I am a 57-year-old white American male infected with Hepatitis C. I am involved in a controlled medical research study by Roche Pharmaceuticals of an experimental Polymerase Inhibitor (RO5024048 also known as RG7128) drug therapy for the virus. This document is the story of my illness and the experience of treatment. My lovely and pretty damn wonderful wife will be contributing her take on the experience as well.

Wednesday, March 24, 2010

Biopsy Is Just Another Word For Really Big Needle

While drifting through limbo in the late spring of 2009, I decided to get a liver biopsy. A biopsy can be a scary concept for a lot of people. The basic process is to take a big needle and push it into your liver to get a small sample of tissue along the length of your liver. They look at it under a microscope and determine what stage the damage to your liver is at.

I decided to get a biopsy because all the reading I had done about Hep C had indicated that only a biopsy could actually tell you how far the damage to your liver had progressed. Blood tests can show the level of liver enzymes and elevated levels can indicate different levels of damage. Blood tests can be problematic for a number of reasons. You can show very little enzyme elevation even though you have advanced liver disease. Conversely, you can show high levels of liver enzymes (me) and potentially be at an early stage of the disease. Ultrasound and CAT scans can tell the size and external condition of the liver and give some information about fatty deposits and granularity of the liver, but the only way you can actually see what stage the inflammation and scarring are at is to look at the tissue.

I talked to my gastroenterologist about a biopsy and mentioned that it seemed to be the only way to be sure of the condition of my liver and that it would give us a baseline to compare with moving forward. He agreed with that assessment and did a thorough job of going over the procedure and possible complications. The major complication is internal bleeding that can occasionally be difficult to control. Another is the possibility of bile leakage.

The actual procedure was pretty straightforward. It was done on an outpatient basis and took a full morning for the procedure. It was done in a “twilight sleep” state rather than full anesthesia. They prepped me and took me in to the procedure room. My wife was actually able to accompany me all the way to the door of the room, which made her much happier and more relaxed. When they moved me to the table and laid me on my side, the anesthesiologist laid out her syringes. When I saw her lay out 3 syringes of Fentanyl, I realized I was not going to be feeling a thing. Somewhat more at ease, I made the mistake of looking back over my shoulder. Doing so, I saw the doctor removing the biopsy needle assembly from its blister pack. It is the longest needle I have ever seen. I don’t know how long it actually is, but it looked like it was about a foot long and the width of a ten-penny nail. I immediately looked away and made sure not to look in that direction for the remainder of my stay in the procedure room.

They shot me up with all the requisite drugs, rolled me on my side and said, “when you hear a click, it will be over.” I felt absolutely nothing, heard a click a few seconds later and it was over. They taped the wound, rolled me over so that the weight of my body pressed down on the bandage, told me to stay that way and sent me back to recovery. The whole stay in the room for the procedure was about 5 minutes.

They kept me for about 90 minutes to wait out the sedatives and monitor the bleeding from the wound and to determine if they could detect any internal bleeding. Every thing went fine and I went home and slept the rest of the afternoon.

The good news was that the biopsy determined I had stage 1 liver disease. This is the earliest stage with the least damage. Doctor C told me in the follow-up discussion that this result bought me time to consider all my options regarding how to proceed against the Hep C. I was not in any immediate danger with my liver, so I was not under pressure to do something before I was ready. This was exactly what I needed to hear. It gave me the space for a lot of serious research and thought about the possible routes I could take with the disease.

The important part of this whole process was the fact that the liver biopsy is not as traumatic as a lot of folks I have talked to believe it to be. While there are risks as with any medical procedure, the sure knowledge of the state of your liver is a great help in deciding how you want to move forward in dealing with Hep C.

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