Need suggestion on medicine & life style

Kumar (Male/42)

Status: - Suffering from Hepatitis B with Liver Cirrhosis since 2003

Present Condition

Date: Aug 11
Test Name Result Comment/Previous status
HBsAg   23.31 IU/ML It is positive since 2003
Pleated count 50000 It is almost same since last 7 years
WBC count     2500 cmm It is almost same since last 2 years
Spleen 17 cm It is almost same since last 7 years
Spleen vain 14cm It is almost same since last 7 years
Endoscopy Grade 1 It is same since last 7 years. Talking Betacap Tr 80 mg once a day
AFT 3.2 It is always under range since last 7 ears.
ALP 165 It is always under range since last 7 years.
Alt[SGPT] 28ml It is always under range since last 7 years.
Ast[SGOT] 37 ml It is always under range since last 7 years. .
Total  Bilirubin 2.09 It is almost same since last 7 years.
Albumin
HBeAg Negative (0.511) It is always negative since last 7 years
HBsAb Negative -0.6
CT-SCAN Triple Phase (30 July,11) Findings are suggestive of cirrhosis of liver with portal hypertension.Moderate to severe spenomegaly.No ascitis. Measures 17Cm and Splenic Vein dilated measure14 mm.(Maximum dialmeter)).The same was observed in Ultrasound since 2003.
Hbv DNA (1-Aug-11) 31893 iu/ml - It was undetected since last 7 years.    - have taken lamuvir for 2 years [from 2003 to 2005].                                            - Detected Positive on Aug 2011 so started Entecavir 0.5 mg[once a day] on Aug 2011

MEDICINE:-

1. Entecavir 0.5 mg once a day -From 1 Aug 2011
2. Betacap Tr 80 mg once a day


Heath Summary:  
• Pre diabetes Patient since 6 months
• Good Appetite, No Weakness, No Bleeding, No Swelling in leg,
• No blood in Stool, No fever, Feeling Excess thrust, Weight 62kg. BP 110/75.
• Pulse rate- 70,Hight: 170 cm, BMI: 22.35, Waist: 34 inch
• Taken inj Havrix-A 1440(adult) on 13/07/11

Query:
1. Can I put stress on abdomen while doing abdominal exercise to reduce bally fat?  
2. I am Pre Diabetes patient so talking juice of Bitter melon ( Karela) & Neem, Will they give any harmful effect on liver Cirrhosis ?  
3. Whether fenugreek (Methi), jamun(Syzygium  cumini) & garlic are anti-platelet?
4. Whether Udiliv(ursodeoxycholic acid) 300 mg a day will help me?
5. Are Citrus-fruits (such as grape-fruit, lemons, limes, oranges, etc.) not good for liver Cirrhosis ?because it contains Methano(wood alcohol),

[stef2011]

dammed doctors i dont understand why they feed hbv virus mutations especially in cirrhosis patients where mutations can be easily deadly

entecavir cannot be used in people who used lamivudine because useless, etv will make other 3 mutations by time please add tenofovir as soon as possible, tenofovir is the only one without hbv mutations/resistance

once started tenofovir check kidneys function because kidneys are damaged ofetn on cirrhosis (creatinine  before starting tenofovir and fter weekly first month)

if you can tollerate stay on entecavir+tenofovir otherwise after 4-6 months discontinue entecavir.

if you can afford start hepatitistechologies products as soon as possible, your cirrhosis is quite advanced so total regression may not be possible but it will improve for sure, especially platlets and albumiin within 1-2 months of use

[stef2011]

take also vitamin d3 supplements to make your vitamin d 25oh  level >50ng/ml, this will boost immune system and reduce diabetes if not cure it.bitter melon is very good, keep it

check also my post on "update about my fatty liver" copy my diet, make excercise, you must be as low bmi less than 24 and weist less than 90cm.cirrhosis gets very bad on overweight people and even without it overweight people have damaged livers they just dont know becaue fibroscan is not used enough....

1. Can I put stress on abdomen while doing abdominal exercise to reduce bally fat?  
yes but running and swimming are better if possible

2. I am Pre Diabetes patient so talking juice of Bitter melon ( Karela) & Neem, Will they give any harmful effect on liver Cirrhosis ?  
bitter elon seeds can be toxic, use moderately

3. Whether fenugreek (Methi), jamun(Syzygium  cumini) & garlic are anti-platelet?
i know curcumin is anti fibrotic i used it and i regressed cirrhosis very fast.it is in heptech but if you cant afford just eat a lot of black rice with oilv oil and curcumin

also bluberries and berries fruit are a must, minimum 165gr daily, lower no effect

lot of coffe too, 3-4 cups daily minimum

4. Whether Udiliv(ursodeoxycholic acid) 300 mg a day will help me?
it depends check with your doctor if you need it, not sure but i think it can be mildly toxic on liver so use only if absolutely needed

5. Are Citrus-fruits (such as grape-fruit, lemons, limes, oranges, etc.) not good for liver Cirrhosis ?because it contains Methano(wood alcohol),

never heard but you have to look for dark colors like blueberries, antociani in dark blue fruit help regress cirrhosis, pomegrane too

[stef2011]

HBsAg   23.31 IU/ML It is positive since 2003

in all this you have a very low hbsag, add alinia (nizonide) 2g daily, use also acidofilus yogurt while on alinia, it may clear hbsag in a short time if it is really so low as 23iu/ml

at tis point it is good to add alinia also for the lamivudine mutations you have, alinia is active on all lam mutations but you also need tenofovir, after 4-6 motnhs you can stop entecavir

do not stay on entecavir monotherapy absolutely, it has 50% mutations on patients at 5 years and lam+etv mutations may make hbv untreatable

[stef2011]

by the way fibroguard from heptech is also able to keep creatinine low and creatinine clearance high
i have problems on both alinia (ntz) and tenofovir but researchers told me that fibroguard may be able to keep optimum kidneys function also on these drugs.
i am not using tenofovir but i do use alinia 2g daily dose and it takes my creatinine to 1.2 which is border high normal, sungin various antioxidants i can keep it 1.0 to 1.1 but as soon as i add fibroguard it lowers to 0.8 which is even lower than my baseline value before starting drugs 0.95

so we can say researchers were right

[stef2011]

i also forgot to menthion simvastatin
it has activity on all hbv mutants, boost antiviral response and prevents liver cancer and decompensation improving portal hypertension

a good doctor is needed to monitor improvment and if sim can have toxicity, doses used are 20mg or 40mg, link to the study here
http://www.ncbi.nlm.nih.gov/pubmed/19208350

cholesterol is connected both to the process of making fibrosis and to virus production and assemple of antigens, studies have reported:
tot chol less than 150
ldl less than 80
hdl more than 60
as optimum

if cirrhosis is ver bad you might already have values like these if not sim will help

if you have fibroscan available you can monitor improvment of liver damage during heptech therapy, complications of cirrhosis are usually around values higher than 25kpa, i am not sure but i think it is risk of varices complications while values lower than 20kpa are usually safer (normal liver less than 6kpa)

[enolia]

What about Shiitake and King Oyster mushrooms, do they help in straightening our liver or immune system? I heard Shiitake is very good and they use it to make drugs.

[stef2011]

i dont know i am not expert with mushrooms because they can be very dangerous for liver, so in general i avoid them all

until now curcumin, blueberries, oliv oil, and all species with a lot of antioxidants are those who help regress fibrosis

i saw no studies on cannella this is the spice with the highest quantity of antioxidants.i only saw study on brain damage but ptobably good for lver too

[enolia]

Thanks Stef.

[kumar301]

Thanks Stef for your advice. your suggestions are really helpful.

[kumar301]

would you please suggest me any test to know the lamivudine  resistant. My local doctor suggested me 'HBV YMDD MUTATION DETECTION' test .Please let me know your opinion. Do you think this test would clear my doubt regarding lamivudine resistant?

in some site i read that "Negative result could occur due to: -- HBV viral load less than 5000 viral copies/ml".

Thanks,
Kumar

[stef2011]

you dont need the test, the mutant is already there otherwise hbvdna would have stayed undetactable

you absolutely dont need a test but a drug that makes no mutants, the most potent one which is tenofovir (not entecavir)

[kumar301]

Alinia (nizonide) is used to treat diarrhea due to certain intestinal parasitic infection and under Phase II Clinical Trial for treating Hepatitis C.i read as  it is early to say would it treat Hepatitis B surface antigen (HBsAg) .since this is antiviral drug so drug resistance should be there?
simvastatin(statin) is lipid lowering drug.
here it is not prescribed for portal hypertension.will it reduce portal hypertension?

[stef2011]

do you know off label use of drugs?the drugs are not active on the diseases indicated on the box, they are active against many other things and studies of researchers and small trials prove it.
but these indications will never come to FDA approval or indications in the labels because this process is too expensive especially if a drug has no patent anymore.nowadays the all
process is f***** up, and even new cure like replicor or new antibiotics or cancer cures are not approved because drug makers can t make enough money or approval to expensve (damn US capitalism has the first position on this)

so if you want to double check my indications make a search on this community and yu will find the link of the studies

as to simvastatin here is the link, you just have to be careful on monitoring alt and creatinine while on simvastatin, al must lower or stay about the same, if they rise over 80 you must stop it

http://www.gastrojournal.org/article/S0016-5085(09)00144-9/abstract

http://www.med.upenn.edu/gastro/documents/simvastatininCCl4rats.pdf

http://www.ncbi.nlm.nih.gov/pubmed/19208350

[kumar301]

Thanks for your valuable advice.these are always helpful .i will try to follow them.