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Avatar universal

Start treatment and have surgery

My husband is seeing doc next week to hopefully start treatment with the newly approved Sofo with RBV and INF. he has issues with his shoulder and thinks he can get surgery for that while starting this treatment. I do not know yet if his doc will prescribe this regimen and even if his insurance will cover it. (Express scripts). From all I have read, for his Hep C genotype 1a, he is going to have to get the INF regardless. Sooooo.....what do you all think. I am so worried about him, when he had is liver biopsy it said he was at a 3/4 ?? Not sure what that means.he has a lot of sensitivity in the area of his liver, and to me, has also appears to have fluid buildup. He looks 8 months pregnant to me, and the way his stomach bulges, i can't believe it is just fat. If it were you would you attempt shoulder surgery while on treatment. When he had his other shoulder done a few years ago, it was a living hell....please please ....tell me what you think. I can't stand to see him in all this pain. He also has much fatigue and sleepless nights and joint pain in general, I try to watch how much Advil he takes, because I know that is not good for the liver.
67 Responses
Avatar universal
Yep! I should find out any day if I'm positive with Q80K.
However....I've decided to ask my hep dr to let me treat regardless. Results show a 15/20% less effectiveness with Solvadi/Olysio if positive with Q80K but as far as I can see from other (AbbVie) trials that makes them pretty much comparable. I'm dead set on not treating with RIBA much less inf.
I have appt tomorrow so will see what he says...
Avatar universal
     is your husband seeing a hepatologist?  i would think he needs expert evaluation, with the sx you have given.  internet advice would not be appropriate for possible cirrhosis
Avatar universal
I would not recommend surgery while undergoing treatment for Hep C.  Treatment drugs will lower his white count and likely cause some anemia, both of which could make surgery more risky.  Also, depending upon the exact stage of his liver damage, a surgeon may or may not be willing to do the surgery.  Surgery can cause the liver to decompensate (stop working properly), so usually a surgeon will need a hepatologist to approve the patient for surgery before agreeing to do it.  If the surgery was difficult before, it is likely to be difficult again.  Much depends on the exact stage of Cirrhosis.  When you say 3/4, I don't know if you mean F3 (Fibrosis stage 3), or if you mean some other gradated stage of advanced Cirrhosis.  If your husband were F3, he would not have any physical symptoms of Cirrhosis, e.g. his tummy wouldn't be swollen, unless he's overweight.  If your husband already has Cirrhosis, and his tummy is swollen, then it is likely that he has advanced Cirrhosis with ascites (fluid collected on the abdomen), which is a sign that the liver is not working well.  You and your husband really need to read the liver biopsy report or consult with the hepatologist to have a complete understanding of his exact stage of liver damage.
If he is F3, a hepatologist may approve the surgery and a surgeon may do the surgery, but probably not at the same time as Hep C treatment.  If he has advanced Cirrhosis, with ascites, a hepatologist will probably not approve the surgery as it may cause his liver to fail.  
Your husband should NOT be taking Advil or any other NSAIDS without approval from a hepatologist.  In fact, he should not be taking any medication or herbal supplements without approval from a hepatologist.  Until he knows for sure whether he is F3 or Cirrhosis, he should avoid red meat, limit sodium, and not take any vitamins with iron.  He should eat more veggies and fruits, preferably organic, and try to make sure he is at a good BMI.
Keep us posted and let us know what a hepatologist recommends.
Advocate1955
Avatar universal
Thank you for the responses. My husband is seeing a Gastroenterologist who has patients with Hep C. What a nightmare, he was in a car accident and had 6 surgeries and then had to have gall bladder removed a few months later. When he was in the ICU for the accident, in a coma for a month, that is when a nurse stuck himself with a needle and protocol called for my hubby to be tested...So we later found out about the Hep C. Oh it has been a wonderful year. I got his report and it was done in May and says Grade 3-4 fibrosis suggestive of early cirrhosis. I will ask his doctor for more of an explanation because that is a bit vague to me. I felt the same as you mentioned, and we should wait with surgery. What kind of painkillers can he take? He is definitely overweight and has a weakness for sugar. I have my hands full, for sure. I love to make salads and fish, but unless he hears it from the doctor, he likes to fight me on what is best. I really appreciate your help. I do research and he just wants me to do it but not tell him, it is as if he doesn't want to think about it. Thank you again, I wish you a happy holiday. I will check in again, if there is any other advice you can give, please do. It feels so good to have people here I can go to for support and strength for my husband.
Avatar universal
I should add I see on the biopsy report "moderate portal fibrosis including extensive bridging, suggesting early cirrhosis." So does that mean he does have cirrhosis for sure? I hope since May, it hasn't progressed.
Avatar universal
Thanks for looking that information up.  From what I'm understanding, the liver biopsy showed F3 (Fibrosis 3), which is the stage before Cirrhosis.  This is good, because the liver has the capacity to regenerate and repair itself before the stage of Cirrhosis is reached.
Your husband has a lot of health issues that can be complicated by as well as complicate treatment for Hep C.  Being overweight can be a contributing factor  to liver disease and also to treating Hep C in several different ways.  One way is that being overweight can cause one to have "fatty liver" (a higher number of fat cells in the liver) which places an extra burden on the liver.  Another way is that overweight people tend to have a lower cure rate.  A third way is that should the time come that your husband ever requires a liver transplant, his BMI must be below a certain number to qualify.  So, for all those reasons, getting to and maintaining an ideal BMI is a positive step.  Additionally diet is important in taking care of the liver.  Generally speaking, a low fat, healthy diet, high in veggies and fruit, preferably organic, is good.  Sugar can be a problem.  You didn't mention if he has been tested for diabetes, but being overweight and having a sweet tooth puts him at risk for diabetes.  Hep C treatments can be very hard on the body and diabetes can complicate treatment.  If he doesn't have diabetes, he should try very hard to prevent it with diet.  If he does have diabetes, he should try very hard to control it.
For the time being, I would try to get him to eat healthier (low fat, reduced sodium, low sugar/sugar free, more fruits and veggies), I would try to get him to walk for 20 minutes each day outside in the fresh air, and I would make sure he doesn't take any vitamins with iron supplements.  Regular vitamins are OK, but no iron.  As far as pain control, he should avoid all NSAIDS, and medications that are filtered through the liver.  I would ask his doctor which pain medications are OK for the liver and advise him to use them in moderation.  Of course, he will need to not drink alcohol or use any recreational drugs.
Also, remember, it is his body and his health.  It is important for him to take ownership in the things that will help his health.  You can't do it for him, and you aren't responsible.  You can support him and help him, but he will make his own choices.  With the number of issues that he is facing, he may be feeling depressed or hopeless as well.
Although F3 is the stage before Cirrhosis, a good gastroenterologist or hepatologist will treat him as if he has Cirrhosis, to be on the safe side.
Advocate1955
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