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What kind of a specialist is your HCV doc?
I''ve moved cities quite a bit and have had different HCV docs over the years.
Some were hepatologists, some were general gastroenterologists, and my current one is an Infectious Diseases Specialist. I've noticed they all have different approaches but I'm most impressed with my current doc.
Has anyone else here dealt with different kinds of specialists over the years?
Do you think one type of specialist is better than the other when it comes to treating HCV, or does it just depend on the individual doctor rather than his/her specialty?
Some were hepatologists, some were general gastroenterologists, and my current one is an Infectious Diseases Specialist. I've noticed they all have different approaches but I'm most impressed with my current doc.
Has anyone else here dealt with different kinds of specialists over the years?
Do you think one type of specialist is better than the other when it comes to treating HCV, or does it just depend on the individual doctor rather than his/her specialty?
So true! I am grad to hear about the CEUs for PCPs. That is something that should be done with ALL PCPs.
I have been blessed there, too! Our PCP of many many years already had heppers as patients when I was diagnosed in 1994, So he had already educated himself about it, was very knowledgeable and helpful and has continued to do Labs, etc over the years.
Like states with rural areas with no hepas, ourCounty is bigger than the state of Rhode Island, and wehad a couple od Gastros onthe east side od the county but none on the west side, where we live. Thank Goodness, that is changing some, now, or like others inthis greater area (Augustinemama, Susan400) my PCP woud have sent me to Mayo in Jax.
Everyone, grow/stay well, and may we all, soon, be HepC FREE. Pat
I have been blessed there, too! Our PCP of many many years already had heppers as patients when I was diagnosed in 1994, So he had already educated himself about it, was very knowledgeable and helpful and has continued to do Labs, etc over the years.
Like states with rural areas with no hepas, ourCounty is bigger than the state of Rhode Island, and wehad a couple od Gastros onthe east side od the county but none on the west side, where we live. Thank Goodness, that is changing some, now, or like others inthis greater area (Augustinemama, Susan400) my PCP woud have sent me to Mayo in Jax.
Everyone, grow/stay well, and may we all, soon, be HepC FREE. Pat
Thanks for your response. I agree with you, decompensation is a whole new ball game. My gastro always told me if I started to decompensate he would send me to NYC to see Dr. Jacobsen. Otherwise he was more than capable.
In the early years, our organization had done CME's (continuing Education Programs for PCP's to get them up to speed to treat their HCV patients as the rural areas of our larger states had no hep docs. Our first one was in Albuquerque, NM (they had no hep docs at the time) and it was very successful. The docs were able to use ECHO (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6318a2.htm) a project that allowed PCP's to converse with hep docs and is very successful.
I think those of us who live in or near major mentropolitan areas are very lucky to have the choice in medical providers but the majority of the country does not.
In the early years, our organization had done CME's (continuing Education Programs for PCP's to get them up to speed to treat their HCV patients as the rural areas of our larger states had no hep docs. Our first one was in Albuquerque, NM (they had no hep docs at the time) and it was very successful. The docs were able to use ECHO (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6318a2.htm) a project that allowed PCP's to converse with hep docs and is very successful.
I think those of us who live in or near major mentropolitan areas are very lucky to have the choice in medical providers but the majority of the country does not.
Hi there! I had cirrhosis by the time I was dx. With the help of this forum I found a hepatologist who worked at a hospital where they do research and transplants. I figured that way if I ran in to trouble, decompensated like Hector did after an operation they would get me in asap. There would not be any lag time. I was very lucky to have a very good doctor who had a full time person on staff just to support the people on Incivk and Victrellis and we did need help and help and help. It was a crazy time.
Of course everyone can pick who ever they like but I would recommend a hepatologist.
I think your life is worth the extra trouble.
Good luck :)
I wish you the very best
D
Of course everyone can pick who ever they like but I would recommend a hepatologist.
I think your life is worth the extra trouble.
Good luck :)
I wish you the very best
D
This thread... http://www.medhelp.org/posts/Hepatitis-C/Harvoni-Treatment-for-Cirrhotics-Complications/show/2376116
Is just one of the reasons people should be treated by a doctor that is completely up to date on treating because just reading the prescribing information sheet might not tell the whole story.
Is just one of the reasons people should be treated by a doctor that is completely up to date on treating because just reading the prescribing information sheet might not tell the whole story.
My husband started with a gastroenterologist who specializes in Hep C treatment, and then when he failed treatment and developed Cirrhosis, she referred him to a hepatologist in a transplant center who specializes in Hep C treatment.
Advocate1955
Advocate1955
No, WM, I was going by the quote above. Just that it backs up what several of us had said previously. I treat with an Infectious Disease Specialist here in FL. he is so knowledgeable, listens, discusses, etc. My previous Dr 20 yrs ago was a Gastro, again, someone who was working with a lot of heppers and connected with the trials/studies at UF's teach hospital in Gainesville. I did think, from the exerpt you quoted, it sounds like he has his finger on the pulse of this disease - but no treatment experience with him. Sorry.
I do still think a hepa is the way to go when cirrhosis becomes decompensated, but with all the treatment protocols we have now, if the patient will do everything he or she can (liver friendly diet, exercise, quit drinking, etc) It might just be that the disease will not have to progress that far. That is, of course, if someone can convince Ins Cos to lobby (AND PAY) for hepc antibody and viral load Labs every one to 3 years to catch this disease early. I truly believe this will be a disease of the past before too many years! Pat
I do still think a hepa is the way to go when cirrhosis becomes decompensated, but with all the treatment protocols we have now, if the patient will do everything he or she can (liver friendly diet, exercise, quit drinking, etc) It might just be that the disease will not have to progress that far. That is, of course, if someone can convince Ins Cos to lobby (AND PAY) for hepc antibody and viral load Labs every one to 3 years to catch this disease early. I truly believe this will be a disease of the past before too many years! Pat
Patra, is Dr. Fried your doc? He is wonderful. I used a gastro for the first 20 years of my diagnosis and he was wonderful. He had a deep understanding of HCV and was truly interested. He kept my cirrhosis compensated for 20 years. Unfortunately he died. I was cured in a trial by an infectious disease doc.
The other thing that Dr Fried underlined for me, that several of us have mentioned before, is that the interest in and the amount of treatment experience - and if they keep up in the field, on reseach, treatment, is the most important thing, no matter which specialist (or GP, etc) you are seen/ treated by.
Well, it might scare you but it is the wave of the future. I would hope that if the non-specialist ran in to a problem, they would have the sense to contact a specialist or make a referral.
I am just sharing with you what the consensus was out of AASLD last week. I didn't make this up.
I am just sharing with you what the consensus was out of AASLD last week. I didn't make this up.
"Consequently, even non-specialists should be able to handle much of the hep C case load in the future."
----------------------------------------
Good luck with that scenario. I find it very scary.
I pity the poor person who gets stuck with a PCP or GP. The majority of them do not even know that positive antibodies do not mean that a person has Hep C.
And most of them have no clue about extrahepatic manifestations, co-morbidities, and complications.
But, to each his/her own.
----------------------------------------
Good luck with that scenario. I find it very scary.
I pity the poor person who gets stuck with a PCP or GP. The majority of them do not even know that positive antibodies do not mean that a person has Hep C.
And most of them have no clue about extrahepatic manifestations, co-morbidities, and complications.
But, to each his/her own.
This is an excerpt from September 2014 issue of Hepmag. Dr. Michael Fried is the author and a well-respected hepatologist from North Carolina.
"If you’re considering treatment for hepatitis C virus (HCV) and haven’t yet found a doctor, you may be wondering what kind of clinician is best for you. Today, most people with hep C go to a gastroenterologist or a hepatologist; and those who are coinfected with HIV often continue seeing their infectious disease physician or HIV specialist for hep C treatment. But is there any benefit to seeing one kind of provider over another?
A gastroenterologist is a specialist in the digestive system, which includes the intestines, liver, pancreas and gallbladder. Meanwhile, hepatology is considered a sub-specialty of gastroenterology, focusing on the liver, as well as the gallbladder, biliary tree and pancreas. While it may seem preferable to seek out a physician who hones her expertise more narrowly on the liver, Michael W. Fried, MD, director of the UNC Liver Center at the University of North Carolina at Chapel Hill, says there is really no fundamental reason why hepatologists are more able to treat hep C over gastroenterologists.
“I think the main criteria are that they are interested in hepatitis C and they have experience and that, like anything else, they consider it a high priority in the management of their patients,” Fried says of what to look for in a specialist.
Indeed, a well-trained gastroenterologist will have a lot of exposure to hepatology, so even if you have severe liver disease, you should probably be fine seeing a gastro who is experienced in treating hep C. Physicians in both specialties can conduct the necessary tests to determine how far the liver has been damaged as well as your viral genotype (which will shape the best course of treatment for you) and viral load. They can then prescribe treatment and follow you through the process to make sure that any side effects that may crop up are properly managed.
This fall, three new crops of direct-acting antivirals are likely to receive U.S. Food and Drug Administration (FDA) approval to treat hep C. In addition to raising treatment success rates, thus upping the chances of a cure, these new medications should result in diminished side effects, making treatment easier to manage. Consequently, even non-specialists should be able to handle much of the hep C case load in the future."
"If you’re considering treatment for hepatitis C virus (HCV) and haven’t yet found a doctor, you may be wondering what kind of clinician is best for you. Today, most people with hep C go to a gastroenterologist or a hepatologist; and those who are coinfected with HIV often continue seeing their infectious disease physician or HIV specialist for hep C treatment. But is there any benefit to seeing one kind of provider over another?
A gastroenterologist is a specialist in the digestive system, which includes the intestines, liver, pancreas and gallbladder. Meanwhile, hepatology is considered a sub-specialty of gastroenterology, focusing on the liver, as well as the gallbladder, biliary tree and pancreas. While it may seem preferable to seek out a physician who hones her expertise more narrowly on the liver, Michael W. Fried, MD, director of the UNC Liver Center at the University of North Carolina at Chapel Hill, says there is really no fundamental reason why hepatologists are more able to treat hep C over gastroenterologists.
“I think the main criteria are that they are interested in hepatitis C and they have experience and that, like anything else, they consider it a high priority in the management of their patients,” Fried says of what to look for in a specialist.
Indeed, a well-trained gastroenterologist will have a lot of exposure to hepatology, so even if you have severe liver disease, you should probably be fine seeing a gastro who is experienced in treating hep C. Physicians in both specialties can conduct the necessary tests to determine how far the liver has been damaged as well as your viral genotype (which will shape the best course of treatment for you) and viral load. They can then prescribe treatment and follow you through the process to make sure that any side effects that may crop up are properly managed.
This fall, three new crops of direct-acting antivirals are likely to receive U.S. Food and Drug Administration (FDA) approval to treat hep C. In addition to raising treatment success rates, thus upping the chances of a cure, these new medications should result in diminished side effects, making treatment easier to manage. Consequently, even non-specialists should be able to handle much of the hep C case load in the future."
One of the problems with insisting on a hepatologist, is that there are not that many of them available. Most are located at academic institutions in big cities and most of the patients are not near enough to get there easily.
Unless one has a complicated case of liver disease a hepatologist is not necessary. Just because one has cirrhosis does not make it necessary either in the view of some of our most experienced hepatologists. A person with compensated cirrhosis can be treated easily by just about anyone according to Dr. Gish, Dr. Poordad, and some of the other hep docs, especially because treatment with the new DAA's is so easy now.
Unless one has a complicated case of liver disease a hepatologist is not necessary. Just because one has cirrhosis does not make it necessary either in the view of some of our most experienced hepatologists. A person with compensated cirrhosis can be treated easily by just about anyone according to Dr. Gish, Dr. Poordad, and some of the other hep docs, especially because treatment with the new DAA's is so easy now.
Well when I looked up clinical trials there where only gastro's doing it in my area. I had to go thru trial could never afford the meds . With my insurance would've been $960 out of pocket. We don't even live on that much every month.
I agree with Can-do. I would go with a Hepatologist. They know the most about Hepatitis C, liver disease, co-morbidities, extrahepatic manifestations, treatment drugs, complications, adverse effects, etc. And for Cirrhotics, having a Hepatologist managing one's care is crucial.
I am going thru a gastro Dr. but they have a complete area just for research , they have been doing trials since 2009. I love the Dr. and the staff even better. They are very good at explaining everything and answering any questions I have.
My last doctor, the one who cured me, is an Infectious Disease doc. I loved being treated by him. He knew so much about the virus itself, as well as the liver. My belief is that an Infectious Disease doc is very qualified to treat, especially if he has HIV experience. I know if there had been a problem concerning the liver itself, he would have called in a hepatologist.
Hey, Can-do: I agree with the hepc hands-on treatment all the time. Both od my hepc treating Drs had large hepc practices -- I believe that is why they were/are so good. I also know tht both of them did/are keeping up with the research, studies, etc. That is important. Pat
Myself I would want a Hepatologist if possible. If not then a good Gastroentrologist and only if he was up to date on the current treatments and has treated many Hep C patients. No jack of all trades for me when it comes to treating hep C. I want somebody that on a daily basis is treating something this serious and are used to what side effects and how to treat them. Been there done that and never again. Wishing you the best.
Y: I agree with Kim. When I was under treatment in the 90s, my Dr was a Gastroentrologist. I am currently under treatment with an Infectious Disease Specialist. they had at least two things in common: they were/are both excellent and both are/were very knowledgeable in liver issues and hepc especially. That is why I believe any of the three specialists can treat hepc.
The trick is to find a Dr who really knows and treats hepc - and is very up to date in it, anf that you like/ feel comfortable with.
again, that is altered if you have ESLD, then you need to be put in touch with a Transplant Center Hepatology team.
Hope this is useful. Pat
The trick is to find a Dr who really knows and treats hepc - and is very up to date in it, anf that you like/ feel comfortable with.
again, that is altered if you have ESLD, then you need to be put in touch with a Transplant Center Hepatology team.
Hope this is useful. Pat
I'm new to the community I have learned about my illness mostly on the internet . I am currently seen at the liver transplant center. I see a P.A. she always makes me feel better just talking to her. I am esld but as far as I can tell she seems to know her stuff. So I'm hoping the treatment I am getting is in my best intrest not the Ins co.
don't know if that helps or not but I hope so.
Shawn.
don't know if that helps or not but I hope so.
Shawn.
Hi and welcome
All 3 of the Drs you mentioned would be OK to treat Hep C.
If by chance you have End Stage Liver Disease or even Cirrhosis, your best bet would likely be a Hepatologist as their specialty is only the liver.
Should you only want to treat your Hep C and are not having any issues,
your current Dr will do just fine. You mentioned that you felt good about him
and it's important to trust the Dr your with.
All of these Drs are qualified to help you treat your Hep C.
Stay well
.....Kim
All 3 of the Drs you mentioned would be OK to treat Hep C.
If by chance you have End Stage Liver Disease or even Cirrhosis, your best bet would likely be a Hepatologist as their specialty is only the liver.
Should you only want to treat your Hep C and are not having any issues,
your current Dr will do just fine. You mentioned that you felt good about him
and it's important to trust the Dr your with.
All of these Drs are qualified to help you treat your Hep C.
Stay well
.....Kim
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