recent surgery with birds eye view of my liver

I have hep c and have stage 4 cirrhosis and recently had resection surgery to remove 2 ft. of Colan. At some point during the surgery the Doctor took a picture of my liver and he commented later to me that he thought it looked good and was surprised that I was told it was stage 4 by the Doctor who did the biopsy back in 2003. I take that as GREAT news to me because of all the pictures of stage 4 livers on the internet I have seen. It gives me hope that I might last long enough for a new medicine to become available and possibly kill the hcv.  I don;t really have a question but after watching some responses in this forum I thought I would just see if any body had any comment on this.
thanks GENE

[eureka254]

Sounds like your surgery went well, with additional good news added in!

It's certainly encouraging that visual inspection of the liver 'looked good,' but remember that Stage 4 covers mild cirrhosis to end-stage disease.  My husband has Stage 4 as well, and liver surface looked "pretty good" on his (liver) resection, but pathology still was Stage 4.  The flip side is that the liver is not homogeneous, so there's possibility that your biopsy happened to get the more scarred tissue and that the surface is in better shape.  Don't mean to be a joy-kill, but it's important to consider all variables. Hopefully all your other indicators show no concern for increasing cirrhosis.

If you are a genotype 1, the 'buzz' seems to be that better meds will be available within this coming year -- if you can kill the hcv, the hope is to never have to worry about progressing to end stage.  Hope that helped, and wishing you a speedy recovery from your colon surgery.  Take care.

[Bill1954]

Hey there, Gene—

Welcome to the discussion group. While it’s certainly encouraging that the liver looked good from the surgeon’s standpoint, I wonder if that coincides with pathology? Still, it’s good to hear it’s not covered with nodules, I bet.

I think you’re likely to find that treatment will be offered as long as you’re liver remains compensated; has anyone mentioned that term to you recently?

Have you undergone therapy for the HCV in the past?

How are you doing in terms of fluid retention; swelling in the legs or abdomen? Any confusion or anything? Are they watching you with an EGD for varices?

Others will hopefully stop in and offer their thoughts regarding stage four; I know a bit about it, but am not overly informed about cirrhosis.

Good luck and take care—

Bill

[gene53]

Hello again Bill,

The biopsy I had in 2003 showed stage 4, but from the picture of my liver and my Doctor's actual birds eye view I thought it was strange. I still understand the biopsy is more thorough then plain eyesight.

Yes, I am still compensated and I have been through 2 complete treatments with the hcv returning shortly after completions of meds.

Not much real confusion,just thought everything was from normal stupidity. I feel fairly healthy but do get tired and stuff.

as far as EGD for varices, I am at berrets esophagus right now and going in for the scope regularly. so far no varices but I am sure there coming sometime in the future.

thanks again Bill

[gene53]

Thanks and no joykill I do understand on the biopsy. I think I was genotype 1a, but regardless I see my liver doctor in Jan. and go over this with him then.

I was curious if the liver at end stage had the noodle stuff or I guess if you could still be at end stage and  show clean liver?

thank you and you take care *** well

[Bill1954]

Hey Gene—

I hope the colon resection was uneventful and everything worked out well for you. What predicated the surgery?

It’s unfortunate that the surgeon didn’t have the prescience to take a core sample of the liver while he had you open; it would have been nice to look inside as well as outside the organ at that time.

It’s good to hear they’re watching your esophagus regularly, although I’m sorry to hear you’re dealing with Barrets. What are they offering you right now for HCV management; has there been any discussion about trying again with interferon while the liver is still compensated? If you responded in the past, it might be worth another try; even if it’s only for 10-12 weeks to see how rapidly you respond.

I imagine you know about and are watching the protease inhibitor class drugs for approval, correct?

Take care, and good luck—

--Bill

[gene53]

Hello Bill,

The surgery went great is what they told me. I am still recuperating and since he knew in advance about my hep c and liver, I wish he would have mentioned doing something like a core sample. I didn't realize he was going to have my liver exposed like it must have been when he took the pictures so now I am frustrated that they could have done a core sample and didn't.

I am in a holding pattern " I guess " I am not doing any meds and I see the hepatoligist in early Jan.  They discussed with me about the possibility that there will be new drugs available for people like me in 2011. I am also frustrated that while right now I am feeling good most of the time, I know it is a matter of time before you know what hits the fan with my liver, and I wish there was something I could be doing now rather then letting this virus destroy what I have left. I will try again if they offer anything.

No, I was unaware what protease inhibitor class drugs are unless that is like the telepriv stuff.  ( I will try and look this up today )

Thanks again Bill for the response and info

[Bill1954]

Hi again, Gene—

Yes, Telaprevir and Boceprevir are both protease inhibitors; there are many more being developed behind them in various stages of development. They are also looking at polymerase inhibitors, helix inhibitors and a whole host of small molecule drugs. Here’s a link to a drug development page; while many of these won’t make it to market, it let’s you know there are a lot of projects in the works:

http://www.hcvdrugs.com/

Good luck, and keep in touch—

--Bill

[gene53]

thanks again Bill and you take care

[RobertBeWell]

No substitute for a good, thorough 50,000 mile inspection.

I've often suspected that though they are the "gold standard" for judging liver damage, that perhaps they aren't so accurate as they are made out to be, for a couple reasons:

1. The samples are so very tiny compared to the liver, the second largest organ in the body. A few centimeters away the damage might be completely different.

2. There is a large component of subjectivity due to the fact that a human (pathologist) has to look at the sample under a microscope and make a judgement call about what they see. This can vary a lot depending on experience, training, and just personal "preference".

Congrats to you my friend. Here's to a cure soon.

[eureka254]

There's also the possibility that you've had some improvement in your liver from reaching undetectable status during  your two previous treatments.  Though you didn't kill the virus permanently, it could be that an extended period of depressed viral activity gave your liver a little healing time.  

The spectrum of cirrhosis covers several steps: (A, B, C classification) before entering end-stage.  I presume what you're referring to about pics on the web and the "noodled" look of the liver would be those pictures of livers that were explanted... more likely than not, those are the livers that are removed as a final result of esld.

In any case, I hope your doctor will give you good answers and good news when you meet in January.

[gene53]

sorry the last comment was I tried to post went to early.

I meant to say I am not real convinced my gastrointestinal doctor is as perfect as he acts just from different experiences with him.

I am seeing another doctor next month and will have several new questions for him

thanks for the comment and best of luck to you

[gene53]

I imagine I have had this hcv since the 70's and that gives it quite a while to destroy my liver.  I was glad to see that it was not covered in the nodule scarring ( sorry not noodled like I said before )  I had seen in other pictures. I also wish the doctor that did my resection surgery would have done a core sample or other test while my liver was exposed.
I will hve plenty to talk about at my next dr. visit next month, and I am really hoping I may still be able to try new med's if and when they come out.
Just curious if you know when your not eligible for treatment? probably when your liver is uncompensated.  

anyway thank you for your comments and good luck to you and your husband

[eureka254]

There are a few contra-indications to hcv treatment, but usually for serious conditions. As you mentioned, decompensated cirrhosis Class Cs are almost always too compromised to tolerate treatment, but it is still possible for Class As and some Class B cirrhotics.  Other exclusions exist and can include (but are not limited to): cardiac/coronary disease, neurological or psychiatric disease, or alcoholic disease.  Good luck to you as well!

[fretboard]

Well I hope that doctor's opinion turns into good health for you!  I have a pic of an infected liver in my profile pics.

[gene53]

To compare the infected liver in your profile pic's, with the pic they took of my liver 2 weeks ago, mine is smooth at least on the outside. Hopefully my liver will last long enough to try new meds as they become available.

thanks for the comment and good luck to you

[gene53]

I have never been told of any classification rating for my liver other then the genotype 1a they told me before.
At this point I just kind of appreciate every day and hope for the best. I know my liver may be full of bad stuff but after viewing the recent picture from surgery I am very hopeful I will be able to get several more miles from it and of course maybe start new medicine in 2011.


thanks again and good luck