Liver Log

2010-02-05T23:06:00.004-07:00

Check-in after a long absence

I loathe spam, spammers, and everything related to them. But "all things work together for good." A spam comment prompted me to open this blog for the first time in over a year. Since I'm here, I may as well check in.

I've been over to visit my friends the Nomads a few times. My recurring theme there is that the reason you see so many folks who relapsed in the forums and on the blogs is that they are still fighting the bug. We who are fortunate enough to have beat it are making up for lost time. It's a full time job.

The three years since I completed treatment have been busy. Elder Daughter is in her junior year at Northern Arizona University and got engaged on New Year's Eve. Wanna-Be-Son-In-Law had the talk with me at the shooting range. I had ready access to lots of weapons and we both survived, so I guess he'll do.

Son is in the Marine NROTC program at the University of Arizona. He has this notion that he wants to crawl through the mud with a knife in his teeth. So we go north to see one, south to see the other. It's a hassle.

Youngest is a sophomore an high school and gets lots of attention. She just finished her season as a cheerleader and wants to take a tumbling class. Cheerleaders get hurt. They throw them around over a wood floor or a track. Youngest weighs about 90 pounds, so she's the one they fling around. She also expects to start driving this year. I'd swear she was eight years old last time I checked. Henry David Thoreau: "A father's life is one of quiet dread."

The big event for me since completing treatment is gathering a collection of my dad's writing into a book. We lost him to colon cancer the year before I went on treatment. Two rough years, '05 and '06. He was a magazine editor who moved into political stuff. He was well-known in his field and what he wrote remains important today. The book was something he and I had talked about for years. I had been working on it off and on for a couple of years before he got sick. I didn't do much on it during the year he was sick because I was attending to other matters. I had just picked it back up when I found I needed to go on treatment. Frankly, I think it's a better product for the hiatus. Feedback has been good, although sales are slower than I'd like. It's getting some good reviews now and I think it will pick up.

If you've been touched by HCV, best of luck and blessings. You have my prayers. If you have questions for me, post a comment here or PM me (I'm cwk) in the Nomads forum.

Come to think of it, Doc wanted to see me this month. I think he's going to want another PCR. So, something else to talk about here.

All best,

Chris

2008-09-11T09:47:00.004-07:00

"Suburban Mom" says...

suburban mom said...

update:
I am genotype 3a and I saw the GI doctor yesterday. He was very encouraging. I will most likely start treatment after Christmas.

Your time frame is similar to mine. Yes, good idea to wait until after Christmas. A poster on one of the forums commented that treating Hep C is not an emergency. It's a slow bug. That's both a blessing and curse. It's slow and insidious. More like a leak in the basement than a fire in the attic. Frankly, it's much better suited to the state of our medical arts. You have time to put things in place. I'd suggest getting long term disability insurance lined up if that's an option. That, and getting regular blood tests were the only overt actions I took when I learned I had been exposed to the bug.

Note that I say I learned I was exposed to it -- I never had a viral load test or showed any symptoms until August of 2005. I had a life insurance questionnaire that asked whether I had ever been diagnosed with any liver disease. I accurately answered in the negative. I had never received a diagnosis. I knew I had been exposed, but at the time I filled out the form I had no symptoms and was, as far as I could tell, virus-free. Maybe I split hairs, but I think it was an accurate statement.

'Burb Mom, having genotype 3a, you're in a lucky group. It typically indicates a 24-week treatment, although that may change with your situation. Basically, your bug is easier to kill, so be thankful small favors. As we head into October, typically the time that Americans make their insurance arrangements, you might also consider putting some extra dollars in a health care reimbursement account. Better to pay for the likely extra medical expenses with untaxed dollars.

Good luck with treatment. I'll be following your blog, so keep it updated.

Chris

2008-09-05T10:27:00.007-07:00

Still in my undies...

Just posted the following to the Hep C Nomads Forum and to the UK Forum

Hi all --

Haven't been here in a while, partly because I had no new news, and partly because I've been crazy busy. But I wanted to share this. I dropped off the sample for my 18-month post tx bloods a couple of weeks ago and just got the call from Doc. UNDIE-tectable! Doc, being a conservative fellow, says I'm "still in remission." I look at it like this: It's gone. It's stayed gone. There's nothing to make me think it will be back ever! I'm done and I feel great. No significant souvenirs of treatment that aren't attributable to the calendar.

To those facing the start of treatment: You have to make your decision based on your situation, but I'm proof that there are good outcomes.

To those in the throes of treatment: Hang in there. There's a finish line and it's worth the work to get there. This bug is beatable, but you have to do your part. When you really start feeling sorry for yourself (you do, admit it!) consider the blessing of being reminded of your own mortality without having to actually face it.

To everyone dealing with this disease either directly or indirectly: There are good results. Keep in mind that this group's post-tx crowd is skewed toward those who didn't have a good outcome. They're still feeling lousy and still need and deserve support. Those of us who have been blessed with a successful outcome have the opportunity (not to mention the responsibility) to make up for six months, a year or more of being out of commission.

All best,

Chris

Not much else to say. The kids are great, Spouse is going crazy with her new job (office manager in junior high school). Eldest is away at school being a dormitory Resident Assistant (kind of a designated adult/babysitter) and Orientation Leader (sell the school to prospective students). It's paying for this semester. She has gotten very serious with a young man we've known for a while. And they're up there with no curfew! Difficult for a dad to get his head around.

Middle (aka Son) is a senior in high school. He is the student body president (as was Eldest) and is playing football. We're having the doors widened so he can get his head through them.

Youngest has also decided to follow the example of the older two and entered school politics as freshman class president. I showed her the "Destiny" clip from Young Frankenstein. Spouse and I wonder at the wisdom of her taking on student government. She's the smart one of the bunch and is in lots of advanced placement classes. "Stugo" takes a lot of time out. On the other hand it's fun and keeps her from burrowing too deeply into the books.

On the whole we've got things down to boring. I'll take boring. Guess that's the definition of middle-age: you learn to appreciate boring.

2008-07-15T15:52:00.003-07:00

Physical Time

Went in for my annual a couple of weeks ago. Blood pressure and such were all normal; cholesterol was a tad high, which is new to me. Going to work on that. I've been eating like my teenage son and have not been exercising as much as I should. The really good news is that the liver panel was normal. I have an appointment with the gastro doc this month and will be getting another PCR (virus count -- see previous post).

I spent last week in Colorado in business meetings and classes. I work for a big technology company you've definitely heard of. The team of guys who do what I do are scattered across the country and we all work on separate projects. We rarely get together, but had an opportunity to have an intact team class. I recounted the last time we got together in a previous post. That was a rough one. I had not seen most of these guys face-to-face, including my boss, in nearly two years. Several comments from the guys. They knew I was going through something and that I was pretty weak last time, but I didn't advertise what I was dealing with. They knew I was kind of a mess from the way I got lost, and from my appearance. What a difference this time. I ran 2+ miles on three of the five days I was there. Much better! I think the PCR test later this month will bear out how good I feel. Sure hope so, anyway.

2008-06-06T19:36:00.004-07:00

Long overdue check-in

I recently got a note from a member of one of the Hep C forums asking me to check in. As I had pointed out in the past, those of us fortunate enough to see SVR often disappear. Consequently, treatment veterans on the boards tend to be those who have relapsed. That skewing of the sample can be discouraging to those who are going through treatment. So, I paid a visit. I had nearly forgotten the vocabulary list below. I wrote it while on treatment and they posted it at the top of the board.

There's been some kind of rift within the two major UK-based Hep C boards. Not having a dog in that hunt, and having friends in both places, I herewith ignore it.

Anyway, here's the list:

Hep C Vocabulary

acetaminophen -- North American generic name for paracetamol. British and other European countries trade name Panadol.

AD -- Anti-depressants. Depression can be a significant side-effect of treatment. Hepatitis C patients often take anti-depressants to counteract the side effects.

ALT -- Alanine aminotransferase. One of the markers for liver inflammation. Typical (non-HEP C) values: Men--10 to 32 IU/L, Women--9 to 24 IU/L. The normal range is 5-40 IU/L, although the numbers can vary.

AST -- Aspartate aminotransferase. One of the markers for liver inflammation. Typical (non-HEP C) value 8 to 20 IU/L, although the numbers can vary.

bx -- Biopsy. Broadly, a diagnostic tissue sample. In this forum it almost alway means a needle biopsy of the liver. A thin needle is inserted into the liver and a small piece examined microscopically. From the biopsy a determination is made of the extent of liver damage. Results of the biopsy are expressed as the HAI score (see HAI score below.

dx -- Diagnosis. In the context of this forum, it specifically means the Hep C diagnosis. Diagnosis is not necessarily the same thing as being positive for antibodies. A certain percentage of people clear the virus and so their diagnosis is negative, even though they have and will continue to have the antibodies.

EVR -- Enhanced Viral Response. A treatment milestone, usually meaning that virus levels have dropped to a point where there is a good chance of a cure.

genotype or type -- Strain of the hepatitis C virus. Several strains or genotypes have been identified. The identification is a number, sometimes followed by a letter. The difference between the letter subtypes is generally academic. There is no difference to a patient whether he or she has type 1a or 1b, it's still a 48-week ride. Genotype 2 and 3 are usually treated for 24 weeks, although some doctors go longer given medical history. Genotype 4 is rare outside the Mideast, although it is widespread in Egypt. It is treated for 48 weeks like Type 1. There are rumblings of more Genotypes out there, but for the patient, the details of the differences are probably academic. It's the same program -- so far.

HAI Score -- Histology Activity Index. A standard system of grading the level of inflammation and scarring in the liver based on a biopsy sample. The HAI score is expressed as two numbers between zero and four. One is given for the level of inflammation, the other for the level of scarring.

HCV -- Hepatitis C Virus. A blood-borne viral pathogen that causes Hepatitis C. Probably the reason you're reading this.

HGB -- Haemoglobin/Hemoglobin. The red part of red blood cells. Part of the Complete Blood Count numbers. Ribavirin tends to depress hemoglobin counts which results in anaemia/anemia.

Howdjuhgiddit? -- "How did you get it?" A rude question. Sometimes asked innocently by well-meaning people, sometimes asked by the morbidly curious who want to know whether you're a closet junkie. How you answer can depend on your mood, your threshold of rudeness, and your willingness to share your medical history.

hx -- History. This is medical chart abbreviation that occasionally makes it into the forum. It is also what people are asking for when they ask Howdjuhgiddit?

ifx or ifn -- Interferon. There are two major brands. Pegasys, manufactured by Roche, and Peg-Intron, manufactured by Schering. Both products are about equally effective, although anecdotal evidence indicates that where one is not effective, the other might work better.

LFT -- Liver Function Test. A blood test that measures various liver-related enzymes in the blood. Also sometimes called a Liver Panel.

neutrophil or "neuts" -- A type of white blood cell. Neutrophils are critical for fighting bacterial infections such as staph or strep. Interferon tends to depress production of neutrophils.

paracetamol -- British generic name for acetaminophen, North American trade name Tylenol.

PCR -- Polymerase Chain Reaction. A test for presence of the hepatitis C virus. There are two types of tests. The "qualititatve" test is a yes/no determination of whether the virus is present or not. The "quantitative" test estimates virus particles per milliliter of blood.

RBC -- Red Blood Count. A measure of red blood cells or haemoglobin/hemoglobin. Normal values are Male: 13-17 (g/dl) Female: 12-16 (g/dl). Values below 10 are cause for concern.

riba -- Ribavirin. An anti-viral drug that has been found to enhance the effectiveness of interferon in fighting the hepatitis C virus.

RVR -- Rapid Viral Response. An inordinately early negative result to a four-week PCR. When the virus is undetectable at four weeks, some doctors call that patient a "super-responder." It might make the patient a candidate for shortened treatment, but RVR status is only one of many factors to be considered. At the very least, it's good news.

Rx -- (Chiefly American) Medical shorthand for Prescription

score-- See HAI Score

SVR -- Sustained Virological Response. The goal of treatment. A medical hedge word used when they don't want to say "cured." A negative PCR six months after treatment is considered an SVR in the UK and US.

sx or sides -- Side Effects. Side effects from treatment can range from none to mild to debilitating. Effects can be mental such as "brain fog," or difficulty concentrating, emotional, such as depression, irritability, physical such as fatigue, headache, "flu" symptoms, or clinically measured such as low white blood cell counts. No one can predict when, if, or how long side effects will appear.

sux -- What sides do.

type -- See genotype.

TV or telly-- Television. Something you will be watching a lot of while you are on tx. Other terms and acronyms you may become familiar with during this period are DVD, VHS, CBS, ABC, NBC, HBO, CBC, BBC, and Tivo.

TX -- Texas. Postal abbreviation for the State of Texas. Not to be confused with tx (lowercase) which see below.

tx -- Treatment. Specifically the 24 or 48-week combination therapy usually consisting of once-weekly subcutaneous interferon shots and twice-daily ribavirin tablets.

undetectable -- The positively great news that the PCR test is negative. The virus, if it is present at all, is in such low concentrations that the test can't find it.

VL -- Viral Load. The presence of the virus in the blood, usually expressed in number of particles per milliliter of blood. Determined via a quantitative PCR.

WBC -- White blood count. A measure of white blood cells in the bloodstream. Interferon can depress white blood cells. Normal range is usually expressed as a number between 4 - 11, but the decimal point can move with your location.

2007-11-20T12:41:00.000-07:00

Thanksgiving Week

Discovered I had left the previous update in a draft state when I posted it two weeks ago. Back from the business trips and the hunting trip. Son got his deer, I missed my shot (it's been replaying in my head for days). I now count the miss as an act of kind providence as we were more than a mile from camp and had pack out the quarters -- two rucksacks at I'm guessing 40 pounds each. Lot of work, not to mention a mess. I'll spare you the details.

Much to be thankful for this year. I have a new appreciation for feeling good. I know that not everyone gets this blessing, so I'm especially thankful that I'm able to undertake some pretty strenuous challenges. Thinking about a marathon next year. I've fallen off my running lately and need to get back to it.

Happy Thanksgiving,

Chris

2007-11-05T19:04:00.000-07:00

Checking In After Three Months

A comment to the previous post brought me back, so I may as well check in. Yes, I'm in a hotel again. A new project, a new nightmare. I'll say it's a mess and leave it that.

I'm due for another liver panel this month. I'm not worried about it.

I've spent the past six months making up for a year with my life on hold. I'm working to bring a book into print (unrelated to both work and Hep C) and trying to get home projects taken care of. That's difficult now, as I'm paying for the bye year from work. Lots of air miles these days. I was looking at my calendar for the rest of the year and I'm back to back. I've been in Tennessee for the past two weeks, going home for the weekend. I'm taking a couple of days to go deer hunting with Son and so won't travel next week (historically, Bambi is pretty safe). The following week is Thanksgiving, after which I have two classes for two consecutive weeks. After that, I'm back here to see what's happened on the project. Who knows what happens after that.

I have to get some work done for tomorrow. To those on treatment, blessings and best wishes. There's an end to it and you can get your life back. That life can be overwhelming at times, but it's sweetened with a new appreciation for health.

2007-08-07T10:43:00.000-07:00

SVR

I went to see the doc last Wednesday. I had returned from a business trip and dropped off a blood sample, but the PCR took too long. The ALT and AST liver enzymes were 16 and 22 — which is which is irrelevant — and the red and white count levels were normal.

But the real news came in a phone call fifteen minutes ago. Undetectable.

Doc says I'm in remission. He's hedging by calling it "remission." He said that he's seen it come back even after being gone for months. Maybe so, but what I've read leads me to suspect it might be re-infection.

For practical purposes, I'm done. I see a few residual signs of the fight, but how many fights do you go through without some scars? I'm functional. I have my life back.

Thanks to those who have followed my fight here. The encouragement and advice have been invaluable.

If you're coming to this because you or a loved one are facing the disease, hang in there. This is a beatable disease. There's an end to it, and it need not be a sad ending. I'll leave this blog up and will check in periodically, but its main purpose is fulfilled.

All best,

Chris

2007-07-25T19:26:00.000-07:00

No updates since April???

Wow! I've really let this thing slide. Naturally, I'm traveling on business again. It hasn't been constant — I didn't travel at all during May and June. Eldest graduated from high school, and was appropriately feted. She's going to Northern Arizona in Flagstaff. I'm hoping to see her take college a little more seriously than she did her high school classes. She took school very seriously as far as student council and prom planning went. But those pesky classes... Now that she's starting out life in debt, she's beginning to get a glimmer of why we nagged and bitched at her so much when she was slacking in her freshman and sophomore classes.

The deal is that we've financed the first year. It's now up to her. Scholarships and her own work and credit. Actually, I think she'll be a better college student. She's certainly smart. And she either has us totally snowed (always a possibility) or she's a very straight arrow. I went around the block far enough to know what being drunk, stoned, or otherwise altered looks like. I've never seen it in any of my kids. And yes, I look for it.

Anyway, here's where I am with the bug. I'll be dropping off a blood sample as soon as I get home on Friday for my would-have-been six month PCR. I had a liver panel and CBC a couple of weeks ago. The doc had not ordered a PCR. I nearly circled the PCR on the lab order form. Called the doc from the lab, but didn't hear back from him until the next day. "Yes, it'd be a good idea to get that...." Brilliant. Anyway, all the rest of the bloodwork looked good, so I'm pretty hopeful. I've even allowed myself the occasional beer. I even had one this evening — along with sushi! I'm totally out of control. I think that's like four since May.

Back in February I ran down my list of sides. Here's an update for the record.

The Itch

Hair

Nails

Brain Fog

Rise and Fall of the Third Reich

Fatigue

Mood

Sleep

Diet and Appetite

Exercise

and do it.

Aches and pains

Summary: I'm not in bad shape for the shape I'm in. I turned 50 two weeks ago. There was a time that I thought 50 was pretty old. I've seen 50-year-olds who certainly looked and acted older than I feel. I just need to continue in that vein. I'm hopeful about the PCR test, and not terribly anxious. If it's back, I evaluate. I don't think it is though.

If you're reading this from the depths of treatment, there is an end to it. The recovery, while not instantaneous, does come. Hang in there.

2007-04-29T22:31:00.000-07:00

Okay, Enough Nagging

My Uncertain friend wants an update. I am capable of updating this blog outside of airports. To prove it, I am presently ensconced in my own office chair in my own converted dining room home office and typing on my vintage 1984 IBM Model M "Clicky" keyboard. I bought it on E-Bay a couple of weeks ago because my hands were killing me from typing on my laptop keyboard. I briefly considered taking it with me on my last trip, but decided against it. Th thing weights about six pounds (three kilos). This is as close to a perfected machine as we have in the IT industry.

And of course, it's obsolete.

I've been in this industry long enough to be a curmudgeon.

Dodgeball

But dear UC wants to know about family and kids, being as how she can no longer read minds. The kids are great. Winding down the school year. Eldest is committed to NAU. I cut yet another business trip short last week to referee a dodgeball tournament at the high school on Firday. Eldest and Middle (aka Son) are in student council and had come up with the tournament as a fundraiser. A fun, but exhausting evening. The team registrations paid all their expenses ($40 per eight-person team and they had 20+ teams) and they committed the door receipts to a charitable cause, the family of a kid in Middle's sophomore class who had turned up with leukemia (of which more shortly). The concession was their fundraiser and netted them over $600 which made it a decent night's work.

Rough Treatment

We've known the kid with leukemia for several years. Son played Little League baseball with him. He was playing in a baseball game and started feeling bad enough that the trainer told his dad to take him to the ER. I would not trade 48 weeks of treatment for one day of what those parents are going through.

As for the kid, well, we all know that hep C treatment is long and grueling. To those on treatment: when when you start feeling sorry for yourself (and you will), consider what this kid is facing.

He has one of those ports installed in his chest where they can dump chemicals directly into a major artery because the stuff is so toxic it will destroy veins.

He has lost his hair. Not thin hair, no hair.

He is on massive doses of steroids giving him a moon face even though he's lost twenty pounts.

His white blood count was so low last month that he was confined to two rooms of the house. Anyone entering had to leave their shoes at the door and wash up. If he went out, he had to wear a mask

Oh, and his treatment calendar? Three years.

I know what treatment is like. I won't minimize it. But, it's a piece of cake compared to full-on chemo. Never forget that. If I have to face a potentially life-threatening disease, hepatitis C is my first choice.

I'm putting my foot down and I won't travel for the month of May — and will probably get more done without the overhead of traveling. Our anniversary is coming up next week (21 years! Our marriage is an adult!). Of course we won't be doing much to observe it until maybe June. Youngest is in a musical and Eldest is graduating from high school. Family and friends, and all that.

With that, I'm out of here. I have an 8:00 AM Eastern Daylight Time (that would be 5:00 AM Arizona time).

2007-04-18T18:40:00.000-07:00

Friday the 13th

I'm traveling on business again. I've been to the Richmond, Virginia area three times in the past six weeks. And I'll probably be back again. I'm rusty at this road warrior thing. There was a time I did it pretty regularly as an instructor, but for the past ten years or so I've stuck pretty close to home.

Much has changed.

First of all is the process of traveling itself. I'm old enough to remember a time when you walked straight from the ticket counter to your flight. The advent of metal detectors provoked predictions of the death of American civil liberties and the Fourth Amendment. The Fourth Amendment didn't die then, but it started getting sick then.

I don't think the current practice of a partial strip-search would bother me quite as much if it made me feel any safer. It doesn't take too much imagination to cause lots of havoc on an airplane that might not be detected by current methods. Conversations with a friend who took a temporary job screening baggage for TSA have done little to ease that concern.

Nothing to do about it.

Today is Friday the Thirteenth. I've been operating on the assumption that things will go worse than they have so far.

I cleared out of my hotel this morning and had that sinking sensation that I'd forgotten something. I could not find my jacket anywhere. I remembered taking it off in the restaurant the night before. Aw shit moment.

Go back to the restaurant. Nobody there.

Back to the hotel check the room. Not there.

Check the car. Not there.

Dial into a conference call on my cell.

Call the restaurant. They don't see it.

Another conference call.

Sudden realization: It's in my suitcase. I remembered hanging it up.

Get my jacket and go to the customer site using my handy little navigation feature on the phone. Make a wrong turn despite the navigation tool. Realize it just as the navigation thing tells me to turn around.

At the airport. Eat lunch in the Appleby's at the airport. Get my computer out and do a bit of work. Finish lunch and walk out with laptop. Sudden stop and return to get case from under table.

Boarding the airplane at last. But first, I can't tell my seat from my gate on the boarding pass. A nice young lady takes my pass from me and tells me where I should sit with the same caring look that I might give as I hold the door for my grandmother.

At the connection. Where's my boarding pass for my connecting flight? No, that's from my last trip. Get the current one. Check gate information. Good. Throw away boarding pass (that's speculation -- I just can't find it). The gate agent printed a new one. Might have been even more interesting if I hadn't put my drivers license back in my billfold before losing the boarding pass.

I'm still in the air. There's plenty of time for things to go wrong, but I'm not going to borrow trouble. Besides my battery is low. In more than one sense.

April 18 Post-Trip Addendum

I survived. The plane arrived an hour and a half late. We were dodging the weather in the accompanying picture. I've flown on all kinds of planes, big and small. We were above 35,000 feet (10,000 meters) and the clouds out the window were a good 10,000 feet (3,000 meters or more) above us. The pilot confirmed my guess.

Was all this the aftermath of treatment? Or did I just have my head in my ass? It's really hard to say, and it probably doesn't make much difference. I have to go back next week.

2007-02-19T08:35:00.000-07:00

Back Home — For Now

My business trip to Virginia got extended into the following week (Valentine's week — yeh, that went over big with my wife). I spent the weekend with family, and then returned to the job site on Sunday night. I had a commitment to take my daughter to a university open house this past weekend, plus an appointment for a physical on Monday (today, as I write), so I put my foot down. I had to be in the air going home on Thursday and would not be returning until late this week (the week of February 18), or better, next week. I hope to push the trip out to next week. I have what I need to get started, and all the standing in security checkpoint lines and riding airplanes is time poorly spent.

Medically, I think I'm doing well. This physical today will tell the tale. I've mentioned a few lingering side-effects with how much I think I've recovered. The Recovery percentages are compared with how I felt before treatment. Purely subjective, but perhaps useful for comparison.

The Itch
An annoyance. This is actually a recovery from a recovery symptom. I'm taking an anti-histamine (Claritin). When I back off the anti-histamine, the itch starts again. Even with Claritin, I get bumps similar to mosquito bites that come to a head and leave little sore — much like a mosquito bite that's been scratched. I also have gotten a few mild canker sores in my mouth (never more than one at a time, and never especially bad), which I suspect are also related. I never had any significant skin issues on treatment, so this all came as a bit of a surprise. Recovery: 50%
Hair
I don't know whether the nails and hair issues stem from interferon or ribavirin. Since it takes a while for the drugs to go away, and then for the hair and nails to grow out, it's not surprising that these side-effects linger. The strange effects on my hair are definitely present — it's all thin and wispy. But my wife and kids swear that the hair on my head is getting darker. I've read other reports of being able to see new hair with a different texture coming in. I haven't seen that yet, except for my beard which is definitely changing. My would-be mustache is darkening and getting more coarse and the dark whiskers seem to be spreading. It's like puberty all over again. Recovery: 10%
Nails
My fingernails started getting thin and brittle several months into treatment. I just learned that fingernails grow at about 0.1 mm per day, or a centimeter in 100 days. So it will take about three months after the drugs work out of my system for fresh nails to grow in. Again, an annoyance. I have to keep them cut short as they tend to split and the split can work its way down into the quick. Recovery: 0%
Brain Fog
I'm a reasonably bright guy, but I've always been easily distracted and not terribly disciplined. I'm still dealing with that. On treatment I had a very difficult time focusing. I'm still having some of that. Case in point: I'm playing with my blog and really need to get back to reviewing a proposed solution that our enthusiastic sales team has concocted. But that's boring and not nearly as fascinating as my treatment adventure. Recovery: 80%
Fatigue
I think the main issue here is my bad habit of not sleeping enough (five to six hours per night) coupled with a sedentary lifestyle for the past year. One thing I've learned is to nap, however that's been tough while I've been on a Death March travel schedule. Toward the end of the day, I find myself fading and not paying attention well. Recovery: 75%
Mood
I went off my anti-depressant at the same time that I quit the rest of the medication. I was on a pretty light dose anyway. My family says I'm more fun to be with. I certainly do better in social situations. I no longer tear up at the slightest provocation, which is a relief, although I think I'm still a little more emotionally sensitive than I was at the start. I also think that being in a better mood, I may be more creative and more willing to explore possibilities. Recovery: 90%
Sleep
I still have trouble falling asleep. That's normal for me — I tend to ruminate when I go to bed and it's often difficult for me to fall asleep unless I'm dog tired. That has been a fact of life for me for years. Where I've gained some ground is that I'm more willing to take a nap during the day. I'm more aware of performance falling off. If I'm able, I take up a prone position on the couch. If not, I at least shut up, as I sometimes get kind of manic when I get tired. Recovery: 100% Plus
Diet and Appetite
My diet was pretty good going into this adventure and it hasn't changed significantly. What has changed is that the metallic taste has disappeared and I no longer have to force lunch down. That's a relief. I do seem to have a bit more of a sweet-tooth than I had previously, and I don't crave fruit like I did while I was on treatment. That's bothersome, particularly having a suddenly heavy travel schedule. At the very least I need to be aware. Recovery: 85%
Exercise
Not enough! But I'm certainly more capable of exercise than I was back in December and January. I can get on an elliptical trainer and get my heart rate up to 185 or 190 in about 15 minutes and keep it up for a half-hour. I haven't started running yet. I expect to get clearance to run today. I have an appointment for a physical today that should include things like an EKG and probably a pulmonary function tests. Recovery: 75%
Aches and pains
Adding this later. I had nearly forgotten it until I took my daily dose of ibuprofen or acetaminophen. I rarely took either prior to treatment. It isn't bad, but it's definitely there. Joint pain, headache, undefined discomfort that goes away as the analgesic kicks in. Like virtually everything else, I'm not miserable. But I know I'm not all the way back. Recovery: 75%

So that's where I am as of February 19. I was fortunate to have mostly moderate side-effects all the way through treatment and feel like I'm being blessed with an easy recovery period.

If you're interested enough in this sort of thing to read this far, then you must be dealing with treatment in one fashion or another. Hang in there. There is an end to it, and even if treatment doesn't kill the bug, there are long-term benefits to giving the liver a chance to heal. The fact is that we're all going to die. Winning in this case is defined as not dying of liver failure caused by Hepatitis C. A knockout is cool, where the treatment kills the virus, but it's also possible to win on points. Many people die with the virus but not from it. Thar's a win as well and treatment improves the odds.

2007-02-04T17:15:00.000-07:00

In the air

I'm traveling on business. I was trying to work on some drawings, but the turbulence on this flight is too bad to do anything that requires working with a mouse. So, I'm writing this in a text editor that only requires hands on a keyboard.

This is my second trip in three weeks. Last month I was in Chicago and Milwaukee. I've been working on that project since July. It was a slow-motion train wreck, but seems to be getting better. The solution sold to the customer was impossible. Neither the customer nor the sales team talked to the technical teams. Hint: To move a data center you don't back a truck up to the old data center, load it up, and ship everything 1000 miles to the new data center, and move everything inside. There are things to go wroing. What if something doesn't come up? Are you going to ship it back? How about a scenario involving a truck in a river? I work for a big company, and they can get stuff pretty quickly from the vendors. But it isn't likely to arrive fast enough to keep from doing a lot of damage to the business.

A realistic solution eventually emerged, but the dates from the original contract were totally whacked. My job is to plan the transition piece. Implementing those plans takes it into another stage, so my piece is done. The Boss popped up in my online chat window on Wednesday. "Looks like you're done with {customer}. Be in Virginia on Monday. Here's the guy you need to talk to for details." Cool. I have family in Virginia. I'm traveling a day early and will watch the Super Bowl with them.

Recovery continues. The itch has pretty much subsided, but I notice that my lips are still swelling like they do sometimes when I eat cantalope. I'm continuing to take antihistamines with a break every couple of days to see whether it's still an issue.

The most noticeable lingering side effect is the hair. My barber recently took on a regular job (it was time for a job with benefits) and I went to a new one. I had not been to this shop before and the girl cutting my hair commented how thin it was. As my previous barber said, the only thing to do is cut it short.

Battery dying. Time to go.

2007-01-06T23:09:00.000-07:00

"Ichabod is itchy...

...So am I!" Quoting Dr. Seuss's ABC, the best alphabet book in the English language.

Indeed I am. From scalp, to legs, and -uhm- in between. I know about the last bit. The past year of enforced sedentary living has resulted in a hemorrhoid flare-up. Hopefully I'll get rid of that as I start working out and get more active.

The skin thing has me kind of mystified. I went through 48 weeks of treatment and had hardly any skin problems. The weather hasn't changed significantly since I went off treatment. I did get a bit of scalp itching when I was on my treatment hiatus. I attributed it then either to the Procrit or to the Neupogen. Now — literally now; this just occurred to me — I'm wondering if it isn't a withdrawal symptom. It stands to reason that since my body had to adjust to the presence of the meds, then it would have to readjust to the absence of those same chemicals. Anyway, my scalp is itchy and I've got tiny itchy bumps. It still isn't terrible, not like a case of hives or chiggers. Just an annoyance. During the last couple of weeks of treatment my eyelids also developed rough patches, but that symptom is fading. I'm also finding that the body aches have been replaced with headaches. It will pass. It will all pass. It's beginning to sink in.

I'm done!

This was the first week back at work after the holidays. I'm amazed at how much my mind has cleared in just this week. I'm finding stuff I did at work and I'm a) suprised that some of it is pretty good, b) surprised at the really big things I forgot, left out, or let slide, and c) surprised that some things somehow got done by someone acting as me, but I have no recollection at all. It was also the week of my review. Under normal circumstances I'd consider it a so-so review at best, but given the circumstances, I consdered it a rave. Told the boss and thanked him. He's been a huge part of making this thing bearable.

I have paperwork for a blood test in three months. I think it's just for the standard liver panel. I'm going to ask for a PCR at three months. I think that will tell me what I really need to know.

2006-12-26T23:46:00.000-07:00

The Cohiba

I am not an expert on cigars, but I like them. I've had my share of experience with tobacco from dipping snuff as a teenager (a rite of passage among the ranch kids I hung with) and smoking cigarettes in the Army (at a tax-free thirty-five cents a pack, it was no wonder most GI's smoked). I gave up tobacco in college, although I went back to the weed now and then in the years following. But I hate to cough and I like to run. That's incompatible with cigarettes. And since I don't work outside, the frothy cup of the indoor snuff dipper would be my constant companion and bane. Add to that having kids to set an example for, tobacco was just incompatible with the rest of my life.

Putting tobacco back down after an occasional dalliance has never been a difficult thing for me, so I don't go out of my way to avoid it. When a co-worker who had been out of the country on business handed me a few cigars that he alleged to have come from an island nation with whom my country discourages trade, the allure of forbidden pleasure was too much to pass up. I received the cigars some five years ago and had kept the last one for a special occasion. I guess completing a 48-week course of interferon and ribavirin would qualify. On Christmas afternoon as the rest of the family napped or explored new toys, I found a sunny spot in the back yard and lit up. All I can say is that it's a good thing that the things are a) illegal in my country, and b) priced around $12 each. Absent those two factors and they could become a habit.

2006-12-25T23:36:00.000-07:00

Merry Christmas

I'm now just about 96 hours post-treatment. I'm feeling the sides from the interferon, mostly fatigue, but I'm enjoying not feeling the ribavirin "hat" — the pressure that forms across the middle of my forehead and encircles my head. Correction: past tense. I don't feel it anymore! That's a serious improvement.

Saturday, the second day post-shot, we went up to see our friend J and her mom in central Arizona. Whether it's chemical or situational, I was much more engaged and maybe even fun to be with on the 90 minute drive. The kids laughed, although I couldn't tell for sure whether it was at my jokes or at me.

I mentioned last time that J has fought ovarian cancer and that it looks like it's back. She and her mom, "M", take care of a nice little house and make whatever money they can through crafts or doing bookkeeping and billing.

Bluntly, the situation looks bleak over the long run. J has a bit of life insurance that will allow her mother to keep the house. She has no medical insurance and a lot of debt. She divested all of her assets putting them in her mom's name and keeping the debt in hers. Nonetheless, she is feeling good right now and stays in the present. A few weeks ago I talked with her about options and she said that she's not going to go through another six-month round of chemo with a 15% chance of remission — remission here defined as pushing the inevitable back six months. She really can't see the point. She's my age, which has brought reality home to me more than once. If she finally decides not to take the chemo, the cancer will not have beaten her and she will not have given in. She will have taken a hard decision not to be defined by her disease. It looks like we're in for another rough year.

J and her mother's avocation (not to mention distraction) is a prolific tribe of feral cats that has adopted them, and which they feed excessively. They remind me of my grandmother who at one point also had a dozen or more cats hanging around. When we were up there before Thanksgiving last month, M, the mom, commented that she'd spent nearly $70 in November on cat food. With my rural background, I might approach the issue a little differently, but it's not mine to say. I privately wondered how long the situation could sustain itself.

The tipping point arrived a couple of weeks ago. They got a cold snap followed by some snow and the hoard of kittens came down with some kind of respiratory infection. Naturally, the kittens went to the warmest spot they knew when they got really sick — M and J's patio. And naturally more than a few turned up dead. It took a lot out of J to spend a week burying a kitten or two every day.

When we were up there this week, they had brought three kittens inside and had set up a kitty infirmary in a bathroom. One appeared to have made it last week and they found a home for it. A second was looking very weak on Saturday and died the night we left. Then there's the third.

Guess who has a new kitten.

My oldest daughter's cat is now sixteen and starting to fade. She's doing pretty well, but the arthritis in her hips is getting worse. My younger daughter got a kitten for her birthday this past summer (three guesses from whom). We got a fair amount of not-so-subtle pressure to take the new one. Alright, alright, whatever. I choose my battles judiciously. Sometimes an appeal to common sense, reason, and practicality is more trouble than it's worth in the long run. We won't have three cats for very long. Needless to say, the kitten is very cute — a calico with a brown patch over one eye and a butterscotch patch over the other — and a fighter. When the dog comes to visit she growls and hisses and doesn't back down for a second. Mother Nature's system is brutal, but it does find the fighters.

Christmas Eve

Several years ago we fell out of the tradition of Christmas Dinner. The time leading up to Christmas is too crazy and Wife didn't want to spend Christmas cooking. We now instead have our big dinner on Christmas Eve. A couple of years ago we made a standing rib roast. It turned out really good that year. We hadn't done it in a while, but this year Wife found one at a good price. I think it's going to become a regular tradition. Wife still had some wrapping to do, and I told her I'd take care of dinner. I spent a couple of hours in the kitchen on my feet. No way I'd have been able to do that last month, or even last week. I enjoyed cooking it and it made Wife so happy that it's probably worth my time to plan a repeat performance. Maybe a New Year's ham and black-eyed peas next week.

2006-12-22T23:39:00.000-07:00

It's done!

Last night I injected the last of 48 Pegasys syringes. A call to the doc the previous day yielded orders to stop everything after that last jab. No more ribavirin, no more Procrit, no Neupogen. Still got 3 Neups left in the fridge, but I took the last Procrit the day before. Tonight my cell phone alarm went off to remind me that I'm not taking any ribavirin pills. Cheering from the kids. I'm done with this part. I have a Cohiba cigar that I've been saving for a special occasion. This qualifies, although it will probably make me sick. Just as well. I don't need to get into a cigar habit.

Today feels much like any other post-shot day. Foggy, tired, a little down emotionally, and an incessant, accursed roaring and ringing in my ears. I'm long-used to some ringing, having tinnitus from a lack of ear protection in my immortal youth, but this is getting to be a bother. What's especially annoying is the low-frequency roaring that goes in time with my pulse. But that's okay.... This too shall pass.

We're going up to central Arizona to see friends for Christmas tomorrow. She has ovarian cancer that's come back after six months of brutal chemo and a year of remission. She showed up sick the year before my virus kicked up. Certainly does place things in perspective.

Now starts the wait. I'll go in sometime next week for a viral load test (PCR), and again in June. That's the one that counts.

To all who read this, be well. Be grateful. Be strong. Hold your loved ones close. If you're contemplating treatment or fighting the bug, know that there's an end to it. I may have done harder things than this treatment, but I can't think of one.

2006-12-18T21:56:00.000-07:00

A Day At A Time

The AA folks are onto something with that "One Day At A Time" approach. The human psyche really can't can't comprehend the long term. We can make plans and talk about what's going to happen some day down the line, but we're pretty much along for the ride. Not quite like a stick in a river — we can choose which part of the river we will float on to an extent. But in real life, we aren't in charge of much. That brings me to a quote I found on another blog, http://www.hepcboy.com/: "I don’t believe in God but do believe in miracles." I rarely take issue with this extraordinarily bright and combative fighter against HCV. A previous non-responder or relapser, he's on the 72-week plan, which from 47 weeks appears as distant and daunting to me as the summit of Everest.

But I do take issue with that statement about God and miracles. I belive in both, being as how I dont' think you can have one without the other.

Gentle Reader, I'll spare you the apologia, but I do find it necessary to say that I'm a Christian, that I believe that Jesus is the Son of God, that he was crucified, died, and rose again. Literally. Whole kit and caboodle. Some stereotypes probably just popped into your head. Most of them are probably wrong. No, I do not think the world was created 6,000 years ago. I'm okay with the idea of evolution and DNA and with the idea of Adam and Eve being of a mythic (folkloric) origin. I could even make a case for homosexuality as possibly being a biblically valid lifestyle choice. But I won't because it's outside of my purpose here and I don't have a dog in that hunt. I hate abortion (I've seen three children in utero when they would have been legal abortions, no questions asked). But I don't think there should be an inquest every time a gynecologist does a D&C. Some things, I'm very happy to leave up to God.

The short version of the basis of my belief is that it makes sense for me. If what I believe doesn't make sense for you, then there's little I can say to dissuade you. I come from a Christian tradition that would gladly thump a non-believer or questioner about the head and ears with a bible. But that's not my thing. Nonetheless, I do believe that if God wants you, you can dodge Him all you want and He's still going to get you. My willingness to say something might make a difference, and I'm under orders to say something in this regard. So I say something, and let God do his thing.

What I believe is that people are hard-wired, whether they believe it or not, to worship. If a human chooses not to worship God, then they will, believe it or not, like it or not, worship something else. Western culture is lousy with mis-directed worship. Pick any vice, bad habit, fad, or profession. All of them objects of worship.

What are the consequences of believing or not believing? It isn't my place to say. Will my homosexual friend T. spend eternity in a lake of burning sulphur because of his non-belief? Will I be rewarded for my belief with a pair of wings and a harp? Honestly, I kind of doubt both points, and I'm thankful that it isn't mine to say.

What I do know is that whenever humans have tried to anticipate God, we've been wrong. Abraham was promised descendants "like sands on the seashore." He got what he was promised, but not in the way he expected. So I don't waste a lot of time puzzling out alleged end-times prophesies or imagining eternity. I just want to get through today, sometimes the next five minutes. But people have been tortured and burned at the stake because they didn't follow the dictates of some religious authority. My bet is that those guys were surprised as they entered Eternity.

Which brings us back to what I set out to write about. I've been able to get through this experience because of the grace of God and my own belief that I had help. Others may be strong enough to do it without God. Hat's off to them. I wouldn't have been able to make it. In short, I've found my life better with God than without, and during this trial, God has given me the chance to depend on Him. I think that He's active in my life in ways that I little suspect. As my dad said upon learning that he had cancer, "News like that will make you look at your hole card." I have taken a hard look at all my cards this past year. Grace is what got me through it. Someday soon I will run down the little synchronicities that got me here. As a Christian, I know where they came from.

But that's all I have to say to that for now.

"I can do all things through Him who strengthens me."
Philippians 4:13

2006-12-16T20:57:00.000-07:00

And then there was one...

There's one Pegasys syringe sitting in the fridge. I injected Number Forty-seven Friday night. Sides are hitting hard. I feel like the stuff is just grinding me down. I'm thankful that this is the end of it. The 72-week program has to be brutal. I took my shot and went to bed last night about 11:30. I didn't get out of bed until 9:30, but eventually crashed again. After a while I figured out that I had a low-grade fever. I've been pretty much worthless all day.

We had a bunch of friends over Friday night (before I took my meds, of course). My wife's talent is project manageent. I've never seen a party that was so easy to put together or clean up after. She made a big pot of chili, put out some paper plates and plastic flatware, scattered some tables around with raw veggies and condiments, and we had a sit-down dinner for 25 people — five families, a dozen kids ages 6 to 18.

As the new year comes along I'll be starting a new project at church. I have an ulterior motive — it's to keep me going to the gym. Our church is about a half-mile away from the gym I go to. Like many churches, ours has activities on Wednesday night. Until I started this viral adventure, I would take the kids and then go over to the gym for an hour. Starting at the first of the year, I'll be leading a class at church. We'll meet at the church, read something Inspirational, and then walk, bicycle, run or skateboard over to the gym. There's a Starbucks next door, so some people might go over there. I don't care — my purpose is not to sell gym memberships. The walk alone would do some of our folks some good. Gluttony is a sin that many Christians fall prey to. I'm far too proud to fall for that one.

2006-12-14T22:47:00.000-07:00

And then there were two...

I started this post last week and never got back to it. There are two Pegasys syringes in the garage fridge. Tomorrow there will be one. At this late date, you'd think I knew all about all the sides. No such luck. I'm finding new ones! My sleep pattern has gotten completely jacked around. I'm up too late — usually in front of this thing — and I'm having a terrible time getting up in the morning. I have a 6:30 AM call that I really should be on, but I only make it about one day a week. Night before last I looked at the clock at 1:30, 2:00, and 3:00, and made a point of not looking when it was probably 4:00. I'm getting that restless leg thing. I'm taking the anti-depressant Elavil (amitriptyline) which stopped the twitches in the first month. Doc has since upped the dosage from 10 to 25 miligrams after I told him that it didn't seem to be doing anything. I'm tempted to bump it again. On the other hand, this is almost a thing of the past.

I'm also feeling the psychological effects. It takes less and less to get the tears flowing — not really my ordinary state. My friend Bob says I should plan on that staying. I'm also crabby. I don't like that if only because it's rude. I hope that goes away.

Eldest Daughter's vocal ensemble concert was tonight. She's 18 and still talking about going to college in Iowa of all places. That child wouldn't last a month there. She puts on a sweater if it's 70°F (21°C). I talked with another dad at church whose daughter is already there. "Then they pull out that God thing," he says. My daughter: "I really think God is telling me to go!" Uh-huh. One year at this little college is the price of four-years at a state school.

The other dad said, "I'm good with that God thing too, but He put this thing between the bones of your head!" I told her that if God wants her in Iowa, He'll make a way for her to fund it.

2006-12-03T00:03:00.000-07:00

Forty-five down, three to go

Opened the last box of four syringes last night. Getting close! I'm ready for this to be done. I'm not feeling terribly bad; I can't point to something and say, "It hurts here." But I'm just wiped. I'm sleeping a lot, but sometimes stay up too late. Sides are coming on stronger, especially the Sunday afternoon/Monday morning. Speaking of staying up late, I've been surfing too many other blogs (Hi, UC).

Speaking of sides, the cognitive effects are hitting hard the past few weeks and seem to be worst on Monday. That's bad, because work is truly nuts. All the issues I've been telling the project management about are coming true. Remarkably, they're doing exactly what I recommended (although they never listened to me long enough to hear my recommendations).

My wife has taken the month of December off work. She applied for a leave of absence under the Family Medical Leave Act. Ostensibly it's to take care of me (which is true enough) but it's also to giver her an emotional break. She's considering changing jobs because things have been crazy for her as well. Suddenly when she started making noises about leaving her little 30 hour a week part-time job, everyone is sitting around her with notepads and chart paper.

To bed. Lots of stuff going on tomorrow.

2006-11-20T09:48:00.000-07:00

Slogging On

Five interferon shots to go. Six weeks or so worth of ribavirin. It is indeed the last long mile. From the far frontier of 42 weeks on treatment I speak with some authority. For me, the dominant feature of this experience is boredom plain and simple. I can't do stuff. I want to do stuff. My body simply won't let me. I'm too tired. I'm too achey. I longingly picture myself running around the block. Cleaning my garage. Hiking in the desert. Going hunting. Things will get better.

I've been thinking lately how I got to this point. I recently found the accompanying picture, which has a lot to do with it. It's in northern Italy about 40 miles north of Venice. I spent all but six months of my three-year career in the United States Army in the "Administrative Area" marked above. It was a Lance Missile unit that worked with the Italian Army. The site was decommissioned in 1992, according to the site I pulled this picture from. It appears abandoned now. It was old when I was there, having originally been an Honest John site. There were about forty of us in this little area. I was the Supply Clerk.

The Italian Army owned the missile motors and launchers, while we maintained control of the warheads. The warheads were potentially nuclear (one option for the Lance was the infamous "Neutron Bomb," which allegedly would kill people and destroy electronics, but leave the buildings and machines intact). I can't say for sure whether they were or not, but we treated them like they were. The warheads were stored a few miles away, but I haven't been able to track the location down; Google Earth doesn't have high resolution images of the area yet.

Our wartime mission would have been to provide missile support to the southern Alps when the Russians came west. It didn't take too much time studying a map to figure out that our task would be to control the passes through the Alps. Of course, we took it for granted that if we ever had to fire the things something just like it would soon be on the way.

The Russians never crossed the line. We were fairly confident that they wouldn't, either. As a practical matter, Gerald Ford was the President, Nixon having resigned just two years before. Memories of Vietnam were still raw. The Soviet Union was beginning to show signs of internal strain. Our comrades-in-arms were the Italian Army. And the missile crewmen spent hours upon days upon weeks drilling in how to destroy the warheads, never how to mount and shoot them. Keep in mind that we were working with the Italian Army. It was not a time of heroics.

Personally, I had joined the Army to be a tourist. I felt I wasn't ready for college and I wanted experience. That's a youthful way of saying I wanted to drink, do drugs, and get laid without having to explain things to my mother.

I had a room in the barracks, but after a year, I got an apartment in nearby Conegliano. I had a pass from 1630 hours (4:30 PM, to you civilians) until 0630 formation Monday through Friday. Unless I had CQ (Charge of Quarters) duty, i.e. sit in the orderly room all night and do communication checks on the radio, the Army didn't much care where I went or what I did after work or on the weekend. I spent most of it getting -uh- experienced.

Which brings us back to the topic at hand. How I got it. I smoked, snorted, drank, ate and otherwise ingested every hallucinogen, stimulant, downer, or any other psychoactive chemical that came my way. Once, in 1977, quite altered and in a mood for something new, I injected something. It may have been morphine. It may have been heroin. It may have been sugar water — I don't recall getting that high, and I was really disturbed that I'd done something with a needle.

At some point during that year — maybe before or after the needle experience — I got sick. I knew something was up, but I didn't feel that bad. I had a bit of a rash and a fever. Sometime after that, maybe weeks, I remember noticing that my shit was the color of peanut butter and wondering what was up with that. Unpleasant, but we're dealing with unpleasant things here.

Nothing else happened. Whatever it was, it was gone.

Or so I thought.

Some twenty-odd years later I'm a pillar of the community, with a career, a wife, a mortgage, and three children, I sign up for the blood drive at work. I fill out a questionnaire. Of course I never used IV drugs. Never. Not me. Only a fool would inject drugs. Two weeks later, the blood collection agency sends me a letter saying, in effect, "We don't want your blood. Don't come back. Go see your doctor."

I spent the next couple of weeks in a fog. It's a singular experience to hear that you have a potentially life-threatening disease. I shared the discovery with a friend. He's a diabetic.

"Let me get this straight: You have a disease that might cause problems someday, maybe five, ten years down the road, maybe never."

"Yes!" I sobbed.

He laughed. "How has your life really changed? A drunk driver could just as easily take you out between now and then."

My diabetic friend had been living with the disease that he can safely assume will kill him for twenty years. He knows he's not immortal. I was just finding it out.

Since that time, about a dozen years ago, I've checked in at the lab every six months to a year for a blood test. Until September of 2005 every thing was normal and I went on with my life. Last year the numbers came up wrong, and I started this blog. So that's how we got here.

A friend of my kids' had to do an interview project for school. She knew I was getting treated and what for; her family put me in touch with a guy who went through the treatment five years ago (I've mentioned "Bob" here before). One of her interview questions was what teens should know about this disease. My answer was that teens need to know that they can get this stuff too. I felt very middle-aged hearing myself give that answer.

2006-10-29T21:19:00.000-07:00

Eight jabs to go

I have two unopened boxes with four syringes each sitting in the fridge. I took my shot late Friday night. Seems like the side effects have really hit me this week. I had to get on a three-hour conference call on Saturday from 10:30 to 1:30 — that project is running headlong into reality. A bunch of contractual deadlines created at the Nineteenth Hole with no particular connection to what needs to happen. But I digress.

I typically sleep late on Saturday after the interferon shot and this Saturday was no exception. I got up with time to grab something to eat drink my coffee and get on the phone. Due to the craziness in the project The Boss scheduled a three-hour call. He didn't join, of course. By the time the call was over, I was starting to feel sides. That afternoon I cleaned the pool and did some other light chores, but wasn't feeling my best.

We had dinner plans with friends, our kids, and their kids. It was good. I still didn't feel so hot, but it got me out and distracted. A distraction is good. Sometimes the worst thing you can do with side effects is to sit around wallowing in it. We decided to rent a movie and went over to their house. It was The Ringer which was all about a guy who decides to fix the Special Olympics. Our kids are old enough to appreciate the cynical humor.

How to inject Pegasys

This is an expanded version of a comment I posted in another blog. It might be useful for someone starting treatment. I've made some minor updates, if anyone is keeping track. Thanks to everyone at Ron Metcalfe's Hepatitis C Forum.

November 20, 2006 update. I've added a recommendation for the injection process itself. Quick and smooth is better than slow.

I use the Roche Pegasys syringe. These are the directions they fail to give you.

Roche Pegasys Syringe

(Picture raided from a post on ronmetcalfe.com by Ginjura)

Assembling the syringe

The syringe doesn't come with the needle installed. The needle is in a separate bubble pack. It's in two layers of plastic. Peel apart the needle package and remove the needle.

I prefer to loosen the plastic cap before installing the needle. I remove it and then put it back on loosely. You'll be able to see where the little semi-transparent needle cap meets the needle assembly. The orange post-use safety cap attaches to the base of the needle.

Hold the the needle assembly tightly down at the base where the orange cap connects and give the clear cap a straight tug. You don't want to twist it off, just pull it straight. Don't try to just loosen it — it doesn't work that way. Pull it straight off in one motion and get your hand away from the needle. I say this because I once tried just loosening it. When it came free, the natural reaction was to try to stop my hands from separating. I ended up pushing the cap back on. I could have just as easily stuck my hand with the needle. Not that that'd be an earth-shattering event, but it would be shattering to me in my shaky emotional state which is exacerbated by my dislike of needles.

Replace the semi-transparent cap loosely. Remove the grey cap from the syringe. You'll see that the glass of the syringe is frosted down at the tip where the needle goes on. That's supposedly to allow a tight friction fit.

Again holding the needle by the base where the orange cap connects, push the needle assembly tightly onto the end of the syringe, being careful not to press the clear cap back onto the needle. Don't worry about the syringe being made of glass. It is not fragile, at least not to straight pressure. I've never experimented to see what it would take to break a syringe, but I've never done it by accident either.

Don't try to twist the needle on. — you won't be able to anyway, as the attachment for the orange cap will just turn around the needle. The needle assembly will not click into place, it's just a friction fit. Push it tightly. I had one come loose as I was injecting and it was disconcerting, to say the least.

Preparing to inject

I usually use a bit of my rather meager love handles for the injection. Sites range from as far back as I can reach on either side to about an inch and change away from my navel. I've also injected above the navel and in the outsides of my thighs or high on my hips. Injections usually leave a silver dollar sized welt. Some folks report itching. I've never experienced it. Use them as markers of previous shots. Don't inject where there's already a welt.

Once I select a site, I scrub it down with an alcohol swab. If you have skin issues, you may skip this step. I haven't had any problem. The reason I scrub isn't because I'm obsessive, but to de-sensitize the area.

While the alcohol dries, push some of the air out of the syringe. This does two things. First, you don't want to inject a bunch of air (although some won't hurt, and can actually help, as we'll see). Second, the plunger has been stuck in one position for some time. Moving it prior to injecting makes it easier to inject.

Injecting

Next, grab a pinch of skin and inject. The Roche instructions recommend jabbing quickly. They're right! For the first forty or sow weeks, I couldn't bring myself to do it quickly. But a recent trip to get a flu shot convinced me other wise. The needle was the better part of three inches (7 centimeters) and it went somewhere near the bone deep in my deltoid. The guy who gave the shot pushed it in with a single smooth motion. I hardly felt anything. I now try to emulate his technique. Don't rush, just straight, smooth, and without hesitation (yeh, that's the hard part!).

I've found that the best feature of the Pegasys kit is that the needle is unspeakably sharp. It slides right in. I've found it is easier to focus on the syringe rather than the needle. At one point when I was more squeamish, I'd block the view of the needle actually entering with a finger.

I've learned that if you're going in an any angle at all, make sure that the bevel is up, away from the skin. In other words, the longer side of the bevel to the skin, the short side away. It takes advantage of the sharpness of the needle (Again, thanks to the Ron Metcalfe forum).

Choose an angle that keeps the needle down and the plunger end up. You want a small air bubble against the plunger. The idea is to empty the syringe of the drug. There's some controversy here. Some say that the syringe is slightly overfilled and that by fully empying it, I am getting a larger dose. It can't be more than a drop, so I don't sweat it. If I were really curious, I suppose I could measure it into a graduated cylinder, but I'm honestly not that worried. Anyway, there's an advantage of injecting a bit of air at the last. It prevents the medicine from leaking back out.

The instructions say that once the needle has been inserted to pull back on the syringe. Skip this step — it's lawyer repellant. It's unlikely you'll hit a vein in the belly or outsides of the thighs.

Push the plunger. Some say slowly, some say quickly or smoothly. I've found it makes no real difference. Just get the juice in your body and get on with killing the bug!

Pull the needle out. Again, do it quickly. Hesitation hurts. You'll probably find yourself letting a held breath out. I do anyway, and my heart is usually racing. This after forty weeks of injecting this stuff once a week, and close to thirty weeks of one interferon, plus a Procrit and three Neupogen injections each week.

Post injection

I usually swab the site again with the alcohol pad. Again, some folks report a bit of leakage and itchiness where the medicine gets on the skin. I haven't experienced this, possibley because I always wipe down afterwards.

Click the post-use cap in place and drop the syringe into the sharps container.

Cross this week's injection off. You've got another one down!

Will you ever get used to it? Maybe. Will you ever learn to like it? I hope not. Does it ever get easy? It depends on how you define "easy." It does get to be routine. I have a diabetic friend who does not feel sorry for me. He takes anywhere from three to five insulin injectons a day. Heppers get little sympathy from him.

2006-10-21T22:47:00.000-07:00

Countdown Enters Single Digits

Last night I took 38 of 48. I now have 9 to go. I'm exhausted. The week has been rough, but better since Friday when the Procrit started kicking in. I take another one on Sunday. I've never looked forward to a shot before. Well, I'll take it back. I also looked forward to my first one back in May.

The house is chaos. My in-laws are here for Eldest Daughter's 18th birthday. Mother, step-dad (they've been married about 30 years), Head Wife's sister and her step-daughter. I get along okay with them for the most part. There are moments though. Last night SIL was all bent out of shape because Eldest had been working and then failed to spend enough time with Auntie to suit her. Eldest was wiped and taking it personally — she was in tears. I finally had enough and stepped in. Enough. Eldest is exhausted and you're doing nothing to help. I'm not going to have somebody come under my roof and push my kids around. So there. It settled things down. SIL is kind of cool toward me today. I honestly don't care.

We did have a nice evening. Went to an Italian restaurant that serves portions that are far too large. Having spent time in Italy, I can say that I've been to maybe three restaurants in this country that offered even an approximation of Italian food. This was not one of them, although it was a fair meal.

Anyway, we had the family, the inlaws, friends from church who sponsor the youth group at church, friends of Eldest, including a young man who dreams of a baseball career. That's his dream, but he's smart enough to have a plan B. He gets good grades and has alternative career plans.
I'm not sure how interested Eldest is for real, but he's got it bad.

As you might expect, the car was a huge hit. Head Wife had bought her a purse that she liked and had put a few useful things in it — lip gloss, Tic-Tacs, car keys, Kleenex. She was pretty shocked. I'd been extra grumpy and kind of naggy this week. She had no clue that was on the way.

There's a frightening drama unfolding in Ron Metcalfe's Hepatitis C forum. A woman in the forum has been talking for the past couple of days about her husband who appears to be in the midst of a psychological breakdown. He's having murderous and suicidal ideation. I'm terrified for them both. He needs a ride in an ambulance to someplace where he can be monitored and treated. I saw the post and was the first response. She has been frightened but hadn't called outside help in last I saw. I have a new respect for the drugs used in this treatment.

It's late. I'm fading fast; should have been in bed an hour ago.

2006-10-18T22:49:00.000-07:00

Saw the doc yesterday

Good news: ALT = 29, AST = 24

Not so good news: WBC = 2000

Even less good news: HBC = 8.7

I know why the WBC is on the low side. I've been sloppy. I've only been getting two shots of Neupogen per week rather than the prescribed three. The hemoglobin at 8.7 explains a lot — like why I'm walking around in a fog. In the appointment Doc said we might raise the Procrit dosage. I called him today and asked whether we couldn't go ahead and raise it. He agreed and I'm now to take it every four days. Hopefully that will bring the hemoglobin back up.

Had a traumatic experience today. We bought our daughter a car for her 18th birthday. It's a 2000 Sentra, but has low miles — only 57,000. We didn't steal it, but didn't get robbed either. I think it was a good deal. It's now parked in a neighbor's back yard. We'll surprise her with it on her birthday.

2006-10-15T00:08:00.000-07:00

Ruminating

A father's life is one of quiet dread

—Henry David Thoreau

I'm waiting up for Son. He went to a Sweet Sixteen party for a little blonde thing whose daddy has way too much money. I can't go to bed while any of the kids are out. It's this thing I have. Not only do I worry, I like to see what kind of shape my kids are in when they come in. Look them in the eye. Chat. Smell their clothes. I'm led to that behavior by the condition I recall being in when arriving home as a fifteen to eighteen-year-old. So far I've either been totally snowed, or my kids are just goody-two-shoes. Not that I'm complaining!

I talked with my mother for an hour or so this afternoon. I'd been overdue to call her (of course the phone works both ways, but I'm leaving that alone). She's essentially consumed with taking care of my youngest sister. Sister is 43 and has been drinking hard since about her sophomore year in high school. She's about 4' 10" (147 cm) and in high school might have weighed 90 pounds (40 kg). Her claim to fame was that she could drink football linemen under the table. No one could keep up with her. Since her head remained relatively clear, she was obviously immune from the effects of drinking. She has been confronted with a different reality. She has cirrhosis and I'm guessing won't live five years without a liver transplant. Hint: It's hard for an alcoholic to get a liver.

Son just arrived — her parents brought him home. He was sober, not stoned (back in the day one would say "straight," but these days that leads down a path where I'd just as soon not stray), and wearing the clothes he had on when he left. So I guess he's doing alright.

Head Wife and I went out car shopping this evening. Firstborn Daughter turns eighteen this week. I'm trying to wrap my mind around getting a car for this bald baby with the huge brown eyes. It used to take us forever to get a seat in a restaurant because all the grandparents (lots of those in Phoenix) wanted to see the baby.

Once again, we're either totally snowed, or things are going pretty well. Her grades aren't the best, but she's frankly not a student. She has a job where she works with children, she sings in the choir at church, and once a week she goes to visit a family of refugee children from Sudan. I'll take it.

2006-10-14T00:16:00.000-07:00

Week Minus 10 — Stalling

I will have ten more to go when I take injection 38 tonight. But I'm stalling. I'm finding my attitude is not so chin-up, what-ho, pip-pip. I've been hanging out in a UK-based forum. The Brits don't really talk like that — well maybe they do, but they don't write like that.

My parents have had an ancient (I mean WWI vintage) record player for as long as I can remember. They dragged that thing all around the country, in fact. Anyway, one of the records is a marching song from the Great War that seems to be coming to mind more often these days:

Oh, they put me in the Army
   and they handed me a pack,
They took away my nice new clothes
   and dressed me up in khak',
They marched me twenty miles a day
   to fit me for the War,
I didn't mind the first nineteen
   but the last one made me sore!

Ch it's not the pack that you carry
   on your back
Nor the Springfield on your shoulder,
Nor the five-inch crust of khaki
   colored dust,
That makes you feel your limbs are
   growing older
And it's not the hike on the hard
   turn-pike
That wipes away your smile,
Nor the socks of sister's that raise
   the blooming blisters
It's the last long mile.

Thanks to http://www.immortalia.com for the lyrics. They have a WWII-era version that is almost word-for-word.

I mentioned it sometime back: this is the time to be careful — to be on guard for sloppiness. So I'm stalling from taking a shot. And I've taken my pills late. Yep, I'm getting sloppy. It's late. Self-discipline. To work. To work.

Ah, shaddup!

2006-10-08T20:47:00.002-07:00

Week Minus Eleven

This is no longer Week 37. I'm now counting backwards. Ten weeks and five days, to be more precise. As I've received the boxes of Interferon I have marked them with the shot numbers. I opened the box marked 37-40 on Friday. It's winding down!

The last couple of weeks the sides have been hitting pretty hard. My hemoglobin count is low and slowly trending downward -- 9.5 month before last, 9.4 this past month. I'm thankful for the fact that I have access to Procrit. I don't think I'd have made it this far through treatment otherwise.

Work has been tough. I've billed between fifty and sixty hours the past couple of weeks. The solution that was sold was not workable. Although some of us raised that flag, no one acknowledged it until the reality was undeniable. I was asked to go to an on-site client meeting. I begged off. I certainly didn't want to be in person trying to make complex decisions after traveling and while fighting the usual Monday brain fog. I dialed into the teleconference. Fortunately, I have the backing of my management.

It's been a strange couple week in terms of rare or odd natural phenomena. I was walking the dog last Sunday night when I saw this fireball.[posted updated to provide a good link]. It was bright despite city lights and high clouds. Others reported that it changed colors. I couldn't see that, but what struck me was that it seemed to slow as it descended. I never saw it burn out -- it went below the level of the trees and houses. I've seen lots of meteors, but this was the brightest and longest I've ever seen. I later learned that it was going away from me, which would account for the slowing.

Then on Friday morning we had a little morning rain with some pretty heavy lightning. I was in that pleasant morning state about 90% asleep vaguely aware of the radio and the thunder outside. My morning doze came to an abrupt halt when it sounded like a grenade had gone off outside my window.

I've heard grenades. I know what they sound like. This sounded exactly like a grenade or something larger. Lightning had struck a tree in the back yard of neighbor just behind and diagonal from my house. The tree was completely destroyed. The neighbor who owned the tree had a section of trunk stuck through a second storey wall. It came through the wall a few inches from their baby's cradle. The neighbor behind me had another five foot section break through a sliding glass door. I had a five foot section of the eight-inch tree trunk in my pool. In the front there were substantial pieces of wood -- a couple of feet or better -- two hundred feet away from the strike. Thankfully, no one was hurt. The only damage at my house was some electrical strangeness. My load controller is apparently fried and one port on my network switch is dead. The load controller is covered by an appliance service contract and the switch is worth about $20. No worries here.

I spoke with a neighbor who was turned away from a blood collection center due to Hep C antibodies. He followed up with his doctor and the virus was undetectable. I told him he needs to buy a lottery ticket. Patients clear the virus on their own in only about fifteen percent of cases.

It's interesting seeing the variety of responses and reactions among the little sample I know personally. There's Bob, Type 2 who cleared it on a 48-week program some five years ago. There's Larry, who relapsed but was apparently not treated aggressively enough. Joe cleared the virus himself. And Ken, Type 1, who relapsed six months after completing treatment.

What that tells me is that nothing is typical about this disease. The only guarantee is the lack of guarantees. As I approach the end of treatment, I have to keep a hard fact in mind: This can come back. But I'm glad to have fought. At least I've pushed the bug back.

Be well.

2006-09-24T22:40:00.000-07:00

Watching the miles tick over

As of this past Friday the countdown is Thirteen Weeks. I found that my prescription plan charges me on a per-prescription basis -- it doesn't matter whether it's a 30-day supply or 90 days. Wish I'd known that earlier. In any case, I received the last three boxes. The unopened boxes are numbered 37-40, 41-44, and 45-48. There is one syringe left in the open box. The end of this business is in sight. On the road to the town where I grew up, there was once a sign that said it was nine miles away. I remember passing that sign and it seemed that the last nine miles was half the trip.

My job has gone nuts. I clocked 50 hours last week and the week before. Between making up for the absence, looming deadlines, and the disturbing realization that the product that was sold is not deliverable without huge changes, the project is getting exciting. Exciting projects are like exciting plane rides. Boredom is much better. I've let the overall project manager know that I'd rather not travel unless there is something very specific to be done that only I can do and only in the faraway city which would justify burning two days worth of travel. In other words, I don't want to travel. At this point, there's little reason for me to climb onto a plane.

I've gone back to the Friday night Interferon schedule. I thought about taking the shot earlier in the day, but couldn't bring myself to mess up a perfectly decent Friday afternoon. This Saturday and last I was able to accomplish a bit -- worked on the car, put up some shelves in Son's room, even a bit of electrical work installing a new outlet (the shelves cover up the old one). But today and last Sunday both I've been moving pretty slow. I had my suspicions, and I found out why on my trip to the doc last Thursday. My hemoglobin count is down again -- around 9.1. I knew it would be low. I can feel it. But, as the doc points out, I'm tolerating the anemia and I'm in the home stretch. No talk of dose reduction.

My friend Bob who went through treatment some five years ago asked me to call another friend of his. Larry finished treatment last year and relapsed. I had mentioned the possibility that statins (anti-cholesterol drugs) might be an alternative. But that's still on the horizon. It turns out he was taking only 1000 miligrams (I'm taking 1200 mg) of ribavirin. When he started breaking out with a skin rash, his doctor reduced the dosage even further. He got himself into Mayo and the liver specialist there said he'd have had him on 1200 mg. daily, and he'd have sent him to a dermatologist for the skin rash. The sides we treat symptomatically; the object is to stay on treatment.

Naturally Larry is weighing options. Treat again? He's over 55. The Mayo doc says he has a 30% chance of developing cirrhosis in 20 years. He has moderate liver damage, this after, in his words, "drowning" his liver in beer for years. He's a construction worker and, again in his words, "That's what construction workers do." He's now a non-drinker. Can his immune system hold the infection off? Or as he gets older will the virus start to move faster?

I had to interrupt our conversation to take a work call, but I'm going to check in with him again. One thing that I'm concerned about is that you can't always count on a disease to give you a nice long linear slide. I remember when my father fought colon cancer he was in decent shape and suddenly took a bad turn. He was dead in a couple of weeks.

I recall when 55 seemed like a terribly advanced age. Now it's only a few years down the road. This mortality thing is really annoying.

Energy and persistence conquer all things.
— Benjamin Franklin

2006-09-08T21:33:00.000-07:00

Back Home -- Chaos, Sweet Chaos

But first, the countdown. I've done two Interferon shots -- Number Thirty-two last Saturday; I stalled Friday night and ended up doing it Saturday morning. And I just opened Box Number Nine and took Shot Number Thirty-three. Fifteen to go. Fifteen.

I got an early flight out of Denver last Friday. Well worth the extra $25. The trip to the airport was far easier than Monday's trip away from it.

The weekend was a blur. All three kids went to a church-sponsored lock-in at a place with about everything a kid could want to do -- rock climbing, go-karts, video games, etc. etc. ad nauseum. Yes, nauseum. They had a "teacup" ride to make themselves sick, which several did. Gosh, I was so sorry that I couldn't chaperone, but you see, I'm on this medication....

Spouse and I made good use of the quiet house. But I had to get up early the next day to deliver a rented van to the church. The kids were pretty wiped which was well. We all did some serious napping on Sunday.

This work week has been nuts. It's a combination of being out of pocket for the previous week and the project plan getting dangerously close to reality. Dangerously because, in the words of the great German strategist von Moltke the Elder, "No battle plan survives contact with the enemy." But in this case, the enemy is baked into the plan. As this plan encounters reality, it starts coming apart at the seams, much as I had predicted when I came to the project. The gap between what we do and what we learned in the class last week.

Despite the gathering air of panic, I bailed out of work early yesterday afternoon to ride with a couple of other dads to the big football game. It's a 3+ hour drive. Our guys won. Son was playing defense as an outside linebacker and picked up a fumble. He tiptoed fifteen yards down the sideline before getting pushed out of bounds (followed by a late hit after the whistle, but that went unnoticed by the officials -- that's football). We finally got home at 1:30 AM. I skipped my usual sleep aid (Elavil, aka amitriptyline) and slept just fine. Up this morning at a little before 7:00 and on wall-to-wall conference calls that actually required participation. Now I'm waiting up for kids. It's 11:20 PM. I think I'll wait up on the couch.

To all who are fighting this and more difficult challenges:

Go for the swine with a blithe heart.
William Churchill

2006-08-30T20:39:00.000-07:00

Sitting In A Hotel In The Denver Area

The trip up here was interesting. I much prefer that my trips be boring. I want the excitement to be once I arrive. The Blue Van showed up at 6:00. I got up at 5:15. As I've mentioned, that's far from standard behavior for me. My flight was at 9:00 which left plenty of time to clear security.

I had decided to throw my heat-sensitive meds (two Neupogen syringes, plus a vial of Procrit and a syringe) into my checked baggage. The gel pack to keep them cold probably wouldn't have made it through security. Besides, I really didn't feel like explaining my medical issues to TSA. I was glad not to be in a rush when I set off the metal detector twice. Two strikes and you're out with TSA. I get pulled out and wanded. I was wearing "carpenter" shorts with a side pocket where I carry a cell phone. I completely forgot that. And I had stuck a pack of gum in my hip pocket. It was a plastic blister pack over a sheet of foil, so naturally that kicked the thing off. At one time I travelled twice a month in my job and could breeze through security. But that was before September 11, 2001. I finally get through Security and head to the gate. Plenty of time -- grab a coffee and a muffin, plenty of time.

The flight itself was boring -- as airline flights should be. It was when I got on the ground that things started to get more interesting. The last time I flew into Denver was more than ten years ago. I flew into Stapleton airport, which was in northeast Denver. The new Denver International Airport is located some fifty miles south and east of Denver. Everyone I know from Denver will quickly point out that Federico Peña, former Denver Mayor and later Transportation Secretary under Clinton, just happened to own much of the land that the airport now occupies. I'm sure there was no taint of corruption. He was, after all, a Public Official.

Anyway, the airport being so far from Denver proper, and especially so for me since I was going to the far northeast of the Denver metro area, I had to make a drive. No worries, I have a map and directions from maps.google.com. Let me give you a hint about maps and directions. It helps to read them before setting off on a drive in a strange rental car in a strange city. It took me three hours to get to where I was going (plus an hour for lunch). Next time I come up here, I'm flying the night before. I finally caught up with my team at a local brew pub. Sadly, I couldn't touch any of their very tasty-looking wares. Hopefully I'll have an opportunity next year. No beer for Chris until I have offically achieved SVR. Shed a tear and hoist a glass of club soda.

The class that formed the pretext for this gathering started on Tuesday. It's pretty challenging. The brain fog is not helping, although that seems better since Tuesday. Things were tough then as well. I didn't do myself any favors when I awoke suddenly. I had not heard the alarm clock. I reached over and dragged it to where I could see it. I wear a nasty optical prescription -- I can literally light cigarettes with my glasses, which were not on the bedside table. So I had to look pretty close at the clock. It said 6:45. I had set it to go off at 6:30. I jumped up, started the coffeepot, and climbed into the shower. When I got out and with my glasses on my head, I turned on the TV. It was just coming up on 5:00 AM. I had changed the hour when I reached across the bed. Needless to say, the afternoon was pretty rough. I spent much of the last two hours of the class standing at the back and furiously taking notes -- an old Army trick.

Speaking of the Army, Here's a closing note:

You must be single minded. Drive for the one thing on which you have decided.
General George Smith Patton

2006-08-27T19:03:00.000-07:00

Countdown -- Shot Thirty-one: Seventeen to go!

I took Shot 31 on Friday morning rather than the evening as I usually do. I have to travel on business this week and wanted to minimize the residual side effects I typically feel on Monday. I didn't notice much in the way of side effects after I took the shot other than a mild headache. I got to bed by 11:00 (early for me, I have a bad habit of staying up too late). I knew it was going to be a rough morning when I had to get up and take Son to football practice at 5:30 AM. My head was ringing. I got up, made sure he was moving, and drank some juice while he got ready. No coffee, I wanted to get some more sleep. Got to get the bicycle fixed! I went back to bed and slept nearly four more hours hoping that the hangover would go away. It didn't. When I got up I was as headachy and dehydrated as I'd been at 5:30. Breakfast, ibuprofen, and many cups of coffee later I was beginning to feel human. Several chores, but nothing heavy. Nonetheless, when I finished them I felt like I'd done something.

As post-shot sides go, this week wasn't bad. I'm going to shift to Friday mornings on a regular basis. I don't recommend it for someone new to treatment, but once it all blurs together into one big blah, it might be a way to get a few more useful hours.

I've been having problems with congestion which is exacerbated by the dehydration. I've been hacking and coughing and hawking up horrible things. Older Daughter asked if I had a hairball the other day. Close to it. One of my net.friends suggested goat's milk as it has less lactose than cow's milk. I decided to pass on that. When travelling in Northern Arizona many years ago I had breakfast at a cafe on the Navajo Reservation. I ordered a glass of milk along with my pancakes. The milk tasted fine -- until I exhaled. Then this musky flavor that I can only describe as goatish followed. I drank it, but I haven't touched it since. Instead, I tried soy milk. There's a brand called "Silk" which I'd had before. It's not bad. What I'm noticing is that I have much less congestion. My singing daughters reaction: "Duh! Why do you think we can't have dairy before a concert?" I'd always thought it was just at tale told by control-freak choir directors.

Son update

He came home all jazzed last week. They've made him a starting running back. For those who don't follow American football, that's one of the guys who stands behind the line and either carries the ball or protects the quarterback if he's throwing. Either way, he's a target. His mother was especially thrilled to hear it. His arm is mending, but still weak. He's wearing a brace and taping it. That isn't helping his ball handling. He caught a pass last week and jammed a pinky finger. Might be broken. The treatment for a broken finger is exactly the same as a sprained finger. More tape. The universal cure. He's spending a few days of practice running.

The blue van is coming tomorrow at 6:00 AM. It's going to be a long week. A class and meetings. My work has been great about not pressing me to travel, this in a job that could easily be 50 percent travel. I reckon it's time to pay the piper. Besides, I need the class and, I need to meet these people I've been working with for more than a year.

One of my blogger-heroes Hep C Boy alway signs off with something inspirational. I'm not feeling inspired at the moment. Need to work on that.

2006-08-18T13:41:00.000-07:00

Shot Number 30 Down!

Eighteen to go. This is feeling more and more like a countdown.

I got a call from Doc on Friday. He had the results of past week's blood test. I'm still in the same borderline low range I was in last week. His suggestion is to gut it out. If he thinks I can, I guess I better gut it out. I raised so much blasphemy over being off treatment I'd rather not reduce the dose. But I have to confess I'm mightily tempted to take two Ribas rather than three tonight.

I missed my Neupogen shot Thursday -- got busy with work. I was on back-to-back phone calls from 5:00 AM until 1:00 PM (The joys of living on Western time while working with folks on Eastern and UK time). It wasn't quite as bad as it sounds. About half of it I didn't have to be completely engaged, but some of it did get pretty intense. Since I was shifting shot times, I decided to put off the Interferon until Saturday night. I had a bunch of house chores stacked up -- a lawn irrigation system that was acting up, my son's room taken apart for a new bed and shelving, but only partially put back together.

The biggest obstacle was the shelves. We took a ride down to the other side of town -- 25 miles -- to the Ikea store. What a nightmare! It was like Disneyland. I hate being herded and Ikea on a Saturday afternoon is all about the herd experience. I felt like all my nerve endings were sitting on top of my skin.

A Miracle Healing

No time for sides today. My son woke up dreaming of somebody shooting him with a watergun. Turns out his ceiling fan had water dripping off of it. The girls' bathroom is above his room. Uh-oh. Check it. The floor was wet around the toilet. Good! The fresh water supply line was wet. At least we don't have a sewer leak! I turned off the water to the toilet and dried the floor. Get everyone up, go to church. Home from church and turned the water back on in the girls' bathroom. No leak. It got well! It's been healed! I still don't know whether someone spilled something or if there's an intermittent leak.

We'd been talking about replacing Son's ceiling fan and light, so he and I went over to the local Home Depot and found a fan. It's not bad installing a fan if there's already one properly installed. I swapped it out without much trouble, but then the thing wouldn't turn. Bad motor. Home Depot exchanged it. The new one is pretty noisy, but it's a $50 fan. We'll see if it doesn't quiet down.

The Roach

Finally, after all the fun, I'm settled down on the couch with the wife. Older daughter was in the kitchen and suddenly let out a shriek. She ran into the family room and dived into the middle of her daddy who is, of course, here to protect her.

A few weeks ago Younger Daughter's kitten brought a two-inch roach into the house -- a playmate for the lonely times of the day. I nearly caught it, but it proved too fast. The Roach made several subsequent appearances, always for the benefit of the females in the house. Since the light was always poor, I'd begun to question whether they were actually seeing a roach. But there was no mistaking this time. Like Brawny Man, I grabbed a paper towel and girded myself for battle. Sure enough, there it was beneath a low trivet on the counter. Mr. Roach wasn't quite so fast this time. I got him in the towel and gave him a good squish.

Now, my wife is nearly as phobic of six-legged varmints as her daughter. But she wanted to identify the body. I opened the towel so she could see. You've seen the horror movie where the bad guy just won't stay dead? You got it -- Mr. Roach jumped out of the towel, leaving some of his guts behind. Fortunately, he didn't get far, else I'd still be roach hunting.

To bed. Seven o'clock call, plus I'm liable to be feeling the usual Sunday sides tomorrow.

2006-08-13T15:18:00.000-07:00

Anemic Again!

Saw the doc on Friday. My HBC is 9.5, right at the borderline of when he took me off treatment back in May. This despite a weekly Procrit injection. I'm going in for another blood work-up this week. Based on how I'm feeling, I suspect it's lower. I now attribute the insomnia to anemia. And the cough. And the congestion. And the constant headache. It's a package deal. Once again, having a number and a name to hang on the way I feel causes me to feel even worse. Or at least like I shouldn't fight it.

On the bright side, the WBC, platelets, and liver panels are all in the normal range. I haven't had a viral load test since starting treatment. The doc has mentioned it, but he doesn't seem in a rush -- something I've both liked and disliked about this doctor. He told me he didn't like to give a 12 week check because some insurance companies refuse to pay for treatment if there has not been a log-2 drop in the virus. And he says that if I'm not undetectable at 24 weeks, I'm off treatment. Well, we're past that. I meant to ask him about it a viral load test at this last visit, but spaced it out. Honestly, I'm not that worried about it right now. He tells me that the consistently good liver enzyme numbers are a good indication. And he operates on the theory that more treatment is better than less, even if someone turns out to be a non-responder or relapser. The more we can slap the virus around, the better.

I took Shot Twenty-Nine yesterday. Nineteen to go. I usually do it on Friday night, but lately seem to be delaying to Saturday during the day. I no longer notice immediate side-effects and I don't like doing the injection at bedtime. Poking myself with a needle is just not the way I like to prepare my mind for sleep.

I saw a recent picture of myself and I was shocked. I've aged ten years. My hair is thinning and my skin is pale and saggy. I have deep-set eyes anyway, but I now stare out of thse hollow sockets. According to everyone who's been through this, the effects go away. People are going to think I've discovered a fountain of youth.

2006-08-10T23:14:00.000-07:00

more insomnia...

But first the countdown... I took injection number 28 last Friday. Twenty to go. It is now indeed a countdown. I'm tired, but can't sleep, foggy, grumpy, can't stick with a task for more than 20 minutes at a time. But I'm counting down. Tomorrow night it will be nineteen to go. I spell out the countdown numers. It feels good. I'm being weird...

The past couple of weeks I've had a tough time sleeping. The pattern is I go to bed at a reasonable hour and end up tossing and turning. Fortunately, my wife has been put on a nightly med that knocks her out, else I'd be hearing about it. When I finally get to sleep, I waken myself with my thrashing. From there it's weird. One night I bedded down on the couch. Another night I slept for three hours on the floor. The next day I'm so tired that I drag all day. If I sleep more than an hour, I won't go to sleep at night.

I did skip my Elavil one night because I failed to renew the scrip (see previous post. Got it the next day, but I wonder if I haven't developed some resistance. I'm only taking 10 mg. It may be time to boost the dose. I'll see the doc tomorrow.

I've been having a lot of congestion in my upper chest -- it's a constant "harumph" and a lot of thick junk. If you're reading this, you must be into this sort of thing. See the first paragraph of the first post of this blog. I'm taking Robitussin expectorant (guaifenesin) to try to thin it out. I'm also having a nasty cough now and then. Yesterday I felt my chest going into bronchial spasms. I recognize it from having a case of bronchitis years ago. That spasm feels like something in your throat but it's not. It's the bronchial tubes going into spasms. It's happened once before since I started this mess. Luckily, we had an Albuterol inhaler left over from an allergy problem my daughter had last year. It was still in date, but I confess I didn't look at the time. One hit set me right.

Home life is busy but seems to swirl past me. My wife is having a tough time at work which seems to have set her off balance. Over the past few months she's started having crying jags. She knew something was wrong and went to the doc who gave her some anti-depressants (and a follow-up appointment). We'd talked about that before. She's not entirely comfortable taking them, but it seems to be doing her some good. She has settled down and says she's more relaxed, but foggy.

The doc doesn't see this as being a long-term issue, it's just a reaction to her situation that seems to have gone over the top. As the doc said, "Step back and look at yourself from another person's viewpoint." With everything that's happened over the past couple of years -- a death and a couple of illnesses in the family, a persistent squabble between two members of her family that doesn't involve her directly, but certainly affects her, my illness and treatment, etc. etc. etc. It adds up.

Meanwhile, the kids are getting ready for school, Son's arm is out of the cast and football practice has started, Daughter 1 and 2 are all off in their things. Daughter 1 in particular had a shock this past week. A friend of hers from school died hiking in the mountains with his brother. I try to be there for her in my clumsy way. It's tough. Both of the older two knew the kid. I'm encouraging them to go to the memorial service -- kids will tend to skip such things if they can. But they need to show support for the family. Way too much reality, that. Sort of puts my little ailment in perspective. My kids are here, healthy, and even speak with me now and then.

Meanwhile, my wife and I bury ourselves in 24. We got hooked on the series last year and have been renting the DVDs. The previous season is the most implausible, convoluted, ridiculous, video game, comic book of a television show I have ever seen in my life. In other words, it's fun. I never knew that L.A. was the center of so much terrorist activity. Oh, and if you're ever following a terrorist and he stops for gas, but you need to delay him while your techie buddy positions a satellite to cover him through the canyons, the best method is to hold up the gas station. If it's good enough for Jack Bauer, it's good enough for me.

I heard they're making a movie version of 24. It will be real time like the TV show, but in order to make it short enough for a movie, they'll just have everybody do what Jack Bauer tells them to. It will be called 2.

Nearly midnight. I think I've bleated here for long enough.

2006-08-03T01:08:00.000-07:00

Insomnia

It's after 1:00 AM and I'm here blogging. My own fault. I let my Amitriptyline prescription run out. I didn't know how much it was helping! I thought I might have trouble sleeping and so had taken a couple of Benadryl tabs. The stuff usually knocks me out cold. It isn't touching me tonight. I can't leave my legs still and I'm constantly tossing and turning. Picking up the new scrip tomorrow.

The past couple of weeks have been pretty good. We were rid of the older kids -- they were off on a church trip -- and the youngest had friends to stay with, so we snuck up to Flagstaff for the weekend. It got us out of the heat. The oldest wants to go to school there at NAU. She was up there a few weeks ago. There are worse places.

The past few days I've been getting lots of sides. I'm tired, grumpy, listless, etc. And the little sores have reappeared at the corrners of my mouth. I also suspect I'm a little anemic. I'm getting the sound of blood rushing in my ears, and my heart is running around 90 at rest. I'm still taking Procrit and Neupogen, which boost red and white blood counts respectively. I really hope I don't have to up the dosage. I hate sticking myself.

Past 1:30. Maybe I can sleep now.

2006-07-23T13:02:00.000-07:00

Shot 26, Week 28

I'm just past the halfway point. I've got a picture of being on a long drive through desolate country; I'm thinking I-40 east of Flagstaff and into New Mexico, or maybe east out of Albuquerque into the Texas Panhandle. The novelty of being on the highway is past, the scenery never seems to change, and you just can't get there fast enough. This is the time to suck it up and do what needs doing, but also to pay attention because it's a time that mistakes creep in. In my case, that means missing meds, not paying attention to changes or new symptoms, or letting relationships dry up.

Speaking of which, my wife is going through a rough patch emotionally. She wonders if she isn't depressed. There's a lot of change and uncertainty in her job and in life. She frankly doesn't deal well with uncertainty at all. She's kind of a control freak and gets uncomfortable when she can't affect an outcome. There's been a lot of other stuff going on as well, and we can't control any of it. Despite all that there's reason to be thankful -- we're all reasonably healthy and whole -- but the past couple of years have been a bumpy ride and I think it's taking its toll on her.

I'm trying to be more supportive. She pointed out a few days ago that I seem to be able to "put on a show" for other people in a social situation, but when it's just us I seem to collapse. This afternoon she really opened up on the possibility of depression. For the past few weeks she's constantly near tears and seems to be getting no joy from life. I think it helped her just to talk. And I think she'll be doing better just for deciding to do something. She'll be calling the doc this week. Something is definitely off-kilter.

We're going to Flagstaff next weekend -- we just need to get out of the desert heat. Temps have hit 118°F/48°C recently which certainly isn't doing anything for her mood.

The road goes on forever.

2006-07-07T23:37:00.000-07:00

Week 26, Shot 24

Wow! I haven't been here in a while. It's been a busy three weeks, but nothing much appropriate for this. Just life. Kids back from camp, extra kids (my nieces) here for an extra week, son to the bone doc a couple of times (he's doing fine -- in a cast to just below the elbow). That followed by a short interlude of comparative normalcy, then a Fourth of July weekend run to California. It's a six-hour drive to the LA area where my in-laws live. I drove there and back. I didn't do a lot in between. We had the usual celebrations and fireworks.

Back home, I'm wiped. I took the rest of the week off and I'm finding I need the rest. Yet I went to bed late last night because I didn't feel like I could get to sleep. I awoke this morning about as tired as when I went to bed.

Today I ran some errands and did some maintenance work at a rental property I manage. By the time I got back I was pretty wiped, yet couldn't sleep when I crashed on the couch. Oh well. This is how I feel. Not bad, just tired and kind of grumpy.

This evening we went over to some church friends' house. Bratwurst on the grill, too much ice cream, the usual. Nice evening. My wife says I can put on a good show. But toward the end of the evening I must have been looking woozy because my host asked if I was okay. Just wrung out.

Now I have to go take shot 24. This is the halfway point. Nothing to do but keep going.

I'm stalling. To bed, but first the shot.

2006-06-17T17:23:00.000-07:00

Interferon Shot 20, Week 22

First, Son's status report. We got into the doc on Monday afternoon. He declared it a Salter Type 2 fracture. There is some growth plate involvement, but chances of a full recovery without complications are excellent. They brought him in the following day to have it reduced further; the emergency room doc had been able to get it close to the right spot, but stressed that it needed further attention. Son now has a splint -- two plaster half-shells wrapped in an Ace bandage. He'll get a regular cast next week. I'm tempted to pay the extra expense for a waterproof cast with a Goretex lining. He'll still be working out for football and the sweat will be pretty intense. It'll be worth that to save the smell, not to mention the whining/whinging (I love the UK version of that word!).

So, son was able make it to church camp, which assuaged some of the bitterness for him. somebody else was going up late and he got a ride. They all got back today tired, sunburned, and apalled at the heat. A week at 7,000 feet/2,133 meters altitude will do that. He and Young Friend from the ER trip are now settled in front of a movie.

I took the last out-of-sequence IFN shot this morning. Next week, I'll be back on my Interferon Friday schedule. I'm now taking five shots per week:

Tuesday: Neupogen

Wednesday: Procrit

Thursday: Neupogen

Friday: Interferon

Saturday: Neupogen

With near-daily shots, I'm having to keep track of where I've poked recently. This is a hassle, but I feel so much better! The only real side effect I'm feeling is a bit of fatigue, the funny taste, and some achiness.

My wife's car had a problem today -- the alternator went out. We have extra kids here and we really need that car. I did it myself to just get it done, and to save the couple hundred bucks that taking it to the mechanic would cost. It took about an hour and everything went smoothly. I guess I'm not suffering too many sides. Last month I wouldn't have even attempted it. I doubt I'd have had enough strength to loosen the bolts!

2006-06-11T21:03:00.000-07:00

Every Day A New Adventure!

My wife and older daughter went to California for a niece's high school graduation party. That left me at home with my son (14) and daughter (12). I had everything lined out. Son was going to a football day camp Friday evening, Daughter went to her friend's house to spend the night, and I went over to friends' house for a boys' night where we planned to do manly stuff like eat brisket and watch war movies. I'd just settled down to my first sandwich and The Great Escape was all queued up when my cell phone rang. It's coach. My son broke his arm. He's on his way to the emergency room.

Friend's son is also good friends with my son and he wanted to go, so we headed out. It was an ER in a college town on a Friday night. Do the math. At least school isn't in session. It took us 25 minutes to drive across town. Son and the coach had arrived about 15 minutes before us. He was in a fair amount of pain. Looking at the X-ray, it's obvious why. This is the view before they set it.

We waited for an hour in the waiting room before they got us in to see a triage nurse. Then it was another hour in a back room waiting for the doc. They had to put him out in order to set the bone. That was another hour. Finally they started an IV and dripped some get-high drugs into him. He enjoyed it way too much. And he spilled his guts to me, which was interesting, and a fair relief -- no earth-shattering revelations. It led me to wonder why we have all the ruckus in Iraq over harsh questioning. Load 'em up with this stuff and have a pleasant chat.

It took another hour for him to come down from the drugs enough to walk out. He was feeling a bit woozy with a hangover, so they gave him a basin. By that time it was approaching midnight. We drove back to Friend's house and let Son walk around. They were still up, fortunately. The basin came in handy. Friend's wife is like a second mother to Son (as my wife is to Young Friend), so she kindly held the bucket when the hangover caught up with him.

Did I mention that I'm on hepatitis C treatment? By this time I'm getting tired. Home to bed. Pain meds for Son, ribavirin and Elavil for me. Tomorrow I'm on the phone trying to find a pediatric ortho. If I don't have an appointment lined up by noon, we're going to the ER of Phoenix Children's.

But tonight, I have to take a hit of interferon. Oh, by the way, I have to be on a call at 6:00 AM. Good night!

2006-06-09T13:12:00.000-07:00

So Far So Good

Had an appointment with the Doc today. He had the results from my latest blood test. The blood boosters seem to be doing their thing. My RBC count is over 15 (low normal), WBC is at 18,000 (also on the low end of normal). I've seen no unpleasant side-effects from the Procrit. The itching I reported when I first started seems to have subsided. I do have some joint pain especially in my knees, plus inside the top of my pelvis and in my forearms. That's consistent with the Neupogen's side-effects. It's an annoyance, but no worse than soreness from a hard workout at the gym, just strangely located inside my bones, rather than in my muscles.

Meanwhile, the bug seems to be at bay. ALT and AST (liver enzymes) are both in the 25 - 27 range, well within the normal range. No abdominal swelling or discomfort.

Meanwhile, the side-effects from the meds are apparent, but comparatively mild. I'm getting those annoying little cracks on the corners of my mouth and my detractors scurrilously allege that I'm irritable. But my detractors allege that about me anyway. Really, I don't think I'm any more irritable than most folks when the temps are in the 106° F/41° C range. I've found it easy to vent most of my irritation while driving. I've given up yelling, I just enjoy the surge of adrenalin the clench of my jaw.

With that in mind, I present:

Rules of driving in Phoenix summers:

Assume the other driver is armed.
Many of us are.... Which may explain why "Road Rage" incidents are relatively rare in Phoenx, or are at least short.

A car with the windows rolled down has the right of way
It's obvious that the air conditioner is broken. See Rule 1 above.

It is permissible to wait for a red light under an overpass as long as said waiting occurs reasonably close to said red light.
"Reasonably close" means within sight. Unless the waiting car has its windows rolled down, in which case the car may wait under any underpass for any red light. See Rule 2 above. And never forget Rule 1.

During the month of May northbound HOV (High-Occupancy Vehicle) lanes are reserved for motor homes and fifth-wheel trailers with Northern plates.
Stay out of their way, they left late for reasons beyond their control and just want to get home before it gets above 105.

Premium Parking is any spot with shade within a half-mile of a business or establishment.
Avoid arguments or confrontations over Premium Parking (see Rule 1).

After 2:00 PM, he spot immediately east of a Hummer is Premium Parking.
The acres of sheet metal provide very tolerable shade from the afternoon sun.

It is forbidden to immmobilize a Hummer in order to obtain Extended Premium Parking.
It is also unwise. See Rule 1 above.

2006-06-05T22:56:00.000-07:00

Second Week Back In The Saddle

Took interferon Shot Number 19 today. The shot was uneventful. It's six days since my last -- I want to get back on a Friday nigh shot night schedule. Ifx and a cc of Neupogen for good measure. Thanks to the break and some apallingly expensive drugs, I'm also back on the full dose of ribavirin. I took my evening pills, along with my weird anti-depressant (Elavil) that is supposed to help me sleep. It seemed to work pretty well on the earlier go-round, but for the past few nights I've found myself awake between 0200 and 0300. I'm fidgety.

I was Being Encouraging in one of the forums about how glad I am to be back on treatment -- a guy with 4 weeks to go was getting really down.

"I'm back on treatment and have now learned to appreciate the headache, the heartburn, the weird sleeping patterns, the falling hair, the grumpy moods, all of it. It means that I'm fighting which beats hell out of waiting and seeing. That's how I feel now, the first week back, I wrote, Helpfully.

Obviously the meds hadn't fully kicked in yet.

"I'm sure I'll be as whiny as usual in a couple of weeks," adding my disclaimer like the fine print on a car add. I can tell it's on the way.

Best go to bed.

2006-06-02T18:44:00.000-07:00

Back On A Full Dose

The doc called out of the blue this afternoon with the results of my Wednesday bloodwork. I didn't have anything to write on, but both RBC and WBC counts are in the low-normal range. I believe 12 and 1800, but I really don't recall. He also gave me my ALT and AST numbers which were both in the twenties, I believe, but again in a very normal range. I didn't ask, but will ask at my next appointment whether the good liver panel readings might be circumstantial evidence that the virus is at bay. They've been normal since I started treatment. That the ALT/AST numbers didn't jump during the break is encouraging. How encouraging, I can only wonder.

Bottom line -- I'm back on 6 Riba tabs a day, will take Shot 19 this Sunday, six days after my re-start shot this past Tuesday. By next week I should be back on the Friday night jab routine -- along with Monday, Wednesday, and Friday night jabs for Neupogen and a weekly Wednesday night Procrit thing. I feel like a damned pincushion. I'm having to survey injection sites. "Let's see, when did I last punch the left side of my spare tire..." Actually, I'm kind of scrawny. There's not much spare tire to punch.

2006-05-30T23:23:00.000-07:00

Latest Bloodwork Results -- Back On Treatment!

Doc called this afternoon (following a call from me). My HGH count is above 10 and the WBC is, I believe 1500. He put me back on. I'm to start with a reduced Ribavirin dose, but the Interferon is the full load (consistent with what I've been reading about fixed dosing of Interferon vs. reduced dose -- the fixed dose party seems to be winning that argument).

We did have a conversation about my concerns. I said to him (in essence) that I trust his judgment and have been following instructions to the letter. But I also read and question. I work in a very fast-moving field and it's not unusual at all for developments to pass me by. I can certainly understand that this is also a very narrow and fast-moving field. He didn't say anything legible, but made agreeable noises. Certainly nothing that would look bad on a deposition. That's another downside of American medicine (outside of the issues of who gets insured and how, a topic I refuse to be drawn into) -- everybody's got a lawyer.

Honestly, I do trust this guy -- he comes too highly recommended to write off. And, to his credit, I notice that he took action consistent with what I'm reading in current literature. In other words, it appears that he's done some reading and possibly some outside consulting. Which is what I was looking for to begin with.

I asked about how the gap in treatment might affect me. He points out that I've been off for less than three weeks and pointed out the slow-moving nature of the bug. Over a 48 week course, it should make little difference. I hope he's right (but meanwhile, we're taking measures to keep me on treatment).

I'm back in full-force. The shot I took tonight replaces last Friday, and he wants me to do it again on Saturday or Sunday, then move back to my usual Friday routine. Meanwhile, I'm to continue the Procrit and Neupogen and get my blood monitored weekly. After next week, he said I would probably go to a full dose of Ribavirin.

I'm the definition of mixed emotions. I have come out of the cloud enough to realize how crummy I felt and I've been kicking and screaming to get back in. Damned whiny Interferon patients! No satisfying them!

I'll need to find a suitable quotation regarding mixed emotions, but it's too late to go trolling the Internet. In any case, back on track. I've already got the lead-like Interferon taste in my mouth. To bed before this stuff comes on stronger!

2006-05-28T22:23:00.000-07:00

On Procrit and Neupogen, Still Off Treatment

The Procrit is a once-a-week shot, the Neupogen is three-per-week. I started them on Wednesday (May 24) and took the second Neupogen Saturday. This has all been a learning process. I had a notion that my blood levels would bounce back quickly after getting off tx and on the blood boosters. Wrong! It takes a while for the numbers to come back.

From the Procrit prescribing information:

Because of the length of time required for erythropoiesis – several days for erythroid progenitors to mature and be released into the circulation – a clinically significant increase in hematocrit is usually not observed in less than 2 weeks and may require up to 6 weeks in some patients.

The Neupogen insert was considerably less willing to set expectations about how long it could take to raise WBC counts. But I doubt it's an overnight effect.

Anyway, I'm still circling the airport.

I'm noticing some mild side-effects from the drugs. Fortunately, no dashing to the bathroom. I have some fatigure, mild achiness, and some mild to moderate itching, mostly on my scalp and back. If I were on treatment, I doubt I'd even notice it.

Meanwhile, I think I've succeeded in pissing off my estimable gastroenterologist. My GP contacted his office saying that I had questsion. The note that came back was that we've already talked and the treatment plan is set. Hmmm.

The thing is, I trust his judgment. His reputation is sterling. My question was whether he was operating on current information. I suspect that's been resolved -- he did prescribe the blood boosters. But the downside is that the damage is done and now I'm having to recover before starting up again. At no point have I seriously considered going back on treatment of my own accord. I've got too much personal experience with these drugs to treat them lightly. No way am I going to take them blindly without medical monitoring.

I have an appointment for a second opinion in mid-June. That's a week after my next scheduled appointment, and I do expect to get back on the treatment before then. Until then, I wait, albeit grumpily.

2006-05-25T09:37:00.000-07:00

Got The Goods!

I picked up my Procrit and Neupogen and took them last night. Both are packaged in single-dose vials and you have to fill a syringe -- a first for me. The pre-filled interferon syringes are so much better! Not only are they handier (getting that last mililiter into the syringe is a bear!), I swear they're sharper. Perhaps pushing through the rubber stopper dulls it just a bit. Anyway, I have to do the Neupogen 3x a week and the Procrit once a week. I hate needles! But the interferon has been pretty good training. I awoke with a headache, but haven't noticed anything else I'd consider a side-effect. I've been warned about diarrhea and bone pain. Another plus for working from home!

I was shocked at the cost of these drugs -- around US$3000 for each! Next time I move around some investment money (not that there's a lot of it), I'm going to pick up some pharma stocks. Fortunately I have good insurance. Lord knows that over the years I've paid enough into the system. And keeping me on treatment will hopefully save the expense and trouble of dealing with complications!

I talked with my general practitioner last night. He believes I'm raising legitimate questions and is going to talk with the GE. The GE that I'm seeing is a doctor's doctor. My GP sends his own family to this guy for colonoscopies and such. In any case I expect to talk further and may get a referral for a consult.

Meanwhile I've been off tx for 12 days. I'm not happy about that, however some current papers I've seen in www.hivandhepatitis.com suggest that I'm still a good candidate to clear the virus due to the fact that I started treatment with low liver damage (some inflamation, mild scarring, no cirrhosis), and that I have genotype 4 rather than 1.

Now to get back on the horse!

2006-05-21T12:01:00.000-07:00

Got Prescriptions For Procrit & Neupogen

There are still insurance hoops to go through, but they should be ready by Monday (tomorrow). The doctor says my white blood cell count is at 1500 and red blood count is at 9 and that he did not want me going back on treatment yet. He wants me to have another blood test on Thursday and then go back on assuming positive results. The trouble is, that means I'll be off the program for over two weeks by the time I get the results. Based on this article, I might be able to start back with support from "growth factors" with my numbers at the current levels. The article says, "Neutropenia is generally defined in many trials as an absolute neutrophil count of less than 750." I don't know whether the number being thrown at me is the "absolute neutriphil count," but mine was 1500 last Wednesday. He's saying he wants it at 2500. We'll talk about it.

When I first broached the subject of Procrit and/or Neupogen, the doctor's response was "I don't prescribe those drugs." At the time I had been reading in Ron Metcalfe's page and on the Hepatitis C Association page that the use of those drugs is close to routine. I suggested to him that it did not seem to be unusual and that maybe he could consult with someone because my priority is to stay on the treatment. He called me later during the day and said that he'd talked with a hemotologist and that I could pick up scrips for both drugs. He has submitted paperwork for the pre-authorization process and I've dropped off the scrips at the local pharmacy so they can order them. These are pretty expensive drugs, but dammit, they're cheaper than cancer treatments or a liver transplant.

What this boils down to is that I will be agitating to resume treatment on Monday. I am also shopping for another doctor, if only to consult with my current one and get him educated. Meanwhile, it looks to me like my chances for sustained remission may have been reduced. Fortunately, this interruption comes at Week 17. At least I'm into the treatment. Here's what the article says:

Today’s Standard of Care

Recently the importance of adherence throughout therapy was studied with regards to its affect on SVR. Maintaining the optimal dose of both interferon and ribavirin is particularly critical in the first 12 to 20 weeks of therapy. One factor that determines adherence is the quality of life of patients during therapy. Another important determinant of adherence is the ability to manage the side effects of therapy including hematologic management.

The lessons to be learned here are important. The most important is that, as a patient, I'm responsible for my own care. If that means I have to drag my care advisor into the Twenty-First Century, so be it. I suspect my doctor has gotten comfortable in his practice and has not stayed current with the literature in this fast-moving field. I'd love to change docs and I may do that anyway, but it took me a month to get in to see this guy to start treatment. That's not an unusual wait to see any specialist as a new patient outside of an emergency setting.

I'm sorely tempted to start treatment myself, however I'm thinking of consequences. If I treat myself against medical advice (nevermind, that I think it's ill-advised), my doctor could easily say that he can't work with me and then I'm on my own. I have a three-week supply of meds. Then what? As I mentioned, it's not unusual for appointments with this sort of specialist to take a month or more. Again, I'm better off educating the doc.

It's been interesting to see myself come out of the ifx/riba haze and realize that I really want to be back in it. I'm feeling about 80% normal now. I'm certainly thinking more clearly than I was on tx, but I want to go back.

With luck, I get the blood boosters AND take the ifx shot and the riba tabs.

2006-05-16T10:03:00.000-07:00

The Doc Called This Morning

I asked about the possibility of using Procrit or other hemoglobin boosters. He said that his concern is the fact that in addition to the low HGH count, my white blood count has dropped sharply (from 3000 to 1000 in a month). It's the combination that he's concerned about. I'm looking around on the Web for instances of people using both Neupogen and Procrit. If anyone here has experience with both drugs in combination, I'd like to hear about it.

I asked him what the break in treatment will do to my chances of SVR. He said he didn't know. I stressed to him that I don't want to be fighting this thing for the rest of my life and that my priority is to complete treatment.

I will be doing a CBC test to check all blood levels tomorrow. Hopefully I'll be built up enough to get back on the horse. Meanwhile, I'm going to call my college buddy who is now an internist and get his thoughts on using both Neupogen and Procrit (or a similar combination).

Fighting on.

2006-05-12T12:10:00.000-07:00

More Anemia

Just got back from doc. My HGH level is 8 and my white blood count is 1000 (normal is about 15 and 5000). He wants me to take a break for a week. No interferon tonight, no riba through next week. He wants me to build back up before resuming tx, possibly with a reduced dose (I'm presently taking 1200 miligrams, 6 tabs per day) and I'm pretty small, 5'-6" and 145 pounds. I've seen other people's dosages in the boards and I seem to be taking a pretty large dose. He also bugged me to stay out of the gym, saying I could go over the edge without realizing it. [Grumble] Never had a doc tell me to get less exercise.

I asked him about the risk of letting the virus adapt and he said that the meds will stay in my system for several weeks, so I'm still fighting the virus even skipping a week. Right now he's more concerned about the blood levels. Procrit is a possibility, but he wants me to take a break first. My friend Ken took it and felt much better, but the sides from that were also pretty bothersome -- diarrhea, headache. Everything has a price.

The grind grinds on.

2006-05-11T11:46:00.000-07:00

Late Week 17 Check-In

I've been spending some time on a couple of support boards. I recommend them both. One, http://hepcassoc.org/messbrd/ is kind of U.S.-centric, but with a fair amount of Canadians. The other, http://www.ronmetcalfe.com/hepcforum/, is hosted out of the U.K. There is a good deal of overlap between the boards. I found that Carol, who raised concerns about my earlier misunderstanding of my treatment plan, is Mrs. Ron of ronmetcalfe.com. So this is a pretty tight-knit little club.

Another blog I've been reading lately is http://www.hepcboy.com/. Another Englishman. He's been kind enough to post a comment or two here. I really like his British stiff upper lip. The best bit of wisdom I've picked up there regards self-discipline. "Be your own tyrant!" He's facing some challenges with his treatment, but doing it with good humo[u]r and a measure of courage.

It's helpful having folks around -- even in virtual space -- who understand what's going on. I feel like anyone who hears me talk about it is going to think I'm whining. My friend Bob checked in with me yesterday. He has pointed out some of the weird little side-effects and occurrences that go with treatment. The taste changes (which he pointed out unprompted) are driving me nuts. The lunch meat I've been making my lunchtime sandwich with for years suddenly seems like it's soaking in brine. I skipped lunch today because nothing looked good. Just ate some cereal and nibbled fruit all afternoon. Dinner was good -- scrambled eggs and hash brown potatoes.

The physical effects are certainly present. I think I've just gotten used to being tired. My son wanted to go to the gym and I figured it's time. He's getting all pumped up for football and didn't think he got enough time in the weight room. He went off and worked on his legs while I spent a half-hour or so on an elliptical trainer. It's easy on the knees and it's easy to vary the intensity. After that I did some stretches and a some light weight work. I'm feeling much better now. My back has been bothering me; that's usually a sign that I'm being too sedentary. Before we left I got on a scale and found that I've lost about five pounds. I'd been working out pretty steady before treatment. Weight is getting redistributed the wrong way.

The physical side-effects are an annoyance, but what's really bugging me these days is the emotional effects. A maudlin country song can make me tear up. My daughter's cockatiel bolted last week and I'm all bummed out. I'm going to the doctor tomorrow. We're going to talk about exercise (I need more -- I'd been avoiding the gym on his orders) and anti-depressants. I'm also having some attention problems. I'm easily distracted and the things I need to pay attention to (like maybe WORK!!??!!) don't hold my attention. I suspect I've always been a little on the ADD side. I suspect I'm like I've always been, only more so.

I'm rambling. That's something else -- once I get into something, I won't let it go. Time for bed. Work tomorrow. Doc. Hey! An outing!

Best to all.

2006-05-02T12:30:00.000-07:00

My doctor just called

I've been operating under a misconception. My doc has no intention to stop treatment for two weeks at Week 24 as I thought. Once I'm on treatment, I'm on for at least 24 weeks, and hopefully 48. If I'm not in or near remission at Week 24, treatement stops and I look for alternatives.

The lack of a 12-week viral load test is a bit of gamesmanship with the insurance companies. He has had patients who failed to achieve a Log-2 drop in viral load at 12 weeks and their insurance company refused to pay for continued treatment. He believes that everyone should get a minimum of 24 weeks regardless because of the therapeutic effect of giving the liver a break. He said that in my case in particular, he wants to continue treatment since my liver enzyme levels are and have been normal since about Week 3.

So far so good. Thanks, Carol for flagging this and helping me get straightened out.

2006-05-02T11:08:00.000-07:00

Week Sixteen

I've been spending some time over in the Hep C Association forums. If you aren't familiar with it, it's a good resource. I'm cwk on that forum.

I posted a question regarding my treatment plan (two-week interruption at Week 24 for evaluation and viral load test). It generated a number of questions there, just as it did from Carol. I have a call into my doctor's office to go over those questions. I haven't had a Week 12 viral load test, and the plan to interrupt treatment for two weeks stirred some concern. This just goes to show that it's a good idea to manage your own care. The doctor wants to be in control, but I'm viewing him as a consultant and advisor.

I took shot number sixteen about 14 hours late. My wife and I had gone to the resort where we were married twenty years ago and frankly, I really didn't feel like dragging needles and sharps containers with me on a romantic getaway. The idea just did something to the mood.

It was a good trip -- just an overnight. The restaurant was the highlight. We spent over US$100 in the restaurant and that's without wine (which I really would have liked, but obviously I'm on the wagon). I had a swordfish steak and she had halibut. Truly an amazing dinner.

I'm feeling pretty good this week. I had some concentration problems yesterday. It seems like Monday is my day for congnitive issues lately. I'm a little better off today, but I don't think this is a good time to take up a new skill.

I mentioned Bob, who went through the program some four years ago. He called me again on Saturday just checking in. Interesting guy and very encouraging to talk with. He has tipped me off to several side-effects. One is the funny metallic taste (he calls it lead-like, I think of zinc) that I have in my mouth. He says that post-treatment one of the things that has stayed with him is an appreciation for good food, well prepared. Having a taste for good food, I was pleased to hear that. I suspect I may have a similar experience.

Bob says that he usually has one or two people in his queue that he checks in regularly with and talks them through treatment. When this is over I intend to return Bob's favor by helping others in the same situation.

Cheers, all.

2006-04-22T17:22:00.000-07:00

Monday of Week 15

Took shot 15 Friday night. I was up and active Saturday and Sunday. Sunday, is usually the toughest day. I was tired, but functional. Today is Monday. Again, I'm tired but reasonably functional.

I'm getting some annoying minor side-effects. One corner of my mouth or the other constantly has a crack. I sometimes get those when I have a cold. Not a cold sore, but similar. Last week it was the left side, this week it's the right. I keep Car-Mex or some similar greasy product on it to keep it from drying out and breaking open. Another thing I'm dealing with seems like constant sinus problems. I seem to be having lots of allergy issues -- something that never bothered me previously. I get a lot of bloody noses, too. Never a lot, just a minor seep. I'm also getting a funny metallic taste in my mouth. It's not terrible, but it seems to distort the taste of some foods. Those are all annoyances. I'll take them compared to other issues I've had or, worse yet, heard of others having.

A friend of a friend who has been through this called me last week. "Bob" is four years out of ending the 48 week course. I commented that he must have been a pioneer. He was. When he did his round, the peg-interferon with Ribivirin wasn't approved in the US. His doctor had him ordering two different medications and he was throwing away half of each. I didn't quite understand it all, but it was an extra hoop. He had Genotype 2, but did the full 48 weeks because that was the protocol then and they hadn't really sorted out the genotypes when he started. I have Genotype 4 and they recommend 48 weeks, but the disease is new enough that they may have some new research. The doc keeps saying he'll find out for me whether there are any new changes. He made the call while I was there last time, so hopefully next month I'll have an answer. If I were to bet, I'd bet I'm in it for the full 48 weeks. Bob's call was really encouraging. The mutual friend was with him on a 100 mile bike race last month. In other words, he has his life back. If anything, he's stronger than ever, according to our mutual friend.

To Sue in Toronto, yes, the weather's nice this time of year, but when it's 115 F/46 C we'll see how envious you are. I've kept my walks up pretty well. My dog nags me, which helps.

She lives for her walk. That's when she gets to chase cats. She doesn't do anything to them, just the chase. One night the cat on the next block mosied out in front of her and paused looking back waiting for her to give chase. All in good fun.

If they don't run, she just kind of sniffs and moves on. Australian Shepherd -- great dog, but they need to be active and stimulated, hence the walks off the leash. She won't cross the street to visit another dog and won't start chasing a cat unless she gets my okay. I wish I could say it's my great training. No, she's just smart enough to know what she needs to do to get to walk without the leash.

2006-04-19T12:41:00.000-07:00

Week 14 - Who really gives a... ?

I'm nearing the end of Week 14 and I now think I understand what someone here referred to as "hitting the wall." I wouldn't characterize it as hitting a wall so much as trying to run across a mud flat. As I've mentioned previously, I work from home which is both good and bad. One bad side is that I work on the Internet. I'm having trouble concentrating and find myself aimlessly surfing. I've learned a lot about things I might not have looked up otherwise -- musicians I hear on the radio, drugs both therapeutic and illegal, topics on Slasdot (http://slasdot.org/).... None of which is particularly helpful in getting work done.

I didn't even have enough ambition to post this -- I had it virtually finished on Wednesday, posted on Saturday.

2006-04-11T09:40:00.000-07:00

Week 13 mid-week check-in

I'm into the second quarter. I don't know whether I'm feeling better, or just used to feeling lousy. What I'm having a very difficult time with is the limitations. It's already getting warm here in the sunny southwest. We're expecting above-90° F / 33°C this week. Consequently, it's time for one of the little rites of spring in this part of the world, opening up the swamp cooler.

For you fog-bound folks in northern latitudes, a swamp, or evaporative, cooler is a form of proto-air conditioning that works by forcing outside air through a wet pad. It only works when the humidity is low -- that means a dew-point of no more than 60 °F / 16 °C . Current dew point is 37 °F / 3 °C, so it's ideal. Above 60 °F / 16 °C and it's miserable.

There are other disadvantages as well -- the increased humidity in the house can cause doors to stick and rust in the ductwork, and since it's pushing outside air through the pad, it brings dust into the house. Not a good plan for those who have allergy problems. I doubt that I'd install a swamp cooler, but it was on the house when I bought it and it's a better quality system. And the thing runs for pennies a day which appeals to my Scottish heritage.

Anyway, it was time to clean the swamp cooler up and get it ready for the season, but my wife had a fit at the idea of my going up to the roof. I occasionally get dizzy, but I've never blacked out. At her insistence I called a friend. He was anxious to find a way to reciprocate us for when he was down with a bad back, so I guess what goes around comes around.

I have a friend who I've written about previously. He has Genotype 1 and relapsed six months after going through the full interferon/ribivirin program. He also went onto Infergen, but that caused some horrible psychological problems including depression. He made the mistake of answering a question about self-destructive feelings half-seriously and found himself in a lock-up on suicide watch. That was a couple of years ago. Now they're just monitoring. His liver's in pretty bad shape. I don't know what else they'll do; it's like a company that is in financial trouble and puts the accountants in charge. They can tell you the exact moment that you're broke, but I don't know what they'll do to solve the problem.

Anyway, he had a biopsy last Tuesday. On Friday he was in the emergency room. Apparently the biopsy clipped a bile duct which caused approximately the same issue as a gall bladder problem. They may be able to treat it with anti-coagulants. I need to call him. I think he's coming home today. Real role-reversal there -- it started out with him holding my hand through the beginning of treatment. Now I'm trying to be someone he can lean on.

Meanwhile, I'm doing comparatively well. I'm tired and I don't feel like running or doing other hard exercise, but I walk the dog a mile or so nearly every night. I come in feeling like I've run a couple of miles, so I guess it's a good thing. Emotionally, it seems that everything is right on the surface. I'm irritable, but I have enough of a sense of humor to recognize it. My daughter was telling me the other night that it's like her daddy isn't around. There's a stranger. He's nice enough, but it's not the same. I asked her if it's that she's not used to me being wimpy. She laughed and said maybe that was it. I know I've kind of disconnected with all the kids. I have to make an effort to talk with them and see what's going on.

I'm spending far too much time on this. Got a work call and things are stacking up.

Cheers all! Keep my friend Ken in mind in your prayers, meditations, or whatever you do.

2006-03-28T11:39:00.000-07:00

Correction -- This Is Week 11!

Mid-week check-in.

Replying to Carol's note to my previous post, yes, I'm definitely hitting something. I'm really foggy. Example: this is Week 11, not Week 10. I was really surprised to see only two syringes in the box on Friday.

My motivation is somewhere around zero, yet I have this weird inertia. Once I start doing something I just continue doing it. But it's really hard to get started. Emotionally, I'm kind of crabby, but no more anger like I experienced a couple of weeks ago.

The physical aspects are really improving. I was up all day Saturday and was really active all day. Shot a good round of skeet (22 of 25). That's good for me; I haven't shot in six months or more. Quality time with the kid was an important bonus.

Sunday I crashed and slept close to four hours in the afternoon.

Monday and Tuesday at work have been challenging to say the least. I work with lots of complex things and inter-relationships, not to mention lots of people. There are a lot of plates in the air and I have to have an idea where they all are.

A friend of mine is a Genotype 1 relapser. We were planning on going to a support group meeting, but it was cancelled. I detect a change in that relationship. It seems he's starting to lean on me more where at the start of this I was really leaning on him. That's fair - I've got a good chance of seeing this thing go into remission and being done with it. He could be facing a transplant in the next few years. Little dose of reality there. My friend does a good job of keeping my perspective straight.

2006-03-24T21:40:00.000-07:00

Week 10 -- Double Digits!

For the past couple of weeks I've been doing pretty well. "Pretty well" is relative, of course. It means I haven't had to punch out and lay down on the couch in the middle of most days. I am blessed to work from home and can do that now and then. Nobody on a conference call knows whether I'm laying down or not.

I have noticed that I'm pretty foggy. That's a fact that was not lost on a project manager at work when I asked him a couple of questions I already knew the answer to. Yesterday I'd have sworn that my wife came in and talked with me.

"Where'd your mother go?" I asked my daughter.

"She's working late today."

Sheesh! I was recalling a conversation from the previous day. It's all running together.

Emontionally, this is a strange time. I caught myself getting really angry over something trivial last week. I realized I was being stupid in time to stop being too much of an idiot. It seems like my emotions are right on the surface. I wonder how much of this is chemical and how much is circumstantial. I'm also cursed to work at home. This is like house arrest. All I need is an ankle bracelet.

My son and I are going to the range tomorrow to shoot a round or two of skeet. Saturdays I'm usually pretty good until mid- to late afternoon. I need the outing.

It's shot time. In Frank Herbert's epic Dune the main character is tested with something called a gom jabbar. "It only kills animals," says the tester. The gom jabbar is a poison needle that the tester holds to the lead character's neck. As long as he keeps his hand in a box, the tester doesn't stick him. "What's in the box?" he asks? "Pain." He puts his hand in and thinks his hand is being burned away, yet he has to endure. To do the instinctive -- the animal -- thing and avoid the short-term pain is death.

There's a parallel here. As long as I keep sticking myself -- and taking the little blue pills (shudder) -- I have a pretty good chance at a normal life. Skipping meds proves that I'm not smart enough to be a human.

So with that thought, I'm off to endure another round with my gom jabbar.

2006-03-04T16:21:00.000-07:00

Week Eight

Saturday Afternoon. Took my shot last night. This is usually the time I start fading. I've been up since around 9:30 doing chores -- light stuff, mostly directing my son and a buddy of his. It's now almost 4:30 PM and I'm still somewhat functional, although tired. Way better than last week. I finished off my second box of IFX (or whatever the Hep C cognoscenti abbreviate it to). I'm one-sixth of the way there. The shot was almost routine. My head was clearer as I went through the process and my hands weren't shaking. I'm almost used to it. Maybe that's over-stating it. But at least it doesn't freak me out like it did the first few times.

Ran into a neighbor at a school function on Friday. We had told her about my problem. She and her husband went to give blood last week. She got a nice thank-you card, but he got this manila envelope. Yup. He has Hep C. I need to buy stock in Roche (company that makes Pegasys). By the end of this decade there will be few people who don't know at least one or two people with this disease. Got to call him. I won't sugar-coat it -- this is no fun. But there's worse things to face.

2006-02-26T20:32:00.000-07:00

Early Week 7 Check-in

Hokey Smokes, Bullwinkle! I'm flat on my back!

Friday is shot night. Saturday morning is usually a better day for me with Sunday my day to really be down. But I was horizontal for 16 hours on Saturday. I didn't even get out of bed until after 10:00 AM, this after going to bed at 10:00 PM. Did virtually nothing.

Sunday I made it to church, and managed to take my son to the sport store to buy some track shoes. I collapsed once I got home and have either been in bed or on the couch since then. I have a bit of a headache, but no flu-like symptoms, I just can't move! This is horrible. My wife is having a hard time with it. She's trying to do what needs doing, but it's hard for her when I'm crashed out.

I'm gradually coming alive this evening. Of course now, it's 9:00 PM and I just took my Elavil (Amitriptyline). Since I started taking it I'm sleeping better. But it that what's whacking me? This is going to be a long year.

2006-02-23T13:40:00.000-07:00

End of week 5 (correction! Week 6) check-in

First of all, thanks for the encouraging comments. I have my share of prayers, good thoughts and positive vibrations coming my way. Much appreciated.

The doc had another hemoglobin test run last week, some 5 days after the previous and called me to say the results were about the same as previously. So, I'm at least not going downhill. This week has been comparatively good. The Elavil seems to be helping me (not to mention my wife) sleep. The biggest annoyance right now is the cold/allergies that has my nose and sinuses congested. I don't think it's all sides -- my youngest is home from school today with a sinus infection and displaying many of the same symptoms I have. I went through a round of antibiotics a couple of weeks ago. This week the General Practitioner gave me a new allergy pill and nose spray.

Although the week has been pretty good, I'm starting to see a pattern of really slowing down on Thursday. I suspect it's the time-release characteristic of the PEG added to the interferon. In any case, I'm pretty tired today and should probably be lying down between phone calls. Last call coming up, and then I take up a prone position.

Cheers all!

2006-02-16T18:27:00.000-07:00

Saw the gastro doc yesterday

I'm anemic. No surprise there. When the girl took my blood pressure my heart rate was around 120. "What'd you do? Power-walk here?" Uh, no. I mosied from the parking lot to the elevator and sat in the waiting room for 10 minutes before I mosied in here. My hemaglobin level is 9. Normal is 14. The doc says it's like being down 3 pints of blood.

That explains the fatigue. Dead tired. Yet, I haven't been sleeping well. The doc prescribed a light dose of Elavil. I took one tiny white tab at 8:00 PM and was groggy by 10:00. I actually slept last night, but the trouble is, I slept today too. About three hours on the couch. Tough to work like that.

Encouraging news as well. My liver enzymes are back to normal -- I didn't get the numbers. But I know they were trending that way from the last test. The doc raised the possibility that this might might be a 24-week course. I have Genotype 4 which is recommended for 48 weeks, but it's a comparatively new genotype and they may be following the more aggressive protocol as a fail-safe. I have mixed emotions. If I stop after 24 weeks and relapse, I'd be facing another 48 weeks. Not something I would look forward to. I'm leaving the whole matter on the back burner. I haven't made it through the fifth week yet!

2006-02-04T21:58:00.000-07:00

Beginning Week Four

Friday was not a good day. It was weird. I was not in pain, not overly tired, nothing, yet I felt just lousy. Uncomfortable. I'm wondering if it wasn't the depression thing that I've heard about.

Friday is shot night, so that may have been a factor. I have to get my head real straight -- last week I had some trouble with the syringe. The genius that designed it made the needle cover fit tighter than the needle fits on the syringe. Consequently, the needle came loose as I was injecting. I had to pull out and reattach the needle before injecting again. Probably a no-no, but I survived. Then as I got down to the bottom I realized I hadn't purged the air -- this as I'm hearing the bubbble entering the needle. Stop pull out. Not enough left to make any nevermind.

This time was better. I went more systematically and made a point of detaching the needle cover and replacing it loosely before attaching it to the barrel of the syringe. Everything went smoothly, but it still creeps me out. It goes against some pretty deep-level conditioning to point a sharp object at one's person and jab!

Today I've felt pretty good. I put some drip irrigation in the front planter (I live in the Sunny Southwest -- we haven't had rain in over 100 days). It's light work playing with 1/4-inch hose and little drip emitters. I kept a glass of water at hand and didn't push it. My older daughter (17) came out and hung out with me. She's good company. This evening I walked the dog down to the corner drugstore -- half-mile round trip. Last month it would have been nothing to run two miles. I'm not complaining, but it's going to be a chore to get back in shape.

Time for meds and bed. Sunday is usually rough. We'll see.

2006-02-01T22:17:00.000-07:00

Late Week 3 Check-in

This sucks! I made a bad mistake on Monday night. I was tired but watched Surface (cute show -- family friendly, lots of excitement and intrigue) with the kids. My mistake was to drink a cup of coffee at 8:00 PM. I came in here and worked on another project until midnight. Next morning I was tired, but functional. Where I think I really made my mistake was in not eating anything from 7:30 AM until after 1:00 PM. When I finally got up I was wiped. Had to knock off at 2:00 and slept for a couple of hours. I tried to start working again, but it wasn't happening. I don't think I was up for more than a couple of hours for the rest of the evening.

Lesson: Eat. Sleep. Not so hard, now is it?

2006-01-30T09:20:00.000-07:00

Beginning Week 3

But first, a review of Week 2. Took the second shot on Friday and was up but loggy all Saturday. Sunday I didn't get out of bed. I had all the sides -- body aches, fever, chills, coughing, sneezing, congestion ... sneezing? My wife went back to the web and the package inserts. Nothing about sneezing there. I had a garden variety cold. And it was fast turning into a sinus infection. Explained a lot. I'm now halfway through a round of antibiotics and doing better with it. I worked all week, but fortunately I work from home and spend a lot of time on teleconferences and doing heads-down work at the computer. I did have to take off on Friday afternoon -- I was dizzy and totally flaked out. Certainly in no shape to take another shot of Interferon. But that's what I needed to do.

It's Monday now and more than anything else, I'm tired. Dead tired. I'm trying to get started working, but along with being tired. I'm having a hard time caring. That may be a side as well. I'm wondering whether the depression associated with this stuff is something systemic, or is it just a rational reaction to the prospect of a year's worth of feeling like this. In my weaker moments I can really start feeling sorry for myself which is just plain dumb. Waste of time and I have too much going on.

2006-01-17T08:56:00.000-07:00

Week One

Summary
Sleep is the biggest issue so far. The ribavirin seems to cause a lot of tension in my back and I tend to clench my fists and arms. My appetite is good and I am having no trouble with any foods. Little chance of this stuff becoming a recreational drug, but I don't feel too bad. This is manageable.

On Saturday after my previous post, I started moving and felt good enough to clean the garage. Between remodelling and having Christmas decorations out, it was trashed. I was doing okay for about three hours when it caught up with me. Fortunately that was just as I was sweeping and ready to shut it down. I went inside and took a two hour nap. When I awoke, I felt exactly as if a case of flu was coming on -- achey, especially in the joints. I took some Tylenol and watched the Broncos beat New England (American tackle football). Life is not all bad.

I went to bed early Saturday night but didn't sleep well due to the fact that I'd already had a lot of sleep and because the achiness was coming on pretty strong. Sunday morning was more of the same. I thought about staying in bed, but then figured that I could feel this way anywhere and laying in bed I was more likely to start feeling sorry for myself which is a downhill slide. It's way too early for that nonsense. I got up and had some breakfast (oh, and my ribavirin, naturally) and some Tylenol or Ibuprofen. I'm trying to mix them up a bit and not take either more than a couple of times in a day.

By the time I got to church, I felt pretty good, just tired and wrung out. The friends who know about this wanted to know how it was going. Pretty good, considering. One guy at church has Genotype 1 and went through the 48-week drill only to have it come back. He's my reality check. There are no guarantees.

I felt good enough after church to go out to eat with my wife and younger daughter. When I got home I flaked out in front of another football game.

Monday was a work day for me. I am fortunate enough to work from home. The commute isn't bad, although I have to occasionally step over the cat on the way to my office. Tylenol and coffee are my friends.

Tuesday I went to the gym. I did my usual ten minute warm-up on an elliptical trainer (kind of like a treadmill, but low-impact). The heart monitor said I hit 189. When I'm real energetic I can usually get it up to about 200 in that time. I wasn't feeling all that energetic. My workout got sidetractked, however as I ended up getting into a pleasantly long-winded conversation about guns and other topics of interest. I've seen this guy, but we've never talked. I think we were both looking for an excuse to slack. He left and I got back on the elliptical for another ten minutes before going home.

As the week progresses, what I'm noticing is that I am just tired, yet I have trouble sleeping. My appetite is good and I have no trouble eating anything, thank God. I can't think of anything that would drag my morale down faster than to have serious stomach trouble for this time.

My biggest gripe (and my wife's) is that I'm not sleeping well. I have this weird tension in my back and tend to clench my hands and arms. I have to will myself to relax. I ended up taking a Benadryl last night to go to sleep. I'd read of that trick in one of these blogs. I'm going to check in with the doc about it, but it worked last night -- except that I'm foggy this morning.

Time and past to get to work.

2006-01-14T09:48:00.000-07:00

Carol said in her comment to the last post:

Many people think that when they take the tablets/jab life changes from then on.

You're right, that's exactly what I was thinking. The big changes are the ones that happen slowly over a long time. On the other hand, there is now a division -- before treatment, and during treatment. And the roller coaster has definitely started.

I took the ribavirin about 10:30 last night and the interferon shot about 20 minutes later. The needle is so small and fine I hardly noticed it. I put it into my budding "love handles" -- I'm not very big and I don't carry much extra weight. I was in bed by 11:00 which is pretty early for me. Awoke at 7:00 and made coffee confident that I was up. I then went back to bed and didn't move until 9:00 AM! Ten hours of sleep is really long for me.

This morning I'm a little achy but sleeping for a long time would explain it. I'm not saying I'm having no sides, but I'm having to look for them. If this were an ordinary morning, I'd be wondering if I was getting sick or if I'd just slept for too long. As I write this I feel a headache coming on -- the ribavirin was 30 minutes ago. Or maybe I'm talking myself into things.

2006-01-13T16:06:00.000-07:00

The time has come. My medicine arrived today.

I just got back from the doctor's office where the nurse gave me a little orientation and the very stylish Pegassist Kit. Gel eyeshade included. The time may come that I'm glad I have it, but right now it seems kind of hokey.

I haven't taken any meds yet -- enjoying the last few hours before a year of . . . maybe nothing. Maybe a bad time. I'm not in a hurry to do it, in any case. The older kids have gone to a church function for the weekend. The youngest (11) is an only child this weekend. We're taking her out for dinner and maybe a movie. Once we get home, Daddy is punching out.

My wife works with a guy who has genotype 3. He just heard from his doc that the virus was undetectable. He has another ten weeks and he's done. Everybody cheer for Steve.

So there is an end to this. Something to keep in mind at the beginning.

Out the door.

2005-12-20T16:32:00.000-07:00

Nearly six weeks since I updated this. I saw my general practitioner a couple of weeks ago and my gastro last week. I asked the GP about anti-depressants. His take (which agrees with mine) is not to start throwing drugs absent a specific reason. I would not describe myself as depressed now. We'll deal with side-effects as they come.

My wife accompanied me to the gastro. He's pretty conservative as well. I got a bit of hard news there. It looks like Genotype 4 is more like Genotype 1. I'm not sure whether it means a 48-week treatment series, but in any case, it's not the easier-to-treat Type 2 or 3. In any case, the gastro doc is saying 50% of patients respond. My wife was working on the assumption that this Interferon round will knock the thing out, like a round of antibiotics for a sinus infection. Unfortunately, it doesn't look like that's how it works. Easy to get discouraged with that.

I start treatment after the holidays. I have the prescriptions. Got a few bureaucratic hoops to jump through with the insurance, but I'll be on treatment by this time next month.

2005-11-08T22:12:00.000-07:00

More medical stuff

Last week, the biopsy, this week the dreaded colonoscopy. This was totally unrelated to the hepatitis thing. I lost my dad to colon cancer last year and the doc wanted a look. Who am I to refuse? I was, thankfully, not present for the procedure.

I will spare you the details of the prep except to say that the best thing I did was not to put any flavoring in the brew they made me drink (let's just say that its effect was to provide the physician an unobstructed view). There were several little flavor packets (sort of like diet Kool-Aid) attached to the 4-liter jug. The pharmacist suggested I pick a flavor I wasn't too fond of since I would forever associate the flavor with the experience to come. I took it straight. It tasted like baking soda. If I'm to have a flavor forever ruined, that may as well be it.

Like the biopsy, the procedure itself was pretty simple for me. The drugs they gave me were pretty high-end. Demerol and something that whacked my short-term memory. I lay down and Doc warned me that I might feel the meds in the IV. I felt a warmth in my chest and the next thing I knew I was sitting in bed chatting, albeit groggily, with a nurse. Afterwards my wife and I were at breakfast and I realized that I could not remember getting there. Twelve hours later I'm still a bit foggy.

Biopsy results

Just realized I hadn't posted my biopsy results here yet. I have "moderate" inflamation (scored 3 out of 4) and "mild" scarring (scored 2 out of 4) with no signs of cirrhosis. Not surprisingly, the doc recommends treatment.

I asked him about a timetable. He recommends I start within the year. He agreed with my analogy that this is more like a slow leak in the basement than a fire in the attic. I plan to start treatment after the holidays.

As chronic and potentially deadly conditions go, I guess this one isn't so bad. I'm facing inconvenience. I think of our friend with ovarian cancer. She has taken a bad turn. Once more I refocus on what is important. I'll take care of business and count my blessings.

2005-10-30T22:15:00.000-07:00

Liver Log

After the Biopsy

As much as I dreaded the biopsy, it was really no big deal. The worst part was having to get an IV that didn't even get used. My wife found a lot of humor at my expense. I'm really not used to being the patient -- I'm pretty healthy outside of this issue. First I had to sit around a waiting room with non-stop cable news. The wait was nearly two hours which set things off on the wrong foot.

Once I went in, they told me to take off my shirt and put on a gown which opens at the back. I was wearing a pair of jean shorts (it's warm where I live) and left them on as well as my shoes.

(An aside, and I know I'll wonder about this again. What is really the point of the gown opening at the back when they're interested in my front?)

Anyway, I'm laying there with my shoes sticking out from under the gown and my wife walks in.

"Honey, don't you want your shoes off?"

"No!"

"You'll be more comfortable...."

"I'm fine!"

She takes off my shoes which makes my feet cold. Now I need a blanket. I was fine before. She figured I just wanted to make a quick getaway. Well, maybe that too.

I finally get wheeled in and make small talk with the crew. I make nervous jokes about fava beans and a nice chianti.

The doc shows up. Tall Jewish guy. Not too young, not too old. That's good in a specialist, especially one who's about to insert sharp instruments into a vital organ. Total medical geek. I work in technology and I recognize the geek type. It's all about the subject at hand, whether technology, or an organ. That's good too. He tells me what the plan is and I sign a release. I close my eyes and punch out. They offer some drugs to make me woozy. I decline. I really don't like woozy and I'm confident. This isn't too different from a root canal. It just tickles more. I hear a sound like a stapler. He does it again and it's done.

So now, I wait for results. I'm pretty sure it isn't going to show anything unusual. I'm not displaying any symptoms to speak of other than a number on a blood test report.

Next week I have a totally unrelated colonoscopy. That I'm dreading.

2005-10-25T20:55:00.000-07:00

Liver Biopsy Tomorrow

Dreading this. Emotionally it's especially tough -- the last person I know who had a needle biopsy was my dad who had a tumor on his colon the size of a softball. He'd had a four inch section of his colon removed fifteen years before. They put it back together by sewing one piece inside the other. The tumor grew on the outside where it was reconnected. Happens in "only" two or three percent of cases. So yeh, I'm nervous. There could be something there more than the hep C. Something more than cirrhosis. It's unlikely, but it gives one pause. I haven't talked about that possibility with my wife. I guess that's why I have this.

Got a call from a friend from church. Her sister went through a year of Interferon when it was still new. She just wanted me to know that we were in their prayers.

Faith. I haven't mentioned much about faith here. Not everybody is built that way. Or, as an evangelical friend says, everbody is built that way, but that not everybody admits it.

Have to tuck the little one in.

SVR

2005-10-23T21:11:00.000-07:00

This week

We celebrated my daughter's birthday this weekend with some friends in the hills north of us. This friend is an ovarian cancer survivor. It's been pretty scary for her. She went through a round of chemo last year. A marker came back elevated, but a CAT scan was normal. That ovarian test is notorious for false positives. Anyway, seeing her keeps things in perspective. Things could be much worse.

I had another "refocusing" experience today at church. There's a guy there who has been fighting this monster for the past several years (he has Genotype 1 and responded beautifully to a round of Interferon, but had it come back on him. Anyway he's telling me what a bad time he'd had with the infergen(?) on the second go-round and is now a candidate for a liver transplant.

It was apparent that my friend was kind of down as he was telling me about it when this guy came up pushing a walker. I'd never met him before -- he was kind of young, maybe 40. I introduced myself and soon learned that he was fighting non-Hodgkin's lymphoma and dumped a bunch of news about living in his car and having it broken into and so on. He asked where he could find something to drink and I directed him to the table where drinks were being served. Ken and I kind of looked at each other.

"Wow," he said. "I was starting to feel sorry for myself!"

Maybe things aren't so bad after all.

Other stuff

I'm scheduled for a liver biopsy next week. I can hardly wait. I think I was put on earth just so I could get all numb and have somebody stick a needle into my internal organs. Yeh, this is positive. I've been told that I had a sarcastic streak.

This doc continues to surprise me. He called me last Saturday with test results. He called me this afternoon (Sunday!) with an answer to a passing question I'd had about whether I should get a flu shot and that he'd mail me copies of my test results. I don't get this kind of service from a plumber! I've heard good independent reports of him. I think I'm beginning to see why.

Questions

I heard that one of the sides is bone density loss. A friend lost the crowns off his teeth. What can prevent that? Calcium supplements? Other dietary things?
I doubt that I will feel like it, but will pushing myself to exercise help? Hurt? I'm thinking about a guy I knew in high school with mononucleosis who damaged his spleen(?) by forcing himself through a football workout.
I've heard about the depression and about the idea of anti-depressants. Frankly, those drugs scare me too -- I've heard too many Prozac horror stories.

If you have an answer, post it. I'm putting these in my notebook that I take to the doc.

2005-10-17T23:37:00.000-07:00

I clued the kids in today. My wife had already talked to our son. His attitude has been that of a 14-year-old lately. Understandable, being as how that's what he is. She basically said she expected him to step up. I had a few minutes with my older daughter (16). She knows what this stuff is -- a guy we go to church with has been fighting Type 1 for years. He's a potential candidate for transplant. Hopefully it won't come to that.

I told my younger daughter (11), unfortunately as I was tucking her in. Probably not the best time tactically, but it was when I was able. We do a little prayers-and-song thing that the other two have outgrown (she has too, but she likes it). Heck I was doing it with the other two -- yes, my son too -- when they were 12. Anyway, I prefaced it with both of them that I fully intend to be around for many years to come and then gave it to her in general terms. She cried a little but I stayed with her and let her know it's going to be okay. Sure hope I'm telling the truth.

I just got back from a run. Took it easy. Ran a bit more than mile and then walked back. I'm really hopeful that I have enough reserve in the tank that the treatments won't put me down too badly. The gastro doc's office called today to set up the liver biopsy. Boy, I can hardly wait for that. I'm looking forward to it almost as much as I'm looking forward to my colonoscopy next month. That's totally unrelated and would be happening if I were 100%. I lost my dad to colon cancer last year and I'm overdue. Hopefully all the Grape-Nuts cereal and whole-wheat has paid off.

2005-10-16T22:48:00.000-07:00

Test results

The gastro doc called me yesterday -- Saturday, to my surprise. My test results are in.

I have genotype 4. I'm told that genotype is more responsive to treatment.

My viral load is 3.9 million. I'd be interested in learning how they calculate that, but according to the doc, it's a moderate load.

My liver enzymes are ALT = 203 and AST = 76. That's higher than last month's and he recommends treatment.

In the best case, I'm looking at a six-month case of flu. Hopefully that will be the extent of it. My wife continues to swear that I don't look good, I continue to swear that I feel fine, I just don't sleep enough (bad habit of staying up too late staring at a computer and writing stuff....). I ran a couple of miles on Friday. Actually cut it short because I felt sorry for my dog -- she's an Australian shepherd and I walk her off the leash at night. She is getting older and slowing down. Poor puppy was 100 yards behind me most of the way.

The big chore will be telling my kids. My wife already clued my son in. I had delayed letting them know because I didn't want the questions hanging over them. But now it's time. I at least have some answers. Not all -- I never will. Mortality is never a fun topic, but when it's your own or that of someone you love, well it's tougher.

2005-09-27T09:06:00.000-07:00

I got the results of my ultrasound last Friday. "No acute changes." So my liver isn't crawling with tumors, cirrhotic, . At least not visible ones. Next week I see the gastro doc.

Lately I've been noticing the "If Hep C was attacking your face..." ads (http://www.hepcfight.com/). The link points to a Roche Laboratories site pushing Interferon. I love free enterprise. The site is typical of Big Pharma -- lots of recommendations to talk to your doc, oh, and don't forget to ask about our product. Obviously they think they have a pretty promising market. Looks like I may be helping to pay for those half- and full-page color ads in major market newspapers and magazines. Fortunately, I'm insured.

2005-09-17T00:23:00.000-07:00

I started the week off with an ultrasound on Monday morning. Other than that, there's little to report. The results aren't back yet (it's Friday night/Saturday morning) so I go through the weekend with the same question mark hanging over my head that has been there for the past month. I have an appointment with a gastroenterologist in three weeks. Earliest I could get in. When the doctor's office called today I asked whether they'd be able to move my appointment up if there was a problem in the tests. They said yes, they'd do that.

The ultrasound was in a medical building that is less than a mile from my house. I walked to it and ran back. I feel fine. I'm a little tired, but I operate on five or six hours of sleep a night and abuse caffeine. That's to be expected. My wife has been saying I look tired for the past, oh, five years or so. She says it more often now. Nothing new. I have deep-set eyes and have always looked like I have circles under my eyes, even after nine hours of sleep.

What's driving me really crazy is the wondering what is a symptom. I'm aware of my abdomen. It rumbles. Is that my liver? I fart. Is that a symptom? I don't have any pain, but I'm uncomfortably aware of my right side. I've had a heat rash on my chest and a spot in the inside of my elbow since June or July. Heat rash isn't unusual -- I live in a hot place. But such things usually go away for me fairly quickly. This has been here for two months. Does that have something to do with this? I look at the color of my shit. It is brown. If it becomes light-colored, that's a bad sign.

This is how hypochondriacs are made.

I went to the natural food store the other day and bought a bottle of something called silymarin and started taking it. It's an extract of a plant called milk thistle. From what I've read it can't hurt. My wife didn't like the idea -- she wants me to wait until I see the doc -- doesn't want it to change any test results. I sort of thought that was the idea. Guess I could drink a couple of beers before my next test... Hey, if my liver is being damaged, and the test results reflect it, I'd just as soon take the pill. So I'm sneaking it. I'm such a rebel.

It's a clear gelatin capsule with what looks like ground weeds inside. It has a strange mustardy taste. Is it having an effect? Who knows? Except for the taste, it could be alfalfa for all I know. I feel vaguely light-headed after I take it. But, again I'm not sure. Everything's a symptom or a side-effect.

I'm going to be a wreck if I start really feeling something. Nevermind. I suspect that the appropriate word is when not if. And when that time comes, I will long for the days that I could walk a mile.

I have to beat this thing.

2005-09-12T16:56:00.000-07:00

First Post -- What This Is All About

The fastest way to get me out of a room is to start talking about ailments and illness. That's why I launch this blog with some trepidation. It's all about my ailments and illness. Of course that's a much more interesting topic than somebody else's ailments. Bear with me. Read on or not as you choose. You've been warned.

Some ten years ago I donated blood at an office blood drive. A few weeks later I got a letter back from the blood bank. It said (in effect), "Thank you for donating, however we can't use your blood and we can't tell you why. Go see your doctor." Surprised and concerned, I made the necessary appointment. Within a week I learned that I had contracted Hepatitis C. I'm not certain of the source, but I have an idea (a topic for another blog entry).

Since that time I have more or less regularly had a blood test on an annual or semi-annual basis, depending on my doctor's views, and on how well I remembered. A few months ago, after a reminder of mortality (dad's death) I resolved to get my bloodwork back current and to have the usual "manly" exams for the middle years -- prostate, colonoscopy, and so on. That was four weeks ago. A couple of weeks ago I received a note from my doctor. Elevated liver enzymes (I need to look them up, but one was 76, the other 140 where normal is 40) and somewhat low white blood cell count (4.2). No alcohol, no Tylenol.

Another appointment. This was a new doctor to me. I told him that I didn't plan to sit back and watch while this thing killed me or even makes me miserable. Now understanding that this was a new development, I'm in the midst of a round of tests. This morning I had an abdominal ultrasound. In a couple of weeks I see a gastroenterologist. Somewhere along the line I'll probably have a CT scan, possibly with a liver biopsy.

Depending on the outcome of those tests, the most likely next action will be to start a round of Interferon along with some other drugs. Depending on the genotype of the bug, it will probably be either 24 weeks or 48 weeks. Or maybe it's something else.

Right now, I'm not sure what I'm facing. I may or may not be in for the fight of my life.

In the meanwhile, it's like the song says: "The waiting is the hardest part."