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320078 tn?1278344720

having a hard time with side effects

Hey

i was wondering if anyone can help!!!! today i feel like giving up on treatment. i am at 22 weeks UND.  but the sides are driving me crazy, i have alot of hair loss, (can deal with that)  the rash (that nothing helps, have tried presecriptions, over the counter, been to two dermtologist) today my entile mouth is ulcers and my tongue looks like it went through a cheese grater and feels it.  i have the everlasting cough.  you name i have.  and the medical costs!  the co pays for the treatment and the doctors and all the prescriptions are driving me broke, and to top it off, i have no sick days left so if i need to take a day off, its leave without pay.  my husband is a car salesman and needless to say witht he current economy no one is buying cars!  ia m at the end of my rope!! Help!!
24 Responses
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338734 tn?1377160168
I am so sorry to hear the difficulty you are having with the side effectsw of TX. I have similar labs to yours and have many of the same symptoms. I am 44 weeks into TX (I am doing the 72 week marathon because I wasn't UND at 12 weeks).

There may not be much to be done about the fatigue other than rest when you can. I have found that the use of a 1% hydrocortisone lotion (OTC) on strategic areas have helped considerably with the itching and rashes.

You have a lot invested in TX so far so hang in there and finish. Talk to your doctor about the possibility of reduction of Peg on the last half of TX. I am told there is some evidence that reduction of Peg is less important in keeping the virus suppressed than the Riba.  Unfortunately it is probably the Riba that is causing the anemia and fatigue.  Reduction of Peg can help out with the dropping neutrophils, though.  My doc has recommended that my Peg dose could be reduced to address dangerously low neutrophils once I am past the 48 week point.

Hang in there on day at a time. Like a long slog on the trail, you just keep putting one foot in front of the other and eventually even the longest treks are conquered.

Good luck!
Helpful - 0
320078 tn?1278344720
Mikki,

I was told the shortness of breath, was because my wbc was low and they gave me an inhaler. It didnt work.  My doctor also said the success is better if they do not change dosage while on tx.  
Im not sure if all that is correct, I'm sure others in here would know alot more then me.
i dont know if this will help, but trying to help may get me out of my own head!

Helpful - 0
Avatar universal
Your doctor may be corrrect that it's the Peg combined with the Enbrel and your low body weight. On the other hand, the symptons are classical of anemia, and what many here have found is that you can have "OK" labs an still suffer from anemia and still need Procrit/epo or possibly even a riba dose reduction. I ended up in the ER with "OK" labs (hemoglobin around 11.6) and I'm not the only one. It's not the absolute number but the rate of fall and very importantly how the individual adapts to hemoglobin levels. Some here do great with big drops and some do not great at all with much smaller drops. Your side effects sound serious and just want to make sure your doc is covering all the bases including the riba base. I think a helper drug (Procrit) discussion is in order, just to err on the safe side.

All the best,

-- Jim
Helpful - 0
394687 tn?1290920840
Sorry you are having a rough time rita - I'm glad i read this post because I am feeling the same way.

I have been flat out for 3 days - can't get up without almost passing out. My heart is under a great deal of stress - major palpatations. Pressure in my chest, mega head aches - totally out of breath. But my labs are OK...I have been on the phone with my Hepa several times this weekend and did not take my shot last night or my riba.

My doctor tells me it is the Peg that is having these effects - That combined with the Enbrel I'm on is just too much for my 101 lb body. The Riba is weight based but not the Peg - so tonight I am going to cut the Peg by 1/3. Please note - I am a 2B and was UND at 3.5 weeks - I am only 6 weeks into tx.

Thanks for the article Hector, Dr. Shiffman really gets around -
Helpful - 0
475300 tn?1312423126
Sorry, I thought you were geno 2.  
Helpful - 0
475300 tn?1312423126
My gastro also did not do a vl until 12 weeks, I also wish I would have known to ask for one sooner.  Must be something about the docs in Pa,   LOL.  No seriously, why would he want you to tx after 24 weeks?  I also know about all the co-pays, my hubby has a landscaping company = zero money in the winter.  I am 9 weeks post tx and was (I hope) geno 2.  I am impatiently waiting for results from 2 weeks ago.  What helped my mouth was liquid maalox and liquid benadryl mixed, swish & spit.  Good Luck & hang in there

Denise
Helpful - 0
505279 tn?1210547267
I was a "failure" and the virus returned after a year...Three years have passed and my body is destroyed. I have chronic pain in all my joints that never went away and I feel that psychologically I am not the same man I was pre-tx.

I have some interesting advice to give you but I don't want to share it in a public forum for fear that some people might take it the wrong way.

Do you have a reg. email add.? I understand if you don't want to give it out but just to let you know that I a m totally AGAINST peg-Intron/ribavarin.

Best
keith
Helpful - 0
Avatar universal
When I started tx I was told that they would do a 12 wk pcr test and if I didn't have a two log drop they would not continue.  Turns out they did my pcr text @ 10 wks in order to have the results in time to send to Insurance Co. to show that tx was working and get me approved for more meds.  I too didn't know anything about the 4 wk test that some are getting.  I have noticed that the people that seem to be getting it done are re-treater or on some sort of newer more aggressive drugs and/or trials and for that reason I believe they are documented and followed more closely.

Point is you were and are UND by wk 12 and that is great news.  Your liver function tests look great in the very normal range.  You are just slightly anemic like I was/am.  Your WBC count is low as mine was same.  My dx put me on Neupogen injections (3 x wk) for that.  You dx would also look at your Absolute Neutrophils Count (ANC) to see if
you needed to go on the Neupogen.

All I can say is hang in there, take it one day at time.  I just finished tx (finishing off riba for a wk) and the year went fast now that I look back on it.  I remember feeling so weak and drained and couldn't barely get myself up and together each day.  I remember reading Psalm 23 outloud over and over again every morning while trying to get it to gather myself to go to work. Now all of the hard times and moments of losing it seem like a blur to me and aren't tangible anymore.  I used to feel like I was going to colapse in the grocery store because I was so weak.  I couldn't cook a meal, I would just jump in the car and go and get something.  I didn't change my sheets for...for...for...several months - O.K. I said it (can't believe that I posted that info) and guess what, I am o.k. and you will be too!

Buy Biotene Mouthwash and toothepaste.  It is for the care of having a dry mouth.  It costs more but helps a lot.  Stay away from any foods that seem to cause the mouth sores.  Drink a lot of water...no matter what!  Buy some leave-in extra moisturizing vitamin styled type of conditioner for your hair. Try your best not to scratch and pick any bumps.  I would use Dial Antibacterial soap as well.

You have gone so far and you are a very strong women.  You are almost at the halfway mark.  It is a down hill ride from here on out.  It may be a rough one and you will get used to it.  Basically to me the feeling is like a horrible hangover ever day all day long and not being able to call in sick.  

Peace and Love to you!

TV

Helpful - 0
320078 tn?1278344720
thanks for all the comments, suggestions, etc.  i wish i had none to ask for a viral load at four weeks, but i am still getting educated on hep c and until i joined this forum i didnt question anything my doctor said...live and learn...but here are my last labs...any thoughts? these are the results on april 30th,

WBC      1.9
RBC       3.64
HEMOGLOBIN   11.4
HEMATOCRIT     32.8
AST                   25
ALT                   20

I AM NOT SURE WHAT ELSE I SHOULD BE LOOKING AT ON MY LABS

THANKS EVERYONE
Helpful - 0
250084 tn?1303307435
Most Dr.s do VL test at week 4 in tx, it looks like you didn't have any until week 12. Your profile says 'week 16 UND' which is why I asked that. UND by week 12 is better than not UND until week 16.

  Anyone just starting tx....please insist on VL test at week 4 (even 2!). I, as many, was tested at week 2, 4, 6, 8, 12 than every 3-4 weeks until done.

Hnag in there Rita!

LL
Helpful - 0
408795 tn?1324935675
All I meant was you were UND at week 16, that's good, then I found out it was really week 12.  Still very good, however when I first posted I thought for whatever reason that you were UND alot sooner.  Sometimes I make errors and get names and situations mixed up.  Firgive give me at any rate, you should most likely continue with the aggresive tx plan that is known to lead to SVR.  God Bless
Helpful - 0
446474 tn?1446347682
Hope this helps as far as your odds of clearing virus...

Understanding HCV Nonresponse and Identifying Candidates for Retreatment
By: Mitchell L. Shiffman, MD

"Rapid virologic response (UND by week 4) occurs in approximately 15% of patients with HCV genotype 1 and 66% of patients with HCV genotypes 2 or 3 treated with peginterferon alfa and ribavirin. It is critically important to identify patients with RVR because these patients have up to a 90% SVR rate if they remain on treatment for 48 weeks for HCV genotype 1 infections (and 24 weeks for HCV genotype 2 and 3 infections)."

"Previous studies have demonstrated that approximately 35% of genotype 1 patients achieve undetectable HCV RNA between Week 4 and 12 of treatment. Recently, these patients have been termed as having a “complete” EVR."

"It is critically important to recognize the point at which a patient achieves undetectable HCV RNA during treatment as this is directly related to the likelihood of achieving a SVR. In other words, the later a patient achieves undetectable HCV RNA during treatment, the higher the likelihood that the patient will relapse after treatment is discontinued following the standard duration of therapy (24 weeks for genotypes 2/3 and 48 weeks for genotype 1) Three recent studies have now demonstrated that relapse can be significantly reduced in slow-to-respond genotype 1 patients—those who achieve undetectable HCV RNA after Week 12—by extending the duration of treatment from 48 to 72 weeks. In each of these studies, the relapse rate was reduced from more than 50% to less than 20%."

"Several studies have now demonstrated that mild reductions in the doses of either peginterferon alfa and/or ribavirin will not adversely affect the chance of achieving SVR, especially if this strategy is employed after the patient achieves undetectable HCV RNA. By contrast, interrupting treatment for more than 7 days because of adverse events leads to breakthrough and relapse. Therefore, it is the recommendation of this author to reduce ribavirin stepwise by 200 mg every 2-4 weeks until adverse events either resolve or are tolerable. Peginterferon alfa-2a can be reduced from 180 to 135 µg/week and peginterferon alfa-2b from 1.5 to 1.0 µg/kg/week. Neither peginterferon alfa nor ribavirin dosing should be interrupted unless the adverse event is particularly severe and there is a concern for patient safety. Whenever the doses of peginterferon alfa and ribavirin are modified or temporarily interrupted, HCV RNA testing should be performed again to ensure that breakthrough has not occurred."

Hang in there!!!
Hector
Helpful - 0
Avatar universal
Just read the entire thread and it appears you were UND at week 12, not week 16, so 48 weeks would be the correct protocol.

As others have suggested, you already invested a lot of time (22 weeks) so you should think hard before stopping, but ultimately it's your decision with no right or wrong answers, especially since you have minimal (stage 1) liver damage.

Unfortunatly your doctor didn't test you at week 4, so it's more difficult to predict the odds that treatment will be successful. Probably somewhere above 50% but below the 80% figure often cited for RVRs (those UND at week 4). Maybe someone with the stats at hand will chime in if that helps any.

-- Jim
Helpful - 0
Avatar universal
Sorry you're having such a hard time with treatment.

In reading your profile, it appears that you were first UND at week 16. If this is not correct and you were UND by week 12, then no need to read any further.

But if my read is correct -- meaning you were still detectible at week 12 -- then you will need to treat for 72 weeks total for any kind of decent chance of being cured. And that assumes you had a two-log drop by week 12. If not, your chances aren't even good with 72 weeks. If this hasn't been explained to you by your doctor, then I would seek another opinion from a liver specialist (hepatologist), as many Gastro's aren't very up on the latest data.

Since you're only stage 1, you always have the option of stopping treatment and trying another day with newer drugs. This is not my recommendation, just trying to point out that it appears your present course -- 48 weeks without a two-log drop by week 12 -- does not present you with very good odds. The other option, of course, is to extend treatment and have your doctor try and deal more agressively with your side effects.

But again, best to see a liver specialist (hepatologist) who can look at your entire health/treatment picture and then present you with what options make the most sense.

-- Jim
Helpful - 0
Avatar universal
Rita, did your doctor do your viral load test right before you started treatment and then again on April 3, which would be 12 weeks later...and that is what the UND is from, the April 3 test?  If yes, you are UND at 12 weeks and that's a good thing.  And, in fact, since your doc didn't test prior to that, you could have been UND sooner than that but you won't know.

As for your treatment ... I'd say you're going through a bad patch .. and at the place where it really gets tiresome.  I'm only in Week 11 so I only say that from watching other people go through this. It seems everybody hits those tough spots where they're just fed up. You've got alot of pressures on you.  There is no saying that treatment next time will be any different.  If you are UND at Week 12, then go for it.  Suck it up, figure out what you need to do to get through it, accept that the next 24 weeks is going to be not much of a social life for you ... and get 'er done.  You only have 26 weeks to go .. and then, hopefully, you NEVER have to do this again.  One year out of a life, Rita.  You're already halfway there.

I would suggest that you post about the side effects that you're not having much success with .. and get suggestions from others who have dealt with them.  Might be some things thrown out that might make a difference for you.  I see it here ALL the time.  

Hang in there, Rita.   Post as needed!

Trish
Helpful - 0
320078 tn?1278344720
wait now i  am confused why week 16 UND confusing to everyone?  its probally my brain fog but i dont know what  you (lady Laur) are asking me., it strted treatment jan4 and UND april 3,  my doctor didnt run viral load until then, if you look at my journal that is a list of my last blood work, all of which i do not understand!!!!
Helpful - 0
408795 tn?1324935675
Week 16?  So sorry I can't believe I misunderstood in such a huge way.  I automatically thought that you were UND for alot longer.  Please hang in there somehow, think of it this way, you don't know me anyways, so forget what I said.  LOL

"This too shall Pass".  God Bless
Helpful - 0
250084 tn?1303307435
Just read on your profile "week 16 came back UND", were you not RVR? Not UND until week 16? That is pretty important here, please post back on this.

LL
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250084 tn?1303307435
So sorry your at that 'I give up' stage, but it PASS'S! From day to day! These days are so hard, at your wit's end. Your are nearly halfway thru this (if 48 weeks).

I agree, 22 weeks with UND is just too much invested to stop now. I could not work by week 5, (but 'only' had 19 more weeks to go.) I came so close to stopping tx at least 3 times. People here pushed me on, comforted me, with some 'buck up girl', which all helped me keep going. With money worries, sides, emotional roller coasters, "God I can't do this another day" and more...here I sit today and I made it thru it and still UND.

You can get thru this. Can you get assistance of any kind? Can any fellow employees 'donate' their sick days? ( a friend of mine, in cancer chemo...5 counties in Fl. donated sick days to her, she worked for the state. She passed, but it was amazing what the all did for her)
Erics idea to call the companies is very good. Please, don't stop now :(

I also push Nygirls Gold Bond lotion for the rash (green btl., red cap). I used Nystantin oral rinse for my mouth-helped.

In the worst times, I'd say "okay, it's week 15, I'll just get to week 18", than by week 18 your having some good days. I'd play that mental game..'2 more weeks' and so on.
Also, if you stop, in 3 mths. you'll most likely be thinking I shouldn't have and thinking of treating, all over again.

ME>>>>>Pushing ((((((((((((((((((((>>>>>>YOU   :)
Hang on awhile longer, no quick decisions.

LL
Helpful - 0
408795 tn?1324935675
I've never been tx'd yet, but if you're not in a clinical trial and you've been UND for quite a number of weeks what would be wrong with asking the doctor to lower your ribavarin a little and see if that helps?  I can't see anyone giving up tx after 22 weeks so in my mind I can only think of alternatives.  I don't understand why medical professionals are so set on 180 mcg of Peg and 1200 of riba.  I know I'm new here maybe I just don't realize the importance, except for one other thing.  If you've been UND for a number of weeks haven't some people, even on this forum rec'd a discount from the 48 weeks to 36 weeks?  Just trying to help.  God Bless
Helpful - 0
220090 tn?1379167187
I think that charm said it all.  I am just writing to say that you can make it through this.  I don't think a day passed without me saying to myself that this is it - I am out of here.  I alway ended up saying to myself that I would make no promises about completing treatment, but I would make it through one more day.

All the symptoms you describe are common to most of us.  I know that I experienced all of them.

You might be able to get the drugs through the drug company.  Call them and tell them exactly what you wrote here.  They all have programs to get the drugs to people that need them and are experiencing financial trouble.

Best of luck to you,
Eric
Helpful - 0
Avatar universal
uts all so different for each one of us
Helpful - 0
276730 tn?1327962946
Everyone is so different with tx. My first month was tolerable. The second month to 22 weeks I got slammed very hard. Lost 35% of my hair, coughing, itching, fatigue and irritability were way out of the ballpark! I never had nausea, never loss of appetite,
but very severe brain fog and just wanted my bed and blankie, My fatigue and depression were severe.

None of us know what tomorrow will bring but today I am pretty close to fine, minus, the dry skin, cracks in  corners of mouth, and some other minor issues.

For now I feel human. Take one day at a time and dont try to look into the future you will drive yourself mad.
Helpful - 0
471113 tn?1245108820
I have not started treatment yet so I know I can't relate to what you are going thru at this point in time but I have read over and over again that the longer you tx the better. You didn't say how much longer you have to tx? are you going to 24 weeks or 48? I hope you can hang in there.
Helpful - 0
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