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475555 tn?1469304339

Gall bladder and hepatitis

Hi, Medhelpers! I'm in Buenos Aires and we are having a heat wave. Man, is it hot! Whew!!!

I got to see the head hepatologist at one of the big public hospitals here last week. Very nice and knowledgable guy, quite different from the screwballs at my own hospital. Many people here have told me that the public hospitals are better than the private ones, and I am beginning to believe it.

This head honcho, Dr. Frider, told me among other things that I ought to have my gall bladder removed as I have stones. He says that the gall bladder is a danger for hepatitics because once you've got cirrhosis the operation to remove it can cause decompensation. So he says I should have it removed now rather than later, when it might be too late. He also said I can have another liver biopsy done at the same time.

This seems to make sense to me, but I wanted to check with people here in the forum about it. Anyone have knowledge or experience with gall bladder problems, or preventative gall bladder surgery?

Any helpful comments will be greatly appreciated.

Cheers!

Mike
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475555 tn?1469304339
You need to post a new question (create a new thread). This thread ended in 2010 and is not being read any more.

Also, from what you say - Hep3(?), Geno stage (?) - I think you are not well informed about HCV. People will help you and give you information if you post a new question in the forum.

Good luck.

Mike
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Avatar universal
I was told I have hep3 seems I got in after blood transfusion back in 1991 after I hemorrhaged from a hysterectomy. I'm seeing a GI next week. the Hep3 was found through a scan after being in hospital for a very low hemoglobin. I was also told I had 4 small stones .I've had pain from GB before but this attack is different and hurts in my back as well. I'm having a pill camera study done to see from where I'm bleeding . I've had  a colonoscopy and a scan to check out the top part of my body, that's  where they saw the stones and my liver, now the pill study will show the middle area. I haven't had my Geno (I think this is correct) stage yet. My brother has Hep C as well and has tired the interferon but was too much for him. I understand the pills are easier on the body then the shots he had to take. Any info on this would be welcomed.
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475555 tn?1469304339
Thanks. Right now my head is spinning with all these unexpected developments.

M.
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971268 tn?1253200799
I read this:

"In 2-3 months your circulation will improve, walking will be easier, and lung function will increase by up to 30%."

I guess that would mean that in 2-3 months your blood might see some change, but I really don't know.

Good luck in any case!
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475555 tn?1469304339
I know I gotta quit this awful habit. The trouble is that I go berserk when I can't smoke. It's a real addiction, and one of the only ones I've ever had. I guess I have a heavy oral thing, because when I stop smoking for a few hours I start eating like I never saw food before, and I talk so much that people don't want to hang around with me. I figure smoking is the lesser evil.

Even if I could stop, don't you think it would take a long time, if ever, for the effects to work and my lungs get back into shape so that my hemoglobin went down? I don't think it's something that works right away, is it?

But maybe that's just making excuses, huh?

M.
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971268 tn?1253200799
Hi Mike,
I noted on your other thread you said smoking can cause high Hgb. So there you go -- quit smoking and you might lower it to help you get into the trial, as well as adding substantially to your overall health. I know -- you LOVE that advice, right?  ;)
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475555 tn?1469304339
Searching the web, I found one site that gives the normal hemoglobin ranges as:
Adult males: 14-18 gm/dl
Men after middle age: 12.4-14.9 gm/dl

According to this I am too high, with usually 16 to 17 gm/Dl.

I'm not at all happy with the idea of doing one or more phlebotomies in oreder to get into that trial, which reopens in March, but maybe I should try it if it's the only PI trial around. Like you say, dumping one or even two half-liters of blood maybe isn't a great idea with platelets down to around 125k.

I don't know what my iron is. The only thing I can find on my blood analyses is serum ferretin, which is very high (around 280 ng/mL in 2008). Saturation (whatever that means) was high, too.

Glad to hear that the anesthetic won't be heavy. I hear that anesthetics are bad for the liver.

Frankly, I hate the whole idea of it. But if it's really justified, I'll do it. What the hell, I'm already the prime guinea pig for the hospital. Might as well do 'em all.

Mike
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475555 tn?1469304339
It seems I am the hospital{s favorite guinea pig. Sometimes I wonder if it isn't a general policy used to scare me off and get rid of me. I'm not very popular there as I am always asking questions and generally being a pest. I think they unconsciously would like me to disappear, one way or an other. It's the "other" way that worries me.

M.
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233616 tn?1312787196
my best guess is it's to rule out the rare bone marrow disease that causes too many red cells to be made. Although, you are only 1 or 2 points out of normal range, so not sure what their thinking is.

It might be better to get your iron accessed...you don't want them to bleed you with your platelets being low, unless your iron is high...having a few too many HGB (red cells) is something most hcv'ers would envy.

anyway, if they are insisting, I'd consider it...they'll give you a fast acting sleeper like versed or something...you should throw it off fine...the fast acters wear off in minutes, and aren't as problematic as the stuff for long surgeries.

You said SOC won't work at 65 type 1??  You are slender, don't have to many other contraindicators, I'd say whoever told you that didn't know that many folks are successful at that age. Particularly those with good BMI index and no IR.  The other thing to consider is if you could SVR, you'd stop the slippery slope now.  How high are your Alt's?  What your iron at?
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338734 tn?1377160168
I have seen honest-to-god guinea pigs that get fewer intrusive tests and procedures than you seem to be getting in BA. Are you the only test animal they have in SA? :-)

Best wishes on your decision. Hope it all comes out OK (no pun intended). Hang in there

Brent
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475555 tn?1469304339
Hey, Brent, how's it going? It's been a while. Hope you are copasetic. How's life on immuno-suppression? Must be a barrel of laughs, huh? (Just kidding of course. My usual perverse sense of humor.)

If farting is the worst consequence of having the GB removed, I'm safe. I fart so much already that no one would notice the difference.

As usual around here in B.A., there are gonna be as many different opinions between doctors on whether or not to remove my GB and when, as there are on when and how to do Tx. Which is the main reason I tend to do nothing: too many choices, not enough facts.

I sorta liked Dr. Frider's argument about not waiting until it's too late. I lean towards the preventive medicine side of things. But there's always that "Don't fix it if it isn't broken" refrain whispering to me from the past. It's one of those damned if you do, damned if you don't situations. I know I don't have to explain that one, right?

Anyway, it isn't happening tomorrow. And now I've got a more pressing worry: this bone marrow puncture they want to do on me. If it ain't one thing it's another. Never a dull moment. Isn't life weird?

M.
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475555 tn?1469304339
Are you pretty confident they're going to approve Telaprevir soon? It would be worth waiting for. But I've read and heard the opinion expressed by several hepatologists that the USG isn't going to approve it, at least not right away. Too many demographic concerns, like creating more virulent escape variants in the population.

I'd sure like to have an inside man at the FDA. But then I guess so would all the folks with Vertex shares [grin].

M.
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475555 tn?1469304339
Hi! How's life?

Yeah, I'm working on getting as much info as possible re the gall bladder thing. I don't even know if I could talk my hopsital into removing it, so there's plenty of time to see about other options. A friend told me just yesterday that some people have had their gall bladder stones removed my laser surgery. That sure sounds like the way to go.

Today my hospital sprung a new one on me: they want me to have a bone marrow punture, apparently to see why my hgb is so high. I don't like the sound of this at all. Like, are they just using me for practicing their procedures? From boredom or something?

Any way, do you know anything about bone marrow? I don't know diddly.

Mike
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475555 tn?1469304339
I've gotten my IBS pretty much under control, by changing my diet and using Miopropan (don't know the U.S. name) once in a while. I changed my diet considerably, to good effect. I still have diarrhea attacks once or twice a month, but it's always because I didn't eat right or at the wrong time. I'm also a very stressed person and that makes it worse.

Yes, they did all the possible tests on me, and they all came back negative. The gastros decided it was due to nerves, improper diet, and diverticulos. Can't do much about the nerves or the diverticulos, but diet change has helped a lot.

I agree that the tests do not jibe. My MELD is high mostly because of my low platelets. But most of my other blood scores are normal (hgb a little high, and transaminases high and going higher). Maybe I've got onbe lobe F2 and the other F3. Seems pretty likely.

BTW, I saw a hematologist today to get an opinion on doing a phlebotomy to get my hgb down so I can get into that trial in New York in March, when they'll be opening it up again. Get this: the hematologist gave me an order for a bone marrow punction! She didn't explain exactly why she wanted it, but it has something to do with my high hgb (16 to 17). I'm kinda scared, as I know nothing about bone marrow punctions, except that they'll be giving me a general anesthetic, so it must be pretty painful. I guess it's some sort of biopsy. I wonder how long it takes to recuperate???

Have you got any info on this? All I know is that someone oin the forum told me to be careful about anesthesia because some of the drugs they use can dammage the liver. Frankly, the whole thing freaks me out. I didn't think my hgb was that high.

I'm going to try and get my GP at the hospital to enquire why they want this bone puncture done. I wish I'd never gone to see that hematologist [grin].

Mike
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475555 tn?1469304339
Thank you, Trish, for all your good words and kind thoughts. It means a lot to me, more than you can imagine, that I now have such good friends as you and the other nice people in the forum who try to help me. I could not have made it this far in one piece if it weren't for you.

Michael
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338734 tn?1377160168
I would think that there might be a risk of gallstone getting into the cyctic duct of common bile duct. I would think that would cause some real problems with the liver. If they know you have the stones, then maybe they can watch them. By all accounts I have heard, you'll know it if the stones start to move or the gall bladder itself gets diseased. Maybe it is better not to remove it until that occurs, but listen to the doctor on that one because I have no idea how much or how fast a clogged duct could affect the liver.

They took my GB out with the liver during transplant. I can't say I have missed it in the least. Maybe I fart a little more! :-)

Good luck to ya, buddy!
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Avatar universal
just google gall bladder removal side effects for more info about it.

as for treating, how do you feel about treating with the new drugs in about a year? this would up your SVR % to around 80+ %. And most likely a shorter course of tx with telaprevir.
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717272 tn?1277590780
See what you can find out about he possibility of dissolution of stones by some other method.  Personally, I am for leaving this earth with as many of my parts and pieces as possible.  On the other hand, I have had several in-laws who had gall bladders removed with no later problems whatsoever.  Makes you wonder why some parts are there if there removal doesn't change your life at all.
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233616 tn?1312787196
I'm a little confused by your fibroscan reading when your MEld is at 10... that MELD is not indicative of stage 1/2.
You do remember I told you one lobe could be in worse shape than another, right?
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233616 tn?1312787196
I know this will sound crazy but trust me it's true.
too little fat is as injurious to the gall bladder as too much.
In fact too little fat in the diet can actually cause inflammation and ruptures because the bile becomes so concentrated it's toxic. Bile is being secreted all the time, some, not all, ends up in the GB where it stores up for the times we eat fat and proteins. Since more bile, or rather concentrated bile helps us digest these hard to break down items, our body thusly provides the solution impeccably.
What will happen minus the GB is a little less breakdown will occur of fats and proteins, but not a lot less. You will still absorb plenty . (although by plenty, I mean around 5% is normal for an adult.)  (absorption is 15% as babies and goes downhill during life as our mucousa and cilli begin to degenerate.

I can't say how much with IBS you might be effected. Have you been tested/treated to see if you have BD or some other bug?  Do you do any probotic type regimes?
My best guess would be it should not end up giving you grief but there are exceptions.
There are people that swear that's what set theirs off...and so you would want to research and look into it.  
here's a link that has some info and also some myths busting dietary info.

http://www.helpforibs.com/news/newsletter/limemint072704.html

although, my experience with folks with bowel irregularities is that there are dietary ways to settle most stuff down, that's assuming that you aren't carrying a virulant bug causing it, or that your immune system hasn't gone into hyperdrive.

I cured myself of IBS years ago (when belladonna was the only cure, so long ago)...I did it by changing my diet and by changing my high stress profession as well.
In any case, IBS is pretty complicated and I don't think the GB surgery is probably the cause, although I suppose if something got botched or injured in the nerve matrix of the intestines then that could exascerbate things.
In any case, read the link, and remember we all need some daily fat, good lipids are essential to health.
Your liver makes a quart of bile a day, and it recirculates about 6 times, so you are drenched in bile anyway, with or without a GB. The oily diarrea folks get after GB is because high fat meals can act like a good lube job, minus enough concentrated bile, but as I said, unless you eat a LOT of fat and protein, that is not usually an issue.  What do you do currently to control IBS?
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Avatar universal
I wasn't suggesting you panic into SOC or even that you go for SOC at all.  I believe I used the word "treatment" - you were looking into trials most recently.  My suggestion to focus on getting your treatment options in order is because that seems to be what your many posts of late have been directed to and it's where you left off at.

"I do not want to, and will not get into the endless SOC thing."

I don't think anyone does.  Usually one round of SOC and then it's a matter of determining what needs to be done to increase one's odds the next time around.  I don't think I know anyone who does endless rounds of SOC.  Having said that, what I believe you're inferring is that you would like this to be a one-shot deal and hedge your odds accordingly.  I think you have some company there.

"To know that, I'd have to know when I got infected, and I don't know that. It could have been in 1962, it could have been in 2005, and it could have been anytime in between. So being F1/F2 now means zilch. "

I agree with you that being F1/F2 now means zilch other than that you have much to be thankful for being only F1/F2 at 60+ years of age.  Not even knowing when you got infected will tell you how fast your fibrosis will progress.  It's different for everyone.  I got infected somewhere back in late seventies, early 1980 I reckon and was still only Stage 1/Grade 1 when diagnosed in 2006.  Others are quite different than that.  What is important is ongoing monitoring and reducing and eliminating those things that can exacerbate the progression of fibrosis.  While fibrosis can advance very fast for some, the balancing thought is that many will die with Hep C rather than because of it.  Being overly alarmist is not helpful.  Being vigilant is what is required because advance of fibrosis is not predictable.

"Doing 18 months of harmful drugs and then having a relapse (as has happened to sooo many people) is not "getting the Hep C over and done with", it's just getting on the Pharma train without a return ticket."

First of all, it's 48 weeks for a Geno 1 and only 18 months if you are one of those who is still not UND at 12 weeks and if all your variables make sense for you to continue on to 72 weeks. That is NOT a given for every person.

Second of all, it's not getting on the Pharma train as if anyone opting for treatment is a no-mind sheep who's been duped into thinking that these drugs can actually cure you.  Well Mike, they actually CAN cure you as the numerous SVR posts attest to.  The drugs are difficult, chance of cure is lower for Geno 1's and yes, it might require a second or further round of treatment.  I respect those who choose not to treat.  I also understand very well those who consider 40% odds worth taking on and there are those with even lower odds who go for the "pharma" route as it's their only option, Mike and will continue to be our only option for some time to come when we're talking about cure.  Pharma is it, like it or not.  

"I don't even want to "test" the SOC drugs to see what sides they cause me, because I'd be creating resistances."

There are those who don't respond as well to interferon/ribavirin combo because their strain of HCV is intrinsically more resistant to interferon. This is NOT the same as developing resistance to interferon that didn't exist prior to injecting interferon on treatment and BECAUSE of taking interferon for treatment of HCV.  From the reading I've done on this, those who develop resistance are in the extreme minority. If I am incorrect, I hope others will post accordingly.

Deciding to hold out for as sure a thing as you can get, particularly at Stage1/2, makes alot of sense. Good luck with that and I hope all the pieces fall into place for you very nicely at an opportune time.

Trish

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Avatar universal
I had my gallbladder removed laproscopically, {stone included}, sorry abot the typo, I was back to work in 3wks full duty....Leah
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475555 tn?1469304339
We're back to the same vicious circle about Tx, Trish. You may be right about not operating my gall bladder now, but on the Tx-or-not-to-Tx issue I stand firm. I do not want to, and will not get into the endless SOC thing. My chances are not 50%, they're more like 25%. Doing 18 months of harmful drugs and then having a relapse (as has happened to sooo many people) is not "getting the Hep C over and done with", it's just getting on the Pharma train without a return ticket. I don't even want to "test" the SOC drugs to see what sides they cause me, because I'd be creating resistances. If and when I go onto a therapy, I want it to be one that works. SOC does not work for 65-year-old geno 1s with high viral loads.

That said, and considering that I don't have any gallstone symptoms either, I'm not rushing over to the operating room and telling them to sharpen the scalpels. Everything in due course.

And by the way, no one knows how fast my fibrosis is progressing. To know that, I'd have to know when I got infected, and I don't know that. It could have been in 1962, it could have been in 2005, and it could have been anytime in between. So being F1/F2 now means zilch.

I appreciate your concern, Trish, but panicking into SOC is not the answer.

Luv ya!

Mike
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475555 tn?1469304339
Yes, well, that's what a lot of people keep telling me, but when you're geno 1b, over 65, and have a high viral load, the statistics are now 26% chance of SVR with SOC. That's not good enough for me, considering the side effects and that I am still asymptomatic. Sure, I could end up badly regretting this decision. But if I do Tx, have bad sides, lose my otherwise excellent health, and end up not clearing the virus, I'll have regrets then, too. And with my luck, I'd probably get run over by a car in downtown Buenos Aires the day after EOT.

M.
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