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Hi Diane, ITR, Thanbey and all.

I've been idle for a while, but like Thanbey, am glad to find the board and its discussions in such good shape on returning. And, really glad to see so many long posts!--makes me feel less ridiculous for running on and on, as I do (and am about to).

Wanted to say to Real, "piecemeal necrosis," as horrible as it sounds, is the earliest dectectable stage of liver cell necrosis--and the lowest grade of fibrosis, other than zero, is usually associated with these words. It is not, in itself, a reason to treat. Either is an ALT score holding steady at 45 or so. Boy would I love to have that ALT score.

To overcome what was for a long time a false faith that liver panel numbers meant a whole lot about liver health, we have had to stress that, in the case of hcv, these enzyme levels don't mean nearly as much as many folks, including too many docs, seem to think.

BUT, that said, lower numbers are usually better to have than higher (in the absence of cirrhosis, which can sometimes, paradoxically, come with lower enzyme numbers), and your numbers are comparatively low, for us. Second, for any individual, whether she is a low-number person or a high-number type, the TREND over time turns out to matter. That is, a person who has tested high for some time usually will not drift lower unless the liver is actually improving-for example during or after tx, and conversely, a person whose numbers were low or steady but start trending higher over time should consider getting nervous. For you, the stable/low, flat curve would seem encouraging. Maybe not as good as totally "normal" results, but for someone testing positive for hep c, you look pretty good to me. Er..your numbers do--don't mean to get fresh here.

So, I agree that your doctor's changed reactions are indeed puzzling. A second opinion, a second biopsy, a few more hours spent pondering the mysteries of medical mentality--all would be useful before deciding that you must treat.

For me, by way of comparison, my numbers are higher than yours, and--more alarming--getting worse over the years. I will go for my second biopsy this summer, and may well choose tx at that time, but just as one person's opinion, if my ALT and AST numbers would only have held steady and low-ish over the recent years, as yours have, I'm not sure I'd even be going for another biopsy yet.

To me then, your situation is, according to my notoriously unprofessional opinion, not scary. So, do NOT let someone scare you into anything.

Now, to jump in on the other 216 discussions that all got launched by this one thread:

Let's ALL send something to HCOP. 'nuff said.

next: HPV is human papilloma virus. it is not herpes, although like herpes, the name covers many related viruses, some more virulent than others. also like herpes, it can it seems sometimes cause warts in bad places to get warts. but still, is diff from herpes.

condoms help prevent the spread of either. I'm getting to think better and better of condoms as time goes on.

next: interferon is extremely heavy duty medicine, for an uncertain chance of result, but that does NOT for a moment mean it is useless or the wrong choice for many of us. I think Thanbey has increasingly tried to counter drug company hype, but simultaneously supported any of us who find real benefit in the products these companies produce. She's just tried to provide the less pretty details so we can make an informed choice.

Taking interferon is a tough choice, a gamble, but the right choice or a worthy gamble for many of us. Let's just leave it at that, and we'll each make a choice as we feel fits. And, we may well change that choice over time. That's okay.

And, just to close on the note that began this thread, I have been very very sceptical of the claims made for interferon, but I am personally ready to say that for some people, those who've made it some years without virus return, they are "cured." Harshly, it happens that not all have then "recovered"--sometimes symptoms of liver damage or interferon complications plague some folks who are long clear of the virus itself. So, once again, we are faced with the fact that the treatment is a gamble, cure is of uncertain definition and uncertain probability, but STILL might be the right choice under lots of circumstances.

To me, that's the real demon here--that we have little certainty no matter what we do. We just have to make the best decisions we can as we go along, knowing all the while what a bunch of semi-incompetent, imperfect human beings we (and our doctors) are. But God bless us for having the courage to face these terrible uncertainties, and carry on as best we can.

And finally, off topic but on my mind: tomorrow my son-in-law, the father of my precious granddaughter (the princess), leaves for Kuwait. He is in the 4th I. D. Let's please wish for a quick end to this war, a quick end with as few military or civilian casualties as possible, please.



[This message has been edited by sean (edited 04-04-2003).]

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