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Hepatitis C often has good prognosis



DEAR DR. DONOHUE: Please save my life. I was diagnosed with hepatitis C five years ago. Tests now say I need treatment. I am scared to death of treatment, about which I have heard horror stories. I have an older husband who will not make it without me. I feel great and have terrific energy. I am 59. Is there something other than the standard treatment I can take? — S.D.

ANSWER: Infection with the hepatitis C virus leads to chronic liver infection in 85 percent of patients. However, illness doesn’t appear until 10 to 20 years after infection. At that time, about 20 percent of infected people develop liver cirrhosis, and 1 percent to 4 percent come down with liver cancer. That means 75 percent of patients do not develop serious liver disease.

Treatment is necessary when evidence of the virus can be found in the blood and when the liver shows changes that indicate cirrhosis will be a likely outcome. Most of the time, that’s determined through microscopic examination of liver tissue obtained by a needle biopsy.

Who has given you the horror stories of treatment? It’s not a picnic, but it isn’t as terrifying as it has been portrayed to you. Ribavirin is one of the drugs used. Its worst side effect is anemia, a drop in the red blood cell count. Stopping the drug just about always returns the count to normal. Peginterferon is the other drug used in treatment. Its most common side effect is flulike symptoms: headache, muscle pain, fever, nausea and vomiting.

Appropriate medicines can control these symptoms. It also can produce a drop in both the white and red blood cell counts. It has aggravated depression and given a few people thoughts of suicide. Hair-thinning is another possible side effect. The list of potential side effects is long. Most resolve when the drug is stopped. And most patients complete therapy without having to greatly modify their activities during treatment. Peginterferon is injected under the skin once a week. People learn how to inject themselves. There are no other effective treatments.

The booklet on hepatitis describes hepatitis A, B and C, and their treatments. Readers can obtain a copy by writing: Dr. Donohue — No. 503W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./ $6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I would appreciate any information on lipomas. In recent years, I’m getting more of them. I am 79 and did not have them until five or six years ago. I have a large one in the middle of my back and a couple on my thighs. I have recently gotten two small ones on my lower arm. — M.B.

ANSWER: Lipomas are noncancerous fatty tumors. About 1 percent of the population has one or more of them. No one knows the cause, so preventive treatment also remains unknown. However, if they cause pain by pressing on adjacent structures or if they are unsightly, they can be removed without much trouble, often as an outpatient.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

©2009 North America Synd.

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