Aa
Liver biopsy?
I go to get a liver biopsy done next week. I'm not looking forward to it, but I don't suppose anybody does.
I've had Genotype 3a for several years, but just saw the doctor today to ask about the new oral meds. He said they weren't out yet, then corrected himself when he saw I had 3a. He really didn't tell me anything about what meds he's going to treat me with, only that Medicare requires a biopsy to pay for them. That if I don't have cirrhosis I'll have to be treated for 12 weeks, or for 24 weeks if I do, but from palpating my liver region he didn't think it felt like it.
My lab results were:
ALT 82 - normal is up to 53
AST 52 - normal up to 40
Billirubin and alkaline phosphatase levels were both normal
They tell me I'll have to lay still for about 3 hours after it's over, but how long does the biopsy itself take? I can't drive myself out, and have nobody that can take me, so I suppose I'll have to take a cab there and back.
I've had Genotype 3a for several years, but just saw the doctor today to ask about the new oral meds. He said they weren't out yet, then corrected himself when he saw I had 3a. He really didn't tell me anything about what meds he's going to treat me with, only that Medicare requires a biopsy to pay for them. That if I don't have cirrhosis I'll have to be treated for 12 weeks, or for 24 weeks if I do, but from palpating my liver region he didn't think it felt like it.
My lab results were:
ALT 82 - normal is up to 53
AST 52 - normal up to 40
Billirubin and alkaline phosphatase levels were both normal
They tell me I'll have to lay still for about 3 hours after it's over, but how long does the biopsy itself take? I can't drive myself out, and have nobody that can take me, so I suppose I'll have to take a cab there and back.
As for the article about Mark S. Sulkowski, MD. This was last year and he is referring to the new drugs out now.
"Platelet count can be indicative of cirrhosis if low but not necessarily."
A blood panel showed a normal white count, hemoglobin, and platelet count. The size of my red blood cells were normal at 92, and the types of my white cells were normal. And as previously stated, my billirubin and alkaline phosphatase levels were both normal.
Sodium, potassium, glucose levels, and kidney functions all normal as well. My BP stays around 120/70.
I haven't drank in 18 years, don't do drugs, don't touch Acetaminophen, am not jaundiced, and the color of my urine could usually pass for water.
I know it's asymptomatic, but I don't think I'm as sick I'm being made out to be, or have cirrhosis. At least the doctor didn't think so when he palpated my liver region.
Thank you, Pamelajean, it's the new meds that prompted me to inquire about treatment. If they'll be out within a year I'm reasonably certain I can hold out that long, and if the only way Medicare will pay for them is for me to get a biopsy I'll get one.
If I was going to settle for just anything I could have taken Interferon and Peg 18 years ago.
A blood panel showed a normal white count, hemoglobin, and platelet count. The size of my red blood cells were normal at 92, and the types of my white cells were normal. And as previously stated, my billirubin and alkaline phosphatase levels were both normal.
Sodium, potassium, glucose levels, and kidney functions all normal as well. My BP stays around 120/70.
I haven't drank in 18 years, don't do drugs, don't touch Acetaminophen, am not jaundiced, and the color of my urine could usually pass for water.
I know it's asymptomatic, but I don't think I'm as sick I'm being made out to be, or have cirrhosis. At least the doctor didn't think so when he palpated my liver region.
Thank you, Pamelajean, it's the new meds that prompted me to inquire about treatment. If they'll be out within a year I'm reasonably certain I can hold out that long, and if the only way Medicare will pay for them is for me to get a biopsy I'll get one.
If I was going to settle for just anything I could have taken Interferon and Peg 18 years ago.
My vote goes with Dr. Mark S. Sulkowski....if you tx now at the very least it's with ribivirin. All orals should be approved this fall/winter.
There is another forum where the geno 3's are waiting...no cirrhosis...for the BMS drugs that they feel have the highest success rate for 3's.
Best of Luck!
There is another forum where the geno 3's are waiting...no cirrhosis...for the BMS drugs that they feel have the highest success rate for 3's.
Best of Luck!
Your viral load has nothing to do with how damaged your liver is. Even if you do have a high viral load you could have minimal liver damage. Then again,
it could be just the opposite. You could have a low viral load and extensive liver damage. You viral load goes up and down daily. Viral loads results are beneficial right before treatment to gage you progress during treatment.
Best to you
it could be just the opposite. You could have a low viral load and extensive liver damage. You viral load goes up and down daily. Viral loads results are beneficial right before treatment to gage you progress during treatment.
Best to you
Hi kuku
Blood tests like AST and ALT do NOT correlate to the severity of your liver condition neither does viral load.
I have had Hep C since probably 1997. I was diagnosed with cirrhosis Jan 2008. The only tests I have that are out of normal are:
Platelet=99 bil/L
ALT=78 U/L
AST=54 U/L
GGT=128 U/L
AFP TUMOR MARKER=26.3 ng/mL
Platelet count can be indicative of cirrhosis if low but not necessarily. The only way to know the condition of you liver is a biopsy. That is why it is frequently refered to as "the gold standard" for diagnosis of cirrhosis.
You said “Medicare REQUIRES a biopsy to pay for them” and “That if I don't have cirrhosis I'll have to be treated for 12 weeks or for 24 weeks if I do.”
The only way they will know if you have cirrhosis is with a biopsy
My best advice to you is “Git er done”
Good luck
Lynn
Blood tests like AST and ALT do NOT correlate to the severity of your liver condition neither does viral load.
I have had Hep C since probably 1997. I was diagnosed with cirrhosis Jan 2008. The only tests I have that are out of normal are:
Platelet=99 bil/L
ALT=78 U/L
AST=54 U/L
GGT=128 U/L
AFP TUMOR MARKER=26.3 ng/mL
Platelet count can be indicative of cirrhosis if low but not necessarily. The only way to know the condition of you liver is a biopsy. That is why it is frequently refered to as "the gold standard" for diagnosis of cirrhosis.
You said “Medicare REQUIRES a biopsy to pay for them” and “That if I don't have cirrhosis I'll have to be treated for 12 weeks or for 24 weeks if I do.”
The only way they will know if you have cirrhosis is with a biopsy
My best advice to you is “Git er done”
Good luck
Lynn
I called my doctors office and spoke to the nurse to see if they had gotten the results of my blood work back yet.
She said no, they have to send that off and it would probably be a week before they got it back. I asked if they could just send it to me, and she said she'd ask, but thought it would probably have to be explained to me and the doctor would discuss it with me before I got the biopsy.
I told her I was most interested in my viral load and that my Primary Care doctor had given me the results of the blood work he had done. I read her back the results.and advised her I had been positive for 18 years, so I knew what the results indicated. and she's supposed to send them to me.
I'll go back and talk to him some more and find out exactly what his plan of treatment is before I rule out the biopsy, and if I don't dig it will look elsewhere for treatment. She did say I could take a cab out, but would need somebody to pick me up to drive me home after the biopsy.
I've seen people posting test results over the last couple days that were much higher than mine. I am just not that worried and don't think that my life hangs in the balance if I put it off a little while longer, but I also know when not to press my luck or I wouldn't have checked into treatment when I did.
She said no, they have to send that off and it would probably be a week before they got it back. I asked if they could just send it to me, and she said she'd ask, but thought it would probably have to be explained to me and the doctor would discuss it with me before I got the biopsy.
I told her I was most interested in my viral load and that my Primary Care doctor had given me the results of the blood work he had done. I read her back the results.and advised her I had been positive for 18 years, so I knew what the results indicated. and she's supposed to send them to me.
I'll go back and talk to him some more and find out exactly what his plan of treatment is before I rule out the biopsy, and if I don't dig it will look elsewhere for treatment. She did say I could take a cab out, but would need somebody to pick me up to drive me home after the biopsy.
I've seen people posting test results over the last couple days that were much higher than mine. I am just not that worried and don't think that my life hangs in the balance if I put it off a little while longer, but I also know when not to press my luck or I wouldn't have checked into treatment when I did.
I've had 3 liver biopsies: 1) 1994, 2) 2011, 3) 2013
I didn't think they hurt. My last one the doctor guided with her hands; no instrument. They have you lie there for an hour or so just to make sure nothing else was punctured and you don't have internal bleeding.
I was not very sore afterward but they give you pain medication to take at home in case you need it.
The entire test (prep, actual, post) takes about 2-3 hours. Good luck and don't be afraid.
HC
I didn't think they hurt. My last one the doctor guided with her hands; no instrument. They have you lie there for an hour or so just to make sure nothing else was punctured and you don't have internal bleeding.
I was not very sore afterward but they give you pain medication to take at home in case you need it.
The entire test (prep, actual, post) takes about 2-3 hours. Good luck and don't be afraid.
HC
I am really surprised to hear that Medicare would have this rule and if so why? As you will read below a lot of doctors are not going the biopsy route with the high cure rates anymore. If your against doing the biopsy I can't see Medicare stopping you from doing treatment as pooh stated 24 weeks is the required Tx time with or without cirrhosis. Maybe its time to stop finding reasons not to do treatment and get it over with before it becomes to late... Good luck.
Thanks to Mikesimon for this,
The Age-Old Debate of Whether to Biopsy in HCV: My Answer for 2013
Mark S. Sulkowski, MD - 1/23/2013
As Raymond T. Chung, MD, pointed out in a recent Clinical Thought, the US Centers for Disease Control and Prevention now recommend that all persons born between 1945 and 1965 undergo a 1-time screening for HCV. The idea is that this will identify persons who are infected and offer them the opportunity for management of their hepatitis C infection, in turn reducing the risk of cirrhosis, end-stage liver disease, and hepatocellular carcinoma. Management of HCV disease can include a number of things, including reduction in alcohol intake and, in some patients, reduction in body weight. It also includes consideration of HCV treatment but, in 2013, does it include a liver biopsy?
A Recent Case
A few days ago, I met a new patient who had just been diagnosed with HCV after screening by the primary care physician based on the patient’s date of birth. The test was positive prompting an effort by the patient to become highly informed about HCV and its management. At the visit, many questions were raised but the two most prominent inquiries were: 1) do I have to undergo a liver biopsy, and 2) do I need to take interferon? Not unexpectedly, the patient was not enthusiastic about either of these interventions.
"Advising the Patient
In a nutshell, my answers were: 1) no, a biopsy is not essential, and 2) maybe you will need interferon, but if your liver is in good shape, then you can wait. My response may seem a bit paradoxical—I care very much about the liver disease stage when making a decision to treat or wait but I don’t think we need a piece of liver tissue to get the information. I still recommend a fair number of liver biopsies but, with interferon-free, all-oral therapies on the near-term horizon (2014?), I am increasingly comfortable relying on patient history, physical exam, routine laboratory tests, and liver imaging as well as noninvasive serum markers to obtain a picture of liver health. In the United States, we do not yet have routine access to transient elastography but, in many regions, this would also be a mainstay of liver staging.
Identifying Minimal Disease
In any event, if all of these factors point to minimal liver disease—no history of heavy alcohol, no exam findings of cirrhosis, normal platelet count, minimally elevated ALT > AST, normal liver ultrasound, and minimal fibrosis by a commercially available fibrosis marker—I am comfortable telling the patient that we can monitor over the next year without liver biopsy and plan treatment following the FDA approval of interferon-free therapies as foreshadowed in the New England Journal of Medicine on January 3. Of course, if concerns regarding more advanced disease are found, I will take the step of recommending biopsy and/or treatment with current triple therapy."
http://www.clinicaloptions.com/Hepatitis/Treatment%20Updates/ClinicalThought/Thought11.aspx
Thanks to Mikesimon for this,
The Age-Old Debate of Whether to Biopsy in HCV: My Answer for 2013
Mark S. Sulkowski, MD - 1/23/2013
As Raymond T. Chung, MD, pointed out in a recent Clinical Thought, the US Centers for Disease Control and Prevention now recommend that all persons born between 1945 and 1965 undergo a 1-time screening for HCV. The idea is that this will identify persons who are infected and offer them the opportunity for management of their hepatitis C infection, in turn reducing the risk of cirrhosis, end-stage liver disease, and hepatocellular carcinoma. Management of HCV disease can include a number of things, including reduction in alcohol intake and, in some patients, reduction in body weight. It also includes consideration of HCV treatment but, in 2013, does it include a liver biopsy?
A Recent Case
A few days ago, I met a new patient who had just been diagnosed with HCV after screening by the primary care physician based on the patient’s date of birth. The test was positive prompting an effort by the patient to become highly informed about HCV and its management. At the visit, many questions were raised but the two most prominent inquiries were: 1) do I have to undergo a liver biopsy, and 2) do I need to take interferon? Not unexpectedly, the patient was not enthusiastic about either of these interventions.
"Advising the Patient
In a nutshell, my answers were: 1) no, a biopsy is not essential, and 2) maybe you will need interferon, but if your liver is in good shape, then you can wait. My response may seem a bit paradoxical—I care very much about the liver disease stage when making a decision to treat or wait but I don’t think we need a piece of liver tissue to get the information. I still recommend a fair number of liver biopsies but, with interferon-free, all-oral therapies on the near-term horizon (2014?), I am increasingly comfortable relying on patient history, physical exam, routine laboratory tests, and liver imaging as well as noninvasive serum markers to obtain a picture of liver health. In the United States, we do not yet have routine access to transient elastography but, in many regions, this would also be a mainstay of liver staging.
Identifying Minimal Disease
In any event, if all of these factors point to minimal liver disease—no history of heavy alcohol, no exam findings of cirrhosis, normal platelet count, minimally elevated ALT > AST, normal liver ultrasound, and minimal fibrosis by a commercially available fibrosis marker—I am comfortable telling the patient that we can monitor over the next year without liver biopsy and plan treatment following the FDA approval of interferon-free therapies as foreshadowed in the New England Journal of Medicine on January 3. Of course, if concerns regarding more advanced disease are found, I will take the step of recommending biopsy and/or treatment with current triple therapy."
http://www.clinicaloptions.com/Hepatitis/Treatment%20Updates/ClinicalThought/Thought11.aspx
I'm sorry that this has come down to getting a ride home. There has got to be volunteer services in your area. If I lived in your area I would be more than willing to come pick you up and take you. There are many others willing to give assistance. You just have to know who to call. Reach out and let some of these agencies know you need help. Your doctor, the hospital the Red Cross. I think you might find people directing you to get the help you need. Again, I'm very sorry this is stopping you from getting a biopsy you need. I can see how this can happen but there is medical transportation services, transportation for seniors and people out there willing to help. Ask!
I did not have anyone around after my biopsy. I did have a friend drive me home, but after that I was alone and I did fine.
"you will need to arrnge to have a friend ,family or a neighbour say they will be around for the next 8 hours afterwards."
I didn't even have one that could drive me 5 miles to the hospital, much less have one that can be around for the next 8 hours afterward. When I get home I'll be alone, just like always.
I could always drive myself there, say I got dropped off, then when it was time to go, pull a Houdini and disappear to drive myself home. Done it before after anesthesia, not a good idea though considering I could get a DUI. Pulling a friend out of a hat like a rabbit is beyond my skill as a prestidigitator.
I've put it off 18 years, a little longer isn't going to make that much difference, though I appreciate your concern.
I didn't even have one that could drive me 5 miles to the hospital, much less have one that can be around for the next 8 hours afterward. When I get home I'll be alone, just like always.
I could always drive myself there, say I got dropped off, then when it was time to go, pull a Houdini and disappear to drive myself home. Done it before after anesthesia, not a good idea though considering I could get a DUI. Pulling a friend out of a hat like a rabbit is beyond my skill as a prestidigitator.
I've put it off 18 years, a little longer isn't going to make that much difference, though I appreciate your concern.
I don't know why having a biopsy is proving to be such a problem. It is still the 'gold standard' of determining the state of your liver, whether you are cirrhotic etc.
A lot seems to be dependent on the results of the biopsy for you. Not only will you know where your liver is at, but you will also be able to determine how long you may have until you really need to treat, and the obvious one for you is that Medicare will pay for the treatment.
If traveling home afterwards was also going to be a problem, I'd inquire as to whether the hospital can provide the transport back. Most will, but you will need to arrnge to have a friend ,family or a neighbour say they will be around for the next 8 hours afterwards.
Biopsies experiences vary so much with each individual. I wouldn't take anyone's experience as being the norm. My 2 were very crappy, but at least I knew what was going on with my liver.
You just wouldn't want the future of your health to be compromised with your decision to put off the biopsy, now would you?
Good luck.
A lot seems to be dependent on the results of the biopsy for you. Not only will you know where your liver is at, but you will also be able to determine how long you may have until you really need to treat, and the obvious one for you is that Medicare will pay for the treatment.
If traveling home afterwards was also going to be a problem, I'd inquire as to whether the hospital can provide the transport back. Most will, but you will need to arrnge to have a friend ,family or a neighbour say they will be around for the next 8 hours afterwards.
Biopsies experiences vary so much with each individual. I wouldn't take anyone's experience as being the norm. My 2 were very crappy, but at least I knew what was going on with my liver.
You just wouldn't want the future of your health to be compromised with your decision to put off the biopsy, now would you?
Good luck.
I know it's a hassle and expense to get to this Teaching hospital but your health is too important not to try and get treatment from them. Call and schedule an appointment or ask your primary care doc to make a referral. Search the hospital/clinic website for the names of the docs that deal with liver disease/hepatitis and get an appointment ASAP. The probably have a hepatology clinic. They may, or may not want you to do a biopsy, if so get it done.
It is important to establish a relationship with a Dr. or team that will give continuity of care. In my case a PA took the lead on getting my Sovaldi/Olysio approved. I am forever grateful to her and told her so, As others here have said, you really don't want to delay treatment unless your doctor thinks its ok to wait for one of the newer meds coming out later this year. The sooner you are cured the sooner you can return to a normal lifestyle and stop the liver damage. The liver can regenerate if not too far gone.
I've only been on treatment a few weeks but these new meds (Sovalid and Olysio) or another Sovaldi combo are really working, Don't put this off, make it high priority. Just do it. Good luck and Godspeed in getting treated and cured.
It is important to establish a relationship with a Dr. or team that will give continuity of care. In my case a PA took the lead on getting my Sovaldi/Olysio approved. I am forever grateful to her and told her so, As others here have said, you really don't want to delay treatment unless your doctor thinks its ok to wait for one of the newer meds coming out later this year. The sooner you are cured the sooner you can return to a normal lifestyle and stop the liver damage. The liver can regenerate if not too far gone.
I've only been on treatment a few weeks but these new meds (Sovalid and Olysio) or another Sovaldi combo are really working, Don't put this off, make it high priority. Just do it. Good luck and Godspeed in getting treated and cured.
"Did you confer with your doctor before canceling the biopsy?"
No, I called his office and spoke with his nurse to tell her the ride I had planned on taking me fell though and I'd have to postpone and reschedule at a later date.
There is a teaching hospital of much better reputation than the hospital here, but it's about 100 miles from where I live. I think I would have a better chance at treatment there, not to mention be more confident in their doctors than the one I saw. There is one medical conglomerate that basically has things tied up here, and my primary care doctor referred me to another in the building.
I had the regular blood panel done and the results I posted supposedly wasn't that high, the rest was all in line or close to it, so except for having a potentially fatal disease, I'm pretty healthy. I've had it since 1996, haven't drank for 18 years, am not doing drugs, and try to live a healthy lifestyle for the most part, so I don't feel that pressed for time.
I was told there were new oral meds out that didn't make you sick and were considered to be the cure everyone has been waiting for, so that's what I wanted to talk to him about. He told me they weren't out yet, then yes they were for 3a, so what does he really know? He didn't even know I was 3a till I told him, and couldn't find that in my records. I have had bad experiences at this hospital, don't know this doctor, and am not going to rush into anything at this point.
I did have other more specific blood work done and should be getting those results next week, so I'll post my viral load and whatever they send me when I get it, look into the teaching hospital, getting there and back.
No, I called his office and spoke with his nurse to tell her the ride I had planned on taking me fell though and I'd have to postpone and reschedule at a later date.
There is a teaching hospital of much better reputation than the hospital here, but it's about 100 miles from where I live. I think I would have a better chance at treatment there, not to mention be more confident in their doctors than the one I saw. There is one medical conglomerate that basically has things tied up here, and my primary care doctor referred me to another in the building.
I had the regular blood panel done and the results I posted supposedly wasn't that high, the rest was all in line or close to it, so except for having a potentially fatal disease, I'm pretty healthy. I've had it since 1996, haven't drank for 18 years, am not doing drugs, and try to live a healthy lifestyle for the most part, so I don't feel that pressed for time.
I was told there were new oral meds out that didn't make you sick and were considered to be the cure everyone has been waiting for, so that's what I wanted to talk to him about. He told me they weren't out yet, then yes they were for 3a, so what does he really know? He didn't even know I was 3a till I told him, and couldn't find that in my records. I have had bad experiences at this hospital, don't know this doctor, and am not going to rush into anything at this point.
I did have other more specific blood work done and should be getting those results next week, so I'll post my viral load and whatever they send me when I get it, look into the teaching hospital, getting there and back.
My advice (based on my husband's nightmare experience with end stage liver disease - transplant - post transplant complications - cirrhosis of his new liver) is do what ever it takes to get rid of this virus as soon as possible.
Get the biopsy now so the doctor can know for certain how many weeks you need to stay on treatment. If the biopsy shows you have minimal liver damage, then you may be able to wait until later in the year for other treatments in the pipeline with higher cure rates.
You are concerned about the effects of the biopsy. I am telling you, you need to be more concerned about the possibility of cirrhosis and liver cancer and how to avoid it.
Nan
Get the biopsy now so the doctor can know for certain how many weeks you need to stay on treatment. If the biopsy shows you have minimal liver damage, then you may be able to wait until later in the year for other treatments in the pipeline with higher cure rates.
You are concerned about the effects of the biopsy. I am telling you, you need to be more concerned about the possibility of cirrhosis and liver cancer and how to avoid it.
Nan
The entire insurance, Medicare, Medicaid, coverage and limitations can be very convoluted. If you have "straight" Medicare the requirements may be one thing. If you have a Medicare "advantage plan" they may differ. Posters here have given you excellent information. Pooh's explanation is spot on. Since it is likely Sovaldi may be one of the meds you would take, you may want to call their toll-free assistance line at 1-855-769-7284, They have support path specialists that can help with navigating the maze. I must say I haven't used them so I can't say from experience how helpful they are. Would be worth a try. They will probably need to know more of your clinical findings including viral load and liver panel results.
You didn't say where you lived but if near a Teaching Hospital or hospital that has a hepatology department you may wish to consider getting a referral.
All here are trying to help others, ultimately any decision you make should be an informed one between you and your doctor. I was looking today for the Medicare treatment guidelines with not a lot of success. I know another poster on this forum indicated they were approved by Medicare. Perhaps they will share their knowledge and experience? Did you confer with your doctor before canceling the biopsy? It is important to maintain a positive relationship with all the practitioners trying to help you.
Protocols and meds are rapidly changing for the better. Your doctor should be willing and able to address and explain these with your clinical history in mind. I find it helpful to get copies of records, tests etc, and/or have them posted by the doc on a secure website. Good luck, hope you get started on the path to a cure. Be well
You didn't say where you lived but if near a Teaching Hospital or hospital that has a hepatology department you may wish to consider getting a referral.
All here are trying to help others, ultimately any decision you make should be an informed one between you and your doctor. I was looking today for the Medicare treatment guidelines with not a lot of success. I know another poster on this forum indicated they were approved by Medicare. Perhaps they will share their knowledge and experience? Did you confer with your doctor before canceling the biopsy? It is important to maintain a positive relationship with all the practitioners trying to help you.
Protocols and meds are rapidly changing for the better. Your doctor should be willing and able to address and explain these with your clinical history in mind. I find it helpful to get copies of records, tests etc, and/or have them posted by the doc on a secure website. Good luck, hope you get started on the path to a cure. Be well
Liver Biopsies are like colonoscopies. Everyone is so scared that it's going to hurt really bad and be just horrible. Then you walk out of both of theses procedures like nothing happened and now your on your way to dinner. The normal liver biopsy isn't at all a big deal. Sure there are rare situations where something could happen. But those are rare. Above ( Frank J. Perrotta)
explained what you should be concerned about and what happens. Frank's advice about biopsies actually save a women's life right on this very forum. Like I said it rare something happens. Honestly, I could have gotten in my car and driven home after all three of my liver biopsies. Just like a lot of people if it was legally allowed. Reschedule that biopsy. It's important and
hardly a big deal.
Best to you
explained what you should be concerned about and what happens. Frank's advice about biopsies actually save a women's life right on this very forum. Like I said it rare something happens. Honestly, I could have gotten in my car and driven home after all three of my liver biopsies. Just like a lot of people if it was legally allowed. Reschedule that biopsy. It's important and
hardly a big deal.
Best to you
I've already called and postponed the procedure.
*insert excuses and rationalization thereof*
*insert excuses and rationalization thereof*
I'd be a bit surprised if the GI doc actually did the biopsy. You should ask the question "who?". The answer could likely be a radiologist. Local anesthesia and an ultrasound to determine target area then a jab in the back with a big needle and a click or two. No big deal except the laying around later.
I think your last remark says it all about if not now you may never.
Also without that biopsy you do not know if you can afford to wait. True a biopsy is not the most fun you could ever have but it is not the worst that could happen. Yes I felt some discomfort / pain specifically on the one where I did take a cab. The other ones I was what they call conscious sedation. You can comply with instructions ( like take a deep breath and hold it) but I did not remember the procedure for the rest. I think it is more scary at least it was for me than anything else.
Please take this opportunity to stop the virus if you can before it can cause any more harm to you and your liver
Best wishes
Lynn
Also without that biopsy you do not know if you can afford to wait. True a biopsy is not the most fun you could ever have but it is not the worst that could happen. Yes I felt some discomfort / pain specifically on the one where I did take a cab. The other ones I was what they call conscious sedation. You can comply with instructions ( like take a deep breath and hold it) but I did not remember the procedure for the rest. I think it is more scary at least it was for me than anything else.
Please take this opportunity to stop the virus if you can before it can cause any more harm to you and your liver
Best wishes
Lynn
"You should check about that cab idea"
The hospital called to do a follow-up and get more relevant details on me after I returned home from the doctors office. I advised them I did not have a ride out, and would probably have to take a cab. That didn't seem to be a problem with the person I talked to, but they did say I could postpone the procedure. Not that I don't think I'm up to driving myself out and back 3 hours after receiving minor anesthesia, but probably not the best idea.
Ribavirin was something I was trying to avoid. I believe I was offered Interferon and Ribavirin back in the day and turned it down after watching my grandmother go though chemo. I did ask what side effects would be involved and he said rash was one, so that's probably what he was referring to.
Waiting another year for the other meds isn't out of the question, since I've gone this long without treatment, and now I'm having more doubts about going through with it. That maybe I'd be better off calling around than taking the first thing handed to me, but chances are if I don't go now I never will.
The hospital called to do a follow-up and get more relevant details on me after I returned home from the doctors office. I advised them I did not have a ride out, and would probably have to take a cab. That didn't seem to be a problem with the person I talked to, but they did say I could postpone the procedure. Not that I don't think I'm up to driving myself out and back 3 hours after receiving minor anesthesia, but probably not the best idea.
Ribavirin was something I was trying to avoid. I believe I was offered Interferon and Ribavirin back in the day and turned it down after watching my grandmother go though chemo. I did ask what side effects would be involved and he said rash was one, so that's probably what he was referring to.
Waiting another year for the other meds isn't out of the question, since I've gone this long without treatment, and now I'm having more doubts about going through with it. That maybe I'd be better off calling around than taking the first thing handed to me, but chances are if I don't go now I never will.
The doctor I'm seeing is a gastroenterologist but am sure I'm not the first Hep C patient he's treated, however, it is the first time I've seen him. I think he's competent enough but don't have any affinity for him. Additional lab work was done yesterday and I'll post that when they mail it to me, that's all the relevant info I had ATM as far as my viral load and such.
I advised him first thing I wasn't too keen on the idea of a biopsy, and if I had been positive for years what was the pint? Couldn't I just go ahead and take treatments? He said nobody "wanted" to have a biopsy, and that Medicare wouldn't pay for the treatment unless I had a one, so the whole thing hangs on me having it.
It's going to be hard enough for me to make it 5 miles to the hospital and back, since they specifically stated I can't drive myself out and back and have nobody else I can depend on, much less 200 miles round trip to where they have a teaching hospital. As far as a liver specialist in my area, I'm not sure there's anyone else I can see.
It's not to late to put it off, but I don''t know to what degree I have any other viable options. I'll still have to have the biopsy at some point anyway if I'm going to take treatments, but not even that is set in stone.
I advised him first thing I wasn't too keen on the idea of a biopsy, and if I had been positive for years what was the pint? Couldn't I just go ahead and take treatments? He said nobody "wanted" to have a biopsy, and that Medicare wouldn't pay for the treatment unless I had a one, so the whole thing hangs on me having it.
It's going to be hard enough for me to make it 5 miles to the hospital and back, since they specifically stated I can't drive myself out and back and have nobody else I can depend on, much less 200 miles round trip to where they have a teaching hospital. As far as a liver specialist in my area, I'm not sure there's anyone else I can see.
It's not to late to put it off, but I don''t know to what degree I have any other viable options. I'll still have to have the biopsy at some point anyway if I'm going to take treatments, but not even that is set in stone.
A biopsy does not take long to do. Most doctors do give some medication so that you really do not feel anything. You have to be awake during the procedure, but they can give you medication which prevents you from feeling pain. My biopsy went very well. I had no problems and just had to lie in the bed for 2-3 hours afterwards. You also do not want to do any lifting for a day or two afterwards. I was a little sore for a day or two, but that was not bad.
An Ultrasound or an MRI will NOT tell you what fibrosis stage your liver is at. They may show Cirrhosis nodules, but they will not show other stages.
I would be concerned that your doctor stated that the new meds are not out yet. The new meds are out and people with all Genotypes are being treated with them. I would also be concerned that your doctor thinks 12 weeks treatment is sufficient for Genotype 3. 12 weeks of treatment for Genotype 3 is NOT sufficient. People treated for 12-16 weeks had significantly lower SVR rates than those treated for 24 weeks. A Hepatologist is preferable when treating for Hepatitis C. If you do not have Cirrhosis, then a Gastroenterologist would be okay. However, it is imperative that whoever treats you is competent and experienced and knows the appropriate protocols for treatment. If a doctor does not even know the protocols for treatment or if the medications are on the market, then I would question what else he.she does not know.
Since you are Genotype 3, the new medication protocol calls for treatment with Sofosbuvir (Sovaldi) and Ribavirin for 24 weeks whether you have Cirrhosis or not. 12 weeks is not long enough for Genotype 3. The SVR rates were low when Genotype 3 patients treated for only 12 weeks, so be sure you treat for 24 weeks whether you have Cirrhosis or not.
Here are the American Association for Study of Liver Disease (AASLD) recommendations:
"Recommended regimen for treatment-naive patients with HCV genotype 3, regardless of eligibility for IFN therapy:
Daily sofosbuvir (400 mg) and weight-based RBV (1000 mg [75 kg]) for 24 weeks is recommended for treatment-naive patients with HCV genotype 3 infection.
The VALENCE study assessed the efficacy and safety of sofosbuvir (400 mg daily) plus RBV for 24 weeks in 250 treatment-naive (42%) and treatment-experienced (58%) subjects with HCV genotype 3 infection. The overall SVR12 was 84% and was higher among treatment-naive than treatment-experienced patients (93% versus 77%, respectively). These results suggest higher response rates can be achieved with a 24-week duration of sofosbuvir plus RBV than those reported for the 12- or 16-week durations studied in the FISSION (Lawitz, 2013b) (12 weeks, SVR12: 63%), POSITRON, (Jacobson, 2013c) (12 weeks, SVR 12: 61%) and FUSION (12 weeks, SVR12: 30%, 16 weeks, SVR12: 62%) trials. The primary reason for the higher SVR with extended therapy among treatment-naive patients was a reduction in the relapse rate from 40% to 5%. In sub-analysis, response rates were similarly high among those with (n=45) and without (n=100) cirrhosis (92% and 93%, respectively)."
http://www.hcvguidelines.org/full-report/initial-treatment-hcv-infection-patients-starting-treatment
Best of luck.
An Ultrasound or an MRI will NOT tell you what fibrosis stage your liver is at. They may show Cirrhosis nodules, but they will not show other stages.
I would be concerned that your doctor stated that the new meds are not out yet. The new meds are out and people with all Genotypes are being treated with them. I would also be concerned that your doctor thinks 12 weeks treatment is sufficient for Genotype 3. 12 weeks of treatment for Genotype 3 is NOT sufficient. People treated for 12-16 weeks had significantly lower SVR rates than those treated for 24 weeks. A Hepatologist is preferable when treating for Hepatitis C. If you do not have Cirrhosis, then a Gastroenterologist would be okay. However, it is imperative that whoever treats you is competent and experienced and knows the appropriate protocols for treatment. If a doctor does not even know the protocols for treatment or if the medications are on the market, then I would question what else he.she does not know.
Since you are Genotype 3, the new medication protocol calls for treatment with Sofosbuvir (Sovaldi) and Ribavirin for 24 weeks whether you have Cirrhosis or not. 12 weeks is not long enough for Genotype 3. The SVR rates were low when Genotype 3 patients treated for only 12 weeks, so be sure you treat for 24 weeks whether you have Cirrhosis or not.
Here are the American Association for Study of Liver Disease (AASLD) recommendations:
"Recommended regimen for treatment-naive patients with HCV genotype 3, regardless of eligibility for IFN therapy:
Daily sofosbuvir (400 mg) and weight-based RBV (1000 mg [75 kg]) for 24 weeks is recommended for treatment-naive patients with HCV genotype 3 infection.
The VALENCE study assessed the efficacy and safety of sofosbuvir (400 mg daily) plus RBV for 24 weeks in 250 treatment-naive (42%) and treatment-experienced (58%) subjects with HCV genotype 3 infection. The overall SVR12 was 84% and was higher among treatment-naive than treatment-experienced patients (93% versus 77%, respectively). These results suggest higher response rates can be achieved with a 24-week duration of sofosbuvir plus RBV than those reported for the 12- or 16-week durations studied in the FISSION (Lawitz, 2013b) (12 weeks, SVR12: 63%), POSITRON, (Jacobson, 2013c) (12 weeks, SVR 12: 61%) and FUSION (12 weeks, SVR12: 30%, 16 weeks, SVR12: 62%) trials. The primary reason for the higher SVR with extended therapy among treatment-naive patients was a reduction in the relapse rate from 40% to 5%. In sub-analysis, response rates were similarly high among those with (n=45) and without (n=100) cirrhosis (92% and 93%, respectively)."
http://www.hcvguidelines.org/full-report/initial-treatment-hcv-infection-patients-starting-treatment
Best of luck.
Have an Answer?
You are reading content posted in the Hepatitis C Community
Learn about this treatable virus.
Getting tested for this viral infection.
3 key steps to getting on treatment.
4 steps to getting on therapy.
What you need to know about Hep C drugs.
How the drugs might affect you.
These tips may up your chances of a cure.
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
Condoms are the most effective way to prevent HIV and STDs.
PrEP is used by people with high risk to prevent HIV infection.
