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Diagnosed with Hepatitis C. Tests showed stage 4 chirosis. Treatment with telapevir and peglated interferon. Information on disease progresses?

DOCTOR OF THE MONTH - Apr 2013
Apr 2013
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I was recently diagnosed with Hepatitis C after contracting it in 1979 from a blood transfusion for a crainiotomy. My last set of tests showed it has progressed to stage 4 chirosis. my doctor has said the next stage will be liver cancer, but has not discussed the advanced symptoms of the disease. I under went 52 weeks of therapy with Ribavirin and interferon which did not work. I the under went therapy with telapevir and peglated interferon. After just 12 weeks, I was told not to continue using it. I just want to know the symptoms I need to look for as this desease progresses.
Posted Mon, 1 Jul 2013 in General Health
 
 
Answered by Dr. Ivan R. Rommstein 42 minutes later
Hi and welcome to XXXXXXX

Thank you for your query.

I am sorry about your serious condition, but I am sure you can find enough strength to fight despite inefficiency of therapy. Cirrhosis is the most serious consequance of viral hepatitis, especially stage 4. But the next stage can be (not "will be") liver cancer. It is found in less than 10% of viral cirrhosis and more common found in hepatitis B infection.

But, next stage can also be liver failure, this is more XXXXXXX than cancer and this is hardly treatable and only chance of treatment is liver transplantation.

Also, the condition of your liver may remain steady for long period. So it is hard to predict which one of these 3 results will occur in your case, but cancer is less possible option.

Progression of cirrhosis will be recognized by jaundice, dark urine, skin itching, easily bruising, frequent infections, weight loss, pain under the right rib arch, legs and abdominal swelling and fluid accumulation, gastrointestinal bleeding, varicose veins, mental confusion.

To detect cancer in early phase, you should do frequent ultrasound check ups, AFP (alpha-fetoprotein) and liver function tests.

Cirrhosis cant be cured and most of medicines you have mentioned aren't useful in terminal cirrhosis, but its symptoms can and should be treated. So there are many medicines which are useful as hepatoprotective drugs, and other which reduce swelling, pain, jaundice and improve general health.

Wish you good health. If you have any question I ll be glad to help.

Regards,
Above answer was peer-reviewed by
 
Follow-up: Diagnosed with Hepatitis C. Tests showed stage 4 chirosis. Treatment with telapevir and peglated interferon. Information on disease progresses? 4 hours later
I currently have several of the symptoms which you mentioned. I am jaundiced 50-75% of the time, my urine will range from a very pale yellow in the morning to a very dark orange in the evening and smells horrible, my skin feels very dry and itches to the point where I will bleed. I bruise so easily that my grandchildren have been told by their moms (my daughters) to be careful when they hug me. I also have peticulla(sp) on my forearms all the time. One heals and goes away and I get new ones. In the last 6 to 9 months I have lost almost 50 pounds. along with all the other symptoms you have mentioned except the gastrointestinal bleeding I also have sever backaches, and cannot sleep. My doctor does an AFP and ultra sounds every six months. My liver function tests are normal, but then I had an anuerism bleed when I was 29 and have had 4 others since then, so my GP says I never do what is normal for a patient. what new symptoms should I be looking for? What should I expect from my doctor?

I have chronic Hepatitis C and my doctor told me he would be putting me on a transplant list
 
 
Answered by Dr. Ivan R. Rommstein 16 hours later
Hi again,

It is definitely indication for liver transplantation and this is the only permanent cure for your condition. I hope you will have luck with it.

The most important is that your LFT (Liver function test) remain stable. Liver is big organ with great potential of regeneration and even less than 20% of liver can be enough for normal function.
You have all symptoms of serious cirrhosis, but since you are not permanently jaundiced there is still some preserved liver tissue.

There is no new symptom,there is only progression or improvement of these symptoms you have now. In cirrhosis, the most common life threatening condition is esophageal varices so bleeding from it should be prevented by by frequent gastroscopic check ups. So if you notice blood in stool and blood vomiting you need to go to ER.

If there is ascites(water in abdomen), it should be drained from time to time. If there is hypoalbuminemia you should receive albumines intravenously. You should prevent infections by flu vaccinations and avoid contact with infected people.

Pain should be managed by medicines which aren't toxic for liver.

I am sure your doctors know all this and that they do good job.

Loss of weight is definitely worrying and you should see medical nutritionst for diet or consider parenteral nutrition occasionally. You need modest protein and low sodium diet( it can be found in special shakes). You really need to improve nutritional status as it is very important for your immune system.
Avoid sedative medicines, such as sleeping pills, antianxiety medicines, and narcotics, it can worsen encephalopathy.

Other treatment depends on status of your other organs. If you don't have heart and kidney insufficiency, this is good sign.

Legs swelling and low urine output should be treated by diuretics. You need to inform your doctor if you notice blood in urine, pain while urinating or incontinence. This can be sign of urinary infection or kidney disorder.

Wish you good health.
Above answer was peer-reviewed by
 
Follow-up: Diagnosed with Hepatitis C. Tests showed stage 4 chirosis. Treatment with telapevir and peglated interferon. Information on disease progresses? 4 hours later
Thank you for all your help and opinions. I do know I am a strong person and I will get through this tough time. I have no kidney or heart problems,so that is good. One last question, my husband is getting tired of me not feeling well. How do I help him get through all this? His mother just recemtly passed from colon cancer and he became very agitated and angry with her when she continued to get more and more ill. She was in her late 80's when she passed.
 
 
Answered by Dr. Ivan R. Rommstein 1 hour later
Hi again,

Yes, unfortunately Hepatitis is very serious and hardly predictive disease which lasts for entire life. It is always more difficult to face with it when you didn't get infected by your fault. But, you cant change the past right? You need to think about the future and give your best.

I am sure you can fight for some more years as you did until now.

It is also always difficult for patient's family and we doctors are aware of this. But you simply need to focus on yourself now. Your husband is probably exhausted already, but I don't think that you necessitate too much attention and care. Although, this is cross that both of you must carry and fight till the end. I think you deserve best possible care and support. It is not easy to fight for more than 30 years like this.

I am sure he can realize that you and your health (both mental and physical) are the most important things at this point.

Just tell him to take some time for himself, don't make him feel guilty if he leaves you for few hours. You can ask some friend for help when you need it.

I am sure that you both want to be with each other now no matter how hard it is.

Wish you good health and luck.

Regards,
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