Monday, September 4, 2017

Baby Boomers - What About HCV, Vaccinations, Liver Health & All That Jazz 

Baby Boomers - What About HCV, Vaccinations, Liver Health & All That Jazz
Whether you're a baby boomer, new to hepatitis C, thinking about getting tested or just looking to close a few knowledge gaps, thanks for stopping by.

With the flu season on its way, the focus today is on vaccinations for adults with HCV, risk associated with the use of acetaminophen, aspirin and non-steroidal anti-inflammatory drugs (NSAIDs). Also a look at risky drinking and drug misuse among baby boomers in the UK and Australia. As for exercise, NPR talks about the dangers of prolonged sitting and risk of a host of diseases, yep, among baby boomers. Last but not least, getting tested for the hepatitis C virus.

Immunization Action Coalition
Vaccinations for adults with hepatitis C infection
One-page sheet describes vaccinations that HCV-positive adults need

Click On Image To Enlarge

Source Link -

Get Your Flu Shot
People 65 years and older, living with chronic liver disease, cirrhosis and liver transplant recipients are particularly at risk from the flu and are more susceptible to flu-related complications.

Recommended Reading
Read all past and current Seasonal Flu Vaccine articles posted on this blog.

More information is available on the CDC website: Frequently Asked Flu Questions 2017-2018 Influenza Season

During The Flu Season Protect Your Liver
When the flu season hits home the first thing we do is run out to purchase an over-the-counter medication to help relieve cold and flu symptoms. According to the FDA, more than 600 medications used to help relieve pain and reduce fever, including prescription and over-the-counter (OTC) medications contain the active ingredient acetaminophen. When checking the label for "acetaminophen" it may not be spelled out in full on the container's prescription label. Abbreviations such as APAP, Acetaminoph, Acetaminop, Acetamin, or Acetam may be used instead.

To lower your risk of liver damage, the FDA suggests the following:
  • Follow dosing directions and never take more than directed; even a small increase in the recommended dose can cause liver damage.
  • Don't take acetaminophen for more days than directed.
  • Don't take more than one medicine that contains acetaminophen at a time. To determine if a medicine contains acetaminophen, read the "Drug Facts" label under "Active Ingredients". It will either say "acetaminophen" or "APAP." (APAP is an acronym for the chemical name, N-acetyl-paraaminophenol.)
  • Talk to your doctor before you take acetaminophen if you drink three or more alcoholic beverages every day, have liver disease, or take warfarin, a blood thinner. Together warfarin and acetaminophen may raise your risk of bleeding.
For a complete list of drug brand names containing acetaminophen, click here.

Tylenol & Viral Hepatitis
Hepatitis C Online is a great site with educational tools to learn more about diagnosis, treatment and HCV management. The following document addresses acetaminophen, aspirin and non-steroidal antiinflammatory drugs (NSAIDs) for people with or without cirrhosis.

Acetaminophen (Tylenol) is a known hepatotoxin that can cause clinically important hepatotoxicity, either through an acute overdose or when taken on a regular basis (even at lower doses): in one large study that examined causes of acute liver failure, patients taking a dose less than 4 grams per day accounted for 7% of the total cases and in some were taking doses as low as 1 gram per day. Among healthy volunteers taking 4 grams per day for 14 days, more than 30% developed alanine aminotransferase (ALT) values in excess of 3 times the upper limit of normal. Concurrent alcohol use greatly increases the chance of acute or chronic acetaminophen-induced hepatotoxicity. Studies have also shown an increased risk of acute liver injury in patients with chronic hepatitis C following acetaminophen overdose, but none have examined the safety of long term, low dosages of acetaminophen in patients with chronic hepatitis C. Guidelines for the safe use of acetaminophen in HCV-infected persons do not exist. Considering many patients with chronic hepatitis C have limited pain treatment options, most experts believe low dosages of acetaminophen (up to two grams per day) can safely be used in most patients with chronic hepatitis C infection without cirrhosis; those with cirrhosis should limit their intake of acetaminophen to one gram per day. Patients drinking excess alcohol should avoid taking acetaminophen altogether. Clinicians should remind patients that many narcotic combination pills and over-the-counter cold and flu medications may contain acetaminophen. Patients taking acetaminophen should have laboratory monitoring for hepatotoxicity every 3 to 6 months.

Aspirin and Nonsteroidal Anti-inflammatory Medications:
A few different types of NSAIDs are available over the counter:
- Aspirin (Bayer, Bufferin, Excedrin) Each caplet of Excedrin Extra Strength Pain Reliever contains 250 milligrams (mg) of acetaminophen, 250 mg of aspirin, and 65 mg of caffeine
- Ibuprofen (Advil, Motrin IB)
- Naproxen (Aleve)

Aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) are generally safe for patients with hepatitis C when taken at standard doses.  The one exception is in patients who have cirrhosis: NSAIDS and aspirin are best avoided in patients with cirrhosis, especially those with decompensated cirrhosis. In patients with decompensated cirrhosis, the use of NSAIDS and aspirin may further increase the inherent risk these patients have for developing nephrotoxicity and gastrointestinal bleeding. Patients with chronic hepatitis C who do not have cirrhosis may take aspirin or NSAIDs at low or standard recommended dosages, with food and water.  Those with cirrhosis who have short-term, minor pain should, in general, avoid taking aspirin or NSAIDs, but can take acetaminophen in this setting as long as the dose does not exceed one gram per day.  In the unfortunate situation involving a patient with cirrhosis who has joint or musculoskeletal pain unresponsive to acetaminophen, NSAIDs can be used for a very brief period of time if given at the lowest daily dose possible.
Download PDF, here.

Of Interest

Harvard Heart Letter
Daily aspirin users 75 or older: Consider taking a stomach-protecting drug
Research we're watching

Roughly half of Americans ages 75 or older take a daily, low-dose aspirin to prevent a heart attack or stroke. New research suggests these people might benefit from taking a stomach-protecting drug to prevent a higher-than-expected risk of gastro-intestinal (GI) bleeding.

The study, published online June 13, 2017, by The Lancet, involved nearly 3,200 people who were prescribed aspirin because of a previous heart attack or stroke. Researchers followed them for up to 10 years to see how many were hospitalized for bleeding — a well-known side effect of aspirin use. Upper GI bleeding usually results from a stomach ulcer, which can cause anemia, heartburn, and abdominal pain.

The risk of serious GI bleeding was much higher among people ages 75 or older compared with people ages 65 or younger. But bleeding events were much less common in people taking prescription heartburn drugs called proton-pump inhibitors, such as omeprazole (Prilosec) and esomeprazole (Nexium). These drugs can reduce GI bleeding by as much as 90%, according to the study authors.

Recommended Reading
HCV Advocate's fact sheet contains information about acetaminophen for people with chronic hepatitis B or C. In this article; It’s Flu Season: When You Have Hepatitis B, Too Much Tylenol Can Damage Your Liver, Christine Kukka explains the dangers of Tylenol for people living with hepatitis B. Or check out this article from Pharmacy Times about general risks associated with over-the-counter pain medications.

Baby Boomers Alcohol & Drug Misuse
A rise in alcohol and drug misuse among the over 50s (commonly known as “baby boomers”) is causing concern, warn experts.
Researchers at South London and Maudsley NHS Foundation Trust and Flinders University in Australia, say the number of people aged over 50 experiencing problems from substance misuse is growing rapidly, with the numbers receiving treatment expected to treble in the United States and double in Europe by 2020.

Commenting on the research, which appeared in the British Medical Journal (BMJ), Vanessa Hebditch, the British Liver Trust Director of Communications and Policy said,

“Urgent action is needed to tackle drink and drug misuse among baby boomers – this research adds to the growing body of data in the UK suggesting that alcohol and other substance misuse is increasing among those in their mid-50s and older.

The over 50s have seen a time when filling up your supermarket trolley with wine and drinking at home has become normalised so that is part of our culture and this all too easily becomes habit forming. Alcohol has become increasingly acceptable and affordable.

The British Liver Trust advises that one easy step that people can take is to make sure that they have two –three consecutive days off every week from drinking – this not only reduces overall units but stops dependency.

However, if we are to turn around the massive increases in liver disease that we are seeing as a result of drinking too much we also need Government measures which tackle the affordability, availability and promotion of alcohol.”

The research found that in both the UK and Australia, risky drinking is declining, except among people aged 50 years and older, they explain. There is also a strong upward trend for episodic heavy drinking in this age group.

With alcohol being the most common substance of misuse among older people, under-detection of alcohol problems is of immediate concern – and may increase further as baby boomers get older because of their more liberal views towards, and higher use of, alcohol, they write.

A lack of sound alcohol screening to detect risky drinking may result in a greater need for treatment, longer duration of treatment, heavier use of ambulance services, and higher rates of hospital admission.

Research suggests that treatment programmes adapted for older people with substance misuse were associated with better outcomes than those aimed at all age groups.

However, the authors point out that clinicians will need improved knowledge and skills in assessing and treating older people at risk of substance misuse.

“There remains an urgent need for better drug treatments for older people with substance misuse, more widespread training, and above all a stronger evidence base for both prevention and treatment,” they write.

“The clinical complexity of older adults with substance misuse demands new solutions to a rapidly growing problem. So far, there has been little sign of a coordinated international approach to integrated care,” they conclude.

Read the full article here

Baby Boomers - Walk A Little Each Day
Get Off The Couch Baby Boomers, Or You May Not Be Able To Later
In a study of sitting and walking ability that surveyed people ages 50 to 71 across 8 to 10 years, those who tended to sit the most and move the least had more than three times the risk of difficulty walking by the end of the study, when compared to their more active counterparts.

Some ended up unable to walk at all. The study appears in the current issue of The Journals of Gerontology: Medical Sciences
Continue reading the article, or listen to the audio posted today over at NPR....

HCV & Baby Boomers
USA Today
Most boomers infected with liver-damaging hepatitis C virus do not know it
Boomers grew up and became young adults before the virus was identified in 1989. So it is likely many were infected through medical procedures and transfusions before improved infection control techniques and blood screening nearly eliminated those risks, CDC says. 
Continue reading...

Most of the 3.5 million Americans living with hepatitis C are baby boomers born from 1945 to 1965. Baby boomers are five times more likely to be infected with hepatitis C than other age groups. 
CDC officials recommend Hepatitis C testing for the following groups of people:

1- People born from 1945 through 1965. 
2- Current or former injection drug users, including those who injected only once many years ago.
3- Recipients of clotting factor concentrates made before 1987, when more advanced methods for manufacturing those products were developed.
4- Recipients of blood transfusions or solid organ transplants before July 1992, when better testing of blood donors became available.
5- Chronic hemodialysis patients.
6- Persons with known exposures to HCV, such as
health care workers after needlesticks involving HCV-positive blood
recipients of blood or organs from a donor who tested HCV-positive

7- Persons with HIV infection.
8- Children born to HCV-positive mothers.
Learn More Here.....

New Hepatitis C Infections Nearly Tripled over Five Years
The rising number of hepatitis C infections are primarily a result of increasing injection drug use associated with America’s growing opioid epidemic, according to the federal Centers for Disease Control and Prevention. Over five years, the number of new infections has nearly tripled, reaching a 15-year high. The highest number of new infections are among 20- to 29-year-olds.

Until next time.

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