Suggest a good doctor for Hepatitis B

I recently got all my blood examinations done and my liver functions test, ultrasound scan are all normal. My CBC count is normal too.

My Vitamin D levels Were 16 about 6 months ago and I take calcirol every once a month.

I was diagnosed of being a HbsAg carrier when I was expecting my baby. Since then I got my antigens regularly & two doctors gave me different versions, one said I don't need any treatment as my virus is dormant, whereas the other put me on Lamavir and said I need it.

But after almost 13 years I had a bout of stomach infection and the gastroenterologist recommended me that I get an HBV DNA to see how is the virus progressing.

My reports shows my HBV DNA as 41,500 IU/mL

I am 40 years of age and looking for a balanced view on exactly what's should be the course of treatment and who is the best doctor in New-Delhi for this kind of a disease. Any suggestion? I would be very grateful for it. Also I don't want to undergo any liver biopsy, so is there an alternative to it too?

[stef2011]

patients just get an increase of creatinine for few days but since there are no tests to detect if a patient has kidneys damage already creatine can stay out of range longer

here in italy patients take antioxidants before and during taking contast, you can take nac,coq10 and vit c, nac especially usefull and has indications specific for this

the doses:
nac,1500-2000mg daily, better multiple doses during the day
coq10, 100-200mg
vit c if possible injection vit C, 1000-2000mg daily

all these are non prescription vitamins, you can take only nac if you like, here are the studies on the damage and prevention, if i were you i d sue the doctors, i obviously dont know laws in your conutry but in italy we sue them every day and you see reports on tv becuase they are not allowed to make any mistake and if they do they will pay very heavy for it and if they dont like this or prepare for this they can do another job

http://www.afibbers.com/atrial_fibrillation/miscellaneous/R91g.htm
http://www.yourhealthbase.com/database/a150b.htm
http://articles.mercola.com/sites/articles/archive/2000/07/23/nac-kidneys.aspx

[stef2011]

http://www.medhelp.org/posts/Hepatitis-B/The-best-place-for-treatment-of-Hepatitis-is-India/show/1574243

check here for a medical center

[Nopatronas]

Thanks for your reply. Would you suggest any questions I need to ask the doctor to check if he's following the protocol as mentioned in the thread you sent me. It seems doctors are out to put everyone with Hep B with anti-virals. What should one keep in mind if the doctor prescribes anti-virals, I would really welcome the suggestions by you as I don't wanna go fal,prey to any haywire treatment.

Thanks

[stef2011]

your point is clear hbv, antivirals alone clear nothing and peginterferon immune modulators almost nothing, recent trials found sequential treatment by antivirals first for 1-3 years and peginerferon add on clear hbv in 40% cases in 1 year

you need an expert docltor to put you on this protocol otherwise if you dont have liver damage it is much better to wait for new drugs

[Nopatronas]

Thanks a ton for your valuable suggestion. Have fixed up an appointment with the doctor on Tuesday and another one on Wednesday, will update you on what they say.

Have a fabulous weekend.

[Nopatronas]

Hi I saw the doctor and he got my tests and felt that I've the virus since birth, probably contracted it from my mom. My mother got screened and is a carrier, but she has normal liver tests as well as her Anti HBS is Non-reactive. Titter<10 mIU/ml.

My tests however are as follow

LFT all within normal range. A/G Ratio1.31

HbsAg Quantifification 22665 iU/ml.

SerumAlfaFeto Protein2.06 ng/ml (normal range: 0-8.5)

Anti HBe reactive

HBeAG non-reactive

HBV DNA 1.18/(multiply) 10^5 IU/ml.

Fibroscan result

Median 6.6

IQR* 0.7

IQR*/med 11%

Success rate100%

My HbsAg genotype is awaited & have to get a CT scan.

Kindly tell me your view.

The doctor I a, seeing is. Great doctor, but he's too much into clinical research & I feel I am like a statistic to him not an individual patient. Also if Incase there's an emergency I doubt he would be available. So I am very confused whom to see.

[stef2011]

liver has no relevant damage, hbsag is too high to clear hbv on interferon so you may wait for better drugs or start tenofovir and see if hbsag goes down at least less than 10.000iu/ml in 3years so that interferon add on may have chances to clear hbv

you are also almost 40yo, it is not safe to keep high hbvdna in the range of years close to 50yo since both hcc and cirrhosis develop more around this age

[Nopatronas]

What are interferons? I am sorry I am really new to these terminologies so may sound ignorant.

The doctor when saw me the first day said that if I've it since birth then the virus hasn't done any substantial damage to me in 40 years. Now since my mother is Hep B positive it is more or less established my source of virus. Does this have any role in my treatment?

Second is the doctor and the place I am going to is of concern to me. The doctor I visited is an authority in his field, but he's way too much into research & trials. The place he sits is a Government run hospital, so kind of chaotic, I am actually looking for a doctor who can give some personal attention to me and I should not be a mere statistic to him.

Another question I've is do anti-virals harm kidneys? I don't know I am really worried and it almost feels like a trappedsituation right now.......I am extremely stressed.

The doctor also put my 13 year old in the radar in spite of us giving her immune globulin and vaccines immediately after birth. She has tested negative soone after birth and then I had to repeat her tests at the age of 7 then also she tested negative. Can someone become positive all of a sudden? Few of the questions are nerve wrecking presently.

Thank you so much & regards.

[stef2011]

we all had it since birth, hbv is cronic (chronic) only that way.adults can get it cronic (chronic) only if immune system is damaged when they get infected, this happens with drug addicts, patients taking immune suppressive drugs and so on.the percentage of adults getting it cronic (chronic) is thought to be around 5% but it is probably much less

most hbv infected have no damage at all from the virus only about 5% gets damage, cirrhosis, liver cancer and this happens after a life time around the age of 50yo

it is also possible to be infected and keep liver healthy by healthy life styles, antioxidants, proper diet.hepatitistechnologies protocol made of vitamins and antioxidants food extracted (not synthetic made in labs like most vitamins sold) can keep the liver healthy dispite infections, a patient o it since more than 6 years could regress a cirrhosis despite being infected by hbv and hcv active

interferon are immune modulators and antivirals like entecavir and tenofovir lower replication and lower liver damage, antivirals have no effect on virus infection and its clearance

by the way both you and your mother, like for most of us, are cronic (chronic) infected, both need to check liver damage by fibroscan every 6 months, being hbvdna und and alt less than 30men and 19 women cant prevent liver cancer or liver damage 100% so monitoring of damage is mandatory anyway

no antivirals make no kidneys damage on hbv patients, only those with already damaged kidneys may have problems with tenofovir and no problems with entecavir.hbv virus itself make kidneys damage and using antivirals improves kidneys function.be aware that there are no sensitive tests for kidneys damage so you may have damage but normal tests, the tests get abnormal only when 50% of the kidneys function is already gone and not while the kidneys are being damaged

if there is vaccine and protective antibody hbsab present in blood there is no way to get cronically infected, hbv is harmless for vaccinated, boost vaccine may be necessary every 10 years

[brij116]

Its very difficult to get a doctor who will give you a personalised as well as an expert guidance. You must share all your reports on this forum. People here will give you the best help. People like Stef are most knowledgeable and extermemly helpful.

Stef,
Her vit d3 was low one year back (count 16 only unit???), that time she took only 5,000 iu/week for 6 weeks. This dose is of no help and I am sure it must have deteriorated over the year.

I believe a high dose of vit d3 like 8,000 - 10,000 iu/day can help her bring down the DNA count, Fibroscan reading and may be HBSAG count also (like me). May be she should try this first, nothing to loose.

[stef2011]

thanks brij to point out nopa vit d level, i didn t notice it was 16ng/ml in the post and yes high vit d is a must for all of us, starting at 10.000iu per day and then checking monthly everything to see improvment

nopa you need to start vit d as soon as possible and then plan therapies once vit d is 80-90ng/ml (no calcium in vit d3 supplements)

[Nopatronas]

Thank you Brij & Stef for being so kind and helpful to me.

I am going to get my Vitmain D screened too. This whole series of testing actually killing my zest more than the virus. I fear one of these days that I might end up having a nervous breakdown or a cardiac arrest, I feel so scared when I go to get a test and then wait anxiously for the report and the doctors verdict which is still awaited. I know you guys are not psychotherapists but it just feels better to tell someone as I can't even share such information with my close friends out of sheer fear of stigma and lack of awareness.

Do you suggest I start the Vitamin D by myself or wait for the a docs prescription?


God Bless you both.

[stef2011]

your first poste said that:
you are on lamivir with detactable hbvdna, so you are now resistant to lamivir and have mutants, so you must take tenofovir absolutely added to lamivir.when hbvdna is und you can stop lamivir (lamivudine) if you like or keep it

you also posted vit d is 16 which is a very low quantity since it should be 80-90ng/ml to be optimum levels for hbv antiviral effect.also taking vit d once a month is not good at all

what was the quantity you were taking?if it was low you may start immediately
the best dose is vitamin d3 (only d3) 10.000iu daily until you reach serum levels 80-90ng/ml

remember to check hbsag and hbvdna every 6 months with US
remember to check vitd25oh and calcium every 3 months at least

making tests is good it makes sure you are healthy and live longer, deadly diseases have no symptoms so without tests you can go directly under the ground, on the contrary making the tests you can be sure you are keeping healthy and you have nothing to worry about

[Nopatronas]

Yes I was prescribed Lamavir like 12 years ago by a doctor, merely on the basis of me being Hep B positive. Then I took the medication for 2 days only before I went to take a 2nd opinion from a renowned Gastrologist, who got my HBV DNA checked from a lab in London (They said said they sent my samples to London as that time, apparently this test was not commonly available in India) Which he said was very normal. So I was asked to get only my LFT checked regularly which I did with almost diligence.

So I just took Lamavir for only 2 days only. That too like 12 years ago. Can that also make me resistance to the drug? I'vent been on any medication since then, except I take eltroxin 100 mg for my hypothyroidism.

Also what is the idea do the genotype test? Mine is still awaited.

[stef2011]

no dont think so, too little time, in this case jsut continue monitoring or go for the sequential treatment tdf and then intf add on when you will think it is time

hypothyroidism may affect calcium balance in this case and i am no expert on it so better to check vitd25oh and calcium every 4 weeks or refer to doctor instructions

[Nopatronas]

Thanks a ton for your valuable advice, much appreciated.

I went back to my gastrolologist with my latest HBV DNA counts, before consulting the doctor suggested by Brij. He also told me to keep monitoring my HBV DNA and LFT every 6 months even though according to medical guidelines I should be on anti-viral ASAP as he feels the benefits are that my HBV will fall but the Disadvantages were far more than the benefits as virus may mutate.

But the other doctor which was suggested by Brij actually got this battery of tests, though in my first meeting he too said, that if in 40 years this virus hasn't done any substantial damage what can it do in next 40. Again, he cautioned by saying it was too early to assess, without all the reports. I am yet to see him with my latest reports. Let's see what's his take now after all the facts and counts. Bu I am planning to start Vit D soon as it may just do me good than any harm.

[brij116]

Start vit d3 as soon as possible. You do not get 10,000 iu capsules in India. So, take Calcirol Sachet (60,000 iu) / week. It is available at all medical stores. But take it from a trusted shop as fake sachets are also present

I too took lamivir for 2 days in 2002. Again, at that time this forum helped me (probably Stef) and I stopped it immediately. So nothing to worry.

Your sumptoms "I fear one of these days that I might end up having a nervous breakdown or a cardiac arrest, I feel so scared"  are exactly the same what I used to have 6 months back. I always used to feel as if something very bad is going to happen and I may not able to continue my job, lifeless. Even later on I developed nurorological sysmptoms like my head splitting in to two parts and found difficult to walk straight. Never felt any energy to do any thing. Felt like commiting sc

Believe me all these have nothing to do anythig with your Hepatitis. Your virus levels are similar to which I have and these are too low to have any perceptible symptoms.

With my vitd3 level improved, all my symtoms (symptoms) have slowly vanished. Now, I work for 12 hrs. everyday and still feel fresh. No more of those horrible feeling. Thanks to Stef for his timely intevention. Otherwise it looked an end to me.

All you need to worry now, is how to improve your d3 level. GO full swing. Take Carcirol (60,000iu/week) for first 6 -8 weeks and then you can reduce it to an interval of 10 days.

You will feel the difference in first 3 weeks but it may take 3-6 months to become normal.

I go to ILBS just for test reports and get ther veiws, but I alway follow Stef's advice only.

Best Regards,

[brij116]

You get the test done for Vit d3 25OH and Serum Calcium also.

If your digestive system is in bad shape like what I had, you can also add Probiotics, like Becelac-pb between meals (1 capsule twice daily) + a simple B complex tablet 1 everyday with your breakfast.

Take Care.

[Nopatronas]

Brij my heart palpitates while read your very very encouraging message. You know I am perpetually teary eyed & dwell into self pity like "why me" blah....and I am a very happy go lucky person, who is always surrounded by friends, happening parties, wine etc....now I feel all this will end. I even gulped a bottle of non-alcoholic champagne yesterday just to feel better, but it seems I've got traumatized badly, perhaps time will heal & this too shall pass.

Can one exercise in the gym etc even if they are on medication etc?

I just ordered Calcirol 60,000 IU as the 98.4 chemist guy told me that 10,000 or lower doses are not available. So do you think I should check my levels first or just start? I take bilifac probiotic and supradin multi-Vit plus calOZ everyday after dinner though.

I've to get a CT scan done, even that is scaring the day lights out of me. Dr. sarin would not honor CT scan done outside ILBS, so will have to get it done from there only. For which he's asked me take some medicine 12 hours and two hours before the scan, then they will put some liquid through intravenous and do a contrast CT. Does it have any side effects?

My husband also told me today that my attitude will define my course of treatment, but mine is so bad right now.

Thank you so much Brij. I do not know you & Stef personally, but you people are God sent angles to me. Wish you and your families
It's of good health and happiness.

Regards

[Nopatronas]

Stef I read few replies from you about CT scan. Do you think it's unnessary? I am planning to get mine done its a CECT for the upper abdomen.

Best Regards

[stef2011]

no definitely not CT scan with contrast, that is needed only if US finds a focal lesion which can be a tumor but if US is ok not need of CTscan.the contrat liquid damages kidneys, DO NOT do it if US is ok

[Nopatronas]

My ultrasound was perfectly fine. Now I've takn Medrol tablet to be taken 12 hours & 2 hours prior to the contrast CT, damn! Don't doctors know its harmful for the patient? So silly, I kept asking Bout the side-effects of the ionic CT, they refused to tell me.

Will one time congrats too damage my kidneys?

[Nopatronas]

Contrast I meant. Lot of spell errors, please pardon them.

Actually now it's too late as when I revived your message, I had already Medrol. I got my scan today, report of which is still awaited. They told me to drink tons of fluids to wash of the contrast dye.

Best regards.

[stef2011]

patients just get an increase of creatinine for few days but since there are no tests to detect if a patient has kidneys damage already creatine can stay out of range longer

here in italy patients take antioxidants before and during taking contast, you can take nac,coq10 and vit c, nac especially usefull and has indications specific for this

the doses:
nac,1500-2000mg daily, better multiple doses during the day
coq10, 100-200mg
vit c if possible injection vit C, 1000-2000mg daily

all these are non prescription vitamins, you can take only nac if you like, here are the studies on the damage and prevention, if i were you i d sue the doctors, i obviously dont know laws in your conutry but in italy we sue them every day and you see reports on tv becuase they are not allowed to make any mistake and if they do they will pay very heavy for it and if they dont like this or prepare for this they can do another job

http://www.afibbers.com/atrial_fibrillation/miscellaneous/R91g.htm
http://www.yourhealthbase.com/database/a150b.htm
http://articles.mercola.com/sites/articles/archive/2000/07/23/nac-kidneys.aspx

[Nopatronas]

This is such an eye opener. I got my kidney function test done 4 days ago, which was fine. I even asked the doctor just before the CT to explain me all the side effects, as they made me sign some consent form. The doctor looked shocked & was trying to control his laughter because I believe not many patients ask questions. Doctors here think they are Gods, they make you wait like eons and then you go through battery of tests at the place of their liking. I've got my LFT itself five times in 1 month span, it's so annoying.

There are no laws as per my knowledge, except you can take them to consumer court, but since they make you sign a contract form....they kind of wash their hands off your side-effects.

I would request you to kindly explain me what is nac & coq? I've no knowledge of a lot of terms here. Really appreciate your time & patience.

Best regards

[Nopatronas]

I read online about NAC & COQ, but I won't know the trade name of the following antioxidant & co-enzymes here in India. So how do I ask for it from a chemist?

[stef2011]

they are vitamins you see full names in the links of the studies, nac is N-acetylcysteine but any pharmacy knows them

nac is very good on liver too, i take it daily in the heptech protocol for my liver damage too and take them also to prevent kidneys damage from the use of tenofovir and entecavir antivirals i take

[Nopatronas]

Hi just got my CT report. Which says Liver is normal in size, outline and attenuation with enlarged left lobe of liver. No evidence of focal lesion or IHBR dilatation is seen.

Portal vein and hepatic veins show normal contrast opacification.

Rest of the report shows normal.

Genotype is D.

Your take?

[stef2011]

that just means no cancer, no fatty liver, nothing else, thats why i hate the over use of ct scans just to stell money to people.if you were to be on early cirrhosis the scan would result the same, it can t see anything about fibrosis

geno d like mine

[ATS247]

we will all get cured just kept on waiting.... myrcludex b and rep 9 ac soon il be waiting ....just kept going !

[Nopatronas]

Is this is a spam or true. Is there really some cure for Heb B?

Kindly shed some light on it.

Regards.

[stef2011]

rep9 ac is the first hbv cure, human trials proved that since 2-3 years ago but no drug maker invests on this so it is not on the market, they are not interested to cure hbv

[brij116]

Do not take any vitamin tablets in night, else you will have sleep disorder.

You can start vit d3 without testing for it. But it's a better idea to get the initial level so that you can monitor the improvement.

You can give your blood sample to your nearest branch of Religare or any other pathological lab, they will not ask for any doctors prescription for this. Once you give the sample, your  report will come in 2-3 days, meanwhile you can start vit d3.

[Nopatronas]

Hi Stef I returned after my review with the doctor with all my reports.

Doctor said since my Fibroscan is a bit borderline, he would like to conduct a liver biopsy on me. After that they will see what stage of cirrhosis I am on. If its stage one, then he might not consider any treatment for me, but if it's stage two then he says he will have to put me on anti-virals. I did not consent for a biopsy today, so he has given me a 3 month grace to make up my mind, in the mean time he wrote on my prescription, "patient not willing for biopsy".

Kindly tell me your views on this whole episode. I don't want to jump the gun this time, like CT scan.

I am also very very afraid of biopsy for some reason.

Best Regards.

[Nopatronas]

Thanks for your kind concern Brij. I've started Vit D without any prior tests, will get it after 4 weeks.

I anyways have a very bad sleep disorder & I have to take sleep aid for it.

Kindly see my above post & give me your view too.

Best Regards

[stef2011]

melatonin will help with sleep with good general effects since it is an antioxidant

monitor fibroscan in a 3 months time, it may get lower by vit d3 and diet, with readings less than 6kpa normal liver so i dont see all that need to check biopsy and prescribe an antiviral especially with the new drugs active on hbv on trial

[Nopatronas]

Thank you very much Stef.

What are these drugs & how effective are they likely to be? Also how long can it take for these new drugs to hit the markets?

Best

[brij116]

I also feel that you should not go for liver biopsy now. See your results after vita d3 then take a call after 3 months.

melatonin will help you restore your sleep and it is better than other slipping pills. Only problem is most probably it is not available in India (I can not say about Delhi). I purchased it thu net but they put heavy custom duty. For a 5$ product, I had to pay addtional 25$ as transport and custom.

[ayaan07]

Sir in my LFT my Bilirubin is 10.5 and SGPT is 60 besides the normal range of 10 & 50, plz give me some suggestion to recover it....

[rprasad]

hi all,
i gone through all the post and it gave me courage to fight with this disease. Recently i went for blood test and found myself hbsag positive i was very scared, i dont know how did i got this infection, my parents are also very worry  about me. i really dont know what to do where to go for treatment. please suggest me and show me the path.

i had visited the doctor (gastrointeriologist) in govt hospital he suggested me to take entacavir 1 tab daily.
i m feeling a  bit pain inside my ribcage. please suggest me where to go in india.
my elisa test shows H21570