Dr James - FixHepC

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20 September 2015 at 3:19 pm in reply to: Incepta’s Twinvir #1385
Dr James
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- Guardian Angel
@fixhepc
1 tablet is all that’s required. We’re just working on getting the price for testing down but Twinvir or Harvoni require a pre test HPLC phase to split the components so it’s more time consuming than pure powders.

Happy to test the first tablet of twinvir that arrives at the offices for free, so if anyone wants theirs tested…..

YMMV
19 September 2015 at 5:05 pm in reply to: Gamma GT #1378
Dr James
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- Guardian Angel
@fixhepc
There is genuinely no pressing need to do any more testing until your SVR moment, but if you wanted to do another one it would be at the end of your treatment course.

This advice, posted at http://fixhepc.com/forum/experts-corner/105-expert-professor-by-email-viral-load-monitoring.html was written by an expert in the field:

Re on-treatment virological monitoring, patients do feel reassured when they see how quickly and profoundly the viral load declines. But, the data indicates that basically 100% of patients taking sofosbuvir-based regimens will suppress virus to incredibly low levels and generally very quickly. Eventually, we may only do one HCV viral load testing after commencing treatment, either 12 or 24 weeks post-treatment. For now, and particularly for patients on generics, it is very reasonable to do week 4, end-of-treatment (week 12 or 24 depending on duration), and then 12 or 24 weeks post-treatment.

YMMV
19 September 2015 at 1:35 pm in reply to: Gamma GT #1376
Dr James
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- Guardian Angel
@fixhepc
Congrats. The budget approach would be simply to do another one 12-24 weeks after finishing the medication.

YMMV
19 September 2015 at 9:54 am in reply to: HELP #1372
Dr James
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- Guardian Angel
@fixhepc
Hello Archer, yes I exist.

https://www.linkedin.com/in/drjamesfreeman

Use the contact form to send your phone number and it will filter through. I’ll give you a call.

Best Regards

James

YMMV
19 September 2015 at 9:36 am in reply to: Liver Cirrhosis does not disappear in 12 weeks #1370
Dr James
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- Guardian Angel
@fixhepc
Accessing these medications might not be as simple as seeing a doctor, going to a pharmacy, and then getting them – but it is entirely possible.

Patients are doing it and the results look good. The absolute proof of SVR24 is not yet available but only because generics have only been available for 6 months. Our testing indicates that the generics are good copies so the only real reason they won’t demonstrate similar results is if the real active ingredient happened to be a small manufacturing by product contaminating the active.

This site, the forum, the chat part are just as much about social proof as they are about provisioning good quality information to people with a need to know.

A Google for

“dr james freeman” hepatitis c

https://www.google.com.au/#q=%22dr+james+freeman%22+hepatitis+c

Will turn up stuff dating back for the last 6 months.

YMMV
19 September 2015 at 2:16 am in reply to: Expert Professor by email – Viral Load Monitoring #1354
Dr James
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- Guardian Angel
@fixhepc
The situation with Medicare and HepC testing are here

http://fixhepc.com/forum/experts-corner/105-expert-professor-by-email-viral-load-monitoring.html?start=6#217

Essentially a Specialist needs to authorise an initial test of viral load but during treatment a GP can order VL tests.

Hepatitis C Virus (HCV) PCR: Qualitative (assessment of antiviral therapy of HCV)
Medicare criteria (4 per year):

Patient is undertaking antiviral therapy for hepatitis C.

Telehealth

Medicare funded Specialist Telehealth is a good example of rationing.

In 2011 when it was set up about 2/3 of all Australians were eligible to see a Specialist online.

On 1st Jan 2013 that number was reduced to 1/3 of all Australians.

By way of example we had a psychiatrist in Brisbane seeing patients on the Sunshine and Gold Coasts saving them ~4 hours travel. All her patients became ineligible overnight when they extended the ineligible zone from central Brisbane to to extend from Noosa in the North down over the border into NSW stopping just short of Byron Bay.

https://gp2u.com.au/links.html

There are about 24 million specialist consults a year. There are 140 million GP consults. Of those 160 million consults only 1/3 of the 24 million = 8 million are eligible for Medicare funded Telehealth. That’s about 5%.

This has never been any funding for GP or Allied Health Telehealth and in my view the Government has done a pretty good job of killing Telehealth off. Even Medibank has given up selling their Anywhere Healthcare business to Telstra for an undisclosed sum following a $15 million loss (disclosed in their IPO).

Why it should matter if a patient uses feet, wheels, wings or video to get to their doctor is beyond me.

YMMV
18 September 2015 at 2:37 pm in reply to: compounding Daclatasvir yourself #1340
Dr James
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- Guardian Angel
@fixhepc
“The Capsule Machine” would be ideal for the task. About $25 on ebay. Here is a great video showing how to use it:

[video]https://www.youtube.com/watch?v=xo92dGCt1Rc[/video]

YMMV
18 September 2015 at 2:25 pm in reply to: compounding Daclatasvir yourself #1337
Dr James
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- Guardian Angel
@fixhepc
If you look here: https://www.medicines.org.uk/emc/medicine/29129

You will see this list of excipients (other stuff in the tablet that is not Daclatasvir)

6.1 List of excipients
Tablet core
Anhydrous lactose
Microcrystalline cellulose
Croscarmellose sodium
Silicon dioxide (E551)
Magnesium stearate

So given that BMS mix it with lactose I would use that as your filler.

You can get lactose from the supermarket/chemist baby formula section and use that as your filler. It’s just milk sugar.

You want a brand with a fine grind (about the same as the active) so it’s easy to mix the two parts evenly.

You can grind something too coarse into a fine powder with an ordinary mortar and pestle if needs be.

YMMV
18 September 2015 at 10:34 am in reply to: compounding Daclatasvir yourself #1335
Dr James
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- Guardian Angel
@fixhepc
Hi, I will be posting on this shortly. Here’s a short video of the professionals doing it. Although they have nice machines there are simple versions where you put the 1/2 capsules in, then add the medication. Then fill up any remaining space with filler. Then tip it all out, have a good mix and repeat the process. Put the caps on and you’re done.

[video]https://www.youtube.com/watch?v=FlkkcMNNsPI[/video]

YMMV
18 September 2015 at 4:03 am in reply to: Please check for medication interactions (+ website link) #1327
Dr James
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- Guardian Angel
@fixhepc
http://www.hep-druginteractions.org/checker

So if you go through the process and
- tick Sofosbuvir + Daclatasvir on the first page,
- next
- the alphabetical search is the default
- next
- then find and tick Sertraline
- scroll down to finish
- you will see the “potential interaction”.
You can get a PDF of that as well.

However if you go and look at some of the research you can be reassured to find:

Comparative CYP3A4 inhibitory effects of venlafaxine, fluoxetine, sertraline, and nefazodone in healthy volunteers.

Which says:

These results demonstrate in vivo that, unlike nefazodone, venlafaxine, sertraline, and fluoxetine do not possess significant metabolic inductive or inhibitory effects on CYP3A4.

So you’re good to take the 60 mg Daclatasvir dose, rather than have to reduce to 30 mg or stop the problem medication.
Attachments:
- HepDI_Sertraline.pdf
YMMV
17 September 2015 at 12:02 pm in reply to: Expert Professor by email – Viral Load Monitoring #1322
Dr James
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- Guardian Angel
@fixhepc
The problem is that a Medicare rebate is only payable to the pathology company if a specialist has authorised it, although when you’re being treated that is not actually a requirement. We don’t usually have any problem but do have a consultant physician who can authorise the testing.

In country NSW we can simply get you to have a Telehealth appointment with a specialist (needs a GP referral) or we can see you and ask our specialist to authorise the testing.

Here are the Medicare rules:

Hepatitis C Virus (HCV) Genotyping
Medicare criteria (one per year):
1. The test is requested by a specialist or consulting physician managing the patient’s treatment, and
2. Patient is hepatitis C Virus (HCV) PCR positive and being evaluated for antiviral therapy of chronic HCV hepatitis.

Hepatitis C Virus (HCV) PCR: Qualitative
Medicare criteria (one per year):
1. The patient is hepatitis C seropositive, or
2. The patient’s serological status is uncertain after testing,
or
3. The test is performed for the purpose of:
a. determining the hepatitis C status of an immunosuppressed or immunocompromised patient, or
b. the detection of acute hepatitis C prior to seroconversion where considered necessary or the clinical management of the patient,

Hepatitis C Virus (HCV) PCR: Qualitative (assessment of antiviral therapy of HCV)
Medicare criteria (4 per year):

Patient is undertaking antiviral therapy for hepatitis C.

Hepatitis C Virus (HCV) PCR: Quantitative
Medicare criteria (2 per year):
1. The test is requested by a specialist or consulting physician managing the patient’s treatment, and[/li]
2. The patient has undergone pre-treatment evaluation for antiviral therapy for chronic hepatitis C.[/li]

YMMV
16 September 2015 at 1:29 pm in reply to: Expert Professor by email – September 13th #1305
Dr James
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- Guardian Angel
@fixhepc
I have it on good authority:

The information on end of treatment “detectable” HCV RNA and SVR was contained in presentations at EASL Conference in April, so not yet fully published.

YMMV
16 September 2015 at 9:31 am in reply to: Australian Customs #1302
Dr James
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- Guardian Angel
@fixhepc
Maybe, but it didn’t work when we tried!

That’s why we advise people to follow the instructions at http://fixhepc.com/getting-treated/how-to-do-it/import-paperwork.html.

These instructions were provided by a very helpful man at customs when I asked “How can we make this work smoothly” and he said “Here’s what you need to do to make our job easier”.

The fundamental issue is that clearances are not by physical packet inspection most of the time, it’s electronic record checking. I think the stat is that only a single digit % gets physically inspected, but everything gets electronically inspected.

Each and every shipment is dealt with on an individual basis.

YMMV
16 September 2015 at 8:23 am in reply to: Mesochem #1299
Dr James
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- Guardian Angel
@fixhepc
Yes, that’s correct. The 5th digit is a 6 and the 7th is a 0.

YMMV
16 September 2015 at 8:16 am in reply to: Australian Customs #1297
Dr James
- Topics: 264
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- Guardian Angel
@fixhepc
As strange as it may seem the physical paperwork attached to the package does not get examined by customs.

The electronic duplicates sent independently are the ones customs actually inspect (unless your package is randomly selected for physical inspection in which case you are going to want them with the package as well).

YMMV
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