Saw The Doc - Have Some Answers

[FlGuy]

Went to see doc#3, one of those

[FlGuy]

I don't recall where I heard of pre-dosing riba first.  Although, we discussed it some here many months ago.  It does take some time for the riba to get up to 'concentration levels' so it sort of makes sense.  But, I wonder at 'guidelines'.  This doc said clear at 4 weeks, do 48 weeks. If longer than 4 weeks, go for 72 weeks.  What if I clear at 5 weeks and not 4?  This stuff is not an 'exact science'.

[GrandOak]

As one who had his Ribavirin reduced at 6 wks instead of augmenting with Procrit, I can speak to the what it did for me:

- Resulted in me getting a qualified HCV doc instead of a Infectious disease (ID) doc.

- Had VL increase 1.9 mil between wks 12 and 24 while attempting to establish Procrit dosage which would allow me to regain original Ribivirin dosage of 1200 mg and increasing to weight-based dosage of 1400 mg.

- Has me thrown the initial 25 wks of tx out the window and starting tx count of 72 wks over upon reaching 1400 mg. Provided of course I show 2 log drop in 8 wks (new wk 12) from my original 72 mil VL base-line last Janurary.

- Augmented tx with Neupogen 20 some wks in because of large ANC drop, which was odd since we were only changing the Ribivirin and Procrit dosages.

In short, by following the PI for Ribivirin my original ID doc set me back significantly and I suspect will eventually will result in a battle with the HMO on tx coverage since I will not be able to afford the 7K plus for a months meds, let alone the follow-up visits and lab work.

[cuteus]

paris, you were not clear by month 3(12 wks)?  if you did not clear until after that, standard tx length might not be enough. go back to that calendar and count!  slow responders might need more time on tx!

flguy; I KNOW I have the top hepatologist!
great thread!  If your intent is to truly rid the freaking virus of its hold, VX might not be an option, unless is the branch with the other two guys(IFN, riba).  That is the proven combo, and since we have no SVR rates with VX yet, it might just be another gamble with just it (at whatever dose you fall into) and IFN.  Tough call, I am glad I don't have to make it!

it looks like you are down to choosing bt two options now. Good luck

[Kalio1]

I'd follow FLGuys doc's advise, if clear at 4, then 48 if not then 72 because his doc definately knows what is UP and in this fast evolving non exact science of Hep C tx for cirrhotics, his word is definately worth listening to IMO he knows of what he speaks.

[amirtracy]

Thanks for posting the info from your dr's visit. it's very helpful and i hope you post your decision. all the best to you.

I have a question for anyone to help with.... didn't want to start a thread and was touched on here...

first backstory...
My doc reduced my riba from 1200mg to 1000mg this past wendesday. weight-based makes it appropriate now.
My hmg is down to 9.8 and he feels like that will help it.(and i'm uninsured so it's not the procrit i can get on the med program for that but the referral to a hepatologist and the associated fees that present the problem). I see my dr in 10 days w/ a cbc the day before to check my hmg again. I've asked him this but he is very vague. keeps referring to the first 12 weeks being the most critical but i don't get the feeling he's "up" on stuff..
My question is-
Did I just increase my chances for relapse by reducing dose even tho' it's appropiately weight-based now?
Is ANY reduction at all detrimental to my outcome?

week 25/48    thanks everyone.

[Mister beagle bailey]

Paris you treated for 24 weeks, right.  If so then you probly were UND at week 4 not 4 months.  Am I right on this?

Tulsa, Someone posted awhile ago a site that listed Drs from all over the country that treat HEP C.  Let send out a SOS and see if someone has the site, I can't find it in my notes.

Flguy, The list you mentioned as the top Drs, Ira would be Ira J and John would be John Hutchington but who are the rest (last names) if you remember them.  Just for future info in case needed.  

Beagle