viral load?

[denzelbrown]

hi,

i have been diagonized with hepc c, my viral load is 2.3million/ml, is it considered very high? is there any treatment? my liver enzymes are normal, so what to do now?

[denzelbrown]

any body has more info about boston IVF? do they allow assisted reprodiction if husband is hep c positive?
thanks

[dancegirl54]

Boston IVF is affiliated with BI and Harvard Medical - might be a good place to start

[merryBe]

as far as I know unless there's some new law I don't know of.... there is no way to stop a person from reproducing unless they are declared mentally incompetant and then they can be sterilized in some instances, for their own protection and that of others.

that does not answer your question as to whether someone would treat your fertility issue however.

I can tell a baby means a great deal to you.
Legally there are no current laws that force a doctor to inseminate or treat a couple with a genetic or blood borne disease because that would then force a doctor into the role of a state/gov. forced decision and prognosis that may go against their own best medical judgment and/or conscious.

If their were such laws, then you would see doctors forced to abort or euthanize just because a patient wants that, and in spite of the fact that many docotrs have spiritual beliefs, and/or hold to the doctors oath to "do no harm".Since you love and want a baby, try to understand that would force an obstetrictian to do a 3rd trimester  month 8 or 9 abortion...(where they suck the brains out of a healthy baby coming down the birth canal, just because the mother has changed her mind ).
Thank God they cannot force anyone to do that proceedure!!!
and then realize how many couples would love to take that baby, but the mother doesn't want to give it to anyone either. she still has to go through the birth...she just wants the thing dead.
I'm glad medicine is still supposed to have and practice having a conscious.
This obviously means there will always be a human element to every decision to treat or not treat.

Trust me, if the government starts regulating decisions of the soul like these, it will be a far worse world than the one we have because it won't allow for any growth of compassion, or personal accountability to each other or to God.

I'd be optomistic that some docs may be willing to help you proceed, given your level of concern and wanting to do things right. Just make sure you are putting your wife and baby's health above all the rest because that's what commitment and laying it all down really mean, as a man especially the willingness to make sacrifices is what separates the men from the boys.

as far as the sperm thing goes, they say this virus is not in the sperm/tears/saliva although the one variable is that a man can bleed through his urethra, and gums can bleed, If there is any open area of rupture in the receiver, then the same thing applies as it does to HIV, it is transmittable.
so the assumption that they could never transmit HCV, only in my opinion of course, is not valid. Actually nobody really ever says it could never transmit that way, only that it is very rare. there is a difference between never and rare, yes?
If a nurse or doctor gets one needle *****, the tests are done for both diseases, because it does not take much blood to get this virus.

If you'd been trying for years with no luck I'm sure running a more complete diagnostic on you was in order, and not meant to cause you any grief but to try to discover what might be affecting your reproduction. there are many diseases that do damage to sperm motility etc.

It is very difficult as I discovered today again, and others will echo this, when someone appears uncomfortable to be working on you (today at the dentist the hygenist was that way with me). You can feel like a leper, as someone in here pointed out recently. Indeed that is a very apt analogy, leper.

However, you can not legislate compassion or care...love and risks are choices even health care providers need to have the chance to make. It seems the more informed ones are less afraid they will catch it, and they know how to be careful.... but since this disease does have a stigma (that druggies, and the sexually active, not just transplant/transfusion people get this)...there are alway going to be some who will turn you down for either legitimate ethical reasons/concerns, or out of their own arrogance/judgment.

Personally my question is, if someone is not comfortable working with you, for what ever reason, why not just move on, and deal with your treatment first?
It makes more sense than to ask "can I litigate?" Should we force someone to do something they aren't comfortable doing? would we want that done to us?

since you just got the news, I'd say you need to take some time and deep breaths,
it's hard not to be angry at first, whether you know how you got it or not...there's a process of grieving and denial/anger/blaming is part of the emotional rollercoaster one must ride before slowing down into acceptance.
You can't change some things,but you'll regain your peace and courage sooner if you try to get past the anger/blame stage.
this disease, if it's going to mess with your life, it's hard not want to throw the flame torch in someone's direction! anyone's if it'll just ease the pain momentarily.....(like bang the head on the wall...it can at times seem logical)....

A better choice might be, to be grateful they caught it in time for a chance of a cure.
If they hadn't you'd be angry in the other direction...like why didn't you guys catch this in time.!!!
...I'm at that end of the equation, and trust me, that's a pretty hard row to hoe also.
It so good to know they are starting to test and catch this in younger people, especially now that their is much more hope, which 10 years ago, there was very little.

At the end of the day, I try no matter what to remind myself that 2/3 of the world have horrendous rates of this disease 170,000,000 and most of them have no insurance, no chance of treating, much less living to see their children grow. There but for the grace of God goes each of us.
And we, we on the other hand, live in a blessed land and need to remember how many people devote their lives to trying to help, however imperfectly, as compared to elsewhere.

today I heard that my friend, who had spinal surgery 5 days ago and is now paralized in one leg, was dropped by the hospital staff upon her first attempt to stand with 4 nurses in attendance.
the experience nurse, who knew how the others had blundered fell into a heap on the floor wailing....
My friend could have gotten angry....but these are the same people that saved her from paralysis years earlier...
her thought was not what lawyer to call, it was who to thank for trying to break her fall.

I guess we all need to keep a little perspective regarding all this.
How old are the two of you if I might ask???

[denzelbrown]

thank u so much for the reply. i left out one imp fact that i think i should address. me and my wife were trying to have a baby for about 3 years. we decided to try assisted reproduction tech like intrauterine insemination to improve our chances, suddenly out of blue my blood work result came back a month ago, confirming my hep c, now the blood work was ordered for some unrelated  related isuue , a generel total check up, now the question is, will we be able to take advantage of the artificial methods for reproduction like the intrauterine insemination? i am worried that when we go to a reprodcutive clinic, they will refuse to perform the procedure, but can they? my hepc positive has got nothing to do with our pregnancy, since we were trying for few years without luck, so my main concern is if there is a law that protects us from some one refusing to treat us, i am not really concerned about hepc, i am worried that even after i am treated, we may be still refused procedures like IUI, IVF for infertility,
any input?

[dancegirl54]

My kids and I are all followed by Dr A - 3 of us in one family, I have had a lot of visits to his office.  March is not that far away, I remember waiting for the first appt and being very freaked out about my v/l.  I talked at length to Laurie, his np, and I am sure that any of his staff would be able to have a conversation with you before your appt that would be very helpful. He will certainly order a biopsy, you'll get a lot of info from it, and depending on your results, he will make some recommendations. so far he has recommended that my daughter and I wait.  My son had a very low v/l but extensive damage so he has treated. Only 2 of us had Fibroscans, I've had 2.  You'll be able to address all your other questions at your visit and he will gear the plan for you considering your desire to have a child. I wish you all the best with that, and hope you get all the answers you are looking for

[scratchinghead]

Sounds like you are shopping for an answer. These people are no dummies. Hep C is big big big life changer.

[merryBe]

if I've learned anything in here it's that the decision of when to treat is one of the hardest no matter what ones other circumstances are. A lot depends on what stage you are at, as well as insuranced etc.
I will tell you 2 more things, one is women can bleed or tear internally during even normal intercourse, depending on the health of the V-gina and so they are more at risk than a male of getting the rare transmission.
two is, no matter how rare it may be, it does happen, and I passed it on to my son, so imagine that heartbreak....thank God he cleared the virus on his own, but only 20% do. what if he had not cleared it?  these are questions in life you still have time to ask yourself in advance. they are decisions you and your wife should make together also.

Let us know what you find out....I'd be very interested in knowing. Yes you will have to wait to see a liver guy, this disease is the new epidemic no one is talking about...(on the news they aren't). anyway, hope you get it all squared a way and have a beautiful healthy baby!!!!!!.

[denzelbrown]

thanks for the long reply!! i am not going to postpone the treatment indefinetely, what i found out from doing some research is that if the father is hiv+ and mother is not, they have an option of intrauterine insemination so that the wife and the baby are protected, so my question is to find out if its true for hepc+ husbands also? i mean when u think about it, i dont have treatment and during these 6 months we get pregnant then i can immeditely start treatment and this way both my wife and the baby will be safe,
so if any one knows anything more about this, please let me know
thanks

[merryBe]

Hi Jim, hoping not to sound alarmist just thoughtful here......

it seemed to me Denzel is in more of a hurry to have a baby than to either make sure he will be there to raise it, or deal effectively with treatment. Hence the strong wording I used.

riba windows aside, the question of full treatment is one that only makes good sense to address while you are young and could possibly eliminate the virus, rather than to have to spend all kinds of time and worry on whether you will pass it on......

like remember the big 4 year old child with the razor scare" in here last week?
does he want that in life??

Sorry Denzel, not trying to scare you, but you do need definitive answers from qualified sources.

I guess my issue is whether or not babies first even makes sense given that you may have suffering with treatment, time off work and even job loss. It is not unheard of. One lady this week had to sell her house to afford treatment.....
Not wanting to be the voice of doom here, just saying there's a difference between the things in life we can't control, like leaving our children fatherless because of a fatal car accident say, versus not being able to care or provide for them because you end up very sick or worse from a disease you could have treated but choose not to, or postponed treating/treated ineffectively because of the desire to have a child.

Not everyone in here has insurance that will cover them indefinitely for multiple years of treatments, especailly if they did not respond to the first round of treatment. So it's very important you try the best treatments available at full doses, your first time treating...that is your very best chance at a cure.
If you have some genotypes, the rate of cure is now 90% with both drugs. Others like 1a which I have, is only 50% curable, but even with only that hope, I would not want to cut the chances down by another 10-20% by doing INF only......who would?

all I'm saying, is it sounds like the question is the cart already before the horse on this one.

of course, my sister has had to deal with whether or not to bring a a child into the world with cystic fibrosis so I'm a little more of a leaner towards thinking of the suffering you may cause others first, and secondly your own desire to reproduce.

there are times when one decision can infect and effect the lives of all your loved ones, wife, children, siblings, etc. so these things must be entered into soberly and with full understandings.
If we produce children we either cannot support, or that may have lifelong ailments,
but we just Have to have them be from our loins.....
or if we produce children knowing deformation/miscarriage chance is greatly increased, I believe either of these choices is borne of improperly thinking through what real love is.

equally improper is for Denzel to jeopardize his chances for a normal healthy future as a healthy dad by settling for a far less successful regime of treatment.

Maybe this will help .....let's say I have a gun, (this disease) and it's pointed at Denzel's head.
Now, does he want me to fill it with 2 bullets or with 4??  
Granted, I may only pull the trigger 2 times, and there's 6 chambers....but if I load with 4 bullets.......well does he want to double his chances of NOT clearing the virus?
that's what happens if I put four bullets in the chamber instead of six.
that's what happens if Denzel treats with half the medicines needed.

so again, the question is possed by someone yearning to have a child and love that child, and express their love for one another via that child.
But if the love is there, the marriage will survive for a couple more years while he treats properly to rid himself of the disease.
Why would that not be sane solution.
The compromising of his or anyones health should not be the first choice, what is truly borne of concern, and what passes for it, do not always line up.

but no, I'm not trying to further stigmatize the disease, just saying, the guy wants some answers...
he also wants opinions.....I just gave him some of each...only mine....everyone has one...just like something else we all have....

maybe you could just have them freeze your sperm DB, or maybe you could ask a brother for a donation for artificial insem. and love it as your own....
but I'm not the one that can definitively tell you how safe all that may be....I can only tell you that the moral high ground would seem to be to treat if you never have...
and deal with the rest once you've crossed that hurdle.

you could also have your wifes eggs frozen and try later that way, if her age is an issue, that would give you both hope of trying with clean slates if it had to be your sperm.... even if it was 3 or 7 years from now! It might not be a bad precaution to take given the circumstances.
there are options, just explore them, that's all.

[jmjm530]

That might be a good question to ask when you see Dr.A. I'm sure this question has come up frequently in his practice.

-- Jim

[denzelbrown]

anyone cares to answer please?

[denzelbrown]

i have a question for couple trying to have a child, me and my wife are both young and i dont want to risk my wife ending up with hep c too while trying to have a baby, i know the risk is low but is still not ruled out, we were wondering if we can get pregnant by assisted reproduction more particularly intrauterine insemination? can any one tell me a place in boston area which allows this procedure knowing the father is hep c+?
thanks

[jmjm530]

Re Afdhal and his office. I know of folks who have gotten in to see him in weeks, not months. The key is to express some sort of urgency to the appointment secretary, or ask to speak to a nurse. In your case, the baby issue might be that sense of urgency. Worth a try if there's a chance you can get in sooner.

-- Jim

[jmjm530]

Yes, you can't do better than Dr. Afdhal, not just in the Boston area, but in the country. Discuss with him all your concerns, including the baby issue. You'll be in good hands.

-- Jim

[denzelbrown]

my main concern is to have a baby, i just feel since the risk of transmission by sex is so low, if we can have a baby before i get exposed to ribavirin, then i can start the treatment in a year, my liver enzyme levels are normal, but my blood count is around 2million, i think waiting another year wont be that harmful, also since someone suggested that the best doc in boston area is dr.afdhal, i sceduled an appt with him, its in march, so guys what do u suggest?

[jmjm530]

I"m a little confused what you're saying. There will be no "deformed" child unless the six-month ribavirin widow isn't conformed to. If you have any medical advice to the contrary please post. There's enough stigma about our disease already and we shouldn't be adding to it with wrong information. But maybe I'm reading you wrong.

-- Jim

[merryBe]

you cannot do the INF without the Riba any more, it would be like giving yourself severe handicap and expecting to still win a race. INF alone has been shown to be very ineffective against this disease.

If you can wait until you treat and stay clear a couple of years you'd be a lot safer in my opinion.
It's just hard to believe the Riba could be so harmful to egg DNA and do no harm to sperm DNA.
And, you don't want to bring children into the world without a sound expectation you'll be there for them.
If you are both in a god awful hurry to have a child, then it would be safer, birth defect wise to adopt a healthy child than to risk bringing a severely affected one into it. You have to think of the well being of your child, not just the needs or wants of you and your wife. Plus the risk of miscarriage is high, and this is very difficult on a woman's health especially.
like JIm said, take a deep breath, get a good doc, read up and learn, and don't be in such a hurry. Can't you just imagine saying to your little boy, "we're sorry you are so deformed, but we just couldn't wait until it was safe to have you ?? ?? ??"
hope this helps.

[jmjm530]

That should be "blood in the semen". LOL. "Semen in the blood" is probably very serious and should be looked into right away :)

[jmjm530]

Sexual transmission in monagamous couples is very uncommon.

Whether or not a couple decides to use condoms ( btw not the current recommendation for monagamous couples) is a personal decision -- however, not allowing for unprotected sex to conceive a child, seems a little extreme, at least to this person -- at least if that is what you're suggesting, although I may be reading you wrong here.

And even if there is semen in the blood, the woman would have to have an open wound/sore for the virus to pass through. And even in that scenario, we really don't know how efficiently the virus is transmitted, as for example needle stick accidents have only a very small incidence (1-3%) of infection. So, yes, risks exist -- I suppose pregnancy and child birth itself has risks attached -- but the question is how big are those risks and what is the appropriate reaction to those risks.

My guess -- and only that -- is that Dr. A (or any hepatologist) would not discourage the conception of a child from a HCV positive father. The ribavirin issue is a separate one. All good questions to ask the doctor.

-- Jim

[copyman]

interesting comment and something he should carefully consider. i'm sure he needs to ask dr A or whoever about this.

[Myown]

if not that bad then wait, have the baby then start.....
-----------------------------------------------
Copyman, even though they say the risk is low as far as sexual transmission.....IF my husband was the one with the hep and I didn't have it, there is a possibility I COULD have gotten it cause he had blood in his sperm several months back and only cause he now uses a condom did we know. So at times men can get an infection or whatever which can cause them to bleed. This was the first time this ever happened to him, but the doctor says its not uncommon - thats something all men with hep should take into consideration IMO.

Take care.

[jmjm530]

I sense that you're in a rush to do something. This is normal. But what many here have found is that it's best to take your time and start out right and with the right doctor. Alternatively, you may be able to move faster, but perhaps in the wrong direction. Hep C is generally a very slow moving disease and investing a month or two (hopefullly it will be less if you explain a sense of urgency to the appointment secreatry) waiting for the right doctor can be a good investment.

[jmjm530]

Think you have to take it one step at a time. How can you make any treatment decisions until you have all the facts? First, go see the doctor, get a proper evaluation, including an assessment of liver damage and listen carefully what he has to say. Then, if you feel necessary, do some research on your own to fill in the blanks. The whole baby/ribavirin issue would be something to discuss with him.

Good luck and let us know how it goes.

-- Jim

[Myown]

You need interferon AND riba and as you know you can't be tx while trying to have a baby, but talk to the doctor. Good luck.