Home Alone

We spent the holidays, as we do most days, home alone with our 2 dogs.  I was quite content until Steve started reflecting on holidays past that were shared with family and friends.  It saddened me that his focus was on what was...rather than what is.

Sure I would love to have a close family and lots of friends, but I accept the way things are.  Over the years, since Steve became ill, it has been hard to maintain our friendships.  It makes it difficult when friends invite you to do things and you are constantly turning them down.  Although they understand Steve is sick, after a while, they stop asking.

So I can see why Steve took comfort in his memories.  But I chose to focus on what we have now...each other.

Disability Hearing and Week 5 Update

On Wednesday, Steve gave himself shot #5.  The weeks seem to be flying by since he is back on the triple therapy.  He has been doing really well this time.  Recently he has experienced some dizziness and started itching but nothing like before.  So hopefully, the addition of the Procrit will keep him from developing anemia again (and the breathlessness that went along with it).

He went to his disability hearing on the 4th.  I went with him, but I wasn't allowed in the room when he was testifying.  The lawyer wanted me to be a witness.  He informed me when we got there, so I was totally unprepared.  When I went into the room, the judge swore me in.  And quite honestly, I was so nervous that it took me a minute to distinguish my right hand from my left.  Then the lawyer asked me a bunch of questions, and I just answered to the best of my recollection.  It was hard to remember the exact timeline of everything- especially since the questions were referring to 2002.  Had I known I was going to be a witness...I would have gone through Steve's medical records again and committed the dates to memory.

One thing I can say is that I believe the judge and the vocational expert knew we weren't BSing.  At one point, while I was talking, I looked over and saw that Steve was crying.  I felt so bad.  He tried to hide it but the tears just came pouring out.  And I know the judge and vocational expert saw it as well.  After the hearing, Steve and I sat around talking about all the things we forgot to mention. But I guess the most important thing is that we were honest, so whatever happens is what is meant to be.

Safe, Healthy, & Happy Holidays to Everyone!!!

In Memory of MaryEllen

She Was Diagnosed With Hep C In The 90's. Her Doctor Convinced Her That The Side Effects Of The Treatment Were Worse Than Effects Of The Virus. She Died Of Liver Failure. Today Would Have Been Her Birthday.

RX Drugs are Expensive Even with Insurance!

We filled his prescriptions with the new insurance (Humana Select HMO) for the first time.  The Pegasys alone was $504, and the RibaPak cost $345.  That's for a one month supply.  As for the Alinia, that was only $50, but Humana only approved a 20 day supply.  So Steve is going to have to call the doctor, and the doctor's assistant will have to straighten that out (hopefully).

I have to say that the doctor and his assistant have both been great.  Anytime Steve needs anything they take care of it without any problem.  Thank goodness for them!

Tomorrow I am going to call Roche Patient Assistance Foundation to see if we qualify for help with the cost of the drugs.  In case anyone else needs help, the number is 1-877-757-6243.  In addition, there are other pharmaceutical industry-sponsored patient assistance programs.  For more information on those, the website is called Partnership for Prescription Assistance.

To those of you who celebrate it, we wish you a Happy Thanksgiving!

All the best to you and yours,

Lisa

Steve's Back on the Treatment!

Steve went to the cardiologist on Tuesday.  All the tests came back normal, and he was given the go ahead to go back on treatment. 

The gastroenterologist says that he wants Steve to start from square one- which means he'll be on Triple Therapy for another 48 weeks.  He'll have his first blood test in two weeks and every two weeks thereafter:  just a standard CBC.  At the 6 week point, he will have his viral load checked (which will be the first time since he's been off treatment.)

Steve's taking 1200mg of Ribavirin daily, 0.5ml of Pegasys once a week, and 1000mg of Alinia daily.  On Saturday, he is going to start taking the Procrit again (40,000 units weekly), and he will remain on the Procrit throughout the Triple Therapy.

He's already feeling the effects of the meds.  Couldn't sleep last night.  Had several charlie horses in his legs.  Today he has had a bad headache all day, and he is freezing again.  

But as I've said before, if it works, it's all worth it.  I am speaking for both my husband and myself when I say that!

Almost a Month Since He's Been Off Triple Therapy

My husband went to the cardiologist last week.  He had an echocardiogram and a stress test.  For the stress test, Steve was injected with a dye that enables the technician to see the heart in 3-D.  After the injection, his blood pressure shot up, so the tech had to give him a blood pressure pill before performing the stress test.

The results won't be in until next week.  Why it takes so long...I don't know.  But the nurse insists that because the test is 3-D, it takes about 2 weeks to get the results.  So based on that, Steve scheduled an appointment to see the cardiologist Wednesday the 18th. 

If all goes well, the gastroenterologist said he can resume treatment immediately.  So we are excited about that.  We would like to get another viral load taken to see if there is a significant change since he has been off treatment (it will be a month on the 14th), but the doctor doesn't think it is necessary.

Right now, Steve is trying to psych himself back up to get ready for the treatment.  He has the disability hearing on the fourth of December, and that is stressing him out.  Because he waited too long to file a claim, we severely doubt he is going to get approved.  Although we could really use the money, my main concern was the medical benefits, and I found out that he wouldn't be eligible for Medicare until 24 months after being approved for disability anyway.  So at least, we have health coverage from my new job.

Once again, I can't stress enough what a great source of information http://www.socialsecurity.gov/ is.  I wish we would have known about the site and all the information that is on it when Steve was first diagnosed.  We wouldn't have waited and things would probably be very different right now.  So as I said before, I hope that someone else can benefit from the lesson we have learned.

A Guide for Caring for Your Loved One with Hepatitis C

I found a guide for loved ones caring for someone with Hep C.  Thought you might find it interesting and helpful.  I did. 

The guide is on HCVAdvocate.org:  For Family and Friends Caring for Someone With Hepatitis C

The subject matter is as follows:

• Common Reactions of Caregivers 
• How to Cope
• Caregiver Stress Danger Signs
• Protect Yourself from HCV Infection
• Sexual Transmission 
• The HCV Patient During Treatment 
• Depression, Anxiety, Irritability and Mania
• Resources 

Blood Test Results Are In - The Procrit is Working!!

Steve has been feeling a lot better  The Procrit is working his RBC count (3.52), WBC count (3.8) and Hemoglobin (12) have all increased. And we've been getting along just like we did before the treatment.  No more fighting over nothing.  I am so happy.  I feel like I have my husband back.

He feels bad about how irritable he was, but we both realize that is quite common and a side effect of the treatment.  He was reading some blogs on Janis and Friends that he could really relate to.  He told me that a lot of bloggers on treatment were talking about how they were fighting with their spouses over nothing but couldn't stop themselves.

Steve is going for his stress test (and echocardiagram) on Wednesday.  If all goes well, he will be resuming the Triple Therapy with the addition of Procrit. 

It has been a long hard road for him, but he definitely wants to continue the treatment (which makes me very happy)!

Finally Stopped the Itching!!

Steve was going out of his mind from the itching.  He said he felt like something was crawling all over him.  It got so bad that he wasn't sleeping at all. He just wanted to jump out of his skin.  The medication that our primary care physician prescribed ( Hydroxyzine HCL 25mg and Triamcinolone 0.1% Cream FOU) wasn't working at all. 

So Monday I called a dermatologist, and they were nice enough to get Steve in the same day.  The dermatologist prescribed Clobetasol Propionate Foam, 0.05%.  The first night he used it my husband was able to sleep, and it has been working ever since.  He itched a little here and there the first few days but nothing like before.  He isn't itching at all anymore.  He uses the foam twice a day (in the morning and before he goes to sleep).

11 Days Off the Triple Therapy for Hepatitis C

He's been off the Hepatitis C Triple Therapy since October 14th.  I realize that it is not enough time for him to feel completely himself again, but I would think that each day he should be feeling better and better.  He's not.  He is still very itchy.  He tried Allegra, Benadryl, Claritin and Zyrtec.  They didn't work.  So our primary care physician prescribed Hydroxyzine HCL 25mg every 8 hours as needed and Triamcinolone 0.1% Cream FOU.  First couple of days it worked but it's not working any longer.  I don't think it is strong enough, and he has more rashes on him now than he did before.

In addition, he is still getting very cold.  You would think after 2 Procrit shots that would be dwindling away as well.  He is still getting very nauseous and has severe acid reflux as well.

I just hope that nothing is wrong.  When Steve saw the gastroenterologist on the 13th, his blood test results showed that he had a low RBC count, low platelet count, and a low white blood cell count.  The doctor said that Steve was anemic and he prescribed Procrit to increase Steve's RBC count.  So I asked the doctor if he was going to order Neupogen for the low white blood cell count.  His answer was that he wasn't concerned about Steve's white blood cell count.  But now I am thinking maybe he should have been. 

I believe that, when the doctor said my husband was anemic, he was referring to Aplastic Anemia.  This type of anemia has the potential to be fatal if not treated properly, so I just hope the doctor prescribed the best possible treatment. 

Steve is going for his first blood test since being off treatment tomorrow.  Once we get the results, we'll both feel better.  At the very least, we'll have a better idea of where he stands.

A Week and A Day Off Treatment

Steve's been off treatment for about a week now.  Since the treatment gave him anemia, the gastroenterologist prescribed Procrit.  After his first shot, he stopped experiencing short of breath.  He still becomes unbearably cold sometimes (even with the thermostat on 77), but he took his second shot today, so hopefully that will stop as well.  Still can't do much.  Just walked the dogs with me and got dizzy, but that's not happening as often either.

Good news!  Steve has been talking about going back on the treatment.  He spoke to our family doctor yesterday.  The doctor told him to make sure he waits until his red blood cell count has been back to normal for a few weeks.  The doctor doesn't want him to resume the treatment until he feels that his RBC will remain stable.  (If he goes back on treatment, he will remain on the Procrit for the duration of the tx.)

His mood is still not back to normal.  But I guess mine isn't either.  We are working on that too. 

May all be well with you and yours,

Lisa

Day 2 - Off Treatment (Temporarily?)

I can't even begin to tell you how I feel right now.  The whole idea of my husband not being on treatment is surreal.  I feel like I dreamt that we went to the doctor, and I'm waiting to wake up. 

Quite honestly, I know that right now my husband dreads the mere thought of going back on the treatment.  It took everything out of him.  I only hope that these feelings will pass.  I know he had a really hard time.  Words can't even describe how he felt.  At times, he literally thought he might be dying.  And still I can't help but feel it might be the only hope for us to have a future together.

Which is why I cried today when I saw the comment that Sheba left for me.  She understands my hope and my fear.  I read it to my husband.  I just hope her words run through his mind if he gets the option to go back on treatment.

Thank you Sheba.

Wk 12 Results Are In ... The Virus is Undetectable!

Good news.  For the first time, the virus is totally undetectable!!

Although, we have hit a small bump in the road.  The doctor is very concerned that my husband is experiencing such severe shortness of breath.  The blood test did reveal that Steve is anemic (RBC 9.4), and the anemia could be the cause. However, since Steve's father had a history of heart disease, the doctor doesn't want to take any chances.  He is ordering Procrit to increase his red blood cell count and temporarily taking Steve off the treatment.

The doctor wants Steve to see a cardiologist and have a stress test before he continues any further.  If everything goes well with the stress test, he is going to go back on the treatment but this time with the addition of the Procrit.

I didn't know how Steve was going to react, but he was actuallly relieved.  I think the doctor gave him the ok to do what he knew needed to be done.  When we were leaving the building, he sat down on a bench in the doorway and started crying (sobbing).  He then said, "At least we know it works, but I just couldn't take it anymore."

Right now he is looking forward to getting his strength back.  A few minutes ago, he was talking about how he is going to prepare himself both mentally and physically to restart the treatment.  At least now, he knows what to expect and hopefully with the addition of the procrit he'll have a better experience.

Most important is the fact that the triple therapy worked...at least up to this point.  So there is hope, not only for my husband, but for others with genotype 4 (and studies are currently being conducted on genotype 1 as well). 

The Transmission of Hepatitis C

Many people are ill-informed when it comes to the transmission of Hepatitis C. You will not get it from mere exposure to a person who has the Hep C Virus (even if the person sneezes or coughs on you). It is typically transmitted through contact with blood.

My husband contracted the disease several years before I met him. We were together 8 years before he was diagnosed, and I don’t have Hep (neither does his ex-wife).

However, that doesn’t mean that we don’t take precautions. My doctor has advised us:

• NEVER use each other’s razor, toothbrush or nail clipper
• Don’t do anything sexually that is likely to result in bleeding (For lack of a better metaphor, using the back door instead of the front).
• Don’t use each other’s comb or hair brush

 In addition, I get tested on an annual basis.

Since my husband’s blood test showed that he could be a carrier for Hep B, I received a series of shots to inoculate me against Hep B as well.

If you’d like more info on the transmission of Hep C, here are some helpful links.

Hepatitis C from a Kiss?

How common is sexual transmission of hepatitis C?

Sexual Transmission of Hep C

HCV and Sex

Modes of Transmission

Week 12, and I'm An Emotional Wreck

At the end of the week, my husband goes for the blood test that will determine if he continues treatment.  He really needs the treatment, because his last liver biopsy revealed that the liver disease has progressed to stage 3/grade 3 (the next stage is cirrhosis).

So this week I am the emotional wreck.  I've been feeling like I could cry at the drop of a hat and I have.  Watching him go through this and wondering if he is going to be able to tolerate another 36 weeks is really getting to me.  (That is if this blood test shows that the Hepatitis C viral load is undetectable.  Otherwise, it's a mute point.  The treatment will be discontinued.)

He has been pretty miserable.  Constantly freezing, to the point that his nose starts to run, even though it's 78 degrees in the house.  He's developed Pruritus, aka the Ribavirin Rash, on his legs and his entire body itches~ especially at night.  So he is having a hard time sleeping.  On top of that, everything he eats is making him sick.  (Oddly enough, the only protein he seems to be able to tolerate is ground beef.  But he can't eat that everyday!)  And he is still getting very short of breath and dizzy.  Yesterday he walked the dogs in the morning (I was at work), and on the way back it hit him.  Luckily, he didn't try to make it the rest of the way.  He went to a staircase in front of a buiding and sat there until it passed.  When I got home last night, he told me that he feels like the treatment is sucking the life out of him.

I can't help but wonder if he is right.  I feel like he could really be endangering himself, but he doesn't want me to call the doctor.  He wants to wait until his appointment, October 13th, so he can get the results of this blood test.  I'm so afraid that something is going to happen to him, but I have to respect his wishes.  If I call the doctor, and he is taken off the treatment, he will always wonder if he would have been cured.  And more importantly, this is literally a decision that will affect the rest of his life, and that is not my decision to make.

Thank You for Your Comments & Support

Sometimes I feel so isolated.  It's really hard watching someone you love deteriorating right before your eyes; and there is nothing that you can do, because the very thing that is eating them up inside is the only hope of a cure.  But when I get your comments, I know that I am not alone.  We are not alone.  And I thank you so much for being there!!  You are the best medicine ~  for my husband and for me.  So I just want to say thank you.

Disability Hearing Scheduled

We heard from Social Security. My husband’s hearing is set for December 4th. I am not hopeful. As I said before, it is my understanding that in order to qualify for disability under Hepatitis C, your symptoms have to be extreme, i.e. internal bleeding, severe encephalopathy or on the transplant list. They don’t take into account the extreme fatigue, lack of stamina, and depression resulting from hep c.

I hope I’m wrong. I’ll let you. But if you’d like to get some info for yourself, the address is: http://www.ssa.gov/disability/professionals/bluebook/5.00-Digestive-Adult.htm#5_05.

Keep in mind that you may qualify under another category, such as mental disorder for depression. There’s a lot of important information on Social Security’s website. If we knew then, what we know now, we would have gone about the entire process very differently. So I hope someone out there can benefit from the lessons we have learned.

The Emotional Roller Coaster that is Hep C

Tonight was shot night- week 10.  I hope this week is better than last week.  Last week was truly rough.   Steve was feeling really awful.  Constantly dizzy and nauseous.

Early in the week he became very emotional.  He started recounting his life, thinking about all the things he would have done differently, and all the words he'll never have the opportunity to say.  He even cried uncontrollably for hours.

By the end of the week, he was miserable and frustrated,  Everything was irritating him.  And I have to admit, it got to me.  I couldn't take it anymore, and we started arguing over the smallest things.  It was rediculous.  Luckily, we realized that the stress had gotten the best of us.  We talked it out, and this week is off to a much better start.

Study Shows Nitazoxanide Could Have the Potential to Eliminate the Need for Ribavirin in the Treatment of Hepatitis C

Found an article on Medical News Today's website that suggests that treatment with Nitazoxanide (Alinia) and peginterferon alpha-2a could have the potential to eliminate the need for ribavirin in the future. Thought it was interesting. Hope you do as well.

Romark Announces Presentation Of New Data For Nitazoxanide In Chronic Hepatitis C At AASLD 2008

Article Date: 04 Nov 2008 - 0:00 PDT

"Romark Laboratories, a privately held biopharmaceutical company, announced that data from studies of nitazoxanide in chronic hepatitis C virus (HCV) infection are being communicated in three presentations made at the 59th Annual Meeting of the American Association for the Study of Liver Diseases (AASLD), also known as The Liver Meeting(R), and the 50th Anniversary Meeting of the International Association for the Study of the Liver (IASL) in San Francisco, October 31 - November 4, 2008."These new studies confirm earlier data suggesting synergistic activity between nitazoxanide and peginterferon in genotype 4 patients and provide a first look at sustained virologic response in a limited number of genotype 1 patients," said Jean-Francois Rossignol, M.D., Chief Science Officer of Romark Laboratories and discoverer of nitazoxanide. "These data also provide interesting insights into the mechanism of action of nitazoxanide, including a potential role for its combination with STAT-C drugs, and confirm previous findings related to its safety."The three presentations include:-- "Evaluation of a 4 Week Lead-In Phase with Nitazoxanide (NTZ) Prior to Peginterferon (PEGIFN) Plus NTZ for Treatment of Chronic Hepatitis C: Final Report," J.F. Rossignol et al., Sunday, November 2, 4:15 PM PST (Oral Session IASL #87), and Tuesday, November 4, 8:00 AM - 12:30 PM PST (AASLD Presidential Poster #1848)In this Phase II study, 44 patients (40 with HCV genotype 4; 3 with HCV genotype 1; and 1 with HCV genotype 2) received 4 weeks of nitazoxanide 500 mg twice daily followed by Pegasys(R) (peginterferon alfa-2a) and nitazoxanide for 36 weeks. Data from Romark's STEALTH C-1 trial was used as an historical control. Analysis of data was by intention-to-treat.Thirty-five of 44 patients (80%) treated with a 4-week lead-in phase of nitazoxanide followed by the addition of peginterferon for 36 weeks experienced a SVR 24 weeks after the end of treatment compared to 50% in the standard of care (SOC, peginterferon alfa-2a plus ribavirin for 48 weeks) historical control group (P = 0.006), 61% in patients receiving a 12-week lead-in with nitazoxanide followed by 36 weeks of nitazoxanide plus peginterferon alfa-2a, and 79% in patients receiving a 12-week lead-in with nitazoxanide followed by 36 weeks of nitazoxanide plus SOC.Of the 44 patients in the study, 78% (n=40) of patients with HCV genotype 4, 100% (n=3) of patients with HCV genotype 1, and 100% (n=1) of HCV genotype 2, had an SVR with undetectable virus at 24 weeks following end of treatment.Adverse events reported for these 44 patients were similar to those reported in the STEALTH C-1 trial. Patients treated with nitazoxanide experienced no more side effects than patients who received the SOC therapy. Only one of the 44 patients discontinued therapy due to noncompliance. There were no serious adverse events or discontinuations due to adverse events."These data confirm findings of our STEALTH C-1 trial related to safety and efficacy of nitazoxanide in patients infected with HCV genotype 4, show that the nitazoxanide lead-in phase prior to standard of care treatment can be reduced from 12 to 4 weeks, and indicate that ribavirin may not be needed to maintain SVR," said Emmet B. Keeffe, M.D., Chief Medical Officer of Romark Laboratories.-- "Potential Role for Nitazoxanide in Combination with STAT-C Agents for the Inhibition of HCV Replication Without the Development of Resistance," Korba, et al. Sunday Nov. 2, 5:30 PM PST (Oral Session #115)This oral presentation by Brent Korba, Ph.D. of Georgetown University Medical Center, described preclinical studies demonstrating synergistic interactions between nitazoxanide and direct-acting antiviral drugs targeting NS5B (2'C methylcytidine and HCV-796) and NS3 (telaprevir and BILN-2061) in HCV replicons. Nitazoxanide was also active against telaprevir- and 2'C methylcytidine-resistant mutant replicons. The authors concluded that nitazoxanide is a good candidate for combination therapies with STAT-C agents in the absence of interferon or ribavirin.-- "Nitazoxanide (NTZ) is an Inducer of eIF2a and PKR phosphorylation," Elazar et al., Tuesday, November 4, 8:00 AM - 12:30 PM PST (Poster #1881)This poster presentation by Menashe Elazar, Ph.D. of the Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, showed that nitazoxanide increases the intracellular levels of phosphorylated eukaryotic translation initiation factor 2alpha (eIF2alpha), a key mediator of host cell antiviral defenses. Co-treatment with interferon increased nitazoxanide-induced eIF2alpha phosphorylation. . Nitazoxanide was also shown to increase the phosphorylation of protein kinase R (PKR), a key step in the activation of PKR's kinase activity towards eIF2alpha."Data presented in each of these communications has provided important information in guiding the ongoing clinical development of nitazoxanide," said Dr. Rossignol.About Hepatitis CHepatitis C is a blood-borne infectious disease that is caused by the hepatitis C virus (HCV). It is the most common cause of chronic hepatitis in the U.S. and may eventually lead to cirrhosis, liver cancer and liver failure. The disease is transmitted by contact with HCV-infected blood. A large majority of those infected do not show symptoms, but fatigue, abdominal pain and nausea can be common. The current standard treatment of care, peginterferon and ribavirin, is effective in about half of all patients treated. According to the Centers for Disease Control, HCV affects an estimated 4.1 million Americans.About Romark LaboratoriesRomark Laboratories (http://www.romark.com/news/11032008.aspx), a privately held biopharmaceutical company, has discovered and developed a new class of small molecule antivirals known as thiazolides. The Company is developing nitazoxanide, the first of the thiazolide class, for the treatment of chronic hepatitis C, and is developing other new thiazolides for treating viral diseases including chronic hepatitis B. Alinia(R) (nitazoxanide) is approved by the U.S. Food and Drug Administration and marketed by Romark for the treatment of Cryptosporidium and Giardia infection.Romark Laboratories http://www.romark.com/news/11032008.aspx

I found the article in Medical News today. To access the article directly, the address is: http://www.medicalnewstoday.com/articles/127968.php.

Wk 8 of Triple Therapy: Experiencing Severe Shortness of Breath

I am really worried. Went out this evening, just to walk the dog, with my husband. (It was a short walk.)

My husband got so out of breath I thought he was going to collapse again. He said his chest felt really tight, and he could hardly breath. He also said it happens often, but he doesn't want to tell the doctor. He's afraid he'll stop the treatment. I'm afraid he is going to have a heart attack.

I don't know what to do...