Aa
first visit w/Gl
Good morning all,
I had my visit w/ my gastro lady on monday, and I must say I was impressed.
I learned alot. She seemed to be very up on all aspects of care and treatment.
I also learned that; 1st although my test shows that I have been exposed to hcv I may not
have the active virus. the 2nd round of blood work will tell if my VL is positive or not.
(fingers xed here) 2nd they no longer have to do liver biopsy!! they are able to tell all from the
blood work! (big smile here) So now it's back to waiting on the test results. and go from there.
Although I am still in a daze from all this, I am coming back around esp. from knowing that hcv
can be beat, and be lived with. Also knowing that there are many wonderful people out here on the island
:-) who care and are willing to share info and support. ( big thank you here)
I still have much to learn about this but there seems to be much info out there so I'll be "wadding" through
many web sites in the coming days.
So again thanks to everyone who has responded and I look foreward to making some new friends.
have a great day all
waterdog
I had my visit w/ my gastro lady on monday, and I must say I was impressed.
I learned alot. She seemed to be very up on all aspects of care and treatment.
I also learned that; 1st although my test shows that I have been exposed to hcv I may not
have the active virus. the 2nd round of blood work will tell if my VL is positive or not.
(fingers xed here) 2nd they no longer have to do liver biopsy!! they are able to tell all from the
blood work! (big smile here) So now it's back to waiting on the test results. and go from there.
Although I am still in a daze from all this, I am coming back around esp. from knowing that hcv
can be beat, and be lived with. Also knowing that there are many wonderful people out here on the island
:-) who care and are willing to share info and support. ( big thank you here)
I still have much to learn about this but there seems to be much info out there so I'll be "wadding" through
many web sites in the coming days.
So again thanks to everyone who has responded and I look foreward to making some new friends.
have a great day all
waterdog
Something I found on the web.
Predicting cirrhosis in patients with hepatitis C based on standard laboratory tests: Results of the HALT_ C cohort (08/05)
http://www.natap.org/2005/HCV/072105_09.htm
The established gold standard for the evaluation of liver disease has traditionally been a percutaneous liver biopsy. Liver biopsy is used predominantly for the diagnosis, prognosis, and staging of liver disease. Despite improvements in serologic diagnostic tests for liver disease, a biopsy is often still indicated to make the diagnosis of many forms of liver disease. Biopsy is also useful for determining prognosis, usually by confirming the presence or absence of cirrhosis. More recently, biopsy has been used for staging fibrosis in viral hepatitis and for decision analysis as to the need for treatment. Many treatment algorithms recommend treatment for patients with septal fibrosis or greater (≥ METAVIR stage 2). Improvement in either tolerability or efficacy of therapy could easily alter this current treatment paradigm, increasing physician and patient acceptability of therapy and reducing the need for liver biopsy.
Liver biopsy is rarely associated with severe complications in this era of ultrasound guidance or marking, and bleeding is rare (1:10,000 biopsies).[1] The major issues with biopsy are cost (approximately $2200) and patient acceptability and anxiety. In addition, recent studies have suggested that biopsy is only about 80% accurate in the staging of liver fibrosis and may even miss advanced fibrosis or cirrhosis in 30% of patients. The factors associated with the inaccuracy of biopsy include the heterogeneous nature of liver disease, the relatively small size of a biopsy compared to the size of the liver, and the experience of the pathologist. This has led to the concept that a liver biopsy should be at least 25 mm in length to reduce the sampling error.[2] Although this is a noble aim pathologically, it remains a clinical rarity, with only 20% of liver biopsies even approaching this length.
These limitations of biopsy have led clinical investigators to study alternative methods to stage liver disease. Noninvasive serum biomarkers are the most widely used alternative to liver biopsy and have recently been reviewed.[3] There are 2 major types of biomarker tests, those that use clinical variables to stage fibrosis and those that use extracellular matrix (ECM) markers.[4,5] There are advocates of specific tests, but overall the performance characteristics of all these tests are relatively similar.
The accuracy of a test is often given as the area under the curve (AUC) of the receiver operator characteristic (ROC). A perfect test with a 100% sensitivity and specificity would have an AUC of 1.0. The majority of proposed biomarker tests—and in particular, those available for use in clinical practice—have an AUC of between 0.80_ 0.85, not for staging disease, but for differentiating mild from (F0/F1) from significant fibrosis (F2_ F4). Since the biomarker is validated against the biopsy, and the accuracy of the biopsy is only 80%, it is probably statistically impossible for a biomarker to perform any better for staging fibrosis. Interestingly, the performance of biomarkers is superior at the extremes of disease; the indeterminate results occur when patients have F1/2 disease. This is not surprising, since these stages are relatively artificial separations of a spectrum of a dynamic disease process.
An alternative method for staging liver disease is to measure liver stiffness or elasticity using a FibroScan.[6] The principle is relatively simple and involves measuring the shear velocity of a 50 mHZ wave propagated through a 2_ 5 cm segment of the liver, and converting this into a stiffness value in kilopascals (kPA). The diagnostic accuracy of the test is similar overall to that reported for biomarkers, but it is probably better in diagnosing cirrhosis, with an AUC of 0.95. The test is simple and the results readily available, but the machine is still investigational in the United States and relatively expensive. Combining a FibroScan measurement with biomarkers may increase the accuracy of both tests.[7]
What can we recommend at the present time? Certainly, when the diagnosis is in doubt, a liver biopsy remains the gold standard (just make sure it is an adequate biopsy!) However, when the issue is staging of fibrosis for either treatment decision or exclusion of cirrhosis, biomarkers and noninvasive tests represent a valid initial alternative. If the biomarkers are clearly indicative of mild or advanced disease, no further evaluation is necessary, and where they are equivocal, a biopsy can subsequently be performed. Eventually one could even anticipate following patients on an annual basis with biomarkers and stiffness scans to follow the progression or regression of disease. It is not yet time to abandon liver biopsy for disease staging, but the lifeboats are out and the sharks are circling.
Predicting cirrhosis in patients with hepatitis C based on standard laboratory tests: Results of the HALT_ C cohort (08/05)
http://www.natap.org/2005/HCV/072105_09.htm
The established gold standard for the evaluation of liver disease has traditionally been a percutaneous liver biopsy. Liver biopsy is used predominantly for the diagnosis, prognosis, and staging of liver disease. Despite improvements in serologic diagnostic tests for liver disease, a biopsy is often still indicated to make the diagnosis of many forms of liver disease. Biopsy is also useful for determining prognosis, usually by confirming the presence or absence of cirrhosis. More recently, biopsy has been used for staging fibrosis in viral hepatitis and for decision analysis as to the need for treatment. Many treatment algorithms recommend treatment for patients with septal fibrosis or greater (≥ METAVIR stage 2). Improvement in either tolerability or efficacy of therapy could easily alter this current treatment paradigm, increasing physician and patient acceptability of therapy and reducing the need for liver biopsy.
Liver biopsy is rarely associated with severe complications in this era of ultrasound guidance or marking, and bleeding is rare (1:10,000 biopsies).[1] The major issues with biopsy are cost (approximately $2200) and patient acceptability and anxiety. In addition, recent studies have suggested that biopsy is only about 80% accurate in the staging of liver fibrosis and may even miss advanced fibrosis or cirrhosis in 30% of patients. The factors associated with the inaccuracy of biopsy include the heterogeneous nature of liver disease, the relatively small size of a biopsy compared to the size of the liver, and the experience of the pathologist. This has led to the concept that a liver biopsy should be at least 25 mm in length to reduce the sampling error.[2] Although this is a noble aim pathologically, it remains a clinical rarity, with only 20% of liver biopsies even approaching this length.
These limitations of biopsy have led clinical investigators to study alternative methods to stage liver disease. Noninvasive serum biomarkers are the most widely used alternative to liver biopsy and have recently been reviewed.[3] There are 2 major types of biomarker tests, those that use clinical variables to stage fibrosis and those that use extracellular matrix (ECM) markers.[4,5] There are advocates of specific tests, but overall the performance characteristics of all these tests are relatively similar.
The accuracy of a test is often given as the area under the curve (AUC) of the receiver operator characteristic (ROC). A perfect test with a 100% sensitivity and specificity would have an AUC of 1.0. The majority of proposed biomarker tests—and in particular, those available for use in clinical practice—have an AUC of between 0.80_ 0.85, not for staging disease, but for differentiating mild from (F0/F1) from significant fibrosis (F2_ F4). Since the biomarker is validated against the biopsy, and the accuracy of the biopsy is only 80%, it is probably statistically impossible for a biomarker to perform any better for staging fibrosis. Interestingly, the performance of biomarkers is superior at the extremes of disease; the indeterminate results occur when patients have F1/2 disease. This is not surprising, since these stages are relatively artificial separations of a spectrum of a dynamic disease process.
An alternative method for staging liver disease is to measure liver stiffness or elasticity using a FibroScan.[6] The principle is relatively simple and involves measuring the shear velocity of a 50 mHZ wave propagated through a 2_ 5 cm segment of the liver, and converting this into a stiffness value in kilopascals (kPA). The diagnostic accuracy of the test is similar overall to that reported for biomarkers, but it is probably better in diagnosing cirrhosis, with an AUC of 0.95. The test is simple and the results readily available, but the machine is still investigational in the United States and relatively expensive. Combining a FibroScan measurement with biomarkers may increase the accuracy of both tests.[7]
What can we recommend at the present time? Certainly, when the diagnosis is in doubt, a liver biopsy remains the gold standard (just make sure it is an adequate biopsy!) However, when the issue is staging of fibrosis for either treatment decision or exclusion of cirrhosis, biomarkers and noninvasive tests represent a valid initial alternative. If the biomarkers are clearly indicative of mild or advanced disease, no further evaluation is necessary, and where they are equivocal, a biopsy can subsequently be performed. Eventually one could even anticipate following patients on an annual basis with biomarkers and stiffness scans to follow the progression or regression of disease. It is not yet time to abandon liver biopsy for disease staging, but the lifeboats are out and the sharks are circling.
Does anyone have any more information on this "blood test" for liver damage.... ??
M4now
M4now
OMG!!!!!!!!!!!!!!!!!!!!!!!!!! REALLY?????!!!!!!
That is just awesome. OMG 6 months, it's been???? Where does the time go. Man, I thought I'd kept up with everyone. Been lurking these last few months, but I missed that one. I am sooooooo happy for you. TX is just such a cr*ppy thing to have to go through, but it makes it all worth it to hear those letters. That is just great.
Mr. O and I are doing very well. Still as much in love as ever - even if I do have a hole in my stomach. he, he. I didn't mention that, did I? I thought I was in pretty good health, but May 05 when I was DX with HCV since then it's been a roller coaster of one thing after another. But getting by every day.
That is just awesome. OMG 6 months, it's been???? Where does the time go. Man, I thought I'd kept up with everyone. Been lurking these last few months, but I missed that one. I am sooooooo happy for you. TX is just such a cr*ppy thing to have to go through, but it makes it all worth it to hear those letters. That is just great.
Mr. O and I are doing very well. Still as much in love as ever - even if I do have a hole in my stomach. he, he. I didn't mention that, did I? I thought I was in pretty good health, but May 05 when I was DX with HCV since then it's been a roller coaster of one thing after another. But getting by every day.
I'm an SVR kinda guy, got the 6 monther done in April. As Mrs. FL put it, I have no reason to be a lazy no-account guy anymore. I'm feeling pretty darn good and staying busy doing a lot of stuff. Hope you and Mr. O are doing well, it's always nice to see your posts.
Hey there guys and gals, friends and foes - ooops nope sorry, wrong forum. he, he.
Debbie - congrats on being SVR. That is just so so so cool!!!! I am really happy for you.
FLGuy - I know you must have finished your second TX by now. Any results?
I'd send hugs - but this forum isn't the huggy kinda place. There are other forums for that. ;)
Debbie - congrats on being SVR. That is just so so so cool!!!! I am really happy for you.
FLGuy - I know you must have finished your second TX by now. Any results?
I'd send hugs - but this forum isn't the huggy kinda place. There are other forums for that. ;)
I have never heard of being able to tell through the bloodwork either Waterdog I would be highly suspect of this - the only true way to tell is to do the biopsy (and it's painless even though it doesn't sound it, it's actually BORING mostly!).
No Val you are NOT out of the loop on this LOL.
They can tell how your liver enzymes are CURRENTLY doing but that doesn't really mean anything as to how much liver damage has progressed. If you are a geno1 (the most common of them all here in the USofA) you need the biopsy to help determine if you need or want to do the treatment.
You won't be able to find anyone else I don't believe who's ever heard of this before.
Let's hope you spontaneously cleared the virus........that is an easier step! But if you haven't.........believe me if you have to have a disease this isn't the worst one by far...in fact you are lucky now that you found out about it before it started to cause you serious problems. The good thing about this one is there IS a "cure" for it and it's a very slowly progressing disease..........so you can live a long happy life!
Good luck.
(don't let them talk you out of the biopsy somehow it is CRUCIAL for us heppers)
No Val you are NOT out of the loop on this LOL.
They can tell how your liver enzymes are CURRENTLY doing but that doesn't really mean anything as to how much liver damage has progressed. If you are a geno1 (the most common of them all here in the USofA) you need the biopsy to help determine if you need or want to do the treatment.
You won't be able to find anyone else I don't believe who's ever heard of this before.
Let's hope you spontaneously cleared the virus........that is an easier step! But if you haven't.........believe me if you have to have a disease this isn't the worst one by far...in fact you are lucky now that you found out about it before it started to cause you serious problems. The good thing about this one is there IS a "cure" for it and it's a very slowly progressing disease..........so you can live a long happy life!
Good luck.
(don't let them talk you out of the biopsy somehow it is CRUCIAL for us heppers)
I'm with the skeptical Mrs. O (hi Val) on the ability to determine, with clarity, the condition of the liver without a biopsy. Back in the day, water and oil prospectors, used diving rods to locate liquids and minerals. When it come to liver condition, the best look is by jabbing in one of those divining rods for a core sample.
UH, excuse me here.....not wanting to jump into something......how can they tell what condition your liver is in by the blood work?
I've been done with treatment for 1½ years and I saw a hepatologist in January whose recommendation was to get a biopsy every five years. He said since I had one in 2005 (my first) it would be worthwhile to get one in two years.
Now maybe I've been out of the loop and there is some information out there I'm missing, but your gastro said you didn't need a biopsy AT ALL???? That all she needed was your blood work?
It might be worth it to get a second opinion from another doctor - just for piece of mind.
But either way you go - very best wishes and good luck to you.
I've been done with treatment for 1½ years and I saw a hepatologist in January whose recommendation was to get a biopsy every five years. He said since I had one in 2005 (my first) it would be worthwhile to get one in two years.
Now maybe I've been out of the loop and there is some information out there I'm missing, but your gastro said you didn't need a biopsy AT ALL???? That all she needed was your blood work?
It might be worth it to get a second opinion from another doctor - just for piece of mind.
But either way you go - very best wishes and good luck to you.
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