useful info

If you take TMG then you need the Folic Acid +B12 to make SAMe


Courtesy of JmJm:

Thought I'd arrange a  menu by stages during treatment for the two labs discussed.

BEFORE TREATMENT:
1) Heptimax (Quest Diagnostics) (5 IU/ml-50 million IU/ml)
2) Quantasure Plus (LabCorp) (10 IU/ml-100 million IU/ml)

DURING TREATMENT ONCE VIRAL LOAD IS BELOW  2,000,000 IU/ml
1) Heptimax (Quest)  
2) Quantasure (LabCorp)  (2 IU/ml-2 million IU/ml)
3) Quantasure Plus (LabCorp)

AFTER NON-DETECTIBLE VIA ANY OF THE ABOVE TESTS:
1) Heptimax (Quest) (
2) HCV RNA QL TMA (Quest) (<5 IU/ml)
2) Quantasure (LabCorp)  
3) Quantasure Plus (LabCorp) (
4) UltraQual (LabCorp)     (<2-3 IU/ml)
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Metavir scoring system:

Grade: (how much active inflammation is presently going on)
A:2 = moderate activity

Stage: the stage of fibrosis (how much damage is already present)
F:1 = minimal scarring


The Ishak Modified HAI
A modification of the Knodell HAI system, more sensitive and accurate in assessing fibrosis. Fibrosis staging is scored from 0 to 6, which permits physicians to better assess the effect of therapy on fibrosis.

HAI: A:2, B:0, C:2, D:3 = 7/18 (7 out of a possible 18)

Ishak modification for hepatic activity index (HAI) for scoring of necroinflammatory activity in chronic hepatitis

(A) Periportal or periseptal interface hepatitis (piecemeal necrosis) -  associated with hepatocellular necrosis (death of liver cells)
Absent 0
Mild (focal, few portal areas) 1
* Mild/moderate (focal, most portal areas) 2
Moderate (continuous around o50% of tracts or septa) 3
Severe (continuous around 450% of tracts or septa) 4

(B) Confluent necrosis
* Absent 0
Focal confluent necrosis 1
Zone 3 necrosis in some areas 2
Zone 3 necrosis in most areas 3
Zone 3 necrosis+occasional portal-central (P-C) bridging 4
Zone 3 necrosis+multiple P-C bridging 5
Panacinar or multiacinar necrosis 6

(C) Focal (spotty) lytic necrosis, apoptosis and focal inflammation
Absent 0
One focus or less per _10 objective 1
* Two to four foci per _10 objective 2
Five to ten foci per _10 objective 3
More than ten foci per _10 objective 4

(D) Portal inflammation
Absent 0
Mild, some or all portal areas 1
Moderate, some or all portal areas 2
* Moderate/marked, all portal areas 3
Marked, all portal areas 4

More biopsy info + details:
http://janis7hepc.com/biopsies.htm#scoring%20and%20grading%20biopies

Cheers!
Hector


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expert forum:   http://www.medhelp.org/forums/show/272
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Mitchell L. Shiffman, MD
"Several studies have now demonstrated that mild reductions in the doses of either peginterferon alfa and/or ribavirin will not adversely affect the chance of achieving SVR, especially if this strategy is employed after the patient achieves undetectable HCV RNA.[15,24] By contrast, interrupting treatment for more than 7 days because of adverse events leads to breakthrough and relapse.[24] Therefore, it is the recommendation of this author to reduce ribavirin stepwise by 200 mg every 2-4 weeks until adverse events either resolve or are tolerable. Peginterferon alfa-2a can be reduced from 180 to 135 µg/week and peginterferon alfa-2b from 1.5 to 1.0 µg/kg/week. Neither peginterferon alfa nor ribavirin dosing should be interrupted unless the adverse event is particularly severe and there is a concern for patient safety. Whenever the doses of peginterferon alfa and ribavirin are modified or temporarily interrupted, HCV RNA testing should be performed again to ensure that breakthrough has not occurred."


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Don't take flax seed or fiber supps anywhere near the time you take any meds or supps or they will get flushed out of your system.
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Keep the calcium in reserve. Iron up to somewhere around double ULN is just going to be your bone marrow crying out for as much as it can get. much above double it might be an idea to try and chelate it.
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From The Life Extension website (courtesy of Evangelin)

Reducing Iron Stores
Elevated serum iron levels are often found in people with hepatitis C and cause further oxidative damage to the liver. Certain nutritional supplements have shown evidence of reducing serum iron levels. To help keep serum iron levels in the low normal range of 30 to 80 ng/dL, high doses of green tea polyphenols and high-allicin garlic may be beneficial.

Lactoferrin, a subfraction of whey protein, may be especially beneficial as an adjunctive treatment for serum iron overload in hepatitis patients. Lactoferrin is a potent antioxidant, antiviral agent, and scavenger of free iron. In addition, lactoferrin is directly involved in the upregulation of natural killer cell activity, making it a natural modulator of immune function (Yi M et al 1997; Ikeda M et al 1998, 2000). As an immune booster, lactoferrin has been shown to work synergistically with interferon to reduce the viral load (Ishii K et al 2003).

Taking 300 mg of elemental calcium can reduce iron absorption by as much as 50 percent. When eating iron-rich foods, hepatitis C patients should consider taking a high-potency calcium supplement at the same time (Hallberg L et al 1991).

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http://tinyurl.com/57gnja     on anemia and fast heart rate.
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They do go up and down and up and down but I wouldn't doubt at all that living a liver healthy lifestyle has helped you.

ALT and AST are important because they represent the amount of liver damage that is currently being done to your liver.  They do matter very much to us.  When I was diagnosed mine were in the 200s.  The first month I started treatment they went straight down to the low 20s.  The lower the better - consistent low liver enzymes is a great wonderful thing to have. (nyg)
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Ribavirin destroys red blood cells which can and often does result in hemolytic anemia. Ribavirin is not primarily responsible for a low platelet count. Ribavirin causes the premature breakdown of red blood cells which results in the anemia which so often afflicts us during treatment.

Interferon can cause myelosuppression (bone marrow suppression) which results in a reduced number of platelets, red blood cells and white blood cells circulating in the blood.

Interferon is the primary cause of decreased platelet count that often occurs during treatment.
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costco,com for sam-e

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• Patients with RVR who had a high baseline viral load ≥ 400,000 IU/mL had a higher SVR rate when treated for 48 rather than 24 weeks (87% vs 73%; P = 0.14).
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Life Extension Super Bio-Curcumin® 400 mg (60 vegetarian capsules)  26.00
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Diet and LFTs'.  http://tinyurl.com/266apm
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(3/1/08 ) Will take Cocksparrows advice and take Shark Liver Oil and Melatonin for awhile and see if it helps improve my platelet levels.
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66% of genotype 2/3s become UND by week 4, which gives a patient of your genotype a 90% SVR rate. When your virus level became undetectable at week 12, your chances of SVR were 49%. So you had a 50-50 chance and you gave it your best shot and since you respond to treatment you are a good candidate for retreatment.
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G3s who RVR have 80-85% SVR rate
G3s who are non RVR have 39% SVR rate.
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To calculate your Viral Load in Logs
Run Calculator on your PC
View Scientific
Enter VL number
Click the Log button

Starting VL 3,020,000 = 6.480 logs. The numbers to the right of the decimal point go on forever. So round up or down to 3 decimal places.
Week 1 VL Test 277,000 = 5.442 logs. Once again number is rounded

6.480 – 5.442 = 1.038 or 1.04 rounded. Concerning logs, the interesting thing during treatment is not how many thousands or millions of international units of virus our viral load has decreased with so far, but how many percentages.

A 1 log drop equals a 90% decrease of viral load.
A 2 log drop equals a 99% decrease.
A 3 log drop equals a 99.9% decrease.
A 4 log drop equals a 99.99% decrease.

What you need by week 12 is thus a 99% decrease. One reason for this is the variance in the results of viral load tests. A test result might vary half a log up or down from the actual viral load. Thus to be sure an actual change has taken place in viral load one has to count with a variance of half a log for each of the two tests one is comparing, i e a one log drop is not sufficient to be sure any decrease has actually taken place.

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(REFINED SUGAR IS HARD ON THE LIVER!)

Veggies and salads are the "macrofibers+ microfibers ". They slow everything down, even the basic enzymatic digestion process : macromolecules in food to absorbable monomers of sugar, amino acids and fatty acids. . . Grains - simultaneously with the above therefore, never as a "bolus' as such by themselves , grains should ideally be mainly oatmeal, little to no wheat and always in moderation. Veggies and salads themselves have slow carbs right in them. What matters is the slow offering of the enterically absorbed "nutrients" to the liver, that has to work them up as they come and therefore can be easily overwhelmed=damaged. if the offerings exceed the available capacity for "nonstressful processing". It is mainly a biochemical processing plant and it can only do so much per minute....Fruits/berries should also be embedded if possible, since they often . contain relative high available monosugar amounts..It is obvious that any true "sugar" containing drinks or even fruit juices are problematic for all these reasons and "deserts" are not even discussed.....
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If you take lactulose prophylactically, then the ammonia producing bacteria will be kept at a low level and the lactulose dose to achieve this will be low, with no unpleasant degree of diarrhea. If a patient has already toxic CNS symptoms, the presribed dose of course will be high and diarrhea will be intense. Again, hepatic encephalopathy can be life threatening and then even lactulose enemas are given to save the patient.
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As far as diet goes, it is real simple, I burn more calories than I take in. I use a treadmill every day and watch what I eat. I eat a lot of fruit and vegetables and salads. I stay away from sugar and white flour stuff.  A typical day is a Slimfast for breakfast, 3 hours later at work I'll have a salad. 3 hours later a yogurt and celary sticks, 3 hrs later some cheese or sardines (I like sardines). When I get home I work out for an hour, then eat something with protein in it like tuna, or lean meat with asparagus or a salad. I drink coffee or diet soda when I get any cravings. Once a week I eat whatever I want. I will go out for steak, or breakfast or something great which gives me something to look forward to. I count calories sort of and as the weight comes off, it get's easier to stay motivated.  Eating several small meals throughout the day with fruit and/or vegetables is easy on the liver and the URQ pain I used to have is long gone.
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3/1/08 update.  I have added HIT weight training to my excercise regimen and have upped my protein intake and calorie intake to 2000 daily. We'll see what happens.
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betaine is just another name for TMg = Trimethylglycine, I have listed here, on this board, all these synonyms in the past to avoid the confusion that sometimes arises from all these different names for the very same thing.

Exactly as CS says above Same is quite expensive, TMG=betaine is cheap. For that reason, very much on purpose i have, considering people on a low budget, only typically  listed the TMG and not the SAme, since TMG can donate its methylgroup to the production of SAMe (S-Adenosyl-Methionine- the activated form of Methionine and therefore the actual donor of Methyl groups in the myriad of critical synthetic metabolic enzymatic reactions that require Methylation).
Nevertheless, if someone can afford it, having extra SAMe supplied directly, without the need to synthesize it from TMG and DMG, might still add extra benefits and will have no neg effects whatsoever (except the extra cost).


To Gauf: Best to not touch Germanium. As a transition type metal element it will have numerous prooxidative toxic effects - that might in some cell types, like macrophages - result in NFKappaB activation with subsequent Interferon production in response to this damage signal. This is not worth the ill defined risk of broad toxicity.

If someone wants to be super complete with respect to covering all nontoxic antifibrotic concepts and approaches, there is one more that I have - again for the purpose of not to confuse and over complicate and dilute the order of priorities - not ever mentioned yet here , since it does require a prescription; It is ursodiol, a bile acid derivative that reduces substantially the inherent stress and toxicity that the bile production burdens the liver with, by enhancing its excretion and reducing the metabolic stress that bile production places on the liver. It is used with great success and routinely in patients with primary biliary cirrhosis, where this mechanism of liver burden and damage is chronically out of control resulting in cirrhosis by itself. But

as an article fairly recently supplied by JIm JIm has AGAIN ( there is lots of previous lit showing small but consistent benefits of ursodiol on all forms of Hepatitis) nicely shown

it is able to reduce ALTS and liver stress in nearly all forms of Hepatitis as expected if one understands the bile production burden/stress on the liver. The problem is, that your hepatologist has to prescribe it to you and you might best achieve this by arming yourself with Jims abstract. If it would also supply benefits while on tx - no clear answer to this question. Now i am hours from departing to NZ and can answer no more questions until middle of march...

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Read these links, Helps explain what each does.
http://www.smile.org.au/OtherMedicalTherapies/HepatitisC.htm
http://www.smile.org.au/OtherMedicalTherapies/HepatitisCRef.htm