Biospy Results Simplified

[milliehepc]

I was wondering why Doctors cannot just tell you have Stage X - Grade X.  It would seem so much more clearer then the following diagnosis:

Diagnosis:
Liver, Right Lobe: Chronic Hepatitis (Clinical HCV) with mild activity (Grade2/4).  

From below there is no grade 2/4 there is grades A,B and C. And why both 2 and 4 - does that mean 2 OUT if 4?
it continues...And Focal Bridging Fibrosis (Stage 2-3/4)

Again which one is it? Stage 2, Stage 3 or Stage 4 or all of the them.  Or do they mean I have Stage 2 - almost on 3 OUTof 4.  Hence, (Stage2-3/4).

Comments from report:
The liver architecture is focal nodular:
There is portal, periportal, septal and focal bridging fibrosis associated with mild hepatocellular regenaration.
(Trichrome and Recticulin stain)

I take that to mean that to mean that I am Stage 3 bridging fibrosis (boy I'm getting good at this lol)

A mild to moderatge inflammatory infiltrate composed of lymphocytes (with focal lymphoid aggregates formation) and pasma cells is seen in some triads and there is mild interface activity.

I gather that this is where Stage 2-3 comes in.  Sort of I'm both 2 and 3.

Minimal bile duct injury is seen; no bile duct proliferation/reaction is noted (PASD)
Lobular inflammation is spotty and numerous acidophil bodies are noted.  

  I think that it just means that I have inflammation.

Macrovesicular steatosis is seen in less than 5% of the specimen.  Ok - as I learned from Will - I have a fatty liver.  

Probably more from drinking - all you need is 10oz a week!) wow that's just two glasses of wine! (which I am giving up) (another blog).  I never knew.......

No siderosis is indentified on Iron stain.?
No alpha 1 antitrypsin globule is seen on PASD.  ?

Again, I gathered from this report that I am both Stage 2 and 3.
I am not clear on what they mean by Grade 2/4 since from the grid below GRADE should be use once you have reach Stage 4?

Stage 1 Hepatitis -- Inflammation only (hepatitis only)
Stage 2 Hepatitis -- Some scarring (fibrosis)
Stage 3 Hepatitis -- More scarring (more fibrosis)
Stage 4 Hepatitis -- LOTS of fibrosis (cirrhosis)

Once a person gets to Stage 4/Cirrhosis, there are three grades:

Grade A -- Compensated (the liver is doing all it should despite the damage; no apparent symptoms)
Grade B -- DecompensatING (the liver is beginning to not be able to do all its functions; starting to have symptoms)
Grade C -- DecompensatED (liver failure -- the liver cannot perform its own functions; lots of symptoms)

Boils down to:
1. Stage 1 = very little fibrosis
2. Stage 2 = a little more fibrosis
3. Stage 3 = bridging fibrosis
4. Stage 4 = cirrhosis  (Grade A cirrhosis)
5. Grade B cirrhosis
6. Grade C cirrhosis (ESLD)
(Complications like Ascites appear in Grade B cirrhosis)

I sure have been lucky so far - virus for 37 years - now 63.  I am glad my Doctor encouraged me to get that liver biopsy for the first time in all the years I've been Hep C (12/6 ) as I would have never known my real condition.  Being that I was asymtomatic I would have continued on my merry way without taking any concrete actions or arming myself with knowledge.  I've been reading the post today and the debates over how the decease may or may not progress faster after age 50.  Obviosly, my Hep C has indeed progressed albeit slowy and incidiously over the decades.  I am into lots of organic food and vitamins for years - but I am also into organic wine.  I love wine which I was doing on average 4 times a month UNTIL my liver biopsy and the "discovery" of what it means to have Hep C.

As always, I have learned lots (can you tell?) in the last several weeks from you all - boy - your all so darn knowlegeble and funny too - I'm blown away.  

Seeing my doctor next week - I think he will be surprise when I spring on him all of my new found knowledgeable  questions.  

Thanks all - and Good Night.

Millie
NYC

[milliehepc]

Eureka:
The was very helpful.  Fully understand now.
Thank you.
Millie

[milliehepc]

Candyce:

I like to know if you are still working?  I am concern with how it will affect me to work. From all the post I have read at the least it will be quite a challenge. I was hoping I can until I am 65 years - that would be 11/2 years away so I can stop working then fullly concentrate ont he Treatment.  
So - I don't know - not an easy decision.

They were going to put me on a trial but I needed to get my Hep A and B vacines - sure don't want to take a chance in complicating my liver further.  

Good luck - I will look out for your post.  Lots of people are starting this month.....

Thanks alot for comments - truly appreciated.  (Yes, I know - NO WINE - lol........

Millie

[milliehepc]

Will, Hector, Eureka, All: ( sorry late response was out working long day)

You cannot imagine how much I appreciate the detailed advice you have given me.  I want to assure you that your efforts will not go in vain.  I am paying meticulous attention to all of you - reading over and over to ascertain that I am internalizing the enormous amount of information.

One of the biggest hurdles for me will be is - YES - that wine organic or otherwise.  I'm pretty social and when I go out I love drinking wine.  The biopsy sure presents one with life changing issue. I have to learn to have fun without the wine.  Hey, maybe I can go to San Francisco and get some of those "brownies"  God, I need something......no pain killers, no wine, what a nightmare lol.  Vitamins - no problem I can work with that.

Next stop:  Treatment - oh God - Incevik gives you hemoroids, or as someone put it - chards of glass - Rabavirin give you rage, I forgot what gives you the dreaded rash - to name a few - the before sx and post tx.  But, I will do my  best - because I have to keep litsenting to all of you when you point out the alternative could be worst.

Hector your invaluable - Wil, Eureka, Jules, so many here - a zillion thank you.  You have just inherited a new member to the Hep C family.

Millie
NYC

[milliehepc]

Thanks Jules:  It is good to laugh helps our endorphins levels.   I have not started treatment yet - I am hoping to see if I can get into an all oral trial.  They say good things are coming in 2012 so cross fingers.

I wish you lots of luck and I'll be looking out for your post to see how your doing.  Lots of positive energy your way.

Millie
NYC

[eureka254]

You've definitely done your homework, and lots of good advice above.
You had questions regarding:

"No siderosis is indentified on Iron stain.?
No alpha 1 antitrypsin globule is seen on PASD.  ? "

Because liver fibrosis can result from other conditions besides hep c, they were checking for iron deposits within the liver tissue (screen for hemochromatosis) and metabolic genetic disease (alpha-1-antitrypsin deficiency) -- both of which can cause liver cirrhosis, but not a concern for you. :)

Remember that most liver biopsies take several core samples... because the liver is not homogenous, different samples may exhibit different degrees of fibrosis, so not unusual to have a mixed number in Stage, yourself being both 2 and 3.

In regards to Grade, that refers only to inflammation as assessed by the biopsy.  The A/B/C categorization in "grading" cirrhosis is actually called not Grade, but Class A, B, or C, technically called the Child-Turcotte-Pugh (or Child-Pugh) score -- CTP classification is not via biopsy, but is actually determined by physical exam and bloodwork results.  Hope that helps. ~eureka

[candyce1953]

Thank you orphan hawk !

[orphanedhawk]

My doctor has me taking D, and calcium.
Interferon can be hard on our bones and teeth.
You want to keep that calcium up and D helps the absorption.
I also take a multi-viamin without iron.

And believe it or not, what is good for your liver is coffee, lots of it.

[desrt]

"I was wondering why Doctors cannot just tell you have Stage X - Grade X"

Because the liver is a complex organ and the damage from viral hepatitis isn't neccessarily uniformly distributed.

[candyce1953]

Hi Millie we are the same too as Jules had said
I am 58, but have hep c 41 years with similar stage and grade to yours
I will be starting triple treatment this month
I thought about an all oral clinical trial too
But given the state of my liver and my age I am afraid to wait for the unknown. Results of trials

I figure I can do the triple now with victrellis
And if it fails to work
Then in 2 years I can go on the all orals
But I have to try to stop the progression of the disease
I think you should too

Also no wine
And watch the vitamins like Will said
I once took herbal vitamins that had what wine has in it and bit a, and it made me very sick to my stomach so I knew was too toxic for my liver

[candyce1953]

So bit d is good for livers
I am low but d on bloodwork
I take 2000 mg no calcium just d

No other vitamins
What do u think?

[willbb]

Not much to add to all the good advice and opinions above other than  just a side note about where you say you are "into organic wine and vitamins"
Good to hear you stopped the wine , and also be cautious of "what " and "how much you supplement vitamins.
This was an article(below)  I just read ,pertaining to both.
I would agree with the above that possibly starting treatment soon would be something to discuss with your doctor before any further progression .

Good luck with everything..
Will

Tip For Improving Liver Health In 2012
According to The Hepatitis Foundation International

You'll need to stop drinking completely to give your liver a break - a chance to heal, a chance to rebuild, a chance for new liver cells to grow. This means avoiding beer, wine, cocktails, champagne, and liquor in any other form. If you continue to drink, your liver will pay the price, and if your doctor is checking your liver function tests, it may be hard to determine if a change in a test means there has been damage to your liver due to the disease itself or because of the alcohol.

Vitamins

What about using antioxidant supplements such as; (beta-carotene, vitamin A, vitamin C, vitamin E, or selenium) for improving liver health?

Excessive amounts of some vitamins may be an additional source of stress to the liver that must act as a filter for the body. Mega-vitamin supplements, particularly if they contain vitamins A and D, may be harmful. Excess vitamin A is very toxic to the liver.

Reported in The Cochrane Database of Systematic Reviews 2011 Issue 3 , no beneficial evidence was found for using antioxidant supplements for the treatment of liver diseases.

Beta-carotene, vitamin A, vitamin C, and vitamin E cannot be recommended for treatment of liver diseases.

An imbalance between too much oxidative stress and too little antioxidative defence has been suggested to cause a variety of liver diseases. Therefore, antioxidant supplements (beta-carotene, vitamin A, vitamin C, vitamin E, and selenium) could have a potential role in patients with liver disease. The evidence on whether antioxidant supplements are effective in treatment of liver diseases is contradictory.

In this review treatment with antioxidant supplements of alcoholic, autoimmune, hepatitis B or hepatitis C virus liver diseases, or liver cirrhosis is assessed.

The review includes 20 randomised clinical trials. In total, 1225 participants were randomised to antioxidant supplements (beta-carotene, vitamin A, vitamin C, vitamin E, and selenium) versus placebo or no intervention. The low number of randomised participants increases the risk of random errors ('play of chance'). Trial quality was low and accordingly the risk of systematic errors ('bias') was high.

Based on the conducted randomised clinical trials, convincing evidence that beta-carotene, vitamin A, vitamin C, and vitamin E or their combinations are beneficial for treatment of alcoholic, autoimmune, hepatitis B or hepatitis C virus liver diseases, or liver cirrhosis could not be found.
View the abstract here.

What about vitamin D ?

In the January 2012 hepatitis C newsletter from HCV Advocate a study on vitamin D3 supplementation was highlighted, more below, click here to view the abstract.

Article

Vitamin D: An Innate Antiviral Agent Suppressing Hepatitis C Virus in Human Hepatocyte –
Gal-Tanamy M, Bachmetov L, Ravid A, Koren R, Erman A, Tur-Kaspa1R, Zemel R. Source: Hepatology; Volume 54, Issue 5, pages 1570–1579, November 2011.

This study looked at the connection between vitamin D3 supplementation and improved response rates to treatment for chronic hepatitis C virus (HCV) infection. The research showed the various pathways that vitamin D3 uses, showing the antiviral properties of vitamin D3 particularly during interferon treatment. Researchers noted that vitamin D3 combined with interferon alfa has a synergistic relationship (the drug interactions are magnified, in this case in a beneficial way).

Also noted was that vitamin D3 combined with interferon alfa decreases viral production more than interferon alfa without vitamin D3.

The Bottom Line: Vitamin D3 may have a significant impact on HCV and treatment for it.

Should People With Hepatitis Be Tested for Vitamin D ?

Presented at last years DDW, researchers reported that low levels of vitamin D were found in 64% of patients with chronic hepatitis B or hepatitis C. The study was was based on 2,312 viral hepatitis patients treated at Weill Cornell Medical Center between 2007 and 2009.

Among these patients, 395 of 2,312 had been tested for vitamin D levels. In those tested, 122 of 395 were vitamin D insufficient and 132 of 395 were vitamin D deficient.

View the complete article written by David Wild here or here.


Institute of Medicine Weighs In On Vitamin D

In 2010 the Institute of Medicine (IOM ) released new guidelines for vitamin D.

Published at Medpage

Because the IOM could not find evidence to support extraskeletal benefit for vitamin D or calcium, the authors of the report decided to base daily intake recommendations on the amount needed for the maintenance of bone health.

For calcium, they reported that children ages 1 to 3 need about 500 mg each day, and those between 4 and 8 have an average requirement of 800 mg a day. The requirement rises to 1,300 mg a day for adolescents, who experience growth spurts and enhanced bone growth, and falls back to 800 mg each day for adults up to the age of 70.

Women between 50 and 70 are exceptions; they should be receiving 1,000 mg of calcium a day, as should all adults 71 and older.

[jules2551]

Millie...I think you have my liver!  lol...I am starting tx on Jan 13 Dr did not want to wait.  So good luck on your journey

Jules

[HectorSF]

Most patients never see their biopsy report or many other tests results because it means nothing to them. It is written for the doctor to understand not the patient. Which is what all the medical terms used for. The reports of tests are given to the doctor so the physician can put them in context of everything else they know about a patient's health, make a diagnosis, and recommend any treatments if needed. I think it is good practice to have your tests results if you are interested in learning more about your illness and to be able to communicate exactly what your tests results are to others if you are on a forum and want to communicate as accurately as possible your condition. Many people come on the forum and say that their liver is "fine", "no problem", "bad" etc which is open to interruption making it impossible for us to assess a person's true health status and to be of much help as far as what options may be available to them.

The physician job is to communicate to the patient at a level the patient can understand. Patients come from all walks of life and all personalities. Some patients want to know and understand everything about their condition and many prefer to know as little as possible and they just trust to doctor to "know what they are doing" and treat them.

I believe their are two major aspects to being a good doctor.

First, they need to have the expertise and experience to understand the test results, make a diagnosis and then help the patient manage their illness whether through lifestyle changes, different therapies including medicines, and in the worse case palliative care or some combination of the above. That is why a person with a serious illness should see a specialist in the field of their illness. This is why we recommend seeing a gastroenterologist or hepatologist for someone with hepatitis and liver disease.

Secondly, a doctor needs to be able to communicate to the patient enough information so the patient can understand the nature of their condition and the options available to them. This is sometimes called "good bedside manner". As I said we are all individuals with different needs, so what my be appropriate for me may not be appropriate for you. The doctor needs to assess each patient and communicate at the correct level. Also it depends on the seriousness of the disease. A patient who is seeing a doctor for a temporary minor condition will have an entirely different level of communication with their doctor than a patient that has a life-threatening illness.

In my opinion a good doctor is one the has both qualities. Expertise in the field and empathy and compassion for the patient.

The other very important component in the relationship is us, the patients. We partner with our doctors for their medical knowledge and expertise. We need to be proactive and advocate for ourselves. If we have questions we must ask our doctor and get an answer we can understand. We should not expect the doctor to read our minds. We are paying for their services and therefore should get the services we desire and need. As easy as it is to blame the doctor, we need to step up to the plate and be involved in our diagnosis and treatment if we want to have the best outcome.

Of course if our doctor is unable to meet our needs medical or emotional we should look elsewhere (2nd opinion) for a doctor that we can communicate with.

I have been extremely lucky and am very grateful to have such a physician in charge of managing all of my hepatitis C, liver disease and liver cancer issues. And I do my part by being compliant with all medical recommends including taking my meds, staying a appreciative diet, having all my routine tests performed and maintaining my health with exercise.

Cheers!
Hector

[spectda]

grade 2/4 (2 of 4) means you have grade 2 inflammation of you liver

stage 2-3/4 (stage 2-3 of 4) means you have stage 2-3 fibrosis, probably means you are very close to stage 3 but not clearly stage 3

Not terrible and not great. Your liver should basically be functioning normally but you probably should think about treating soon to prevent more damage.

-Dave

[milliehepc]

Thanks OH:  

I see him next week.  Will ask for him to simplify in laymen's term.  When I first got them he just said I'm stage 2/3.  But, I will get more specifics.  Lots of people on the forum have taught me so much already - 100 x's more than the doctors.

Millie

[orphanedhawk]

Your doctor is supposed to meet with you and interpret the results.
A follow up appointment with my hepatologist is always scheduled along with my biopsy.
After all this time, most of the labs are still mysterious to me.