dizzy, faint, weak

[HazelAustralia]

Hello all,

I am on my 15th day and generally it's been okay.
I cannot imagine what it will be like to be (hopefully) free of this virus.

But yesterday and today I am feeling faint when I stand, can't walk far, can hardly chew food as my jaw aches. I dropped the dictionary as my wrist just kind of hurt and collapsed. I can really hardly lift my arms to hang the washing out (I did it in three goes, over an hour).

Yesterday I had my blood pressure checked and it was okay. I am meant to have another blood test this week for bilirubin levels (which were high), but it's holiday season and they have all the young casual staff on at the pathology centres up here, just out of the 6 week TAFE course (not to be rude, but not everyone is straightforward in terms of getting blood). I went to one yesterday and another one today and have a whole lot of bruises and marks on my arms but no blood successfully drawn. It will be next week now until they are open again.

I know, Philly, you said you were exhausted in week 2 or 3. So I guess this is just part of the ribaviron treatment and it too shall pass.

Is it???
Will it???

I hope everyone in this hemisphere has a wonderful New Year's Eve tonight.

[KimInTheForest]

Hi Hazel. What you are describing in terms of dizziness and weakness sounds very much like the ribavirin-induced anemia kicking in. I experienced all that myself, although for me it started around Week 4 and got progressively worse until end of treatment. For some people on ribavirin, the anemia starts sooner but then levels off by Week 4. Not for me. My hemoglobin and red blood cells were lower each time my labs came back.

I think it is important that your hemoglobin and red blood cell count be checked throughout treatment, since it can be dangerous to fall too low. Some doctors reduce a patient's dosage of ribavirin if that happens. Others pull them off riba altogether. EPO shots to stimulate the marrow to produce more red blood cells can also be used. But I think the better course of action is to dose-reduce if needed. Your doctor will know. Just make sure you are getting those things checked frequently enough during treatment. ask for copies of all your lab results.

And don't push yourself when you have the anemia. This is not a 'no pain, no gain' situation. Your blood is under-oxygenated, and you don't want to make your organs and tissues require more oxygen than your blood can supply. I continued to walk daily, but more slowly and was less likely to take on hills when the anemia got really bad my last few weeks of treatment.

Good luck, and keep us posted!

[Lynn K]

I took ribavirin and that does sound like it could be ribavirin induced anemia. I was easily winded on stairs.

I was having blood draws to check my HGB (hemoglobin) every week which fell every week beginning with week 1. After 4 weeks my HBG was below 10 which is the lowest my doctor wanted to see so I dose reduced from 1200mg to 1000mg and that was all that was needed my HGB climbed back to 10.1 and I went to monitoring every 4 weeks.

When I stopped taking ribavirin and my HGB was tested 10 days later my HGB was almost back to pre treatment levels.

When I treated previously with interferon and ribavirin I also became anemic.  My doctor added epotin but I have heard that some doctors now feel dose reduction is preferred to using epotin.

If it is ribavirin induced anemia they can dose reduce lower than 1000mg as needed.

Hope you get it figured out soon
Best to you
Lynn

[HazelAustralia]

Thanks Lynn,

I am on 1200mg ribaviron.  My eyes are not yellow. It is just bad timing that it is the holidays and that I couldn't get my blood taken the last two days. Is there anything I should look out for that would be a warning sign - I can call the Abbie-Vie nurse (I think they are 24/7) or I can go to the emergency room if needed.
Thanks for responding,

Hazel

[HazelAustralia]

Hi KimIntheForest,

Thanks for responding, it's reassuring to hear. I can't imagine how you got through a whole treatment like this. Verrrrry slowwwwwly, I guess. The cat is enjoying my enfeebled self.
if you know of any signs to watch out for please tell me?
It will be at least 4 days until the medical centre opens again.

Best,

Haxel

[KimInTheForest]

Hi KimIntheForest,

Thanks for responding, it's reassuring to hear. I can't imagine how you got through a whole treatment like this. Verrrrry slowwwwwly, I guess. The cat is enjoying my enfeebled self.
if you know of any signs to watch out for please tell me?
It will be at least 4 days until the medical centre opens again.

Best,

Haxel

Shortness of breath and getting winded very easily are also signs. Sometimes I would get out of breath walking from living room to kitchen! It didn't take much. Also, my legs/thigh muscles were really weak and shaky for first hour each morning. Almost felt like my legs wouldn't support me. My nurse said that was the riba anemia.

My hemoglobin dropped to 10 by Week 4, and was at 9.5 by end of treatment. Reference range is 11.5-15.5 at my lab. I didn't get back up to normal (11.5) until 18 weeks POST-treatment.   It wasn't pretty. It turned out I was also iron deficient (not caused by the ribavirin), and I think that is why it took so long for my hemoglobin to rebuild itself - even once I started taking iron supplements.

My treatment team didn't think I needed to be dose-reduced, so I wasn't. They told me that if I had any history of heart problems or heart irregularities, it would be a different story. But with no known heart issues, 9.5 wasn't dangerously low. Didn't feel very good though.

kim

[Lynn K]

Ribavirin for me had no effect on my bilirubin. Mine has always been normal range so far and I have never experienced jaundice

What I think you may need to be looking for would be symptoms of anemia just to add I am not a doctor.

http://www.hepatitiscentral.com/news/anemia_and_hepa/

Anemia is one of the most clinically significant side effects of Hepatitis C therapy. Symptoms of anemia include:

Shortness of breath
Fatigue
Pale skin color
Chills
Rapid heart rate
Depression
Reduced quality of life

If not carefully monitored and treated, hemolytic anemia can lead to jaundice, dark urine, an enlarged spleen and, in severe cases, a heart attack. Because this side effect can be severe, there is a regime for handling anemia while on Hepatitis C treatment. In general, the first approach is to reduce ribavirin dosage. If that is insufficient, an erythropoiesis-stimulating agent (ESA) like Procrit or Epogen is given to boost red blood cell production.

Call your doctor right away if you have chest pain while taking ribavirin.

For now just take it easy and don't over exert

Lynn

[HazelAustralia]

Okay, thanks Lynn,

I was getting the two confused.

Best wishes

Hazel

[Philadelphia]

It sounds like ribanaemia to me, but I'm not a doctor. Weeks 2 and 3 I was a write off. It took me 20 minutes to get up enough energy to walk from the staff room to my car one day. It was only 300 metres. I spent all weekend horizontal on the couch. My blood tests showed  my Haemoglobin had dropped a fair bit and they reduced my riba to 2 tabs a day from 5. Take it easy. You need to. Gets your bloods drawn. Talk to your specialist.