Results of my biopsy

Hello everyone...........
                         The results of my biopsy are
Grade 3 stage 2 (ludwig)  

Hepatic parenchyma with mild steatosis, mild to moderate periportal mixed cellular infiltrate (lymphocytic and eosinophilic) with fibrosis ( reticulin and trichrome stains) and focal lobular inflammation . No increased iron deposition see on iron stain .

I am 37 yrs old male
geno type 1b
vl 143000


I would like some honest comments on my biopsy please ........

I have my treatment drugs on the way .
I plan to start treatment on 7/28/06

I would like some comments to prepare for treatment also.
I live alone and have no family around to help me  i am reluctant to tell any of my friends that i have hep c or that i am going to do treatment . I am hoping for the best when i am on treatment. My job is physically demanding . I work in construction. All comments are welcome

Dale

[jmjm530]

Welcome to the forum.

Stage 2 puts you right about in the middle. That means good arguments can be made either to treat right away or watch your liver condition and wait for the newer drugs. In fact, we've had some pretty good arguments here on that very topic :) and so has the medical community.

If you do decide to treat, my personal opinion is to be careful who you tell, especially at work. It's a catch 22 because if you don't tell, then a potential decline in work productivity may be viewed one way. But some who have disclosed, suffered discrimination. You just cannot overestimate the stupid factor in people and little known condcitions like Hep C really bring that out.  

What to expect? It's really all over the place. Some  have very little if any symptons and continue working full time as if nothing has happened. Others, have significant side effects and either cannot work at all or have to significantly cut back. And most fall somwhere in the middle. As someone who works with their body in construction, you may be tested more than most. My advice here is to have some sort of back up plan in place in case you either have to cut back or even take some time off.

Lots of other stuff for you to learn and I'm sure others will offer their advice. As you probably know, there are no doctors here.

-- Jim

[fishdoc]

Its hard to sugarcoat reality, your biopsy shows that you have some liver damage.  Treatment is a b!tch.  Several folks on here work construction: strator and dyce for a couple, and they can certainly help more than I can.  I do not think I could, and I am 6 months into tx.  BUT the tx will absolutely help your liver, it will improve even if you dont clear, and your age, viral load and health are WAY WAY in your favor, so you have a good shot.  Put on your hard hat, and those cute little belts that pull them jeans down to the hipbones and get ready to rumble!!!  Best of luck
c.

[friole]

Someone just the other day was asking for pictures to show her husband to explain "the progression" of hepatitis C.  Since I probably can't find that post again, I will post them here and hope she sees them to.  These are pathology slides and you can see various liver diseases.

http://www-medlib.med.utah.edu/WebPath/LIVEHTML/LIVERIDX.html#6

HepcD - You have quite a bit of inflammation so it is a good thing (in my meagre opinion) that you are beginning treatment.  I feel that you should be able to reverse some damage there and stop the inflammation so the damage cannot continue.  

Doing physical work and doing tx is not a cake-walk.  There are several here who can tell you that.  I have a desk job, and haven't taken an excessive amount of days off.  I have told only a few people - only 1 in the office of 6 where I work.  Not sure I have really pulled that one off, but nonetheless, it is a personal decision, and many don't tell.  I am on week 52/56.
frijole

[Pdilly]

How important is Grade.  Mine is  2-3 and my Stage was the same.
If the grade (scarring) is a 4 is that the one that makes it cirrosis (cirrhosis)?

[Moniker]

I just finished 48 weeks of Pegasys/Ribavirin treatment. I was stage 2, grade 3. My doctor thought that it was important for me to treat with those numbers. I'm genotype 1a, viral load was 1,900,000. I was undetectable at 12 weeks, 24 weeks, and at one week post treatment. I finished treatment five weeks ago. I'm glad that I treated, and I hope I that will stay undetectable.

Stage indicates liver damage on a scale from 1 to 4. Grade indicates inflammation.

[Pdilly]

Good news.  You sound like you took treatment better than some. I am still learning.  Get confused with it all at times.

[bobbyullc]

good luck, with a stage 3-4 you do not have too much time to wait. it is one stage before cirossis. the tx hopefully will lower you stage a little.
some of us do not have severe sides and some are bedriden for the whole time.wait and see.
bobby

[jmjm530]

Pdilly,

Stage 4 means cirrhosis. Grade has to do with inflammation.

Bobby,

HepCD is stage 2, not stage 3-4. That gives him options IMO.

[Pdilly]

If the grade is inflamation (inflammation) then is it as critical as the stage?

[hepcD]

Do you have any idea of time frame from stage 2 to stage 3 would be, or is that another debateable question ? I am sure i contracted hep c about twenty years ago. So being a stage 2 will it take another twenty years to get to stage 4 ?

[jmjm530]

To be honest, I really haven't read all at much about "grade" other than it reveals the amount of inflammatory activity. Most of what I hear/read is about "stage" which is a snapshot in time of the amount of liver damage.

[jmjm530]

You'll get lots of answers on this and I don't really have one.

Personally, it took me close to 40 years to go from stage 0 to stage 3. That said, some suggest once you get to stage 3, it may progress faster. As a stage 3 (3 years ago) when I posed this question to my first hepatologist, his educated guess was that I was around ten years from cirrhosis if I didn't treat. Some people will never reach cirrhosis even without treatment and some may progress relatively fast. That's why anyone who takes a watch n' wait approach should be seen on a regular basis by a liver specialist and biopsy every 3-5 years. Newer blood marker tests like fibrosure and non-evasive devices now in trial like Fibroscan hopefully will make the monitoring process a lot easier by allowing more frequent monitoring with less risk, less time, and less cost.

-- Jim

[jmjm530]

Just wanted to add that it's very hard for anyone to give you the answers I know you want because: (1) none of us have all your stats, have taken your history, or examined you, nor are any of us are doctors; and (2) Even if we were doctors, as a stage 2 you might get conflicting opinions anyway.

If in doubt, and if time and finances allow, a reasonable strategy is to see 2 or 3 hepatologists and discuss your case with them. Hopefully, between that, and any independent research you might do, at some point a particular approach will resonate with you.

This discussion group is very useful but it has the obvious limitations of lay people giving opinions about medical topics.

-- Jim

[goldyn]

Everyone reacts differently to the meds,but being as you are in constuction  if you do decide to treat i would  start in the cooler months, if you live in a hot place, the heat just tends to make every thing harder, and when your just starting out and needing to work i think its better to start in cooler weather.

[jmjm530]

Just to add on my last thought, wonder if you saw or read "All the President's Men" about Woodward and Bernstein and the Watergate case?

Well, if memory servers me -- and it often doesn't these days -- the then boys (Woodward and Bernstein) would show up at Ben Bradlee's office (Bradley was the editor of the Washington Post) with an important "fact" about the case. Bradley's answer was always the same -- don't bring anything to me unless it's confirmed by at least two independent and reliable sources.

Well, the same thing holds true here. The internet and groups like these can be wonderful starting points but if you don't confirm what you hear with at least two independent sources you are asking for trouble. Of course, as you get to know more about hep c, your built-in "filter" will start getting pretty smart, but that takes time. Unfortunately, too much on the internet is spoken as fact but in reality "A" is repeating what "B" said who heard it from "D", if you understand what I mean.

-- Jim

[jmjm530]

Good basic, but occasionally outdated info here:
http://janis7hepc.com/

[jmjm530]

Here are some sites to check out:

http://www.projectsinknowledge.com/

http://www.hivandhepatitis.com/hep_c.html

http://www.hcvadvocate.org

[hepcD]

Thanks Jim
           I do get your point. I am a ask four people the same question kind of guy. Knowledge is king. Sorting truth from fiction is a lost art but, i still like to try. Thanks again for your comments you have been helpful to me.

[bobbyullc]

jim,oops on the backwards interpretation. with stage 2 he has options. i have this for 37 years before stage 3 and that was with liver abuse. if he is stage 2 after 20 years it is SLOW moving. the site below may shed info on grade.

hepcd,
here is a site on grading and progression.

http://www.gastro.org/user-assets/Documents/08_Publications/06_GIHep_Annual_Review/Articles/Keeffe.pdf

bobby

[bobbyullc]

sorry wrong site. post tx fog.

http://www.hepnet.com/hkn/c14.html

[painterlady13]

ok Now I am really confused about this
I am 45 female
geno 1 (not sure if a or b)
stage 1
grade 1  
vl of 2,5000,000
I just wonder why the Dr and liver specialist are so adament about me starting treatment now as opposed to waiting for next year's trials.  It sounds like I could wait for better meds.

[Drarig]

It good that you are going to start treatment in a couple weeks.  It will only help you liver.  It is probably best you don't tell anybody at work.  I didn't tell anyone either & I waited years to treat because I was afraid to. (I am F, 45, Geno 1A in Week 20/48).  Treatment(tx) can be hard on many but ususally yield results. At the very least, your liver will get a break.  Everyone has different side effects (sx), but many can still function.  Your job is physical & that may be a challenge, but it's certainly possible you may be able to do it.  I know there are others here on tx that have physical jobs as well.  TX can cause really bad sx to where people can't work (blood counts go down, anemia, etc). Others have them bad, but somehow manage to work.  Then there are those who have only mild sx or none at all. All I can tell you is everyone is different.   I don't really have any sx except low white blood count for which I take rescue drugs.  Starting some hair loss.  I still work full-time, have kids & teach 7 fitness classes per week.  That's probably the exception to the rule. From what I understand, most people would not be able to do all that on tx, but I guess I have just been lucky.  Prior starting tx, find out what from your doc what you can take for sides, like tylenol, etc.  Drink LOTS of water! First shot sometimes causes flulike symptoms for most. I know I had them, but only with first shot.  Has been smooth sailing for me so far.  So don't give up hope, it's definitely possible to get thru this & get yourself better.   Good luck to you!

[NYgirl]

Do you have any other problems that might contribute to the hep because honestly I can't see as a 1/1 why they would really push you to treat now = except that the new drugs are NOT guaranteed in ANY way (others have come and gone in the past without FDA approval) and they might believe it might be better for you to try and beat it now - the sooner you treat supposedly the better the chance for SVR.

I would ASK them.  I'm about the same age, a Geno 1A and 1B, Grade 2 Stage 3 so I didn't really have much choice.

[jmjm530]

Ask them. If they won't take the time to answer, or you're still uncomfortable with what you hear, then seek another opinion or two.  

The medical community, like here, is divided on treating those with little or no liver damage, but in the end it's your liver and your decision.

So speak to as many doctors as you have to, do as much homework as you're comfortable with, and don't be pressured into any decisions one way or another.  

-- Jim

[friole]

I visualize grade of inflammation and stage of scarring as such -

The hepatitis C virus causes chronic inflammation in the liver.  At first, this inflammation is localized - at the port of entry, so to speak (called the portal triads -- where the incoming and outgoing blood vessels and the bial ducts (sewer pipes, so to speak) are. That would be grade 1.  Then it starts to spread outside the portal triads.  Outside the portal triads, it is grade 2 & 3.  After that, the inflammation starts spreading out - it looks like tentacles - and becomes lobular, not portal -- that is it spreads to larger areas of the liver - that is the highest grade of inflammation - 4.  

It is the inflammation that causes the scarring.  A little bit of scarring around the portal areas is Stage 1.  As the inflammation spreads out, the scarring is more prevalent in areas outside the portal areas -- this is stage 2&3.  As the inflammation starts spreading out with the tentacles, the scarring starts bridging from one area to another, cutting off areas of good liver tissue.  When this is prevelant throughout the liver, it is considered cirrhosis.

Having a clear picture of all of this helped me to make my decison to treat, even though I was Grade 1, Stage 1.  I looked at it as motion. Everything was "on the move" and I wanted to stop it now, rather than wait.

So Hepatitis C causes chronic inflammation, and inflammation causes fibrosis (scarring) and scarring causes cirrhosis and that leads to necrosis (cell death).

[cuteus]

she was my first hepatologist, ;-)
definetely wanted me to buy the book, but the library had a copy I borrowed for a while.

It sounds like you will make the best decission for you.

[painterlady13]

Thank you for all your input.  I will discuss this with the specialist.  But also after reading up on this a little more (both here and a couple other sites),  I am thinking they might believe that because 1's don't always achieve SVR the first thime they want me to treat asap to try to get the best results possible.  Plus being a stage and grade 1 it will limit the amount of damage to my liver in the long run.  I hope so anyway.... I really don't want to put myself thru this TX but if it is going to make me healthier then I must do it... like it or not.  anyway thank you so much for your input and I definitly talk a ittle more to the Doc before we actually treat.

[merlino]

I am basicslly in the same stage as you. I have decided to treat. Reasons, I want it gone and I am afraid If I wait too long it will more difficult to clear. I don't have the knowledge most of the people here have about this disease all I know is I want my life back. If I have to give up a year I will do it. I am scared, very scared but I know in my heart for me I am making the right decision.

[cuteus]

some interesting readings
http://www.hcvadvocate.org/news/reports/AASLD_2005/11%2015%20treatment%20-1.htm#treat_15

http://www.hepcuk.info/data/usercontentroot/home/the%20hepatitis%20c%20trust/Parliamentary%20Debate.asp

http://www.hcvadvocate.org/news%5CnewsRev%5C2005/NewsRev-96.html#10

and liverdisease.com, this dr favors tx while damage is mild also.

maybe it does play in our favor to treat before it goes further down south, as I was a 1a, treated and cleared the hcv, without severe effects.

[painterlady13]

wow thank you for the info
I followed the links,  lots of information,  I especially liked the one for Liverdisease.com she has a lot of information regarding women with HCV,  although still scary, she does put it into perspective when looking at the info she gives for treating asap.  I will be keeping that link in my favorites as I like the options she gives for treating various sx's.

[Kalio1]

Did you discuss waiting with your doctors? Myabe you could ask him his reasoning. Some doctors do not go for the idea that people should "wait" at all. Where I treat they encourage all diagnosed to treat, they don't demand it but they feel strongly that it is best to try to rid yourself of it due to the nonlinear features of this virus and the stil unkown factors of the disease. All the remaining unknowns about future health consequences of having HCV are to be incuded in the "risk ratio". HCV is not a liver disease though it affects the liver, it is a BLOOD disease. It can affect many aspects of your health. It can put you at much higher risk for a number of other nasty diseases and disease processes to have this virus.
Maybe your doc is in that school of thought too.
I mentioned to my doc before I started "don't some people wait to treat? aren't there better drugs being developed?" and he said we "used to" feel that way, but the more we learn about this virus, the less we know" we advise all to try to fight it.
This is one docs opinion, but his message got thru to me that the consequeces of just having the virus on my future health was proof enough I should fight it now. The younger you are when you try to clear it, the better chance you have of clearing it, that much has been proven.

[bailezz]

I experienced a little of that "cocked eyebrow" look when I let my employee know I was getting on program for treatment of HepC.  But this is such a serious disease that I do not let that bother me.  Let them think and assume what they will.  This is your life! As for the treatment, I was on pegasas for 1 year.  Went from 400,000 vc to non detectable.  Within 2 months of getting off treatment I went up to 2,5 million.  My last lab results were 12,6million( thats million) which was a mis read and which made me almost faint. So within within 5 months, it went from non detectable to 2,500,000. He says I'm a repeater?  My dr is going to put me back on treatment but this time he said it will be for 2 years.  Don't want to but I want to get well...   The new medicine for treatment is suppose to come out in about a year but the dr says there is no guarantee when it will be out so if you have a high viril count, better get on the pegasus...