HealthWise: Choosing Not to Treat Hepatitis C

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HealthWise: Choosing Not to Treat Hepatitis C

http://www.hcvadvocate.org/news/newsLetter/2009/advocate0909.html#2

Imagine this scene. Your medical provider recommends treatment for chronic hepatitis C virus infection (HCV). You’ve had HCV for 30 years and your liver is moderately scarred. You have genotype 1 so treatment will likely last for 48 weeks. You have read about the side effects of the medications and, after careful consideration, you’d rather take your chances with hepatitis C than with the treatment.

Regular Healthwise readers probably think I am going to try to persuade this fictitious patient to reconsider. After all, if I didn’t believe in treatment I would not have tried it once, let alone twice. However, the decision to undergo treatment is a complicated one, and what worked for me might not work for others.

So, this month, I am headed in a different direction. I explore the other path—making the choice to not treat. I recommend ways to support your liver and general health. This advice applies to nearly everyone, but particularly those with liver disease.

There are many reasons for rejecting HCV treatment. Here are some:

You are concerned that you might not be able to work.

You are troubled by the potential side effects, particularly depression.

You are bothered by the fact that the medication is given by self-injection and concerned it may trigger a relapse from drug recovery.

You distrust the pharmaceutical industry and their products.

You are committed to natural or alternative medicine.

You are afraid that treatment will be unendurable.

You are paralyzed by indecision.

You are scared that the medication will harm, maim or kill.

You favor waiting for better HCV medications.

You are unwilling to go through treatment without better odds of success.

You feel well and don’t want to give that up for a year.

Your liver has little or no fibrosis and waiting makes sense.

You think a sharp stick in the eye sounds like a better alternative.

Let’s assume you discussed all of this with your medical provider and your mind is made up. Now what?

First and foremost, minimize stress to your liver. Abstain from alcohol use. If you aren’t willing to quit, limit your drinking to no more than one standard size drink a day. One standard drink is 12 ounces of regular beer, 8 to 9 ounces of malt liquor, 5 ounces of table wine, or 1.5 ounces of 80–proof spirits. If drugs or alcohol are a problem, get help.

Keep your weight under control. Nonalcoholic fatty liver disease (NAFLD) is quickly becoming a serious health problem in this country. NAFLD is the most common cause of elevated liver enzymes. Tragically, NAFLD is striking children as well as adults. Complications from NAFLD include liver cancer and death.

Fortunately, NAFLD is treatable and potentially reversible. Weight loss is an effective treatment for NAFLD. Exercise may help. Patients with NAFLD showed improvement with as little as 60 minutes a week of low-to-moderate intensity exercise. Patients who exercised but did not lose weight also had significant improvements in fasting blood glucose, insulin resistance, and cholesterol and triglyceride levels.

Eat a low fat, high-fiber diet. Include fresh fruit, vegetables, and whole grains. Avoid trans-fatty acids, saturated fats, corn syrup and excess salt. Eat real food—rather than stuff out of a box.

Practice safe food habits. Avoid raw or undercooked shellfish. Raw or undercooked oysters and clams may carry Vibrio vulnificus—bacteria that cause a number of serious clinical conditions. Uncooked shellfish may also harbor hepatitis A.

Beware of poisonous mushrooms. They contain toxins that can destroy even the healthiest liver.

Do not eat wild mushrooms unless you are 100% sure of what you consume.

Aim for 30 or more minutes of exercise every day. If you are confused about exercise, here is a simple place to start. Put on comfortable walking shoes and sunscreen. Step outside and walk 15 minutes or more. Then turn around. Make this a daily goal. If 30 minutes is too much, start with something you can do. A walk to the mailbox is better than no walk.

Protect your liver from other viruses. If you aren’t already immune to hepatitis A and B, get vaccinated. Make sure all immunizations are up to date, including an annual flu shot.

Get regular check-ups. Your medical provider will recommend how often you should be seen and what labs and other diagnostic tests need to be performed. This all depends on the condition of your liver. Blood tests are usually done every six or twelve months, more frequently if you have cirrhosis. Medical appointments are usually scheduled annually, more often for patients with advanced liver disease. If you have cirrhosis, your provider may order an abdominal ultrasound every 6 months. Liver biopsies are usually recommended every 3 to 5 years. If you already have cirrhosis, there is no need to biopsy the liver.

If you use herbs or dietary supplements, learn how to do this safely. Some herbs are toxic to the liver. Large doses of any supplement are strongly discouraged. More is not better. Vitamin A in high doses can cause liver injury. Iron supplementation should only be taken under medical supervision. Herbs should never be used by people with decompensated cirrhosis. For more information about dietary supplements, visit www.hcvadvocate.org.

Act responsibly around blood and bodily fluids. This means not infecting others, and avoiding infections from others. Wash your hands. Practice safer sex. Cover all cuts or wounds. Do not share personal hygiene instruments, such as razors, cuticle scissors, nail clippers, toothbrushes or other items that might be exposed to blood. Properly discard all feminine hygiene products. Use good judgment when getting tattoos or body piercings.

Strive for the best health possible. If you smoke, try to quit. If you don’t floss your teeth, make this a daily goal. Wear your seat belts. Look for every opportunity for improvement. If you hear yourself groaning about this, consider an attitude adjustment. We don’t have to improve our health—we can take chances. Alternatively, we can take our future into our own hands and start feeling better now.

Keep abreast of medical news. Science is making giant leaps. The Hepatitis C Support Project provides the latest news on liver disease. You can subscribe to regular updates or go to www.hcvadvocate.org. At this website, there is an extensive list of HCV and other liver-related drugs that are in various stages of development.

Finally, think about others. Although you cannot donate blood to a blood bank, you may donate your organs and tissues after death. To register, visit www.donatelife.net The Harvard Brain Bank would love your brain. www.brainbank.mclean.org 1-800-BRAIN BANK (1-800-272-4622) Consider giving this ultimate gift.

http://janis7hepc.com/not_to_treat_hepatitis_c_faq_ne.htm