Day 96 Morning - Weary Of Taking All Those Damn Pills Every Day: Pill Fatigue Article Shows How Important Medication Adherence Is To The Cure

Every single day. Every morning and every night, I have to take those pills. Ribavirin (three pills at night and three in the morning) and the two Protease Inhibitors in the morning. Naturally, this does not include all the medicines to deal with the side effects like the vast array of Anti-Histamines to battle the allergic reactions and the rash like Doxepin, Diphenhydramine, Hydrozine and over-the-counter Allegra three times a day.

The Endless Array Of Pills For Hep C Treatment Naturally Leads To Pill Fatigue

Not to mention the Omeprazole and over-the-counter Imodium to control the constant acid indigestion and diarrhea that plagues my body and turns eating into a daily chore and struggle. Plus there is Trazodone and the Lunesta to help me sleep when the itching is out of control. Let's not even mention the three different prescription creams and ointments used to battle the rash as well. And, of course, the Aplenzin antidepressant medication that I take once in the morning to avoid the darkness that this treatment offers as a special delivery to all the willing patients as patience runs low.

Is it any surprise that I have pill fatigue and medication exhaustion? Below is a powerful account of an article from the Annals of Internal Medicine that shows how such a reaction truly becomes a barrier to the cure. Am I perfect with my medication? Please... that is not even a consideration. To be considered well in the clinical trial, 80% medication adherence is considered acceptable and a-okay. I believe that I am probably hovering around the 95% range, but I have definitely spaced a day or two, here and there.

Not Again: A Constant Battle Every Day Against Medication Exhaustion

Have I done it consciously or is it just an unconscious mistake on account of sickness and exhaustion? To be honest, I would have to say that it is a bit of both. There have been certain days when even the idea of popping pills in my mouth makes me gag, and I cannot imagine getting up and stuffing them down my gullet. Those are the bad days, but they are few and far between in most cases.

If I can't be honest about the challenges faced and my difficulties, what the hell can I be honest about? This is my truth and this is what I am experiencing and I am not always doing my best, but I must admit that I am doing better than expected considering the torrential storm of side effects and I am hanging in there as the rains pound the pavement and the razor wind rips away the smile from my face.

Here is the article excerpted below...

October 13, 2011 - AIDS MEDS WEBSITE (From the Annals of Internal Medicine)

Hepatitis C Medication Adherence Is an Important Challenge, Study Shows

Identifying and overcoming barriers to hepatitis C medication adherence is an essential component to treatment strategies, according to study results published online by Annals of Internal Medicine.

Patients being treated for chronic hepatitis C become less likely to take their medications over time, the study suggests. The researchers also demonstrated that treatment responses are better when the medications are taken correctly, a finding that should prompt health care providers to assess their patients for barriers to medication adherence and to develop strategies to help them stay on track.

“Our findings are particularly timely since many chronic hepatitis C patients are now being prescribed direct-acting antiviral drugs”—the hepatitis C protease inhibitors Incivek (telaprevir) and Victrelis (boceprevir) are examples—“which have a complex dosing regimen that may be even harder for patients to maintain than the two-drug standard therapy,” said lead author Vincent Lo Re, MD, of the Perelman School of Medicine at the University of Pennsylvania in Philadelphia in an accompanying press release. “These data show us that we need to develop and test interventions to help patients be more successful at taking their medicine and have the best chance at being cured.”

Literacy issues, financial hurdles and socioeconomic problems such as unstable living situations can all hamper patients’ abilities to properly maintain their drug regimen. The authors suggest that refilling patients’ pill boxes for them, creating easy-to-follow dosing and refill schedules, and helping them set alarms to remind them to take their medicine may all help improve adherence.

Lo Re’s group studied 5,706 people living with hepatitis C who had been prescribed the standard treatment for the virus—once-weekly pegylated interferon injections and twice-daily ribavirin—using pharmacy refill data and test results for virologic response during treatment. The researchers found that patients who refilled their prescriptions on time had a higher likelihood of being cured of the infection. However, over the course of patients’ treatment, adherence waned—and more often for ribavirin.

That pattern, the authors note, is similar to that among patients taking drugs for other chronic conditions, such as HIV, during which patients often develop so-called “pill fatigue.”

The newer, more powerful direct-acting antiviral drugs, which must be taken every eight hours, will add to the complexity, and cost, of hepatitis C treatment. In addition, if the newer direct-acting antiviral drugs aren’t taken properly, the hepatitis C virus may become resistant to treatment, compromising the chance of a cure.

Monitoring for and treating drug-related side effects may also be a key factor in boosting adherence, the authors conclude. The study results showed that patients who received medication for thyroid dysfunction, anemia or low white blood cell counts—common side effects associated with hepatitis C treatment—were more likely to remain adherent to their antiviral therapy.

“We know that a major barrier to adherence is side effects of these drugs. People don’t feel good when they’re on them,” Lo Re said. “If we can identify those problems and treat them when they occur, patients may be more motivated and feel well enough to continue with their prescribed regimen.”

Day 81 Morning - Sorry For The Silence After The Extremity Of The Last Post, And, Yes, I Am Hanging In There A Bit Better Than 50/50

Yes, I know the last post was a bit extreme, but that was an extreme experience, and I do my best to be honest and faithful to what is actually happening in the up and down roller-coaster ride of this treatment process. Sometimes I think the only one that truly understands is Owen, but then I remember that he's a Bulldog and I have this tendency to project my own emotional longings into the eyes and expressions of animals. Then again, truly there are worse sins in this world, as we all know, and sometimes we take hold and grasp onto our consolations wherever we can find them. I am a man in the process of surviving a treatment that is supposed to save my life but is deeply disturbing the equilibrium of my health in the process so I take whatever solace I can find that avoids the bitter taste of self-pity and regret.

Strange To Be Hanging In There As Life Continues And Moves On For You

Yes, I know that one day this will be over, and I have faith that my health will be restored. I know that I actually will go another whole day in the future without even thinking about itching. But today I cannot go a single hour, except when sleeping and knocked out by Trazadone or Lunesta, without beholding the small itch below my consciousness as it rears its annoying fangs and digs into my flesh. Yes, there has been so much written about chronic pain, but not all that much about a chronic itch. Pain can be managed, although I do not downplay that horror and can only imagine from glimmers of past experience how truly awful it must be, but there is no easy cure for the persistent itch.

What works best... working and becoming engaged in an activity where my mind does not stumble across this ever-present reality. Today, I actually went by myself to see the movie 50/50 with Joseph Gordon Levitt, Seth Rogen, Anna Kendrick and Anjelica Huston. I stopped for a second to address the rumblings of my right kneecap, and now the left is crying out for a little nail-bitten attention as well. In any case, I truly enjoyed the film because I awfully like Joseph Gordon Levitt, and I identified with his character even beyond the medical similarities. Mind you, the character's cancer in the film is so much worse than my Hepatitis C Treatment. But he's a nice guy who so often is overlooked and doesn't get his due, and I like how the crisis brings him into his own.

I Don't Like Destroying Art, But Liberation From A Crap Relationship Rocks!

There definitely are choices that I would not have made that take the story down a notch or two, but I love how dealing with a disease that reduces Adam to the bare facts of reality and allows him to recognize his own truth and abandon past delusions and indulgences. There is a certain freedom in catastrophe and finding your back against a wall with no choices left to make beyond the ones that lead to your survival and ultimate freedom. What else can you choose when the doctors turn out to be right?

Spoiler Alert! There are some sweet moments in the film that continue to resonate with me. When Adam realizes that his mother is all alone because his father has Alzheimers and he never returns her calls so she has nobody to talk to about what is happening to the men she loves. When Adam stumbles across the book in his friend Kyle's bathroom that teaches you how to handle with care someone you love when they are going though such a profound crisis of health. When Adam refuses to take back his self-centered girlfriend just because she is hot and wants to be held without recognizing how her betrayal hurt him and truly accepting the responsibility of loving him when he needs that love more than anything else in the world. When Adam finally allow his anger to be expressed. These moments resonate and they echoed in my soul and there soft sweetness continues to be a balm as night passes into morning.

Sunrise In Los Angeles As A City Night Passes Into The Calm Of Morning

But let's be perfectly clear: there is a profound difference between Adam and myself. He did nothing to deserve the cancer that he comes down with in the film and he just loses that particular genetic lottery and he is screwed by life. In contrast, I chose to share a needle on that one stupid day and I chose to do all the drugs that could have killed me a thousand times over so I must not whine about such consequences. They are ultimately of my own doing and I accept this burden without blinking. Yes, it suck that my side effects are the worst that they have seen in the clinical trials and that what I am experiencing is so difficult, but I surrendered the right to complain when I chose to put a needle in my arm. Instead, I choose to move forward, hanging on to a touch of grace and a little dignity, and doing my best to allow the suffering brought on through this crucible of treatment to help bring forth the man I actually was put here on this earth to be.

For this blog, by the way, I choose not to compare Anjelica Huston's worrying mother to my sweet mom who truly cares for me, I choose not to go into the death of Joseph Gordon Levitt's brother, Burning Dan Levitt, to a drug overdose in 2010 or discuss that loss and our friendship, and I choose not to criticize the boundaries crossed by Anna Kendrick's character, Katherine the Therapist, in the movie. Some stones are best left alone for now, even if the ideas grumble and growl at the pit of my skull.

RIP: Burning Dan Levitt, Founder of the Flow Temple, (1974-2010)