PART 2
4 My situation is a limited not serious example I guess
Fibertest July 2013 FS 3 FA 3 Dr says now F3/F4 probably F4 Class A,
June 2012 Biopsy Stage 2 grade 2
limited prior ULTRASOUND and 3D CT abdominal related 2010 2011 (lack of recent test)
see comment #3 April 11
http://www.medhelp.org/user_journals/show/993621/My-Hepatitis---History---Biopsies---Blood-Test---Other-Conditions-
GT2 Started SOV/RBV 1 week ago. ALT, AST dropped to normal Na dropped from 142 to 136 low sodium diet,
Message to Hep NP
66 and try to restrict salt use in my food, take Hydrochlorothiazide and drinking a little more water than usual during treatment.
I noticed in the MELD Na calculator
On Dialysis : NO, Creatinine : 1 ,Total Bilirubin: 1, INR :1, Sodium :140 or higher = Meld Na score *6
Changing just the sodium to 136 results = Meld Na score *9
* Please verify all calculations prior to clinical use.x
Do you think I should ease up on restricting salt use but not using an excessive amount? Other thoughts?
Response
I would not worry too much about the Sodium, although changing the value does affect the MELD calculation significantly, (MELD scores are valuable BUT it is a calculation and has to be taken with a grain of "sodium")
Your sodium is still within normal range, and when I looked back over the past 4 years your sodium value has fluctuated between 136 - 143 (all within normal range), it will vary a little during any given time period.
Obviously I'm not that concerned about it.
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5. Most suggestions recommend low sodium diet and at least an amount of water to stay well hydrated to prevent a lot of problems during treatment.
Does anyone have any opinions regarding the inclusion of Na in MELD for F4 Class A and/or consideration if a quite excessive consumption of water such as greater than 4 liters or about 140 oz of water a day during treatment with decreasing sodium below 140 135 etc?
6. Playing around trying different numbers INR and Creatine with 1.1 1.2 etc have some what of an effect and hardly any with Total Bilirubin
7. the http://www.livercancer.eu/calculators.html shows both MELDNa and MELD-Na It appears the MELD-Na calculator is different and shows 6.4 as aposed to 9.8 for my value of 9 with the Mayo MELD-Na calculator.
My opinion Conclusion Part 1
Don't assume much or get worried. That's a good reason why you need a excellent doctor with cirrhosis, liver, HCV, hepatology, experience and/or for decompensated cirrhosis a medical practitioner with expertise in that condition (ideally in a liver transplant center) .
What are your topic relation non medical opinions?
It is only used for people that are cirrhotic with complications arising from their liver disease. It has no meaning for folks with lesser liver disease.
"2. The lowest possible score is 6 usually mean just over 1% chance of dying in the next 3 months. So who does this apply to with HCV? "
"6" has no value for anyone without cirrhosis that has advanced to a certain point. The lowest number the MELD can go to is 6 so all folks without complete cirrhosis (meaning with at least some portal hypertension have normal liver function as shown by normal blood levels so everyone will have a MELD score of 6. So a person with stage 0 liver disease and stage 3 liver disease or even early stage 4 liver disease will all have a MELD score of 6.
Cirrhosis is usually easy to determine. Any good hepatologist or even a good gastro can tell if someone has cirrhosis by performing a simple physical exam. All they need is their hands and a stethoscope. They can tell the size of both the liver and spleen. They can feel for a hard and nodular liver and enlarged spleen both which are suspicious of cirrhosis. And they can tap to assess if there is any ascites. I've had med students do this and assess my cirrhosis correctly in 2 minutes. Diagnosing cirrhosis is not brain surgery by any means.
Only incomplete cirrhosis (meaning no to little portal hypertension can be harder to determine). But then again it makes little difference any way. What does it matter if someone has early cirrhosis without portal hypertension or with portal hypertension? The person will still be a Childs-Pugh class A. Hepatitis C treatment would be the same either way.
Only when the complications of cirrhosis start to appear (decompensation, Class B cirrhosis) does the nature of the cirrhosis substantially change.
As I said I am not sure what you are trying to determine out but for relevant results you need to use the right tools.
"5. Most suggestions recommend low sodium diet and at least an amount of water to stay well hydrated to prevent a lot of problems during treatment.
Does anyone have any opinions regarding the inclusion of Na in MELD for F4 Class A and/or consideration if a quite excessive consumption of water such as greater than 4 liters or about 140 oz of water a day during treatment with decreasing sodium below 140 135 etc? "
These factor have no effect on treatment. All that is important is that a person is healthy enough to tolerant treatment. Those with more advanced cirrhosis must be monitored more closely for signs of decompensation or liver failure. Sovaldi has already proven to to safe in patients with compensated cirrhosis.
Cheers
Hector