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To dose reduce or not to dose reduce
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To dose reduce or not to dose reduce

I'm in week 17 of triple tx w/Vic.  I have been undetectable at week 8, 12 and 16.  I have been on a maintenance regime of procrit and nuprigin since week 8.  Last week for some reason my rbc and wbc dropped to 8.5 and 1.7 respectively.  I had been able to go to work up until last week.  I have now missed 7 days.  Dizzy, poor equilibrium, serious fatigue, poor mental clarity.and joint pain.  My rbc and wbc have come back up to 10.0 and 2.7 this week but I still feel totally out of it.  I went the first 16 weeks in pretty good shape.

My doctor wants to reduce my rib from 1200 to 1000  daily and pegintron from 1.5 to 1.3 per week. I am reluctant because I have had an experience 10 yrs, ago where I was undetectable and because of anemia they reduced the riba and I relapsed.  My doc says it is apples and oranges.  This tx includes vic and the reduction is minimal.  I thought if I could get back to feeling like I did a couple of weeks ago I would stay with the original dose but I don't seem to be getting there.
Thoughts?
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10 Comments Post a Comment
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Avatar_m_tn
How long do you plan on treating for? What was your starting HGB and where was it at weeks 4-12? How much do you weigh? Did you have a 6 week viral load (2 weeks after introducing vic?).

If you are treating for 28 weeks and your HGB is at 10 then I would personally do nothing but monitor often (once or twice per week). If you are taking 40,000 units per week of procrit maybe you can increase to 60,000 if your hgb declines further. Many of us did that in the trials myself included and still remained well below 10 hgb.

Of course trying to work through this makes a big difference and makes it much more difficult. Unfortunately you probably won't feel great again until it's over. It's rough but maintaining the dose as you mentioned will give you the best chance of success. Is short term disability a possibility for you?

-Dave


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Avatar_n_tn
Dave, thanks for getting back to me. Tx is 36 weeks. Starting hgb 15.5.  Week 8 it was 8.5 that is when I started the procrit...good response 10.5.-11.5.
No 6 week test, but I started out 3.5 mill. at week 4 130,000. at week 8 und.and so on. No on the short term D/A.  I have applied for FMLA and my sick leave is up so...savings will be it.  
If I read you correctly you are saying stick with the original dosage.
Thanks.
Paul
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190885_tn?1333029491
i'm at 1000 now on week 16...from 1200...i didn't tx before but my body can't take 1200.....at least now it can't.........lots of folks have to reduce their doses...billy
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Avatar_f_tn
I am struggling with same thing.. have been UND since week 7 and at all other PCR tests (have it done every 4 weeks) I have 9 weeks and 2 days left and have been on reduced riba (1000mg to 800 mg)  for 4 of the last 6 weeks.  My body just can't handle the full dose even with rescue drugs.. I get very bad chest pains and feel like I am having a heart attack, plus can't lift my head.  So doc wants me on reduced riba for remaining weeks.  A bit nervous about this obviously.   My HGB has not gone below 9, but everyone can't handle 8 in my opinion.  
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Avatar_n_tn
I have been down in the 8s twice so far it is a whole nother ballgame for me. But what I'm struggling with is that even with it back at 10 I feel totally wiped out.  I spoke again with my doctors physicians assistant today and she is pushing hard for the reduction,,,but she also said what Dave said, that I probably won't get back to feeling like I did a couple of weeks ago....bummer.
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179856_tn?1333550962
Get back to feeling like a couple of weeks ago?  You can do that once you have succeeded and have SVR!!!!!!!!!!!!!!!!!!!!!  :)
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Avatar_n_tn
you made me laugh..thanks.
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Avatar_m_tn
Why would the  assistant be pushing hard for a dose reduction  when the procrit has done what it has supposed to do and brought your HGB up to 10.??(which is not at all in the danger zone)

As far as not feeling all that great...it would make sense when your normal HGB. is 15.5 and now  it is at 10..however remember the most important goal is to eradicate virus and sometimes feeling like crap unfortunately is part of that process for some.

Hang in
Will.

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Avatar_m_tn
  sorry meant...".unfortunately you feel like crap as part of the process"
.  
the way I posted sounded harsh..which it was not meant to be :)
Best to you...
Will
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Avatar_n_tn
No sweat Will.  I think she is trying to get me to the finish line and has seen fluctuations in both rbc and wbc counts.  I have decided to hang tough and decline the reduction at this time.  
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