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Hepatitis A through C Podcast

  • SARA LOMAX-REESE: I want to welcome Dr. Donee Patterson.

    DONEE PATTERSON, MD: Thank you.

    LOMAX-REESE: And Dr. Eyob Feyssa.

    EYOB FEYSSA, MD,MPH: Thank you. 

    LOMAX-REESE: Welcome to the program.  So let's start with the question of the liver; we know that hepatitis has a direct impact on the liver.  Can you share with us kind of a 101 on what the liver actually does?

    PATTERSON: Sure.  So the liver is very important.  It is actually the second largest organ in the body, second to the skin and it's known to convert a lot of nutrients that we take in into forms that our body cells can use.  It is used to produce bile and bile salts which helps us to break down fat and helps us to absorb certain vitamins and it helps us remove lots of damaged red blood cells or toxins that are in the body.  It has a lot of functions.  It also helps us make cholesterol and even though cholesterol has a bad name, every cell needs cholesterol, so the liver helps us make that.

    LOMAX-REESE: In looking at the information, I didn't realize that there were so many different kinds of hepatis.  I knew about A, B, and C, but apparently there is A, B, C, D, E.  Dr. Feyssa, I wanted to see if you could talk specifically about hepatitis and what is happening in the liver with these different types of hepatitis.

    FEYSSA:     Hepatitis simply means inflammation of the liver and essentially inflammation of liver cells.  We generally classify hepatitis into two broad categories, one is infectious hepatitis and the other one is non-infectious hepatitis.  As you mentioned, there are different organisms which could cause infection of the liver, resulting inflammation and damage, mostly viruses.  It happened that we give them names, A, B, C, E, up to E, but there are also other hepatitis.  For example, the most common well to mention is alcohol.  Alcohol can cause damage to the liver, resulting in inflammation.  There are other metabolic problems.  People who have diabetes, obesity, high cholesterol, can have a fatty liver, that can also result in inflammation and there are other metabolic and genetic disease which can cause inflammation.  These are not infectious but non infectious cause.

    LOMAX-REESE: So there is the infectious but there is also sexual transmitted.  B is primarily contracted through sexual….

    FEYSSA: Very good question.  I can give you an example.  In the case of viral hepatitis, for example hepatitis B or hepatitis C, these are blood borne disease and in the same way, there is a risk for transmission from one partner, infected partner, to the non-infected partner during a sexual encounter.

    PATTERSON: So Sara, just to clarify a little bit; when we say non infectious we mean we can't pass them from one person to another.  So alcoholic hepatitis, someone who may have damaged their liver from excessive alcohol, they can't pass that to someone else.  Whereas the others are infectious; they are viruses and you can pass them back and forth to people.

    LOMAX-REESE: So one of the things that we often hear in connection with a diseased liver is cirrhosis of the liver.  What exactly is that and is there any connection to that with hepatitis?

    PATTERSON: Cirrhosis s of the liver means that the liver has been damaged and there is some scar tissue involved.  It can actually progress to what we call end stage liver disease, where the liver can actually stop working and then all those important cell functions would stop as well.  So it's from having hepatitis for a long time and its chronic damage of the liver.

    LOMAX-REESE: So let's go through A, B and C since they are the predominate forms of hepatitis.  I know that hepatitis B, there are a disproportioned number of African Americans who have hepatitis B so I kind of want to start there and then we can go to A and C from there.  I will start with you Dr. Feyssa, what are the causes of hepatitis B and in general, what are the signs of symptoms so that people can begin to understand if they should be concerned?

    FEYSSA: Hepatitis B is a virus so the mode of transmission or contraction is through contact with an infected blood.  Unfortunately, an infected mother can pass the disease to an unborn child.  Also, any high risk behavior, the presence of a tattoo, piercing and using uncleaned and un-sterilized instruments can also expose an individual to this infection.  Before 1976, we were testing about hepatitis B so people who received transfusions or transplantation before that I think are at increased risk.  In African Americans, there is a high rate of end stage renal disease and people are on hemodialysis or getting dialysis are also known to have a high rate of hepatitis B and that's another group which needs to be screened for this infection.  Hepatitis B infection can be classified in two forms, the acute form, where a patient can have flu like symptoms; they can have fatigue; severe tiredness; they can have decreased appetite; can have joint aches and pains and in some severe forms can have yellowish discoloration of their eyes and pain in their eye sight but in most cases patients may  not know that they have contracted hepatitis B.

    LOMAX-REESE: So how do you diagnose it?  Is it a blood test?  What is the process for diagnosis?

    FEYSSA:     A doctor can do a simple blood test to find out if somebody has hepatitis B or not.  Basically you can also classify whether that is an acute infection or a chronic infection that a person has and in that way you will be able to determine whether there is significant liver damage or not.

    LOMAX-REESE: Is hepatitis something that is curable or once you have it you are kind of living with it for the rest of your life?

    PATTERSON: It is interesting because there are people who have hepatitis A and B particularly and it actually goes away.  A lot of times they don’t even know they have it and it can go away, but there are cases where it does go to be chronic and then the person will have it for a lifetime and that can be treated but it is not cured.  

    LOMAX-REESE: Now one of the things about the liver that I find really fascinating is that it can regenerate and so if you have a damaged liver, I would imagine it depends the extent of the damage, but what is the resiliency of the liver, if you had had hepatitis whether you knew it or not, how would you know if your liver could be built back up to full function?

    FEYSSA:      Again, as you clearly mentioned, it depends on what the cause of the disease, how severe it is and other factors.  How healthy an individual is, that determines how fast a disease can progress and resulting in cirrhosis. The way to define whether a liver is regenerating or getting healthy is getting blood tests, tests like ultrasounds and of course a liver biopsy.  This will be determined in a discussion between the patient and the physician.

    LOMAX-REESE: So in terms of the blood test, is this something that is a part of your normal panel of blood test or do you actually have to request it?

    PATTERSON: That's a good question.  It is not usually part of the normal health maintenance screen.  We will test cholesterol and sugar and kidney tests.  We will check liver tests but it is not really a great way to follow hepatis.  We mostly check it if people are having symptoms.  If they have unexplained weight loss or they are having feverish chills or diarrhea that has lasted for a while.  We do screen it in people who are high risk, we use it as a screening test but often you have to ask for it or present with some of the symptoms.  So that is why we want to talk about this today.  We are going to talk about HIV later but people don't really think about hepatitis the same way they do about HIV.  We just want to get the word out there because it actually it is more easily spread 100 times more than HIV.

    LOMAX-REESE: We are talking with Dr. Donee Patterson, she is a family physician with Einstein Department of Medicine and Dr. Eyob Feyssa who is with Einstein as well and we are talking about hepatitis today, A, B, C, D and E, but primary A, B and C.  Let's move backwards to hepatitis A because one of the things that caught my eye and as somebody who likes to eat out a lot, I was like oh darn.  Simply eating out in a restaurant can put you at risk for hepatitis A and I hope that is an overstatement, but talk to me about hepatitis A and why eating out could put you at risk.

    PATTERSON: The good thing, I try to be a glass half full type person, but the good thing about hepatitis A is actually that it is the least dangerous of the forms of hepatitis and it doesn't go on to form chronic liver disease, although people can die form it, it doesn't go on to form the chronic type of inflammation in the liver.  People get this form of hepatitis by eating contaminated food, usually from fecal oral, so from the feces of an animal that is carrying the virus.  That is how you can get it from a restaurant, if they don't rinse off the fruits or if they don't rinse off the lemon in your water, or if they actually don't wash their hands well, they can pass it to you.  Hepatitis A is commonly known as a traveler's diarrhea because people travel to other countries and they come back and that is the diarrhea that they often have.  Also, the nice thing about, if there is a nice thing about having hepatitis, that you can get vaccinated and we highly recommend that people get vaccinated against hepatitis A and B, those are the ones that we have vaccines for.

    LOMAX-REESE: That is something, and I will turn to you Dr.  Feyssa that is a little bit controversial because babies, newborns, are generally vaccinated with …

    PATTERSON: Hepatitis B.

    LOMAX-REESE: Hepatitis B, and I know that some people really feel like one, there is an over saturation of vaccinations generally right now and that this is not necessary necessarily to vaccine a newborn against hepatitis B, I don't know if either one of you want to comment on that.

    PATTERSON: I am sure Dr. Feyssa has his opinions about this as well, but if you think about it I understand people's concerns about vaccines, but if you think about it within another 50, 60 years, all the school age children that will have been vaccinated will be protected against this very dangerous disease that can actually cause cirrhosis which can lead to liver cancer.  People don't realize that you can actually get cancer from this type of virus.  We understand that it is what we call herd immunity.  If you immunize everyone then everyone will be safer, but it is a very devastating, very deadly disease in certain cases and we can really prevent damage.  If a pregnant woman actually passes hepatitis to her baby, her baby is much more like to die and to get liver failure.

    LOMAX-REESE: Dr. Feyssa do you want to add anything?

    FEYSSA: In the case of hepatitis A, children should normally get vaccinated at the age of one year.  But it is very important to check whether somebody has developed immunity to the vaccine, to the virus, even at that age and those patients who are planning to travel outside the country who have an exposure.  People who work in day care services need to be tested and to get appropriate vaccines.  In regard to hepatitis B, all newborn children will get vaccinated; especially it is very important for a child born to a hepatitis positive mother needs a vaccination and immunoglobin at the same time.  A patient who has chronic liver disease, patients who have HIV, patients who have diabetes, patients who have chronic disease would also need to be tested even in adulthood, and if they are not immune they will need a vaccination.

    LOMAX-REESE: What are the side effects?  This is always…you got the herd immunity and all that, but what are the side effects?  I know and I'm not necessarily saying related to the hepatitis B vaccine, but I know that the whole issue of autism and the rise in the number of children who have been diagnosed with autism, some parents connect that with all the immunizations.  I am curious. What are the side effects if any of the hepatitis vaccine?

    PATTERSON: The very small risks are of course local inflammation, swelling or pain at the injection site.  But the risk that you are speaking of, the CDC and I read the CDC guidelines, Center for Disease Control guidelines quite frequently.  Really, the risk outweighs the benefit. 

    LOMAX-REESE: You mean the benefit outweighs….

    PATTERSON: Right, I'm sorry, the benefits greatly outweigh the risk and there hasn't been 100% link to autism and yes, there is some intuitive cases.  I have my own cases but I also immunize my  children because I really do think the benefits outweigh the risks and that  the studies have not fully panned out and it just shows so much greater benefit for the patient.

    LOMAX-REESE: That was Dr. Donee Patterson and we are also talking with Dr. Eyob Feyssa who are both from Einstein, Department of Medicine.  We are talking today about hepatitis.  We are talking about hepatitis A, B, C.  We haven't mentioned C as of yet.  I think we have to go to a break and when we come back we will talk a little bit about C.  I want to invite callers, if you have questions, give us a call 215-634-8065 or toll free 866-361-0900.  I also want to talk about prevention and how you keep your liver healthy.  We will come back in just a moment, don't go away.

    LOMAX-REESE: And we are back.  You are listening to Health Quest Live on 900 AM, WURD.  We are talking today about hepatitis and there are a number of different varieties of hepatitis.  We are talking with Dr. Donee Patterson and Dr. Eyob Feyssa from Einstein.  Before we went to break and we will come to the phones in just a minute, we wanted to zero in on hepatitis C because we talked about A and B and the next most common one is hepatitis C.  So Dr. Feyssa, do you want to speak about hepatitis C?

    FEYSSA: Yes, in fact the hepatitis C remains to be the most common hepatitis here.  There are some things, based on the 2010 census about 17000 new infections happen every year.  About 75% of people don't know that they have hepatitis C.  It can equally cause chronic disease, it can easily cause progressive disease, cirrhosis and in some cases liver cancer and remains to be the number one reason why people require liver transplantation.

    LOMAX-REESE: So again, really  needing to be proactive and to understand what is going on in our bodies so that when we do go see a physician, hopefully everybody has a physician, they can talk about what they are going through; if they are tired; if maybe jaundice; maybe diarrhea; those kinds of things so the tests can be order.  This is all great information.  We are going to the phones.  We have Leon from Center City.  Welcome to the program Leon.

    LEON: Good afternoon.  Sometimes when I hear medical science people talk about how the benefits of these vaccinations outweigh the risks, it dawns on me that a lot of times they don't tell the patient what the real risks.  They only talk about the benefits.  I am thinking mainly of hepatis B at this point.  I have read some researchers suggest that it can lead to asthma in children and I wonder if they can address that.

    LOMAX-REESE: Asthma, Dr. Donee?

    PATTERSON: I do want to say that before we do any kind of injection, flu shot, anything, we definitely talk to our patients and explain it and we often give people handouts so that they can understand it better.  To my knowledge, there is no correlation between hepatitis B vaccine and asthma.  It is so incredibly important for people to recognize how devastating some of these viruses can be especially if they don't get treated; how it can totally change a person life or cause early death and if a vaccine can prevent that, even for myself I have gotten all the vaccines that we have talked about.  Hepatitis A, hepatitis B, I've gotten the booster.  I often tell people I don't ask them to do things I wouldn’t myself do.

    LOMAX-REESE: I think there is a healthy skepticism that we often hear in our listening audience.  As much as science has progressed and it has probably made us a healthier nation, we are still not particularly healthy and a lot of that has to do with lifestyle things etc.  Last week there was a cover story on the New York Times about colonoscopies.  I don't know if either of you read it but it was so unnerving because basically they were saying that colonoscopies have been…that the bloat in the medical system and the fact that there is so much money that is being wasted essentially based on procedures that aren't necessarily as effective or more effective than things that are less expensive.   The money in health care is what I think makes people so nervous about information because you think about the pharmaceutical companies and capitalism is alive and well in the delivery of health care and that is what concerns people.

    PATTERSON: I get that.  I totally understand the skepticism but if people could see how sick a child can get from hepatitis A; if people could see people dying of cirrhosis of the liver or dying of alcoholic hepatitis, if they could actually see, but then if we could have prevented it from a vaccine so that if they were exposed that their bodies would take care of it, I think people would understand better.  Myself, I like to travel, but I traveled with people to Africa for example and one of the persons I traveled with came back and she had hepatitis B and she was extremely sick toward the end and then several people got travelers diarrhea.  I was just very thankful that I wasn't included in that and they really suffered for months.

    LOMAX-REESE: It is always that balancing act and that's why I really appreciate the information that you guys bring because it really is about knowing what the totality of the issue really is; the benefits, the risks, the opportunities, all of those things.  I wanted to ask you before we run out of time about prevention.  I was looking at what traditional Chinese medicine says about the liver and it says that anger, when you have problems with your liver, it is associated with anger.  That is just kind of a backdrop of my question around prevention.  How do we take good care of our liver? We talk about detoxes and things like that, flushing out the toxins from our system which is what the liver is that mechanism to clean ourselves out. I will start with you Dr. Feyssa.

    FEYSSA:      Absolutely.  I can the liver a factory of our body.  It is involved in a lot of things.  It is involved in our nutrition, in our immune system; it involves keeping us healthy, so keeping the liver healthy is very important.  First, these hepatitis, they are called silent but serious disease, so for most people they don't know if they have hepatitis C, hepatitis B so getting the appropriate testing, initiating the discussion with their physician is very important.  If there is hepatitis, then taking care of it will be appropriate.  Of course the most common way we can help our liver to stay healthy is to avoid alcohol.  Alcohol is a toxin for the liver and can make any existing disease worse.  As you mentioned in all the books, it is stated that sleeping well, exercise regularly, keeping an ideal body weight and also stay stress free will help the liver work better.

    LOMAX-REESE: Well all of those things are like the recipe for good health no matter what the organ, but some of those things are not easy.  I think in the society that we live in now, which is very much on the go all the time, leading a stress free life is almost impossible. Dr. Donee, do you want to add to prevention?

    PATTERSON: Well one thing that might be easy is to not take medications more than it's prescribed and if you are on multiple medications, make sure you are bringing them to your doctor and make sure you are bringing any herbal or over the counter medicine to your doctor because those are things that your liver has to work to break down as well.  In addition to just making sure that you are eating healthy and getting lots of rest also remember to get lots of fluids and not alcoholic beverages.

    LOMAX-REESE: That is great, great, great information.  I think that realizing that we need to adopt healthier lifestyles across the board.  What do you guys think about detoxes because that is a big industry right now and a lot of the focus of detoxes is on the liver.  What do you think Dr. Donee?

    PATTERSON: I think detoxes are fine.  I think everyone needs a good cleaning out; I think they are fine.  I think the shorter ones make more sense to me and that the longer ones, when we look at the studies, people don't actually realize what they are doing to their body and they are so restrictive at times that they actually get dehydrated; their electrolytes go down and when we check their liver and kidney function tests during those extended detoxes, they are actually putting some stress on their kidneys and on their liver.  So the very extended ones I have a problem with but the short ones I think are fine.

    LOMAX-REESE: OK, great.  Dr. Feyssa any thoughts?

    FEYSSA:     I agree.

    LOMAX-REESE: OK, good, good, good.  I think we are just about out of time for this segment.  We got a double header today with the Einstein doctors.  Right now we are going to close things out regarding hepatitis.  Are there any resources, any places people can go to get more information about hepatitis or about treatment options?

    PATTERSON: Just as a reminder, everyone should be tested.  If you have never been tested, that is something you should…if you are adult and have never been tested it is something to bring up to your doctor and then after you have been tested, if you engage in high risk behavior,   you should definitely be tested again.  Just to make sure you are communicating with your doctor, make sure you get the results.  A lot of times people get tested but don’t follow up for their results.

    LOMAX-REESE: All right, I want to thank you both, Dr. Feyssa, Dr. Donee.  You are going to be sticking around with us for the next segment, but Dr. Feyssa thanks so much for all your information about hepatitis today and hopefully we will be able to have you back sometime.

    FEYSSA: Thank you.