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475555 tn?1469304339

Fibroscan: Is it any good?

Hello again, fellow Medhelpers! Greetings from Buenos Aires, where we avidly await the beginning of spring. The winter down here in the Southern Hemisphere has been too long, and some people here think there won't be any summer at all this year. Global warming, melting ice caps, and all that sorta stuff. Argentines are hysterical. But it sure is unseasonably cold.

I hope I am still remembered by y'all with affection in spite of my past weird and occasionally wicked postings. I certainly haven't forgotten any of you dear people. You have been my port in the storm.

To give a quickie update, I am still without Tx, waiting for my hep MD to make up his mind what to do with me. I think these Argentine medics are kinda scared to do anything, afraid of scandal (can you see the headline: "American Tango Dancer Succumbs to Third-World Hepatitis Treatment"?).

The latest, and the real reason for this post (aside from my penchant for aggravating everyone with my dubious attempts at humor), is that they just got a Fibroscan machine at my hospital, trained a young female medic to run it, and I have been one of its first victims...er, I mean subjects.

The results are crazy and scary. It gave F2/F3. Now, just a year ago a biopsy and a FibroTC (tomography analyzed, see my images page), as well as many blood analyses and ecodopplers and whatnot, gave me as being F0/F1. How the heck can someone with almost normal hepatic enzymes (transaminases), otherwise totally normal blood tests, and scores of F0/F1 a year ago, suddenly be F2/F3? Is this possible? Is it credible? Or is their new Fibroscan machine a piece of junk, despite the cute operator?

Anybody out there with an opinion on this, my latest predicament?

All replies will be appreciated, and the one that is most helpful wins a free trip to Buenos Aires (by kayak and Moped) and three free tango lessons from yours truly (if I'm still above-ground).

Hugs.

Mike

90 Responses
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Avatar universal
Dear Sir,

Echosens is made the FibroScan machine under their brand name FibroScan.
Is their any other company manufacture such type of machine?

Regards,

Hasan
Helpful - 0
475555 tn?1469304339
Hi, Sue! You have all my best wishes for some nice cold weather there. Down here in the Southern Hemisphere we're still waiting for the spring to show up. Brrr!

Mike
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475555 tn?1469304339
Okay, I am absorbing your info and suggestions and experiences. All good stuff, gets me thinking on the right track.

BTW, why was your trial stopped at 36 weeks, apparently before the scheduled end? (I'm sure I knew this, but my memory is completely shot.)

Mike
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Avatar universal
I have never had a fibroscan as they have never been available to me in this county under my health plan.  I have however, had 4 biopsies and I know that I hate them!  

As far as the weather topic.  I'm sick of the heat!  Florida has been so hot..., it's Oct. and coming up on Nov. next week and for crying out loud, we are still in the 90's!  Enough already!  I can speak for most of us in that we are good and ready for some lower temps!  At least in the mid to lower half of the state that is!

Susan400
Helpful - 0
Avatar universal
WID beat me to it - if you participated on a trial in Argentina, it would be dictated by the requirements of the trial when it comes to tests.  You'd be tested more frequently and at sensitivities lower than regular treatment - for the most part - but certainly lower than <50. So - if you get a good trial with acceptable risks (there are always risks on a trial) then that's cool.

Aside from a trial - <50 is inadequate, yes and until recently in Canada that was the best we could get.  I think we are down to <15 now but I'm not sure about that.  Around the time I was investigating treatment, the highest our government-funded tests available to us could measure were 1.3 mil IU/mil and <50 - and that was 2008.  My trial was <15 and I can't get anything lower than that in Canada even now, I think.  Some consider <15 inadequate and I would prefer the lowest sensitivity I can get but I settled for that since I'd have to go to the U.S. for anything lower and I suppose for some that's taking a bit of a flyer.  However, I was UND at Week 6 and have stayed that way through the remainder of the 36 weeks of treatment til they pulled the trial and the subsequent nine months post treatment - I did get a test at 9 months post since they tested at 6 months and trial dictated that I get a test at six months past when I WOULD have finished treatment if the trial had continued - weird but comforting also since it was just extra cement on the SVR outcome.  So...if I had virus kicking around between 1-14 all that time - the little buggers aren't multiplying - and let's face it, they don't exist.

So apply all that to your test of <50 and when you get tested and it's a bigger flyer to take on a <50 test but let's face it, if you're detectable at 4 weeks on a <50 test, then you're detectable.  If you're not ... well it's a damn good indicator.  You could get tested at 2 weeks into treatment and that would be even more preferable.  Whatever you can do to tailor a SOC treatment in Argentina with that kind of sensitivity.  You could also see about flying to the US to get PCR's or perhaps shipping your blood out to a testing place in the US for PCR's if that's possible - perhaps there are out-of-the-box things you can do if the testing sensitivities are the issue for you.

I know when I was preparing to do regular treatment, I was also preparing to get tested in the U.S. for my starting viral load, etc.  Then the trial came along.  So I was also preparing to be creative in much the same way only my proximity to the U.S. is a little easier than yours.

Sort of similar variables to you.

So...homework. :)

You start looking for an adequate trial in Argentina.
You start investigating how you can get the PCR's you want in and out of Argentina.
Investigate a trial in the U.S.
Investigate treatment in the U.S.

Process of elimination, my dear friend.  

And apologies...I'm writing this on the fly and it's not as comprehensive as I'd like - I will come back later and add more or flesh it out more when I have had more time to think it out better, but I wanted to add at least this much.

Take care.

Trish
Helpful - 0
971268 tn?1253200799
If you participate in a trial they will have their own standard for the viral load test, and it will go lower than 50.  Most of the trial results I've read talk about >10 being the standard for UND.  So I don't think, if you participated in a trial, that they would be relying on your doctor's inadequately sensitive viral load test.
Helpful - 0
475555 tn?1469304339
I tend to agree with you, Trish. The time has about come. And I think the idea of doing a trial back in the States may very well be my best option at this point. But after five years here in Buenos Aires, it's a really hard decision to make.

How do you see a VL test that only goes down to 50U/ml working during a trial? How can you tell if and when you're SVR with such a test? Wouldn't it just be shooting in the dark?

M.
Helpful - 0
Avatar universal
And what about doing a trial in the US?  Is that possible?  You're still an American.  You might not need medicaid or insurance of any kind to do a trial in the US.  In most cases, you're getting top notch care - alot of trials are done out of major medical centres.  And as for the Medicaid, it's the doc you have and the treatment you're getting that is important.  You may qualify for the drugs to be free if you go through the drug company's assistance programs.  You put up lots of roadblocks, Mikey.  Start taking them down.

I think I'd like to see you do treatment and get it done.  I'm still not buying the F3/F4 diagnosis - even if you're there and the scenario has gotten more complicated, you can't change that, can you.  You still have to go for it and get it done and it ceases to be a matter of if but when and how.  

I'd check out both options - treatment in the US with a good medical team - pick your centre - isn't Mount Sinai where Dr. Dieterich treats out of in your 'hood? - and check out the protocol they're using in B.A.  A test of <50 is workable as long as the protocols you're being treated with are sufficient - the dosages, the testing, all that.  You can get tested sooner than 4 weeks, if they'll agree to it, to give you a good idea how you're doing up until that 4 weeks.

Anyway --- seems the time has come, don't you think?
Helpful - 0
Avatar universal
The NS3-4A serine protease enzyme and the NS5B RNA-dependent RNA polymerase enzyme are primary targets for oral antiviral agents, since both enzymes are essential for HCV replication. Unfortunately, HCV's high replication rate -- billions of copies per day -- leads to drug resistance. In fact, mutations in HCV's protease and polymerase domains have already been characterized, both in vitro and in vivo (Le Pogam 2006; Zhou 2008).

The consequences of acquiring HCV drug resistance are currently unknown; it may be a transient phenomenon since HCV does not integrate into the host cell's genome. But it is possible that mutations may confer resistance to an agent -- or an entire class of agents. Drug-resistant HCV may be less fit, but a lower replication capacity will be a scant consolation for people who have acquired a treatment-resistant virus (Mo 2005; Zhou 2007). Studies of people who have developed resistance to HCV antivirals should be performed in order to fully understand the clinical implications of HCV drug resistance.


http://www.thebody.com/content/art46370.html

"If an atheist has to go to court, do they make him swear on the Bible?"




Helpful - 0
Avatar universal
P I just means protese inhibitor......polymerase inhibitor is  a different drug ,im not sure of the short lingo for it,i think its just Poly.

Yes,ive read if you dont respond to the PI`s,you can still do the Poly.,im not 100% on this ,but ive read it
Helpful - 0
475555 tn?1469304339
You wrote: "When you do PI`s,and you dont respond,its known the virus mutates and becomes resistant to that PI.But ive heard you can still do the Polymease Inhibitor.and you can still do SOC."

Do you mean that you can still do another polymerase inhibitor?

M.

Helpful - 0
475555 tn?1469304339
I read that,too. In the enclosed brochure. But I took it to mean that if you've got hepatic insufficiency then your liver can't clear it and that it therefore stays in your system longer, not that it causes fibrosis or liver disease. It's not the same thing, I don't think.

But it is a worry. All meds are a worry when your liver's not right. I've stopped my dental work from fear of amoxyciline, a baaad antibiotic that's what they prescribe for dental surgery. It also loused up my intestines so that now I've got Irritable Bowel Syndrome. Antibiotics are nasty. So, probably, are all sorts of other drugs.

And these pill-pushers just keep pushing them. Seems like that's about all they know how to do.

Mike
Helpful - 0
475555 tn?1469304339
Thanks for your take on this, Bill. Sure, we have to take everything with a grain of salt. Still, there must be some cause for my sudden huge jump from F1 to F3/F4, and the drugs I'm taking are probably the first place to look. I have two candidates: the meds I'm on (including Valium), and the radiation from the tomographies I did for the FibroTC test. Nothing else I'm doing now is different from what I was doing always.

Mike
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475555 tn?1469304339
Thanks for the URL, Rocker.
Helpful - 0
Avatar universal
Why can't you do another trial with a PI if you've already done one?

When you do PI`s,and you dont respond,its known the virus mutates and becomes resistant to that PI.But ive heard you can still do the Polymease Inhibitor.and you can still do SOC.
Helpful - 0
Avatar universal
You have been taking valium daily you mentioned,how long have you been doing this,you may be able to relate this to how and why your BX`s differ so much.Maybe
Helpful - 0
Avatar universal
Organic changes such as leukopaenia and liver-damage of the cholostatic type with or without jaundice (icterus) have been observed in a few cases.
Helpful - 0
Avatar universal
Continual daily doses of diazepam will quickly build up to a high concentration in the body (mainly in adipose tissue), which will be far in excess of the actual dose for any given day.

Diazepam is metabolised in the liver via the cytochrome P450 enzyme system. It has a biphasic half-life of 1-2 and 2-5 days, and has several pharmacologically active metabolites. The main active metabolite of diazepam is desmethyldiazepam (also known as nordazepam or nordiazepam). Diazepam's other active metabolites include temazepam and oxazepam. These metabolites are conjugated with glucuronide, and are excreted primarily in the urine. Because of these active metabolites, the serum values of diazepam alone are not useful in predicting the effects of the drug.




http://www.medic8.com/medicines/Valium.html
Helpful - 0
971268 tn?1253200799
Roche itself says Valium use is contraindicated in patients with "severe hepatic insufficiency."  They also state that in people with chronic Hep C the half-life of the drug is increased; with cirrhosis it's increased 2-6 times.  This would personally give me pause about taking it routinely, but I guess everyone's level of caution is different.
Helpful - 0
Avatar universal
The Two Step Detox Process

The liver converts drugs in a two step process called Phase 1 and Phase 2 pathways into substances that can be more easily excreted in the urine. For most drugs the liver uses the route that will get rid of the chemical as rapidly and safely as possible but in cases where the preferred pathway is not working efficiently often other pathways can be used with the danger that it is not eliminated so quickly or efficiently. The result here is that toxin stays in the system longer, may get turned into a more toxic form or may not get completely detoxified so it can cause damage to health.



http://thedetoxspecialist.com/blog/2009/07/01/how-drugs-damage-your-liver/
Helpful - 0
87972 tn?1322661239
(Sigh…) Mike, despite the negative implications of the truncated paper posted above regarding diazepam (Valium), it continues to be prescribed worldwide to HCV patients by some of the most advanced, cutting edge clinics .

Everything we ingest has a degree of risk; our doctors weigh these risks and determine what’s in our best interest. I took alprazolam (cousin of Valium) for 15 years prior to diagnosis and treatment for HCV. I had significant liver damage, and the drug was readily approved for my continued use.

As always, beware of advice on the internet. Let these forums drive your questions, but consult your doctors for decision power—

Bill
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Avatar universal
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC301753/
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475555 tn?1469304339
Why can't you do another trial with a PI if you've already done one?
Helpful - 0
Avatar universal
Here you are ,im not trying to scare you or anything,im just trying to help

http://resources.metapress.com/pdf-preview.axd?code=q38u428408225621&size=largest
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