should i re-injected the pegasys?

[niceguy2007]

guys i just realized i didnt warm the pegasys in the palm of my hand before injecting yesterday.  should i re inject today?

could not warming it lead to the pegasys malfunctioning?

i do, however, remember that the nurse held it in her hand for at least 30 seconds while she chatted to someone.

[niceguy2007]

and i used the same thigh on 2 consecutive shots. did i mess up ?

[GrandmaA]

Call the Be in charge nurse. They will help you. That's what they are there for. They have a 24 hour phone line. 1-888-437-2608. Pegasis also probably has such a phone line for patients.

[GrandmaA]

Those of us on peg-intron just take the syringe out of the refrigerator for 30 min. before injecting it.

[sunspot]

I only let it warm so as to avoid a cold spot on me tummy. You'll be alright. I did some of my shots cold.
BTW, I did all my Procrit shots cold because they stung so much warm. I also iced the site pre-shot.

[friole]

No big deal.  The warming is for comfort, not activation of the medicine.  Believe me, it will warm up right quick to 98.6 (F).

[jmjm530]

Someone was having some fun with you. It makes no difference if you roll or warm the Pegasys in your hand. It is for comfort reasons only. No reason at all to re-inject the pegasys.

[GrandOak]

As I understand it, the reason for warming is two fold:

1) Make it more comfortable when you inject it into your body.

2) Allow serum to become more fluid thus making the injection process easier.  Some serums become thicker as they chill requiring that either a large diameter needle be used or the serum to warm up and become thinner to make the injection process easier. The size of the needle for Pegasys (27G) is rather small and if the serum is thicker, it can be harder to force it through the needle into the body.  Personally I've found that if I do not allow it to warm up very much that the depression of the plunger is harder to get started and may take a bit more force to get the entire injection into my body and that the more I allow it to warm up that I encounter less resistance.

[GrandOak]

Given the nature of some of your questions, I am curious to ask if you have regular access to a doctor or their nurse?  Also, do you have web access to the internet where you can visit the Pegassist support?  Are you able to call the Pegassist support phone support line?  Do you have a specialty pharmacy associated with where you obtain your meds that you can call?

The reason I ask is that it seems that many of your questions could be easily answered at many of these sources by trained professionals who should know more than us patients here who can only convey anecdotally what we have learned or experienced.

It would also seem that if your doctor knew the type of questions you are having with respect to tx that they could better understand where you are at and know to what level they need to convey information with respect to your case to you.

Trained professionals, while sadly not always true, are more reliable sources of information that a lot of stuff you find on the Internet.  To rely so heavily upon information from the Net without consulting you medical professionals to affirm or disclaim it's legitimacy can be very risky.  In all my years of watching the Net grow from what used to be a Unix-To-Unix connection of computers, I've seen to much mis-information, wives tales, folk lore, and down right wrong information being presented in very authoritative manner that can lead to trouble if one does not question or substantiate it's validty.

[niceguy2007]

hi everyone...

now i'm typing from my desktop pc.
i find my mobile phone's web browser so much faster to read and download with, but its more expensive of course.

thank you for answering my queries...

i have a couple of "logistical" problems where i live in pakistan. first, the area i live in has some very ancient phone lines, even though the rest of the city has modern ones.  that's why i can't install DSL on my home computer.  

the natinoal phone company somehow has not upgraded the landlines in this area, and instead is trying to follow a quick fix solution by encouraging people to take up CDMA wireless phones.  one of these days i'll get my lazy butt off and try to get a CDMA internet connection, though i doubt it wuld be better than DSL.  Right now i'm using a 56K dialup modem.

the other thing is, the phone line getse shot during severe thunderstorms.

third, i can't call the Pegasys support line in America without a calling card.  i need to buy one, cuz the standard phone service makes you "book" an international call, which is a hassle. so i make my international calls thruogh calling cards, which my neighbourhood store holds perpetually in short supply.  However, I did call the local Roche reps in Pakistan.  

now about the other issue.  Pakistan is short of doctors; therefore each doctor has to give less time to each patient.  The nurses don't know much about Pegasys, because most people here use un-pegelated interferon 2b, brand name Uniferon.  My regular doctor is an army doctor.  However now i'm considering shifting to a better civilian one.  

There is a solution.  There is a good government-run hospital in a neighbouring city about an hour's drive away.  one of these days i'll go there instead of relying on these army doctors.

[niceguy2007]

oh i just got my CBC...

hemoglobin 13.6
platelets 304
WBC 6
MCV 100

the mcv keeps on suggesting macrocytic anemia..which maybe due to vitamin b12 deficiency...i'm taking b compelx 3 times a day... or maybe its a lab error?  cuz the other lab never showed that a month ago, even though this one did pre-tx.

[jmjm530]

I kind of had a feeling you were somewhat isolated in terms of Hep C care as opposed to most of us here in the U.S.  

Just keep in mind what GO said -- that there is a lot of misinformation on the internet. For that reason, consider your sources, and try and double-check everything whenever possible the best you can under the circumstances.

That said, while none of us are doctors, hopefully we can continue to be of help by sharing our treatment experiences.

Anyone who can post to a discussion group, on a cell phone, and  not their native language has my respect.

So far, treatment seems to be going well for you. Just keep on top of your current doctors until you make any changes.

Be well,

-- Jim

[jmjm530]

Your hemoglobin sounds fine. Do you know what it was pre-treatment?

I know very little about the signficance of your MCV score,  but I do know that B12 often isn't absorbed very well in tablet form.

Have you had a serum b12 and serum Folate test taken? If it turns out your serum B12 is low, speak to your doctors about taking b12 sublingually or by injection.

[niceguy2007]

jim yes my hemo pre treatment varied.  the last measurement from this same lab said it was 14.3.

In japan they measured it at 15.5 in July.

Its funny they're saying my platelets are 304, however, after my recent blood tests, the blood actually accumulated and congealed just above the punctured vein, on both my arms.  this has never happened to me before.

[niceguy2007]

i havent had a b12 blood test...will do.

tommorrow is Eid here...happy Eid to all of u :)

[jmjm530]

Your hemoglobin seems to be doing OK. Did you end up on weight-based ribavirin or not? I forgot. If you're not on weight-based, consider asking your doctor about it since your hemoglobin seems to be holding.

From your previous post I'm just starting to appreciate what you're going through.

Most of us here, see a doctor, get a pegalayted interferon and ribavirin prescribed and have the whole (or most of it) paid by our insurance company.

In your country this doesn't seem to be the norm at all with most still on the non-pegalayted form.

So obviously, you did some homework, reached outside your local community and sought out more up-to-date care, including corresponding with a Japanese doctor and having your father ship you some Peg from Japan. Not to mention your internet and phone issues making it necessary at times to use a cell phone to access the internet. Again, my hat is off to you!

Hopefully, MH will continue to be another good resource for you in getting the most up to date care.

Be well,

-- Jim

[niceguy2007]

jim thanks for your kind comments :)

i'm on 800mg riba a day, which is weight based. i weigh 60 kilograms.  do you think i should now increase it?

i'm slightly concerned about my ALT being 47 on a 0-55 scale.  
isn't that slightly high for 2 weeks on treatment?
Moroever, the sample was about 2 days old befroe it was tested.  I gave blood on saturday, they shipped it to another city, Sunday was a weekend and the hospital was off, so they tested it on monday.  Could that have affected results?

i had a feeling goofy was at least partially kidding with the mice.  however i thought what he said about rolling in hand actually tallied with the pegasys manuals on the  internet..and somehow thought it was something serious.  interestingly, i suspect that a mouse or a rat DID open my fridge door, while trying to gnaw on the rubber insulation!  my top floor has been infested with rats..and i need to do something about it.

[NYgirl]

Whomever prescribes your medications - can't you seek them out for advice on these thing?

You shouldn't really rely on people on the internet for advice because everyone may have differing ideas and give you BAD advice that at the time seems reasonable.

Can you email the doctor in Japan? That would seem like a good thought - find out if they have email and then send THEM all of the questions.

you really can't trust everything in here - we are not doctors and really should not be advising solely. you NEED to have a DOCTOR to ask these things of - this is only for temporary advice and should NEVER EVER EVER be used in place of a doctor.

I've gotten some BAD advice in here that could have cost me my course of treatment.  Now - I verify EVERYTHING with the two doctors that I have before I listen.

Good luck.

[niceguy2007]

well i'm sure my japan doc would repeat that 800mg is just fine for my weight.

nygirl what do you think about the ALT?

[NYgirl]

I think you are doing just GREAT.  it's only been two weeks right...I bet by week 4 it's down even MORE as the medicines kill off more of the virus and your liver stops being damaged even more.

my enzymes go around 20 - 30 all of the time up and down (they were originally in the 200s) so if you see - I have been on treatment for 56 weeks now and mine are NOT that much lower than yours!

You're doing great I think. :)

[jmjm530]

At 60 kg it does seem you are weight based, so increasing it would run the risk of additional side effects. Maybe something to ask your new doctor after you start testing viral load.  

As to the ALT, mine was 38 (not really much different) at week 2. My guess is you will more of a drop in ALT at weeks 3 and 4, but even if not, it doesn't mean treatment isn't working. The first real indicator will be your week 4 viral load test which you should get.  

Sorry about the rat problem -- I actually had a moth infestation during tx, but I think rats are a lot worse.

-- Jim

[niceguy2007]

nygirl not to sound ungrateful, but that would be quite reassuring if my ALT were constantly in the 200s like yours..however, mine varied GRAETLY pre tx.

like for examploe, 247, 103, 56, 74, 216.

on a lab in japan, on a scale of 0-40, it measured 24! and then 103, again after a month on the same lab.

[niceguy2007]

but the good news is, i'm eating ALL kinds of stuff, without any exceptions.  this includes lots of butter on bread 2 times a day with ribavirin :) and all kinds of greasy stuff. and of course eating almost 250 grams of meat DAILY. something i never did earlier.

i keep thinking...if eating all that heavy stuff is keeping my enzymes normal...then something must be working.

[GrandOak]

Thanks for the clarification.  I figured that perhaps you did not have access to the same level of the medical care many of us in the US are fortunate to have, and sadly take for granted.  I think we often forget that even some of the doctors that many of us take for quacks in the US would appear to be specialists in many other parts of the world.

Many of your questions appeared to be pretty basic ones that most doctors, even those less knowledgable ones, often go over with their patients here.  Perhaps the reason why you may have seen some levity being thrown around on some threads.

I hope that the assistance you've gotten here has been helpful and hopefully should someone feed you any wrong of incomplete information there are enough folks here to steer you in the right direction to help you overcome this insidious disease which we all share in common that knows no race or territorial boundary.  

During the course of my tx it certainly has helped keep in the fore front of my mind that despite our many differences, we still are all commonly bound in our humanity and desire to lead productive and fruitful lives.

I wish you well my friend in your battle with this dragon and always remember that there is no such thing as a stupid question if even one person is able to gain some knowledge from it's answer!!

[NYgirl]

You know more than me - I don't really know what my enzymes were before except when first tested in the 200s then down to the 20s.

It sounds like you are finally getting used to being on treatment and are doing just fine.  The longer you do it the less you will worry about anything and the more you will see, it's out of our hands.

We can only do what we are told to (take our meds on time for example) and the rest has no guarantee.

Just continue to do the best you can. I would definitely try to get an email address that you could ask a doctor questions to though - so you have someone monitoring what is going on with you much more than we could possibly do.

A question you should find out - will someone monitor your thyroid levels? That is pretty important. Continue to keep a good eye on your hemoglobin - as you've read it can drop FAST. As long as it goes down slowly you will be much better off and right now yours is still just FINE.