Hep B Blog

Category Archives: Hepatitis B Diagnosis & Monitoring

Mosquito Repellent and Hepatitis B

Summer has arrived and so have your annoying neighborhood mosquitoes, who show up uninvited to every party.  Everyone’s first impulse is to spray on the DEET, an effective, insect repellent, to keep them away.

If you have hepatitis B, and are working hard to “love your liver”, you might be wondering what affect DEET will have on your liver.   Your liver is an amazing organ responsible for filtering just about everything we inhale, ingest or absorb through the skin.  DEET is an effective, but strong chemical, that when applied to the skin, or accidentally inhaled while spraying, or ingested due to poor hand washing, may be found in the blood stream up to 12 hours later.  It’s your liver’s job to ensure this toxin is filtered from your system.   An over-taxed liver can be problematic for anyone, but placing additional burdens on your liver when you have HBV can contribute to liver damage over time.

Here are a couple of things to consider.  Mosquitoes and other flying, or biting insects are vectors for numerous diseases that can make us very sick.   (Please keep in mind that mosquitoes are NOT vectors for hepatitis B.)  As a result we have to consider other options, or weigh the risks vs. the benefits of spraying on a dose of DEET.  If you do decide that DEET is the best protection against mosquitoes, consider limiting your exposure by applying it to your clothing, rather than directly to the skin.  When you’re back inside and out of mosquito territory, wash it off.  Don’t wear it to bed.

A natural alternative to chemically produced repellents is citronella, which has been registered for use in the U.S. since 1948.  It is made by steam distillation of certain grasses, and is considered a biopesticide, a naturally occurring substance that controls by non-toxic means.

Citronella can be purchased in various outdoor candles and natural, registered products such as Burt’s Bee’s Herbal Insect Repellent, or Avon Skin So Soft.  Citronella and other remedies can be purchased as essential oils and applied to the skin.  Please remember that natural does not equate to safe.  Make sure directions-for-use are legitimate and followed explicitly.  These oils are dangerous when ingested, and they are not packaged in child-resistant containers to avoid accidental swallowing.  Be sure to research all natural remedies or chemical products, and ensure the directions-for-use are legitimate, and that they are stored out of reach of children.  In researching this blog, I ran across various factoids and instructions-for-use with natural remedies that were contradicted in other articles.

Here are some additional tips that may require a little more forethought, and may not be as effective as a chemical repellent.  However, they can provide some relief and perhaps a balance.  Recommendations include:

  • Wear light colored clothing.  Mosquitoes are attracted to dark clothing.
  • Cover as much skin as possible with clothing… long sleeves, pants, socks, hats, etc.
  • Consider the fragrances you wear.  Floral or fruity fragrances, scented soaps, perfumes, hair products, scented sunscreen and even fragrance from fabric softeners and dryer sheets attract mosquitoes.  In my house, nothing smells clean and fresh.  Everything is unscented.
  • Avoid being out when mosquitoes are most active – dawn and dusk.
  • Use external fans.  Mosquitoes don’t fly well in a stiff breeze!
  • Avoid areas with standing water.
  • Eat garlic…lots of it.  My pharmacist is Indian, and also prescribes natural remedies.  She told me garlic is often consumed in massive quantities to discourage mosquitoes.
  • Bats are your friends…   I grew up with two medium-sized, but stagnant ponds on our property.  We had lots of bats and no mosquitoes.

As always, it’s all about common sense and balance.  If you’re having a picnic at the Dismal Swamp, or traveling to countries where the risk of disease carrying mosquitoes is very high, then you might want to think about bringing along the can of DEET, and using it responsibly.  Perhaps an outing here or there may also warrant the use.  Otherwise, make an attempt to combat mosquitoes naturally, or make a concerted effort to avoid them at their worst.  Yet another way to incorporate “loving your liver” into your daily life!

 

 

 

 

 

 

Choosing a Liver Specialist to Treat Your HBV

Got HepB?  Which doctor is right for you?  Do you need a hepatologist, gastroenterologist (GI doctor), or an infectious disease doctor?  Is the patient an adult or child?  If you’re new to HBV, these specialty doctors are likely foreign to your doctor line-up, and weeding through the specialty titles and training can be confusing.   However, if you have HBV, it’s essential that you find a knowledgeable liver specialist to monitor and potentially treat your hepatitis B.

A hepatologist is a doctor that specializes in diseases associated with the liver.  Hepatology is a sub-specialty of gastroenterology.  This is an obvious choice for patients with HBV, but it may be difficult to find a hepatologist in your vicinity.

A gastroenterologist, or GI doctor, specializes in the function and disorders of the GI tract, which includes the esophagus, stomach, pancreas, intestines and the liver.  This covers a very broad spectrum of functions and diseases.  The key is to find a GI doctor that has experience treating patients with liver disease – specifically, viral hepatitis, and hepatitis B.  If your GI candidate spends much of his week performing endoscopies, he is likely not a good choice for a liver specialist.

Because hepatitis B is an infectious disease, it would seem logical that an infectious disease specialist would be the best choice.  However, this is not usually the case with hepatitis B, or viral hepatitis, but rather HIV and other infectious diseases.  Your best bet will most likely be a hepatologist or a GI doctor.

If the patient is a child, it is imperative that the child see a pediatric liver specialist.  Some of the best and brightest, cutting edge doctors are both pediatric hepatologists and GI docs.  Children with HBV are monitored and treated much differently than adults.  The labs look different, and the treatment protocols also differ.  You need a pediatric specialist.

Ultimately, the key is finding a liver specialist that has experience monitoring and treating patients with hepatitis B.  You need to ask the important questions.   How many patients are they currently monitoring and treating with hep B?  How is your doctor keeping abreast of the latest and greatest advances in the management of hepatitis B?  Does she attend conferences on viral hepatitis?

HBV is a chronic disease, so you are potentially entering into a long term relationship.  Be sure to ask questions that are important to YOU.  How are test results disseminated?  Are frequent visits required?  Is your doctor open minded – perhaps willing to consult with other experts treating patients with HBV?  It would be great if this specialist is affiliated with a large hospital or university center.  This may provide additional options such as clinical trials, should they become available.  Plus they tend to have a larger patient population, hence more case specific experience.

Typically, the need to visit your liver specialist is not that frequent, unless you are undergoing treatment.  Even then, much of the monitoring and follow-up are in the blood work, and much of that can be drawn locally, with the results sent to your liver specialist.  Some treatment protocols require more monitoring and blood work than others, but even so, it is typically for a short period of time.  This fact is significant, as it expands the size of your geographic circle of potential experts.

The Hepatitis B Foundation maintains a wonderful database of liver specialists for both adults and children.  From there you can check out your potential expert with members of HBV support groups that may have personal experience with your candidate.

Good luck choosing your liver specialist!

Why Vaccinate Infants Against Hepatitis B?

Sadly, out of all age groups, it is infants and very young children that are at the greatest risk for acquiring a chronic, life-long infection with hepatitis B.  In fact 90% of babies exposed to HBV will become chronically infected, and will live with the virus for the rest of their lives.  This includes mother-to-child transmission, and horizontal transmission from close contacts.  This is why the first dose of the hepatitis B vaccine is recommended before leaving the hospital.  The vaccine is safe and effective.  Choosing to vaccinate is an option those of us with HBV infected children would have LOVED to have.

Hepatitis B is a silent disease.  Forty percent of people living with HBV have no idea how they became infected.  Others have not yet been diagnosed.   Many likely acquired it at birth, or early exposure, and have had the virus smoldering for decades.  They may find out about it in routine blood tests, or from the Red Cross following a blood donation.  Hepatitis B is non-discriminating, although it is more prevalent in certain high risk groups.   Sometimes being part of a high risk group is as simple as having a parent born in a country where HBV is endemic.  Hepatitis B is 100 times more infectious than HIV, and yet many people say they would get vaccinated against HIV if a vaccine existed.  Why not hepatitis B?

So why have your infant vaccinated at birth?  It just makes sense.  How can you be assured all house-hold contacts are not infected?  War heroes get infected, as do health care workers, and other loving family members – mommies, daddies, grandparents, aunts, uncles, and cousins.  Parents go to work, and little ones go to day care.  They play at the neighbor’s house or with friends at pre-school.  Blood spills occur and sometimes they’re not properly managed, or even noticed.   Boo-boo’s come uncovered and little friends touch.  Sometimes “love-bites” are exchanged much to the dismay of parents.  Even the most vigilant parent is going to miss something.   HBV is not transmitted casually, but the possibility of exposure cannot be denied – especially at such a young age.

Hepatitis B is a poster-child for infant vaccination.  It is a tenacious virus, and there is no true cure.  If you are a pregnant woman, be sure you are tested for hepatitis B during your pregnancy.  If you are HBV positive, break the cycle One in five at-risk babies in the U.S. may NOT be receiving the necessary treatment, so SPEAK UP and ensure your baby receives prophylaxis treatment at birth.  Complete the vaccine series and have your baby tested for HBV at his one-year checkup to ensure he is protected.

If you are not HBV positive give yourself piece-of-mind.  When your baby is born, be sure to have her vaccinated before you leave the hospital, and give her a lifetime of protection against hepatitis B.

Hepatitis B and Chocolate

Planning on digging into your favorite dark-chocolate stash, or biting the ears off of a dark-chocolate bunny this weekend?  Dark chocolate is popping up everywhere.  Even some old favorites have a new, dark chocolate wrapper, replacing the now-passé milk chocolate.  Recently, studies have extolled the benefits of dark chocolate, and how it potentially prevents heart disease, reduces the risk of brain damage after a stroke, lowers the risk of heart failure, lowers blood pressure, reduces heart disease, has anti-cancer benefits, slows dementia, raises libido, and last but not least, is mood enhancing.  What about those suffering hepatitis B associated liver disease?

Last year there was a study out of Spain that investigated the benefits of dark chocolate to patients with liver disease – specifically patients with cirrhosis.  Cirrhosis causes portal pressure to rise, potentially resulting in damage to blood vessels in the liver.  Eating causes an additional rise in pressure, which becomes more dangerous as liver disease progresses.  Half of the study participants were given white chocolate, and the other dark chocolate.  The dark chocolate group saw a larger decrease in the blood pressure of the liver, and increased blood flow.  Keep in mind that this was a small study with only 21 participants.

The good news is that dark chocolate, specifically the cocoa component, is rich in antioxidants called flavonoids, and other beneficial components such as  phenylethylamine, theobromine,  anandamide, magnesium, copper, and vitamins E and B.  That’s certainly a mouth-full, but it is these key components that provide all the benefits of chocolate.

Here’s the bad news.  Many of us enjoy milk chocolate, or even the dreaded white chocolate, which has little or no benefit due to the processing of the cocoa, and the resulting loss of flavonoids.   In fact, the lighter the chocolate, the fewer the benefits.  In a perfect world we would be eating unsweetened, cocoa powder right out of the tin, or a chocolate bar with upwards of 85% cocoa.  That can be a pretty biting chocolate.  The chocolate many of us enjoy has a larger quantity of white sugar , which is not beneficial to the liver, or any other organ, nor is the additional butterfat, which is added to lighter chocolate.  However, if you can adjust your tastes a little and learn to adapt to less sugar and butterfat, dark chocolate is great addition to your diet.

Aren’t most of us looking for an excuse to add chocolate to our diets?  Ultimately, all things in moderation is the key.  A small amount (roughly 6.7 grams) of dark chocolate added to your daily diet is certainly not going to hurt you, and may in fact reduce abdominal pressure and portal pressure in the liver.  Perhaps the greatest redeeming quality of chocolate is it’s mood enhancing qualities.  If it feels good, and eaten in moderation, then why not reap the benefits of dark chocolate and enjoy your improved mood.

Do You Have Hepatitis B?

Have you been told you may be infected with  hepatitis B?  Did you get a letter following a blood donation, or receive lab results indicating infection?  It’s important you relax, educate yourself, and don’t let the news scare you.  The next step is to determine if you are infected, and if so, do you have an acute or chronic infection.

You’ll want to talk with your doctor, and have a hepatitis B blood panel run.  It is essential that you do not ignore the possibility of infection.  That being said, it’s equally important that you not panic.

When you get your lab results, ask your doctor to explain them to you.  It’s possible that you are not infected, but if you are, then you will need follow-up testing.  Be sure to ask for copies of your labs for your own records.  The test results are initially confusing, so you will want to refer back to the hard-copy results.

It is important to determine if you have an acute or chronic infection, but this may take some time.  If you were infected with HBV as an adult, there is a good chance you are acutely infected.  Fortunately, 90% of infected adults resolve the virus on their own. Recently infected adults may have flu-like symptoms, fatigue, yellowing of the eyes, or they may have no symptoms at all.  The answer is in the lab work.  Your doctor may run an HBc-IgM test, which will tell you if the infection is newly acquired. If it is a new infection, you will be monitored for the next one to six months to see if the HBV infection clears, and to ensure you are safe.  During this time, you are infectious to others, so it is important to practice standard precautions and ensure household members are vaccinated.  It is important to eat properly, rest, and avoid alcohol and tobacco. Talk to your doctor about the use of prescription and OTC drugs.  Hopefully your body will be able to mount an appropriate immune response, and you will be able to rid yourself of the virus.  If you remain surface antigen positive (HBsAg+) for more than six months you will be considered chronically infected.

Ten percent of those infected with HBV as an adult, will not clear the virus, and will become chronically infected.  Another group of adults that may just be learning of their Hepatitis B status, are those that acquired HBV at birth.  HBV infected mothers may unknowingly transmit HBV to babies.  Transmission can be prevented with vaccination at birth, but in many countries where HBV is endemic, a cycle of HBV transmission may exist where vaccination has not been available, and the virus is passed unknowingly from one generation to the next. Unfortunately, 90% of those infected at birth are chronically infected, even though it may not be determined until adulthood.  HBV is usually an uncomplaining disease, so it may be picked up accidently with blood-work , or when liver disease progresses due to decades of chronic infection.

Keep in mind that being vaccinated against hepatitis B will not protect you against the virus if you were infected with HBV prior to vaccination.  This can be confusing since most people are not screened prior to vaccination, and is  especially pertinent in high risk groups where the likelihood of mother to child transmission is greater.

The Hepatitis B Foundation has a step-by-step, comprehensive, yet-easy-to-understand tutorial that leads you through the process of determining your hepatitis B status, specific test results, and practical advice for coping with your HBV diagnosis.

Got Hepatitis B? B Sure to Take Care of U!

As a mother of a child with hepatitis B, I was always concerned my child would transmit the virus to others.  One day a toddler came up and bit her in the finger and drew blood.  She was strapped into her stroller, and yet I felt guilty and fearful she might transmit the virus to “the biter”.  I rushed my child to the pediatrician, and immediately inquired about the safety of the other toddler.  He reminded me that that “blood is a two-way street for the transmission of infectious diseases”.   I should worry about MY child.   The other child was likely vaccinated since HBV vaccination is required in my state. I heeded his advice, and from that day forth I started thinking about the safety of MY child and others infected with HBV.

Fortunately, hepatitis B is a vaccine preventable disease, so that does ease concerns regarding the transmission of HBV to others.  A simple three shot HBV vaccine series does the trick.  There is no reason someone should NOT be protected against a vaccine preventable virus that is 100 times more infectious than HIV!   Stop feeling guilty, and start thinking about protecting YOU!

If you have HBV, Hepatitis A (HAV) can be very dangerous.   HAV is vaccine preventable.  A simple two shot series will keep all those with or without HBV safe from highly-contagious HAV.

Unfortunately, there is no vaccine for HCV or HIV.  If you are HBV+, a  co-infection is complicated and dangerous, and can result in significant liver damage.  The best way to combat infection from HCV, HIV and other infectious diseases is to use standard precautions.

Make standard precautions part of your everyday life.  Simple hand washing and proper avoidance of contact with someone else’s blood and body fluids is an easy way to avoid transmission of potentially life threatening illnesses, or any illness.  Cover open cuts with a Band-Aid.  Provide a barrier between someone else’s blood or body fluids, and any open wounds, sores, mucus membranes and orifices.  You don’t want to get infected with another blood borne pathogen!  Does this mean you need to look like someone out of a bio-hazard lab with goggles and gloves?  No!  Use common sense, and you can be safe without going overboard.   A simple barrier between you and someone else’s body fluids is the best way to avoid exposure.  Keep something like a clean diaper, towel or wrapped sanitary pad, in a plastic baggie, in your car, and on each level of your home.

Personal toiletries should be just that…personal.  Keep your toothbrush away from your sibling, friend or SO. Neatly dispose of used feminine hygiene products because it’s the right thing to do.  Don’t leave your razor or nail clippers lying around.  Sharp, personal objects really are a perfect transmission route for infectious disease.

Got HBV?  Remember, keep YOURSELF safe!  And the kid in the stroller… well she’s a teen, today.  Now there’s a whole new set of worries.

Who’s On Your HBV Team?

No matter where you are with your hepatitis B – chronically infected since birth, or recently learned you are HBV positive, you want to be sure you are surrounded by all of the right people to give you the medical guidance and emotional support you need.

Start with your primary care physician (PCP).  You want a doctor that listens to you and is willing to work with your liver specialist.  Your PCP’s office may be coordinating your annual or bi-annual lab work for HBV monitoring and is your first line of care .

HBV can be complicated when it comes to making decisions about whether or not you need monitoring, treatment, or monitoring for liver cancer (HCC).  There are many phases of HBV, and you want to be sure you are followed through ALL phases.  You need a liver specialist that has experience working with patients infected with HBV.  This doctor is nearly always a Gastroenterologist (GI doc) or a Hepatologist.  If the patient is a child, you need a pediatric GI doctor or hepatologist.  Although well qualified, an infectious disease doctor is not really the best fit because of the involvement of the liver.  Once again, experience with HBV infected patients is crucial.  These specialists are often found at large, or University Hospital centers.

Check out this directory of liver specialists in your area.   Keep in mind that living a couple of hours from your liver specialist should be fine.  Visits are typically annual or bi-annual.  Visits may increase depending on treatment you may require.  Lab work can usually be coordinated with your local lab via your PCP.

Get to know your local pharmacist.  They are a wonderful source of information on everything from prescribed HBV medications to choosing the best OTC cold medicines, or pain relievers.  I am on a first name basis with my pharmacist, and try to visit when the volume of customers is low, so no one feels rushed.

Living with a chronic illness can take its toll on your mental health.  Each patient is unique, but generally all patients cycle through initial fear or denial, isolation, worry, and acceptance.  If you feel you are depressed and need help coping with your HBV, seek advice from your PCP, liver specialist, or a mental health expert.

Consider joining a support group.  Sometimes it’s lonely dealing with a complicated, chronic illness like HBV.   Support groups are a great forum for addressing the many concerns when dealing with various aspects of your HBV, from the best treatment protocols to sex and dating.  I belong to two HBV support groups and I find the interactions extremely informative, and the list members caring and very supportive of members in all stages of their HBV.

Take a look at The Hepatitis B Foundation’s website.  There’s a multitude of information from simple HBV basics to in-depth information from world-renowned liver specialists and researchers, along with personal stories.  Ask away if you have any questions.  HBF is here to help, and we hope to be part of your team.