Resume full dose riba or reduce procrit dose?

[eureka254]

A very informal poll, if you will:

Undetected at week #13, reduced riba from 1200mg to 1000mg since week #30 due to anemia, procrit 2x a week, hgb at 9+ weeks #31-41,  10+ weeks # 42-52, and now, finally at week #54, hgb at 11.3.  (Whew!) Question is:
What would you do if you called the shots (no pun intended)? Resume 1200mg riba?  Space out the procrit?  Reduce the procrit?  None of the above?  

Two things I keep tossing back and forth in my mind is the risk of relapse vs. the risk of procrit use... and I'm aware that members here aren't doctors, but plenty of you know more about treatment than the average GI specialist, and I'd greatly value your feedback.  (And those who don't feel they know much are welcome to comment too :] !) Besides, for the most part, treating hep c seems like a balancing act based on the heaviest data any particular doctor is weighing at that particular moment...  please weigh in (and Brain Mass Index is not a factor).  Thanks!

~eureka
PS: Additional question for those of you who have AFP readings regularly... what's been your highest reading?

[nygirl7]

Ooops I didn't check when I had my allergy panel run he did my hemo too it's over 13 now......but that is three years post tx.

Normal 11.7 - 15.5

So now at 11 someone would definitely not really be prescribed it as it's in the normal range still especially for a woman.  It makes sense I guess why they make us suffer.

[nygirl7]

The use of Procrit is at the discretion of the physician. "

PS I think mostly it is the insurance company that says no...........at 6grand a box of 10 I can see how they would feel it should be warranted.  I could use a shot now to tell you the truth I'm so tired ;)

[nygirl7]

I think the point was that the black box warnings say not to let the hemo go rapidly up over 12, isn't that it?  I know my doc wanted me to stay right where I was at 10.5 or so and when I had gone up over 12 (from taking 40,000 x 2) he went berserk and I didn't understand why until the warnings came out.

AT 11.5 or 12 one might "think" they needed procrit but really that is almost a normal perfect hemo for a woman.  Two years later and I believe mine is 12.3 or something like that............CERTAINLY manageable to anyone.

When Iost six points in ten days from 15+ to 9 - THAT was bad...it's not only the number but how fast you go down that is key to the issue.  Going back up 10.5 was tolerable (not pleasant but safe and tolerable).

[mikesimon]

Generally a Hgb of 11.3 would not warrant Epo.
But, it is easy to imagine a scenario in which Epo might be appropriate with an 11.3 Hgb.
Say, for instance, a man is 3 weeks into TX and his HGB drops from 16 to 11.3.
Starting Epo might be prudent in that situation. It's always about the individual circumstances.
Mike

[newleaf09]

I agree that 11.3 does not warrant Procrit but if she goes back to full riba, she will likely end up continuing the procrit.  Some people become more accustomed to the drugs as TX drags on but not all of us do.  Low HGB is no better for a woman than a man.  Below 10 is breathless, exhausted and weak for anyone.  Can you keep plugging along just the same? Sure.  You do what you gotta do.  Do people drop out of TX because they are so incapacitated by low HGB that they can't work? Sure again. In the U.S. 8.5 will get you a tranfusion.  The use of Procrit is at the discretion of the physician.  If he sees that you have difficulty functioning in the 10's, you'll get Procrit.  No point memorizing all the negative side effects of a drug.  That's one of the things that keep perfectly sensible people from starting the peg/riba therapy until they are verging on liver failure.

[jessiejames1973]

i didnt say i had a hb of 8.5 i said others,
yes hb is a personal thing some will cope better than other at lower levels , it does not change the fact that procrit can be dangerous if abused, a hb of 11.3 does not warrant procrit it is not needed the risk out weighs the benefit at THIS level.