to LIZ,, ot

[Guest guest]

awww, that WAS wonderful!!!elizabethnv1 <elizabethnv1@...> wrote: I was so sure I wouldn't hear from him , and when he called it was 4pm here which means it was 1am there . Military life doesnt allow them usually to stay up that late , but he said he did just to call me ....lol how sweet Re: Test your brain hahah,, I FOUND ALL 6saleem chaudhary <saleem.charudhary@...> wrote: Dear friends. test your and your children brain. saleem ALZHEIMERS' EYE TEST Count every " F" in the following text: FINISHED FILES ARE THE RE SULT OF YEARS OF SCIENTI FIC STUDY COMBINED WITH THE EXPERIENCE OF YEARS... (SEE BELOW) HOW MANY ? WRONG, THERE ARE 6 -- no joke. READ IT AGAIN ! Really, go Back and Try to find the 6 F's before you scroll down. The reasoning behind is further down. The brain cannot process "OF". Incredible or what? Go back and look again!! Anyone who counts all 6 "F's" on the first go is a genius. Three is normal, four is quite rare. Send this to your

friends. It will drive them crazy.! And keep them occupied For several minutes..! More Brain Stuff . . . From Cambridge University. O lny srmat poelpe can raed tihs. cdnuolt blveiee taht I cluod aulaclty uesdnatnrd waht I was rdanieg. The phaonmneal pweor of the hmuan mnid, aoccdrnig to a rscheearch at Cmabrigde Uinervtisy, it deosn't mttaer in waht oredr the ltteers in a wrod are, the olny iprmoatnt tihng is taht the frist and lsat ltteer be in the rghit pclae. The rset can be a taotl mses and you can sitll raed it wouthit a porbelm. Tihs is bcuseae the huamn mnid deos not raed ervey lteter by

istlef, but the wrod as a wlohe. Amzanig huh? yaeh and I awlyas tghuhot slpeling was ipmorantt! if you can raed tihs psas it on !!REGARDS. SALEEM __________________________________________________

[Guest guest]

thanks,, I do want to get down to see you!elizabethnv1 <elizabethnv1@...> wrote: Well girl I have lots of patience , but hopefully sometime this year you guys will make it out here . Luv ya Re: FLORIDA ANNUAL HEP FEST Well, I am going and I don't know who else is going and I live in Denver so I have no idea who has multiple personalities LOL - could ya write to me privately and fill me in??? I got my room in that La Quinta Inn too - I'm really looking forward to going! - hugs, Kerry Jackie Jackie Jackie Jackie Jackie

[Guest guest]

Well that is true,, it can take a long time for the docs to send the info,, but what if you dont have that much in background because, like me, I just took pain meds and continued on working until the treatment made me too anemic to work,, I tried to get my medical records from when I had my son and they gave me the infected blood, but my records had "suspiciously" disappeared! I did do all the legwork but they kept turning me down,, but the weird thing was that with each appeal, they did not ask for any new info,, but when the AL judge saw my stuff, he wondered why they wouldnt take the word of my doc's when they said I couldnt work and yet they took the word of the government ssdi doc who said that hep c is NOT a disabling disease and he had never even laid eyes on me,, I have heard this is a typical thing and not uncommon, Alsup who worked with me on this said that almost 99 percent of those who apply do get turned down at least once if not more... they

typically turn ya down on the first time just to see if you will go away.. I was much sicker than rog and he got approved the first time too,, but he had serious joint issues that I had but did not have the past medical history of going to docs for it,, he did,, I dont know what I would have done if the AL judge had turned me down, probably killed myself,, and when they tried to take it away from me at 18 months, I hired a local ssdi attorney and he told me what to do and what not to do ( like NOT going to see the doc they set me up with who was NOT required to read any of my past history and all she had to do was to look at me and she could say that I looked fine) and then I would have lost it... I sent them my biopsy that was done when I had my gallbladder removed and while the cirrhosis was not noted at that time, it still showed chronic and acute changes in my liver and they suggested that I might have PBC,, which later proved to be negative but I also

insisted that they base my decision on MY DOCS records and not send me to some doc who was more than an hours drive from my home. Then they called me and threatened me and I of course call the atty back and he said not to worry, they always do that in an attempt to scare you into going to their doc who has an incentive NOT to help you.. it was a nightmare Liz,, so I followed his advice and they HAD to approve me. There is a little known law that states that IF you turn 50 while on ssdi and if you have never had a desk job,, that they cannot reqire you to take a desk job if you become less disabled. I didnt know that so he told me that they would HAVE to approve me based on what my biopsy showed and my refusal to drive that far away to see some doc who had no interest in me or my case. I was so glad I called this guy as he really helped me not to be so intimidated by these 's at the state who make the decisions.. so the AL judge saw all my info

and approved me for permanent ssdi,, thank God,, I just dont know what I'd do if he hadnt! well Im gonna go to bed, this weather change is killing me and my joints, have spent a lot of time in the hot tub today and have had to take extra morphine... talk with you soon honey! jackieelizabethnv1 <elizabethnv1@...> wrote: I was lucky only because of an article that taught me what to do to increase my odds of being approved . I went to every doctor

and hospital that I have ever gone to and got original copies of all my charts .I had to drive to california and all over to get the papers I needed . Allot of the time people are denied is because they don't have the necessary medical records at hand . If you wait for the hospital and drs to send the information it can take months . Re: Re:

hello, I am a new member a DONT count your chickens before they hatch honey,, Hep C is NOT a recognized reason for disability unless you have cirrhosis of the liver. The Government considers it an "unsymtomatic" disease... I KNOW MORE people who have waited 2 or MORE years to get it and some finally just gave up trying to get it. Thats NOT to say that you wont have an easy time getting it,, but you have to be prepared for a long fight. Depression is one that they recognize for disability, unfortunately hep c is not unless you have cirrhosis.. what stage of damage do you have? I was stage 3-4 with early cirrhosis and had to go to the administrative Law judge to get it and then they only gave me 18 months and had to re-evaluate it and they gave me all sorts of grief and tried to take it away at 18 months, but I hired an attorney and he helped me to stop them from taking it

away.. Liz is the exception to the rule,, lucky liz, but most have to fight for a long time to get it... jax moderatora <vesta3553 > wrote: Thanx, I was alittle worried there--I don't know what I would do if Ihad to wait years---I can't live on charity forever that isn't me. Ihave worked most of my life and always took care of myself--at leastwith the ssi- I paid into it so I know what i will be getting will bemine. Thanks again> > Hello,> > My name is ine, I have had hep c for over 25 years (maybe more)> > due to drug use when I was young and foolish. I am a non repsonder> > to treatment and have been on treatment twice in the last 6 years.> > The stress of that and my job got to me last year. I quit my job> > and I had a small business going from my home. that didn't work out-> > -I have been approved for Mass health so I can go to a doctor. Has> > anyone had a problem with swelling in their hands? My hands swell> > and my joints in my hands and wrist hurt--it would seem like I

have> > carpel tunnel but this seems a little different. Every joint hurts> > in my body. Even my neck. I have always been a very active person--> > always worked and even worked overtime even through treatments. now> > I can barely get through my day--I get extremely tired. I had> > stopped reading about hep c after my doctor did my last test to> > check on my viral load. That was last year and It had started to> > creep back up. They said that they didn't want to depress me so> > they didn't want to do any more test to check my viral load as there> > really isn't anything that they can do for me. I am going to go to> > a doctor when I get my helath card in the mail as I am feeling> > pretty poorly and I need some relief from the pain that I am> > feeling. All the advil, naprosen and aleve don't really do much for> > it. I keep getting fluid in

my ear--what a mess LOL. thanks so> > much for listening I don't have anyone that I talk to about any of> > this and I appreciate any suggestions that I can get.> > ine> > Thanks for listening--> >> >> >> >> >> >> >> >> > ---------------------------------> > Talk is cheap. Use Messenger to make PC-to-Phone calls. Great> rates starting at 1¢/min.> >>>>>>> Jackie>Jackie Jackie

[Guest guest]

Wow sounds like they put ya through the wringer , I have heard other stories like yours and it amazes me . Our gov. can tax us up the u no what but if we need to get something back they sure put up a fight .

Re: Re: hello, I am a new member

a

DONT count your chickens before they hatch honey,, Hep C is NOT a recognized reason for disability unless you have cirrhosis of the liver. The Government considers it an "unsymtomatic" disease... I KNOW MORE people who have waited 2 or MORE years to get it and some finally just gave up trying to get it. Thats NOT to say that you wont have an easy time getting it,, but you have to be prepared for a long fight.

Depression is one that they recognize for disability, unfortunately hep c is not unless you have cirrhosis.. what stage of damage do you have? I was stage 3-4 with early cirrhosis and had to go to the administrative Law judge to get it and then they only gave me 18 months and had to re-evaluate it and they gave me all sorts of grief and tried to take it away at 18 months, but I hired an attorney and he helped me to stop them from taking it away..

Liz is the exception to the rule,, lucky liz, but most have to fight for a long time to get it...

jax

moderatora <vesta3553 > wrote:

Thanx, I was alittle worried there--I don't know what I would do if Ihad to wait years---I can't live on charity forever that isn't me. Ihave worked most of my life and always took care of myself--at leastwith the ssi- I paid into it so I know what i will be getting will bemine. Thanks again> > Hello,> > My name is ine, I have had hep c for over 25 years (maybe more)> > due to drug use when I was young and foolish. I am a non repsonder> > to treatment and have been on treatment twice in the last 6 years.> > The stress of that and my job got to me last year. I quit my job> > and I had a small business going from my home. that didn't work out-> > -I have been approved for Mass health so I can go to a doctor. Has> > anyone had a problem with swelling in their hands? My hands swell> > and my joints in my hands and wrist hurt--it would seem like I have> > carpel tunnel but this seems a little different. Every joint hurts> > in my body. Even my neck. I have always been a very active person--> > always worked and even worked overtime even through treatments. now> > I can barely get through my day--I get extremely tired. I had> > stopped reading about hep c after my doctor did my last test to> > check on my viral load. That was last year and It had started to> > creep back up. They said that they didn't want to depress me so> > they didn't want to do any more test to check my viral load as there> > really isn't anything that they can do for me. I am going to go to> > a doctor when I get my helath card in the mail as I am feeling> > pretty poorly and I need some relief from the pain that I am> > feeling. All the advil, naprosen and aleve don't really do much for> > it. I keep getting fluid in my ear--what a mess LOL. thanks so> > much for listening I don't have anyone that I talk to about any of> > this and I appreciate any suggestions that I can get.> > ine> > Thanks for listening--> >> >> >> >> >> >> >> >> > ---------------------------------> > Talk is cheap. Use Messenger to make PC-to-Phone calls. Great> rates starting at 1¢/min.> >>>>>>> Jackie>Jackie

Jackie

[Guest guest]

I know,, it really makes me mad cuz most of us with hep do get sicker and do need to stay home and try to get well.. yeah, they are like the insurance companies that gladly take your premium each month but do not want to pay out on anything.. and its OUR money, WE paid into the system for it should we ever need it.. yeah, they put me through the wringer and I know lots of others who have been through it too,, you were so lucky Liz!elizabethnv1 <elizabethnv1@...> wrote: Wow sounds like they put ya through the wringer , I have heard other stories like yours and it amazes me . Our gov. can tax us up the u no what but if we need to get something back they sure put up a fight . Re: Re: hello, I am a new member a DONT count your chickens before they hatch honey,, Hep C is NOT a recognized reason for disability unless you have cirrhosis of the liver. The Government considers it an "unsymtomatic" disease... I KNOW MORE people who have waited 2 or MORE years to get

it and some finally just gave up trying to get it. Thats NOT to say that you wont have an easy time getting it,, but you have to be prepared for a long fight. Depression is one that they recognize for disability, unfortunately hep c is not unless you have cirrhosis.. what stage of damage do you have? I was stage 3-4 with early cirrhosis and had to go to the administrative Law judge to get it and then they only gave me 18 months and had to re-evaluate it and they gave me all sorts of grief and tried to take it away at 18 months, but I hired an attorney and he helped me to stop them from taking it away.. Liz is the exception to the rule,, lucky liz, but most have to fight for a long time to get it... jax moderatora <vesta3553 > wrote: Thanx, I was alittle

worried there--I don't know what I would do if Ihad to wait years---I can't live on charity forever that isn't me. Ihave worked most of my life and always took care of myself--at leastwith the ssi- I paid into it so I know what i will be getting will bemine. Thanks again> > Hello,> > My name is ine, I have had hep c for over 25 years (maybe more)> > due to drug use when I

was young and foolish. I am a non repsonder> > to treatment and have been on treatment twice in the last 6 years.> > The stress of that and my job got to me last year. I quit my job> > and I had a small business going from my home. that didn't work out-> > -I have been approved for Mass health so I can go to a doctor. Has> > anyone had a problem with swelling in their hands? My hands swell> > and my joints in my hands and wrist hurt--it would seem like I have> > carpel tunnel but this seems a little different. Every joint hurts> > in my body. Even my neck. I have always been a very active person--> > always worked and even worked overtime even through treatments. now> > I can barely get through my day--I get extremely tired. I had> > stopped reading about hep c after my doctor did my last test to> > check on my viral load. That was last year and It had

started to> > creep back up. They said that they didn't want to depress me so> > they didn't want to do any more test to check my viral load as there> > really isn't anything that they can do for me. I am going to go to> > a doctor when I get my helath card in the mail as I am feeling> > pretty poorly and I need some relief from the pain that I am> > feeling. All the advil, naprosen and aleve don't really do much for> > it. I keep getting fluid in my ear--what a mess LOL. thanks so> > much for listening I don't have anyone that I talk to about any of> > this and I appreciate any suggestions that I can get.> > ine> > Thanks for listening--> >> >> >> >> >> >> >> >> > ---------------------------------> > Talk is cheap. Use Messenger to make

PC-to-Phone calls. Great> rates starting at 1¢/min.> >>>>>>> Jackie>Jackie Jackie Jackie

[Guest guest]

I know and I personally think that everyone with Hep C should have access to disability,, especially when they have serious symptoms.. and NOT have to have cirrhosis as a requirement to getting it... elizabethnv1 <elizabethnv1@...> wrote: I am glad that you were finally approved , something should have been done years ago to change social security laws . Re: Re: hello, I am a new member a DONT count your chickens before they hatch honey,, Hep C is NOT a recognized reason for disability unless you have cirrhosis of the liver. The Government considers it an "unsymtomatic" disease... I KNOW MORE people who have waited 2 or MORE years to get it and some finally just gave up trying to get it. Thats NOT to say that you wont have an easy time getting it,, but you have to be prepared for a long fight. Depression is one that they recognize for disability, unfortunately hep c is not unless you have cirrhosis.. what stage of damage do you have? I was stage 3-4 with early cirrhosis and had to go to the administrative Law judge to get it and then they only gave me 18 months and had to re-evaluate it and they gave me all sorts of grief and tried to take it away at 18 months, but I hired an attorney and he helped me to stop them from taking it away.. Liz is the exception to the rule,, lucky liz, but most have to fight for a long

time to get it... jax moderatora <vesta3553 > wrote: Thanx, I was alittle worried there--I don't know what I would do if Ihad to wait years---I can't live on charity forever that isn't me. Ihave worked most of my life and always took care of myself--at leastwith the ssi- I paid into it so I know what i will be getting will bemine. Thanks again> > Hello,> > My name is ine, I have had hep c for over 25 years (maybe more)> > due to drug use when I was young and foolish. I am a non repsonder> > to treatment and have been on treatment twice in the last 6 years.> > The stress of that and my job got to me last year. I quit my job> > and I had a small business going from my home. that didn't work out-> > -I have been approved for Mass health so I can go to a doctor. Has> > anyone had a problem with swelling in their hands? My hands swell> > and my joints in my hands and wrist hurt--it would seem like I have> > carpel tunnel but this seems a little different. Every joint hurts> > in my body. Even my neck. I have always been a very active person--> > always

worked and even worked overtime even through treatments. now> > I can barely get through my day--I get extremely tired. I had> > stopped reading about hep c after my doctor did my last test to> > check on my viral load. That was last year and It had started to> > creep back up. They said that they didn't want to depress me so> > they didn't want to do any more test to check my viral load as there> > really isn't anything that they can do for me. I am going to go to> > a doctor when I get my helath card in the mail as I am feeling> > pretty poorly and I need some relief from the pain that I am> > feeling. All the advil, naprosen and aleve don't really do much for> > it. I keep getting fluid in my ear--what a mess LOL. thanks so> > much for listening I don't have anyone that I talk to about any of> > this and I appreciate any suggestions that I can

get.> > ine> > Thanks for listening--> >> >> >> >> >> >> >> >> > ---------------------------------> > Talk is cheap. Use Messenger to make PC-to-Phone calls. Great> rates starting at 1¢/min.> >>>>>>> Jackie>Jackie Jackie Jackie Jackie

[Guest guest]

WOW Liz,, In all the time we have spoken, I havent heard you mention anything at all about your daughter and all of that,, wow,,, well Im glad she is fine now and you handled everything just perfectly... Im so glad you are my friend Liz,, I love you so much! Yes, most ppl are ashamed to say that they are depressed,, and you are right, depressed persons get disability much easier than those like me who tried to get it for the hep c and the damage that treatment did to me... just awful if you ask me! love ya meelizabethnv1 <elizabethnv1@...> wrote: The one thing that we hep c patients tend to forget or are ashamed to say they suffer from depression when they apply for the ssd/ ssi . And what's even crazier is that a depressed person can get approved automaticly , while someone who is real sick with liver disease has to really fight to get it .My disabled daughter was born weighing only 1 lb 4 oz and in need of extreme medical care , her first 10days alone in the NICU cost over 2million . I am happy to say that by age 9 she was totally normal , she is 14 now and just started high school . Re: Re: hello, I am a new member Hi a You should apply for SSDI since you are disabled,, and it will be a long hard fight to get it but do NOT give up.. Get a good doc who can substantiate your claim and just expect that they will turn you down at least twice and it will take you around 2 years to get it,, and you may have to go before to judge to get it as I did. Dont give up tho, you paid into your ss and its there for you to use when you need it and it sounds like you need it now... jaxa <vesta3553 > wrote: Thanks Sharon for sharing the info with me. I use to take

magnesiummaleate a few years ago. I do have some form of arthritis but I haven'tbeen to a doctor in almost a year--I had changed doctors when I hadmoved and miss my old doctor. I haven't had health insurance for awhile. Do you have fluid in your hands and feet? I have it and alot ofpain in my hands-all I have to do is get up and start moving around,pick up even something small and it all starts-my knuckles swell up withfluid and my fingers get tight and sore-sometimes my hands hurt so muchthat they wake me up in the middle of the night. I have tried milkthistle and different things.I did treatments twice--with the first the doctor told me to stop after3 months because my viral load had started to go down and then reversed.a few years later when my vital load was just under 2 mil and I wasfeeling bad I started again but only 1 shot a week and 4 pills a day--itwas slow going but I got down to 700 after 10 months and

then it went upto 1300 before I had even ended treatment. That was 2 years ago--lastdecember I was at 125,00.. I am not feeling well at all and can't work. I need to get some kind of assistance so after I go to the doctor I willapply for something. I am 53 years old and have had this for a verylong time-since the middle 70sSharon, are you in remission now? How are you doing? And thank you somuch for answering me.a> Hello,> My name is ine, I have had hep c for over 25 years (maybe more)> due to drug use when I was young and foolish. I am a non repsonder> to treatment and have been on treatment twice in the last 6 years.> The stress of that and my job got to me last

year. I quit my job> and I had a small business going from my home. that didn't work out-> -I have been approved for Mass health so I can go to a doctor. Has> anyone had a problem with swelling in their hands? My hands swell> and my joints in my hands and wrist hurt--it would seem like I have> carpel tunnel but this seems a little different. Every joint hurts> in my body. Even my neck. I have always been a very active person--> always worked and even worked overtime even through treatments. now> I can barely get through my day--I get extremely tired. I had> stopped reading about hep c after my doctor did my last test to> check on my viral load. That was last year and It had started to> creep back up. They said that they didn't want to depress me so> they didn't want to do any more test to check my viral load as there> really isn't anything that they can do for me. I am going to go

to> a doctor when I get my helath card in the mail as I am feeling> pretty poorly and I need some relief from the pain that I am> feeling. All the advil, naprosen and aleve don't really do much for> it. I keep getting fluid in my ear--what a mess LOL. thanks so> much for listening I don't have anyone that I talk to about any of> this and I appreciate any suggestions that I can get.> ine> Thanks for listening-->>>>>>>>> ---------------------------------> Talk is cheap. Use Messenger to make PC-to-Phone calls. Greatrates starting at 1¢/min.>Jackie Jackie Jackie Jackie

[Guest guest]

you are right,, true friends are hard to come by,, i luv ya!elizabethnv1 <elizabethnv1@...> wrote: My youngest wasn't the only preemie I had , the daughter before her only weighed 3lb's . It's easy to forget that time in my life now since it has been so long ago ,lol And I am just as happy being your friend , I count myself truly blessed to have you and as friends . Now days friends are hard to come by ... Re: Re: hello, I am a new member Hi a You should apply for SSDI since you are disabled,, and it will be a long hard fight to get it but do NOT give up.. Get a good doc who can substantiate your claim and just expect that they will turn you down at least twice and it will take you around 2 years to get it,, and you may have to go before to

judge to get it as I did. Dont give up tho, you paid into your ss and its there for you to use when you need it and it sounds like you need it now... jaxa <vesta3553 > wrote: Thanks Sharon for sharing the info with me. I use to take magnesiummaleate a few years ago. I do have some form of arthritis but I haven'tbeen to a doctor in almost a year--I had changed doctors when I hadmoved and miss my old doctor. I haven't had health insurance for awhile. Do you have fluid in your hands and feet? I have it and alot ofpain in my hands-all I have to do is get up and start moving around,pick up even something small and it all starts-my knuckles swell up withfluid and my fingers get tight and sore-sometimes my hands hurt so muchthat they wake me up in the middle of the

night. I have tried milkthistle and different things.I did treatments twice--with the first the doctor told me to stop after3 months because my viral load had started to go down and then reversed.a few years later when my vital load was just under 2 mil and I wasfeeling bad I started again but only 1 shot a week and 4 pills a day--itwas slow going but I got down to 700 after 10 months and then it went upto 1300 before I had even ended treatment. That was 2 years ago--lastdecember I was at 125,00.. I am not feeling well at all and can't work. I need to get some kind of assistance so after I go to the doctor I willapply for something. I am 53 years old and have had this for a verylong time-since the middle 70sSharon, are you in remission now? How are you doing? And thank you somuch for answering me.a> Hello,> My name is ine, I have had hep c for over 25 years (maybe more)> due to drug use when I was young and foolish. I am a non repsonder> to treatment and have been on treatment twice in the last 6 years.> The stress of that and my job got to me last year. I quit my job> and I had a small business going from my home. that didn't work out-> -I have been approved for Mass health so I can go to a doctor. Has> anyone had a problem with swelling in their hands? My hands swell> and my joints in my hands and wrist hurt--it would seem like I have> carpel tunnel but this seems a little different. Every joint hurts> in my body. Even my neck. I have always been a very active

person--> always worked and even worked overtime even through treatments. now> I can barely get through my day--I get extremely tired. I had> stopped reading about hep c after my doctor did my last test to> check on my viral load. That was last year and It had started to> creep back up. They said that they didn't want to depress me so> they didn't want to do any more test to check my viral load as there> really isn't anything that they can do for me. I am going to go to> a doctor when I get my helath card in the mail as I am feeling> pretty poorly and I need some relief from the pain that I am> feeling. All the advil, naprosen and aleve don't really do much for> it. I keep getting fluid in my ear--what a mess LOL. thanks so> much for listening I don't have anyone that I talk to about any of> this and I appreciate any suggestions that I can get.> ine> Thanks for

listening-->>>>>>>>> ---------------------------------> Talk is cheap. Use Messenger to make PC-to-Phone calls. Greatrates starting at 1¢/min.>Jackie Jackie Jackie Jackie Jackie

[Guest guest]

HI, The water is callled "Smart Water" as opposed to "dumb water" :-)

Looking for a deal? Find great prices on flights and hotels with FareChase.

[Guest guest]

LOL

Re:To Liz,, ot

HI, The water is callled "Smart Water" as opposed to "dumb water" :-)

Looking for a deal? Find great prices on flights and hotels with FareChase.

[Guest guest]

Hahaha true

Re: What is Primary Biliary Cirrhosis (PBC)?

VERY SCARY stuff Liz,, I was SOOO scared when I as asked to be tested for this after the biospy when I had my gallbladder removed,, and I was SOOOOO relieved when the test was negative...elizabethnv1 <elizabethnv1earthlink (DOT) net> wrote:

What is Primary Biliary Cirrhosis (PBC)?By J. Worman, M. D.Primary biliary cirrhosis (PBC) is a disease characterized by inflammatory destruction of the small bile ducts within the liver. PBC eventually leads to cirrhosis of the liver. The cause of PBC is unknown, but because of the presence of autoantibodies, it is generally thought to be an autoimmune disease. Other etiologies, such as infectious agents, have not been completely excluded. PBC has a worldwide prevalence of approximately 5/100,000 and an annual incidence of approximately 6/1,000,000. The prevalence and incidence appear to be similar in different regions of the world. About 90% of patients with PBC are women. Most commonly, the disease is diagnosed in patients between the ages of 40 and 60 years. Most patients with PBC present with pruritus (itching). After pruritus, jaundice (yellow skin caused by bilirubin retention) is the most common presenting symptom. Several patients also present with complaints related to chronic portal hypertension (increased blood pressure in the veins that go to the liver that can lead to symptoms such as bleeding in the esophagus or fluid retention in the abdomen). Some patients are discovered to have PBC during workup of another illness. Since the widespread use of routine serum biochemical analysis, many patients present for evaluation of an elevated serum alkaline phosphatase activity that was detected on laboratory examination. Patients with PBC have abnormalities in several blood tests. In essentially all patients, the serum alkaline phosphatase and gamma-glutamyltranspeptidase activities are markedly elevated (these are enzymes present in the bile ducts). Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activities are usually moderately elevated (these are enzymes made by hepatocytes, the predominant liver cell type). The serum bilirubin concentration is normal early in the disease and raises as the disease progresses (which causes jaundice or yellow skin). Most patients have an elevated serum cholesterol concentration which is largely contained in an abnormal lipoprotein, termed lipoprotein X, which is produced in patients with bile duct obstruction. The total gamma-globulin concentration is usually normal until late in the disease when cirrhosis develops. Almost all patients with PBC have an elevated serum IgM concentration (a type of antibody). The prothrombin time (a measure of blood clotting) and serum albumin concentration (the major protein in blood that is made in the liver) are normal until cirrhosis develops later in the course of disease. Serum autoantibodies are of primary importance in the diagnosis of PBC. Antibodies against mitochondria are characteristic of PBC and found in about 90% of patients. About 50% of patients with PBC also have antinuclear antibodies. Antibodies against mitochondrial and nuclear proteins are found in several diseases besides PBC, but the cDNA cloning of several mitochondrial proteins has shown that antibodies against specific antigens are virtually diagnostic of PBC. The same has been shown to be true for antibodies against nuclear proteins in about 25% of patients. Because of the presence of specific autoantibodies, PBC is thought to be an autoimmune disease. Several laboratories around the world are actively involved in determining how the immune response relates to the bile ducts destruction characteristic of the disease. In addition to clinical and laboratory abnormalities and the presence of specific autoantibodies, histological examination (looking at tissue under the microscope) of liver tissue is of central importance in the diagnosis of PBC. Tissue for this purpose is obtained by liver biopsy which is generally an outpatient procedure. Histologically, PBC is classified into four stages. Stage I is referred to as the florid duct lesion or nonsuppurative destructive cholangitis and is characterized by mononuclear inflammatory cells surrounding a small bile duct. In stage II, there is proliferation of small bile ductules. Stage III is characterized by fibrosis or scarring. Stage IV is cirrhosis. These histological stages demonstrate the progression of the disease from destruction of the intrahepatic bile duct to fibrosis and cirrhosis. Histological features of more than one stage can be seen on one liver biopsy. Because of sampling differences, the stages can also vary in liver biopsies done at different times on the same patient. In general, however, there is a gradual progression over years from the histological features of stage I to stage IV. The diagnosis of PBC must be based on a combination of historical, laboratory, serological and histological criteria. In general, patients are middle aged women who present with pruritus early and jaundice late. Patients that present late in the course of disease may also have signs and symptoms of cirrhosis and hepatic failure. Many patients are referred for evaluation of an isolated elevated serum alkaline phosphatase activity on laboratory testing for other purposes. Essentially all patients have elevated serum alkaline phosphatase and gamma-glutamyltranspeptidase activities. The serum IgM concentration is almost always elevated. About 90% of patients have autoantibodies against specific mitochondrial proteins (the E2 subunits of the oxo-acid dehydrogenase complexes). Approximately 50% of patients have antinuclear antibodies, sometimes against very specific proteins (nuclear pore membrane protein gp210, transcriptional activator Sp100, inner nuclear membrane protein LBR). The absence of an elevated serum IgM concentration and/or specific autoantibodies should place the diagnosis of PBC in doubt. Patients with PBC must have a consistent liver biopsy. The histological findings alone are frequently not diagnostic as the florid duct lesion is often not seen and other features, such as ductular proliferation, fibrosis and biliary cirrhosis, can be seen in other liver diseases. PBC is a progressive disease that leads to cirrhosis and liver failure. The time from diagnosis to end-stage liver disease can range from a few months to 20 years depending upon when the diagnosis is first made. Several mathematical models based on clinical, laboratory and histological criteria have been devised to predict disease progression. In general, the development of portal hypertension indicates a poor prognosis. The serum bilirubin concentration is the best prognostic indicator of all laboratory values. Once the serum bilirubin concentration reaches 6 mg/dl, the average life expectancy is about 2 years. At this time, patients should be evaluated for possible liver transplantation. Despite extensive studies, medical therapy has not been shown to have a significant impact in slowing the progression of PBC. Patients with PBC should take vitamins and calcium to help prevent osteoporosis (loss of bone), a common complication of this disease. Colchicine may play a role in inhibiting liver fibrosis and improves laboratory values but not signs or symptoms. D-penicillamine has been studied in several series but the results have shown it to be ineffective and possibly toxic. Various immunosuppressive agents have been studied in patients with PBC. Corticosteroids are probably not effective and may aggravate the osteoporosis commonly present in patients with PBC. Azathioprine (Imuran), methotrexate and cyclosporin A have been examined in several studies and are still being investigated, but these agents will not likely produce radical improvements in clinical course. Ursodiol (Actigall or Urso), a bile acid, has been shown to improve the laboratory and clinical parameters in patients with PBC and the results of one study suggest that it may slow the progression of the disease. Orthotopic liver transplantation is highly successful in patients with end-stage liver disease resulting from PBC. Jackie

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