Jerry,
Interferon kicks my butt. Riba didn't give me the fevers, fatigue, low whites and platelets. After every injection for the first 3 months, sick as a dog. Other than my hair falling out, hgb a little low and a slight rash on my back, haven't had any problems with the riba. Lucky not to have the riba rage or brain fog too bad either. Not to say it hasn't contributed to the overall effects of tx, but interferon has definately been the culprit for me.
Trin
Like all things related to HepC, I think that depends on who you are and how you take to these drugs. Anyways, hope you're doing well with your ribavirin situation and the rest of your tx.
fret
It's not the interferon that makes us feel SO BAD but the ribaviron. Take it from someone that has ( and IS) done it both ways. jerry
sorry about that, wrong link. This is the right one.
http://infectious-diseases.jwatch.org/cgi/content/full/2007/711/2
Yes, I think this is a link to that study which is dated as November 2006. good read
http://www.hepcassoc.org/news/article130.html
That's a very motivating letter and I can certainly respect the good doctors intention. On the other hand there are so many doctors who truly have no idea what inteferon is capable of putting the human body through. Let alone the mental anguish that it puts some of us thru while undergoing tx. The objective of txing HepC is to clear the virus and not to create other health problems that could be equally as bad. The good doctor misses the boat on this fact with a slick as mucos, rah, rah, rah. I appreciate what he has done for his patient and I hope the patient was able to go thru tx without any additional health problems. You'll have to excuse me, but I just can't appreciate any opinion from anyone on the subject of inteferon. Especially since they have never used it themselves. Personally I have run into a couple of doctors like this who would rather have you focus on the positive and avoid the negative. A patient needs to look at the bigger picture before making up their mind whether or not they want to tx and they need to see the good, the bad and the ugly. Not just a pretty picture that someone has drawn to get their patient through treatment. I think he did a good thing for his patient, but that's as far as it goes.
A great letter, shows humanity and kindness. Nice to see,
Willing thank you also for some of the clarification. Nice to see also!
interesting comments, thanks for posting. I have to agree with Mike that I'm utterly amazed a Dr. would take the time to write at such length and depth (and with a poetic twist at that!)
Indeed, the virus is anything but stupid; the one tactical mistake it *might* have made is to be too picky about its host species.
Some details.
The 'expert opinion' review he's referring to is likely:
http://www.ncbi.nlm.nih.gov/pubmed/18761607
HCV was not first identified at the CDC but at Chiron in May '88. There was a nasty patent fight between Chiron (now owned by Novartis) and the gov. because a CDC scientist, Dan Bradley, collaborated on the find (settled in '94).
A good summary on ACCELERATE and other recent studies such as Mangia'05 and Dalgard'04 regarding G2/G3 dosing and duration is Jacobson'09:
"Optimal dose of peginterferon and ribavirin for treatment of chronic hepatitis C."
http://www.ncbi.nlm.nih.gov/pubmed/18637069
Here's the closing paragraph of that section of the article
"Is there a potential advantage of therapy longer than 24 weeks for some patients? For patients without RVR shorter duration than 24 weeks is clearly suboptimal. However, even standard 24-week treatment is unsatisfactory, with SVR rates of 50–77% [47,49,52], raising a question of the potential merits of an extended course of therapy beyond 24 weeks in this not-so-easy to treat subgroup. Willems et al. [59] retrospectively examined available data on SVR and relapse rates following PEG-IFN alfa-2a plus RBV in genotype 2 and 3 patients who did not achieve RVR from two large clinical trials [5,7]. SVR rates were, in fact, higher in patients receiving 48 weeks and higher dose RBV (1000/1200 mg daily) compared to those treated for 24 weeks, and 48 weeks and FD RBV (800 mg daily) (76%vs 65–67%). The relapse rate was lower with 48 weeks of therapy (4–13%vs 24–26%), and lowest in those patients treated for 48 weeks with RBV 1000/1200 mg daily. A randomized open-label study is planned to evaluate effects of 24 vs 48 weeks of combination therapy with PEG-IFN alfa-2a plus RBV on SVR in patients with HCV genotype 2 or 3 who do not achieve RVR [60]."
Nice post. I enjoyed reading his perspective. I agree with Meakea.....the tunnel gets dark in the middle and it gave me a boost to read this. Thanks.
hepcD.....oh, so true=) Lemons and lemonaide, baby!!
Great post ! I wish all doctors had that perky go get em attitude. It reminds me of a story my father once told me. He told me that a doctor was doing a study involving twins. One twin was a happy go lucky kid and the other twin was some what depressed and not nearly as happy as his sibling. They took the unhappy twin and put him in front of a door and asked him to open the door and look inside. He agrees and opens the door. What he sees is a room full of horse shat . The doctor then ask the boy. What are you think right now. The boy says with a frown. I think you are going to make me clean this mess up. The doctor then put the happier twin in front of the same door and ask him to open it. He agrees and opens the door. With great amazement the boy starts digging in the horse shat. The doctor ask him what are you thinking right now. The boy replies WOW ! with this much horse shat in here . There has to be a PONY in there some where!
I liked it it shows compassion. He may not have treated but there are those here now who have not but do try understanding both side of the fence. One being one who speaks of IR and the complications of treatment because believe it or not the demographics suggest the age group that is about to start treating has some form of this diabetes which will in fact divert some from the path of the journey.
jasper
Thx for posting I really like that guy (the doc) his attitude and do you know what i also think Dr Dieterish would like the letter if he saw it.
And just to inform you how doesnt now Dr Dieterish has been treating twice on soc!!
I came to think of the two espials in the bible Joshua and Caleb the only ones that wasn´t afraid when Israel was about to go in and take the Holy Land.
That could be this doc and doctor D lol very encourating indeed thx once again GK.
ca
I must say that in all my years, I've never encountered a specialist writing a personal letter to a patient, let alone such a long one. I'm intrigued.
Last I heard, specialists didn't have time to make it home for dinner with their kids.
A doctor took the time out to do this?? Thats amazing to me. I have never seen a doctor do this.
But then I dont know many doctors.
I was touched by his caring to do so.
Charm
I enjoyed the letter very much. I enjoyed the spin and hearing of the passion he felt for his subject. I liked his conjecture on how the disease would have been spread before transfusions and needles. I thought it was very poetic, in fact.
Since my first shot I've felt there's a war raging inside (and they're marching through my tummy dragging their spears and wearing dirty shoes with spurs or something). I just wish these warriors could take a day or two off. Wave a white flag, call a momentary truce, and let me have a day or two wihtout any sx.
/whining
I agree with Trinity, no one suggested the man ignorant, but that doesn't mean we share his perceptions and passions, and indeed many of us are equally as passionate about our perceptions :) The whole idea of how the medical community perceives/views and deals with side effects -- both long and short term -- has been discussed here at length in the past.
In the 70's I worked at the Mayo Clinic as a medical secretary and I was part of the "float pool" that would cover for other secretaries who were out on maternity leave, etc. During that time, I worked with doctors from just about every department at Mayo and I usually worked for the Heads of the Departments - the ones that were the best of the best. Each and every one of them were "very into their work". They were very aware of the suffering different diseases or treatments caused their patients and they focused on trying to find ways to either cure the disease or find a better treatment. Being aware of suffering and death and dying is what drove them to help find better ways. I don't believe for a second that one has to take a treatment to know how much a patient suffers. The type of doctors I'm referring to see or read of suffering every day.
Though I don't know much at all about this particular doctor, from the tone of the information he cared to share in his letter, I believe he probably falls into the category of knowing full well both sides of the coin of this treatment and he was trying to give his patient a brighter attitude to help bring him through treatment. Just my take.
When I read the post, it gave me a boost and it meant a lot to me, especially since I'm at the halfway doldrum point in my tx.
I am very impressed that a doctor would take the time to write such a letter to a patient. Unless this is a form letter sent to every patient this doctor is very atypical - he/she really seems to care and that's a good thing.
Mike
I don't see where any of us seemingly indicated the man was ignorant. To the contrary, each of us praised him and in our own way and gave feedback on how we viewed his perceptions. Again, I think it was very well written but I don't share his passion or enthusiasms.
Trin
i still have no sides...and i look like the day i started...no muscle loss at all..but my REDS and WHITES are low....im not bragging but i feel excellent still...and im goin tru a problem with my empoyer....just call me super newfie
All respect due to your posts, but don't you think this Dr. is WELL aware of the side effects these drugs cause?
-----------
In all respect, actually no I don't believe that most docs understand fully the side effects of these drugs because they look at patients through a professional prism, partly of their own making and partly of the patients -- and given their investment in treating large numbers of patients, probably this is necessary to survive. As to patient distortion, I never disclosed the extent of my side effects during treatment for fear of being pulled off the drugs. Many here have said similar. I also note that this Doctor started med school in 1997. So, assuming he's a specialist, he probably is practicing no more than five years. Just an observation.
-- Jim
LOL I would like to hear his opinion after about 6 weeks on SOC drugs :-) How warm his heart & rest of body would be as he shakes uncontrollably 4 hrs after that first shot :-)
LOL hahaah
I defenitly dont feel like a spartan soldier...
Trinity your very much right...
Interferon is not a poision...never was....like the article says...side effects are the not the direct cause of the drugs....its the fight goin on within the cells
All respect due to your posts, but don't you think this Dr. is WELL aware of the side effects these drugs cause? He is very intimately aware of the suffering both through his formal education and through meeting an speaking with his patients. He doesn't have Hep and isn't taking the medicine....I get that. And I know no one knows exactly what we go through unless they go through it. I get that, too.
But you guys are makng him seem completely ignorant of what the medicine does, and I think that's completely false. He is simply injecting his postive and educated perspective on the situation.