Liver Specialists of Texas RSS Feed

Dr. Galati Discusses Fruits and Vegetables

Joseph Galati, M.D. - noemail@texasliver.com — Sun, 29 Jan 2012 18:00:00 GMT

In this video blog, Dr. Joe Galati discusses frozen fruits and vegetables, and how to make the best selection at the food store.

View the You Tube Video here.

29-Jan-12 12:00 PM

Psychiatric Side Effects of Hepatitis C Therapy: Parts 1 and 2

Joseph Galati, M.D. - noemail@texasliver.com — Fri, 11 Nov 2011 14:00:00 GMT

Our latest video, as part of the Hepatitis C Education Program, is a two-part video featuring Dr. Jennifer Pate, a psychiatrist specializing in the care of patients with chronic liver disease.

The video blog can be viewed here for more details.

11-Nov-11 8:00 AM

Hepatitis C Treatment: Side Effects Management with Dr. Saira Khaderi

Joseph Galati, M.D. - noemail@texasliver.com — Sun, 02 Oct 2011 04:00:00 GMT

In this You Tube video, Dr. Khaderi discussed several of the commonly encountered side effects related to hepatitis C therapy with interferon, ribavirin, and the new protease inhibitors.

To view the video on our You Tube Channel, click here.

1-Oct-11 11:00 PM

Liver Specialists of Texas Newsletter 21-Sep-11

Joseph Galati, M.D. - noemail@texasliver.com — Thu, 22 Sep 2011 13:03:30 GMT

Welcome to the Liver Specialists of Texas newsletter of upcoming events, articles, and more from our membership. We all appreciate your interest in our practice, and learning more about liver disease, new treatments that are available, health and wellness, and the prevention of disease.

Here is the latest from Liver Specialists of Texas.

Colon Cancer Video: Colon cancer is the number three cancer that adults are at risk for. We recently posted a video that is a perfect example of a patient who neglected rectal bleeding, only to find out there was a large polyp looming in his colon. To view the video, click here.

New Hepatitis C Research Opportunities: We continue to participate in clinical research studies for hepatitis C that are available for those either naive to HCV therapy (never treated) or those that have experience with therapy and never fully cleared the virus. One of the new studies is specificially researching African American and Latino adults with hepatitis C. If interested, you can contact our office for details. To learn more, click here.

Inside Look at Liver Transplant Surgery: View photographs of a liver transplant performed a couple of years ago, performed by Dr. Mark Ghobrial, and photographed by Dr. Galati. To view the video, click here.

New FDA Approved HCV Therapy-What You Need to Know, A Podcast: Listen to Dr. Galati discuss the new hepatitis C therapies recently FDA approved. Listed here.

Dietary Fiber: By request, one of the most popular downloads, this article reviewed a plan to increase your dietary fiber. With planning, you can increase your daily fiber to 30-40 grams. Start increasing your fiber by clicking here.

Tune in to Your Health First: Every Sunday evening at 7:00 p.m., tune into Your Health First, Dr. Galati's weekly radio program that discusses current health and wellness topics, with experts from around the world. Listen live at 740 KTRH or on the web at www.ktrh.com.

Staff Profile-Saira Khaderi, M.D.: Dr. Saira Khaderi has been with Liver Specialists of Texas for 1 year, and her presence has enhanced the patient experience greatly. Dr. Khaderi this year will be developing a specialized clinic for those individuals with non-alcoholic fatty liver disease. Deatails on this will follow in the next few months.

Stay up to date with our RSS feeds.

22-Sep-11 8:03 AM

Dr. Saira Khaderi Discussed Liver Disease

Joseph Galati, M.D. - noemail@texasliver.com — Tue, 17 May 2011 00:00:00 GMT

16-May-11 7:00 PM

Liver Specialists of Texas Newsletter 14-May-11

Joseph Galati, M.D. - noemail@texasliver.com — Sun, 15 May 2011 03:58:05 GMT

Welcome to the Liver Specialists of Texas newsletter of upcoming events, articles, jobs and more from our membership.

Yesterday, the FDA give approval to Boceprevir, the first in-class direct acting agent against hepatitis C. This is a long awaited announcement, and great news for patients and providers caring for hepatitis C. A You Tube video is available for review, with Dr. Galati's discussion of how patients will be evaluated and considered for treatment with Boceprevir.

Boceprevir Receives FDA Approval: A You Tube Video

A You Tube video of the announcement by Dr. Joe Galati is posted, discussing how Liver Specialists of Texas will evaluate and treat both new and old patients with Boceprevir. After years of research, and great anticipation by patients and physicians involved in the care of patients with hepatitis C, Boceprevier was finially approved yesterday. Yesterday was a very important day for those of us involved in the care of patients with hepatitis C, as well as the millions of... [More Info]

Conatus Continues New HCV Drug Development

A new financial report by Conatus, a company who is involved with HCV drug development, reports continued investment in their new HCV drugs. We are fortunate that we are conducting studies with their new agents, with good results. For more information, read the blog entry here.

New Hepatitis C Drug, Boceprevir, Features in New England Journal

Dr. Galati posted a blog entry from Berlin where he is attending the European Association for the Study of Liver Disease. Read the entire blog here.

Liver Specialists of Texas Supports The First Colony Dream League

Dr. Galati and Liver Specialists of Texas are 2011 supporters of the First Colony Dream League. First Colony Dream League is a Little League program in Sugar Land, Texas. The Dream League is a division of First Colony Little League (FCLL) and was established in Spring 2007. The Dream League roster is approximately 60 physically- and/or mentally- challenged players. In addition, the league has an Angels in the Outfield program, where approximately 150 teenage boys and girls from Ft.... [More Info]

OraSure Technologies Rapid Hepatitis C Test

OraSure Technologies Rapid Hepatitis C Test has been submitted to the FDA for a CLIA waiver, which would allow greater availability to this screening hepatitis C test for those at risk for hepatitis C. Read Dr. Galati's blog entry for more details.

The Five Most Common Questions Liver Transplant Patients Ask Dr. Galati

Dr. Galati recently narrated this You Tube video on The Five Most Common Questions Liver Transplant Patients Ask. If you have additional questions, contact us.

Telaprevir and Boceprevir: FDA Approval Soon

There is great excitement regarding the soon to be FDA approval of both Telaprevir and Boceprevir, in the treatment of chronic heaptitis C. Read here for more information on Dr. Galati's opinion on what will be coming later this summer.

Stay up to date with our RSS feeds.

14-May-11 10:58 PM

Boceprevir Receives FDA Approval: A You Tube Video

Dr. Joseph Galati Galati - noemail@texasliver.com — Sun, 15 May 2011 01:30:00 GMT

A You Tube video of the announcement by Dr. Joe Galati is posted, discussing how Liver Specialists of Texas will evaluate and treat both new and old patients with Boceprevir.

After years of research, and great anticipation by patients and physicians involved in the care of patients with hepatitis C, Boceprevier was finially approved yesterday.

Yesterday was a very important day for those of us involved in the care of patients with hepatitis C, as well as the millions of individuals affected by it. I received word yesterday afternoon that the FDA has approved boceprevir for the treatment of G1 CHC in previously untreated patients and patients who have failed previous interferon and ribavirin therapy. Boceprevir is the first in class direct acting antiviral to be FDA approved for CHC. Manufactured by Merck pharmaceutical company, the new drug will be commercially available by the name VICTRELIS.

It is expected that VICTRELIS will be available in your local pharmacy very soon.

Keep in mind these new protease inhibitors are given in combination with interferon and ribavirin.

For the first time in nearly 10 years, we have a new drug to treat and cure those with hepatitis C. The clinical research leading up to its approval is stunning, with the highest success rates ever seen in hepatitis C. This is truly a landmark breakthrough in medicine. For those waiting for “the new drugs to treat hepatitis C”, you day has come.

For those patients of ours at Liver Specialists of Texas, I anticipate to be hearing from all of you very soon. It will take time to get all of you scheduled and seen by our hepatitis C treatment team. Call our office to get the ball rolling, and in the meantime, I’d ask that you do the following:

Make sure you have all of your old records related to past hepatitis C treatments. It is important to see how you responded previously, and what special attention you may need as we re-treat you.
If you have had a prior liver biopsy, an outside facility, do your best to get a copy of the report.
When you call the office, we need to know if you have been treated in the past, or naïve (never treated) for hepatitis C.
If you have been treated, we’d like to know your past response to therapy.
Were you a null responder, non-responder, or a responder relapser. Again, this will help tailor how you will be treated.
When speaking with our staff, let us know if you have diabetes, heart disease, kidney disease, or received a prior liver or kidney transplant. The more information we have about you, the better we can care for you.

In the next few days, we will have posted on the web a hepatitis C questionnaire, dealing with some of these issues just mentioned. All of are looking forward to an orderly evaluation process for our patients.

If you are going to be new to our practice, additional intake information will be needed and forwarded to you.

All of us at Liver Specialists of Texas are very happy with these developments, and we look forward to caring for you.

Visit our website often as new information will be posted daily.

14-May-11 8:30 PM

Conatus Continues New HCV Drug Development

Dr. Joseph Galati - noemail@texasliver.com — Thu, 14 Apr 2011 17:00:00 GMT

For more information, read the blog entry here.

14-Apr-11 12:00 PM

New Hepatitis C Drug, Boceprevir, Features in New England Journal

Dr. Joseph Galati Galati - noemail@texasliver.com — Thu, 31 Mar 2011 23:00:00 GMT

Dr. Galati posted a blog entry from Berlin where he is attending the European Association for the Study of Liver Disease. Read the entire blog here.

31-Mar-11 6:00 PM

Liver Specialists of Texas Supports The First Colony Dream League

Dr. Joseph Galati Galati - noemail@texasliver.com — Sun, 27 Mar 2011 19:00:00 GMT

Dr. Galati and Liver Specialists of Texas are 2011 supporters of the First Colony Dream League.

First Colony Dream League is a Little League program in Sugar Land, Texas. The Dream League is a division of First Colony Little League (FCLL) and was established in Spring 2007. The Dream League roster is approximately 60 physically- and/or mentally- challenged players. In addition, the league has an "Angels in the Outfield" program, where approximately 150 teenage boys and girls from Ft. Bend area schools volunteer to assist Dream League players during the game, becoming a loyal buddy in the process.

View the opening day video here.

27-Mar-11 2:00 PM

Job Opportunity: Internist Needed

noemail@texasliver.com — Mon, 25 Jan 2010 14:00:00 GMT

Houston Based Liver Specialists of Texas is Seeking Internists for Their Growing Hepatology and Liver Transplant Program Internists are needed to expand within a busy clinical Hepatology and Liver Transplant practice, caring for the Internal Medicine needs of patients with all facets of liver disease. Disease management of hypertension, renal disease, hyperlipidemia, obesity, metabolic syndrome, and endocrine disorders in a supportive environment, located in the world’s largest medical center, has openings for April, July, and December 2010. Houston, TX, January 25, 2010: Internist needed for Hepatology and Liver Transplant Program. Located in Houston’s world-famous Texas Medical Center, we are seeking an energetic BC/BE internist to join a well established and respected program. This physician will care for the internal medicine needs of patients with liver disease and recipients of liver transplants in an integrated fashion. Clinical support from hepatologists,...

New Hepatitis C Research Study to Begin: Update September 2009

noemail@texasliver.com — Thu, 25 Sep 2008 23:00:00 GMT

Dr. Joseph S. Galati and Liver Specialists of Texas are pleased to announce the start of a new investigational study for patients with hepatitis C. As of September 2009, we will be having additional investigational studies for patients with hepatitis C. The studies are classified for patients based on any prior treatment for HCV. Naive patients have never received any form of anti-viral therapy for hepatitis C. This would include Rebetron, Intron A, Ribavirin, PEG-Intron, Pegasys, or Infergen. Other classes of patients will include those previously treated with any of the above drugs. Further, patients will be classified as either responder-relapsers, or non-responders. Once we are able to screen your records, we can detwrmine if you could participate in any of the studies. There are several large companies sponsoring these studies, with a number of very exciting medications that will be used. The basic inclusion criteria for these study include: male or female...

Clinical Research Coordinator

Sat, 15 Jan 2011 00:25:08 GMT

Title: Clinical Research Coordinator
Description:

Research Specialists of Texas is seeking a qualified clinical research coordinator to work on ongoing clinical research studies in hepatology.

Required Experience:

Three years of clinical research.

Education Required: High School, college
Planned Duration of Employment: Full Time
Salary($): $30,000 - $45,000
Position reports to: Medical Director

Contact info:

Dr. Joseph Galati Galati (Add to Contacts)

Liver Specialists of Texas

6624 Fannin Street, Suite 1990

Houston, TX 77030
US

Internist

Wed, 22 Oct 2008 05:00:00 GMT

Title: Internist Description: Internist needed for Hepatology and Liver Transplant Program. Located in Houston's world-famous Texas Medical Center, we are seeking an energetic BC/BE internist to join a well established and respected program. This physician will care for the internal medicine needs of patients with liver disease and recipients of liver transplants in an integrated fashion. Clinical support from hepatologists, surgeons, hospitalists, and PA's makes this a rewarding work environment. This private practice opportunity is affiliated with a major academic, research, and teaching hospital. Competitive salary guarantee, generous benefit and retirement package, relocation allowance, and partnership opportunity. Houston and surrounding communities are family oriented with good schools and a stable economy boasting a reasonable housing market. Contact Jeff Toal at 714-794-0700; jtoal@texasliver.com. Required Experience: Completed approved ABIM Internal...

Free Hepatitis C Testing

Mon, 03 Jan 2011 21:37:30 GMT

Fill out this form to receive more information about free Hepatitis C testing.

31 Days of Wellness

Mon, 03 Jan 2011 19:17:23 GMT

Start the new year with a month of wellness in January.

Latest Liver Podcast Episodes

Thu, 02 Dec 2010 16:22:40 GMT

Listen to Dr. Galati's latest health and wellness podcasts.

Research and New Treatments in Hepatitis C

Thu, 02 Dec 2010 16:21:21 GMT

Learn more about the latest treatments and therapies for Hepatitis C patients.

Breaking News in Hepatitis C and Liver Disease

Thu, 02 Dec 2010 16:21:03 GMT

Get the latest information about research in Hepatitis C and liver disease.

Fatty Liver Disease

Thu, 02 Dec 2010 16:20:01 GMT

Learn more about fatty liver disease.

Liver Specialists of Texas: Our Staff

Tue, 27 Sep 2011 23:06:34 GMT

Staff Members

Saira Khaderi, M.D.

Delores Wade: Practice Manager

Lauren Thomas, R.N. Nurse Practitioner

Aracelli Diaz: Medical Assistant

Diane Villareal: Medical Assistant

Herman Ortiz, LVN: Research Manager

Bernadette Chapa: Patient Schedule/Insurance

Gil Gomila: Billing/Insurance Supervisor

Research Specialists of Texas 2010
Back row:Left to right: Herman Ortiz, Kim Walker, Lacie Ford

Front row: Left to right: Lauren Thomas, Dr. Galati, Diane Villareal, Araceli Diaz

TIEC Open House Photo Album

Hepatitis C Studies are Now Avalable

Wed, 25 May 2011 18:12:48 GMT

Hepatitis C Research: New Therapies for Patients Previously Treated with Interferon and Ribavirin, and Those Naive to Antiviral Therapy Opportunities are available to participate in clinical research protocols through Liver Specialists of Texas and Research Specialists of Texas. Update: New Hepatitis C Drugs Approved: read more About half of all people with chronic hepatitis C virus (HCV) infection achieve a sustained virological response (SVR) or undetected HCV, with the standard treatment of pegylated interferon plus ribavirin; rates are even lower for patients with difficult-to-treat HCV genotype 1. Researchers have studied various antiviral agents that directly target various stages of the HCV lifecycle. Namely protease inhibitors have shown promising results. For patients who have been previously treated with Pegylated Interferon and Ribavirin and have not responded to treatment or have relapsed while on this treatment you may be...

Update: New HCV Drugs Approved-Boceprevir and Telaprevir

Wed, 25 May 2011 18:11:39 GMT

Over the past week, two new drugs have been FDA approved.

Saira Khaderi, M.D., MPH

Tue, 17 May 2011 18:10:57 GMT

Dr. Saira Khaderi has joined Liver Specialists of Texas. Dr. Joseph Galati is pleased to announce that Dr. Khaderi has joined Liver Specialists of Texas, increasing patient access to specialized liver care, from one of America's largest liver practices. Saira Khaderi, M.D. was born in Indiana but moved to Houston at a young age. She attended the University of Houston and graduated Magna Cum Laude in 1999 with a major in Biology and minor in Chemistry. In 2001 Saira completed her Masters in Public Health from the University of Texas School of Public Health. She attended medical school from 2001-2005 at the University of Texas Medical Branch in Galveston. In 2008, Dr. Khaderi completed her Internal Medicine Residency at the world renowned Cleveland Clinic Foundation. It was there...

Liver Failure

Fri, 29 Apr 2011 02:42:47 GMT

Liver failure or fulminant hepatic failure is a condition where a person with no preexisting liver disease develops severe liver dysfunction over a matter of days or weeks. Fulminant liver failure is associated with a high mortality rate and is a clear indication for liver transplantation.

The cause of liver failure is quite varied but includes medications, certain infections, trauma, alcohol, disruptions in proper flow of blood to the liver, and unfortunately, there are causes of liver failure that never had a clear identifiable cause.

Patients with liver failure rapidly develop abnormal liver chemistries associated with signs of liver insufficiency associated with the development of ascites [fluid in the abdomen], fatigue, abdominal pain, and most importantly, the development of hepatic encephalopathy, which is a confusion state that is associated with severe liver dysfunction.

Patients with suspected liver failure need to be transferred immediately to a liver center specializing in transplantation where the best therapies can be offered.

Fatty Liver

Sat, 19 Feb 2011 03:24:20 GMT

Some individuals can develop fatty liver. Most people who do not abuse alcohol and have fatty liver are obese. The term that has been accepted is non-alcoholic fatty liver disease (NAFLD). Fatty liver is called steatosis, and fatty liver with liver inflammation is called or steatohepatitis. Steatosis and steatohepatitis can be caused by alcohol and other drugs and can also sometimes occur in patients with diabetes mellitus. The factors that determine who will develop fatty liver are not known. Some mildly obese and occasional non-obese patients will develop fatty liver while some who are severely obese will not. There is a direct relationship between the metabolic syndrome and NAFLD. Patients with fatty liver or steatohepatitis usually present to a physician with unexplained elevations in the serum aminotransferase (ALT/AST) activities. Serum alkaline phosphatase and gamma-glutamyltranspeptidase (GGTP) activities can also be elevated. The patient is usually 10% or more above...

Hepatitis C and Interferon Side Effect Management

Sat, 19 Feb 2011 03:19:36 GMT

This section of the web site will be dedicated to answering questions regarding specific topics commonly encountered by patients in our practice. The goal is that this information will supplement the information you have received in the office during a visit, as well as serve as a stable resource of information you can review on a regular basis. When you have non-emergent questions regarding your care, we hope that the majority of questions can be answered on these pages and avoid unnecessary calls to the office. Of course, any serious matter needs to be addressed with the office as needed. Hepatitis C: By far, most questions we are asked are related to hepatitis C. These questions relate to the natural history of hepatitis C (what's going to happen to me ?), the required work-up needed to determine the stage of your infection (what's my genotype and do I need a liver biopsy ?), what form of therapy will I receive, and lastly, what can I expect from the therapy and...

Colonoscopy

Sat, 19 Feb 2011 03:16:06 GMT

Indication Colonoscopy is an endoscopic procedure that enables a physician to examine the inner lining of your colon (large intestine) for abnormalities by inserting a flexible tube, approximately as thick as your finger, into your anus and slowly advancing it into the rectum and colon. Colonoscopy is indicated for a large number of problems that commonly include, but are not limited to chronic abdominal pain, colon caner screening, diarrhea, weight loss, colitis, blood in the stool, a prior abnormal barium enema, constipation, a personal history of colonic polyps, or a family history of colon cancer. Preparation Prior to performing colonoscopy, the colon needs thorough cleansing so that there can be unobstructed view of the entire colon. Depending of the bowel preparation selected for you, you will need to be placed on clear liquids for one to two days prior to the procedure. This will increase the effectiveness of the bowel preparation. Similar to other procedures we...

Our Location

Sat, 19 Feb 2011 03:11:22 GMT

6624 Fannin, Suite 1990
Houston, Texas 77030
Tel: 713-794-0700

For a map to our office, please click here. (Opens Mapquest map in new window)

Directions to the O'Quinn Medical Tower at St. Luke's:

Address:
6624 Fannin Street
Suite 1990
Houston, Tx 77030
713-794-0700
Fax: 713-794-0610

From The North:
I-45 South To Highway 59 South. On Highway 59 South, Exit Fannin Street. Take Fannin Street South To The St. Luke's Medical Tower Facility (Mirrored Twin Tower Facility). Park In Tower Parking Lot (Entry From Fannin).

From The East Or West:
I-10 To Studewood/Studemont. Studemonte (Turns Into Montrose) South To Main Street.Main Street South To The St. Luke's Medical Tower Facility. The St. Luke's Medical Tower Sits Between Main And Fannin Streets. Park In Tower Parking Lot (Entry From Fannin).

From The South
I-45 North To Loop 610 West. Loop 610 West To Fannin Street. Fannin Street North To The St. Luke's Medical Tower Facility. Park In Tower Parking Lot (Entry From Fannin).

We are located on the 19th floor.

For your convenience, St. Luke's Medical Tower offers both valet and self-parking.

Liver Cancer (Hepatocellular Carcinoma)

Sat, 19 Feb 2011 03:09:31 GMT

Hepatocellular carcinoma is cancer that arises from hepatocytes, the major cell type of the liver. Hepatocellular carcinoma traditionally has been relatively rare in the United States, though with the rise in the number of cases of hepatitis C, the rate of new cases of liver cancer is rising. Worldwide, however, it is either the number one or number two cause of cancer death. It is especially prevalent in parts of Asia and Africa. About 80% of people with hepatocellular carcinomas have cirrhosis. Chronic infection with the hepatitis B virus and hepatitis C virus also increases the risk of developing hepatocellular carcinoma. Aflatoxins, which are produced by a mold that is a contaminant of nuts (most commonly peanuts), grains, and beans, have also been implicated as a major risk factor for causing hepatocellular carcinoma. Although virtually non-existent in the United States, aflatoxins, are common in other parts of the world and often contaminate food. Most...

Lorem ipsum survey

noemail@texasliver.com — Fri, 10 Aug 2007 18:51:28 GMT

Objectives:

Lorem ipsum dolor sit amet, consectetuer adipiscing elit, sed diem nonummynibh euismod tincidunt ut lacreet dolore magna aliguam erat volutpat. Ut wisis enim ad minim veniam, quis nostrud exerci tution ullamcorper suscipit lobortis nisl ut aliquip ex ea commodo consequat. Duis te feugifacilisi.

Duis autem dolor in hendrerit in vulputate velit esse molestie consequat, vel illum dolore eu feugiat nulla facilisis at vero eros et accumsan et iusto odio dignissim qui blandit praesent luptatum zzril delenit au gue duis dolore te feugat nulla facilisi.

Ut wisi enim ad minim veniam, quis nostrud exerci taion ullamcorper suscipit lobortis nisl ut aliquip ex en commodo consequat. Duis te feugifacilisi per suscipit lobortis nisl ut aliquip ex en commodo consequat.Lorem ipsum dolor sit amet, consectetuer adipiscing elit, sed diem nonummy nibh euismod tincidunt ut lacreet dolore magna aliguam erat volutpat.

Ut wisis enim ad minim veniam, quis nostrud exerci

Release Date: 10-Aug-07 1:51 PM
Expiration Date: 10-Nov-07 1:51 PM

Ut wisis enim ad minim veniam, quis nostrud exerci

Does everyone need a liver biopsy?

Sat, 19 Feb 2011 03:22:28 GMT

Because no two individuals have the same natural history, it is difficult to determine the extent of damage the liver has experienced. In many cases, the laboratory values and ultrasound images do not accurately determine the degree of fibrosis or scarring that is present. Additionally, the presence of symptoms (fatigue) does not correlate with liver damage. Because of these factors, I believe a liver biopsy yields the greatest amount of information to make subsequent decisions regarding treatment.

The decision to perform a liver biopsy will be determined after all aspects of your care are reviewed in detail. Dr. Galati and Dr. Khaderi will make sure you understand the risks and benefits of a liver biopsy.

View Dr. Galati performing a liver biopsy here.

What is the natural history of hepatitis C?

Sat, 19 Feb 2011 03:17:41 GMT

The natural history is the expected course in a particular disease. In the majority of diseases, it is well known what will occur when someone has a disease and receives no treatment. Hepatitis C does not always follow a particular set of rules. It is estimated that if left untreated, hepatitis C has the potential to progress to cirrhosis in 15% of the cases over a 20-25 year span. Individuals who consume alcohol or have other diseases of the liver may develop cirrhosis in a shorter period of time. There are many factors that affect the natural history of hepatitis C, all of which need to be discussed with the patient.

Neutropenia (low white blood cells)

Tue, 18 Dec 2007 23:11:52 GMT

Similar to a drop in hemoglobin related to ribavirin, interferon caused a drop in white blood cells (WBC), manufactured in the bone marrow. Hite blood cells are used to fight infections in the body. If the WBC drops below an acceptable value, G-CSF (filgrastin) may be used. This stimulated the bone marrow to produce WBC, raising their value above acceptable limits. Similar to ribavirin, it seems beneficial to maintain the appropriate dose of interferon rather than dose reduce. If the WBC is below a critical level, therapy may be reduced or discontinued. G-CSF is associated with certain adverse reactions including skin rash, bone pain, muscle aches, and an exacerbation of psoriasis.

Anemia

Tue, 18 Dec 2007 23:11:34 GMT

Anemia is a very predictable complication of therapy, usually due to ribavirin. Ribavirin causes a hemolytic anemia, damaging red blood cells, which are later removed from the body resulting in the anemia. Symptoms of anemia include increasing fatigue, shortness of breath, lightheadedness, and dizziness. A significant complication of anemia is myocardial ischemia, which can lead to heart failure or a heart attack. For this reason, anemia is treated aggressively.

Reducing the dose of ribavirin usually results in a rise in hemoglobin and improvement in the anemia. This dose reduction in ribavirin may jeopardize the final result of therapy and a lack of viral clearance. It has been generally accepted to treat the anemia without reducing the dose of ribavirin. This is accomplished by making use of erythropoietin.

Erythropoietin is a protein naturally made in the body, which regulates red blood cell production in the bone marrow. It has been successfully manufactured nearly identical to the form in the human body and used in an assortment of conditions for the past 10 years. It is safe and well tolerated. It is very effective in treating the anemia seen with ribavirin use.

The use of erythropoietin not only increases hemoglobin, but also improves upon the fatigue reported in these patients. In most situations, the dose of ribavirin can be maintained, increasing the likelihood of clearing the virus. Blood transfusion is rarely required, but may be an option. Monitoring the effects of erythropoietin requires more frequent blood tests, usually on a weekly basis. Once erythropoietin is used, it is generally used the entire duration of therapy. It is given by weekly injection similar to the interferon.

Headaches

Tue, 18 Dec 2007 23:10:23 GMT

Minor headache complaints generally respond to remaining well hydrated and over the counter preparations such as acetaminophen and non-steroidal anti-inflammatory agents, such as ibuprofen. Patients that have a history of migraine headaches may find that there will be an exacerbation of these headaches once therapy with interferon and ribavirin begin. If they have been on prior therapy for these migraines it may be ineffective.

It will be recommended that in such situations, consultation from a neurologist or headache specialist will be required to continue on with anti-viral therapy. If such a specialist has already evaluated you, we will need to work closely with them to organize a specific plan of care for you.

Nasal Congestion

Tue, 18 Dec 2007 23:10:02 GMT

Nasal congestion is an uncommon complaint, but if present, can be annoying. Symptomatic relief can be obtained with over the counter medications, such as Claritin-D. Remain well hydrated, and avoid cigarette smoke and other nasal and sinus irritatants.

Nausea

Tue, 18 Dec 2007 23:09:45 GMT

Nausea on its own is difficult to treat. There are so many other causes for nausea that this complaint on its own may require a visit to the office. Results vary, but over the counter medications such as Zantac or Pepcid-AC may help. If not, we may recommend other prescription strength medications to reduce stomach acid. There are other classes of drugs that specifically address nausea, but as stated above, this may require a visit to the office for evaluation.

Mouth Ulcers

Tue, 18 Dec 2007 23:09:31 GMT

Some patients are prone to mouth ulcers, which can be rather painful. This may contribute to reduced calories and weight loss (see anorexia). My personal recommendation is to use Kenalog Orabase Dental Paste, which requires a prescription. There are other lesions that affect the mouth so it may require a quick visit to the office before we fill the prescription for you.

Heart Burn/Indigestion

Tue, 18 Dec 2007 23:09:14 GMT

Many patients develop an upset stomach during therapy. If they gave symptoms of gastroesophageal reflux (GERD), symptoms may get worse. Typically, over the counter agents work, such as Zantac or Pepcid-AC. Maalox or Mylanta may also alleviate symptoms. Prescription strength medications such as Nexium, Protonix, or Acifex may be needed. Avoid going to bed with a full stomach, and I recommend at least 4 hours after your last meal before going to bed.

Eye Complications

Tue, 18 Dec 2007 23:08:57 GMT

A baseline examination of your eyes is usually ordered prior to starting therapy with interferon, especially in patients with diabetes or hypertension. Be alert for changes in your vision and report them to the office. Changes may occur in the form of red eyes, blurred vision, eye fatigue, or the need for new prescriptions. It may be necessary to discontinue therapy.

Umbilical Hernia in Cirrhosis

Mon, 06 Feb 2012 01:33:04 GMT

Umbilical Hernia in Cirrhosis

Mon, 06 Feb 2012 01:33:04 GMT

Notice the slightly ulcerated tip of the hernia. This can lead to infection and rupture.

Umbilical Hernia in Cirrhosis

Mon, 06 Feb 2012 01:33:04 GMT

Umbilical Hernia in Cirrhosis

Mon, 06 Feb 2012 01:33:04 GMT

Umbilical Hernia in Cirrhosis

Mon, 06 Feb 2012 01:33:04 GMT

Umbilical Hernia in Cirrhosis

Mon, 06 Feb 2012 01:33:04 GMT

These hernias can be painful.

varices11

Mon, 06 Feb 2012 01:33:04 GMT

Small esophageal varices seen at the lower end of the esophagus in a patient with hepatitis C and cirrhosis.

Band Ligated Esophageal Varices

Mon, 06 Feb 2012 01:33:04 GMT

Notice the scarred mucosa.

Small Gastric Varices

Mon, 06 Feb 2012 01:33:04 GMT

On a retroflexed view, small varices in the stomach are noted. These cave the capacity to bleed similar to those in the esophagus. Notice the red whale (at 4 O'clock) -a sign of recent hemorrhage.

Gastric AV Malformation

Mon, 06 Feb 2012 01:33:04 GMT

Small AV malformation in the stomach of a patient with cirrhosis.

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2007-08-10T18:51:28Z

Instructor: Instructor

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