Thursday, April 12, 2012


I've been seeing a lot of young patients recently with Hepatitis C. Kids in their 20s who have gotten into IV drug use, and who are now struggling with both sobriety and having Hepatitis C. That's a lot for a kid to deal with. I go in to the room, sit down and look over at them. More often that not, they come in with a parent. I mean, they're kids. They're not fully mentally developed. People who abuse drugs are in a sort of arrested development. They have poor coping skills. Thy have impulsivity issues. They don't do well with mental or physical pain. Babies.

I explain what Hepatitis C is, what the treatment is like, why it's important to try and cure it. I explain that the treatment is difficult, and I talk about the side effects: nausea, fatigue, muscle and joint aches, headaches, depression. I then explain that the most important thing they can do is stay sober. They are so eager to start treatment, that some are disappointed they can't start now. I explain that the treatment can drive them back to their drugs of choice. I explain that unless their depression is under control, the treatment might cause them to become suicidal. Some of them recognize that they are not ready, and they breathe a sigh of relief.

I have them come back in 6 months to talk again. Sometimes I think I'm too eager to start them on treatment as well. I've had 2 patients who have relapsed after starting meds. I feel a little responsible. Maybe I should asked more questions or listened to my gut. It's just hard to hold back treatment and explain how important that gut feeling is. I think I'll need to figure that out, so that I can help get people treated when it's really the right time.

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