Riba Increase?

[epiphiny]

I'm about to start week 45 of 48 and have had my last blood tests until EOT.  I've been on a riba reduction of 200mgs per day (from 1200 to 1000)  for the past 3 weeks . My hbg is still at 10, no rise since last test.  I weigh 73kgs. By my calculations this makes my dose borderline for my current weight, depending on whether you calculate it out at 13 or 15 mgs per kg.

There will be no more blood tests until I finish treatment (ie: no supervision) and I had intended to go back up to my full dose for the last leg of the journey despite the nurse saying she didn't think I needed to. Before I do this I would be interested to hear any pros and cons from members.

Basically, are there any benefits to going back to full dose for the last 3 weeks or will I simply make myself feel rotten?  Btw, I don't care if I cross the finish line crawling on my hands and knees, bleeding and bruised.  I just want have the best possible chance at SVR.

I also have the option of extending for an extra week as I have an extra shot and enough riba to continue for 7 days after scheduled eot.  Any thoughts, ideas and opinions on this as well?

Many thanks,

Epi :)

[Tippyclubb]

Yeah what is this upside down method?  I have this vision in my mind of you standing on your hands while someone injects you.  Tell me it isn't so.  Lol!

[geterdone]

Squeezing the grapes eh? Dis is good.

jasper

[lalapple]

i agree with what Kristina said, maybe it's best to take it step by step if you really want to increase dose.  i love your attitude and definitely think it's important to stay at full dose, but the body takes time to adjust.  1000 is already a lot if you ask me, my full dose is about 800 (take 4 pills a day, each pill is 200mg) and i've been sticking to it.

and what is the upside down method?

[epiphiny]

Thanks for that, I haven't increased as yet, was still debating and actually having similar thoughts to those you have outlined above.  

Methinks the key factor is that my Hbg is just sitting on 10 even after 5 weeks of reduction, so as you say, it is holding a steady serum level and I do believe I will tank if I go up as well.  If I had gone back up to 10.5 or so then I would have been happy to the roll the dice that way knowing that I probably wouldn't fall below 10 before eot.

I'm leaning toward the week extension, or a taper situation if I can just find some sterile needles to make my extra shot of IFN stretch out.

I'm also doing the upside down shot method so I have roughed up the playing field a little prior to the end...

Btw, that song was great, brought back so many great memories!!  Great theme song for the last  few miles!!!

[geterdone]

Have you increased your Riba yet? If no, I would rethink your decision to do so and stay at your present dosage to the eot. It would seem to me that your red blood cells love the riba and ***** it up like a sponge and your system is not clearing it fast enough and am sure you will tank if you up your dose.

It was suggested that blood transfusion and intensive haemoglobin level monitoring is necessary for at least 4 weeks after the RBV, because of the high accumulation of phosphorylated ribavirin in erythrocytes even after stopping ribavirin administration.

[Kristina538]

P.S.  I do remember someone posting that when they reduced to 800,  rather than increase back to 1000, the doctor recommended they do 900 i.e. 800 one day; 1000 the next.    Perhaps you could do the 1100...

[Kristina538]

Hey lady;  I admire your fighting spirit and look forward to seeing you finish.   I have to say that another NZer whom I've spoken to your about (Geno 1 48 weeks tx and still UND at 3 months),  had a riba reduction about 6 weeks before EOT and chose to up her riba about 3 weeks before EOT.

She became anemic again in her last week and continued feeling really really bad for almost 2 weeks post.   I 'talked her' through a couple of nights where she had that 'liquid brain' thing (you know, where you turn your head and your brain follows a millisecond after), headache, breathlessness and dizziness.   I sometimes thought that the AD's made her more brave as I would've been to the A & E if I'd been going through the same....

I was expecting her to crash a little when she said she was upping her dose again and it happened, but neither of us realised how long it took for her to stabilise after she finished the last riba.

All I'm saying here, is to just be aware that this stuff is accumulative, and whenever you start increasing, I would expect it to build up again.   I don't mind 'bleeding and bruising' to the finish line;  but I'd hate to see you really laid up.

So, if you go with the increase (hehe and I'm pretty sure you will!) please notice the wee subtle changes that are letting you know that your hgb is dropping further (so that it doesn't jump up and bite too hard all of a sudden) and maybe drop again for a day or three?  I really want to see you do a fireworks blazing finish, but without burn fingers.  

Nice to see you posting - I was hoping all was well and here you are!! Blazing strong and determined as usual.  Hats off to you Epiphany.

[Emilio44]

I'm with you merryBe.  I think you should stick with the 1000mg and go the extra week, not a bad dose for your weight, right on the money actually.  Great news on still being UND this far in and no rebounding.  I'm sure the extra 200mg for a few weeks wouldn't do much in terms of sx's and that option is okay too. But stretching out the length of tx is statistically the better option in my opinion, but without additional peg and a good riba half life others may say don't bother.  You have the option to taper out your last three peg shots and dose up on the extra 200mg riba and rely on the natural riba taper.  I am at week 56/63 and have decided to taper down on my last 3 shots of peg.  I too have some additional riba and am undecided how I will consume them, big bang or extension??? Good luck with your decision. Emi.

[merryBe]

>>>>>>>Basically, are there any benefits to going back to full dose for the last 3 weeks or will I simply make myself feel rotten?  Btw, I don't care if I cross the finish line crawling on my hands and knees, bleeding and bruised.  I just want have the best possible chance at SVR.


I think you just answered your own question. For whatever reason longer tx means higher SVRs across all genotypes, especially against the tough ones, so if one week gives you a 1, 2 or 3 % better chance at SVR....play the odds....

Like why Am I making the trek to 88 weeks....don't know...just the odds and stats mean something...somethings that took me from 40% to 80%...they all added up....it could still backfire, but at least when you know you gave it the real college try.....

mb

[geterdone]

One other analogy, flying in a jet at 32k feet and hit an air pocket! (dead air space) Jet drops 300 feet, what do you feel?

geterdone

[geterdone]

Only the “Treatment Experienced” will push the pedal to the metal under the radar. Cursing at 65 on the open desert highway with the intentions of turbo boosting to 85 takes guts and mental illness to attain ultra satisfaction to the end of never, never land. Yup, ain’t never going to do that again, lol. But, it is a personal decision and one need to look at it like this, your body had become accustom to the 1000mg riba and the riba is the back side of the killing field (clean up crew), so in order to destabilize the field one must get it out of its comfort zone and the extra 200 octane will indeed do that as the last virions mutation process will defiantly send it over the exhilaration edge if there are any left. But will caution here, you will feel the effects of the extra riba as when you first started. Good Luck in your decision.

Jasper

http://www.youtube.com/watch?v=Hw9CzSSk218

[epiphiny]

Hmmm, just figured out have been on reduction 5 weeks.  Wish I could just take my foot off the pedal but I have to keep driving this crazy tx car.  Keep your hands on the wheel, and your eyes upon the road.  Isn't that a song?

Trin, I'm trying to weigh the pros and cons but I have the normal human tendency to be attracted to pleasure and avoid pain and so of course pleasure-self  is leaning toward staying on the 1000mgs.  But how would I feel IF I relapsed?  Could I live with the self disappointment?  I don't know.  I got a lot of thinking to do...

[Trinity4]

No answer here either and I don't know how much difference the 200 mg more of riba a day for the next 3 weeks will make in your overall riba serum level.  Since you are hanging at 10 with the 1000 mg that is close to the edge and with 3 weeks left I would play it safe and stick with the 1000 mg.  Don't think an extra shot will make much difference either.  I think by now your body has done all that the meds intended it to do,  
If adding the riba back will make you feel better about the outcome but physically worse than the cons outweigh the pros  


Trin

[epiphiny]

Oh, forgot to mention the good news.  The reduction appears to have had no impact on my VL, still currently UND after 3 week riba reduction.  Woohoo!  Good boost for the last few weeks...

[epiphiny]

Yes, I want to give it everything.  I believe I calculated I could up the dose and do the extra week at full dose as well, would just need to recheck that when I get home tonight.  That would mean one more month at full dosage all round.  

It's all tempting that's for sure BUT I don't want to end up in the ER, esp as there will be no-one monitoring my safety bloods and as the 200 reduction brought me up .3 in 3 weeks it would follow it would probably drop me again in a similar amount of time.  It was no fun being down in the 9s, that's for sure.

Appreciate your input, ladies.  Really starting to feel like I'm starting to fly outside the envelope as the landing strip gets closer...

[zazza]

The extra week sounds tempting to me.

Oh, look who is talking, who took extra riba her last month of tx just because she had some laying around. = me. (Don't think upping the riba would make any difference this late in the game, but maybe you are like me who wanted to give it everything I had.)

Do you have to choose? If you do, I would pick the extra week.

[GreatBird]

I don't have an answer for you either, but I've been thinking about your question and this is what I'm thinking . . .

I don't know how much your HGB would go down with a dose increase. Will it stay in the 9's? That's probably doable. Would it get to a dangerous number? That isn't something you want to do. Increasing the riba without a blood test to check might be dicey.

It just seems to me that you're so close . . . stay as healthy as you can. How to do that isn't the easiest thing to figure out.

I don't think anyone can tell you definitively what the best course of action would be. But the more I think about it the more I think that the extra riba and extra shot won't make a difference at this point.

[Tippyclubb]

I had a Riba reduction yesterday from 1000 to 600, my 11th week.  I know how your feeling. I am not informed enough to give advice but sure someone will.  Just wanted to give you a bump too.