DISCLAIMER: Neither HeCSC nor the hepc.bull can endorse any physician, product or treatment. Any guests invited to our groups to speak, do so to add to our information only. What they say should not necessarily be considered medical advice, unless they are medical doctors. The information you receive may help you make an informed decision. Please consult with your health practitioner before considering any therapy or therapy protocol. The opinions expressed in this newsletter are not necessarily those of the organisation.

(Alanine aminotransferase serum)

ALT, an enzyme appears in liver cells, with lesser amounts in the kidneys, heart, and skeletal muscles, and is a relatively specific indicator of acute liver cell damage. When such damage occurs, ALT is released from the liver cells into the bloodstream, often before jaundice appears, resulting in abnormally high serum levels that may not return to normal for days or weeks.

The purpose of this blood serum test is to help detect and evaluate treatment of acute hepatic disease, especially hepatitis, and cirrhosis without jaundice. To help distinguish between myocardial (heart) and liver tissue damage (used with the AST enzyme test). Also to assess hepatotoxicity of some drugs.

ALT levels by a commonly used method range from 10 to 32 U/L; in women, from 9 to 24 U/L. (There does exist differing ranges used by various laboratories.) The normal range for infants is twice that of adults.

Very high ALT levels (up to 50 times normal) suggest viral or severe drug-induced hepatitis, or other hepatic disease with extensive necrosis (death of liver cells). (AST levels are also elevated but usually to a lesser degree.) Moderate-to-high levels may indicate infectious mononucleosis, chronic hepatitis, intrahepatic cholestasis or cholecystitis, early or improving acute viral hepatitis, or severe hepatic congestion due to heart failure.

Slight to moderate elevations of ALT (usually with higher increases in AST levels) may appear in any condition that produces acute hepatocellular (liver cell) injury, such as active cirrhosis, and drug-induced or alcoholic hepatitis. Marginal elevations occasionally occur in acute myocardial infarction (heart attack), reflecting secondary hepatic congestion or the release of small amounts of ALT from heart tissue.

Many medications produce hepatic injury by competitively interfering with cellular metabolism. Falsely elevated ALT levels can follow use of barbiturates, narcotics, methotrexate, chlorpromazine, salicylates (aspirin), and other drugs that affect the liver.

Be Aware: Serum liver enzymes can create confusion for both patients and physicians for these tests are highly sensitive, but very nonspecific. Tests commonly referred to as liver function tests or LFTs do not actually determine liver function. Instead, they are static, primarily diagnostic parameters that serve to detect liver disease rather than quantitative liver function.

Rather than liver function tests, it is more useful to refer to these tests as serum liver tests and to mentally categorize them according to the pathophysiologic processes they truly reflect. The serum liver enzyme AST (formerly known as SGOT) and ALT (formerly known as SGPT) are primarily nonspecific markers of necrosis (cell/tissue death) and inflammation, whereas alkaline phosphatase (AP), gamma glutamyl transpeptidase (GGT) and 5'-nucleotidase (5'-NT) are nonspecific indicators of cholestasis (stoppage or suppression of the flow of bile). The serum albumin level and prothrombin time (PT) reflect hepatic synthetic ability, but are too static to quantitate liver function. Likewise, the serum bilirubin level reflects prehepatic, intrahepatic, and posthepatic factors, making the differential diagnosis of jaundice complex. Of the available liver tests, only a handful such as the C-aminopyrine breath test and galactose elimination capacity (GEC) truly quantitate liver function.

AST

(Aspartate aminotransferase serum)

One of the two main liver function blood serum tests (the other being the ALT test). The purpose of this blood test is to detect a recent myocardial infarction (heart attack); to aid detection and differential diagnosis of acute hepatic disease and to monitor patient progress and prognosis in cardiac and hepatic diseases.AST levels by a commonly used method range from 8 to 20 U/L although some ranges may express a maximum high in the 40s. (Check with your physician.)

AST levels fluctuate in response to the extent of cellular necrosis (cell death) and therefore may be temporarily and minimally elevated early in the disease process, and extremely elevated during the most acute phase. Depending on when the initial sample was drawn, AST levels can rise—indicating increasing disease severity and tissue damage or fall—indicating disease resolution and tissue repair. Thus, the relative change in AST values serves as a reliable monitoring mechanism.

Maximum elevations are associated with certain diseases and conditions. For example, very high elevations (more than 20 times normal) may indicate acute viral hepatitis, severe skeletal muscle trauma, extensive surgery, drug-induced hepatic injury, and severe liver congestion. High levels (ranging from 10 to 20 times normal) may indicate severe myocardial infarction (heart attack), severe infectious mononucleosis, and alcoholic cirrhosis. High levels may also occur during the resolving stages of conditions that cause maximal elevations. Moderate-to-high levels (ranging from 5 to 10 times normal) may indicate chronic hepatitis and other conditions. Low-to-moderate levels (ranging from 2 to 5 times normal) may indicate metastatic hepatic tumors, acute pancreatitis, pulmonary emboli, alcohol withdrawal syndrome, and fatty liver (steatosis).

GGT

(Gamma glutamyltransferase)

The purpose of this blood serum chemistry test is to provide information about hepatobiliary diseases, to assess liver function, and to detect alcohol ingestion. Another purpose is to distinguish between skeletal disease and hepatic disease when serum alkaline phosphatase is elevated. A normal GGT level suggests such elevation stems from skeletal disease.

Normal results in females under age 45, range from 5 to 27 U/L; in females over age 45 and in males, levels range from 6 to 37 U/L. Serum GGT values vary with the assay method used (colorimetric or kinetic). The sharpest increases in GGT levels indicate obstructive jaundice and hepatic metastasis. Elevations may indicate any acute hepatic disease, acute pancreatitis, renal disease, alcohol ingestion, postoperative status, and prostatic metastasis.

This test is nonspecific, providing little data about the type of hepatic disease. GGT is particularly sensitive to the effects of alcohol in the liver, and levels may be elevated after moderate alcohol intake and in chronic alcoholism, even without clinical evidence of hepatic injury.

One of our members up-island has asked us to share some good news with you. Our friend, who has cirrhosis, had a blood test in August of 1998 which revealed AST-93, ALT-50 and a disturbingly low platelet count of 52.

After taking the following herbal extracts, CELA-M and CELA-2-M, under the supervision of a naturopath, blood tests in November 1998 revealed AST-50, ALT-23 and a platelet count of 81. He also feels great.

I just got back from the HCV Conference in Ottawa and I wanted to let you know the highlights of the meeting (which was fabulous).

First of all, I have to thank Jeremy Beaty for getting me an invite. The opportunity to be at this groundbreaking conference was due to his negotiations and involvement with the MRC and Health Canada.

I took two books of notes (!!!!) and will put it all in electronic form and on the web as soon as I have a chance.

This conference was unique because it not only involved the top hepatologists and gastroenterologists but also public health, CBS, epidemiologists, virologists, molecular cell biologists, psychiatrists, pediatrics and the list goes on. Of course all were specialized in HCV.

The highlights :

1. The CBS (Canadian Blood Supply) will be adopting PCR testing soon (in the next few months—I can't remember exactly but I have it written down).

2. The Nurses union had a meeting last weekend and have started a new specialty in hepatology. More help coming for us!!

3. Everyone recognizes the appalling lack of info on the part of GPs and Family Practitioners and a plan was proposed to get them up to snuff. Hallelujah.

6. Recognition that we MUST have more clinical trials coming to Canada to offer more treatment options especially for those people that relapse, etc. We must have fast tracking similar to the AIDS model to encourage drug companies to come to Canada.

7. Fatigue was recognized by ALL as being a major symptom of HCV and one that must be studied more. New tests that assess fatigue and quality of life must be HCV specific and get into much more detail.

8. Genotyping MUST be available for EVERY HCV patient. Anything less is providing substandard health care. The genotyping is necessary to make specific treatment recommendations e.g.—type 1b (they estimate that to be in the 85% range) must be treated for 1 year for the most favourable response and type 2 or 3 only need 6 months. I also stressed that this must not be done to exclude patients from treatment.

9. Long term follow up on responders to the combo is necessary to assess both the continued response and the long-term effect of the side effects (they have no idea what that will be).

10. Dental transmission was recognized. As were all forms of body piercing

Why do women wear evening gowns to night clubs? Shouldn't they be wearing night gowns?

When someone asks you, "A penny for your thoughts," and you put your two cents' worth in, what happens to the other penny?

Why is the man who invests all your money called a broker?

Why is a person who plays the piano called a pianist, but a person who drives a race car not called a racist?

Why are a wise man and a wise guy opposites?

Why isn't 11 pronounced 'onety-one'?

"I am" is reportedly the shortest sentence in the English language. Could it be that "I do " is the longest sentence?

If lawyers are disbarred and clergymen defrocked, doesn't it follow that electricians can be delighted, musicians denoted, cowboys deranged, models deposed, tree surgeons debarked and dry cleaners depressed?

This column is a response to requests for a personal classified section in our news bulletin. Here is how it works:

To place an ad: Write it up! Max. 50 words. Deadline is the 15th of each month and the ad will run for two months. We'd like a $10 donation, if you can afford it. Send checks payable to HeCSC Victoria Chapter, and mail to HeCSC, Attn. Squeeky, 1611 Quadra St., Victoria, BC V8W 2L5. Give us your name, tel. no., and address.

To respond to an ad: Place your written response in a separate, sealed envelope with nothing on it but the number from the top left corner of the ad to which you are responding. Put that envelope inside a second one, along with your check for a donation of $2, if you can afford it. Mail to the same address as above.

Where to start? At the beginning! I am 38 years old. In 1988, at age 22, I had blood and platelet transfusions during emergency heart surgery and a series of operations on aneurysms that came up all over my body. The diagnosis? Endocarditis—most people don't live.

I did. I recovered enough over five years to rebuild something of a life again.

I knew I had hepatitis symptoms a month after getting out of the hospital. I was diagnosed with Non-A/Non-B hepatitis, which they renamed hepatitis C in 1989.

My GP at the time said, "You've nothing to worry about. It's just a hepatitis that you got from the blood work in the hospital. You had it and are now fully recovered. You have antibodies now. You'll always be a carrier but you won't have any symptoms."

I changed GPs in late 1992. I told the new doctor I had hepatitis C. He ordered blood work, and then told me exactly the same thing as the first GP, but added, "You can't pass it sexually or anything. You won't ever have any symptoms. You are just a carrier." He did one more round of blood tests in 1994, which he said were for the liver.

I went to him at least every six months, sometimes more, for Pap smears, etc., from 1992 until 1998.

He'd always ask, "Are you feeling are right?" I was better than I had been since my horrific 1988 illness. I managed retail stores, working 14 hours a day, 6-7 days a week. I was happy to start building a life again and having an income.

I went into property management in 1996. I loved it. I finally found my vocation—working 70 hours a week, enjoying every minute of it. I was doing well in every way except romantically. Even though both doctors led me to believe I could not pass it sexually, I felt obligated to tell prospective relationships I had it. That killed any romantic involvement.

I joined class action in 1996. They advised me that I was one of the ones with no symptoms, so settlement would be significantly smaller. I did not hang any hopes on settlement. I felt great, rising to be one of the top property managers in the company.

I was never phoned or contacted with results, so I assumed everything was still OK. In April, 1998, I went for a Pap smear and was told, "Your enzymes were slightly raised from the blood test in January. You should go to Dr. Anderson, a liver specialist, and have a liver biopsy."

I couldn't take this in during the appointment. I went back a week later and got into a large fight with him. I changed doctors that day. How could this be? I spent the summer reading everything I could, getting more and more worried, waiting for the specialist appointment in September, the earliest I could get in. I started taking herbs and vitamins, and my job began suffering. On the recent review of blood work done in blood tests—1992 through 1994—the AST level was twice normal range, as high as it was showing now. No GGT or ALT tests were done.

On October 16, 1998, a liver biopsy was performed. Dr. Anderson told me I'm in the last stages of cirrhosis grade 3-4. I also have autoimmune hepatitis, which has been destroying my liver. I was devastated.

I took steroids for eight months to try to stop it. I asked him if I had found this out years ago, could we have stopped the destruction to my liver? He said yes.

Now I was fighting for my life. The whole life I had managed to build, I saw being snipped away. Besides the emotional and side effects from the steroids, I still had no symptoms.

I filed a lawsuit against the GP. How can these doctors treat people with such ignorance and lack of care? I may die before anything comes of it, but if it makes one doctor send one patient to a specialist because he admits he knows nothing about this horrible virus, it will do some good.

That is why I am writing to the newsletter. If I had felt lousy, I would have demanded to see a specialist, but in feeling great, I trusted this doctor to at least keep up with treatments and everything else to do with this virus. When he assured me I was fine, I believed him because I felt fine and wanted to put all illness behind me. This is a bitter lesson—and one that may be too late.

Camp Church and Associates

Sharon Matthews / Kim Graham

4th Floor, Randall Building

Vancouver, BC V6B 1Z5

1-(888)-236-7797

Grant Kovacs Norell

Bruce Lemer

Grosvenor Building

930-1040 West Georgia Street

Vancouver, BC, V6E 4H1

Phone: (604) 609-6699 Fax: (604) 609-6688

Before August 1, 1986

Klein Lyons

David A Klein

805 West Broadway, Suite 500

Vancouver, BC V5Z 1K1

(604) 874-7171 or 1-(800) 468-4466

(604) 874-7180 (FAX)

also:

Dempster, Dermody, Riley and Buntain

William Dermody

4 Hughson Street South, 2nd Floor

Hamilton, Ontario L8N 3Z1

(905) 572- 6688

The toll free number to get you in touch with the Hepatitis C Counsel is 1-(800)-229-LEAD (5323).

Pre 1986/post 1990

Mr. David Harvey

Goodman & Carr

200 King Street West

Suite 2300

Toronto, Ontario, M5H 3W5

Phone: (416) 595-2300

Fax: (416) 595-0527

TRACEBACK PROCEDURES:

The Canadian Red Cross Society

4750 Oak Street

Vancouver, BC, V6H 2N9

1-(888) 332-5663 (local 207)

This information is for anyone who has received blood transfusions in Canada, if they wish to find out if their donors were Hep C positive.

If you would like more information about class action/compensation, you can contact:

Trisha Plunkett Tel. (250) 479-5369

Tel. 1-(888) 780-1111