When and how to take meds ?

I will start SOC (180 Peg/1200 Riba) any day now.

What are the best times to take the meds ?

Any advice , I know Riba is best taken with a fat containing meal

does it need to be spread out exactly 12hrs apart ?

How does one start first day ?  Riba in the AM and than

PEG + Riba in the PM ?

[Trinity4]

Everyone is different.  Read all the many many posts on this subject.

[nygirl7]

Your doctor will show you and advise you on how to take the meds.

As Trin said there are about 10000 posts in here on what WE consider the best advice however your doctor knows your particular situations and health and has to be the one to advise in the end.

[willing]

so the roller coaster is creaking to the top of the climb, eh -  have fun!

Agreed on the fats effect:
"Although a standard meal did not affect ribavirin bioavailability (F1), administration of ribavirin with a high-fat meal increased bioavailability by 46% relative to the fasting state."
from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1804105/

(but you've got to balance this against high HOMA if that's an issue for you).

I'd suggest starting the rbv a couple of weeks before the 1st shot. It takes a while to get to steady state and when those first shot of ifn hit you want them to have full effect.  By two weeks you'll be thoroughly marinated and it won't matter what time of day you take your pills.

Another advantage of starting the rbv ahead is that you an gauge the sides and Hgb drop independently of ifn. Even with weight-based guidelines (calculate your mg/kg - should come in at 15 or better) rbv dosing is still variable, but if you don't see your Hgb drop significantly that might be a concern.

Still taking the NTZ ? With a full load of rbv and ntz aboard and low vl to boot I'd check VL weekly - you might be pleasantly  surprised how soon that 1st und comes in. Good luck!

[jusjames]

best just send me your meds i will take care of them for you

[FlGuy]

Do you have the prescription yet?  Do you understand the refill process? What specific date will you start?

[jusjames]

Another advantage of starting the rbv ahead is that you an gauge the sides and Hgb drop independently of ifn. Even with weight-based guidelines (calculate your mg/kg - should come in at 15 or better) rbv dosing is still variable, but if you don't see your Hgb drop significantly that might be a concern.


great advice i agree , except the bit about hgb drop, if not significant could be a problem, i dont think everyone experiances big drops some people tolerate riba surprising well.

[Trinity4]

I was one of those who tolerated riba well.  I started riba 2 weeks prior to injections with no significant hgb drops doing 1000mg and weighing 114 lbs.  That's why I always say my body did not metabolize the riba effectively even with meals and I believe I could have tweaked the the dosage upwards without much trouble.

Can't use me as an example though.  I am only one person and I did not have any IR issues.

[jusjames]

do you think people with ir  suffer more or less with riba than? ,
or do you just mean that if taken with high fat it would metabolize better?

[Trinity4]

I did take it with high fat or at least sufficient fat.  I don't think there was an adequate blood serum level maintained in my case.  They don't usually measure the blood serum levels without going to a lot of trouble but good hgb drops are always an indication the riba is doing what it's supposed to do.

IR prohibits the interferon from doing it's job effectively to the best of my knowledge.

[jusjames]

ok thats what i thought too,
knowing what is suffient fat level is the hardest i think , you dont want to go mad , i think oatmeal with milk is more than enough, i tend to have fairly low fat meals in general i think, grilled chicken and boiled potatoes etc never processed meal or fries, sweets  etc , ehm maybe iam too good !

[Trinity4]

Hubby is a diabetic so we eat very healthy too and our weight is quite good because of it.  You don't have to eat unhealthy to get the fat content,  just smart.

Your fine jj, keep up the good work

[jusjames]

ha ha thanks , its catching this worring thing , juice anyone?

[copyman]

most people do the shot on friday night before bed so they have the weekend to recover. you can do the riba with breakfast & dinner. It don't have to be exactly 12 hrs. not sure if anyone mentioned it but it helps to take tylonol 1/2 hr before shot. usually the first shot is the worse.

best of luck

[Bill1954]

From Schering-Ploughs PEG-Intron prescribing info:

http://www.spfiles.com/pipeg-intron.pdf

Effect of food on absorption of ribavirin:

Both AUC and C-MAX increased by seventy percent when Rebetol Capsules were administered with a high fat meal: (841 kcal, 53.8 g fat, 31.6 g protein, and 57.4 g carbohydrate) in a single-dose pharmacokinetic study.

[jusjames]

thanks Bill
just out of observation i supose
53.8 g fat x two = 107.6g daily thats 50 % more than the daily reccommended ! bit worrying ..

[jdwithhcv]

avocado with riba worked well for me

[Trinity4]

I remember those heated debates I had with jmjm about the hgb drops because I was already taking more riba than my weight called for and not experiencing dramatic drops in my hgb so I wasn't going to accept it.  He was so very right and I would more than gladly take my upcomings from him now.  Not to say those who don't see big hgb drop won't go on to SVR but it rang true for me.  

I did peanut butter in the morning and a fruit smoothie with my meal at night.

I needed the x-tra calories too. Lost 15 - 20 lbs but the weight isn't falling off me anymore.  Battle of the bulge is back and I do miss not being able to eat anything I want to.

[Bali05]

"so the roller coaster is creaking to the top of the climb, eh -  have fun! "

Right on , just not so much fun !

Very good advice, I have been over @ Nomad forum and got a lot of posts

regarding predosing Rib and tapering of SOC at the end (if one ever gets to there)

I also learned about insulin resistence which I will check asap. Always thought

I am good with always normal glucose but apparently that is not enough.

So no breakfast tomorow and of to LabCorp for fasting glucose and insulin.

My BMI is 23 and been watching my sugar (ex low carber) for many years also

excersise regularly but I guess you never know. IR is a big indicator to INF

response. I am in the last stages of getting ready. I will pick up the meds

tomorrow. Don`t know yet what day I start but checked the expiration date

of my Peg which is 2012 (just kidding)

My Vit D  25 Hydrox. just came back 74.5 (very happy with that)

How bad is my iron for tx ?
Serum iron is 111  (40-155) been trying to get this down
Iron Saturation      27%  (15-55)
Iron binding Cap TIBC 418  (250-450)
UIBC                  307   (150-375)

[Bali05]

saw my doctors PA today for "teaching class"

did not get that information. He just showed me how to use syringe.

Theywill let me taper of meds after EOT but he was reluctant about predosing riba.

Looks like more and more I want to do that.

I propably would not double dose INF first time going since I do not know yet

how my body will react.

[Marcia2202]

I spaced my riba exactly 12 hours apart. I would take it with food and a tablespoon or so of virgin coconut oil. I would keep the oil in a cool place so it would harden and gulp it down with water, cause the liquid would make me gag. I'd stick the capsules into the oil. I was such a dork. During the period where I could only eat apples, I would take it with two tablespoons full.

Why don't you check out the health pages. Before I treated, I put together some TX related pages by gathering information from all experienced TX'ers here on the board and doing endless research. I found them quite helpful for myself.

DO's on TX, DON'Ts on TX, TX shopping list, TX rescue drugs

http://www.medhelp.org/health_pages/list?cid=64

[willing]

sorry, haven't had much occasion to look into iron levels. Yeah, IR is definitely one of the things to check into before starting (and also seems to be a big factor for 4s, see
http://www.ncbi.nlm.nih.gov/pubmed/19671541
) , however, I think its big impact is for those with pre-tx  BMI/diet/exercise obstacles which  don't seem to be problems in your case. Since simply having the virus raises IR (see that recent halt-c study in the sugar thread you started), so it's something of a loop.

Changing a good diet to a bad one for the sake of the rbv doesn't seem like a win - maybe try to mix the pills with whatever ends up being the main source of fat in your diet;  I used to take mine with peanut butter, avocado sounds good. Knowing whether you're getting enough is certainly  a challenge , but if it doesn't make a dent in your HgB I'd be suspicious - there seems to be a weak (not statistically significant)  but consistent association between HgB drop and SVR - see Fig 3 and the related discussion  from
http://www.ncbi.nlm.nih.gov/pubmed/18796095
(free access tab on right).

Personally, I think whether you do/don't start the rbv ahead is your choice; not doing so means taking the ifn without  being at rbv steady-state for the first (critical) weeks of tx.

[Marcia2202]

It doesn't matter if you don't space the riba exactly 12 hours apart. If I remember correctly, they should be at least 8 hours apart. it's not such a big deal. I just liked to have it exactly that way.

The first day I took riba am and pm. I did my shot at 3 pm all the way through tx.

Are you going to do Pegasys or Pegintron?

It seems that the reaction to the shots are different. I did my shots on Tuesdays, 'cause I figured that I would like to feel better on weekends. That turned out to be a total flop. That's when I would feel the worst. I was on Pegasys.

It seems like Pegintron kicks in the same day or the next. That's why people on Pegintron usually do their shots on Fridays, so they can go back to work on Mondays.

I wish you good luck on starting tx. Hope you will kick this thing once and forever!

[Bali05]

thanks for the link ! that`s great help !

Shot it over to my Hep-doc right away. On the plus side my glucose,BMI,low viral load
diet ect.... point towards not being IR but I understand how important it is and the
virus can cause this without me having symptoms.

If I turn out IR I will have to look into double dosing INF for better response.
Do you know anything about Metforin (spelling?)

In terms of riba diet , not all fats are bad and when I eat a lot of fat I usually
try to avoid carbs at the same time so fat gets burned rather than stored.

[Bali05]

thanks Marcia

Going to pickup Pegasys180/ Copegus 3x200mg/twice per day from the pharmacy.

They wanted to deliver but I figure I want to know where the source is located.

I was thinking of doing Peg two hrs before bed and take a Tylenol 1hr before bed

and hopefully sleep thru the first attack.Since everyone is different Iguess I have to see

what my sx/reaction/timing turns out to be.

[Bill1954]

Bail, I’ve been using metformin for eight years now, so I’m somewhat familiar with it. If you have any specific questions about it, I might be able to help.

Bill

[Marcia2202]

You might never have any attacks from the peg. The first few shots were totally uneventful for me. I've seen a lot of people react that way. I never took any tylenol for the shots. The funny thing is that I felt like I had taken a low dose of valium after taking my first Riba.

Our bodies all react so differently. There have been 2 people I know about who conked out after their first shot and didn't wake up for over 24 hours. One of them was called on their cell phone and thought they were dreaming listening to music.

Don't want to scare you, but strange things can happen. I was sure not to be alone on my first day, but nothing happened.

[Bali05]

of course

From day 1 of dx  6/09/09 I decided to research and try everything but SOC
because when I asked my first Hepatologist what I would do when I failed
there was silence in the room.....

I might have to go back to those protocols Berkson,Zhang  should
Peg/Rib not work. I am now patient with all these Drs and they support
my decision whatever it is.
It took me a tremendous effort I flew to New Mexico twice to see Berkson and
it seems I can start and write book about all this.

I set my self a time frame which was loosely set by the 12wkAlinia lead in + SOC
protocol. Iwas dx June09 , found out about Alinia trials July09. Believe it or not
it took me until Nov09 until Ifinally had the original Alinia in my hands.
So I started predosing it.
AT THE SAME TIME , I called Berkson in July09 and got first available appointment
Dec09.
I could go on and on and on ....

So you get the picture , I have always looked and will always look at both traditional
medicine as well as alternative.

Now , the question of SOC has been hovering like a dark cloud over my head since
June09 and I knew all a long that the moment would come (unless I miraculasly
self cleared like the "miracle man " himself  LLoyd Wright..............)

So  ,after 9 months of endless tests ( 5 ultrasounds , 2 upper GI endoscopies , 1 CT-scan with oral andIV contrast , 3 FibroSures , 1 FibroScan, to many bloodtests
to count right now ) ALA IVs , Modern Chinese Medicine , HR preferred supplement list ect ect ect...

It was never really a question IF I want to try eliminate the virus but when and how.

And from the looks of it SOC+Alinia  time has come.

Nobody knows what Telaprir is doing for Geno4 and I like the idea of having a planB
in case plan A does not work.

So that is it.

Any particular questions about my experiences so far?

[Bali05]

Thanks Bill , I might hold you to that.

I am going to lab tomorrow to specifically test fating glucose and insulin.

Is this going to give me 100% result if I am IR ?

I have no other indication that I would be ?

[Diane12855]

Thank you for posting that link above. I'm new here and didn't know so much info was available in one spot.

[copyman]

wow!  quite a joruney in such a short time.

you have done a lot in such little time. you have done research and gathered all the information to help yourself.  You know how I feel about berkson & zhang (so does MH that is why they always delete anything I say about it) but I commend you for everything else you did to give yourself the best chance of "cure".

If anyone deserves to be cured of this disease it is you.

Best of luck

[Bali05]

thanks , we all do and some day it will happen.

my big problem at this point is stress (not good)

you have to understand before I was dx the last 3 years I have been battling

my mothers pancreatic cancer. She passed in Sept.08 and strating Jan09

I came down with IBS symptoms leading to HepC dx in June09.

I researched day and night to find a cure for her.By the way this is how I first

found Berkson , not because of my HepC but pancreatic cancer.

We flew her (82 years old on chemo) to Stanford for Cyberknife radiation trial.

Same actor Patrick Swayze had. It gave her one more year.

It took alot out of me consulting with John Hopkins Clinic, Georgetown ect...ect...

Only to now face my own demons.

Since June09 I am trying to find out what this virus is doing to me and unfortunately
it took me 9 months to get the impression
it is progressing fast. This is based on consulting 4 hepatologists, 2 gastros,
2 GPs , 1 oncologist and 1 Chinese doctor (Harvard Grad)
They do not think so ,but I do at this point.

It is my believe that G4 is understudied in terms of severity of progression and
tx response.

None of these physicians really know the whole picture and what I am experiencing
but i do and i have every labtest i ever did and I know what I feel.

OK , so my body will see some INF soon.

I am now interested in getting the last minute prep.:

just found out about insulin resistance factor yesterday and already went to lab this
am for test.

My labs for the past 3 months were all normal ALTs of 29,32 . Now that I am going

to do tx all of a sudden my ALT spikes up to 72 ! At this point I expect my always low

VL (38K,99K,46K)  to spike as well.

It has been a long fight and the toughest battle still lays ahead.

Need to find some relaxation but on the other hand you snooze you loose.

The insulin resistance is a perfect example , why isn`t this tested routinely before

putting people on INF ?

[Trinity4]

I really wonder if those who end up in the Berkson camp following his protocal to the tee actually believe they will be cured?  I'm not talking about lowering enzymes, viral load or living with the virus, I mean cured forever.  Isn't that sad.

[tashka]

No, Trinity, people who go to Berkson don't believe they will be cured; and he doesn't promise or claim to cure anyone.

[nygirl7]

He was so very right and I would more than gladly take my upcomings from him now.  "

Yes but believe me I wish I had never listened about taking as MUCH riba as I did because the six point drop in the first ten days of HGB almost killed me. Thank God I listened to everyone and didn't give up but still I would NOT do that again - even though I was almost UND at week 4 I was not UND till after 12 before 24.  Got stuck at 400 VL and adding all the riba in the world wouldn't matter.

I think once your body DOES reach it's highest level serum concentration that it can the rest is a moot point.  Just so as nobody makes the same mistake as me.  

I found peanut butter and yogurt shakes helped me alot as did ice cream.........you have to know there is enough fat in a bowl of ice cream right ;)

And Trinity I agree 100% it is VERY VERY sad.  But we've done all we can and that is all we can do.  I wish grapefruit juice would do the trick boy that would be some easy course of treatment too right ;) I think some people do not understand that VL and LFTs aren't really much to the story at the end of the day. Sad very very sad.

[Trinity4]

I have done some reading and didn't know if cure was one of those unspoken possibilty.  

I know I don't like his statement of:  "There are no remarkably effective treatments for chronic hepatitis C in general use. Interferon and antivirals have less than a 30% response rate and liver transplantation is uncertain and tentative."

I have never agreed with the 50% cure rate with antiviral therapy.  More like 40-45% and that's under the best of circumstances but stating under 30% is just wrong.
And the percentage who advance to cirrhosis is also low.  Looks like scare tactics to me but hey, he marketing a product right?

Trin

[tashka]

Yes, all of this is correct. But he doesn't say anywhere that he will cure patients of hepatitis C-unlike Lloyd Wright, for example.

Not everybody will advance to cirrhosis, but some people do, even despite of multiple treatment attempts. And he gets these patients. I am sure people do their research before going and understand that alpha lipoic acid IVs can not eliminate hepatitis C virus. Most patients that go to Berkson failed treatment.

[Bali05]

I have met and discussed Hep C with Dr. Berkson in person about 7 times

average visit 1hr and spoke to many many of his patients

So far I did 2 visitis to Las Cruces NM in only 3 months totaling 5.5 weeks

being at his office 5 times/week , two times per day.

I think I can allow myself to have a good opinion about his protocol

and the people whos quality of  live he improves.

This is exactly why I did such an intense program.

If anybody is interested I am more than happy to share my experience

objectively and in detail.

---NEWS FLASH -- NEWS FLASH-- NEWS FLASH--NEWS FLASH--NEWS FLASH--

Just got back from Mt. Sinai Hospital NYC home of famed Dr. Dietrich

Dr. Ds schedule would have only allowed appointment mid April so I took

his collegue Dr. James Park, MD,CNSC (assit. Prof. of Med. Div. Liver)

to perform FibroScan

Result: 10 readings (100%accuracy)  5.9 kPa = F1

My last FibroScan in Aug09 (germany) was 8.0 kPa = F2-F3

Could it be that my approx. 50 ALA IVs reversed some liver damage or

maybe the strongly  targeted anti fibrotic herbal formulas of Dr. Zhang ?

Dr. Park felt very confident with the result and says I have time to wait for better

meds. The fact that my ALT spiked to 72 did not bother him very much since

these enzymes flactuate especially with Hep C and should be looked at

over time not just one reading.

I was planning on picking up Interferon on my way back from Mt. Sinai

but now I have to digest this new information.

What a freaking Rollercoaster !

[Trinity4]

I had a sneaking suspicion something like this may happen.

[Bali05]

unfortunately "sneaking suspicions" do not help anybody with Hep C

but tell me what is your suspicion , I don`t know myself yet what to do or not

to do. Just got back from the hospital.

[Trinity4]

Just the history and ongoing dilemma Bali.  You ultimately have to make the decision.  

Isn't that your third fibroscan now?  All different?  

As they say, the balls in your court along with your doctors, not the members of this forum.  Your are the one that has to take the medications and we already know what the odds are with SOC and the new meds.

If I remember correctly, you haven't had a biopsy?  If it were me, that's the route I would go.  Seems like you have spent a lot of time, money and effort pursuing the best possible options in treating this disease and regardless of what you may think, biopsy is still the gold standard in determining the health of you liver.  That seems like the most logical thing to do given your conflicting reports and uncertainties.

Trinity

[nygirl7]

Bail you realize full well that fibro is not nearly exact whatsoever and in mid-stage of liver disease is often completely and totally all over the place.

This is why we do biopsy because it is the MOST honest way to tell liver damage extent for real - not just guessing at somewhere in the middle.

If you'd had a biopsy and showed me you went from stage 3 to 1 then I would be forced to believe it. But with the disease in hand your liver did not regress that much - it is not possible to happen so.  

Gosh just when I was going to post that i thought you had really made amazing progress in understanding of the disease.  Please note there are plenty of 'my fibro said this, then this' posts all over the internet.

you have learned better by now.

[nygirl7]

So are we to all assume that you've decided not to do treatment now because your liver histology is suddenly and miraculously improving do to the ALA and Dr. Zhangs miracle herbs?

[Bali05]

I discussed bx option with my treating PA.

He agreed that it is not 100% acurate either and ultimately would have to look

at labs as well to evaluate.

I showed Dr.James Park (Asst. Prof.Med.Div.Liver) my bloodwork as well.

He is also telling me why bx ? FibroScan is accurate at dx F4 and F0 and

F1 error margin  would mean I am possibly F2 , in any case time to wait.

Each reading  he took (10) had 100% success rate and a variance factor of 1.4

which is very small and means all 10 readings were close to F1.

I mentioned my previous FibroScan in Germany F2-F3 (90% success rate) before

we started so he really tried to get a good reading.

His comment to why the difference was his readings were 100% success rate

in Germany only 90%.

Anyway another doctor another evaluation.

Need to digest this , or more importantly destress and enjoy the weekend

[Trinity4]

I say no more on the subject then.    

Good Luck with whatever path you choose.

[nygirl7]

Me too obviously you know much more than us and we wish you all the best in the world, hope you know that but I've never ever ever heard of a doctor who thought that fibro was more accurate than biopsy.  Never.  Just so new members might realize this as well it measures best at both ends of the scale (no damage on one side cirrhosis on the other) but in the middle is not accurate nearly as reliably as bx.  (As you can tell by the varied numbers in Bali himself).

Good luck.

[willing]

re IR/metformin/tapering etc: as always, take all advice posted with a grain of salt (maybe two!). IR/diabetes tests *are* routinely applied pre-tx, Drs may not have flagged them in your case simply because with bmi 23, good  diet/exercise it's likely not a relevant factor. Before adding metformin/pioglitazone check the supporting studies. Two of those that found benefit
http://www.ncbi.nlm.nih.gov/pubmed/19919569
http://www.ncbi.nlm.nih.gov/pubmed/19845037
have questionable applicability. Note the very low SVR rates in the control arm for both, and lack of overall stat significance in the 2nd (and associated published comments)
From the Wang/Kao comment to the metformin study:
"The possible mechanisms of improving insulin resist-
ance therefore include metformin itself, concomitant weight loss during treatment, or reduction of HCV RNA level. To further address this interesting and important issue, the authors could provide data for analysis about viral load decline and the amount of weight loss at week 24 of therapy"
Before adding another drug, it's definitely worth evaluating whether it's needed/effective, which does not seem the case.

Riba predosing isn't firmly supported either, but there are scads of results showing (a) rbv effect is crucial (b) rbv plasma levels are variable initially then level out. Put those together and by *not* pre-dosing you're basically using ifn w/o rbv at the troughs before steady state. Benefits of gradual-reduction/tapering on the other hand remain speculative (not a reason to not do it).

Re the new FS,  Dr. Park seems right on point, not because FS 6 vs 8 is significant but because either way you're not in tx-now range. Look again at that Afdahl FS/BX summary from HCV/DART09 - the bottom line is that fibrosis staging and its quantification are very very imprecise/variable. You can distinguish cirrhosis at a cutoff of kPa 12 from everything else reliably (as measured by sensivity/specificity 0.8) but beyond that  trust in precision is unwarranted. From his slide 24
"Fibrosis staging is an inexact and artificial system with doubtful relevance to clinical practice and  significant potential for pitfalls in clinical decision making"

With FS readings of 14/10, I'm quite a bit closer to the waterfall than you are but still think another year or so is no problem. And yes, agreed that adding a bx at this point would tell you nothing new.

BTW - it's great you have access to resources you do, but I can't help think this makes a poster presentation of what's wrong with the US health system...

[Bali05]

everyone is free to believe want they want.

I am just reporting what is happening during my journey.

Dr. James Park @ Mt Sinai told me today he did not believe bx was necassary

in my case and I could wait.

That is just a fact and I have to seriously consider this result.

Why the FibroScan is F1 today and F2-F3 in Aug. Germany I do not know for sure.

All I can tell you is what happend in between.

Believe me I have a lot of ???????? myself and don`t get me started on FibroSure

those were F2,F3,F4  in six months time.

Dr. James Park is also involved in liver transplants so I assume he knows what

he sees.

Honestly even though every MD I showed those F3,F4 Fibrosures (taken 1 week apart)

did not believe it because of my labs. Still when you get a piece of paper telling

you you have cirrhosis it does a number on you phsycologically.

Believe it or not since I got those FibroSure results my ALT literally went from 32

to 50 in two days (got labs!)

I now know I am nowhere near F3,F4 but maybe F2 worse case.

Todays result can not be a complete and utter error.

It consists of ten separate measurements. What , all ten are wrong ?

It also is physical not chemical like bloodmarkers which makes it more reliable.

My BMI is 23 (not obese) rather slim it is very easy to find my liver

I would do bx in a heartbeat if I knew it was 100%

Actually I would have had one if they would have excepted me in the

R7128 trial.

One more thing about Dr. Zhang. I asked him what he would do if he were me

and he replied if I had some time I could try SOC for 12wk to see if I respond.

So did my gastro same comment. One more thing about Berkson

he is the only one not favoring SOC and that

is mainly because of all the failures that he sees on a daily basis and the additional

serious health problems SOC can cause.I really pushed the issue believe me

and in one of our last meetings he said he propably has his view because he

hardly sees any successes because of who is walking thru his doors

By the way at NO time did Dr.Berkson ever

as a physician  tell me not to do SOC , he simply said it was up to me.

Just want to get it straight that people like Berkson or Zhang are not curing Hep C

but they are helping people living with Hep C.

Unlike characters like Lloyd Wright and such. You propably find a lot of miracle

cures in cancer as well or those people who use religion and claim to have the power
of god to cure.

Actually Dr.Zhang and Dr. Jacobson know each other. Dr.J invited Dr Z to speak

at Cornell Medical once.

They even went to the same University , can you believe this ?

[Bali05]

thank you so much for all that good advice.

i will study all the links you posted.

Got a pm from CS applauding your posts as well.

When I asked Dr.J Park today what they test pre tx of course

IR was in the routine which I now know it should be since you can be IR

for no other reason that having HepC. My HepC-treaters should have put

this on my lab menu regardless of BMI ect.... it is to important , no excuse!

Just another wake up call . If it were not for you guys on the various forums

I would not know 75% of what I know today and it keeps going.

[copyman]

I'm sorry but the ride ends here for me.

I'm sure you don't need my help but this is the last time I will try and help you. you are now on this roller coster without me.

You need to step back away from the internet and get it together.

good luck

[mikesimon]

I don't understand why this thread was started - "When and how to take meds ?"

I mean it makes for scintillating reading and it takes up a lot of space but why do you bother asking these questions if you haven't decided to treat? Honestly, it's getting rather boring. Why don't you quit asking all these irrelevant questions and just WAIT?

Mike

[RCM829]

I agree with you Mike, this is all just a little too self indulgent for me.
Good luck to you Bali.

[Bali05]

if that`s the case I am sorry to , I value your opinion
maybe you will change your mind again some day
the ride for me does not end
what whould you do if right before you are about to start tx (actually already pedosing
Alinia) you are being told by a liver specialist you have a lot less damage than you originally thought and you are being told you can wait ?
Especially with new drugs on the horizon ?
Simply did not expect this result today and still need to digest it.
Just because I am not immediately jumping into SOC now like I thought
I was doing does not mean that all the useful advice I received so far is
a waist of time. Quite the contrary and I am better prepared for it whatever
may come

thanks copyman

[Bali05]

I know what you mean.
this post got totally side tracked from its title but i noticed this
happens quite often in this forum

[Trinity4]

That's not true Bali.  Nothing written caused a total diversion from your original question and it does not come as a surprise that there is yet another twist and turn.

As I said, the balls in your court and you have been volleying this ball for a long long time even before these last test results so it shouldn't come as a surprise to you that people are rolling their eyes a bit.  People are different and there as those who run  every scenario by the group and probably need that interaction but the bottom line is we can't make the decision for you.  That is why you have that elaborate team of doctors so ponder the facts and use your own judgement.  Based on what I've seen from your posts regarding biopsy, doctors opinions and fibroscan results, the matter of when and how to take the meds holds no relevance for you in the near future.

Trinity

[GSDgirl]

I think that your doctor should be very qualified to tell you "When and how " to take your meds

[R Glass]

  When and how to take meds ?
After reading this thread, if there is any justice in this universe, 15 minutes should be taken from your life and added to mine.

[Bali05]

"Based on what I've seen from your posts regarding biopsy, doctors opinions and fibroscan results, the matter of when and how to take the meds holds no relevance for you in the near future"

If only that were true. I would want to give you a big hug.

Anyway I learned alot about taking Riba/peg on this post so thank you.
I will definatly looking into predosing atleast a couple weeks at which point
it does not matter to take the 2 doses exactly 12hrs apart and taking it
with a moderate amount of healthy fat helps absorption.

I do not know why but the my PA did not tell me this. he just said to take with
food.

The taking Tylenol part with peg I was told , but everyone can react a ittle different
so I guess you have to experience the effects first to know how to best
time injection.

That pretty much wraps it up .