MRE and Front Biopsy

[48weeks]

I am in my 8th month of triple therapy formerly with Incivek and now just R and I.  I have been undetected since week 4, but my liver enzymes are still high in the 140 range.  I'm hoping this ends up normalizing at some point, but I would still like to get an idea of what shape my liver is in. The last biopsy I had was 6 years ago and showed minimal fibrosis. I have a hard time tolerating the liver biopsys from the side for some reason they are extremely painful to me.  I have had two biopsys done from the front. Comparatively they were awesome.  A couple of questions, Has anyone else had a biopsy done from the front? What was your experience? Why is it so hard to find info on a front liver biopsy? I am also interested in finding out more about the accuracy of an MRE and where is the closest place to me to get one. I am currently living in Delaware.  Thanks for any info.

[heart_in_the_keyes]

2009 I had a front biospy. I thought it strange at the time. My hep/liver specialist was out of country at time and it would be two months before they could get me in because I had missied an appointment and he is hard to get in to so I ended up seeing one of his associates.  When I went back in the associate told me my liver biospy was fine, no signs of cirrhois, and my HCV load was normal.  To go home and continue to do what I was doing, as their was no other treatment for the HCV at that time he could recommend.  I had previously had 3 side biospies over a 10 yr period. None hurt as much as the front biospy.  He's a specialist right? He said to right I probably had over done.  Believed them. He said to make a followup appt. for the next year.  So I take this as good news, go home and alot of family related things happened, my sister/bf died, my exhus died, my mother had a stroke, I was managing a 40 people 60 hrs a wk at work.  Go a year & 1/2 forward, start having extreme fatigue, back pain so I made an appt and got back in with my reg liver specialist who had blood work, MRI and a couple of other tests done before my appointment and was aghast at me and wanted to know what and heck I was doing to myself.  I told him what the other doctor said. Had paperwork from those visits which for some odd reason was not showing up in my records and he was furious. I don't drink, smoke, do drugs except I was taking the recommended daily dosage for NASID's to relieve stomach pain which I would later find out was from ulcers.  And we have been working together for the last 3 years.  I am G1, Stage 4 ESLD w/HE minor ascities, high HCV load, MELD 13.  After the last few years I really that the frontal biospy gave a false impression of the state of my liver. Have had 3 treatments that I have been unresponsive to...interferon by itself, the combo riba/interf and the pegaferon.  I was scheduled to do tx but not can not because liver decompensation is so severe.  Was my frontal biospy an error? Yes in my mind, Was that associate doctor in error? Who knows? Was I? But what do you do when you are almost out of it and they are prepping your chest instead of your side and your objecting but you are being told this what was ordered.  Probably, as I have learned in the last year the best advocate for you is yourself and loading yourself with knowledge and reaching out to people who are in your same shoes. I feel secure with my liver specialist that I have had for the last few years and will see absolutely no one else.  So I don't know...now I realize I should have questioned this even more after reading the replying posts to this original question. Mis-information starting 20 yrs ago forward from GP's to associate liver specialists has delayed my success of treatment and survival. I have in the past few years learned to interview and question my doctors.  Good/great doctors are out there.  Something doesn't some right, question it.

[Idyllic]

That is curious. How much higher are your enzymes compared to your baseline enzyme levels. Does minimal fibrosis mean stage 1?  Plus I was wondering when your last PCR was.  Do your physical copies of your labs that state the virus is not detectible. You probably thought of all this already but is it possible you have a drug interaction with possible other meds you take?

I hope you keep in touch and let us know how you are doing - you have come a long way. Hang in there :)

[Bali05]

The meds can cause the enzymes to go up in some people.
My ALT was 72 @ EOT and dropped down to the 20s as soon
as I stopped the meds.

[rambleon40]

i would want an explanation for why my liver enzymes are high if the virus is undetectable.

[FlGuy]

a.k.a Fibroscan.    http://www.echosens.com/

[48weeks]

MRE = magnetic resonance elastography - I've seen a few people post about them in this forum.  Thanks for the info on Thomas Jefferson, that's close.

[HectorSF]

Biopsy from the front? Do you mean a Percutaneous biopsy?

There are 3 main types of liver biopsy -

Percutaneous Liver Biopsy - The most commonly used technique for collecting a liver sample is percutaneous liver biopsy. For this method, a hollow needle is inserted through the abdomen into the liver.

Transvenous Liver Biopsy - Transvenous liver biopsy is used when a person has advanced cirrhosis and  blood clots slowly or when excess fluid is present in the abdomen, a condition called ascites.

Laparoscopic Liver Biopsy - A laparoscopic liver biopsy is use to get a sample from a specific area or from multiple areas of the liver or when the risk of spreading cancer or infection exists.

"I am also interested in finding out more about the accuracy of an MRE and where is the closest place to me to get one. I am currently living in Delaware."

Do you mean an Magnetic resonance imaging (MRI)?
An MRI is not used to stage liver disease it is used most commonly to look for anatomical abnormalities or growths in the liver, such as liver cancer (HCC). MRIs are very expensive (many of thousands of dollars) and highly accurate. Most people with hepatitis C do not need an MRI unless they have advanced liver disease (cirrhosis).

You need to find a gastroenterologist or hepatologist to manage your hepatitis C and any liver disease. They know what and when tests are needed and can schedule them for you. This is NOT something a patient does.

The closest large hepatitis C and liver disease center is in Philadelphia.

The Hepatitis C Center
Thomas Jefferson University Hospitals
111 South 11th Street
Philadelphia, PA 19107
215-955-6000 – Main Number
Physician Referrals or Appointment Requests
1-800-533-3669

* Expert consultations for referring physicians and patients including a detailed plan highlighting potential drug interactions and treatment considerations

* An active clinical trials program

* A twice-weekly outpatient hepatitis C treatment clinic

* A multidisciplinary monthly HIV/hepatitis C coinfection clinic


Good luck!
Hector

[FlGuy]

Assuming you achieve SVR there really isn't a reason to have another liver biopsy unless you have liver problems.  The curiosity to know how the ol liver is doing is compelling to the patient but most docs won't rx a bx for the purposes of curiosity.  Non-invasive methods would be about as close as needed.  The liverhead who treated me suggested that cirrhotic svr's have imaging CT/MRI twice a year to look for gross liver issues.  I've been doing it about once a year but for non-liver issues.  I just ask the techs to include the liver in the scope of stuff their looking at.  None of this stuff is cheap.