At what point should my doctor be doing a liver ultrasound or biopsy?

Again, new poster here so bare with me. Got the diagnosis of Hep B at end of July/beginning of August. Do not know how long I have had it but the symptoms started around the same time, so I suspect I got it recently. Eventually got sent to the Office's GI specialist.

After a couple of visits, and significant weight loss of about 15lbs in 2 months, I started to ask questions as I was concerned. One of them was "Should I be worried about liver cancer or have an ultrasound or something done?"

The GI Specialist told me that with my age (36) and the numbers he has seen, my liver enzymes were only mildy elevated at this point and in order for him to determine any issues with my liver, he would have to do the liver biopsy and he didn't feel my numbers warranted it.

He asked me if I had any symptoms such as clay colored stool, dark brown urine, pain in my upper abs, etc. I didn't, though once in a while I feel as if there is a flutter of some sort in upper abs (ironically when I am sitting and getting the vertigo feeling). He then tapped around the area where the liver was, took a urine sample and said everything looked fine and my liver functions seemed normal to him.

As an FYI, I was a moderate drinker for the past couple of years. Usually on weekends. A month before I discovered this, my friends and I went on a trip that involved mostly drinking. When my liver enzymes said they were elevated before I got the HBV blood test result back, I just assumed it was from all the drinking I did the previous months. Asked the doctor about this and he said "With your numbers, you could have a beer here and there and it won't kill you. Just don't get drunk." I was shocked to hear the GI say this.

Also: My liver enzyme count has been going down since they have been monitoring me and my GI Doctor actually added an extra 2 more months of monitoring to me on top of the 6 months (He's counting from the time I first started to see him and not the regular MD office) because he wants to see my body clear this before sending me to an infectious disease specialist.

Should the GI at least be doing an ultrasound at this point?

 

         hi again luckyman,    i would hold off on that beer or two, while waiting for the virus to resolve.  its useless to do expensive and invasive tests until your dr is convinced that you are chronic.  then biopsy and imaging are in order.   your enzymes coming down can be caused by discontinuing alcohol or the start of natural recovery. 

          you seem to be in good hands with your gi doc.  even if you cant pass it on your own, your numbers and non reactive to E antigen should be predictive of long term eradication with tx.  if you would like any help finding educational stuff on hep b, sing out. 

barry

 

Worried Daughter: Thanks for the advice and the story. I don't even want to think about a liver transplant at this point and I sure hope it does not come to that point, ever!

ppm guy: The weekend before my last blood test, I did have a couple of drinks. Probably not the best idea and I actually expected my liver enzymes to be elevated at that next appointment because of this, more than the last test but my surprise was that it went down. I have had a few here and there since then, but I have already decided I wanted to stop and see how it goes my next appointment. I suspect the drinks I had to my prior appointment is what caused the spike in the viral load. By the way, what does "tx" mean?

MamaLama: Apologies for the multiple posts. I'll definitely keep you guys posted here. This place so far has been the best I have found and the people seem to be nice all around, and responsive. My GI doctor was supposed to draw blood every month for 6 months but told me at my last appointment that he thinks I don't have to come back every month and could wait a couple of months for follow up. So at this point, I'm coming back in January of 2014.

Also, a quick question to all. Let's say I have to go on meds. What's the best that will give me least side effects? My doctor mentioned Viread. Also, how expensive are these meds? Will insurance cover them and I'll have to pay something small out of pocket?