feb98c

February 1998 - hepcBC.bull

Squeeky's Corner

Virtual Hits Victoria: Victoria Chapter of HeCSC on the Web
http://www.pacificcoast.net/~hepcvic/hepcvic~1.htm

email:hepcvic@pacificcoast.net

Well folks, it finally happened. We iz airborne, ethereal, electric,
virtual and linked. We are on the Web. Thanks to the kindness and
generosity of Aaron Butters, John Woods and all the other rilly nifty
people at Pacificcoast.net here in Victoria, the Victoria Chapter of the
Hepatitis C Society of Canada now has its own Website and email
account—donated for free for a year. Yay!!

We've been wanting to do this for some time—establish quicker links to the
HepC community—but it's been difficult. Thanks to the tireless efforts of
Jim Lodge (who recently stepped down), we did manage to get a computer
donated to the office. And thanks to other members, in particular Dave
Smith, we even managed to get an office!!

We do have our wonderful bulletin—oh yah, you already know this cuz yur
reading it now— which goes online at Darlene's HepC BC page, and out to all
of you subscribers by snail mail (YOU WILL REMEMBER TO RENEW YOUR
SUBSCRIPTIONS----RIGHT???), but, nevertheless, for those with Web and/or
email access, our presence in virtual reality will really make a difference.

Because we now have a good and widely publicised email address, we hope
that many of you with questions, queries and conundrums will click us a
quick post, and be able to get detailed replies very promptly. Being on
the Web allows us to do database searches much more quickly and
effectively, and to keep you more up-to-date than ever with regard to Hep C
research, Class Action Litigation, and other issues of concern.

Our new site is also linked to the Hepatitis WebRing, and our stories are
available to anyone anywhere on this earth with a computer and internet
access.

Speaking of which: stories? Stories? STORIES??? We need stories. Your
stories, to put on your own Webpage. We need input from you as to what you
think would be important to share with the rest of the WorldWide Hep
community. We also need to know about links that you may have found that
you think should go up on our site.

Below is a list of some of the things you will find when and if you visit
the site. We have links to and articles on: Hepatitis C; Who We Are;
Personal Stories; Peppermint Patti's FAQs; The Liver; HEPV-L Hepatitis
Support and Information Mailing List; HepC BC; Medical and Hep-related
Sites of Interest; Class Action Law Suits: British Columbia; Hep C and
Pregnancy; Hepatitis C and the Beauty Industry; Hep C and IV Drugs; Hep C
and Sex; and lots more.

Remember your feedback is needed. After all this is your site, too.

squeeky

>From the Yale University Symposium:
"Living with Hepatitis C," November 1995

THE LIVER: WHAT IT IS, WHAT IT DOES

James L. Boyer Professor of Medicine, Chief, Section of Digestive Diseases
Director, Yale Liver Center Department of Medicine, Yale University School
of Medicine

THE LIVER: WHAT IT IS

The liver is the largest organ in the body weighing approximately 1500
grams, or 3-4 pounds. Despite its large size it is hidden beneath your rib
cage on the right hand side of your body. Normally the liver remains hidden
and is your silent partner. Perhaps this is why its function is so
mysterious and unknown to many. It is only when it is injured by a variety
of different disease processes that one becomes much more familiar with
this vital organ. Functionally the liver is the most complex organ in the
body carrying out a multitude of different processes which will be reviewed
briefly below.

In ancient times the liver held a special place in the conscience of
society. Persian armies chose their military routes after priests divined
the solution by "looking into the liver." In ancient times the liver was
thought to be the "seat of the soul." Still today the liver holds a much
more noble position in European and Asian societies than in the United
States. In France, when one does not feel well, it is always "mal de foie,"
rather than our customary headache or stomach ache.

THE LIVER: WHAT IT DOES

The liver both stores and releases glucose, an essential sugar and source
of energy required to maintain body functions. This is particularly
important during periods of fasting, for example during sleep when the
liver releases glucose which is vital for brain metabolism.

The liver is the primary source for the synthesis of proteins, particularly
for proteins circulating in the blood, such as albumin and many of the
clotting factors necessary to prevent bleeding into tissues. Many common
drugs and potentially toxic substances are metabolised in the liver where
they are excreted into the bile or through the urine. The liver both
eliminates toxins as well as occasionally forming toxic substances from
drugs which then paradoxically may result in liver injury. Common
substances such as alcohol and sleeping medications stimulate the drug
metabolising enzymes and thus may alter affect the body levels of many
medications, which may often be detrimental.

A unique function of the liver is the secretion of bile. This is an
essential function of the liver, for when bile secretion is impaired,
chronic liver disease may result leading in some instances to the need for
transplantation. Bile is the major route of excretion for cholesterol and
is important in helping to absorb fat in the diet. Thus bile performs both
an excretory and a digestive function.

The liver is the major organ for detoxifying ammonia, an important
by-product of protein metabolism whereby ammonia is converted into urea
which is excreted by the kidney. The liver makes cholesterol which is
important for cell membrane function but causes problems with
arteriosclerosis and coronary heart disease when excessive amounts are
produced.

THE IMPACT OF LIVER DISEASE

Liver disease in an important health problem in the United States. In 1993,
720,000 non-federal hospital admissions were caused by liver disease. The
net costs exceeded $7.8 billion dollars. There are more than 100 different
liver disorders which effect the lives of millions of Americans. Three and
a half million people alone suffer from chronic hepatitis, the subject of
today's symposium. This can be contrasted with 500,000 Americans who
underwent removal of the gall bladder for gall stones annually. Thirty-four
hundred people have undergone liver transplantation in 1993 and in 1992
forty-four thousand people died of liver disorders.

TYPES OF LIVER DISORDERS

There are five different types of liver injury:

1. Hepatitis, which can be both an acute and chronic inflammation of the
liver produced by either a virus, drug, autoimmune or metabolic disorders.
There are several forms of viral hepatitis; A, B, C, D, E, F and more
recently G. Hepatitis B and hepatitis C are the most significant.

2. The second form of liver disease is cirrhosis. This term means that the
liver has been damaged more severely so that its normal architecture is
distorted and there is an increase in scar tissue in the liver and the
liver mass is often reduced. Cirrhosis may be in consequence of
long-standing injury from alcohol, certain viruses, bile duct injury or
metabolic disorders including iron and copper storage diseases.

3. The liver can be affected by infiltrations from many different
substances. The most common is fat which often occurs in patients who are
over-weight and in diabetics. Tumours that spread from other parts of the
body often invade the liver. At this stage cancer is usually wide spread.

4. Certain disorders effect the circulation in the liver such as heart
failure, or vascular shock.

5. Finally many liver disorders result from abnormalities in the bile ducts
both within and outside the liver that drain bile into the intestine. These
disorders may occur secondary to gall stone or pancreatic disorders, from
autoimmune damage to the bile duct tissue (Primary Biliary Cirrhosis,
Sclerosing Cholangitis) or to tumours of the biliary ducts.

Many of the blood tests physicians order help define the type of liver
disorder. Often a liver biopsy may be necessary to more firmly establish
the diagnosis.

This article can also be found at our new Website:
http://www.pacificcoast.net/~hepcvic/hepcvic~1.htm

----------------------------------------------

Chronic Hepatitis C Virus Infection Causes a Significant Reduction in Quality of Life in the Absence of Cirrhosis

PMID: 9425939, UI: 98085908

G. R. FOSTER, R. D. GOLDIN, AND H. C. THOMAS

The effects of chronic hepatitis C virus (HCV) infection, in the absence of
cirrhosis, on patients' quality of life was assessed using the short form
36 (SF36) symptomatology questionnaire. Patients with chronic hepatitis C
were polysymptomatic and had significant reductions in their SF36 scores
for all of the modalities tested. Patients with chronic hepatitis B virus
(HBV) infection showed a reduction in the SF36 scores that assessed mental
functions, but they had no decrease in the scores that measured physical
symptoms, indicating that the symptoms associated with chronic HCV
infection are qualitatively different from those associated with chronic
HBV infection. Patients with chronic HCV infection who had used intravenous
drugs in the past had the greatest impairment in quality-of-life scores,
but the reduction in quality-of-life scores was still found in patients who
had never used drugs. The reduction in quality of life could not be
attributed to the degree of liver inflammation or to the mode of
acquisition of the infection. Hence, chronic infection with HCV per se
gives rise to physical symptoms that reduce the quality of life of infected
patients.

Address reprint requests to: G. R. Foster, RCP, Department of Medicine,
QEQM Wing, St Mary's Hospital, Praed Street, London W2 1 PG, UK. Fax:
44-171-724-9369.

Copyright © 1998 by the American Association for the Study of Liver Diseases.

----------------------------------------------

Variceal Pressure Is a Factor Predicting the Risk of a First Variceal Bleeding: A Prospective Cohort Study in Cirrhotic Patients

source: http://www.hepatologyjournal.org/abs27_1/v27n1p15.html

FREDERIK NEVENS,1 RAMI BUSTAMI,2 ILSE SCHEYS,2 EMMANUEL LESAFFRE,2 AND JOHAN FEVERY1

Predictive criteria for a first variceal hemorrhage lack substantial
accuracy. Cross-sectional studies suggest a close relationship between
variceal pressure (VP) and the occurrence of variceal bleeding.

In the present prospective cohort study, the significance of VP measurement
for prediction of a first variceal bleed was assessed. Eighty-seven
patients with cirrhosis and large esophageal varices who had never
developed variceal bleeding were followed for 12 months. The endpoint of
the study was the presentation or not of a variceal hemorrhage. Thirty-four
patients (39%) were in Child's class A, 37 in class B (43%), and 16 in
class C (18%). The median interval between endoscopic diagnosis of varices
and the beginning of the study was 15 months. Twenty-eight patients (32%)
developed a variceal hemorrhage with a bleeding-related mortality of 18%
(n=5). The 1-year mortality overall was 16% (n=14). Variables predictive of
a first bleed identified by Cox proportional hazards regression model were:
the level of VP, the North Italian Endoscopic Club (NIEC) score, and the
interval between the diagnosis of varices and the start of the study. By
adding VP to NIEC, a significant gain in prognostic accuracy was obtained
(P = .003). In conclusion, the present study provides evidence that the
level of VP is a major predictive factor for variceal hemorrhage, and that
it provides further prognostic information in addition to the NIEC index.

Address reprint requests to: Frederik Nevens, M.D., Ph.D., Dept. of Liver
and Pancreas Diseases, University Hospital Gasthuisberg, Herestraat 49,
Leuven, Belgium. Fax: 32-16-34-43-87.

Copyright © 1998 by the American Association for the Study of Liver
Diseases. August 23, 1997

MY LAST PRISON STORY

As I prepare to re-enter society and leave prison life behind, I
have made an effort to have the Hepatitis C Peer Facilitator’s position at
William Head Institution classified as an employable position. This would
ensure some degree of dedication and accountability for the effort required
to maintain a constant amount of information gathering and distribution.

People are being diagnosed weekly with HCV. They seek me out for
information and I try to give them reassurance that their lives and
hepatitis C virus can coexist.

Luckily Jim Tompson has volunteered to carry on after I leave. If
it weren’t for him I feel the Hepatitis C Awareness Group would slip into
obscurity. The main reason, i.e., five or six dollars a day x 5 days,
cannot be justified. I quote one of the feeble reasons for denying my
request: “We can’t have a paid position for every disease that comes
along.”

I was dumbfounded to hear this from a seemingly intelligent woman.
It reminded me of what an institutional doctor told me 18 months ago:
“You’ve had it for 10 years. Now you’ll live another 10. Quit worrying
about it.”

A large initiative from Corrections Canada is geared toward
HIV/AIDS, where every institution has a paid position for an HIV/AIDS
facilitator. This is absolutely warranted and their coverage is
commendable. With an infection rate of 10-20 HCV prisoners to 1 HIV/AIDS
prisoner, I feel $5.00 per day is justifiable, if, through the spread of
information about Hep C, the transmission rate is reduced from what it is
now.

We’ll all be released into society sooner or later, infected or
not. With the proper information, hopefully not infected. From a
financial standpoint the $5.00 per day Corrections Canada is saving today,
at William Head, is going to cost them far more in a couple of years with
the added strain on their health services from a growing population of
hepatitis C infected prisoners.

Mike G.

(Ed.: The following is a letter that Mike wrote earlier in the year)

May 16, 1997

Dear Ladies and Gentlemen,

First off, I appreciate your taking the time to read this, and I do
thank you in advance for any help or information you can provide.

I have received your address from the internet via a member of the
Hepatitis C Society of Canada in Victoria, BC. I also am a member
and am infected with the Hep C virus.

As briefly as possible I will relate my situation to you.

I am currently incarcerated and am serving a ten year term for
manslaughter. I should be paroled sometime in the next six months. My
first day of incarceration was Dec. 5th, 1992. I was hospitalised with
wounds and unbeknown to me at that time, blood was taken. After a couple
of days, I was taken to Vancouver pre-trial to await a court appearance.
After three days I was transferred to another Pre-Trial closer to the
courthouse. This one was Surrey Pre-Trial Centre. I remained at Surrey
Pre-Trial for twelve months. My health at that time seemed to be abnormal.
I experienced pains in my right side, nausea, depression and fatigue.
Also at this time I was insulin dependent and handling my own blood two or
three times a day for testing and injecting insulin.

For the year I was there, no solution, remedy or reasons for my
deteriorating health were offered.

In November ‘93, I was sentenced to ten years. In December ‘93 I
was transferred to a federal institution. All transfer papers said “No
Contagious Diseases.” At the Matsqui Reception Centre my health was still
in question. I couldn’t understand why I always felt ill. No answers or
explanations were given to me.

In February ‘93 I was transferred to my permanent institution,
William Head in Victoria, BC (on Vancouver Island). Again, all transfer
papers said “No Contagious Diseases.” All the time I have been at William
Head I have been ill. Nobody knows why!

In December ‘95 I requested a Hep C blood test. January ‘96 the
results came back “Positive”. Health care officials, i.e., the nurses and
the doctor seemed surprised. So after four years of illness, I now have a
name for it: “Hepatitis C.”

Today, May 16th 1997, I have chronic viral hepatitis. My liver has
piecemeal necrosis with bridging fibrosis. My enzymes are 4 to 8 times
above normal.

In June ‘96 a specialist recommended interferon treatments and
nothing has been done to this day.

I was transfused with two litres of blood in 1988 at Prince George
Regional Hospital. I believe I am one of the twelve thousand people who
received tainted blood from the government and the Red Cross between 1985
and 1990.

Out of curiosity I applied through the Freedom of Information Act
to receive my provincial medical file. Upon receiving it last year, I was
very surprised to read a blood test from a lab dated December 19, 1992, and
that my blood was positive for the Hep C virus. There were four individual
papers stating I was positive for Hep C. Needless to say, I was very
upset. For four years I have gone unnotified and untreated.

I then perused my federal medical files by the same method. There
were the blood tests from 1992. Very easy to read, I might add.

In keeping this brief I have everything I have said here
documented, including my medical files from the hospital where I was
transfused in which I was given two litres of blood.

My quality of life has deteriorated greatly in the past five years.
I would appreciate some answers from these people. I’d like to know why I
wasn’t told and offered some treatment. I feel the doctors and nurses at
the Surrey and Vancouver Pre-Trials were careless and very negligent in
their duties in not informing me (Who else could I have infected?). I am
upset over this situation and I hope you can help me or point me in an
appropriate direction. To date I have received no treatment, although it
was recommended by a specialist. I fear my ability to earn a moderate
living upon my release is diminishing along with my health.

Thank you for your time and consideration.

Mike G.

PS: I’ve wondered lately if I am the only case, or is there a conspiracy
to cover up the Hep C cases in provincial jails to avoid treatments?

Methionine and Liver Disease- A Word of Caution

by Darlene Morrow, BSc

Methionine or SAM has been recommended to people with HCV as a
liver protectant particularly in conjunction with tylenol (500mg twice a
day). While it is generally accepted that methionine is a liver
protectant, the evidence is not conclusive as to the recommended dosage and
possible side effects. Extreme caution is necessary in individuals with
severe liver disease because drugs/substances are processed in the liver.
The effects of hepatitis C and liver disease vary from individual to
individual. The extent of damage and your particular condition (fibrosis,
cirrhosis, etc.) will all have a bearing on your body's ability to deal
with outside substances. The following excerpt demonstrates the possible
dangers of self-medicating. We strongly recommend that all supplements be
approved for your use by your physician.

Please keep in mind when reading
the following article that the suggested dosage of methionine was 2 x 500mg
which is equal to 1g.

“Should Methionine Be Added to Paracetamol (Tylenol) Formulations?
- Caution in Patients with Liver Disease!”

Reprinted with permission from
[Drugs & Ther Perspect 10(11): 11-13, 1997. (c) 1997 Adis International
Limited]

source:
http://www.medscape.com/adis/DTP/1997/v10.n11/dtp1011.04/dtp1011.04.html

Adverse effects associated with methionine include nausea,
vomiting, drowsiness and irritability. [8] Moreover, methionine should be
used with caution in patients with severe liver disease as this agent may
aggravate hepatic damage and this drug should not be used in patients with
acidosis. [8] Although methionine (an amino acid) is an essential dietary
constituent, studies have shown that methionine may cause reduced serum
folate levels, leucocytosis, changes in serum pH and potassium and
increased urinary calcium excretion when given at dosages of 8 to 13.9
g/day for 4 to 5 days. Moreover, functional psychoses have been seen in
schizophrenic patients receiving higher dosages of 10 to 20 g/day for 2
weeks, and single doses of 8g have precipitated hepatic encephalopathy in
patients with cirrhosis. [3] Although there is no evidence in humans,
animal studies indicate that methionine may have adverse effects on the
cardiovascular and coagulation systems. [3,4]

References:

3.Jones AL, Hayes PC, Proudfoot AT, et al. “Should methionine be added to
every paracetamol tablet? No: the risks are not well enough known.” BMJ
1997 Aug 2; 315: 301-4

4.Krenzelok EP. “Should methionine be added to every paracetamol tablet?
Yes: but perhaps only in developing countries.” BMJ 1997 Aug 2; 315: 303-4

8.Martindale. The Extra Pharmacopoeia, 31st ed. London: Pharmaceutical
Press, 1996: 683-4.

Thymosin Alpha-1

by Darlene Morrow, BSc

The thymus is a gland located just beneath your breastbone. Immune
system cells (such as T cells) are processed in the thymus into either CD4
cells or CD8 cells. CD4 cells (helper cells) are lymphocytes which are
part of the white blood cell group. They help to turn on certain immune
functions and stimulate the production of antibodies. CD8 cells (killer
cells) are guided by the CD4 cells to destroy invading cells such as
viruses.

The CD4 cells are extremely important because of their ability to
control the functions of the immune system. They do this by secretion of
certain substances (for example alpha and gamma interferons), which act as
messengers to tell specific cells to attack and destroy invaders. They also
instruct the bone marrow to manufacture more T cells and have a role in the
production of white blood cells, red blood cells and specific natural
killer cells which attack and destroy cancer cells.

The programming of these T cells is mediated by a substance called
thymosin (Thymosin Alpha-1). Current studies are looking into the effect
of thymosin on HCV. The drug company SciClone has manufactured this
hormone under the name Zadaxin. Clinical trials by SciClone are looking at
thymosin alone or in combination with interferon for the treatment of HCV.
Further studies are looking at various combination therapies for HIV, and
there are extensive trials into the effects of thymosin on HBV.

In September ‘97 SciClone Pharmaceuticals announced that the
European Patent Office granted a use patent for the use of thymosin alpha-1
as a treatment for hepatitis C as a monotherapy or in combination with
interferon. The exclusive use patent covers 15 countries on the European
continent as well as the United Kingdom.

ZADAXIN, which is given by injection, has been shown to be an
extremely safe and well tolerated agent. There has been no evidence of
toxicity and virtually no reports of drug-related side effects in over
2,000 patients studied to date.

An article in the Hepatology Journal, September 97 issue written by
Herbert L. Bonkovsky, M.D., of the University of Massachusetts Medical
Centre reviews and summarises the literature discussed at the recent
National Institutes of Health Consensus Development Conference on the
management of hepatitis C. The conference examined approaches to the
treatment of the disease other than the current standard therapy, alpha
interferon.

Dr. Bonkovsky writes: “Because current standard therapy of chronic
hepatitis C with alpha interferon is less than ideal, numerous other
approaches have been studied....Several cytokines and immunomodulators have
undergone limited study; perhaps the most promising of these is thymosin
alpha-1.”

The review article looks at clinical data from the Fourth International Meeting on Hepatitis and Related Viruses held in March in Kyoto, Japan. The data showed that histological improvement was most evident in those patients who received both thymosin alpha-1 and alpha
interferon.

References

1. Sean Hosein. Treatment options for hepatitis C: Treatment Update
68. Volume 8, no 4. May-June 1996. http://www.catie.ca/tuts/tu68.html#II-B

2. THYMOSIN ALPHA-1 INFO SHEET source:
http://www.aidsnyc.org/pwahg/info/thym.html PWA Health Group 150 West 26th
Street, Suite 201 New York City, NY 10001. (212) 255-0520 Fax: (212)
255-2080

3. Thymic Protein A: Its Development May Signal A New Tool for
Rejuvenating Immune Function. Life Extension Magazine July 1997
http://lef.org/cgi-local/shop.pl/page=july.html#Thymic

4. Article Points to Promise of Thymosin Alpha 1 as Hepatitis C
Therapy. 25 Sep 1997. source: http://www.pslgroup.com/dg/3a1c2.htm

5. Herbert L. Bonkovsky, M.D. Other Options for Treatment of Hepatitis
C. NIH Consensus Development Conference on Management of Hepatitis C.
Hepatology 1997 Sep; 26(3 Suppl 1):143S-151S

6. Liaw YF. Current therapeutic trends in therapy for chronic
viral hepatitis. J Gastroenterol Hepatol 1997
Oct;12(9-10):S346-S353.

DAVE’S COLUMN

In my last column I talked about the benefits of being an optimist and how
it translates into positive physiological responses. Well I must say at
this time that in the last three weeks I have experienced the most
depressing interlude since I had my liver transplant nearly two and a half
years ago.

It seemed as though everything I had learned about myself and how
to stay positive had just flown out the window. I felt like I was flying
in uncharted territory. I was unanchored, unhinged. I felt like I was
freefalling, spiralling. I couldn't eat or sleep. I have to say that I
felt pretty awful. It looked like I was going to have to take those damned
anti-depressant drugs after all! It was all that I could do to get up in
the morning and come to the office.

How did I deal with this new development in my post transplant
journey? Well, fortunately a part of me knew what was going on. I think
that something as serious as a liver transplant leaves lasting psychic
scars—a kind of post-traumatic stress syndrome, if you will. The
invasiveness of the procedure alone is enough to inexplicably scramble your
wiring. Layer on top of that the cumulative effects of end stage liver
disease, which in my case lasted two years, and how could I not have
crashed at some point? I have talked to numerous other recipients over
time and I've heard it said that a crash occurs around the two year mark.
Perhaps two other reasons for this sort of crash happening are the effects
of the drugs on your moods—most notably prednisone. I had stopped taking
it in Feb. of ‘97. Since then I have lost close to 25 lbs. It certainly
had its effect on MY appetite and its effects on mood are quite
well-documented. The absence of prednisone after taking it in megadoses
(at the beginning anyway) for 18 months would undoubtedly have an
incredible effect on the psyche. Factor in what life deals you under
"normal" conditions and you have a recipe for major upheaval.

There's one more thing that I would like to suggest is an important
factor—perhaps THE most important—and that is the effect of the donor organ
with its own DNA, hormones and enzymes, on the host body. We've all heard
the stories about the recipient who upon re-entry to post transplant life
suddenly craved foods that he'd never eaten before only to discover that
they had been well-liked by the donor while still alive. Draw your own
conclusions! I have personally experienced dreams that seemed not to be my
own and I have noticed changes in my personality, albeit subtle, over the
last two and a half years also. A new liver would have an undeniably
profound effect on someone who was at end stage. I can only conclude from
all this theorising that no one really knows the full extent of the effects
of transplantation on the psyche of the recipient. Let’s go way out there
for a minute and suppose that every instant of a person’s life is locked up
in their DNA. In transplantation then, could it be possible that we
hardwire a complete set of memories from donor to recipient? If there is
any truth to this then I could say that I am harbouring a complete set of
memories somewhere deep inside of me and somehow they are influencing my
behaviour in a subtle yet profound way. With all due respect, I have no
idea who my donor might have been, and not a day goes by that I don't think
about that person and give thanks for the life I've been given.

So to get to my original question on how I'm dealing with all this
stuff. First of all, I started a course of accupressure and I've had two
treatments so far; and secondly, I started meditating again. The
accupressure has shown immediate results in my level of stress. Waves of
anxiety would wash over me in an uncontrollable fashion and they had all
but disappeared by my second treatment. Meditation, on the other hand, is
something that doesn't start working immediately but its long term benefits
are quite profound. So, I must stick with it. I think there are two
important things to consider here and they are: recognising that, hey,
there's something wrong here. Why do I feel the way I do? and then
resolving to do something about it. Meditation and accupressure (along
with other potential solutions) will give you insight into what's causing
the depression and provide the tools for dealing with it. There is no
quick fix and it requires constant attention if you’re to see positive
results. Sometimes, though, you can't see the forest for the trees and at
this point you've just got to drag yourself into the doctor's and ask for
help.

David Smith

A Hepatitis Centre for Excellence Proposed

A proposal is being developed for a Hepatitis Centre for Excellence
in British Columbia!

A broad-based steering committee, comprising a variety of agencies,
health providers and consumer representation, has been established to
develop a business proposal and implementation plan. A number of working
groups complete with HCV patient representation have been meeting in
January to provide input to the process.

Key components being discussed for the Centre include:

· Epidemiological analysis/forecasting, prevention and screening

· Treatment and ongoing management of hepatitis

· Outreach and education

· Research

It is expected that the business proposal and implementation plan
for the Hepatitis Centre for Excellence will be completed by March for
submission to the Vancouver/Richmond Health Board and the Ministry of
Health.

Your ideas and suggestions for the Centre are invited. Please
contact one of the following people to participate with your input:

· Herb Moeller: 604.241.7766 email: Hmoeller@compuserve.com

· Darlene Morrow: Fax: 604.987.7396 email: hepcbc@iforward.com

· HeCSC Victoria: 250.388.4311 email: hepcvic@pacificcoast.net

Stay tuned for more details.

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