What You Need to Know about Hepatitis C

Living with Hepatitis C: Personal Stories

Wanda:

"I need to stay healthy, because I have two little girls and they keep me busy! I had a biopsy and my doctor says my liver is doing okay. So far, so good..." "... but I worry about my family. Sometimes I let my kids drink from my glass, or I forget to cover my mouth when I cough. Could that give them hepatitis C? And what about my partner? Can you get hepatitis C through sex?"
Hepatitis C is not spread through casual contact like coughing, sharing cups or eating utensils, hugging, or kissing. Hepatitis C is only spread through contact with infected blood. The most common ways that hepatitis C is spread are:

• sharing needles and other equipment (" works") used to inject drugs or other substances
• mother to baby during birth
• accidental needle-stick injuries, mainly to health care workers on the job
• sex without using a condom (this is a rare way to get hepatitis C, but it does happen)

It may also be possible to spread hepatitis C through:

• sharing razors, toothbrushes, or nail clippers with a person who has hepatitis C (because these items may have traces of blood on them)
• tattoos or piercing, especially if it is not done by a professional with sterile equipment

A woman can pass hepatitis C to her baby during birth. About 5 out of 100 babies born to women with hepatitis C will be infected. Talk to your child's doctor about when to test your child for hepatitis C.
Before 1992, people also got hepatitis C through infected blood transfusions and organ transplants. Now, all blood and organ donations are tested for hepatitis C, so it is safe to get blood or organs.
It is possible to spread hepatitis C during sex, but this is rare. On the other hand, HIV and other STDs (sexually transmitted diseases) are easily spread during sex. Always use condoms to protect yourself and your partners.

Keeping your loved ones safe

Hepatitis C is spread through blood. To avoid giving hepatitis C to others:

• do not share needles, syringes, or other injection equipment (" works")
• do not share razors, toothbrushes, nail clippers, or other household items that could have blood on them
• clean up blood spills right away with bleach
• keep cuts or sores covered with a bandage

Carlos:

"When I found out that I had hepatitis C, I was really angry. I worked so hard to get off drugs and was just starting to get my life together. Then they told me I had this disease. I couldn't believe it. I didn't go back to the doctor for a while - I didn't want to deal with it.
Later I realized it wasn't going to just go away. I want to stay as healthy as I can. Is there is a treatment for hepatitis C?"
You are not alone. Dealing with recovery and hepatitis C can be stressful. It may help to know that there are many other people in the same situation. Ask your doctor, counselor, or case manager about support groups for people in recovery who have hepatitis C.
There is a treatment for hepatitis C, but it does not work for everybody. The treatment is a combination of two medicines: pegylated interferon and ribavirin. Pegylated interferon is injected under the skin (like a shot) once a week. Ribavirin is a pill that you swallow. Treatment usually lasts for 12 months; sometimes it is shorter.
Hepatitis C treatment does not work for everyone:

• About half of people treated with pegylated interferon and ribavirin have healthier livers and no hepatitis C in their bodies at the end of treatment.
• Some people's livers get healthier during treatment, but the hepatitis C is not completely removed from their bodies. They may still have liver damage from hepatitis C in the future.

"I'm also in a methadone program. Will I have to stop taking methadone if I want treatment for hepatitis C?"

No. You can be treated for hepatitis C while you are on methadone.

Michael:

"My doctor says I should think about getting pegylated interferon and ribavirin treatment for my hep C. She says it has a good chance of helping my liver.
But I've heard that interferon has side effects that really mess you up. I have HIV, and when I started taking HIV medicines, I felt sick all day long. My doctor changed my HIV treatment, and I feel okay now, but I don't know if I want to deal with side effects like that again.

What are the side effects of hepatitis C treatment? Do most people get them?"

Pegylated interferon and ribavirin are strong drugs. Many people treated with them get side effects like:

• flu-like symptoms (fever, chills, headache, muscle pain)
• feeling very tired (fatigue)
• mood changes (depression, bad temper)
• temporary hair loss
• anemia (reduced red blood cells)

Some people have mild or no side effects. Some people have very severe side effects. For many people, the side effects become less severe over time.

"I don't know if I'm ready for all that. Do I have to start treatment for hepatitis C right away?"

This is not an easy question. There are good reasons to delay treatment - and good reasons to start treatment sooner:

Reasons to delay hepatitis C treatment

• Side effects from interferon and ribavirin could make you sick.
• Better treatments may be available in the future.
• Your hepatitis might not get worse— some people never have serious liver problems.

Reasons to start hepatitis C treatment sooner

• Treatment might not work as well later.
• Your hepatitis C could get worse very fast.
• If your liver gets too badly damaged, you might need a liver transplant.

When and how to treat your hepatitis C is a hard decision. Family needs, side effects, work, substance use, health issues, and many other parts of your life will affect your choice. Your doctor or nurse can help you look at all of the factors to decide what is best for you.

Depression is a common side effect

Severe depression can happen to anyone who is taking interferon. It is more likely in people who have a history of depression or other mental illness. If you have a history of any mental illness or substance use/abuse, tell your doctor before you begin treatment with any type of interferon. Your doctor may suggest that you start anti-depressant medicine or see a psychiatrist before you begin your hepatitis C treatment. Your doctor can also refer you to support services like hotlines or counseling so that if you do have mood changes, you can get help right away.

 http://www.health.ny.gov/publications/1801/stories.htm

Nail fungus

 Nail fungus is a fungal infection in one or more of your nails. An infection with nail fungus may begin as a white or yellow spot under the tip of your fingernail or toenail. As the nail fungus spreads deeper into your nail, it may cause your nail to discolor, thicken and develop crumbling edges — an unsightly and potentially painful problem.
An infection with nail fungus may be difficult to treat, and it may recur. But medications are available to help clear up nail fungus.

 There are different classifications of nail fungus — depending on type of fungus and manifestation — which may have somewhat different signs and symptoms. In general, however, you may have a nail fungal infection — also called onychomycosis (on-i-ko-mi-KO-sis) — if one or more of your nails are:

• Thickened
• Brittle, crumbly or ragged
• Distorted in shape
• Dull, with no luster or shine
• A dark color, caused by debris building up under your nail

Infected nails also may separate from the nail bed, a condition called onycholysis. You may feel pain in your toes or fingertips and detect a slightly foul odor.

When to see a doctor
Once a nail fungal infection begins, it can persist indefinitely if not treated. See your doctor at the first sign of nail fungus, which is often a tiny white or yellow spot under the tip of your nail.


 Nail fungal infections are typically caused by a fungus that belongs to a group of fungi called dermatophytes. But yeasts and molds also can be responsible for nail fungal infections.
What are fungi?
Fungi are microscopic organisms that don't need sunlight to survive. Some fungi have beneficial uses, while others cause illness and infection.
All of these microscopic organisms:

• Live in warm, moist environments, including swimming pools and showers
• Can invade your skin through tiny visible or invisible cuts or through a small separation between your nail and nail bed
• Cause problems only if your nails are continually exposed to warmth and moisture — conditions perfect for the growth and spread of fungi

Toenails vs. fingernails
Nail fungus occurs more in toenails than in fingernails.

• Toenails often are confined in a dark, warm, moist environment inside your shoes — where fungi can thrive.
• Diminished blood circulation to the toes as compared with the fingers makes it harder for your body's immune system to detect and eliminate the infection.

RISK FACTORS

Aging is the most common risk factor for nail fungus for several reasons, including:

• Diminished blood circulation
• More years of exposure to fungi
• Nails may grow more slowly and thicken with age, making them more susceptible to infection

Nail fungus tends to affect men more often than it does women, particularly those with a family history of this infection.
Other factors that can increase your risk of developing nail fungus include:

• Perspiring heavily
• Working in a humid or moist environment
• Having the skin condition psoriasis
• Wearing socks and shoes that hinder ventilation and don't absorb perspiration
• Walking barefoot in damp public places, such as swimming pools, gyms and shower roomsHaving diabetes, circulation problems or a weakened immune system

 Nail fungus can be painful and may cause permanent damage to your nails. It also may lead to other serious infections that can spread beyond your feet if you have a suppressed immune system due to medication, diabetes or other conditions.
Fungal infections of the nail pose the most serious health risk for people with diabetes and for those with weakened immune systems, such as people with leukemia or AIDS or organ transplant recipients.
If you have diabetes, your blood circulation and the nerve supply to your feet can become impaired. You're also at greater risk for cellulitis, a potentially serious bacterial skin infection. Therefore, any relatively minor injury to your feet — including a nail fungal infection — can lead to a more serious complication, requiring timely medical care. See your doctor immediately if you suspect nail fungus.

 You're likely to start by seeing your family doctor or a general practitioner. However, in some cases when you call to set up an appointment, you may be referred immediately to either a doctor who specializes in skin conditions (dermatologist) or one who specializes in foot conditions (podiatrist).
To make the most of your time with your doctor, it's good to prepare for your appointment.
What you can do

• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, vitamins and supplements you're taking.
• Write down questions to ask your doctor.

For nail fungus, your questions might include:

• What is likely causing my symptoms or condition?
• Are there other possible causes for my symptoms or condition?
• What tests do I need?
• What is the best course of action?
• What are the alternatives to the primary approach you're suggesting?
• I have other health conditions. How can I best manage them together?
• Is there a generic alternative to the medicine you're prescribing?
• Are there brochures or other printed material that I can take home? Are there websites you recommend?

Don't hesitate to ask any other questions you have.

 Your doctor will likely examine your nails first. To test for fungi, your doctor may scrape some debris from under your nail for analysis.
The debris can be examined under a microscope or cultured in a lab to identify what's causing the infection. Other conditions, such as psoriasis, can mimic a fungal infection of the nail. Microorganisms, including yeast and bacteria, also can infect nails. Knowing the cause of your infection helps determine the best course of treatment.

• Having athlete's foot (tinea pedis)
• Having a minor skin or nail injury, a damaged nail, or another infection

 Nail fungus can be difficult to treat, and repeat infections are common. Over-the-counter antifungal nail creams and ointments are available, but they aren't very effective. If you have athlete's foot as well as nail fungus, you should treat the athlete's foot with topical medication and keep your feet clean and dry.
Oral medications
To treat nail fungus, your doctor may prescribe an oral antifungal medication. Studies have shown the most effective treatments to be terbinafine (Lamisil) and itraconazole (Sporanox).
Your doctor is likely to recommend oral medication if you:

• Have diabetes or other risk factors for cellulitis
• Have a history of cellulitis
• Are experiencing pain or discomfort from your nail infection

Treatments

These medications help a new nail grow free of infection, slowly replacing the infected portion of your nail. You typically take these medications for six to 12 weeks, but you won't see the end result of treatment until the nail grows back completely. It may take four months or longer to eliminate an infection. Recurrent infections are possible, especially if you continue to expose your nails to warm, moist conditions.
Antifungal drugs may cause side effects ranging from skin rashes to liver damage. Doctors may not recommend them for people with liver disease or congestive heart failure or for those taking certain medications.


Other treatment options
Your doctor may also suggest these nail fungus treatments:

• Antifungal lacquer. If you have a mild to moderate infection of nail fungus, your doctor may prefer to prescribe an antifungal nail polish called ciclopirox (Penlac). You paint it on your infected nails and surrounding skin once a day. After seven days, you wipe the piled-on layers clean with alcohol and begin fresh applications. Daily use of Penlac for about one year has been shown to help clear up some nail fungal infections.
• Topical medications. Your doctor may also opt for other topical antifungal medications. You may be advised to use these creams with an over-the-counter lotion containing urea to help speed up absorption. Topical medications usually don't cure nail fungus, but they may be used with oral medications. Your doctor may file the surface of your nail (debridement) to lessen the amount of infected nail to treat and possibly make the topical medication more effective.
• Surgery. If your nail infection is severe or extremely painful, your doctor may suggest removing your nail. A new nail will usually grow in its place, though it will come in slowly and may take as long as a year to grow back completely. Sometimes surgery is used in combination with ciclopirox to treat the nail bed.

 Sometimes, because current treatments can take a long time to work and aren't always effective, people turn to home remedies. Two remedies purported to help nail fungus are vinegar and Vicks VapoRub.

• Vinegar. While there's no direct evidence that a vinegar soak can cure nail fungus, some studies have shown that it can inhibit the growth of certain bacteria. Experts suggest soaking your feet for 15 to 20 minutes in a mixture of 1 part vinegar to 2 parts warm water. Be sure to rinse well and pat your feet dry when you're done. You can soak your feet like this daily. But if your skin becomes irritated, try soaking only two to three times a week.
• Vicks VapoRub. As with vinegar, there have been no controlled clinical trials to assess the effectiveness of Vicks VapoRub on nail fungus, but there have been numerous anecdotal reports that it works. There's no consensus on how often to apply this product, so check with your doctor before using it on your nails.

Treating nail fungus with a laser or photodynamic therapy — intense light irradiates the nail after it's been treated with an acid — may also be successful. However, this new treatment may not be available everywhere.

http://www.mayoclinic.com/health/nail-fungus/DS00084/DSECTION=lifestyle-and-home-remedies

Prevention
By Mayo Clinic staff
To help prevent nail fungus and reduce recurrent infections, practice good hand and foot hygiene.

• Keep your nails short, dry and clean. Trim nails straight across and file down thickened areas. Thoroughly dry your hands and feet, including between your toes, after bathing.
• Wear appropriate socks. Synthetic socks that wick away moisture may keep your feet dryer than do cotton or wool socks (you can also wear synthetic socks underneath other socks). Change them often, especially if your feet sweat excessively. Take your shoes off occasionally during the day and after exercise. Alternate closed-toe shoes with open-toe shoes.
• Use an antifungal spray or powder. Spray or sprinkle your feet and the insides of your shoes.
• Wear rubber gloves. This protects your hands from overexposure to water. Between uses, turn the rubber gloves inside out to dry.
• Don't trim or pick at the skin around your nails. This may give germs access to your skin and nails.
• Don't go barefoot in public places. Wear shoes around public pools, showers and locker rooms.
• Choose a reputable manicure and pedicure salon. Make sure the salon sterilizes its instruments. Better yet, bring your own.
• Give up nail polish and artificial nails. Although it may be tempting to hide nail fungal infections under a coat of pretty pink polish, this can trap unwanted moisture and worsen the infection.
• Wash your hands after touching an infected nail. Nail fungus can spread from nail to nail.

http://www.mayoclinic.com/health/nail-fungus