What in the World is Hep C?; Raw Footage 10

Ben's been filming me for 30 years. This is like 20th time he's filming it. That's it. And it has been 30 years, but I don't know. We started in junior high school. It has, it's just amazing to think back. Facilitator of health policy discussions in state government. So she's been really helpful on a lot of the health professional recruitment stuff that relationships with you and am. And a lot of really cool stuff. You really should, you'd like her. She's a real central person. I just got a call just before she started. I've been writing for the New York Times. And I've pitched a piece on workforce. Because not one of the presidential candidates is really talking about workforce. Which is a critical issue.

And what I'm going to do is write it in probably a partnership with John Frye. You remember John Frye's chairman of the Family Medicine of Wisconsin. It's been on the national scene. It's probably a report from two different states of work. Excellent person to talk to. Along with the usual suspects, Jerry Harris and other people who work on this. And then you know there's going to be this health workforce summit or conference or something here in a couple of weeks. The Valerie Leggett is putting on. I didn't know that. Yeah. I think it's called a pipeline conference summit, something something on me this. And it resolved the problem. But that's okay. You got a brainstorm. You got to do these things. That's a pretty critical issue though. And you know I think we're still discussing it from like a 1980 perspective. I think we're having a heck of a time talking about it in 2008. Reality.

Because there's no switch. You're going to flip. That's going to make all the medical students in the country going to family medicine. That's not going to happen. I mean it's not. So I mean if we can improve it some let's improve it some but we're just not going to. I mean all those people pouring into the specialties. I mean maybe in 10 or 15 or 20 years we can reverse it but it's not going to reverse tomorrow. It's a fresh problem that's come my way here recently. And you know well how do we hire more doctors? Well let's see pay them $300,000 a year or something. I mean it's about the only way you can make doctors come into a community. I'm not sure you know it's just reinvented the national service board. Well or the social service obligation like you do in Mexico. Yeah yeah. Which is a reasonable thing to think about. Well now we're back to how to get into the heads of the presidential candidates so that they get interested in this stuff. Because even Bill Clinton as you know we didn't. We couldn't move him very well. Ready guys? Sounds good, looks good. So Alfred we're talking about HEPC.

Tell me about the epidemiology of HEPC in New Mexico. What's the extent of the problem that you know? Well for me personally that's a very interesting question. I think the epidemiologist could give you the nice straight scientific answer which has to do of course with IV drug abuse or past use. Transfusion prior to 1992. Getting tattoos especially in unsanitary circumstances like in prisons. So that's somewhat of the simple answer. But the reason I say that's interesting to me is because when I was a medical student every once in a while, blood tests were shown that somebody had a kind of a hepatitis that was poorly identified and otherwise they seemed okay, health wise. So we would just put that diagnosis on their problem list in their chart and then forget about it. And unless they were jaundice or had liver failure or had some complication it was just this side issue and we went about dealing with their other health concerns.

We couldn't treat it. We really didn't know what to tell people about that. So we ignored it and that continues to this day to some degree because we're still trying to educate the health care system about the importance of all this. But the epidemiology of this has revealed a number of other connected health care issues. There's a phrase that's popular out there now called the social determinants of health meaning what things and people's lives and their environments and their families connect with health and hepatitis C is sort of the perfect, it's the epitome of that way of thinking because by the time you have somebody with either liver failure or cancer of the liver knowing that that all came from lifestyles that they once lived even if that was long in their past or some accident like needing a transfusion before 1992 I mean all of those give you tremendous insight into people's lives

and the kinds of circumstances they've had to live. So again it's simple to talk about where hepatitis C comes from, much more complicated and also very interesting to talk about the social structure that led to people getting hepatitis C in the first place. I want you to tell me even though it's simple no one has told us this yet so I want you to tell us about where hepatitis C comes from again. The major things. Well we're talking about a virus and a virus that lives and attacks the liver preferentially and this virus then is transmitted basically through blood products through blood contamination so it's not spread in the air or by touching somebody, it's spread through blood product and so again blood transfusion prior to 1992 when this was not tested for is one route.

Another route is IV drug abuse especially sharing of needles in particular and then another route is getting tattoos in unsanitary circumstances such as prisons. Now any licensed tattoo operator uses sterile equipment and so that's not the risk or the danger. Only people who don't follow the proper procedures for tattoos are at risk. Talk to me about harm production. We actually shot needle exchange in a program down in South Valley. But tell me what the Department of Health and others are doing to try with harm reduction particularly in the view of hepatitis C? Well that phrase harm reduction is a really important concept for people in the health care system to understand but also legislators, policymakers and even citizens I think.

You know there's a lot of things in the world we wish we could just change. I mean we wish that no one would ever abuse drugs and that they certainly would not abuse drugs that would require injection. We would hope that even people in prisons would not allow themselves to be tattooed under unsanitary circumstances. We wish people just wouldn't be even exposed to this virus at all and that could be the end of it. But that's not going to happen as far as we can tell in spite of our best efforts. And sometimes then in this world in spite of the fact that you try to prevent something from happening in the first place, you have to do the best you can given realistic circumstances in life. And this is a very hard concept for people to get. And we do have challenges I think with health people in the health care system and even policymakers who say all we should be talking about is basic primary prevention of the behavior in the first place.

We should to use an old phrase tell people to just say no and that's all we should talk about. But harm reduction is a critical, critical tool in public health. Again realizing that human beings are human beings are going to engage in behaviors even when it's not good for them. Now whoever's listening to this film shouldn't seem to be too judgmental about what I'm saying because we're all in this boat. All of us are supposed to eat right, we're supposed to exercise right, we're supposed to keep ourselves from developing diabetes and high blood pressure. We're supposed to drive under the speed limit, we're supposed to keep our seat belts on at all times, we're supposed to brush our teeth three times a day. All of us are supposed to be living perfect lives and none of us do. And the fact that human beings don't live perfect lives means that we need to do harm reduction to try to minimize harm in complications for the way people actually live. And so getting back to have a tie to see them which again is an important issue. Yes we do try to prevent exposure to the virus in the first place at any event.

But in harm reduction with needle exchange programs as an example realizing that there is a population of addicts that cannot be cured overnight. We try to offer needle exchange programs as well as education so that hopefully people will minimize the likelihood of using and sharing used needles. So that's one level of harm reduction. Another level of harm reduction that we can pat ourselves on the back about is that we do now test blood for blood transfusions. We do can now basically guarantee that blood and blood transfusions is safe from hepatitis C. And there basically have been no important exposures of the hepatitis C virus since 1992. So that approach to harm reduction has been excellent and a major success. And then in the area of tattoos and prisons again we try to educate people in prisons not to be tattooing.

There really is no such thing as offering them safe tattooing because they're in a correctional setting. And so unfortunately prisoners you know will tattoo almost no matter what. That's a very thorny situation because there's almost no way to prevent that entirely. So those are some of the harm reduction measures that we're working on. There's a whole bunch of people out there who have hep C and don't know they have it. How does this health department, how do public health people think about reducing that number or at least allowing those people to find out about what they got. And then what do we do about? Well that raises another type of harm reduction which is identifying the people who currently have hepatitis C and educating them or better said the hepatitis C virus and educating them about keeping from passing it on to other people. Tell me about that again.

Kind of start with another kind of harm reduction might be. How are you identifying this people? Yeah so another type of harm reduction is identifying people who carry the hepatitis C virus and educating them about how not to pass on that virus or expose other people to the virus that they themselves have. Now step number one of course is you have to know who has that virus and we think here in New Mexico it may be as high as 35,000 people which is a very large number. And most of those people do not know that they carry the virus. So again anybody listening to this program if they have been IV drug users in the past have had transfusion of received transfusion of blood before 1992 or who may have had tattooing under less than sterile circumstances should be tested and find out if they have the hepatitis C virus. And again when we do identify people with that then we provide education.

But a big part of this is educating clinicians, medical providers just in general practice to be on the lookout for people in these high risk groups but certainly doing testing on people in correctional settings, people in drug treatment programs. Anywhere though including basic family practices to be on the lookout for people in these high risk groups so that we can test and hopefully identify as many of these 35,000 people as we possibly can. Is the state doing anything to folks are there any campaigns or can you imagine there would be I mean if you had your brothers how would you how would you educate people about the fact that Hep C is out there. Is it even the state's responsibility to do it? Well it absolutely is the state's responsibility this is what the department of health has as one of its missions within the department of health and specifically in the public health department clinics that we run. Our clinicians are thoroughly educated and we have a small army of health educators and community health workers who are focused on finding people in these high risk groups and getting them tested.

And we do a lot of education in the communities in general reaching out to schools and doctors offices and hospitals and clinics spreading the word about this. A very important thing that we do is we partner with the University of New Mexico School of Medicine and their efforts in hepatitis C education and treatment. Medical students and residents now receive far more education than I ever did in the subject of hepatitis C. I've got to tell this quick little story when I was a medical student we knew about hepatitis A and we knew about hepatitis B. But we knew that there were these people who had abnormal liver tests and they were given the title non A non B. They didn't even want to give them the letter C because they weren't sure what caused non A non B. They just knew that when they did the Bud test specific for A and B came out negative but these people seemed to have some type of hepatitis anyway.

And it took quite a number of years to finally identify the virus and finally even give the label C, let alone talk about how to test forward where it came from, how to treat it, et cetera, et cetera. So I just had to tell that quick little side of a story that a lot of, I've heard a lot of people say what's this business about hepatitis C anyway. I've never heard of it really. I mean this seems to be a quote new thing. Well it's not a new thing. It's a very, very old thing. It's just that we're now getting enough information to be able to educate people. So we educate medical students and residents on it now and we hope that our newer doctors in particular are good at incorporating this in their regular practice. But there are a number of campaigns. There are a number of educational activities going on with doctors, physician assistants, nurse practitioners when they go for their continuing medical education courses. And we're updating people again with the main message number one, be on the lookout for people in any kind of a high risk group and test them.

If the test positive, make sure they get the proper education and counseling. And then finally, there is now treatment and potential cure for hepatitis C, which is another area that we're trying to expand as rapidly as we possibly can. There are more people with E, then there are people with HIV. Most folks when they think about the fact that what's the worst disease they can think of is HIV. But talk to me about that part of the epidemiology that there are actually more folks with hep C than there are HIV. Yes, that's absolutely true. And in some ways, then there's more ways to get hepatitis C. And as we've already talked about, only recently has it been really clear how hep C is acquired. So it's only been in fairly recent years that we've been able to solidly talk to the population and to clinicians about where hep C comes from and what kind of education we should be offering.

The other interesting sidelight is that HIV is a relatively recent virus. It has not been with us as long as hepatitis C or the other viruses. So that's something that makes that a little different as well. Hepatitis C worldwide is the leading cause of liver cancer and liver failure requiring liver transplantation. And so the effects of this are major. This is not just something that is an abnormal test in your chart, in your medical chart. This is something that causes a tremendous amount of morbidity and mortality in the world, especially globally, but certainly hearing the United States. So this is not an esoteric or academic kind of a subject. This is very serious and affects very large numbers of people and has major, major impacts on the healthcare system, again, in terms of human suffering certainly, but also in terms of financial cost. Many people have hepatitis C, even if they don't have total liver failure, can have a lot of liver complications and require a great deal of medical care and suffer other complications in the meantime.

So this is a very, very important disease. And again, the fact that it can be spread in certain ways and passed on to innocent victims, if you want to call it that, makes it a very important disease to address. What's the public health burden? How are you talking about public health terms? The cost, the only thing that the cost of what Hepatitis C will bring to our society? I wish I had those numbers at my fingertips. I don't. Again, it's by far in a way the major cause of the need for liver transplantation and liver transplantation is an incredibly expensive proposition. Also the leading cause of liver cancer and treatment for any kind of cancer, but certainly terminal cancer can be extremely expensive. And then again, the large number of people who have liver complications from cirrhosis and other complications from the hepatitis is also very, very substantial.

So I wish I had those numbers at my fingertips, but we're talking about a very, very substantial cost. Talk to me about Project Dicco. Tell me what Echo does and how it stands in terms of innovative projects. Well, here in New Mexico, we are very grateful that the University of Mexico School of Medicine developed this project led by and really developed by Dr. Sanji Barura from the Department of Internal Medicine, the Division of Gastroenterology. The fundamental model behind Echo is the belief that specialty care can be shared with small rural communities without actually having to get specialists to live there or work there. Dr. Arora's observation was that he was terribly backed up trying to take care of people with hepatitis C, especially treatment for that could possibly lead to a cure by being based in Albuquerque and had really no way of sharing that or helping people outside of Albuquerque. They had to travel to Albuquerque to see him or other gastroenterologists for that treatment.

And he and others brainstormed and said, well, what can we do about this? We're not going to be able to recruit a lot of gastroenterologists due to Mexico, and we're certainly not going to be able to put them into small towns or villages in New Mexico where people actually live. What could we possibly do? And with that brainstorming and thinking then came the concept that's actually an old agricultural concept of having extension agents out in the communities away from the agricultural college. And so he came up with this Echo program to number one trained people in small communities, family physicians, physician assistants, nurse practitioners, nurses, clinical health workers, in all the important features about hepatitis C, all the things we've been talking about, identification of risk groups and screening and those sort of things. But then being able to actually treat patients with the drug interferon that can in most cases be curative of hepatitis C and again in their own community so they would not have to travel into Albuquerque.

That model though is not just for hepatitis C, that is now being expanded to areas such as rheumatology, psychiatry, treatment of diabetes, behavioral health, substance abuse. A number of other areas where it would be helpful to have specialty type services in the communities without actually having to have the specialist located in those small communities. I want you to tell me that again, but short it up, this is what Project Echo does and you don't have to mention Aurora's name. And it provides speciality support for the treatment and care of people with hepatitis C and small communities around the state and its purpose is to provide that specialty support from the medical school without specialists actually having to go to small communities or having to have people who live in small communities call them all the way into Albuquerque. And to Albuquerque for their care.

Tell me about HEPC reporting. What are the rules and rights about reporting about reportable diseases specifically hepatitis C? It's a reportable disease here in New Mexico, which means it's supposed to be reported to the Department of Health. There can be difficulties with that though in the real world setting. Sometimes people just forget that it's reportable and forget to report it. Now most of the blood testing for hepatitis C actually occurs in our state laboratory as well as other laboratories that are in communication with our state laboratory. So we are getting better and better at capturing positive hepatitis C blood tests so that there's now more and more of an automated mechanism such that when somebody's blood test is positive, it's sort of automatically reported. And then we have a database where we can follow and track down people for communication and education purposes if that has not already occurred with their practitioner.

Do you think that's occurring? It is occurring. As a matter of fact, it's occurring to such a high level that we're now above our resources for being able to really manage the group. We have detected so many people with hepatitis C. We're having to work very, very hard to make sure that each and every one of them receive the whole scope of services that they truly need. Just because those numbers just keep coming through the door, we were in a meeting the other day where we were estimating that it takes about an hour and a half worth of time to sit down with somebody with a new hepatitis C blood test and make sure that they're adequately educated, told about the pros and cons of treatment, given other support and education for other components of their lifestyle that might have to do with a hepatitis C. I say average and I do mean average. Some people require a little less. Some people much more because if in detecting the hepatitis C, you also find out that they have a drug problem or that they've in some other high risk group, then providing appropriate services for those problems, of course, is going to be a much larger undertaking.

But it's very important thing to do. Number one, if somebody does have, for instance, an alcohol or substance abuse problem, they need treatment for that no matter what. But if they have hepatitis C virus, then continuing those behaviors puts them at much higher risk for complications. And so just to keep their hepatitis C in a control, they also need to be treated for the drug abuse or alcohol abuse problem. How do we pay for all of them? Well, good question. The quick answer is we pay for it the way we pay for everything else. And so if somebody has insurance or Medicaid or Medicare, then those systems, you pay at least to some degree. As we all know, the problem in New Mexico is the approximately 20% of the population who have nothing, no form of financial coverage. And that's extremely difficult. The answer is sometimes they aren't able to access financially either the blood tests or the drugs necessary for treatment.

Now, the echo program at the University of New Mexico has been able to identify some other limited sources for drugs and other treatment, which has been extremely helpful and beneficial. And I need to say, too, that we're fortunate here in New Mexico that we have a system of what are called community health centers, which receive federal and state funding to treat patients who cannot access care any other way. And that funding is for any kind of health care that they need. Now, that does not mean that at those community health centers, all care is free and unlimited. The coverage is fairly limited, but it's a lot better than nothing and the community health center is shoulder most of the burden for people who have no other form of financial coverage. Can you think of anything else that you would say in terms of how we can get word out, how we can, you know, what as the Secretary of Health, you would like people to do.

Well, as we've already touched on, hepatitis C is sort of like the canary in the mind. It's a reflection and an indicator of bigger, broader issues and problems. Again, putting aside the issue of transfusion before 1992, we're talking about drug abuse and especially injection drug abuse. We're talking about drug addiction. We're talking about other high risk lifestyles, which in and of themselves are connected to low economic status and low educational status. And so we're really not going to, you know, be able to claim success and controlling hepatitis C until we can claim better success with drug problems, which means getting better success with economic and education issues here in New Mexico. And again, you know, state government and federal government and city and county governments are working hard on job opportunities and improving education.

But I think almost anybody in New Mexico would agree that we need to do a better job with both substance abuse prevention and substance abuse treatment. This is a major tragedy and especially in some communities in New Mexico and hepatitis C, unfortunately, is just another branch of the tree of that problem. I think you've got it all. Everything's in there. Good. Thanks. Thank you. It's good stuff. Yeah. I can't. I'm okay. Yeah. Yeah. Yeah.

Yeah. Nothing was still doing that. Really? Oh, I'm sorry. That's all right. Okay. Hey, I'm doing some filming. Okay. Hey, guys, where are you? Good. Anybody call for me? Give them time. Hello.

Hey. Okay. Oh, okay. Well, I want you to already be walking away. When you say, okay? I'll give you. Yeah. Okay. Hey, there, Scott. How are you? Good, huh? Yeah, just unnatural, huh? Yeah. That's what I'm afraid of. Let me close your door. Okay. Okay. You can check your, you can check your man like me. Okay. Scott, how are you? Okay. Yeah, that's fine right there. Okay. Okay.

All right. Yeah. Okay. And some stuff right here. Is that okay? Right here. Got it. Got my scanner here. Nope. Okay. Okay. Okay. Okay. Okay.

Oh, my own time. Okay. Oops. Okay. I'm going to call somebody and see if I can. Oops. He's on the phone. Okay.

All right. The first thing, you know, and I might have asked you this before, but I want you to put your job and your own listen context. I honestly think that I was able to complete treatment because of my job. It gave me something to do. And I did not do the greatest job when I was here, but my boss would say that 50% of me was better than 100% of some other people. So he was really encouraging in that way. And he felt that he could get 50% of me a work out of me that he was more than happy with that. And it really was something for me to go, you know, place for me to take my mind off of treatment for eight hours a day. And it really made a difference.

They were also very, very encouraging. The vice president was one of my biggest cheerleaders. I mean, he would let me kind of ramble on about how I felt that day. And sometimes I just needed to talk to somebody to tell him how horrible I felt. And it was good therapy for me. It kind of kept a little bit of a perspective that I still even though I was going through a pretty hard experience, I was still able to maintain a little bit of a semblance of having a life. And because at home, I did nothing. I mean, I would be in bed by 6.37 o'clock at night. And I would get up and I would come to work. And that was it. So work was a real good outlet for me. A lot of the people here were just great support. They gave me so much support. One of the gals that I work with Alicia did have my work for me probably. I mean, she was just always concerned and asking me what she could do for me and things like that. So it made a big, big difference without work. I don't think I would have made it.

I do. So people, other people contemplating treatment for Pepsi. What kind of advice would you give? I think that you're short-changing yourself if you don't try to at least do the treatment. And you have to dedicate yourself to doing the treatment. I mean, I felt that it was my last chance because of my age and everything else. And I was extremely determined that I was going to go through the whole treatment. And it's not going to go away. It's not going to get any better. And the only thing that you can do is take the drugs that are being proven to come out on top of it that they are able to make headway now with the clearing of the virus from your system. It's going to be hard. But there are a lot of things that are hard and you have to do them. But I think that if you get the right treatment, you get enough support.

You have a good support system. And you can try and maintain some semblance of a life that will definitely go a lot easier. And not everybody has to do a year and a half. I was one of the unfortunate ones that had a general species of 1A. And that unfortunately is the longer treatment plan. And some of the other ones I have friends or people that I've met since then who have only had to do six months and they have been perfectly fine and have never shown any sign of the virus after five and six years. So it's something you have to at least give yourself that opportunity to try it. Or a little more work maybe. Tell me that about getting the treatment again. And you did a wonderful job. You don't tell it to me in four lines. I think it was the attitude that I saw at UNM when I went down there.

Don't tell me about UNM. You did a great job. I just want to see if you can do it a little bit short. It pays you to get the treatment. You're giving recommendations to other people. I have to think about it again. You have to give advice to somebody else about hepatitis C and treatment. I would urge everybody to go for treatment. It's not going to go away. It doesn't get better. And you need help from somebody else that has had some kind of experience with it. I found that there are different practices that treat people. And the one that I was in was very involved with me.

They gave me all sorts of support. So if you're afraid that you don't have enough support to help you get through that, there's a medical community that will help you with it. That was taken care of as far as my depression and the different side effects. Any side effect that I had, there was always some type of something that could be done or they could suggest. It made it a lot easier. It's not going to be easy by any means. It's going to be one of the hardest things that you have to do in your life. But your life depends on it, I think. So I don't think anybody should turn down treatment and say that they can take herbs or they can do anything else for it because it doesn't work that way. It definitely has to be treated with the drugs. Is that okay? That's wonderful. That's it. Well, 25. I've been through it. I probably got it the same way Tom got it. You'll never know. You'll guess it for as long as you live on how you got it. You probably know in your own head how you got it. I think I could. And with all that behind me, Michelle took care of me. So she's been in it for over a year.

Yeah, because I was part of it almost a year ago, two years ago. So I was I was cured. Although I haven't had my six months follow-up blood test yet. But when you're off the program, that means you're done. Your hair happens non-detectable anymore. And he looks great. Thank you. I feel I feel so much better. I haven't felt this good in a long, long time. So if you're out at all, are considering it, all I can tell you is do it. You'll put up with L for a while, but I'd say that but it's true. He knows it's true. So that's my story. I'm sticking to it. James, I'm here as Bordelson. I'm Ruba. And how long have I been on it? I feel like it's a jail sense or two years. I'm on my 27th shot today. She's not far behind me.

They're both like in the midst of it right now. I had all positive, you know, I heard a lot about things like my family thought because I'm real dramatic that I wouldn't be suicidal because it could be a symptom. You know, if anything, I've been more easy to deal with and my skin cleared up, but I was disappointed because I heard you lose weight and I didn't lose weight. I haven't either. I've been waiting. I got it. That's the only desert disappointment. I was just hoping I was planning it. Well, we're tank tops when I'm done. So this is nice because you can get a feel for a couple different, you know, some patients have difficulty with some side effects like, you know, eating and it seems like fatigue, and tiredness are kind of a commonality with everybody, but you're already kind of experiencing some of them.

But everybody's affected differently on the treatment. You know, one person's going to have some symptoms and another person's not going to experience those symptoms and have other symptoms. And some people don't have any symptoms or side effects or all side effects. Those are pretty far between, so far in my experience. But I do have that fatigue and tiredness. My energy is short lived or I'll tell him, okay, I'm like, I think I'm going to faint, but till now I haven't. That, but it doesn't even bother me because I was worse before I knew I had the tightest C. I was getting tired and I just wasn't feeling right and just a lot of things were going wrong. And I was more depressed, but I didn't even know it was wrong with me. And you never know how you could get it. I mean, there's so many ways you could, it's so strange. And there's no evidence that you have this disease. Unless you can get the blood test.

Well, but you start saying, why am I so tired? Why am I not being able to do anything? That's what got me in to get the test. It was Dr. Sava that said, well, we've got to do this test to verify. And then he said, well, you have Hep C and that put it all together. I mean, if you're feeling more tired now than you did with the Hep C, I'm surprised because I... Well, you know, maybe you know, I was tired, I was tired then too, but now maybe I'm a little dizzy. I was just sleeping a lot before. And I used to like to go out and I think that I think it was more serious the last two or three years before treatment because I stopped wanting to go out at night and I was sleeping like nine or ten hours. I was more quiet, less social. And my skin was awful and people were telling me, oh, at that time I was merging 40, but not yet, like 30 something. People go, you're so old, why are you getting acne now? I don't even know. It's amazing how everybody has different symptoms.

And then in the literature, I was just reading the day. It says, you know, sometimes you don't even know you have it. And it's not... The most common symptoms I have come across is nausea, headaches, and headaches. Yeah, I didn't put that together. They asked for the most common symptoms. Not a lot, no. I did, but I thought I was just a woman like, you know, whatever. I won't bring that. Right now, that'll play a part in it. All right, well, are there any general questions at this point that anybody has as far as treatment goes or side effects or anything like that, especially from the newcomers? Anything that's been burning? I know how I got it. I got full blood transfusion. And I didn't know how bad it was until I was drowning. And my liver was pushing all the water. Wow.

And I drank into my body cavity. And you could just touch me anywhere and leave a dent. And when I went into the hospital. Transfusion. How long did that take from the transfusion to where you got symptoms like that? Oh my gosh. Well, I'm 57 now. And I think I was in my late 20s. Okay. And I had the blood transfusion. She served for 30 years, almost 30. And then did that event push you in the hospital when you were very indemnitist like that? Well, I'd always had problems with blood clots. So I always had water retention, but nothing like that. And then on Valentine's Day, he says, you just blew up within a few days. Something is definitely wrong. I mean, I just blew up. She sounds like one of those that when she's off the treatment will probably see her whole new life in front of her. Well, and don't you have a little bit of liver dysfunction at this point?

And the neat thing, when Dr. Savas saw Connie, he said, we need to get on this client right away. And get her presented with Dr. Aurora. That's kind of the next step is, you know, we'll do an interview with you like we did this last time. Then we take that information to Dr. Aurora. And he's the specialist in town that kind of helps us out here to make sure that we're, you know, seeing patients and doing just as good of a job as the specialist doing town. So, you know, he'll see your case and then he'll decide to take the next step forward and consider treatment. And it would be good for you because I've heard a lot of stories of even patients with the beginnings of some liver damage. You know, get the treatment. It'd be successful when you see the reversal of that liver and it can regenerate its tissue and build a new. So you could really benefit from treatment. So, what you said, bringing questions at this point.

I was from a tattoo. I had a clinical drug. But I had a drinking problem when they told me that I had it. I just stopped drinking. Because I know that it was missing out my liver. Yeah. You know, that was the, you know, the main thing that I won't, because you know, they told me they never killed you. Yeah. The tattoos is a common way, you know, if they're not even local tattoo parlor in town. I had some patients in town that didn't receive it from a local tattoo parlor. Basically, it's if they're not changing out the ink, I guess. And then all the reason I know who I should buy it. About the tattooing, you know. Actually, they sterilized, make sure the tattoo body and pressing or whatever equipment sterilized. Well, this would happen. I tattooed this girl. I got it off this girl. I tattooed her. And then when they tattooed me, I got it off her.

Right. And she took off and I never went and told her, well, you know, I got this from you. Yeah. They drew my blood because the seizures in that they draw my blood and check my dial out level. That when the doctor, I told me I need to see you. I went in front of her and she told me I'd dry shoot up. And I told her, I don't shoot up. She goes, you don't need tattoos. I said, I got a pressure on you. Let's tell you, you got to have a tattoo to see. And I was wondering what was that tattoo to see. And then when they told me that they'll mess up your labor and that, then I talked to the doctor and they told me, you know, if you drink, it's going to kill you. So I stopped. Yeah. I have one more question about that. So I don't have tattoos. So when they do a tattoo, they use a needle, but what you're saying is, or what is it that it's like a little needle and they, they change that needle, but you're saying that the ink that was in there from her getting it. Well, say if you don't change out your ink bottles, you know, you're tattooing and you're putting it back into the ink. Oh, it's not like it's loaded. It's going back and forth.

Exactly. Okay, so that's why you ask them. You know, once you break the seal on this, I think. Now I'm just, you know, thank you. Well, what it is, is that what, when we there, you're actually seeing that a whole lot of their prisons and their doing tattoos. The tools are probably pretty primitive. I always make the gun and everything. Very good source for them. You know, but you got to do a lot of that. You know, time, you know, to twist the ink, you know, you just put a pack of another person and, you know, is that same thing? Can a little bit of this wipe off? Go on to the next person. There's a lot of guys in the pen touch of that. That's right. I didn't hear. I think I heard from these folks that that's, it's more prevalent there per capita than about anywhere, right? Yeah. And you have a population like that as opposed to a population in the outside world. It's much more prevalent. Oh, yes. So Lisa, let's go to side effects now. What side effect are you dealing with the most right now?

Not yet. Headache, fatigue and bitchiness. Can you relate to any of those side effects room? But I mean, I'll deny it. In the body case. The body hurt, but my legs and I was like, I can't walk sometimes. But in that, I feel great. I mean, you know, I have one bad Monday of three, you know. Your kids are still alive. And my kids are still alive. They may hate me at times, but they're still alive. That's probably said that you get bad right away. I'm, Mondays through Wednesday. I have to catch myself because I'm not irritable. I'm like on them. You know, I'm waiting for them to screw up, you know. And I'm like, hey, okay, mom's just to be today. Get away from me, you know. You reject on Monday. Yeah, I did my injection a the clock this morning. And I start feeling, by evening, little worse.

When I do my injection, I get a real bad headache, nausea. You know, but if that's the worst of it. Hey, and I can't walk up, you know, my daughter stares in her classroom till like Thursday, you know, it ain't happening. This is too painful. My legs just quit. They hurt. They won't. They just not go on the flight of stairs. And I go and have this massage lady I don't see now over two weeks. And by then, I'm like, okay, just rub them out. Good. That's a great alternative type of measure to take. Yeah, it's just my, that's the worst thing, I think. And the dryness. I'm so itchy and dry. I have like just, so I'm usually like, scale here. I call it from head to toe, you know, and I've got, if you put me in a pool, I'd be just film.

You know, from a sexual ocean, as I rub it on. So do we have any suggestions, Tom, or Erin, and Ruben, how we deal with these side effects? Do you force yourself to drink a lot of water? Yeah, I do that. How much do you drink a day? I drink it all day. So if not, I'd get dehydrated, like. Yeah, I always drink between a half a gallon and a gallon each. You're lucky I can have three and a half of these a day. It's actually a lot of restriction. Oh yeah. So yeah, a little bit triggering. Well, you do the treatment. The key thing about the water is it can help tackle a lot of the symptom. It helps with the, you know, keep you hydrated, like you said. Yeah. It helps with the itching. If you weren't drinking that much water. Oh, yeah. You're with symptoms. I call home. She might have a harder time because she is on our restricted water. That's going to be an interesting.

Yeah. All of that will be interesting. Does that only pertain to water? Can she drink clear liquids or tea? What is that? Oh, if this should just water with flavor. I think it's a fluid. You have no raw fluid. It's a fluid. It's a fluid period. And that's because, yeah, I have a milk of the morning. If I have a half a cup of milk with my cereal in the morning, I have to include that. Oh, right. And what I'm thinking. I think it's difficult. Yeah. But that's a good way to have to drink water. Another good tip is to flavor it. I have one of my patients. I don't know. I don't know. I have to force myself to drink all day. We have patients taking Tylenol for headaches, which I think is the best. And then ibuprofen for light body aches. And a lot of times it's good to pre-treat prior to your injection with these medications. And then maybe around the clock for a day or two to get through the... Because this is the way one patient described it to me, you know.

It takes his injection on, say, Friday. It gets onto the work week or the week. Monday, Tuesday. And then Wednesday rolls around starting to dread the whole injection day. Thursday and then Friday, you know, comes again. And that's when they start to get agitated. Because here comes injection day. I'm not just maybe Wednesday. And I just catch myself. You know, and I'm like, just... Everybody, get away from me. Because I'm going to be mean to everybody. And I take sleeping pills now. I was becoming crazy. Really. I wasn't sleeping three days. It was unbelievable. I didn't understand it. I had the trasodone, okay. And how's that working stuff? Well, how have you been on it now? I haven't finished a bottle because I wasn't taking it always that first. I'm crossed. You gave it to me like two months ago and I still have two tablets. Okay, so you kind of take it as needed then whenever you... Yeah.

And are you sleeping better now? If I take two for sure, but there was a while I would take it. I would take three hours to fall asleep. I feel like I went to vomit, but I don't. Okay. Lucky pill. Yeah. All right. And first she was waiting until she couldn't fall asleep to take the first one. Three, four, five, or whatever. Okay. You know, taking it on a nightly basis for a week or so, just every night and around the same time, but only take the one. You see what kind of a pattern that got you into. Because another one of my patients had trouble with the sleep and he takes the trasodone as well and sleep is not a problem anymore for him. So, did you deal with insomnia a little bit? A little. I remember I got some who was able to sleep at the drop of the hat. Any time. You can have a work. Yeah. I remember you saying that you could fall asleep at the computer. Well, that was, you know, a fear on in the right there. Bitnet.

You asked her. I just wanted to say this is something I had that I have not heard of here yet that I thought everybody gets. And it's called brain fog. Yeah. You kind of retarded. Well, no. I mean, I could be looking at a computer. I could be working. I have a book and I've got work. And I'll start out finding about five minutes or less. You don't know what you're doing, right? That's me. I do the same thing. But I just thought it was me. You know? No. You don't treat me when I'd be driving in my own town that I was talking about. It's the definition of depression was. But I think that the brain fog and the depression are very similar. So, they prescribed some anti-depressive drugs. And I had plenty of side effects with those. So, we were passing back and forth in these meetings. It was a year of real hell for me. But one thing these two, these clavis meetings I've come to have shown me is how very the symptoms are. I know someone else is going through it now that has none of the symptoms.

Yeah. Well, I did that. I just thought it was me. You know, I figured I'd find some brain cells or something. I don't think I know. If you take a sleep aid or an anti-depressant, you're supposed to take a vitamin or any type of, you have to have vitamin B2 because what do you call it? I don't know. I don't know. I don't know. I don't know.

I don't know. I don't know. I don't know. I don't know.

I don't know. I don't know. I don't know. I don't know.

I don't know. I don't know. I don't know. I don't know.

I don't know. I don't know. I don't know. I don't know.

I don't know. I don't know. I don't know.