Matt's Blog

Depression Caused By Chronic Illness
Chronic
illness causes depression in some people. A chronic illness is an
illness that lasts for a very long time and usually cannot be cured
completely. However, chronic illnesses can often be controlled through
diet, exercise, and certain medicines. Examples of chronic illnesses
include diabetes, heart disease, arthritis, kidney disease, HIV/AIDS,
lupus, and multiple sclerosis (MS).
Why is Depression Common in People With a Chronic Illness?
People
diagnosed with chronic illnesses must adjust to the demands of the
illness itself, as well as to the treatments for their condition. The
illness may affect a person's mobility and independence, and change the
way a person lives, sees him or herself, and/or relates to others. For
these reasons, a certain amount of despair and sadness is normal. In
some cases, a chronic illness may actually cause depression.
Depression
is one of the most common complications of chronic illness. It is
estimated that up to one-third of individuals with a serious medical
condition experience symptoms of depression. Depression and illness may
occur together because the physical changes associated with the illness
trigger the depression, the individual has a psychological reaction to
the hardships posed by the illness, or simply as a coincidence.
Which Long-Term Illnesses Can Lead to Depression?
Any
chronic condition can trigger depression, but the risk increases with
the severity of the illness and the level of life disruption it causes.
The risk of getting depression is generally 10-25% for women and 5-12%
for men. However, those with chronic illnesses face a much higher risk
-- between 25-33%.
Depression
caused by chronic illness often aggravates the illness, especially if
the illness causes pain, fatigue, or disrupts your social life.
Depression can intensify pain. It causes fatigue and sluggishness that
can worsen the loss of energy associated with these conditions.
Depression also tends to make people withdraw into social isolation.
The rate for depression occurring with other medical illnesses is quite high:
* Heart attack: 40-65% experience depression
* Coronary artery disease (without heart attack): 18-20% experience
depression
* Parkinson's disease: 40% experience depression
* Multiple sclerosis: 40% experience depression
* Stroke: 10-27% experience depression
* Cancer: 25% experience depression
* Diabetes: 25% experience depression
What Are the Symptoms of Depression in People with Chronic Illness?
Patients
and their family members often overlook the symptoms of depression,
assuming that feeling depressed is normal for someone struggling with a
serious, chronic illness. Symptoms of depression are also frequently
masked by the other medical conditions, resulting in treatment for the
symptoms -- but not the underlying cause of the symptoms -- the
depression. It is extremely important to treat both forms of illness at
the same time.
What Can Be Done to Treat Depression in People With Chronic Disease?
Treatment
of depression in people with chronic disease is similar to that offered
to other people with depression. Early diagnosis and treatment for
depression can reduce distress, as well as the risk of complications
and suicide. People who get treatment for depression that occurs at the
same time as a chronic disease often experience an improvement in their
overall medical condition, a better quality of life, and are more
easily able to stick to their treatment plans.
If
the depressive symptoms are related to the physical illness or side
effects of medicine, treatment may just need to be adjusted or changed.
If the depression is a separate problem, it can be treated on its own.
More than 80% of people with depression can be treated successfully
with medicine, psychotherapy, or a combination of both. Treatment with
antidepressant drugs can start to work within a few weeks.
Tips For Coping With Chronic Illness
Depression,
disability, and chronic illness form a vicious cycle. Chronic illness
can bring on bouts of depression, which, in turn, can lead to a
run-down physical condition that interferes with successful treatment
of the chronic condition.
Following are some tips to help you better cope with a chronic illness:
* Learn how to live with the physical effects of the illness.
* Learn how to deal with the treatments.
* Make sure there is clear communication with your doctors.
* Try to maintain emotional balance to cope with negative feelings.
* Try to maintain confidence and a positive self-image.
* Get help as soon as symptoms of depression appear.
Reviewed by the doctors at The Cleveland Clinic Department of Psychiatry and
Psychology.

Should I take antiviral therapy for hepatitis C? Please see this
website.......
http://www.webmd.com/hepatitis/hepc-guide/Should-I-take-antiviral-therapy-for
Introduction
This
information will help you understand your choices, whether you share in
the decision-making process or rely on your doctor's recommendation.
Key points in making your decision
Your
decision about taking antiviral medication for hepatitis C depends on
your current health and your chances of developing cirrhosis or liver
cancer in the future. Consider the following when making your decision:
*
You may not need to take antiviral medications if you have normal or
only slightly elevated liver enzyme levels and your liver biopsy
results indicate little or no liver damage.
*
Doctors recommend treating long-term (chronic) hepatitis C if you are
at risk of developing serious liver damage, such as cirrhosis or liver
cancer. The risk of serious liver damage increases if you have high
levels of liver enzymes in your blood for at least 6 months and a liver
biopsy shows that you have significant liver damage.
*
Treatment usually is not recommended if you have major depression, low
blood counts, heart disease, a risk of stroke, hyperthyroidism, kidney
disease or transplant, an autoimmune disease, or active substance abuse
(including alcoholism) or are pregnant.
*
Treatment is more likely to stop the virus if you have the genotype 2
or 3 strain of hepatitis C than if you have genotype 1. Most people
with hepatitis C have genotype 1.
*
Significant side effects of medication include flu-like symptoms, such
as sore muscles and fever, irritability, and depression. About 10% to
25% of people stop their treatments because they feel too sick to
finish them.1
*
Antiviral treatment for hepatitis C is expensive. Sometimes, your
insurance company will help pay for the costs of the medicines. If you
do not have insurance, you may be able to get help in paying for
treatment from the drug companies that make peginterferon.
Medical Information
arrow
What is hepatitis C?
Hepatitis
C is a liver disease caused by infection with the hepatitis C virus.
Most infections begin with a short-term, acute illness that often is so
mild that most people who have it do not know anything is wrong.
However, up to 85% of people who are infected with the virus will go on
to develop long-term, chronic hepatitis C.2 Over time, hepatitis C can
lead to serious liver problems such as cirrhosis, liver cancer, or
liver failure.
What is the treatment for hepatitis C?
Treatment
involves taking a combination of antiviral medications: peginterferon
and ribavirin. Peginterferon is given as a shot once a week. Ribavirin
is a pill taken 2 times a day.
Acute
hepatitis C is rarely treated because most people do not have symptoms
and therefore are not diagnosed at this stage. However, doctors may
recommend treating acute hepatitis C when it is diagnosed.
Doctors
recommend treatment for chronic hepatitis C when you have a risk of
further liver damage, such as from the development of cirrhosis or
liver cancer.
How effective is treatment with antiviral medications?
How
well treatment works is measured by whether you still have the virus in
your blood 6 months after treatment. In general, treatment works
anywhere from 40% to 80% of the time, depending on different factors,
including your viral genotype.3
Your Information
arrow
Your choices are to:
* Try antiviral therapy.
*
Monitor your liver with regular blood tests and possibly a biopsy to
make sure that your liver isn't being severely damaged. (You also will
need these blood tests if you try antiviral therapy.)
The
decision about whether to take antiviral medications for hepatitis C
takes into account your personal feelings and the medical facts.
Deciding about antiviral medications Reasons to take antiviral medication
Reasons not to take antiviral medication
* Antiviral medication is the only treatment at this time for chronic
hepatitis C infection.
*
You are at increased risk of developing cirrhosis over time because you
have a chronic hepatitis C infection (elevated enzyme levels for more
than 6 months); a high level of virus in your blood, indicating an
active infection; and a liver biopsy that shows significant liver
damage.
* You are more likely than not to have a good response to treatment because
you are infected with genotype 2 or 3.
*
You have no other serious medical conditions, such as heart disease,
poorly controlled diabetes, depression, or active substance abuse.
*
The newer peginterferon medication (combined with oral ribavirin) only
needs to be injected once a week, rather than 3 times a week as is
needed for standard interferon treatment.
* Your health insurance plan will pay for most of the treatment. Or, you
have other resources to pay for your treatment.
Are there other reasons that you might want to take antiviral medication for
hepatitis C?
*
About half of people who take these medications develop significant
side effects, including flu-like symptoms, such as fever and muscle
aches, as well as anemia and mood changes such as depression.
*
You are not likely to develop cirrhosis because you have normal or only
slightly elevated liver enzyme levels and a liver biopsy shows little
or no significant liver damage.
*
You have another serious medical condition such as diabetes, an
autoimmune disease, depression, heart disease, or active substance
abuse. Studies on the effectiveness of antiviral treatment have not
been done on people who have other serious conditions.
*
You have no health insurance, or you have insurance but cannot afford
to pay for costs not covered by your plan. Sometimes, however,
medicines for hepatitis C are available free of charge through the
companies that make them.
* You will not be able to perform your job or take time off if you have
significant side effects from the medicines.
Are there other reasons that you might not want to take antiviral medication for
hepatitis C?
These personal stories may be helpful in making your decision.
Wise Health Decision
arrow
Use
this worksheet to help you make your decision. After completing it, you
should have a better idea of how you feel about antiviral treatment.
Discuss the worksheet with your doctor.
Circle the answer that best applies to you.
My liver enzyme levels have been elevated for more than 6 months. Yes No
Unsure
The genetic material (RNA) of the hepatitis C virus has been found in my blood,
which means that I have an active infection. Yes No Unsure
A liver biopsy showed that I do not have any liver damage. Yes No Unsure
I have genotype 1, which is harder to treat. Yes No Unsure
I have genotype 2 or 3, which is easier to treat. Yes No Unsure
I have another serious condition such as diabetes, heart disease, depression, or
substance abuse. Yes No Unsure
I am worried about side effects such as flu-like symptoms, depression, and
anemia. Yes No Unsure
I do not mind having a shot once a week (peginterferon). Yes No Unsure
Use the following space to list any other important concerns you have about this
decision.
What is your overall impression?
Your
answers in the above worksheet are meant to give you a general idea of
where you stand on this decision. You may have one overriding reason to
take or not take antiviral medication for hepatitis C.
Check the box below that represents your overall impression about your decision.
Leaning toward taking antiviral medication
Leaning toward NOT taking antiviral medication
References
arrow
Citations
1.
Group Health Cooperative (2003). Hepatitis C Guideline, pp. 127.
Seattle: Group Health Cooperative.
2.
Dienstag
JL (2005). Chronic viral hepatitis. In GL Mandell et al., eds.,
Mandell, Douglas, and Bennett's Principles and Practice of Infectious
Diseases, 6th ed., vol. 1, pp. 14411464. Philadelphia:
Elsevier/Churchill Livingstone.
3.
Lindsay
KL, Hoofnagle JH (2004). Chronic hepatitis C. In L Goldman, JC Bennett,
eds., Cecil Textbook of Medicine, 22nd ed., vol. 1, pp. 917924.
Philadelphia: Saunders.
Credits
arrow
Author Colleen Cronin
Editor Renée Spengler, RN, BSN
Associate Editor Lisa Shaw
Associate Editor Terrina Vail
Primary Medical Reviewer Martin Gabica, MD - Family Medicine
Specialist Medical Reviewer Steven L. Flamm, MD - Gastroenterology
Next Article:
We want to hear from you.
Please send us your feedback.
WebMD Medical Reference from Healthwise
Last Updated: September 28, 2005
This information is not intended to replace the advice of a doctor.
© 1995-2006, Healthwise, Incorporated, P.O. Box 1989, Boise, ID 83701. All
Rights Reserved.
Hepatitis C? Treat It Now.
Hepatitis C? Treat It Now.
Hepatitis C? Treat It Now.
* Treatment Quiz: Options, Decisions
* Questions to Ask Your Doctor
* Consider the Most Prescribed Medication of Its Kind
---------...and the beat goes on......." Sonny Bono.....I will say of the L-rd,
He is my refuge andmy fortress: my G-d; in Him will I trust.Psalm

Understanding Hepatitis -- the Basics
What Is Hepatitis?
Hepatitis
is a general term that means inflammation of the liver. It can be acute
or chronic and has a number of different causes. It can be caused by a
group of viruses known as the hepatitis viruses, including A, B, C, D
and E. Other viruses may also be the culprit, such as those that cause
mononucleosis (the Epstein-Barr virus) or chickenpox (the varicella
virus).
Hepatitis
also applies to inflammation of the liver caused by drugs and alcohol
abuse or toxins in the environment. People also can develop hepatitis
from other factors, such as trauma or an autoimmune process in which a
person's body makes antibodies that attack the liver.
Hepatitis
is the most common of all serious contagious diseases. Thousands of
cases are reported to the CDC each year, but researchers estimate that
the true number of people in the United States who have the disease
(acute and chronic) is much higher than the number reported.
Many
hepatitis cases go undiagnosed because they are mistaken for the flu.
Hepatitis is serious because it interferes with the liver's many
functions. Among other things, the liver produces bile to aid
digestion, regulates the chemical composition of the blood, and screens
potentially harmful substances from the bloodstream.
The
five hepatitis viruses can be transmitted in different ways, but they
all have one thing in common: They infect the liver and cause it to
become inflamed. Generally, the acute phase of the disease lasts from
two to three weeks; complete recovery takes about nine weeks. Although
most patients recover with a lifelong immunity to the disease, a few
hepatitis victims (less than 1%) die in the acute phase. Others may
develop chronic hepatitis, in which the liver remains inflamed for six
months or more. This condition can lead to cirrhosis and possibly death.
What Causes It?
Although
their effects on the liver and the symptoms they produce can be
similar, the various forms of hepatitis are contracted in different
ways. In the case of viral hepatitis, the severity and duration of the
disease are largely determined by the organism that caused it.
Hepatitis
A, which is generally contracted orally through fecal contamination of
food or water, is considered the least dangerous form of the disease
because it almost always resolves on its own. Also, it does not lead to
chronic inflammation of the liver. The hepatitis A virus commonly
spreads through improper handling of food, contact with household
members, sharing toys at day-care centers, and eating raw shellfish
taken from polluted waters.
Hepatitis
B can spread through sexual contact, blood transfusions, and needle
sharing by intravenous drug users. The virus can pass from mother to
child at birth or soon afterward; the virus can also travel between
adults and children to infect whole families. In a third of all
hepatitis B cases the source cannot be identified.
The
majority of hepatitis B patients recover completely, but a small
percentage of them can't shake the disease and become carriers.
Carriers can transmit the disease to others even when their own
symptoms have vanished. A smaller percentage of patients who cannot
fight off the virus will develop chronic hepatitis B. Like carriers,
those with chronic hepatitis B are able to pass on the virus. Up to 25%
of chronic hepatitis B patients die prematurely from the disease as a
result of cirrhosis or liver cancer.
Hepatitis
C is usually spread through contact with blood or contaminated needles
-- including tattoo needles. Although hepatitis C may cause only mild
symptoms or none at all, approximately 20% of those infected develop
cirrhosis within 20 years. The disease can be passed on through blood
transfusions, but screening, which started in the early '90s, has
greatly reduced the number of such cases. In a third of all hepatitis C
cases, the source of the disease is unknown.
Hepatitis
D occurs only in people infected with hepatitis B and tends to magnify
the severity of that disease. It can be transmitted from mother to
child and through sexual contact. Although less common, hepatitis D is
especially dangerous because it involves two forms of the disease
working at once.
Hepatitis
E occurs mainly in Asia, Mexico, India and Africa; only a few cases are
reported in the United States, mostly among people who have returned
from a country where the disease is widespread. Like hepatitis A, this
type is usually spread through fecal contamination, and it does not
lead to chronic hepatitis. This form is considered slightly more
dangerous than hepatitis A, especially in pregnant women, who may die
from this infection.
Other
viruses may also be responsible for causing hepatitis. These include
the Epstein-Barr virus (often associated with infectious mononucleosis), the
varicella virus (which causes chickenpox), the herpes simplex virus (HSV), and
cytomegalovirus (CMV).
Alcoholic,
toxic, and drug-related hepatitis can produce the same symptoms and
liver inflammation that result from viral hepatitis. This form is
caused not by invading microorganisms but by excessive and chronic
consumption of alcohol, ingestion of environmental toxins, or misuse of
certain prescription drugs and over-the-counter medications such as
acetaminophen.
WebMD Medical Reference
SOURCES:
American Academy of Family Physicians. WebMD Medical Reference:
"Hepatitis C." WebMD Medical Reference: "Hepatitis B." WebMD Medical
Reference from Healthwise: "Combination antiviral therapy for hepatitis
C." Manual of Family Practice, pp 360-361.
Reviewed by Cynthia Dennison Haines, MD on August 01, 2005
Edited on August 01, 2005
© 2005 WebMD, Inc. All rights reserved.
---------...and the beat goes on......." Sonny Bono.....I will say of the L-rd,
He is my refuge andmy fortress: my G-d; in Him will I trust.Psalm

Oh My, It will take us 3 days to read this blog, but i am sure it is
informative. I am going to beddy bye now. Will try to read it
tomorrow,.......hopefully
nmilover <nmilover@...
Date: Sat, 17 Mar 2007 06:38:06 -0700
Management of Hepatitis C Treatment Failure
Emmet B. Keeffe, M.D.
Chief of Hepatology and Co-Director of Liver Transplant Program
Stanford University School of Medicine
Despite impressive progress in the management of chronic hepatitis C over the
past ten years, treatment failure still occurs in about half of patients who use
current therapies. Sustained virological response (SVR), defined by convention
as continued undetectable serum HCV RNA six months after the completion of
treatment, occurs in only a limited number of patients undergoing retreatment
after failure of initial therapy. This article will discuss the different types
of hepatitis C treatment failure, which patients are likely to respond to
retreatment, expected SVR rates with retreatment, and management strategies and
experimental approaches for patients who have experienced prior treatment
failure and are not candidates for retreatment.
Treatment for Chronic HCV
Treatment of chronic hepatitis C with interferon-based therapy has evolved
dramatically since the early 1990s (see Table 1 for a comparison of treatment
response rates). In 1998, the Food and Drug Administration (FDA) approved the
combination of interferon alfa-2b plus ribavirin, which became the standard
therapy for people with chronic hepatitis C virus (HCV) infection. Interferon
alfa-2b (3 million units [MU] three times weekly) plus ribavirin (1,000-1,200 mg
daily) produced SVR rates of 38% and 43%, respectively, in pivotal American and
European trials. These studies also showed that patients with HCV genotypes 2 or
3 were more likely to respond to treatment than those with genotype 1 (SVR of
66% vs 29%). Patients with genotype 1 had an increased SVR rate after 48 weeks
of therapy (compared with 24 weeks), while those with genotypes 2 or 3 did not
see an additional benefit from longer treatment.
Table 1
Comparison: Sustained Virological Response Rates in Treatement-Naive Patients
Sustained Virological Response
Treatment Regimen Duration Overall Genotype 1 Genotypes 2 or 3
IFN1 24 wk 5-10% 2-5% 15-20%
IFN1 48 wk -15% -10% -30%
FN + RBV2,3 48 wk 41% 20% 66%
PEG-IFN alfa-2b+RBV4 48 wk 54% 42% 82%
PEG-IFN alfa-2b+RBV5 48 wk 61% 48% 88%
PEG-IFN alfa-2a+RBV6 48 wk 56% 46% 76%
PEG-IFN alfa-2a+RBV7 48 wk 61% 51% 78%
IFN=interferon alfa-2b monotherapy twice weekly; IFN+RBV=interferon alfa-2b
twice weekly plus ribavirin 1000-1200 mg daily; PEG-IFN+RBV=peginterferon
alfa-2b (Peg-Intron) or alfa-2a (Pegasys) once weekly plus ribavirin 800 mg
daily to 1000-1200 mg daily.
1Poynard, T. et al. Hepatology 1996, 24:778
2McHutchinson, J. et al. New England Journal of Medicine 1998, 339:1488
3Poynard, T. et al. Lancet 1998, 352:1426
4Manns, M. et al. Lancet 2001, 120:958
5Manns, M. et al. Lancet 2001, 120:958; with weight-based ribavirin dosing at
6Fried, M. et al. New England Journal of Medicine 2002, 347:975
7Hadziyannis, S. et al. Journal of Hepatology 2002, suppl. 1:3
Today, the current treatment of choice for chronic hepatitis C is peginterferon
(the correct generic name, but also commonly called pegylated interferon)an
altered form of interferon that lasts longer in the body and can be injected
once rather than three times weeklyplus daily ribavirin. Scherings
peginterferon alfa-2b (Peg-Intron) was approved in January 2001, and Roches
peginterferon alfa-2a (Pegasys) was approved in October 2002. Initial studies
showed that peginterferon monotherapy was more than twice as effective as
standard interferon monotherapy (SVR of 39% vs 19% with Pegasys vs Roferon-A,
and 23-25% vs 12% with Peg-Intron vs Intron A). Subsequent studies showed that
combination therapy with peginterferon plus ribavirin produces an overall SVR
rate of 54-61%.
Treatment Failure
Despite improvements in treatment, many patients still do not respond to initial
therapy for chronic hepatitis C.1 These include relapsers, who experience
reappearance of serum HCV RNA after achieving an undetectable level at the
conclusion of a course of therapy (an end-oftreatment response), and
nonresponders, who do not achieve viral clearance by the completion of therapy.
Some patients experience breakthrough nonresponse, an increase in HCV RNA after
achieving an undetectable viral load during continuous treatment. Some have no
decrease in HCV viral load during therapy, or experience only a modest decrease
of 1-2 logs. Others have an HCV RNA decrease of at least 2 logs, but their viral
load remains detectable during therapy (often called a partial response).
Patients who experience a significant decrease in HCV RNA may demonstrate
decreased serum liver enzyme, e.g., alanine aminotransferase (ALT) levels and
reduced liver tissue damage, even if they do not achieve an
undetectable viral load.
Retreatment
Improvements in HCV therapy raise the possibility that people for whom earlier
attempts at treatment have failed might be helped by new and better regimens.
Approaches to retreatment include use of higher doses of interferon, longer
duration of therapy, use of different types of interferon, e.g., peginterferon,
and the addition of ribavirin or use of a higher dose. Several factors predict
whether retreatment is likely to be successful (see Table 2). People who have
relapsed are more likely to be successfully retreated than nonresponders, as are
those nonresponders who had a significant decrease in HCV RNA during initial
treatment (even if they did not achieve an undetectable viral load).
Table 2
The type of initial treatment also plays an important role. Retreatment with the
same regimen is unlikely to be beneficial unless the previous dose and/or
duration of therapy were inadequate. Relapse or nonresponse may have been due to
noncompliance with a prescribed regimen; if this was the case, better patient
education and management of side effects may increase the likelihood of
adherence and successful treatment. People who previously experienced treatment
failure with a less effective regimen may respond to retreatment with more
effective therapy. Patients who received prior treatment with interferon
monotherapy are considerably more likely to respond to further treatment than
those previously treated with standard or pegylated interferon plus ribavirin.
Other factors that predict the likelihood of successful retreatment include
lower HCV viral load and infection with HCV genotypes 2 or 3.
Retreatment of Relapsers
Patients who relapse after initial HCV therapy are more likely to be
successfully retreated than initial nonresponders. The combination of interferon
plus ribavirin was originally approved by the FDA for retreatment of patients
with chronic hepatitis C who had relapsed after treatment with interferon
monotherapy. In a large multicenter study by G.L. Davis and colleagues, 48% of
relapsed patients treated again with interferon monotherapy achieved an
undetectable viral load during treatment, but the sustained response rate was
only 5%.2 In contrast, 82% of initial relapsers retreated with a combination of
standard interferon plus ribavirin became HCV RNA negative, and 47% achieved an
SVR.
To date, there has only been one published preliminary study on the use of
peginterferon plus ribavirin for retreatment of patients who relapsed after
initial treatment with standard interferon plus ribavirin.3 In this study, 55
patients were retreated with either peginterferon alfa-2b 1.0 mg/kg once weekly
plus ribavirin 1000-1200 mg daily or peginterferon alfa-2b 1.5 mg/kg once weekly
plus ribavirin 800 mg daily; 32% and 50%, respectively, achieved a SVR.
Retreatment of Nonresponders
Most published information about retreatment is from studies of standard
interferon plus ribavirin in patients who failed previous treatment with
interferon monoherapy. S.J. Cheng and colleagues performed a meta-analysis of
nine randomized controlled trials (RCTs) comprising 789 patients.4 After six
months of standard combination therapy, the pooled SVR was 13%; combination
therapy was almost five times more effective than interferon monotherapy. A
second metaanalysis by K.J. Cummings and colleagues looked at 12 RCTs with 941
patients.5 In this analysis, the pooled SVR was 14% for patients retreated with
combination therapy, compared to 2% for those retreated with interferon alone.
R. San Miguel and colleagues analyzed ten RCTs with 1728 patients, and found a
pooled SVR of 13%.6 In addition, a systematic review of randomized trials of
interferon (with or without ribavirin) showed that approximately approximately
15% of nonresponders achieved a SVR when retreated with
combination therapy.1 Overall, then, retreatment with standard interferon plus
ribavirin benefits no more than about 15% of patients who did not respond to
initial interferon monotherapy (see Table 3).
Table 3
Another approach to retreatment is the use of highdose induction interferon plus
ribavirin in patients who did not respond to standard interferon monotherapy.
The rationale for using higher induction dosing comes from studies such as that
of A.U. Neumann and colleagues, who showed a more rapid decline in HCV viral
load with 10 MU versus 5 MU of interferon daily over 14 days.7 Furthermore,
recent research shows that early viral kinetics correlate with SVR rates in
previously untreated patients receiving high-dose induction interferon followed
by standard doses of interferon plus ribavirin. There are few studies of
high-dose induction interferon in patients who have not responded to previous
HCV therapy. A.H. Malik and colleagues studied 25 interferon monotherapy
nonresponders randomized to receive one of two interferon regimens.8 One group
was treated with 10 MU of standard interferon daily for 10 days, followed by 5
MU daily for 74 days, then 5 MU three times weekly for 24
weeks; the second group received the same interferon regimen plus ribavirin
starting at day 11. One-third (33%) of the patients receiving induction
interferon plus ribavirin achieved a SVR, compared with none of those receiving
induction interferon alone.
Because it is so new, there are few published studies on the use of
peginterferon plus ribavirin in people who did not respond to prior therapy with
standard interferon with or without ribavirin. M. Buti and colleagues found that
previously untreated patients with genotype 1 HCV who received high-dose
peginterferon alfa-2b (3 mg/kg) experienced a significantly greater reduction in
viral load over 48 hours and greater HCV RNA clearance at week 12, compared with
those who received a typical peginterferon dose (0.5 mg/kg).9 I. Jacobson and
colleagues are conducting a study of peginterferon alfa-2b plus ribavirin in
patients with genotype 1 HCV who did not respond to prior treatment with
interferon monotherapy or interferon plus ribavirin.2 Preliminary data from this
study show that 16% of patients with genotype 1 who had failed prior interferon
monotherapy and were treated with peginterferon 1.5 mg/kg weekly plus ribavirin
800 mg daily achieved a SVR, compared with 27% of
patients treated with pegylated interferon 1.0 mg/kg weekly plus ribavirin
1000-1200 mg daily. However, among the patients who did not respond to previous
combination therapy with standard interferon plus ribavirin, the SVR rates with
retreatment were only 5-9% with the two treatment schedules.
Similarly, M. Shiffman of the HALT-C Trial Investigators team has reported
preliminary data from a large study of peginterferon alfa-2a 180 mg weekly plus
ribavirin 1000-1200 mg daily in patients who did not respond to standard
interferon therapy with or without ribavirin.9 Patients who previously received
interferon monotherapy had a SVR rate of 34%, compared with a SVR rate of 11%
for those who initially had received standard interferon plus ribavirin.
Management Options for Nonresponders
In summary, 47% of patients who relapsed after prior interferon monotherapy
achieved a SVR when retreated with standard interferon plus ribavirin, and
preliminary results show a SRV rate of about 32-50% for those treated with
peginterferon plus received a typical peginterferon dose (0.5 mg/kg).9 I.
Jacobson and colleagues are conducting a study of peginterferon alfa-2b plus
ribavirin ribavirin. Among nonresponders to interferon monotherapy, 13-15% of
patients achieved a SVR when retreated with standard interferon plus ribavirin,
while 25-40% achieved a SVR when retreated with peginterferon plus ribavirin.
Early data suggests that only about 10% of patients who did not initially
respond to combination therapy with standard interferon plus ribavirin will
respond to peginterferon plus ribavirin.
Since many nonresponders do not achieve a SVR even after retreatment with the
best currently available therapies, management of nonresponders should include
determining who is most likely to be successfully retreated and whether
nonresponders can benefit from further therapy. Retreatment with peginterferon
plus ribavirinor experimental regimensgenerally should be reserved for
patients with favorable factors that predict SVR, such as prior relapse (as
opposed to nonresponse), previous therapy with interferon monotherapy (as
opposed to combination therapy), partial virological response (significant
decrease in HCV RNA) during initial therapy, lower HCV viral load, and/or
genotypes 2 or 3. Tolerance of and adherence to prior therapy should also be
taken into account, as should the severity of underlying liver disease.
Patients with advanced liver fibrosis or cirrhosis (stage 3 or 4 fibrosis as
determined by a liver biopsy) have progressed further along in the course of
their disease, and are at greater risk for developing decompensation or
end-stage liver failure in the subsequent 5-10 years. Such people are candidates
for additional treatment, including experimental therapies. On the other hand,
patients with only mild to moderate (stage 0-2) fibrosis can generally afford to
wait for newer developments in therapy, although their liver health should be
monitored on an ongoing basis.
Maintenance therapy with low-dose peginterferon may reduce the risk of
developing decompensated cirrhosis and liver cancer (hepatocellular carcinoma)
in people with advanced fibrosis. It has been observed that up to 40% of these
patients can experience a histological response (improvement in liver tissue
damage) even if they do not achieve an undetectable viral load. Several studies
are underway looking at whether long-term peginterferon monotherapy is a
beneficial option for people with advanced liver disease.
References
1. Shiffman, M.L. Retreatment of patients with chronic hepatitis C.
Hepatology 2002, 36(suppl.1):S128-S134.
2. Davis, G.L., Esteban-Mur, R., Rustgi, V., et al. Recombinant interferon
alfa-2b alone or in combination with ribavirin for retreatment of interferon
relapse in chronic hepatitis C. New England Journal of Medicine 1998,
339:1493-1499.
3. Jacobson, I.M., Ahmed, F., Russo, M.W., et al. Pegylated interferon
alfa-2b plus ribavirin in patients with chronic hepatitis C: A trial in prior
nonresponders to interferon monotherapy or combination therapy and in
combination therapy in nonresponders: Final Results. Gastroenterology 2003,
124:A-714.
4. Cheng, S.J., Bonis, P.A,L., Lau, J., et al. Interferon and ribavirin for
patients with chronic hepatitis C who did not respond to previous interferon
therapy: A meta-analysis of controlled and uncontrolled trials. Hepatology 2001,
33:231-240.
5. Cummings K.J., Lee, S.M., West, E.S., et al. Interferon and ribavirin vs.
interferon alone in the re-treatment of chronic hepatitis C previously
nonresponsive to interferon. Journal of the American Medical Association 2001,
285:193-199.
6. San Miguel, R., Guillen, F., Cabases, J.M., and Buti, M. Metaanalysis:
Combination therapy with interferon-a 2a/b and ribavirin in patients with
chronic hepatitis C previously non-responsive to interferon. Alimentary
Pharmacology and Therapeutics 2002, 16:1611-1621.
7. Neumann, A.U., Lam, N.P., Dahari, H., et al. Hepatitis C viral dynamics in
vivo and the antiviral efficacy of interferon-a therapy. Science 1998,
282:103-107.
8. Malik, A.H., Kumar, K.S., Malet, P.F., et al. A randomized trial of
high-dose interferon alpha-2b, with or without ribavirin, in chronic hepatitis C
patients who have not responded to standard dose interferon. Alimentary
Pharmacology and Therapeutics 2002, 16:381-388.
9. Buti, M., Sanchez-Avila, F., Lurie, Y., et al. Viral kinetics in genotype
1 chronic hepatitis C patients during therapy with 2 different doses of
peginterferon alfa-2b plus ribavirin. Hepatology 2002, 35:930-936.
10. Shiffman, M.L. Retreatment of HCV Non-responders with peginterferon and
ribavirin: Results from the lead-in phase of the hepatitis C antiviral long-term
treatment against cirrhosis (HALT-C) trial. Hepatology 2002, 36:295A.
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---------...and the beat goes on......." Sonny Bono.....I will say of the L-rd,
He is my refuge andmy fortress: my G-d; in Him will I trust.Psalm

..... and there are many attachments, if you want, email me.......
seems expensive, but you use drops.......... please tell me what you
think.......

I
received this from my kindergarden friend...... an RN a surgical
RN..... yes she is healthy ..ya know age, arthritis and stuff.........
but found in one of the documents........and haven't read all......
Reduces Viral Load:
Once the heavy metal concentrations have been reduced, the zeolite
latches onto viral pieces or components. Because viruses replicate by
first manufacturing viral components and then assembling them into a
complete virus, liquid zeolite, in essence, removes parts from the
assembly line and blocks viral replication. Which in turn helps with rheumatoid
arthritis, multiple sclerosis, and hepatitis C.
seems expensive, but you use drops.......... please tell me what you
think.......
-
Attached is information on Natural Cellular Defense(NCD, The Drops,
Zeolite), it is referred to by several names. I will be sending
several other emails with testimonies and patent info. Call if you
need my help at any time.
Judy
The Most Important Supplement
You Will Ever Use!!!
Judy Lawhorn
865-207-2693
www.zeolites4life.com
---------...and the beat goes on......." Sonny Bono.....I will say of the L-rd,
He is my refuge andmy fortress: my G-d; in Him will I trust.Psalm

New City Assemblyman Zebrowski dies after struggle with liver illness
By SUZAN CLARKE
THE JOURNAL NEWS
(Original publication: March 18, 2007)
Assemblyman Kenneth P. Zebrowski, who had been hospitalized for a hepatitis C
infection, died today at Nyack Hospital.
He was 61.
The New City Democrat's illness had caused him to miss part of the legislative
session.
He underwent a procedure earlier this month to treat the hepatitis, and also was
being treated for a blood clot in his leg.
Vince Monte, the chairman of the Rockland Democratic Committee, said he was
saddened by the news.
"When he because the current Assemblyman ... he quickly spoke out on the floor.
He went up there like a seasoned incumbent because of all his experience in the
local level and he was very comfortable and he loved being in the Assembly.
Quite frankly, I'm going to miss the discussions of politics and government,"
Monte said. "I'm really going to miss him, and reminiscing about our time when
we came up as young Democrats."
Zebrowski was elected to the New York State Assembly in 2004 and in 2006.
Before then, he served on the Rockland County Legislature for 21 years,
including four years as chairman and two years as majority leader.
Harriet Cornell, the current chairwoman of the county Legislature, called
Zebrowski "a force of nature."
"He knew what he wanted and never gave up," she said in a written statement. "He
was a fierce competitor but also a loyal friend and devoted family man. Few
people were as intelligent, articulate or impassioned as he."
Zebrowski served the 94th District, which includes town of Clarkstown,
Haverstraw, and parts of Ramapo.
Read more about this story tomorrow in The Journal News.
http://www.lohud.com/apps/pbcs.dll/article?AID=/20070318/UPDATE/703180438

Hepatitis in prisons poses challenge for California
By PAIGE AUSTIN
The Press-Enterprise
Facing a hepatitis pandemic in its prisons, California could soon become one of
the only states to automatically test inmates for the disease.
An estimated 30 percent to 40 percent of all prisoners enter the California
prison system with the disease. State officials are considering new policies to
expand testing and treatment in prison to keep the disease from spreading among
California's 172,000 inmates and the communities to which they are paroled, said
Dr. Dwight Winslow, statewide medical director for the California Department of
Corrections and Rehabilitation.
The inmate and parolee population is 15 to 20 times more likely to carry the
potentially fatal hepatitis C than the general population. However, neither
Riverside nor San Bernardino county health departments have disease control
programs that target parolees.
More than $1 billion is already spent each year in the country on hepatitis C,
and those costs are expected to soar unless prevention and treatment are
expanded.
Hepatitis C is a blood-borne virus that damages the liver and affects more than
4 million Americans. Today, it is most commonly spread via injection drug use,
non-sterile tattooing, unprotected sex and unsanitary conditions, said Winslow.
There are no statistics to show exactly how many contract the disease in prison
and then carry it back into the community upon release.
"These numbers are astounding no matter how you look at it," Winslow said. "It's
a huge public health problem."
About 16,851 or 14 percent of the state's parolees live in Riverside and San
Bernardino counties, where the infected population is on the rise despite a
decrease in new cases nationwide.
Both county health departments have programs aimed at reducing the spread of the
disease, but their education and testing efforts largely target medical
professionals or places such as public parks frequented by hypodermic drug
users.
When inmates parole to Riverside County, disease control officials provide
access to hepatitis testing or treatment only if the inmates have been
identified as being HIV positive, said Barbara Cole, Riverside County's director
for disease control. The program is funded by a state grant focused mainly on
curbing the spread of HIV. The program links hepatitis C and HIV because people
infected with HIV through drug use tend to be at higher risk for hepatitis C.
Parolees in San Bernardino County get no such treatment because the county
doesn't have the funding, said Marie Byrne, the county's public health manager.
Almost 10 years ago, Riverside County tested its jail population and found that
about 26 percent of the inmates had hepatitis C. The county developed a formal
hepatitis education and prevention program in the jails, but it has since fallen
by the wayside, said Cole.
"There is still a lot of work to be done," Cole said. "It makes sense to target
the inmate population, but we would need funding to do it."
Cases Drop Sharply
According to a report released by the Centers for Disease Control and Prevention
on Thursday, new reports of hepatitis A, B and C are dropping dramatically -- by
about 79 percent and 88 percent for the A and B viruses. Scientists credit
childhood vaccinations and stricter sanitation requirements in the medical
community for the decline in hepatitis A and B cases.
However, the report cautions that new reports of hepatitis C are harder to track
accurately because it can take years for the symptoms to develop, and many
people don't know they are infected.
While dropping in the general population, new reports of the disease remain high
among certain segments of the population, including inmates, drug users and
people living in unsanitary conditions.
"This is not necessarily a prison problem. It's a public health problem," said
Dr. Joseph Bick, chief medical officer at the California Medical Facility in
Vacaville.
"Many of these people come into the system with the disease, and they are going
back out with it. Jails and prisons need to be front and center in any public
health discussion about the control of contagious diseases. We have a tremendous
opportunity to diagnose, treat and prevent the spread of this disease."
Toward that end, California prison officials are also rewriting the policies
that help doctors decide which prisoners should be treated for the disease, said
Winslow.
Universal testing is an aggressive measure that few states or county jails have
taken. Rhode Island is one of the only states to test incoming and outgoing
inmates for hepatitis.
Such testing raises complex issues about inmate privacy rights.
Also, because California is required by its Constitution to provide adequate
medical care to its inmates, increased testing could mean that the state would
have to treat more inmates for the disease.
Testing costs between $5 and $10 an inmate, but the findings could put the state
on the hook for costly treatments ranging between $10,000 and $20,000 in some
cases, Bick said.
In 2005, a federal judge placed California's prison health care into
receivership because of a class-action lawsuit over the state's inability to
provide adequate medical care for inmates suffering from diseases, including
hepatitis C.
At the time, the judge found that prison medical staffs lacked access to sterile
equipment and that exam rooms in prisons such as the California Institution for
Men in Chino didn't even have sinks for doctors to wash their hands in between
treating patients.
Federal receiver Robert Sillen will have the final say on the state's revised
hepatitis C policy.
Getting Lucky
Some of the infected are lucky: One in every five people who get hepatitis C
will clear it out of their system naturally. But without treatment, one in every
four will suffer liver failure or develop liver cancer.
Last year liver cancer was the only one of the top 10 fatal cancers in this
country to increase, in large part because of hepatitis C.
The course of treatment can take a year, and involves taking pills twice a day
and weekly injections. Side effects are like those associated with chemotherapy
-- nausea, exhaustion, depression, debilitating aches and pains -- and the cure
only works about half the time.
Limited studies indicate that fewer than 10 percent of prisoners who have
contracted hepatitis C are treated.
"The doctor gave me a death sentence," said Leslie Czirr, 36, a former inmate at
the California Rehabilitation Center in Norco. "He told me, 'There's no cure for
this and you will die from it unless you are hit by a truck first.' "
Lt. Mike Brownell, the Norco prison spokesman, said he could not comment on the
prison's hepatitis-treatment policy.
Not every inmate patient receives treatment for the disease, said Winslow,
adding that doctors base the treatment upon individual case factors.
Rep. Barbara Lee, D-Oaklan, recently reintroduced legislation that would mandate
prison testing and treatment of hepatitis C. Earlier similar proposals in recent
years have failed.
"The plain fact is that prisoners do not stay in prison. With more than 90
percent of incarcerated persons returning to their communities, it is clear that
when a prisoner is infected, we are all affected," Lee said.
The Associated Press contributed to this report.
Reach Paige Austin at 951-893-2106 or paustin@...
http://www.pe.com/localnews/inland/stories/PE_News_Local_C_hepc17.4452701.html

Hi All. I am GONE AGAIN :-) I am leaving later today and will be back next
Thursday evening. Georgia's Hepatitis Awareness Day at the Capital! :-)
Take care of each other and thank you to all the people who wrote me two weeks
ago when I went to a meeting and forgot to post. I appreciated your concerned
messages! I guess I post more than I realize and appreciated your noticing
when you didn't get any emails ;-)
Peace
Pam
I will be COMPUTERLESS :-(

Hey Dennis. Glad to see you commenting on articles. I always love reading
your comments. You are SO intelligent! :-) I am off again tomorrow.......
and will be back on Thursday. Take care!
Peace
Pambi

In the trial they give all variations -
I saw a Dr. on television and he showed a healthy liver and a fatty liver which
you could hammer a nail through it was that hard. These side effects don't seem
that bad for this little amount of time compared to what was. Interesting to
see what happens with this person and I wish them "luck." Thanks Pam for
keeping us up to date on this.
PeachStatePam <figment@...
Last Thursday was Day 71 of of my 3 month trial of Interferon and Vertex VX950.
I had my eleventh injection of pegylated Interferon so I've one more to go. 2
more weeks of oral VX 250mg lozenges x 3, 3 times a day.
We finish on the 29th March which will be Day 85 with a finale of hourly blood
tests to monitor the pharmo-kinetics of the VX/Peg combo. On this day I'll be
told whether I've cleared the virus which has vexed my liver for the last 30
years. Unlike Prometheus I'll be free. I don't know for definite whether I'm
possessed of an uncanny percipience, steeped in denial or awash with residual
hippiesque naivete but I'm convinced right down to the DNA that its worked and
I'm free.
If thats the case I'm going to be one of a select group of people who've
cleared genotype 1b in 12 weeks rather than a year, and without ribavarin to
boot. The next test will be to see if I'm still clear in 4 weeks, then 8 weeks.
Each one of these chronological milestones safely passed geometrically increases
the percentage possibility of a permanent cure - and I can begin to breathe
again.
Right now I'm just counting down the days and relishing the prospect of being
free of the 8 hour tyranny of the medication - first thing when i get up, last
thing at night - and a permanent metallic taste in my mouth, arms constantly
buzzing like nettle rash, a constant headache that roller coasters up out of the
subliminal to full volume then down again, a seething wounded mass of
intolerance and hypersensitivity that causes me to jump as though struck at the
slightest sound and flare into homicidal rage and self-pity at the most atomic
of perceived affronts ( like someone not immediately getting out of my way on
the bus or the street). Yeah never mind the cure, just for today stopping the
meds will be reward enough. More later...
http://nickaround.blogspot.com/2007/03/vx950-trial-for-hep-c-update-unblinding.h\
tml

Tragedy of Buddy Miley lingers 10 years later
By ED KRACZ
phillyBurbs.com
He was 17 when his body turned to stone.
He held tight to hope for the next 10 years. It vanished.
For 13 years after that, his hope was that God would take him. He never did.
So he arranged his own meeting with death, with the help of Dr. Jack Kevorkian.
Ten years later, Buddy Miley's tragic life and untimely end still resonate.
Buddy Miley still lives here, in the home of Bob Miley. He lives in photos and
framed collages.
"He was my best friend as well as my brother," Bob said. "From the time he was
5, he was my third leg. We did everything together."
Buddy became a standout athlete, playing football, basketball and baseball,
first at Archbishop Wood for three years, then at William Tennent for his senior
year. Bob, who was a young teacher of political science and American history at
William Tennent, was always there for Buddy, on and off the field.
That's what made one autumn Saturday more than 33 years ago so painful.
It was the day Buddy's life stopped.
Bob saw it. He was sitting in the bleachers at Plymouth-Whitemarsh's football
field. What Bob saw on Sept. 29, 1973, four months before Buddy would have
turned 18, still haunts him.
There was a player pileup near midfield. One by one, the players rose. Buddy
didn't.
Minutes passed. Buddy still hadn't risen, still hadn't moved.
Bob left his seat and made it down to the field.
"I think I knew at that moment that he was paralyzed," he said.
Buddy was taken by ambulance to the now-closed Sacred Heart Hospital in
Norristown.
"I remember walking into the emergency room and talking with him," Bob said. "He
kept saying to me, "Am I paralyzed, am I paralyzed, am I paralyzed?' I told him
I didn't know. I had to lie. I didn't know from a medical viewpoint, but I
sensed it, because nothing worked. He couldn't feel my hand on his arm. He
couldn't feel my hand on his knee. He didn't react at all."
Buddy kept saying he was thirsty.
Bob found a sponge, soaked it in water, and dripped some of the liquid onto his
brother's lips.
His name was Albert George Miley Jr. He was the second of three sons and the
fourth of seven children born to Albert and Rosemarie Miley. Bob believes he was
in second grade when Albert became Buddy. "I think it was my father who created
the name Buddy to distinguish between himself and my brother," Bob said. "He was
always Buddy to me."
A BAD SITUATION
Patty Miley was a sophomore at Archbishop Wood, hanging out with friends at
Plymouth-Whitemarsh's field when her brother went down. She remembers going to
the hospital, but not realizing the gravity of her brother's plight until hours
later.
"I didn't know what a broken neck was," she said. "To me, it was nothing
different than a broken leg. I just didn't know. I didn't realize how serious it
was until I got home that night. One of Bob's friends called who was in med
school and I told him what happened. He said, "What?' I knew it was a bad
situation."
Linda Miley, only slightly a year younger than Patty, was at her parents'
Warminster home with Jimmy, the youngest family member, as her brother lay
motionless.
"My aunt told us, and I remember her having me and Jimmy drop to our knees and
start praying right there on the couch," she said.
For 231/2 years after that fateful Saturday, Buddy lived in an addition the
Mileys had built onto their home. Patty and Linda got married, becoming Patty
Rudolf and Linda Farrell. They had six children between them. Both of Patty's
sons remember Buddy in their own way.
Matt Rudolf, now 22, had a small tattoo in Buddy's memory etched onto his back.
Shane Rudolf, a junior lacrosse player at Hatboro-Horsham, wears a T-shirt
beneath his uniform with Buddy's old football number, 6, framed with angel
wings. And only recently, Montana Farrell chose to write a three-page essay on
her Uncle Buddy as part of a ninth-grade assignment, although she was just 5
when Buddy left and never really knew him.
"I miss him," said Patty. "[But] I'm glad he is at peace."
The Mileys still refer to the addition as Buddy's room. The bathroom is still
Buddy's bathroom. And the family members still get together in Buddy's room each
Christmas, just as they did when he was alive. What they don't talk about much
is why. Why Buddy?
"Everything happens for a reason, even though you may not ever see it," Linda
said. "But I believe when you are born, there is a plan for you. You go through
things and you may not see why, but the plan is there. Maybe he was the chosen
one because he could handle it best, because of the effect he could have on
others. Maybe he was chosen to teach others to be grateful for what they have."
He walked onto the field in his white sneakers, hair flowing from beneath his
helmet. The face mask had three bars, like a lineman's, not the typical two-bar
quarterback job. There was almost a rock-star quality to him. Then he started
hollering at the Plymouth-Whitemarsh players warming up across the field. He was
brash. He was confident. "One of my teammates said either he's stupid or really
good," said Carmen Frangiosa. "Turns out, he was really good."
WHAT IF, WHAT IF, WHAT IF?
Carmen Frangiosa didn't know Buddy Miley that well, although he saw him
periodically through the years at various fundraisers the Plymouth-Whitemarsh
community conducted for Buddy.
He was there that Saturday. He was one of the Plymouth-Whitemarsh tacklers on
the play Buddy never got up from, a play he has replayed over and over ever
since.
"I thought about it a thousand different times," Carmen said. "If he had not
turned [the play] up, if he had just gone out of bounds - what if, what if, what
if? How many times can you slice it?"
The play was a reverse pivot option. Playing quarterback, Buddy started right,
then pivoted back and began to run left before trying to cut upfield. He was
swarmed.
"That play in itself was a nothing play. It was routine," said Carmen, a middle
linebacker, "something you run 100 times in practice."
Pat Delaney wasn't there that Saturday, but he knew Buddy. They were 12 when
they met playing for the Pennsylvania Little Quakers, a regional football
all-star team. He would've been on the field the day Buddy was injured, but his
quick temper had gotten him in trouble and the coach had asked him to leave the
team a week earlier.
"I feel bad for anyone who didn't know him," Pat said of Buddy. "My man was
special."
When Pat heard of Buddy's injury, he began visiting him at the hospital,
sneaking six packs of beer in for "Monday Night Football" games. He would hide
under the bed when the nurses made their bed checks every hour or so.
Pat still does something for Buddy.
Nine years ago, he and his wife, Lisa, began a scholarship at William Tennent.
The Buddy Miley Scholarship is for athletes, but not necessarily those who get
good grades. It's also for those who need financial assistance. The scholarship
is in the amount of $5,000 per year for four years.
"I celebrate Buddy's life," Pat said. "He always saw the good in people. It was
confusing watching him suffer for 23 years. I used to be confused, anyway. I
always looked for a reason why, and everybody has their own reasoning, but he
changed my life.
"I cherish life. I cherish people a lot more than I used to. To me, I thank God
I was exposed to him. I truly feel special. To this day, I sit and count to 10
before losing my temper, and I don't do it much anymore. Buddy taught me that."
Carmen Frangiosa went on to play at Wake Forest on a scholarship and took the
memory of that day, of Buddy lying motionless, with him.
"Everyone else went on and did whatever else they did," Carmen said. "And Buddy
that day, boom, right that day, he was done. Time stood still for him."
He was really good, all right. Baseball might have been his best sport. At 6
feet 3 and 170 pounds, with a slingshot for an arm, a college scholarship
probably awaited him. Bob said Buddy shared his ultimate goal - the one he had
before he became tethered to a hospital bed and a wheelchair. He wanted to play
football at Arizona State, but, even more, he wanted to raise a family and be a
coach. "He would have been a great coach," said former Central Bucks West coach
Mike Pettine, who developed a close relationship with Buddy after the accident.
"He was always intrigued with the X's and O's. We used to talk philosophy on
end."
RIGHT ON TOP OF IT
Bill Juzwiak was 29 when Buddy went down. He's 63 now. Thoughts of that day
remain, in his words, "fuzzy."
"Exactly what happened, it's hard to tell, hard to remember," Bill said. "In a
sense, I think what God does for us [is] he helps us forget things he doesn't
want us to remember."
Bill can't remember how many of his William Tennent players, if any, quit the
team Monday morning. Others have said several football players across the
Suburban One League quit their teams after hearing about Buddy's accident.
Bill can't remember how many games Tennent won that year. One, maybe two, he
thought. He does recall after one win piling his team onto a bus that went
straight to Sacred Heart to deliver the game ball to Buddy.
"You think about it," he said. "I was very close to the situation. I could've
said, "Don't play. You shouldn't be a football player.' I could've not been the
coach. I didn't play a big role in it, but then again, I was right there, right
on top of it. It does affect you."
Bill continued coaching and teaching math at Tennent until 1985.
Buddy remains with him.
"It was very rough," he said. "It still is. But God has taken care of me."
Two fractured vertebrae in his lower neck left him paralyzed from the neck down.
But his spinal column wasn't completely severed, so there was some feeling. More
like excruciating pain. The ungodly pain that would crash over his body way too
often felt like electrical shock or, as Patty said, "like he was getting sharp
knives in him all the time." The distress would show on his face and he would
just stop talking, even in mid-word, to let the horror subside. The bedsores
were bad, some of them the size of a fist, the worst ones maybe two, three
inches deep.
On March 17, 1997, Bob Miley looked over his right shoulder, the way he did
every evening after spending two to three hours with his brother, and said,
"I'll see you tomorrow." Buddy looked firmly back at Bob, not saying a word. "I
didn't know it at the time, but maybe he did, that that would be the last time
he would ever see his brother alive," Bob said.
Buddy had grown weary of the pain and had abandoned hope of ever walking again.
It was time for action.
HE CALLED TO SAY GOODBYE
Buddy had seen Dr. Jack Kevorkian on CNN's Larry King show in 1995. He
approached Bob, asking him his thoughts on suicide. He talked to Linda about
suicide. Ultimately, he was taken to see Kevorkian by Jimmy, who declined to be
interviewed for this story, along with his mother, although both told their
stories to a Philadelphia newspaper and on an HBO special.
It was Jimmy who accompanied Buddy on trips to see faith healer Pat Robertson
and to the Shrine of Lourdes in France. Nothing cured Buddy.
Kevorkian was Buddy's final, desperate hope.
Jimmy told an HBO interviewer that, on March 18, 1997, he and Buddy went to
Detroit, checked into a Quality Inn outside town, and waited. At sunset, there
was a knock at the door. In walked Kevorkian and two assistants.
Also known as Dr. Death, Kevorkian was the Michigan doctor who specialized in
putting ailing people out of their misery by using a homemade suicide machine.
With the click of a switch, the machine would release a lethal cocktail of
concentrated Pentothal, to induce a coma, and potassium chloride, to produce a
heart attack.
Kevorkian claims to have assisted at least 130 people in their deaths between
1990 and 1998. He was sentenced to 10 to 25 years in prison in 1999. Now 78,
he's in failing health, suffering from Hepatitis C, according to his lawyer. On
Dec. 13, it was announced that he would be paroled June 1.
When Kevorkian arrived at the Quality Inn, he questioned Buddy, Jimmy recalled
during his HBO interview:
"Are you sure you want to do this?" the doctor asked.
"I don't want to do this, I have to do this," Buddy responded.
Before checking into the hotel, Buddy phoned Linda from the airport.
"He called to say goodbye," Linda said. "It was very strange when you know
you're talking to somebody for the last time. I tried to say the right things in
a short time."
She hung up the phone and cried for 10 minutes. She called Patty, crying, to
tell her the news.
Jimmy returned home to welcoming arms. Bob was the first to greet him, promptly
wrapping Jimmy in his arms.
"I'm not angry," Bob said. "He was neurologically sound. He was quite capable of
making his own decisions. Ex post facto, I have to support his decision. He was
a rational, thinking human being who did not want to live anymore."
He left behind a taped message for his mother, telling her that the pain had
become too intolerable, that he was happy where he was, and that, if she needed
anything, to call on him. He signed off, "your guardian angel." He also left a
note to Bob, one written the way he did all his writings, with a pencil between
his teeth. Three more words: "Sorry. Love, Bud." He was 41.
Ed Kracz can be reached at 215-345-3069 or ekracz@....
March 18, 2007 6:15 AM
http://www.phillyburbs.com/pb-dyn/news/108-03182007-1316094.html

Health Officials Warn Of Statewide Hepatitis C Epidemic
March 18, 2007
Health officials are urging residents to get tested for Hepatitis C, saying it's
become a statewide epidemic.
According to the New York Post, cases of the virus have doubled in the last five
years. And officials say, that's only the tip of the iceberg.
The most recent statistics show that the city had more than 14,000 cases of
Hepatitis C in 2005. Last year's data isn't available yet, but officials are
predicting a big hike.
Hepatitis C is commonly spread through needles or sex with multiple partners.
But many people may not show symptoms for up to 20 years.
Health officials encourage people to get tested regularly. New medication has
also been recently released that can get rid of the virus in most cases, if it's
diagnosed early enough.
The state health department is sponsoring a conference in Manhattan this week to
unveil its plans to battle the virus.
http://www.ny1.com/ny1/content/index.jsp?stid=1&aid=67779

Last Thursday was Day 71 of of my 3 month trial of Interferon and Vertex VX950.
I had my eleventh injection of pegylated Interferon so I've one more to go. 2
more weeks of oral VX 250mg lozenges x 3, 3 times a day.
We finish on the 29th March which will be Day 85 with a finale of hourly blood
tests to monitor the pharmo-kinetics of the VX/Peg combo. On this day I'll be
told whether I've cleared the virus which has vexed my liver for the last 30
years. Unlike Prometheus I'll be free. I don't know for definite whether I'm
possessed of an uncanny percipience, steeped in denial or awash with residual
hippiesque naivete but I'm convinced right down to the DNA that its worked and
I'm free.
If thats the case I'm going to be one of a select group of people who've cleared
genotype 1b in 12 weeks rather than a year, and without ribavarin to boot. The
next test will be to see if I'm still clear in 4 weeks, then 8 weeks. Each one
of these chronological milestones safely passed geometrically increases the
percentage possibility of a permanent cure - and I can begin to breathe again.
Right now I'm just counting down the days and relishing the prospect of being
free of the 8 hour tyranny of the medication - first thing when i get up, last
thing at night - and a permanent metallic taste in my mouth, arms constantly
buzzing like nettle rash, a constant headache that roller coasters up out of the
subliminal to full volume then down again, a seething wounded mass of
intolerance and hypersensitivity that causes me to jump as though struck at the
slightest sound and flare into homicidal rage and self-pity at the most atomic
of perceived affronts ( like someone not immediately getting out of my way on
the bus or the street). Yeah never mind the cure, just for today stopping the
meds will be reward enough. More later...
http://nickaround.blogspot.com/2007/03/vx950-trial-for-hep-c-update-unblinding.h\
tml

Fremont to offer hepatitis tests
Library to offer free screening, information on virus that affects many Asian
Americans
By Linh Tat, STAFF WRITER
Article Last Updated: 03/18/2007 02:28:37 AM PDT
FREMONT - Of the estimated 1.4 million Americans who are long-term carriers of
the hepatitis B virus, more than half are of Asian descent, according to the
Asian Liver Center at Stanford University.
If untreated, the virus could lead to cirrhosis of the liver, liver cancer and
even death. But because symptoms often don't manifest themselves until it's too
late - toward the end stage of cancer, said Jordan Su, program manager at the
Asian Liver Center - some individuals aren't aware that they even carry the
infectious virus.
Individuals often are infected with the disease during birth - when the mother
passes it on to the newborn - through contact with infected blood or through
sex. At least half of Asian Americans with hepatitis B were infected at birth,
Su said.
To address the issue, a group of Bay Area students, including two from Mission
San Jose High School, have persuaded nine cities to declare this week hepatitis
B Awareness Week. The cities are Fremont, Newark, San Ramon, Milpitas, Palo
Alto, Los Altos, Sunnyvale, Cupertino and Saratoga.
Events in Fremont include an informational display at the Fremont Main Library
and a free blood test to screen for hepatitis B from 1:30 to
4 p.m. Saturday at Warm Springs Community Center, 47300 Fernald St.
Additionally, students at Mission San Jose High can receive informational
materials all week about the disease and win prizes for completing
questionnaires after reading the literature.
The students will cap off the week with a screening of a documentary titled
"Another Life: The Untold Story of an Asian Epidemic." Admission will be $1,
with proceeds going to the Asian Liver Center.
The city of Newark also has an informational display up at its library, and
Mission San Jose student Brandon Shih has arranged to have the same documentary
that will be aired at the high school shown in Milpitas on Saturday.
Meanwhile, Shih's classmate CindyGuan has been organizing the events at the
school.
"Hepatitis B is commonly known as the silent killer. So many people have it, but
they don't show any symptoms until it's too late," Guan said.
"That's really upsetting because so many people can survive and be safe, and no
action is being taken," she said in reference to vaccines that are available to
reduce one's chances of developing cancer.
A large number of hepatitis B patients are Asians, and many are immigrants who
did not receive proper immunization in their home countries.
To register for Saturday's free hepatitis B screening, call the American Cancer
Society at (888) 566-6222. For information about the disease, visit
liver.stanford.edu.
http://www.insidebayarea.com/argus/localnews/ci_5465213

Mass recall of dog and cat food after pets die
POSTED: 2:01 p.m. EDT, March 18, 2007
WASHINGTON (AP) -- Pet owners were worried Saturday that the pet food in their
cupboards could be deadly after millions of containers of dog and cat food sold
at major retailers across North America were recalled.
Menu Foods -- a major manufacturer of dog and cat food sold under Wal-Mart,
Safeway, Kroger and other store brands -- recalled 60 million containers of wet
pet food Friday after reports of kidney failure and deaths.
An unknown number of cats and dogs suffered kidney failure and about 10 died
after eating the affected pet food, the company said in announcing the North
American recall.
Product testing has not revealed a link explaining the reported cases of illness
and death, the company said.
"At this juncture, we're not 100 percent sure what's happened," said Paul
Henderson, the company's president and chief executive officer.
However, the recalled products were made using wheat gluten purchased from a new
supplier, since dropped for another source, spokeswoman Sarah Tuite said. Wheat
gluten is a source of protein.
'Cuts and gravy' food sold in cans, pouches recalled
The recall covers the company's "cuts and gravy" style food, which consists of
chunks of meat in gravy, sold in cans and small foil pouches between December 3
and March 6 throughout the United States, Canada and Mexico.
The pet food was sold by stores operated by the Kroger Co., Safeway Inc.,
Wal-Mart Stores Inc. and PetSmart Inc., among others, Henderson said.
Menu Foods said it makes pet foods for 17 of the top 20 North American
retailers. It is also a contract manufacturer for the top branded pet food
companies, including Procter & Gamble Co.
Procter & Gamble announced Friday the recall of specific 3 oz., 5.5 oz., 6 oz.
and 13.2 oz. canned and 3 oz. and 5.3 oz. foil pouch cat and dog wet food
products made by Menu Foods but sold under the Iams and Eukanuba brands. The
recalled products bear the code dates of 6339 through 7073 followed by the plant
code 4197, P&G said.
Menu Foods' three U.S. and one Canadian factory produce more than 1 billion
containers of wet pet food a year. The recall covers pet food made at company
plants in Emporia, Kansas, and Pennsauken, New Jersey, Henderson said.
Henderson said the company received an undisclosed number of owner complaints of
vomiting and kidney failure in dogs and cats after they had been fed its
products. It has tested its products but not found a cause for the sickness.
"To date, the tests have not indicated any problems with the product," Henderson
said.
FDA also working to target brands
The company alerted the Food and Drug Administration, which already has
inspectors in one of the two plants, Henderson said. The FDA was working to nail
down brand names covered by the recall, agency spokesman Mike Herndon said.
Menu Foods is majority-owned by the Menu Foods Income Fund, based in Ontario,
Canada.
Henderson said the recall would cost the company the Canadian equivalent of $26
million to $34 million.
Below are lists of specific brands recalled by Menu Foods, in addition to
Procter & Gamble's recall of certain Iams and Eukanuba products. Menu Brands
lists the brands on its Web site, www.menufoods.com, and advises consumers to
call 1-866-895-2708 for more information.
Recalled cat foods
Americas Choice; Preferred Pets; Authority; Best Choice; Companion; Compliments;
Demoulas Market Basket; Fine Feline Cat, Shep Dog; Food Lion; Foodtown; Giant
Companion; Good n Meaty; Hannaford; Hill Country Fare; Hy-Vee; Key Food; Laura
Lynn; Li'l Red; Loving Meals; Main Choice; Nutriplan; Nutro Max Gourmet
Classics; Nutro Natural Choice; Paws; Presidents Choice; Price Chopper;
Priority; Save-A-Lot; Schnucks; Sophistacat; Special Kitty; Springfield Pride;
Sprout; Total Pet; My True Friend; Wegmans; Western Family; White Rose; and Winn
Dixie.
Recalled dog foods
America's Choice; Preferred Pets; Authority; Award; Best Choice; Big Bet; Big
Red; Bloom; Bruiser; Cadillac; Companion; Demoulas Market Basket; Fine Feline
Cat; Shep Dog; Food Lion; Giant Companion; Great Choice; Hannaford; Hill Country
Fare; Hy-Vee; Key Food; Laura Lynn; Loving Meals; Main Choice; Mixables;
Nutriplan; Nutro Max; Nutro Natural Choice; Nutro; Ol'Roy; Paws; Pet Essentials;
Pet Pride; President's Choice; Price Chopper; Priority; Publix; Roche Bros;
Save-A-Lot; Schnucks; Springsfield Pride; Sprout; Stater Bros; Total Pet; My
True Friend; Western Family; White Rose; Winn Dixie and Your Pet.
Recalled Cat Product Information
Recall Information 1-866-895-2708
1.. Americas Choice, Preferred Pets
2.. Authority
3.. Best Choice
4.. Companion
5.. Compliments
6.. Demoulas Market Basket
7.. Eukanuba
8.. Fine Feline Cat
9.. Food Lion
10.. Foodtown
11.. Giant Companion
12.. Hannaford
13.. Hill Country Fare
14.. Hy-Vee
15.. Iams
16.. Laura Lynn
17.. Li'l Red
18.. Loving Meals
19.. Meijer's Main Choice
20.. Nutriplan
21.. Nutro Max Gourmet Classics
22.. Nutro Natural Choice
23.. Paws
24.. Pet Pride
25.. Presidents Choice
26.. Price Chopper
27.. Priority
28.. Save-A-Lot
29.. Schnucks
30.. Science Diet Feline Savory Cuts Cans
31.. Sophistacat
32.. Special Kitty Canada
33.. Special Kitty US
34.. Springfield Prize
35.. Sprout
36.. Total Pet
37.. Wegmans
38.. Western Family
39.. White Rose
40.. Winn Dixie
Recalled Dog Product Information
Recall Information 1-866-895-2708
1.. Americas Choice, Preferred Pets
2.. Authority
3.. Award
4.. Best Choice
5.. Big Bet
6.. Big Red
7.. Bloom
8.. Bruiser
9.. Cadillac
10.. Companion
11.. Demoulas Market Basket
12.. Eukanuba
13.. Food Lion
14.. Giant Companion
15.. Great Choice
16.. Hannaford
17.. Hill Country Fare
18.. Hy-Vee
19.. Iams
20.. Laura Lynn
21.. Loving Meals
22.. Meijers Main Choice
23.. Mighty Dog Pouch
24.. Mixables
25.. Nutriplan
26.. Nutro Max
27.. Nutro Natural Choice
28.. Nutro Ultra
29.. Nutro
30.. Ol'Roy Canada
31.. Ol'Roy US
32.. Paws
33.. Pet Essentials
34.. Pet Pride - Good n Meaty
35.. Presidents Choice
36.. Price Chopper
37.. Priority
38.. Publix
39.. Roche Bros
40.. Save-A-Lot
41.. Schnucks
42.. Shep Dog
43.. Springsfield Prize
44.. Sprout
45.. Stater Bros
46.. Total Pet
47.. Western Family
48.. White Rose
49.. Winn Dixie
50.. Your Pet
FDA News
FOR IMMEDIATE RELEASE
P07-48
March 17, 2007
Media Inquiries:
Mike Herndon, 301-827-6242
Consumer Inquiries:
888-INFO-FDA
Recall of Pet Foods Manufactured by Menu Foods, Inc.
The Food and Drug Administration (FDA) has been informed that Menu Foods, Inc.,
a private-label pet food manufacturer based in Statesville, Ontario, Canada, is
recalling all its "cuts and gravy" style dog and cat food produced at its
facility in Emporia, Kansas between December 3, 2006 and March 6, 2007. The
products are sold in the United States, Canada and Mexico.
The recall was prompted by consumer complaints received by the manufacturer and
by tasting trials conducted by the manufacturer. There has been a small number
of reported instances of cats and dogs in the United States that developed
kidney failure after eating the affected product. Ten deaths, one dog and nine
cats, have reported at this time. The firm has undertaken extensive testing of
the pet food products in question, but to date has been unable to find the
source of the problem.
The products are packaged in cans and pouches under numerous brand names and are
marketed nationwide by many pet food retailers including Ahold USA Inc., Kroger
Company, Safeway, Wal-Mart Stores, Inc., PetSmart, Inc., and Pet Valu, Inc.
Menu Foods, Inc. has identified the potentially contaminated products on the
Internet at www.menufoods.com/recall. Consumers who have any of these products
should immediately stop feeding them to their pets. Dogs or cats who have
consumed the suspect feed and show signs of kidney failure (such as loss of
appetite, lethargy and vomiting) should consult with their veterinarian. Menu
Foods, Inc. is notifying retailers by telephone and mail and is arranging for
the return of all recalled products.
FDA is conducting an investigation and working with Menu Foods, Inc. to ensure
the effectiveness of the recall. Consumers with questions may contact the
company at 1-866-895-2708. Consumers who wish to report adverse actions or other
problems can go to http://www.fda.gov/opacom/backgrounders/complain.html to
contact the FDA complaint coordinator in their state.
####
Menu Foods, Inc. Press Release
Nestlé Purina PetCare Company Press Release
Hill's Pet Nutrition, Inc. Press Release
P&G Pet Care Press Release (Consumers who have purchased IAMS or Eukanuba pet
food who have questions should check the IAMS web site. Consumers who have
purchased other pet food distributed by Menu should contact Menu.)
http://www.cnn.com/2007/US/03/17/petfood.recall.ap/index.html

Screening measures for new healthcare workers strengthened
The Department of Health published new guidance to the NHS on screening new
health care workers for tuberculosis (TB), hepatitis B, hepatitis C and HIV.
These measures reinforce and strengthen existing guidance and will help further
reduce the risk of transmission of TB and blood-borne viruses from health care
worker to patient.
All new health workers will require medical checks for tuberculosis and
hepatitis B and will be offered vaccinations if needed. In addition, all those
new to performing "exposure prone procedures" that carry an increased risk of
cross infection such as surgery or obstetrics and gynaecology must be cleared
for hepatitis C and HIV.
The guidance follows expert advice from a risk assessment group and consultation
with stakeholders including the NHS, the Royal Colleges, academic institutions
and public health bodies. It aims to strike a balance between the risk to
patients and the privacy of health care workers.
Public Health Minister Caroline Flint said:
"Our aim is not to prevent new healthcare workers with blood-borne viruses from
working in the NHS, but to stop them working in clinical areas where their
infection may pose a risk to patients in their care.
"These new measures will protect patients, reduce the number of patient
notification exercises and help new health care workers to make appropriate
career choices."
Dr. Alison Rimmer, Chairman of the Association of NHS Occupational Physicians,
said:
"This guidance will be very helpful in ensuring that new health care workers are
screened appropriately at the start of their NHS careers so that those who are
infected with serious communicable diseases can be guided into appropriate areas
where their health problems pose no risks to them from their work, and where
they would pose no risk to patients. It will be very useful in ensuring that
screening practice across the NHS, which is currently inconsistent, is
standardised. It will also enable us to ensure that these new recruits to our
workforce are treated appropriately for conditions which they may not know they
have, before their health deteriorates. It is very welcome."
Alongside the new measures on screening healthcare workers, Caroline Flint also
announced a limited relaxation of restrictions on hepatitis B infected health
care workers who are taking antiviral drug therapy.
Under new guidance published today, all hepatitis B infected health care workers
with relatively low levels of infection will be allowed to perform exposure
prone procedures whilst taking long-term drug therapy to suppress replication of
the virus. These workers will however be subject to regular checks by
occupational health.
Caroline Flint said:
"Our relaxation of the restrictions on hepatitis B infected healthcare workers
is a sensible measure based on advice from experts. The guidance sets out the
criteria for skilled hepatitis B infected healthcare workers to carry out a full
range of duties while taking antiviral drug therapy without compromising patient
safety.
"We are determined to take a balanced approach to this whole issue and only
implement restrictions where necessary to protect patients."
http://www.emaxhealth.com/24/10292.html

Doc fakes hepatitis blood test
By ROBIN PERRIE
March 17, 2007
A DOCTOR faces jail for hiding the fact that he had hepatitis B to get jobs in
ten hospitals.
Daniel Mutunda, 43, worked in accident and emergency wards all over Britain -
defrauding the NHS out of around £500,000.
Congo-born Mutunda lied to hospital bosses about his condition and even used a
PAL'S blood sample to pass medical tests.
Around 100,000 records have had to be checked in case any patients were put at
risk.
Hepatitis B is a highly infectious liver disease passed on through bodily
fluids.
Mutunda began cheating in 2001 after being refused a job because of his
condition.
The General Medical Council suspended him in 2004 after his lies were exposed -
but he STILL got work.
The dad of two, of Barking, East London, will be sentenced at Hull Crown Court
next month after admitting deception.
Det Sgt Dave Wescott, of Humberside Police, said: "It shows a massive loophole
in the NHS procedure. No one checked."
Mutunda worked in Barnsley, Exeter, Hull, York, St Leonards-on-Sea in East
Sussex, Preston and four London hospitals.
r.perrie@...
http://www.thesun.co.uk/article/0,,2-2007120693,00.html

Egyptian teachers to take hepatitis check
Published Date: March 17, 2007
By Hanan Al-Saadoun
KUWAIT: High ranking officials at the Ministry of Education told Kuwait Times
that all Egyptian teachers contracted from the beginning of the academic year
2004-2005 would compulsorily have to undergo a hepatitis C test to ensure that
they were free of the virus, known to spread quickly amongst Egyptians. They
added that teachers at primary schools would be examined over two days - March
24 and 25 - to be followed by teachers from other stages successively. They
remarked that those failing to undergo the tests on schedule would have to do it
latest by March 28, adding that all tests would be conducted in the afternoon.
Several Egyptian teachers however have expressed their dissatisfaction over the
decision amid fears of its consequences. A female teacher expressed her fears by
telling Kuwait Times that an Egyptian physiotherapist had been fired from the
Ministry of Health but by using his connections, he managed to get a private
sector residency visa and remained in Kuwait. "What about those with no
connections or wasta," she exclaimed. Officials also told Kuwait Times that as a
precautionary measure, other Egyptian teachers would be re-examined on returning
from every vacation to ensure that they were completely healthy and
hepatitis-free.
http://www.kuwaittimes.net/read_news.php?newsid=MTQxOTE3NjQ1MQ==

ok!! now I know, thankyou! hepc sure does manifest itself , I experience all
this.depression,fibromyalgia ect... humans are so amazing in what we can
endure!! Vera/CA
Vera Williams

Men Are Just Happier People
What do you expect from such simple creatures? Your last name stays put. The
garage is all yours. Wedding plans take care of themselves. Chocolate is just
another snack. You can be President. You can never be pregnant. You can wear
a white T-shirt to a water park. You can wear NO shirt to a water park. Car
mechanics tell you the truth.
The world is your urinal. You never have to drive to another gas station
restroom because this one is just too icky. You don't have to stop and think of
which way to turn a nut on a bolt. Same work, more pay. Wrinkles add
character. Graying hair adds attraction. Wedding dress~$5000. Tux
rental~$100. People never stare at your chest when you're talking to them. The
occasional well-rendered belch is practically expected. New shoes don't cut,
blister, or mangle your feet. One mood all the time. Phone conversations are
over in 30 seconds flat. You know stuff about tanks.
A five-day vacation requires only one suitcase. You can open all your own jars.
You get extra credit for the slightest act of thoughtfulness. If someone
forgets to invite you, he or she can still be your friend. Your underwear is
$8.95 for a three-pack. Three pairs of shoes are more than enough. You almost
never have strap problems in public. You are unable to see wrinkles in your
clothes.
Everything on your face stays its original color. The same hairstyle lasts for
years, maybe decades. You only have to shave your face and neck. You can play
with toys all your life. Your belly usually hides your big hips. One wallet and
one pair of shoes one color for all seasons. You can wear shorts no matter how
your legs look. You can "do" you r nails with a pocket knife You have freedom
of choice concerning growing a mustache. You can do Christmas shopping for 25
relatives on December 24 in 25 minutes.
No wonder men are happier. Send this to the women who can handle it and to the
men who will enjoy reading it.

---------...and the beat goes on......." Sonny Bono.....I will say of the L-rd,
He is my refuge andmy fortress: my G-d; in Him will I trust.Psalm

HAHAHAHA, Mac Freak, sally
pretty funny.
http://www.youtube.com/watch?v=AGHty_S0TU0
wen
---------...and the beat goes on......." Sonny Bono.....I will say of the L-rd,
He is my refuge andmy fortress: my G-d; in Him will I trust.Psalm

From Medscape Gastroenterology
Hepatitis C Expert Column
Hepatitis C and the Effects of an Aging Population
Posted 03/06/2007
Nancy Reau, MD; F. Fred Poordad, MD
Author Information
Introduction
It is estimated that as many as 5 million persons in the United States have
been infected with hepatitis C virus (HCV). Up to 85% have chronic
infection, and only a small minority have been diagnosed and treated.
Hepatitis C is the leading cause of both liver transplantation and
hepatocellular carcinoma (HCC) in the United States, directly contributing
to 13,000 deaths annually.[1,2] Fortunately, the incidence of hepatitis C
has decreased dramatically over the past decade as a result of better
screening of blood products, implementation of universal precautions, and
implementation of educational and needle exchange programs. There were
approximately 26,000 newly acquired cases of hepatitis C in 2004, which was
down from 240,000 annually in the 1980s.[1]
However, the overall liver disease burden has not significantly decreased,
and it may actually increase as this population ages. It is projected that
disease complications associated with HCV infection will peak around the
year 2015, as many chronically affected patients will have been infected
more than 20 years.[3,4] Specifically, the incidence of hepatitis C-related
cirrhosis may double during this period, resulting in a dramatic increase in
complications, including hepatic decompensation, HCC, and death. This will
have an obvious economic impact on the healthcare industry, with estimates
of direct medical expenditures related to HCV infection reaching $10.7
billion during the period 2010-2019.[3,5]
Given this scenario, it is hoped that hepatitis C therapy is on the brink of
transformation. The small oral molecules in development may significantly
alter current practice. There is great anticipation that these new compounds
will improve viral clearance rates, but it is unlikely that any single one
will necessarily be the complete "silver bullet" for hepatitis C. Indeed,
there are challenges that will likely be associated with these therapies,
notably resistance. Approval of these compounds, the so-called Specifically
Targeted Antiviral Therapies for HCV (STAT-C), is still a few years away,
and optimizing the use of future combination therapy is even further into
the future. Therefore, at present, those in need of therapy should be
treated with the current standard of care of pegylated interferon and
ribavirin-based regimens.
FULL TEXT:http://www.medscape.com/viewarticle/552614?src=mp
---------...and the beat goes on......." Sonny Bono.....I will say of the L-rd,
He is my refuge andmy fortress: my G-d; in Him will I trust.Psalm

Date: Sat, 17 Mar 2007 06:38:06 -0700
Management of Hepatitis C Treatment Failure
Emmet B. Keeffe, M.D.
Chief of Hepatology and Co-Director of Liver Transplant Program
Stanford University School of Medicine
Despite impressive progress in the management of chronic hepatitis C over the
past ten years, treatment failure still occurs in about half of patients who use
current therapies. Sustained virological response (SVR), defined by convention
as continued undetectable serum HCV RNA six months after the completion of
treatment, occurs in only a limited number of patients undergoing retreatment
after failure of initial therapy. This article will discuss the different types
of hepatitis C treatment failure, which patients are likely to respond to
retreatment, expected SVR rates with retreatment, and management strategies and
experimental approaches for patients who have experienced prior treatment
failure and are not candidates for retreatment.
Treatment for Chronic HCV
Treatment of chronic hepatitis C with interferon-based therapy has evolved
dramatically since the early 1990s (see Table 1 for a comparison of treatment
response rates). In 1998, the Food and Drug Administration (FDA) approved the
combination of interferon alfa-2b plus ribavirin, which became the standard
therapy for people with chronic hepatitis C virus (HCV) infection. Interferon
alfa-2b (3 million units [MU] three times weekly) plus ribavirin (1,000-1,200 mg
daily) produced SVR rates of 38% and 43%, respectively, in pivotal American and
European trials. These studies also showed that patients with HCV genotypes 2 or
3 were more likely to respond to treatment than those with genotype 1 (SVR of
66% vs 29%). Patients with genotype 1 had an increased SVR rate after 48 weeks
of therapy (compared with 24 weeks), while those with genotypes 2 or 3 did not
see an additional benefit from longer treatment.
Table 1
Comparison: Sustained Virological Response Rates in Treatement-Naive Patients
Sustained Virological Response
Treatment Regimen Duration Overall Genotype 1 Genotypes 2 or 3
IFN1 24 wk 5-10% 2-5% 15-20%
IFN1 48 wk -15% -10% -30%
FN + RBV2,3 48 wk 41% 20% 66%
PEG-IFN alfa-2b+RBV4 48 wk 54% 42% 82%
PEG-IFN alfa-2b+RBV5 48 wk 61% 48% 88%
PEG-IFN alfa-2a+RBV6 48 wk 56% 46% 76%
PEG-IFN alfa-2a+RBV7 48 wk 61% 51% 78%
IFN=interferon alfa-2b monotherapy twice weekly; IFN+RBV=interferon alfa-2b
twice weekly plus ribavirin 1000-1200 mg daily; PEG-IFN+RBV=peginterferon
alfa-2b (Peg-Intron) or alfa-2a (Pegasys) once weekly plus ribavirin 800 mg
daily to 1000-1200 mg daily.
1Poynard, T. et al. Hepatology 1996, 24:778
2McHutchinson, J. et al. New England Journal of Medicine 1998, 339:1488
3Poynard, T. et al. Lancet 1998, 352:1426
4Manns, M. et al. Lancet 2001, 120:958
5Manns, M. et al. Lancet 2001, 120:958; with weight-based ribavirin dosing at
6Fried, M. et al. New England Journal of Medicine 2002, 347:975
7Hadziyannis, S. et al. Journal of Hepatology 2002, suppl. 1:3
Today, the current treatment of choice for chronic hepatitis C is peginterferon
(the correct generic name, but also commonly called pegylated interferon)an
altered form of interferon that lasts longer in the body and can be injected
once rather than three times weeklyplus daily ribavirin. Scherings
peginterferon alfa-2b (Peg-Intron) was approved in January 2001, and Roches
peginterferon alfa-2a (Pegasys) was approved in October 2002. Initial studies
showed that peginterferon monotherapy was more than twice as effective as
standard interferon monotherapy (SVR of 39% vs 19% with Pegasys vs Roferon-A,
and 23-25% vs 12% with Peg-Intron vs Intron A). Subsequent studies showed that
combination therapy with peginterferon plus ribavirin produces an overall SVR
rate of 54-61%.
Treatment Failure
Despite improvements in treatment, many patients still do not respond to initial
therapy for chronic hepatitis C.1 These include relapsers, who experience
reappearance of serum HCV RNA after achieving an undetectable level at the
conclusion of a course of therapy (an end-oftreatment response), and
nonresponders, who do not achieve viral clearance by the completion of therapy.
Some patients experience breakthrough nonresponse, an increase in HCV RNA after
achieving an undetectable viral load during continuous treatment. Some have no
decrease in HCV viral load during therapy, or experience only a modest decrease
of 1-2 logs. Others have an HCV RNA decrease of at least 2 logs, but their viral
load remains detectable during therapy (often called a partial response).
Patients who experience a significant decrease in HCV RNA may demonstrate
decreased serum liver enzyme, e.g., alanine aminotransferase (ALT) levels and
reduced liver tissue damage, even if they do not achieve an
undetectable viral load.
Retreatment
Improvements in HCV therapy raise the possibility that people for whom earlier
attempts at treatment have failed might be helped by new and better regimens.
Approaches to retreatment include use of higher doses of interferon, longer
duration of therapy, use of different types of interferon, e.g., peginterferon,
and the addition of ribavirin or use of a higher dose. Several factors predict
whether retreatment is likely to be successful (see Table 2). People who have
relapsed are more likely to be successfully retreated than nonresponders, as are
those nonresponders who had a significant decrease in HCV RNA during initial
treatment (even if they did not achieve an undetectable viral load).
Table 2
The type of initial treatment also plays an important role. Retreatment with the
same regimen is unlikely to be beneficial unless the previous dose and/or
duration of therapy were inadequate. Relapse or nonresponse may have been due to
noncompliance with a prescribed regimen; if this was the case, better patient
education and management of side effects may increase the likelihood of
adherence and successful treatment. People who previously experienced treatment
failure with a less effective regimen may respond to retreatment with more
effective therapy. Patients who received prior treatment with interferon
monotherapy are considerably more likely to respond to further treatment than
those previously treated with standard or pegylated interferon plus ribavirin.
Other factors that predict the likelihood of successful retreatment include
lower HCV viral load and infection with HCV genotypes 2 or 3.
Retreatment of Relapsers
Patients who relapse after initial HCV therapy are more likely to be
successfully retreated than initial nonresponders. The combination of interferon
plus ribavirin was originally approved by the FDA for retreatment of patients
with chronic hepatitis C who had relapsed after treatment with interferon
monotherapy. In a large multicenter study by G.L. Davis and colleagues, 48% of
relapsed patients treated again with interferon monotherapy achieved an
undetectable viral load during treatment, but the sustained response rate was
only 5%.2 In contrast, 82% of initial relapsers retreated with a combination of
standard interferon plus ribavirin became HCV RNA negative, and 47% achieved an
SVR.
To date, there has only been one published preliminary study on the use of
peginterferon plus ribavirin for retreatment of patients who relapsed after
initial treatment with standard interferon plus ribavirin.3 In this study, 55
patients were retreated with either peginterferon alfa-2b 1.0 mg/kg once weekly
plus ribavirin 1000-1200 mg daily or peginterferon alfa-2b 1.5 mg/kg once weekly
plus ribavirin 800 mg daily; 32% and 50%, respectively, achieved a SVR.
Retreatment of Nonresponders
Most published information about retreatment is from studies of standard
interferon plus ribavirin in patients who failed previous treatment with
interferon monoherapy. S.J. Cheng and colleagues performed a meta-analysis of
nine randomized controlled trials (RCTs) comprising 789 patients.4 After six
months of standard combination therapy, the pooled SVR was 13%; combination
therapy was almost five times more effective than interferon monotherapy. A
second metaanalysis by K.J. Cummings and colleagues looked at 12 RCTs with 941
patients.5 In this analysis, the pooled SVR was 14% for patients retreated with
combination therapy, compared to 2% for those retreated with interferon alone.
R. San Miguel and colleagues analyzed ten RCTs with 1728 patients, and found a
pooled SVR of 13%.6 In addition, a systematic review of randomized trials of
interferon (with or without ribavirin) showed that approximately approximately
15% of nonresponders achieved a SVR when retreated with
combination therapy.1 Overall, then, retreatment with standard interferon plus
ribavirin benefits no more than about 15% of patients who did not respond to
initial interferon monotherapy (see Table 3).
Table 3
Another approach to retreatment is the use of highdose induction interferon plus
ribavirin in patients who did not respond to standard interferon monotherapy.
The rationale for using higher induction dosing comes from studies such as that
of A.U. Neumann and colleagues, who showed a more rapid decline in HCV viral
load with 10 MU versus 5 MU of interferon daily over 14 days.7 Furthermore,
recent research shows that early viral kinetics correlate with SVR rates in
previously untreated patients receiving high-dose induction interferon followed
by standard doses of interferon plus ribavirin. There are few studies of
high-dose induction interferon in patients who have not responded to previous
HCV therapy. A.H. Malik and colleagues studied 25 interferon monotherapy
nonresponders randomized to receive one of two interferon regimens.8 One group
was treated with 10 MU of standard interferon daily for 10 days, followed by 5
MU daily for 74 days, then 5 MU three times weekly for 24
weeks; the second group received the same interferon regimen plus ribavirin
starting at day 11. One-third (33%) of the patients receiving induction
interferon plus ribavirin achieved a SVR, compared with none of those receiving
induction interferon alone.
Because it is so new, there are few published studies on the use of
peginterferon plus ribavirin in people who did not respond to prior therapy with
standard interferon with or without ribavirin. M. Buti and colleagues found that
previously untreated patients with genotype 1 HCV who received high-dose
peginterferon alfa-2b (3 mg/kg) experienced a significantly greater reduction in
viral load over 48 hours and greater HCV RNA clearance at week 12, compared with
those who received a typical peginterferon dose (0.5 mg/kg).9 I. Jacobson and
colleagues are conducting a study of peginterferon alfa-2b plus ribavirin in
patients with genotype 1 HCV who did not respond to prior treatment with
interferon monotherapy or interferon plus ribavirin.2 Preliminary data from this
study show that 16% of patients with genotype 1 who had failed prior interferon
monotherapy and were treated with peginterferon 1.5 mg/kg weekly plus ribavirin
800 mg daily achieved a SVR, compared with 27% of
patients treated with pegylated interferon 1.0 mg/kg weekly plus ribavirin
1000-1200 mg daily. However, among the patients who did not respond to previous
combination therapy with standard interferon plus ribavirin, the SVR rates with
retreatment were only 5-9% with the two treatment schedules.
Similarly, M. Shiffman of the HALT-C Trial Investigators team has reported
preliminary data from a large study of peginterferon alfa-2a 180 mg weekly plus
ribavirin 1000-1200 mg daily in patients who did not respond to standard
interferon therapy with or without ribavirin.9 Patients who previously received
interferon monotherapy had a SVR rate of 34%, compared with a SVR rate of 11%
for those who initially had received standard interferon plus ribavirin.
Management Options for Nonresponders
In summary, 47% of patients who relapsed after prior interferon monotherapy
achieved a SVR when retreated with standard interferon plus ribavirin, and
preliminary results show a SRV rate of about 32-50% for those treated with
peginterferon plus received a typical peginterferon dose (0.5 mg/kg).9 I.
Jacobson and colleagues are conducting a study of peginterferon alfa-2b plus
ribavirin ribavirin. Among nonresponders to interferon monotherapy, 13-15% of
patients achieved a SVR when retreated with standard interferon plus ribavirin,
while 25-40% achieved a SVR when retreated with peginterferon plus ribavirin.
Early data suggests that only about 10% of patients who did not initially
respond to combination therapy with standard interferon plus ribavirin will
respond to peginterferon plus ribavirin.
Since many nonresponders do not achieve a SVR even after retreatment with the
best currently available therapies, management of nonresponders should include
determining who is most likely to be successfully retreated and whether
nonresponders can benefit from further therapy. Retreatment with peginterferon
plus ribavirinor experimental regimensgenerally should be reserved for
patients with favorable factors that predict SVR, such as prior relapse (as
opposed to nonresponse), previous therapy with interferon monotherapy (as
opposed to combination therapy), partial virological response (significant
decrease in HCV RNA) during initial therapy, lower HCV viral load, and/or
genotypes 2 or 3. Tolerance of and adherence to prior therapy should also be
taken into account, as should the severity of underlying liver disease.
Patients with advanced liver fibrosis or cirrhosis (stage 3 or 4 fibrosis as
determined by a liver biopsy) have progressed further along in the course of
their disease, and are at greater risk for developing decompensation or
end-stage liver failure in the subsequent 5-10 years. Such people are candidates
for additional treatment, including experimental therapies. On the other hand,
patients with only mild to moderate (stage 0-2) fibrosis can generally afford to
wait for newer developments in therapy, although their liver health should be
monitored on an ongoing basis.
Maintenance therapy with low-dose peginterferon may reduce the risk of
developing decompensated cirrhosis and liver cancer (hepatocellular carcinoma)
in people with advanced fibrosis. It has been observed that up to 40% of these
patients can experience a histological response (improvement in liver tissue
damage) even if they do not achieve an undetectable viral load. Several studies
are underway looking at whether long-term peginterferon monotherapy is a
beneficial option for people with advanced liver disease.
References
1. Shiffman, M.L. Retreatment of patients with chronic hepatitis C.
Hepatology 2002, 36(suppl.1):S128-S134.
2. Davis, G.L., Esteban-Mur, R., Rustgi, V., et al. Recombinant interferon
alfa-2b alone or in combination with ribavirin for retreatment of interferon
relapse in chronic hepatitis C. New England Journal of Medicine 1998,
339:1493-1499.
3. Jacobson, I.M., Ahmed, F., Russo, M.W., et al. Pegylated interferon
alfa-2b plus ribavirin in patients with chronic hepatitis C: A trial in prior
nonresponders to interferon monotherapy or combination therapy and in
combination therapy in nonresponders: Final Results. Gastroenterology 2003,
124:A-714.
4. Cheng, S.J., Bonis, P.A,L., Lau, J., et al. Interferon and ribavirin for
patients with chronic hepatitis C who did not respond to previous interferon
therapy: A meta-analysis of controlled and uncontrolled trials. Hepatology 2001,
33:231-240.
5. Cummings K.J., Lee, S.M., West, E.S., et al. Interferon and ribavirin vs.
interferon alone in the re-treatment of chronic hepatitis C previously
nonresponsive to interferon. Journal of the American Medical Association 2001,
285:193-199.
6. San Miguel, R., Guillen, F., Cabases, J.M., and Buti, M. Metaanalysis:
Combination therapy with interferon-a 2a/b and ribavirin in patients with
chronic hepatitis C previously non-responsive to interferon. Alimentary
Pharmacology and Therapeutics 2002, 16:1611-1621.
7. Neumann, A.U., Lam, N.P., Dahari, H., et al. Hepatitis C viral dynamics in
vivo and the antiviral efficacy of interferon-a therapy. Science 1998,
282:103-107.
8. Malik, A.H., Kumar, K.S., Malet, P.F., et al. A randomized trial of
high-dose interferon alpha-2b, with or without ribavirin, in chronic hepatitis C
patients who have not responded to standard dose interferon. Alimentary
Pharmacology and Therapeutics 2002, 16:381-388.
9. Buti, M., Sanchez-Avila, F., Lurie, Y., et al. Viral kinetics in genotype
1 chronic hepatitis C patients during therapy with 2 different doses of
peginterferon alfa-2b plus ribavirin. Hepatology 2002, 35:930-936.
10. Shiffman, M.L. Retreatment of HCV Non-responders with peginterferon and
ribavirin: Results from the lead-in phase of the hepatitis C antiviral long-term
treatment against cirrhosis (HALT-C) trial. Hepatology 2002, 36:295A.
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