Hep C and Staging/Grading

[Pirategold]

Do Grades and/or Stages ever decrease?  

Since the Grade measures inflamation, is it possible that healthier choices and use of natural products to improve the immune system could bring down the inflamation.  

During treatment, does the liver actually repair itself or is the Stage of Cirrosis permanent once treatment begins?

I'm still studying, but I thought someone hear can provide some quick answer to these questions as I dig through the postings and the Janis site.

Thanks,
Pirategold

[v eggie dip]

howdeee girl :)

How's everything going down there?

It's colder than a well diggers butt up here...I think we will get snow soon!

*frozen dipper* (hey that sounds lik eone of those drinks that come with a little umbrella in it)  lol

[v eggie dip]

I hope you can catch the anemia in time and have the booster drugs right away...I honestly don't know how anyone can work while on treatment...If I decide to tx at least I can stay in bed all day long if I choose to...

I see the punk kid I call my Doc on the 18th so hopefully my bx results will be there waiting...But, it's Canada and they are slow, so maybe not...

Wishing you better days...

Beth

[NYgirl]

Hey Beth!  *smiles back and waves*

Yesterday was hell - honestly didn't think I could make it from the parking lot to my desk.  But once I was here I was like ok I can do this.  Thank God I have a desk job!

At lunch everyone else went to the cafeteria and I took a nap for an hour I swear to God.  People were like oh you were sleeping so soundly I didn't want to wake you up (several people here now have figured out something is going on).

I am able to come in so I do.  It's like just a fraction more ill and I would stay home but as I've seen others say...it's like you're just not bad enough not to really take sick time.

I'm saving my sick days up just in case it gets worse...the anemia kicks in or something else.

So what is the word with you?  Now that you've had the bx any word on when you are getting the results back?  it has to have been long enough but I don't think I've seen them yet!

Debby

[dammitjanet]

Hi Beth.  Good to see you "out and about".  I've been having computer problems lately.  Just tried to email you, but the dang thing won't let me type anything in the box.  Don't know what's up with that, but I'll work on it.  It's allllways something!  DJ

[dammitjanet]

Deb - Just in case you ever need it, world's greatest excuse for calling in sick:

Employee:  I'm sorry I can't come into work today.  I have anal glaucoma.

Boss:  Anal glaucoma?

Employee:  Yeah, I just can't see my a** coming to work today!


Dare you to try it! (But hope you won't need it!)     DJ

[jmjm530]

That's odd. Five slides sounds about right for a complete set. That's how many I have. I doubt if they would put blanks in there. Whoever gave you the original slides should know.

[mikesimon]

Revenire's case indicates that it's the tx that reverses fibrosis. He is not svr but he improved his liver histology. There are examples of hbv patients improving and hcv patients improving without attaining svr. Some doctors extend treatment for patients with advanced fibrosis just for the potential histological improvement. Mike

[mikesimon]

Hey Rev it's good to be seen. I am doing okay, thanks for asking. It's funny that I almost did kill myself on a bike after becoming SVR. So I came pretty close to your doctor's story. How are you doing? Are you optimistic about the Vertex drug in development? It looks promising from what I've read and I'd invest in the co. except I don't want to jinx it and I've been known to do that once I get invested. Take care of yourself my friend. Mike

[GoofyDad]

Thanks Jim. I'll mess around with the calculator. There was a neat little stack of about 5 slides in the package I delivered. My assupmtion, upon reading in the report, was that some were H&E and some were trichrome. It could be that the slides come 5 to a pack, but they only used 2. They did only zap me twice during the biopsy procedure, if that means anything.

[jmjm530]

My opinioniations. :) SVR gives you the best chance at fibrosis regression. Tx length would be quite secondary. Not sure if anyone knows if it's the interferon that helps the regression or just diminished virus caused by inteferon. My strong guess is it's the latter in cases of SVR. Sounds like you specialist got the two biggie slides but I asked for all them from the original pathologist after the same thing happened to me. Low platelets is one marker for predicting advanced fibrosis/cirrhosi but biopsy overrides. Go to archives and search under "calculator". Full thread is "cirrhosis calculator". Read about it, plug some numbers in it, and take it for what it's worth.

-- Jim

[mikesimon]

The rule was "there is no cure for cirrhosis" and this was THE TRUTH according to all the medical experts pre interferon treatment for hep c. When it was first suggested that fibrosis and/or cirrhosis could be reversed with interferon many a voice was raised in oposition to this heresy. I would think that an alcoholic who stopped drinking would show reversal of fibrosis if the mere absence of the antagonist would effect that. But I have never heard such a thing and one would think that this was investigated time and time again. But the rule always was "there is no cure for cirrhosis". It has long been known that the liver repairs itself but it does not repair cirrhosis. At least I've never seen anything printed about it and, believe me, I've wanted desperately to find something. That's the way I see it. But I like your style Goofydad. Mike

[NYgirl]

"This disease isn't taking me without a hell of a war."

Love you revenire.  With an attitude like yours...I just can't imagine this thing not shaking in it's boots to be in your body.  You are going to beat it eventually and THEN it's going to be double the pleasure cause you will know you never gave up.

Praying for you and everybody here, we all need it!

Debby

[mikesimon]

That is a very interesting argument which pokes some nice holes in my post. Maybe recovering alcoholics do have improved histology afterall. Thanks Rev. Mike

[v eggie dip]

Hi Debby *smile*

How's it going at home and at work since you started tx?  Do you think you will be able to continue to work?


I was thinking about you and wanted to ask...

*dippity do dah!*

[GoofyDad]

Looking at the biopsy review I received from the specialist I took it to, is says the following:

"I received H&E and trichrome stain for review. TAS, iron, reticulin and special stains were not available for review...."

My question is whether the stains not provided would have normally been expected. Is he missing information that would be helpful in diagnosis, prognosis, or treatment?

Thanks,
Goofy

[GoofyDad]

Let me add just a couple more thoughts to what the other (more knowledgeable) folks have already commented.  

First, you probably have this figured out, but we normally talk about stages of fibrosis. At one end of the scale is none - at the other cirrhosis. Cirrhosis is the next progression following bridging-fibrosis. There are certain structural changes required to support a diagnosis of cirrhosis by biopsy (missing veins here, forming nodules there) but I'm sure I don't understand any of that.

I've heard it's possible to regress from cirrhosis all the way to stage 0 (upon clearing the virus) but I think that's pretty unusual. I've been staged 4-transitioning-to-5 on the ISHAK scale which is staged 0-6. A different pathologist had staged me 4-cirhosis on the 0-4 knodell scale, but I'm thinking he was just having a bad hair day or something.

Anyway, my doc gives me a 50-50 shot of going back 2 grades (probably ISHAK) if I get SVR.

We've had discussion here on whether Interferon alone can cause fibrosis reversal, but I don't think there's a consensus. In other words, in my case say I achieve SVR with either a 24 month treatment or a 48 month treatment. Would the 48 month treatment have a better likelyhood of fibrosis/cirrhosis reversal? I dunno.

Here a question for those in the know (or the opinionated anyway :-). Pre tx my bloodwork shows WBC and Plateletes falling a bit out of range to the low side. That's a fairly recent development, say 12-15 months or so. Bilirubin and Albumin are well within range. No fatty liver according to biopsy. Everyone agrees the low plateletes and WBCs result from portal hypertension. Is this a condition seen in say Bridging Fibrosis stages, or is it a strong vote cast for cirhossis? No one seemed too concerned about it at my former GI office, pre-bx. Was that simply cranial-rectal syndrome?  

[GoofyDad]

Is it not true that while under tx you were essentially virus free? I'm open to the possibility that the liver repairs itself when the virus isn't actively re-scarring the new growth. I'm starting to feel like a terrier on a porkchop here - I just can't let this go. But understanding as much as I can about the repairing mechanism is pretty important to me.

Here's another uncomforting thought. Any studies that suggest either pegylated interferon as being more anti-fibrotic than the other?

[GoofyDad]

Ya know - just on a personal note I want you to know how heavily your story weighs on me. That just plain old sucks to be undetectible for so long and then relapse.  I can't remember what caused you to extend treatment, but I can go back and look. Anyway, seeing your positive outlook is tonic indeed.

[jmjm530]

Grade can go up down w/o treatment.

Stage, which is more important, in most cases progresses or stays same  w/o treatment although the progression is very slow in most cases and depends on a lot of variables including age infected. Even cirrhosis can be reversed in many if you attain SVR (cure).  On a personal note,  I contracted hep c 37 years ago and I'm stage 2-3. I started tx 32 weeks ago.

Glad to see you're doing some research. The more you dig yourself, the more you'll find along the way. Here are two more excellent sites. The first has some really good downloads as well as webcasts.

http://www.projectsinknowledge.com/
http://www.hivandhepatitis.com/hep_c.html


-- Jim