53 yr old male, can't decide if I should treat

[JimS007]

I am a 53 yr old male. I have just been diagnosed with Hep C. I have not had a biopsy but have had an ultrasound which showed a fairly normal liver, some light shadowing. I have been feeling fatigued for a year or so. I figure I was exposed 27 years ago. I am having a hard time deciding if I should start treatments or wait until some new drug options surface. I am a General Manager of a very busy Hotel, I a worried if I get sick from treatment I will lose my job and my healthcare. How much will the year of torture extend my life. I have lived with this disease 27 years with very little damage, 27 more years would make me 80. Really don't know what to do or think.I am really still trying to wrap my head around all this. I welcome all and any advice.

[Idyllic]

I agree with what has been said so far especially about the ultrasound. If you are on the fence with treating knowing how far your fibrosis has progressed is a great determining factor. Your genotype also determines the kind of treatment you would have (dual or triple).

As far as "shadowing" of the liver on an ultrasound:

"...A shadow area is thus an area which cannot be characterized by ultrasound. Your doctor telling you that you have a shadow on your liver says that there was something in the way of his ultrasound probe and will need to do further imaging to characterize this area"

https://www.zocdoc.com/answers/4279/what-does-a-shadow-on-the-liver-indicate

[Idyllic]

Page 6 of this Treatment Guide lists some things that are helpful to know to decide whether to treat.

Genotype –These strains of HCV determine the length of your treatment and the dose. Knowing your genotype can help you assess the potential for a favorable response.

Viral load – This may be used to decide which medicine to use and to estimate your potential for a favorable response.

Baseline labs – These may be used to decide which medicine to use and to estimate your potential for a favorable response.

Liver biopsy results – You may or may not have this information. Some doctors perform routine liver biopsies, while others only biopsy certain patients. Liver biopsy results may be used to decide if treatment is needed at this time and to estimate your potential for a favorable response.

★¸¸.☆ Your medical provider’s reasons for recommending
or not recommending treatment.★¸¸.☆

Treatment regimen – What HCV medication does your medical provider want you to take? What is the dose and duration of treatment? Do you have concerns about the proposed plan? HCV genotype 1 patients
have longer treatment periods usually between 24 andv48 weeks. If you do not respond to the medications, treatment may be stopped after 12 weeks. Genotypev2 or 3 patients are usually treated for shorter periods.

Note: Treatment is based on the latest research.
If your medical provider suggests a treatment
duration or dose that is different from what you
expected, discuss this. Your provider might make
recommendations based on new information

Health history and a few other items are mentioned.

http://www.hcvadvocate.org/hepatitis/factsheets_pdf/Treatment_Decision_Guide.pdf
______________________

I encourage you to get a second opinion. With either a Hepatologist or a Gastro with experience treating Hepatitis C. Recommending that you start treatment (without even knowing what stage you are)  when you express reluctance to me indicates the doctor at minimum did not present you with treatment options.

Here's a single page one from the VA web site:
http://www.hepatitis.va.gov/patient/treat/decisions-single-page.asp

[JimS007]

Here is some information I failed to include in my original post

genotype 1
viral load over 5,000,000
liver enzmes slightly elevated

I do not know all the rest of my numbers, I'm not sure what numbers I need to know.

I am going to schedule a biopsy. From what I am hearing that should have been recommended. My doctor did offer it but said it really wasn't necessary.

As a recently diagnosed patient of this disease I am just trying to find my way through all the information. I want to make an educated decision not one based solely on fear. I would like to thank you all for your comments any info or help I can get is greatly appreciatted.

[JimS007]

I forgot to mention my doctor recommended triple treatment for 48 weeks.

[BoceprevirGal]

  I am glad you are scheduling a biopsy.  I had one last year, and it was a piece of cake. They have an ultrasound machine so they can see where they are going.,and an Ativan drip, so it was pain free, for me, at least.
   I had an Ultasound done before my biopsy, which said everything looked perfectly normal, but my biopsy had me at Stage 2, with grade 3 inflammation, so I did decide to treat.
   One thing that confuses me:  I only had to treat for 28 weeks. Unless you have cirrhosis, your G.I. wouldn't know if you were going to treat for 24~28 wks, or 48 wks, with the current meds used to treat Geno 1.  There are guide-lines, so: if you began taking the meds, and cleared the virus by 4 weeks, and your werent cirrhotic, you would only have to do 24 or 28 weeks, depending on which protease Inhibitor you decide to use, there are two of them.
   If your biopsy has you only at stage 1 or even 2, you could wait until next year, because an easier treatment is waiting to be approved.  I did choose to Treat my Hep C at Stage 2 (stage 4 is cirrhosis) because my blood-work also had some abnormalities, such as my platelets slide below normal for the first time, since I had had Hep C, which was for twenty years.
  

[pooh55811]

Since you are Genotype 1, your doctor would not know how long you would need to treat until you know the results of your liver biopsy. You have never treated before so you are considered treatment naive. If you have not progressed to Stage 4 liver fibrosis (cirrhosis) and you become undetectable for the virus at 4 weeks of triple medication treatment, you would be able to treat for 24 weeks if you were doing Incivek, Interferon, and Ribavirin, or 28 weeks if you are doing Victrelis, Interferon, and Ribavirin. If, on the other hand, you have Stage 4 liver disease or you do not become undetectable at week 4 (Incivek) or week 8 (Victrelis), then you would need to do 48 weeks of treatment.

As far as the new treatments, no one knows for sure when they will be available to the general public so. It could be next year but it also may not be next year. Plus, no one knows how willing the insurance companies will be to pay for the new drugs as it is projected that they will cost more than the current treatment. I just don't want you to misled into thinking there are any definite dates when it comes to the availability of the new drugs.

Based on your posts, it seems that your doctor is not real familiar with diagnosing or treating Hepatitis C. One thing you need to have if you are going to treat Hep C is someone who is knowledgeable and experienced in treating Hep C. It is better to get someone who knows what they are doing right away rather than having to switch to a new doctor during the middle of treatment. I just would not really trust anyone who thinks your liver is fine based on an ultrasound or who does not know the exact treatment regimens.

I originally had a less experienced gastroenterologist and I had to switch to a hepatologist mid treatment. I should have gone with a hepatologist from the start because my treatment would have gone much smoother and my side effects would have been addressed mush sooner and much more appropriately if I had been with the hepatologist from the beginning. However, because I was new to all of this when I started, I did not know any better, and I paid for that lack of knowledge with a lot of unnecessary misery from side effects that my original treating team had no clue how to assess or treat and were also reluctant to treat. I could not believe the difference in the treatment I received after i switched. It was like night and day.