Hi James,

While you are probably dehydrated (given saunas strip the water out of you) we see the combination of:

1) Dark urine
2) Light coloured stool

When the bilibrubin being processed in the liver can not get down the bile duct and into the gut. In this case it goes out via the urine and make it dark. Because it’s not in the stool this is light.

The most common reason is gallstones but anything that obstructs bile outflow including cirrhosis and tumours can do it.

Testing is simple. Do a urine dipstick. If it is dark due to bile obstruction we detect a lot of urobilinogen. If it is dark due to dehydration then the specific gravity is high.

As a simple homebrew alternative you could have a day where:

a) You don’t gym/sauna or do other things that make you sweat a lot
b) Drink 4 litres of water

If this results in your urine ending up light yellow to water like than your problem is dehyration. If it does not you need to see a doctor.

Sadly drug abuse and addiction crosses all social boundaries.

It’s interesting that she says she does not have Hep C. Hard to transmit something you don’t have, regardless of whether you’re stealing drugs… It’s also very easy to prove with a Ab and PCR if she ever had the disease or did have the disease.

The claim not to have Hep C might be based on having a negative PCR (due to natural clearance or getting treated). A lawyer would allow stating “I don’t have hep C” in this context as it it true. It might leave out “but I did, and got rid of it”… but that’s lawyers for you.

Hello Mikey87,

Any changes?

Your L31M provides resistance to the NS5A in Viekira (Ombitasvir) leaving you with only the Paritaprevir (NS3/4A) and Dasabuvir (NS5 to do the job. Dasbuvir is significantly inferior to Sofosbuvir and clearly not up to the task in you.

You should be easy to retreat and could retreat now with Viekira + Sofosbuvir (that’s what we use) but Vosevii would be equivalent if you can get it.

http://www.aidsmap.com/Treatment-intensification-with-sofosbuvir-permits-cure-after-failure-of-previous-HCV-treatment/page/3014995/

If you fail Vosevii you will probably be incurable unless you could get Maviret and add Sofosbuvir and Ribavirin. So it’s probably best to take your consultant’s advice on this one.

The retreatment success rate with Vosevii is “only” 96%. Nobody wants to be in the 4% but 1 in 25 patients will be, regardless of what they want. While Ribavirin might not add much not taking it and then relapsing again would leave you wondering… what if?

Hi Ron,

If you wife with stomach you doing it there is little doubt that meat is a great natural source of iron and protein.

If keeping the peace means no BBQ then iron tablets help.

Iron deficiency is not the only cause of anaemia so it needs looking into. For meat or iron to work we should see a microcytic anaemia (small red cells)

Red cells also need B12 and folate. Vegetarians tend to be B12 deficient as it is only made by animals (so flat out vegans survive on B12 contamination or chemical factory produced B12 supplements). With B12 or Folate deficiency we see a macrocytic anaemia (big red cells)

Sometimes people are both iron AND B12/Folate deficient in which case we can see a normocytic anaemia (like we may see with bleeding) as the small vs big balance out.

In non cirrhotic patients taking DAAs it is unusual to see anaemia. Even in cirrhotics it is very unusual to see much change in red cells unless we are using Ribavirin in which case it is expected.

Hello mrcleanrt,

Yoir experience is not unusual. As a doctor I have to paint a realistic, verging on pessimistic picture. On the whole these drugs are very clean in terms of side effects and effective in terms of results.

Best of luck for SVR.

Those are some great looking numbers Sven!