Have You Been Tested for Hepatitis C?

Last month the Centers for Disease Control and Prevention (CDC) proclaimed May 19, 2012 as the first ever National Hepatitis Testing Day and proposed that every US baby boomer (people born between 1945 and 1965) be test for Hepatitis C. Why this unusual mandate? Because the CDC says that two million, or one in 30, baby boomers are infected with the Hepatitis C virus. This group accounts for more than 75 percent of US adults living with the virus. 

Testing is critical because most people aren't aware that they're infected with Hepatitis C, which can damage the liver for years with few perceptible symptoms. According to the news release, “Identifying these hidden infections early will allow more baby boomers to receive care and treatment, before they develop life-threatening liver disease,” said Kevin Fenton, M.D., director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and Tuberculosis Prevention.


The release goes on to state:

"Current CDC guidelines call for testing only individuals with certain known risk factors for hepatitis C infection. But studies find that many baby boomers do not perceive themselves to be at risk and are not being tested.

CDC estimates one-time hepatitis C testing of baby boomers could identify more than 800,000 additional people with hepatitis C, prevent the costly consequences of liver cancer and other chronic liver diseases and save more than 120,000 lives."

I hope this proposal is approved. I wish that circumstances were different before I developed cirrhosis and needed a transplant. Trust me... no matter how terrible the treatment might be, a transplant is harder. MUCH harder.

Photo by Wojciech Wolak

Beaux Had His Transplant!

After blogging long enough, I imagine that we'd all stumble upon (or be stumbled upon) people who share something in common with us, the reason our blogs exist in the first place. At least, that's how it's been for me.

One of the people whom I've become especially attached to is Beaux, a father, husband and name on a liver transplant waiting list until March 8th this year, when he finally had a transplant. Beaux is an inspiration to me, the way he persevered through myriad difficult symptoms caused by cirrhosis. His angel of a wife, Lo, blogged for a while after his transplant and kept those of us in cyberland updated about his progress.

But I'm worried. The last post on his blog, from Lo, was April 23. At that point docs thought he might have CMV.

Beaux, I'm praying for you, Lo and your daughters. I'm worried and would love a quick little "All's OK" or "Things suck."

I hope anyone who stumbles upon my blog will join me in sending good wishes and healing prayers to Beaux and his family.

Thanks.

A Simple Tip for Easier Access to Veins that Just Don't Cooperate

In the years since I started this blog I've posted more than once about how difficult it is to find a good vein in my arms for drawing blood or running an IV. (Usually I'm complaining about nurses or lab techs who won't listen to me and end up sticking me several times, without success - grrrr.)

Recently, a really wonderful lab tech suggested that I run hot water over my hands for a minute or two before she attempted the draw and, Eureka!, it worked like a charm. For every draw since then I've used the hot water technique and it's made the experience SO much better.

Yesterday I had a CT scan with contrast and we ran into the same issue - my two good veins weren't an option for several reasons and the veins on the back of my hand were tiny and rolling. Then I remembered the hot water trick and BAM!, the vein worked. The only downside was that they didn't warn me how the contrast was going to burn in my vein going across my hand and over my wrist. I literally yelled, "Oh, shit!" Frankly, they were lucky I didn't drop the f-bomb (I have a terrible potty mouth). Lord, I hate it when I'm not told to expect something in advance. No matter how bad it's going to be, just tell me or I'm going to hate you and never trust you again.

I digress. This post is to recommend the hot water trick for people like me, who have crappy veins and suffer because of it. I hope this works as well for you as it has for me!

Photo by William Stadler

Hepatitis C and Baby Boomers

Hepatitis C has made headlines recently, following the release of a study by the Centers for Disease Control and Prevention (CDC) that, among other things, revealed that one of every 33 baby boomers (people born between 1945 and 1965) is living with hep C. Furthermore, research reported in the Annals of Internal Medicine showed that three-fourths of the approximately 15,000 people who died from hep C in 2007 were between the ages of 45 and 64.

These findings and more were reported in an article in The Wall Street Journal, Hepatitis C deaths up, baby boomers most at risk. Some of the notable items in the story include the following:

"Deaths from liver-destroying hepatitis C are on the rise... "

"About 3.2 million Americans are estimated to have chronic hepatitis C, but at least half of them may not know it."

"In fact, in 2007 there were 15,000 deaths related to hepatitis C, higher than previous estimates — and surpassing the nearly 13,000 deaths caused by the better-known AIDS virus."

The CDC is deliberating "... whether to change testing guidelines to recommend that anyone born between 1945 and 1965 get a one-time screening."

I hope hep C screening becomes more widely adopted. By the time I experienced symptoms caused by hep C, my only option was a liver transplant. Discovering the disease early and getting treatment using one of the promising new, more effective drug regimens could save many lives.

Photo by Vangelis Thomaidis

New Year, New Opportunity?

Wow! It's been nearly two months since I last posted on this blog. The chaos of the holidays have kept me busy, but now they are over and there's lots of news to share.

The biggest change for me in the past 60 days is that my doc switched my immunosuppressant from Prograf to Gengraf. The docs at my transplant center are going to try one of the new Hepatitis C treatments on a small group of transplanted patients and those patients must take Gengraf. I'm one of the people being offered the chance to try the treatment, which creates a dilemma for me. A year or two ago I probably would have jumped at this opportunity, but now that I feel better I'm very reluctant to go back to feeling unwell all the time, which is almost certain to happen on the drug regimen. And because my liver has become cirrhotic, I'm not confident it will work.

So what's the right road to take? For now I've adopted a wait-and-see approach. Because it takes just four weeks to know if the meds are effective, I want to observe what happens to some of the transplant patients who take them. If it's successful, I might give it a go. Regardless of the outcome, I'm very grateful to have this choice.

In the meantime I'm trying to determine if I can handle the Gengraf side effects. The acne (ugh! face and back!) and hair growth (face and who knows where) aren't pleasant, but they fall into the "inconvenient" category. Leg cramps, night sweats, upset stomach, etc. - these are a bigger issue.

The year is off to a good start and 2012 promises to be as much of a roller coaster as ever. Here's wishing you and yours peace, grace and health.

Photo courtesy of michaelaw

Organ Transplant Recipients Twice as Likely to Develop Cancer, At Increased Risk of Developing 32 Types of Cancer

A study of more than 175,000 transplant recipients reveals their significantly increased risk of developing cancer, according to a study by the National Cancer Institute (NCI), part of the National Institutes of Health, that was published in the November 2, 2011 issue of the Journal of the American Medical Association.

A news release issued by NCI stated, "Organ transplant recipients in the United States have a high risk of developing 32 different types of cancer, according to a new study of transplant recipients which fully describes the range of malignancies that occur."

Researchers discovered that the most common cancers among transplant recipients were non-Hodgkin lymphoma, lung cancer, liver cancer and kidney cancer. Of particular interest to me was the following finding:

The risk of liver cancer was elevated only among liver recipients. Studies of cancer show, in this group, the occurrence of liver cancer can be partly attributed to recurrent hepatitis B or C infection in the transplanted liver, or to diabetes mellitus, which is also common among transplant recipients.

Organ transplants save lives, but there are numerous risks and challenges: Hypertension, diabetes (I was taking medication for these conditions almost immediately after my transplant), skin cancer (and 31 other types of cancer, according to this study), and much more. It's a lot to take on and for me, well worth it. But there's no denying organ transplants aren't for the faint of heart.

Photo by Johany López

The Effect of Cirrhosis on the Brain

Several months prior to my transplant I began experiencing "brain fog," or hepatic encephalopathy, which the US National Library of Medicine defines as, "... a worsening of brain function that occurs when the liver is no longer able to remove toxic substances in the blood." Among the symptoms are change in sleep patterns, mild confusion, forgetfulness, mental fogginess, personality or mood changes, and poor concentration. Symptoms may become severe and life-threatening.

What is the lasting impact of hepatic encephalopathy on the brain? Doctors in Spain and Italy conducted preliminary research on this topic in a study published in the September 2011 issue of Journal of Hepatology. Researchers used advanced magnetic resonance imaging and Voxed based Morphometry analysis to assess brain tissue density of 51 healthy subjects and 48 patients with cirrhosis.

The researchers reported the following results:

Patients with cirrhosis presented decreased brain density in many areas of the grey and white matter. The extension and size of the affected areas were greater in patients with alcoholic cirrhosis than in those with post-hepatitic cirrhosis and correlated directly with the degree of liver failure and cerebral dysfunction (as estimated by neuropsychological tests and the antecedent of overt hepatic encephalopathy). Twelve additional patients with cirrhosis who underwent liver transplantation were explored after a median time of 11 months (7–50 months) after liver transplant... Compared to healthy subjects, liver transplant patients showed areas of reduced brain density in both grey and white matter.

The doctors concluded, "... the loss of brain tissue density is common in cirrhosis, progresses during the course of the disease, is greater in patients with history of hepatic encephalopathy, and persists after liver transplantation."

This study isn't definitive, given the small sample size, yet should lead to further research. Nonetheless, it's troubling information for those of us with cirrhosis. At the same time, it explains a lot. When I become forgetful, I don't just have to use my usual excuses - advancing age, menopause - and can simply blame it on liver disease.

Image courtesy of The New York Public Library. www.nypl.org