Aa
Treatment failed
Hello Readers.
I am a caregiver for a male patient 49 years old, with hepatitis c. Genotype 3a. Beginning viral load 3 million and some change. *PAST* history from age 8 too 40 of drug abuse. Aside of the hepatitis closed head injury (2) 4 bad disks in back, bad circulation in legs and past neck injury. Patient see's a pain doctor aside from the gastrologist, and also suffers badly with E.D.
Tests done:
CT abdomen with and without contrast
Visualized GI tract unremarkable. Gallbladder, spleen, pancreas, adrenals, and kidneys unremarkable. Minimal aortoiliac calcification. Incidental circumaortic left renal vein. No focal hepatatic lesions however the liver has a very subtle pattern of surface nodularity especialy involving the left lobe which could indiacte developing cirrhosis but there is on evidence of portal hypertension currently. Examination also notable for mild upper abdominal adenopahty including 3 cm x 1.7 cm precaval, 2 cm x 1.2. cm celiac axis, 2.1 cm x 1.1 cm porta hepatis, and mutiple small and borderine peripancreatic lymph nodes.
liver biopsy
blood tests galore!
endoscopy (for acid reflux GERD issues)
stress test
When patient was started on ribasphere 200mg two tablets 2 times a day, Pegasys once weekly subcutaneously, prilosec 20mg once in the morning. Ritalin 10mgs -given too patient when patient lost 35 pounds in 3 months for hunger stimulation, celexa 20mgs one tablet once daily, methadone 40mgs two tablets 2 times daily. Valium 5mg -taken once daily. Patient is a smoker 1/2 to 1 pack per day.
Patient took too treatment very well, feb08 HCV quanity low linearity and remained this way through June of 08. After treatment was completed at six months, blood test now in November almost 4 months later patient went from low linearity back up too 859,057.
Patient did fairly well during treatment but did suffer from rash's on upper hands and arms, difficulty sleeping and eating, and a lot of confusion and his platelettes were very low - starting at 183 in January and fell too 67 in april thru june, and now in November there at 135. Also noticed iron is high - started out high and remained high but liver biopsy showed nothing in regard too damage from the iron.
In closure too all this, here we go again? I'm taking him for a second opinion, though we both know he'll probably end up having too do this again, and they are suggesting this time instead of six months, but a year now.
Why did this happen? why did it come back so soon? I thought 3a was easy too treat? is it maybe we stopped too soon? just because blood results showed undetectable we should of maybe kept on it for awhile more too try and; pardon my expression" kick the virus's *** and too make sure it was staying that way?
I'm frustrated for him, and for myself, because i too have the same genotype and we agreed two people doing this at the same time wasnt perhaps so good too do, one of us should wait, he's had this disease a lot longer than myself, AND my insurance horrible and they do NOT like too send patients too a specialty doctor and have continued too tell me, "lets watch your blood results". I personally feel why wait for damage too occur, i've already been juandice and hospitalized once, why wait and let things get worse, i'd hit it before it even got there, but that's just my opinion for whatever it's worth.
So what does anyone think? another round of this interferon but now a year? can someone handle this after going through six months of this do this for a year, so soon?
Any suggestions and/or comments be appreciated and many thank you's for anyone taking the time too read and post.
Best regards and happy holidays too all of you.
Anita -Michigan
I am a caregiver for a male patient 49 years old, with hepatitis c. Genotype 3a. Beginning viral load 3 million and some change. *PAST* history from age 8 too 40 of drug abuse. Aside of the hepatitis closed head injury (2) 4 bad disks in back, bad circulation in legs and past neck injury. Patient see's a pain doctor aside from the gastrologist, and also suffers badly with E.D.
Tests done:
CT abdomen with and without contrast
Visualized GI tract unremarkable. Gallbladder, spleen, pancreas, adrenals, and kidneys unremarkable. Minimal aortoiliac calcification. Incidental circumaortic left renal vein. No focal hepatatic lesions however the liver has a very subtle pattern of surface nodularity especialy involving the left lobe which could indiacte developing cirrhosis but there is on evidence of portal hypertension currently. Examination also notable for mild upper abdominal adenopahty including 3 cm x 1.7 cm precaval, 2 cm x 1.2. cm celiac axis, 2.1 cm x 1.1 cm porta hepatis, and mutiple small and borderine peripancreatic lymph nodes.
liver biopsy
blood tests galore!
endoscopy (for acid reflux GERD issues)
stress test
When patient was started on ribasphere 200mg two tablets 2 times a day, Pegasys once weekly subcutaneously, prilosec 20mg once in the morning. Ritalin 10mgs -given too patient when patient lost 35 pounds in 3 months for hunger stimulation, celexa 20mgs one tablet once daily, methadone 40mgs two tablets 2 times daily. Valium 5mg -taken once daily. Patient is a smoker 1/2 to 1 pack per day.
Patient took too treatment very well, feb08 HCV quanity low linearity and remained this way through June of 08. After treatment was completed at six months, blood test now in November almost 4 months later patient went from low linearity back up too 859,057.
Patient did fairly well during treatment but did suffer from rash's on upper hands and arms, difficulty sleeping and eating, and a lot of confusion and his platelettes were very low - starting at 183 in January and fell too 67 in april thru june, and now in November there at 135. Also noticed iron is high - started out high and remained high but liver biopsy showed nothing in regard too damage from the iron.
In closure too all this, here we go again? I'm taking him for a second opinion, though we both know he'll probably end up having too do this again, and they are suggesting this time instead of six months, but a year now.
Why did this happen? why did it come back so soon? I thought 3a was easy too treat? is it maybe we stopped too soon? just because blood results showed undetectable we should of maybe kept on it for awhile more too try and; pardon my expression" kick the virus's *** and too make sure it was staying that way?
I'm frustrated for him, and for myself, because i too have the same genotype and we agreed two people doing this at the same time wasnt perhaps so good too do, one of us should wait, he's had this disease a lot longer than myself, AND my insurance horrible and they do NOT like too send patients too a specialty doctor and have continued too tell me, "lets watch your blood results". I personally feel why wait for damage too occur, i've already been juandice and hospitalized once, why wait and let things get worse, i'd hit it before it even got there, but that's just my opinion for whatever it's worth.
So what does anyone think? another round of this interferon but now a year? can someone handle this after going through six months of this do this for a year, so soon?
Any suggestions and/or comments be appreciated and many thank you's for anyone taking the time too read and post.
Best regards and happy holidays too all of you.
Anita -Michigan
Concerning your friend:
Was the ribavirin and interferon weight dosed?
This is often not the case for geno 3s. The presumption that geno 3 is easy to treat unfortunately often leads to underdosing and too short treatment. A good weight based dose of ribavirin is 13-15 mg per kilo. PegIntron should be dosed at 1.5 mcg per kilo. Or if Pegasys: the full syringe of 180 mcg.
When did your friend become undetectable?
A viral load test needs to be done at week 4. If not UND by then, treatment should have been extended to 48 weeks. Since he has relapsed once, he should retreat for 48 weeks next time, but be sure to ask for the week 4 viral load test this time around.
Concerning yourself:
I feel uneasy reading that you are waiting to treat. You say you have had jaundice and been hospitalized. Have you had a biopsy done? You need to take care of yourself as well. Comeagain who posted above is my ex. We have 3 kids together and we treated simultaneously. It was not always easy but we made it through. Is your friend dependant on your care? As women it is so easy for us to step back and wait, but we really need to take up some space and make sure to take care of ourselves as well.
Was the ribavirin and interferon weight dosed?
This is often not the case for geno 3s. The presumption that geno 3 is easy to treat unfortunately often leads to underdosing and too short treatment. A good weight based dose of ribavirin is 13-15 mg per kilo. PegIntron should be dosed at 1.5 mcg per kilo. Or if Pegasys: the full syringe of 180 mcg.
When did your friend become undetectable?
A viral load test needs to be done at week 4. If not UND by then, treatment should have been extended to 48 weeks. Since he has relapsed once, he should retreat for 48 weeks next time, but be sure to ask for the week 4 viral load test this time around.
Concerning yourself:
I feel uneasy reading that you are waiting to treat. You say you have had jaundice and been hospitalized. Have you had a biopsy done? You need to take care of yourself as well. Comeagain who posted above is my ex. We have 3 kids together and we treated simultaneously. It was not always easy but we made it through. Is your friend dependant on your care? As women it is so easy for us to step back and wait, but we really need to take up some space and make sure to take care of ourselves as well.
Click my profile you see my story.
Shortly Im a geno 3 soon ending second tx.
Before you treat be sure to get a doc that is up to date like elaine suggested.
Get educated your self in order to advocate for your self ( learn to ask the doc the right questions) to get the best possible strategi for you.
That you can do by keeping in contact here at the forum you can also get links from people to study but learn the basic first.
You can google janis and friends and there get some basic info .
Good luck to both you your self and the guy your taking care of.
ca
Shortly Im a geno 3 soon ending second tx.
Before you treat be sure to get a doc that is up to date like elaine suggested.
Get educated your self in order to advocate for your self ( learn to ask the doc the right questions) to get the best possible strategi for you.
That you can do by keeping in contact here at the forum you can also get links from people to study but learn the basic first.
You can google janis and friends and there get some basic info .
Good luck to both you your self and the guy your taking care of.
ca
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