round 2 advice and other IR stuff

not really a question,... just wanting some opinions...

I figured when she told me "all of my patients clear" , she meant the ones that last the duration of 12 weeks with svr.... well duh... .. talk about spin.

cw - I am exercising now on a treadmill that they have set up for the teachers where I teach.. even has cable tv!  very cool.

my glucose is still high in the morning, 110-120, even thought the metformin has been doubled and I am exercising... maybe it takes awhile?

HI apache!  yeah, i remember all that.

I am just hoping and praying that IR is the reason I failed.

As far my doctor goes... of course I am getting a new one... and am seriously thinking of trying to talk my pcp into treating me, as he is quite open to all options.  I think he would probably do anything I asked as long as I can back it up with studies , etc.
It is just too hard to run around trying to find a gastro or hepa that is willing to work a little outside of the box... many seem to be content with just following standard protocol.. I guess they reluctant due to lawsuits.

My liver doc does want me to come back in , in april for an ultrasound... probably worthless, although I have had an ultrasound tech that an ultrasound will show a fatty liver as well as liver cancer.

I am going to try an wait on the polymerase/protease inhibitor combos for round 2.
I just don't have much faith in the infergen, or a retreatment with riba/inf.        any opinons?

thanks,
bandman

[lalapple]

hmm.... it really depends on what you want to do with your life right now, continue txing, or move on?  that's a really big decision to make and i trust you will make the right one.

best of luck

[Kristina538]

I don't know whether IR makes a difference with the PI's??   The earlier we find out the realtime date when the PI's are SOC, so many plans will be able to be made for so many.    Hopefully a new doc can assist you with the decision making.  What was your last biopsy result?   Sorry to hear what you've been through.  

A lady I've met was not UND at 12 weeks, and her docs are very hopeful (can't give her any 'promises' but are already congratulating her on her progress because of the 2 log drop.   It's such a hard decision and perhaps a 'second' opinion would be good.  Good luck.

[apache1]

bandman, good to hear from you.

Well here is my opinion.

Don't exactly remember your bx, but seem to remember you had very little liver damage.

If I myself was going to do the watch and wait, I would verify with multiply corresponding tests( fibroscan, fibrosure, bx..etc.,at least 2 of them)  that I am under stage 2-3. I hear of way to many people 'mysteriously' progressing almost instantly to a much higher stage of liver damage. My Dr chalks that up to error rate on BX. Hence my reason for multiply tests. This is way to important to make a mistake on damage, and consequently make a mistake on tx delay.

Its good you are keeping your IR under control, since on triple therapy with the new drugs, you will also need to respond to inf.
This is a catch 22 though, since HCV causes IR and once you clear the HCV you probably will not be IR anymore. Maybe Co will maybe chime in on this and explain better.

If you did decide to treat again now with soc and your IR under control you might be RVR. If not RVR or at least cEVR I would stop tx and wait for the PI drugs added to soc.

But on the other hand, with the new drugs right around the corner and shorter duration tx, you might be better off waiting and watching carefully if you have a verified lower damage bx. This is a very important decision you have to make with your Hepatologist.

Anyhow, very happy you found out about your IR. This is a very positive finding as far as you being able to clear HCV ...with combo therapy or the new triple therapy.

apache

[bajawoman]

Great News!
you brought your HOMA down, and in a very short period of time. That is the first step for sure in getting ready to tx old or new drugs

Does your insurance coverage require you to have a GI or Hep Doc?  My GI is now really responsive to IR and ordered a Insulin and Glucose blood test the last one I had to do myself  so now my Insurance will cover it  He is discussing IR with his colleagues in the Mainland Mx

What are you waiting for  Vertex?

I am also going to wait, until my HOMA is normal  Now to convince my Insurance Co through my doctor  to treat with newer drugs but I have time to work on him  with research back up

Already I  feel the difference with the IR diet Thanks for recommending the book don't like any of the receipes but getting creative with eating right Most Important life altering change besides excercise

Are you taking any Sups? I am sure feeling better these days and have my regime down now after experimenting with like  which ones to take in the morning and at night and which ones with food etc.  and feeling now comfortable with the program and notice the change in me for the better  

then the IR Diet which works Co!, cutting out caffeine and adding SAMe Sups in the morning I do not need any Xanex as I do not have any more panic attacks

I have a lot more energy and am able now to actually program excercise into my life  it is such a mental challenge more than physical but the two sure go together hope the pain level from excercise is more tolerable now    

getting my waist back is happening slowly just from the diet and sups so combined with excercise feeling better makes pain levels better too

We  should be in great shape in a year with the pre-tx plan

Noticed on the ALA bottle not to take with medicines like Metaformina
Really into reading labels these days
Looking forward to CS's progress to SVR

So do you have a Marching Band?
baja

[desrt]

Exercise: good.

Metformin: good.

What's your diet like? I've found that limiting carbs is also critical for keepng things under control.

apache1: I'd be interested in reading any studies that show SVR eliminates IR. My IR didn't progress to full diabetes until I'd been clear for five years.

[portann]

This is really great news. Thanks for sharing.

I remember you already had the meds in your fridge but despite that, you stepped back, did tons of research, travelled far to see HR and realized that investing in your health prior to tx would maximize your odds for success.

I'm cheering for you. You re-charted your course, all for the best possible outcome. And the bonus is you feel better already.

Port

[apache1]

desrt, interesting.
What stage were you before you cleared ?

I could be mistaken, but seem to remember Co posting many of those studies here on the forum. Think one mentioned exactly what you are asking for. Maybe Co will chime in.

I will also look for them. Might take a while, since Co has posted many many IR studies, and its also possible that its in one of the many abstracts about IR I have read from abstract central, liver meetings, or other sources. But pretty sure I have read of one study being done that showed a marked improvement in IR after SVR. Think that the IR drugs were not needed for many after SVR was accomplished.

apache

[bajawoman]

Thanks Port  
Yes the meds are still in the fridge can't give them back, Insurance politics you know like Safeway cannot give away the food that is to old to sell but very usable going to sneak them to my GI for his fridge if needed by a patient?

Thanks for the cheering section I am happy to have it  

Co, CS and HR have been of great help to me to understand my situation and of course all the info on MH and to Bandman for recommending a good book

The book that Bandman recommended is
"The Insulin-Resistance Diet"  

Being a Yo Yo dieter all my life
this is the first book that really explained BALANCED EATING the information is written like learning a second language book format
same info over and over again explained in interesting  different ways that keeps you reading and the mind does not have a problem accepting it and re-vamping old diet habits with ideas that work

It is written for the general public and very beneficial for everyone to read especially PARENTS
The Insulin-Resistance Diet the quote is: "how to turn off your body's fat-making machine"
authors:
  Cheryle R Hart and Mary Kay Grossman
baja

[desrt]

My last biopsy before tx showed "mild fibrosis, no cirrhosis" - never given a stage and grade but was probably infected for 30 years.

[bajawoman]

Hope Co chimes in
Just  a naive opinion but from what I understand you were most likely IR before and during tx and
after SVR  maybe less as I have read the studies from Co about that but do not have copies

IR still there  after you cleared but you and your doctors  were not aware as you  did not have the proper tests I assume  to know it  but then IR was not a factor for some doctors until recently

The IR progressed eventually to full blown diabetes even with SVR but took 5 years in your case
it was there all along  having the virus in your system for 30 years did not help as it most likely caused the IR problem in the first place as in my case

Which is why Co is so insistant on getting a HOMA test there are so many studies available to back up her theory  
Since your liver damage was so low even with IR you cleared that is the great news

protien carb fat balancing with diabetes is very important

best of luck to you
baja

[nygirl7]

A lady I've met was not UND at 12 weeks, and her docs are very hopeful (can't give her any 'promises' but are already congratulating her on her progress because of the 2 log drop.   It's such a hard decision and perhaps a 'second' opinion would be good.  Good luck. "


you know this is why the studies suggest doing the 72 weeks.  I didn't WANT to do the extra time but I DID get SVR and in the end that is what matters.  Once you are already on treatment and accustomed to it's problems and the fixes...it seems much easier to me to continue and extend rather than risk failing and REtreatment.

You should advise your friend to read the Sanchez Tapias and Berg information that is out there.  The extension really DOES give a better chance for those of us who did not clear by 12 but are clear at 24.

[bandman54]

If I myself was going to do the watch and wait, I would verify with multiply corresponding tests( fibroscan, fibrosure, bx..etc.,at least 2 of them)  that I am under stage 2-3. I hear of way to many people 'mysteriously' progressing almost instantly to a much higher stage of liver damage. My Dr chalks that up to error rate on BX. Hence my reason for multiply tests. This is way to important to make a mistake on damage, and consequently make a mistake on tx delay.

Its good you are keeping your IR under control, since on triple therapy with the new drugs, you will also need to respond to inf.
This is a catch 22 though, since HCV causes IR and once you clear the HCV you probably will not be IR anymore. Maybe Co will maybe chime in on this and explain better.

"If you did decide to treat again now with soc and your IR under control you might be RVR. If not RVR or at least cEVR I would stop tx and wait for the PI drugs added to soc."

Apache - I do not know what cEVR even means... thats a new one... but I am really leaning toward waiting.



"But on the other hand, with the new drugs right around the corner and shorter duration tx, you might be better off waiting and watching carefully if you have a verified lower damage bx. This is a very important decision you have to make with your Hepatologist."

I don't have a hepatologist... there was one on staff , and I got a charge from him at every visit.. but I never even talked to him... saw him  in the hallway once.... I would like to think he was reviewing my chart... yeah right.


This is why I am seriously thinking about talking my pcp into treating me next time.. he is so open to new things and ideas.  I mean, cs has already done all the work!  lol.  I could just cut a paste!

Its good to hear from you!  Are you still minus your belly?? Mine is starting to creep back... I decided it was the protein drink that was responsible for this and have started that back up.

I will definitely talk to my soon to be ex-doctor about another biopsy... I don't think there is a fibroscan anywhere in arkansas....... I get so sick of hearing them talk about the biopsy being the "gold standard"... at 70% accuracy.... not the kind of gold I want.

bandman

[bandman54]

yes, I do take sups... pretty much everything that gauf and cs recommend...  I like the SAMe as well , but god it is expensive.   I was doing some herbal suppliments but got scared of those and quit em all, although I still do a little reishi mushroom extract on occassion and lots of green tea and stevia, of course.

I do not have a marching band, but we do have a concert band, jazz ensemble and drumline where I teach....

keep me posted as far as your plans go, we are kind of in the same wait and see situation.

bandman

[bandman54]

I think i have a very good diet...  whole grains, vegetables , fish, I rarely eat beef and never eat fried food.  I do eat fruit but not to an extreme due to the IR.  I also balance my carbs with protein.     No sugar, lots of green tea and maybe 2 cups of joe per day., sometimes none..... I know, coffee is a big no-no for IR.  I am weak.  lol.
bandman

[bandman54]

ps -  what is ALA???

and to all, I never even got a 2 log drop, so the duration thing seemed to be irrelevant to the lady in charge of my tx.
She mentioned infergen at my last visit but we both kind of agreed that that was too brutal and pointless.

but here is the deal...that I keep going back to...
what if I did not get the 2 log drop due to the IR???? and then I think, well lets try it again and just got the 12 weeks and see what happens???

arrgghhh.
bandman

[bajawoman]

ALA  is Lipoic Acid I am taking super R-Lipoic Acid the  short name R-ALA 300mg caps
but it has a warning I noticed to be careful using it with drugs like Metaformin

I take the ALA with TMG and SAMe you need to take Folic Acid and vitamin B12 with these to work better do these in the morning
along with many others
then only the TMG , ALA and the B12 again at night along with many others don't take the SAMe with Lexapro doesn't mix also do not do the green tea at night as I sleep better
yeah sups are expensive especially because insurance won't cover them and I am taking a medicine cabinet full

Yeah we are in the same frame of mind I get nervous about the wait  
Having a Hep B panel done I really want to know if I have both also  along with a follow up insulin and glucose tests plus CT scan
My GI is starting to be cooperative seems I got across to him about the IR
Baja

[bandman54]

oops,  am taking lipoic acid... is this  a problem with metformin??

bandman

[apache1]

quote from bandman:early virilogical response,
=============================================================
Apache - I do not know what cEVR even means... thats a new one... but I am really leaning toward waiting.
=============================================================

cEVR = complete Early Virological Response =  (und by wk12 of tx)
vs
EVR  =  2 log drop by wk12 of tx

Ya, don't blame you for leaning that way.
If I were in your position, probably would lean that way too.

apache

[CoWriter]

"am seriously thinking of trying to talk my pcp into treating me, as he is quite open to all options.  I think he would probably do anything I asked as long as I can back it up with studies , etc."
--------------------
For Pete's sake...this is the man who didn't know how to read the results of a 2 hr GTT.  He didn't recognize hyperinsulinemia even though it was pulling on his lab coat saying, "Hi, I'm hyperinsulinemia and I'm making your patient's blood sugar go way down and he's about to pass out in the lab".

It isn't just about finding somebody who will agree to what you want....but finding somebody who will know how to treat the side effects that happen from going outside the box.  And your doc wouldn't.

An ultrasound isn't worthless.  It's a way of ruling out cancer...and yes, it can tell you if you have fatty liver.

I agree with apache, a fibroscan would be a good idea.  Maybe you can find one...in the next state?

You have time to wait.  First of all, wait to see how CS does.  He was IR and failed twice and he didn't get a 2 log drop either time.

I really think his tx plan is going to work.  I started helping him do the research in August and by then he'd been researching for months.  It isn't just what the plan includes....but all the things we looked at.  

The last two times he treated he had no side effects.  This time he's not feeling well at all.  I think he'll RVR (clear at 4 weeks)....if he can deal with the mental stuff.  Seems yesterday I was the wicked witch of the west (yeah CS, and your little dog too...LOL)and today I'm back to being good witch...LOL  

Co

[CoWriter]

"I don't know whether IR makes a difference with the PI's??  "

------------------

IR causes the pancreas to make too much insulin....and high levels of insulin make the interferon ineffective.  And you will still need to use the interferon with the PI's.

Co

[CoWriter]

"This is a catch 22 though, since HCV causes IR and once you clear the HCV you probably will not be IR anymore."
-------------------
I believe bandman is already diabetic.  He had a fasting blood sugar of 130 (two consecutive readings above 126 is diabetes), and he was already on Metformin.

For him, SVR is not going to make it go away.

Co

[CoWriter]

"the IR Diet which works Co!, cutting out caffeine and adding SAMe Sups in the morning I do not need any Xanex as I do not have any more panic attacks"
--------------------

That is wonderful news.


"don't take the SAMe with Lexapro doesn't mix"
---------------------

I can't believe I didn't  see that before.  SAMe is not supposed to be taken with anti-depressants because it can cause mania.  I'll have CS ask HR what to do.


" Which is why Co is so insistant on getting a HOMA test there are so many studies available to back up her theory"
--------------------  

It will happen....one day....

This comes from a panel of drs discussing IR.....

"Dr. Harrison: The bottom line for me is that you should be testing for insulin resistance. Baseline, when you are ordering a viral load, getting a genotype, checking the CBC, the platelet count, that sort of thing. I think throwing in a fasting insulin and a fasting glucose, but ensuring that it is a fasting glucose, and by just adding a fasting insulin, I think gives you a tremendous amount of data that could be used. Whether or not you decide to treat the patient, that is a whole other discussion about how to address the insulin resistance if you are going to treat the patient. But I think at this point there is enough compelling data with fibrosis progression, and with outcomes. If you are going to tell your patient what their probability of a response is, how can you do that if you do not know if they are insulin-resistant. The IDEAL study was recently published. It did not collect insulin, it looked at fasting glucose, showed a significant reduction in SVR with fasting glucoses greater than 100 mg/dL. You could argue that maybe just getting a fasting glucose would work, but I still think you are selling yourself short if you do not get a fasting insulin."

http://cme.medscape.com/viewprogram/17843_pnt

Co

[CoWriter]

"I remember you already had the meds in your fridge but despite that, you stepped back, did tons of research, travelled far to see HR and realized that investing in your health prior to tx would maximize your odds for success. "
---------------

CS and I "adopted" Baja.  Why her?  We never believed her Fibrotest results.  Based on her multiple symptoms we thought she must be more advanced.  

Here was a woman who clearly didn't feel well....about to start a tx that would make her feel even worse....with a doctor who had no experience treating....and she was so willing to do whatever it took to make things better.  

I remember CS telling me, "Tell her what you think but don't scare her".  And then of course I would worry about that....LOL

She has worked very hard.  We're very proud of her.

Co

[evangelin]

I found something about taking Sam e with an anti-depressant.  Joe was taking 800 mg. along with Celexa for quite a while with no apparent problem.  I talked to a pharmacist who thought it would be ok.  From the sound of this article, they have experimented with even higher doses.  Swanson vitamins had their 400 mg box for $12.??(can't remember the cents) but it was the cheapest price I had ever seen.  We had quit taking the Sam e for a while because of the cost.  
After 9 months of pegasys /Riba and Alinia Joe was still detectible so they have switched him to daily Infergen and I bought some more Sam e and will try 1200 mg for a while but I don't think it would be a good idea to stop the Celexa.  This article below gives me some peace about it.
  

SAM-e Offers Hope When Antidepressants Do Not Work
New York NY, 5 May 2004
Source: CO2

Research at Massachusetts General Hospital indicates that antidepressants used in combination with dietary supplement SAM-e were significantly more effective in relieving depression than medication alone.

Study Findings Presented Today at the American Psychiatric Association Annual Meeting in New York City

More than 18 million Americans a year are diagnosed with major depression. Five out of 10 of those people will not respond or will only partially respond to standard antidepressant treatment, or they will discontinue use because of side effects.

The Boston-based Massachusetts General Hospital (MGH) study findings presented today at the American Psychiatric Association Annual meeting indicate that the addition of dietary supplement S-adenosylmethionine, better known as SAM-e (pronounced "sammy"), to a patient's current selective serotonin SSRI (most widely used antidepressants such as Zoloft, Paxil, Prozac) regimen, improves patient response.

"The SAM-e/antidepressant combination was comparable to that of two antidepressants, with faster onset of action and fewer side effects such as weight gain and sexual dysfunction," says Jonathan Alpert, MD, PhD, associate director of the depression clinical and research program at Massachusetts General Hospital and lead investigator of the trial.

"It is common practice for physicians to add a second agent with established or putative antidepressant properties when one alone does not help a patient," adds Alpert. "Recently, interest has increased in adding dietary supplements and other complementary therapies to current treatment options."

"SAM-e is known for having few side effects and being well tolerated," says Maurizio Fava, MD, associate chief of psychiatry for clinical research and the director of the Mass General Hospital Depression Clinical and Research Program. "Based on the trial results, we feel it may be a more acceptable solution for patients who require combination therapy."

Study details

The open trial was designed to evaluate the safety, tolerability and efficacy of oral SAM-e tosylate as an antidepressant adjunct. The trial included thirty patients with current Major Depressive Disorder (MDD) despite an adequate dose of a single Selective Serotonin Reuptake Inhibitor (SSRI), the most common class of antidepressants or venlafaxine (Effexor XR). The patients were given 800 to 1,600 mg of SAM-e over six weeks. The mean patient age was 48.4 +/- 13.0 years.

The primary outcome test was the number of responders and remitters. A responder was defined as someone with a 50 percent reduction in HAM-D-17 score from baseline to endpoint. A remitter was defined as someone who had a final HAM-D-17 score greater than or equal to seven. (Overall, 93% of patients improved. See results, below).

Secondary efficacy measures included the Montgomery Asberg Depression Rating Scale (MADRAS), the Clinical Global Impressions—Severity (CGI-S), Improvement (CGI-I) scales and the 90 item Kellner Symptom Questionnaire (SQ).

When used in combination with prescription antidepressants, SAM-e was associated with a 50 percent intent-to-treat response rate, acceptable tolerability, no weight gain, and statistically significant reductions in reported sexual dysfunction, anxiety symptoms and serum homocysteine levels.

No patient experienced a serious adverse event. Moderate side effects reported in the trial include constipation, GI upset and headaches.

Pharmavite LLC funded the trial and provided the active ingredient. The promising results of this preliminary study provide the basis for a larger, controlled follow-up study that is being funded by the National Institutes of Health.

About SAM-e

S-adenosylmethionine (SAM-e) is a naturally occurring methyl donor in mammals and has been available in the United States in recent years as a dietary supplement.

SAM-e is involved in more than 35 biochemical processes in the human body. SAM-e's broad metabolic role in all tissues, including the brain, suggests that its antidepressant mechanisms may include increasing the availability of neurotransmitters, such as serotonin and dopamine, as well as increasing the number of neurotransmitter receptors.

In December 2002, the Agency for Healthcare Research and Quality (AHRQ) reviewed 39 placebo or active-controlled clinical trials, involving a total of 2,485 patients, on the role SAM-e has in treating depression. AHRQ concluded that SAM-e is more effective than placebo, and is as effective as standard prescription medication for treating patients

[portann]

Thanks, Co. That was tons of valuable input you provided last night while I was doing diddly-squat. I wish you would adopt me, too!

Hope CS is feeling okay.

Sending you sugarless kisses,

Port

[CoWriter]

You have impecable timing.  Thank you very much for the article.

Co

[CoWriter]

"Sending you sugarless kisses"
-----------------

This one time, I was teaching a diabetes class and it was close to Valentine's...and some of the people in class, asked me, "What are you giving us for Valentine's?".  So I thought I better look into it.

I went to this very nice candy store.  You know, the ones that have all the fancy, very pretty candy.   I told them I was a Diabetes Educator (you'd be surprised how well we're treated because we can promote their product in our classes) and wanted to look at their sugarless candy.

They took me in the back of the store, showed me how they made it and said I could have free samples for my whole class.

On Valentines day I explained to my class that anything that contains calories will raise your blood sugar.  For example, a sugarless cookie is made with flour, eggs and butter and all those things contain calories.  So even though that cookie has no sugar, it will still raise their your sugar.

Then I told them about my visit to the candy store and gave them a list of the ingredients used to make the sugarless candy...which included mannitol and manilol.... dehadrating agents which can cause diarrhea.  And since I liked them alot, my present was not to give them diarrhea.....LOL

Now....about those sugarless kisses....

LOL

Co

[bandman54]

co -
I don't know if this is true or not , but the IR diet book I just read said that  artificial sweetners "confuse" your system and cause you to produce too much insulin...  do you think that is possible.  I used to drink diet cokes, but quit over a year ago.
this book also says that caffeine stimulates the body to produce insulin as well.  possible?

also, is SAMe ok with celexa? I have been taking both and do not feel maniacal at all.

hmmm.

baja - could you please pm me details on how you went about getting a fibroscan... and anyone, is a fibroscan more accurate than a biopsy??

thanks,
bandman
bandman

[bajawoman]

About artificial sweetners  this I heard from my  true years ago from my Brother who besides being a musician wrote medical papers that are in UC at Berkeley
that it is better if you are going to go for a soda drink it with sugar  
however all cabonated drinks are not that healthy at least this is my Dad's opinion  He would not allow them in the house growing up bireley's orange was ok as it was not carbonatet had sugar though  thinking back I think we all ate healthier in the old days

SAMe bothers me with the AD lexapro didn't set well today taking the SAMe in the morning going to take it later in the day as I take lexapro at night before bed  think they need some spacing  for me

In my opinion after having a Fibroscan I do believe they are more acurate over all  but bx has it's place too   I will be following up with a Cat Scan soon if it showed abnormalties I would I guess get a bx will PM you

If you read the labels of the Sups they do tell you what to take with and what not too mine do but mine are from Lef. on line Lef.com Resveratrol I get directly from the company that makes it as they have stronger doses  I am still not up to the 2000mg a day recommendation but working on it

baja

[jmjm530]

First, I think it's wonderful that you have taken things into your own hands and proceeded beyond what was offered by your original doctor in Mexico. Both the scan and your diet/nutritional program seem very positive and to be working.

That said --  and as I mentioned to you last year after your scan was completed -- you still need a traditional needle biopsy to reconcile things. Call it a "reality check" or simply call it Hep 101 for someone your age with potentially signficant liver damage. But whatever you call it, I would not put it off, especially since you have gone so far. Getting a CatScan at this point IMO serves no purpose other than to give you some unnecessary radiation.

Is it possible you can get an appointment with a top hepatologist in the California area to review your entire case plus your scan results? This would be my strong suggestion and I would not wait any longer. My gues is they will recommend needle biopsy and frankly I don't see any downside only an upside. It will also give you an opportunity to meet and evaluate a hepatologist who could then quarterback your treatment should you start treatment in the future.

All the best,

-- Jim

[bajawoman]

thanks for the post Jim  wish my insurance worked in the states to do just that but who knows maybe business will pick up and I can afford to go for the medical help you suggest  Working is a major factor for me now and I work 7 days a week off to work now .  
lived here for almost 25 years so no benefits here or on the other side of the border Just the insurance that covers me here If I can get my GI who is my registered insurance doc to order a test here in Mexico
I can have it and it is 100 percent paid for

tried to talk him into a MRI which was recommened and  which we have here now but he did not go for it insisted on a Cat scan to see my liver and pancreas etc.
will check it with the MRI too maybe with time I can convince him    

( I do not think any of the male dr. or dentists need a vasectomy they are radiated sterile)  
I have had many x-rays here also many scripts for penicillan the all around health cure  remembering the first mamogram (mammogram) I had on an old out dated xray table machine ouch would be hirlarious if it wasn't my body  
took three times to get it done if I live to 80 it will be a miracle  

I was always self employed in the USA  but will look into SS which I paid into so many years ago maybe I can qualify for some help not sure
doin the best I can with what I have to work with  thanks jim I know you care

[jmjm530]

Baja,

I understand the limitations you have, but you seem like a resourceful person when motivated -- like your scan in CA and diet, etc -- so I'm thinking you just need more motivation :)

You're in your 60's and may have significant liver damage. In spite of all you're doing by yourself, at some point -- perhaps in the near future -- you are going to need to treat.

Your treatment resources in Mexico, by both admission and what you posted here, are limited and questionable.

Therefore, at a very minimum, you need some sort of let's say "quarterback" in the form of a well-versed hepatologist with a large, clinical practice who can put everything together for you and then at a minimum devise and supervise your treatment when it starts. This you cannot do for yourself, and all of what you are doing is no substitute for this.

So, without sounding like a broken record, I'll try it once again:) You've done everything except probably the most important thing which is to get a liver biopsy and line up someone to supervise your treatment. You can accomplish both things by coming to the States one more time and seeing a hepatologist like Gish in California, or perhaps someone else in his league.

If it were me, I'd see this as a life priority because any money you save by not doing this pales compared to the consequences of not having as ironclad diagnosis as *** soon as possible and not being ready to leave the starting gate with a competent treatment doctor in place should you have to. I just don't see that all your ducks are lined up to start treatment when needed and they really have to be. We've discussed this since October and the clock is still running :)

Be well,

-- Jim

[jmjm530]

Here's a compromise. Forget committing to the biopsy and expense -- why don't you line up an appointment with Gish (or similar), and have them review you're entire chart. If they think a biopsy is necessary, then you will have their case. If they don't think a biopsy is necessary, then you save the money. In any event, no one can force you to have a biopsy, but the important thing is to have your case evaluated and get someone in place to at least supervise your treatment when you do start. Other than travel, a one-time consult should cost you (guessing here) no more than $500 U.S. and maybe less if you tell them that you don't have insurance coverage. Many people find their "quarterback" right before or after they start treatment. This is the wrong time as you will be under too much stress, especially with the travel involved. Sounds like this might be the right time.

[CoWriter]

"co -
I don't know if this is true or not , but the IR diet book I just read said that  artificial sweetners "confuse" your system and cause you to produce too much insulin...  do you think that is possible. "
-------------------------
You miust have missed my post.....


Daily Consumption of Diet Soda Linked to Metabolic Syndrome, Type 2 Diabetes

February 11, 2009. Drinking diet soda at least daily is associated with significantly greater risks for select incident components of the metabolic syndrome (MetSyn) and type 2 diabetes, according to the results of an observational study reported in the January 16 Online First issue of Diabetes Care.

"Two longitudinal cohort studies have shown positive associations between diet soda consumption and incident MetSyn independent of baseline measures of adiposity," write Jennifer A. Nettleton, PhD, from the University of Texas Health Sciences Center in Houston, and colleagues. "Replication of previously observed diet soda-MetSyn associations in a distinct cohort would bolster their credibility and provide further insight into the nature of the relationship. Previous studies have not addressed associations between diet soda and individual MetSyn components or risk of type 2 diabetes nor have they fully addressed potential longitudinal mediators of these relationships, i.e., changes in adiposity status."

The goal of this study was to evaluate associations between diet soda consumption and the risk for incident MetSyn, its components, and type 2 diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA).

Initial evaluation was performed from 2000 to 2002, at which time baseline food frequency questionnaires measured diet soda consumption. Three follow-up evaluations were performed from 2002 to 2003, 2004 to 2005, and 2005 to 2007. Incident type 2 diabetes was defined as fasting glucose levels of more than 126 mg/dL, self-reported type 2 diabetes, or use of diabetes medication. National Cholesterol Education Program Adult Treatment Panel 3 criteria were used to define MetSyn and its components. After adjustment for demographic, lifestyle, and dietary confounders, hazard ratios (HRs) were estimated for type 2 diabetes, MetSyn, and MetSyn components.

Compared with participants who did not drink diet soda, those who drank diet soda at least daily had a 36% greater relative risk for incident MetSyn (HR, 1.36; 95% confidence interval [CI], 1.11 - 1.66) and a 67% greater relative risk for incident type 2 diabetes (HR, 1.67; 95% CI, 1.27 - 2.20).

Of the individual components of MetSyn, only high waist circumference (men: ¡Ý 102 cm; women: ¡Ý 88 cm) and high fasting glucose levels (¡Ý 100 mg/dL) were prospectively associated with consumption of diet soda. Associations between diet soda intake and type 2 diabetes were independent of baseline measures of adiposity or changes in these measures. In contrast, associations between diet soda and MetSyn were not independent of these factors.

"Although these observational data cannot establish causality, consumption of diet soda at least daily was associated with significantly greater risks of select incident MetSyn components and type 2 diabetes," the study authors write.

Limitations of this study include observational design, precluding determination of causality; possible confounding by other dietary and lifestyle/behavioral factors; and difficulties in estimating intake of diet soda or artificial sweetener.

"These results corroborate findings from the ARIC [Atherosclerosis Risk in Communities] and Framingham studies and show stronger adverse associations exist between diet soda and type 2 diabetes," the study authors conclude. "Diet soda consumption, either independently or in conjunction with other dietary and lifestyle behaviors, may lead to weight gain, impaired glucose control, and eventual diabetes."

The National Heart, Lung, and Blood Institute supported this study. The study authors have disclosed no relevant financial relationships.

Co

[CoWriter]

"this book also says that caffeine stimulates the body to produce insulin as well.  possible? "
-------------------------

You must have missed my other post too....

Caffeine worsens insulin resistance in prediabetics.(Metabolic Disorders)
Article from: Family Practice News
Article date: April 15, 2007
Author: Evans, Jeff

WASHINGTON -- Caffeine intake appears to exaggerate post-meal insulin resistance in prediabetic adults who regularly drink several cups of coffee each day, according to preliminary results of a randomized, double-blind, crossover study of 50 individuals.

The results "suggest that caffeine consumption promotes the development of type 2 diabetes in those people who are at greatest risk for this disease," James D. Lane, Ph.D., said at the annual meeting of the Society of Behavioral Medicine.

This is the first time that caffeine's effects on insulin resistance have been measured in habitual coffee drinkers with prediabetes, said Dr. Lane of the department of psychiatry and behavioral medicine at Duke University, Durham, N.C. More than 12 other studies have shown that caffeine administration acutely raises insulin resistance both in healthy, nondiabetic volunteers and in patients with type 2 diabetes.

Other studies have shown that coffee drinking is associated with a significantly reduced risk of type 2 diabetes, but these conclusions have been "based on correlational observations, not controlled, experimental studies," he noted.
In the current study, all participants had prediabetes (average impaired fasting blood glucose level of 111 mg/dL) and drank at least 2 cups of coffee per day, which was confirmed by a 7-day food diary. Each person fasted overnight and did not consume any caffeine, which preserved any tolerance that they had developed from their continued exposure to caffeine.

On the first day of testing, the participants received either 250 mg caffeine or placebo pills and had their fasting blood glucose levels measured. On the second day, they received the opposite of what they had taken on day 1. After 60 minutes, they had their blood glucose levels measured again, and they received a booster dose of 125 mg caffeine or placebo. They also drank a BoostPlus liquid meal replacement shake (75 g carbohydrates, plus fat and protein), which is similar to an oral glucose tolerance test except that it is more like a real meal, Dr. Lane said. Blood samples were drawn during each of the next 3 hours.

The total 375-mg dose of caffeine was equivalent to about 3 cups of brewed coffee, similar to what subjects consumed on average each day (409 mg).

For the first 41 participants with full results available, CAFFEINE INCREASED the 3-hour area under the curve (AUC) for PLASMA GLUCOSE BY 15% more than placebo, though the result was not statistically significant. But the 3-hour AUC for PLASMA INSULIN WAS 18% greater with caffeine than with placebo--a significant difference. AUC is the standard method for measuring responses to oral glucose tolerance tests, said Dr. Lane. "This pattern of results shows that caffeine did increase insulin resistance in these prediabetic subjects."

A normal response to the extra insulin produced with caffeine would have been to reduce the peak glucose level to a point lower than what was seen with placebo. But "'the glucose response was, if anything, a little larger in the caffeine condition," he said. "Given the conditions of our study, we think that this insulin resistance effect occurs every day as these prediabetic individuals and others like them consume caffeinated beverages in the real world."


"also, is SAMe ok with celexa? I have been taking both and do not feel maniacal at all."
-------------------------
Thast's good because I can only deal with one maniacal person at a time and the post is alreadyb taken.

This would be a good thing to check with your doctor.  Also, show him the article Evangelin posted.

Co

[bandman54]

thanks for the posts...... yes, I did miss them the first time around.

I will look for the evangelin post as well.

And I would ask my doctor(s) about SAMe and celexa, but they would have no idea.... I will ask my pharmacist sis instead.

bandman

[bandman54]

that being said.....
what about stevia, do you think that it to "confuses" the system, resulting in "impared glucose" control??  I hope not.  ME like stevia!

I am starting to fear that perhaps I should not anything that tastes sweet.... honey , fruit, stevia, black strap molasises (not really, I don't even know what that is!).

bandman

[CoWriter]

There are too many variables that can influence whether somebody will become a diabetic or not besides having Hep C. Like....genetics, obesity/diet, yo-yo dieting, amount of exercise, use of meds (like steroids) that can increase the risk of diabetes, smoking (which can cause insulin resistance), previous exposure to toxins (like agent orange), HIV co-infection, lypodystrophy (fat atrophy and re-distribution), having other infections, use of supplements that decrease insulin resistance.... and many more.

A recent study called "Incidence of type 2 diabetes mellitus and glucose abnormalities in patients with chronic hepatitis C infection by response to treatment: results of a cohort study" said that......

Recent studies have shown that in HCV positive patients with an abnormal HOMA IR (insulin resistance test) value who achieve SVR, insulin resistance improves while in Non-responders and Relapsers there were no changes, suggesting that viral eradication may be beneficial in correcting insulin resistance and glucose intolerance.

The study showed that after an 8 year follow-up, the incidence of glucose abnormalities between long-term SVR's and Non-Responders was not significantly different.

HOWEVER.....glucose abnormalities appeared later in long-term SVR's than on Non-Responders. This difference may be explained by the benefit that clearing the virus has on insulin resistance. And interestingly, 6 out of 17 cirrhotic Non-Responders developed glucose abnormalities....while only 1 of the 7 cirrhotics with long term SVR developed glucose abnormalities.

Patients who developed Impaired Fasting Glucose (IFG) and Diabetes had more diabetes risk factors at baseline (family history of diabetes, older age, higher BMI, abnormal HOMA Insulin Resistance values, liver fibrosis and steatosis) which probably played a crucial role in inducing glucose abnormalities despite viral eradication.

Bottom line.....achieving SVR may lower the risk of glucose abnormalities but having a family history of diabetes plays a crucial role in determining which patients are at higher risk of developing diabetes. On HCV patients with long-term SVR, the possibility of developing diabetes is better predicted by the diabetes risk factors they have at baseline rather than by virus eradication.

(I have the whole study in pdf.  If anybody would like a copy, let me know).

Co
P.S.  SVR gets rid of hepatic IR.  To expect SVR to get rid of peripheral IR caused by obesity from a lifetime of poor eating habits is wishful thinking.

[CoWriter]

Stevia was part of the research we did for CS's plan.  We read every single study on Stevia.  It improves insulin signaling.  So it's safe.

Co

[CoWriter]

So your doc won't know about celexa/SAMe?  

LOL....and you want to treat under him, huh?

bandman....the article Evangelin posted in THIS thread.

Co

[bandman54]

well yeah, i am thinking of treating under him....

all i have to do is post everything going on and you guys can figure it out!  .... I am telling you, he will do whatever I suggest... so if I treat soon we basically go with the pegintron or pegasys, riba, alina and metformin along with suggested sups.  We also check viral load as frequently as I can afford and maybe try something along cs' plan.
I have enough interferon stockpiled that I could pump it up even if the doc does not go along (an he will), but I am concerned that insurance will not pay to predose, double dose , etc.  If I get too sick, I just bail or cut back.   I mean it would not take long to tell if my vl was dropping faster than round 1 and if that turns out to be the case, I tough it out for 12 weeks and see what happens.


the lady doc that treated my first round, only went by the book.... but i am going to try and find a local hepatologist first, IF can find one that knows what he/she is doing as far as treatment is concerned....  how?  lots of questions!  Its pretty easy to tell who is full of b.s.  I will start by asking their view of IR and its effect on tx success and see how they react.  I bet few to none will know what I am talking about.

But, if my next biopsy or fibroscan is good, then I am definitely going to wait a couple of years and see what comes out.

I am thrilled to hear that about stevia! made my day.  Stevia good!

bandman

[CoWriter]

Here's one from June 2007.

"HCV clearance improves insulin resistance"

Conclusion:

In conclusion, the authors wrote, "We showed that clearance of HCV improves insulin resistance, beta-cell function, and hepatic IRS1/2 expression."


http://www.eatg.org/eatg/Global-HIV-News/News-archive/HCV-clearance-improves-insulin-resistance


Co

[CoWriter]

"all i have to do is post everything going on and you guys can figure it out!  .... I am telling you, he will do whatever I suggest."
---------------------

That would be irresponsible, unsafe and illegal.  We're not doctors.  And although some people may disagree, we don't have god-like complexes....LOL.


"well yeah, i am thinking of treating under him."
"maybe try something along cs' plan."
---------------------

I'll make you a deal.  When you know as much as CS does, you can treat with whoever you want.  I get to test you and tell you if you pass.  Until then, if you decide to treat, it will be under a good hepatologist.

Remember that CS's treatment plan was approved by his doctor.  So if anything goes wrong, his doctor will be able to handle it.

Co

[bandman54]

I knew you would say that!  lol!

bandman

[bandman54]

ps - I will be back for my test!

psps - now for the task of finding a good hepatologist willing to personally treat hcv in arkansas!

I will let you know how the search goes....
anyone out there know of one?

bandman

[CoWriter]

"ps - I will be back for my test! "
----------------------

If you think CS is going to tutor you, forget it...LOL

Co

[bandman54]

tutor... I don't need no stinking tutor!

anyway, one last thing and I will go back under my rock for a few weeks...
the past several mornings my glucose level has been 100.... I know that sounds a little highish... but quite better than the 120s I was getting.
I am exercising on a treadmill and taking 1000mg metforming 2x per day.
This all sounds better, does it not?
I will refigure homa at end of month.

an oh yeah,, here is the good news, I am no longer starving all of the time and I feel much more "normal" phsysically.. if that makes sense.

bandman