mhudnall and Dr Berkson

[Upbeat]

I have waiting to see furter posts on your treatment with Dr Berkson.  How has it been going?  His work with Alpha Lipoic Acid and I believe LDN peeked my interest.   You were giving updated reports on your viral load and alt ast numbers.  Its been awhile and just curious as to where you stand now.

[Willy50]

MikeH may be closer to a stage 4 and therefore the fibroscan may be quite useful for monitoring, but less so if he was a stage 2-3.

I believe that somewhere in this forum I suggested that I didn't think that it was going to get approved and then amended the post since (I believe) one of my later posts provided a link where (Shiffman?) said that he thought it was going to be approved by the FDA.  I guess, still a good diagnostic tool, but not across the board.  Useful perhaps to Mike H due to his staging.....  
But.....I know you know most of this.....  Without regard..... who wouldn't want to get a fibroscan and consult w/ HR?  Seems like money well spent.  I'd love to hear him weigh in on this.....

~~~ Willy
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http://www.easl.ch/press4.asp

These results were also presented by Dr. De Ledinghen in Vienna. The study of 268 patients showed that FibroScan® provides just as accurate a diagnosis in the case of alcoholic liver cirrhosis as with HCV patients. Furthermore, in comparison with various biological markers, FibroScan® proved itself to be the best non-invasive method for the diagnosis of liver cirrhosis.
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Echosens: Canada Approves FibroScan(R) and its 3 Probes
Wed Sep 9, 2009 10:45am EDT

http://www.reuters.com/article/pressRelease/idUS163702+09-Sep-2009+MW20090909
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http://www.aetna.com/cpb/medical/data/600_699/0690.html

"For cirrhosis, the summary AUCs for FibroTest and FibroScan were 0.90 (95 % CI not calculable) and 0.95 (0.87 to 0.99), respectively.  The authors concluded that FibroTest and FibroScan have excellent utility for the identification of HCV-related cirrhosis, but lesser accuracy for earlier stages.  They noted that refinements are necessary before these tests can replace liver biopsy."

[copyman]

Have to disagree with you that the Fibroscan is the best way to assess fibrosis. It basically is only good to identify cirrhosis. Not good at all for staging fibrosis. I do agree that fibrosis is not the same throughout the liver. The best test would be a biopsy with core samples taken from different parts of the liver.

I have said this before that perhaps this is why Fibroscan has not been approved by the FDA in the USA.

Please see the following PubMed article for full study data : http://www.ncbi.nlm.nih.gov/pubmed/17850410


CONCLUSIONS: FibroTest and FibroScan have excellent utility for the identification of HCV-related cirrhosis, but lesser accuracy for earlier stages. Refinements are necessary before these tests can replace liver biopsy.

[mhudnall]

Yes,

I agree with that. I hope that HR will email me to schedule a Fibroscan appointment. If not, I am going on a family vacation to Europe next summer and I will get one where you got one Bali.

Meanwhile, however, the alpha-2 macroblobulin assay is a valuable marker for me. At least it is something measurable that I can monitor for progress, other than AST/ALT. Since I have not been very active with my program for a while, the macroglobulin  assay from the fibrosure test will be a baseline measurement for my efforts as I step them up.

So I appreciate the suggestion to do one, and I am glad I did. I just think the fibrosis staging part of it is not too valuable. Since the other markers are all pretty good, I will just monitor AST/ALT and macroglobulins, in addition to my other labs. All info is good, even out of range labs.

The macroglobulins seem pretty important to get lower, when you look at their activities in the body. They trap your endogenous proteinases, so I am loading up on a supplement that contains serratia peptidase, bromelain, papain and catalase, hoping that those proteases will fill the binding sites of the macroglobulins so they will leave my endogenous proteinases alone.

I haven't discussed that strategy with my doc, but he gave me the supplements and I am just upping the dose. I will see him next week, so I am sure the macroglobulins will be a topic of some long discussions.

I'll let you know what I find out. Also I will probably do new labs in a month; I'll post them.

Mike H

[tashka]

I absolutely agree with you. Fibrosis is not uniform, so assessing different areas of the liver and averaging them out is the best way to go. It is great you were able to do Fibroscan.

[Bali05]

To Mike and everybody else,

Please correct me if I am wrong but I am trying to understand this.

From what I know the process of fibrosis does not occur uniformly.

If you have fibrosis than you will have it at different stages in different

areas of the liver. You could be F2 in on spot and F4 in another.

I think it is wrong to try to give the entire organ one grade just based

on one area. The most accurate information overall will be from many

readings covering the whole liver and averaging out an overall grade.

FibroScan is the closest test to achieve this that I know of. My Fibroscan results

consisted of 10 readings. Some F1 , some F2 , some closer F3.

Overall came to F2 the same as my FibroSure test.

I see absolutely no advantage in doing a biopsy , as a matter of fact

the Professor of the Liver Center that currently treats 5000 hepc patients

and does FibroScan to garade liver damage advised me against it.

Am I missing something here ?

[mhudnall]

By the way, I hope there is not an autoimmune component to this liver inflammation. That would not be good at all, and certainly not unheard of - autoimmune hepatitis on top of hep c?

I do not like that thought.

Mike H