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Post Info TOPIC: Symptoms of cirrhosis
mallani


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RE: Symptoms of cirrhosis
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Hi Mary et al,

Ah, platelets. Humour me while I ramble a bit.

By all means, eat the foods as detailed in Tig's references. They're essential for healthy living. However, don't expect an increase in platelets, unless you have a specific deficiency e.g. Vit. B12 or Folic Acid.

We know platelets are produced from megakaryocytes in the bone marrow. They're called 'cells' even though they are just bits of cytoplasm without a nucleus. Their production is regulated by a hormone called Thrombopoietin which is mostly produced by hepatocytes in the liver. The usual Lab. range is 150,000 to 400,000. Many conditions cause decreased platelets. We are mostly interested in liver damage and drugs. Obviously, liver damage causes decreased Thrombopoietin production. Decreased platelet levels in cirrhotics is common. Portal hypertension results in an enlarged, engorged spleen. Many believe that reserves of platelets are 'trapped' in dilated splenic sinusoids. Others believe in a condition called 'hypersplenism', where platelets are actively destroyed. Serotonin and an autoimmune response probably contribute. Even HCV patients with less severe damage may have decreased platelets.

Many drugs effect platelet levels. Common drugs such as aspirin and the NSAIDs decrease levels. Interferon is well known as a bone marrow suppressant, and some Hepatologists will not use Interferon if the before treatment levels are below 100,000 ( or 75,000 depending on the Hepatologist). Age is also a factor. As patients age, the number and 'quality' of the platelets decrease. Over the age of 60, platelet levels of between 100,000 and 150,000 are not considered significant. Older patients may have normal levels, but decreased 'stickiness' of the platelets. This is why older people often have bruises or ecchymoses on their arms.

What level of platelets is safe? I have a mate who is an Haematologist. He has an autoimmune condition, and his platelets run at 70,000-80,000. When my platelets dropped to 30,000 during my treatment, I asked what was a safe level. He thought 50,000 was OK, but be careful with sharp objects-HAHA. I've no idea what is generally accepted, but he should know.

How can platelet levels be increased? Obviously stop any drugs like aspirin or NSAIDs etc. Elthrombopag is a drug that stimulates platelet production. Platelet transfusions may give instant but temporary relief. These are usually reserved for patients on Interferon, where you really don't want to decrease the dose.

So, if you have HCV, don't be surprised if you have low platelets. Although it suggests you have significant liver damage, the virus itself may cause autoimmune problems that affect the bone marrow. Since SVR, my platelet count has increased to 220,000, so SVR is a good way to get your count up.

As far as I know, the new DAA's don't have a significant effect on platelets, but a low level may preclude treatment. Cheers.



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Geno 1b, IL28B CT,  x3 prior relapser,  ex-cirrhotic, 75 yo, did 48 weeks with Victrelis/Peg./Riba.  VL 1.28m at start, UNDET. at 8 ,12 ,16 ,24 ,30  and 48 weeks.  EOT 15 Feb 2013 , UNDET. at EOT + 28 weeks. SVR!  Still Undet. at EOT +5 years

Malcolm
Mugsy


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Thanks, Gracie. I think I will go to the health food store tomorrow and look for beet powder. 

And to answer your question, it was realizing all my bras felt too tight and I needed to get a larger bra size (not cup) and I had not gained weight, it was the enlarging liver that created the need. I also have the red palms, tenderness on the right side, spider naevi and fatigue. Sorry for the TMI  ;)



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62 y/o F     Genotype 1b  for 40+ years    cirrhosis    Started Harvoni  on 11/23  for 12 weeks       UND  12/22/2014     Ended treatment on Feb 15th.

12 week's EOT viral load      <15 
Gracie


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I have heard that beet juice raises platelets. And you can buy beet powder at a health food store. Great for smoothies. 



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  1. Gracie

1A. Previously treated non responder Rebetron in 2000 And Incevik in 2014 with a breakthrough at week 12. Fibroscan 15.5. VL 6,000,000. Finished 24 weeks harvoni on Dec. 19, 2015. SVR. Latest Fibroscan 8.8.
Huey


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Mugsy wrote:

So Malcom, what can be done for low platelets? I am pre-treatment and my platelets have been declining (under 100,000)  since 2008. My latest done yesterday was 70,000, down from 78,000 in March. INR is 1.1 and protime is 14.2. My doctor at OHSU has said he has successfully treated patients with platelets as low as 35,000. My PCP suggested trying blackstrap molasses. From CT scans and ultrasounds, my spleen doesn't seem to be holding onto the platelets.

Thank you, I appreciate any feedback you might have.

 Getting a blood transfusion from a 2ed rate clinic that don;'t test or even know what HCV is like they had in the 70's would raise your platelets, " I am being sarcastic"



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  HCV Genotype 3a , now Psot-Tx was on S/riba. First VL was 5.8 mil on 7-5-13 then "und" at 3.8 weeks. 06/13/14 still und. off meds 3 days back on 7/29 Last pill 08/10/14 SVR+4

 
Gator Man


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Isiscat2011 wrote:

I am looking forward to reading what Malcolm has to say as well, Mary.  I too have low platelets (fluctuating in the 90s).  Transfusions and drugs can be used when they become severely low (<50) or life threateningly low (<10).  

SVR is very likely to increase our platelets.  As I'm sure you know the new DAAs don't appear to cause either short or long term platelet decreases.  Check this out:  http://www.ncbi.nlm.nih.gov/pubmed/23001404  

 

 

When I had aplastic anemia, my platelet counts were at or below <10 for several weeks. I had numerous pooled random donor platelet transfusions before my bone marrow regenerated. Given the significantly higher number of pooled donors versus single donor packed red cells that contributed to my transfusions, I probably had more chance of contracting Hep C from the platelet transfusions. I'll never know and it doesn't matter, but I have always been curious about the source of infection. My doctor asked me if I felt an unusual sensation after any of the platelet transfusions. Its been too many years and I was way too sick to have any specific recollection.

An issue that is worthy of comment is platelet levels in relation to HCC risk. Yet another reason for those of us at F3-F4 to get to SVR and improved platelet levels sooner than later, although mine so far have been around the 200 range before and after Tx.



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Geno 1b, compensated cirrhotic, 54 yo, prior null responder. Pre tx VL approx 595,000, tx with Sovaldi/Olysio (no Riba) started 1/8/14. VL 40 @ 2 weeks, UND @ 4 weeks. Still UND @ EOT + 1 year.

Gator Man SVR12, Dragon 0, Final Score.
Mugsy


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Thanks Tig  you are always right there with awesome input. I'm going to try adding beetroot and carrot juice to my smoothies. My diet includes a lot of the recommended foods already. Thanks again!



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62 y/o F     Genotype 1b  for 40+ years    cirrhosis    Started Harvoni  on 11/23  for 12 weeks       UND  12/22/2014     Ended treatment on Feb 15th.

12 week's EOT viral load      <15 
Isiscat2011


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I am looking forward to reading what Malcolm has to say as well, Mary.  I too have low platelets (fluctuating in the 90s).  Transfusions and drugs can be used when they become severely low (<50) or life threateningly low (<10).  

SVR is very likely to increase our platelets.  As I'm sure you know the new DAAs don't appear to cause either short or long term platelet decreases.  Check this out:  http://www.ncbi.nlm.nih.gov/pubmed/23001404  

 

 



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Diagnosed in 2011, Incivek triple in 2011, tx discontinued, Genotype 1a, CT, VL 7mill, cirrhosis dx in 2012, age 67, waiting for new DAAs.
Tig


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Hi Mary,

Here's some home remedies I found online. Of course, everything should be discussed with your healthcare team to determine how they might impact your current treatment protocol. I Googled "how to increase platelet count with diet" and came up with a number of ideas and recommend you take a look. If things get dire, your physician can recommend a transfusion. Good luck...

http://www.ethnichealthtips.com/home-remedies-to-increase-platelet-count.html

http://www.wikihow.com/Raise-Blood-Platelet-Level-Naturally

Tig



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Tig

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Mugsy


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So Malcom, what can be done for low platelets? I am pre-treatment and my platelets have been declining (under 100,000)  since 2008. My latest done yesterday was 70,000, down from 78,000 in March. INR is 1.1 and protime is 14.2. My doctor at OHSU has said he has successfully treated patients with platelets as low as 35,000. My PCP suggested trying blackstrap molasses. From CT scans and ultrasounds, my spleen doesn't seem to be holding onto the platelets.

Thank you, I appreciate any feedback you might have.



__________________

62 y/o F     Genotype 1b  for 40+ years    cirrhosis    Started Harvoni  on 11/23  for 12 weeks       UND  12/22/2014     Ended treatment on Feb 15th.

12 week's EOT viral load      <15 
mallani


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Hi Gracie,

Good topic. Cirrhosis may be silent, and the vague Symptoms of tiredness, loss of appetite, nausea and vague abdominal pains are easy to blame on something else. Unexplained weight loss should always be investigated. In my case, I probably had cirrhosis for 5-8 years before treatment. Even retrospectively, there is no symptom I can find. On the other hand, there are signs of cirrhosis. A slightly enlarged liver, a palpable spleen, spider naevi of the skin, palmar erythema ( red palms), Dupytron's contracture (thickening of the palmar fascia) can all be present in cirrhosis. I had all of these.

When cirrhosis is more advanced and reaching the decompensated stage, it's a different story. We've discussed ascites, varices, hepatic encephalopathy, bleeding disorders (low platelets, increased prothrombin time) etc.

The fact remains, all patients with HepC should have a liver assessment. IMHO biopsy is the way to go initially, without follow-up by Fibroscan. Cheers.



__________________

Geno 1b, IL28B CT,  x3 prior relapser,  ex-cirrhotic, 75 yo, did 48 weeks with Victrelis/Peg./Riba.  VL 1.28m at start, UNDET. at 8 ,12 ,16 ,24 ,30  and 48 weeks.  EOT 15 Feb 2013 , UNDET. at EOT + 28 weeks. SVR!  Still Undet. at EOT +5 years

Malcolm
Isiscat2011


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Hi Gracie:

Fatigue, fatigue, fatigue.  Also, I sometimes feel digestive problems such as nausea and not being able to eat very much without feeling bloated.  Those are the main things.

I have no visible physical signs except for red palms which is called "palmar erythema. "  People are shocked to learn I have cirrhosis as I look very healthy. You can't usually tell by looking at somebody.  That goes double for women because we have our ways of looking better than we sometimes feel.  :)

I have noticed that my eyes are sometimes bloodshot but that could be due to my increased time on the computer lately.  Years ago I turned yellow for about a day but it went away.  

Please get a fibroscan if you can.  You need to know if you have cirrhosis.  You could also go for a biopsy but it is an invasive procedure with some risks.



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Diagnosed in 2011, Incivek triple in 2011, tx discontinued, Genotype 1a, CT, VL 7mill, cirrhosis dx in 2012, age 67, waiting for new DAAs.
Gracie


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Thanks Mike for such a detailed reply. I guess the fact that you can remain symptomless or with vague symptoms isn't really what I wanted to hear, but it's a good deterrent to being vigilant. I know what a cites is, my mom passed away 7 years ago from ovarian cancer and I was with her for quite a few draining sessions. That scares me more than any other symptom as it was so uncomfortable for her. I don't drink to speak of, maybe had one or two small glasses of wine in the past year which I didn't finish as I feel guilty. The eating healthy has been a struggle, darn chips are my Achilles heal. I get lots of exercise and Just try to live as good a life as I can.

This thing hangs over my head still. If I feel a twinge I think it's cancer, if I feel bloated, I think it's ascites, if I happen to get a tan, I think it's yellowy, aka jaundice. I do get fatigued, but that could be the hep c, I don't itch too much, I eat too much, and generally feel pretty good, so hoping I can remain healthy enough to wait for the new treatments that will work for me. I do find my hands swell though which is a sign of edema, I think. i guess even if I develop cirrhosis I can still beat it with the new treatments, or at least, that's what I'm hoping for. Gotta ramp up my healthy eating for sure... Thanks guys!



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  1. Gracie

1A. Previously treated non responder Rebetron in 2000 And Incevik in 2014 with a breakthrough at week 12. Fibroscan 15.5. VL 6,000,000. Finished 24 weeks harvoni on Dec. 19, 2015. SVR. Latest Fibroscan 8.8.
pizzacake


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Excellent post! I've had Hep C and cirrhosis for so long that I also began to feel that fatigue and extended belly was normal. 

I just lost a friend this week to end-stage liver disease. He didn't get treatment in time. 

We need to get the word out somehow. 

 

 



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Age: 62, Lived with Hep C since 1971 (Sharing infected needles)

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Genotype: 1A

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Begin 3-month treatment June 24: Sofosbuvir, Ribavirin, and Interferon

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Tig


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Excellent post Mike! Thanks for sharing that with us...

Tig



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wmlj1960


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Hi Gracie,

I've probably had cirrhosis for multiple years but I did not address the symptoms due to my being well into an alcohol/drug addiction. It's amazing how bad I felt, but kept on going to support my addictions.

I've been increasingly feeling fatigued 24/7 for many years but that feeling kind of became the 'normal' feeling for me. Other than that I've managed to remain asymptomatic for over 20 years of HCV/HIV infection UNTIL...January 2014, when I was admitted to the hospital suffering from severe abdominal pain. This was caused by excessive fluid build up in my abdominal cavity called acites, a condition that is associated with advanced decompensated liver cirrhosis. This fluid can be drained out of the abdominal cavity via a procedure called paracentesis, which is not fun, trust me.

Also I experience occasional loss of memory and confusion associated with another advanced cirrhosis condition called hepatic encephalopathy, which is caused by toxins not being neutralized in the blood, which is a normal function of a normal healthy liver.

I also have portal hypertension, which is the inability of the blood to transfer from the portal vein, through the liver, and on through the hepatic vein. The liver tissue becomes so scarred from cirrhosis that blood has a hard time penetrating through as it normally would which causes blood pressure to rise, and for blood flow to be diverted to alternative, non-preferred pathways, One of these pathways include the esophagus, where veins called varicies can rupture due to the excessive blood pressure. This condition can be life threatening if not addressed quickly.

These acites/encephalopathy/portal hypertension symptoms/side effects are the result of well advanced, decompensated stage of cirrhosis and are not something that will likely be experienced by someone in early stage cirrhosis.

As I said, really the only noticeable Sx I experienced in early cirrhosis was fatigue and part of that could certainly be a result of my self-destructive lifestyle. But Sx's can be different, and to a varying degree for each person. Some basic things to look for are listed in the link that Tig56 gave, but remember there are many other issues in our lives that can cause these same Sx's, so if you are experiencing any of these, contact your Dr and get tested before jumping to conclusions.

I'm no Dr and I'm really only beginning to learn about this disease so take that into consideration for what I post. I'd say I'm ballpark close with the medical explanation, and I know I'm right about fatigue from personal experience.

Bottom line is: Whether or not you have cirrhosis, you have HepC which causes it. The only cure for that is Treatment, but there are many ways we can help along the way to slow the progression of cirrhosis such as eating healthy, no alcohol etc. Please believe me when I say, "not taking care of your liver now can be such a big regret in your future. smile

 

 

 



-- Edited by wmlj1960 on Saturday 16th of August 2014 07:34:26 PM

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60 yo, geno 1a, Dx 1994 HCV-HIV co-inf, Dx 2013 decompensated cirrhosis
Tx #1 - 24wks Sov+Riba /SOT 7-24-2014/UND@EOT/DETECTED@EOT+16 wks
Tx #2 - 24wks Harvoni /SOT 7-25-2015/UND@EOT,+12,+24,+52 = SVR

Mike

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Tig


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While I don't have cirrhosis, I thought you might find some useful information on this website. 

http://www.medicinenet.com/cirrhosis/article.htm

Tig



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Tig

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Gracie


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Wondering if you guys could give me an idea of what symptoms you felt with cirrhosis. My doctor said I don't have it, however, I havent had a liver biopsy since 2002 and wanted to know some of the things which might indicate its progressing to that. This of course is a message to those who have cirrhosis. Thanks.



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  1. Gracie

1A. Previously treated non responder Rebetron in 2000 And Incevik in 2014 with a breakthrough at week 12. Fibroscan 15.5. VL 6,000,000. Finished 24 weeks harvoni on Dec. 19, 2015. SVR. Latest Fibroscan 8.8.
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