The Blues Ain’t News

Once upon a time there was a little boy with a bad temper. His father gave him a bag of nails and told him that every time he lost his temper, he should hammer a nail in the fence. The first day the boy had driven 37 nails into the fence. But gradually, the number of daily nails dwindled down. He discovered it was easier to hold his temper than to drive those nails into the fence.Finally the first day came when the boy didn’t lose his temper at all. He proudly told his father about it and the father suggested that the boy now pull out one nail for each day that he was able to hold his temper. The days passed and the young boy was finally able to tell his father that all the nails were gone. The father took his son by the hand and led him to the fence.

“You have done well, my son, but look at the holes in the fence. The fence will never be the same. When you say things in anger, they leave a scar just like this one. You can put a knife in a man and draw it out, it won’t matter how many times you say ‘I’m sorry’, the wound is still there.”

I’ve been running a low grade fever, and feeling flu-like symptoms since Friday night. I’ve also got the deep muscle aches that are becoming a normal thing after the shot. I’ve been in bed for most of the weekend..hopefully I’ll have some energy to get the studio adverts done so I can get some students rolling in!

Here we are at the end of week #4 , and I’m happy to report that I’m feeling just fine. I have some big red circles around the injection sites, however with my psoriasis it just blends right in. I’m used to looking like a burn victim…

I may go ahead and try the RAPTIVA treatment for the Psoriasis soon..we’ll see.

I weighed in this morning at 192.4 pounds.

Just a little tired today. We did manage to get out on the beach for awhile though, so that was nice!

I’m trying not to get too stressed out about our new house situation. We’ve been in this new place for 1 month, and we’ve been served with foreclosure papers. It seems the owner hasn’t made payments for a year! She rented to us KNOWING this was going to happen. It doesn’t do much for my faith in people…she could’ve just told us what was up.

I’m not sure what we’re going to do now. We spent months trying to find this place, and even let her rent it out an extra month to a snowbird so she could make some money…what luck we have…

Tonight is shot #3.

So far, the sides have been OK, and I haven’t experienced anything awful. I do get deep muscle aches in various parts of my body. Last week it was my hips, and down my legs, and last night, it was in my shoulder. I just took some ibuprofen and it was better.

I have been feeling slightly sick to my stomach, and I get the occasional migraine which also makes me sick. I weighed in at 194.6 pounds this morning. I’m losing a little over 1 pound a week..if this keeps up, I’ll look like Mick Jagger by the end of treatment…lol

Here’s a clip from the other night. I haven’t performed that tune in 20 years, so I forgot some words..haha! But it was fun anyway

Not Gonna Let It Bother Me (042808) - Atlanta Rhythm Section

 

The wife and I are going to go see my old band mates tonight in Panama City beach. It’s always fun to get up and sing a few whenever I see them!

I feel fine today. I REALLY wonder if these drugs are working. Last year I tried HUMIRA for my psoriasis, and that had ZERO effect on me. I guess I’ll find out at my first 3 month blood test whether my Viral Load is dropping. If not, I guess I’ll be considered a non-responder, and I’ll just wait until something better comes along…or, nothing at all.

I took a Tylenol PM and slept through the night. No aches, or sweats..awesome! I just hope that the lack of side-effects doesn’t mean that the meds aren’t working. I’m just taking it one day at a time..trying not to have any expectations one way, or the other.

The wife and I are off to buy a grill We received a Target gift card for X-mas, and the grill we’ve been wanting is finally on sale. God, we’re so easily amused.

I weighed myself in at 196.4 pounds this morning. I’ve been a steady 205 for years…good stuff.

Took shot #2 last night and feel OK. I should have taken a Tylenol PM before bed because I developed a bad ache starting from my hips, and down both legs, making it impossible to sleep. So I took one at 3AM and finally got to sleep.

I just took my Ribavirin. I’m going to try to stay in bed for awhile today. I have a student later today.

Tomorrow I will have my 2nd shot. I’m just feeling a little run down..I’m not used to taking naps during the day, however if that’s what it takes then so be it.

I appreciate the kind words of support from everyone!  I just try to keep myself busy with teaching, and the band will be out playing soon.

Except for the night sweats, and restlessness I feel pretty good. I’m going to venture out this morning after my RIBA for a bit of exercise..I think I’ll go for a hoof down the beach.

Man, I hope this is as bad as it gets for me, and I’m able to clear this crap…

I actually feel better today than yesterday. I do notice a slight pain in the area of my Liver. The Liver doesn’t have any nerve endings, however the sheathing around the Liver does, and you will feel it if it enlarges,or shrinks. I hope this means that it’s shrinking..lol

It’s probably all in my head. Anyway..I’m not dead on my ass sick like I planned to be..at least not yet. If this is the worst of it, I may actually get a break for once in my life.

Well, day one is done…now I guess we’ll see how bad my ass is going to get kicked. I’m planning for the worst, but hoping for the best.

I  started my 1st dose of Ribavirin today at 9:00AM. I thought that I had shaken any nervousness, however when the hour rolled around, I found myself fairly apprehensive. I guess this is pretty normal given the change to my life that has just been initiated. It’s now 9:44AM, and if I’m not mistaken, I’m starting to feel a bit light-headed.

I jumped on the scale, and have a starting weight of 198.6 pounds. It will be interesting to see how the drugs will effect my weight..(I could stand to lose a few..lol)

Hopefully, I can coerce MYNURSE into joining this blog, so I can stop harassing her at work..she, and all of the staff at my Doctors office are awesome
I will take my 1st injection of the inteferon this evening around 6:00PM, as well as my 2nd dose of the Ribavirin. I have an early rehearsal with the band tonight, and 1 student this afternoon. I have a new student tomorrow at 4:00PM, so hopefully I’ll feel up to teaching for an hour. Other than that, my schedule is clear for the weekend.

Until tomorrow–

I will start my journey on Friday. I will also start adding to this blog in earnest..hopefully, on a daily basis depending on how I feel.

Wish me luck

When things in your life seem almost to much to handle, when 24 hours in a day are not enough, remember the mayonnaise jar……and the beer. (I’ll settle for a nice Green tea..lol)

 

A Professor stood before his philosophy class and had some items in front
of him.  When the class began, wordlessly, he picked up a very large and
empty mayonnaise jar and proceeded to fill it with golf balls.  He then
asked the students if the jar was full.  They agreed that it was.

So the Professor then picked up a box of pebbles and poured them into the
jar.  He shook the jar lightly.  The pebbles rolled into the open areas
between the golf balls.  He then asked the students again if the jar was
full.  They agreed it was.

The Professor next picked up a box of sand and poured it into the jar.  Of
course, the sand filled up everything else.  He asked once more if the jar
was full.  The students responded with an unanimous “Yes.”

The Professor then produced two cans of beer from under the table and
poured the entire contents into the jar, effectively filling the empty
space between the sand.  The students laughed.

“Now,” said the Professor, as the laughter subsided, “I want you to
recognize that this jar represents your life.

The golf balls are the important things - your family, your children, your
health, your friends, your favorite passions - things that if everything
else was lost and only they remained, your life would still be full.

The pebbles are the other things that matter like your job, your house,
your car.  The sand is everything else - the small stuff.”

“If you put the sand into the jar first”, he continued, “there is no room
for the pebbles or the golf balls.  The same goes for life. If you spend all
your time and energy on the small stuff, you will never have room for the
things that are important to you.  Pay attention to the things that are
critical to your happiness.  Play with your children.  Take time to get
medical checkups.  Take your partner out to dinner.  Play another 18.  There
will always be time to clean the house, and fix the disposal.  Take care of
the golf balls first, the things that really matter.  Set your priorities.
The rest is just sand.”

When he had finished, there was a profound silence.  Then one of the
students raised her hand and with a puzzled expression, inquired what the
beer represented.

The Professor smiled. “I’m glad you asked.  It just goes to show you that no
matter how full your life may seem, there’s always room for a couple of
beers.”

ROLLING STONE KEITH RICHARDS has been inundated with requests to donate his body to medical science when he dies, because doctors want to examine his immune system.

The Brown Sugar rocker, who spent much of the ’70s addicted to heroin and continues to live a rock ‘n’ roll lifestyle, credits his survival to a high tolerance of toxic pollutants.

And the 64-year-old even claims to have conquered blood disease Hepatitis C by simply letting his body deal with it.

Richards says, “Doctors all over the world want my body when it finally goes.

“Apparently, I do have an incredible immune system. I had Hepatitis C and cured it myself. Just by being me…

“They (doctors) want it so they can study it and figure out how to make other people much better.
“I mean, I eat everything wrong. I shove terrible things inside me.”

Of special interest for those who have relapsed after Hepatitis C pegylated interferon therapy: Medical experts are gaining insight into why some courses of treatment are unsuccessful. By aiming to eliminate the likely causes for previous failures, more non-responders may be good candidates for re-treatment.

by Nicole Cutler, L.Ac.

In the United States, the Hepatitis C virus (HCV) is one of the leading causes of chronic liver disease. Accounting for about 15 percent of acute viral hepatitis, 60 to 70 percent of chronic hepatitis and up to 50 percent of cirrhosis, end-stage liver disease and liver cancer, HCV is a major threat to the health of our population. While it has undergone many improvements over the past decade, the current standard of therapy for HCV has a far way to go before this virus can be considered curable. Understanding why those with chronic HCV may not respond to treatment outlines the potential for successful re-treatment.

Sustained Virologic Response
The most common way to measure HCV treatment success is via the virologic response. To measure virologic response, doctors use a blood test to measure how much virus is in the blood. While Hepatitis C RNA may be undetectable immediately following treatment, this test must be repeated six months later to see if any of the virus remained and reproduced. Also referred to as viral load, the best outcome is a sustained virologic response (SVR). When the virus remains undetectable in the blood six months (or more) following HCV therapy, SVR is considered attained. So far, studies following those with HCV for two to three years after SVR have demonstrated a low relapse rate.

While the virologic response is primarily dependent on the action of the pegylated interferon, the prevention of relapse is mostly reflective of the action of ribavirin and the maintenance of its dosing. However, relapse prevention is also affected by the following variables:

· How quickly undetectable HCV RNA is attained after the start of treatment.

· How long the patient remains on treatment after achieving undetectable HCV RNA.

Broken down by the most common HCV genotypes, the following are estimates of how frequently SVR is attained with pegylated interferon and ribavirin therapy:

· Approximately 40 to 45 percent of those with chronic HCV genotype 1, the most common strain in the United States, achieve SVR.

· Approximately 75 to 80 percent of those with chronic HCV genotypes 2 and 3 achieve SVR.

Non-Responders
While those attaining SVR may be permanently free of HCV, the remaining people on pegylated interferon and ribavirin are non-responders. However, there is plenty of evidence that previous non-responders can be re-treated successfully, eventually achieving SVR. Identifying which HCV non-responders are appropriate candidates for re-treatment requires a complete understanding of the various virologic response patterns and the pitfalls associated with achieving and maintaining virologic response.

There are many reasons that a person may not achieve SVR. The individuals without any response to interferon-based therapies are poor candidates for re-treatment. These people have no significant decline in HCV RNA during treatment and are essentially immune to the effects of interferon. Aside from those without any virological response, the four most common reasons assumed responsible for continued HCV infection after treatment are missing doses, premature discontinuation of ribavirin, insufficient ribavirin dosage and infrequent viral load testing.

1. Missing a Dose – Recent studies highlight missing a dose of peg-interferon alfa and/or ribavirin as a leading contender for not achieving SVR. Missed doses can be a result of physicians instructing their patients to temporarily stop treatment because of significant treatment-related side events, patients missing a dose by accident or intentional skipped doses in an attempt to self-treat side effects.

2. Premature Discontinuation of Ribavirin – Stopping ribavirin too soon increases the person’s chance of viral load rebound. In those who demonstrate a slow virologic response, several studies have demonstrated that relapse can be significantly reduced in those with HCV genotype 1 patients by prolonging the duration of treatment from 48 to 72 weeks.

3. Insufficient Ribavirin Dosing – Another frequently encountered reason for HCV relapse is initiating ribavirin treatment with an insufficient dosage. Three randomized trials have demonstrated that patients who initiate treatment with a higher dose of ribavirin have a lower relapse rate.

4. Infrequent Viral Load Testing – In addition, experts believe that SVR is attained by those who quickly recognize when viral load is undetectable and their current treatment regimen is adjusted swiftly. For this reason, viral load must be assessed periodically during treatment to identify this point as soon as possible.

By recognizing the patterns associated with a poor response to interferon-based therapy, physicians can better approximate why therapy failed and who might be a good candidate for re-treatment. If a non-responder attempts pegylated interferon and ribavirin treatment again, all efforts must be made to maintain adequate, sufficient dosing for the required time interval and frequently evaluate viral load. As long as there was some type of viral response to initial treatment, virologists estimate that a sizable percentage of previous non-responders are good candidates for HCV re-treatment.
References:

http://clinicaloptions.com, Understanding HCV Nonresponse and Identifying Candidates for Retreatment, Mitchell L. Shiffman, MD, Clinical Care Options LLC, 2008.

http://digestive.niddk.nih.gov, Chronic Hepatitis C: Current Disease Management, National Institute of Diabetes and Digestive and Kidney Diseases, 2008.

I went to my TX “Training” class yesterday. It was very informative, and the Nurse/Pegintron rep was very helpful. She didn’t really provide any information that was new to me, however, she was very warm, and caring. Her own husband found out he had the virus 2 years ago, was stage 1 even after 30+ years, and was unable to reach SVR.

She explained in detail how the liver,virus works, what we may expect from treatment, new drugs that are being developed (Protease inhibitor)and lastly, how to use the redipen. We all got to practice on some fake skin. We each received a bag lunch of snack food that we are encouraged to keep on hand..and of course, a bottle of water!

I was encouraged to find out that Pegintron would continue my drugs free of charge if my insurance were to lapse, or run out, etc..

As soon as we set a date, and time to start my 48 week journey, the drugs will be shipped to my door. I have to say that everyone involved has been most helpful..the rest will be up to me, and the dragon.
The Book: According to the Hitchhiker’s Guide to the Galaxy, the best drink in the known universe is the Pan-Galactic Gargle Blaster. It has the effect of having your brains smashed out with a slice of lemon… wrapped around a large gold brick.

Depression Due to Treatment with Pegylated Interferon plus Ribavirin May Be Under-diagnosed by Clinicians The occurrence of depression has been reported in 20%-30% of cases that evaluated psychiatric side effects in chronic hepatitis C patients using pegylated interferon alfa plus ribavirin. However, the diagnosis of depression in these studies was determined solely based on the impression of the study investigators.
In the current French study, supported by Roche Laboratories, manufacturer of pegylated interferon alfa-2a (Pegasys), investigators assessed the incidence of depression during treatment with Pegasys plus ribavirin under “real life” circumstances using the Mini-International Neuropsychiatric Interview (MINI).

MINI is a short, structured diagnostic interview to assess psychiatric disorders that makes a correlation between the MINI results and the diagnosis made by a clinician and with the Beck Depression Inventory score (BDI).

The multicenter study is expected to enroll 150 HCV monoinfected patients treated with Pegasys plus ribavirin. The incidence of depression will be assessed at baseline, at weeks 4, 12, and 24, at the end of the treatment, and at the end of follow up using MINI, clinician observations, and BDI scores.

Interim study results from baseline through week 12 for the 123 first patients enrolled were presented at the 58th Annual Meeting of the American Association for the Study of Liver Diseases in Boston (November 2-6, 2007).

Results

Baseline patient characteristics were as follows:

Mean age: 48 years

Sex: 73 (59%) male;

HCV genotype 1: 67 (54%);

Advanced (stage F3-F4) fibrosis: 45 (37%);

Previously treatment-naive patients: 73 (59%).

History of injection drug use: 53 (43%);

History of alcohol abuse: 29 (24%);

At baseline, MINI revealed current major depression in 9 patients (7%).

7 received anti-depressant therapy before (n=5) or after (n=2) the beginning of Pegasys plus ribavirin treatment.

Between baseline and week 12, 21 (18%) cases of major depression were diagnosed by MINI.

In 16 of these cases (76%), clinicians assessed was no depression.

Conversely, in 7 cases (6%) the diagnosis of major depression was made by the clinician but not confirmed by the MINI.

Anti-depressant therapy was started in 17 cases (81%).

The correlation between MINI and BDI score was poor.

Conclusion

Based of these results, the investigators concluded, “The incidence of depression between baseline and week 12 was 18%.”

Furthermore, they stated, “Major depression [in patients using Pegasys plus ribavirin] seems to be under-diagnosed by clinicians.”

Finally, they concluded, “The systematic use of the Mini-International Neuropsychiatric Interview (MINI)…may be useful during peginterferon therapy.”

Hepato-gastroenterology, CHU de Nancy, Vandoeuvre les Nancy, France; CHG Saint Dizier, Saint Dizier, France; CHG Tourcoing, France; CHU Amiens, France; CHR Metz, France; CHU Besancon, France; CHU Lille, France; CHR Colmar, France; CH Saint Philibert, Lille, France. CH Belfort, France.

J Bronowicki, P Melin, N Talbodec, and others. The depression induced by peginterferon alfa-2a and ribavirin in the treatment of chronic hepatitis C is under-diagnosed by the clinician. 58th Annual Meeting of the American Association for the Study of Liver Diseases. Boston, MA, November 2-6, 2007. Abstract 337.