insist on biopsy?

[runsincircles]

I went to the hcv dr today and I'm not sure how I feel about things.    He told me that if I'm gonna do tx in the next year, biopsy is an unnecessary risk.  He told me my liver was just as healthy as his and I didn't need to worry about any meds I was taking.  He did say he had to clear it with the neuro I saw for my seizures but didn't say I needed to check anything else.  Don't you usually have to get an eye exam and other tests before actually starting tx?  My reg dr called him and got the blood tests ahead of time.  He basically said take care of the cervical dysplasia then call him and we can "get trained" and start tx.  What things do they usually check before starting tx?  What is the eye dr looking for in the eye exam?  

[Dee1956]

Hi my doctor thought I looked fine in 2007 according to my blood work told me I could take my time trying to decide what to do. Then 3 months later he did the biopsy and found I was at the very beginning of cirrhosis, and said I needed to treat right away.
Good luck to  you
Dee

[runsincircles]

I'm not sure what I'm gonna do until I talk to my dr.  I think I have to have a referral to see a different dr and I'm not sure how it all works.  I also had a chance to see the best gyno in the county and he put me on Lupron without telling me any risks at all.  Now I still have problems and he says it's just not possible that the Lupron caused them.

[Bovary73]

I am being treated in Europe / Norway and haven't had either biopsy, fibroscan or eyes checked.

My tx doctor says it's not nescessary, based on blood tests. Don't ask what he's basing this one, I recognize that most of you being treated in U.S. mostly have biopsy. Also we don't use as much rescue drugs for low hgb and neutrophils.

I've come to a "conclusion" that at some point I just have to trust my doctor. Don't have much options and it stresses a lot to question everything he descides..

[arlenedupee]

Had a biopsy in 08, very painful procedure. Tells the doc where your liver stands as well as what stage of fibrosis or liver damage your liver has suffered from the Hep-C, viral load and type of Hep-c you have.

[James10500]

A biopsy proved to be beneficial to me I believe.  I was a G2 and was thinking about waiting and not treating until new drugs came out. Got the biopsy and was stage 3, grade 3. So I started treatment ASAP.  Turns out the new drugs (PI'S) were never approved for g2 anyway.  Without a biopsy I might still be waiting to treat and my liver would be getting worse possibly to the point of chirrosis.

[beeblessed]

Hey Run,

I am probably one of the few who also did Not have a biopsy.  After much soul searching, I finally decided to get one but when I told my tx doc, she decided she did not need me to do one since I had already agreed to be treated.

As for the eye exam, I learned that the eyes can tell us a lot.  My Opthamologist was able to tell about a blood pressure spike just by looking in my eyes.  It is important to have a baseline so they can be on the look out if any changes come up.

Here is a link to the training I went through:
http://www.medhelp.org/user_journals/show/312058/4-hour-Training-to-Minimize-Sides

Best to you,
Bee :)

[pooh55811]

You need a baseline eye exam by an opthamologist before you start Hepatitis C treatment. They need to do a thorough exam. Mine did all sorts of checks and exams and he also did a retinal scan. This was before I started treatment. I told him I was starting Hep C treatment and needed the baseline eye exam and he knew exactly what I was talking about (has done many before).

Both Interferon and Ribavirin can cause eye problems. You need the baseline so the opthamologist will know if anything has changed if you have eye problems duuring treatment. Mine did the baseline and then another at 2 months after starting treatment. Mine will also do an exam post treatment to be sure everything is okay.


"Ophthalmologic (eye) disorders have been recognised as potential side effects of interferon-alpha (IFN). These disorders include reports of retinal vascular occlusions, retinal hemorrhages, and cotton wool spots (CWS) and, uncommonly, potentially sight threatening optic neuropathy."

http://i-base.info/htb/10971


"Ocular side effects have included abnormal vision, blurred vision, diplopia, dry eyes, eye pain, lacrimal gland disorder, lacrimation, nystagmus, and photophobia in less than 5% of patients. At least seven cases of retinopathy in patients receiving high dose interferon alfa-2b have been reported. Vogt-Koyanagi-Harada syndrome and serous retinal detachment have been reported during postmarketing experience."

http://www.drugs.com/sfx/interferon-alfa-2b-side-effects.html


"Ocular side effects associated with oral ribavirin in combination with peginterferon alfa-2a, peginterferon alfa-2b, or interferon alfa-2b have included blurred vision (up to 6%). Corneal ulcer has been reported in less than 1% of patients treated with peginterferon alfa-2a alone or in combination with ribavirin tablets. Conjunctivitis (up to 5%) has been reported with ribavirin capsules/oral solution in combination with peginterferon alfa-2b or interferon alfa-2b. Serous retinal detachment has been reported during postmarketing experience with oral ribavirin in combination with peginterferon alfa-2a, interferon alfa-2b, or peginterferon alfa-2b. "

http://www.drugs.com/sfx/ribavirin-side-effects.html


Just for the record, I did have some eye problems. Showers of floaters and flashing lights, like lightening in the corner of my eye. They got me in to see the opthamologist right away (the same day) both times. Neither problem was due to the Interferon or Riba, but he had the baseline to compare with if they had been.

I know people on the forum have had cotton wool spots and I think a couple had retinal problems.

[willbb]

There seems to be 2 schools of thought in the medical community on need for biopsy.
On the one hand with the possibility on newer treatment possibly coming to market in the next 3--5  years( projected).. patients and doctors alike would be  interested  in knowing the degree of liver damage(fibrosis)  in order to converse about  whether it may be better to to treat currently or possibly the option of waiting
.Also if one has cirrhosis the time frame of therapy may be different that  with less extensive damage

On the other hand ,,if  along with the recommendation from their doctor  a patient is going to treat currently regardless of amt. of fibrosis ..then there may be no need to subject the patient to the invasive procedure of biopsy.

Always best to be guided by a physician knowlegable with treating HCV..
Best ..
Will

[Bill1954]

Many doctors don’t feel that risk of biopsy is warranted for GT-2 patients. He’s probably taking into account your age, stated lifestyle history and biochemical results from recent labs. If you treat soon, you’ll clear the virus; this can’t historically be said for other genotypes.

A doctor can discern cirrhosis from fibrosis using platelet counts and other, common labs. If you had developed severe liver disease to date he’d have notified you. For what it’s worth, I agree with your doctor.

Good luck-

Bill

[can-do-man]

You have the chance to see one of the best Hep-C doctors there is and he's also very much up to date on the new PI's. Was the principal investator. I treated with him and it doesn't get much better... I would see him... Good luck

[runsincircles]

No, just blood work.  He said it didn't matter if I'm getting ready to tx anyway, but he would do it if I wanted.

[orphanedhawk]

Is your hcv doc a hepatologist ? A liver specialist? It's hard to imagine one wouldn't want a biopsy unless you have cirrhosis.
You don't need one to do treatment but if you know you liver's true health, you have more options available to you.

However, I have no idea how your other health problems may be affecting his decision. You need to ask him specifically why. It is an invasive procedure and though very slight, there is always the chance of risk.

Because treatment can affect your vision, the only way to know is to first have your eyes tested.

I've started a list of questions which I'll provide for you:
Questions for the doctor:

How experienced are you in dealing with Hep C ?
Do I need a biopsy before treatment?
How often will I be doing labs during treatment?
What is your protocol for dealing with low wbc or rbc?
What about other side effects?
How often will I be seeing you during treatment?

[suezeeque]

How does your doctor know the condition of your liver if you haven't had a biopsy?  Have you had a FibroScan?