please recommend a Hep C medical group in San Francisco

[pocomilk]

Hi,
I would appreciate a recommendation for a medical group with lots of experience treating Hep C for a friend.  I  would prefer a group with staff support that would be good with patient communication and support.  I am thinking of a group where a nurse would call you with lab results if you are having anemia and struggling with terrible symptoms and not just tell you to come back next month.  
Thank you for any help.

[pocomilk]

Thanks for your comment.  I will share that with my friend and hopefully he will make the switch to that group. I know I would worry less once he is there.

[pocomilk]

For someone who was going out the door, you gave very thoughtful and informative comments, complete with a citation!  I wish my friend's docs are half as helpful.  Thank you, Bill.

Unfortunately, my friend's visit with the PCP was not productive. First of all, on Thursday, he showed up at the office only to find out that there was some mix-up and the doc wasn't even there.  And this was the visit that my friend was counting on.  He was  told to come back today afternoon.  A late Friday afternoon appointment is not a good thing. But more on that later since I need people to weigh in on that and my kids are calling for me right now.

Many thanks and best always

[debnevada]

Have to ring in on Doctor Gish.  He is the absolute best.

[Bill1954]

Hey there,

I’m out the door right now, but I’ll try to touch on a couple of ?’s. Tylenol is by far the most frequently prescribed OTC for pain, despite its liver toxicity in large doses. Usually, an MD will allow up to 2000 mg/day acetaminophen for pain; possibly less if decompensated cirrhosis is present:
~~~~~~~~~~~~~~~~~~~~~~~~~
Tylenol in HCV treatment

Jorge L. Herrera M.D.
Division of Gastroenterology
University of South Alabama College of Medicine
Mobile AL

http://www.hcvadvocate.org/hcsp/articles/Herrera.html

“Acetaminophen use: Contrary to popular belief, acetaminophen (the active ingredient in Tylenol®) is perfectly safe for patients with cirrhosis as long as it is used cautiously. Any person who drinks alcohol regularly should not consume any acetaminophen. For patients with early cirrhosis (CPT class A or B), the use of acetaminophen is safe as long as the recommended dose is not exceeded (1,000 mg per dose, repeated no more often than every 6 hours). Patients with more advanced cirrhosis should take only ½ of the recommended dose. In fact, for patients with cirrhosis, acetaminophen, when used as described, is the preferred medication for the treatment of pain.”
~~~~~~~~~~~~~~~~~~~~~~~~~~~
CPMC doesn’t have 24 hour facility for outpatient therapy; they will refer to ER; I really can’t help with ER facilities in SF; I’m in Sacramento. They do have off-hours transplant patient phone consult available, I believe.

Gotta go- talk again soon. Best wishes for a productive visit with the Primary care guy this PM—

Bill

[pocomilk]

Hi Bill,

Thanks, Bill, for your very helpful comments.  I was worried enough to drive over to his house last night to check on him, with the excuse of bringing him some soup.  Luckily, I got to see him and was very glad to see that he was able to be up, walking around; I was not even sure he would answer the door! I also brought him a thermometer and the print out of Dr. Gish' s group.  He has an appointment with his primary today, but not till later in the day. I would have prefer that it be early in the day.  In fact, if he was my brother, I would have put him in my car last night and drove him to the ER.

I won't find out the result till he decides to tell me.  Usually, I have to ask him, always feeling a little intrusive.  He is very independent, and probably does not want to bother me or anyone. I could be a better advocate for him, if he would let me. I would worry less if he was in the care of a better group.  

Now, I am wondering about the PCP's quality also.  He commented that the receptionist seems completely confused and is not helpful.  Also, being located in San Francisco, he should have referred my friend to the Gish group at CPMC or some other group, and not to a solo practioner for this very challenging treatment.  

Last night I told him to ask his doc about whether Ibuprofen would interfere with the hepatitis med.  But of course, with his current docs, you can't get a quick answer to a simple question like that. The PCP probably would not know, and in any case, the receptionist is all confused I don't even know if my friend feels he can call off hours.  The hep doc, to whom we should direct this question is out of town.

By the way, do you happen to know which is the best ER in San Francisco for people on this treatment?  Would that be CPMC?  Also, if you are a patient with the Gish group, do they have after hour urgent care so you would not have to go to the general hospital ER?  I know when my mom had cancer treatment, the oncology clinic had their own after-hour clinic.

Thank you for all your help.

[Bill1954]

I’m so sorry to hear you’re friend is dealing with the problems he is; there’s no need for this. Intervention for hemolytic anemia from ribavirin is generally initiated at around hemoglobin 10.0 g/dL; either dose reduction of ribavirin or Procrit/epogen is initiated. The later is much preferred; dose reduction tends to reduce the odds of treatment success.

Additionally, if anemia is allowed to progress, it can eventually become life threatening. Has your friend contacted his primary care doctor for help yet? He can always go to the ER if he feels it’s necessary as well; they can transfuse red cells if indicated; typically in the vicinity of hemoglobin <8.5 g/dL.

CPMC has an excellent staff; they generally return calls the same day, and are accustomed to situations like this; they treat an astonishingly high volume of HCV patients. I hope they can take your friend in and he’s able to complete his course of treatment with them. Make sure they understand the situation; that he’s already under someone else’s care, and currently in Tx.

If your friend isn’t located directly in SF, they have outreach clinics as well throughout Northern California; make sure he is seeing the one closest to him. Stay in touch; there are folks here that can help walk him through the maze :o).

Again, best to both of you—

Bill

[pocomilk]

Thank you very much for your prompt information. I was very impressed with the fast replies and the general support here. Thank you, Bill for having gone through the trouble of getting me the complete contact information. I already checked Dr. Gish' s site and gave my friend the information. I hope he is going to switch soon since I am very concerned about the care he is getting. He is currently sick with a fever which is probably from anemia and dehydration, (and probably a viral infection on top of it all.)  I am very worried about him especially as he seems to get very little help from his docs.  He has been anemic for weeks, with severe symptoms, and has yet to find out his blood  test result from weeks ago.  He said his liver doc is out of town and "my docs don't seem to want to be bothered."
Anyway, thanks again.

[Bill1954]

Boy, do I have the doctor for you! FlGuy got it almost right; not bad for a southerner, huh :o)? Try California Pacific Medical Center (CPMC). They are a hepatology group, transplant center and research facility in San Francisco; with outreach locations throughout Northern and Central CA, as well as Nevada.

I treated with them (successfully) for a few years, and they are an excellent team. It’s headed up by Dr Robert Gish, a well known and internationally acclaimed Hepatologist. It might take a couple of months to get in, but well worth the wait if you can afford to.

Here’s there contact number in SF:

CPMC
2340 Clay Street, 2nd floor
San Francisco, CA  94115
[phone]
Fax [phone]

You can also visit them on the web:

http://www.cpmc.org/advanced/liver

Let me know if I can be of further help,

Bill

[FlGuy]

I think someone will come along with the precise information for Dr. Gish & gang of docs.  Look for a reply from Bill1954 or Goofy or several others who have treated there.  Think the name is something like CPMG. Not sure if in the city or in the Bay area somehwere.