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Article / Updated 03-26-2016

The term hepatitis simply means inflammation of the liver. But when you're talking about hepatitis C, you're talking about viral hepatitis, and hep C isn't the only form of hepatitis caused by a virus. So far, five different viruses have been found that cause hepatitis, and they're named with letters: Hepatitis Avirus causes hepatitis A; hepatitis B virus causes hepatitis B; hepatitis C virus causes hepatitis C; and hepatitis E virus causes hepatitis E. Hepatitis D virus is a special case, because it can't infect you unless you also have hepatitis B virus. The different types of viral hepatitis have similar features but also important differences. Depending on the hepatitis virus, the disease may be temporary — an acute form, which lasts less than a year. With hepatitis B or C, though, infection can become chronic and last for decades, or life, unless you undergo successful treatment against the virus. Hepatitis A virus Hepatitis A (also called infectious hepatitis) was identified in 1973. Hepatitis A spreads through food or water that has been contaminated with infected feces. You can get hepatitis A from: Not washing your hands after exposure to feces: Examples include not washing your hands after using the bathroom or changing a diaper. Eating contaminated food: This situation can occur with uncooked food and food prepared by someone who didn't wash his hands after using the toilet. Drinking contaminated water: Dealing with contaminated water could be a problem when traveling. Sexual contact with someone who's infected: Practice safer sex and especially take care if you have anal or oral–anal sex. Hepatitis A causes an acute infection. In the United States, 200,000 cases of hepatitis A are reported yearly, and a third of all people have already been exposed to hepatitis A virus at some point in their lives but may not have known it. If you've been exposed to hepatitis A in the past or gotten a vaccine, you'll be immune, or protected from future hepatitis A infection. Hepatitis B virus The hepatitis B virus (serum hepatitis) was found in 1963 and spreads through contact with infected body fluids (including saliva, vaginal fluid, and semen) and blood. You can get hepatitis B from Injection drug use Unprotected sex Transmission from mother to child during birth The razor or toothbrush of an infected person Occupational exposure of healthcare workers or emergency personnel to infected blood or body fluids Hepatitis B can cause an acute or chronic infection, but chronic infection occurs in only approximately 5 percent of cases. A hepatitis B vaccine protects against hepatitis B (and hepatitis D). Hepatitis C virus The hepatitis C virus was discovered in 1989. For decades before that, it was called "non-A non-B" hepatitis because researchers knew that it wasn't caused by the other known hepatitis viruses at the time. Hep C is transmitted through blood, and 75 to 85 percent of people infected will have a chronic infection, which puts them at risk for cirrhosis, liver cancer, and liver failure over many decades of infection. No vaccine is available for hepatitis C, so prevention is the key to avoiding infection. Hep C infection can last a lifetime, so you need to take good care of yourself physically, emotionally, and financially. Medical research is ongoing to develop more effective drugs with fewer side effects. Currently, combination therapy with two drugs — pegylated interferon and ribavirin — is the best treatment, but it doesn't work for everyone. Hepatitis D virus Hepatitis D was discovered in 1977 and is an incomplete virus thatcan't infect you on its own; it has to tag along with hepatitis B virus. When it does, it can produce more-severe hepatitis B disease. Transmission of hepatitis D is the same as for hepatitis B. Vaccination against hepatitis B prevents hepatitis D infection, too. Hepatitis E virus The hepatitis E virus was discovered in 1983 as another hepatitis virus that's transmitted through contamination of water with feces. Outbreaks of hepatitis E occur primarily in developing countries in Africa, Asia, and Central America due to unsanitary water supplies. Hepatitis E is rare in Canada, the United States, and other developed countries. Hepatitis E is an acute infection. For some as-yet-unexplained reason, pregnant women appear to be at risk of a more severe disease when infected with hepatitis E. Other hepatitis viruses Researchers believe that most people with viral hepatitis have one of the hepatitis viruses from A to E. But scientists are always on the lookout for new viruses that can cause disease. The viruses called hepatitis G virus (HGV), TTV (transfusion transmitted virus), and sentinel viruses (SEN) have all been discovered in the blood of people with hepatitis. But it's not absolutely clear that these viruses actually cause hepatitis. Hepatitis F is a name for a virus that's no longer thought to cause hepatitis.

Article / Updated 03-26-2016

Soon after you first become infected with the hepatitis C virus, you may have flu-like symptoms or even jaundice (abnormally yellow skin or eyes) during the acute phase (within the first six months) of infection. Most people in the acute phase are asymptomatic, meaning that they don't notice any symptoms, or they have symptoms that are mild or initially confused with other illnesses. When your disease becomes chronic (after six months), you may develop some of the following symptoms in the months or even decades after infection. You probably won't have all of these symptoms, but being aware of possible symptoms is good, so if one of them does occur, you'll recognize it. Keep in mind that some symptoms happen as a function of aging, stress, or menopause. Each person with hepatitis C is an individual, and your symptoms depend on many factors. Fatigue: In a class of its own, the most commonly reported symptom is a feeling of weariness. The sense of sluggishness can be physical or mental or both. Digestive problems: Nausea, vomiting, diarrhea, bloating, gas, indigestion, abdominal pain, or loss of appetite in any combination or experienced separately is a signal that something's wrong. Emotional problems: Depression, anxiety, and mood swings are among the indicators of a condition or illness that warrants attention. Flu-like symptoms: Headache, low-grade fever, night sweats, chills, joint and muscle pain, and weakness are not only signs of the flu, but also symptoms of other medical concerns. Hormonal problems: More intense premenstrual tension or menopausal symptoms, irregular periods, loss of sex drive, or erectile dysfunction can accompany the aging process, as well as progressive diseases. Jaundice: Yellowing of skin or eyes, dark urine, pale or clay-colored stools often relate to liver problems. Skin issues: Dry skin, itchy skin, bruising, reddened palms, red spidery spots, swelling of your hands, feet, or face call for monitoring, especially if symptoms intensify over time. Sleep problems: Insomnia and night sweats may occur sporadically or frequently. Thinking problems: Brain fog, encephalopathy, associates with cirrhosis. Your hepatitis C may directly cause some symptoms; others may be side effects of medications or the result of worrying about your illness. Like the chicken and the egg, it doesn't matter what came first. If you have any symptoms, tell your physician. Working with your doctor, you can deal with your symptoms.

Article / Updated 03-26-2016

One way of defining stress is the body's response to a change or challenge. The change or challenge that causes the stress is called a stressor, which could be anything from the freezing temperature outside, to a new medicine you're taking, to an attack dog that's charging after you! Acute versus chronic stress During the stress response, energy is diverted from your immune, digestive, and reproductive systems and focused on giving you a supreme burst of energy. The body is designed to deal with short-term (acute) stress. When a stressor first arrives — in the form of an attack dog, for example — your body takes most of its energy reserves to fight or help you run like the devil to save your life. When the dog is gone, your body returns to normal because you no longer need the extra energy diverted to save your life. In modern times, we have a lot of long-term (chronic) stress. These are challenges that don't go away and keep us stressed out for long periods of time. These stressors can range from a difficult boss or financial worries to a long-term chronic illness, like hepatitis C. This fight-or-flight biological response was well suited to the precarious lives of cave dwellers and their many physical threats. The problem with long-term stress is that your body doesn't get to go back to a nonstressed state. In modern times, when mundane things like traffic jams and deadlines trigger stress, it's not so useful to lose precious energy in response to these almost-constant stressors. When you have hepatitis C, the last thing you want is for energy to be taken away from your immune system. Physical stress A healthy body is in an exquisite state of balance called homeostasis. Any disruption to your body from an injury or an illness causes physical stress. The hepatitis C virus causes physical stress just by being a foreigner in your body and making your immune system go into attack mode. Likewise, to keep its balance, your body needs proper amounts and types of nutrition, rest, movement, fresh air, and warmth. Too much of anything (including food, exercise, and heat) and the wrong types of things (such as polluted air, junk food, and dangerous drugs) also cause stress. If a physical stress is short term — like missing some sleep on exam night or having an occasional ice cream — the body can usually recover. But with long-term physical stress, like not sleeping for weeks or smoking cigarettes for years, the body has a more difficult time regaining its balance. Emotional and mental stress Much of our modern stress comes from mental and emotional anxiety. Pressures and worries to get to work on time, make deadlines, pay bills, get your kids into college, and so on can trigger an emotional stress response. With hep C, you probably have worries related to one or more of the following things: Overall health Sexual interest or ability (due to hepatitis C or medication) Financial situation Work hours, job conditions, or the job itself Lifestyle (diet, alcohol consumption, smoking) Emotional stress is a funny thing because any type of change, even good change, can be stressful. Think of the stress that can accompany the first year of marriage or bringing home a new baby! Linking stress and illness Illness is a major challenge to the normal workings of your body and causes stress in different ways. The physical aspects of the stress caused by hep C are pretty straightforward and include the interaction among the following: The hepatitis C virus: The virus is growing and making proteins inside your body, which affects your immune system, your liver cells, and other parts of your body. The immune system: Your immune system is now in attack mode because it senses danger from the hep C virus. Your liver: The liver has trouble doing its job when the war between the hep C virus and the immune system is being fought in its midst. These physical components of hepatitis C virus infection interact with the emotional aspects of stress. Anxiety, fatigue, and depression are common emotional components of hepatitis C. Because stress hormones affect the brain and the body, stress affects your mind and your body. Whether you have physical or emotional stress, remember that stress of one type can add to the stress of another type, so stress itself is stressful! It's a two-way street: Physical stress can lead to emotional stress, and emotional stress can lead to physical stress. And both play a role in lessening your body's ability to protect itself against hep C. Reducing stress — one way or another Stress is so pervasive in modern life and potentially harmful — even more so for folks with a chronic illness like hep C. The good news is that there are lots of ways to deal with stress and diminish its effects on your health and your life in general. The key to keeping stress from hurting you is in your reaction to it. Practice some of these techniques, and you'll be humming or giggling instead of stressing out. Taking care of body basics You can start fighting stress by taking care of your body through three basic measures: exercise; regular, nutritious meals; and plenty of quality sleep. Keeping the physical body in good shape gives you more resilience to deal with stress. Remember to avoid physical stressors like breathing polluted air, smoking cigarettes, taking street drugs, and drinking alcohol). Respecting your limits and needs An important part of emotional stress is the feeling of not having control over your life. You may feel that having hepatitis C has put you on a roller coaster that you don't know how to stop. Here are some ways to bring back some of your personal power: Say no. One of the easiest ways to get stressed is to take on too many tasks. Recognize your limits and accept them. Ask for help. Don't be afraid to ask for help. Ask your family and friends, social service workers, doctors, fellow support group members, and neighbors for help when you need it. Get information. The more you know about your options with hep C, the more empowered and less stressed you'll feel. Enjoying life If you're not feeling well, you may forget to do the things you love. Remember the pleasures of life, which can distract you from your pain and may even make you feel better. Listen to music. Music therapy can bring you some joy. Find a CD or radio station that plays music that soothes you, whether it's jazz, classical, or folk. Other types of sounds, such as waves, sometimes also have a calming effect. Engage your creative side. Everyone has creativity waiting to be expressed. Lose yourself in drawing, taking photographs, or sewing a piece of patchwork. Or maybe you enjoy dancing, playing the piano, cooking a meal, or arranging a few flowers in a vase. Connect with nature. Try to experience nature. Whether it's the beach, a forest, or the mountains, get outdoors and breathe some fresh air. Or simply go to your backyard or a local park and notice the different types of trees and flowers Focus on spirituality. Whether you belong to an organized religion or you have your own way of expressing the divine, find a way to bring the sacred to your everyday life: Light a candle; say the prayers of your particular faith; make up your own prayers; or take time for meditation. Play with your pets. Research has shown that spending time with your furry friends helps reduce stress. They're less stressed than humans are, so they can help you relax, especially when they start purring or wagging their tails. Spend time with family and friends. In today's world, it's easy to isolate yourself or get too busy to keep in touch with others. But calling an old friend or inviting a family member to dinner can give you a real pick-me-up. Find humor: Laughter is a known healer. Find a funny movie or interact with pets or children who have a sense of humor.

Article / Updated 03-26-2016

When you go for a physical, your healthcare practitioner frequently orders blood tests. Many folks first find out they have hep C after undergoing a routine blood test and finding that one or more of the tests is abnormal. There's no one test that indicates chronic hepatitis C disease. Tests for the effects of hepatitis C on your liver include: Liver enzyme tests: These tests measure current liver cell injury by the amount of enzymes that are "leaked" out of damaged or dying liver cells. Liver function tests: These tests look at levels of proteins made by the liver. If your liver damage is such that your liver function is impaired, levels of these proteins will be low. If your bilirubin, clotting factors, or albumin levels are low, you may have cirrhosis or late-stage liver disease. ALT Small amounts of ALT (alanine aminotransferase) are normally found in blood. When the liver is damaged, ALT is released into the bloodstream. ALT is found in organs other than the liver (kidneys, heart, muscles, and pancreas), but most increases in ALT are from liver damage. AST AST (aspartate aminotransferase) is also called SGOT (serum glutamic-oxaloacetic transaminase). Like ALT, AST is found mainly in the liver but also in other parts of the body. AST and ALT are usually measured together and are good indicators of liver disease or damage. Sometimes, test results give AST/ALT ratios. ALP ALP (alkaline phosphatase) is found in all parts of the body, with particularly high concentrations in the liver, bone, and placenta (during pregnancy). Like ALT and AST, ALP might leak into the bloodstream when liver cells are damaged as a result of hepatitis C. Children (who have growing bones), pregnant women (especially in their last trimester), and people with bone disease also have higher levels of ALP. GGT GGT refers to gamma-glutamyl transferase, but it's also called gamma-glutamyl transpeptidase (GGTP) or Gamma-GT. High levels of GGT are found in the liver, bile ducts, and the kidney. Bloodstream GGT levels will be higher in people with diseases of the liver and bile ducts. 5'N'Tase Higher levels of the enzyme 5'N'Tase (5'nucleotidase), also known as 5'NT, in your blood indicate a problem with bile secretion. Hepatitis or cirrhosis can cause a blockage of bile flow. Albumin Albumin is the major blood protein made by the liver. One function of albumin is to keep the blood from leaking through the blood vessels, which can cause fluid retention in the ankles (edema), lungs, or abdomen (ascites).Low levels of albumin may be due to liver or kidney disease, malnutrition, or even a low-protein diet. Bilirubin This pigmented (yellow) waste chemical comes from the normal process of red blood cells' dying after 90 to 120 days. A healthy liver converts bilirubin and sends it out of the body with the bile that goes to the intestine. Excreted bilirubin gives feces (stools) their characteristic brownish color. When the liver is diseased, bilirubin isn't converted and excreted. Stools might, therefore, be light-colored. The bilirubin that's not properly excreted builds up in the body and gives a yellowish color to skin and eyes (a condition known as jaundice) and dark brown tea color to urine. High levels of bilirubin are due to either too much production of bilirubin (from red blood cells dying) or because the liver isn't processing bilirubin, which happens when the liver is damaged. This is one of three tests used to determine wait time for a liver transplant. In addition to using a blood test, urine can be tested for bilirubin. PT test The PT (prothrombin time) test measures how quickly your blood clots, which is dependent on clotting factors (proteins) that are made by the liver. The PT test is used as a marker of advanced liver disease and can indicate blood-clotting problems where it takes you longer to stop bleeding. Your laboratory may also give PT results that have been converted to an internationally recognized and easily comparable value that's called the International Normalized Ratio (INR). The INR is one of the three factors used to determine wait time for a liver transplant. Other blood tests Additional tests that measure other markers in your blood give your doctor a clearer picture of any liver disease and also any effects from the combination peginterferon drug treatment. Complete blood count (CBC) A complete blood count (CBC) looks at the number and types of cells in your blood. Your doctor will look for problems such as Reduced white blood cells or platelets: This may indicate portal hypertension, a complication of cirrhosis in which pressures are increased in the portal vein. Indicators of anemia: This problem is very common during ribivarin treatment. The complete blood count includes the following tests: White blood cell (WBC) count: The total number of white blood cells. Changes can indicate problems of hepatitis C infection or side effects of interferon treatment. Interferon can cause neutropenia, which is a decrease in neutrophils, one type of white blood cell. Red blood cell (RBC) count: The total number of red blood cells. Low levels can indicate anemia. Hematocrit (HCT): Percentage of blood cells that are red blood cells. Low levels can indicate anemia. Hemoglobin: The amount of this oxygen-carrying protein. Low levels can indicate anemia. Platelet count: Number of platelets in your blood (may be altered in cirrhosis). AFP Tests for AFP (alpha-fetoprotein) are used to screen for liver cancer in people with cirrhosis. But not everyone with liver cancer has this marker. Pregnant women usually have higher levels of this protein, which is also used to look for problems in pregnancy. You may have slightly high levels of this protein if you have hepatitis or cirrhosis. Iron The liver stores iron, and an overabundance of iron (iron overload) can add to the damage caused by hepatitis C. Too much iron can be a problem during interferon treatment. See your physician to determine whether you should avoid supplements that include iron. Creatinine Creatinine is actually a breakdown product of creatine, which is made by the liver and transported to your muscles. The kidneys excrete the waste product creatinine, and when your kidneys are damaged, creatinine levels rise. When the liver stops functioning in end-stage liver disease, this can cause serious kidney problems as well. This test is one of the three used to determine your wait time for a liver transplant.

Article / Updated 03-26-2016

Keeping all your medical information up-to-date and in one place is a good idea. Your best bet is to assemble some sort of notebook where you can store everything. You can use an actual notebook, a three-ring binder (and a hole puncher), a folder, or any combination of these. Whatever system you use, keep the information organizedand easy to find. Include the following types of information: Results of lab tests and other diagnostic procedures: Include such things as blood test results, scanning results, biopsy reports, and other diagnostic information. Here are some tips on maintaining those records: • Request copies of the results of every single test you take. Ask as soon as you have the test or when you first get the result. You may have to pay for copies in some instances. • Consider using a ringed notebook. The documents won't fall out, and you can access them easily. • Make sure the name of the test, the results, and the test or procedure date are legible. Diary of symptoms: You can write this on loose-leaf paper to keep in your ringed notebook or in a separate bound notebook with lined paper. Make sure to date each entry, and write down when the symptom started and when it disappeared or was treated. You may have daily entries to record how you feel each day. This information is an essential part of monitoring your treatment. List of prescription and over-the-counter medications, vitamins, and minerals you take: Go through your medicine cabinet, and write down each one. Include the amount (50 mg, 100 mg, and so on) and how often you take it (once a day, once a week, and so on). List of questions: Write down questions you have for your doctor and other healthcare professionals and keep the answers when you get them. List of doctor visits: For each visit, write down any information or advice the doctor gives you. This information also helps you keep track of health insurance and payment issues. General information on hepatitis C: Include material that you receive from doctors, drug companies, the American Liver Foundation, and so on. Depending on how much information you have, you can place this info in your ringed notebook or folders. Food diary: Some practitioners ask you to keep a food diary. As you do with the diary of symptoms, you can keep a record of what you're eating so that if you have a problem, you can figure out which foods may have caused it. When your first notebook is full, get another, and keep collecting all your information. Keep your old records and notebooks; they have important information you might need at some point. Get creative, and put in healthy affirmations or happy pictures on the front of your notebook or within the pages. Positive thinking can help you get well faster. Your doctor will appreciate your effort to manage your disease on your end. Having all this information conveniently on hand allows you and your doctor to make the best use of the time you have together during visits — more time for discussions and questions, and less time spent on, "Uh, let me think . . ." and "Now, where did I put that?"