'minimal wetting sub phrenic spaces'

[niceguy2007]

guys my last ultrasound showd "minimum wetting of sub phrenic spaces" and fatty infiltration of liver.

what could it mean? two doctors didnt think much of it.  but i was worried it cud be a buildup of ascites?

anybody have any idea about minimal wetting of subphrenic spaces?

subphrenic means below the diaphragm i think.

[GoofyDad]

I really don't know what the affect of 800 riba vs weight based riba is, regardless of whether you do it now or if you started off that way. I also caution you not to place too much weight on what I say. I'm no expert, scientist, or doctor. Again, I suggest you get the studies (there are 2 more studies on the same stuff floating about) and review them with your doctor. Often we really do need to be our own advocates in all this. Good luck.

[headsrtails]

Comnsidering what has been said, would it be too late right now to up dose to a weight-based tx???Headsrtails

[GoofyDad]

The Mangia and von Wagner studies show quite clearly that G3's who don't RVR have significantly less chance of SVR. To me, the 4 week test for G3 is like the 12 week for G1. If you don't achieve the 4 week, the barometer's not looking so great. Just as more attention is being focussed on a 4 week for g1, I would like to see them study a 2 or 3 week test for G2/3. I think it could be very telling. At this point though, the 4 week looks like the real predictor. If I hadn't had the 4 week administered, I was definitely going for the full 48 weeks. So in my case it bought me a 24 week pass. (It strikes me that I speak as though SVR is mine, and of course things can change, can't they?) For others, detectable VL at 4 weeks may raise a flag. Be well.

[Kalio1]

I agree, SVR at 4 weeks even with substantial damage puts a 3a in a good position to clear. I do think "other factors" are still at play, your weight, age, etc. Lots of doctors/insurance companies are still focused on the 12 week mark. New patients are told they don't "need" a 4 week PCR and 12 weeks is what counts. I think everyone needs that 4 week PCR so they can adjust their game plan regardless of geno. Plus if you are clear by then it can be a big boost to keep going and finish treatment knowing your chances are better to clear.
Haven't seen anything showing geno 3's who EVR relapse as often or not, it is next to impossible to find much on geno 3 in general, but it makes sense to me your relapse rate would not go up and likely would go down or stay the same. I sure hope it improves!

[NYgirl]

Said:   really think the key is the 4 week RVR

That is what the studies are seemingly saying too.

I honestly just think the whole thing (protocol) needs to be revised and looked at - DOES extending really help as it is showing right now? If so...if they changed the length to say 48 for 2, 3,4 and 72 for geno1 - would people actually DO IT?

I think that they need to be more aggressive and stop calling anyone other than a 1 "lucky" cause you ask me it ain't "lucky" in any way.

[GoofyDad]

I really think the key is the 4 week RVR. Looks to me like not acheiving that milestone should raise the red warning flags. From what I can tell, making RVR, end of treatment response, and weight base riba dosing should put one at somewhere in the neighborhood of 90% - even with significant damage (not talking decompensated cirrhosis. It's unclear that continued treatment would improve those odds, which is why I chose not to extend. Have you seen significant relapse rates in geno 3's who acheive 4 week RVR?

[Kalio1]

Im a geno 3a, my viral load was low (700,000) I cleared by week 12, did 24 weeks and relapsed on weight based Riba.

I think it is risky for geno 3's to consider shortening tx considering our higher relapse rate. Sure, we can clear the virus but it seems to pop back up after EOT. I know statistically we have better odds than geno 1 but with all the geno 3 relapsers we see, even just on this board, I'd go at least the recommended 24 weeks if I had any liver damage at all. Problem is that so many geno 3's do not have biopsies prior to tx so they don't have that info, if they do have a biopsy and it shows moderate to severe damage, I think they should seriously consider going a longer course of tx and definately not attempt a short course.

[headsrtails]

She (she is not a doc per se I believe, since the px always come with her signed name, though it has the stamp of another doctor?) siad that wieght based tx is not conclusive. At this date of Ri., day 18, can I just up the dose from 800 to 1000-1200? Would that increase my chances?

[Eisbein]

can someone with normal spleen, platelets and albumin have ESLD or ascites?
Add to that a normal bilirubin, and a normal Pro-time (Pt-time),and
the answer is no.

Ina

[GoofyDad]

I glanced at a couple studies:


Peginterferon alfa-2b and ribavirin for 12 vs. 24 weeks in HCV genotype 2 or 3 (Mangia, et al)

Peginterferon-alpha-2a (40KD) and ribavirin for 16 or 24 weeks in patients with genotype 2 or 3 chronic hepatitis C (von Wagner, et al)

Over all, it looks like viral load at baseline may be a significant factor for those who don't clear at wk 4 (genos 2 & 3). I didn't note your VL but, not knowing that, odds for those who don't clear at week 4 are not so great. Looks like if you clear at week 4, odds are over 80%, and if not, between 40% and 50%. I could have misinterpreted, and I ain't no doctor. You can google those studies and probably get the full text versions for a modest fee and review them yourself. You might want to do that and discuss any concerns with your doc.  

Sorry if the news is a bit grim, but if it were me asking, I'd want to hear the real story. Also, note that these studies are based on weight based riba, which is generally more than the 800mg often prescribed.  

Be well.

[jmjm530]

Should probably add that I believe the "short-course" participants were on weight-based ribavirin as opposed to a straight 800 mg per the "normal" protocol.

[jmjm530]

The way we say it with geno 1's is that if you're non-detectible by week 4, your chances of SVR go up. As mentioned, not sure how exactly it works with geno 3's, but being non-detectible at week 4 is always a good sign. Overall, as a geno 3, your chances of SVR are around 70-80% from the start, so not to worry too much.

Where the week 4 PCR comes in handy is if you're considering a shorter-course (12 week) treatment. Here's some info that if sounds appealing you can discuss with your doctor. Keep in mind that this is a Peg Intron study and the similar Pegasys study treated for 16 weeks if memory serves me. Short course aside, it can also come in handy if you are forced to make a decision later in treatment to cut it short because of side effects. Knowing you cleared at week 4 (or not cleared) is one more piece of information to factor in.

http://content.nejm.org/cgi/content/abstract/352/25/2609

All the best.

-- Jim

[headsrtails]

Actually, I think I posted that doc would not do PCR until week 12. However, I went last Tuesday for bc and rattled a slew of info. I garnered from this forum and diplomatiicaly insisted on  week 4 PCR. She said ok; but also said if I am not ud to not worry; that it does not mean I will not reach SVR..is that right??? About my ramblings, I think I more effected by the psychological and emotional pressures of HCV. The physcial sx have been really nothing so far, though I am only going on sht 4 on Friday and have been on Riba for 15 days. I'll see what happens on when bc's drop? However, just last Friday I was walking down the busy city streets of Manhattan going to work with Ipod on and I had this strange feeling of wanting to get violent on the first person that crossed me. I hate admitting this, its like some Mr Hyde thing...and was rather startiling; is the Riba rage I have heard so much about? Thank god it was just a momentary lapse of reason. Whew!!

[jmjm530]

Yup. That could be the "rage" :)

I really don't know the odds of geno 3's clearing who were detectible at week 4 but non-detectible at week 12. Not as good as non-detectible at week 12, but really don't know. I thought in your previous post you weren't going to be tested till week 24 which is another thing. Maybe my math is amuck but you said "I am only going on sht 4 on Friday and have been on Riba for 15 days." If you started riba with your first shot, wouldn't you have been on riba closer to 21 days? Anyway, good luck with treatment.

-- Jim

[headsrtails]

9/22--1st sht was day 1 of ri..2nd sht was day 8 of ri., 3rd sht was day 15 of ri. Actually today, Sunday is day 17 of ri. I stand corrected. So you are saying that if I am not ud by 4th week I have less of a chance SVR than if I am cleared on week 12??

[jmjm530]

second sentence should have read:
"Not as good as non-detectible at week 4, but really don't know."

[copyman]

hi headsrtails, i also have been obsessed with the internet trying to educate myself about this hvc disease that i have, and at the same time try and find some hope before i start tx this week. what i have found is a vast amount of information but not much hope positive stuff. i understand this and attribute it to most people that post on these forums are people that are having trouble and need help. it can be quite depressing and really work on your head, especially for a newbie like myself.  but i also see how many go out of their way to help here and on other sites. i now feel that i would like to help some other newbies as i start to tx soon and share anything i have learned in the last several months with them. good luck to you

[jmjm530]

As a geno 3 with stage 1 damage, you're sitting pretty sweet as far as Hep C goes. In your case, there's no more reason for the specter of death than in any person, hep c or not. Still, it's natural to obsess, especially when someone starts treatment. Part of your problem may be your doctor as you said he won't test your viral load until week 24. That would make me rifle through my labs as well cause that's simply not enough feedback on your progress. Is it feasible for you to see another liver specialist who will test more often? You don't have to drop the one you have until you find someone else.

Be well.

-- Jim

[headsrtails]

about obsession: Is it me as a newbie, or am I always living with the specter of death that makes me have to be on this forum, and always looking for some kind of signal of hope. Reading and rereading my reocrds and going n the internet to tyr to get some kind of leverage through knowledge...for some sort of assurance...I know that my condition compared to others is almost embarrasing to feel this way. But I do not want to be consumed by HCV and know that this a psychological battle that is begin waged as well...I need to get on with my life, keep on tx, and hope for the best????

[Tater-ToT]

LoL... U crack me up.... so THAT's What That's For...LoL

[jmjm530]

Don't have much to add what "dsrt" says except ascites is associated with cirrhosis and from what you've posted it doesn't appear you have that. Certainly your doctors would be concerned if they thought you did.

[GoofyDad]

I just got report from my 6 monthly U/S screening. This is the first time they've actually sent the report, and I've now requested last two previous for comparison.

History is 'early' cirrhosis, 6 mos tx, and 6 mos SVR. The US report is normal. The US just prior to tx said probable fatty liver. BX showed no fatty liver and doc said they can only detect textural changes, not whether that's cirrhosis or steatosis.    

From the report:
The liver is normal in size and echo texture without focal lesions. There is no evidence for nodularity. There is no evidence for intra or extrahepatic biliary dilatation.

Docs report the liver is oversize and firm by palpation, and I tend to believe them. What would explain the discrepancy with US? Does the 'no evidence of nodularity' from the US carry mmuch weight, or is it a matter of the U/S just shooowing itself as a not-so-good diagnostic tool?

[GoofyDad]

I guess that's what the KY's for. "You see officer, this is my honeymoon, and well my huusband's balance sheet attracts me more than his balance beam, if you get my drift. So sometimes I'm left with minimal wetting of my subphrenic spaces." "Sorry lady. Still only 3 ounces per customer. Why don't you apply what you can now, then grab an extra packet of that Kraft cheese spread they're serving on the plane?"

[desrt]

Don't know anything about "sub phrenic spaces", but fatty infiltration of the liver (also known as steatosis or Non-Alcoholic Fatty Liver Disease NAFLD) is more common with genotype 3s than with other genotypes. I still had it when I did my one year post-tx sonogram, but it didn't seem to concern my gastro very much.