Calculating amount of water needed

[HazelAustralia]

Good morning,

It's a lovely Sunday morning here in Victoria (Australia) and thankfully, the bush fires seem to have settled down.

I read somewhere on the forum an algorithm for how much water you should drink - your weight in imperial measure, halved, or something like that.
Can anyone remember that please?

Also, has anyone heard of a problem with drinking grapefruit juice?

Thanks,

Hazel.

[lporterrn]

Welcome Hazel. There are various algorithms. I prefer a personalized method - if your output is pale yellow or clear, you are probabably getting enough water - if it is concentrated (dark yellow), you need to drink more. The feedback method takes into consideration all sorts of variables, such as heat, sweating, water retention, etc.

As for grapefruit juice, I am not sure if you mean drinking it in general or during treatment. The only thing to be sure of is if it interacts with any medications you take.

Hope this helps.

[Gaj]

Hi Hazel,

I am also in Victoria. With the hot weather we have been getting it is important to avoid dehydration especially while on medication. Water is ideal for this but other fluids and the fluids in food we eat also counts. In my case I am 72kg and find I am drinking 2-3lt of water per day plus my other intake (possibly more on those 40°+ days we had recently). Another good guide is that if you find the frequency of the need to "go" gets really annoying then you are probably hydrated enough and can afford to back off a bit. 

For grapefruit juice, sadly I can't have it with the Daclatasvir I am on as it interferes with the CYP3A4 enzyme. A quick google indicated recommendations against for Viekera Pak per one example below. Scroll about halfway down the page.

"Using this medicine with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.

Grapefruit Juice"

http://www.drugs.com/cons/viekira-pak.html

[BillT]

Hi Hazel,
            I'm on the Viekia also and I asked about the grapefruit because it was discussed on another thread.They told me to stay away from it because it does interact with the Viekira.I'm not sure how but it evidently does.

[HazelAustralia]

Hi all,

Nice to meet another Victorian here Gaj, I hope you're going well. I'm in a rural area in treatment at a regional hospital where no one has yet completed treatment, so I'm finding these forums really helpful.

Yes, Lucinda, I meant drinking grapefruit juice while on treatment (generally, I drink a fair bit of it, & have never checked whether it's okay for the liver).
I had a glass yesterday but I'll stay away from it. Thanks for the info BillT & Gaj.

I've just been using the Liverpool uni drug interaction charts, I wasn't aware of this other one, thanks Gaj.

And as for the water - yes I'm pretty sure that I am drinking enough and it is just my raised bilirubin that is making it appear that I'm dehydrated.

Best wishes

Hazel

[Gaj]

Hi Hazel,

I'm on the Mornington Peninsula but head up to town for monitoring of my liver and generic treatment as I was previously a participant in a trial there.

I assume you mean this chart as the Liverpool one?

http://www.hep-druginteractions.org/Interactions.aspx

It does pick up grapefruit juice as a potential (amber) but not tested issue due to the same effect from cyp3a4 as with Daclatasvir. The Liverpool database is pretty good as it does include known problematic non-drugs/foods,etc (and illicit drugs) though people often think it is only for prescription and over the counter drug interactions.

[Philadelphia]

Hi GAJ, Liverpool Uni does an app for drug interactions - you dl the app, put In the hcv treatment you are taking, then put in the drug you are wondering about. It's called iHep. There is another one called iHIV too. My specialist recommended it.

[HazelAustralia]

Hi Philly,
How's Canada?

I downloaded the Liverpool uni app based on your recommendation on your blog (and my nurse practitioner is now using it too), thanks. Gaj's link is to is a website of the same thing made by the same people - but actually has more functionality.

Hope you're having fun,

Hazel

[HazelAustralia]

Hi Gaj,

The website version is very easy to use, thanks. That's good that the team who you did the trial with are continuing to support and treat you. When will you be finished?

Hazel

[Philadelphia]

Canada is cold, damp and lovely.
We are off to the Capilano suspension bridge tonight. It has lights up in the winter. North Van is completely clouded in at the moment so that'll be interesting.

[Gaj]

Hi Hazel,

You're welcome re the website version, I just didn't have the link on the machine I was using in my first response.

I'm on 24wks Tx so finish on 3rd May which seems so far away but I suspect will go quickly.
Yes, my clinic has been very supportive with monitoring although strictly speaking I am treating myself. 
When my liver damage started accelerating 12 months ago we looked for another suitable trial but none available at the time. Then PBAC approval came through in April 2015 but of course not PBS approval so I was "waiting" as we heppers so often do! Then at the start of Oct I heard rumours of the availability of generic DAAs in Australia and started investigating. Two days later my specialist gave me the bad news of my second HCC. After discussing how to treat that I asked him about the generics, half expecting a negative response and the need to go it alone. Instead he said I needed treatment 'now' and if I could nominate a generics source he trusted he would write me a 'private' script that had nothing to do with the clinic but that the clinic could monitor my treatment of myself during my normal care. I told him that I believed that the FixHepC buyers club was assisting people to purchase, NATA lab test and encapsulate generics and he wrote me the script. So it was all a bit political back three months ago but I understand there are a number of us at the clinic these days who sourced via one of the three reliable Australian avenues and there certainly seem to be a lot more smiling people when I visit.

Of course last week we had the announcement of PBS approval and funding for DAAs from April 2016 with allegedly no restrictions or triaging. The details are yet to come although I suspect there may be some queuing instead of "waiting" just based on the number of potential patients vs the available medical resources.
Anyway based on the treatment prices extracted from the pharmcos we are hearing thrown about, either the Australian government has the toughest negotiators since Dirty Harry or we can give a lot of thanks to people like Greg Jefferys, Dr James Freeman and the 3 compounding pharmacies for having the courage to break the monopoly position with generics and thus creating a competitive marketplace where the drug companies had to reduce their prices significantly or risk losing much of the Aussie market. Greg's blog posts on here over the last few days have more details. See 24th & 27th Dec. http://blogs.hepmag.com/gregjefferys/

Gaj

PS I have no regrets about paying for my own generics. It was a small price to pay to get urgent treatment when other availability was an unknown and hopefully I have allowed someone else who can't afford a couple of grand faster access when PBS becomes available from April.

[Philadelphia]

While I'm sure that the buyers club created some media attention and enabled an alternate path to treatment, I think it only fair to also pay respect to the advocacy groups, organisations and individuals also agitating for change. They've been working hard for years to have these treatments firstly put on the PBAC, then listed on the PBS so they are available for every Australian, not just those who can afford generics or get on a trial. So have many specialists and medical health professionals working in this area.

I appreciate the work the generics folk have done but I don't think they turned the tide single-handed.

[Gaj]

Hi Philadelphia,

I agree, the various advocates, medical professionals and individuals have put a tremendous amount of effort and hard work over a number of years into achieving the changes that allowed listing and were definitely the ones who initiated the recommendation by the PBAC that they be made available to all Australians. So credit where it is due!

It is also fantastic that the government has managed to negotiate prices far below what any other first world country has achieved to now and which should allow PBS treatment of all Australians who want it without sending the country broke (with drug company funding of over-quota treatments annually).

The generics importers have only been active in any volume for about 6 months and certainly weren't invited to sit at the negotiating table so it is obviously just speculation that they had any influence at all on the second paragraph above.

And yes I recognise that I am tremendously lucky to have been able to not only participate in a trial but to afford generics when the trial failed to cure me and my health was failing. But more importantly I am deeply indebted to the medical professionals who during both these stages saw me as a patient needing treatment and fulfilled their Hippocratic oath.

Gaj

[Philadelphia]

I had no idea you were up to your second go-round with Hcc, GAJ. How stressful for you! Yes I too am grateful to my medical peeps who have by and large been awesome. My treating team at St Vincents have been exceptional. My own GP has monitored me closely (every month while on treatment) and bulk billed me into the bargain.

Right now I'm sitting in my daughters living room in Vancouver planning to head down town to do some sightseeing and I'm thinking about the great amount of good fortune that's got me to this point.