Dragon?

Hi I am new to this forum. Actually I am newly diagnosed. I was wondering what the dragon stands for? I just found out that I have Hep C in June. I have only been to one Dr. appointment since then. He ordered some more "detailed"(as he called it)tests,& I have a scheduled biopsy on the 26th. How long does it take to get these tests back? And do you think he is jumping the gun on the biopsy?

[mikesimon]

Dragon=hep c. Before the biopsy I'd want to know my genotype and viral load. If you are type 2 or 3 the biopsy may be a subject of discussion. There are different opinions as to the advisability of a biopsy. Some say that if you are type 2 or 3 and are intent on treating and have no other conditions that a biopsy is not warranted. If you are type 1 and have some reserve about tx (treatment with interferon and ribavirin) then a biopsy is probably indicated. Talk with your doctor about type and load etc. Good luck. Mike

[britgirl]

I personally think that it is a good idea to have a biopsy even if you are genotype 2 or 3. It is the only way of knowing how damaged your liver is. Blood tests alone cannot tell you. That way, even if the treatment fails, you will know how urgent it is to change your lifestyle, look for other possibilities.

[mikesimon]

Why not wait until after treatment? If it fails then have the biopsy. For type 2 and 3 I really question the biopsy if you are going to treat. There is a risk to the procedure and I think most of us afflicted with this virus will try to lead a healthier lifestyle regardless of the amount of liver damage. The notion that we will benefit from the knowledge gained from a biopsy is arguable unless it will impact our decision to treat. Mike

[Eyedeas]

I've gotta agree with britgirl on this.  Ultrasounds are unreliable and a biopsy is the gold standard to determine liver health.  I think you need to know that condition.  Whether or not you treat, you will then have a baseline for future decisions.  The procedure is not risk free, but the majority seem to have no complications other than a day or two of residual soreness.  Hep C is not risk free.  Get a biopsy!  Of course, that's just my opinion.

Kim

[mikesimon]

I guess we can agree to disagree. I would point out that GI.PA does not generally biopsy type 2 and 3 if they are going to treat. Mike

[Galen]

...and then you have Travisb who didn't get a bx before tx, failed to achieve SVR, and was left not knowing how much damage was mitigated by tx.  Personally, I would want to know.

[ts2010]

I'm with Mike on this one.  If you decide to do tx regardless of the results of a bx, what is the point in having the bx?

Galen, if someone has a bx, then does tx and fails, they would need a second bx to determine what damage was mitigated by tx.  So now you would have had 2 bx's and have the information about what damage was mitigated.  The question is what do you now do with that information?

[ts2010]

The above post got me to thinking of posting this question to all.

What is the logic in doing a PCR at the end of tx?  If someone clears at their 12 week or 24 week PCR and then finishes their required tx an end of tx PCR will tell you one of two things.

#1 - you still have some viral load which would mean that you had a breakthrough.

#2 - you are still undetectable in which case you need another PCR in 6 months to determine if you are still undetectable.

What is the benefit in knowing that you are undetected at the end of tx when it doesn't mean much as you still have to do another in 6 months?

All opinions are welcome.

[indyjo]

My input.... I know that type 2s and 3s respond extremely well to treatment, so most would treat regardless of biopsy results. However, if a biopsy showed that I had NO damage, I might wait  to treat until a treatment was approved that was possibly easier to tolerate and more effective. I had a biopsy before finding out the type, and at stage 2, I was motivated to do treatment regardless of type. I am type 1a by the way. I think it is important to do the biopsy to see how aggressive one needs to be. Just my input!

[willing]

blueskies: congratulations! I know it'll ring truer when those pcr results come in but in range alt sounds promising to me..

ts: good question; the only reason I can see is to distinguish "relapse" from "non-response". If your VL breaks through on your last day of tx the medicines failed to depress viral replication; if  your VL jumps after the medicine has cleared either there was too much (undetectable) VL left and/or your immune response failed to deal with replication of the remainining virus on its own. The distinction is kind of academic, but relapsers have a better chance of clearing on retreatment than non-responders.

[mikesimon]

Just to clarify: If someone is undecided about tx then a biopsy is appropriate regardless of type. But if one is a 2 or 3 and definitely going to treat then I think a biopsy is not a good idea. If you want one have one. It will probably go fine and if you positively have to know the shape of your liver then go ahead. I just don't see the point if you are going to treat and are a 2 or 3. Treat, hopefully clear and get on with your life in a healthy fashion. That's it. I'm done. Mike

[GI.PA]

Point one:  The biopsy question in type 2/3.  With response rates over 80%, I do not routinely get a biopsy pre-treatment.  However, if a patient has some issues around treatment (heart disease, depression) and I really want to know exactly what we are dealing with (and how agressive to be), then I will biopsy 2/3.  If the patients requests a biopsy, I will biopsy 2/3.  If they fail treatment, I will wait a year or so and biopsy them to determine how aggresivly we need to find another option (a study with different drugs or higher doses).

Point 2:  I get an end of treatment viral load on every patient..is it neccessary..no...Is it helpful, yes.  The data we are getting tells us there is probably a bio-chemical difference in those that breakthrough before the end of treatment and those who relapse after treatment is over.  Down the road, we may opt to re-treat these two populations differently based on this biochemical difference..I want to know where the failure was...Probably an academic point, but five years from now, I dont want to "wish" I had collected this data.

Gi.PA

[nurse12hr]

My husb. is a type 3--had a relatively low viral load (approx 1 million) pretreatment.  Did have a biopsy prior to treatment--has cirrhosis and extensive fatty liver infiltration.  Failed his first go round with a year of Infergen (this was a few years ago) to become a sustained responder with Peg Intron alone for after a year.  
But his liver 'zymes are high and still climbing.  So will find out in a couple weeks when he has another follow up visit what the heck is going on.

But I am glad he had that biopsy, 3 or no 3.  Gave us good info.  Getting another one soon.

[Galen]

Hey Lori, I am praying with you, I am sure you are going to be just fine.  You knocked the snot outa that dragon!!

[Indiana]

Your labs so far look REAL good. Now we ALL get to wait for the rest of it. Mine took 7 days.
Tell them lab people you want those results PRONTO so you can start your new job...........lap dancer.
We all want photos...........Hahahahahahahaha
Good luck.

[harley dude]

If alot of GI's don't recommend a biopsy for 2 or 3's, why is it that I'm a 2b with stage 3 fibrosis and my GI wants to treat for 48 weeks instead of 24, if he hadn't done a biopsy he would have never known I was stage 3, that doesn't make any sense, or does it.-- HD -- PS- Hope you'll all have a side free weekend.

[willing]

Hi HD, I'd guess that now that he knows you're a stage 3 he wants to throw everything at it and try to push your probability of svr from this first treatment even higher than the 75-80% you can expect as a 2b. Overall there's not much statistical evidence that those extra 24 weeks are going to make a  difference, so "in theory" your treatment should be same whether you had done the biopsy or not. However, in practice he may know of reasons why the extra time may make a difference in your case. Have a good weekend.

[harley dude]

Yea I prbably know the reason, about $50,000.00 reason in his bank account.