1. Exercising The Human Spirit! Celebrating the Gift of Life

2. Exercising The Human Spirit! You don’t have to win the race to be a winner.

3. Objectives Liver Function Liver Disease What is Hepatitis  Signs and Symptoms How is it Transmitted Treatment for Hepatitis  Nutrition  Exercise My Personal Experience with Hepatitis C Support Group

4. Why should I care about my liver?  The liver performs many important functions:  Stores energy  Helps build muscles  Helps make bile to digest foods  Stops cuts from bleeding  Kills germs  Removes substances that are harmful to the body  Processes everything we eat, drink, breathe and absorb through our skin  When your liver is not healthy, it cannot keep you healthy

5. Healthy Liver

6. Unhealthy Liver

8. Liver Disease Impact  Over 30 million Americans have liver related diseases and certain liver diseases are on the rise such as:  Fatty Liver Disease  Hepatocellular Carcinoma (type of liver cancer)  You can help to stop the spread of liver disease

9. What causes liver disease?  Liver diseases are primarily caused by one of the following:  Genetics  Viruses  Unhealthy lifestyle choices  Reactions to medications or chemicals  There are more than 100 different liver diseases

10. What is hepatitis?  Hepatitis means inflammation (swelling) of the liver  Many conditions can cause hepatitis such as:  Autoimmune disease  Viruses  Alcohol and toxins  Fatty liver  Hepatitis A, hepatitis B, and hepatitis C are the most common forms of viral hepatitis in the U.S.

11. The A’s, B’s and C’s of Hepatitis Hepatitis AHepatitis BHepatitis C Not chronicChronic in about 5% of cases Chronic in about 85% of cases Transmitted through feces due to poor hygiene or contaminated food or water Transmitted through bodily fluids Transmitted blood to blood Vaccine available No vaccine available. Prevention is key.

12. Action Steps for Hepatitis A  Talk to your healthcare provider about the hepatitis A vaccine and get vaccinated before traveling to countries where hepatitis A is common  Always wash your hands after using the bathroom or changing a diaper  Always wash your hands before preparing and eating food  Avoid consuming contaminated water or foods  Avoid sexual behaviors that expose you to fecal matter  Avoid eating uncooked shellfish

13. Action Steps for Hepatitis B  Talk to your healthcare provider about the hepatitis B vaccine and get vaccinated before traveling to countries where hepatitis B is common  Get screened if you are pregnant  Get tested if you are at high risk for hepatitis B  Practice safe sex  Do not inject drugs or share needles  Do not share personal items such as razors, toothbrushes, or nail clippers  Make sure only clean equipment is used when getting tattoos or body piercings

14. Hepatitis C  Hepatitis C is a liver disease caused by the hepatitis C virus (HCV) that causes the liver to swell.  Chronic hepatitis C can cause cirrhosis (scarring), liver failure and liver cancer  Most people have no symptoms and have the disease for many years before it is diagnosed  Currently, over 4 million people in the U.S. are infected with the hepatitis C virus

15. How is Hepatitis C transmitted?  Hepatitis C is transmitted blood-to-blood  You may be at risk if you  Have ever used drugs (even once)  Received a blood transfusion or organ transplant before July 1992  Received a clotting factor made before 1987  Have ever been on hemodialysis  Have had abnormal ALT levels several times on blood test results  Have ever worked or come in contact with infected needles or blood  Have ever worked or been housed in a prison  Were born to an HCV-infected mother  Have ever had unprotected sex  Have ever had a sexually transmitted disease  Have ever had tattoos or body piercings

16. Hepatitis C is not spread by…  Casual contact  Hugging  Sneezing  Coughing  Sharing food, water, eating utensils or drinking glasses  Breastfeeding

17. Hepatitis C Testing  Antibody Test  Blood test that indicates if the body has developed antibodies to the hepatitis C virus  Confirmatory Test  Second test may be done to confirm the results of the first antibody test

18. Hepatitis C Tests and Procedures  Liver Enzyme Test  Measures the amount of enzymes in the blood  Viral Load Test  Measures the concentration of HCV in the blood  Genotype Test  Determines the HCV strain (or genotype)  Liver Biopsy  Provides detailed information on the condition of the liver

19. Global Distribution of Hepatitis C Genotypes

20. Prevent the Spread of Hepatitis C  Cover cuts and sores on skin  Do not share razors, toothbrushes or other personal items  Do not share needles, cookers, water, cotton, ties or crackpipes  Do not share straws used to sniff cocaine  If you are HCV-positive, practice safe sex and tell your partners  If you are HCV-positive, do not donate blood or sperm

21. Living Healthy with Hepatitis C  See a healthcare provider regularly  Get vaccinated against hepatitis A and hepatitis B  Avoid alcohol  Get support  Consider attending a risk reduction program or a drug treatment program

22. Diet/Exercise and Hepatitis C  Talk to your healthcare provider or nutritionist about the best diet for you  Eat a healthy, well-balanced diet  Maintain a healthy weight and exercise  Talk to your healthcare provider before taking any medications (over the counter, prescription, vitamins, or natural supplements)  Learn about your medicines and how they affect your liver  Follow dosing instructions

23. Treatment/Management Options  Treatment options and success vary by person.  Be sure to consult your healthcare provider when considering treatment options.  Medical Treatment  Antiviral medication  Pegylated interferon  Combination therapy with pegylated interferon and ribavirin  Clinical trials  Alternative Symptom Management  Holistic remedies

24. Treatment/Management Considerations  Side effects of HCV medications include fatigue, depression, muscle pain, headaches, weight loss, nausea/vomiting, anemia, skin rashes, itching, flu- like symptoms and fever  Pregnant women should not take interferon or ribavirin due to birth defects  Herbal supplements that are good for your liver may not necessarily be good for other conditions

25. Treatment Success  Medical  Sustained Virologic Response (SVR)  Treatment for hepatitis C is considered successful when the virus can no longer be detected in the body six months after the medication has been completed.  SVR varies by individual  SVR varies by genotype  SVR for genotype 1 is between 40% – 55%  SVR for genotypes 2 and 3 is between 70% – 80%

26. Treatment Costs For Hepatitis C  Costs include  Doctor Visits  Blood Tests  Liver biopsy  Medications  $50,000 plus

27.  Education  Communication  Support  Family  Co-workers  Friends  Continue on with your daily routine  Positive attitude My Personal Experience With Hepatitis C

28. For More Information  ALF Helpline at 1-800-GO LIVER  www.liverfoundation.org www.liverfoundation.org  Center for Disease Control  www.cdc.gov www.cdc.gov  Other resources  Department of Health  National Institutes of Health  Contact Your Physician  Contact a Hepatitis C Survivor

29. Hepatitis C Support Group PROBLEMS SEEM SMALLER WHEN THEY’RE SHARED WITH A GROUP Meets 3 rd Monday of each month Bismarck's Medcenter One’s Outpatient Services Building 414 North 7 th Street 7:00 PM For information contact Lynn at 701-222-4136

30. Family Support Is Number One! My Support Team.

31. 106 th Boston Marathon April 15, 2002

32. Exercising The Human Spirit! You don’t have to win the race to be a winner.

33. A New Race Begins ! I Run The Race Not For Myself, Instead I Run The Race For All Those That Will Struggle With Hepatitis C.