Aa
? on CBC/HFP and VL during TX
Good Day all and Happy Friday!
Had 2 shots and 12 days worth of Riba at the time of my first blood work this past Tuesday. Feeling pretty normal, but blood work came back (doc visit yesterday) with low levels of WBC and Neutrophils. They were:
WBC 3.1 (4-10.5)
Absolute Neutrophils 1.5 (1.8-7.8)
Everything else normal range.
High end of low but dropped a lot from pre-tx test (WBC 8.5 & Neutros 5.7)
Doc says this is not unusual and will check again in 2 weeks when he does my first viral load during tx. He also says it may recover, level off and be OK.
As far as the liver panel goes ALT/AST were normal for the first time since June. They were 34/31 respectively. All other items on liver panel normal before and now. I had a recorded high of 299/127. 2 years ago and always before that I know of I was in the 20's.
My questions are:
1. What is the drug that you take for the WBC/Neutro situation? Is there anything I can or need to do to aid in this problem. How low is too low. Neither the doc or I want to lower the dosage. Is it the Interferon or Riba that does this?
2. Concerning the RNA test. I have an order for a "Hep C viral RNA/PCR Qualatative. It is thru LabCorp. Iam questioning because the test used to dx was the HCV QuantaSure Plus (non-graph) which sounds like Quantity not Quality. What is the difference and is it the sensitivity? Is Qualatative better? Sounds better....My Quantasure read 6,120,000. Looking for less than 61,200 right?
3. That test leads to next question. I understand there is a "better" time to do this 4 wk test. Shot days are Thursday nights. I am suppose to go for draw 12/10 which is 4 days after the 4th shot. Does that sound OK? Both doc and I are limited on what days we can have our pow wows and this works for both of us.
4. Lastly. I am hoping the normal ALT/AST is a good sign. Any input on this result? Doc seemed excited!
If you need more info, I have some posted on profile. Ask though if you need more info.
Thanks in advance!
Had 2 shots and 12 days worth of Riba at the time of my first blood work this past Tuesday. Feeling pretty normal, but blood work came back (doc visit yesterday) with low levels of WBC and Neutrophils. They were:
WBC 3.1 (4-10.5)
Absolute Neutrophils 1.5 (1.8-7.8)
Everything else normal range.
High end of low but dropped a lot from pre-tx test (WBC 8.5 & Neutros 5.7)
Doc says this is not unusual and will check again in 2 weeks when he does my first viral load during tx. He also says it may recover, level off and be OK.
As far as the liver panel goes ALT/AST were normal for the first time since June. They were 34/31 respectively. All other items on liver panel normal before and now. I had a recorded high of 299/127. 2 years ago and always before that I know of I was in the 20's.
My questions are:
1. What is the drug that you take for the WBC/Neutro situation? Is there anything I can or need to do to aid in this problem. How low is too low. Neither the doc or I want to lower the dosage. Is it the Interferon or Riba that does this?
2. Concerning the RNA test. I have an order for a "Hep C viral RNA/PCR Qualatative. It is thru LabCorp. Iam questioning because the test used to dx was the HCV QuantaSure Plus (non-graph) which sounds like Quantity not Quality. What is the difference and is it the sensitivity? Is Qualatative better? Sounds better....My Quantasure read 6,120,000. Looking for less than 61,200 right?
3. That test leads to next question. I understand there is a "better" time to do this 4 wk test. Shot days are Thursday nights. I am suppose to go for draw 12/10 which is 4 days after the 4th shot. Does that sound OK? Both doc and I are limited on what days we can have our pow wows and this works for both of us.
4. Lastly. I am hoping the normal ALT/AST is a good sign. Any input on this result? Doc seemed excited!
If you need more info, I have some posted on profile. Ask though if you need more info.
Thanks in advance!
The discussion has been detoured a little into a "battle of the tests :) " , but I think the single most important thing to carry away is that you do not want a Qualitative test (as your doctor suggested) at this point in treatment. What you want is a sensitive Quantitative test that will give you a viral load number. Once you finally become UND, then Qualitative tests can be given. It's possible your doctor or nurse simply made a mistake because they did order a pretty good test the first time.
-- Jim
-- Jim
Either way, I have to call the doc and tell him I am questioning his orders. But it's my body....right guys?
You will get VERY used to doing this as the course of time and treatment go by. Unfortunately, some doctors treat as if they are using an old dial up line and don't realize they can use cable...most of the time they just don't know it exists.
My doctor while at first irked by my constant questioning and pointing things out at the end was learning LITERALLY from me and although most docs don't have the ego to do so...I was lucky and he was wonderful and thanked me (not sarcastically either). It worked out well for his next patients TOO.
I would NOT worry about the "ceiling" of th "best" test at all...if you are still over 2 million it won't matter one whit. Week 4 is crucial because the earlier you respond to UND the better your chances of SVR should be.
One example my 4 week test was 411. Great! Woo hoo! So it appeared I had everything going on ... then my 12 week test was 419 - I hit the draed plateau that sometimes exists. Had I not had the 4 week test I would have falsely believed I was on a steady decline. I wasn't. In the end it lead me to do tye 72 weeks of treatment that now have me SVR. Had I not known I could have falsely done 48 and perhaps not gotten in.
You will get VERY used to doing this as the course of time and treatment go by. Unfortunately, some doctors treat as if they are using an old dial up line and don't realize they can use cable...most of the time they just don't know it exists.
My doctor while at first irked by my constant questioning and pointing things out at the end was learning LITERALLY from me and although most docs don't have the ego to do so...I was lucky and he was wonderful and thanked me (not sarcastically either). It worked out well for his next patients TOO.
I would NOT worry about the "ceiling" of th "best" test at all...if you are still over 2 million it won't matter one whit. Week 4 is crucial because the earlier you respond to UND the better your chances of SVR should be.
One example my 4 week test was 411. Great! Woo hoo! So it appeared I had everything going on ... then my 12 week test was 419 - I hit the draed plateau that sometimes exists. Had I not had the 4 week test I would have falsely believed I was on a steady decline. I wasn't. In the end it lead me to do tye 72 weeks of treatment that now have me SVR. Had I not known I could have falsely done 48 and perhaps not gotten in.
After a little quick research -- there is no "reflex" test that will accomplish what was suggested, however, it's still easy enough.
Each of the two tests requires a single tube that will be frozen and sent to the lab. What you want your doctor to specify is that they draw enough blood for TWO frozen tubes. LabCorp will then keep those tubes and your doctor then has the option to ADD the second test, should the first come in over its limit of 2 million IU/ml. Apparently, LabCorp will hold the second tube automatically, but if it were me, I'd have the doctor add a little note saying to hold the second tube as a second test might be added.
-- Jim
Each of the two tests requires a single tube that will be frozen and sent to the lab. What you want your doctor to specify is that they draw enough blood for TWO frozen tubes. LabCorp will then keep those tubes and your doctor then has the option to ADD the second test, should the first come in over its limit of 2 million IU/ml. Apparently, LabCorp will hold the second tube automatically, but if it were me, I'd have the doctor add a little note saying to hold the second tube as a second test might be added.
-- Jim
H20: What if I do the Quantsure plus (10 IU/ml) for now and then once undetectable (assuming of course) then go the the more sensitive to be sure from there on out?
------------------------------------------
Good thinking, but actually you might try the opposite. Do the test "HR" recommends first, and then ask the lab if they would "reflex" the test into the one I recommended should the viral load be over the 2 million IU/ml limit. If they can't do it automatically, ask if some xtra blood can be drawn and then held for that purpose if needed. I would make the calls to LabCorp myself and see if this is feasible. If they won't speak to you, maybe someone in your doctor's office might speak to them. The concept here is to do the most senstive test but to cover yourself if you don't have the expected drop. Sort of like doing the two tests, but you only pay for one if the first gives you a result below 2 million. Hope this makes sense.
As to the difference between 2 and 10 IU/ml, I've never seen one of the major "rule" studies that used anything less than 10 IU/ml, but I would presume that the more sensitive the test used, the more certainty you might have in projected SVR rates if you show UND. On the other hand, if you show 4 IU/ml, not sure how you should
react:) FWIW Heptimax by Quest is sort of in the middle with 5 IU/ml and has a very wide dynamic range. That's why it's a good "one test for all" type of test.
Good luck and do let us know how it all works out.
-- Jim
------------------------------------------
Good thinking, but actually you might try the opposite. Do the test "HR" recommends first, and then ask the lab if they would "reflex" the test into the one I recommended should the viral load be over the 2 million IU/ml limit. If they can't do it automatically, ask if some xtra blood can be drawn and then held for that purpose if needed. I would make the calls to LabCorp myself and see if this is feasible. If they won't speak to you, maybe someone in your doctor's office might speak to them. The concept here is to do the most senstive test but to cover yourself if you don't have the expected drop. Sort of like doing the two tests, but you only pay for one if the first gives you a result below 2 million. Hope this makes sense.
As to the difference between 2 and 10 IU/ml, I've never seen one of the major "rule" studies that used anything less than 10 IU/ml, but I would presume that the more sensitive the test used, the more certainty you might have in projected SVR rates if you show UND. On the other hand, if you show 4 IU/ml, not sure how you should
react:) FWIW Heptimax by Quest is sort of in the middle with 5 IU/ml and has a very wide dynamic range. That's why it's a good "one test for all" type of test.
Good luck and do let us know how it all works out.
-- Jim
If you knew me you would know how naive I am. You are right! If I had called them I would have alerted them! Go Big D!
I understand you too then to believe that the "best" test is the one I need. The one drawback though is the ceiling. Is that though less of a concern then the floor so to speak?
I guess the only sure way is to do what Jim said and ask for both tests.
I made copies of both. I am going to fax them to the doc and tell him the pros and cons of both and see if he will order both. What do ya think?
Also copyman and all.....why is the 4 week so important? I know a early response is good, but is the difference between the 2 and 10 UL/ml gonna make that big a difference at that point? Am I missing something?
Gotta get ready for the office......will be back later.....
I understand you too then to believe that the "best" test is the one I need. The one drawback though is the ceiling. Is that though less of a concern then the floor so to speak?
I guess the only sure way is to do what Jim said and ask for both tests.
I made copies of both. I am going to fax them to the doc and tell him the pros and cons of both and see if he will order both. What do ya think?
Also copyman and all.....why is the 4 week so important? I know a early response is good, but is the difference between the 2 and 10 UL/ml gonna make that big a difference at that point? Am I missing something?
Gotta get ready for the office......will be back later.....
Morning!
I assume it is weight based. I weigh 159 and am 5'5'' doing 1000 a day. Need to get down to 149 but with my new taste buds, probably will be the easiest weight loss program on the planet.
As for the VL tests I am doing the research right now and have printed off the 2 tests thru lab corp. At worst may be a small co-pay for the NGI Quantasure. I think I now understand the subject a little better.
I can't possibly think of it being over 2.5 IU's BUT your caution in the area of possibilites is understood as well. What if I do the Quantsure plus (10 IU/ml) for now and then once undetectable (assuming of course) then go the the more sensitive to be sure from there on out?
Back again to my question (post above this second one this am). Is there some correlation to being less than 10 IU/ml vs 2 when it comes to SVR and relapse? Will that small difference actually be the reason for relapse or is that (as is everything about HCV) going to vary from person to person. It all goes back to our individual immune systems I suppose.
It worries me that people may be getting false hope if they are getting tests that are less than desired to get the true picture.
Thanks HR and JIM and all who come here your input makes me better able to cope with this disease. Knowledge truly is power!
I assume it is weight based. I weigh 159 and am 5'5'' doing 1000 a day. Need to get down to 149 but with my new taste buds, probably will be the easiest weight loss program on the planet.
As for the VL tests I am doing the research right now and have printed off the 2 tests thru lab corp. At worst may be a small co-pay for the NGI Quantasure. I think I now understand the subject a little better.
I can't possibly think of it being over 2.5 IU's BUT your caution in the area of possibilites is understood as well. What if I do the Quantsure plus (10 IU/ml) for now and then once undetectable (assuming of course) then go the the more sensitive to be sure from there on out?
Back again to my question (post above this second one this am). Is there some correlation to being less than 10 IU/ml vs 2 when it comes to SVR and relapse? Will that small difference actually be the reason for relapse or is that (as is everything about HCV) going to vary from person to person. It all goes back to our individual immune systems I suppose.
It worries me that people may be getting false hope if they are getting tests that are less than desired to get the true picture.
Thanks HR and JIM and all who come here your input makes me better able to cope with this disease. Knowledge truly is power!
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