November 2003
November 19 -- Support Group Members Interact

Room 220
We will share our concerns, strengths and ideas

Upcoming Agendas:
Meeting Agenda:
6:30 p.m. (sharp) - Theme Song: I Will Survive
6:35 - 6:45 announcements
6:45 - 8:45 (or earlier) group members interact 'til we adjourn

December 17 -- Clsrm 3&4 -- Christmas Potluck
Next Quarterly Business Meeting of I Will Survive:

5:30 p.m., Nov. 19, 2003 - Room 220
All are encouraged to attend (1 hr. prior to regular meeting) and to consider becoming involved in helping with support group chores
More News
Our Meetings: 3rd Wednesdays of every month; at SCC (Sutter Cancer Center, aka: Buhler Bldg) classroom 3&4 or Room 220; 2800 L St (@ 28th & L: kitty corner across from the 2-story parking & across L St. from Sutter Hospital)
Contact Us: Phone number: (916) 444-6996
Our Web Site> www.sacmall.net/transplant/hepc.html
Email: dck@innercite.com (include "I Will Survive" in subject line or your message might be delected before being read).
*New readers of this newsletter, see the following.
If you want to be included on our mailing/emailing list and you can afford to include a donation, make it to "I Will Survive, The Effort", P.O. Bx 2180, Loomis, CA 95650 for:
$24 if you want the Newsletter by U.S. mail
$15 if you get the Newsletter from the website (if you wish, each month we'll email a link to you)
$ 0 if, right now, you can't afford to pay dues. In which case "I Will Survive" will mail monthly Newsletters to you. Please contribute to the "Donations" Box at the meetings as you are able.

From the October 2003 HCV Advocate:
...Any patient with hepatitis C might be expected to wonder: "How will I know if I get cirrhosis?" Cirrhosis, generally considered irreversible, is late stage liver disease characterized by distortion of the liver architecture due to scarring. As a result, liver function declines which produces a number of physical as well as laboratory findings. Although these findings often indicate cirrhosis, they are not specific only to liver disease.
Physical signs:
...Ascites: accumulation of fluid in the abdominal cavity. In many cases, several liters of fluid can build up causing severe abdominal distention. Nearly 60% of all patients with compensated cirrhosis will develop ascites in 10 years.
...Spontaneous bacterial peritonitis (SBP): infection of ascitic fluid. Manifestations of SBP include fever, abdominal pain, abdominal tenderness, and altered mental status. In the event of SBP, a provider must do a diagnostic paracentesis (draining of the fluid from the abdomen).
...Hepatomegaly: enlargement of the liver. The cirrhotic liver will have a firm and nodular consistency and may be large, normal sized, or small.
...Splenomegaly: enlargement of the spleen is common in patients with cirrhosis.
...Caput medusa is noted when the veins in the abdomen are very prominent (appearance said to resemble the head (caput) of the mythical Gorgon Medusa).
...Hepatic encephalopathy: potentially reversible disturbance in consciousness and behavior. Disturbance of sleep pattern is a common early feature that typically precedes overt neurologic features; patients often feel very confused. Physical findings include Asterixis which is the bilateral but non-uniform flapping motions of outstretched hands.
...Fetor hepaticus: sweet, pungent smell to the breath of cirrhotic patients caused by increased concentrations of a chemical which is not being detoxified by the liver.
...Variceal hemorrhage occurs when, under very high-pressure blood flow, a blood vessel breaks. This is a devastating complication occuring in 25-40 percent of patients with cirrhosis.
...Jaundice: yellow coloring of the skin and mucus membranes that results from increased serum bilirubin.
...Spider angiomata, also known as spider telangiectasias, are "spider like" markings on the body (most frequently on the trunk, face and arms). Each has a central circular artery with smaller vessels radiating out (looking like spider legs). The lesion is typically red or purple and the central part may pulsate when compressed with a glass slide. The number and size of the spider angiomata generally correlate with the severity of liver disease.
...Palmar erythema: exaggeration of the normal spotty redness on the palms of the hands characterized by a deep redness on the fleshy part of the palm.
...Nail changes are sometimes found. Muehrcke's nails are characterized by paired horizontal white bands separated by normal color in the nail. In another nail disorder, Terry's nails, the two-thirds of nail plate closest to the hand appears white whereas the furthest one-third is red.
...Gynecomastia: benign growth (typically feeling firm and rubbery) of male breast tissue. Afflicts 2/3 of men with cirrhosis. Loss of chest or underarm hair and inversion of the normal male pubic hair pattern also occur.
...Constitutional symptoms such as weakness, fatigue, anorexia, low grade continuous fever and weight loss also occur.
Laboratory findings:
... Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are usually moderately elevated in cirrhotic patients. AST is often more elevated than ALT, but levels can be normal in cirrhotics.
...Alkaline phosphatase is usually elevated but less than 2-3 times the upper normal limit.
...Bilirubin is often normal in well-compensated cirrhosis, but will rise as cirrhosis progresses.
...The levels of Albumin, synthesized exclusively in the liver, fall as liver function declines due to worsening cirrhosis. Serum albumin levels can help to grade the severity of cirrhosis.
...The liver synthesizes many proteins required for normal clotting. The prothrombin time (PT) reflects the degree of liver dysfunction. The PT increases as the ability of a cirrhotic liver to synthesize clotting factors diminishes.
...Anemia may occur in cirrhotic patients due to a number of causes.
...Thrombocytopenia (low platelets): very common in cirrhotic patients; often caused by an enlarged spleen which can sequester up to 90% of circulating platelets.

If you have no money or insurance call:
Sacramento Clinical Trials
Schering's Commitment to Care 1-800-521-7157
Infergen's Safety Net Program 1-888-508-8088
Roche's Patient Assistance 1-800-443-6676
Dr. Gish, et al, call: Pacific Hepatology, (916) 443-0503
Dr. Pimstone UCD Med Center, (916) 734-1557
Dr. Rossaro UCD Med Cntr, call: Katherine Suggett (916) 734-8696



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