Gregory M. Ledet

Yesterday was my appointment with the GI PA, but I just couldn’t make it.  The car was acting up, and so was my stomach.  She ended up calling me and we went over my latest blood tests, so I guess I’ll go over them with you guys now!

Everything looks par for the course with this treatment.  White count and red count are both low, as is hematocrit.  Albumin is high as well.  My AST is 67 and my ALT is 58 (slightly higher than last time, but I’ll chalk that up to changing my pain meds from Vicoprofen to Percocet and the APAP in it).  The AST is high, but not bad.  The one that stuck out was my TSH.

The normal range for TSH is 0.47 to 4.68 and mine came in at 5.85.  It’s not terribly high, but my hep doc wanted me to talk with my family doc about it, so I went in to talk with her today.  Let me explain this TSH thing to you guys.

The thyroid gland produces thyroid hormone. When it functions properly, the thyroid is part of a feedback loop with your pituitary gland. First, the pituitary senses the level of thyroid hormone that the thyroid has released into the bloodstream. The pituitary then releases a special messenger hormone, known as “Thyroid Stimulating Hormone” (abbreviated as TSH). TSH stimulates the thyroid to release more thyroid hormone.

When the thyroid, for whatever reason — illness, stress, surgery, obstruction, or, in this case, peginterferon therapy — does not produce enough thyroid hormone, the pituitary detects this reduction in thyroid hormone, and it moves into action. The pituitary then makes MORE TSH, to help trigger the thyroid to produce more thyroid hormone. This is the pituitary’s effort to return the system to “normal” and normalize thyroid function. There, a TSH that is higher than normal suggests a thyroid that is underactive and not doing its job of producing thyroid hormone.

Thyroid dysfunction is normal for people to experience during interferon therapy.  Because of this, my family doc isn’t too concerned at this point, but she wants to run some more tests.  I’m going to have T₃ and T₄ test done tomorrow morning to see exactly what the thyroid hormone levels look like.  I’m also having a lipid panel done, so I need to be fasting to have it done, hence the reason for tomorrow morning.

Hopefully everything works out OK and I don’t have to spend the rest of my life taking Synthroid.  My wife had her thyroid removed years back, and I’m not looking forward to that.  So, that’s about it for now.  Other than that stuff, and a change from Zoloft to Wellbutrin, it’s been pretty normal.  I have been a bit edgier than normal, and more prone to anger, but I’m trying to keep that under control.  I know that I just over a month left to go on this, so I can’t wait for it to be over.  Once this treatment is over, you can bet that there’s going to be a party somewhere!

Yeah, it’s been a while since I’ve posted.  I’ve been busy as hell, not to mention feeling like hell.  The treatment has really been taking it’s toll on me.  I guess you can say that the interferon has killed off all the bad stuff and now it’s starting to kill off the good stuff, namely me.  Here’s a little update on what’s been going on.

I’ve been working hard on trying to get Le’ Day Consulting up and running, but it’s been hard with the treatment.  I’ve got a couple of clients out there, but it’s a little slow.  On top of that, the treatment has everything in my system running low.  My white blood cell count is 2.4.  The normal range is 4.8 – 10.8.  So basically, I’m immunocompromised.  My red count is on the low side; 4.23 and a normal range of 4.60 – 6.20.  Hemoglobin and Hematocrit are both low as well.  The only things that aren’t low are my AST and ALT.  My AST is 59 and my ALT is 79, which are better than what they were last month.  They were 78 and 83 respectively.  My liver is getting better, but my body is falling apart.

The virus is still undetectable in my body!  That is excellent news!  Let’s just hope that I can achieve SVR and not have to worry about this crap again once I’m done with treatment.  I’ve been through 17 injections now and 16 weeks of treatment, so hopefully I only have 8 more weeks to go and I’m done with this.  I’ve made it this far, so there’s no way in hell I’m going to give up now, no matter how bad I’m feeling!

On a completely different subject… THE SAINTS ARE WORLD CHAMPS!!!!  I still can’t believe it!  The USA set a Winter Olympic record of 37 metals and Canada set a record with 14 GOLD metals, so both Jasmine and I are very happy with our countries right now.  I’ve been throwing around the idea of getting another Anschutz, specifically this one, and start shooting again with hopes that I’d be able to make the Olympic team again.  The only problem is that target rifles are extremely expensive and so is all the travel that you have to pay for to go around the country to competition.  I remember that I had a blast back in 1996 and with shooting, you really don’t need to be 18 years old to keep up with the field.  It’s the only Olympic sport I’d have a shot at making (pun intended).

I find it kinda funny that right before the Saints won the Super Bowl, the northern part of the US had to deal with Snowpocalypse.  Washington DC was under 3 feet of snow in one day, so I guess you can say Hell froze over!  We had a shitload of snow here as well. That Friday of all the bad snow we got 14 inches and over the past 30 days we’ve had about 2½ feet of snow.  That’s set a record for Logan County.  Mad River Mountain, the ski resort here, must have been happy as all hell for all of that show!

Well, that’s about it for now.  The treatment is working, I’m dying, Al Gore is lying, the Saints won, and the USA kicked ass.  Until next time, peace!

-Greg

I have slept all damn week long.  Literally.  I can’t think of a time in my life when I’ve slept this much… not even when I was a teenager.  Wednesday night I got really into a new webapp that I was working on and didn’t get to sleep until yesterday at 6am.  I slept until noon and came downstairs only to go back to sleep at 1:30 or so.  I woke up just before 5, went to bed at 8 (no sleeping pills needed) and didn’t wake up until 10:30 this morning.  I had to take a Ritalin just so I didn’t fall asleep again today.  It’s been like this all week.  I sleep and sleep and sleep and I’m still tired.

This is not to mention the lack of appetite.  I’ve been having to force myself to at least eat a sandwich or something everyday just to make sure I have something in my stomach.  I’m getting tired of throwing up and not having anything in my stomach to come out.  It’s too damn painful.  Even the nausea meds aren’t helping as much as I’d like.

I’ve been trying to keep my mind on things other than feeling like complete ass.  I’ve just finished my second mobile webapp, admittedly it’s just another calculator and it looks similar to the first, but there’s a lot of difference in how the back end works.  I’ve already started working on porting it over to the Palm Pre and Pixi, but I’m running into issues with formatting.  I’ll figure it out.

Today’s injection site was the top of my right thigh.  Yes, it sucks.  I took it around 10:30 and I’m already feeling it bad.  I know tomorrow is going to suck royally, but I just need to push through it.

That’s about everything that’s going on right now, so until next time…

Today started off horribly.  The doorbell rang at 10:30 and I was still sleeping, seeing as I didn’t go to bed until 4am.  I knew my wife was downstairs, but I still wanted to see what was going on.  I made the first step and my feet slipped out from under me.  Down the stairs I went.

Not a good pic, but click for larger image

I screwed up my arms pretty good, but that’s just the part I can show you here.  My lower back and and tail bone are destroyed.  My neck is killing me.  It hurt like hell when it happened, and now it’s getting worse as everything tightens up.  I only thought that I wasn’t doing good with the treatment, now I have this to contend with.  Trust me when I tell you… I’m in a shitload of pain.  The best part about it?  The doorbell was UPS delivering more Pegasys.  I went through pain to take delivery of pain.  It was so loud when I fell down the stairs that the neighbors came running over to see if I needed help.  I couldn’t move for about 10 minutes.

While I was sitting here in pain I tried to get some things done knowing that I have company arriving tomorrow and I had a doctor’s appointment today at 3 and it was going to take an hour and a half to get to the doctor’s office.  This is where to good day comes into play.  The doctor’s appointment was my first meeting with the PA that will be taking care of me during my Hepatitis treatment.  It was also my first look at the blood work I’ve had done since I started treatment.  We got to the office and everything went OK at first.  We went over the CBC and CMP info and I was informed that my white count was a little low, but my AST and ALT were looking better!

Click the image for full spreadsheet containing values

For those of you that don’t know, the AST and ALT are liver enzymes. Liver enzymes allow doctors to learn about the health of your liver. There are thousands of these enzymes in the liver and blood stream, but two of them — known as AST and ALT — are especially useful for determining the severity of liver disease.  When liver cells are damaged, AST and ALT are “leaked” into the blood stream.  The amount of these enzymes give the doctor an idea of just how screwed up your liver is.  When the levels are high it causes concern because the liver isn’t functioning the way it should.  In simple terms: if AST and ALT are high, that’s BAD.  Liver enzymes are like golf scores.  By looking at the teal and orange lines in the chart above, you’ll get an idea of what my liver enzymes have been doing this year.  I started treatment on Nov. 20th, so they have gone down since then.  Click that chart and bring up the full numbers and the spreadsheet.  Lots of info in there, including the numbers that you need to make that chart look right.

So, now we know that my liver is working a little better because they’ve gone down since my last test.  This is a GOOD thing, but it isn’t what I wanted to know.  I wanted to know my Viral Load.  That’s the test that I needed.  It’s going to give me a number and that number is the amount of virus found within a given volume of blood.  My last test, in September, gave me a viral load of 1,720,000 IU/mL.  That mean there’s 1.7 million of those little viruses swimming around in that vial of blood.  I had the viral load done again on the 21st and, I’m happy to say, it came back UNDETECTABLE!  That’s right!  The HCV RNA was not detectable in a range of 43 IU/mL to 69,000,000 IU/mL.  It could still be there, but it’s less than 43 IU/mL.  The next test I’m going to have done will be able to detect it down to 10 IU/mL.  If it’s not detected there, then it’ll be save to say that I’m kicking it’s ASS.  Or at least, I’ve kicked at least 1,719,957 of their asses so far.

5 more months of treatment and it’ll be looking VERY good for me attaining SVR.  This is what this treatment is all about.  It’s about it working.  It’s about me beating it and not letting it beat me.  And this is also help for all of you out there that are looking into starting treatment.  There is hope!  I’m a guy that started treatment before and stopped after 4 weeks.  I had well over a year to let the virus mutate on me and build an immunity to the treatment, but it didn’t.  It’s still getting it’s ass kicked, and as am I.

Speaking of getting my ass kicked, falling down the stairs this morning really sucked.  My body is really starting to tense up and hurt like hell.  I’m eating pain pills right now like mentos just trying to take the edge off.  I mean hell… I sat on my nuts when I fell.  Yes, my full 240 lbs of weight landed on my testicles as I was dropping down the stairs. It still really hurts…  Not to mention that I popped a cyst on my kidneys when I fell (I have Polycystic Kidney Disease too) and I’ve been pissing blood all afternoon.

I’m still going to keep updating this blog, especially with info on my blood tests and everything.  But the question still remains… How do you feel my day went.  Was it a good day?  Was it a bad day?  Or, was it just Tuesday?

I’m still sleeping all day long.  I can’t believe that today is already Wednesday and that the day is nearly over.  I guess because I’ve been sleeping so much, I feel like I just slept the week away.  I’ve been trying to get some stuff done, mainly working on a few websites and trying to get the house cleaned up a little bit, but with all the sleeping it’s making things hard.  I’ve also had a monster headache for the past few days.  The injection sites on my stomach are bright red, swollen, and itchy.  I’ve been putting a topical antihistamine on there, but it’s still not helping.  The dry eyes have kinda cleared up, but they are still a little dry.  Nothing that some eye drops can’t handle.

Other than that, things have been going OK.  The joint and muscle aches haven’t been bad at all since I woke up on Monday.  I’m not looking forward to Friday though.  I’m going to have to take Friday’s injection in my thigh because I’ve taken the last 2 in my stomach and I need to let that heal for a while before I go rushing back in there.  The problem is, this is a subcutaneous injection, not IM and I have very little fat on my legs.  This one is going to hurt like hell, but that’s all part of the treatment!

I didn’t want to get out of bed this morning. I’m having some body aches and my internal thermostat is all screwed up.  I’m taking delivery of a new recliner tomorrow, so I had to get off my ass and clean the living room and vacuum.  That was a process that should have taken all of 10 minutes, but turned into an hour ordeal because I can barely move.  I’m still sitting in my recliner, moaning in pain, and bitching about how bad I feel.  I wish I could just stop sweating for 5 minutes though.  My wife is wrapped up on the couch in flannel pants and sweatshirt, curled up under a comforter, yet I’m sitting here in a pair of shorts complaining that the backs of my knees won’t stop sweating even though I have the AC on and set to 65.

I wanted to try to get out of the house today and do something, but that’s just not going to happen.  I did finally finish the Google Latitude widget that I started working on the other day, so at least I got something done.  I’m trying to get my consulting business website finished, but because the meds are messing with my head and I’m having to take the Depakote to keep me sane while on the meds, I’m having a hard time concentrating long enough to come up with good content for the site.  Another drawback of treatment… lack of concentration.  I can’t even watch a movie in the days following an injection because it’s hard for me to concentrate through the whole movie.  Oh well, it’ll be over in 22  more weeks…

I’m starting to have some new things pop up on me.  The main thing being dry eyes.  I mean VERY dry eyes.  I can put eye drops in and 3 minutes later they feel like I’ve been pouring desiccant into them.  Another thing is a very bad taste in my mouth in the morning.  It tastes like a cross between leather and guano.  And finally, the thing that I’m worried most about; a bad sweet tooth.  I want something sweet all the damn time.  My appetite has gone to hell, but I constantly crave candy and kool-aid.  That’s just plain weird…

-Greg

Last night I felt a lump at the injection site. It kinda worried me that maybe the medication didn’t make it’s way entirely into my body, so I’m going to do things a little differently on this coming Friday’s injection.  Well, that’s neither here nor there, so here’s today’s video!

Ok, now that we got that out the way, let’s talk about genotypes.  It is much easier to talk of the Hepatitis C virus as if it is a single organism but in fact it is a range of viruses, similar enough to be called Hepatitis C virus, yet different enough to be classified into subgroups. Consequently, a better way to understand the terms HCV ‘genotypes’ and ‘subtypes’ is to compare them to things that we can more readily relate to.

The group of birds we call ‘raptors’ (birds of prey) have evolved into different main types. Imagining raptors as being Hepatitis C viruses, you could take one major raptor type, such as eagles, and imagine these as being one of HCV’s main types (genotypes). But eagles as a group are made up of different sub types such as the Bald Eagle and the Golden Eagle. You could imagine each of these as being one of the HCV subtypes that make up an HCV genotype.

Within each of above particular types of eagles, there are further differences. All Bald Eagles, for example, differ from each other in regard to wing span, weight, color, beak size, etc. Similarly, within a Hepatitis C sub-type, individual viruses differ from each other ever so slightly. Such viral differences are not significant enough to form another sub-type but instead form what’s known as quasi-species. It is believed that within an HCV sub-type, several million quasispecies may exist. Scientists predict that people who have Hepatitis C, have billions of actual viruses circulating within their body. Although there may be one or two predominant sub-types, the infection as a whole is not a single entity and is composed of many different quasispecies.

Biologists are generally not known for creativity when it comes to naming things – hence Hepatitis C virus. The most commonly used classification of Hepatitis C virus has HCV divided into the following genotypes (main types): 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 and 11. As we’ve highlighted, HCV genotypes can be broken down into sub-types, some of which include:

1a, 1b, 1c
2a, 2b, 2c
3a, 3b
4a, 4b, 4c, 4d, 4e
5a
6a
7a, 7b
8a, 8b
9a
10a
11a

It is believed that the Hepatitis C virus has evolved over a period of several thousand years. This would explain the current general global patterns of genotypes and subtypes:

1a – mostly found in North & South America
1b – mostly found in Europe and Asia.
2a – is the most common genotype 2 in Japan and China.
2b – is the most common genotype 2 in the U.S. and Northern Europe.
2c – the most common genotype 2 in Western and Southern Europe.
3a – highly prevalent in Australia and South Asia.
4a – highly prevalent in Egypt
4c – highly prevalent in Central Africa
5a – highly prevalent only in South Africa
6a – restricted to Hong Kong, Macau and Vietnam
7a & 7b – common in Thailand
8a, 8b & 9a – prevalent in Vietnam
10a & 11a – found in Indonesia

Here’s a little graphic that will show how the different genotypes are distributed across the globe:

Current scientific belief is that factors such as duration of a person’s HCV infection, their HCV viral load, age, grade of liver inflammation or stage of fibrosis may play an important role in determining response to interferon treatment. Recent studies have suggested that a person’s HCV subtype (or subtypes) may influence their possible response to interferon, or interferon-ribavirin combination treatment.

I have genotype 2a. With this genotype, there’s around an 70% chance that I will achieve SVR after 24 weeks of treatment, and that’s good news. I don’t know how I ended up getting a rare genotype to the US, but it happened and I’m glad that it did.  Genotype 1 as a much lower chance (around 40%) of achieving SVR after 24 weeks of treatment and most people have to go 48 weeks.  Combine that with the fact that we caught it early and the chances of me getting through this without major liver damage are pretty high.

Well, that’s just about everything I can tell you about HCV genotypes. If you have any questions, do not hesitate to use the new comment system I put in place last night. You can login with your facebook, twitter, yahoo, or openID accounts so you don’t have to register for this site to post a comment.  Thanks again for reading and I’ll see you guys tomorrow!

-Greg

Things are a little better today.  I’ll go ahead and get the video out of the way now, then we’ll talk about SVR.

Yeah, that rash is still aggravating me, as is the injection site.  Muscle aches are coming on a little stronger as I type this, but nowhere near what they were Saturday morning.  Now, let’s talk about Sustained Virologic Response (SVR).

SVR is the closest I’ll get to “a cure” for hepatitis. Sustained virologic response, or SVR, is the goal of this peginterferon/ribavirin treatment. This treatment I’m on doesn’t necessarily eliminate the hep C virus from my liver. It can, however, suppress the virus to undetectable levels for an extended period of time. In clinical language, this is called a “sustained virologic response,” or sustained response. It means that during the six months after I complete treatment, there is no detectable hepatitis C virus in my blood.

SVR is a good thing. Studies have shown that with a six-month SVR (which means no detectable virus in your blood for six months after finishing treatment), relapse occurred in only 1-2% of patients. So, for every 100 people who finished treatment and attained SVR, the virus will return in only 2 of them. However, for these people, the virus never really left. The medicine was able to eliminate most of the virus (so much that medical tests couldn’t detect it), but after treatment ended, for whatever reason the virus was able to continue replicating itself.

Early SVR is beneficial. Since the liver has incredible regenerative ability, achieving SVR as quickly as possible is important. This is important because some liver damage can be reversed if the cause of the damage is removed. After SVR is reached and depending on the degree of damage from the virus, the risk of hepatocellular cancer is reduced and about 25% of people see an improvement in fibrosis.

SVR compares one treatment to another. For those of us in treatment, SVR is the goal. However, for physicians and scientists researching new hepatitis treatments, SVR is also used to evaluate new medicines and compare them with proven therapies. For example, depending on the genotype, treatment with interferon alone usually achieves SVR in 15% of the patients. When interferon is combined with ribavirin in the same genotype, SVR is increased to 70% in some people.

Tomorrow I’m going to try to get into genotypes as well as the genotype that I have and what my chances at SVR is.

-Greg

References: About.com and hivandhepatitis.com

I just went upstairs to take my shower for the evening and when I was drying off, I felt pain in my face as the towel went across it.  It almost felt like I had a very bad sunburn on my face.  Once the mirror had cleared, I noticed a very bright red rash on my face.  The picture below really doesn’t show just how red it is (it’s only the shitty camera on an iPhone).  I’ve provided a “before” picture for comparison (click for larger).

Before	After

If you’re thinking “man, that really sucks”, you’re right.  It does suck.  I wish I had a camera and proper lighting to show what it really looks like.  Every time I run my hands across my face, I can feel where I “scratched” for about 45 seconds after, as though my hands were still there.  It goes from my chin to my hair line and is very bad on my chin under my goatee and just above my mustache.

I’ll continue to post any weird things that happen to me on the course of this treatment and I’m going to make videos as often as possible!

***EDIT***

Here’s a new pic, taken about 2 hours after the first and you can start to see the rash on my face getting darker and redder.  I’m starting to itch all over my body and I just took 3 Benadryl to help with the itching and help me sleep. (Click for larger image)

It's starting to get worse

Day 3 sucks, but nowhere near as much as yesterday and the day before did.  I still have bad body aches and a monster headache, but it’s starting to clear up some.  The one thing that really sucks is the injection site.  One of the side effects of the injection is “pain, swelling, or redness”.  I’m getting all 3.  In fact, check out my fat belly…

It’s kinda hard to see in that picture, but I’ve drawn a rough circle around where the swelling and redness is.  That dark spot within the circle is where the needle went in.  Anytime something brushes across the injection site, like my shirt or something, it feels like someone is running 80 grit sandpaper across my skin.

I’m hoping that I’ll wake up tomorrow finally felling rested.  I haven’t really slept in a week.  I was all nervous about starting this treatment, which screwed up my circadian rhythm, and then I started the treatment, which doesn’t let me sleep all that much.  Even taking Lunesta and Ambien I’m having trouble sleeping.

I’ve decided not to do a video blog today… I’m still very tired and I just don’t have the energy to do it.  I hope this is enough!  I’d like to thank all of you for the support that I’ve gotten over the past few days.  It means a lot to me.  Now, let’s talk about dem Saints!!!  10 and eaux!  I would love to see a Black and Gold Superbowl!

-Greg