extreme weakness

i received blood tests today. All things are normal but hgb has come down from 12.8 to 12.2 in 2 weeks. Today im feeling too much weakness. I have lost 5 kgs in 7 weeks. sometimes i feel that i m falling down. I m feeling dizzy, faint ,thirsty all the time. I m also facing lose stoll problem. Can i reduce riba dose myself ?? (im on double dose 1200 mg / day, my weight is 48). How can i manage weakness. what diet i should take. i requst every body to give me diet suggestion

[fretboard]

Well you ask if you can reduce your riba dose yourself.  The answer is yes, you control your med intake so yes, but I don't think that's the answer and you could really screw up by doing that.  I think I remember reading that you're using the old INf-alpha that you inject 3 times a week.  That in itself could be the reason or at least part of the reason that you're having such weakness and lowering your Riba dose may do nothing.  Doctors prescribe you a set amount of Ribavirin to attack the HepC agressively.  With that said most doctors haven't tx'ed themselves so they don't really know how bad you feel.  I don't think you should just willy nilly drop your Riba dose, but like I've said before, start taking some amino acids without iron.  Or call your doctor and ask for some Provigil or something that will give you a boost.  Heck even a B-12 shot may help, with weakness, ask him for one if he won't give you the Provigil.  good luck  

[Spazzz]

I am also very tired and short of breath. My Doc did reduce my riba after a few weeks but it was after I was UND,so far so good. I do feel better as my HBG is up a little bit. Don't do anything without speaking to your Doc first

Best of Luck to you. Hang in there!

[epiphiny]

I'm inclined to agree with fret and think it might be the 3 x weekly shots of interferon that you are getting that could be causing this.  My Hb dropped from 14.5 to 9.5  at about week 5  and is now  around the low 10s and while at first I felt dizzy and weak that settled once my body got used to running at a lower level.  I am not taking any rescue drugs for it as they don't offer them in my country.

And yes, you could lower the dose yourself but I would be very cautious about doing that, esp in the first 3 months.  You really need to get to UND to have a good chance at SVR and maintaining riba levels is important.

Are you trying to do too much and are you getting enough rest and water?  You don't say whether you are trying to work while treating and you don't mention when the weakness and dizziness is at it's worst?  Also what is the temperature like in your country as I recall on my last treatment hot weather made me feel very, very bad.  You really need to keep those fluids up, you probably need to be drinking about 2.5 liters a day if you can manage it.

Please let us know how you are doing...

Epi.

[nygirl7]

Dose reductions are one of the worst things you can do on treatment - and a 12.2 hemo is really not that low.  You have to give your body a chance to acclimate to the lower oxygen levels in your blood - they should iron out in time, but you have to take it easy and give it a chance.

Doctors really won't pay much attention to a hemo of 12 - not until it goes down to under ten do they consider it bad enough to medicate. Procrit / Epogen WILL help you however...generally the best you can hope for is to get back up over ten with it.

I don't know why they have you double dosing but there must be a reason. I did and had drastic anemia at week 3 - (from 15+ to 9 in ten days) however I am sure if I had reduced I would not have made it to SVR.

Unfortunately weakness and weight loss are very common parts of treatment side effects - it's just something you have to face and deal with if you want to get to SVR...UND is not SVR and you haven't even gotten to that point yet?

Don't throw in the towel just yet.  Playing with your meds on your own....not a great idea at all.

[jankar]

Hiya.

I was feeling weak and dizzy for a week or so about week 5 and am now feeling less dizzy in week 6 - it seems my system has got used to whatever is happening, as people suggested.  My bloods were low but not too low to reduce the riba at that time.  Anyway I decided to hang in there and it did get better.  I try to drink as much as I can, take lots of paracetamol, panadol and also Ibuprofen - every four hours when things are really bad and that helps a lot.  Also sleep when I can, rest.

I did have about 3 or 4 red meat (beef and lamb) dinners in the last week, plus I seem to be craving egg sandwiches.  Normally I eat a lot of eggs but not a lot of red meat, or even meat at all.

I am still weak - cannot walk at all without getting breathless, but happily not dizzy all the time, which is a definite improvement.

take care

jankar

[alijee]

Yesterday my weight was 50kg (reduced 1 kg in 35 days) which is not so fast reduction. i was expecting to be 48 kg due to weakness. I m so sorry i told you all 48.
During week 4,5 my hgb reduced 14.5 to 12.8 so it was very bad. At week 6,7 it was little better. week 8 is again very bad and my hgb is reducing to 12.2 again. whenever my hgb gets reduce i feel very much weak and itching and un-easiness all in my body. My heart beat is often 80-85 / minute even if i m in the bed. sometimes it comes down to 60. I have to go for work. i m computer operator. i m asking my boss for 3 months leave.  Before tx i use to go to office on bicycle. The distance is 3 kilometer. But now i go to office on taxi. i hardly go from the main gate of the office to my room. i sit in the office  and lay in the bed at home all the time and dont walk much, but still tired and weak. I drink 3-4 litter water per day but still thirsty. What is it? i have some questions waiting for answers.

-can i get blood transfusion now at 12.2 hgb level?
-can i eat eggs, butter  and meat a lot? i have heard that these are not useful for liver.
-what is the cause of palpitation and itching in all my body.
-how long you all people can walk? i hardly can walk 15-20 meters.
-Can i change my doc? my present doc is MBBS, FCPS not GI.

[IAmTheWalrus]

I sympathize with your symptoms. I have many of the same.

Usually a transfusion is considered for hgb < 8.  A Hgb of 12.5 really is not too bad compared to most on TX.  Procrit/Epogen have a possibility of stroke if they are admisistered with hgb levels that are not low. See the FDC warning on the subject:

http://www.medpagetoday.com/ProductAlert/Prescriptions/5231  

I was told by my hepatologist it was not dangerous to use Epogen to get hgb back up to 12, but should be discontinued unless/until hgb dropped again below 10.

Many of the symptoms you feel may be because of side effects of interferon and ribavirin and not necessarily due to anemia.

"paracetamol, panadol and also Ibuprofen"
Too much of these drugs (acetominophen, paracetamol, panadol) can damage the liver. They may relieve pain but will do nothing to combat fatigue or breathlessness.

"itching" is a common side effect from the Tx drugs. I have heard a lot of remedies for this on this site but do not have personal experience except for the topical applicatioin of a 1% hydrocortisone.

Some people feel little effect of TX on their lives. I think it is fair to say this is not typical and most seem to suffer more than just a little. I can walk a mile if I have to, but a few steps up the stairs leaves me breathless.

I don't know the situation with changing doctors in Pakistan. In the U.S. this is usually allowed but may have some financial consequences due to insurance coverage, or lack of it. In the U.S. it would be better to see a specialist (hepatologist or GI).