jmjm labs

[tktn]

jim'
my 4 wk tx labs came back i don't believe so good.i started at 1'987'468 and thier down to 1'400'000.now here is the out of range items from lab corp.
glucose    115     (70-99)
wbc        3.3     (4.8-10.8)
lymph%     19.0    (20.5-51.1)
mono%      14.8    (1.7-10.0)
lymph ct.  0.6     (1.2-3.4)
mch        31.1    (27.0-31.0)


am i dead yet? this is greek to me and my doc is out of town any help would be app. from you jmjm or anybody. the only thing i can see good is im slow to respond.

thanks you guys and gals

[mikesimon]

I trust that Jim will give you a more exhaustive analysis but I will say that your viral load drop would not be characterized as a rapid response and the little drop that you see could be attributed to fluctuations that occur even without treatment. I don't see these results as very encouraging but hopefully you will see a more dramatic drop by week 12. Your fasting glucose (if it is a fasting glucose) is not a positive predictor and you should discuss this with your doctor if this issue hasn't already been addressed. I have no knowledge of your genotype or any other relevant factors so my perspective is extremely limited. Mike

[jmjm530]

Let me re-copy the viral load results because there may have been a typo in your post.

Assuming your pre-treatment viral load was 1,986,468 and your three week viral load is 1,400,000, then yes, the drop is insignificant and so far it's fair to say you're not responding. If these figures are correct, I'd try and have my doctor or nurse contacted to see if any adjustment in meds is warranted, etc. They like to see at least one-log drop during the first month. Don't know what week you're at now -- guessing week 5 or 6 -- but personally, I'd get another viral load test the day before my next shot to have more data for your doctor.

What's your genotype, weight, dose of peg and riba, liver damage? Is this your first time treating?

-- Jim

[tktn]

1b is my geno and my weight is 225 this is my first time tx and i was a 5/6 on a 6 as far as damage. i have had no sx with peg 180 per wk and 1200 per day.

[jmjm530]

Also, missing from your posted labs is your "hemoglobin" value. Do you know your hemoglobin at both week 3 and pre-treatment?

[tktn]

hemoglobin pre tx was the same as after tx started  14.8

[jmjm530]

Given your weight and lack of side effects, you might discuss with your medical team upping your ribavirin. Not sure, but I think you're borderline at 1400 for weight-base anyway and you might be able to tolerate even more, especially if your hemoglobin hasn't dropped too much from pre-treatment. We have some members here on as much as 1800/day. I think that would be Bill, but also flagged FlGuy as I think he's taking more than 1200/day but not sure.

-- Jim

[jmjm530]

Just caught your last post. It appears you may be one of those folks who aren't getting enough ribavirin into their system, for any number of reasons. Some studies suggest that a drop in hemoglobin is a barometer of how well riba is being absorbed and in your case it doesn't seem to be absorbed very well. Are you taking your riba with food that has at least a moderate amount of fat? You also should not be taking antacids or fiber supplements within 2-3 hours of your ribavirin dose. Definitely talk to your med team ASAP about upping the riba based on the combination of your flat viral load curve and flat hemoglobin curve. If your doctors wave you off, a second opinion from a liver specialist (hepatologist) is always an option.

All the best,

-- Jim

[jmjm530]

I was assuming that the hemoglobin you posted was at least three weeks post treatment. It does take a couple of weeks to start dropping.

[FlGuy]

I'm sort of wondering about the reading of that 1,400,000 result.  Do you have the report in hand?  For an even number, that seems kind of odd.  Especially since the pre-tx vl was a quite specific number.  Could it possibly the sensitivity of ther test perhaps.  There are some that have upper limits of 2,000,000.  Are you able to transcribe the result, as printed on the report, to a comment?  And have you re-verified the 'blood draw dates' on those reports to make sure?

BTW, I'm on standard weight-based riba, not an increased dose.  The 1200 seems to be effective, my hgb has been driven to Arnaesp territory.

[tktn]

jim thankyou for your responces. my diet is basic lean cusines not alot of fat because my trig. shot up to 977 before tx.i also got a question for you on ribi. my body chemistry copes better with brand name rather than generic and do you know which ribi is i was thinking copgus  is brand name and i might be just chasing rabbits because all threds seems to be on ribi just a thought. with tricor brand name my trig. came down to 204 last blood test.also my hbp med is brand also does a fine job keeping it down. my weight is droping started at 238 so i believe you hit it right on the ribi amount but what is your thoughts on brand vs generic.
thanks a million'
tktn

[tktn]

my test date was sat 3/10/07 4 wks and 1 day post tx thought i would have a good results that way but like jmjm said whats the use. my test was lab corp


hep c quant pcr   ftnote f
hep c pcr =1,440,000iu/ml

[nygirl7]

There have been studies that say that since riba is a drug that binds to fat for soluability...the best thing is to make sure to take fat with the drug.

Even if it's just some peanut butter on crackers with your lean cuisine (I know it sounds wrong but...in reality with your lack of sides and non-dropping hemo it DOES sound like you for some reason are not retainning the riba).  Treatment can't work on just the interferon - the riba is crucial.

If that drop is correct in your VL - I am quite surprised your doctor or nurse practioner has not contacted you IMMEDIATELY to adjust meds as it is pretty much a non-response.

I would get a second opinion as soon as possible really.  Something isn't quite right and the first 12 weeks response is crucial to your success.

Is there perhaps another doctor you can go for a 2nd to?  Even though my doctor was quite adequate (with my help haha) I did go to a world renown doctor at one point to verify my course of treatment.

Remember - in here we have opinions but NOONE is a doctor.  It would be best to find out just WHY you aren't responding.

My bet is the riba but then...I'm not a doctor and it could be anumber of things.

[nygirl7]

PS NO difference between brand and generic as far as any of us have ever ever heard.  It's really marketing and using different companies with the basic same formulations - like ibuprofen vs. advil - exactly the same stuff - just fancier packaging on the Advil ;)

[Bill1954]

Hmmm, you might be one of us that hyper-metabolizes ribavirin. During my last treatment, my assigned dosage was 1800mg/day, with a body weight of 250lbs. That gave me a ratio of ~16 mg/kg/day. This treatment, I have lost about 65 lbs, and my assigned dosage is 2000 mg/day, giving me a new ratio of ~23.8 mg/kg/day. This is substantially higher than the Standard Of Care, and also demonstrates that at least some of us may require higher doses to achieve full therapeutic benefit. BTW, I have yet to require Procrit/Epogen, with my Hgb values currently at about 12.5 at Tx week 27/72. You might print the following abstract for your doctors review:

http://tinyurl.com/2pzoml

Hopefully, if they have further queries, they can access the full text study through Blackwell-Synergy or full-service Pub-Med.

Take good care, and keep munching those little pills :o),

Bill

[jmjm530]

Yes, the Sweedish pilot study that Bill linked, developed the first very dramatic data on higher-dose ribavirin and influenced my initial treatment.  However, the doses in that study were quite high, and without serum riba monitoring (not avail in this country) could be dangerous. You therefore may want to consider this if presenting to your doctor as he could be scared off. Still, doses like Bill took -- 1800-2000 mg/day, seem a very reasonable compromise for someone who is not responding and doesn't seem to be absorbing the ribavirin very well.

-- Jim