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HCV treatment preliminaries
Sep 14, 2005

I am 67 years old, male, work over 40 hours per week. I am genotype 1, and I am being followed up by an oncologist, after surgery, in 2002, for resection of a lung tumor caused by kidney cancer, and kidney removal, in 1987. At the time of the nephrectomy, it appears that I contracted HCV through a blood transfusion. I have never had chemotherapy or radiation. Recently, the oncologist told me that my viral load has gone up two-fold from February to April, and more since then. In 2004, I went through a battery of tests for possible treatment for HCV, including a liver biopsy, and the HCV specialist decided that my case was mild, and he left the decision for treatment up to me. I decided against treatment at that time. Based on the most recent blood tests by my oncologist, I have decided to get treated for HCV and have taken some preliminary tests prior to treatment for HCV, including a blood test and stress test. The stress test was characterized as non-diagnostic because I could not get my heart rate up high enough. The folks at the laboratory forgot to tell me that I should have foregone taking my Atenelol for high blood pressure the morning of the strees test. At the laboratory, they toldme that the Atenelol could have prevented my heart rate from going up high enough for the purpose of a successful stress test. My blood pressure read at 130/80. I also had the results of a recent, complete PET/SCAN (from my oncologist's need for follow-up), faxed to the HCV specialist. I had the results of a recent eye exam, done by my opthalmologist, faxed to the HCV specialist's office. The HCV specialist noticed that my iron count was low, and says (though his nurse) that he may want me to undergo both a colonoscopy and an upper endoscopy, before he begins treatment. I had a colonoscopy in March, 2003, and the gastroentolgist noticed that I had divertucolitis. I also have a hiatal hernia, for which I take Nexium every day.

When do all the preliminary tests end, and the treatment begin? What is he looking for that the oncologist, who is also a hemotologist, was not concerned about (other than high viral load) in my most recent visit to the oncologist in July, 2005? Are all HCV specialists this cautious? Does working many hours affect iron count? It's hard to get an answer from the HCV specialist, because he does not come to the phone. His nurse may call me next week to set up an appointment.

Response from Dr. Dieterich

You certainly have had a thorough work up! Caution may be the wrong word here, reluctance is probably the correct one. Your GI is hoping you will change your mind while undergoing all the other tests. Also it is a lot easier for a GI MD to do procedures (and more lucrative too) than to treat a complicated patient like yourself for HCV. It is not unreasonable to do the tests given your cancer history and iron deficiency. However don't let him stall anymore after that! Good luck! DTD



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