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Julia Kizhner
Julia Kizhner, Physician Assistant
Category: Health
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Experience:  7 years experience working in Primary Care as well as Gastroenterology, Sleep Medicine & Weight Loss
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this is my biopsy results Serial sections of liver biopsy

Resolved Question:

this is my biopsy results: Serial sections of "liver biopsy" show mild fatty change. lobular inflammation is spotty. the portal aeas are expanded by lymphoid infiltrate. The piecemeal necrosis is mild. Iron stain reveals absent iron. The trichrome stain exhibits moderate fibrosis with fibrous portal expansion. Clinically, patient is positive for Hepatitis C viral markers. The findings are those of chronic Hepatitis C with mild activity (Grade 2 on a scale of 0 to 4) and moderate periportal fibrosis (stage 2 on a scale of 0 to 4)

Diagnosis:

A. Chronic Hepatitis C with mild activity (Grade 2 on a scale of 0 to 4) and moderate periportal fibrosis (stage 2 on a scale of 0 to 4)

B. No Evidence of Cirrhosis or Malignancy.

Today at my follow up visit to biopsy, Doctor wants me to treat, he already wrote out the prescription for the rivabarin and peg. Interferon? he said no need to wait, to risky, could lead to liver cancer or accelerate to level 3-4, don't take chances. I asked about new drugs and can I wait for them, Doctor replied don't hold your breath in regards XXXXX XXXXX drugs, he said they have been talking about that for years, no need to wait and gave me prescription and told me to come and see him 1 week after 1st SHOT!!!

not sure what to do, I want to wait for new drugs, but I don't want to progress to something worse! and suggestions would be appreciated.
Submitted: 4 years ago.
Category: Health
Expert:  Julia Kizhner replied 4 years ago.

Hello and thank you for your question.

 

Could you please tell me approximately how many years have you had the infection? Do you happen to know the year you were infected?

 

Thanks,

Julia

Customer: replied 4 years ago.
my high risk years would have been late 80's early 90's received several tatoos back then, after 92 lived clean married for 23 years so I am thinking must have been then, not sure. I have psoraisis and always have open sores due to that, but not sure where I got it from.
Expert:  Julia Kizhner replied 4 years ago.

Thank you for your reply.

 

So it sounds that you've had the infection for the last 20 years or so. In the last 20 years you have progressed to Stage 2 (out of 4 stages) of fibrosis. Fibrosis means scar tissue. When liver biopsy is done, to quantify the damage to the liver, this system of 0-4 is used. Stage 4 means cirrhosis, stage 0 means no scar tissue. So you are right in the middle.

 

I completely understand your doubts about treatment. Treatment, unfortunately, causes horrible side effects and you have to go through the treatment for 12 months. Also, Type 1A Hepatitis C is resistant to the treatment, with good results of eradication in 65-70% of cases, which leaves about 30% of people still with the virus after the treatment.

However, the good news about going through treatment is that you still have a 70% chance of getting rid of the virus and even if you do not get rid of the virus completely, treatment will help reverse the damage done to your liver. The scarring may go down from stage 2 to stage 1. That is very important.

 

I, personally, think that waiting for the new drugs is not a great idea. We dont know when something new is coming out and, even if something new is coming out soon, we dont know how effective it will be. The older you get, the more difficult it will be to handle side effects of treatment. Also, there is no way to predict with what speed the virus will continue damaging your liver. You may remain in stage 2 for the next 10 years or the scarring can get worse in the next 3-4 years and you will progress into liver cirrhosis.

 

So, in my opinion, you should start the treatment. If you body does not get rid of the virus, you will at least improve the damage already done to the liver. This will give you more time to wait for newer drugs to come out. Also, you have to think positive throughout this entire treatment. You have to keep saying "I will get rid of the virus" and truly believe that. I cannot reinforce importance of positive thinking.

 

I hope you find this information helpful. If you need any clarification or have any additional questions, please let me know and I will be glad to assist you further.

If you are satisfied with your answer, please click the green "ACCEPT" button, otherwise your deposit stays with JustAnswer and I do not get compensated for my work.

 

Best wishes,

Julia

 

Expert:  Julia Kizhner replied 4 years ago.

Do you have any other questions I might be able to answer for you? Anything that I can clarify?

 

Julia

Customer: replied 4 years ago.
are you sure about the 70% I researched online i read genotype 1A is 40% to 50% but with the new drug that is already approved estimated to come out 2012 there called protease inhibitors and you add that to the current peg interferon and ribavirin and it improves your success to 80% to 90% SVR and you only treat for 24 weeks instead of the current 48 weeks.

is this correct this is what im learning online from http://medhelp.org on there hep c forum.
people who have been through this are telling me I should wait for that drug, that the current stuff is hard on your body and it's for 1 year and no guarantees.
I don't know what to do just a little scared, I have 4 kids and I am there sole provider, I cannot afford to be out of work for not even 1 day:(
Expert:  Julia Kizhner replied 4 years ago.

There definitely are many many side effects from the treatment. It feels like you have flu-like symptoms for an entire cycle of treatment. Sometimes there are skin side effects with rashes, sometimes thyroid can become dysfunctional, often depression is also a side effect of treatment. If you are the sole provider and cannot miss work, this will be very difficult.

In my experience, eradication of the virus is about 60% with Type 1A.

 

If you completely avoid alcohol and things that irritate liver (fried foods, Tylenol) you will most likely be ok waiting until 2012 to start treatment. You've had the virus for about 20 years and so far, it only progressed to stage 2, so chances are you will not progress further, or at least you will not progress to stage 4 (cirrhosis) in the next 2 years. However, the problem with waiting for a new drug to come out, is that there is a chance that it will be pulled off the market before coming out. This cannot be predicted. Something goes wrong in the clinical trials and the drug gets pulled. It has happened before with other drugs.

 

There are pros and cons to the treatment and ultimately the decision is yours. Yes, there will be side effects and yes, there is only a 60% chance of getting rid of the virus, however, you do reduce further damage to the liver and stop the virus from replicating.

 

I know I am not giving you a yes or no treatment, however, I am unable to do that. That, again, is ultimately your decision. There is no urgency in starting treatments today or tomorrow. You can wait and think about it for the next month or so. If you do not feel comfortable with the treatment, then you shouldn't start it. This is going to be a life-changing experience for you and, until you are ready, you should not start. You know the pros and the cons of treatment as well as the pros and the cons of no treatment, and you have to weight them. No one can guarantee you that your liver will remain in stage 2 level for the next 2 years, however, statistically speaking, it should remain there.

 

Please feel free to let me know if you have any other questions. I will be glad to assist you further. I am here to help.

If you are satisfied, please click the green "Accept" button.

 

Julia

Julia Kizhner, Physician Assistant
Category: Health
Satisfied Customers: 1126
Experience: 7 years experience working in Primary Care as well as Gastroenterology, Sleep Medicine & Weight Loss
Julia Kizhner and 8 other Health Specialists are ready to help you
Customer: replied 4 years ago.
thank you that was very helpful, I know I have alot to think about, especially my 4 boys who I want to see go to college and get married one day, I am very scared and hopeful though being that im not alone and the advancement of medicine, some things are on my side:)
Expert:  Julia Kizhner replied 4 years ago.

I absolutely agree with you. There are many good things on your side. Try to stay positive no matter what. If you have never read a book my Lance Armtrong about his battle with cancer, I would suggest you do. It shows how positive thinking can help someone in their battle with the disease.

Good luck to you.

 

Julia

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