Tuesday, July 12, 2011

If At First You Don't Succeed, Try, Try Again

Try AgainImage by lydiashiningbrightly via Flickr

American educator Thomas Palmer (1782-1861) wrote this famous proverb in his Teacher's Manual
'Tis a lesson you should heed, try, try again. If at first you don't succeed, try, try again.
Well, Mr. Palmer, I am taking your advice

A week or so ago I went for a follow-up appointment with my hepatologist about my chronic Hepatitis C infection.  He told me two things at that appointment.  First, that my viral load had gone from 11 million to 24 million in a little over 12 months.  Second, that I apparently have the gene variant that makes me sensitive to pegylated interferon alpha, which increases my chances of responding to Hepatitis C treatment.

We also talked about the two new antiviral drugs approved for the treatment of Hepatitis C by the FDA in May: Incivek (telaprevir) and Victrelis (boceprevir).  So far, my doctor has 10 patients undergoing treatment with one of these two drugs.  When I asked about using the two new drugs together, my doctor told me that since they are both protease inhibitors they cannot be used together.  So the new standard of treatment is pegylated interferon, ribavirin and a protease inhibitor.

As for a real Hepatitis C drug cocktail, that is still a few years away.  There are polymerase, NS5A, NS4B and NS3/4A inhibitors in the drug pipeline, but even with FDA fast track status it will be at least two years for approval.

I mentioned that I was having more problems managing my diabetes before I got my viral load results, and it was interesting to hear my doctor talk to me about how the Hepatitis C virus interferes with the action of insulin in the body, causing insulin resistance.  Usually, it's me insisting there is a connection and my doctor dismissing, denying or deflecting the inquiry.  It's both validating and a little scary when your doctor starts agreeing with your anecdotal reports.  Scary because having your doctor agree with you makes it feel even more real ... and threatening.

I also talked about having more fatigue, something that I knew was the truth but was trying to pretend wasn't so.  My higher viral load though pretty much puts the kibosh on thinking otherwise.

So on the car ride home, I asked Robert if it was time to consider trying Hepatitis C treatment again.  I talked about how I thought I might be in a better place given that taking a daily Vitamin D supplement has treated my Vitamin D deficiency and gotten my immune system functioning better.  I also reviewed with him how adding a protease inhibitor to the mix could cut my treatment time down from 48 to 24 weeks.  And since I am a responder to pegylated interferon, my chances of treatment success might be pretty good--if I can tough out the treatment and all the side-effects.

My next appointment is in January 2012.  This will give my doctor some more time gaining experience using the new medications.  This will give me time to prepare and get into the right mindset.  This is my timeline to getting to the starting line and trying Hepatitis C treatment again. 

Yes, I am going to try, try again.

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