First exam after finished my treatment

[Moses]

Hello Guys/girls!

My name is Moises, and I did my 54 weeks Hep C treatment in Portugal 10 years ago, and believe its now my first attempt to take a look how my things inside me are. A month ago a went to a doctor and ask about some blood screen, and also about Hep C, Ok I got lots exams but my Hep C is not Clear, I think she dont know exactly what to find on people who already did the treatment, looks like she just make a test if I have or no virus.
My WBC come with 2.5 and you know it should be between 4.0-10.5, but she (the doctor) keep wanting to wait to see if it is my ''normal'' and I dont want to wait so long, I want to go to some doctor who understand about Hepc C and not just a ''first time doctor''. What you suggest me?? I am living in Jefferson City, what kinda exam I need to ask to doctor?? I asked to the clinic to send me to some Gastroenterologist to show all my blood tests I have, and Im not feeling good lats days. Well I gonna stop texting for now until see some feedback. God Bless you my friends!!

[Lynn K]

If she tested you for hepatitis c antibodies, because you were once infected you will probably always test positive for the rest of your life. People who were once infected should not be tested for antibodies to the virus as we know what the result will be.

The test you need to have is the HCV RNA by PCR test which looks for the hep virus itself. If that test comes back not detected with no viral load you are cured of hep c.

Did you have a liver panel to check for your liver enzymes? If those are elevated it could indicate possible hep c infection as most people with hep c have slightly elevated liver enzyme levels although not all and elevated liver enzymes can be caused by different things.

[Lynn K]

Mayo Clinic causes of low WBC

http://www.mayoclinic.org/symptoms/low-white-blood-cell-count/basics/causes/sym-20050615

Aplastic anemia
Chemotherapy
Radiation therapy
HIV/AIDS
Hypersplenism — a premature destruction of blood cells by the spleen
Tuberculosis (and other infectious diseases)
Kostmann's syndrome — a congenital disorder involving low production of neutrophils
Leukemia
Lupus
Rheumatoid arthritis and other autoimmune disorders
Malnutrition and vitamin deficiencies
Myelodysplastic syndromes
Myelokathexis — a congenital disorder involving failure of neutrophils to enter the bloodstream

[Lynn K]

Also from the Mayo Clinic

https://newsnetwork.mayoclinic.org/discussion/low-white-blood-cell-count-not-always-a-sign-of-medical-problem/

Low White Blood Cell Count Not Always a Sign of Medical Problem

February 4, 2011

Dear Mayo Clinic:

I was told after my recent physical that my white blood cell count was low. Is this something to be concerned about? Am I more susceptible to catch colds or viruses?

Answer:
A low white blood cell count can sometimes be a sign of an underlying medical problem, but not always. First, it's important to determine what your health care provider means by "low." Not all medical laboratories use the same range to decide what's normal and what's not. Second, you need to consider factors such as your age, gender and ethnic group. Some groups of people just have naturally lower white blood cell levels than others. If your white blood cell count is truly lower than it should be, then further investigation is warranted to uncover the root cause.

[Moses]

Thanks brother for you replay

This is what I have FROM Hep C
Component - Hep C Antibody by CIA Interpretation
Your Value - High Pos
Standard Range - Negative

Component - HCV Ab Index Interp
Your Value - >11.00 IV
Standard Range - IV

This is some blood tests results:
IRON + TRANSFERRIN PANEL - Details
Component      Your Value   Standard Range
Iron          96 ug/dL    65 - 175 ug/dL
Transferrin       221 mg/dL    174 - 364 mg/dL
TIBC Calculated    276 mg/dL    mg/dL
Iron Saturation %    35 %       20 - 55 %

FOLATE - Details
Component      Your Value   Standard Range
Folate          10.1 ng/mL    3.1 - 20.5 ng/mL

VITAMIN B12 - Details
Component      Your Value   Standard Range
Vitamin B12       237 pg/mL    213 - 816 pg/mL

CBC W/O DIFFERENTIAL - Details
Component      Your Value   Standard Range
WBC          2.5 x10E9/L    4.0 - 10.5 x10E9/L - Low
RBC          4.16 x10E12/L    4.70 - 6.00 x10E12/L
Hgb          13.8 gm/dL    13.5 - 18.0 gm/dL
HCT          39.1 %       42.0 - 52.0 %
MCV          94.0 fl    78.0 - 100.0 fl
MCH          33.2 pg    27.0 - 31.0 pg
MCHC          35.3 gm/dL    32.0 - 36.0 gm/dL
RDW          14.1 %       11.5 - 14.0 %  -  HIGH (15.7 from another lab)
Plt Ct          89 x10E9/L    150 - 450 x10E9/L
MPV          11.0 fl    6.0 - 9.5 fl

SH - Details
Component   Your Value   Standard Range
TSH       2.08 uIU/mL    0.35 - 4.94 uIU/mL

LIPID PROFILE - Details
Component      Your Value   Standard Range
Cholesterol       171 mg/dL    <200 mg/dL
Triglycerides       80 mg/dL    <150 mg/dL
VLDL Calc       16 mg/dL    <31 mg/dL
HDL Chol       28 mg/dL    >40 mg/dL  - low
LDL Calc       127 mg/dL    <160 mg/dL - High (0-99)

COMPREHENSIVE METABOLIC PANEL - Details
Component      Your Value      Standard Range
Sodium               139 mmol/L       136 - 145 mmol/L
Potassium       4.1 mmol/L       3.5 - 5.1 mmol/L
Chloride       107 mmol/L       98 - 107 mmol/L
CO2          23 mmol/L       22 - 29 mmol/L
Anion Gap       9 mmol/L       9 - 16 mmol/L
Glucose       123 mg/dL       70 - 105 mg/dL   - high
BUN          16 mg/dL       8.4 - 25.7 mg/dL
Creatinine       0.95 mg/dL       0.72 - 1.25 mg/dL
BUN/Creat       16.8            11.7 - 20.6
Calcium       9.0 mg/dL       8.4 - 10.2 mg/dL
Protein Total       7.3 gm/dL       6.4 - 8.3 gm/dL
Albumin       4.3 gm/dL       3.5 - 5.0 gm/dL
ALT/SGPT       52 U/L          0 - 55 U/L
AST/SGOT       34 U/L          5 - 34 U/L
Alk Phos       101 U/L       40 - 150 U/L
Bili Total       0.8 mg/dL       0.2 - 1.2 mg/dL
Globulin Total       3.0 gm/dL       1.3 - 4.7 gm/dL
Alb/Glob Ratio       1.4            1.1 - 2.2
Osmolality Calc    271 mOsm/kg       260 - 286 mOsm/kg
eGFR MDRD       >60 mL/min/1.73m2    >60 mL/min/1.73m2
eGFR MDRD AFR AMR    >60 mL/min/1.73m2    >60 mL/min/1.73m2

[Lynn K]

The first 2 tests are antibody tests as it would be expected you are positive for hep c antibodies this test is of no value for someone who was ever infected with hep c. This is the expected result.

The only test you should have to determine current infection is the HCV RNA test. There is no reason to have an antibody test.

Your AST and ALT as well as your bilirubin are all normal these tests are related to liver.

Unless you were fasting your glucose test is meaningless.

[St4rgazer4]

Let us know the result of your HCV RNA test if you do decide to get one. Godspeed

[Moses]

thanks for comment my friend St4rgazer4

On the next week I'm going back to my primary doctor, I intend to ask hare to send me to some Stomatologist cause I need take a look and my liver, pancreas and gallbladder things,  I'm not feeling so good on this days. And I'm gonna ask her to repeat my Hepatitis exam that time with HCV RNA by PCR and not just antibody like last one, she told me to back in 3 months but I can not wait that much. I will post here as son I have some results my brothers!!!

[Lynn K]

So when you say stomatologist do you mean a gastroenterologist?

A gastroenterologist is a specialist in all things gut related. Or maybe a hepatologist a liver specialist who would also know about the gall bladder and probably the pancreas.

[Moses]

Yes you right, I wanted to say ''gastroenterologist'', and I'd like to see what happens with everything inside me, and now to complete my disgrace I just noticed I'm a diabetic grrrr...7.5 with 140 glucose. Changed completely my life stile, walking 2 hours every sing day and trying to lost some weigh. I;m completely scare with my exams on 5 November, I think something very bad happening, every morning I woke up with some pain on my bally, and sometime headache, going to ask to doctor  check everything inside me.. Thanks for you support about my questions..

[Moses]

Sorry I dont know if I open a new subject or keep posting on this one...

I got some news, but I need met with doctor to know more about, but for now he told me my liver is OK, a little bit fat but the worst part he want to take my Gallbladder out, there someone here already take Gallbladder out?? should I did it?? its not bother me so much, but looks like the doctor are making me some pressure..and I really don't want cut my Gallbladder.

[Lynn K]

I had my gall bladder removed about 9 years ago. I was disgnosed with gall blather stones about a year before. I was fine at first but about 6 months after they said I had galls stones I started having painful (basically doubling over with pain) attacks. So they decided to remove my gall bladder. Since then no attacks and feel fine. Surgery is a day surgery they often only have to make a small incision and use a scope so not a big deal. You can sleep in your own bed afterwards. I had had surgery on a broken ankle twice before that and 5 liver biopsies so having surgery was not as scary for me by then but if you never have had any 9type of procedure I can understand it could be a very scary thing.

Ask your doctor more questions about the gall bladder surgery. Will it just be a small incision? Why are they recommending you have this surgery?

One thing I know from personal experience gall bladder attacks are something you don’t want to experience. It is a not uncommon surgery to have.

Did you get your hep c HCV RNA test results yet? Do you know your genotype and viral load? Are they going to prescribe treatment for hep c to cure you of the virus?

Was that a fasting glucose test? Had you eaten anything before the test? The glucose test does not mean anything if you have eaten anything for I think at least 8 hours before having blood drawn.

Good luck

[Moses]

Hy Brother, thanks for your answer..


Why are they recommending you have this surgery?
R) I dont know yet, gonna see the doctor, but he wants to see me to make appointment to surgery, I gonna wait a little bit, if have some pain for now its all ok with me..I heard about if you stones is big you can live with that but if is smal is better to cut it off..

Did you get your hep c HCV RNA test results yet?
R) no yet, have doctor on December 24, but he told me on phone its OK, my liver is just a little fat..

Do you know your genotype and viral load?
R) Well I think my genotype was b1, its spent 10 years i did my treatment..

Are they going to prescribe treatment for hep c to cure you of the virus?
R) I  did my treatment about 10 years ago with interferon for 54 weeks (arg!!) im negative now..

Was that a fasting glucose test? Had you eaten anything before the test? The glucose test does not mean anything if you have eaten anything for I think at least 8 hours before having blood drawn.
R) when I did my glucose test was fasting, and my 140 sugar I think is because I was eating so many honey and Karo all morning with bread, now I have about 98 average, max I got was 114 I toke after eating all day. I'm eliminating sugar as possible, eating dark bread, but some time some chocolate and still good..and I start to walk and hiking..

[Lynn K]

I had a friend who had no idea he had gall stones. He ended up having emergency surgery to have them removed so sometimes a gall bladder attack can be quite serious.

Ok so you don’t have hep c and were cured years ago with interferon congrats! Your genotype probably was 1b (not b1) which was more likely to be successfully treated with interferon than the most common type that I had 1a. Interferon only worked for about 30% of people with 1a. So yes it is very likely you will test negative for hep c and are not infected.

“when I did my glucose test was fasting, and my 140 sugar I think is because I was eating so many honey and Karo all morning with bread”

I think you are talking about two different tests and that the one where the result was 140 you were not fasting and had earen before taking that test. If that is the case eating anything before having a blood sugar test would throw off the result whether honey and bread or simply a glass of orange juice. So the 140 result means nothing only a fasting test has interpretive value.

For fatty liver your doctor has probably told you that if you are overweight the best thing you can do is lose some weight through diet and exercise. If you lose weight you can also help get fat out of your liver. Having excess fat in your liver irritates your liver and can sometimes cause an increase in liver enzyme tests.your walking and hiking is just perfect.

While we all tend to eat too much sugar having a rise in gloucose levels after eating is totally normal so a little sugar in moderation should be fine but you should discuss any diet choices with your doctor if you need to restrict sugar or any other diet choices you need to make.

So congrats again on not needing treatment for hep c as you were cured 10 years ago with interferon. If your doctor wants to take out your gall bladder I would consider doing it. Good job with the exercise. Keep it up

[Moses]

Thanks for correcting some mistake..about genotype..b is right
And after my record for glucose was high i had a specific test to check diabetes and its come with 7.5, now my sugar are under control, my average is 98

Today  I had appointment with a doctor to talk about my gall bladder, he consider my surgery a little risky for now, for some reason my White blood cell are so low, even my Alt and Ast value are very normal, they don't know what is the cause, I had another appointment with a doctor specialist in blood to take a look on it, they think any surgery now can be bad, I gonna bleed so much and maybe take so long t  regenerate, and because my gall bladder is not with any infection..they decide to wait than we back to talk about any surgery, and on December 22 I gonna see my doctor who is taking care about my hepatitis thing, he gonna ask me to some endoscopy to see if I have Esophageal varices and maybe gonna ask to some biopsy..all I know now my liver is a little fatty.

[Lynn K]

Genotype 1b right? It could also be 2b or 3b and so on. I think there are a total of 24 different genotypes and quasispecies of hep c. It doesn’t really matter what genotype you had in the past because you are not infected for many years now.

The cause of any changes in liver enzymes is not related to hep c it could be from fatty liver or many other causes. Also liver enzymes can change a lot in a short time it just depends on what is cousing the elevations. But hey normal range is a good thing so that is great news.

A lot of things can cause low white cell counts so your doctor will need to do testing to find the reason. Here is some info about possible causes of low white blood cells.

https://www.mayoclinic.org/symptoms/low-white-blood-cell-count/basics/causes/sym-20050615

Why are you at risk of bleeding do you know? I just looked at your test results again and noticed you have a low platelet count. Have you discussed your this with your doctor? This would be why you have an increased risk of bleeding. You should ask your doctor but you likely need to avoid pain meds like aleve and aspirin as they can increase your risk of bleeding. My doctor says I should only take Tylenol for pain as I also have a low platelet count. My low platelet count is caused by my liver cirrhosis that causes the spleen to enlarge and sequester platelets as well as white blood cells.

You said you are seeing a doctor about your “Hepatitis thing”. I thought you had said you cured your hep c with interferon years ago so I am a little confused. If you were cured you don’t have a Hepatitis thing. Did you become reinfected? Did you have a HCV RNA test done? What was the result of that test?

Why are they checking you for esophageal varicies? Varicies can be a complication of liver cirrhosis. Does your doctor think you have cirrhosis? I must be missing something.

Anyway good luck with your upcoming tests if they are trying to figure what is going on with your health it probably is a good idea to hold off on the gall bladder surgery for now.

[Moses]

''You said you are seeing a doctor about your “Hepatitis thing”. I thought you had said you cured your hep c with interferon years ago so I am a little confused. If you were cured you don’t have a Hepatitis thing. Did you become reinfected? Did you have a HCV RNA test done? What was the result of that test?''

''Why are they checking you for esophageal varicies? Varicies can be a complication of liver cirrhosis. Does your doctor think you have cirrhosis? I must be missing something.''

Yes I said about ''Hepatitis thing'' because I did talk to the doctor who are checking my status about Hep, he ask me to do some exams now I need back to see if i need some biopsy.  I start to hate that medical system,  why they don't do all things the same time?? yesterday I paid 45 dollars just to heard the another doctor telling me he are not gonna do my surgery for now, and that I need a doctor to see my blood.
 ''''Why are they checking you for esophageal varicies?'' Doctor said, its part of all things he need to check, and yes I have some cirrhosis, even when I start my Hep C treatment I knew I have some..But they are confuse because nothing on my blood show any kind infection or cancer..but my white blood cell is very low..Next year I'm going to do COLONOSCOPY and endoscopy the same day. And about ''HCV RNA'' I now nothing yet, on my online results did show it, but on December 22 I will ask him, why I dot have it on my records.

This is my last records..

   

Glomerular Filtration Rate,Cal*   92 ML/MIN/1.73 M2   >60
RBC MORPHOLOGY*                Normal
PLATELET SLIDE REVIEW*             Normal
Monocyte %*       2 %      Normal Range 0 to 13
Creatinine*      0.9 mg/dL   Normal Range 0.6 to 1.3
BUN*            19 mg/dL      Normal Range 7 to 25
Total CO2*         23 mEq/L      Normal Range 21 to 31
Potassium*      3.9 mEq/L      Normal Range 3.5 to 5.1
Sodium*         139 mEq/L      Normal Range 136 to 145
Prothrombin Time*   13.4 Sec      Normal Range 10.6 to 13.4
Calcium*         9.1 mg/dL      Normal Range 8.8 to 10.6
Monocyte %*         2 %         Normal Range 0 to 13
MCH*            32.7 pg      Normal Range 27.0 to 33.0
MCHC*            35.3 g/dL      Normal Range 32.0 to 36.0
Monocytes %*         3.6 %      Normal Range 0.0 to 13.0
Eosinophil %*         0.4 %      Normal Range 0.0 to 6.0
Basophil %*         0.0 %      Normal Range 0.0 to 1.0
Lymphocyte #*         1.65 10^3/uL   Normal Range 0.72 to 4.21
Monocyte #*         0.09 10^3/uL   Normal Range 0.00 to 1.40
Eosinophil#*         0.0 10^3/uL   Normal Range 0.0 to 0.5
Basophil #*         0.0 10^3/uL   Normal Range 0.0 to 0.1
Immature Granulocytes %*   0.0 %      Normal Range 0.0 to 1.0
Immature Granulocyes #*      0.00 10^3/uL      Normal Range 0.00 to 0.10
RDW-SD*            48.10 fL      Normal Range 35.00 to 55.00
RDW-CV*            14.70 %      Normal Range 11.00 to 15.00
MPV*            10.5 fL         Normal Range 9.4 to 12.4
SGPT/ALT*         24 u/L         Normal Range 7 to 52
SGOT/AST*         23 u/L      Normal Range 13 to 39
Alkaline Phosphatase*      78 u/L   Normal Range 34 to 104
Total Bilirubin*      0.6 mg/dL      Normal Range 0.0 to 1.0
Albumin/Globulin Ratio*      1.8   
Globulin*         2.6 gm/dL      Normal Range 1.5 to 3.8
ALBUMIN*         4.6 g/dL      Normal Range 3.5 to 5.7
Total Protein*         7.2 g/dL   Normal Range 6.4 to 8.9
Glucose*         90 mg/dL      Normal Range 70 to 105

[Lynn K]

Ok got it you had hep c in the past and were cured but had already developed cirrhosis by that time.

So unless you somehow became infected again you don’t have hep c.

There is not some cirrhosis, either you have cirrhosis or you do not. Cirrhosis is extensive liver scaring sometimes called end stage liver disease.

Since you cured your hep c there is about s 50/50 chance your liver may improve with time. But curing hep c should stop the progression of additional liver damage unless you have other things harming your liver like having a fatty liver or drinking alcohol.

Because you don’t have hep c your liver is not being injured by the virus so your liver enzymes should be normal. Having elevated liver enzymes only means something is bothering your liver now it does not relate to extent of damage.

I have had cirrhosis for 10 years 7 before I was cured. My liver enzyme tests have been normal since I was cured but my plateletts are still well below normal at 110 but higher than they were before treatment at 90.

I had an upper endoscopy the first year I was diagnosed with cirrhosis which was repeated two years later and then again the next year because I was beginning to have worsening esophageal varicies. I ended up having to have my varicies banded which was 4 upper endoscopies one per month the get rid of them all. That was 2012.

I see my hepatologist who works with a liver transplant center every year and have blood testing for Liver enzymes, CBC and AFP along with an abdominal ultrasound every 6 months to monitorfor the possibility of liver cancer to catch it as soon as possible. I was having annual upper endoscopies to monitor for a return of varicies but my doctor said we can do that less often now since I have been free of varicies for 5years and since I was cured they hopefully won’t develop again.

Liver cirrhosis is a serious medical condition. We need to be monitored carefully probably for the rest of our lives. So your reason to see a hepatologist is not the Hepatitis but your advanced liver disease which is liver cirrhosis.

Until your doctor does testing they don’t know what should be their next move. First they test evaluate the results and then decide what to do. That is just how it goes.

Anyway I hope you are under the care of s hepatologist or at least a gastroenterologist associated with a liver transplant center as they are best able to follow patients like us with advanced liver disease. This is not to say we need a transplant right now but that way they will be familiar with our case and have the training to best treat patient who are very ill as we are.

It is hard to accept because we feel more or less fine but our health is compromised. I hope you have been immunized against Hep A and B as well as having the  pneumonia vaccine normally only given after 60 years old as well as getting your flu shot as early as it becomes available that is what my doctor has me do.

Do you know how long you have had liver cirrhosis? I remember reading when I was first diagnosed that I had about a 50% of being either dead or needing a liver transplant within 10 years of diagnosis so basically I am very lucky to still be alive with few symptoms of my cirrhosis.

Best of luck with your additional testing and your endoscopies.

[Moses]

Sorry, i made a mistake, when I started my Hep C treatment I don't have Cirrhosis, i have Fibrosis...Now the said I have some cirrhosis ( I was drinking like a crazy, now i decide to ban alcohol from my life hope is not to late ) not bad one..as I said I going to see my gastroenterologist doctor on 22 December than I will now all I need, I had Hep A when was kid, and now doc ask me to do Hep B vaccine cause I don't have antibody.

this is just what I have about  hep for now, its come on my last record..

HEPATITIS B CORE AB, TOTAL   NEGATIVE
HEPATITIS B SURFACE AB   NEGATIVE
HEPATITIS B SURFACE AG   NEGATIVE
HEPATITIS A AB, IGM      NEGATIVE

Thank you so so much for you time and patience on me...God Bless you!!

[Lynn K]

Ok thanks I think I have it this time

So since you have cirrhosis you should not drink alcohol. You need to abstain completely.

There is no “some” cirrhosis you either have cirrhosis or you do not.

Cirrhosis is a signifigant medical condition and can become life threatening so not something to play around with.

There are basically two phases of cirrhosis, compensated where you liver is still able to perform its important jobs, and decompensated where the liver can no longer perform its jobs and you are experiencing liver failure. Right now we are considered to be compensated cirrhotics.

As long as you stop hurting your liver (with having a fatty liver or drinking) it should stabilize and not progress further into liver failure. It may improve with time. But the primary concern is we remain at increased risk of liver cancer (HCC or Hepatocellular carcinoma) because we have cirrhosis.

Because of this we will need to be monitored as per our hepatologists recommendations but probably for life.

https://www.niddk.nih.gov/health-information/liver-disease/cirrhosis

“Cirrhosis is the 12th leading cause of death in the United States, accounting for nearly 32,000 deaths each year.”

[Moses]

Thanks so much Lynn you are like a light in the dark to me, I'm scared with all that situation, I just feel like those doctor  gonna spend a year in something they can do in a month, I hope on 22 I have most of my case clarified.