Biopsy and alcohol

[HarlemHon]

My doctor, who I am not happy with and am leaving for a hepatologist, will not do a liver biopsy unless I have not had a drop of alcohol for three months.  I cut back significantly (down to two drinks a week) but that was not good enough, so I have now totally quit for over a month.  I certainly know alcohol is not good for people with Hep C, but what bothered me is that she was pushing me to decide about treatment without a biopsy ("Come back to see me in three months if you are ready to start treatment; otherwise,come back  in six months"--I think her plan was to do the biopsy in three months after I had decided to have treatment since she didn't want to see me at three months unless I had decided to treat).  I think the order should be biopsy then decide about treatment, not the other way around.  Any thoughts on this?  Some people may not be able to stop drinking, so I guess this doctor would not do a biopsy or treat them.  As it happens, the hepatologist can't see me until July anyway, so that will be four months not touching a drop.

[JDB1964]

You stated you have three children. do it for them! I made a quick committed desicion to stop drinking the moment of diagnosis. Thought it would be a peice of cake(not)but learned through the help of a group of likeminded people (AA) that is not only possible but a joyous way of living.

[jenni633]

i am 30 and have had hep c for 6yrs. drank non stop for the last 5yrs of that. i was told 6months w no alcohol before the liver bio could be performed.. every addiction is hard to stop. but if you have a good support system you can do it.

[thunderfan]

I am also struggling with alcoholism and hep c. As much as i know its killing me i cant seem to stop drinking. I have 3 children and am terrified to leave them and terrified to have the biopsy because ive heard its painful and iM afraid to find out how much damage ive done. i agree i feel selfish for continuing to poison myself especially when my kids need me and im only 29 i am not ready to die yet. I understand both sides of the alcoholic with hep c and those struggling to live. I hope yu and i both find the strength to choose life over a buzz

[BoceprevirGal]

Heeheee, but we get a free lunch, that goes with it!
     But I was surprised at how attached I have become, to the people in this group. Most that attend, were cured years ago, and are there to support the people who are trying to make a decision, or who are Txing.
   We also get to see the people who didn't listen to the doctor, (and continued doing drugs/alcohol) come back to the clinic, to be seen by the doctor, and that can be a lesson, also.
   I have elevated Bilirubin, so I am kind of this yellowish/greenish color, and I get to see other people there,with the same symptoms, that are the same color as Shrek, like me. It makes me feel less alone, etc

[suezeeque]

Thank God I didn't have to go to those meetings before participating in my study.  That kind of thing is definitely not my bag.

[BoceprevirGal]

Good point, I notice my Doctor has made everybody at the Clinic I go to, wait about 2 months, minumum, before treatment.
   The thing that differs about my treatment, from what I have read on here, is that my Doctor is an Internal Medicine Doctor, and an Addiction Psychiatrist, and she runs a weekly support group, and then finishes with a lecture.
   So, before she would treat me, I did attend the weekly support group for two months, and we all go around the room, and say something about our experience with Hep C, why we are there, etc.
   Meanwhile, the Doctor listens to us, and can then access, from our behavior, if we are making the meeting regularly, and on time, and by are appearance and speech, etc, if we are clean and sober.
   I have noticed it is almost impossible to B.S. a whole room of people, most who have used drugs or alcohol them-selves, in the past!
   Another good thing about the support group, and our speaking at it, is that she can find out what our usual mental state is. That way, if we have to go on treatment, she has an idea of what our pre-treatment mental state is, so if she s=notices a change in our behavior, after treatment starts, she can prescribe the appropriate psych med for that, as well.
  Of course, many people will not need these kind of meds, but many will, also~

[Advocate1955]

Congratulations on being proactive and taking charge of your health.  That is a lot of information to learn and process in just a few months.  Maintain your sobriety.  Everyone here is correct in saying that many/most doctors will not treat for Hep C if the patient is drinking or using recreational drugs.  I know that is one of the questions my husband's hepatologist reviewed in depth.  Although my husband had not had a drop of alcohol for over 20 years, she asked many questions along those lines, so I think it must be a key factor in making sure that the patient is not further harming his/her liver and also to make sure that there is a stronger likelihood of treatment success.  As far as the liver biopsy goes, my husband's first liver biopsy was part of the routine steps of the process after his Hep C diagnosis in 2007.  It was also part of the routine steps of the process 3 years after his first treatment failure, so he had another biopsy in 2010.  However, his hepatologist said that another biopsy was not needed now, since he had progressed to f4 Cirrhosis between 2007 and 2010.  She said that since we already know that he has progressed to Cirrhosis, there is no need to do a further biopsy.  I don't know if that will hold true in the future, or if it was just in response to his question at that point and time.  So, my suggestions to you are:  1) stay sober, 2) treat your liver kindly (medications, diet, exercise, etc.), 3) find a hepatologist that you feel comfortable with, 4) find out your stage of liver damage, and 5) follow all of your hepatologist's recommendations.  You may need other vaccinations to prevent other types of hepatitis that can cause increased stress on your liver (e.g. Hep A, Hep B).  You may need an ultrasound or other diagnostic tests on your abdomen/liver to check for cysts or masses.  You may need an endoscopy or colonoscopy to make sure that you don't have any other gastroenterological problems.  There are many steps that hepatologists like to complete before making recommendations about Hep C treatment, and all of that can take some time, let alone getting insurance approval for Hep C meds and getting them scheduled for delivery, so just take it one day at a time, and get the process started.
By the way, there are many things to consider regarding treating with triple tx vs. clinical trials, so be sure to read up on both before you decide.
Best wishes on this journey.
Advocate1955

[suezeeque]

Congrats on staying dry for over a month.  Keep it up, whatever you are doing is working.  ;)  

I don't necessarily disagree with the doctor saying no biopsy til you stopped for a period of time.  Perhaps the doctor wants to see if you are serious about wanting to change your life.  If you hadn't stopped drinking, treatment wouldn't be an option.

I waited a couple/few months to see the hepatologist.  It's not uncommon to have to wait.  It feels like forever but many of us have had HCV for decades so what's a few more months, right?

However, when you are newly diagnosed, the sense of urgency you feel about wanting to DO something about it certainly isn't uncommon either.

Good luck, stay sober.  :)

[1swimmer]

Yo,
Thanx for the info. There is so much to learn.
C

[BoceprevirGal]

I thank you for posting such a thought provoking discussion (to say the least) and I was also pretty over-whelmed with this Forum, when I first joined, I'd never seen anything like it, hah!
  The main thing about these sometimes controversial debates we get in here, is it gets me to reading and educating myself about different Hep C tools, and treatments.
   I also want to thank the posters who provided the links, about past drinking and tx, because I am trying to get my husband ready for treatment, he is genotype 1a, but he has to take alot of other medications, because he has many more health problems than I. He told me flat out, after watching what I am going thru, that he doesn't think he would be able to handle the triple tx I am going thru.
   I was told that the Clinic I go to, for my tx, will be conducting a new Trial, in 6 months, and he thinks he would like to start with that, and I think it makes sense.
   It is lousey that you found out that you have Hep C,  but at least now (compared to the past) we are starting to see alot more Hep C cure medicines coming our way~
    My Doctor says that alcohol tends to raise the AST, and your labs really show that to be true. Try to pamper yourself, with some fancy smoothie drinks, for a substitute. Dont deprive yourself, by just sticking to water, life goes on after a Hep C dx.

[Idyllic]

Wow has this thread grown a head and a couple of other lives!!

So, you just stumbled on to the fact you have Hepatitis C? Whoa, that must be incredibly overwhelming. Oy, WE must be incredibly overwhelming!! I am hearing some "Speak for yourself thoughts out there," so...

I am glad you made arrangements  to see a different doctor and a Hepatologist at that. Some of the stuff about your other doctor just felt wrong but it is a truly a choice the individual has to make.

I hope you check in and keep us informed as well as continue to bone up on different kinds of HCV treatments especially since July is not that far off.
Take care and be well,
konyha

[HarlemHon]

You have all overwhelmed me with the info and good wishes.  Regarding ALT, went down from 58 to 44 when I cut back on alcohol and AST went from 50 to 36, which according to the report is within normal range.  I have not had bloodwork redone since I completely quit.  I feel great and would have never known I had HEP C except that my PC wanted to treat for something else and the drug could cause liver problems, so he ordered the bloodwork to see why AST, ALT elevated.  I am already changing doctors and have cancelled the appointment that I had with the dr. I felt was pushing treatment w/o biopsy.  Hopefully, I will be more comfortable with the hepatologis I will see in July.  Honestly, if I can avoid triple tx, I will after reading what many of you are going through.

[nygirl7]

LOL No Pro I should have right away!  Us and the alcohol threads.... ;)

Congrats to your 18th year that is TRULY remarkable and something that should give hope and encouragement to HarlemHon for certain!

(Maybe I can start another alc. thread and then PM you right away ;)

Congrats again my friend on such a wonderful and inspirational anniversary. Some of you guys never cease to amaze me in here!!!!!!!!!!!

[Proactive]

Oh no, you didn't PM me? I almost missed an alcohol thread! Hey, this April marks the 18th year of prohibition for me(g). Weeks turn into months, months into years and we move forward..Some memories are good, and some ain't.

pro
Best'o luck HarlemHon

[rivll]

I am sorry James-I know it is easy to get on a conversation and forget about the op-I was tired last night-nothing personal. :-)

[nygirl7]

When a liver cell dies it releases an enzyme.  If you already have cirrhosis for example - you have scarred tissue that is not releasing the enzymes, therefore your liver enzymes may be low.

However, some people have normal enzymes at the time of testing therefore it appears they do not have cell death going on.  If they are tested at another time the numbers could be way up. Or liver enzymes can be elevated due to strenuous exercise or medications that have nothing to do with HCV.

That is why we do NOT rely on liver enzymes as an indicator of the condition of our liver and instead do biopsy.

[1swimmer]

Hi there,
Interesting little tidbit I just learned. Our liver enzymes reflect healthy liver tissue being inflammed. Dead tissue cannot do this. There are people out there that have liver damage and normal liver enzymes. This information came from my genetech go-to person.
cheers,
C

[nygirl7]

Was I wrong to misunderstand that the doctor said no biopsy until you have proven you can remain sober for a lengthy period of time? That makes sense to me in the fact that it would be a waste of time money and a medical procedure if you cannot.

If you start drinking again you will not be able to treat so it would have been a waste of services and money. I think it was rather prudent to see what would happen first.

I have a friend who pretended to have quit, got a new liver - blew that one away and got another one and then died. He never stopped. What a waste of two healthy livers that others could have been respectful of.

[mollybaby]

thank you hector like yourself I have seen and still see so many abusing alcolhol and drugs and it doesnt affect them much to see what I am going thru. I urge all to quit drinking and doing drugs. It destroys lives and like ourselves who have chose to live and fight its very frustrating and somewhat hardens your heart to those who dont care about their life to change it. I too dont feel sorry for those who continue in this lifestyle and will not tolerate it around me nor condone it. I have to live with the mistakes i made in life and have learned at a high exspence- my health. But I still try to urge those who want to quit and will do what i can to help but they have to want to and go any distance to do so if not they are on their own.

[James10500]

Sorry for the highjack

[James10500]

I would think a biopsy would be more important than ever now. With the optimism that surrounds 7977 if I was a stage 1 or 2 I would wait fo sho.  Interersting that the ALT and AST numbers are so low, is that an indication of minimal damage?

[FlGuy]

It's not unusual for a doc to recommend treatment without a biopsy. What's your geno type?  If you don't know your geno type the doc does not have even have enough preliminary information to either recommend treatment or prescribe a biopsy.

[1swimmer]

Greetings,
My thoughts for you; learn what you can, use this site, do as you are doing by asking questions. Finding the doctor that is right for you, may be on the top of your to do list. Have you had your A and B vaccines?
For me, I did not want a biopsy. I opted for a fibrosure test. I know my doctor favored the biopsy but he respected my leaning. From what I had read, if you know you are going to do treatment anyway, biopsy wasn't always necessary.
BTW, I was 7 years sober, living pretty healthily, and was unhappy that my liver enzymes did not reflect that. I requested further tests and dx: hep c.
Anyway, good luck on your journey. Find yourself a doctor/ally!

[rivll]

Bochgal and James-get off this thread-you just hijacked Harlemhon's post.