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PA's and how mad I am at them...

Hello all,
I was diagnosed with Hep C in 1995. At that time I had a liver biopsy(most painful thing I went through). My Doctor at the time said they had an experimental treatment (interferon) that was very expensive and un proven. Anyways... I've had 2 PA's(physician assistants) since then in charge of my care. Both claimed to be very knowledgeable of Hep C. They monitored my blood work and were careful not to prescribe any liver harming drugs, except for Cymbalta, which turns out to be a liver killer and a drug straight from the devil. Been off of the cymablta for 3 years.

Skip to present day...2 weeks ago I got dizzy and went to the ER. A little heat prostration I assumed. They did blood work and found I had a platelet count of 50. They wouldn't let me go back to work until my PA cleared me. When I saw her she said ..oh your platelets are always low..around 90. Their back up to 75 now. So I go to a hematologist who sends me for an ultrasound. Shows my spleen is swollen and my liver is normal size. I'm waiting to see a specialist in the next couple of weeks.

I'm just upset that she didn't see my platelet numbers shrinking as a sign of a complication. That and my ankles retaining liquid.

I've been clean and sober since 12/7/1994.

No more PA's for me....
4 Responses
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2059648 tn?1439766665
You have right to be upset.  Come back and let us know the outcome of your appointment.  

Best to you
Helpful - 0
446474 tn?1446347682
It appears that you may have cirrhosis of the liver with portal hypertension which causes low platelet counts and and enlarged spleen. You probably have many other complications of cirrhosis you are not aware of because they are not easy to detect. If this is the case you need to get help at a liver transplant center ASAP before your liver disease progresses further and becomes irreversible. You need to see a hepatologist (liver specialist) to assess your liver disease and help you manage your health. At the point you will need a liver transplant to continue to live.

Liver disease is caused my many things other than alcohol. You should have been diagnosed years ago and found out what was causing your liver disease so if possible you could have stopped the damage that has occurred in the last 20 years. Unfortunately you can't change the pass. You can only do what you can now bases on your current situation.
Cirrhosis results from damage to liver cells from toxins, inflammation, metabolic derangements and other causes. Damaged and dead liver cells are replaced by fibrous tissue, which leads to fibrosis (scarring). Liver cells regenerate in an abnormal pattern primarily forming nodules that are surrounded by fibrous tissue. Grossly abnormal liver architecture eventually ensues that can lead to decreased blood flow to and through the liver. Decreased blood flow to the liver and blood back up in the portal vein and portal circulation leads to someof the serious complications of cirrhosis. Blood can back up in the spleen causing it to enlarge and sequester blood cells. Most often, the platelet count falls because of splenic sequestration. The low platelet count seen in cirrhosis is due to trapping in the spleen, not due to a primary problem with production in the bone marrow. If the pressure in the portal circulation increases because of cirrhosis and blood back up (note: this can also sometimes occur in severe cases of acute hepatitis and liver damage), blood can flow backwards from the portal circulation to the systemic circulation where they are connected. This can lead to varicose veins in the stomach and esophagus (gastric and esophageal varices) and rectum hemorrhoids or rectal varicies). Gastric and esophageal varices can rupture, bleed massively and even cause death. Hypertension in the portal circulation, along with other hormonal, metabolic and kidney abnormalities in cirrhosis, can also lead to fluid accumulation the abdomen (ascites) and the peripheral tissue (peripheral edema).

If for any reason your blood platelet count falls below normal, the condition is called thrombocytopenia. Normally, you have anywhere from 150,000 to 450,000 platelets per microliter of circulating blood. Because each platelet lives only about 10 days, your body continually renews your platelet supply by producing new platelets in your bone marrow.

Thrombocytopenia has many possible causes.

Trapping of platelets in the spleen
The spleen is a small organ about the size of your fist located just below your rib cage on the left side of your abdomen. Normally, your spleen works to fight infection and filter unwanted material from your blood. An enlarged spleen — which can be caused by a number of disorders — may harbor too many platelets, causing a decrease in the number of platelets in circulation.

Reduced production of platelets

Platelets are produced in your bone marrow. A disease or condition that involves your bone marrow, such as leukemia and some types of anemia, could lead to a reduction in the number of new platelets produced. Viral infections, including HIV infection, may reduce your bone marrow's ability to make platelets. Toxic chemicals, chemotherapy drugs and heavy alcohol consumption also can reduce platelet production.

Increased breakdown of platelets
A number of conditions can cause your body to use up or destroy platelets more rapidly than they are produced, leading to a shortage of platelets in your bloodstream. Examples include:

Pregnancy. Being pregnant may cause mild thrombocytopenia.

Idiopathic thrombocytopenic purpura (ITP). In ITP, your body's immune system mistakenly identifies platelets as a threat and forms antibodies that attack them.

Autoimmune diseases. Other diseases in which your body's immune system attacks healthy tissue may cause thrombocytopenia. Examples include lupus and rheumatoid arthritis.

Bacteria in the blood. Severe bacterial infections involving the blood (bacteremia) may lead to destruction of platelets.

Thrombotic thrombocytopenic purpura (TTP). TTP is a rare condition that occurs when small blood clots suddenly form throughout your body, using up large numbers of platelets.

Hemolytic uremic syndrome. This rare disorder causes a sharp drop in platelets, destruction of red blood cells and impairment of kidney function. Sometimes it can occur in association with a bacterial Escherichia coli (E. coli) infection, such as may be acquired from eating raw or undercooked meat.

Medications. Certain medications can reduce the number of platelets in your blood by confusing the immune system and causing it to destroy platelets. Examples include heparin, quinidine, quinine, sulfa-containing antibiotics, interferon, anticonvulsants and gold salts.

Tests to diagnose thrombocytopenia
Tests and procedures used to diagnose thrombocytopenia include:

Blood test. A complete blood count determines the number of blood cells, including platelets, in a sample of your blood. Normal blood contains 150,000 to 450,000 platelets per microliter. If the complete blood count finds you have fewer than 150,000 platelets, you have thrombocytopenia.

Physical exam. Your doctor may do a physical exam to look for signs of bleeding, such as excessive bruising or petechiae (purple dots). Your doctor may also feel your abdomen to see if your spleen is enlarged.

Other tests to determine the cause of thrombocytopenia
Once your doctor diagnoses your thrombocytopenia, you may undergo other tests and procedures to determine the cause. The tests and procedures you undergo depend on your other signs and symptoms.

Helpful - 0
1654058 tn?1407159066
I hope your appointment goes well. Good for you! If you're voice isn't being heard, you gotta find another doc. Sry you had a bad experience. Karen:)
Helpful - 0
163305 tn?1333668571
You have a right to be upset.If it were me, I'd be tempted to let those supposed experts know how far off they were.

However, now all you can do is go forward.
Hopefully you are now seeing an experienced hepatologist who can help you.

BTW: I've had several biopsies and none hurt at all. If done correctly, there should not be pain.
Helpful - 0
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