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Re: [GIWorld-Hepatitis] Doc

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  • Constance Dickson
    I take 5 mgs of Glucatrol daily. Where would I look on arms and forearms? Have found some on the back of my neck too. I think they worry Eddie more than me.
    Message 1 of 22 , Feb 3, 2002
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      I take 5 mgs of Glucatrol daily. Where would I look
      on arms and forearms? Have found some on the back of
      my neck too. I think they worry Eddie more than me.
      :-) Only ones that is real prominent is the one
      behind left ear and the ones on the back of my head.
      Take Care and Thank You.
      Connie
      --- Doc <gidoctor@...> wrote:
      > Dear Connie,
      > You do seem to have enlarged glands , I am wondering
      > if they are on the arms and forearms as well..if so
      > they maybe nerve sheath tumors( benign) called
      > neurofibromas.
      > If they are indeed enlarged lymph nodes then you
      > must have one biopsied or aspirated straight away.
      > Being on IFN for this long lowers your immunity and
      > makes you prone for a lymphoreticular disorder like
      > lymphoma.
      > I am also wondering why the docs you have been
      > seeing and paying so much cant tell you what they
      > are!
      > You lower BS indicates that you must cut down on
      > your diabetic medication for otherwise you may
      > experience changes in conscious level. Let me know
      > what your current meds are and I will help.
      > Lowering of sugar may also be causing you weight
      > loss, anyway its best right now that you stay away
      > from Combo.
      > Take care, I am doing fine, say hi to Eddie as well.
      >
      > Dr Sharat Misra MD,DM,FACG
      >
      >
      >
      > Doc,
      > What would make most of my Lymph nodes be
      > enlarged
      > especially in the head and neck area area? Have
      > found
      > enlarged ones that did not know that they existed.
      >
      > The ones that I thought were part of my skull now
      > have
      > ones closer in across from each other. The one in
      > the
      > regular place on area of left ear is big and hard
      > and
      > is kind of has a point on it. Have them on my
      > neck to
      > and in armpits. Keep finding new ones. A couple
      > in
      > the groin area also. I am also trembling and
      > jerking
      > tonight is making it hard to type. Saw a pain
      > management Dr yesterday he was pretty thorough.
      > They
      > tested my blood sugar and it was 69. He told me
      > about
      > something new where you take it before you eat and
      > once it gets BS lower it cuts out, forget the
      > name.
      > Do you think BS went down because being off Meds?
      > He
      > was quite expensive but he was worth it, $124 for
      > initial appt. then will be $75 when go back. He
      > gave
      > me 10 mg Lortabs and more than the 30 Dr A was
      > giving
      > me of 7.5, Soma 35 mg and the amitriptylimine.
      > Also
      > gave me Celexa for depression but was $75 so I did
      > not
      > get it filled. The Amitriptylimine has some
      > anti-depressant in it and I think that it will
      > take
      > care of it, well at least I hope it will. He does
      > something that I think is good he has you sign a
      > contract about what you do with pain meds. He
      > said I
      > should take the amitriptylimine for the Fibro and
      > I
      > figure it might help the pain I have been having
      > in my
      > hands from the CTS. I have been feeling so much
      > better lately. I do have some pain in Liver and
      > Spleen area more so in Liver area than spleen, it
      > is
      > kind of like a gnawing pain, don't know why having
      > pain there. Dropped 12 lbs since off meds,
      > thought it
      > was 10 but looked at journal and was 12, my
      > abdomen
      > has went down some too which I figure is good. He
      > is
      > a very nice and understanding Dr.
      > Take Care, Connie
      > PS Eddie asked how you and family were doing and
      > told
      > me to tell you Hi and to Thank You for helping me.
      >
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      > [Non-text portions of this message have been
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    • Doc
      You can try and break it up by taking it 1/2 before breakfast and half before dinner, that may prevent the fall in sugar you are experiencing in the late day
      Message 2 of 22 , Feb 3, 2002
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        You can try and break it up by taking it 1/2 before breakfast and half before dinner, that may prevent the fall in sugar you are experiencing in the late day time.
        Regarding your glands I think you should have one tested by aspiration cytology.

        Dr Sharat Misra MD,DM,FACG



        I take 5 mgs of Glucatrol daily. Where would I look
        on arms and forearms? Have found some on the back of
        my neck too. I think they worry Eddie more than me.
        :-) Only ones that is real prominent is the one
        behind left ear and the ones on the back of my head.
        Take Care and Thank You.
        Connie
        --- Doc <gidoctor@...> wrote:
        > Dear Connie,
        > You do seem to have enlarged glands , I am wondering
        > if they are on the arms and forearms as well..if so
        > they maybe nerve sheath tumors( benign) called
        > neurofibromas.
        > If they are indeed enlarged lymph nodes then you
        > must have one biopsied or aspirated straight away.
        > Being on IFN for this long lowers your immunity and
        > makes you prone for a lymphoreticular disorder like
        > lymphoma.
        > I am also wondering why the docs you have been
        > seeing and paying so much cant tell you what they
        > are!
        > You lower BS indicates that you must cut down on
        > your diabetic medication for otherwise you may
        > experience changes in conscious level. Let me know
        > what your current meds are and I will help.
        > Lowering of sugar may also be causing you weight
        > loss, anyway its best right now that you stay away
        > from Combo.
        > Take care, I am doing fine, say hi to Eddie as well.
        >
        > Dr Sharat Misra MD,DM,FACG
        >
        >
        >
        > Doc,
        > What would make most of my Lymph nodes be
        > enlarged
        > especially in the head and neck area area? Have
        > found
        > enlarged ones that did not know that they existed.
        >
        > The ones that I thought were part of my skull now
        > have
        > ones closer in across from each other. The one in
        > the
        > regular place on area of left ear is big and hard
        > and
        > is kind of has a point on it. Have them on my
        > neck to
        > and in armpits. Keep finding new ones. A couple
        > in
        > the groin area also. I am also trembling and
        > jerking
        > tonight is making it hard to type. Saw a pain
        > management Dr yesterday he was pretty thorough.
        > They
        > tested my blood sugar and it was 69. He told me
        > about
        > something new where you take it before you eat and
        > once it gets BS lower it cuts out, forget the
        > name.
        > Do you think BS went down because being off Meds?
        > He
        > was quite expensive but he was worth it, $124 for
        > initial appt. then will be $75 when go back. He
        > gave
        > me 10 mg Lortabs and more than the 30 Dr A was
        > giving
        > me of 7.5, Soma 35 mg and the amitriptylimine.
        > Also
        > gave me Celexa for depression but was $75 so I did
        > not
        > get it filled. The Amitriptylimine has some
        > anti-depressant in it and I think that it will
        > take
        > care of it, well at least I hope it will. He does
        > something that I think is good he has you sign a
        > contract about what you do with pain meds. He
        > said I
        > should take the amitriptylimine for the Fibro and
        > I
        > figure it might help the pain I have been having
        > in my
        > hands from the CTS. I have been feeling so much
        > better lately. I do have some pain in Liver and
        > Spleen area more so in Liver area than spleen, it
        > is
        > kind of like a gnawing pain, don't know why having
        > pain there. Dropped 12 lbs since off meds,
        > thought it
        > was 10 but looked at journal and was 12, my
        > abdomen
        > has went down some too which I figure is good. He
        > is
        > a very nice and understanding Dr.
        > Take Care, Connie
        > PS Eddie asked how you and family were doing and
        > told
        > me to tell you Hi and to Thank You for helping me.
        >
        > __________________________________________________
        > Do You Yahoo!?
        > Great stuff seeking new owners in Yahoo! Auctions!
        >
        > http://auctions.yahoo.com
        >
        > Yahoo! Groups Sponsor
        >
        >
        >
        > Welcome to GIHepWorld
        >
        > Post message: GIWorld-Hepatitis@yahoogroups.com
        > Subscribe:
        > GIWorld-Hepatitis-subscribe@yahoogroups.com
        > Unsubscribe:
        > GIWorld-Hepatitis-unsubscribe@yahoogroups.com
        > List owner:
        > GIWorld-Hepatitis-owner@yahoogroups.com
        > URL to this page:
        > http://groups.yahoo.com/group/GIWorld-Hepatitis
        >
        >
        > Your use of Yahoo! Groups is subject to the Yahoo!
        > Terms of Service.
        >
        >
        >
        > [Non-text portions of this message have been
        > removed]
        >
        >


        __________________________________________________
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        [Non-text portions of this message have been removed]
      • Carol
        Doc, I wish I could just up and come to the US. In a perfect world, I would get the meds I really need. Due to financial problems, and being on
        Message 3 of 22 , Feb 26, 2002
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          Doc, I wish I could just up and come to the US. In a perfect world, I
          would get the meds I really need. Due to financial problems, and being
          on disability...which the pay leaves a lot to be desired lol....there's
          no way I can do it. I'll work on my Doc, but I know he can't prescribe
          what isn't approved yet. I didn't know that Canadian medical is good in
          the US. Won't ever buy travel insurance anymore :-( Thanks anyway,
          you're quite a guy!!

          Carol

          Doc wrote:

          > Your liver disease is not too advanced anyway and you need to have a
          > viral load test and Peg + Riba. You need to work on your docs or go to
          > US or come here! Did you know that Canada health insurance is valid
          > anywhere in the World.
          > I have treated some Canadians and that is how I know.
          >
          > Dr Sharat Misra MD,DM,FACG
          >
          >
          >
          >
          >
          > Thanks Doc. You're the only one who answered my email, I guess no
          > one
          > knows what to say to me. The cirrhosis was probably caused by my 20
          >
          > years of party life, heavy, heavy drinking...no drugs, no tylenol.
          > I
          > wasn't surprised that I had it, I have the red palms and upper chest
          >
          > rash, have had it for years, just didn't know what it meant. To add
          >
          > insult to injury...I also have an abcessed tooth...started taking
          > penicillin last Tuesday and have felt great ever since. Must have
          > had a
          > lot of infection in my body to make such a difference in how I
          > feel. I
          > feel great!
          >
          > Btw, I am NOT drinking at all....haven't in 7-8 years. So hopefully
          > the
          > cirhossis will not continue. My alt level is one and 1/2 higher
          > than
          > normal, still in double digits. They don't do viral load tests in
          > Canada anymore, DUH.
          >
          > Carol
          >
          > Doc wrote:
          >
          > > Dear Carol,
          > > It does seem that you have cirrhosis but if your ALT is high with
          > +ve
          > > HCV-RNA you should go for treatment with Combo albeit with lower
          > dose
          > > of IFN
          > >
          > > Dr Sharat Misra MD,DM,FACG
          > >
          > >
          > >
          > > Hi gang
          > >
          > > I am not amused. Biopsy isn't very good at all. Will post this
          > as
          > > it
          > > reads:
          > >
          > > The core needle biopsy of liver shows marked distortion of
          > normal
          > > liver architecture. There is severe fatty change present.
          > There is
          > >
          > > periportal fibrosis with well-established cirrhosis present.
          > The
          > > portal triad shows mild chronic inflammatory cell infiltrate
          > > including
          > > lymphocytes and macrophages present. The bile ductules and
          > vessels
          > > are unremarkable. There is no PAS diastase positive granules
          > > present.
          > > There is mild parenchymal injury, less than four injured cells
          > > (acidophilic bodies, ballooning degeneration) seen /10hpf. The
          > > central venules are unremarkable. The iron stain is negative.
          > > There
          > > is no bile stasis present.
          > >
          > > Dammmmmmmmm. If you recall, I live in Canada where treatment is
          > the
          > >
          > > old one, not peg. Doc, am I too far gone to even bother with
          > > treatment? Especially with the old combo, not peg. I'm geno 1b
          > of
          > > course. I guess I should at least try treatment. Any
          > thoughts? I
          > > think I'm still rather stunned at this report.
          > >
          > > Thanks all
          > > Carol
          > >
          > >
          > >
          > >
          > > [Non-text portions of this message have been removed]
          > >
          > >
          > > Yahoo! Groups Sponsor
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          > >
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        • Lora
          Doc, Just wondering if you might have missed my question again, haven t seen a reply? Thanx, Lora Hi Doc, I might have had the question you missed so here it
          Message 4 of 22 , Mar 22, 2002
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            Doc,
            Just wondering if you might have missed my question again, haven't seen a reply?
            Thanx, Lora



            Hi Doc,
            I might have had the question you missed so here it is again... thanx, Lora
            ----- Original Message -----
            From: Lora
            To: GIWorld-Hepatitis@yahoogroups.com
            Sent: Wednesday, March 13, 2002 11:22 AM
            Subject: Re: [GIWorld-Hepatitis] Post Tmt Update


            Hi Doc,
            I really appreciate you taking the time to post the info you do.
            I'm wondering since I'm a genotype 2b, on PEG/combo, tested non-detectable @ 4 weeks, should I have the 12 week follow up? Prior to starting meds my viral load was 4055000 H copies/ML. My last liver biopsy (#2) showed little change from the original, mild portal fibrosis without septa or bridging, score 1 out of 4, mild portal inflammation with rare acidophil body, score 1-2 out of 4. I was diagnosed in 1996. Age 39 now.

            I'm the one having a hard time convincing myself to do 48 weeks and leaning towards 24 instead.

            Thanx for you time, Lora


            ----- Original Message -----
            From: Doc
            To: GIWorld-Hepatitis@yahoogroups.com
            Sent: Wednesday, March 13, 2002 1:08 AM
            Subject: Re: [GIWorld-Hepatitis] Post Tmt Update


            Currently the view is that if you are undetectable at 12 wks of combo, only then you should go on for full 24 or 48 wks.
            Most people on combo who have >2000 copies at 12 wks do not generally achieve a response.

            Unfortunately most docs or protocols dont test HCV load at 12 wks but do so at 24 wks.

            Dr Sharat Misra MD,DM,FACG



            Lora,

            Do the whole 48 unless your blood work gets so bad you or your doctor can't
            manage it. It was pretty easy for me, relatively speaking, after week 24.
            The last half was definately better than the first half of treatment.

            You will significantly improve your odds for success if you do 48 whole
            weeks. I know....it seems too long....I know, I know!!

            My dr. says if you are non-detectable at 24 weeks or less and stay on the
            whole 48 week treatment, then you got an 85% chance of staying undetectable
            for the rest of your life. Who would want to repeat a regimen again after
            stopping at week 24 for ANY reason? I wouldn't. Hang in there, you can do
            it.

            Edie

            ----- Original Message -----
            From: "Lora" <prov356@...>
            To: <GIWorld-Hepatitis@yahoogroups.com>
            Sent: Sunday, March 10, 2002 6:14 PM
            Subject: Re: [GIWorld-Hepatitis] Post Tmt Update


            > Hi Edie,
            > I want to thank you for sharing your experience. I'm @ week 9 on the
            Peg/combo, with a non-detectable viral load @ week 4. I really think I'm
            only going to do 24 weeks of this, plggg! Anyway, I wanted to let you know
            how encouraging your words are, there IS a light @ the end of the tunnel!
            > Grace & peace, Lora
            > ----- Original Message -----
            > From: Edie
            > To: GIWorld-Hepatitis@yahoogroups.com
            > Sent: Sunday, March 10, 2002 8:31 AM
            > Subject: [GIWorld-Hepatitis] Post Tmt Update
            >
            >
            > Hello Everyone,
            >
            > It has now been a full week since I came off most of my medications, and
            boy, do I feel better. I am far from 100%, but I did not expect to feel
            this good this fast. I am about 70% bounced back.
            >
            > A week ago last Saturday, my first day off treatment, I helped my
            husband move some new furniture into our house. Now, normally, if I had even
            tried such a thing, I would have been in bed all day Sunday. Instead, I
            bounced back after a few hours and did not have any bad effects on Sunday.
            Sunday night, I even cooked dinner for the family, and I have continued to
            cook every night since then. It is no longer painful and agonizing to go to
            work.
            >
            > On Sunday, I noticed I could shop for groceries and remember what I was
            supposed to buy. Also on Sunday, my mouth went from dry (dry the whole time
            on treatment) to normal. It is so nice to have spit back!
            >
            > On Tuesday, I noticed an increase in my ability to concentrate and solve
            problems at work. I am a computer programmer and have really been
            struggling at work trying to do my job. All of a sudden, I think I got my
            mind back! (Well, SOME people would debate that I ever had my mind to begin
            with!!)
            >
            > My extreme tiredness is just about gone. I still do tire easily and
            still can't stay up very late, but at least I am not in bed at 7 pm or
            sooner. Also, my desire for lots and lots of fluids has slacked off
            significantly. It sure is nice to only get up once or twice a night to pee.
            >
            > My dr. was telling me Friday that if my PCR comes back with a viral load
            in 6 months, his new recommendation would be to put me back on a 48 week
            combo regimen. He would, however, DOUBLE the interferon dose (1.5 units to
            3.0 units per kg of bodyweight) for the first 12 weeks and then put me back
            on the normal dose of interferon for the rest of the time. Lets hope that
            doesn't happen, as those first 12 weeks would be hell.
            >
            > I still can't sleep very well (still taking Ambien and Benadryl) and am
            still taking one of my anti-depressants. In two weeks, I am going to start
            cutting back on those.
            >
            > Last night, I had pain and tenderness in the liver area around the
            frontside. I think my liver is just trying to get rid of all those nasty
            chemicals.
            >
            > Edie
            > Combo Survivor
            >
            >
            > [Non-text portions of this message have been removed]
            >
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          • Doc
            Lora, Sorry I had missed that earlier. ... Doc, Just wondering if you might have missed my question again, haven t seen a reply? Thanx, Lora Hi Doc, I might
            Message 5 of 22 , Mar 25, 2002
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              Lora,
              Sorry I had missed that earlier.
              Read on for response:

              >>>>>>>

              Doc,
              Just wondering if you might have missed my question again, haven't seen a reply?
              Thanx, Lora

              Hi Doc,
              I might have had the question you missed so here it is again... thanx, Lora
              ----- Original Message -----
              >>>>>>
              Hi Doc,
              I really appreciate you taking the time to post the info you do.
              I'm wondering since I'm a genotype 2b, on PEG/combo, tested non-detectable @ 4 weeks, should I have the 12 week follow up? Prior to starting meds my viral load was 4055000 H copies/ML. My last liver biopsy (#2) showed little change from the original, mild portal fibrosis without septa or bridging, score 1 out of 4, mild portal inflammation with rare acidophil body, score 1-2 out of 4. I was diagnosed in 1996. Age 39 now.
              I'm the one having a hard time convincing myself to do 48 weeks and leaning towards 24 instead.
              Thanx for you time, Lora>>>>>>

              It is good that youre nondetectable now and thus a 6 months course of combo will suffice for you. This holds true for genotype 2, 3 and 1 with low viral loads. Make sure at the end of 6 months that you remain HCV negative.

              Dr Sharat Misra MD,DM,FACG


              [Non-text portions of this message have been removed]
            • lora632001
              Thanx so much Doc! Take care of you! Grace & peace, Lora ... haven t seen a reply? ... again... thanx, Lora ... detectable @ 4 weeks, should I have the 12
              Message 6 of 22 , Mar 26, 2002
              • 0 Attachment
                Thanx so much Doc! Take care of you!
                Grace & peace, Lora



                --- In GIWorld-Hepatitis@y..., "Doc" <gidoctor@u...> wrote:
                > Lora,
                > Sorry I had missed that earlier.
                > Read on for response:
                >
                > >>>>>>>
                >
                > Doc,
                > Just wondering if you might have missed my question again,
                haven't seen a reply?
                > Thanx, Lora
                >
                > Hi Doc,
                > I might have had the question you missed so here it is
                again... thanx, Lora
                > ----- Original Message -----
                > >>>>>>
                > Hi Doc,
                > I really appreciate you taking the time to post the info you do.
                > I'm wondering since I'm a genotype 2b, on PEG/combo, tested non-
                detectable @ 4 weeks, should I have the 12 week follow up? Prior to
                starting meds my viral load was 4055000 H copies/ML. My last liver
                biopsy (#2) showed little change from the original, mild portal
                fibrosis without septa or bridging, score 1 out of 4, mild portal
                inflammation with rare acidophil body, score 1-2 out of 4. I was
                diagnosed in 1996. Age 39 now.
                > I'm the one having a hard time convincing myself to do 48 weeks
                and leaning towards 24 instead.
                > Thanx for you time, Lora>>>>>>
                >
                > It is good that youre nondetectable now and thus a 6 months
                course of combo will suffice for you. This holds true for genotype 2,
                3 and 1 with low viral loads. Make sure at the end of 6 months that
                you remain HCV negative.
                >
                > Dr Sharat Misra MD,DM,FACG
                >
                >
                > [Non-text portions of this message have been removed]
              • jcmmo@webtv.net
                3 weeks ago I had a compression fracture of my left femur. I was in traction for 4 days while the doctors looked for reasons to cause the fracture. There was
                Message 7 of 22 , Apr 6, 2002
                • 0 Attachment
                  3 weeks ago I had a compression fracture of my left femur. I was in
                  traction for 4 days while the doctors looked for reasons to cause the
                  fracture. There was no trauma or fall. One of the doctors suspected a
                  tumor but the bone and body scans were negative. The ortho doc put a
                  titanium rod and 3 large screws to fix the bone. A catheter was put in
                  before surgery and was removed 2 days before I went home. 3 days after
                  coming home I spiked a temp of 102.5 and went to my doctor. I had no
                  idea what was wrong.
                  B/P was 78/52, pulse 132 and I was jaundiced. I felt like I was dying.
                  I was sent back to the hospital and put in the telemetry unit. After
                  cultures were done I was diagnosed as being septic with Ecoli that
                  originated in a UTI. I am very lucky that it was caught in time. I am
                  concerned that the infection might have caused more damage to my liver.
                  Since the infection
                  I have pitting edema in both feet. I am on 20 mg of lasix and my home
                  nurse called my doctor for an increase in dosage.
                  I am taking potassium, cipro, calcium, hydrocodone and iron tid. My
                  hemoglobin
                  went down to 8 while in the hospital.
                  I am praying that this infection hasn't ruined my chance for treatment
                  for hep c.
                  I am a 1b with cirrhosis,vl 365,000 IU.
                  I wish I had more info to give you.
                  Thank you for your help.


                  Judy M


                  http://community.webtv.net/jcmmo/Affirmation
                • Doc
                  Hi Judy, You seem to be having an acute systemic infection , it might make your LFT abnormal as well. It is important that this infection be adequately treated
                  Message 8 of 22 , Apr 6, 2002
                  • 0 Attachment
                    Hi Judy,

                    You seem to be having an acute systemic infection , it might make your LFT abnormal as well. It is important that this infection be adequately treated and once its taken care of you should be able to undergo Hep C threatment. Have your LFTs checked, none of the drugs used will harm the liver but if LFTs are abnormal I would cahage the cipro to a cephalosporin.

                    All the best.

                    Dr Sharat Misra MD,DM,FACG



                    3 weeks ago I had a compression fracture of my left femur. I was in
                    traction for 4 days while the doctors looked for reasons to cause the
                    fracture. There was no trauma or fall. One of the doctors suspected a
                    tumor but the bone and body scans were negative. The ortho doc put a
                    titanium rod and 3 large screws to fix the bone. A catheter was put in
                    before surgery and was removed 2 days before I went home. 3 days after
                    coming home I spiked a temp of 102.5 and went to my doctor. I had no
                    idea what was wrong.
                    B/P was 78/52, pulse 132 and I was jaundiced. I felt like I was dying.
                    I was sent back to the hospital and put in the telemetry unit. After
                    cultures were done I was diagnosed as being septic with Ecoli that
                    originated in a UTI. I am very lucky that it was caught in time. I am
                    concerned that the infection might have caused more damage to my liver.
                    Since the infection
                    I have pitting edema in both feet. I am on 20 mg of lasix and my home
                    nurse called my doctor for an increase in dosage.
                    I am taking potassium, cipro, calcium, hydrocodone and iron tid. My
                    hemoglobin
                    went down to 8 while in the hospital.
                    I am praying that this infection hasn't ruined my chance for treatment
                    for hep c.
                    I am a 1b with cirrhosis,vl 365,000 IU.
                    I wish I had more info to give you.
                    Thank you for your help.





                    [Non-text portions of this message have been removed]
                  • Doc
                    Dear Claudine, Thanks for your kind words and generous offer :) , we treat women with respect and admiration, however young or old they maybe. We are having a
                    Message 9 of 22 , Apr 26, 2002
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                      Dear Claudine,
                      Thanks for your kind words and generous offer :) , we treat women with respect and admiration, however young or old they maybe.
                      We are having a Hep B group meeting in PA this year and I wish I could organise something like a Hep C meet sometime!

                      You are right in thinking that a lot of docs overdrug and over or under test. The problem is they never talk to the patient or relatives. That is their pitfall.
                      I sometimes only talk to patients and do not prescribe any medication, at these times they only want some explanations or assurance, not meds or tests.
                      Elderly are special and I always compliment them for reaching the age they have. Maybe because I never saw any grandparent ( they all died before I was born except my materanl grandmother with whom I spent some delightful summer vacations as a young kid).

                      Hope your grandmother gets well soon and maybe you can call us for her centenary birthday celebrations.

                      Dr Sharat Misra MD,DM,FACG


                      --- Doc <gidoc@...> wrote:
                      > I agree, individual needs have to be considered and treat each case
                      > on its merit and not merely by the book.

                      Hi Doc,
                      I just HAVE to comment! I can't think of any one thing that is
                      more important than what you have said! I know sometimes it's not
                      always easy for a doctor to do this when they have a lot of patients
                      to see and treat, not to mention insurance companies to deal with,
                      but when you have a doctor who can do this it can make all the
                      difference in the world. I feel real lucky to have found a PCP who
                      really listens to me and doesn't treat me like I'm crazy if I say I
                      feel bad when according to some book or lab I should feel good! And
                      over this past 3 months, dealing with one doctor after another who
                      wants to lump my 93 year old grandmother into the exact same mold as
                      anyone else her age has made me REALLY appreciate it! It is very
                      annoying to try and discuss her needs with a doctor who is seeing her
                      for the first time, and he hasn't even bothered to read her chart or
                      review her health problems and what's been going on with her during
                      this period, and he just starts telling us it's this or that just
                      because of her age and wants to just drug her up. I've never seen a
                      group of doctors in my life so anxious to hand out pain medications,
                      anti-psychotics, sleeping pills, tranquilizers, etc., and yet you
                      have to argue to get a simple blood test done to check her sodium
                      levels when we (who know her better than anyone) KNOW that in the
                      past when these symptoms occurred her sodium level was very low. If
                      I'm sounding frustrated today it's because I am! I just got home from
                      12 long, physically and emotionally exhausting hours in the nursing
                      home where my grandmother is. No one seems to care. THANK YOU for
                      being you! You remind me that there really are doctors who care. I
                      know you aren't the only one, but sometimes I feel like it!
                      Claudine




                      [Non-text portions of this message have been removed]
                    • claudine intexas
                      ... You re welcome, but does that mean you don t want her? Oh well, you would have to be an animal lover (she has dogs, cats, a pet scorpion named Veda, and a
                      Message 10 of 22 , Apr 26, 2002
                      • 0 Attachment
                        --- Doc <gidoc@...> wrote:
                        > Dear Claudine,
                        > Thanks for your kind words and generous offer :) ,

                        You're welcome, but does that mean you don't want her? Oh well, you
                        would have to be an animal lover (she has dogs, cats, a pet scorpion
                        named Veda, and a 5' pet albino python named Bones); and of course
                        you would have to move to Texas. If you change your mind, let me
                        know.

                        > We are having a Hep B group meeting in PA this year and I wish I
                        > could organise something like a Hep C meet sometime!

                        That would be so great if we could do that sometime! This group has
                        become like another family to me. Maybe someday we will manage to do
                        this!

                        I'm glad you think elderly are special. I think so too. There is not
                        enough respect for the elderly in this country. Many are just sent
                        off to nursing homes by their family, and most of these nursing homes
                        are pretty depressing places. It is very sad to watch what so many
                        are going through, not just health-wise, but many are so very lonely!
                        And bored too! My grandmother is 93 and has lived a good long and
                        happy life. She is the most kind hearted person I have ever known and
                        is loved by many. I would love it if she was still around to
                        celebrate her 100th birthday, but only if she is happy and
                        comfortable during those years. Hopefully she will get well, but if
                        not I just hope she does not suffer. She is my last surviving
                        grandparent. I knew them all, and the relationships I had with each
                        of them was unique and wonderful. I love my parents, but my
                        grandparents were special is a different way. I hope that someday I
                        will be as wonderful a grandmother to my grandchildren as she/they
                        were to me. (If I ever get any! Don't forget my offer!)

                        My daughter would KILL me if she knew about this, lol!
                        Claudine




                        __________________________________________________
                        Do You Yahoo!?
                        Yahoo! Health - your guide to health and wellness
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                      • Doc
                        It would be nice to have a Hep C Meet , look for a place and sponsors...Hep C has been in big news . Dr Sharat Misra MD,DM,FACG You re welcome, but does that
                        Message 11 of 22 , Apr 27, 2002
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                          It would be nice to have a Hep C Meet , look for a place and sponsors...Hep C has been in big news .

                          Dr Sharat Misra MD,DM,FACG


                          You're welcome, but does that mean you don't want her? Oh well, you
                          would have to be an animal lover (she has dogs, cats, a pet scorpion
                          named Veda, and a 5' pet albino python named Bones); and of course
                          you would have to move to Texas. If you change your mind, let me
                          know.

                          > We are having a Hep B group meeting in PA this year and I wish I
                          > could organise something like a Hep C meet sometime!

                          That would be so great if we could do that sometime! This group has
                          become like another family to me. Maybe someday we will manage to do
                          this!

                          I'm glad you think elderly are special. I think so too. There is not
                          enough respect for the elderly in this country. Many are just sent
                          off to nursing homes by their family, and most of these nursing homes
                          are pretty depressing places. It is very sad to watch what so many
                          are going through, not just health-wise, but many are so very lonely!
                          And bored too! My grandmother is 93 and has lived a good long and
                          happy life. She is the most kind hearted person I have ever known and
                          is loved by many. I would love it if she was still around to
                          celebrate her 100th birthday, but only if she is happy and
                          comfortable during those years. Hopefully she will get well, but if
                          not I just hope she does not suffer. She is my last surviving
                          grandparent. I knew them all, and the relationships I had with each
                          of them was unique and wonderful. I love my parents, but my
                          grandparents were special is a different way. I hope that someday I
                          will be as wonderful a grandmother to my grandchildren as she/they
                          were to me. (If I ever get any! Don't forget my offer!)

                          My daughter would KILL me if she knew about this, lol!
                          Claudine




                          [Non-text portions of this message have been removed]
                        • GWhel@aol.com
                          Hi Doc, I ve completed 21 weeks of combo, 16 of neupogen, and 13 of procrit. Had 850,000 copies before treatment. PCR now shows 133,000 copies. Doctor said
                          Message 12 of 22 , Dec 9, 2002
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                            Hi Doc,

                            I've completed 21 weeks of combo, 16 of neupogen, and 13 of procrit.

                            Had 850,000 copies before treatment.

                            PCR now shows 133,000 copies. Doctor said today I'm not responding and that I
                            should withdraw from treatment and wait a few years for new treatment.

                            Does this seem correct? I'm 1a and, though I had my fingers crossed, I was
                            prepared to be a nonresponder since I didn't respond twice to mono therapy
                            before, but I was hoping to stave off HCC and possible get some reversal of
                            fibrosis by staying on treatment for full term.

                            I'm really bummed having to quit treatment.

                            Thanks for your response.

                            Your friend,
                            Gene
                          • AlleyPat
                            Gene sorry to hear that. Usually with genotype 1 s, if you don t go undetected by the 6th mo, the doc takes you off treatment. Now there are people out there
                            Message 13 of 22 , Dec 11, 2002
                            • 0 Attachment
                              Gene sorry to hear that. Usually with genotype 1's, if you don't go undetected by the 6th mo, the doc takes you off treatment. Now there are people out there who chose to continue treatment anyway, and eventually did to undetected. But you have to weigh your current health concerns with what the treatment might do to you as well.

                              Good luck

                              Alley

                              "You are only given a little spark of madness.You mustn't lose it." Robin Williams

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                              [Non-text portions of this message have been removed]
                            • Mzgee1@aol.com
                              Hey Gene...just htought I d share this with you.. Tho I am 2b, I didn t go undectable until 9 months into treatment (standard combo). My doc often referred
                              Message 14 of 22 , Dec 11, 2002
                              • 0 Attachment
                                Hey Gene...just htought I'd share this with you.. Tho I am 2b, I didn't go
                                undectable until 9 months into treatment (standard combo). My doc often
                                referred to me as a 2b who acted like a 1 !!! My poiny: wo knows what will
                                happen in a few weeks more..or even another 3 months or even 6...as far as I
                                know I am still undectable, or at least was at the 9 month post treatment
                                mark. I am 16 months post treatment and over due for a PCR..but still feel
                                confident it will be undect.. If your doc will let you, why not hang in
                                there fro a while longer?? Like I said, just wanted to share my story with
                                you. luv, gee


                                [Non-text portions of this message have been removed]
                              • GWhel@aol.com
                                Alley and Gee.....thanks for your responses. I hope to hear from Doc soon and see what he says. The blood was drawn two weeks ago for the PCR, so that was only
                                Message 15 of 22 , Dec 11, 2002
                                • 0 Attachment
                                  Alley and Gee.....thanks for your responses. I hope to hear from Doc soon and
                                  see what he says. The blood was drawn two weeks ago for the PCR, so that was
                                  only 19 weeks into treatment.

                                  Going from 850,000 copies to 133,000 sounded positive to me. I asked my
                                  doctor if I should increase from .4 peg to .5, and he said, no, because it's
                                  working. Then he left the room to go talk to the main HCV doctor and came
                                  back and said I wasn't responding, that they were going to stop treatment and
                                  wait to see what becomes available in the next few years. I just about begged
                                  him to leave me on treatment, especially since the weekly Procrit injections
                                  have brought my hemoglobin up from 9.1 to 12.5 and the Neupogen has increased
                                  my absolute neutrophil count, but he said it was certain I wouldn't respond
                                  and so there was no sense in continuing treatment. Bummer....

                                  I mentioned I had been hoping the interferon would at least stave off HCC and
                                  maybe even reverse some fibrosis, even if I didn't clear the virus, but he
                                  didn't think that would be the case. It was a long ride home from the Omaha
                                  VA back to Des Moines.

                                  I have enough meds for another four weeks, and I feel like continuing until
                                  it's gone.

                                  Gene
                                • Doc
                                  Hi Gene, Recent work has shown that a 4 wk HCV-RNA load reduction following therapy is highly predictive of response to treatment. A minimin of 2 log reduction
                                  Message 16 of 22 , Dec 12, 2002
                                  • 0 Attachment
                                    Hi Gene,

                                    Recent work has shown that a 4 wk HCV-RNA load reduction following therapy is highly predictive of response to treatment.
                                    A minimin of 2 log reduction at 1 month follows a good chance of ETR( HCV-RNA undetectable).
                                    Do you have any previous readings of HCV-RNA after beginning treatment?
                                    Also what is your current ALT?

                                    Your viral load is definitely down and that alone has been associated with histological improvement in the long run.

                                    I would continue to monitor HCV-RNA load and continue treatment for 48 wks, barring any side effects. There is no better treatment and none forthcoming either so there is a slim chance of a ETR at the end of one year. However, if there is no change in viral load after another 3 months or it begins to rise , then I would discontinue treatment.

                                    All the best and hope this helps.

                                    Dr Sharat Misra MD,DM,FACG



                                    ----- Original Message -----
                                    From: GWhel@...


                                    Hi Doc,

                                    I've completed 21 weeks of combo, 16 of neupogen, and 13 of procrit.

                                    Had 850,000 copies before treatment.

                                    PCR now shows 133,000 copies. Doctor said today I'm not responding and that I
                                    should withdraw from treatment and wait a few years for new treatment.

                                    Does this seem correct? I'm 1a and, though I had my fingers crossed, I was
                                    prepared to be a nonresponder since I didn't respond twice to mono therapy
                                    before, but I was hoping to stave off HCC and possible get some reversal of
                                    fibrosis by staying on treatment for full term.

                                    I'm really bummed having to quit treatment.

                                    Thanks for your response.

                                    Your friend,
                                    Gene



                                    [Non-text portions of this message have been removed]
                                  • GWhel@aol.com
                                    Hi Doc, I had told you I d completed 21 weeks of combo when my doctor took me off 12/09. Is HCV-RNA the result of PCR? I had 850,000 copies a year ago. Wasn t
                                    Message 17 of 22 , Dec 12, 2002
                                    • 0 Attachment
                                      Hi Doc,

                                      I had told you I'd completed 21 weeks of combo when my doctor took me off
                                      12/09.

                                      Is HCV-RNA the result of PCR?

                                      I had 850,000 copies a year ago. Wasn't done again till two weeks
                                      ago...133,000 at that time.

                                      I thought that indicated I was responding.

                                      You asked about my ALT:

                                      01/26/98 160
                                      02/27/98 118
                                      03/02/98 114
                                      04/02/98 113
                                      05/29/98 126
                                      06/22/98 152
                                      09/15/98 120
                                      04/05/99 129
                                      05/17/99 152
                                      10/14/99 150
                                      11/29/99 116
                                      04/10/00 127
                                      05/30/00 117
                                      11/13/00 134
                                      12/05/00 139
                                      03/26/01 135
                                      04/01/02 153
                                      04/09/02 114
                                      12/09/02 57

                                      AST is 43, which is half of the lowest value in four years. It's been around
                                      100 for the past four years.

                                      I'm thinking of writing the doctor (I'd call but probably wouldn't reach him.
                                      He comes to the Omaha VA from the University of Nebraska Medical Center and
                                      I'm in Des Moines, IA) to ask if I can be put back on treatment. I never did
                                      actually get to talk to him. The doctor assigned to me left the exam room
                                      with the lab results and had a conference with the head doctor, then came
                                      back to me with instructions to cease treatment because I should have been
                                      lower than 133,000 at 19 weeks.

                                      I don't want to put you on the spot, but I have 21 weeks invested. Do you
                                      have any suggestions concerning how I can plead my case?

                                      I don't want to make you feel uncomfortable, but I trust your opinion and
                                      don't want to wait another few years. Right now my next appointment is on
                                      06/08/03 for CBC. The doctor then plans to talk to me about a biopsy. The
                                      last one was done 01/96 and showed mild fibrosis.

                                      I've been taking Procrit and Neupogen. Hemoglobin is 12.5. ANC is around
                                      1500.

                                      Thanks,
                                      Gene
                                    • Mscue40@aol.com
                                      HI Gene, I couldn t believe they are going to take you off the medicine. You have been such a great trooper. I hope you can find another Dr. to take a look at
                                      Message 18 of 22 , Dec 14, 2002
                                      • 0 Attachment
                                        HI Gene, I couldn't believe they are going to take you off the medicine. You
                                        have been such a great trooper. I hope you can find another Dr. to take a
                                        look at your medical records.
                                        All my thoughts and prayers have been with you.
                                        You have always been so kind to me.
                                        Donna


                                        [Non-text portions of this message have been removed]
                                      • GWhel@aol.com
                                        Donna, Thanks for your concern. I m uninsurable. I think the VA knows that many Vietnam veterans may be infected because of their service, and though they are
                                        Message 19 of 22 , Dec 15, 2002
                                        • 0 Attachment
                                          Donna,

                                          Thanks for your concern.

                                          I'm uninsurable. I think the VA knows that many Vietnam veterans may be
                                          infected because of their service, and though they are not admitting
                                          liability, they are treating us. If a doctor refuses to treat me further
                                          right now, I doubt the VA would allow me to side step and go seek treatment
                                          at another VA facility. I could be wrong.

                                          I was having blood work done every two weeks (was on procrit and neupogen),
                                          but as it stands now, my next appointment is sceduled for 06/08/03 for CBC.
                                          My doc in Omaha will decide then whether nor not to scedule a biopsy. He's
                                          wanting to wait for newer developments in treatment.

                                          He took me off at week 21. I have enough meds for 24. I'm going to finish
                                          them up anyway.

                                          Take care,
                                          Hope you're well,
                                          Gene
                                        • willem landstra
                                          HI.So at least yr Doc. is waiting for new developments inTX also.I had no reaction,except one,on my posting about new developments.One of t he new
                                          Message 20 of 22 , Dec 16, 2002
                                          • 0 Attachment
                                            HI.So at least yr Doc. is waiting for new developments inTX also.I had no reaction,except one,on my posting about new developments.One of t he new developments will be protease-blockers either mono or in combination with Ribavarine or Peg-interferon.Some yrs ago people where dying of aids,today,at least in the western world,nobody is dying of Aids anymore and live almost normal lives.That.s the way it will be with Hep-C.Even when the virus cannot,in some cases,being completely erradicated it can be kept in check.The virus is causing the damage,if the viral-load is low,the damage will be less or am I wrong.In a few yrs from now Hep-C. will be,at the worst,a treatable chronical disease of which you will not die and live a normal live.I hve great faith in science and all over the world they.re searching for cures.My concern is with the so-called third world where western medicines to combat HIV and Hep-C are not readily avaiable and people dying unneccesary
                                            ----- Original Message -----
                                            From: GWhel@...
                                            To: GIWorld-Hepatitis@yahoogroups.com
                                            Sent: Sunday, December 15, 2002 9:11 PM
                                            Subject: Re: [GIWorld-Hepatitis] Doc


                                            Donna,

                                            Thanks for your concern.

                                            I'm uninsurable. I think the VA knows that many Vietnam veterans may be
                                            infected because of their service, and though they are not admitting
                                            liability, they are treating us. If a doctor refuses to treat me further
                                            right now, I doubt the VA would allow me to side step and go seek treatment
                                            at another VA facility. I could be wrong.

                                            I was having blood work done every two weeks (was on procrit and neupogen),
                                            but as it stands now, my next appointment is sceduled for 06/08/03 for CBC.
                                            My doc in Omaha will decide then whether nor not to scedule a biopsy. He's
                                            wanting to wait for newer developments in treatment.

                                            He took me off at week 21. I have enough meds for 24. I'm going to finish
                                            them up anyway.

                                            Take care,
                                            Hope you're well,
                                            Gene

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