Bx -Jim

Jim, howdy, I'm gonna be getting a bx soon and it says on the paper that I have to be there 5 or 6 hours,,, I'm trying to decide the best way to get into the city. If we take the car, its a pain cause of parking. If I hire a service, I won't be able to tell them a definite time of when to pick me up,,but if its okay to do a little walking I can take a cab to the Port of Authority and hop on a bus home. This way no subways involved, but once in the P of A, there is a bit of walking, not a whole lot - well I'm sure everyone has been to the P of A, so you know.... Is is okay to walk that distance inside the P of A? To tell you the truth I hate to think about taking a car in. I hate the way my husband drives - especially in NYC.

[FlGuy]

Stay in the city overnight.  Go home the next day. Schlepping to PA later in the day and getting in the mass migration to the burbs is no way to take it easy after a procedure like that.

[Myown]

Thanks for your reply, but I live in Jersey. Is it okay to walk around after a bx though or do they want people not to walk around at all. I would be walking just for about 10 minutes or less inside the port of authority after a dreaded cab ride with a maniac cab driver.

[FlGuy]

Although it's been a couple of years and a couple of tx's in between, I think the instructions were for someone to get me home (accompanied) and take it easy (like lay down and be waited on).  I can't imagine that getting to PA, smelling all that diesel exhaust, taking that bumpy ride through the tunnel with a mass of humanity qualifies as 'taking it easy'. Possible? Yes.  But keep in mind, a fairly important organ has just been punctured.  Also, could be some post-op discomfort not to mention a case of the 'willies' just being in PA.

[Myown]

I can't imagine that getting to PA, smelling all that diesel exhaust, taking that bumpy ride through the tunnel..

FlGuy, New Jersey - state with the highest taxes is where I reside - real close to NYC - heartbeat away and since I am from Jersey smelling diesel exhaust is the norm along with airplane exhaust.
So its a quick ride, just wanted to know if I can walk at all.

Here's the thing,,,I wouldn't stay in a NYC hotel for all the tea in China. You've probably read about the bed bug problem they are having in ALL the hotels? I'm not going to chance bringing bugs home. Anyone that has to come to NYC for business should cross the GW bridge and stay in a hotel in Fort Lee, NJ or somewhere in that vicinity. I really mean it - the bed bugs are a real problem now in the NYC hotels.

[Myown]

"But bedbugs on Park Avenue? Ask the horrified matron who recently found her duplex teeming with the blood-sucking beasts. Or the tenants of a co-op on Riverside Drive who spent $200,000 earlier this month to purge their building of the pesky little thugs. The Helmsley Park Lane was sued two years ago by a welt-covered guest who blamed the hotel for harboring the critters. The suit was quietly settled last year.

And bedbugs, stealthy and fast-moving nocturnal creatures that were all but eradicated by DDT after World War II, have recently been found in hospital maternity wards, private schools and even a plastic surgeon's waiting room.

Bedbugs are back and spreading through New York City like a swarm of locusts on a lush field of wheat.

Infestations have been reported sporadically across the United States over the past few years. But in New York, bedbugs have gained a foothold all across the city.

"It's becoming an epidemic," said Jeffrey Eisenberg, the owner of Pest Away Exterminating, an Upper West Side business that receives about 125 bedbug calls a week, compared with just a handful five years ago. "People are being tortured, and so am I. I spend half my day talking to hysterical people about bedbugs."

Last year the city logged 377 bedbug violations, up from just 2 in 2002 and 16 in 2003. Since July, there have been 449. "It's definitely a fast-emerging problem," said Carol Abrams, spokeswoman for the city housing agency.

In the bedbug resurgence, entomologists and exterminators blame increased immigration from the developing world, the advent of cheap international travel and the recent banning of powerful pesticides. Other culprits include the recycled mattress industry and those thrifty New Yorkers who revel in the discovery of a free sofa on the sidewalk.

And that new mattress delivered from a reputable department store, which kindly hauled away your old one? It may have spent all day in a truck wedged against an old mattress collected from a customer with a bedbug problem"

[FlGuy]

From what I've read over the months you seem like a Hudson County person. I grew up near the GW.  In fact my hcv source is a short A train ride from  the PA.  If you trek home, have someone with you.  You can call the procedure scheduling people, they should know the post-op procedure.  At least a cab to PA.  Once your there not a too long walk to the platform.

[Myown]

Ya know what when you said PA,, I'm not thinking Port Of Authority - I'm thinking you meant Pennsylvania - yeah its past my bedtime.

I seem like a Hudson County person? Whats that? I'm not a democrat. LOL

[jmjm530]

Good to hear you've decided on a biopsy.

As to getting home, isn't that what husbands are for?

But seriously, ask your doctor if it's OK to walk some (I'm sure he'll say OK) -- but have a back up plan in case you're not feeling up to the walk.

Be well,

-- Jim

[Myown]

Good to hear you've decided on a biopsy.
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Yeah hopefully I will get it. They already messed up the appointment date - didn't put me in - even tho I know he filled out the slip cause it was right in front of me. But I got it straightened out today. You have to have eyes behind your back with ALL these offices. I just wish people would do their job.

[jmjm530]

Just make it a point to find out in advance exactly who will be sticking you. Do not be afraid to ask how many biopsies this person has performed in the past year. You want someone with a lot of experience, not some resident using you as a learning experience.

-- Jim

[Myown]

I thought the doctor would be doing it?

[Myown]

Just checked my email. First they didn't have me down, NOW they send me the WRONG DATE. I made sure I repeated it back to her too!

PLUS the real kicker is that when she told me she didn't see me in the computer and then she made the 'new appointment' for me, and hour later she calls me and says "oh I see an appointment earlier than that - a week earlier- and I said that sounds good......next thing ya know my mail comes and I open a letter from the doctors office and ITS THE BX DATE WITH INSTRUCTIONS and its the DATE that she just gave me,,,,,YET IT WASN'T IN THE COMPUTER....so I figure okay calm down - its all taken care of  - relax,,,,BUT NOW I open up my email and she sent me instructions WITH THE FIRST DATE SHE GAVE ME (TODAY).

So now I have to call her tomorrow. Yeah yeah, relax, but Jim ya know what? This is too much. This office stinks.

And now you say check out who is going to do my BX? I thought my doc does it. My luck I'll get a Doogy Houser and I'll pass out when I see him put a little step stool next to the table so that he can climb up to stick me.

[Myown]

I think the doc does the bx cause they talk about "his schedule." I'll find out tomorrow, cause I don't want it if he doesn't do it. I'm not going to let someone do it when he is supposed to be my doctor.

[jmjm530]

MO:   I thought the doctor would be doing it?
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Probably, but always ask, ask, ask in advance.

As to how some of the offices work, I hear you. If they ran a business like some of these places, they'd be belly up in a week. Make that a day. UGH!

-- Jim

[jmjm530]

FWIW, my first biopsy was done almost 40 years ago by what I remembered to be a resident. Not such a good experience, but what did I know to ask. LOL.

From then on out, I asked. All subsequent biopsies were done by my treatment doctors, who were VERY experienced.

Then, right before treatment, I was thinking about having another biopsy. So I of course asked my liver specialist at the time, if he would personally do it. He said, I'd be better off with Dr. "X" because he personally hardly ever does them and Dr. "X" has done hundreds, and that is who he personally would use on himself. That made sense, and if I decided to get a biopsy with that group (I ended up passing) I would have used Dr. "X" but made sure it indeed was Dr. "X" and not some resident working for Dr. "X".

[Myown]

I do think he's doing it ,,,,now I'll be up all night asking the forum....hey guys anyone still on forum, I can't sleep cuz Jim said something to me that he should have waited until the morning to tell me cuz Jim should know me by now LOL.

But anyhow when I asked the doc what drugs do you give me before the bx and he said ' demoral (I think thats what he said) and that other one that begins with a "V" - the one that everyone on forum likes - well a few had mentioned it (mike) and I can't remember who else. You probably know which drug I am talking about. So if that drug is as good as they say, I guess the bx won't be a problem as far as stress. I'll probably let the security guard do my bx - the way everyone raves about that drug.

[Myown]

Okay its 12:46am, time to go to bed.

Btw, glad you lived thru a resident doing your bx. But it is in a way alot better when you don't know too much of what can go wrong.

I'll leave ya with 2 jokes from an email I just received. The email had alot of funny ones, but some may find them offensive, I thought they were all funny - Irish one too.
                                                              
What did the blonde say when she found out she was pregnant?
"Are you sure it's mine?"

Why does Mike Tyson cry during sex?
Mace will do that to you.

[ladybug52]

I didn't get any drugs till afterwards when I complained about my headache. My choices were darvocet or morphine.....I took two darvocet and my headache went away:)
I had to fly to St. Louis that night and the plane was delayed so I went to my daughters third floor apt. Up and down those stairs a few times, out to dinner and finally to the airport. Good thing I was full of darvocet, had to get to St. Louis for my dad's birthday....I didn't tell my kids about the biopsy, I didn't want them to worry, so I pretended I hadn't just been released from the hospital, but had just got off work. Luckily my husband was driving....
Hugs,
Bug
BTW my kids knew all along, and were playing dumb. They didn't want me to worry about them worrying about me. Glad I was finally honest, lying is not good!

[Myown]

Thats funny that your kids knew and were playing dumb so you wouldn't worry. Sounds like your kids are good kids. I would think they would be tho with having you as their mother and a nice daddy - your Michael, who sounds like he came from the same mold as my Michael. We are two lucky chicks, huh?  

So you sound like you did alot of walking after the bx. I might even be better just taking a cab right from the hospital to my house. My husband wants to drive now but he really does scare me when he drives and even tho NYC cab drivers are scary drivers too at least I can say "slow down" to him without having to listen to a lecture entitled " Don't tell me How To Drive."

Now I can't wait to get started again - just to get it over with. But its weird cause I have been getting a pain on my left side - not painful, just annoying when I move a certain way. Can't be my liver cause its not the right side. Its strange tho - never had this before. Something else to get checked out I guess.

See ya later bug.

[wyntre9]

I had to be at the hospital at 5Am and didn't want to inconvenience anyone with getting up that early to drive me so I took a car service.

I thought I'd be able to drive home myself, even though the hospital made such a big deal about it, but they were absolutely right.

i was faint, dizzy, disoriented and while not in pain, i was in no shape to do much of anything.

There's no way i coulda walked from PA to a doctors office through the crowds and the traffic of NYC.

Either have hubby drive you or take a limo service home from the procedure.  Mass transit is ok for getting there but not for the return trip.

wyn

[Myown]

Either have hubby drive you or take a limo service home from the procedure.  Mass transit is ok for getting there but not for the return trip.
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I'd much rather have a limo service, but how do you give them a time, when I have no idea when I will be ready. I have to be at the hospital at 7am, but who knows what time I will really be getting bx and then they say I will be there 5-6 hours after bx.

I wouldn't be walking from PA to the doctors office - would be taking a cab to PA or maybe should take a cab all the way home (scary). See the whole problem is ....I am trying to avoid having my husband or a cab driver drive me all the way home - don't know which one is worse. I'm not a good passenger. I was in a car with my friends years ago - "Lincoln Tunnel Approach" and had an accident ( I wasn't driving) and since then I'm not a good passenger - or at least thats when I think it started where I feel tense when someone else is driving. My husband does alot of the driving when we have to go somewhere, but its a pain cause he makes me nervous. You know how we all drive around here - I'm just as bad with the way I drive, but when its yourself driving, you feel like you have everything under control. Its a mental thing or a control thing I guess. But anyhow thanks for letting me know how you felt after bx, I will have to consider that. Its my husband that is making me nuts over this. I told him how I want to do it and NO, he has to do it his way - whatever that winds up being - so I guess I will forget about it and just ask him "so what did you deceide," - (in order to keep peace in the house).

Thanks Wyntre

[wyntre9]

The hospital may have a list of limo drivers who will work around your schedule.

That's how i found the company that picked me up and dropped me off.

Wyn don't you call the hospital and ask?  I had my BX at Valley Hospital in Ridgewood and the staff was able to help me out.  I think it's the patient intake department or patient services or something like that.  They often have to transport elderly people or folk without rides so I would think someone would be able to point you in the right direction.  

Apparently this happens quite often so the hospitals may be able to refer you to a company they work with.

DON'T DRIVE yourself and PLEEZE don't take public transportation.  I doubt you'll feel up to it.

Just my take.

wyn

[Myown]

The hospital may have a list of limo drivers who will work around your schedule.
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Wyntre! Thats the solution. Thanks a million!!

[wyntre9]

Let us know what happens.  Good luck,

wyn

[mikesimon]

Increased T-Cell Sinusoidal Lymphocytosis in Liver Biopsies in Patients With Chronic Hepatitis C and Mixed Cryoglobulinemia.
Carmack S, Taddei T, Robert ME, Mistry P, Jain D.

Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA.

Mixed cryoglobulinemia (MC) has a strong association with hepatitis C virus (HCV) infection and is associated with a higher degree of fibrosis and poor response to therapy. Currently, there are no known histological findings on liver biopsy that correlate with the presence of MC in HCV-infected patients, although we have occasionally noted prominent sinusoidal lymphocytosis in MC patients. The goal of this study is to determine whether sinusoidal lymphocytosis is a histological marker of MC in liver biopsies from patients with chronic hepatitis C. The liver clinic database at our institution was searched for chronic hepatitis C patients with MC who underwent liver biopsy during 1999-2005. Ten such cases were identified and were included in the study. Ten chronic hepatitis C MC-negative cases were matched for age and stage of fibrosis to serve as controls. Histological features (sinusoidal lymphocytes, inflammatory activity, acidophil bodies, and fibrosis stage) were evaluated in each biopsy. Clinical and laboratory data (serum protein electrophoresis, liver enzymes, hepatitis C viral load, treatment status, comorbidities, etc.) were also recorded. Formalin-fixed, paraffin-embedded sections were submitted for immunohistochemical analysis using antibodies against CD3, CD20, CD4, CD8, and CD68. Sinusoidal lymphocytes were counted in 5 hpf (40x) on hematoxylin and eosin (H&E) stain, and on CD3 and CD20 immunostains. The number of CD68+ Kupffer cells was also counted in a similar fashion. In the MC-positive versus MC-negative cases, mean fibrosis stage (2.4 vs. 2.4), inflammatory grade (1.7 vs. 2.1), lymphocyte count (359 vs. 128/5 hpf), and Kupffer cell count (239 vs. 220/5 HPF) were assessed. There was a significant increase in sinusoidal T-cell lymphocytes (P < 0.05) in MC-positive cases as compared to MC-negative cases. Nearly all sinusoidal lymphocytes were CD8-positive cells in both groups. Other histological parameters did not differ in the two groups. MC-positive cases tended to have a lower viral load as compared to controls (P= 0.059). The role of sinusoidal T cells in the pathogenesis of MC is currently unknown. It is unclear if the presence of these cells implies ongoing antigenic stimulation that may lead to increased risk of lymphoma. This feature may be an important clue to predict the presence of MC, an HCV-associated phenomenon that has important implications for response to treatment and disease progression.

Mike

[Myown]

Thanks Michael, but if you get time can you break it down? I see a few things but not really comprehending it all but one thing I see is MC - poor response to therapy. I had a 'good - fast response, but it didn't stick around, so I don't know if RVR yet no SVR is considered "poor response."  Then the other thing I see in the above is the mention of "prominent sinusodial
lymph. in MC patients AND I do have that ongoing sinus problem on the right side, but I also was just reading that when a person has a weakened immune system the tissue in the nose area - I don't know I'd have to find it again but it said something about immune response and nasal blah blah.

Then I see "serum protein electrophoresis" which I think is one of the tests the Rheumy gave me.

And it says that MC positive cases have a lower viral load. I have a high VL. But all in all maybe you showed me this to let me know why its important to get a bx as there are other pieces of the puzzle that can be put together? I never read that MC positive cases have low VL - none of the doctors even mentioned that. Well that helps me a bit as far as hoping the test was correct(hopefully) in showing MC neg.

Hope so because I am afraid to jump back into tx if there is a possibility of some underlying condition that can prevent me from SVRing again. Of course I would want to 'fix' whats wrong first and then do tx.

My doc said that the Rheumy mentioned there might be some autoimmune thing going on, yet he wants to tx me. I thought autoimmune meant that you can't tx, but I do have the confidence in the doctor as far as if he says I can tx - then I guess I will. Hopefully next appointment Rheumy will have more answers. He did alot of tests last appointment.

Also my doc said for me to go to an ENT about the sinus thing. Thats where I started out tho (before dx) and they didn't help me. The sinus thing - ear noise is all immune related as far as I am concerned and unfortunately IMO there's not enough of an overlapping of knowledge in what doctors specialize in - so a hep doc may know more than a GI, but all and all none of them connect the dots.
They draw a circle around the organ they specialize in and don't take into consideration how the rest of the body is being affected by that diseased organ. As far as I am concerned a specialist knows "alot" about ONE thing and a PCP knows a "little bit," but not enough about EVERYTHING - so at times I feel I am in between 2 people who should compare notes, but don't.

But anyhow if you can, let me know what you see in this study in relation to me.

Thanks Mike.

[mikesimon]

"Currently, there are no known histological findings on liver biopsy that correlate with the presence of MC in HCV-infected patients, although we have occasionally noted
prominent sinusoidal lymphocytosis in MC patients.....

There was a significant increase in sinusoidal T-cell lymphocytes (P < 0.05) in MC-positive cases as compared to MC-negative cases. Nearly all sinusoidal lymphocytes were CD8-positive cells in both groups. Other histological parameters did not differ in the two groups......
The role of sinusoidal T cells in the pathogenesis of MC is currently unknown. It is unclear if the presence of these cells implies ongoing antigenic stimulation that may lead to increased risk of lymphoma. This feature may be an important clue to predict the presence of MC, an HCV-associated phenomenon that has important implications for response to treatment and disease progression."

Mike

[nygirl7]

I think you responded but you just didn't get all the bugs.  If you treat more aggressively for a longer term I'm sure you can get them - from what I remember you didn't have any trouble getting the number of the VL down...you just relapsed right?

PS MikeSimon sometimes forgets that most of us aren't nearly as smart as he is.......   :)

[Myown]

I still don't understand what you are saying.Maybe you are saying the bx will reveal why I didn't svr and that maybe bx will say something about sinusoidial T cells and tie everything in and show that my sinus problem is related to undetected cryo, but I can't keep guessing at what you are saying.I know my sinus thing is hep related, as far as I am concerned, I've told them,but it is falling on deaf ears. It would be good if the bx can reveal a missing piece of the puzzle. But I still don't know if thats what you mean. Nygirl is right - some of us need a commentary with the study.
Thanks though.
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NYgirl,,I was RVR, but I am afraid of just going back into tx without first knowing what the underlyng condition is and taking care of that first. If I would have listened to myself the first time, I wouldn't have started tx without getting to the bottom of things - but there is only so much a person can do when dealing with medical people. I'm a geno 2 which means 'put her on a trolley track,' and she will be fine, yeah sure.

[Myown]

And if you are thinking lymphoma. I have mentioned that.They either will listen or not listen - I've done all I can possibly do at this point. Its up to them now to figure it out. I'm tired of guessing.

[mikesimon]

Increased sinusoidal T-Cell lymphocytes might suggest cryoglobulinemia. As stated:
"The goal of this study is to determine whether sinusoidal lymphocytosis is a histological marker of MC in liver biopsies from patients with chronic hepatitis C."
It suggests that this feature may be significant when reading a biopsy. Since you're about to undergo a biopsy I thought you might have an interest. It's not relevant to any sinus problems you might be having in my opinion. It's not about that "sinus". As to lymphoma the article states: "It is unclear if the presence of these cells implies ongoing antigenic stimulation that may lead to increased risk of lymphoma." So while an increase in sinusoidal T-Cell lymphocytes seems associated with mixed cryoglobulinemia in the HCV setting whether this poses an increased risk of lymphoma is unclear.
Mike

[Myown]

Since you're about to undergo a biopsy I thought you might have an interest.
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Yes it does interest me. Thanks. But .......will they see this when looking at the bx if this problem is there OR will they have to know in advance that they are to look for this because the patient may have this condition? I don't know if I am making myself clear: when a bx is performed on a patient with Hep C, do they look beyond what stage/grade they are and also look for other things that might require specific tests with my poor little chunk of liver that misses being a part of me?

[mikesimon]

"Sinusoidal lymphocytes were counted in 5 hpf (40x) on hematoxylin and eosin (H&E) stain, and on CD3 and CD20 immunostains. "
Before you ask, I don't obtain samples or prepare or read biopsy slides so I won't be much help along those lines. Of course, as you well know, there is a blood test for cryoglobulinemia but my recollection is that you didn't have any confidence in your last test result. I doubt seriously that this is the preferred diagnostic approach to determine the presence of cryoglobulinemia. I just found it interesting but then I love biopsies. I had one on my birthday in 2006 and I drove myself to and from but it's only a 45 minute drive. I ate Chinese food later that day too and I think that helps a lot.
Mike

[Myown]

Love biopsies? I wish we were a wrestling tag team - I'd tag ya. I'll remember to eat the Chinese food afterwards - Chicken egg foo young for my boo boo, thanks.

[GrandmaA]

Can bed bugs get HCV?

[Myown]

Ewwh, I hope not. Imagine that though. Epidemic on top of epidemic.

I guess I'm more of a threat to the bed bug than he is me. I just get a bite mark - he gets hepatitus (hepatitis) C.