Hep C Discussion Forum

Congratulations Angie

So glad youre officially part of the dragon slayer club

You dont have a signature line so we dont know what level of damage you have/had, but its probably a good idea to be cautious about stuff that could cause further liver damage.

I used/use bio identical hormone replacement creams that I have compounded at a specialty pharmacy. 

Yay angie,

I agree with 5, so glad you are back with your news!

Wonderful you have your SVR12 now (well .. actually you are quite a bit longer than/past SVR12!), but, very good news all the same.

It is such a relief to know you are cured of it, isn't it.

How have you been feeling, in general - since EOT?

These milestones make us feel good and grateful, but I am hoping you have been feeling/sensing improvements since treatment. Let us know how all else is.

Thanks for letting us know your very good and welcome lab news. : ) C.

angie, i am so happy for you ... another virus bites the dust  

thank you so much for coming back to let us know

I see.  Thank you.  I guess I have one of those type doctors you speak of.  But no worries,  I plan on whipping out my list of questions & jotting down each response she gives me! 

I have a question  . . I found a MELD score calculator online & I put in all the information it asked for except the INR.  Out of all of my labs, I don't have a test/result for that.  So I just put in the considered normal range for it, a 1.0.  I got a 6.  When I put in 1.1, I got 7.  My question is, if I don't have a lab result for it because my doctor didn't order it, is it safe to figure that it's probably within normal range? Idk how doctors conclude or decide about what tests to give.

Lol! Ya'll so silly! I didn't even realize it rhymed!  (One of my hidden talents realized haha!!)

Hey Iris! Pretty cool how we're running together neck in neck with our whips in our hands... we'll slay the dragon yet!

Hi there! Good to meet you.

Sounds like we are neck in neck with the dragon slay,   started my beans on July 1st, so we will be finishing right around the same time! Wishing you the best,  busy woman!!

Bb, Iris

Heya Angie,

YOU sound GREAT!

Working full-out all the while. Doing well in the water drinking dept. Not allowing the sides to get the better of you. Good on the water drinkin to help keep the sides down to a workable level. I am impressed! With all that water, it must be hard to slip away from busy work to take those many inevitable bathroom breaks at work - BUT - keeping the ole bod well flushed is likely helping you more than a person can realize. It's got to be done. You will be the benefactor of this extra water work.

Wish we could give you some time off work, with pay, we would if we could! Where IS that magic wand we keep looking for around here!

"Bean 17" - ha! - she's a poet, she just don't know it!

You are on the ball (getting your meds pre-ordered), and, you are on a roll - hey, that sounds dangerous to do at the same time, rolling balls! Oh, you know what I mean.

Good you are keeping a journal (of any sort is good), good you have a list of questions to take with you for the appointment at the end of the month, and what a wonderful thing to share about how you are feeling, about getting your treatment.

I think I know what you are feeling about getting this good treatment. I too felt lucky - VERY lucky, and grateful and relieved, and so, so appreciative that they helped me and allowed me to win one of the last seats in my Gilead drug trial - had i not been successful at winning this seat, i would have done sofa/riba, and only if i had failed sofa/riba, then would I have even been offered the next choice which would have been sof/dac. I was very lucky indeed to get into my Vosevi trial. I will always be grateful to them for getting me into the trial and for Gilead for their good drugs and preemo treatment.

Those were good tears to cry, and that IS a place of hope (your St. Hope). Maaaaaverlous m'dear.  C.

Hey all!  Just checking in.. Sorry it's been a while but work has been keeping me busy. 

Things have been going well so far.  No sides except for when I don't drink enough water, then I get mild headaches & body aches. Other than that, sometimes I get a little tired.  But I chalk that up to the " not enough water" as well.  (That & my fast paced, never -a-break job.)  I keep a journal & have been diligent with a daily log of things, even if it's just the date & the # of magic bean I'm on.  My first lab & doctor visit is this month on the 30th.  I'm looking forward to it, I'll tell you what!!  I'm excited to see where I stand.  I'm also writing down a list of questions for her, as I've many.  They told me that I needed to call the pharmacy there 10 days before my last pill  to order the next bottle, so I did that a few days ago.

I don't think that I mentioned that the place I go is a place called St. Hope.  I was accepted by Gilead to receive my treatment at no cost, however,  i still pay for office visit.  I believe the labs during treatment are going to be at a very low cost.   At any rate, I consider myself blessed to be receiving such an expensive & lifesaving treatment for free!  I'm not insured & like many others, I never thought I'd ever be able to get treatment.   I cried the day I found out Gilead approved me.  

And so, my journey continues.   Hope ya'll are faring well, I've been thinking about ya'll 

Sorry Angie ... I am tromping all over YOUR thread, but, being that we started talking about NASH and research and studies and such, and then Sleestak wandered in - I have to say hi to Sleestak here, as he has no other place he lives (it would seem).

Hi sleestak! See you posted again (since your last interesting post of June 17th), you are into reading, research and study of interesting things.  Good, you and I and some of the others here have much in common then! 

I am still hoping you will update me, i can't find any OLD posts (history) from you (outlining your personal journey), other than your sig. line - just your current interests? Can't you direct me to an area or a thread where we can talk more about you?

OK, Angie, back to you!  

Good idea Tig to start a NAFLD/Nash area - it could fill up quick with interesting stuff! 

Before we get carried away with posts on NAFLD, I'm going to establish a section in our Knowledge/Info section. I think it will be a better location to discuss it. If we leave it here in Angie's New Member thread, all the information will get swallowed up by time and will be unsearchable. Please give me time to set it up before adding additional information here. I may not be able to merge these posts with the new section, but I'll try. Thanks for your patience and understanding!

This is an excellent topic and I do appreciate all the interest and contributions!

Hi Angie,

I agree with Canuck, that kind of information would be more helpful if posted in our Knowledge/Useful Info section under a title that could be searched. I can try and set something up if you would like or you could place any further data in a new thread of your choosing. It’s up to you.

I couldn’t read all of it but found the use of herbal supplements interesting. Aside from their anti inflammatory effects, I’m curious to know more on their claim that they have anti viral properties. There have been so many discussions on those claims, it boggles the mind. I used Milk Thistle for years and did see it reduce my enzymes and if it kept me from going full cirrhotic, God only knows. I certainly came close, (F3) so I think the anti inflammatory action of my supplementation had to help. I don’t encourage people to reach out to supplemention as a potential cure for HBV or HCV. They may help while waiting for actual anti viral therapy, but I wouldn’t take them expecting any kind of cure. The article does ignite some questions though. Herbals are powerful...

There is a lot of new information being reported in the medical journals on Non-Alcohol Fatty Liver Disease and I wish to start a log in my journal to keep track of my research through the medical journals. There may be information here to help prevent the disease, and also to help reverse the disease. Other people are welcome to contribute to this " work in progress".

Avocado was the subject of some research and I was surprised that some scientists had done a review in 2015 of foods that help with NAFLD, and had this to say in the abstract: " This article provides an overview of the foods that show the most promise and their potential benefits in NAFLD/NASH, specifically; oily fish/ fish oil, coffee, nuts, tea, red wine, avocado and olive oil. Furthermore, it summarises results from animal and human trials and highlights potential areas for future research. "
( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4588084/)

Choline is showing up in many publications to help and I came across a web site by Bill Sardi that gets right into the nuts and bolts and has abundant references back to 1934.
" Choline is not the only natural antidote

Seven natural molecules that are reported to help control fatty deposits in the liver and blood circulation are choline, inositol, betaine, methionine, rice bran IP6, garlic (allicin) and resveratrol. [Biochemistry Journal April 1951; Anticancer Research 1999; Lipids Health & Disease 2010; World Journal Hepatology April 2014] All are widely available as dietary supplements."
( http://knowledgeofhealth.com/how-simple-dietary-supplement-can-quell-modern -diabesity-epidemic/ )

There have been some reports of the TMAO being responsible for atheroclerosis and since it is a byproduct of choline metabolism there is the suspicion that choline could increase this malady. Resveratrol is a TMAO inhibitor and this publication states that one mechanism by which the resveratrol inhibits the TMAO is by altering the bacteria in the gut: " Resveratrol Attenuates Trimethylamine-N-Oxide (TMAO)-Induced Atherosclerosis by Regulating TMAO Synthesis and Bile Acid Metabolism via Remodeling of the Gut Microbiota."
( https://www.ncbi.nlm.nih.gov/pubmed/27048804)

Here is a link to a report showing that the TMAO prevents atherosclerosis
( http://www.sciencedirect.com/science/article/pii/S0021915015301921)

I reviewed several publications for evidence that resveratrol helps with NAFLD and found evidence of very mild positive effects.

I found a meta-analysis from 2013 about the effectiveness of probiotics on NAFLD: 
" CONCLUSION:
Probiotic therapies can reduce liver aminotransferases, total-cholesterol, TNF- and improve insulin resistance in NAFLD patients. Modulation of the gut microbiota represents a new treatment for NAFLD "
( https://www.ncbi.nlm.nih.gov/pubmed/24187469)

" Found this comment of interest: " Protracted exposure to TNF- has been shown to generate oxidative/apoptotic stress that overwhelms antioxidant/antiapoptotic defenses, leading to non-alcoholic steatohepatitis (NASH). Studies in humans with NASH demonstrate that the relative risk for the development of steatohepatitis correlates with increases in TNF- or decreases in adiponectin. "

I do not remember Dr. Gundry discussing the fatty liver disease epidemic, but it looks like reducing the TNF- by reducing the lectins will also improve fatty liver disease problems. 

" Fatty liver disease (FLD) refers to a broad spectrum of conditions characterized simply by fat accumulation within hepatocytes. It affects an estimated 70% of obese individuals and 30% of the general populace. Based on MRI, prevalence is approximately 1/2 of Hispanic Americans, 1/3 of whites, and 1/4 of African Americans. It is the most common cause of chronic liver disease and subsequent cryptogenic cirrhosis, and is known to contribute to the progression of other liver diseases such as Hepatitis C and hepatocellular carcinoma. " "

CIRRHOSIS AND CIRRHOSIS REVERSAL
I did some research on cirrhosis reversal and was surprised there is evidence, in pubmed, of compounds that help with reversal of cirrhosis. One was a animal study of curcumin, and the other was a review from March, 2017 that reviewed most of the research results up to that date. I will include some excerpts that stood out to me and then links to the pubmed publications.

" Curcumin was effective in preventing and reversing cirrhosis, probably by its ability of reducing TGF-beta expression. "
( https://www.ncbi.nlm.nih.gov/pubmed/18705752)

" In the past, liver cirrhosis was considered an irreversible phenomenon. However, many experimental data have provided evidence of the reversibility of liver fibrosis. Moreover, multiple clinical studies have also shown regression of fibrosis and reversal of cirrhosis on repeated biopsy samples. "

" In this article, we present the underlying mechanisms of fibrosis, current experimental and clinical evidence of the reversibility of liver fibrosis/cirrhosis, and new agents with therapeutic potential for liver fibrosis. "

" Chronic inflammation is the main cause of hepatic fibrogenesis and it was found to be present in the majority of chronic liver diseases such as viral hepatitis, toxic liver injury, alcoholic hepatitis, non-alcoholic steatohepatitis (NASH), and autoimmune liver diseases [5] "

" In fibrotic NASH, progression is intimately linked with insulin resistance/type 2 diabetes as well as lipotoxic hepatocyte death and intestinal dysbiosis, providing rational targets for both anti-inflammatory and antifibrotic therapy. Therapeutic strategies include reducing oxidative stress, improving insulin signaling, activating the farnesoid X receptor (e.g., with obeticholic acid), fibrosis-targeted inhibitors of hedgehog signaling, combined PPAR-/ agonists, or manipulation of altered gut microbiota using probiotics or microbiota transfer [120]. Although oxidative stress is an important cofactor in fibrosis, the use of antioxidants has proved disappointing. "
( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5339475/)


A publication from June, 2017, World Journal of Hepatology :
" The most applied medical plants in herbal treatments were selected and their mechanism of action on liver diseases and on immun system were searched to establish the Table Table3.3. Flavonoid derivatives such as silybin, silymarin, obtained from milk-thistle [Silybum marianum (L.) Gaertn.] decreased alkaline phosphatase (completely) and gamma-glutamyl transpeptidase (partially) in CCl4 induced liver damage[17]. Moreover, it has been claimed that Silymarine containing preparations are the principal therapeutic of choice in liver diseases caused by oxidative stress. Many studies have proven that plant phyto compound Silymarin has medical applications to cure (alcoholic and non-alcoholic) fatty liver, cirrhosis, ischaemic injury, drug and chemically-induced hepatic toxicity, radiation toxicity, viral and toxic hepatitis by means of its anti-oxidative, anti-lipidperoxidative, anti-fibrotic, anti-inflammatory, liver regenerating and immunomodulating effects. Several studies have identified that continuous usage of Silymarin has significantly proved to increase the survival period of patients with alcohol-caused liver cirrhosis and primary liver cancer[18] (Figure (Figure1).1). Scientific studies also have shown that, both silybin and silymarin normalized immunoregulatory failures by restoration of the cellular thiol status, T-cell activation (CD69), together with a substantial decrease in TNF[18,19]. Effects of the selected herbal medicines on immune and liver were summarized in Figure Figure1.1. Another study demonstrated that an edible plant Artichoke (Cynara scolymus L.) prevented CCl4 and oxidative stress-induced hepatotoxicity and it protected the liver[20]. Inulin, obtained from artichoke, stimulates components of the IS[21]. The extract of the rhizome Turmeric (Curcuma longa L.), which has hepatoprotective plant, amplified both Th1 (IL-2 and IFN gamma) and Th2 (IL-10) cytokines signifying its dual immune roles. Polysaccharide fraction of this rhizome showed potent immunostimulatory action in the direction of proliferation of splenocytes cell number and IL-10 secretion. Polysaccharides of the plant extract might be causative of these proliferative and cytokine release assets in murine splenocytes. In different studies have been shown that the cytokine productions (TGF-, TNF-, GM-CSF, IL-1, IL-5, IL-6, IL-8, IL-10, IL-13, etc.) have been modulated by polysaccharide-enriched fractions[18,22-24]. Fennel (Foeniculum vulgare Mill.) and liquorice (Glycyrrhiza glabra L.) have also shown immunomodulatory and hepatoprotective effects[18,25-27]. "
( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5474722/)

Here is a link to the table #3, mentioned in the quote above:
( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5474722/table/T3/)

Inulin is a prebiotic found in many health formulas and there is well documented evidence that the inulin is very helpful for a variety of health problems. I will include a link to the reference in the above quote that addressed inulin, from 2005:
( https://www.ncbi.nlm.nih.gov/pubmed/15960982)

I also took note of the emphasis on the substantial decrease in TNF by silybin and silymarin, the major active compound in milk thistle. Suppressing TNF is the main goal of a variety of biologics.

Angie,

Wow, 7 days done already! 

You were wondering ... " if any side effects were going to rear their little heads, would that have happened already? Or, are they known to happen anytime throughout treatment "...

this is always hard to answer, cause EVERYONE is different, each of us can have a different experience! Some folk feel nothing at all (really!), others are like you after a few days or during thier first week may notice something, often mild, ... like " a stomache thing", or some have complained of feeling perhaps "things in the body" ... a bit achy/fluish, but it just varies so darn much from person to person, that it is hard to generalize. If we were forced to try to generalize, then i guess we could say that when people do feel something, we might see it happen early on during the first few weeks, then lots of folk have a lessening of whatever it is they have noticed. Hopefully you will be one of those, and with lots of water and flushing you will not feel fluey/achy for very long at all!

I would say the tendancy is for the person (if they notice any side) for them to notice it sooner (than later), and that it tends to decrease or disappear. Some generalize that sides are noticed mostly during the first few weeks, then improve. But, everyone is dif! 

Are you taking your epclusa with meal? - that may be a wise thing to do (in my book), it may not only help with absorbtion but may be easier on the gut as well.  

Many people have a hard time (at first) believing about drinking lots of water (I did - and I was not a "natural "water drinker at heart - so, as usual I learned best the hard way!) - some folk have initial sides, then they try experimenting with drinking more water!, thus why we see some people with some sides more in the beginning than later in treatment, headaches especially (I think), sometimes body pain/fatigue -  people suddenly discover that they can prevent/control headaches with adequate hydration! But ... I do  (also) believe (as long as we are really well diluted) that any sides we may notice at first, likely do decrease as we go along, and/or we just get used to the drugs being in our system and we tolerate them doing their work.

Treat yourself as good as you can, get as much rest/good food as you can, try not to over extend yourself, especially if you are feeling "sidey", I believe what you are feeling this will pass soon for you. Good you are onto the water thing. 

Thanks for linking that interesting sounding thing - but we would all have to join up to read the thing you posted - is it a huge long thing?? Maybe it could just be copied and pasted instead of us all joining? Sounds interesting - i will consider joining the thing if there is no other way to read it. Thnaks. C.

Hello all!

 Just checking in, hope everyone is faring well.  As for me, tonight will be pill #7.  No troubling side effects to speak of, so far. Except, one thing I've noticed since yesterday, is a mild flu like feeling.  Achy feeling.. Anyhow, nothing I can't work with.  I've been overdosing on water, as advised.  Overall, it I'm doing alright.  I'm left to wonder though, if any side effects were going to rear their little heads, would that have happened already? Or, are they known to happen anytime throughout treatment?  Just curious.  Oh!  Not sure who on here has heard of Team Inspire but I ran across the following in that forum:

NAFLD and Cirrhosis Reversal- Recent Developments - nobeta1's journal - Inspire
https://www.inspire.com/nobeta1/journal/nafld-recent-developments-reported-in-the-medical-journals

I found it pretty interesting & useful, perhaps someone else may, as well

So, water & I are fated to become best friends,I see

It'll take some doing but I've always been good at putting my best foot forward Here's a "virtual" cheers to all as I hold up my favorite cup in a toast!  Ugghh!

Hi Angie,

Lovely to see you join us. I am also on Epclusa (week 9) We are all so lucky to be given these wonderful new DAA's for sure. My treatment is 12 weeks - 84 pills in total which came in 3 bottles of 28. I remember day one being a little intimidating but its all good. Its understandable to be a little apprehensive. I have been fortunate in not suffering much in the way of sides. Most peoples sides seem quite minor. Most important to make sure you drink plenty and rest up when you need to and I am sure the time will fly by for you. The outcome makes it a magic time which we can be very hopeful that we we finally be free of this virus, and our livers will have a chance to recover. All the best on your journey. I look forward to reading more from you over time.

Hi Angie,

Welcome to the forum and congratulations on finally getting started. From what I can garner from your results, things are starting out looking fairly normal, aside from the positive HCV viral load, but even that isn’t extreme. It’s good to know that viral load doesn’t impact the rate of success anymore. It does reduce the length of treatment sometimes.

I’m curious why your nurse and/or doctor haven’t ordered an abdominal ultrasound to review the general size, shape and flow of things. It is generally a requirement before an insurance provider will even consider treatment approval. They used to be very clear on that. There are blood tests that can help determine fibrosis and that may have been completed. All you can do is ask for the results. Here in the USA, they are required by law to give you copies of all tests performed, in writing. It’s a good idea to get them and keep them, forever. You never know when they may be of value. 

Best advice is to be certain you rest, eat well, stay active (walking is good, no hard exercise) and drink a gallon of water, every single day! Not kidding... everyday! It will reduce fatigue, body and headaches that will be noticed if you don’t. If you do those simple things, you’ll fly through this easily and successfully! 

Now go slay that Dragon!

Hi Angie,

Welcome here. Glad you joined in to the site and glad you got a good treatment - Epclusa.  Happy day one!

Your pre-treatment labs (nice you shared them), there is a lot there! Nice to know you had them all done - most of the basics they do when being thorough. From assessing your Hep A/B status to having a look at your pre-treatment bloods sugars, kidney/thyroid function, cholesterol - very good to have all these things looked at. They are hard to read in a pile like that, but from what I can glean almost all of yours are good, within normal limits. Even though you do not have the most recent pre-treatment ones available to you yet - you could still do up a signature line with what you do have (your older pre-treatment labs) .... ie, as an example of a signature line ...

... F, Age ___, Dx 1998, GT2B. Pre-treatment VL 550,000 IU/ml, ALT 37, AST 28. Rx 12 weeks of Epclusa. SOT Jul 2?, 2018 to Sept 24?, 2018. ...

Your Fscore (which could be F0 through to F4) would be good info to know, the level of "fibrosis", (in part) your liver "firmness" - as determined by a "Fibroscan". Or, an Fscore and fibrosis level can also be determined by certain bloods tests (such as a Fibrotest, and others). An AFP and GGT are other common blood tests.

Abdominal ultrasounds are commonly done to assess how your liver and other organs appear, and is another good test to have done (aside from a fibroscan) and aside from various "blood test methods" to determine fibrosis levels. 

If you have not had a fibroscan done, or a Fscore number estimated for you, or have not had an abdominal U/S done, then those are things you could ask your practitioner for. Mention it just like you did here - ask if you could please have these tests done, because you see other people routinely getting them done as part of their work-up and treatment.

Your nurse practitioner likely works hand in hand with or under the control of a doctor, who will OK tests that she may not necessarily be able to order for you, without checking with the overseeing doctor first, so, just ask about tests you think you should have or would like to have.

You are off to a very good start!  C.