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

[OnAPrettyPoison]

I will watch for beagles with red crosses...and beagles in black capes....and beagles period!  

Dyce, heck after 33 weeks of the pretty poison, I can't tell anymore if the anemia is better or worse.  It is just the general warmed over death feeling I have become accustomed to on treatment ;o)  I really feel pretty good most days!

[can-do-man]

Just odd how these studys and doctors go, agree with one then agrees with another on the same topic.

[jmjm530]

Same fellow. Different study. Jacobsen does a lot of studies/research. He's part of the Hepatitis Center in NYC.
http://www.hepccenter.org/jacobson.php

[dyce]

Man pretty, I can only imagine right now how you feel, I don't like the way I'm feelin at 12'7. I wonder how your iron levels are?

Watch out for BB, He is actually a bloodhound dressed in a redcross suit!

Dyce

[can-do-man]

Pretty just becareful if a person comes to your door claming to be from the red cross. asking for dontations. They don't do it that way, plus they don't have a hose and bucket.

BB, Shame on you, just seen on the news about a blood sucking banit posing as the red cross

[OnAPrettyPoison]

Glad you are hanging tough.  Anemia is the bane of my existence at the moment.  My hemoglobin fell from 12.7 to 10.3 and am waiting on my last batch of blood work to see if they want to up the procrit.  Mr. BB have you been drinking my blood via the internet????

[can-do-man]

Is this the same one? I. M. Jacobson, Weill Medical College of Cornell University,

Curious cause he was in the same study that my doctor was in and was in the link i posted?

[jmjm530]

Dyce,

Your approach has a good logic to it. Personally, I'd make the cut off non-detectible at week 12 with a very sensitive test down to 5-10 IU/ml. You also might try a week 4 PCR to make sure you've had a least a 90% drop in viral load. If the response is too slow, or sides get too bad, pulling out to fight another day makes a lot of sense in your case, as you got plenty of days left.

CanDo,

CDM says:From what my doctor said 85 to 105 kg is 1200mg.

So what are you smoking these days? Who are you asking if someone who weighs 60lbs my senior should be taking my 1200mg/day. LOL.

Seriously, as Goofy says, you do fit within the weight-based guidelines but on the conservative end. Here is Jacobsen's weight-based study.
http://www.hivandhepatitis.com/2005icr/aasld/docs/111805_a.html

Depending on your sides, what you want to accomplish, etc, going to 1400 or even higher has a logic, as long as you have a doctor who will support you with support drugs if needed.

-- Jim

[dyce]

BB Thanks guy, You got every1s back here and I really appreciate your support.

Beamish, Ha ,sounds like ya nees some deep purple or jimi hendrix to go with that trippin er dude(LOL).  I to get some weird feelins up in the ole noggin, I believe the riba is the culprit.

Ya ever heard of e.j dailey, the fomous adirondac trapper and lure maker? The adirondac mountainman.

Dyce

[can-do-man]

It was when i questioned him on it he was going by the san francisco aasld conference in 2005.

I question him alot, he's used to it though from me

[dyce]

When I started tx I had the same thought on riba dosage. Being a stage 0 I made my mind up that I am not beatin my self to hard with the meds. If I get the undet. or 2 log drop at 12 weeks I'll continue. If it don't work at grade 1 imflamation, maybe it will reverse that and I'll wait til later for thr newer drugs. Imflamation is the processor to fibrosis and I want to try and put a halt to that now if possible. Also I read that hcv patients with low or no damage have a higher svr chance even being geno 1. So I'm rollin myself on this 1. Hope it works. Have had this virus for 20 years and was dx in 1991, so Ive been waitin on better drugs for 16 years now.

How are you energy levels? Gettin better I hope!

Dyce

[GoofyDad]

A conservative number (maybe from the insert) is 13.3 mg/kg. My Docs like to go with 15mg/kg. At least one study I read showed improved success with 15.5 vs. 13.3.

I would venture that 1,200 would be the min for 91 kg.

[can-do-man]

I found this on weight base at this site.


http://tinyurl.com/ob7yy

[can-do-man]

jim from what my doctor said 85 to 105 kg is 1200mg. So 91kg would be for 200 lbs. Right?

[jmjm530]

I thought weight-based riba would be 1400mg/day for someone over 200 lbs. Others, who are treating more agressively are taking even more ribavirin per body weight. Again, one advantage of Procrit is that it allows you to take more ribavirin at the same base hgb level.

That said, as a stage 0, you might not want to fight as agressively. The more agressive you fight (higher doses, longer treatment) the more risks you're taking with your short and long-term health.


-- Jim

[can-do-man]

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

So you feeling better everyday? Quit sleeping with that riba under your pillow. Their safe.

[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.

[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

[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

[dyce]

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

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]

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

[dyce]

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

Dyce

[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