in my culture neither and its way older than yours.
Seems like you like to twist everything are the meds hard on you??
No, I'm not twisting things. Our profiles are things that should be left on the profile page unless we personally choose to share it here. Lots of people post personal info on their profile pages to use for other reasons. I don't believe Kathy asked to have her specific weight looked at with a fine tooth comb, if you will. We have to limit that sort of thing because people have misused personal profile information in the past. I hope that makes sense. This is about a broader issue, not an individual one. Again, I know you were trying to be helpful. I should have been a little more courteous in my initial reply to you.
"We have to limit that sort of thing because people have misused personal profile information in the past". Oh yeah, how?
If someone is asking about treatment you can see geno type and yes weight, viral load and much more, the more you write there the more others can see what your dealing with.
Its much more effective then when people have to ask all the time.
Easier to get valuable comments about your treament that way.
So you heppers who hasn´t write anything in your profile its a good advise to do
so.
BTW I had that dangerous fat my self lost about 25lbs during tx though.
First tx didn´t loose one lbs also relapsed!!
But also just half the lengt of tx and 400mg less riba a day.
Kathy started this thread, and her subject was her high BMI. She began the discussion, yet you are trying to cast her as a victim of our bad behavior. If it is inappropriate for us to discuss Kathy's BMI, then why did she make it the subject of the thread? If you do not want a discussion of your personal statistcs it would be wiser not to post them on a public forum.
What I find inappropriate is the implication you have superior intellect, together with your statement that other members should not discuss information without having taken at least three courses in statistics.
(That was a joke!)
In this case though Kathy is the one who brought it up originally months ago and again and again and again. It was not as if someone found a secret from her past and was being viscious it was the point of the entire conversation.
Personally I feel people that post their every single move on a myspace or facebook are quite ridiculous but in this case - it's not as if somebody went to one of those sites, found out information then copied it over here.
And nobody is being rude by not saying "sometimes" everyone has said all along that your odds are WORSE when you have certain conditions. Something there simply really is no debate about if you believe the experts who spend their lifetimes compiling the information to HELP people with a disease. If you can't believe them then really why come to an internet forum where PATIENTS have any opinion?
And comeagain is a friend of mine and could never be construed as rude - spelling / grammar might not always be so perfect but rude? That's be like Rocker eating a cheeseburger.
"BTW I had that dangerous fat my self lost about 25lbs during tx though. First tx didn´t loose one lbs also relapsed!! " Taking extra riba...........yes this is the reason we all so rudely pointed out that a high BMI is a negative thing - some people find out taking extra riba and losing weight in advance DO have benefit and to not point that out would be a complete disservice. I cannot see how you cannot understand this?
Rocker did you lose the weight this second time while you are UND on the way to SVR or before the first time you relapsed? We've been together so long on here it's all blended together at this point...I cannot remember but it seemed interesting to me. Either way like taking extra riba you did add the trial drug - which again is the reason in the first place anyone said anything about it rather than lie and ignore it.
Moving on...
You said:
"In this case though Kathy is the one who brought it up originally months ago and again and again and again."
I guess my trying to share what I feel is valuable information, maybe not to you but perhaps others, is repetitious.
Dem bones dem bones......... ;)
(I think the boce got you SVR too).
By the way on a serious note, I put on weight after stopping tx almost 6 months ago. I'm about 25 lbs overweight and see how the metabolic syndrom (syndrome) markers are rising. When my weight was almost normal during tx and all my #'s, i.e. BP,Glucose,Cholestoral all were normal. I have seen them steadily increasing as I gain weight. So for me BMI is a major factor in my health. For me I have to lose weight and I know it will add years to my life.
You are so right! Apart from quitting smoking, losing excess weight is about the best thing any of us can do for our health.
I lost about 35 lbs of muscle mass during tx, and since finishing tx I have gained about 25 lbs of jiggly fat. This was not unexpected. During treatment for cancer I lost a lot of muscle mass and afterward I gained back every pound of it. I'm struggling to lose the weight now, and although it is no fun at all I will do it because I know it will add years to my life, and the quality of my life will improve.
The problem with comparing anything to treatment is that treatment is not all reality. I'm not even sure that pre and post treatment is comparable. After treatment, I put on the weigth that I lost, and then some. I committed that I was not going to act like the post treatment gorging (which I thought I deserved) could continue. We read a lot here 'all things in moderation' - so true.
Sorry about that momma crack. Hope you don't have a short fuser about it.
My mama is a Martian....
FLGuy:
~~I guess that I will never consider Geno 1 as a difficult genotype to treat. It's puts all people with Geno 1 in a negative category. So, to all those with Geno 1 and cirrhosis, congratulations - it must be a very happy day for you.
Geesh. ~~~
Not only are you abusing copy's mama, you're stereotyping us geno 1's. I'm totally offended. ;)
Thanks but I think I'm already ahead for the night I just don't really see the point any longer. There are a lot of people on here who care about people in general and have spent years trying to help them. People who seriously want help and discussion - not to just say / do the same thing over and over expecting a different answer. You know what that is the definition of?
After all ostriches don't REALLY bury their heads in the sand......and some of us are smart enough to realize that.
Good luck and SVR for Kathy.
FLGuy, funny stuff. Since we are talking about momma's... your momma is so fat that she needs her picture printed out on a wide format copier ! (blue print machine).
and by the way I did pick up on the word you used "fuser". this is a very common part used in every laser printer or copier.
Good stuff
jd, I think that's quite inaccurate. You don't quantify what you mean by overweight and it's not true to say that all overweight people are automatically unhealthy. I think I've been overweight for some time, statistically. When I started treatment, I didn't have a single health issue or concern other than HCV. I had no thyroid issues at the time, I had no diabetes, no high cholesterol, no high blood pressure, in fact my blood pressure was quite low, so low my nurse was shocked. My cardio was in great shape. If someone came up to me and said I was unhealthy because I was overweight, it would be laughable.
I think it's more accurate to say that being overweight puts you at a higher risk for health complications and the more overweight you are, perhaps the greater the risk.
"I have to say that you bringing up this topic makes me think about how it might cause someone to despair a bit to be told they had better odds if they lose weight because, for a significant number of people, that's much easier said than done. If it were that easy, we'd all be doing it. So - I do agree that a certain amount of sensitivity and understanding is required when discussing treatment options with someone who is high BMI."
Can we all do this? Studies aren't absolute. Can we get a little past them as being absolutes and start to see a bigger picture. "
----------------------------------------------------------------------------------------------------------
Kathy, don't get me wrong. I maintain that it's important to talk in facts. What I would do differently after your thread giving me reason to digest this topic a little more is to deliver that truth with a little more understanding and sensitivity. Studies don't actually say that people with high BMI or people who are obese or overweight should not treat. They point out the risk factors. Anyone going into treatment should be aware of the risk factors and approach treatment with full awareness of these risk factors and with strategies to mitigate them wherever possible. In your case, the risk factors generally associated with being obese, such as diabetes and IR, are not present and that's a good thing for you. Someone else who is obese may not be so lucky.
What is really important is to talk about the why here and I really have to thank you for bringing up this topic. It made me read more and I came across an article that explains they "why" in better detail. There have been discussions about IR here but not every overweight person has IR, as you've capably pointed out. It is, however, something that overweight/obese persons should investigate prior to starting treatment. Also, different responses per Genotype:
"Different HCV genotypes seem to be associated with steatosis through differing mechanisms. Genotype 3 HCV appears to directly promote the build-up of fat in liver cells, while steatosis in genotype 1 patients appears to be linked with co-existing metabolic conditions such as insulin resistance."
http://www.hivandhepatitis.com/hep_c/news/2006/072806_a.html
Did you know that excess fat in the body can decrease the amount of interferon "on active duty" in the body when you take your injection? I didn't:
"Finally, excess fat tissue reduces the amount of circulating interferon in the body during treatment, possibly due to impaired absorption after injection. "
I'm going to post the article in it's entirety in this thread - or another one - because there was just so much good stuff in it. Your question was why can't obese people treat - and again, this article does NOT say that they should not treat. It promotes awareness of the challenges for obese persons and it doesn't avoid the truth. The best case scenario is to lose weight. No doubt about that. It goes on, however, to talk about other strategies if this is not a reality and let's face it, it is extremely hard for many people to do. That does not, however, change the risk factors.
"Management of Obesity
The Mayo Clinic researchers reported that reducing body weight and improving underlying metabolic factors may help "overcome the low sustained viral response rates observed in obese patients infected with HCV."
The first-line approach to managing obesity involves lifestyle modification, including exercise and a healthy, balanced diet. Weight loss has been shown to improve insulin sensitivity, lower ALT levels, and improve liver histology.
If such measures are not adequate, anti-diabetes drugs such as metformin (Glucophage), pioglitazone (Actos), and rosiglitazone (Avandia) may also be used to increase insulin sensitivity, which may help reduce fat accumulation in the liver. While these medications have not yet been studied extensively in people with hepatitis C, there is data suggesting that they are associated with reduced ALT and improved liver histology in HCV negative patients with non-alcoholic fatty liver disease.
The authors also suggested that use of higher doses of pegylated interferon and ribavirin for extended periods might help overcome the lower response rates observed in obese patients. Weight-based dosing and longer treatment durations are currently the subject of considerable research, but the authors also suggested higher dosing based on levels of insulin resistance or amount of visceral fat, rather than body weight alone.
Together, these studies suggest that liver disease progression should be considered among the deleterious outcomes of obesity and the metabolic syndrome, along with diabetes and cardiovascular disease."
I want to thank you again for bringing this up. I think it's an important discussion and one that is far more nuanced than simply saying that being overweight is a risk factor in and of itself for positive treatment outcomes. That would be misleading and not enough information on it's own to allow people to properly address the risk factors that COULD be introduced as a RESULT of being overweight.
That blanket statement with no explanation could induce the kind of panic that I see in LuckyLiver's post.
I hope you are SVR, Kathy. I've seen your posts all along and I've felt your encouragement in the past for my own treatment outcomes and for many others. We often see posts from people who say things like "this is my situation, has anyone been successful with this situation?" and they are desperately looking for some hope. I hope you will be able to say "I treated while overweight and I am SVR" and it will give them hope.
Trish
There's no getting around it .. if you can lose some weight it will most likely decrease your risk factors. By how much, I'm not sure the studies bear that out sufficiently as it seems to be dependent upon which co-existing condition exists as a result of you being overweight that would introduce extra risks for you when undergoing treatment.
If you can't lose weight right now - and you would not be alone in that, then learn as much as you can about what the conditions are that can create extra risk for you and get tested for those. Your treatment drugs may need to be adjusted accordingly. Make sure you have weight-based ribavirin, etc. Get tested for IR - not a subject I know alot about but others here certainly do. The key is to learn as much as you can about your risk factors, be aware and choose the best strategies you can. However, at stage 3/4, I personally would go through treatment but with eyes wide open. I would also make sure you have a doctor - a hepatologist - who really knows his stuff. If your doctor hasn't brought up weight at all and you are, as you say "REALLY overweight" then...I'd wonder a bit on his experience level. When you are at Stage 3/4, you really want a hepatologist who knows what they're doing, who is up on the latest treatment protocols and will give you the best shot possible.
Trish
First, good luck to you Kathy. I hope you acheive SVR.
I always toss in the part about being a porky g3 when I've talked about my journey on many threads. I was ignorant. Information freaked me out so I resolved to remain ignorant and then take a leap of faith into treatment.
Please note: I do not recommend this approach.
I arrived here two weeks after I started tx. People asked me if I was on weight-based Riba. My response was "huh?"
I did not know that weight impacted SVR. I did what any good treating hepper would do in their third week of tx when I got the news that my outcome would probably be bad - I pooped my pants.
Then I went to see a hepatologist, especially since I didn't clear in 4 weeks. Close, but that only counts in horseshoes and hand grenades.
Fast forward to today. I'm SVR. I'm healthy as a horse except for debilitating arthritis. Arthritis has been my biggest demise factor n the last 12 years. Up until I was 40, I ran 20+ miles a week, played racquetball and went skiing when I could. It came on so suddenly that everything became a challenge. I also (stupidly) quit smoking around the same time that my activity level plummeted and I packed on the poundage.
I worry about two things - all of my joints are totally shot and I may have cleared HCV but I still have fatty liver.
I'm not unhealthy but I am at risk for a big boatload of other health problems if I don't get some of this weight off. The orthopedist who gave me a shot in the hip a few weeks ago suggested that I use the time to MOVE MORE since I don't look like I belong on a poster at the moment.
And now I'm off to run the halls of a local hospital for the next 8 or 9 hours. This weekend I will swim or bike or do something to raise my heart rate.
I wish you all a beautiful sun-filled day.
for making an effort!!
God bless !!
ca
Kathy
NYGirl is not out of order she said nothing wrong, just stop bitching now for gods sake
The assumption I do not make is that everyone with a high BMI has an eating disorder.
Often times it is chemistry not emotional or over eating that creates a high BMI.
How do I know this, because this is what I had. On 1200 calories weighing and measuring every drop of oil and morsel every day for a year I lost no weight due to these deficiencies. My doctor argued vociferously that I did not have these syndromes, but proper testing at our local teaching hospital proved I did have exactly what I had diagnosed myself as having.
Item: hcv people have a much higher rate of thyroid disease than the general public.
They also have far far more pituiatry dysfunction, they also have far more pre-diebetes AKA Insulin resistance.
The current research is showing that HCV itself is slowing the endocrine system to a crawl and hence creating metabolic syndromes.
All I am suggesting, is that she be checked for such things so that she does not have to endure years of starvation diets with little result. In order to lose the weight and give herself a better chance at treatment it would be advantageous to make sure the systems that effect whether calories are burned or stored are working as they should be.
You may want to read my thread in here on HGH, or search pubmed for connections between hcv, endocrine dysfunction and high BMI.
mb
I never had a high BMI until I took Interferon the first time in 1994 and ended up with much less energy than I had prior to taking the treatment.
The people that are giving you a hard time, have never had a hard time with their weight. I didn't read all the comments, but it's been my experence that the strong pick on the weak only because they can, and if something were to go wrong with their treatment, making them take a turn for the worst, then were told that they couldn't take the treatment!!! You would never hear the end of their of their screeming.
I try to exercise and eat good food, but I can't seem to even budge off my weight, maybe some day the worm will turn for us.
Sandbur
I don't mean to sound disrespectful or "yes, but" your comments, but I have done PLENTY of reading and research in that area and have also read numerous threads here. Trust me when I tell you I'm not lacking of knowledge in this area. I'm not a medical expert, but far from being uneducated in this area. That being said, I understand where you're coming from in that everyone, esp someone w/high bmi, should be checked out for such conditions. Without a doubt that is an excellent recommendation. I was primarily referring to an implied assumption from some people that people w/high bmi are unhealthy, which isn't accurate. My objections, often, have to do with the language that's being used when it implies an absolute fact in which there is no room to disagree. And I also wasn't referring to eating disorders. But by all means, I stress this again, people w/high bmi should certainly have a thorough medical workup for the issues you mentioned. That is a really good point that you made.