Aa
Multiple Procrit injections at once or spread out through week?
For those doing more than 40,000 U of Procrit, which requires multiple injections because 40,000 U is the largest single vial dosage, do you inject them all in one sitting or spread them out over the week?
I'm on 100,000 U right now (yes 3 injections at once makes me feel like a pincushion or a watercan that's been shot with buckshot) and we looking at splitting that up to 50,000 U two time per week to even the level at which it is present in my system. Yea, it means yet another injection per week, but hey it'd only be a maximum of 2 per sitting.
Has anyone else done this, or know of anything which indicates that a steadier level throughout the week is better than a single weekly boost at one time?
I'm on 100,000 U right now (yes 3 injections at once makes me feel like a pincushion or a watercan that's been shot with buckshot) and we looking at splitting that up to 50,000 U two time per week to even the level at which it is present in my system. Yea, it means yet another injection per week, but hey it'd only be a maximum of 2 per sitting.
Has anyone else done this, or know of anything which indicates that a steadier level throughout the week is better than a single weekly boost at one time?
I have not done procrit, but have done aranesp which is the same thing but longer acting peg form. I had to get two shots of it at once in the dr's office. I had no problem from it. Not sure about procrit...
You can indeed split it. Actually you have several options.
Rather then do 100,000 IU weekly you can do 200,000 every two weeks. In away that's easier as you simply use 40,000 vials for all shots. That's one shot every three days excepting only one after 2 days to fit in five shots spread out over two weeks. (I'd go that way if it was me.)
Option 2: Get a 3CC syringe with a 25g needle or even larger. Then get 27g needles, 1 per syringe. Draw up a 40,000 and a 20,000 in the same syringe using the 25 or larger needle. (Makes drawing it up and getting it all without it foaming faster and easier.) Then get the air out of the syringe just like you were going to use it. Next simply twist off the horse size needle and twist on the smaller gauge needle. You do not, and should not try and get air out of this one. It will do it automatically and you can then use a dry needle. There is one nice advantage, the needle is dry on the outside and thus you will reduce any injection site reaction. You can use a smaller needle, 28 or even 29 but don't. Procrit as you already know is thick and the tiny needle will leave you sitting there forever while you try and force that thick fluid through the tiny needle. This is a little awkward and at least for me I tried it for a month and went back to using standard 1cc syringes. (And yes ma'am that is the voice of experience speaking.) Then do the remaining 40 two or three days later.
Option 3. Same as above but draw all up into one shot. Personally there is no way I'd go this route.
Other options of course are single needles for each shot. You could do all in one day, but here again I wouldn't.
Procrit is like most injectable drugs, blood serum levels of EPO go up quickly and gradually come down. By spreading it out over a period of time you actually will keep a more steady serum level of EPO which most likely will be more effective. Doing all at once gives you huge boost but much of the week would show serum levels way down, if any. Additionally, as with any drug, Procrit does have potential side effects. By megadose at one time you vastly increase the risk of those side effects. May not be an issue, but....
Ice 5-10 minutes before will take all sting out of the shot, for that matter you can't even feel the needle that way. Ice back on for 10-20 minutes after shot will eliminate or minimize bruising should that be an issue for you. (Same for IFN shots and most other shots too.) Likewise make sure you warm it up. (This one I'm sure you already know.)
Procrit can also be done IM and that might work even better if you only want to do one shot in one syringe. Also should you happen to get an IV for any reason whatsoever it can be done IV. I had them add mine to an IV of packed RBC the two times I had that done just to save me a shot.
I think I suggested this to you before but just in case;
If this is your GI ordering this I'd strongly suggest
you go to a hemotologist. No matter how experience the GI doc is he will pale in experience as compared to a hemotologist. I say this for several reasons. First when you start wondering into the 100,000IU Procrit range there are risks. Also Procrit only works in 45% of patients and that number is based on general patients with other forms of anemia. I'll stay simple and not go into all the details but basically the problem us heppers on tx run into is that RIBA destroys the cells primarily responsible for producing red blood cells. And I am not referring to kidneys which I saw someone mention, but rather the major producer of these cells, bone marrow. If enough of these are impacted all the Procrit in the world will not increase HGB. In fact taking it even farther the only option in the event these are disrupted enough is transfusion or RIBA reduction, or of course the alternative I know you don't want, stop treatment. Likewise B12, B6, and/or iron won't do a dang thing unless you are short of these vitamins/mineral. B12 and B6 are water soluable and excess will just be carried out in urine and perspiration. If however you have not had these tested then you absolutely should get test for these. And honestly these should be tested even before you crank Procrit up sky high.
If I could ask, what are your weight? What are your current levels of HGB, RBC, etc? How long on tx and at what rate did they drop? What is your RIBA dose? Genotype or treatment duration? Pre or Post menopausal? Ulcers or any other internal bleeding issues? Oh platelets too. Any heart issues whatsoever? Are you having symptoms of anemia? Have you had O2 levels checked? How often are you getting labs? How long on Procrit? (Took three months to do me a dang bit of good an even then it was just enough to keep me from getting transfused again.)
I'm new here and of course you don't know me, so I could simply be some delusional paranoid nutcase, and I as far as you know I have no clue what I'm talking about. As it happens though I am all too familar with Procrit and various blood values. So if nothing else please see a good hemotologist, please. If you have already done so I apologize for wasting your time, I'm just concerned.
Doug
Rather then do 100,000 IU weekly you can do 200,000 every two weeks. In away that's easier as you simply use 40,000 vials for all shots. That's one shot every three days excepting only one after 2 days to fit in five shots spread out over two weeks. (I'd go that way if it was me.)
Option 2: Get a 3CC syringe with a 25g needle or even larger. Then get 27g needles, 1 per syringe. Draw up a 40,000 and a 20,000 in the same syringe using the 25 or larger needle. (Makes drawing it up and getting it all without it foaming faster and easier.) Then get the air out of the syringe just like you were going to use it. Next simply twist off the horse size needle and twist on the smaller gauge needle. You do not, and should not try and get air out of this one. It will do it automatically and you can then use a dry needle. There is one nice advantage, the needle is dry on the outside and thus you will reduce any injection site reaction. You can use a smaller needle, 28 or even 29 but don't. Procrit as you already know is thick and the tiny needle will leave you sitting there forever while you try and force that thick fluid through the tiny needle. This is a little awkward and at least for me I tried it for a month and went back to using standard 1cc syringes. (And yes ma'am that is the voice of experience speaking.) Then do the remaining 40 two or three days later.
Option 3. Same as above but draw all up into one shot. Personally there is no way I'd go this route.
Other options of course are single needles for each shot. You could do all in one day, but here again I wouldn't.
Procrit is like most injectable drugs, blood serum levels of EPO go up quickly and gradually come down. By spreading it out over a period of time you actually will keep a more steady serum level of EPO which most likely will be more effective. Doing all at once gives you huge boost but much of the week would show serum levels way down, if any. Additionally, as with any drug, Procrit does have potential side effects. By megadose at one time you vastly increase the risk of those side effects. May not be an issue, but....
Ice 5-10 minutes before will take all sting out of the shot, for that matter you can't even feel the needle that way. Ice back on for 10-20 minutes after shot will eliminate or minimize bruising should that be an issue for you. (Same for IFN shots and most other shots too.) Likewise make sure you warm it up. (This one I'm sure you already know.)
Procrit can also be done IM and that might work even better if you only want to do one shot in one syringe. Also should you happen to get an IV for any reason whatsoever it can be done IV. I had them add mine to an IV of packed RBC the two times I had that done just to save me a shot.
I think I suggested this to you before but just in case;
If this is your GI ordering this I'd strongly suggest
you go to a hemotologist. No matter how experience the GI doc is he will pale in experience as compared to a hemotologist. I say this for several reasons. First when you start wondering into the 100,000IU Procrit range there are risks. Also Procrit only works in 45% of patients and that number is based on general patients with other forms of anemia. I'll stay simple and not go into all the details but basically the problem us heppers on tx run into is that RIBA destroys the cells primarily responsible for producing red blood cells. And I am not referring to kidneys which I saw someone mention, but rather the major producer of these cells, bone marrow. If enough of these are impacted all the Procrit in the world will not increase HGB. In fact taking it even farther the only option in the event these are disrupted enough is transfusion or RIBA reduction, or of course the alternative I know you don't want, stop treatment. Likewise B12, B6, and/or iron won't do a dang thing unless you are short of these vitamins/mineral. B12 and B6 are water soluable and excess will just be carried out in urine and perspiration. If however you have not had these tested then you absolutely should get test for these. And honestly these should be tested even before you crank Procrit up sky high.
If I could ask, what are your weight? What are your current levels of HGB, RBC, etc? How long on tx and at what rate did they drop? What is your RIBA dose? Genotype or treatment duration? Pre or Post menopausal? Ulcers or any other internal bleeding issues? Oh platelets too. Any heart issues whatsoever? Are you having symptoms of anemia? Have you had O2 levels checked? How often are you getting labs? How long on Procrit? (Took three months to do me a dang bit of good an even then it was just enough to keep me from getting transfused again.)
I'm new here and of course you don't know me, so I could simply be some delusional paranoid nutcase, and I as far as you know I have no clue what I'm talking about. As it happens though I am all too familar with Procrit and various blood values. So if nothing else please see a good hemotologist, please. If you have already done so I apologize for wasting your time, I'm just concerned.
Doug
Doug: so I could simply be some delusional paranoid nutcase
----------------------------------------------------------
Don't worry, you won't be alone here :)
Too tired to do the math, but when I was on 60,000 units/wk Procrit, I shortened the days between injecting the 40,000 unit vial (5 days if I remember correctly) as opposed to injecting 60,000 units at one time. So, Oak might try something similar.
In regards to using the 3ML barrel. I actually used a 3ML barrel with the B-D Luer Lok Twist off system, but the reason was to end up with a sharper needle, i.e. discarding the needle that pierced the rubber topper.
At least with my anatomy, I found anything more than 1CC of fluid (I think that's what was in the 40,000 unit vial) was too much for a sub Q shot. So, unless you have A LOT of fat in your target zone, you might be better off with multiple shots as opposed to one super shot.
I also thought that 100,000 units/wk is on the high side and in fact NYGirl's consultant warned her of some potential consequences of too much Procrit. So getting another opinion on this does sound reasonable.
Welcome to the discussion group Doug, you obviously have much to contribute.
-- Jim
----------------------------------------------------------
Don't worry, you won't be alone here :)
Too tired to do the math, but when I was on 60,000 units/wk Procrit, I shortened the days between injecting the 40,000 unit vial (5 days if I remember correctly) as opposed to injecting 60,000 units at one time. So, Oak might try something similar.
In regards to using the 3ML barrel. I actually used a 3ML barrel with the B-D Luer Lok Twist off system, but the reason was to end up with a sharper needle, i.e. discarding the needle that pierced the rubber topper.
At least with my anatomy, I found anything more than 1CC of fluid (I think that's what was in the 40,000 unit vial) was too much for a sub Q shot. So, unless you have A LOT of fat in your target zone, you might be better off with multiple shots as opposed to one super shot.
I also thought that 100,000 units/wk is on the high side and in fact NYGirl's consultant warned her of some potential consequences of too much Procrit. So getting another opinion on this does sound reasonable.
Welcome to the discussion group Doug, you obviously have much to contribute.
-- Jim
Are you the same Jim as in Hep Neighborhood? If so I'm dvalverde, aka Doug there.
Doug
Doug
Haven't posted there much recently. BTW have you been following that "who relapsed after 6-month" thread? That guy Bill appears to be a fountain of misinformation, especially regarding the definition of SVR. Hard to believe. :)
-- Jim
-- Jim
Jim,
Read the first part and quit following it, I'll go back and check on the rest. I hadn't been there in awhile. You're west coast if memory serves me correct. I dropped into the chat room there earlier to see if anyone I knew was still there. But nope.
Doug
Read the first part and quit following it, I'll go back and check on the rest. I hadn't been there in awhile. You're west coast if memory serves me correct. I dropped into the chat room there earlier to see if anyone I knew was still there. But nope.
Doug
I did 60,000 units every 5 days of procrit. I would spread it out to allow it to work better, Let me know how you make out. Will be thinking of you.
Beagle :)
Beagle :)
Thx for the info, some good ideas there, both new and some I'd forgotten about.
Actually I have a pretty good doc. Here's his basic credentials:
Director of the Division of Gastroenterology, and Director of the Liver Transplantation Program at the University of Minnesota Medical Center in Minneapolis. Dr. Lake is a past president of the American Society of Transplantation. He is the Chair of the Liver and Intestinal Committee of the United Network for Organ Sharing. He is an Associate Editor for the American Journal of Transplantation. He is on the editorial boards of Liver Transplantation and Surgery and Transplantation Proceedings. He is a co-author of the textbook, Comprehensive Clinical Hepatology. Dr. Lake has published more than 200 scientific papers and book chapters on topics ranging from hepatitis C in liver transplant recipients to changes in quality of life after liver transplantation among adults.
As for the rest:
1A
Stage 4
Base VL 72 mil
wk 8: 2.4 mil
wk 12: 1.8 mil
wk 24: 2.9
CBC 8/29 8/31
WBC: 2.5 2.4
RBC: 2.67 2.76
Hgb: 9.3 10.0
HCT: 27.5 28.8
ANC: 1.9 1.4
Platelets: 52 64
Iron normal, new RBC production detected.
36 wks on tx
treatment duration? base 48 wks, Now possibly 99 wks
How long on tx and at what rate did they drop?
13.5 base to 9.8 in 4 wks.
What is your RIBA dose?
ID doc cut from 1200 to 600 at wk 3
Switched to Dr. Lake wk 8
wk 10 Epoetin-Alpha 40,000
wk 14 RBN 800 mg
wk 18 Epoetin-Alpha 60,000
wk 19 RBN 1000 mg
wk 21 RBN 1200 mg
wk 24 Epoetin-Alpha 80,000
wk 27 Neupogen
wk 27 RBN 1400 mg
wk 31 Epoetin-Alpha 100,000
wk 31 Neupogen
new 12 wk for 2 log drop from 72 mil began wk 27 if achieved tx 72 wks from wk 27
Pre or Post menopausal? Pre-male, but wife claims still Riba-PMSing
Ulcers or any other internal bleeding issues? Only as pre-teen
Any heart issues whatsoever? No
Are you having symptoms of anemia? Yes
Have you had O2 levels checked? No
How often are you getting labs? Bi-weekly, unless doing a Neupogen regiment
Follow-up initial every 4 wks, now 6 wks after wk 27
Actually I have a pretty good doc. Here's his basic credentials:
Director of the Division of Gastroenterology, and Director of the Liver Transplantation Program at the University of Minnesota Medical Center in Minneapolis. Dr. Lake is a past president of the American Society of Transplantation. He is the Chair of the Liver and Intestinal Committee of the United Network for Organ Sharing. He is an Associate Editor for the American Journal of Transplantation. He is on the editorial boards of Liver Transplantation and Surgery and Transplantation Proceedings. He is a co-author of the textbook, Comprehensive Clinical Hepatology. Dr. Lake has published more than 200 scientific papers and book chapters on topics ranging from hepatitis C in liver transplant recipients to changes in quality of life after liver transplantation among adults.
As for the rest:
1A
Stage 4
Base VL 72 mil
wk 8: 2.4 mil
wk 12: 1.8 mil
wk 24: 2.9
CBC 8/29 8/31
WBC: 2.5 2.4
RBC: 2.67 2.76
Hgb: 9.3 10.0
HCT: 27.5 28.8
ANC: 1.9 1.4
Platelets: 52 64
Iron normal, new RBC production detected.
36 wks on tx
treatment duration? base 48 wks, Now possibly 99 wks
How long on tx and at what rate did they drop?
13.5 base to 9.8 in 4 wks.
What is your RIBA dose?
ID doc cut from 1200 to 600 at wk 3
Switched to Dr. Lake wk 8
wk 10 Epoetin-Alpha 40,000
wk 14 RBN 800 mg
wk 18 Epoetin-Alpha 60,000
wk 19 RBN 1000 mg
wk 21 RBN 1200 mg
wk 24 Epoetin-Alpha 80,000
wk 27 Neupogen
wk 27 RBN 1400 mg
wk 31 Epoetin-Alpha 100,000
wk 31 Neupogen
new 12 wk for 2 log drop from 72 mil began wk 27 if achieved tx 72 wks from wk 27
Pre or Post menopausal? Pre-male, but wife claims still Riba-PMSing
Ulcers or any other internal bleeding issues? Only as pre-teen
Any heart issues whatsoever? No
Are you having symptoms of anemia? Yes
Have you had O2 levels checked? No
How often are you getting labs? Bi-weekly, unless doing a Neupogen regiment
Follow-up initial every 4 wks, now 6 wks after wk 27
I'm another who did the 5 day procrit rotation for 60,000 weekly. It was an easy way to get the stuff in me. Never got me above hgb 10 though -- and my doc didn't want to go more.
I learned not to double whammy Neupogen with the Procrit. Maybe psycological (sp), but it seemed to bother me. So when they fell on the say day, I just shifted one to another day. In fact, 6 mos off tx and I still have 3 Neups to go till I'm caught up ;-)
I learned not to double whammy Neupogen with the Procrit. Maybe psycological (sp), but it seemed to bother me. So when they fell on the say day, I just shifted one to another day. In fact, 6 mos off tx and I still have 3 Neups to go till I'm caught up ;-)
When I was doing 80,000 Epogen I did 40k one day and 40k 3/4 days later. when my hemo started to rise I switched to every 5 days and then the doc dropped me now back to once a week.
I wouldn't do it all at the same time though...and I tried not to do it on shot night (just because I am wierd and kept thinking of drugs mixing and all sort of INVALID wierd things I convinced myself that wouldn't help me LOL).
I wouldn't do it all at the same time though...and I tried not to do it on shot night (just because I am wierd and kept thinking of drugs mixing and all sort of INVALID wierd things I convinced myself that wouldn't help me LOL).
Mr. Grandoak,
Ooops, sorry about the menopausal question. And just for the record, if all your wife says is you have PMS she's much kinder then mine.
Stage 4 answers a lot. Certainly explains why you and your doctor are willing to take some risks. I did the same at 3/3 and had told my doc that at the get go. Which is why my HGB hovered at 7.0 except post trans and post tx. Which both are kind of cool in a weird way. You can literally see the counts go up. First tiny pink lines chriscross that nice Casper complextioin. Then the skin turns pink, and finally I got my first tan. Killed my budding movie career though, I figured I was gonna be a star in vampire and ghost films. I mean look at the cost savings on makeup artists. Oh well.
Drops I experienced were also about the same. 16.9 down to 11.8 at 30 days down, 10.4 next time, weekly labs after that and to the end of treatment. Procrit, 20,000 a week later, 2 weeks later 7.8 procrit 40.000, made it two more weeks and one unit packed RBC bumped me all the way up to 8.8 and dang that felt good. One monnth later 6.8 and back to hosp for another unit of packed RBC again. Then immediately to hemo doc. 60,000 Procrit. HGB 8.6 post trans. Fell to 7.2 over the next four weeks and then the miracle, up to 7.4, stabalized rest of tx at around 7.8 up and down 0.2 or so but no more. WBC stayed between 1.8 and 2.4 the entire time. Never had so much as a sneeze though. Also I was real lucky, even with HGB at 7.8 I never had shortness of breath and my O2 content remained consistently in normal ranges. Now I would get tired running up a couple flights of steps, but heck I smoked and would get tired going up those two flights anyway. I did make it, as a matter of pride, a practice to run up the one flight of steps I needed to get to my lab. I absolutely refused to take the elevator. Goofy I know, but that was my benchmark I was okay. BP and pulse remained dead steady at 110/70 pulse 72. Give or take a small amount that is what it has been my entire life. That too gave me a perverse pleasure.
FWIW as I've heard the Neupogen shot is no fun my doc let me slide to 1.8 and it was like things finally bottomed out there. As I did not get sick we let it ride. Helped I'm sure that I'm retired and my son is 17 and not prone to illness. Exposure to disease was reduced. Gotta admit always scared me when I had to go to the hospital and doctors offices. (Psst, I'll let you in on a little secret, sick people go there.)
Assume your failure to move faster towards undetectable was due to lowering RIBA, cranking back up hopefully with get that undetectable soon.
My compliments to your doc. He obviously realizes the importance of this to you and is willing to let you determine what is acceptable risk. My doc did the same and unless somebody shoots him, or me, I wouldn't switch for all the supermodels in the world. (Now I'm lying through my teeth 'cause after the worlds supermodels were through with me I think I'd be happy to die.)
Looks like yall got bases covered, only things would be B12 and B6, wouldn't hurt to have those checked, along with O2 for grins. (O2 isn't that great as it really only measures O2 in the existing cells and can be normal as long as a few cells float by, but if you end up with a lot of immature cells that are incapable of carrying O2 it's an easy way to tell.
I assume your doc is also considering potential of future TP, if he can get this sucker beat if and when you ever needed a TP you'd be miles ahead of us.
If I don't clear on my next round I may move back up to MN just for your doc. I lived in Winnegago for a year. We loved it and my wife hated to give up that house. She cried when she first saw it but I saw the potential. I spent 20,000 grand fixing it up with me doing all the labor. House sold for three times what I paid for it in 3 days. First time I've ever had a realtor aplogize for not charging more. With a doc like you've got it would be worth the move. (I might have to have terrorist hit that ethenol plant though, on the rare days the wind changed..........)
Other then I'd split the shots and the few test suggested above, my only other advice would be relax and enjoy the ride. With this doc's attitude and yours I'd happily bet money on the outcome. Just be prepared for transfusion if you hit 7.0 or below, but considering all you've been through that ought to be a walk in the park. I plan on starting my next round in Jan., I think I'm going to see if it is possible to donate a few units for storage, just not sure what shelf life of packed RBC is.
Stupid though, wouldn't hurt to wonder by a BP chair in a phamacy and keep a close eye on BP, just in case ya know. Besides I've always like those chairs and as a kid could never pass up the chance to sit in one, okay okay, I still never pass up the chance.
Relax, go with the flow, and think of the story you'll have to tell your great grandkids.
Doug
Ooops, sorry about the menopausal question. And just for the record, if all your wife says is you have PMS she's much kinder then mine.
Stage 4 answers a lot. Certainly explains why you and your doctor are willing to take some risks. I did the same at 3/3 and had told my doc that at the get go. Which is why my HGB hovered at 7.0 except post trans and post tx. Which both are kind of cool in a weird way. You can literally see the counts go up. First tiny pink lines chriscross that nice Casper complextioin. Then the skin turns pink, and finally I got my first tan. Killed my budding movie career though, I figured I was gonna be a star in vampire and ghost films. I mean look at the cost savings on makeup artists. Oh well.
Drops I experienced were also about the same. 16.9 down to 11.8 at 30 days down, 10.4 next time, weekly labs after that and to the end of treatment. Procrit, 20,000 a week later, 2 weeks later 7.8 procrit 40.000, made it two more weeks and one unit packed RBC bumped me all the way up to 8.8 and dang that felt good. One monnth later 6.8 and back to hosp for another unit of packed RBC again. Then immediately to hemo doc. 60,000 Procrit. HGB 8.6 post trans. Fell to 7.2 over the next four weeks and then the miracle, up to 7.4, stabalized rest of tx at around 7.8 up and down 0.2 or so but no more. WBC stayed between 1.8 and 2.4 the entire time. Never had so much as a sneeze though. Also I was real lucky, even with HGB at 7.8 I never had shortness of breath and my O2 content remained consistently in normal ranges. Now I would get tired running up a couple flights of steps, but heck I smoked and would get tired going up those two flights anyway. I did make it, as a matter of pride, a practice to run up the one flight of steps I needed to get to my lab. I absolutely refused to take the elevator. Goofy I know, but that was my benchmark I was okay. BP and pulse remained dead steady at 110/70 pulse 72. Give or take a small amount that is what it has been my entire life. That too gave me a perverse pleasure.
FWIW as I've heard the Neupogen shot is no fun my doc let me slide to 1.8 and it was like things finally bottomed out there. As I did not get sick we let it ride. Helped I'm sure that I'm retired and my son is 17 and not prone to illness. Exposure to disease was reduced. Gotta admit always scared me when I had to go to the hospital and doctors offices. (Psst, I'll let you in on a little secret, sick people go there.)
Assume your failure to move faster towards undetectable was due to lowering RIBA, cranking back up hopefully with get that undetectable soon.
My compliments to your doc. He obviously realizes the importance of this to you and is willing to let you determine what is acceptable risk. My doc did the same and unless somebody shoots him, or me, I wouldn't switch for all the supermodels in the world. (Now I'm lying through my teeth 'cause after the worlds supermodels were through with me I think I'd be happy to die.)
Looks like yall got bases covered, only things would be B12 and B6, wouldn't hurt to have those checked, along with O2 for grins. (O2 isn't that great as it really only measures O2 in the existing cells and can be normal as long as a few cells float by, but if you end up with a lot of immature cells that are incapable of carrying O2 it's an easy way to tell.
I assume your doc is also considering potential of future TP, if he can get this sucker beat if and when you ever needed a TP you'd be miles ahead of us.
If I don't clear on my next round I may move back up to MN just for your doc. I lived in Winnegago for a year. We loved it and my wife hated to give up that house. She cried when she first saw it but I saw the potential. I spent 20,000 grand fixing it up with me doing all the labor. House sold for three times what I paid for it in 3 days. First time I've ever had a realtor aplogize for not charging more. With a doc like you've got it would be worth the move. (I might have to have terrorist hit that ethenol plant though, on the rare days the wind changed..........)
Other then I'd split the shots and the few test suggested above, my only other advice would be relax and enjoy the ride. With this doc's attitude and yours I'd happily bet money on the outcome. Just be prepared for transfusion if you hit 7.0 or below, but considering all you've been through that ought to be a walk in the park. I plan on starting my next round in Jan., I think I'm going to see if it is possible to donate a few units for storage, just not sure what shelf life of packed RBC is.
Stupid though, wouldn't hurt to wonder by a BP chair in a phamacy and keep a close eye on BP, just in case ya know. Besides I've always like those chairs and as a kid could never pass up the chance to sit in one, okay okay, I still never pass up the chance.
Relax, go with the flow, and think of the story you'll have to tell your great grandkids.
Doug
You said your doc let your white count go to 1.8. Do you mean ANC? My WBC doesn't go above 2 and my ANC goes down to .4, but my dr. makes me get Neulasta when it goes below 1.0, so I was wondering about the 1.8. Maybe your labs use a different value?
BTW Thanks for the dinner invite! Sounds like you cook up a storm, if I can make it I will be sure to see what the menu is for the night!
BTW Thanks for the dinner invite! Sounds like you cook up a storm, if I can make it I will be sure to see what the menu is for the night!
The change being made to my Procrit regiment is instead of 100,000 U at one sitting, to spread it out to 50,000 in a couple of sittings through the week.
As indicated in my question the objective is to maintain a more steady level of the med in my body rather than a single boost which tapers off over the week until the next boost.
This sounds much similar to what Beagle Bailey, nygirl, and goofydad have done during their tx and I'm hoping to achive a similar result which hopefully will kick my Hgb up another notch or two and lessen the chance of long-term sx's from the med. From what goofydad experienced, I now know to not place to high an expectation on the Hgb boost, which is one thing I was wondering about. The other is how effective it will be keep Hgb at levels it currently has reached with the existing dosage being split into injections spread out over several days?
Like Jim, I too found multi-ml was too much for a single injection.
As indicated in my question the objective is to maintain a more steady level of the med in my body rather than a single boost which tapers off over the week until the next boost.
This sounds much similar to what Beagle Bailey, nygirl, and goofydad have done during their tx and I'm hoping to achive a similar result which hopefully will kick my Hgb up another notch or two and lessen the chance of long-term sx's from the med. From what goofydad experienced, I now know to not place to high an expectation on the Hgb boost, which is one thing I was wondering about. The other is how effective it will be keep Hgb at levels it currently has reached with the existing dosage being split into injections spread out over several days?
Like Jim, I too found multi-ml was too much for a single injection.
Not sure if this ground has been covered, but with all the Procrit you're taking, have you had your iron stores checked?
Adequate iron stores are needed for hemoglobin production and Procrit over a period of time can deplete them. The two iron store tests are Serum Ferritin and Transferrin Saturation (TSAT). These are different and usually have to be ordered separatly from the basic serum iron test that is somewhat routine.
In general, if Ferritin is below 100 or TSAT below 20%, you probably need supplemental iron for the Procrit to work. This sounds counter-intuitive to what we learn regarding iron supplementation, but what we learn assumes normal iron stores. In fact, in the Swedish High Dose Ribavirin study, all of the participants eventually ended up on Procrit and I believe all or at least most required supplemental iron.
I do think spreading your dose out over the week might be a good idea but haven't heard or read anything to that effect. I should also add that my NP did tell me at one point during treatment that there is a point of diminishing returns regarding adding Procrit and also suggested that compromised kidney function (from the interferon) could also inhibit hemoglobin production or Procrit efficacy -- not sure which, but I assume your doctor is monitoring your kidney function tests carefully in light of all the Procrit.
All the best in your fight to get those red cells up !
-- Jim
Adequate iron stores are needed for hemoglobin production and Procrit over a period of time can deplete them. The two iron store tests are Serum Ferritin and Transferrin Saturation (TSAT). These are different and usually have to be ordered separatly from the basic serum iron test that is somewhat routine.
In general, if Ferritin is below 100 or TSAT below 20%, you probably need supplemental iron for the Procrit to work. This sounds counter-intuitive to what we learn regarding iron supplementation, but what we learn assumes normal iron stores. In fact, in the Swedish High Dose Ribavirin study, all of the participants eventually ended up on Procrit and I believe all or at least most required supplemental iron.
I do think spreading your dose out over the week might be a good idea but haven't heard or read anything to that effect. I should also add that my NP did tell me at one point during treatment that there is a point of diminishing returns regarding adding Procrit and also suggested that compromised kidney function (from the interferon) could also inhibit hemoglobin production or Procrit efficacy -- not sure which, but I assume your doctor is monitoring your kidney function tests carefully in light of all the Procrit.
All the best in your fight to get those red cells up !
-- Jim
Jim,
I did read the full post on six months post relapse. I think the biggest kick out of it was when Bill57 claimed he has degrees in both biology and chemisty, yet he can't spell, write well, punctuate, and has no clue of scientific method. If that guy has degrees in anything I might as well go shoot my son now as no telling how far education will fall before he graduates High School and he's a senior.
Anyway last post I saw from him dated the 20th of August. Hopefully the powers to be on that site quietly evicted him.
Doug
I did read the full post on six months post relapse. I think the biggest kick out of it was when Bill57 claimed he has degrees in both biology and chemisty, yet he can't spell, write well, punctuate, and has no clue of scientific method. If that guy has degrees in anything I might as well go shoot my son now as no telling how far education will fall before he graduates High School and he's a senior.
Anyway last post I saw from him dated the 20th of August. Hopefully the powers to be on that site quietly evicted him.
Doug
Yeah, I was going to chime in on the thread, but when someone posted like the definition of SVR from half a dozen sources, I figured talking to Bill would be like talking to a rock.
Just checked my labs.
These are labcorp, perhaps Quest reports differently?
Reference numbers for White Cell Count for my age and sex:
4.3-10.8 X10^3/CM Pre-tx mine generally run just a tiny bit on the high side, 12 or so, during tx generally stayed in low 2 range with occasional dips to 1.8. My GI wouldn't even consider Neupogen until 2.0.
Doug
These are labcorp, perhaps Quest reports differently?
Reference numbers for White Cell Count for my age and sex:
4.3-10.8 X10^3/CM Pre-tx mine generally run just a tiny bit on the high side, 12 or so, during tx generally stayed in low 2 range with occasional dips to 1.8. My GI wouldn't even consider Neupogen until 2.0.
Doug
My WBC was also below "2" for much of treatment. I think what SF was suggesting is that ANC (absolute Neutrophils), a WBC fraction, is usually what determines Neupogen intervention. In fact, my hepatologist was never concerned about WBC as long as my ANC was within limits.
Some doctors intervene with Neupogen when ANC hits 1000 but many let it fall to 500 or even lower before prescribing Neupogen. My med team doesn't get concerned until ANC remains close to 200-300.
ANC has a tendency to bounce around a lot. One week my ANC was 320, and a couple of weeks later it was over 1000. This was without Neupogen intervention. In fact, recent studies suggest that interferon-induced low WBC does not correlate with higher infection rates for those treating for HCV. My thinking is that many doctors are still working off older data which suggested WBC did correlate with higher infection rates.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=16082419&dopt=Abstract
--Jim
Some doctors intervene with Neupogen when ANC hits 1000 but many let it fall to 500 or even lower before prescribing Neupogen. My med team doesn't get concerned until ANC remains close to 200-300.
ANC has a tendency to bounce around a lot. One week my ANC was 320, and a couple of weeks later it was over 1000. This was without Neupogen intervention. In fact, recent studies suggest that interferon-induced low WBC does not correlate with higher infection rates for those treating for HCV. My thinking is that many doctors are still working off older data which suggested WBC did correlate with higher infection rates.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=16082419&dopt=Abstract
--Jim
Yes, I was referring to the ANC numbers. My doc doesn't care if my WBC is 1.4, but if my ANC is .8, he says he will take me off tx if I don't do the shot. GRRRR Maybe I need to space my appts. with him...
I haven't heard of anyone getting infections from low ANC around here, have you? I tend to believe that study, as I have had lots of opportunities to get sick and have not, when my WBC is low.
I haven't heard of anyone getting infections from low ANC around here, have you? I tend to believe that study, as I have had lots of opportunities to get sick and have not, when my WBC is low.
Jim,
That's why we did additional labs last Thursday after Tuesday's showed Hgb continuing to drop. Results were Iron mid-range norm and new red cell count mid-range normal.
Doug,
My ANC it 700 and 600 before I was prescribed the Neupogen regiment. Throughout most of tx ANC has hovered around 1000 - 1100.
That's why we did additional labs last Thursday after Tuesday's showed Hgb continuing to drop. Results were Iron mid-range norm and new red cell count mid-range normal.
Doug,
My ANC it 700 and 600 before I was prescribed the Neupogen regiment. Throughout most of tx ANC has hovered around 1000 - 1100.
I see it is a calculate value but how the heck is it calculated? I looked but the calculations I found still don't match my lab work, in this case standard CBC although I do love all the lines that say either;
Slide Reviewed - Consistent with instrument results
Results Verified - Consistent with recent patient results.
Now don't statements like that on lab work give you that warm fuzzy feeling. <grin>
Doug
Slide Reviewed - Consistent with instrument results
Results Verified - Consistent with recent patient results.
Now don't statements like that on lab work give you that warm fuzzy feeling. <grin>
Doug
Statistically, you're probably OK, but the serum Iron test you mention is different from the iron stores panel which consists of two additional tests: Serum Ferritin and Transferrin Saturation (TSAT).
If your doctor hasn't already, I can't see any harm ordering these tests given your high dose of both riba and Procrit. As I mentioned earlier, almost the entire high-dose ribavirin study group was on supplemental iron presumably because of low iron stores. Don't at all mean to be intrusive with your treatment, but from experience I've found that even the best doctors sometimes don't order the iron stores test because statitically you should have enough iron stores to last an average treatment. On the other hand, we all don't fit into the statistical model.
-- Jim
If your doctor hasn't already, I can't see any harm ordering these tests given your high dose of both riba and Procrit. As I mentioned earlier, almost the entire high-dose ribavirin study group was on supplemental iron presumably because of low iron stores. Don't at all mean to be intrusive with your treatment, but from experience I've found that even the best doctors sometimes don't order the iron stores test because statitically you should have enough iron stores to last an average treatment. On the other hand, we all don't fit into the statistical model.
-- Jim
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