Aa
I need your help interpreting my numbers
I need your help interpreting this for me. I picked up my medical records to day. I am a
As I see it, if the treatment of Hepatitis was easy, no-one would need this forum. Goodness knows its tough enough for patients, and believe me its hard for Docs as well. In part, this is because there are many controversial areas, and areas in which our knowlege is sadly deficient, and decisions are based on "experience" and "gut feelings" rather than science. The natural consequence of this is that there are areas of hepatitis treatment and management generally that even experts in the specific area disagree with each other about. In some ways this is a good thing; if there was complete agreement on everything our knowlege probably woudn't progress.
I happen to be extremely conservative in my management decisions, especially about use of liver biopsy (in case you haven't noticed); in part this is through having seen the major complications of biopsy at tertiary referral centers. Other docs, with equal legitimacy, perform liver biopsies more readily. However, if I do express an opinion, I like to think I can back it up with some evidence, and where possible would cite a reference. Thats not to say I think its the ONLY legitimate approach to the problem, it just happens to be the way I am comfortable practising. Thats actually one of the great things, IMHO, about the US healthcare system (and where I practise); if the patients doesn't like the particular practise style of their Doc, they are free to get other opinions.
cheers,
Sonic
I happen to be extremely conservative in my management decisions, especially about use of liver biopsy (in case you haven't noticed); in part this is through having seen the major complications of biopsy at tertiary referral centers. Other docs, with equal legitimacy, perform liver biopsies more readily. However, if I do express an opinion, I like to think I can back it up with some evidence, and where possible would cite a reference. Thats not to say I think its the ONLY legitimate approach to the problem, it just happens to be the way I am comfortable practising. Thats actually one of the great things, IMHO, about the US healthcare system (and where I practise); if the patients doesn't like the particular practise style of their Doc, they are free to get other opinions.
cheers,
Sonic
I agree with "Missy" and telling a doctor that "he might not know what he is talking about", when the poster obviously does not know what he is talking about, is not the way to help this discussion group. We are very lucky the few times doctors stop by here to ofter another perspective, and my guess is that in most cases the reason they leave is from this sort of disrespectful intercourse. You can disagree and voice your own opinions without being disrespectful and without mischaracterizing what someone says.
-- Jim
-- Jim
Look, any chance we can get back to the topic? There are some people who read this forum for medical help and information, not to read tedious ego-driven posturing.
No-one, certainly not me (I have written or co-authored scientific articles about liver biopsy), debates that fact that a liver biopsy is the best currently available tool to assess whether or not the liver is damaged and to quantify the degree of that damage.
But the point I was making, which is quite different, is that not everyone with HCV NEEDS a biopsy; certainly those individuals with genotype 2 HCV present for < 10 years have both an extremely low risk of cirrhosis (<0.5%) and an extremely HIGH probability (~90%) of clearing the virus with treatment. In this setting, as with all other patients with HCV, the prevention of further liver damage due to HCV is PRIMARILY dependent on clearing the virus, and whether or not this occurs will be measured and confirmed by HCV PCR of serum, not further biopsies. Doing a biopsy in patients like this contributes little to their management other than exposing them to the small, but not zero, risk of biopsy (which does include death in 1 per 2-10,000 biopsies depending on the series). As stated, I have seen one person DIE from an UNECESSARY biopsy; How would you then feel if your Doc had suggested against it but you "insisted" on it, perhaps on a family memeber? Once you lacerate the right hepatic artery with a TruCut biopsy needle, as was done in this case (under ultrasound control, I might add) you are potentially in major league trouble, even if you can get to a good liver surgeon pronto.
There is also NO reason why, if needed, a biopsy couldn
No-one, certainly not me (I have written or co-authored scientific articles about liver biopsy), debates that fact that a liver biopsy is the best currently available tool to assess whether or not the liver is damaged and to quantify the degree of that damage.
But the point I was making, which is quite different, is that not everyone with HCV NEEDS a biopsy; certainly those individuals with genotype 2 HCV present for < 10 years have both an extremely low risk of cirrhosis (<0.5%) and an extremely HIGH probability (~90%) of clearing the virus with treatment. In this setting, as with all other patients with HCV, the prevention of further liver damage due to HCV is PRIMARILY dependent on clearing the virus, and whether or not this occurs will be measured and confirmed by HCV PCR of serum, not further biopsies. Doing a biopsy in patients like this contributes little to their management other than exposing them to the small, but not zero, risk of biopsy (which does include death in 1 per 2-10,000 biopsies depending on the series). As stated, I have seen one person DIE from an UNECESSARY biopsy; How would you then feel if your Doc had suggested against it but you "insisted" on it, perhaps on a family memeber? Once you lacerate the right hepatic artery with a TruCut biopsy needle, as was done in this case (under ultrasound control, I might add) you are potentially in major league trouble, even if you can get to a good liver surgeon pronto.
There is also NO reason why, if needed, a biopsy couldn
You are very appreciated and welcomed here by me!
sorry that what ever their name is has the audacity to insult you.
None of us here are Drs. and you are therefore you have my respect and anything you have said has been pretty much the same level of every Dr. I've been to and I even fired my 1st Dr. I thank you for your presence and your information. Now if you were my first Dr. I had, you would get the boot.
Please stop by as you are an asset.
Missy
sorry that what ever their name is has the audacity to insult you.
None of us here are Drs. and you are therefore you have my respect and anything you have said has been pretty much the same level of every Dr. I've been to and I even fired my 1st Dr. I thank you for your presence and your information. Now if you were my first Dr. I had, you would get the boot.
Please stop by as you are an asset.
Missy
I'm insulted on Sonic's behalf! You have grossly misrepresented all of his statements. Your perception of his help and information is way off.. It's not reality, and most of your comments could be labeled slander.Regarding our healthcare, I agree with him, and it's sad that so many people can not afford tx. They are doing without, stopping early, or coming to sites like this to seek help.
I forgive,but I guess you're very new and most of us were impressed with sonic band aid to even come here to help with his busy schedule. His information is very intelligent and very obvious that he is a doctor. There are Drs. that do things a little different ,but he was also stating that was within the medical protocol.
I don't think I need to say more.
Maybe in the future change your words around ending in a question mark. Please try to realize who you're talking to. I think we've had enough toes stepped on these days.
Peace
Missy
I don't think I need to say more.
Maybe in the future change your words around ending in a question mark. Please try to realize who you're talking to. I think we've had enough toes stepped on these days.
Peace
Missy
Sorry, I did not mean to offend you guys.(I really mean it)
I gave my opinion on topics where I was confused
I gave my opinion on topics where I was confused
1. A biopsy is the MOST efficient and EFFECTive way to find out exactly what is going on and how desperately we need to treat (or not). There is no other way to find this information out.
2. As far as I am aware - we are not allowed to have a biopsy mid-treatment. So that wouldn't be useful in the slightest bit because we are ALREADY on treatment and potentially our liver enzymes would have been lowered and half way during treatment is a VASTLY different number between some people and others.
For me treatment was 72 weeks for others it is only 24.
What good would it show at that point at all anyway?
The most ideal feature would be a biopsy BEFORE and then AFTER to see how much (if any) recovery had happened and then a year LATER to see even more.
3. Why on earth would anyone EVER give an HBV test into a vain? If an innoculation is made to go into the muscle.............well thats where they darn well better be putting it. I'd imagine a nurse could find your shoulder or your forearm easily enough.
4. I am DAMN glad I live in the US and have this healthcare system as crappy as sometimes it can truly be. Read some of the posts from NICEGUY and some others who do NOT have access to it and then you will realize how absolutely foolish that statement to the contrary is.
While it does have limitations - universal healthcare SOUNDS marvelous and in the perfect would it would be great BUT...have you ever seen how second rate it is to our system? There are serious limitations to the drugs that are allowed to be used and things like that.
Arnold Schwarenneger doesn't impress me very much in the slightest at all to use to make ANY valid point. I think he's an abusive drunken pain in the ass and can't fathom HOW that man got to be governor of anywhere except Fondleland.
2. As far as I am aware - we are not allowed to have a biopsy mid-treatment. So that wouldn't be useful in the slightest bit because we are ALREADY on treatment and potentially our liver enzymes would have been lowered and half way during treatment is a VASTLY different number between some people and others.
For me treatment was 72 weeks for others it is only 24.
What good would it show at that point at all anyway?
The most ideal feature would be a biopsy BEFORE and then AFTER to see how much (if any) recovery had happened and then a year LATER to see even more.
3. Why on earth would anyone EVER give an HBV test into a vain? If an innoculation is made to go into the muscle.............well thats where they darn well better be putting it. I'd imagine a nurse could find your shoulder or your forearm easily enough.
4. I am DAMN glad I live in the US and have this healthcare system as crappy as sometimes it can truly be. Read some of the posts from NICEGUY and some others who do NOT have access to it and then you will realize how absolutely foolish that statement to the contrary is.
While it does have limitations - universal healthcare SOUNDS marvelous and in the perfect would it would be great BUT...have you ever seen how second rate it is to our system? There are serious limitations to the drugs that are allowed to be used and things like that.
Arnold Schwarenneger doesn't impress me very much in the slightest at all to use to make ANY valid point. I think he's an abusive drunken pain in the ass and can't fathom HOW that man got to be governor of anywhere except Fondleland.
Sonic: I would be grateful...if you DO NOT EVER misrepresent what I have said again.
-------------
Sorry you're running into what happens here every day -- words being mispresented and disprectful discourse instead of a respectful exchange of ideas. I think most of us here appreciate that you're making the time to give us your unique medical perspective on some of these issues. Unfortunatly, if you continue to post here, you will continue to be misrepresented at times -- especially when your ideas are different from others or the common "wisdom". Hopefully that will not stop you from participating in the future.
Catll,
You have indeed grossly misprepresented what Sonic said, per his explanation and my own read of the mentioned posts.
Also keep in mind that in the medical community, like here, people are divided on many issues such as the need for biopsy prior to treatment. I personally may not agree with Sonic's take on the biopsy issue, but many doctors do, and to suggest that he "may not know what he's talking about" shows not only disrrespect, but a lack of knowledge on current HCV protocols. Again, I'm more pro biopsy than "Sonic" but you only have to go to the "Clinical Options" Web site to see other (U.S.) doctors more in line with Sonic's point of view, at least in selected cases.
-- Jim
-------------
Sorry you're running into what happens here every day -- words being mispresented and disprectful discourse instead of a respectful exchange of ideas. I think most of us here appreciate that you're making the time to give us your unique medical perspective on some of these issues. Unfortunatly, if you continue to post here, you will continue to be misrepresented at times -- especially when your ideas are different from others or the common "wisdom". Hopefully that will not stop you from participating in the future.
Catll,
You have indeed grossly misprepresented what Sonic said, per his explanation and my own read of the mentioned posts.
Also keep in mind that in the medical community, like here, people are divided on many issues such as the need for biopsy prior to treatment. I personally may not agree with Sonic's take on the biopsy issue, but many doctors do, and to suggest that he "may not know what he's talking about" shows not only disrrespect, but a lack of knowledge on current HCV protocols. Again, I'm more pro biopsy than "Sonic" but you only have to go to the "Clinical Options" Web site to see other (U.S.) doctors more in line with Sonic's point of view, at least in selected cases.
-- Jim
I actually said NO such thing!
The need or otherwise for a liver biopsy in ALL cases of HCV infection has been debated among liver specialists for years, and there is GENERAL agreement amongst hepatologists that it is NOT necessary in all cases: See the Practice Guidelines for management of Hepatitis C, published by the American Associaction for the Study of the Liver (AASLD) which states, in part:
https://www.aasld.org/eweb/DynamicPage.aspx?Site=AASLD3&webcode=ViralHepatitis
"Utility of Liver Biopsy
The role of liver biopsy in the management of patients
with chronic hepatitis C is currently being debated. In the
initial treatment trials of hepatitis C, a liver biopsy was
regarded as an important parameter in helping to guide
management and treatment, particularly at a time when
response to treatment was low. More recently, with the
improvement of treatment effectiveness, the value of the
liver biopsy has been questioned because of the potential
risks of the procedure and the concern of sampling error.
39 This has prompted some to challenge the need for
biopsy and to suggest that the procedure may not be necessary
as a prelude to treatment. ...."
My point is just that biopsy is UNECESSARY in ALL patients (but may be helpful in SOME, and it is certainly POTENTIALLY hazardous (as any competent Hepatologist is obliged to inform you BEFORE he / she performs one).
I DID NOT SAY biopsy halfway through treatment was the way to proceed; my statement was that IF biopsy had been obtained then the information could be useful in advising people with adverse effects of treatment as to how important continuation with therapy (and putting up with the side effects) is.
I DID not recommend HBV vaccination into the blood stream, just said it would do no harm if performed inadvertently. When HBV vaccine has been administered to HBV patients in high doses deliberately, it actually suppresses HBV replication. This is fact. See the paper by Pol, S. 1995. Immunotherapy of chronic hepatitis B by anti HBV vaccine. Biomed Pharmacother 49:105-9.for this.
I did NOT say the US healthcare system was ineffective; just that there are many people in the US who have little access to it and a more universal Healthcare system (as veing considered in California by that arch socialist, Arnold Schwarzenegger, by the way, may be helpful for some people,
Finally, I try to answer questions as rapidly as possible, and do so in a way backed by the medical and scientific literature. I would be grateful, Catll, if you DO NOT EVER misrepresent what I have said again.
The need or otherwise for a liver biopsy in ALL cases of HCV infection has been debated among liver specialists for years, and there is GENERAL agreement amongst hepatologists that it is NOT necessary in all cases: See the Practice Guidelines for management of Hepatitis C, published by the American Associaction for the Study of the Liver (AASLD) which states, in part:
https://www.aasld.org/eweb/DynamicPage.aspx?Site=AASLD3&webcode=ViralHepatitis
"Utility of Liver Biopsy
The role of liver biopsy in the management of patients
with chronic hepatitis C is currently being debated. In the
initial treatment trials of hepatitis C, a liver biopsy was
regarded as an important parameter in helping to guide
management and treatment, particularly at a time when
response to treatment was low. More recently, with the
improvement of treatment effectiveness, the value of the
liver biopsy has been questioned because of the potential
risks of the procedure and the concern of sampling error.
39 This has prompted some to challenge the need for
biopsy and to suggest that the procedure may not be necessary
as a prelude to treatment. ...."
My point is just that biopsy is UNECESSARY in ALL patients (but may be helpful in SOME, and it is certainly POTENTIALLY hazardous (as any competent Hepatologist is obliged to inform you BEFORE he / she performs one).
I DID NOT SAY biopsy halfway through treatment was the way to proceed; my statement was that IF biopsy had been obtained then the information could be useful in advising people with adverse effects of treatment as to how important continuation with therapy (and putting up with the side effects) is.
I DID not recommend HBV vaccination into the blood stream, just said it would do no harm if performed inadvertently. When HBV vaccine has been administered to HBV patients in high doses deliberately, it actually suppresses HBV replication. This is fact. See the paper by Pol, S. 1995. Immunotherapy of chronic hepatitis B by anti HBV vaccine. Biomed Pharmacother 49:105-9.for this.
I did NOT say the US healthcare system was ineffective; just that there are many people in the US who have little access to it and a more universal Healthcare system (as veing considered in California by that arch socialist, Arnold Schwarzenegger, by the way, may be helpful for some people,
Finally, I try to answer questions as rapidly as possible, and do so in a way backed by the medical and scientific literature. I would be grateful, Catll, if you DO NOT EVER misrepresent what I have said again.
Maybe it's just being gone for a few days, but some of the threads lately sure seem a bit strange. Maybe "Willows" had a point or two, but who knows, I'm still coming off some of the drugs they gave me.
Be well,
-- Jim
Be well,
-- Jim
Just wanted to say hello. Knew something wasn't right. I've been staying busy and resting. Not too much computer other than the last few days, but I didn't see any of your post. Now I understand. I hope you're ok. Take it easy.
Hope you feel better
Missy
Hope you feel better
Missy
I made the visit today and got to have a good talk with the Doctor. He compared earlier results to the ones I posted and explained even though they are still elevated, they have dropped dramatically. My SGPT was 587 and now 200. The 587 were due to the combination of Hepc, Cholesterol Meds, Blood Pressure Meds, Loratab, Jim Beam, and Miller Lite. I told him I quit taking everything but the Loratabs when I was diagnosed about 2-1/2 months ago. Since I quit drinking my Blood Pressure has been fine. Today it was 118/80. He said he could lower the dose of cholesterol meds. and keep an eye on my enzymes, I said no thanks. He said my ultrasound didn
There was no misrepresentation!
I am too new here and too busy with my HCV if I do not understand a posted item, I ask direct question. You might be a medical student, doctor, or just regular patient as me.
Could not realize that my questions offended you, sorry in advance.
I just asked for an explanation
I am too new here and too busy with my HCV if I do not understand a posted item, I ask direct question. You might be a medical student, doctor, or just regular patient as me.
Could not realize that my questions offended you, sorry in advance.
I just asked for an explanation
A doctor might not insist on a biopsy but I would. IF you have little or no liver damage you might just want to hold on for a while and see what happens with the new drugs that are coming out.
Although "2" is considered often enough the "Lucky" genotype there are plenty of people that have NOT gotten SVR on the first shot. In the olden days it was a given that because the odds were so good (80% chance of success versus the 50% for genotype 1) that all 2s should treat but...in my opinion it is definitely worth checking out whether you need to or not.
These drugs can cause long term damage - while they are a lifesaver to those of us who have extensive liver damage (I am geno 1A and 1B, treated 72 weeks, grade 2 stage 3) there are drugs that look promising and you personally might have a lot of time to wait and see if they pan out.
All else said - it's a personal decision. Even before I found out any of my biopsy info I knew I would treat...I wanted this GONE big time - but for others the last thing they want to do is treatment and so they just don't.
Either way - make sure you keep a check on your liver enzymes...that should tell you how much damage is CURRENTLY going on in your liver but it can't tell you what has ALREADY been done.
Good luck
Although "2" is considered often enough the "Lucky" genotype there are plenty of people that have NOT gotten SVR on the first shot. In the olden days it was a given that because the odds were so good (80% chance of success versus the 50% for genotype 1) that all 2s should treat but...in my opinion it is definitely worth checking out whether you need to or not.
These drugs can cause long term damage - while they are a lifesaver to those of us who have extensive liver damage (I am geno 1A and 1B, treated 72 weeks, grade 2 stage 3) there are drugs that look promising and you personally might have a lot of time to wait and see if they pan out.
All else said - it's a personal decision. Even before I found out any of my biopsy info I knew I would treat...I wanted this GONE big time - but for others the last thing they want to do is treatment and so they just don't.
Either way - make sure you keep a check on your liver enzymes...that should tell you how much damage is CURRENTLY going on in your liver but it can't tell you what has ALREADY been done.
Good luck
If for no other reason the biopsy will be for peace of mind. I did have an ultra-sound done. We will discuss that today and who knows, he may say I don
My reading of this lot is VERY positive, and I suspect you have a >90% probability of SVR with treatment. As I indicated in my previous posts, I would treat someone like this WITHOUT a biopsy, all else being equal. You have indicated yourself, very reasonably, you would proceed to treatment irrespective of the biopsy result. In this setting what does the biopsy contribute? The treatment will be modified by the serial bloodwork you will have, including early PCRs if you are seeing a Doc who believes in RVR (I do), while treatment success or failure will be determined by PCR. You obviousl have a Doc (from the bloods he/she has ordered) who is very thorough, and I'm sure will follow through with appropriate blood to ensure clearance is confirmed. In my view, in uncomplicated individuals, biopsy just adds expense and a small, but finite risk. Other docs, legitimately, take a different view.
My goodness, what kind of dr are you seeing? He's ordered more labs than I normally see, but I'm not a person that draws or looks at blood, by any means. I was looking up the different blood tests and some of the tests he ordered are tests for genetic defiencies. In other words he's looking for other possible reasons for liver disease, I guess.
The person I flagged will know more than any of us, if he happens to see this post.
Maybe the rest of the tests will be easier to read. I hope!
Bug
The person I flagged will know more than any of us, if he happens to see this post.
Maybe the rest of the tests will be easier to read. I hope!
Bug
Elaine, Been vacationing the past few days in the local hospital with a case of atrial fibrillation. (The more you know about what's going on, the scarier being in a hospital is. LOL.) Anyway, I'm back home now and doing now doing fine. Assuming my ticker keeps the correct 'time', I should be back to normal activities in a day or so. Thanks for the nice welcome.
-- Jim/Jack
-- Jim/Jack
Hope things are going to be ok. I recall you mentioned your family history. BTW, you haven't mentioned it in a while - the skin stuff resolved?
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