Cirrosis and Stage 4 hep C

New Topic Post Reply Printable Version
[ << Previous Thread | Next Thread >> ]

Butterfly422
Regular Member


Date Joined Jun 2013
Total Posts : 50
   Posted 6/12/2013 11:06 AM (GMT -6)   
ok
 
Is there four stages in both... or when they say stage 4 they mean both? I really understood him to say he is in stage 4 of his hep C... now I am confused about Cirrosis... Can you help me to understand...
 
Thanks

NicechapLondon
Regular Member


Date Joined Dec 2012
Total Posts : 108
   Posted 6/12/2013 11:43 AM (GMT -6)   
Hi Butterfly,

My understanding is that Hep C has four stages:

1. Acute - this bares no relation to the severity of the disease, but rather the 6 months following infection during which the virus takes hold.
2. Chronic - the period after six months, during which the majority of sufferers will have failed to clear the virus spontaneously. This is when the illness is considered a chronic one and it is during this stage that fibrosis will eventually start to occur.
3. Compensated cirrhosis - the point at which the chronic infection has resulted in irreversable damage to the liver. Whilst it is not possible to reverse the fibrotic changes to the hepatic architecture, the liver continues to perform its vital functions without manifesting any of the symptoms of decompensation.
4. Decompensated cirrhosis, or end-stage liver disease. The point at which the virus has caused the cirrhosis to progress to the stage that the signs of decompensation occur - i.e. HE, refactory ascites, HRS, variceal haemorrhage.

NOTE: HRS = Hepatorenal Syndrome

The four stages of cirrhosis (taken from livestrong.com)

STAGE 1
The Merck Manuals Online Medical Libraries indicate that this stage of cirrhosis is characterized by the presence of inflammation, meaning there is swelling, an influx of inflammatory-promoting immune cells and some destruction of liver tissue. Additionally, there may also be the growth of abnormal connective tissue. These two factors, inflammation and abnormal connective tissue, are confined to the portal area of the liver. The portal area is the region surrounding the large hepatic artery, vein and bile duct. This is the area where blood and fluid flow into and out of the liver.

STAGE 2
The second stage of cirrhosis is also characterized by inflammation, but fibrosis is also beginning to occur. The American College of Gastroenterology describes fibrosis as the replacement of normal liver tissue with scar tissue. There are no symptoms at this stage of cirrhosis because the remaining normal liver tissue is able to compensate for the non-functional scar tissue that is starting to form. However, scar tissue can never progress back into normal functioning liver tissue, meaning this transformation is permanent.

STAGE 3
As cirrhosis progresses, the damage to the liver becomes increasingly more severe. In this stage of cirrhosis, the fibrosis forms "bridges," and is called bridging fibrosis. The Merck Manuals describe how these bridges makes abnormal connections between the hepatic artery, vein and other vessels that cause abnormal blood flow and increased blood pressure in the liver. This increased blood pressure, called hepatic hypertension, can cause even more liver damage.

STAGE 4
Stage 4 is the most advanced stage and the growth of scar tissue has progressed to the point that the liver is not functioning normally. Whereas the previous stages are not normally associated with symptoms, advanced-stage cirrhosis has many symptoms. According to the American College of Gastroenterology, these symptoms are: bleeding in the digestive tract; jaundice, which is yellow coloring of the eyes and skin; mental effects such as confusion, unusual sleepiness and slurring of speech; the build-up of fluid in the body, medically termed edema; and intense and unexplained skin itching.

It appears to me that Stage 3 of HepC progression coincides with stage 2 of cirrhosis progression, and Stage 4 appears both in terms of HepC and Cirrhosis to be ESLD - ie. at Stage 4 they are essentially one and the same.

Post Edited By Moderator (hep93) : 6/12/2013 11:27:46 AM (GMT-6)


Butterfly422
Regular Member


Date Joined Jun 2013
Total Posts : 50
   Posted 6/12/2013 11:47 AM (GMT -6)   
The reason why i needed clarity is because he is definately ESLD.. but gosh after reading so much of what is happening here my husband doesnt seem like he is that sick...

I hate to imagine it getting worse than this. Since taking the lactulose he is up and working in yard with me again. Its like my hubby is back. I maybe thought I could be confused but i see i am not.

hep93
Elite Member


Date Joined Jul 2005
Total Posts : 12014
   Posted 6/12/2013 12:29 PM (GMT -6)   
Thanks for that info, NLC. I cleaned up the spacing a bit and added a definition. I am going to copy this over to the Hepatitis Resources folder, as we often have people asking about this.

Hugs,
Connie
hep93
Forum moderator - Hepatitis


"But that was yesterday, and I was a different person then."

Lewis Carroll, Alice in Wonderland

Liver transplant recipient, Oct. 27, 2011, at Mayo Hospital, Jacksonville, FL

AIHer
Regular Member


Date Joined May 2012
Total Posts : 162
   Posted 6/12/2013 1:27 PM (GMT -6)   
I have always understood these are the 4 stages of liver damage and only the last one is cirrhosis. The first ones are inflammation, fibrosis and bridging necrosis (may be that bridging necrosis precedes fibrosis - can't remember) - but they are not cirrhosis.

I can't find anything on the Merck site that shows this - only the Livestrong one has this definition.

Indeed I found this which definitely is from Merck:

http://www.allabouthepc.com/allabouthepc/documents/pdf_liverprogression.pdf

I am not trying to be pedantic - it can be hugely important to people that they have fibrosis not cirrhosis especially as fibrosis can reverse whereas almost certainly cirrhosis can't. In many liver diseases such as AIH, progression to cirrhosis can be prevented. So I agree these are the 4 stages of liver damage but they are not all cirrhosis.

Ann

hep93
Elite Member


Date Joined Jul 2005
Total Posts : 12014
   Posted 6/12/2013 1:43 PM (GMT -6)   
Ann, as it reads, it is the development of cirrhosis, from inflammation to fibrosis to cirrhosis. Maybe it should be retitled Stages of Liver Disease?

My last biopsy showed Grade 2, Stage 3-4 fibrosis...so progressing towards cirrhosis. This will not reverse, as it is caused by hep C and Mayo is dragging their feet about getting me on treatment, due to other acute problems.

Having hep C is a whole different ball game than AIH.

Hugs,
Connie
hep93
Forum moderator - Hepatitis


"But that was yesterday, and I was a different person then."

Lewis Carroll, Alice in Wonderland

Liver transplant recipient, Oct. 27, 2011, at Mayo Hospital, Jacksonville, FL

AIHer
Regular Member


Date Joined May 2012
Total Posts : 162
   Posted 6/12/2013 2:30 PM (GMT -6)   
I thinking calling it stages of liver disease is a brilliant and correct title! I know that hep C is very different to AIH but stages of liver disease apply to all liver diseases so I think it is a much better description. On this occasion I think Livestrong.com just got it plain wrong in calling them stages of 'cirrhosis'.

In 14 years with AIH I have moved from stage 1 inflammation to almost certain stage 4 cirrhosis (biopsy soon to confirm but all ultrasounds/MRIs etc indicate cirrhosis). But many people stay in the early stages and indeed some with fibrosis find with treatment that they reverse to inflammation - think that can also happen in fatty liver disease as well as the autoimmune diseases. But I do appreciate it doesn't happen with Hep C.

I have every hope of being able to stay compensated for a very long time which I know is much less likely in many other liver diseases.

Ann

themiz
Forum Moderator


Date Joined Feb 2013
Total Posts : 697
   Posted 6/12/2013 3:00 PM (GMT -6)   
Hummm, and what happens when one has Hep C but is SVR? Themister's biopsy has "Grade 2 Hep C, Stage 4 Cirrhosis". He has had Cirrhosis Stage 4 since 2005.

Themister did threat the Hep C, which as a virus obtained Sustained Viral Response. I think biopsies with AIH will certainly not have grades of Hep C, being none is there. Or, Alcoholic Cirrhosis, no Hep C necessarily. Or grades on Hep B? Fatty liver?

What do biopsies state as the grading on people that do not have Hep C on the grade of the causation...vs the stage of liver damage?

I find this fascinating.

Butterfly422
Regular Member


Date Joined Jun 2013
Total Posts : 50
   Posted 6/12/2013 3:06 PM (GMT -6)   
ok family,

I am a real simply young lady and I think the same way too... I am confused again...

What do i ask the doctor.? What grade is the Hep C? When they did the biopsy he said Stage 4 Hep C with less than 10% of the liver functioning...

I am sorrry I am trying to see ... I do, then it get blury agqain..

Butterfly422
Regular Member


Date Joined Jun 2013
Total Posts : 50
   Posted 6/12/2013 3:09 PM (GMT -6)   
ok... nevermind.. its obvious he is stage 4 and grade 4...He is still working just with challenges now..

I think I just cant except where he is at. I keep looking at whats being said and I want to say "he's not that bad" when he is.

No option at this point but Transplant. I get it... sorry guys i am just scrambling

themiz
Forum Moderator


Date Joined Feb 2013
Total Posts : 697
   Posted 6/12/2013 3:44 PM (GMT -6)   
Butterfly, If he is stage 4 and ESLD, he will need a transplant. That is the only cure. This is a tough disease. Some people live a real long time with Cirrhosis before the MELD goes up to transplant levels.

I know how difficult this all is to absorb. I was a wreck from Dec-May this year when my husband's MELD went to the place one gets a transplant evaluation. There is certainly loss and grief for the spouse of someone who has ESLD. The uncertainty about drives us mad. You are on the roller coaster we caregivers live with. Be grateful for his good days. We had a lot of them post the Cirrhosis diagnosis. Big hugs, kiddo. themiz

Butterfly422
Regular Member


Date Joined Jun 2013
Total Posts : 50
   Posted 6/12/2013 3:56 PM (GMT -6)   
thank you....

i am a simple lady... this is simply not simple. I just found out our home will not be paid off in the event of death. I got him a hem doct appt on 24th... hopefully i can learn more there as well. When his job did the insurance evaluation last year they mentioned someone in the loop was in for a liver transplant but was no longer with them. This would have affect the employees premiums... how scarey is that they can see that or even know this. He is the facility director at a treatment program, I am certain they would try to let him go once this is known.... We are trying to buy time to get things in order.. It at times doesnt seem possible.
Sometimes if i rattle on and on just bare with me. I just need to vent. I am joining a church this weekend for spiritual support. We have enjoyed their services just never took the time to join since he has found comfort simply sleeping on the weekends. Which by the way is that good to let him do that or should I encourage him to do more?

I canceled him at the gym yesterday to save $. that was hard because I had to embrace we will never work out together again ... there anyway.

ok i am done for now. let me see if I can focuse to end my day at work.

You all are simply gentle angels with me sitting on your wings to carry me...

Thank you bunches.

**David**
Veteran Member


Date Joined Nov 2009
Total Posts : 3212
   Posted 6/12/2013 4:44 PM (GMT -6)   
I have never heard of a bank, or mortgage company that will loan money for a house, without life insurance on the owner(s).
nullum beneficium impunitum...

Butterfly422
Regular Member


Date Joined Jun 2013
Total Posts : 50
   Posted 6/12/2013 4:49 PM (GMT -6)   
Not sure what happened but I am digging into it . We weren't married when the house was bought so I am thinking he assumed it was a part of the actual morgage insurance . I know he thought he would live forever at that particular time .

A.Ziffle
Veteran Member


Date Joined May 2011
Total Posts : 1824
   Posted 6/12/2013 6:28 PM (GMT -6)   
 Maybe " Reverse Mortgage " I believe personally it's not a good thing but a lot of people are doing it . Gotta check the paperwork ( Fishy ) . Just rumors but heard that if one persons name is on the title and dies the other spouse is out on their ear married or not .
 
 
 Ziff
" Never try to teach a pig to sing , It wastes your time and annoys the pig . "

themiz
Forum Moderator


Date Joined Feb 2013
Total Posts : 697
   Posted 6/12/2013 6:44 PM (GMT -6)   
Hi B,
about the mortgage insurance. If it is PMI, it does not benefit survivors. It benefits only the lender. Not many have any type of mortgage insurance that pays off the loan for the benefit of a survivor. Your husband may have another life insurance. Did your husband think he had something that paid off the mortgage? There is one kind, but that is not likely. It is called, Mortgage Protection Life and pays off the mortgage. I will be surprised if he has that insurance.

about resting. Since your husband is working full time, I am certain the fatigue is crushing. Personally, I realized themister has only got so much energy he can give to life in one week. It has changed drastically in the last year. Mornings are normally the best. There is not one thing he can do to change this. Today, for example....he had no HE, was happy, had his fun personality working, and even took a short walk at dawn. He ate, and was able to sit at the computer for a couple of hours cracking jokes, and enjoyed getting some NFL news online. He made a couple of calls.He was down for a nap with major fatigue by noon. Slept about two hours, and never gets up after that much. We moved the big TV to the bedroom a couple of years ago. He is now watching a movie, his normal afternoon. I am making his low sodium dinner, took him a snack, made certain he was level with brain function, and know he will not be up except to eat and go back to bed today for more TV. This is a good day! So, yes, I would let him rest when he needs to. I had to take over driving when the HE manifested. I had some health problems and was the less active one for many years. You can only do what you can do. We hire help for what used to be simple.

I cycle through stages of anger, sadness, loneliness, fear, and exhaustion. But him, I love. No one really thinks the sickness part of "in sickness" will be more than the flu. I am here for the duration and honored to walk through this with him.

Hugs. You are human, it is humane to be human. themiz

Angie1953
Veteran Member


Date Joined Jul 2011
Total Posts : 933
   Posted 6/12/2013 7:39 PM (GMT -6)   
Thinking so much of you caregivers as you struggle through these times and wonder, "do I let him sleep, wake him up, feed him more, feed him different." And am so sorry that you have to experience the anger, sadness, loneliness, fear and exhaustion.

Hugs to you all, it is really really hard, no matter how much you love them. I have never have done anything harder in my life than take care of my hubby through 2 years of ESLD. Thoughts are with you all. Keep posting, it helps us all.
Angie1953

Butterfly422
Regular Member


Date Joined Jun 2013
Total Posts : 50
   Posted 6/13/2013 7:27 AM (GMT -6)   
you all are simply wonderful.

This morning he gets up and is back to "normal" getting me up at 5am ready to go..LOL after I stayed up half the night doing house chores. He is simply wonderful.
Yes he has a policy that wont really cover much but grateful to have it. i am in the process of finding a lawyer for a will. I am learning that is very important. I thought since we were married and I was his wife that it didnt but i see it does. that is the next thing on my list to do ASAP.

I dont know about Probate or what it is but investigating now. He is to inherit a nice sum from his mom so I think that will care for the house. His sister told me not to worry about monetary issues they are here to help..What a relief that was to see some financial relief come ...

Anyways, enjoying the day..Its a great day with a wonderful loving hubby. You know it becomes challenging when mother nature shows up because I seem to become more challenged with issues at that time. I can become pretty hateful myself. I recognize this and so I tell him to Hang On.. my body is in a change and he keeps loving me more and more. You know he calls me TEACUP.. because a teacup is refined through the fire... what a sweet thing.

Ok family, I am off to the races another day of preparing, working on notebook of needs, tests, doc visits, and a diary of events .. Such a great idea.

Have a good day and thanks again.

NicechapLondon
Regular Member


Date Joined Dec 2012
Total Posts : 108
   Posted 6/13/2013 7:44 AM (GMT -6)   
Butterfly, on the not-so-nice issue of Probate, and not knowing the ins and outs of your family dynamics could I just sound a word of caution about his inheritance? My Uncle just recently passed away from ESLD and was prior to his death due to inherit half of my Grandmother's quite significant estate. When his son and I had the conversation with him about the possibility that he might die, he restructured his will to ensure that his partner would be looked after - the vast majority of capital assets to be held providing her with an income until such time as she passed away at which point it would pass to his children (my cousins). However, he did not reckon upon my the fact that following his death, my Grandma's intention is to cut his estate out of her will, making my father and my cousins the direct beneficiaries of her estate, thus bypassing his wishes for his partner. Whether or not one agrees with this approach (in this instance it is a very sensible one for my Grandma to have taken) - there remains the fact that in order for your partner's inheritance to be certain he will have to out-survive his Mother, unless the law in the US and UK is fundamentally different (which, I accept, is a possibility). In my experience, during times of crises families can behave very strangely and it would be awful is somebody as trusting and caring as you ended up in a difficult situation and were left disappointed that, having thought the best of people, they let you down. So, I don't wish to add to your burden, but rather make sure that you have considered all of these possibilities. I hope you have a wonderful day today (not sure if that's your tomorrow - still not to grips with the time differences)! Bests, Jamie.

Mae be here
Veteran Member


Date Joined Nov 2012
Total Posts : 1256
   Posted 6/13/2013 7:53 AM (GMT -6)   
Couldn't have said it better myself chap, so true. Watched it happen a few years ago. Money makes people do surprising things. Get a lawyer!
Mae

"I don't like to make plans in advance because then the word 'premeditated' gets bandied about in the courtroom"

Caregiver for brother's liver transplant
Blessedly rec'd liver 1/13/2013 at Mayo Clinic, FL

Butterfly422
Regular Member


Date Joined Jun 2013
Total Posts : 50
   Posted 6/13/2013 8:02 AM (GMT -6)   
Such great information... thank you so very much for that insight.

Butterfly422
Regular Member


Date Joined Jun 2013
Total Posts : 50
   Posted 6/13/2013 8:34 AM (GMT -6)   
I must say Ziff, you got my attention with your post.. I guess that is why i get an attorney now to make sure things like this do not slip through the cracks.......

Thanks

MamaLama
Forum Moderator


Date Joined Oct 2010
Total Posts : 3698
   Posted 6/13/2013 9:29 AM (GMT -6)   
Jamie knows what can happen.

Pay attention.

I am working on a case like this at this time. My sister's female partner of 42 years died. They were not legally related--those laws are changing now, but not in time.. But the partner's will was clear. Everything went to my sister, not to her family.

That is over and done and though there was talk of contesting the will, that didn't happen.

But, they had a verbal agreement about the second to die. In the first to die situation, that the estate would transfer in total to the other with the notion that they'd built a nest egg together (though investments separate) and would pay for the survivor to live out the life they saved for.

However, the undocumented agreement was that upon the death of the second, the remaining estate would be divided between the families. I have made sure my sister (who has early stage dementia)'s documents state this clearly...half and half. But my sister is feeling angry. Seems the partner's family blamed my sister for keeping their daughter/sister/auntie from a "proper" marriage with husband, children, etc. and they have totally turned their back on my sister. What shall she do? What shall I advise?

For now, I have advised playing it totally as her partner advised, though the beneficiaries on both sides of the equation are to the next generation for the benefit of grand and great grand niece/nephew's educations.

Families can be a mess. Take care. Write stuff down. Hire a lawyer.

Hugs,
Mama Lama aka Carol
MamaLama
Forum moderator - Hepatitis


Partner received liver transplant May 1, 2011, Jackson Memorial, Miami, FL

Butterfly422
Regular Member


Date Joined Jun 2013
Total Posts : 50
   Posted 6/13/2013 10:01 AM (GMT -6)   
GOT AN ATTORNEY MEET HIM NEXT TUESDAY....see I listen to yall.... lol. I will post what information I get. BTW...this process is very expensive too... dang


Thanks so much...

**David**
Veteran Member


Date Joined Nov 2009
Total Posts : 3212
   Posted 6/13/2013 5:09 PM (GMT -6)   
It's more expensive not to take care of these things. The day I had my transplant, I realized that my ex was my sole beneficiary. My lawyer changed my will in a few minutes, faxed it to MGH and I signed it, with 2 nurses as witnesses. Turned out, it wasn't necessary, but what if...
nullum beneficium impunitum...
New Topic Post Reply Printable Version
Forum Information
Currently it is Friday, July 25, 2014 6:15 AM (GMT -6)
There are a total of 2,179,161 posts in 242,313 threads.
View Active Threads


Who's Online
This forum has 153588 registered members. Please welcome our newest member, tampagirl.
342 Guest(s), 11 Registered Member(s) are currently online.  Details
Mischa252, Radsret, tampagirl, Erika777, SpecialLady, Chartreux, Mommanoesbest3391, Judy2, Mr. Positive, lostson, London Lurker


Follow HealingWell.com on Facebook  Follow HealingWell.com on Twitter  Follow HealingWell.com on Pinterest  Follow HealingWell.com on YouTube
Advertisement
Advertisement

©1996-2014 HealingWell.com LLC  All rights reserved.

Advertise | Privacy Policy & Disclaimer