riba dosage

[rita863]

Just got back from the dr. I was there last week after blood work, and the sides to riba.  He dropped it 800mg.  I got a second opinion and that doctor agreed 800 was fine, based on my weight.  now he wants to drop to 600 because my count is down

any help is appreciated.

peace
rita

[rita863]

thanks Trish i appreciate everything you have said, and i think you have given me very sound advice.  I am not dropping the dosage, i will go friday for the blood work and see if he calls me to say my numbers dropped or stayed the same.  my next appt, if there are no problems is three weeks.  

i may just have to philly to the other doc, after all this 1/2 point and if at all possible i would like to tx only once, so i want the best treatment possible.

thanksfor being so patient.

hope your shot goes well,

hugs to you

peace
rita

[Trish77]

Thanks for your patience in answering my questions.  That clarifies a great deal.   This "old doc" of yours was the same one who wanted to reduce your dosage because you had mouth sores, I think it was, and he told you they wouldn't go away unless you stopped treatment..something like that, if I recall.  

I'm only going to tell you my opinion here. If I were in your shoes... I wouldn't dosage reduce with the information you've given.  You're not at any risk from the sounds of it, you're tolerating your sides well enough....he wants to drop your dosage based on what, I still don't understand, because your hemoglobin looks okay and dropping your riba isn't going to impact your ANC the way dropping your interferon would and there's a body of thought out there that says no response needed until your ANC gets down to 500 or so.  

How often is he monitoring your bloodwork?

If I were in your shoes, I'd get your doc to explain better why he insists on this dosage reduction, which drug he's talking about reducing .. and maybe you might want to consider going to this other doc permanently .. sounds like you're right back in the same boat again.

I drive an hour plus for my care and it's worth it .. I'm in a trial but I didn't know I'd be in a trial when I hooked up with these docs.  I just wanted good care.

Alot to think about.  My shot night too, btw....so set all this aside for now....and let's get 'er done, sweetheart.  :)  Hang in there.

Trish

[rita863]

they both agreed that 1000 was too much so they dropped to 800, i was ok with that being that it was eweight based,  the new doc was in line with what my doc was doing so he said i didnt need to change (the comute to the new doc is about an hour)  now i went to my old doc just for my routine and he want to drop to 600...thats what i am concerned about

[Trish77]

Did the doc already drop your dosage?  Is this the doc you went to for the second opinion?

[rita863]

my sides have been really mangeable for the past two weeks, i havent lost weight for past  three weeks, i havent missed worked,  i basically have felt the best i have since starting TX  they are doing blood work next friday, to see if the lower dosage of riba (600) which i dont want to do,  has an effect on the blood work next week.  does that all make sense?  

they really have me nervous tonght, and its shot nite!!!!

[Trish77]

Thanks Rita .. your hgb looks okay .. 11.3 is getting down there but you're not in the 10's yet .. your ANC is getting down there and some docs get a bit concerned around that mark.  I say concerned.  Some docs take measures there and some docs don't...seen a number of people posting that general thought seems to be you can go down to .5 .. 500 .. before having to respond with rescue drugs.

Wondering which count specifically your doc is worried about?  AND....wondering how you're holding up with the side effects?  Reasons for dosage reductions are not only counts going down but also how someone is doing in the total picture with other impacts on the body due to the side effects.

You do want to keep an eye on that ANC.  That's going down.  That's the true measure of  how your white blood cells are doing.

(Anyone else who can elaborate better, please kick in.:)

How often is the doc doing your labs?

[rita863]

wbc     1.8
rbc       3.62
hgb      11.3

is ANC  absolute neutrophils if so its 898

ALT    22
AST   23

doe those help you?

[Trish77]

I don't have long distance at the moment.  I know. Odd.

Anyway...your blood test will have the letters beside it and the corresponding numbers.  Should have ANC, WBC, RBC, HGB, things like that.  If you see that and the numbers, post everything you've got and we'll try to help you out.  Does that work for you?

[rita863]

can one of you call me i am on my daughters computer and its a mac i dont what i am doing pm and i will give you my number.....all these numbers on this test have me really confused

[Trish77]

Rita, how is your ANC and your HGB?  And how are your side effects?  How are you managing in other ways?  Any other complications?  Did the doc express any concerns beyond that your counts are down?  And which ones is he concerned about?  There's a whole complete picture to take into account. It isn't as simple as "all dosage reduction - bad".  

Take care.

Trish

[jdwithhcv]

hemoglobin, hematocrit, red blood count, white blood count

[rita863]

im confused what numbers do you want?


deb and jd i am pm you

[nygirl7]

Agree with JD 100%.  

Dr. Ira Jacobson agrees that weight based is perfect however the best thing you can do is to NOT dose reduce. I asked him at my visit (in my list of questions that are commonly asked on the forum...hey I wanted my $600 worth of information for that one visit!!!  :)  ).

What is your hemo? Does the doctor understand that most of us go through this and at 10 we are given Epogen to manage the anemia?  My hemo dropped from 15+ to only 9 in the first three weeks of treatment however i did NOT reduce the riba and I would have found another doctor if he tried to make me do so.

I would not let them drop you to only 600 - you are then taking chances with your odds of being able to achieve SVR.  I am 5'7 and weighed 120 when i started and I insisted on extra riba when he tried to put me on only 800 - seriously.

[jdwithhcv]

Which count is down?  Hgb?  What are the numbers?  Have you discussed rescue drugs with either doctor?

As I understand it, you should take the full dose of riba or as much of that dose as you can possibly tolerate.  Ask about procrit (assuming its your hgb thats down) if you're not already taking it.

jd