white blood cell count

[timedog]

Mine has dropped Dr. concerned. don't have the exact numbers. what do you guys know? Retesting on monday wants me to delay my next shot until we get the results on tuesday. monday is my typical shot day.

[friole]

You need to call him back and have him fax a copy of the bloodwork to you or you need to go and pick it up and post it on this thread.  My WHite Blood Count was 1.5 and ANC was at .5 Monday and and has hovered around .6 all throughout treatment (I am on week #40) even though I take Neupogen every week to keep it up. I have never reduced my interferon dose.   What week are you on?  I would wait until you know what the ANC (absolute neutrophils) are before you dose reduce.  The norm is to lower the doseage of Interferon if the ANC is below .750.  However, it has been studied and determined that hep C patients can withstand a lot lower ANC than cancer patients who pick up a lot of infections.  

While you are waiting to get more results from the doctor, stay out of crowds - the mall, church, etc, and wash your hands frequently.  

Don't worry too much
friole

[Karay]

When my count got low my dr. wanted to take me off the meds for awhile - I fought back (thanks to the info from this website) and he put me on neupogen - my levels increased immediately and everything is fine.  Don't come off the meds if you can!!

[timedog]

thanks for your input my absolute neutrophils are in the .600's.  My liver function is now normal. the postion my dr put forth was that the treatment is doing everything it is suppose to be doing, but my body may be particularly sensitive to the drugs/tx. hence skipping one shot may boost white blood cell count.

[goldyn]

your abs nuets. can go up and down and hover for a while..timedog if your still in your first 12 weeks please try not to skipp a dose like friole said you still can go  lower and be ok most of the time be sure and talk to your doc about the white cell boosters the main thing is to try and stay on full meds for the first12 weeks.
my abs nuets went down to .5 and started climbing back up by thierselves now im going on19/48 and im at 1.2.

[Bill1954]

I believe that the ANC results are quite dynamic, and can vary from day to day. I would consider asking for another CBC before dose reducing. You might have tested previously on a

[FlGuy]

Went to my tx doc today.  Went in to pick up rx for a 6 month post tx pcr having completed in Dec.  Went in there with a list of questions, most dealing with expectations about liver fibrosis improvement as a result of tx and good clean living.  My assumption is that pcr will indicate svr.  I feel good, looking better, gaining weight, occasional nite sweats are gone

[timedog]

Again thanks for everyones input. Does anyone know what the down side is to reducing meds or even skipping a week (within the first 12 weeks)? Are there any studies that show if you skip a week or reduce that over all outcome can be effected?

[GoofyDad]

Hey buddy! Wow, ain't that a bite in the touche! Welcome to the 3a/stage 4 club - we're a very exclusive club.  

Man, that makes no sense that they wouldn't have told you about the cirrhosis the first time around. I mean, if you need scoped now for varicies, why didn't you need scoping back then?

Yeah, the low platelets are an indicator. My asleep at the wheel GI just sorta watched mine drop over time, and I didn't know any better. Finally after the bx, I got educated and asked about the dropping platelets. Hey says, Huh? Flips though chart and says, Yeah that's most likely your liver. Great! Fine time to figure that one out, after I'm cirrhotic. That's when I moved on.

Have you got the full biopsy report? My first one said simply Stage 4 - Cirrhosis. I took the slides to a top hepotologist and got a full report, the jist of which said it's not 'true' cirrhosis, but transitioning. They think I have a favorable outlook if I get the SVR. 50% chance of recovering 2 stages. Even if not, they didn't seem too concerned. Will reevaluate need for 6 mos cancer screenings in 2 years.  

The scoping for the varicies was a piece of cake. Few minutes and I was done. Had to wait about 6 hours to be able to drive, but I was pretty much 100% in about 3 hours. I was completely clean, I'm very hopeful you will be too. If not, they can take care of it pretty quick.

Are you vaccinated against A & B? Also, the protocol is for 6 mos ultrasound (or CT scans) and 3-6 mos alphafeto protien blood work as a cancer screening.

Best luck my friend. I know it feels like a ton of bricks right now. Your load will lighten in time.  

[goldyn]

.Are you doing ok with all of this news..your 6mths post tx and you ar awaiting your results right...as of right now you are svr and as far as you see it nothing has changed with your svr.all the changes are from what your doc is telling you now,that he knew all along, Im sorry you have to go through all of this now but at least your getting checked out from head to toe to find where you are at and you can go on from there.

[Forseegood]

hey, sorry about the news, doesn't sound like your docs are really quick on the uptake though...course, I know diddly, but I do have more than a few friends with cirrhosis and all I can deduce is that it sounds worse than it is for most people...my younger sister had 3rd stage cirrhosis and getting sober and clean living and diet brought her back from that considerably...one of my friends has had it for 9 years...guess there's that phenomenon of people having the cirrhosis, and it kind of stabilizes from there....like Goof says, you prob did your liver a whole lot of good for treating...keep up the good work of taking good care of yourself, youre a nice guy and I'm sure you'll be okay...

[can-do-man]

Well the tests makes sense. Like goof said upper gi is a piece of cake, I had the other test execpt for the colonoscopy but being a stage 4 like me these test should have long been done. If he thought you knew all this id ask him why wasn't the upper gi (the main one for cirrhosis) and the ultrasound or ctscan  done either before at the start of tx.? Best of luck to ya

[FlGuy]

I've been replaying year-old converstations in my mind and recall the doc saying the 'beginning of cirrhosis' and thought I recalled the stage as reference to fibrosis, not cirrhosis. I'll check on the slides.  As he was leafing through the file today the only image that I captured were photos of some nasty looking colon polyps he harvested a year ago, ergo reluctance to the scopes. But I know I gotta do it. I'll cool my heels for a few days until all the blood results are in and the U?S.  The mind is a funny thing, at least mine is.  While driving to work after all this my main worry was how I was going to get to daughter's softball playoffs and son's county track meet on the same day 50 miles apart. And then wondering if they scope through the throat for the varicies can they just add an extension cord to complete the journey to the colon and if the scope makes it to the other end can they pull it back and forth like a magician who stitiches his fingers together.  Ahh the wonders of modern medicine.

[Algernon]

This sounds horribly scary but it ain't over till the fat lady sings (I can say that as I have a nice fatty liver) so just keep collecting the data until you've got all the facts.  Hoping for the best for you. Big Hug, Deb

[Mister beagle bailey]

Sorry you have to do all these tests, don't know why they weren't don't before.  BTW- the colonoscopy is a piece of cake, after you wake up you feel like nothing was done to you.
I'm sure your PCR will come back clear and your'll be SVR.
Are your drs. in the area you live in or from futher south?  I tried 3 drs. in your area and none wanted to treat me because of the thalassemia, that's how I ended up in NY.

Beagle

[Dale_Ray]

That is a nightmare come true. I'm sorry you have been hit with this and like this.

EVerytime I see my doctor he wants to do a colonostopy. I told him they did one in October of 2006. I think he owns interest in the test facility. They really push that procedure when you cross the 50 line. It's painless but not shameless.

Now I'm wondering if my doctor is hung up in definitions. My biopsy showed mild fibrosis and scarring. I'm a 1A.

Good luck Flguy. Keep us informed.

[FlGuy]

Foresee: Thanks for the reference to you sis. As I get a little clarity I wondered if cirrhosis increases if aggravators dont't exist like being svr, I don't drink (spontaneous headaches) and otherwise fairly healthy.
All: When I get all the results I'll go hunting for a second.  Would like to get to Schiff, close by at Univ of Miami, but not insurance-friendly territory so may end up at U of Fl in Gainesville where there is a less-renowned liver clinic.  Need to count the pennies. Maybe my early error was getting a gasto (not heptologist) in the first place - although gastro was recommended by 3 local docs. Thought my circumstances were more cut and dried than they turned out to be. Got an uh-oh feeling this am when I told the doc I was interested in a Fibroscan at some point to track liver progress.  He said 'blood tests are not reliable'.  I said 'no, not fibrosure, fibroscan. You know, down at UM where you are associate professor'. He said ' I'll have to check into that I'm not familiar'.  I'd just like to go a month wihtout being poked, probed, injected, scoped, medicated, evaluated, referred.  My current insurance card is used more than my wife's credit card. It was not my goal in life to be on a first name basis with the folks at Quest Diagnostics, they all call me honey now.

[jmjm530]

They got the colonoscophy drugs down real well, at least my doc did. It's an unusual drug combination where I still can't figure out if you're unconscious or just that you can't remember what happened, as I believe one of the drugs is partially an amnesiac -- sort of like the so-called date rape drugs. So, yes, Goof does have a point about waking up with roses :) In any event, the drugs are very relaxing and my only regret is that I kept losing consciousness before the procedure was over. At least in my case, they had the whole thing on a TV monitor and while it's really not prime time viewing, under sedation it was quite fascinating.

-- Jim

[FlGuy]

I guess it's  coming of 'age' thing for those of us north of 50.  And, I suppose, that as we get older and run into these various maladys that it's also time to check our modesty and humility at the door.  As you commented about your family cardiac history my family seems to have the colon trait. Once a year is no problem for riba veterans.  I just wish we didn't have to be so anal about it.  The preparation is almost as bad as the event. Maybe we should call on the fibroscan inventor to come up with the polypscan.

[can-do-man]

At least in my case, they had the whole thing on a TV monitor and while it's really not prime time viewing, under sedation it was quite fascinating.............

Hmmmm, quite fascinating you say. Whatever turns you on jim. Guess you could rent you a video and make some popcorn and enjoy.

[Pdilly]

Hmmm  have me running scared now.  I have an appointment (my first) with a Gas Int doctor.  I'm not going to a Heptoloogistl  SHould I cancel and get a new doctor?   I just went where my MD sent me. Although he said he is good.

[jmjm530]

Just read your earlier post and terribly sorry you're hearing this stuff so late in the game.

Like Goofy said, get hard copy of your biopsy report and check for yourself as you have to make sure whether your doctor was right the first time or this time.

If you see the word "cirrhosis" anywhere, then a trip to U of Miami sounds like a very good idea. And, of course, bring your original biopsy slides with you -- or send them in advance. The report is not enough as they will want to review the slides themselves. (BTW the slides are a set, usually 4-6 slides. Don't let them give you just the main slide like they did with me the first timer around)

Schiff is the head honcho at Miami  and he has the Fibroscan device. In fact, if it were me, I'd have them do the endoscophy and colonoscophy as well, if time and logistics work out.

I hate to generalize but the more posts I read, the more I advise people to seek out a hepatologist rather than simply a GI. As I've said before, treating hep c isn't rocket science but it's pathetic that so many doctors don't do their homework. How come you know what Fibroscan is and your doctor doesn't? This gets me pis*d off.

I truly hope your doctor made a mistake with the cirrhosis thing but Schiff is the one to give you direction moving forward.

Stay positive until things get sorted out.

-- Jim

[jmjm530]

Pdilly,

Why not ask for a hepatologist? Better yet, insist nicely. If your doc says you don't need one, tell him he may be right, but you still *want* one. Best ones are often at your larger, teaching hospitals. Worth a little travel if need be. Good luck!

[susan400]

I had my blood work drawn on Tues.  Today, the doctor's office called and said that my white cells had dropped a bunch.  Every time he orders my labs fasting, it does this. I mean normally the white cells are low, but not low enough to cause the doctor to be alarmed.  But, when he does them fasting, every time, I end up getting a call from the nurse telling me I need to get redrawn.  And when they do the redraw, the white cells come up a bit because on the redraw I'm not fasting.  I know this makes no sense, but its happened that way again and again.  I don't know why the fasting thing would make such a difference in my white cells.  Any comments here?

Susan

[jmjm530]

Some tests are more accurate with fasting blood. Others it doesn't matter. Maybe that's the case with WBC. Dunno. But if it is, then you should do follow-ups fasting for consistency. BTW, not sure why your nurse is concerned with WBC anyway. Many hepatologists only look at the ANC (absolute neutrophils) fraction. These are portion of white blood cells that fight infection and are more relevant to treatment decisions. Most don't get concerned until ANC drops below 500. Many, like my doctor, allow it to go as low as 200. All said, it just may be a coincidence that your fasting WBC is always lower. I found that WBC and ANC bounce around a lot -- both way -- often in as little as during a five day period. Hope this finds you well.

-- Jim