Living with Cirrhosis
What is Cirrhosis?
According to wikipedia, "Cirrhosis is a consequence of chronic liver
disease [such as Hepatitis C] characterized by replacement of liver tissue by fibrous scar tissue as well as regenerative nodules (lumps that occur as a result
of a process in which damaged tissue is regenerated), leading to
progressive loss of liver function. Cirrhosis is generally
irreversible once it occurs, and treatment generally focuses on
preventing progression and complications. In advanced stages of
cirrhosis the only option is a liver transplant."
However, there are those that would not say that cirrhosis, even from Hepatitis C, IS irreversible. The liver, after all, is the only human internal organ that actually can regenerate itself! Some say that certain natural options can help reverse this condition. See the interview with Johnny Delirious for more on this by clicking here
Living with Hepatitis C and Cirrhosis
The diagnosis of cirrhosis in a patient with hepatitis C should NOT be regarded as an impending death sentence. However, efforts should be made to focus on stalling the evolution of hepatic decompensation through diet and supplements, and ensure that your doctor is providing effective surveillance of your liver condition. If you have cirrhosis and your feel death looming, it may comfort you to hear this quote from a paper published in the American Journal of Gasterology, "The authors conclude that HCV-associated cirrhosis often has an indolent course, shows a slowly progressive increase in morbidity, and portends a relatively long-life expectancy."((Am J Gastroenterol 1998;93:1386–1387. © 1998)
Preventing and Living with Cirrhosis from Hepatitis C
HCV Advocate has tons of really informative information and great monthly newsletter. Visit their site for more helpful information.
The majority of those with chronic hepatitis C virus infection
(HCV) will not progress to advanced liver disease. However,
roughly one in five of those with HCV have cirrhosis. A full,
productive life is possible even with this level of liver damage.
Now we'll go into more detail, concluding with how to help
ourselves live with cirrhosis or avoid it altogether.
The best way to prevent cirrhosis is to eliminate or minimize excess
inflammation. Living with HCV means there is already a potential
source of inflammation. This is the result of the immune system's
attempt to eradicate HCV. Over time, inflammation may lead to tissue
damage, or fibrosis. If the damage becomes severe, the liver hardens
into cirrhosis. Fibrosis is common with HCV but does not usually
advance to cirrhosis. If it does, progression to cirrhosis usually
takes twenty or more years.
Treatment is a potential remedy for HCV-induced damage. The liver has
remarkable recuperation power, so removing the source of damage allows
the liver to recover. Even if HCV isn't permanently eradicated, there
is often some benefit. For example, I underwent treatment in 2003. My
liver biopsy showed dramatic improvement although I had not had a
sustained response. Even cirrhotic patients have shown improvement
There are other potential causes of liver inflammation. Alcohol is a
common one. The amount of alcohol that can cause tissue damage is
surprisingly low. The maximum safe alcohol allowance for healthy adult
women without liver disease is one drink daily. For healthy adult men
without liver disease, that maximum is 2 drinks daily. These
recommendations drop to zero for those with HCV, substance abuse,
other medical conditions, pregnancy or those taking medications.
Even those without risk factors must exercise caution when drinking
alcohol. Safe alcohol use is measured as one 12-ounce bottle of beer
or wine cooler, one 5-ounce glass of wine, or 1.5 ounces of 80-proof
distilled spirits. A glass of wine is likely to exceed 5 ounces when
enjoying an evening with friends. It is easy to rationalize a second
or third drink if you only drink on weekends. However, this excess
puts extra load on the liver. Over time, this can amount to tissue damage.
Sadly, risk for cirrhosis is increasing along with our waistlines.
Excess fat in the liver may lead to a fatty liver. This may lead to
inflammation. Left unheeded, the inflamed liver may become scarred and
Those at risk for fatty liver disease tend to have other diet-related
conditions, such as obesity, diabetes, or high triglycerides. However,
someone without these problems may still develop a fatty liver. The
movie Super Size Me is a good illustration. For thirty days, Morgan
Spurlock ate only McDonald's food. Simultaneously, he reduced his
exercise level to the national average. Before the month was over,
Spurlock was sick. Lab tests confirmed this, including abnormal liver
enzymes. In one month, Spurlock developed a fatty liver.
So, if you are overweight, try to lose those extra pounds. Do this
slowly and wisely. Don't try to lose more than a pound or two weekly.
Discuss this with your medical provider, particularly if you have
diabetes or high triglycerides. Include regular physical activity in
your fitness goals.
Drugs may cause liver damage. Not just illegal ones, but prescribed
and over-the counter drugs. Best known for liver toxicity is excess
acetaminophen or Tylenol®, although it is generally safe if taken as
prescribed. This drug is often combined with other drugs, such as cold
or pain medications. Drug-induced inflammation commonly occurs when a
patient is unaware of the amount of acetaminophen he or she is taking.
Discuss your medications with your medical provider. Always take
medications as directed.
Dietary supplements may also cause liver damage or may interact with
foods, drugs, or other supplements. Excess iron and vitamin A are
noteworthy examples. Discuss dietary supplements with your medical
provider. Spend some time doing research and choose supplements carefully.
For more information about dietary supplements and the liver, check
HCSP's fact sheets such as HCV & CAM: Dietary Supplements to Avoid
While visiting his physician, a patient started to hyperventilate.
"I'm sure I've got cirrhosis," he exclaimed. The doctor asked, "Why do
you think that? The liver is a non-complaining organ, so you wouldn't
feel any discomfort if you had cirrhosis." "Exactly!" said the
patient. "Those are my precise symptoms."
The silent nature of liver disease is one of the reasons that regular
medical check-ups are important. Each physician will tailor their
recommendations for each patient, likely ordering regular blood tests
and physical exams. Here are some general guidelines:
No cirrhosis – minimal fibrosis (Stage 0-early stage 2)
* Annual physical exam
* Yearly or twice-yearly lab tests, including liver panel and
complete blood count (CBC); regular viral load tests are unnecessary
unless you are undergoing treatment
* Liver biopsy every 5 years
No cirrhosis – moderate to severe fibrosis (late stage 2-3)
* Yearly or twice yearly physical exam
* Every six months – lab tests, including liver panel and complete
blood count (CBC); regular viral load tests are unnecessary unless you
are undergoing treatment
* Liver biopsy every 3 to 5 years
* Late stage 3 fibrosis – ultrasound and alpha-fetoprotein (AFP)
lab test may be ordered every 6 months
Cirrhosis (stage 4)
* Regular, more frequent physical exams, depending on severity
* Regular, more frequent labs, depending on severity – more
extensive tests ordered including AFP; regular viral load tests are
unnecessary unless you are undergoing treatment
* Regular ultrasound; liver biopsy only if necessary; other
diagnostic tests may be ordered
What You Can Do
There are measures you can take to help stave off cirrhosis or live
with it if you are already there. Here are some recommendations:
* Abstain from alcohol
* Discuss all your medicines with your medical provider, including
over-the-counter, herbs and other supplements
* Do not exceed the recommended dose of acetaminophen (Tylenol®)
* Maintain a normal weight
* Do not eat wild mushrooms unless you are 100% sure of their safety
* Avoid exposure to vibrio vulnificus, an organism found inraw or
under cooked shellfish
* Those with cirrhosis and open sores may need to avoid the ocean
in areas where there is a risk of vibrio vulnificus exposure
* Keep immunizations current
* Consider HCV treatment
Drinking coffee may provide some benefit – specifically the
caffeinated kind. The studies are small and although caffeine use is
associated with liver tissue (histological) improvement, correlation
is not the same as causation. Links about caffeine and the liver are
included at the end of this article.
Cirrhosis is a scary subject but it does not mean that life is over.
Some have used potentially life-threatening diagnoses as opportunities
to make lifestyle changes. They turned their health around and lead
full lives. Sometimes the end is actually the beginning.
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