Treatment Begins

May 17, 2012 treatment begins  Viral Load 12 million
May 31, 2012 undetected


Pegays 180 mcg/0.5 ml syringe once week
Incivek 750 mg-  (2pillsx375) 3 times a day 7-9 hours apart with food 20 grams of fat and H2O
Riba Pak  1-600mg at p.m.
      "         1-400mg at a.m.

Request copys of all labs to be mailed to your home address:

CBC       7/3/12         7/19/12       7/31/12

WBC         3.6                3.0             2.6                Range:   4.0-10.5
RBC          4.21              3.75           3.43              Range    3.77-5.28
Hgb          12.7              11.0           10.3               Range    11.1-15.9         8 or lower for blood trasfusions
Platelets      92                 97            106               Range    140-415

Record blood pressure once a week.  Heart rate is very important if your experiencing chest pain/palpitations.  

I have an appt. with a Hemotologist on 8/13/12 to request CBC once a week in his office.   Advantage.... instant read!   My preference is a controlled/scheduled plan in place for transfusion if need be.  I will not fall victim to my gastro dr. who says, "get yourself to ER".

It's not about where we've been that matters,  it's about getting to the finish line!

[Bill200]

Nice!

[willbb]

Congrats on your RVR and I would imagine the HGB , will hold given the level now that you are finished the Incivek, making a transfusion  (usually only done <8.5)  a moot point..

Good luck the rest of the way and welcome to the zoo....
..
Will

[frijole]

fantastic.  UND at 2 weeks.  Your labs look good.  What is your ANC?  Your hemoglobin is declining but you have a good plan put together.  I assume the hemotologist will be the one rxing the procrit or neupogen if needed?

[frijole]

Are you finished with the INC as willbb said or only at week 2?

One other thing -- what test was run for your VL and if it said <43, did it contain the wording "undetectable?"

[frijole]

Duh - like I think it is May.  Okay, it is August and  you are done with the INC.  Congrats.  The Riba can still impact your hemoglobin but since you are still in the 10s and done with INC, you should be okay.

[pooh55811]

Congratulations! Things look good for you.

[Idyllic]

Maybe I am missing something but why wait for a transfusion which is usually administered when Hgb is much lower than 10? I mean why not line up Procrit? If your Hgb continues to drop at the pace that it currently is then you it is likely you might be ready to start a once weekly regimen of 40,000 units of Procrit on 13 Aug. While there is no real way to predict this but I am not sure your Hgb will be low enough to warrant having a transfusion by the 13th.

I think Will is right when it comes to how low your Hgb usually has to be to warrant a transfusion. Although I am sure it varies, from what I have seen it is usually somewhere between 8 and 8.5.

Trust me you do not want to wait until your Hgb gets that low. You do not want to have to function while your Hgb is in the 9's and upper 8's.

I think it is wise you are not waiting around for your doctor since I would rather have Procrit right off the bat and not hassle with a Riba dose reduction.

[orphanedhawk]

Great labs, congrats at the RVR !

[finishline225]

Thank You everybody for cheering me on, more importantly your feedback!  
I stand corrected....My treatment started in June not May.  With one month to go on Incivek.  My GI won't discuss any treatment with me until Hgb levels reach 8 or lower...Hence, thought it best to visit a hemotologist now to look at labs as a second opionion and course of treatment. Procrit versus transfusion,  Riba dose reduction, etc.  

HCV RT-PCR, Quant (non-Graph) was used to determine: HCV not Detected.  It's a combination of Taqman real-time PCR (LLOQ 43 IU/ml) plus reflex to another Taqman assay (LLOQ 25 iu/ml) for Geno Type 1

ANC  level  1.5 low     Range 1.8-7.8

[willbb]

The GI  who says "I won't discuss with you treatment for anemia until your HGB is  <8 " is not following correct protocols for  patients doing HCV therapy  and should quite frankly, not be treating HCV or at the very least spendf the time to become knowlegable about his trade

Hemolytic anemia is considered anything below<10 and protocol is to reduce Riba and /or to possibly introduce the 'growth factor Procrit

Transfusions should only be initiated as  a very last resort when  the proper steps(mentioned above) are  tried with little or no effect in order to keep the patient  treating.

With only 4 weeks left doing the Incivek you may find that "hemolytic anemia " will not be a problem,however as some of the above members have mentioned it is a good idea to confer with a hemotologist and at the very least institur a plan

Having said that it is the GI that is in charge lowereing the Riba when the HGB gets <10 and this warrents discussion with him/her

Good luck...
Will

http://www.clinicaloptions.com/inPractice/Hepatology/Hepatology/ch8_Mgmt_of_Hep_C_Infection/Pages/Page%2012/Subpage%202.aspx


Telaprevir also causes anemia, which can be managed with ribavirin dose reductions and/or, if necessary, erythropoietin use, without impacting treatment efficacy. Anemia may occur rapidly (within 2-4 weeks of initiation) and may be severe.[FDA Briefing; Telaprevir PI] A total of 7% (38/530) of patients treated with telaprevir in the REALIZE trial required blood transfusions. Older patients with low baseline hemoglobin and lower BMI were more likely to develop severe anemia and more advanced fibrosis was a risk factor for anemia development.[Roberts 2011] As with boceprevir, the dose of telaprevir can never be reduced. For both telaprevir and boceprevir, anemia requires closer monitoring than with peginterferon/ribavirin alone and for older patients or those with cardiac risk factors, consideration of cardiac evaluation prior to therapy may be reasonable to reduce the risk of unexpected cardiac events due to severe anemia.

[finishline225]

Hello Will,
As a newcomer to the zoo...(.chuckle), I thank you for the significant information in your last post!.   The <10... riba reduction/procrit approach makes sense to me. I now have the ammo needed to approach GI with these findings.    Stay well

[Ironpony]

great job putting your bloodwork together for us to check out...and congratulations on your RVR!

[working dog]

its likely that you hgb will go lower in the next few weeks....in your case with und at 2 weeks riba reduction seems like the best thing...i raised my riba up too fast a couple times after reducing it and that was a mistake...if your hgb gets into the 8s take it easy...your pulse will go up to compensate for low hgb...keep an eye on it...weekly cbcs are a great idea...sounds like your going to do fine....billy

[finishline225]

Hello frijole   I actually began treatment in June not May, which leaves me 4 more weeks of Incivek.... Yes, I know I posted May as a start month.  A bad typo on my part indeed!  Any suggestions on how to correct it?  Very sorry to confuse the heck out of everybody, including myself.  

The test taken on 3/06/12 with a VL of 12,101,000
HCV-RT-PCR, Quant (graph)
HCV log10IU/ML

Wishing you all the best.

[FaithforHealing]

Such good news for you, and the community!
Just awesome, hang in there and I wish you continued good luck!
Thanks for posting....we need to hear more good news like this!

[finishline225]

Thank You for choosing your kind words so wisely. Indeed great news for us all.  Tomorrow I check in with the Hemotologist to check CBC/Diff Ambiguous Default.  Most concerning is the Hgb which was at 10.3 two weeks ago.  Copys immediately go to GI for a read and plan of action.   Wishing you successful tx.

[finishline225]

Hello Everybody!  

Results of CBC show improvement!

WBC          3.1  up from   2.6
RBC          3.44  up from  3.43
Platelets  114 up from 106

On 8/3/12   GI started me on Ferrous Sulfate 5GR (325mg) Iron  1Tab 2x's day.

HGB dropped to 9.8  from 2 weeks prior of 10.3
Protocol for tx once Hgb reaches 10 or below is to reduce dosage of Ribavirin to 600mg.  Requiring a new RX to be written by Doctor.  My GI feels that by reducing the dosage of Riba chances are good that viral load will appear.  Do I want to go backwards?  No.
The plan is to continue drawing blood at 2 week intervals.  If HGB reaches 8 doctor will transfuse.  
Not a great candidate for Procrit because BP readings are unstable, despite medication.
Yes, I get heart palpitations, which most often are not serious, unless caused by arrhythmia.  In preparation for triple treatment, I had a 24 hr. halter test done, along with a stress test.....my heart is good!
I realize that the heart and lungs need to work much harder to carry oxygen to all organs while HGB levels are critically low.  So, I lay low.  Only 23 more days of Incivek left.....and it will no doubt be a long and winding road.
Last month I started working nights instead of days to lighten the load, it helped tremendously.  I also cut back from 5 shifts to 3.  There's still plenty of room for adjustments should I become more sedentary!

Victory and Defeat are each of the same price.....Thomas Jefferson