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Hep C treatment and weight loss
My husband has lost about 20 lbs while on treatment (Sovaldi/Ribavirin 24 weeks). I thought things would improve now that he's off treatment but he continues to lose weight. He is down two sizes in his pants and the latest pair I bought just a few days ago are already loose.  Has anyone experienced this and do you have any advice on how to turn things around?
His appetite is back but he is eating much less than he used to.
Thanks for your help.
Nan
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766573 tn?1365170066
That your hubby's appetite is back is a good sign things are turning around. Quite honestly it takes time like anything else. I became Hypo thryoid during treatment and I still lost weight. Not the 'good' kind of weight gain either (like, say two inches from my waist haha) but the overall gaunt kind of look where it was obvious something was up. I still haven't gained the weight back and it has been close to two years but I am healthier and working out at least.

The thing is I saw in your profile where you mentioned that your hubby is ESLD, (Stage 4 Cirrhosis) so there may be a whole different set of circumstances that apply for him ~ especially when it comes to getting certain nutrients. If one of the vets who knows about cirrhosis does not respond to this I would post on the Cirrhosis of the Liver Forum.

Best of Luck your spouse is lucky to have you :)
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He is post transplant and has cirrhosis again due to the recurrent Hep C and bile duct damage.  I just wanted to know if this loss of weight is a typical side effect of the meds or if something else may be going on. I tried giving him Boost during treatment but the high protein drink worsened his HE so I had to stop it.  I will contact his dr if he continues to lose weight.
Thanks for your response and input.
Nan
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446474 tn?1446351282
Hi Nan,

Did he suffer with nausea during treatment? That is the only common side effect that would affect weight.
Top side effects of treatment:
Fatigue
Headache
Nausea
Insomnia
Pruritus

Weight loss is seen in many patients with cirrhosis and portal hypertension. There are multiple factors in cirrhotic patients that can lead to weight loss, muscle wasting and malnutrition.

Many cirrhotic patients unintentionally follow a low calorie diet, a fact that is attributed to various complications observed in cirrhosis. For example a low protein diet in order to avoid hepatic encephalopathy often leads to poorer nutritional status.

Loss of appetite is common. Some patients have abdominal pain, nausea and bloating that can lead to a poor appetite as well as affecting the absorption of nutrients.

Portal hypertension causes poor nutrient absorption because the blood is shunted around the liver so absorption of nutrients by the liver is reduced. Portal hypertension also can cause a higher heart blood volume which can lead to some cirrhotics being considered hypermetabolic with their resting energy expenditure higher than normal so they require more calories.

Any bile issues would also affect the absorption of food.

A balanced diet of calories and protein are essential for to prevent weight loss and malnutrition. Your husband’s transplant center should have a dietitian that can help to put together a proper diet to prevent further weight loss which can be detrimental to his overall health.

I had dietary help both pre and post transplant at my center.

Please contact the transplant center and let them know about this issue before he loses any more weight.

Take care.
Hector
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Thank you, Hector.  I will definitely be contacting
the transplant center.  He has started to eat better
since stopping treatment so I do think the meds
had something to do with it even if it's not listed as
one of the side effects.
He is a just such a unique case. His HE worsened 100%
on treatment and this week he is much more consistently clearer
just taking the lactulose. I am just worried about the weight loss and will
definitely talk to the dietician and his doctor.
  Thank you for steering me in the right direction.

Nan
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Weight loss is a real issue with these Hep C drugs, as they create havoc on the endocrine system.  
I struggled to keep my weight on thru out Tx.  
Am now EOT 4 months, and my weight has started to stabilize.  Do believe the meds are responsible as the Riba has a tendency to hang on 6 months post Tx.
You might try to stick with a high fat diet using healthy fats.  Peanuts, cheese, smoothie with banana, yogurt, chicken or fish, avacodos, are just a few.
If he's not diabetic,  milkshakes, healthy muffins, sweet rolls, cheesecake, and cranberry juice (high in calories).
At this stage of the game being to thin is detremental to his health.
I would probably be not to worried as you say he has a good appetite.  The Tx regimen was fairly severe, and should settle down soon.
So very happy he was able to finish Tx
Take care
...Kim
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Thanks for the suggestions, Kim.  He was eating alot of those already but when his appetite went,  it was hard to get him to eat much at all.  I am hoping things will get better in the days ahead.  I will definitely be pushing those items at him.  :-).  I think I was worrying that something more serious was going on (HCC).  It's just been one worry after another so I just need to learn to relax and let nature take its course (with a little help from some fattening foods) now that the meds are done.  I appreciate your help.

Nan
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I don't think its the meds.  As you know I am right with you and hector and Hcc.  I am on week 28 of Sov and Riba   and I have gained weight. More than I care to.
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N:  First, I am NOT a dr and NOT trying to diagnose, but in considering what you have said, and someof my own life experiences, and what I have seen others go through recently, with meds, have you all considered that he might need a regular course of plain, unadulterated real yogurt?  If I ubderstand he has other meds besides the hepc meds.  Meds, alone or in combination can play havoc w/ our systems. when I get to where I have problems, including no appetite, I try to eat a tablespoon or so of regular, 'healthy' yogurt with all the right enzymes to help my system.  We have so many bad bacteria inour systems that them good guys need help every once in a while.  Correcting that balance will help with appetite, and he will be getting good fat/calories while doin it.  JUST A THOUGHT.  Thought I would mention it.  Pat
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N: Please forgive the lousy typing above.  I meant to say tye yogurt 3 or 4 times a day.  P
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As far as I know, my husband does not have HCC. Because of the weight loss I have been worrying that that could be the cause.  Labwork however, has only been showing improvements. The reason I think it's related to the meds is because in his case his encephalopathy was made worse while on treatment which leads to an inability to eat.  Over time (he was on treatment 6 months) that can definitely result in weight loss.  
My concern is that I don't see his appetite returning
now  that he's off treatment and his HE is much improved.
  I think Kim hit the nail on the head. It will take time to get these meds out of his system and I need to encourage him to eat things that will help put on the weight yet not set off an HE episode.

Thanks for your input, Upbeat.  These responses help me to  think  through all possibilities and figure out my next steps to help him get to a healthier life.

Patra - I don't think anyone can go wrong eating the good yogurt. I will add that to his list.  Thanks for your suggestion. Much appreciated.

Nan
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Nan...how old is your husband?  Only ask because as we get older we do start eating less normally.  

Since I started sovaldi / riba combo have lost 10#.....which is okay........I have a scale that measures my muscle and water content....I watch those daily.  I have lost a total of 30# since last winter which is okay.  Have gone down from 14 to 8.  Per doctor prior to transplant he would like to see me lose about another 20#'s ...he said it would make the transplant and recovery easier.  

I have cut out sugar, carbonated drinks, lowered sodium, no red meat....  eat little meals all day.....just make sure they are as high in protein as I can tolerate...you've got to have a balance of protein, carbs and fats....all in the proper portions.  

Have basically completely changed my way of eating...even my family are getting use to my vegetarian dishes and I eat a lot of Greek salad and yogurt....love greek yogurt...mix w a little fresh fruit.   Am a cheese freak....juice fruits and vegetables....roast vegetables.

I use to eat a lot of food....now I have to remind myself to even eat.  Am just not hungry.  On those days I just don't want to fuss making scrambled eggs or something simple I grab an Ensure protein or muscle drink....if they are really cold they aren't that bad...

But you know, my Mom who is 88 and her little group of friends all say the same thing.  She could care less about food and forces herself to keep a eating schedule.  I see it with older people with just aging and people who have gone through some kind of trauma all the time.  

They told me that I'd be able to stop with the Xifanan for the HE once I have the transplant....hope that is true.  Right now doing sovaldi / riba to rid HCV......prior to transplant.  

It will take a while for him to get back to normal....his appetite might get better...he may or may not gain weight....  You know...the body is a strange wonderful instrument....we just have to listen to the tune it is playing....

Personally I am glad for the weight loss....it compensates for the steroids they gave me years ago and I put on 60#'s....which they kept telling me to lose....steroid weight is not that easy to lose....

I wish your husband well.....you know...keep in mind your stomach is the size of your balled up fist....so a half a cup of food here...a cup there...that's why I went to eat 6 small times a day.
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He's 68.  Since he's post transplant on treatment and immunosuppressant drugs, with cirrhosis again as a result of the recurrent Hep C, I think he is just unique in how he responded to treatment.  I am praying that once these drugs are out of his system things will normalize again.  
     In your case, I agree that losing the weight in preparation for transplant is a good plan.  I so wish you SVR before transplant so you won't have to go through what he has gone through.
Thank you for your response. Much appreciated.
Nan
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