High Altitude Side Effects

[Peso2007]

I am in week 5 of 48, geno 1a, living and working at 10,000 feet in the Rockies and have developed a skin rash that has the doctor worried he will have to stop treatment. Has/is anyone living at high altitudes with TX dealing with serious skin issues (sometimes called Ribi-rash)?

I have been taking Zyrtec every morning for almost 3 weeks without much success. Just started taking prednisone two days ago prior to injection Thursdays though it's too early to tell if this is going to be the answer.

This treatment may be kicking my butt, but I am not ready to give up so quickly. Any suggestions?

[NorthernArizona]

Hi,
    I live in Flagstaff, Arizona, which is at 7000 feet.   The high altitude can certainly cause or exacerbate a skin rash.  The problem is multifaceted.  The high altitude supports less moisture in the air. The cold air here causes people to turn up their heaters. The dryness causes an increases positive charge on the surface of your skin which adds to dry skins irritability.
     The  decreased pressure causes a person to lose a lot of water through their lungs.  Higher atmospheric pressure reduces water loss across the membranes in the lungs.  
    My eczema went generalized (full body) when I moved here. It is a constant struggle for me to stay hydrated enough to keep my blood pressure under control.  The result of that is my kidneys are unhappy and I have hematuria (blood in the urine).  
     Both allergist and my dermatologist have recommended full rain forest biomes for me to consider relocating to.  I'm sure meds can cause rashes...I personally wouldn't be so quick to dismiss high altitude living as a potential cause or exacerbate of some conditions. Good luck to you!

[Uplink]

Something that everyone missed here is that dehydration is much worse at higher altitudes. It's hard enough to stay hydrated while on TX, but a body will lose TWICE the water through skin and lungs at 6,000 feet vs. at sea level because of the lower air pressure. That dehydration is bound to aggravate skin rashes.

[merry1244]

I had a horrible blistering swollen skin rash, tried alot of over the counter skin creams everything, the only thing that helped was fresh aloe vera plant , immediate releif, and within days it was almost completely gone, it really works for the various skin irrtations that come with tx, lucky for me I have some growing in the backyard. hopefully you can get a hold of some at your high altitude.

[lanier]

So glad you have a partner to share the beauty of the Rockies and be there for your treatment.  good luck to you.
Lani

[Mr Liver]

While the elevation cools the hot summer days nicely, It also can fry your skin quickly because of the reduced solar protection. Especially when you are taking a drug that has been known to cause photoallergic, photosensitive and phototoxic reactions.I'm speaking about Ribavirin. Even suncreen has not worked on some with photosensitive issues on tx.

I'm not saying this will solve your problem, it is just a thought. Ever go over the pass to Leadville to the lakes ?

Best of luck
PK

[Peso2007]

Had the virus for probably 30 years though I just diagnosed positive in July.

I live just a few miles shy of Independence Pass gate. Absolutely love this country and had every intention of retiring in 13 years with one home here in the Top of the Rockies and one on the coastline in Georgia. I just turned 48 and now I am re-evaluating my plans for life. The material things are no longer so important...

The most important thing is sleeping peacefully on the couch next to me (negative for HepC!). Making her happy and leaving her well taken care of if this treatment doesn't work is now my mission in life.

[Peso2007]

Alagirl, I take Benedryl pills every night before bed. Although I'm not allergic to anything that I know of, I react badly to cortizone so it's not an option. I've tried it on wasp stings, bug bites and the like and it seems to make the effects worsen. Get numerous blisters that itch like crazy. They pop on their own and spread sores. Just like what I've got now only worse. The ones on my wrists and knuckles crack and bleed if I try too much range of motion.

As I said, I'm civil service and don't have to worry about telling anyone at work what my problem is though still keep it non-descript as "liver problems" which require peg-interferon and ribivivin. Some of the people I work with have experience with HepC in the family plus one guy's wife works at the local hospital. I'm fairly sure a few know, but are polite enough to leave it alone.

As I said before, this is kicking my butt, but I'm working 40+ hours a week with no pain meds or anti-depressants. I'm getting help where I can.

Starfish, You guys are loads of help in more ways than one. I spent weeks in Sydney long ago and even got a nice tat near the rock at the bottom of the bridge. Nothing personal, but I think there's a good chance I may have picked up this nasty virus on one of those visits. Having said that, no matter where I landed in the down under, you people took good care of me. 3 visits to Sydney, 2 to Perth and 1 to Hobart. Almost moved there...

[lanier]

hey neighbor!! I had a really sweet condo in Georgetown (elev 8400) and used to go to aspen, and dillon all the time.  I worked for clear creek county are you in that area?  altitude sickness and o2 could affect your quality of life on treatment I think depending on your age, how long you have had virus, platelet count, grade and stage and of course viral load.  everything is connected.  So I think your concerns with regard to altitude have merrit, but it all lead back to any other underlying things you have going on with your overall homeostasis.  your viral load is low, mine is 5 million last time I checked.  and you must be a younger person living in the Rockies and working up that way.  Good luck to you.  I remember my first year up your way dry snow in the winter and wet snow in the spring right up until june, but heaven on earth in so many ways.

Lani

[Aquila]

Hi everyone.  I'm a serial lurker here, have been for a few years.  My main hangout is over on an Aussie hepper forum (with a different username) and that's where I met Peso.  We have mostly Aussie members but the odd one from elsewhere on the planet.  

Hey Peso.  Glad to see you came over here to ask some questions. I guess I barked up the wrong tree when I suggested that maybe the altitude could be contributing to the rash.  I have an idea that the sun can make it worse, and surely the sun is more intense at altitude??  Maybe that's just the VX rash.

I suggested Peso come here to ask you well-informed people about the rash, hoping there would be some local info.  We don't get that Gold Bond cream down here, and Procrit is really hard to get your hands on down here too.  Different system.

When I treated 3 years ago my specialist just dose reduced when my neuts went down.  I didn't know much at all then so I trusted him.  I did 48 gruelling weeks then relapsed.  I have learned that we have to stay on top of all the new developments ourselves and  take control of our disease and treatment.  In Australia you only get one shot at treatment, although lately I'm seeing a few people get a second chance through the pharmaceutical sponsored Compassionate Access Program.  We also weren't included in any of the PROVE trials but the rumour is that we're getting in on the phase 3 round.  Tx naive only.  Bummer.

Good luck, Peso.  And you're doing the right thing, trying to stay on treatment and keep the dose up.  Apart from the threat of dose reduction, I bet the rash is brutal to live with!  Ouch!

Cheers
Aquila/Starfish/Murph   ...   I know, it's complicated.  

[alagirl]

I wasn't really inferring that you were about to drop out.  It just seemed like some of the advice you were being given was that it was ok to drop out and just wait for another treatment to come around.  And really, I don't believe that it is.  That's just my opinion, that treatment needs to be relentless when it comes to hep c.

So I'm glad you're in the treatment for the long haul and glad your doc is doing 48 wks since you're a type 1.  So am I, by the way.  Although I'm a 1b.  I start treatment next week.  And trust me, I'll be a big weenie baby whiner all over these boards.  But I will be staying in treatment.  I really wouldn't have thought that the zyrtec WOULD work on the rash.  Now the prednysone, which is a steroid type med, that may work.  I would try a topical mix too of cortizone and perhaps benadryl cream if your doc says its ok.  Of course, I always do a lot of things without my doc's ok, but I never advocate that for others.  Your doctor might be able to prescribe you a steroidal cream, something akin to what he would presribe for you if you'd tumbled into poison ivy.  Something of that nature might work.  

Do they know at work that you tested positive?  I'm assuming that if they do that your job is safe since you have some type of government employment?  I hope so.  Also, I'd ask your doctor for procrit sooner rather than later if your blood levels are going down.  It will give you a lot more energy if you can get your red blood cell count up.  I'm lucky in some ways in that I already have anemia so I have procrit at home and I'll be able to dose pretty much at will.

[Peso2007]

Thanks. Apparently I sometimes present the image that I am considering ending treatment when nothing could be farther from the case. When I was found positive earlier this summer, I didn't believe the doctor and went to a specialist for verification. When that turned out positive too, I immediately started tx even though the only test results outside of PCR were elevated liver enzymes. I'm a bit of a realist at the core and although I personally don't have faith that my treatments will lead to SVR (I think my percentage rate for success is just too low to be excited about the outcome), I am going to do everything in my power to give the tx it's best chance for success.

I just moved out here from the east coast about 18 months ago and sank most of my savings into a downpayment on a $330K home in the mountains. The average home takes 2 to 3 years to sell around here and there aren't that many hydro-electric plants around the country that I have options to be able to move to. I'm going to make it through the Riba-Rash, the anemia and the high altitudes because those are side effects and I feel like that's a personal choice to deal with them or throw in the chips. I'm not a gambler and those "chips" are what life dealt me so I'm playing them.

In 8 years I'm eligible to retire from government civil service, a healthy TSP (401K) and my military retirement. I can do 8 years standing on my head if I have to.

So I'm about 10% of the way through 48 weeks and I'm asking for help with this rash when it's looking like I need to just deal with it and pray it's only going to last through the beginning phase. Sorry if that sounded insincere, it wasn't meant that way. Every week seems to bring a different issue with side effects and I need to just be patient.

I guess finding out you are HCV+ is never at a good time in life and this surely wasn't for me. I can't complain too much since starting this new job is what identified that I was positive. Without the new job, I may have just continued on unknowingly until the liver started to show signs of failure. At least I have a fighting chance now.

Thanks again.

[alagirl]

with cancer, esp when they biopsy a tumor in liver cancer, you're correct in thinking that doing a biopsy CAN cause cancer cells to spread to other areas and thus, cause the cancer to spread.  But Peso, in a liver biopsy where there is no cancer (and they would know because they will prob do an mri or ultrsound or catscan first and those tests can show tiny tiny tumors of all types) and they are merely checking the liver for things such as fibrosis and iron levels and that sort of thing, as opposed to taking a biopsy of a tumor, you aren't risking that sort of thing, so it is very safe.  

Actually though, I will reiterate what I said before and tell you that regardless, due to the enormity of the studies I have read on this topic, I am a huge advocate of completing treatment with peg-a interferon and rebetol (ribavirin) anway, and since you are a type 1, it should really be for 48 weeks to be on the safe side, but you'll have to talk to your doc about that.

[alagirl]

Peso, I can't see how the altitude would be a factor in the rash, but many people reportedly do get a rash during tx at the beginning.  Hopefully, it will go away soon, as I hear it sometimes does?  I lived in Telluride during my formative years and was back there this past August.  I can see how it would be more difficult doing the tx there due to lack of oxygen causing one to become even more fatigued at that altitude while on treatment.  All I can tell you is that I hope you and your doctor (even if you have to get a new one) can get past the rash, because truly, I believe this is a disease that needs to be treated.  You only have one liver and one body.  Even if you had to move away from the rockies for a while to go through tx, in my mind, it would be worth it.  The way I feel at this point, tx is the most important thing to me.  I have read, and continue to read, every article and study about hep C that I can find.

What I have taken away from all of those materials is that this is a disease that is progressive and that the sooner you treat, the better your chances at a successful outcome.  Also, just because you don't feel sick, you can't assume that the virus is not doing damage, allowing it to remain in your system basically gives it time to replicate - giving it a stronger stranglehold on your body, and further damaging your liver.  It's not as though the virus just sits there sipping kuba libra's the entire time, it wants to replicate, that's what viruses do.

I'm consistently amazed, I think, not that the medical professionals sometimes tell people to go ahead and wait until it gets bad, and then we'll do something about it, but that patients who are infected actually buy into it and think that's an ok route to go.  Waiting for your liver to sustain a certain measurable amount of damage?  Seriously?  That's insanity.  Why would anyone want to wait until the medical profession deems their liver scarred to that extent before beginning treatment again?  You know what that really means is that your liver is hard and fibrotic to that extent and can no longer adequately clean your body of toxins.  People should just go ahead and wait until then?  Why??  It's not like they're passing new livers at K-Mart, and even if you get an organ transplant, that comes with years of nasty anti rejection drugs.

I'm sorry, but I can only believe that when people keep advising to wait to treat its some form of denial.  Sorry, I know I'm going to **** some people off with this, but its truly what I think.  If someone isn't actively treating then they can pretend that they aren't really sick, and truly, this is the only thing that makes sense to me when it comes to people not jumping into the doctor's office for treatment.  Because at this point there are few protocols out there, but the others being tested?  If you REALLY WANTED TO, you could tx with the combo therapy and order one of the new promising drugs offline.  If I had  already been through the combo tx and it didn't work (and who knows, I may well be there in a few months) that's what I would be doing.  

I have been fighting since the day I found out I had Hep C, about 4-6 weeks ago, to get tx as quickly as possible, and I can guarantee you that if one doctor tries to quit treating me for any reason - rash, not responding quickly enough, whatever - I will go to another.  I will go to Canada, buy it off the internet, or do whatever I can to treat.  Because if you have hep C, then you ARE sick.  Even if you don't feel bad.  And even if you aren't in treatment.  So my best advice is, try to get the doctor to treat your rash but try, at all costs, to stay on treatment.  In my mind, treatment is the only good option.  

[PSP-n-Me]

are you the one that took those herbs all through tx, and also - didn't you shorten your tx?

[ShoshanaPNW]

If cancer is present in an organ, under some circumstances it can expand through the channel created by the biopsy needle. This is not the case for hepatitis.

[GrandmaA]

I took Procrit about once or twice a month. You might need more. One of the herbs I was taking from Dr. Zhang helped the red blood cells so I didn't need as much Procrit. Also, I was eating Chinese red dates.

The biopsy is usually done before you treat. If a person is at stage 0-2 they can wait for the new meds and if they are a stage 3 or 4 they need to treat.  It's very accurate. Mine was a breeze, didn't feel a thing. I never heard of a person getting a bx after starting tx.

[Peso2007]

I see your point with the biopsy being a benchmark but that's water under the bridge at this point.

My doctor is on a 10 day vacation so maybe it's a good time to see how this prednisone is going to fair. If it doesn't, I'll request a referral to a dermatologist and ask about the Procrit.

Thanks.

[Peso2007]

I've had family members dignosed with cancer (both liver and lung) and when they either opened them up or stuck a needle in to get the biopsy sample, they're cancer accellerated and they died soon after. Maybe genetics, maybe bad luck, but in any case the luck turned really bad quickly.

And no, I'm not a pilot (good sense of humor by the way). I am a hydroelectric plant supervisor so keeping my wits about me is still paramount to doing my job without killing people.

[jmjm530]

Some doctors don't biopsy if a patient is going to treat anyway. The advantage, however, is that it gives one a gauge as to how agressively to treat. For example, someone with stage 3 liver damage may elect to go 72 weeks if they respond slowly, while someone with zero liver damage, may elect to stop treatment with a slow response, then regroup to fight another day. But that's water under the damn.

I don't know what you hemo numbers are (before and during tx) but many of us are prescribed the helper drug Procrit to help. Among the more agressive liver specialists, this is the preferred choice to dropping the ribavirin dose. Lowering ribavirin is associated with lower SVR rates, especially during the first 12 weeks. I would also highly recommend a viral load test NOW and not wait until week 12. Your result will give you a heads up as to whether the treatment drugs are working or not and whether your doc has to change strategy. The viral load test should be taken the day before your injection and it should have a sensitivity of at least 50 IU/ml, preferably down to 5 or 10 IU/ml.  I would also have a dermatologist look at the rash.

-- Jim

[PSP-n-Me]

the rash is common in some people that take Riba - I only got a small amount of it early on - Try a sortisone cream - ask the doc for it - Some people in here swear by Gold Bond, but I had no luck with it..

I honestly do not understand what you are saying about a biopsy accelerating a illness, are you sure that is what you are saying - If so, that makes no sense at all...

The high altitude is not going to induce a rash - but, anemia will be worse for you at a high altitude - I sure hope you are not a pilot LOL

[Peso2007]

I am more than motivated to continue the treatments at this point. My doctor is an internal medicine specialist with a good bit of experience treating HCV patients. He's just never seen skin reaction this bad and it has him worried. I'm the one thinking the altitude is excaberating the problem, not him.

He just reduced my Rib from 1000 to 800 per day but that was because my blood cell count was dropping a little too much. Since I work between 10,000 and 13,000 feet, the anemia was causing problems at work. In my line of work I can ill afford to get incoherent on a mountain peak.

My genotype is 1A and my viral load prior to starting tx was over a million. My doctor chose not to perform a liver biopsy because he feels that if this is something I have had for 25-30 years with no side effects (found I was HCV+ when I started a new job that requires full blood test and my liver enzymes were high the first two years in a row) and I was electing to go through tx right away, the tx would naturally change the condition of my liver so why not wait until after the treatment to determine my liver condition. We weren't planning on doing another viral count until week 12.

This has caused mixed response from people and frankly I'm not sure about how I feel about it. I have seen biopsies which appeared to accellerate a terminal illness condition so rapidly family members have died within a matter of weeks.

[jmjm530]

If you've motivated to continue on with treatment, you will need a doctor both experienced in treating hepatitis c, and willing to fight side effects agressively. I don't know the extent of your skin problems, but many here have had bad skin problems (including rash)  and continued treatment without reducing the medications. I agree re altitude probably not being a factor with the rash,  although it could be a factor in terms of anemia.

What is your genotype? How much liver damage do you have? Did your doctor give you a week 4 viral load test?

- Jim

[ShoshanaPNW]

Why does your doctor think altitude is a factor? Lots of people get the riba rash (in other words, ribavirin-related rash). You may want to search this forum for more information.