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  • in reply to: Weight Loss or Weight Gain on DAA’s #15945
    dope-on-a-rope.jpgDr James
    • Guardian Angel
    • ★★★★★
    @fixhepc

    I gained 4 kg Didn’t need it really but at 60 I’m not going to fret too much about it :) :)


    YMMV

    in reply to: zero(12),14,16,18 or 20 weeks is the answer #15933
    dope-on-a-rope.jpgDr James
    • Guardian Angel
    • ★★★★★
    @fixhepc

    Take them all, not because your chances of cure are small @ 12 weeks but rather because you would be beating yourself up if you relapsed knowing you gave away a % of SVR, and the extra weeks add 5%

    94% = 17:1 in your favour

    99% = 99:1 in your favour

    It’s only 5% but in odds terms…..


    YMMV

    in reply to: Dr. Freeman on Google News! #15931
    dope-on-a-rope.jpgDr James
    • Guardian Angel
    • ★★★★★
    @fixhepc

    Gilead must be pretty pissed about now…..

    Gilead are businessmen. Amoral perhaps, but businessmen all the same. They will always have known their high price run was time limited, although generic competition may not have factored into their timelines.

    Gilead’s decision is simple – if they chase us they give the generic flame oxygen. Media oxygen.

    Ignoring generics is their best option and what they have been doing. If you look at the upside/downside risk, selecting do nothing is the way to go.

    I doubt a bit of anger is going to make them drop the ball. They may be bastards, but they aren’t stupid.


    YMMV

    in reply to: St Vincents Melbourne good news #15909
    dope-on-a-rope.jpgDr James
    • Guardian Angel
    • ★★★★★
    @fixhepc

    Congratulation on SVR4 :cheer:


    YMMV

    in reply to: DAAs and Liver Cancer Risk #15898
    dope-on-a-rope.jpgDr James
    • Guardian Angel
    • ★★★★★
    @fixhepc

    Hi Jill, let’s do them now and more later.


    YMMV

    in reply to: DAAs and Liver Cancer Risk #15882
    dope-on-a-rope.jpgDr James
    • Guardian Angel
    • ★★★★★
    @fixhepc

    Hi Jill,

    I’ve sent you another path form. It’s that same as the last one but we have not seen the results. It has the AFP (alpha Feto Protein) HCC (liver cancer) test on it.


    YMMV

    in reply to: UPI On Board! #15880
    dope-on-a-rope.jpgDr James
    • Guardian Angel
    • ★★★★★
    @fixhepc

    It is in the quotes section but this one from JFK bears repeating:

    “The great enemy of truth is very often not the lie–deliberate, contrived and dishonest–but the myth–persistent, persuasive and unrealistic. Too often we hold fast to the cliches of our forebears. We subject all facts to a prefabricated set of interpretations. We enjoy the comfort of opinion without the discomfort of thought”

    – JKF Commencement Address at Yale University, June 11 1962

    Gilead are charging outrageous prices for an inexpensive medication they did not invent. They do not even pay their taxes. Citizen payers are dying due to their pure unadulterated greed.

    http://www.bloomberg.com/news/articles/2015-02-26/gilead-avoids-billions-in-u-s-taxes-on-its-1-000-a-pill-drug

    Anybody who sees this as acceptable lacks capacity for rational thought.


    YMMV

    dope-on-a-rope.jpgDr James
    • Guardian Angel
    • ★★★★★
    @fixhepc

    It’s turned out to be academic.

    The Washington Post, New York Times and Boston Globe have all decided NOT to run the story.

    While one view would be the evil hand of Big Pharma suppressed the story it’s probably a bit more pragmatic.

    If we had FAILED that would have been news, but given the lack of failure….

    The problem is that the story was effectively communicated as “Cheaper versions of already proven American drugs have been proven to work by people who are not Americans, treating people who not Americans, reporting to people who are not Americans somewhere which is not in America called Spain, at some conference which is not American called the EASL ILC 2016”

    Getting this story to float in the mainstream media in the USA is going to take work, and quite possibly a blonde hair, big boobs and uber fame celebrity endorsement.

    Sad as it may be if Pamela Anderson had said “I had Hep C, took generics, and got cured” then the US media would be all over it.


    YMMV

    in reply to: Afraid to take the meds due to severe anxiety #15878
    dope-on-a-rope.jpgDr James
    • Guardian Angel
    • ★★★★★
    @fixhepc

    With GT3 you do not have a 100% chance of being less than LLOQ ie <15 at 4 weeks. The chances of being undetected are even less.

    That's why I never do a qualitative test at 4 weeks - I do a QUANTITATIVE - coming back at 20 (when it was 1 million) is a lot more reassuring than coming back detected - which the majority of GT3s still are...

    Here is what the SOF+DCV kinetics look like in both GT3 and GT1. Notice that GT1 responds faster but both are better than SOF+PEG+RBV. Note that 1.18 on the log scale is <15 and the line below that is the UND line.

    ScreenShot2016-04-17at11.07.31am.png


    YMMV

    in reply to: Bile Reflux #15876
    dope-on-a-rope.jpgDr James
    • Guardian Angel
    • ★★★★★
    @fixhepc

    Hi Stew,

    That seems a bit NQR. I don’t like Not Quite Right.

    It could be “we” as in modern medicine are missing something.

    My advice would be to see another doctor, not because your current GP is not good, but just for a second opinion, devoid of bias from all past knowledge.

    I would be looking for things like

    Making sure you have SVRed of course and have normal liver functions

    If you are SVR but your LFTs are off a bit I would be looking for a retained stone in your bile duct, hemochromatosis, bile duct stricture or bile duct/pancreatic/liver/blood cancers

    My approach would be along the lines of “if you hear hoof beats think horses” and if I found no horses I would start looking for zebras…..


    YMMV

    in reply to: DAAs and Liver Cancer Risk #15875
    dope-on-a-rope.jpgDr James
    • Guardian Angel
    • ★★★★★
    @fixhepc

    Here are some very simple guidelines:

    1. If you have HCV treat it now – putting it off will almost certainly be worse
    2. If you don’t have cirrhosis, and have never had an HCC, have an AFP at EOT, 3 months and 6 months along with your viral loads and then stop worrying – if it’s all clear, you’re as good as it gets
    3. If you have previously had an HCC things are not great, and they are not going to get better by delaying treatment. Treat but monitor AFP monthly during the 6 months of treatment and monthly for the 6 months after. After that you can reduce the frequency of monitoring.

    YMMV

    in reply to: Using Milk Thistle whilst on treatment. #15873
    dope-on-a-rope.jpgDr James
    • Guardian Angel
    • ★★★★★
    @fixhepc

    Milk Thistle does have some useful impact on the liver in several disease states.

    You can take it again the day after you finish your DAAs.


    YMMV

    in reply to: Unable to acquire a prescription in NZ #15837
    dope-on-a-rope.jpgDr James
    • Guardian Angel
    • ★★★★★
    @fixhepc

    Which geographical area are you in NZ?


    YMMV

    in reply to: Fear of being healthy again #15811
    dope-on-a-rope.jpgDr James
    • Guardian Angel
    • ★★★★★
    @fixhepc

    Hi Jeff,

    With your history of HCC you have a 1:3 chance of seeing it back, on average within 3.5 months so make sure you have an AFP every month for the next 6 months and an ultrasound, triple phase CT, or MRI if the is any substantial increase.

    Don’t skip this!


    YMMV

    in reply to: Quote of the day #15807
    dope-on-a-rope.jpgDr James
    • Guardian Angel
    • ★★★★★
    @fixhepc

    Desiderata
    Go placidly amid the noise and haste, and remember what peace there may be in silence.
    As far as possible without surrender be on good terms with all persons.
    Speak your truth quietly and clearly; and listen to others, even the dull and ignorant; they too have their story.
    Avoid loud and aggressive persons, they are vexations to the spirit.
    If you compare yourself with others, you may become vain and bitter;
    for always there will be greater and lesser persons than yourself.

    Enjoy your achievements as well as your plans.
    Keep interested in your career, however humble; it is a real possession in the changing fortunes of time.
    Exercise caution in your business affairs; for the world is full of trickery.
    But let this not blind you to what virtue there is; many persons strive for high ideals;
    and everywhere life is full of heroism.

    Be yourself.
    Especially, do not feign affection.
    Neither be critical about love; for in the face of all aridity and disenchantment it is as perennial as the grass.

    Take kindly the counsel of the years, gracefully surrendering the things of youth.
    Nurture strength of spirit to shield you in sudden misfortune. But do not distress yourself with imaginings.
    Many fears are born of fatigue and loneliness. Beyond a wholesome discipline, be gentle with yourself.

    You are a child of the universe, no less than the trees and the stars;
    you have a right to be here.
    And whether or not it is clear to you, no doubt the universe is unfolding as it should.

    Therefore be at peace with God, whatever you conceive Him to be,
    and whatever your labors and aspirations, in the noisy confusion of life keep peace with your soul.
    With all its sham, drudgery and broken dreams, it is still a beautiful world. Be careful. Strive to be happy.

    © Max Ehrmann 1927


    YMMV

Viewing 15 posts - 1,261 through 1,275 (of 1,968 total)