Post TX Procrit--how long? And Open Post.

[Algernon]

I'm looking for info/advice about whether/how long to take Procrit post TX.

I took my last Riba this past Monday.  My last Procrit last Saturday.

My hgb is good now (13) but I started at 14.9 and dropped to 9.8 after the first four weeks of TX.  On Procrit almost the entire trip.

Last time I saw my doc (rare treat), he told me to take 1 to 2 shots post TX IF I had extra Procrit (implying that if I didn't have any, don't worry about it).

Here's my question.  My last HGB was tested 3 days after my last Procrit.  It seems like my HGB should hang steady or go up without Riba.  BUT the Riba stays in us a long time, right?  

The Procrit has really rattled my bones badly the past month so I'm on the fence about whether to take a shot.

[friole]

Ina, by golly you are right.  Check this out.

http://www.newsrx.com/health-articles/327335.html

I think I was looking at it as causing bone loss because of all the teeth problems txer's have which, in fact, may be more related to the drying up of the saliva than interferon.

goof -- I know it is not logical and the Procrit is slow acting, but I also felt it started helping within the first week of injection.  I suppose I could go back to Wednesday on the P, tho.

Ha ha, you stumbled on my true for almost ever nick name that I have been saddled with since girl scout camp and all through high school -- based on my maiden name.  Beanie!  I tried to bequeath it to my brother when I graduated high school, but he would have none of it.
frijole bean

[Algernon]

Thanks for the link!  This makes me feel a lot better.  I'm going to get the full article.  Algie.

[Algernon]

I've read a few reports that TX can be associated with bone loss, especially in post menopausal women (but in men too).  I can't find any good studies on this this but we should probably all get a bone mineral density test once we're past all the TX business.

[friole]

algernon, I was put on Fosamax shortly before starting tx and was glad for it.  I too have read of bone loss for women on tx.  A bone density test after treatment would be interesting to see - I think I am due for it anyway.  Another thing I am going to ask my internist after tx -- I have read that the tx for hepatitis C can actually help COPD.  It is thought that hepatitis C causes inflammation in the lungs just as it inflames the liver.  I had a pulminary test just prior to tx that showed mild COPD (even tho I quit smoking in 1983) and I want to see if it is improved.

Goof - if I take the Neup on Sunday it will bump up my CBC results on Monday and I will look like the ANC superwoman.  And, I tell you, by Tuesday, I really really need the Procrit as I am wiped out.  Think I will just live with it unless it gets worse.  Thanks for the idea -- By the way I told my hemo nurse that I would institute the goof Neupogen plan if my ANC is .5 for 2 weeks in a row ( a shot the day before the interferon and a shot 2 days after).  So far, I have escaped it.
frijole

[GoofyDad]

LOL, you remember my schedule better than I do. I honestly would have had trouble remmebering that, but you're right of course. Not pushing my plan by any means, but I do believe the procrit is slow acting and what you shoot on Tues isn't really doing anything for a couple weeks or so.... that's my take anyway. I hope you don't go onto the double Neup shots, another injection isn't what you need. Best wishes to you Beanie!

[OnAPrettyPoison]

I too am almost at the end of treatment and started developing bone pains...mostly in my forearms and shins, but also in my shoulder areas, and it kind of rotates around.  It seems to start in my shins, shifts to my shoulder making the muscles knot up some, and finally to my forearms.  I do attribute it to the procrit.  I take mine on Tues nights and the bone pain kicks in Thursday mornings when I get up.  This has happened before, but it happening consistently is relatively new.  I will probably do one procrit post riba just to boost my hgb a little more.

[GoofyDad]

It came and went for me too. Maybe you could squeeze an extra day in between? Might help. Good luck.

[friole]

You know, I have been noticing that joint pain lately too.  I do the Neupogen on Monday and the Procrit on Tuesday, and am pretty achey for a couple of days -- it almost got to "flu-like" this last week.  I thought it was odd, because I have been on them since October and have not had problems until latley.  Gues the body is getting tired of them or maybe there is some buildup(?)

Return - thanks for posting that study.  That information helps.
frijole

[Algernon]

I do plan on a 4 (or 5) week PCR.  I really want the info.  If the news is bad, I do not plan on treating again right away. But I'll keep following the research and the drug developments.

I've come to the same conclusion that Jim has about when/whether to treat.  I think these drugs are so toxic that the potential rewards of treatment need to CLEARLY outweigh the costs.

If I were stage 3 or 4, I'd keep on trucking with treatment.  But at 2 or less (especially after many decades with no problems from the Hep), at least based on my experience, I'd wait for better drugs.  I keep reading that Riba info sheet from the drug company that says "potential carcinigenic effect."  

Whoever it was that said this treatment is like Jumanji was right on.

[GoofyDad]

My doc had me watch cbc's and stop procrit at 12. I ended tx at 10.1-10.5 and did one or two procrits following. He cautioned me that too many could thicken blood and risk stroke if I just kept squiting away blindly. I'd say it's a comfor thing, unlikely to goo too high or too low either way. Hard to weigh in on what to do because only you know how bad the procrit makes you feel -- and how long that lasts.

Planning on a 4 week VL test? That's another personal thing... hard to know whether it's good to know or not...

Best of luck to you -- enjoy feeling better....

[Algernon]

Return:  Thanks for the article.  Almost pushes me toward one more shot of Procrit.  

I'm with Jim on wanting to clear the system of all drugs.  I want to be "clean" again.  Tonight is the first night in months that I stayed up late (well, a little late anyway) talking and laughing with friends--I could almost feel the oxygen surge today (of course, some of that is my last Procrit shot).

Friole, I loved that Procrit for many weeks as I recovered from that 9.8 but the Procrit has been creating some of my worst side effects this past few weeks.  I've never had joint pain before that and I've barely been able to lift my arms over my head recently.

Thanks to all you guys for weighing in.  Luck to all of us, Alg.

[returntosender]

Please take a look at this study (from 2003) on the "Delayed recovery of PEG/Riba induced anemia - http://www.actions-traitements.org/breve.php3?id_breve=62

BTW, the mean drop of HGB was 3.7 gm.dl.

Basically, about 50% of combo treaters recovered their pre-tx HGB in 4 weeks.  Resolution is getting back to within 1 gm of the value where you started.  I started at 14.8 so that resolution would be 13.8.  36% resolved by week 12.  9% by week 24 and 5% did not recover during the study.  

16 people became clinically anemic - <10 gm/dl.  This patients seemed to follow the general population if they used Procrit.  If they did not it took them longer to recover and in some cases did not recover during the term of the study. Authors conclude that in anemic patients, the use of Epo/Procrit was a factor in resolving the HGb of anemic patients.

This is an old study - didnt really find anything newer in my travels but I thought it was interesting.

[friole]

I am not done yet, but I intend to take the Procrit for a couple of weeks after.  I figure the more I can help my system recover the better.  If it takes up to a month for the riba to leave the body, then it makes sense that the bone marrow may still need help making RBC after that last Riba.  Just my thoughts on the matter
frijole

[jmjm530]

More reflection, I notice you said you took your last Procrit on Saturday and your last riba on Monday, so that means your riba has a two day lead. In my case, I took an extra week of riba after my last Procrit shot, so my riba had a 7 day lead. My guestimate then is the 1 or maybe two shots your doc suggests would probably be enough to stop any dip in hemoglobin, but of course at the expense of any sides. My dip btw was less than one point.

-- Jim

[jmjm530]

On reflection, my hgb did dip a little for a couple of weeks after EOT so maybe your analysis of riba staying in the system longer than the Procrit is correct. So, I guess you probably have to weigh a small initial dip in hgb and proabably a slower climb back to pre -tx against any side effects from the Procrit. Again, I just wanted ALL drugs out of my system at that point, but that is me. You should be fine, whatever, and more important, conratulations again on finishing treatment and all the best going for that SVR!

-- Jim

[Algernon]

Thanks.  Just second guessing everything at this point.  Sudden fear of "The Return of Anemia."

No more needles.

Algie

[jmjm530]

make that low 12's at EOT.

[jmjm530]

My pre-tx hgb was 14.8. End of treatment hgb in the high 12's. My doc and NP told me to stop Procrit with my last shot. I was hesitant but followed their advice. My hgb returned to 14.8 in about 8 weeks although it was in the 13's last week. At hgb 13 I would think yours would go up even faster.

As yourself, I had some extra Procrit in the Fridge and was tempted to take it anyway for a couple of weeks. In the end I decided not to because I was really sick of all the drugs and just wanted them out of my system as soon as possible.

As your doc suggested, either decision is probably fine. Your hgb is really pretty good at this point.

All the best.

-- Jim