Aa
MELD Score Change
Just received a complete evaluation of my condition from Dr. Robert Gish, the Hepatologist.
Last few years my MELD score was 7, now it's 6. How's that possible? I was under the impression that this disease constantly advances, slowly or quickly.
Another interesting point: Last few years, my ALT and AST readings were in the low to mid 100's. This year, they are both no higher than 83. Normally I would contact the doctor to get this all understood, but there are two factors of why I'm asking here. First, Dr. Gish is extremely busy and very hard to get a hold of. Second, with all the brilliant minds here, I'm sure someone can answer these puzzling readings. Anybody?
Thanks,
Magnum
Last few years my MELD score was 7, now it's 6. How's that possible? I was under the impression that this disease constantly advances, slowly or quickly.
Another interesting point: Last few years, my ALT and AST readings were in the low to mid 100's. This year, they are both no higher than 83. Normally I would contact the doctor to get this all understood, but there are two factors of why I'm asking here. First, Dr. Gish is extremely busy and very hard to get a hold of. Second, with all the brilliant minds here, I'm sure someone can answer these puzzling readings. Anybody?
Thanks,
Magnum
To add what Asle said above, HE is Hepatic encephalopathy.
Hepatic encephalopathy is a worsening of brain function that occurs when the liver is no longer able to remove toxic substances in the blood. A.D.A.M.
Causes, incidence, and risk factors
Hepatic encephalopathy is caused by disorders that affect the liver. These include disorders that reduce liver function (such as cirrhosis or hepatitis) and conditions in which blood circulation does not enter the liver. The exact cause of hepatic encephalopathy is unknown.
An important job of the liver is to change toxic substances that are either made by the body or taken into the body (such as medicines) and make them harmless. However, when the liver is damaged, these "poisons" may build up in the bloodstream.
Ammonia, which is produced by the body when proteins are digested, is one of the harmful substances that is normally made harmless by the liver. Many other substances may also build up in the body if the liver is not working well. They can cause damage to the nervous system.
Hepatic encephalopathy may occur suddenly in people who previously had no liver problems when
damage occurs to the liver. More often, the condition is seen in people with chronic liver disease.
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001347/
----------------------------
It's great he is now going to USF, he should be in very good hands. Good luck and welcome to the forum
Hepatic encephalopathy is a worsening of brain function that occurs when the liver is no longer able to remove toxic substances in the blood. A.D.A.M.
Causes, incidence, and risk factors
Hepatic encephalopathy is caused by disorders that affect the liver. These include disorders that reduce liver function (such as cirrhosis or hepatitis) and conditions in which blood circulation does not enter the liver. The exact cause of hepatic encephalopathy is unknown.
An important job of the liver is to change toxic substances that are either made by the body or taken into the body (such as medicines) and make them harmless. However, when the liver is damaged, these "poisons" may build up in the bloodstream.
Ammonia, which is produced by the body when proteins are digested, is one of the harmful substances that is normally made harmless by the liver. Many other substances may also build up in the body if the liver is not working well. They can cause damage to the nervous system.
Hepatic encephalopathy may occur suddenly in people who previously had no liver problems when
damage occurs to the liver. More often, the condition is seen in people with chronic liver disease.
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001347/
----------------------------
It's great he is now going to USF, he should be in very good hands. Good luck and welcome to the forum
Welcome to the forum.
Firstly, this is a very old thread. It is best to ask your question using the brown box on the top of the page which says 'Post a Question'.
There is also a search engine for this site located on the top right hand side of this page, next to Log out, which says 'Search Medhelp'.
The entire article is at: http://www.medscape.com/viewarticle/572659_11
MELD score has been adopted since 2002 for organ allocation to patients listed for liver transplantation in the United States.[30] According to the MELD-based policy, patients with the highest score have a priority for organ allocation. More recently, MELD score has also been adopted in several European countries as well as in South America. The impact of MELD score on liver transplantation is discussed below.
Please pose your questions as new questions, and there will be people offering informed advise ASAP.
Firstly, this is a very old thread. It is best to ask your question using the brown box on the top of the page which says 'Post a Question'.
There is also a search engine for this site located on the top right hand side of this page, next to Log out, which says 'Search Medhelp'.
The entire article is at: http://www.medscape.com/viewarticle/572659_11
MELD score has been adopted since 2002 for organ allocation to patients listed for liver transplantation in the United States.[30] According to the MELD-based policy, patients with the highest score have a priority for organ allocation. More recently, MELD score has also been adopted in several European countries as well as in South America. The impact of MELD score on liver transplantation is discussed below.
Please pose your questions as new questions, and there will be people offering informed advise ASAP.
Would someone mind telling me what a HE and MELD scores are/means? My boyfriend has Hep c and stage 4 liver disease and hasn't had very good care (in my opinion). he's being referred to USF (we live in No. Ca) and I'm trying to understand as much as I can to support him. Right now I'm working on supporting him in a much cleaner diet. He also has Ascites.
Thank you so much. What an amazing support site this is.
Thank you so much. What an amazing support site this is.
I know this is an old thread but since my MELD dropped from 15 to 9 I'm 6 months I've been going thru old info. I guess my diet, rest and exercise have been positive influences on my particular progress. Just hope I can keep it beat back. Not on transplant list now with this score and very happy about that. Just always thinking of your particular misfortune in getting hit with the cancer. Always in the back of my mind that this too could strike me down also and just grateful for the reprieve for awhile. Hope the new treatment knocks the C out so you can get a liver.
My husband last had a blood MELD score of 7, but he could technically be 29 if he get declared eligible for listing (stage 2 hcc give him 22 added points).
"I just looked mine up, it's 1.1. I take it that's not too good? "
I dunno about that. I think 1.0 might be the norm - and if there were much difference between 1.0 and 1.1, then I'm guessing a finer gradient might have been used in the scale.
I dunno about that. I think 1.0 might be the norm - and if there were much difference between 1.0 and 1.1, then I'm guessing a finer gradient might have been used in the scale.
Magnum, I was wondering exactly how they computed MELD and so went to wikipedia. It's a brief but interesting read;
http://en.wikipedia.org/wiki/Model_for_End-Stage_Liver_Disease
I too figured that generally the blood values can vary from day to day and hour to hour; it's not like a biopsy where actual tissue is analyzed.
I was also hoping that your diet and supplements may be helping you. Yes, we may assume that in general the liver disease and damage is cumulative, but possibly (or possibly for some people) the diet, supplements, antifibrotics could make a difference. I hope that is the situation in your case.
Hector, I don't know how soon that the results of the stat-c drug trials will be public. It could be soon for Vertex, even if it were preliminary; seems like their trial (TVR and VX-222 and arms w/ and w/o IFN and RBV)) started in the spring.
The other stat-c drug trial but if memory serves, it has been over a year and a half since they first dosed, and it would seem that SVR rates might soon be available, maybe at this next AASLD....... They had good results, but they started at a slower pace than Vertex.
http://www.hivandhepatitis.com/2009icr/aasld/docs/111309_a.html
My assumption would be that the Vertex trial had two more potent components and therefore might see a higher SVR rate, or may succeed with fewer add on components such as either IFN, RBV or both. It could well be that stat c TX will not tax the livers as much as current SOC. I don't know the answer but we should get some data sometime soon.
At this point we may be looking at TVR approval in 2011(I hope), and approval of the Stat-C's about 2015ish, ; )
best to you both...
Willy
http://en.wikipedia.org/wiki/Model_for_End-Stage_Liver_Disease
I too figured that generally the blood values can vary from day to day and hour to hour; it's not like a biopsy where actual tissue is analyzed.
I was also hoping that your diet and supplements may be helping you. Yes, we may assume that in general the liver disease and damage is cumulative, but possibly (or possibly for some people) the diet, supplements, antifibrotics could make a difference. I hope that is the situation in your case.
Hector, I don't know how soon that the results of the stat-c drug trials will be public. It could be soon for Vertex, even if it were preliminary; seems like their trial (TVR and VX-222 and arms w/ and w/o IFN and RBV)) started in the spring.
The other stat-c drug trial but if memory serves, it has been over a year and a half since they first dosed, and it would seem that SVR rates might soon be available, maybe at this next AASLD....... They had good results, but they started at a slower pace than Vertex.
http://www.hivandhepatitis.com/2009icr/aasld/docs/111309_a.html
My assumption would be that the Vertex trial had two more potent components and therefore might see a higher SVR rate, or may succeed with fewer add on components such as either IFN, RBV or both. It could well be that stat c TX will not tax the livers as much as current SOC. I don't know the answer but we should get some data sometime soon.
At this point we may be looking at TVR approval in 2011(I hope), and approval of the Stat-C's about 2015ish, ; )
best to you both...
Willy
That's good news Magnum. And very cool that you reached out to help Hector. My Meld has typically been a 7, but occaisionally dips into 6. Playing with the calculator I decided it's the PT-INR value of 1.1 that's holding me in 7. A 1.0 INR get's me a 6 MELD.
Best wishes to you Hector. We're all pulling for you.
Best wishes to you Hector. We're all pulling for you.
Mag -
Thanks for the kind thoughts. I figure it is outta my hands. I have no control over my blood levels. Each person's disease progresses differently. I'm planning for the worse (transplant) but hoping for the best (meds that kill the virus). Time will tell.
I agree Vertex doesn't want any potential lawsuits before the release. Makes sense even to me.
Take care. Glad you are stable despite your cirrhosis.
Hectorsf
Thanks for the kind thoughts. I figure it is outta my hands. I have no control over my blood levels. Each person's disease progresses differently. I'm planning for the worse (transplant) but hoping for the best (meds that kill the virus). Time will tell.
I agree Vertex doesn't want any potential lawsuits before the release. Makes sense even to me.
Take care. Glad you are stable despite your cirrhosis.
Hectorsf
As you received one of my messages about me trying to get you a "compassionate use" for Telaprivir through my contact at Vertex, I received an email reply from the main decision makers that your doctor needs to apply for it. However, not to discourage you, but if you remember my thread on the subject, that's what my doctor did and unfortunately the FDA said it's out of their hands and up to Vertex.
With all the lawsuit loving Americans in this country ready to sue at the drop of a hat, Vertex is reluctant to release the drug on a “compassionate use” because of a potential massive law suit, wether or not you sign a release form.
I personally think it's politics at play. In other words, they don't want to show the FDA any sort of disaster before the clinical trials are over and the NDA (New Drug Application) is submitted. I wish I had better news for you. Hang in there. As you can see, my MELD score lowered, so there is always hope. Time flies and before you know it, due to the Fast-Track NDA being submitted, you may get it by the first quarter of next year. Keeping my fingers crossed for you...
Mag
With all the lawsuit loving Americans in this country ready to sue at the drop of a hat, Vertex is reluctant to release the drug on a “compassionate use” because of a potential massive law suit, wether or not you sign a release form.
I personally think it's politics at play. In other words, they don't want to show the FDA any sort of disaster before the clinical trials are over and the NDA (New Drug Application) is submitted. I wish I had better news for you. Hang in there. As you can see, my MELD score lowered, so there is always hope. Time flies and before you know it, due to the Fast-Track NDA being submitted, you may get it by the first quarter of next year. Keeping my fingers crossed for you...
Mag
My doctor said she would treat me with Telaprevir IF my MELD stays under 20. I don't think that is going to happen based on the way my heath has deteriorated this year. That is why I have been pursuing getting listed at two liver transplant center. If things continue as they have been doing I will probably be at least in the mid 20s if not higher in a year when Telaprevir comes to market.
As everybody knows I have been waiting for Telaprevir for years. But being realistic about it, I think that option is pretty much gone for me. So only thing now is a new liver. If by some fluke my MELD stops progressing then I'll be there first in line and will sign any form even at the risk of acute liver failure during treatment. At this point I'd rather have my liver fail then hang on for year after year until I have a MELD score is in the upper 30s, which is where you have to be to get a liver here in Northern Cal.
I am glad the new meds will be out soon for everyone who is still relativity healthy. This STAT-C revolution will prevent many many patients and their families from ever having to suffer with ESLD from HCV.
If and when I get a new liver I will be treating my HCV at some point. So the advances in STAT-C meds will prevent my new liver from progressing to cirrhosis again. The future looks bright.
Hectorsf
As everybody knows I have been waiting for Telaprevir for years. But being realistic about it, I think that option is pretty much gone for me. So only thing now is a new liver. If by some fluke my MELD stops progressing then I'll be there first in line and will sign any form even at the risk of acute liver failure during treatment. At this point I'd rather have my liver fail then hang on for year after year until I have a MELD score is in the upper 30s, which is where you have to be to get a liver here in Northern Cal.
I am glad the new meds will be out soon for everyone who is still relativity healthy. This STAT-C revolution will prevent many many patients and their families from ever having to suffer with ESLD from HCV.
If and when I get a new liver I will be treating my HCV at some point. So the advances in STAT-C meds will prevent my new liver from progressing to cirrhosis again. The future looks bright.
Hectorsf
I have nothing to add but just wanted to offer my support and say I am glad for you better than stable reports.
. I do hope these PIs will be readily available by early next year. I know Trinity and of course, magnum plan to treat then. What about Hector?
frijole
. I do hope these PIs will be readily available by early next year. I know Trinity and of course, magnum plan to treat then. What about Hector?
frijole
Hey, great to hear you're doing better friend. Help is just around the corner.
Dont'cha love good news?
Dont'cha love good news?
I think it's all the positive thoughts that have been flowing your way from the forum that's what did it :D
Regardless of how I am happy you are doing better and I have to say 190 at 6' and cheating a bit with my pals ben and jerry now that's amazing ;)
Regardless of how I am happy you are doing better and I have to say 190 at 6' and cheating a bit with my pals ben and jerry now that's amazing ;)
I have nothing of substance to add. I agree with Bill and Hector and Trinity.
I only want to say that I am happy to see that you're doing so well. I always like to see enzymes decrease even though I know they can fluctuate.
Stay well Magnum and stay happy.
Good luck,
Mike
I only want to say that I am happy to see that you're doing so well. I always like to see enzymes decrease even though I know they can fluctuate.
Stay well Magnum and stay happy.
Good luck,
Mike
Hi Magnum!
MELD scores very all the time. Because blood test values vary over time. In this case INR, bilirubin and creatinine. As you can see with your AST and ALT. When MELD reaches higher numbers it is common to have MELD measured for often as this will affect priority on the transplant list..
Lab Test Frequency
* MELD score greater than or equal to 25; Labs needed every 7 days
* MELD score 24-19; Labs needed every 30 days
* MELD score 18-11; Labs needed every 90 days
* MELD score less than or equal to 10; Labs needed every year
Today I happen to be looking through my copies of my doctor's tests and notes for the last 3 years. My blood test numbers vary constantly. Although I can see the trend over time as more and more values are out of range.
Slice of pizza?! Your killing me!!! If I ate pizza I'd look like I was pregnant with twins in two days (thanks ascites!) from the salt. I'd gain about 10 lbs in fluid. Yuck!
MELD= 6! Your a lucky man indeed! I was at 15 most of the year and now at 18. Sux!
Whatever your doing keep doing it. Just avoid any obvious things that are toxic to the liver. Anesthesia was what started my decompensation. Many people don't know that anesthesia and liver disease don't mix and with advanced cirrhosis it can cause liver failure. I had cancer so it wasn't like I had a choice to operate or not. No nose jobs, liposuction for me. Shucks!
Stay stable and healthy...and enjoy your pizza!
Hectorsf
MELD scores very all the time. Because blood test values vary over time. In this case INR, bilirubin and creatinine. As you can see with your AST and ALT. When MELD reaches higher numbers it is common to have MELD measured for often as this will affect priority on the transplant list..
Lab Test Frequency
* MELD score greater than or equal to 25; Labs needed every 7 days
* MELD score 24-19; Labs needed every 30 days
* MELD score 18-11; Labs needed every 90 days
* MELD score less than or equal to 10; Labs needed every year
Today I happen to be looking through my copies of my doctor's tests and notes for the last 3 years. My blood test numbers vary constantly. Although I can see the trend over time as more and more values are out of range.
Slice of pizza?! Your killing me!!! If I ate pizza I'd look like I was pregnant with twins in two days (thanks ascites!) from the salt. I'd gain about 10 lbs in fluid. Yuck!
MELD= 6! Your a lucky man indeed! I was at 15 most of the year and now at 18. Sux!
Whatever your doing keep doing it. Just avoid any obvious things that are toxic to the liver. Anesthesia was what started my decompensation. Many people don't know that anesthesia and liver disease don't mix and with advanced cirrhosis it can cause liver failure. I had cancer so it wasn't like I had a choice to operate or not. No nose jobs, liposuction for me. Shucks!
Stay stable and healthy...and enjoy your pizza!
Hectorsf
My meld score is at 6 too according to my blood values. Very good number if you ask me.
Far as I know, he's still in the bay area and comes here once a month and wants to see me once a year. I guess that's better than wanting to see me every few months. He also states that the chances of me getting liver cancer in the next year are 3%.
As for weight, I'm glad you asked that my learned friend. He specifically said to keep my weight down. No more Ben & Jerry's (well, I cheat a little) and no more pizza (cheat again). My weight fluctuates between 190-195 at 6'0". He said that's acceptable. The 190 is minus the treats, the 195 is with treats. No math genius needed there.
Now I move on to other things he said are okay. Milk Thistle, Fish Oil with Omega3 daily, Alpha Lipoic Acid, but three times per week instead of daily, and the same applies with an additional 500mg Vitamin C, 2000iu Vitamin D3 daily and get enough sleep, stay away from anger and stress (gotta get rid of my girlfriend), and enjoy life one day at a time.
His capacity for me is evaluative. In other words, my Gastro is the director, Gish is the advisor. I guess I'm in good hands. I was worried there would be bad news, but this all sounds good. Excuse me while I go have a slice of pizza and some Ben & Jerry's. Shhhhh...
Magnum
As for weight, I'm glad you asked that my learned friend. He specifically said to keep my weight down. No more Ben & Jerry's (well, I cheat a little) and no more pizza (cheat again). My weight fluctuates between 190-195 at 6'0". He said that's acceptable. The 190 is minus the treats, the 195 is with treats. No math genius needed there.
Now I move on to other things he said are okay. Milk Thistle, Fish Oil with Omega3 daily, Alpha Lipoic Acid, but three times per week instead of daily, and the same applies with an additional 500mg Vitamin C, 2000iu Vitamin D3 daily and get enough sleep, stay away from anger and stress (gotta get rid of my girlfriend), and enjoy life one day at a time.
His capacity for me is evaluative. In other words, my Gastro is the director, Gish is the advisor. I guess I'm in good hands. I was worried there would be bad news, but this all sounds good. Excuse me while I go have a slice of pizza and some Ben & Jerry's. Shhhhh...
Magnum
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.
