anybody have cirrhosis on biopsy with the rest of the tests totally normal?

[niceguy2007]

after reading about the palmar erythema occuring at stage 2 posted by one member here,

i was wondering if anyone on the forum has ever been diagnosed with cirrhosis on a biopsy, with:

- normal platelets
- normal spleen size on ultrasound
- no fatty liver / or some fatter liver on ultrasound
- totally normal abdomen and organs on ultrasound

??

[sfbaygirl/John]

I may have red palms and fatty liver, but I don't have cirrhosis. I am a stage 1/2 according to bx and fibroscan. So don't worry about it! Theres not much you can do at this point. No dr. will give you a bx on tx. Maybe you can get one after.

[niceguy2007]

what you guys have said is correct, but the thing is, the test i used at week 4 wasnt very sensitiive...went down to 500 IU/ML only.

i got another more, sensitive test from a distant hospital at week 7..i think that was at least 100 IU/ML...though don't know the exact amount, may have been even more sensitive.  still have to confirm from the hospital.  that was UND too.

now i've injected at least 3 shots on bruised tissue.

WBCs and HB have risen slightly from week 6 to week 10.

i'm contemplating extending treatment to 48 weeks now.  


factors in my favor:

-young age, 25.
-less than 4 years of HCV infection
-low pre-tx viral load of about 50,000 IU/ML.
-normal ultrasound
-normal platelets
-very low weight (56-60 kg)
-lean body with very little fat

factors against me:

-a rapidly developing small blotch of palmar erythema under my little finger (pre tx)
-coupled with suddenly developing tiny telangectasia on ribs and ankles (pre tx)
- weight gain of 4 kg on treatment

[FlGuy]

Being UND at week 4, even if it only down to 500, is very good progress and good news to you.  If it was me, and I relaize it's not, there would be no way that I would extend beyond 24 with the attributes that you have unless I was detectable beyond weeks 8 or 12 .  There is a reason that geno 2 and 3 typically have higher tx success rates.

[sfbaygirl/John]

what genotype are you? A 2? The factors you list don't sound like reasons to extend to me. You can get a fibroscan in France to see what stage you are. You tests were UND, albeit not very sensitive at 4 weeks. You are young, haven't had this long, without knowing the stage, I don't know if I would extend. See what your dr. says.

[niceguy2007]

i have (or rather, had hopefully) genotype 3a :)

[HepCBoy]

Yes, my palms are normal too.

Have you thought about anti-anxiety meds?

[FlGuy]

In somes ways it's sort of academic now. I think you are in about week 11, going 24, tolerating the meds ok and I expect you intend to finish the 24 weeks, right?  You reached und early, around week 4 have not had hcv very long and have not had a biopsy. So at this point, or until you have a bx, there's not much action you can take anyway.  Although not an expert in field, cirrhosis can come with a number of 'side dishes' like platelets, palms, nevi and a number of others that can be sign or symptoms of cirrhosis.  Since you are getting farther down the tx path, the action seems to be keeping up with the tx and managing sx as best you can.  You've got seveal positive indicators in your favor, just work your way through tx and finish what you started.

[Kalio1]

Normally ONE symptom does not make a diagnosis for any illness. With cirrhosis having only "red palms" but no drop in platelets or enlarged spleen or any other symptom or sign would make it highly unlikely that you have cirrhosis. I don't even think a doctor would recommend a biopsy for you as you do not have signs that indicate the need for a biopsy or signs that you have cirrhosis other than red palms and red palms CAN be normal for some people or have some benign cause.

I agree with others that suggest you might benefit from the use of an anti anxiety med. Treatment is anxiety inducing and as I recall even before you started treatment you were dealing with a high level of anxiety. You might want to talk to your doctor about using an anti anxiety med. for the remainder of your therapy.

Hang in there, you are almost half way there!

[NYgirl]

Please nice guy you need anti anxiety medications.  You really must stop with all the obsessions. It's needless and might hurt your chances of SVR if you continue.
You have a normal problem and it must be addressed.

Stage 2 isn't cirhossis.  You know that.

[sfbaygirl/John]

there are a few 3's that relapsed here. I guess it's a decision you are going to have to talk with your dr about. I wouldn't base your decision on those factors you listed. You did get UND at 4 weeks. What was your starting VL?

[GrandOak]

Being a stage 4 I probably should have a palm problem too, but we won't go there ;-)

[scubadiver30]

Hi Florida Guy
I was wondering how old were u when u did your first round and your VL after relapse?
Nowadays, I kinda agree with niceguy about the extending 2 48 issue...
We have several weeks of TX on our backs and we realize that we can tolerate this thing for more than 6 months (or we think we can)...so even if the standard TX for 2/3 calls for 24 weeks why can't we be proactive and extend? I remember several episodes of red palms in my life and now I'm really getting scared.
My FS says 10KPA and thst F2/f3...
I'm a big man, over 40 and I haven't lost any weight on TX (in fact I'm gaining pounds) because of the fat ingestion for the riba absorbtion.- Tomorrow I go for for my 4 wk PCR and still don't know the results from the previous 2wk...:-(

Do u think I may expect to get worse SX as I go or do the SX level out after a month?
Gracias for your response and have merry Xmas

[FlGuy]

I finished 1st tx this time last year and was 54. For the reasons I mentioned (cirrhosis, age, riba) the doc feels I relapsed and I think those are factors to consider if thoughts are to extend, with the greatest decisions based on vl levels in the early (2-6) weeks.  Six months after tx vl was at 6 million copies.  In Niceguy's situation, he doesn't have all that 'bad' stuff - in my opinion.  I just hate to know that people are taking one more riba or one more shot then they need, but it's all a calculated risk.  As to sx's, I think they are cumulative.  I felt pretty good in the first 4 weeks, and now (week 8) I feel that focus, energy, lethargy degrade a little more each week.  It takes a few months on tx to get a consistent (good or bad) trend going to set expectation for the long haul. I don't think I'm even quite there yet.

[Kalio1]

I also think you should seriously consider extending however I do not believe niceguy needs to extend, he does not have damage like you do. I know he worries a lot, but all his info points to him having either no damage at all or a very small amount plus he cleared it by week 4.


I too am a 3a and relapsed, my recent Fibroscan score was 11.1 which is not a whole lot more than what you have. I would extend if you can, Scuba. I would do 48 weeks if I were you. Also you have a bit of a weight issue, I'd try to lose that if possible. You dont have to eat a ton of fat with the Riba, just some to get it rolling. That aspect is important in the first part of tx but you dont have to keep up massive amounts of fat for the entire tx. How much riba are you on? I'd take the max I could get my hands on in the beginning of tx.

[FlGuy]

I'm a relapsed G3, but there were reasons that I relapsed that are not necessarily applicable to you (early cirrhosis, older than dirt, underdosed with riba, bad pcr scheduling and a few others) - almost the opposite of you.  Without a compelling reason to extend, why would you?  If anything, you might consider a shorter, rather than a longer course, of tx.  Talk to your doc.

[NYgirl]

Thank God for you - it's so nice to know my thought process isn't that off the beaten path.








hahahaha ;)

[scubadiver30]

thanks for responding...
So if I feel reasonably well the first 4 weeks that does not mean I'm not gonna feel crappy later on right?
So I guess I'll base my decision on the VL readings early on...
but the male + >40 + BMI formula is gotten me paranoid and since I'm tailoring my TX based on the experiences here, I thought it was common sense to extend :-(
Today I feel exceptionally well (except a mild riba rash) and I have found the I'm able to concentrate better and produce several good ideas at work...I wonder if my body can feel it has achieved SVR? That would be extremely cool wouldn't it? naahhh


Good luck this time

[scubadiver30]

Hi Kalio, gracias 4 your input
I'm doing 800 RIBA /180 IFN...the standard for 2b.
Tomorrow I will insist on the 48 wk. But like I said before, I have no means of getting procrit or neupogen on SS so I guess I have to be extra careful...They didn't want to give me more riba to start with.
My 10 KPA is also scary, and my 90 kg also are negative predictors... and the red palms that I never considered issues before :-(
One question, did u levelled out after the 24th week?

thanks and best wishes

[FlGuy]

There are a lot of variables that play in our minds, especially when we read of the experiences of others.  About a year ago, and it comes up every once in a while, is the risk/reward about extending tx. If we consider just geno 3, the question that we undoubtedly ask ourselves is 'how better off would i be if I did 36 instead of 24?'.  What magic may lurk in those additional 12?  If I do only 24 and then relapse only to do another 48, that's a total of 72 and how much of that could have been avoided if I did 36 in the first place? How much of a handicap (in weeks) are things like age, weight , significant fibrosis, blood sugar and diabetes.  All tough questions to answer and tougher to committ to.  It's usually later in the tx week (4-5 days after shot) that I begin to feel a little more spry and useful. But then it all starts agin in 2 days. As to the BMI, I would expect that riba at 13-15 mg per kg is a minimum - are you in that range?  Being a replapser (24 and now 46 more) my point of view is jaded and not so sure where my objectivity is right now.
Feliz Navidad

[Kalio1]

I don't think Im a great example for how people do on tx. Put it this way, I would not be chosen as the poster girl for treatment! I have had a pretty rough time although I have NOT had to use any rescue drugs, I have had lots of bone/joint pain and extreme fatigue and nausea all the way through. My Hgb has hovered around 10 the entire time (including the first tx of 6 months and now an additional 10 months more tx so far)I have had a few days where I felt pretty good, was able to take a walk or participate in life in a normal way, but they are few and far between. Usually if I attempt activities, by the time I am showered and dressed to go  I have to go throw up. LOL Then if I DO go, I start getting light headed and feel like I will pass out. I am so glad to hear you are able to work and so far not having a hard time with it. No one knows how you will do, it is different for everyone.

I also took 800 riba the first time as instructed. I do feel I was underdosed on Riba. This round I took twice that for the first 6 weeks.
Please post your PCR results when you get them! Im dying to know how that went.

[scubadiver30]

I'd say I needed 1200 riba but the doc insisted on my geno. Said 800 enough and even Dr Cecil says on his web that 2/3 "easy to treat non americans" could even do with 400 Copegus a day??? weird..Like Rev says, this thing is messing me up mentally...(even more than the meds) Just to wait 2 weeks for a darn result drives me nut.
On thing about my FS results..the first one was 3.8 KPA and with a 6 months difference it jumped to 10 KPA??? I didn't fast int he least 2.. HR mentioned something about blood thickness.
I ask myself is that degradation biologically feasible even if I stopped drinking & smoking after I learned I was HCV+??

[Kalio1]

I agree, the head trip is a big part of the battle. Keep in mind that MOST with your geno DO clear the virus on 800mg a day Riba and 24 weeks treating. We always think the worst, and I have already relapsed so my view is jaded.

All relapsers get a bit jaded, the polish is definately off the apple for us. So remember here, like ahywhere people give their opinions, always "consider the source"  a person who has not relapsed will tend to be more optimistic about tx success than those of us who have had to go at this more than once.


I hope you have a wonderful holiday and all your loved ones do too!

[scubadiver30]

Today was the Xmas party a the office and decided not to go, cause there's gonna be a lot of booze and food and dancing.
My coworkers that know I'm treating say I look fine and also my wife says it is a piece of cake (based on how I look) God, what do they expect??...the crypt keeper in 10 days?? c

[NYgirl]

I get ya Scuby.  Ours is a black tie event on Friday night. I am going to go for appetizer hour to make an appearance then I'm outta there.

While I know I ADORE the little appies (no fras gras for us give us little hotdogs and chicken on a stick hahahah!) and can eat them instead of being tempted with a drink...I just can't take the chance on staying all night.

So I'll go home and do my shot and just PRAY I don't win the full length full coat or the plasma screen tv that are just two of the door prizes.  Can't win unless you are there.....and that is my luck hahaha.

I think you're smart. We can go to office parties next year and for the rest of our lives. :)