WEBVTT - Ep 45 Hepatitis C: Hepatiti? 0:00:01.160 --> 0:00:04.160 In two thousand and five, my life changed forever. My 0:00:04.240 --> 0:00:07.280 mom had just been diagnosed with hepatitis C and advised 0:00:07.320 --> 0:00:09.880 me to get tested. When my doctor told me I 0:00:09.920 --> 0:00:13.400 also had it, the room went dark. All my thoughts stopped, 0:00:13.600 --> 0:00:16.680 and I didn't hear anything else being said. I worried 0:00:16.720 --> 0:00:20.079 that I'd given my kids a deadly disease. The next day, 0:00:20.160 --> 0:00:23.880 I scheduled my family to be tested. Everyone's results were negative, 0:00:23.920 --> 0:00:26.960 but this didn't end my personal nightmare with the disease. 0:00:27.880 --> 0:00:31.240 I was witnessing hepatitis C ravaged through my mom's body. 0:00:31.760 --> 0:00:35.000 A liver transplant would only buy her time. She ultimately 0:00:35.080 --> 0:00:38.160 chose not to undergo a dual organ transplant and passed 0:00:38.200 --> 0:00:41.600 away on May sixth, two thousand and six. My liver 0:00:41.880 --> 0:00:45.360 began to deteriorate quickly. I went from stage one to 0:00:45.440 --> 0:00:48.600 stage four in less than five years, which terrified me. 0:00:49.159 --> 0:00:54.000 I saw no hope. After years of unsuccessful treatments and 0:00:54.080 --> 0:00:57.880 being unqualified for clinical trials, I was finally accepted for 0:00:57.920 --> 0:01:00.840 a clinical trial in early twenty thirteen and began the 0:01:00.880 --> 0:01:05.600 treatment later that year. My viral load started at seventeen million. 0:01:06.120 --> 0:01:08.199 I went back for a blood draw in three days 0:01:08.240 --> 0:01:10.560 and it had dropped to seven hundred and twenty five. 0:01:11.120 --> 0:01:13.480 At day five, I was at one twenty four and 0:01:13.520 --> 0:01:18.160 in seven days my viral load was undetected. This trial 0:01:18.240 --> 0:01:21.039 drug had destroyed the very thing that killed my mother 0:01:21.200 --> 0:01:25.360 seven years earlier. Today, I've managed a sustained viri logic 0:01:25.440 --> 0:01:27.960 response for four and a half years, but it's been 0:01:28.000 --> 0:01:31.560 along road. One thing I always tell people who contact 0:01:31.600 --> 0:01:34.440 me is that nobody's hepatitis SEA journey is the same. 0:01:34.920 --> 0:01:37.280 We may have the same symptoms, but how our bodies 0:01:37.319 --> 0:01:41.440 respond to treatments is unique. Don't hide in shame about 0:01:41.440 --> 0:01:44.560 having hepatitis SEA. It doesn't matter how you contracted it. 0:01:44.880 --> 0:02:31.000 What matters is that we get tested and treated. That 0:02:31.240 --> 0:02:36.200 was from Kimberly Morgan Bossley and her story with hepatitis 0:02:36.240 --> 0:02:40.720 C that we found on Healthline. Hi, I'm erin Welsh 0:02:40.760 --> 0:02:42.440 and I'm erin omen uptake. 0:02:42.400 --> 0:02:45.160 And this is this podcast will kill you today. 0:02:45.200 --> 0:02:47.480 We're talking about hepatitis C. 0:02:47.880 --> 0:02:50.240 As you may have guessed, it's. 0:02:50.160 --> 0:02:52.880 Kind of like in the first hand a bunch of times. 0:02:52.840 --> 0:02:56.800 Yep, yep. So what are we drinking this week? 0:02:57.160 --> 0:02:59.360 We're drinking Live and Let Liver. 0:03:01.280 --> 0:03:02.880 And what is in live and let liver. 0:03:03.280 --> 0:03:06.840 Well, of course there's alcohol, which is you know, take 0:03:06.880 --> 0:03:09.000 it easy on the alcohol on this one, guys. 0:03:08.960 --> 0:03:11.359 Or just make yourself the plasy Burta that too. 0:03:12.600 --> 0:03:17.600 But in the quarantini we have gin, grapefruit juice, lime juice, 0:03:17.919 --> 0:03:18.959 and grenadine. 0:03:19.280 --> 0:03:23.280 Yeah, it's delicious, and we will post the recipe to 0:03:23.440 --> 0:03:26.600 our alcoholic quarantini as well as our non alcoholic placy 0:03:26.600 --> 0:03:29.639 Burta on our website This podcast will kill You dot 0:03:29.680 --> 0:03:35.440 Com and our social media pages so Twitter, tpwkhy, Instagram, 0:03:35.480 --> 0:03:38.200 this podcast will kill you and Facebook. Yep. 0:03:38.880 --> 0:03:39.200 Cool. 0:03:39.880 --> 0:03:42.400 Cool. I'm excited for this episode. 0:03:42.600 --> 0:03:45.440 I know you are. I know you are, But what 0:03:45.560 --> 0:03:47.040 am I also excited? 0:03:48.440 --> 0:03:49.360 You're such a nerd. 0:03:49.680 --> 0:03:55.000 I know. I can't believe that's the first time I've 0:03:55.000 --> 0:03:57.200 ever said that joke. Actually, that was a good joke. 0:03:57.640 --> 0:03:58.640 I was a good joke. 0:03:58.800 --> 0:04:02.480 Thank you. Let's take a really short break and then 0:04:02.960 --> 0:04:38.560 dive in to hepatitis. So hepatitis literally just means inflammation 0:04:38.640 --> 0:04:44.400 of your liver. Okay, makes sense. So we probably most 0:04:44.520 --> 0:04:49.440 often at least many of us, think of viral hepatitis 0:04:49.480 --> 0:04:52.719 when we hear the word hepatitis, But do keep in 0:04:52.760 --> 0:04:55.560 mind that that's not by any means. The only thing 0:04:55.600 --> 0:04:57.360 that can cause inflammation of your liver. 0:04:58.520 --> 0:05:01.120 What else can cause inflammation of your Oh my gosh, 0:05:01.720 --> 0:05:06.599 bacteria can cause it. You know that parasites asking me 0:05:06.680 --> 0:05:07.679 to ask that question. 0:05:07.760 --> 0:05:12.599 I know parasites can cause hepatitis. You can have autoimmune hepatitis, 0:05:12.880 --> 0:05:15.919 you can get like hepatic involvement if you have things 0:05:15.960 --> 0:05:19.520 like lupus, blah blah blah. It's so many things can 0:05:19.600 --> 0:05:25.360 cause inflammation of your liver. But often acute hepatitis is 0:05:25.600 --> 0:05:29.679 very commonly caused by viruses. I would argue that, in fact, 0:05:29.760 --> 0:05:34.560 we are just very uncreative in naming viruses because the 0:05:34.880 --> 0:05:42.640 viral hepatitises are named hepatitis A, B, C, D, and E. 0:05:43.760 --> 0:05:46.320 I mean to be honest, like, it's not a bad. 0:05:46.560 --> 0:05:48.640 Wait, it's not a bad It's not bad, you know. 0:05:49.839 --> 0:05:52.440 But one thing that makes it very confusing is that 0:05:52.480 --> 0:05:56.720 all of these different hepatitis viruses have nothing to do 0:05:56.800 --> 0:06:01.919 with each Did you just say hepatiti Yeah, it's terrible. 0:06:03.440 --> 0:06:08.080 All of these m M, all of these viral hepatite. 0:06:07.800 --> 0:06:12.640 Mmm, hepatit, I think is the word that you're looking for? 0:06:13.440 --> 0:06:16.800 No, not hepatiti erin? 0:06:18.160 --> 0:06:19.200 Is that not the plural. 0:06:19.440 --> 0:06:20.400 It's not the plural. 0:06:21.080 --> 0:06:24.640 We'll see, okay, see by the end of the episode, 0:06:24.640 --> 0:06:25.680 it will be all right. 0:06:27.760 --> 0:06:34.159 All of these viral hepatitis viruses, they have nothing to 0:06:34.200 --> 0:06:37.600 do with each other. Erin hepatitis B is not closely 0:06:37.640 --> 0:06:41.479 related to hepatitis C, et cetera. Okay. They just all 0:06:41.560 --> 0:06:44.040 are viruses that happen to affect the liver. 0:06:44.720 --> 0:06:46.440 What that's wild? 0:06:47.000 --> 0:06:48.360 It is it is wild. 0:06:49.000 --> 0:06:52.159 So these are not even the same type of viruses. 0:06:52.640 --> 0:06:55.320 Oh heck, no erin. 0:06:56.040 --> 0:06:58.559 Okay, So that part is where I disagree with the naming. 0:06:58.640 --> 0:07:01.880 Then thank you. Okay, I'm glad that you're finally on 0:07:02.000 --> 0:07:07.080 my page. So we're only discussing today one of these 0:07:07.880 --> 0:07:14.840 hepatitis viruses, and that is hepatitis C. Okay. And it 0:07:14.920 --> 0:07:20.240 turns out actually that TPWKY listeners are very familiar with 0:07:20.280 --> 0:07:24.600 this family of viruses that hepatitis C belongs to. Hepatitis 0:07:24.640 --> 0:07:26.720 C is a flavavirus. 0:07:27.360 --> 0:07:30.280 I was bowled over when I saw that. 0:07:30.680 --> 0:07:35.240 I know, it's very cool. Yeah, So if you like, 0:07:35.320 --> 0:07:38.920 if these words like flavavirus are confusing to you, don't worry. 0:07:38.920 --> 0:07:43.040 You're not alone. Flavaviruses include dengay, the one we just 0:07:43.120 --> 0:07:49.320 talked about a few weeks ago. Also yellow fever, et cetera. Okay, 0:07:49.400 --> 0:07:52.800 if you remember, yellow fever is called yellow fever because 0:07:52.880 --> 0:07:55.600 it is a favor that turns you yellow because of 0:07:55.640 --> 0:08:00.640 its effect on your liver. Right, Okay, So, like the 0:08:00.720 --> 0:08:05.760 other flaviviruses, hepatitis C is an RNA virus. Hepatitis C, 0:08:06.360 --> 0:08:10.320 like many RNA viruses, has a huge amount of what 0:08:10.360 --> 0:08:14.320 we call antigenic variation, so it has a lot of 0:08:14.360 --> 0:08:19.320 different antigens on its surface like the flu does, okay, influenza, 0:08:19.920 --> 0:08:22.000 So that means it's really hard to target from a 0:08:22.040 --> 0:08:25.360 vaccine perspective because it has a lot of variation. There's 0:08:25.360 --> 0:08:27.720 a whole bunch of different targets. It's hard to get 0:08:27.760 --> 0:08:31.840 them all. They're constantly changing. RNA viruses also have really 0:08:31.920 --> 0:08:36.680 high mutation rates, so they evolve very quickly. Hepatitis C 0:08:36.920 --> 0:08:41.960 is one of those so spoilers. We don't have a vaccine, 0:08:42.840 --> 0:08:46.520 But unlike many of the other flavaviruses, you don't get 0:08:46.559 --> 0:08:49.120 hepatitis C from mosquitoes. 0:08:49.200 --> 0:08:52.760 Which I find very interesting. Also, but there are also 0:08:52.880 --> 0:08:57.880 there are tickborn and non vector born flavvivirus. 0:08:57.360 --> 0:09:00.839 Viruses yeah, there are absolutely, and you do get hepatitis 0:09:00.880 --> 0:09:06.160 C from blood, which ultimately is where mosquitoes get flaviviviruses 0:09:06.200 --> 0:09:12.240 from anyways, So yeah, you're just missing the vector. So 0:09:12.559 --> 0:09:18.240 hepatitis C it invades your liver cells, your hepatocytes, that's 0:09:18.280 --> 0:09:21.880 where it tends to replicate, and then it bursts out 0:09:21.920 --> 0:09:25.040 into your blood stream and circulates in your blood. So 0:09:25.280 --> 0:09:29.239 it's transmitted person to person when you come into contact 0:09:29.400 --> 0:09:34.280 with that blood. So in the past, when blood products 0:09:34.559 --> 0:09:37.439 weren't screened properly, and I know aarin you're going to 0:09:37.480 --> 0:09:40.560 talk a lot more about that, right, Oh, yeah, yeah, 0:09:40.840 --> 0:09:44.480 blood products were a very big source of infection prior 0:09:44.559 --> 0:09:47.560 to screening. In some areas of the world. Blood products 0:09:47.600 --> 0:09:50.200 are still a source of infection if it's very difficult 0:09:50.200 --> 0:09:53.720 to screen or if there's not access to good screening tools. 0:09:54.840 --> 0:10:00.839 But hugely important are actually medical tools used in things 0:10:00.880 --> 0:10:05.320 like surgeries, injections. That's actually one of the most common 0:10:05.360 --> 0:10:10.240 sources of infection today is medical injections using not properly 0:10:10.240 --> 0:10:16.080 sterilized needles or glass syringes. And then the other big 0:10:16.120 --> 0:10:19.760 source of infection today is injection drug use. It is 0:10:20.120 --> 0:10:24.880 possible to get infected via sexual transmission. But it's honestly 0:10:25.040 --> 0:10:28.480 very rare. It's not like hepatitis B, which is much 0:10:28.520 --> 0:10:33.920 more likely to be transmitted sexually. So okay, okay, So Aaron, 0:10:34.120 --> 0:10:36.240 I think I told you last week, like, oh yeah, 0:10:36.240 --> 0:10:38.120 hepatitis C is going to be so easy for me 0:10:38.200 --> 0:10:41.360 to research. It's like really straightforward, we know a lot. 0:10:42.000 --> 0:10:43.920 Yeah, you were like, oh, it'll take me no time. 0:10:44.559 --> 0:10:44.839 Yeah. 0:10:45.000 --> 0:10:48.880 Then you texted me today and you were like, oh god, uh, 0:10:49.440 --> 0:10:49.959 it took. 0:10:49.760 --> 0:10:51.960 Me forever, and Aaron I, I'm not going to have 0:10:52.000 --> 0:10:57.200 answers to any of your questions. Ah, Aaron, Okay, So 0:10:57.280 --> 0:10:59.839 let's talk about how you get sick from hepatitis C. 0:11:00.520 --> 0:11:00.840 Okay. 0:11:01.480 --> 0:11:06.200 While it can and often does cause an acute hepatitis, 0:11:06.240 --> 0:11:08.440 which we'll talk about the symptoms of in just a second, 0:11:09.000 --> 0:11:12.439 the biggest issue and most dangerous part of hepatitis C 0:11:12.800 --> 0:11:17.760 is that, in between fifty to eighty five percent of cases, 0:11:18.120 --> 0:11:22.320 it results in a chronic infection that can eventually result 0:11:22.400 --> 0:11:26.760 in liver failure and or liver cancer and death. 0:11:28.520 --> 0:11:36.280 First question, Oh god, okay, sorry, fifty to eighty five 0:11:36.920 --> 0:11:40.560 is quite a big range. What determines whether someone is 0:11:40.640 --> 0:11:42.440 going to become chronically infected or not. 0:11:42.840 --> 0:11:46.720 Excellent question. There's a number of different things comorbidities. So 0:11:47.320 --> 0:11:51.880 things like having diabetes can increase your risk of chronic infection. 0:11:52.600 --> 0:11:56.439 Heavy alcohol use, especially more than fifty grams of alcohol 0:11:56.440 --> 0:11:59.400 a day, which is like four alcoholic beverages a day, 0:12:00.320 --> 0:12:04.880 can increase your risk of chronic infection. Being immuno compromised, 0:12:05.520 --> 0:12:10.160 for example, coinfection with HIV definitely increases your risk for 0:12:10.240 --> 0:12:14.040 chronic infection. So yeah, things like that. The amount of 0:12:14.120 --> 0:12:17.600 virus that you're infected with is not actually associated with 0:12:18.080 --> 0:12:20.640 whether or not you develop a chronic infection, which is 0:12:20.679 --> 0:12:23.880 different than a lot of other viral diseases that we see. 0:12:24.120 --> 0:12:27.360 Okay, if you get infected with hepatitis C and then 0:12:27.400 --> 0:12:31.079 you do not develop chronic infection, can you get reinfected 0:12:32.760 --> 0:12:36.840 and then develop chronic infection? Okay, so you're not like immune, 0:12:37.200 --> 0:12:40.240 which I guess is then the struggle with creating a vaccine. 0:12:41.679 --> 0:12:50.440 Yep, Okay, good question. Okay, So chronic infection means in 0:12:50.480 --> 0:12:53.080 this case that even though a person might not have 0:12:53.120 --> 0:12:56.840 any symptoms, the virus stays in their body, continues to 0:12:56.920 --> 0:13:01.520 replicate and many many years where talking like ten twenty 0:13:01.840 --> 0:13:04.840 thirty or more years down the line can result in 0:13:05.200 --> 0:13:09.440 serious disease. So then the question that we that I 0:13:09.480 --> 0:13:12.040 always like to try and answer on this podcast is 0:13:12.480 --> 0:13:19.120 how does this virus actually cause disease? Yeah, Aaron, we 0:13:19.960 --> 0:13:20.800 don't know. 0:13:21.840 --> 0:13:25.000 What do you mean? I mean, we don't know. 0:13:26.040 --> 0:13:28.320 So here are the things we do know. 0:13:28.800 --> 0:13:32.280 Okay, when hepatitis. 0:13:31.640 --> 0:13:38.280 C invades your liver, it does stimulate an immune response. 0:13:38.480 --> 0:13:42.600 So your innate immune system which I think we talked 0:13:42.640 --> 0:13:46.480 about the innate versus adaptive immune system in the first 0:13:46.559 --> 0:13:49.959 vaccines episode if you want like a really nice intro 0:13:50.120 --> 0:13:54.520 to your immune system. But basically, the very nonspecific first 0:13:54.559 --> 0:14:00.680 immune response is triggered when you get infected with hepatitis C. However, 0:14:00.920 --> 0:14:06.680 for some reason that is unclear, the downstream effects of 0:14:06.760 --> 0:14:12.000 that don't really happen in a lot of people infected 0:14:12.120 --> 0:14:14.920 with HEPSI. So what that means is, you know, you 0:14:15.000 --> 0:14:18.800 have your first line defenders like macrophages and stuff that 0:14:18.880 --> 0:14:23.720 come in release a bunch of chemical signals to trigger 0:14:23.760 --> 0:14:27.640 things like natural killer cells, which we talked about in 0:14:27.680 --> 0:14:31.160 the Vacciness episode, that are supposed to come in and 0:14:31.320 --> 0:14:35.520 kill any viral infected cells. So that that virus doesn't 0:14:35.520 --> 0:14:40.840 continue to replicate. Something doesn't work right in that response 0:14:41.400 --> 0:14:46.080 when you get infected with HEPSI. So we know that 0:14:46.160 --> 0:14:50.520 people who develop chronic infections with hepatitis C, which again 0:14:50.600 --> 0:14:53.960 is the majority of people who get infected, they don't 0:14:53.960 --> 0:14:57.000 have a good T cell response, so their T cells 0:14:57.080 --> 0:15:01.680 aren't responding well to fight down this infection. But that's 0:15:01.680 --> 0:15:04.080 all we know. We don't know why. We don't know 0:15:04.120 --> 0:15:06.760 how to predict who is going to do a good 0:15:06.840 --> 0:15:09.440 job of fighting off the infection versus who isn't. And 0:15:09.480 --> 0:15:12.920 we don't know what the virus is doing specifically to 0:15:13.120 --> 0:15:17.880 cause these changes in people's immune response that it gets worse, 0:15:17.920 --> 0:15:19.000 it gets therein. 0:15:19.000 --> 0:15:25.640 Okay, Okay, I'm just shocked that we can treat this, dude. 0:15:26.320 --> 0:15:28.920 This is why I thought we knew the answers to 0:15:28.960 --> 0:15:32.280 these questions, because the amount of advances that we have 0:15:32.360 --> 0:15:35.200 made in treatment for hepatitis C over the last like 0:15:35.400 --> 0:15:40.240 five years is bananas. Yeah, So I was like, of course, 0:15:40.280 --> 0:15:42.240 we know, Yeah, we got tons of treatment, we can 0:15:42.280 --> 0:15:44.360 cure it now, no big deal. So I mean, not 0:15:44.440 --> 0:15:47.160 no big deal, But you know, I thought we knew, Aaron, 0:15:47.240 --> 0:15:50.120 we don't know, and the other thing is like the 0:15:50.120 --> 0:15:52.400 whole cancer thing, which we're going to talk in more 0:15:52.440 --> 0:15:55.800 detail about. Actually we're not because we don't know. We 0:15:55.960 --> 0:16:00.720 don't know how hepatitis C causes cancer. We don't no, 0:16:01.720 --> 0:16:04.880 it's the title of this episode, hepatitis C. I don't know. 0:16:05.480 --> 0:16:05.960 We don't know. 0:16:07.320 --> 0:16:07.880 Wow. 0:16:08.560 --> 0:16:16.680 Okay. There are six different genotypes of hepatitis C. Overall, 0:16:16.800 --> 0:16:22.080 they're not associated with different risks of ultimately liver failure. 0:16:22.920 --> 0:16:26.920 But genotype one B is one of the most common genotypes, 0:16:26.960 --> 0:16:29.800 and that one is associated with an increased risk of 0:16:29.840 --> 0:16:33.880 liver cancer. Okay, but it's not because we don't know why. 0:16:34.000 --> 0:16:36.400 It's not clear why, of course. 0:16:36.560 --> 0:16:37.680 Yeah, oh my. 0:16:37.720 --> 0:16:41.120 Gosh, who knew? I didn't. Well, let's talk about what 0:16:41.160 --> 0:16:44.120 we do know, and that is the signs and symptoms. So, 0:16:45.400 --> 0:16:48.880 in an acute infection, the incubation period, so the time 0:16:48.920 --> 0:16:51.360 from when you first get infected to when you first 0:16:51.440 --> 0:16:55.040 show symptoms, is actually quite long. It's usually like around 0:16:55.120 --> 0:16:59.920 seven weeks, okay, which is pretty long. Only about thirty 0:17:00.080 --> 0:17:05.520 percent of people infected with HEPC will actually have acute 0:17:05.880 --> 0:17:12.439 symptomatic infection, and generally this presents with malaise, so feeling 0:17:12.480 --> 0:17:16.800 fatigued and feeling crappy, you often get nausea, which isn't 0:17:16.800 --> 0:17:20.159 surprising since your your liver is very involved with your 0:17:20.200 --> 0:17:24.800 GI tract, you know, and right upper quadrant pain. Your 0:17:24.840 --> 0:17:28.240 liver is in the right upper quadrant of your abdomen, 0:17:28.880 --> 0:17:33.880 so your liver hurts, okay, and then what you also 0:17:34.000 --> 0:17:37.960 get is dark colored urine, And that's because you get 0:17:37.960 --> 0:17:42.400 an increase in bilirubin, which is basically a breakdown product 0:17:42.440 --> 0:17:45.359 of your red blood cells that your liver is supposed 0:17:45.440 --> 0:17:48.040 to get rid of. But your liver's not working right, 0:17:48.640 --> 0:17:50.960 So then bilirubin builds up and you have to pee 0:17:50.960 --> 0:17:51.320 it out. 0:17:52.040 --> 0:17:52.639 Huh. 0:17:52.720 --> 0:17:57.400 So instead of your poop being poop colored, your urine 0:17:57.440 --> 0:18:02.120 is kind of poop colored. And then as that bilirubin 0:18:02.160 --> 0:18:05.119 continues to build up, that's when you see things like jaundice. 0:18:05.359 --> 0:18:07.960 So that's literally your skin turning yellow from how much 0:18:08.000 --> 0:18:13.880 bilirubin is circulating in your system. Right. Another huge thing 0:18:14.240 --> 0:18:18.560 that you see in acute hepatitis infections are if you 0:18:18.680 --> 0:18:22.440 test your blood to look at specific enzymes that your 0:18:22.480 --> 0:18:26.000 liver produces, they will be off the charts high, like 0:18:26.200 --> 0:18:30.080 thousands of times or at least tens of times elevated 0:18:30.680 --> 0:18:33.600 on what they normally are, and that's a really big 0:18:33.640 --> 0:18:36.639 sign that you have an acute That means first time, 0:18:37.520 --> 0:18:43.280 shortly after you get infected hepatitis infection. Okay, But for 0:18:43.359 --> 0:18:47.720 the most part, acute infection, even when it's symptomatic, is 0:18:47.800 --> 0:18:52.280 self limited. So with hepatitis C, you are very unlikely 0:18:52.400 --> 0:18:55.800 to die from what we call fulminent, which is like 0:18:56.160 --> 0:18:59.600 very rapidly progressive acute liver failure. 0:19:00.200 --> 0:19:03.000 Okay. The real risk comes in the chronic. 0:19:03.240 --> 0:19:08.320 Exactly exactly, And in general disease symptoms are pretty long lasting. 0:19:08.359 --> 0:19:11.440 You can be sick anywhere from like two to twelve weeks, 0:19:12.080 --> 0:19:15.920 but for the most part, people do recover, okay. In 0:19:15.960 --> 0:19:19.320 the case of hepatitis C, however, up to eighty five 0:19:19.400 --> 0:19:24.679 percent of infections become chronic, and for the most part, 0:19:24.840 --> 0:19:28.959 during this chronic infection, a person won't necessarily have that 0:19:29.000 --> 0:19:32.439 many signs or symptoms. If you were to test their blood, 0:19:32.720 --> 0:19:37.520 they might still have slightly elevated liver enzymes, but you 0:19:37.560 --> 0:19:40.359 can see these elevations in liver enzymes from a number 0:19:40.400 --> 0:19:44.560 of different things, so it's not like that specific to 0:19:44.840 --> 0:19:51.600 chronic hepatitis infection, okay, But progressively as this infection kind 0:19:51.640 --> 0:19:55.159 of goes along its course. The biggest symptom that people 0:19:55.200 --> 0:20:00.600 tend to experience is fatigue, like really bad fatigue, never 0:20:01.320 --> 0:20:06.520 never really feeling fully energetic. It's kind of one of 0:20:06.560 --> 0:20:10.560 the biggest symptoms. But as we'll talk about, there are 0:20:10.640 --> 0:20:13.120 some other symptoms that you start to see, especially as 0:20:13.119 --> 0:20:17.200 the disease progresses, because basically what's happening inside your liver 0:20:18.000 --> 0:20:23.119 is fibrosis. So fibrosis is the result of chronic inflammation 0:20:23.280 --> 0:20:27.760 in the liver that leads to scarring. Very mild. Fibrosis 0:20:27.920 --> 0:20:32.000 can be reversible. But what happens with fibrosis, especially when 0:20:32.040 --> 0:20:36.760 it's a chronic infection, is that it progresses to what 0:20:36.800 --> 0:20:40.280 we call cirrhosis, which is kind of the end stage 0:20:40.440 --> 0:20:41.560 of fibrosis. 0:20:42.280 --> 0:20:44.119 Huh okay, I realize that. 0:20:44.520 --> 0:20:46.959 Yeah, I didn't either. I had to double google it 0:20:47.000 --> 0:20:50.119 to make sure I was saying it correctly. I should 0:20:50.200 --> 0:20:53.160 know these things, Arin, I'm going to be a doctor. 0:20:55.320 --> 0:20:56.879 That's what Google exists for. 0:20:57.840 --> 0:20:59.919 Yeah, I checked doctor Google too. 0:20:59.800 --> 0:21:02.320 So oh oh good. 0:21:02.680 --> 0:21:06.240 So cirrhosis, which is kind of the end stage fibrosis. 0:21:06.240 --> 0:21:11.120 It's like your liver is so fibrotic, it's all It's 0:21:11.160 --> 0:21:13.520 like your liver is supposed to be nice and red 0:21:13.960 --> 0:21:19.000 and beefy looking, but when it starts to get progressed 0:21:19.000 --> 0:21:24.000 from fibrosis to cirrhosis, it gets hard, it doesn't move 0:21:24.080 --> 0:21:27.359 as much, it can't. The blood flow is really bad. 0:21:28.119 --> 0:21:31.000 And this happens in about twenty to thirty percent of 0:21:31.080 --> 0:21:33.480 people with chronic hepatitis C infection. 0:21:34.000 --> 0:21:35.840 Wow, that's a lot. 0:21:36.080 --> 0:21:39.520 It's a lot. Yeah, And cirrhosis itself can lead to 0:21:39.600 --> 0:21:42.760 liver failure and eventual death, but in the case of 0:21:42.800 --> 0:21:47.000 hepatitis C, it's also associated with an increased risk of 0:21:47.200 --> 0:21:52.800 hippatocellular carcinoma aka liver cancer. Okay, so what are some 0:21:52.880 --> 0:21:55.840 of the symptoms that we see when you progress all 0:21:55.880 --> 0:21:57.399 the way to cirrhosis. 0:21:58.720 --> 0:22:00.760 I don't know what are they? Let me tell you. 0:22:01.880 --> 0:22:07.560 So the symptoms are. They can be severe depending on 0:22:07.600 --> 0:22:10.399 how bad you know, how bad the fibrosis has gotten 0:22:10.440 --> 0:22:13.960 if it's truly cirrhosis at this point. Fatigue is still 0:22:14.240 --> 0:22:18.440 a big one. Muscle weakness is another because basically, just 0:22:18.480 --> 0:22:21.360 like your liver is in charge of doing a lot 0:22:21.400 --> 0:22:25.080 of things to make products that the rest of your 0:22:25.080 --> 0:22:28.560 body uses, and if your liver can't do that, then 0:22:28.600 --> 0:22:30.800 your muscles and things can't work the way that they're 0:22:30.800 --> 0:22:31.240 supposed to. 0:22:31.760 --> 0:22:32.119 Gotcha. 0:22:32.800 --> 0:22:36.840 When you eat food and you absorb nutrients, all of 0:22:36.840 --> 0:22:39.600 those nutrients get absorbed into your blood stream. All of 0:22:39.640 --> 0:22:43.320 the blood from your whole GI tract, for the most part, 0:22:43.800 --> 0:22:48.280 travels to your liver through one big vein called the 0:22:48.320 --> 0:22:52.040 portal vein. Okay, so all of the blood from your 0:22:52.080 --> 0:22:56.000 GI tract for the most part, is going to your liver, 0:22:56.160 --> 0:22:58.119 and then your liver is going to process all of that. 0:22:58.560 --> 0:22:59.000 Okay. 0:22:59.240 --> 0:23:04.280 As your liver starts to become serotic and hardens, that 0:23:04.640 --> 0:23:08.600 closes off that blood vessel and so it basically puts 0:23:08.680 --> 0:23:12.840 increased pressure on that portal vein and it backflows it. 0:23:13.000 --> 0:23:13.760 If that makes sense. 0:23:13.880 --> 0:23:15.120 Ooh, that sounds terrible. 0:23:15.200 --> 0:23:17.439 It is terrible. It's like squeezing the end of a 0:23:17.480 --> 0:23:22.639 garden hose, right, yeah, And that garden hose that goes 0:23:22.800 --> 0:23:26.800 to your liver when it backflows, it backflows into your 0:23:26.800 --> 0:23:29.439 GI tract, and so this can cause all of the 0:23:29.520 --> 0:23:33.840 veins associated with that to then start to dilate. So 0:23:33.920 --> 0:23:36.959 this can cause what we call verices or varicose veins. 0:23:37.160 --> 0:23:40.080 You've heard of those in like your legs. Yeah, well 0:23:40.119 --> 0:23:42.960 you can get those associated with your gi tract, so 0:23:43.040 --> 0:23:47.080 around your belly button you can get huge amounts of 0:23:47.119 --> 0:23:51.840 varicose veins. You can get them in your esophagus because 0:23:51.920 --> 0:23:54.719 even your blood flow from your esophagus goes to that 0:23:54.760 --> 0:23:58.520 portal vein, and those, if they're under too much pressure, 0:23:58.680 --> 0:24:02.000 can burst. Oh my god, and then you can bleed 0:24:02.040 --> 0:24:06.800 out and die because what's mm hmmm, m yep, that 0:24:06.840 --> 0:24:09.960 can happen. Another thing that can happen if you think 0:24:10.000 --> 0:24:12.320 of closing off the end of a garden hose, how 0:24:12.400 --> 0:24:15.200 much pressure you can build up in that garden hose. 0:24:15.600 --> 0:24:19.240 Eventually that hose is going to start to leak from 0:24:19.240 --> 0:24:22.720 the sides, right uh huh, It's going to like spew 0:24:22.840 --> 0:24:25.440 liquid out water out from the sides. The same thing 0:24:25.480 --> 0:24:28.080 can happen in what we call your portal tract in 0:24:28.119 --> 0:24:32.160 that portal vein, which can cause the fluid that's supposed 0:24:32.200 --> 0:24:35.400 to be in that vein to start leaking into your abdomen. 0:24:35.640 --> 0:24:37.840 So you can get a huge amount of fluid in 0:24:37.880 --> 0:24:40.120 your abdomen. That's what we call ascides. 0:24:41.440 --> 0:24:42.400 Oh my gosh. 0:24:42.440 --> 0:24:45.600 I have seen people in liver failure not necessarily from 0:24:45.640 --> 0:24:50.520 hepatitis C, but from cirrhosis that we've drained eight liters 0:24:50.520 --> 0:24:52.840 of fluid from their belly. 0:24:53.359 --> 0:24:56.520 Where is that liquid coming from from? 0:24:56.680 --> 0:24:59.480 It's from your bloodstream, like you retain it, I know, 0:24:59.560 --> 0:25:06.160 but eight leaders, eight leaders. It's it's not good. That's 0:25:06.200 --> 0:25:11.000 like really bad. So yeah, you can imagine that that 0:25:11.600 --> 0:25:15.640 can cause a lot of complications, right, A whole bunch 0:25:15.680 --> 0:25:18.960 of fluid just in your abdomen that can be anidis 0:25:19.040 --> 0:25:22.879 for infection, so you can get abdominal infections because of it. 0:25:22.880 --> 0:25:24.879 It also is just putting a lot of pressure on 0:25:24.920 --> 0:25:28.159 all of your organs. All this pressure in the veins 0:25:28.200 --> 0:25:30.520 can lead them to burst, like I said already, So 0:25:31.920 --> 0:25:34.800 in general, liver failure is not good news. 0:25:35.080 --> 0:25:36.600 Well yeah, and then some of. 0:25:36.560 --> 0:25:38.919 The other signs and symptoms that we see are similar 0:25:38.960 --> 0:25:41.840 to what we see in acute liver disease, So things 0:25:41.880 --> 0:25:45.720 like jaundice, weakness. Itching is a really big one because 0:25:45.760 --> 0:25:49.360 as bilirubin builds up and actually causes a really intense 0:25:49.480 --> 0:25:56.760 itching why I don't really know, I'm not really sure, 0:25:56.800 --> 0:25:58.439 but it does just makes you itchy. 0:25:59.040 --> 0:25:59.600 Interesting. 0:25:59.800 --> 0:26:03.600 And then hepatitis C can actually also have extra hepatic 0:26:03.720 --> 0:26:08.959 so outside of the liver manifestations, especially by increasing abnormal 0:26:09.000 --> 0:26:12.359 proteins in your blood, which can have issues like making 0:26:12.400 --> 0:26:16.359 your blood too thick. Blah blah blah. Hepatitis C is 0:26:16.400 --> 0:26:17.400 not a good disease. 0:26:18.400 --> 0:26:20.520