Home Forums Main Forum FixHepC Admin My doctor is insisting on another Ultasound. Treatment 8/16

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  • #29369
    beahavan
    • Topics: 5
    • Replies: 81
    • Total: 86
    • Guardian Angel
    • ★★★★★
    @beahavan

    I finished treatment for G4 with Harvoni in 11/16. I had Ultrasounds in 2013, 2015 and 2018. They were fine. Now my doctor wants to order another. He says there are no guidelines that say that I am in the clear. I was F0-1 before treatment. I just saw this article posted yesterday in Greg Jefferys ‎ Hepatitis C Treatment Cure and Community Facebook group. I don’t want to spend the time or co-pay on another Ultrasound but perhaps I should go along with my doctor’s request.
    ‎http://hepcbc.ca/2019/02/22/no-time-to-relax-about-liver-cancer-after-hcv-treatment-time-to-change-monitoring-protocols/?fbclid=IwAR0qmWfb8UEU-RPz2Af4mijHF5AxGYxPRiFDF09GZ2E-ZSukuAQltBgd6Wg


    G4
    F0-F1
    diagnosed in 2006
    Tx naive
    Treatment started 8/12/16, Ledipasvir/ Sofosbuvir (Harvoni) supplied by Monkmed
    8/1/16 ALT 36 AST 40
    1/4/17 ALT 17 AST 21
    7/13/17 ALT 17 AST 25
    12/28/17 ALT 22 AST26
    2/22/18 ALT 19 AST 25
    7/10/18 ALT 26 AST 32
    1/8/19 ALT 16 AST 28
    7/2/19 ALT 16 AST 26
    Hcv Rna, Quantitative Real Time Pcr <15 NOT DETECTED (IU/mL) NOT DETECTED

    #29428
    Avatar photosabrecat
    • Guardian Angel
    • ★★★★★
    @sabrecat

    Hi beahaven,

    I was F3 from memory in 2012 when my G.P. found high AFP levels and a subsequent ultrasound a HCC.

    Post liver re-section I was getting CT and ultra sounds every 6 months – now just ultrasounds. I think I progressed to F4 in the years following until treated successfully with DAAs.

    I don’t have to pay, but would if I had to. Just like servicing a car and probably cheaper too.

    I understand that paying and getting the ultrasound done is inconvenient, but so was the HCC for me.

    Hope this helps

    Jeff

    #29429
    beahavan
    • Topics: 5
    • Replies: 81
    • Total: 86
    • Guardian Angel
    • ★★★★★
    @beahavan

    This is good advice. Thank you. I have had so many dental issues (root canal and dental implants) since treatment. I lost a lot of bone. This has been a great expense. I’m just worried about costs. However, you made a good point about maintenance. The cost of HCC would be a great deal more. I wish you well.


    G4
    F0-F1
    diagnosed in 2006
    Tx naive
    Treatment started 8/12/16, Ledipasvir/ Sofosbuvir (Harvoni) supplied by Monkmed
    8/1/16 ALT 36 AST 40
    1/4/17 ALT 17 AST 21
    7/13/17 ALT 17 AST 25
    12/28/17 ALT 22 AST26
    2/22/18 ALT 19 AST 25
    7/10/18 ALT 26 AST 32
    1/8/19 ALT 16 AST 28
    7/2/19 ALT 16 AST 26
    Hcv Rna, Quantitative Real Time Pcr <15 NOT DETECTED (IU/mL) NOT DETECTED

    #29435
    dope-on-a-rope.jpgDr James
    • Guardian Angel
    • ★★★★★
    @fixhepc

    Hello beahaven – from your F0-F1 starting point your HCC risk is pretty much the same as the general population (ie very small).

    Normal, F0 and F1 are all close together. F3 and F4 are close together. F2 is a middle ground. You are at the lowest possible end for fibrosis and the lowest possible risk for HCC. While there is a push to extend surveillance to F3 patients there is not a push to extend it to F2 or F1 or F0.

    Your doctor would seem to be being over cautious. Monitoring your AFP is almost certainly sufficient (if you are of a paranoid disposition), particularly if funds are tight.

    If you were my patient I would not be monitoring you for HCC (with either AFP or U/S) and would have declared you cured.

    The occasional patient with F0, F1 and F2 will get an HCC. So to will the occasional patient who does not have Hep C (or Hep B) or any other liver issue.


    YMMV

    #29439
    beahavan
    • Topics: 5
    • Replies: 81
    • Total: 86
    • Guardian Angel
    • ★★★★★
    @beahavan

    My last 3 AFP test results were
    12/1/15 1.9
    1/4/17 2.2
    2/22/18 2.6

    I will suggest another AFP test rather than an Ultrasound. Cost is an issue. Thank you.


    G4
    F0-F1
    diagnosed in 2006
    Tx naive
    Treatment started 8/12/16, Ledipasvir/ Sofosbuvir (Harvoni) supplied by Monkmed
    8/1/16 ALT 36 AST 40
    1/4/17 ALT 17 AST 21
    7/13/17 ALT 17 AST 25
    12/28/17 ALT 22 AST26
    2/22/18 ALT 19 AST 25
    7/10/18 ALT 26 AST 32
    1/8/19 ALT 16 AST 28
    7/2/19 ALT 16 AST 26
    Hcv Rna, Quantitative Real Time Pcr <15 NOT DETECTED (IU/mL) NOT DETECTED

    #29442
    dope-on-a-rope.jpgDr James
    • Guardian Angel
    • ★★★★★
    @fixhepc

    Hello beahavan,

    Although there is a form of HCC that does not produce AFP the pre test probability of you having an HCC are the less than the general population (without HCV) because of all the monitoring we have done excluding it.


    YMMV

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