Sounds to me like they're not up to date on their protocol info, or they're
cherry picking theories to suit their office policy, but without knowing why
they said what they did I can't say for sure.

Tylenol/aceteminophen is the drug of choice for tx side-effects and, if
taken within the recommended daily dosage, is the easiest on your damaged
liver... except for opiates. Most docs are reluctant to rx opiates because
they're addictive, and opiates will usually wreak havoc with your digestive
system, causing nausea and severe constipation and killing what little
appetite you'll have. Oxy is an opiate.

I'd do my shot at midnight, taking a generic Tylenol and Gravol about an
hour, and I slept through the worst of the side-effects. I know I slept
through the worst, because I did an experiment on my last shot: no meds.
That was a mistake, believe me, but it proved to me that the T&G was
effective. Because I have cirrhosis, I was leery of Tylenol but excellent
research posted on this group let me confirm that it was the lesser of
evils.

Twelve weeks is the magic number for the viral-load count that determines if
your tx is working. If you've not had a two-log drop at that point, there's
no point continuing because the tx is very likely going to be unsuccessful.
If you achieve the two-log drop, then you should continue for another 12
weeks. Perhaps 12 weeks of tx is successful in some cases, but it's reducing
your chances of SVR and I'd be insisting to do the 24 week regimen,
presuming the two-log drop. Genotypes 2 and 3 (which I had) are treated the
same, and we are happy heppers because we don't have Genotype 1, which
requires nearly a freakin' year of tx :-)

The anemia caused by tx is not related to iron overload or hematomochrosis,
a condition unique to people of Irish-Scottish descent (something to do with
the potato famine). Request a test to determine if your body is storing too
much iron and, if it isn't, don't worry. If it is, phlebotomy will reduce
the levels. We all generally consume far more iron than we need, so paying
attention to the amount in your diet, and limiting it, is never a bad idea.
However, if all you can stomach on tx is a baked potato, don't beat yourself
up-- nutrition is more important.

Good luck,

Waterspider

Because GPs aren't necessarily well-read on any specific disease - and
particularly in a disease or treatment thereof that they don't specialize in -
or see a lot of affected patients. If you're just discovering how little GPs
understand about HCV and its treatment, put your helmet on - it could be a
rough ride.

The safest OTC pain reliever for folks with HCV is Acetaminophen - and no more
than 2 grams per day (I'd keep it to 1 gram per day if possible, just to be on
the even safer side).

NSAIDs such as aspirin and ibuprophen depress platelets, among other side
effects, and folks on anti-viral therapy often are already dealing with low
platelet count and don't need the extra aggravation.

Vicodin, Oxycodone, and Hydrocodone are essentially interchangeable, and all
contain some amount of Acetaminophen (the versions I've used were typically
350mg, but some were as much as 500mg per dose). Keeping track of any/all
drugs you take that have Acetaminophen is important to avoid taking more than
the maximum recommended daily amount.

On the up side, I had to do 48 weeks of therapy, and never needed more than a
500mg "Maximum Strength" Tylenol about an hour before my Friday Nite Shot, and
another 500mg Saturday morning. After a couple of months on therapy I didn't
need the Saturday morning pill, and by the 4th month I didn't need the Friday
nite pill, either. The fluish symptoms associated with the aftermath of the
injection had nearly disappeared by then, and I never really had any pain that
I associated with therapy through the entire 11 months anyway.

I'll note that over the years I've read a few posts here from folks that felt
they needed something more substantial than Tylenol to get them through
treatment. So it's possible you might be in that camp. Time will tell.

That the GP doesn't prescribe Vicodin/Oxycodone/Hydrocodone for heppers on
treatment isn't surprising - it's probably the typical attitude stemming from
the automatic association of HCV with drug abuse. It sucks, but there you are.

I suppose I should state now (before it's too late) that I would never
recommend hooking up with a GP to handle HCV therapy. I just don't think GPs
have the knowledge or experience to look for the associated problems that may
crop up, or do the right things to handle them. They typically don't do
frequent enough testing, and they're the first to cut treatment meds in light
of falling blood counts - instead of treating the falling blood counts with
available/appropriate drugs. If there is any way for you to identify a gastro
doc that handles significant cases of HCV therapy, I strongly urge you to do
so.

That this GP said  you could most likely stop at 12 weeks is a huge red flag
from where I'm sitting. Do the full course of 24 weeks, no matter what your
doc says. The durable SVR statistics do not support cutting back to 12 weeks
for G2s, with few exceptions - and I would bet this GP won't do the necessary
testing to even know if you fit the exception case in the first place.

Finally, as to the iron intake: has this doctor even tested your blood for
iron loading - or even gotten a single Serum Ferritin count? I'm betting he's
done neither. Unless you are one of the incredibly few that actually has a low
iron load and low Serum Ferritin count, it would be wise to limit your intake
of dietary iron - whether you are in treatment or not. Iron is rocket fuel for
HCV wrt to liver damage. If you become anemic on treatment because of either
hemolysis or marrow suppression, or both, eating iron isn't going to fix it.

No matter what doctor you use to handle your therapy, you should have a
detailed plan on how frequently he/she will run blood counts and viral load
tests. Ideally, you should have a full blood workup the week prior to starting
therapy to know your starting condition and your baseline viral load. This
should include a CBC with SDIFF, an Hepatic Function Panel, a Thyroid Function
test, and a quantitative Viral Load test.

Within two weeks of starting therapy you should have your full blood work done
again to see if any counts (particularly RBCs, WBCs and Platelets) are falling
precipitously. At the end of the 4th week you should get your first
on-treatment viral load check along with the full blood work. If nothing
untoward is going on with your blood tests, you should get another VL check at
12 weeks, and the last one at the end of the 24 weeks on therapy.

You should also have an agreement that if you become anemic - if your
Hemoglobin falls below 11g/dl (as a female) - that your doc will prescribe
Procrit/Epogen/Aranesp instead of cutting your treatment meds; and if you
experience Neutropenia (your Absolute Neutrophil Count falls below say
1.5K/ml) that he will put you on Neupogen instead of cutting your treatment
meds. You should also know what his treatment strategy is if your Platelet
count falls: some doctors have hair-triggers that will go off far too early.

Finally, when you get your treatment drugs, read the Product Information
Sheets. You will find a wealth of information therein that will help you
converse with your doctor in an intelligent fashion - and may help you avoid a
stupid doctor decision that could affect your success.

Good luck!

/greyhackles

They sound like a gang of uninformed nitwits to me.  No offense, but when
you know better than they do, it's best to follow your own advice.

I found a handout from Quest Diagnostics in Medical a few days ago.  It was
on STD's, and guess what?  They included HCV with chlamydia and syphilis and
all the rest.  Also, at one point in time Medical was making it a *point* to
give all inmates diagnosed with HCV multivitamins with iron.  Their
rationale?  They said they wanted "to see how it affects the biopsy."

All together....one....two....three.....DOH!

My hepatologist was uncomfortable prescribing opiates for me,
especially as tolerance increased and my need for escalating dosages
followed. My NP referred me to a competent pain management specialist;
I now I take 50 mgs of methadone per day in divided dosages...this has
dramatically improved the quality of my life.

Certainly of the opiates I have tried, methadone is far and away the
best for _chronic_ pain...prior to switching I was on OxyContin, which
has a short half-life which does not live up to its billing, left me
feeling much more drugged, is zillions of times more expensive (if
that matters), and seemed to provide crappy pain relief even at the
ever-increasing dosages my rapidly increasing Oxy-tolerance demanded.

Oddly enough, hydrocodone worked much better than oxy for me, but
there is no such thing as pure hydro in the US...

If you want to try something non-scheduled, you might wish to try
tramadol

http://en.wikipedia.org/wiki/Tramadol

...for some, 100-300 mgs of tramadol/day (Ultram) in divided dosages
would be sufficient. It's a long-lasting synthetic opiate with
antidepressant properties...be forewarned, however, that withdrawal
from tramadol can resemble a combo of opiate and antidepressant
withdrawal, and it is certainly addictive...

Chardonnay, you just never know as for pain etc. I also read the
suggestions to take Tylenol before Friday night shots or soon after,
but I never did. I just bit the bullet. I had severe osteo arthritis
in left hip that I was basically not taking anything for at that
point, either, becuase I just felt it was senseless and my doc would
not give me anything stronger. There was no cartiledge left in the hip
and the suggested "physical therapy" seemed ludicrous to me - Like
"why will that help regrow cartiledge?" DUH!

Once on Tx, I was on so many nasty drugs I was really paranoid about
taking anthing more that I could possibly go without - I heard all the
pros and cons on Tylenol vs NSAIDS and was so confused, I just refused
to take either. Maybe a couple of times I broke down and took tylenol.
I'm not trying to sound like a martyr here or anything, I was in a lot
of pain constantly, but just chose to "bite the bullet" and try to
sleep thru the worst of it, and as often as possible.

Bottom line, I survived. I commend you for trying to sort all these
things out and go into TX as informed as possible, I was the same way,
but try to take life one day at a time, and cross each bridge as you
come to it. Don't waste any more energy than necessary or worrying
about the What If's..... Good Luck! Slam that Dragon!!!!