hemolytic anemia

[dyce]

Hello all, I hope all are well today. My ? is ,my baselin hmg was 15.5 , after 3 weeks of tx it was 13.5 a 2 point drop. From my personal research, the hmg is not dropping real fast. Yesterday I had a cbc draw and that will tell us how the hmg is doin at the 5 week mark. I should have those results in a hour or so. Have anyone here had white spots on thier palms when looking down at em? A friend at work also drives ambulance and he said it looks like my blood is oxygen defficient. This riba is slowly killin my blood and if it's 2 more points lower this test, I'm gettin to a hemotologist.

Dyce

[jmjm530]

CDM: don't think that 2000mg of riba a day had any thing to do with that? Jim the double up man, just darned on me your screen name is even double jmjm
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LOL. Of course the added riba caused my hgb to drop faster -- but it was the three-point drop itself in a short period of time that put me in the ER, not the riba dose per say.

Others, taking the same amount of riba might have faired much better -- conversely, many take the normal amount of riba and run into trouble early. It all depends on the rate of drop and how your body reacts.

BTW I was cleaning up the other day and came across a little pink riba pill on the floor. Got all choked up.

-- Jim
-- Jim

[Mister beagle bailey]

Dyce my friend, as we discussed before you started treatment that having a script ready for procrit would be good in case your HGB drops to low.  Low HGB seems to be norm for those of us on riba.  Your HGB is still in the safe zone for now but get a script for the procrit so you can start if need be.

[Mister beagle bailey]

Dyce my friend, as we discussed before you started treatment that having a script ready for procrit would be good in case your HGB drops to low.  Low HGB seems to be norm for those of us on riba.  Your HGB is still in the safe zone for now but get a script for the procrit so you can start if need be.

[dyce]

Thanks all for the good advise. The doc hasn't called yet but the team tx'ng with me work real close with a reputable hemotologist. I made sure I would get to this doc quickly and they assured me that it would happen . This team has txed alot of hcv patients and have quite a few txing for hcv there as we speak. I will see when the latest results come in today. I'm not waiting for things to get out of hand before getting to the blood doc.

How are you guys doin?

Dyce

[Mister beagle bailey]

Dyce my friend, as we discussed before you started treatment that having a script ready for procrit would be good in case your HGB drops to low.  Low HGB seems to be norm for those of us on riba.  Your HGB is still in the safe zone for now but get a script for the procrit so you can start if need be.  let us know when you find out what the numbers are.
About the palm, that I don't recall with my self.

Beagle

[Mister beagle bailey]

Sorry about the triple post as I was up all night checking under my pillow to make sure Jim didn't get to my riba.  Even though it's well protected you never know with the super powers of the MOTH MAN.  

Beagle

[can-do-man]

Can't hide them riba from jim. He can stiff them out a block away. Heck he can even tell how many you have in that bottle. He goes in a drug store shakes a little then says wow you have 2000 of them here.

So how is Mr bb doing? Been out blood hunting today?

[lilmoma]

can-do says: Ill bend over and check my buns!!!!!!!!!!!!!!!
I thought I would never stop laughing at that one.
You are TOO funy!!!!!!!
lilmoma

[dyce]

Thanks brother, The doc is watching the blood work for me but the insurance I have won't approve the procrit until the hmg drops to 10, which is pretty low if you ask me. I'm going to get to the hemotologist way before it hits that unless I have a real rapid drop  I did call the hemotologist and they told me they work close with my team and assured me I'd get in thier office immediatly. Hopfully I'll hold up well, we can only hope.

How is your hmg holding up? Hope you are well.

Dyce

[dyce]

Hmg is holding at 12.7 and that is after 5 weeks of txing. The wbc is 2.7 and I believe I'm ok there, if I'm wrong please advise. I'm on 180mikes of pegasy and 1200 riba. I read somewhere that us heppers wbc can be allowed to drop a little lower as compared to cancer patients.

Hopefully I'll not need procrit during this tx , high hopes,

Dyce

[can-do-man]

Sounds good there dyce, just watch out for beagel, he might try and roll ya and steal some of that blood.

[jmjm530]

Dyce says: The doc is watching the blood work for me but the insurance I have won't approve the procrit until the hmg drops to 10
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Recent protocols endorsed by some top hepatologists suggest Procrit should be administered based on rate of drop from baseline and not just absolute level. It might be worth a call to your insurance company to find out if they go along with the newer protocols if you could show them something in print. If so, I'm sure we can dig up some of recommendations.

This also might be a good time to get your iron store checked. Your Ferritin should be at least 100 and your trans ferrin saturation should be at least 20%. If not, you may need supplemental iron.

Also, a good idea to get your blood pressure checked. If it's high, they will probably recommend controlling it with medications before starting the Procrit.

-- Jim

[jmjm530]

Hgb 12.7 doesn't seem to require Procrit. Regarding WBC, many hepatologists don't care how low it goes. Mine was around 1.2-1.4 for most of treatment. The number to look at is ANC (absolute Neutrophils). Some doctors suggest the rescue drug Neupogen if it drops below 750, but more and more doctors are allowing it to drop as low as 200-300 before intervening with Neupogen. I hit 325 at one point but it bounced back to over 1000 within a couple of weeks. ANC has a tendency to do that and can also be influenced by any infections going on.

-- Jim

[beamishboy]

Dyce-my hgb dropped slowly over 10 weeks-for a while i had hoped to forgoe the added injection! When i bottomed out at 10.3 i was couchmush & weak as a kitten and not nearly as cuddly....insurance came thru at week 12,i think ??? 2 weeks,2 shots of 40,000 and i 'started feelin ' sorta better.....ha!!!! Sounds like yu got yur ducks inna row,GOODLUCK!
i just started takin zanax 0.25 hope it kicks in quik-ANYBODY else on this med? what amt?what relief? lately my shrunken brain has been acting poorly;sometimes i feel like i'm trippin(only the bad sx's -dang!)social isolatation,heightened sense of unreality,anxiety & disorientation.......does not a happy hepper make..

[jmjm530]

I really forgot all your stats, including your weight -- but if you're a big guy with a hard to treat genotype (1a or 1b), you might talk to your doctor about adding some more riba -- especially since it seems to be holding in the 12's. The upside would be a potentially higher serum riba level which some associate with a better chance of SVR. The downside would be lower hgb, perhaps some more sides and more of a possiblity of needing a rescue drug like Procrit.

-- Jim

[Mister beagle bailey]

Dyce--Don't worry it will all turn out fine, we will get through this like everything else. My HGB is at 8.3 at the moment.
BTW- Has anyone heard from amommy tonight is her 15th shot? Have not seen her post in a few days.

Can do-- said: Jim shakes a bottle of riba and knows there are 2000 riba in that bottle.  Sounds like he's the real MONK,  looks like we have a real actor among us.

HGB is at 8.3 but I'm banned from all hospitals and blood banks, but can't imagine why.  Maybe it's because I've been seen with a siphon, hose and bucket.  Don't understand what all the fuss is about.

beagle

[dyce]

Thanks jim, I read the other day about hmg rate of drop and procrit intervention but right now I can't remember exactly what it said, I'm gonna do a google on that and then I'll call insurance, any help is greatly appreciated jim, I wish I had more time for the research. The np. told me my iron was ok( I still eat a little red meat when the stomach allows it)but I didn't ask about the anc but I'll pick up copys of my labs tomarrow and will ask ? on that. On the blood pressure,I check it dailey myself as does the np and it's been 120 over 80 so I've been ok there. Thanks for the concern, I'm still Learning new thing daily, this is a broad subject.

Dyce

[dyce]

Ha dude, you tellin me bb is a blood hound?

Dyce

[dyce]

I started at 200# , I was 220 but lost the 20# to be leaner goin in to tx . Now I'm at 190# and have seened to level off there. Next visit to hepatologist I'll ask him his experience on upping the riba since we're doin weight based tx any way. I believe your right on that and if we up the dose I can get days off work if needed if the sx's get to rough.

I'm geno1-a at 5.000.000 viral load. Stage 0 grade 1.

Dyce

[Mister beagle bailey]

Your HGB is holding at 12.7 and that is higher then my 11.0 when I started tx.  You will be fine, we'll get through this.  Make an appointment with the hemo dr. so your ready to go if need be.  He will do all the paper work for the procrit if you need it.  If you do ,remember it's not the end of the world it's just one step closer to SVR and that's the bottom line.  look at me my HGB is 8.3 and I'm still fighting at any cost.  My friend every thing will work out so don't worry , just go with the flow and all will work out.  I'm here for you remember that.

Beagle

[dyce]

Thankyou guys for the help! Yikes , daughter needs puter, cya.

Dyce

[Dale_Ray]

Don't mess around with it Dyce go ahead and see a good hemo doc. I don't know about the white spots on your hands but any change would be of concern. Send a note when you get those results back today. Thinking about you partner. Dale

[can-do-man]

nope my palms look the same, hold on a second and i'll bend over to see if my buns are turning pale. Nope all ok there to. Let us know how your hgb is holding, so far thats still high. Good luck to ya

[jmjm530]

Dyce,

A two point drop from baseline during the first three weeks of treatment can cause people anywhere from very mild symptons to something more serious often requiring intervention with a rescue drug like Procrit. A lot depends on age, sex, general health and simply our individual adapt to a hgb drop. I dropped from 14.8 to 11.3 in 2-3 weeks and ended up in the ER. Near the end of treatment, after my body adapted, I went power walking with hgb 11.3.

I don't know about your palms, but dropping hemoglobin is par for the course when treating and not necessarily bad. What I mean by that is that some researchers suggest lower hgb means your body is absorbing the ribavirin more efficiently, which is a good thing.

Depending on how far your hgb drops -- and equally important -- depending on how you feel and your general health (any heart conditions, etc) -- this would be a good time to discuss the rescue drug Procrit with your doctor. Even if you don't need it now, it takes 2-4 weeks to kick in -- plus the insurance process -- so it's really never too early to at least get an rx written in case.

Regarding seeing a hemotologist -- some doctors like mine, prescribe Procrit themselves, again based on a combination of absolute hgb, rate of drop, and how you feel and are tolerating treatment.

If you think your current doctor is not up to speed on Procrit/Neupogen, etc, then seeing a hemotologist sounds like a good idea.

But, personally, I don't think anything unusual is going on -- white spots or not -- other than a normal reaction to the ribavirin. But your friend is right, you are oxygen deficient. We all are while treating.

Hope it all works out.

-- Jim





discomfort depending on age and constitution.