Hepatitis C: A Rational Call To Arms

By Tina Banwart and Reuben Banwart

Contentment
I awoke this morning and immediately initiated my morning ritual. I rose from my bed, got dressed, and followed the aroma of freshly ground coffee brewed by my son. I poured myself a cup and proceeded to indulge in the process that someone my age develops when preparing their morning cup of joe. I added creams and powders until the deep brown concoction became liquid gold. I carried my formula out the patio door and joined my son in his morning rundown of how the events of the previous day required yet another quick tailoring to the way he perceived the world.

Reuben, my son, possesses an understated melodrama about him; he is a paradox, but the good kind. He detests narcissistic, self-indulgent behavior while simultaneously presenting, quite passionately, his own perceptions and beliefs. Reuben commonly speaks in metaphor when attempting to discreetly present his point of view, as he detests having to bluntly state it. He crafts scenarios that seem unrelated in his effort to convince the person he’s conversing with to arrive at the same conclusions about life that he has.

These conflicting personality traits lend themselves to a lot of his statements being forwarded with the disclaimer, “I know this isn’t right for everyone, but in my experience…” This particular morning he decided to forgo that formality as he said to me,

“Most mornings I make myself some coffee and drink it outside with my first cigarette of the day. I always set my coffee down somewhere and pace around while I smoke. No matter how much distance I put between myself and that cup of coffee when I ash my cigarette a breeze will always carry a couple of ashes and quickly deposit them right into my coffee. EVERY TIME. What bugs me so much about this is that you’d think by now I’d do something about it. I enjoy my coffee in the morning, and even though I know I should quit smoking it’s still a part of me I am unwilling to give up. So over the years I've had to review my options of resolving this little problem. I already decided that I will continue to smoke and drink coffee at the same time, and because of this the consequences will remain the same so I am left with two choices. I could fish the ashes out or simply pretend they aren't there and just drink them. The first year or two I just fished the ashes out. Nowadays, I just accept that there will be ashes in my coffee and I drink them. Do you understand what I’m saying Mom? I’m saying that being content will be the death of me, well contentment and the cigarettes.” He then smiled at me as to say, “The previous lectures on smoking have been received and digested, save yourself the trouble.”

I immediately related my son’s statements with issues that are relevant to me. One of them being Hepatitis C. When I was diagnosed in 1999 I threw myself into research. Understanding the disease was my way of coping with what was happening to me. I soon came to realize the factors involved in the development, and progression of chronic Hepatitis C are not completely understood. However, there are studies that have identified variables that contribute to disease progression; Age at time of infection, HIV co-infection, alcohol, and possible genotype. As for the indicators for treatment, liver damage is the number one reason; If bridging fibrosis (Stage 2 or 3) is found on biopsy this is an important predictor of future progression to cirrhosis and therefore an indication for treatment. However, if a patient has no or only minimal fibrosis on biopsy (Stage 0-1) they have a low risk for liver-related complications and liver-related death (over the next 10 to 20 years). As for myself, I wasn't inclined to authenticate the progression of my disease. I decided to treat and was successful. As for anyone else, treatment obviously can only be determined by you and your physician. With telaprevir and boceprevir soon to be FDA approved the chances for achieving SVR are higher with possible shorter treatment duration. With the efficacy of these new drugs this could be the deciding factor to under go therapy.

Contentment

People living with Hepatitis C may feel a lack of urgency to seek treatment. They may see the side effects of treatment as much more detrimental then the disease itself. The symptoms of Hepatitis C manifest very slowly. It is easy to dismiss treatment because it appears that there is nothing to be treated. Hepatitis C is an agent of sabotage. Slowly sowing dissent in your liver, chipping away year after year, and leading a quiet coup against your health and well being. Like a good spy Hepatitis C retains its cover as a non-threatening entity in your “political body”. We all require the knowledge to fight this cloak and dagger conflict. There are numerous sources with that valuable information to do so. But it’s up to you and your physician to recognize the potential threat. I urge you not to slip into contentment with this disease. If you have liver damage consider seeking treatment earlier then later before this despicable infiltrator is allowed to carry out its mission, a possible slow or rapid attack on your liver.


Diagnosis, Management, and Treatment of Hepatitis C:
An Update 2009

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