A biopsy is a bitch, no doubt. But I wonder from time to time about ordering another one a year or so down the road. I would love nothing more than to find out there has been some recovery. I am old, and happy, and active, but I would like to enjoy an occasioanl glass of dry, red wine with Supper. I'm just saying. But without a reliable liver report I can't do that with a clear conscience.

Alan

That's for sure!  There's much more awareness in recent years so more money invested into research.  It can only get better.  Non-invasive testing would be great; biopsies are not fun stuff.

Well, now that the medical world has realized the severity of the HCV infection worldwide

I'm sure there will be a lot more money invested into everything related to the liver. Newer, better

technology and newer, better meds. I know that there's a lot of research being done to find meds to

reverse cirrhosis with some success. We can only hope we're around to usher in the future treatments.

Exactly, Neil.  What we have out here -- the FibroSure -- isn't much.  I've also read mixed reviews on the FibroScan.  Then again, what if a liver biopsy was taken from a "better" area of the liver?  All-in-all, that is why some dr's offices use all 3...the FibroScan, Ultrasound, and Biopsy.

Here in the U.S.A., you'll find most people have never heard of FibroScan.  I looked it up and found that FibroTest is known as FibroSure in the U.S.  It is a blood test. 

In reading posts on other forums, I've learned that there's a lot of debate about the accuracy of FibroScan.  A few nurses have said they never used FibroScan only, but FibroScan, Ultrasound, and Biopsy to get an overall picture of state of liver.

I haven't read many good things about our FibroSure blood test out here in the U.S.  I've read it can't provide info on inflammation and its clinical utility in determining fibrosis is questionable.

@Joanne   Wow...was sure Fibroscan would be available in US before here in Canada. Sure hope it gets approval soon. Was almost too easy for procedure.

Robin, you know you have genotype 3 but you don't know what Stage or Grade of the disease you are in.  That's why you would need one.  An ultrasound will not tell you; only a biopsy will.  If you don't reach SVR after tx and go for a couple of years or so before starting a newer tx...that's why you would need another biopsy.  I know people who have had 5 or more.

Hi Robin, don't know if you have heard of the alternative route...Fibroscan.  I chose this route as it was available at a hospital near me. It cost me $90 but was worth it. It works similar to an ultrasound, non-invasive and is done in less than 10 mins.

Hi Robin, yes Malcolm is right, and a lot of people with gen 3 do have biopsies done.  I didn`t have one because it just wasn`t an issue with my medical team.  I`m not saying that was right or wrong, it was just what happened and I certainly would have had one if I`d been told it was necessary.

A lot of people need to have a biopsy as a necessary requirement before they can start tx and it can provide some very valuable information on the health of the liver.  And for anyone who is wondering whether it`s safe to wait for new drugs to be available or whether they should start tx as soon as possible it`s the only reliable way they can find out.  ~ Jill

The Fibrosure test is nothing like the Fibroscan. It measures the time taken for sound waves to penetrate the liver where Fibrosure is a series of blood tests. 

http://www.fibroscan.co.uk/

Robin, Geno 3 is just as likely to develop fibrosis and cirrhosis as Geno 1. 

Your doctor has decided you don't need a biopsy, which is fine, but if it was me, I'd want a biopsy before starting treatment.  Best of luck.

I was under the immpression that you had to only do that once, my best friend told me it hurt like hell and she will never DO IT AGAIN,I have geno 3 and do not have to have one so why more than 1

Looks good Alan!  In 1971 I was only 4, hehe!  You still look much the same.

Robin, the biopsy is the only true way to determine how damaged our livers have become.  It's been the gold standard.  I've heard about the Fibrosure/Fibroscan but it's not available for me; I live in So Cal and have Kaiser.

why in the world would you ever need another biopsy!!

Wow, down to stage 1...Absolutely amazing!

Truly wonderful news.

That should make any wait for the newer drugs way less stressful.

Have a wonderful Christmas!

Brad

Thank you Kristy and Alan!  Btw Alan, I love your profile pic!  Was that in your senior year of high school?

Sensational I am over the moon for/with you. Happy Happy joy joy xx

Thank you all!  Yes, it's true what you guys are saying.  A few of my family & friends were very worried that I was having another biopsy, and didn't agree with my decision.  But I really needed to know.  I'm so glad I did; I needed some actual proof that tx did reverse some of the damage.  For anyone who was in doubt, you now know that the break we get while in tx is essential, regardless if we relapse or not.  Remember, I was only able to complete 23 weeks of tx.  I was SO sick and twice hospitalized but now I see it was worth it.

Btw, my dr told me yesterday that they also do interferon implants into the upper arm, just like the Depo birth control.  It gives you even doses for your tx time, so you do not have to inject, ever.  Sx are much less, as well.  Just thought I'd mention it, as I've never heard of it before.

Really pleased for you Judy, that is great news!  I`m sure you had to really psych yourself up to go through another biopsy but this result shows that it was well worth it.   And it really does demonstate the beneficial effects that tx has on the liver...well done!    ~ Jill xx

Awesome Judy... your liver got a vacation..thanks for sharing all the best to you and your family P & L MJ

Thats great Judy that should lift a lotta weight off

Wow, that's great Judy. Now go for a run to celebrate!......Congrats!

Wow Judy, very impressive! Very happy for you.  This really shows the beneficial effects of Rx. This should reassure some members who are worried about failure to achieve SVR. You have time to relax and fully assess any future Rx options. THIS IS WHY YOU NEED A BIOPSY!

Thank you guys, so much, for all the comments.  They are Really appreciated. 

I got the results of biopsy today at my dr appt.  I'm shocked.  My last biopsy was March 2000; nearly 13 years ago.  It showed Stage 2, Grade 2.  Now.....13 years later......I am down to Stage 1, Grade 2!!!!!  I was SO sure I'd be at 3 or 4 by now!  I can only attribute this to the work of God, the help of 23 weeks of tx, and clean living with regular exercise.  I have much to be thankful for.  Very grateful.  Will continue good habits and seek newest tx end of next year or 2014, whenever avail.

Here is the diagnostic part of my biopsy:

Happy your experience was better this time.   And thankful its over.  

Well done Judy, must be a relief to have that over with!   Glad it was easier this time, even though you still experienced a lot of pain, and it`s very good to hear that you received the right medical attention and a detailed explanation from your doctor.

Hoping you get good news on Monday!    Take care, Jill xx

Sorry I missed this thread Judy. Congrats on getting through the procedure with relative ease.

I really do hope that you get results which are tolerable with no big surprises (unless the surprise is a good one). big hug

Yeah, glad it's over, Jim!  My resting heart rate is 67 - 72.  I get the results from my tx dr on Monday.

You made it!   Yea, I've had 2 biopsy's and had the shoulder pain both times too.  Thinking about it, it hurts just typing this...lol.   Glad your feeling better today. That's some low BP you got there. What's your resting heart rate?  I wish mine was that low. I'm 115/70 most of the time.

At least now you'll know how your liver is doing.

Thank you my friends so much, as always.

Had the bx yesterday with real-time ultrasound guidance.  I did get the rt shoulder-to-neck referred pain again.  So did all 3 women in the Recovery Room with me.  Actually, I got it slightly when the dr was injecting the novocaine!  So he knew I would for certain get it with the biopsy.  The shoulder tip pain was 7 - 8 on 1 - 10 scale.  They put morphine into my IV and then went down to 5.  Today it is almost gone.

My dr talked with me prior to bx and explained that the liver capsule is all around the liver and our livers are filled with blood vessels, as it's our main filter.  When blood gets anywhere around the liver capsule, it can touch the Phrenic nerve which goes up to the shoulder tip, so we feel that strong, dull pain there in shoulder tip to neck area.  He said some pts have a stronger nerve connection than others. 

We found on u/s where I have the least amount of blood vessels so he went in, there.  A bit higher up.  He showed me the needle he would use and then afterwards, he showed me the liver segment he removed.  Looked like a 1-inch-long worm, lol. 

New thing this time...he put a gelfoam plug into my liver from where he removed the segment.  He said there's slight chance of infection as it's foreign in my body, but never happened with them before.  I have no signs of infection.

Overall, this bx experience was much better than first one in 2000.  Shoulder pain well managed, and worst was only a few hours.  The area around my liver (front, side,& back) was quite sore all night; I woke twice in pain but I did not take any pain meds at home; it was bearable.  Today pain is less but still quite tender all around liver area.  This was OK; not too bad!

Oh yes, my blood pressure did fall after medication (Fentanyl, Versed, Morphine).  It was 86/50 at lowest; b/p automatically read every 15 mins and I was hooked up to it for about 7 hours.  Mostly stayed at about 90/55 but my normal b/p is 90/60 so that's fine. 

Try not to worry, Judy, I`m sure you`ll take it in your stride this time.  Best of luck, let us know how it goes, you`ll be in our thoughts today.  You`ll be fine!   Jill xx

Hi Judy, you know all this. For every person you find who had Bx pain, there are 20 patients that didn't. Most pain is at the Bx site, and settles in 1-2 hours. Thorough local anaethesia is the key to avoiding this. Only 1 in 50 will get R shoulder tip pain. This again settles quickly (1-3 hrs), but may need some analgesia. Maybe 1 in 500 will get severe pain or bleeding that may require active Rx or Hospital admission. Maybe 1 in 10,000 will die!

Just for interest, I did not use Fentanyl. Most patients are fine after a thorough explanation. Only a few patients, usually children, required very mild sedation.  I liked the patients to be co-operative, so they could hold their breath when required- this is important when the needle is being inserted and the gun fired. I also didn't use sandbags -they are not necessary.

Regarding your question about pain increasing after 2 weeks. This could happen, and be due to continued bleeding. A CT would confirm this. I have never seen this.

Your bleeding profile is supurb and you will have no problems!!!!!

Good luck with your biopsy. It's too bad that science hasn't found a way to take a piece of the liver without actually doing so.

prayers to you Judy... good luck P&L MJ

Thanks Jeremy.   :)

Hoping for the best Judy! Keep your faith , your time will come soon. If you need anything you know how to reach me :)

Thank you Malcolm, Iris and Bouba. 

Iris, I remember that feeling of my organs being moved like that in 2000, too.  That was bizarre to say the least.

Bouba, I am getting the Twilight Anesthesia (with Fentanyl & Versed).  Don't recall what they gave me in 2000 but I remember everything, hehe!  Yeah, I'll be laying on my side for at least 4 hours afterward, on that sandbag thingie.  My shoulder pain lasted about 12 hours and it was severe; the meds were not helping it.  That's why it scares me for this time.

Malcom, I've been finding several people online who have had the extreme shoulder pain like me (9 on 1 - 9) and for some it lasted over 2 weeks.  One lady was going back to dr tomorrow because her shoulder pain has gotten worse, 2 weeks later, to point of unbearable.  You are the only person I could think to ask...do you know why that might happen?  I'm just curious.  And nervous, lol.

I should be OK as far as bleeding.  My lab from Nov 28 shows INR at 0.97.  (Normal 0.8 - 1.2)  Before tx it was 1.02.    APTT is 29.  (Norm 23 - 38).   My Platelets are 177 now; used to be around 100 on tx.

Hi Judy

i have had 3 of those. Honestly, I would prefer this one to a tooth extraction . A bit of post biopsy shoulder pain was immediately stopped by a shot. They usually sedate you during the procedure. So, painful emotions were very few if at all. The worst part was being locked there for almost 8 hours, but that does not hurt much either. Good luck and nothing to be afraid of.

Hi Judy Good Luck with the biopsy. I remember it being not much fun. The pain I experienced was like all of my innards went sucking out towards the needle, whoosh!  oh,  and I had forgotten about the shoulder ouch....

Here's a hug in advance(couldn't find an actual hug)

Your a trouper though...I know you'll get by. Sending you love. Be well.  Blessings, Iris

Hi Judy, yes, the phrenic nerve supplies sensory fibres to the liver capsule. The R phrenic nerve is nowhere near the biopsy region. The only nerves in the liver are vagal, from the sympathetic and para-sympathetic systems, and these are not sensory. Relax, you'll be fine

Hi Judy, not like me to be argumentative but there are no nerves in the liver. The pain is from blood tracking out of the biopsy 'hole' and  under the liver capsule. If the liver capsule is stretched it can cause pain . As the same nerve segment supplies the shoulder, the pain is actually felt in the shoulder tip. A good operator with ultrasound should be able to avoid blood vessels.

Thanks Malcolm and love your new pic!  I'm curious what the result will be.  And hoping I have enough healthy liver cells to stop bleeding and heal OK.

 Hi Cathy.  Thank  you.  I've had pain between my shoulder blades before, and it was related to my gallbladder and 3 ulcers that I had.  A biopsy will sometimes give a referred pain to the right shoulder.  Even though the bx is guided by ultrasound or CT Scan, they cannot see nerves.  So if a nerve is hit, the pain is referred to your rt shoulder.  Not fun!  They told me there's a 50/50 chance I'll get it.  Yes, ultrasound is quite useless to show the degree of liver damage.  Many ultrasounds show normal liver (mine always have, too) but biopsies tell the real story.  Hehehe, I Wish a simpler procedure like ultrasound could do the trick!  I'm mighty nervous about the bx, yikes! 

Judy,  I also had a pain in the back of my right shoulder.  I never connected it to my biopsy.  Hopefully you won't have to deal with this on the next one.  I wonder if there will ever be another biopsy in my future.  I hated it but the ultrasound showed a normal liver.  The biopsy showed i needed to be treated.   Good Luck to you.