HM Medical Clinic

Therefore, it is necessary to see your doctor about any defects cialis australia but also by those who experience temporary dip in sexual activeness.

h e p c . b u l l
www.hepc HEP C & YOUR MOUTH by Joan King
People with hepatitis C tend to have more Here are some things you can do to reduce Here are some studies taken from the 59th problems with their mouths and their teeth dry mouth symptoms: Annual Meeting of the American Association than those not infected. Problems can in- 1. Sip water and other sugarless beverages for the Study of Liver Diseases (AASLD) on clude decay, infection, and dry mouth. Let's throughout the day. Oct 31-Nov 1 2008 in San Francisco, CA 2. Drink water with meals to help you chew Many of us with Hep C have dry mouth, BI 201335
which can be an important cause of decay 3. Sugarless gum and candy help stimulate Boehringer-Ingelheim is developing a pro- and other mouth problems. It is thought that saliva. tease inhibitor called BI201335. Results of a Hep C infection itself can cause dry mouth. 4. Say away from coffee, alcohol and to- Phase 1b trial were presented at the latest Little research in humans has been done, but bacco. They dry your mouth. AASLD. The study enrolled 34 treatment- a study with a mouse model showed that the 5. Use a humidifier. naïve subjects with genotype 1. They were first symptom of HCV observed in these mice 6. Spicy and salty foods can make a dry assigned to one of 4 ascending doses for 14 was dry mouth. One study with humans mouth worse. days, after which standard therapy (IFN + found 50% less saliva production in subjects 7. Reduce bacteria and plaque by brushing weight-adjusted ribavirin) was added for at least twice a day. Use toothpaste with another 14 days. All the subjects were white, What else causes dry mouth? One cause fluoride and floss daily. with an average age of 49. Most were men. may be inadequate salivary glands. Medica- 8. Brush immediately after eating, espe- Fibrosis scores were 0-3. There was a pla- tion such as Hep C treatment or antidepres- cially food that is chewy, sticky or sugary. cebo arm. Those with less than a 1 log10 sants can cause dry mouth. The newer antide- 9. Go to the dentist at least twice a year. decrease in viral load after 10 days did not pressants like venlafaxine and reboxetine, or 10. Talk to your doctor about a saliva substi- continue after day 14. the SSRIs (selective serotonin reuptake in- tute Except for 1 patient receiving the lowest hibitors) are less likely to cause serious cases 11. If you have mouth sores, try drinking dose, all participants receiving BI201335 of dry mouth, so switching drugs may help. through a straw. Antipsychotic medications and antiparkin- had greater than a 2 log10 decrease in viral 12. When you have mouth sores, use only sonian drugs are also culprits. Interferon, of load in the first 14 days. Unfortunately most mouthwashes and toothpastes that don't course, is notorious for causing dry mouth. patients had a rebound of their viral load burn. Biotene is expensive but worth it. during the first 14 days. Side effects were Be sure to go to your dentist before starting Here's my favourite "mouthwash" recipe for treatment, and get everything fixed. Some- mild and there were no dropouts due to ad- times deep cleaning can release bacteria verse events. There were changes in bilirubin which can enter the bloodstream and even related to the amount of BI201335 taken. 1/3 liquid Benadryl cause sepsis (blood poisoning), and we are There was also a group of 19 genotype 1, 1/3 lidocaine viscose 2% solution more susceptible to infections when taking previous non-responders, also all white, av- (You can buy Benadryl and Maalox at the interferon. Your dentist may advise you to not erage age 49, and mostly men. In this group, have anything unnecessary done while you (Continued on page 6) none of the subjects received monotherapy are on treatment. At the same time, it's not a or the lowest dose of BI201335. Again, a good idea to stop and start treatment if it's rapid decrease in viral load was experienced not necessary. (By the way, those of you with INSIDE THIS ISSUE:
by all the patients (>2 log 10). There was no low platelets should discuss bleeding control viral rebound during treatment in the 240 HepC & Your Mouth
with your dentist.) mg. dose group. One patient stopped treat- Why do we worry about dry mouth? Dry ment because of anxiety. Research
mouth can cause a lot of problems, such as "The results support further study of loss of the sense of taste, difficulty in chew- Kelly's Dream / HCV Basics
3 BI201335 as a once-daily potent antiviral for
ing, swallowing, and speaking. Saliva con- treatment-naive HCV patients," said the re- trols bacteria, viruses and fungi, so a lack of Pain Management
4 searchers.
saliva can promote infections. Patients may iGive / Alison Crowe / PegCARE / PegAssist
have a sore tongue, gums or cheeks, foul EFT: Creating a Peaceful Holday
breath or teeth that are over sensitive. Severe Abstracts 1849 and 1882. dry mouth can lead to tooth decay and infec- (Continued on page 7) Coming Up
hepc.bull DECEMBER 2008 Issue No. 117
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From HepCBC's Pamphlet Series
old needles to get new ones. You should be FOR HEPATITIS C".
able to get a supply of new, sterile needles. How can I tell if I have hepatitis C?
One to two months after the hepatitis C virus Get Rid of Your Used Syringes Care-
infects your body, antibodies appear in your fully
blood. A blood test can detect these antibodies Taking your old syringes to the needle
and show that you have been infected with the exchange is the best way to safely get rid
hepatitis C virus. Not everyone who has anti- of dirty needles. You also get a new supply
bodies in their blood is still infected with the of clean needles when you bring your old
virus, but most people are. If you test positive ones in. Needle exchange programs pro-
for the antibodies, assume you are infected and vide sharps containers for safe disposal. If
can infect other people. If you test positive for you do not have one, put the needle and
the virus, you definitely have it.
syringe into a tin can, or heavy plastic con- tainer with a closing lid (like an empty What are the symptoms of hepatitis C?
milk or bleach jug), then dispose of it in a Some people feel well and have no symptoms, garbage can or take it to your local needle so they don't know they have hepatitis C. exchange. If sharing is impossible to Other people may have a brief illness with avoid, equipment can be cleaned between symptoms of hepatitis usually appearing six to Dr. Siegfried Erb (above, left), Clinical users as a LAST RESORT. THIS IS NOT nine weeks after they have been infected with Associate Professor of Gastroenterology, SAFE! Bleach should stay in the syringe the virus. Symptoms of acute hepatitis C infec- accompanies Kelly O'Dell to see Mayor Sam for at least 30 seconds. Remember not to tion may include: fever, tiredness, jaundice flush out into the clean bleach solution or Sullivan (right) to discuss Vancouver's host- (yellow skin or eyes), abdominal pain, dark water. Do not use hot water: it will make ing of Kelly's "Dream of a Global World urine, loss of appetite, and nausea (feeling sick the blood clot so traces may be left behind. Awareness Concert for Hepatitis C". to your stomach). Boiling equipment may not remove all the Kelly is proud to have the complete sup- If you're an IV drug user, there's a good blood, and disposable equipment usually
port of Dr. Erb concerning the need for chance you already have hepatitis C.
buckles if boiled. It is safer to use the nee- global awareness with his submission of "Hep C," or "HCV," is over 10 times more dle exchange program! medical facts about hepatitis as a growing contagious than HIV. It's really easy to get if epidemic. O'Dell hopes for the concert to HCV and IV Drug Use: Cleaning
you shoot or snort, and very difficult, if not take place in Vancouver late 2009. Equipment
impossible, to get rid of. With Hep C it doesn't For more information about how you can 1. Pour a small amount of 5% household matter how long you've been shooting or bleach solution into a small containter and get involved or how to support this concert, snorting, the fact is that many people get it then draw it through the needle into the contact after only using once. Up to 85% of IV drug syringe, fill completely and flush three users test positive for Hep C. The problem is that hepatitis C is sneaky. It 2. Soak the bleach-filled syringe in the can lie there for years without doing anything, bottle of bleach solution and leave for 10 and then, when you finally get clean, all of a minutes. sudden you get really sick or find out that 3. Draw fresh cold water through the nee- you're dying because your liver isn't working dle into the syringe and flush three times right. Hep C, like Hep B and HIV, can be trans- WARNING: Using a new disposable nee-
mitted by sharing toothbrushes, razors, nail dle each and every time is much safer than clippers, or other items that can cause bleeding. cleaning equipment. Sexual transmission is considered a possible
but unlikely mode of transmission. So play it Get Tested! Get vaccinated for Hep A
safe. Practice harm reduction!
Sharing any drug injecting equipment or If you have ever shared needles, even snorting equipment can easily lead to Hep C once, twenty or thirty years ago, you may and other diseases carried in the blood being have Hep C and still not even know it. passed on. Equipment is not just the needle and Nine out of ten IV drug users may have it. syringe, but also includes spoons, mixing Get tested. There is a treatment. There is dishes, filters, water and citric acid. If you in- no vaccine for Hep C, but you can protect ject drugs, use a new needle and syringe each yourself from getting Hep A & B. time. Don't share any injecting equipment. It's worse to have more than one kind of TIP OF THE
Clean the injection site with alcohol and a new hepatitis. Hep A and B vaccines are free cotton swab. Use sterile water to prepare drugs. for IV drug users and those with Hep C in Boiling equipment in tap water for several BC—no questions asked. Check with your minutes will sterilise it. Don't use old needles, local public health unit or needle ex- VISIT YOUR
cookers or cotton to prepare drugs. New equip- change. ment can be bought from some pharmacies, or is available free from needle exchanges. Most needle exchanges don't require you to bring in hepc.bull DECEMBER 2008 Issue No. 117
PAIN MANAGEMENT by Darlene Morrow (Reprinted from hepc.bull Feb 1999)
I was recently asked fluid. There is one anti-inflammatory that does the portal vein and it backs up. This causes what we are supposed not use sodium and that is Voltaren Rapide a back pressure and in a worst case sce- to do when we have a which uses potassium. It may not be covered nario you could see esophageal bleeds. painful episode. This If you couple that with an anti- question was asked Finally—both the anti-inflammatories and inflammatory, would it be possible to has- about back spasms and Cytotec are excreted by the kidneys. Long ten the onset of a bleed? anti-inflammatories. term usage can show problems here. You can If your physician has given you the go People are frustrated help to avoid that by drinking LOTS of water ahead on taking anti-inflammatories, there by the warnings about when you take these medications. are a few different kinds that can help Ibuprofen. Tylenol is out, so what is left? There is an effective anti-inflammatory guard against this problem. First and foremost, you have to discuss this which is called a COX 2 inhibitor. C e l e b r e x First and foremost on my list is Pantoloc with your physician—preferably your spe- (produced by Pfizer) is used for treatment of (Pantoprazole). It is a very powerful aid in cialist. All bodies react differently to drugs. both osteoarthritis and rheumatoid arthritis. the prevention of damage to the intestinal Your specific stage of liver disease will also COX 2 inhibitors do not have gut-damaging tract and in the resolution of duodenal ul- play a big role in the decision making. But a cers. This medication is covered by Phar- little information beforehand will enable you When the pain stems from arthritis, it is of- macare if it is prescribed by a specialist. If to prepare careful questions for your physi- ten caused by muscles in spasm. It is possible your GP orders it, it may need pre- that muscle relaxants may provide more relief approval, or it may not be covered at all. At a St. Paul's conference Dr. Anderson than anti-inflammatories. The only one that I You'll need to check. 14 pills cost $34 but replied to a question about whether Tylenol would talk with your physician about is Flex- one pill covers the whole day. It is NOT was okay for HCV patients, and he replied eril (cyclobenzaprine). This is not a benzodi- for long term use. that it was the lesser evil—but only 2 regular azepine like Valium (diazepam), which is very Other medications to protect the gut in- strength or 1 extra strength. We are talking addicting and also tends to tranquilize, how- clude Cytotec (Misoprostol), which de- about a short duration episode—not some- ever Flexeril is both metabolized and excreted creases acid production and increases mu- thing that is taken on a regular basis. primarily by the liver so you would want to cosal protection, and Sulcralfate (Sulcrat), Anti-inflammatories have been studied in discuss this very carefully. which reacts with stomach acid to form a HCV to see if they would be a useful adjunct Other drugs such as Elavil (amitriptyline) thick paste which adheres to the gut lining. to interferon therapy. The rationale was that have also been found to be effective in some One of the problems with these medica- there can be significant inflammation of the cases of chronic pain syndrome and fi- tions is that Cytotec can initially cause liver so then perhaps the anti-inflammatories bromyalgia. It is usually sufficient to take an diarrhea and Sulcralfate can cause consti- would provide a benefit. Studies have looked extremely low dose of this tricyclic antide- pation in some individuals. at both Orudis (ketoprofen) and Indocid pressant to obtain pain relief. This drug is Used as adjuncts to anti-inflammatory (indomethacin). The research found that it extensively metabolized by the liver. usage and for the very short term, the pros didn't make a difference in the response rate. Non-drug therapies are the preference for may outweigh the cons. But are these drugs harmful to the liver? people with liver disease. It may not be possi- Another medication is Arthrotec which There are almost as many types of anti- ble to get pain relief from an attack that comes combines Cytotec and Voltaren diclofenac) inflammatories as there are people. The rea- up suddenly but it is something to work on in a single tablet. This is paid for by Phar- son there are so many is that they have a dif- long term and it can decrease the number of macare with pre-approval only. It is a ferent effect on different people. One anti- painful episodes. The Thorson Pain Clinic in costly drug if you have to pay for it out of inflammatory may totally erase pain in one North Vancouver and the Victoria Pain Clinic your own pocket. individual and have no effect on another. No are two very excellent facilities. You need a You can always go the other route and one really knows how you will react until referral to the Thosrson clinic. There is a long several brands of anti-inflammatories are you take it. One of the biggest concerns with waiting list, but once you get in there is no available in suppository form. I find this is some anti-inflammatories is that they cause a additional cost to you (above the user fee often my preferred route, as you do not reduction in the mucosal lining of the intesti- for massage therapy, etc). They attempt to have to have a full stomach to take the nal tract. This allows the acid in your stom- break the pain cycle and to train you to re- medication whereas any of the oral medi- ach free access to the lining of the tract and spond differently to the pain such that it is not cations require you to eat. Voltaren sup- the results can be devastating. Many people aggravated. Biofeedback, autogenics, creative positories are available, as is the generic end up in the hospital or die as the result of a visualization, and meditation are examples of and cheaper make Diclofenac. Indocid bleeding ulcer. You might think that you the type of approaches that have proven effec- (Indomethacin) is also available in sup- would feel pain before this developed to the tive in this way and are taught at the Pain pository form, but this is a very strong and point of an ulcer but the drug works in pain Clinics. They also cover a multi disciplinary potentially damaging drug (even in this prevention and can block the very sensation approach using massage therapy, physiother- that would alert you. apy, hypnotherapy, acupuncture, and Rolfing Some of the anti-inflammatories are at- I think that the dangers for those with hepa- to name a few. There is a good list of pain tached to sodium because it makes a very titis are probably the worst when the progres- good binder. But the effect of this is often sion of the scarring of the liver has reached a an upset in the fluid balance. This is par- point where portal hypertension exists. Basi- ticularly important, and one way to coun- cally the blood can't flow smoothly through teract that effect is by drinking lots of hepc.bull DECEMBER 2008 Issue No. 117
HepCBC is now officially part PegCARE is a reimbursement program to of You can now help people who have been prescribed Pegetron and need assistance with any co- payment they might have, whether through and you can do- their provincial coverage (i.e., Pharmacare) nate at the same time. All you deductible or their 3rd-party health insurance. have to do is go to the iGive web- It is pro-rated, so the less the family income site: Then you choose the is, the more help they get. If someone's net family income is less than $30,000, they will organization you want to support. get 100% reimbursement. The income maxi- IGive works in two ways. If you do your mum is $100,000. Patients must be signed up shopping through iGive, a percentage of what for Fair Pharmacare to qualify, and they need you buy goes to HepCBC (or other charity or to provide a copy of last year's T4 form. organization of your choice). If you use the There is a 24/7 Nursing Hotline and bilin- iGive search feature, 2 cents goes to the or- gual assistance available, at no charge. Other services are access to live translation services ganization every time you use their search (150 languages) and injection assistance from engine. It's that easy! And it's free to register registered nurses. Patients starting on with them. They have over 680 stores, includ- Pegetron should ask their doctor or nurse to ing the ones where you would probably shop TIDINGS CONCERT
enroll them in PegCARE. It's an easy single- anyway, like The Gap, Staples, Best Buy, page form to fill out, which they will pro- eBay, Expedia… and all from the comfort of Allison Crowe
vide. PegCARE: 1-866-872-5773 home. No long line-ups! With Special Guest Billie Woods Tuesday, December 16 - 8:00 p.m.
Alix Goolden Hall
907 Pandora Ave.
The PegAssist Reimbursement Assistance Victoria, BC
Program provides reimbursement coordina- tion assistance for patients who have been Advance: $20 General/$15 Students & prescribed Pegasys or Pegasys RBV. The Seniors (all charges incl.) program will assist in securing funding for patients to ensure that they can start, stay on, To Aid Artemis Place and HepCBC
and complete their treatment successfully. Holiday Snack Mix
PegAssist Reimbursement Specialists are "The Yule-tide find of the year" available (Monday to Friday, 10 AM- 6 PM The Record EST) by calling: 1-877-PEGASYS or 1-877- Tickets: Lyle's Place (770 Yates), The
734-2797. Patients can also obtain a program Patch (719 Yates), & Ivy's enrollment form from their nurse/physician 5 cups Rice Chex Bookshop (2188 Oak Bay Ave.) to gain access to the program. 4 cups Corn Chex The program provides financial aid to Expect plenty of holiday cheer, laced 3 cups Golden Grahams qualified patients, alleviating any financial with overtones of Leonard Cohen, 1 cup flaked coconut barriers which may prevent patients from Joni Mitchell, The Beatles, jazz and starting treatment, i.e., deductibles and/or co- 1 cup slivered almonds Broadway, as Canada's popular 3/4 cup butter or margarine bicoastal singer-songwriter Allison In partnership with CALEA Pharmacy, the Crowe brings "Tidings" to Alix Goolden program can conveniently deliver the medi- 1 cup light corn syrup cation directly to patients' homes or to the Music is as elemental to Allison Crowe clinics. as breathing. And she's grateful Grease two 15-in. x 1-in. baking pans; set for the opportunities that music provides her—to play for people, and to contrib- In a large bowl, combine cereals, coconut and ute to global causes of peace and justice, almonds; set aside. and aid community-based groups deal- In a heavy saucepan, combine the butter, ing with various issues including mental sugar and corn syrup. health, anti-violence, cancer and MS. H epCBC is looking for writers for the next issue of the hepc.bull, and is willing In Victoria, Allison is delighted to team to pay $50.00 for a featured article. The arti- Bring to a boil over medium heat, stirring up for Tidings with Artemis Place cle should be original, consist of 500 to 800 Boil for 10 minutes, stirring occasionally. which provides integrated life skills may be, for example, about the author's ex- Pour over cereal mixture and stir until well and academics for girls, and our own perience with hepatitis C, a study (with refer- ences) on some aspect of the disease, or a call Spread onto prepared pans. for action. Submissions should be in by the Cool stirring occasionally. 15th of next month, stating interest in the
bonus. If there is more than one submission
Good to share at our meeting. "Treat yourself to one of the mightiest chosen, the editors reserve the right to print talents on the singer-songwriter both, or leave one for a future edition. scene today." Bob Muller, (USA) hepc.bull DECEMBER 2008 Issue No. 117
By Karen Hodson, BA, EFT-ADV EFT Practitioner
This is a regular segment of a series on us- more balanced feeling is present. Once neu- wonderful tool to help you get back to a ing EFT (Emotional Freedom Techniques) tralized, go onto the next set-up and tapping place of peace. When we can become peace-to create more personal peace in a rapidly phrase. ful within ourselves, we have hope that one changing world. day we will have world peace. It all starts Karate Chop Set-up: For some people the holiday season is with each person choosing peace—one mo- "Even though I don't have enough money, filled with an abundance of joy, peace and ment at a time. Wishing everyone a joyful, time and energy for holiday activities that I bliss. For many others it's an exhausting peaceful holiday season! have enjoyed in previous years, I deeply and experience, with too much stress, spending profoundly love and accept myself." Karen is an EFT Practitioner in West Van- and eating, having to deal with relatives and couver and is offering a reduced fee for Tapping a phrase on each point: co-workers that you would rather not spend EFT sessions to people with hepatitis. You All this holiday stress; I am so scared; I time with, and feeling overwhelmed by it must mention this article, some restrictions don't know what I can give; It's hard enough apply and sessions can be over the phone. just coping with hepatitis C – I just can't This year we are dealing with the added Karen would love to hear from you, please deal with it; all these financial fears; this just stress of a global financial crisis, massive e-mail any comments or feedback. For more isn't going to be a good holiday; I can't layoffs, cutbacks, loss of retirement savings, information: (604) 913-3060 change; I feel so hopeless; I feel so humili- uncertainty, etc. Having hepatitis C adds to ated; it's just too exhausting; I never get to the already high financial, emotional and or enjoy the holidays. physical stress. Many are struggling, and this will be a lean holiday compared to more Karate Chop Set-up: (Hep C & Your Mouth—Continued from page 1)
prosperous years. Where do you find the "Even though I don't know how I am going pharmacy, over the counter. I easily got a joy, peace and bliss in all of that? to survive the stressful holidays as well as prescription for Lidocaine at a walk-in clinic My teacher Nancy Shipley-Rubin said, dealing with all of the anxiety of a global when they saw my mouth.) "The world is changing, and we can either crisis, I deeply and completely love and ac- Hep C has been shown to cause depres-change with it or be changed." In other cept myself anyway." sion. Depression can lead to poor hygiene, words we do have a choice. We can accept Tapping a phrase on each point: and often those affected by depression ne- where we are at and make the most of it, I'm so angry that my world is changing; the glect their visits to the dentist. The cause for perhaps even enjoying the ride, or we can holidays will never be like they used to be; the decay could be blamed on the use of act out with rebellion, moving though the what if I can still have a joyful holiday?; I methadone to control cravings for heroin, process kicking and screaming. Using EFT can't possibly have a wonderful holiday; all but many of those with Hep C have never tapping is a wonderful way to quickly move these financial fears; what if this crisis turns used IV drugs. So what about the rest? How to that place of acceptance. out to be something good for me?; I will can Hep C cause these problems and what EFT gets right to the core of what is being never be able to survive this holiday; I can we do to remedy the situation? triggered but without judgment of making it choose encouraging thoughts. Dental health can be improved by stopping right or wrong. Saying the truth, such as "I smoking and/or using opiods, which can lead am overwhelmed, scared and I don't know These sequences can be repeated for as to gum problems. Regular trips to the dentist what to do" releases the pent up energy in- many rounds as needed. Once a more neu- for cleaning are essential. Regular brushing stead of covering over it. Once the trigger- tral feeling is present the following positive and flossing can ward off the majority of ing emotions are acknowledged, you begin phrases can be introduced until it feels com- cavities. Unattended, cavities can progress to to feel more relaxed and stable and it can plete. infection and abscesses. Infections in your even be liberating. With more EFT tapping, Tapping a Positive Phrase on each point: mouth can pass throughout your body and you can reach that place of peace. I love that blissful holiday feeling; it feels so affect the organs. For those with end stage From that peaceful space you have more good to have such deep inner peace; I choose liver disease, dental problems can even mean clarity and can connect with that deep inner to create a joyful holiday; I love that feeling being kicked off the transplant list. knowing that tells the truth–that in this mo- of grace in my body; I trust in a positive out- There is a need for education about the spe- ment you are OK. You don't go into the past come; It feels so good to let this peaceful cial needs about oral health for those with of what just happened or the future of what feeling in; I love all this joy inside of me; I Hep C and their doctors, focusing on preven-may happen, but rest only in this moment. release these nagging thoughts; I allow com- tion. That is where the real joy, peace and bliss passion to flood my body; I am so grateful are. for this peaceful feeling. Here is what an EFT tapping session on The holidays can bring out the best and the Creating a Peaceful Holiday could be like: worst in all of us. It's a time of generosity, (See for tapping connection and sharing. It's also when fam- App_CmsLib/Media/Lib/0610/ points and a full description of how EFT ily issues come up and overindulging with food and finances can trigger our emotions. Tap the Karate Chop (side of the hand) the When we are under stress our triggers tend to Set-up Phrase (repeated up to 3 times) then go off easier and more frequently. the Tapping Phrase Sequence (top of head, There will always be things that show up eyebrow, side of eye, under eye, under nose, and throw us off balance. Daily EFT tapping, collar bone, under arm) is repeated for you can help to sustain that inner balance publishing.nsf/Content/phd-hepc-manual-as many rounds as needed, adding new and when emotional triggers go off, you can toc phd-hepc-manual-ch5 phd-hepc-manual- words or phrases as they come up, until a quickly tap to get centered again. EFT is a hepc.bull DECEMBER 2008 Issue No. 117

(AASLD—Continued from page 1)
HCV infection," said Dr. McHutchison. The PF-00868554
company believes that the data shows that the drug clears the virus from infected liver LAW FIRMS
PF-00868554 is Pfizer's oral, non- cells, which the interferons and antivirals 1986-1990
nucleoside polymerase inhibitor. 32 treat- aren't designed to do. The antivirals work to Bruce Lemer/Grant Kovacs Norell ment-naïve genotype 1 patients, mostly stop viral replication. We often see the virus Vancouver, BC white males, average age 45, were enrolled eliminated from the blood, but left to repli- Phone: 1-604-609-6699 in 4 groups of 3 different doses of the drug, Fax: 1-604-609-6688 cate in the liver. "An HCV-targeted cellular or a placebo. They were treated for 8 days. immune response is essential to curing a Pre-1986/ Post-1990
There were no dropouts. There was a rapid patient with hepatitis C." decrease in viral load up to 2.13 log10 in the Vancouver, BC 1-604-874-7171, "Tarmogens are whole, heat-killed recom- 1-800-468-4466, Fax 1-604-874-7180 highest dose arm (300 mg 3 times a day) binant S. cerevisiae yeast that express anti- during the first 48 hours, but none in the gens from one or more disease-related pro- David Harvey lowest dose arm or in the placebo arm. The teins." Lauzon Belanger S.E.N.C. (Quebec) viral load in most subjects then either pla- teaued or rebounded. One patient in the Phone 416-362-1989; Fax 416-362-6204 AASLD_08.htm 03 Nov 2008 highest-dose arm sustained viral suppression through day 8. All doses were well- BOCEPREVIR
Roy Elliott Kim O'Connor LLP. tolerated, with mild or moderate headaches, The results from Schering's SPRINT-1 hepc@reko .ca gas and fatigue. A study combining the drug Phase II study, which treated 595 genotype 1 Kolthammer Batchelor & Laidlaw LLP with standard therapy is underway. patients, were released at the AASLD on #208, 11062 – 156 Street, Source: November 4, showing that Boceprevir, an Edmonton, AB T5P-4M8 aasld/docs/111108_d.html Abstract LB11. Tel: 780-489-5003 Fax: 780-486-2107 oral protease inhibitor, is safe for up to 48 weeks when combined with standard treat- ment. As well, it almost doubles SVR com- Merck presented the results of a trial of its William Dermody/Dempster, Dermody, Riley & Buntain pared to standard treatment alone. The study Hamilton, ON L8N 3Z1 1-905-572-6688 protease inhibitor MK-7009 at the latest found that a 4 week treatment with standard AASLD meeting in San Francisco. The trial therapy alone before starting the Boceprevir enrolled 800 genotype 1 patients, mostly reduced the possibility of breakthrough Ca
nadian Blood Services Lookback/Traceback & Info
males, with an average age of 43 years. The (recurrence of the virus during treatment). Line: 1-888-462-4056 drug was well-tolerated, with no dropouts Lookback Programs, Canada: 1-800-668-2866
Drop outs due to side effects were between 9 Canadian Blood Services, Vancouver, BC
due to side effects. Rapid decreases in viral and 19% for the Boceprevir-treated patients, 1-888-332-5663 (local 3467) or 604-707-3467 load were found in all the doses studied. The compared to 8% in the standard-therapy- Lookback Programs, BC: 1-888-770-4800
best results were found in the group receiv- only arm. The company is planning a large Hema-Quebec Lookback/Traceback & Info Line:
ing 700 mg. twice daily, which produced an
Phase III trail. Manitoba Traceback: 1-866-357-0196
average 4.6 log10 decrease in viral load on Source: Canadian Blood Services, Ontario
day 8. A Phase IIa study combining the drug AASLD_07.htm (11/04/08) 1-800-701-7803 ext 4480 (Irene) with standard treatment is underway. RCMP Blood Probe Task Force TIPS Hotline
1-888-530-1111 or 1-905-953-7388
AASLD_09.htm (11/04/08) Mon-Fri 7 AM-10 PM EST 345 Harry Walker Parkway, South Newmarket, ON L3Y 8P6 Fax: 1-905-953-7747 TARMOGEN (GI-5005)
GlobeImmune has produced a therapeutic vaccine called GI-5005 or Tarmogen. The Phase II clinical trial, which enrolled 140 Class Action Suit Hotline: 1-800-229-5323 ext. 8296
Health Canada Compensation Line: 1-888-780-1111
genotype 1 patients and lasted 4 weeks, Red Cross Compensation pre-86/post-90 Registra-
compared results of standard treatment to tion: 1-888-840-5764
the results of Tarrmogen combined with Ontario Compensation: 1-877-222-4977
standard treatment. Adding Tarmogen Quebec Compensation: 1-888-840-5764
showed results that doubled viral clearance in all major subgroups. It also more-than- doubled the RVR (rapid virologic re- sponse—a predictor of a sustained response) 1986-1990

in treatment-naïve subjects with high base- Administrator 1-877- 434-0944 line viral loads (600,000 IU/mL). The re- sults included previous non-responders (26% of the subjects). Pre-86/Post-90

"These data represent early but important Administrator 1-866-334-3361 evidence that a patient's natural immune response can be harnessed to positively in- fluence important virologic endpoints with the potential to impact the course of chronic hepc.bull DECEMBER 2008 Issue No. 117

Armstrong HepCURE Contact: 1-888-437-
North Island Liver Service - Viral Hepa-
Contact 905-940-1333, 1-800- 2873 Phone support. titis Information, support and treatment, Barrie Hepatitis Support Contact
serving Fanny Bay North to Pt Hardy, AIDS Vancouver Island HCV support
Jeanie info/appointment Vancouver Island. Toll free 1-877-215- ♦ Campbell River: Drop in, harm reduc-
tion, support, education. Contact: 250- Sandi's Crusade Against Hepatitis C/
830-0787, Pender Harbour Contact Myrtle Win-
Quebec City Region Contact
Durham Hepatitis C Support Group
Comox Valley 355 6th St. Courtenay; chester 604-883-0010
Renée Daurio 418-836-2307 Contact Sandi:
sarah.sullivan@avi.orgDrop in, harm Powell River Hep C Support Powell
reduction, support, education. Saint John & Area: Information
River Community Health, 3rd Floor– CANHepC/ and Support. Contact Allan Kerr ♦ Nanaimo Info: Contact Anita 250-753-
Ave. Contact: Rosemary 2437 604-485-3310 Hamilton Hepatitis C
Hardy (Port McNeil, Alert
Group 1st Thurs. monthly, 6-7 PM,
Bay, Port Hardy, Sayward, Sointula and Prince George Hep C Support Group 2nd
Cape Breton Island, NS The
Hamilton Urban Core Community Woss) 7070 Shorncliffe Rd, Contact Tom, Tues. monthly, 7-9 PM, Prince George Re- Hepatitis Outreach Society Sup- Health Centre, 71 Rebecca St, Ham- port Group 2nd Tues. monthly 150 250-949-0432 Edu- gional Hospital, Rm. 421. Contact 250- ilton. Contact Maciej Kowalski, Bentinck Street, Sydney, NS. 7-9 cation, harm reduction, support, drop-in 963-9756, Ilse 250-565-7387 Health Promoter 905-522-3233 PM. Call 1-800-521-0572, 902- ♦Victoria 1601 Blanshard St., 250-384-
Princeton Contact the Health Unit (Princeton Hepatitis C Network of Windsor
2366 Harm Reduction. General Hospital) 250-295-4442 or Beverly at & Essex County Last Thurs.
monthly, 7 PM, Teen Health Centre- PRAIRIE PROVINCES:
Boundary HCV Support and Educa-
250-499-8877 Street Health Program Office, 711 tion. Support, education, presentations.
Regina, Saskatchewan HepC
Prince Rupert Hep C Support Contact: Pelissier St., Suite 4, Windsor, ON.
Contact Ken 250-442-1280 ksthom- SK Contact Doug 306-545-1628
Dolly 250-627-7942 hepcprince- Contact Andrea Monkman: 519-967- 0490 or Castlegar Contact Robin 250-365-6137 Queen Charlotte Islands/Haida Gwaii &
Kingston Hep C Info HIV/AIDS
Northern BC support. Contact Wendy 250-557-2487, HeCSC Edmonton Contact:
Regional Service. Contact 613- 545- Courtenay HCV Peer Support and Educa-
1-888-557-2487, Jackie Neufeld 780-939-3379. 3698,, tion. Contact Del 250-703-0231 dggrim-
Wood Buffalo HIV & AIDS
Society #002-9908 Franklin Ave,
Kitchener Area Chapter 3rd Wed. Fort McMurray
Cowichan Valley Hepatitis C Support Con-
Slocan Valley Support Group Contact Ken
monthly, 7:30 PM, Zehrs Commu- Contact 780-743-9200 tact Leah 250-748-3432 250-355-2732, nity Room, Laurentian Power Cen- tre, 750 Ottawa St. S., Kitchener. Cranbrook HeCSC-EK Phone support. Con-
Smithers: Positive Living North West 2nd Contact: Bob 519-886-5706
Manitoba Hepatitis C Support
tact Leslie 250-426-6078, Wed monthly, 12 PM, 3862 Broadway Ave or Mavis Community Inc. Each 2nd &
contact Lucy 1-866-877-0042 last Tues. monthly, 7 PM, United HepCBC, Church, Crossways-in-Common, ♦ Victoria:
Drop-in/Office/Library, 306-620 Sunshine Coast-Sechelt Healthy Livers
222 Furby St., side door, Main Niagara Falls Hep C Support
View St. Phone support, interviews, info ses- Support Group Information/resources, Floor. Look for signs. Everyone Group Contact Rhonda 905-295-
sions. Contact 250-595-3892 contact Catriona, 604-886-5613 is welcome. Contact Kirk: 204- 4260, ♦ Fraser Valley: Support/info 604-597-3881 or Brent, 604- 772-8925 740-9042 Owen Sound Info and support. Con-
Kamloops AIDS Society of Kamloops
tact Debby Minielly, 1-800-263-3456 (ASK) Living Well HIV/HEPC Peer Sup- VANDU The Vancouver Area Network of
Medicine Hat, AB Hep C Sup-
port Group, each Thurs. 11-2 PM, 433 Drug Users. 380 E Hastings St. M-F 10-4 Ext. 1257, 519-376-9420, Ext. 1257, port Group 1st & 3rd Wed. monthly,
Tranquille Rd. Office 250-376-7558 Sup-
6:30 PM, HIV/AIDS Network of S.E. ca AB Association, 550 Allowance Ave. port/ Referral. 1-800-661- Contact 403-527-7099 7541
: Pre/post liver transplant support Peel Region (Brampton, Missis-
sauga, Caledon) Contact 905-799- Kelowna Hepkop: Last Sat. monthly, 1-3 PM, Contact Gordon Kerr
7700 Sep-May, Rose Ave. Meeting Room, Kelowna Vancouver Hepatitis C Support Group
General Hospital. Contact Elaine 250-768-3573, St. Catharines Contact Joe 905-, Lisa 1-866-637-5144. ljmor- 682-6194 3rd Wed. monthly, VGH, Lauener Room,
LP2809, near Sassafras Cafe, Jim Patti- Sudbury Circle C Support Group
If you have a Canadian HCV
Mid Island Hepatitis C Society 2nd Thurs. son Pavilion, South. Contact Gordon 1st Tues. monthly. Contact Ernie support group to list here,
monthly, 7 PM, (Location to be arranged.) 778-898-7211, to 705-522-5156,
please send details to
Contact confirm, or if you want to talk or meet for by the 15th of the month.
Nanaimo Hepatitis C Treatment Peer
or Monique (Hep C nurse) 705-691- Support Group Meetings 1st & 3rd YouthCO AIDS Society HepCATS NEW 4507.
Thurs. Monthly 4-5 PM, AVI Health ADDRESS: 900 Helmcken St, 1st floor, Toronto CLF First Mon. monthly
Centre, #216-55 Victoria Rd, Nanaimo. Vancouver 604-688-1441 or 1-877- Oct. through June, 7:30 PM, North
YOUTHCO Support pro- Contact Fran 250-740-6942. hepctxpeer- York Civic Centre, 5100 Yonge Street. More info: Nakusp Support Contact. Contact Vivian 250-
Contact Billie 416-491-3353, Vernon HeCSC HEPLIFE 2nd & 4th Wed.
265-0073 FAQ Version 8.1 ! monthly, 10 AM-1 PM, The People Place,
Nelson Hepatitis C Support Group 1st Thurs. 3402-27th Ave. Contact 250-542-3092, Thunder Bay Hep C support. Con-
Download it now, FREE
monthly 7-8:30 PM. ANKORS Offices, 101 Baker tact Janet Adams 807-345-1516 (or for 807 area only 1-800-488-5840) St. Drop-in library M-Th 9-4:30. Contact Alex 1- Whitehorse, Yukon—Blood Ties Four
Directions Contact 867-633-2437
Unified Networkers of Drug Users Nationally All you ever wanted to York Region Hepatitis C Educa-
know about Hep C.
New Westminster Support Contact Dianne
tion Group 3rd Wed. monthly, 7:30
Latest research!
Morrissettie, 604-525-3790 before 9 PM. dmor- PM, York Region Health Services, 4261 Hwy 7 East, B6-9, Unionville. hepc.bull DECEMBER 2008 Issue No. 117



Dr Taryn Cowain Clinical Director RGH Ward 17 Long known about psychological effects of Post trauma reactions documented as far back In 1915 a clear account of PTSD described in The Lancet by Dr Forsyth. Experience of re-experiencing, reliving, arousal Defence of Rorke's Drift 1RAR 1960. At end of Malayan Emergency The problem – In The USA 2000 - 2009: USA Department of Defence


A joint initiative from Norfolk County Council and Norfolk Health Services Schools in Norfolk asthma guidance Together we can make it happen! Introduction and key messages . . . . . . . 3 Asthma is the most common chronic childhood ❖ Training in asthma management. condition, affecting an estimated 16,500 Norfolk ❖ Identified asthma link staff.