Sore Troat

[Bobby1952]

I have been on Hep C tx for 12 weeks now. My Viral load is due back any day now. I am Genotype 3a. My question is has anyone experienced constant throat pain since they have been on treatment. I am annoyed because when the sore troat started i went to my general practitioner and told him I was on interferon. He looked at my throat and mis diagnosed it as a Bacterial infection. Duh !! Anyway I finally went to my Liver Doctor after the second relapse and he saw right away that it was a Fungal infection which caused blisters on my throat. He gave me a script for CLOTRIMAZOLE lozenges which are not working. I read somewhere that there is a better product that treats it systemicly. Had anyone heard of this. The reason I am so concerned is because last week the Fungal infection got into my blood stream and I felt like dieing.

Any info would ne appreciated
Thanks

[Bobby1952]

I am not so concerned about the sores per se , its just that when its gets infected and gets into my blood stream i get concerned because antbiotics don't really work and the clotrimazole doesnt seem tro be working either.

[nygirl7]

Nothing worked on my stupid mouth sores...........you are so lucky that it worked I am so jealous (but not enough to try treatment again to try that clotimzole LOL)

I am very glad for you they are gone - they were just so painful nobody could ever understand. By the end of treatment I swear it looked like I had a forked tongue it was so ripped up.

[Bobby1952]

I can see the gargle with Salt water, but just curious what does the baking soda do. How much do you gargle with. Do you mean the quart of water lasts you the whole day?

Tks Bobby

[dogsledder]

I have periodic sore throat and really painful mouth sores. I used CLOTRIMAZOLE for the mouth sores and it worked. Sore throat I gargle 5x per day with a salt (2 tsp) and baking soda (2tsp) mix in 1 qt water. I am 56, 1a and in wk 40 of 48. Seems to keep it under control. Haven't needed antibiotics although this tx  wears down your autoimmune system.

[nygirl7]

I has the tongue and throat problems from the interferon myself and personally for me it was one of the hardest things to tolerate during treatment.

Once I was off the interferon however the joy of eating an Oreo almost over took me.  I'd never been in love with food before but after not eating or enjoying anything for over 72 weeks.........well let me tell you, you have something wonderful to look forward again once you're done.

Just be careful - I gainned back the 20 I lost and then ADDED 10 pounds on top.......and now.......I have to avoid those same delicious little cookies at all cost!

[jmjm530]

Thanks. Not sure if my ENT uses a disposable Sheath in his office of not, but I think I might ask next time. But from what you say, sounds like he might not given the fact that I saw some of those laryngoscope's floating in some sort of liquid. Not sure if you caught my post above the one your responded to. Hopefully, that "<10" of yours means you are already UND and not that you have 10 IU/ml of virus left.

-- Jim

[Facta_non_verba]

I'm pretty certain my exposure was from a needle stick. I work at a county hospital with a large indigent population in which use of IV drugs is not uncommon. Like every other surgeon, I occasionally get stuck with a needle. It's typically a suture needle, and a small one at that. The amount of blood it carries is small compared to a stick with a hypodermic needle. Probably the riskiest thing I do is facial trauma. If there is a mandible fracture the jaws need to be wired shut before the fracture is plated. The wires are big and covered with blood, and before they are cut to size they are all over the place.

As far as disinfectants in the hospital I can't say exactly, but In the OR the room is thoroughly cleaned with disinfectant before each case. I understand that both HBV and HCV are hardy and can live in dried blood for up to two weeks. Still, you'd have to have blood to blood exposure.

I know the scope you are talking about. It goes by various names, but we call it a flexible fiberoptic laryngoscope. At my hospital we no longer soak the instrument; we use a disposable sheath and then wipe it down with alcohol after each use. The sheaths are expensive, but we know that the sheath is sterile and we don't have to expose expensive equipment to water and disinfectants. I agree that there is the potential for blood to blood contact if an unsterile scope is used. The procedure often causes a small amount of bleeding, and if the scope were dirty you could be exposed.

Jeff

[jmjm530]

If you don't mind discussing, do you have any thoughts how you may have been exposed to HCV? I'm asking, of course, because of the risks in your profession.

Also, would like your comments on disinfectant procedures in hospitals and offices in your field re HCV.

Two examples come to mind. Endoscophy and that small fibrooptic? light probe ENT's stick up your nose to examine your vocal chords.

I assume the scope used for endoscophies are autoclaved, but what I observed at my ENT's office was that the wire-like fibro-optic probes appeared to be sitting in a wall-holder filled with what I assumed to be a disinfecting fluid. Wondering if that is proper procedure (assuming that is all they do) and if indeed imersing these instruments in a disinfectant fluid is enough to kill the virus with 100% certainty. I mention this, of course, because blood can easily be transferred as the scope passes through the nasal canals.

-- Jim

[jmjm530]

Facta: My last test was at week 20 which was quantitatively <10 but not zero.
----------------------------
From the tests I'm familiar with, the notation "<10" means undetectable, with the "<10", simply the sensitivity of the test. You will note that the "<10" probably is in the "in range" or "normal" column. If you have the lab resuts at your disposal, you can check this and also if you give us the name of the test it can be confirmed, but I'm pretty sure based on what you said that you're UND at week 20. (None of the tests go down to zero, the most senstive ones being "Heptimax" by Quest Diagnostics that goes down to 5 IU/ml and a Quant by LabCorp that goes down to 2 IU/ml. A test like you took, that goes down to 10 IU/ml is still considered very sensitive).

Assuming then that you were UND (to <10) at week 20, you will still probably need 72 weeks of treatment for a decent chance of SVR per the studies posted earlier. Also, given your late response, consider testing monthly throughout treatment using the test you're taking (or one of the tests mentioned above)  to make sure the virus stays down.

-- Jim

[Facta_non_verba]

Thanks for your comments. Throughout this whole thing I've tried to stay out of the role of doctor and into the role of patient. I'm a surgeon and truly don't know a whole lot more (and probably less) than the people here on this forum do about hepatitis C. I got a routine blood test and TB skin test earlier in the year and was surprised to find out I was infected. The first thing I did was to call the hepatologist who runs the hepatitis clinic at the county hospital where I work. His main practice is at a nearby university hospital. Thankfully, he didn't just give me a curbside consult and some Rx's like physicians often get. I had to do the whole deal, even the injection class, before he would start me on treatment. Now that I see for myself what this treatment is like for me as a patient, I'm glad that I'm letting someone I trust take care of me.

As far as the 12 week log 2 drop, I may actually have achieved it. Because of my schedule I came in at week 11 and my count had gone from 3,100,000 to 48,000. He upped my ribavirin to 1400mg/day and at week 13 it was 8,520 or greater than a log 2 drop. My last test was at week 20 which was quantitatively <10 but not zero.

If I'm not at undetectable by week 24 I will probably call it quits and wait for the newer drug(s) in the pipeline. Again, thanks for all your comments.

Jeff

[tahoeunicorn]

I am in my 5th week of tx. I too have sore Throat and as my husband says I can Screech real easy now. Sometimes I whisper then my voice will change to a rasp , then to the screech.. I have one spot in the back of my throat that hurts real bad. I have gotten  some Sore Throat Spray and use two or three squirts when needed an it'll help, may take a couple times to really numbs the throat.

Good-Luck

Lynn

[geterdone]

had you had a Thyroid Cascade Test done yet? Had one just before the beginning of tx 01/31, normal and then again at 06/07 normal, but had symptoms I could not explain. Two thing happened, one my thyroid was bouncing in and out undetected that is, and could not picket it up on a test until 08/04 and it finally showed up as Hyper and then on 10/11 it went Hypo and finally got the meds for it. I had the on and off again sore throats up to that time. But at the same time on 07/06 I had reduced my riba 1000mg. I am pretty sure that the higher does of Riba was the culprit.

Might help to get a Thyroid test.

jasper

[jmjm530]

http://www.natap.org/2006/AASLD/AASLD_34.htm

"....Outcome in patients without an RVR and an EVR
An extension of therapy to 72 weeks in patients without an RVR and an EVR (Group C) provided an SVR to just 4% of patients.
- this confirms the clinical utility of EVR as an evaluation point for continuing or discontinuing treatment."
----------------------

[jmjm530]

You may find this study helpful, especially if you access the full-text version. I see no mention here of those who did not achieve the two-log drop, but memory serves me that they did not benefit from 72 weeks. Perhaps that is in the full-text version or you can pursue that more on your own if interested.
http://www.hivandhepatitis.com/2007icr/easl/docs/042407_a.html
---------------------------------------

Selected Patients with Genotype 1 HCV May Attain SVR by Extending Treatment Duration to 72 Weeks

The current standard of care for chronic hepatitis C patients with genotype 1 is pegylated interferon plus ribavirin 1000-1200 mg/day for 48 weeks. However, just under half of patients on this regimen do not experience sustained virological response (SVR), defined as undetectable HCV viral load (< 10 IU/L) 24 weeks after the end of treatment. Some studies have suggested that it may be possible to increase SVR rates by extending the duration of treatment beyond 48 weeks.

In a retrospective analysis of data from 3 multi-center studies conducted in Spain, Austria, and Germany (n = 1338), researchers investigated the relationship between virological response after 4 and 12 weeks of treatment and SVR rates in patients treated for 72 vs 48 weeks. The objective was to identify which patients would be most likely to benefit from extended treatment duration.

All studies compared 48 vs 72 weeks of treatment with pegylated interferon alfa-2a (Pegasys) plus ribavirin (800 mg/day or 1000-1200 mg/day). Overall, 95% of participants had genotype 1 HCV infection.

Rapid virological response (RVR) was defined as HCV RNA < 50 IU/mL after 4 weeks of treatment. Early virological response (EVR) was defined as no RVR but HCV RNA  2 log10 HCV RNA decrease), sustained response rates were higher after 72 vs 48 weeks of therapy.

Conclusion

In conclusion, the authors wrote, “These exploratory data indicate that genotype 1 patients with an EVR (> 2 log10 drop) receive benefit from extension of combination therapy to 72 weeks.”

They added, “Treatment optimization in these patients requires confirmation in large prospective studies using the currently recommended doses of ribavirin (1000-1200 mg/day).”

Hospital Clinic Institut Investigations Biomediques August Pi I Sunyer, Barcelona, Spain; Medical University Of Vienna, Vienna, Austria; Hospital General, Valencia, Spain; Hospital Universitario De Valme, Sevilla, Spain; Saarland University Hospital, Homburg-Saar, Germany; Universitatsklinikum Charite, Campus Virchow-Klinikum, Universitatsmedizin Berlin, Berlin, Germany.

04/24/07

Reference

J M Sanchez-Tapias, P Ferenci, M Diago, and others. How Can We Identify HCV Genotype 1 Patients Who May Benefit from an Extended Treatment Duration with Peginterferon Alfa-2a (40KD) plus RBV? 42nd Annual Meeting of the European Association for the Study of the Liver. April 11-15, 2007. Barcelona, Spain.

[jmjm530]

I assume you understand that you may be facing very long odds without a two-log drop at week 12 even if you extend to 72 weeks?

The more recent extended course studies for genotype 1's only appear to recommend 72 weeks if two-logs (EVR) are accomplished by week 12 and then only if UND by week 24. Personally, I don't think I'd continue on unless I had significant liver damage and therefore willing to extend to more than 72 weeks, but even there, the waters are uncharted by studies.

Have you tested since week 12 via sensitive TMA. Being an MD, you should be able to test at will, and at this point weekly TMAs might be in order to see how close to week 12 you become UND.

All the best,

-- Jim

[Facta_non_verba]

I've had the same problem as you since starting treatment nearly 6 months ago. Here's the kicker: I am an ENT specialist. For over a month the left side of my throat hurt. I felt the pain in the area of my tonsil, but the exact area was hard to pinpoint. Since I treat a lot of people with throat cancer I finally went to a colleague of mine in the same specialty and got checked out. He found nothing. Since that time the pain has gotten better and worse and has involved one/the other/both sides of my throat.

I tried two courses of antibiotics, prednisone and some medicated solutions to gargle. Nothing worked. I have less pain now, but that may be because it has been eclipsed by this terrible cough that won't go away.

STATS: 51 y/o male, first timer, genotype 1b, initial viral load 3.1 million. My viral count didn't down quite 100-fold as desired at 12 weeks, and my ribavirin dose was increased to 1400mg per day. That's when the cough really started getting worse. That's also when the anemia became noticable to me. I got started on ProCrit, which helped quite a bit.

Seems like I've had most of the side effects that others have suffered from, but I think I got off a little easier than many since I've been able to continue to work a fairly heavy load (hospital based practice and two private offices plus starting another business unrelated to medicine). I think my wife is suffering as much as me due to my mood. Wellbutrin has helped. The oddest thing is that many of the things I say that affect my wife don't seem offensive to me at all. Sometimes i realize what I said was hurtful, but the words just tumbled out of my mouth

Sorry for getting off topic, but no one at work knows and neither do even most of my family. I don't want to worry them, and I don't want people asking me if I'm OK all the time. It feels good to just write this out.

Jeff

[charm27]

I have had an on again off again sore dry throat since my 2nd shot. Its horrible. Goes away for a few hours and returns again. Very congested too.

[jmjm530]

Sorry about the problems. Best person to dx a sore throat would be an ENT specialist, as they have the proper tools to light up and inspect the upper gullet. One cause of sore throat, often missed, is Laryngopharyngeal Reflux (LPR). Unlike ordinary reflux or GERD, LPR often presents without the hearburn, but the damage caused is by the same acid reflux that causes hearburn in the lower esophagus. Just in this case the damage is caused higher up, in the vocal chord region. Are you experiencing any hoarseness by any chance? Persistent hoarseness is a classical sympton of LPR. I know because I had LPR for most of treatment, and still have some symptons post treatment but nowhere near the same.

-- Jim