fishdics consults-interesting

[fishdoc]

OK, everyone in the area of Albuquerque, Dr. Arora is the real mccoy.  I put 11 years of labwork into a spreadsheet, my list of questions, and this is the skinny.  Just to update those that don't remember, baseline 2,890,000 12 week was 38,700. His resident said "thats close enough", and I was thinking HUH UH< I have read the literature...  Dr. came in with two students, and said. You failed to achieve a 2 log drop.  If you continue the current course, you have a 5% or less chance of SVR.  However, it may be that you are not a true nonresponder, because your hemoglobin has remained virtually unchanged, which tells me you are one of less than 5% of patients that hypermetabolize ribavarin. ( he has conducted 17 clinical trials with ribavarin)  Essentially, you are on monotherapy.  Options: increase ribavarin, 6 weeks at 1400, then up to 1600 for another 6 weeks, redo the PCR.  If you are undetectible at the 12 week, you have a 65% chance of SVR.  If you fail to hit undetectible, then stop the treatment.  If I am undetecitible, my 48 weeks starts today.  If I stop, and  start again in 6 months, you start out with the same odds as this time (I wondered about that).  He also said that he has a VX-950 trial coming up for....... nonresponders.  You have to have failed to achieve a 2 log drop, and failed to hit undetectible at 24 weeks.  Starts in 6 months or a year.  So trip was well worth it.  Cops came and hauled the crazy uncle off while I was gone, man, I'm a making progress.  Thanks for all your well wishes, I could feel the vibes...

[cuteus]

anyone  remembers one of the presentations at the FCO AASLD conference that dealt with using Procrit at the onset of tx, which yielded higher SVR rates?  How would anyone in a study like the one mentioned, know of hypermetabolization of Riba if Procrit is used from the begining? I guess none of the subjects experienced that situation, given the high SVR results. I can't believe how complicated this treatment can be!

[goldyn]

My mom told me a story when she was little she got a piece of glass in her hand well it kept moving deeper into her skin and was getting infected really bad infected , my great grandma put the salve on her infection and within 2 days it had pulled the glass right out of her hand and she was healed, must be good stuff.......

[jmjm530]

I believe it takes about approx 2-weeks for a change in riba dosage to reflect itself in a change of hemoglobin levels. So, personally I'd ask for a hemoglobin test in another two weeks -- and if the hemoglobin hasn't moved downward much, I'd speak to him about upping the dosage even more so you don't have a repeat of last time,  and see what he says. Anyway, I'm calling it a night. Have a great weekend and glad you found someone who is knowledgeable and will work out of the box with you.

-- Jim

[beamishboy]

sounds like yu got some answers,hope this does the trick and you lose the vrus like the crazy ol uncle...Goodluck

[dyce]

No doubt fishdoc , the 1st rd the riba wasn't dosed high enough. From the post I've seen, others whose hmg dropped from base , got anemic , seemed to have the best results. In other words , the more redblood it's killin, the more hcv goin down too. How close is  that clinical study the new consult mentioned?

[can-do-man]

hey how ya doing, up late aren't we?