and good evening.

>> Thank you so much for watching HealthLine here on PBS Fort Wayne, I'm Mark Evans, your host.

>> Interesting topic tonight in fact, we're hearing more and more about this if you keep your ear to the ground when itps about the prevalence and incidene of hepatitis C worldwide and in the U.S. and there are different types of hepatitis.

We'll talk about those a little bit and we're going to talk about why hepatitis is in the spotlight on this show tonight a very special guest.

He's brand new to the PBS panel and we hope to have him back already.

>> I like this guy because we were talking in the green room before the show.

He is Andy Barcus, a nurse practitioner and his specialty is infectious diseases.

So thank you very much for spending time with us tonight.

>> I'm delighted to be here.

Thank you.

So glad.

So let's go ahead and just I'm going to build the platform from the show because we have a part of me we have a phone number on the screen and that is going to be up there throughout the show from time to time.

Please call that I'm talking to our viewers right now call that at any time during the program to ask questions that might arise as we're discussing things.

Hepatitis C has become very prevalent here recently and we're going to find out a lot about it this evening.

So I'd like to go ahead and and just find out what is hepatitis in general.

>> Yeah, that's a great question.

Hepatitis is a generic term that we use for describing a situation where the liver is inflamed and that can be caused by many things.

It can be caused from certain medications that many people take on a daily basis but also it could be from viruses and that's really what I'm excited to discuss with you tonight.

>> OK?

And so it's mainly in the liver liver disorder.

>> That's right.

OK, so how many types of hepatitis are.

>> I did a little research and I think there's what A B and C.. Yeah so they're from a viral standpoint there's hepatitis A, B and C and then there's D and a few others.

>> OK so how are they different.

He said viral and then there's another type of hepatitis that is not viral.

Yeah.

So hepatitis could be caused by medication like we mentioned also alcohol is a very important cause of hepatitis.

It's unrelated to a virus.

So if if we if we go to our primary care provider or health clinician and they tell us we have hepatitis, it doesn't really clarify what that actually means.

>> It's not until we find out what's caused that that type of hepatitis.

So so a blood test is not going to tell you what type of hepatitis it is.

>> Eventually it will.

So to get to get some clarity on what type of viral hepatitis you have, it is a blood test that we would need to get that would tell us whether we have hepatitis B or C and hepatitis A is passed through contaminated food and water which is very different than some of the other types of hepatitis.

>> Yeah, I knew somebody who had hepatitis A and it was not a good journey for them.

>> Yeah, it can be a really intense situation.

>> Not everybody gets terribly ill with hepatitis C but many people do and it can be very, very serious.

Right now why is hepatitis C so prevalent now?

>> Where are we talking about it this evening?

That's a great question.

Historically the treatments for hepatitis C have been fairly difficult in some situations it was more difficult than actually having hepatitis C in the early stages I should say because there's different stages of hepatitis.

There's an acute phase where we are exposed to the virus.

We might feel ill. Kind of like the flu but after a week or two we start to feel better and we're none the wiser.

Right.

And so that's why hepatitis C and B for that matter both hepatitis B or pass through contaminated blood and body fluids.

So to that to that point those are those are some pretty important distinctions to make.

So if we're at risk for hepatitis C, we're also at risk for hepatitis B I it's no big secret.

>> I talk about it from time to time but I do work in the funeral profession during the day and we are required if we work in various capacities if you will like preparing bodies and so forth for viewing we're required to take hepatitis shots and I certainly understand that why we would have to do that.

So and that's totally for prevention.

>> So we're going to talk more about prevention down the road.

But as far as hepatitis C is concerned, what are the stats and the reason why we're talking about this?

>> It has become a little bit more prevalent and can you tell me what the stats are in the U.S. versus worldwide?

>> Yeah, so estimates are that there's over 50 million people living with hepatitis C worldwide and then within the United States between two to three million.

And one of the most interesting facts about hepatitis C epidemiology is how many people who are living with hepatitis C actually are aware of that in the United States it's 50 percent of individuals living with hepatitis C are aware roughly are you kidding?

>> And the other 50 percent don't even realize they have it .

>> That's that's why I'm glad I'm here.

Yeah.

To talk more about where we go but then worldwide it's about 20 percent people are aware of their status when it comes to hepatitis C and how are they getting this and you know, if you don't mind going through that again because we do have various types of hepatitis definitely yeah.

So hepatitis C is passed through blood and body fluids primarily blood to blood contact.

Very rarely could it be passed through sexual activity.

It is possible but generally if there's any contaminated blood that comes in contact with our blood then we're at risk for contracting hepatitis C now and we'll talk more about maybe maybe we talk about risk factors now.

OK, so so some pretty common risk factors would be, you know, share sharing razors with somebody who's living with hepatitis C toothbrushes.

Actually we don't often think about that but in the in the middle of the night if you grabbed the wrong toothbrush or the morning the lights are out there you go.

But but also if tattoos that are done at shops that are not FDA approved, I'm thinking more like home tattoos where ink is shared, needles are not replaced and every time and then blood transfusions would also be an important risk factor pre nineteen ninety ninety three.

>> So if we've had blood transfusions since that time it's been screened.

OK very good.

>> So that has improved.

Yes.

So right now it's the share of sharing of needles and the passage of various bodily fluids.

>> That's right.

And if I could also add Markwayne if there's sometimes intravenous drug use is a very important risk factor that we want to make sure that we talk.

Do you think that's one of the reasons why it has kind of boomed here lately?

>> It certainly has helped increase the numbers and two thousand twenty in the United States through about one hundred thousand New infections.

>> Another important reason to to talk about this tonight.

OK, Tel.

is 866- (969) 27 two zero.

We're live on PBS Fort Wayne tonight talking about hepatitis C with Andy Barcus, a nurse practitioner specializing in infectious diseases.

>> All right.

so what are the complications related to hepatitis C once you have it so initially most people do just fine.

In fact they don't feel like they have any medical problems perhaps the most common symptoms with hepatitis C are fatigue and then some people will have headaches .

In addition to that, sometimes people feel like they're walking around in a fog from time to time.

You know, so when we get people through treatment sometimes they say wow, I can't believe how bad I felt until we get them after we get them treated.

>> And so is that a slow ongoing process?

>> I mean you don't wake up one day going home.

I wonder if I have hepatitis or hepatitis C most of the time it's not like that at all actually ramps up.

It can be a slow burn.

Yeah.

In fact it's the later stages of hepatitis hepatitis C when we've been living with it maybe for decades and that's when things really start to you know the wheels start to fall off things.

>> Well how I mean for instance our viewer watching right now thinking I wonder if I have it I mean is that something that we should ask for when we go to the doctor the next time maybe getting a blood test for it?

>> It's a great question.

The recommendations actually are for folks eighteen and above to be tested at least once in their lifetime also for pregnant women to be tested with each pregnancy and if anybody has any no risk factors which we kind of talked about tonight any blood to blood contact maybe work exposure if you're in the health care field, needle stick injuries, things of that nature, then you would also be tested at those times as well.

>> So let me ask this again only because I think it's very important who should be tested.

>> So we're talking about pregnant women.

Yes.

Anybody over the age of 18.

>> Correct.

Any possible not that it happens now but maybe some drug use in the past year.

>> Absolutely.

And you said not necessarily sexual transmitted but promiscuously maybe in the past you should be tested as well.

>> Yeah, that's why I met with a number of individuals who come to me with advanced fibrosis meaning their liver is very, very scarred to the point where they have cirrhosis and that's how they find out what if somebody is a drinker?

>> Yeah.

And they have hepatitis, is that only going to complicate things and speed up the process?

>> That's right.

When we have hepatitis C or hepatitis B for that matter.

But if we we drink alcohol we can really go through these stages of fibrosis which basically it's a fancy term.

>> It's a way of saying our liver gets scarred really quickly and when alcohol is involved it can accelerate that.

Yeah, I can see how that would work.

Yeah.

All right.

Well we do have a call coming in right now.

In fact it's Molly and she is preferrin to be offline.

>> Some of our viewers request that you don't like the way their voice sounds or various reasons but she's asking should the Hep C vaccine be required for public service workers?

>> And that's really a good question.

Thank you.

Yeah, that's a good question.

Sadly there is no vaccine for hepatitis C we have vaccinations for hepatitis A and hepatitis B but at this time there is no vaccine for hepatitis C.. Another reason why it's in the limelight today because of the research that's going on and yeah, I knew you know, as I mentioned before, I did some research before the show as I always do and I was a little confused what there are vaccines for as far as hepatitis.

Now I don't want to get too far away from hepatitis C, but what are there vaccines for ?

>> That's right.

So hepatitis A there's a vaccine for hepatitis A and hepatitis B for both of those but not for C that's right.

>> Now why is that?

I mean have they figured that out?

>> Well, of course if they figured that out they probably have a vaccine, right?

Yeah, I know right.

>> I don't know that I could really give you a good answer for that to be quite honest.

Okay, well we'll just be following the research.

>> I'll let you know next time.

Next time here.

Get back anyway.

OK, what were the we're going to talk about current day treatments in just a moment but what were the treatments like in the past?

Yeah so hepatitis C, hepatitis C you can break it down into different subtypes and depending on the subtype of hepatitis C you have you you may or may not have qualified for treatment.

So we call those strains the genotypes.

You don't need to remember that however certain genotypes you could treat some you could not.

And so that's that's another reason why this is such an important topic because some people were told sorry you don't qualify now times have changed in tell you about the treatments first it's one of them was called interferon and this was an injectable.

I remember that.

>> Yeah.

OK, good.

Yeah, well not good because it was so intolerable for a lot of people it felt folks had to get these injections once a week and they would last somewhere between six and 12 months and if you didn't tolerate but you were somebody that was very gung about going through treatment and you're committed to this it was a year it was very difficult for you in the only folks that really use that now are oncologists.

As I understand, I've never actually prescribed interferon because it's kind of an older medication and one of the side effects of interferon flu like illness is the most common one you body aches, headaches.

We had to be screened by psychiatrists before we actually started that medication because it could exacerbate depression.

>> Oh wow.

Wow.

OK, so that was treatment in the past.

>> Let's turn the page and get with the treatment currently.

Yeah yeah this is this is one of the most hopeful parts of my job because the treatments are very well tolerated there.

The duration is much shorter than interferon days.

We can get somebody treated as in as short as eight weeks eight to 12 weeks standard course of treatment for hepatitis C and we're really doing about one pill a day or just a few pills a day.

>> Oh, that's remarkable.

It's very, very different.

The interferon was was that pintravenous it was an injection of injection the the pills and do they have any side effects that that are quite common?

>> The most common side effect that I see in clinical practice and that's been studied in recognizes fatigue most of the time though fatigue is is a common symptom of hepatitis C so it's really difficult to tease that apart.

But by and large the medications are very well tolerated and are we seeing some progress?

>> Are these treatments new treatments working very well?

Yes, the the treatments that we have available the cure rates are between 95 and ninety nine percent so it is curable curable to never come back.

>> Now one of the hepatitis is hepatitis if you will non curable correct is B non curable hepatitis B we have medications to suppress it but we don't have anything to cure it right now.

But there's before 2014 there was just a lot of research going into hepatitis C treatments and cures and things and we're seeing some of that kind of energy it behind hepatitis B treatments.

I just find it amazing or fascinating that you have these different types of hepatitis.

>> Some are curable, some aren't uh some have vaccines and some don't.

It just seems like a very complex type of disease and you got a core disease of hepatitis.

>> Right.

And then it what spins off into A B or C or am I simplifying it?

>> Well, too much hepatitis they're fairly different strains of viruses.

Right.

So one actually hepatitis B in particular it's a DNA virus and so that acts differently than even an RNA virus.

So DNA viruses that can actually sometimes incorporate themselves into our livers DNA and that's why it's so difficult to extract that and get it treated.

Hepatitis C doesn't have that same kind of investment in our liver so to speak to pregnant women.

>> If they have hepatitis they're going pass that on to their child.

>> Great question.

Hepatitis C we estimates are that about five percent of women who are pregnant living with hepatitis C have the capacity to all the all the capacity but about five percent actually transmit to their children.

>> You know those numbers are being looked at currently actually.

OK, very good.

Again, if you're pregnant, get tested.

>> Yeah.

In your obstetrician your your your your women's health team they actually test you for that or if you've made your primary care provider they should they'll probably be testing for that as well.

>> All right.

We're talking to Andy Barcus who is a nurse practitioner specialty and infectious diseases and tonight specifically talking about hepatitis and hepatitis C which seems to be a lot more prevalent than it used to be.

>> And here's a question for you what if I have been treated before for hepatitis C and it just didn't work?

Is this because I was treated with the interferon many years ago and it didn't work or what other variables are there?

>> Yeah, the cure rates with interferon somewhere between 30 to 40 to 50 percent.

>> So half the people that got treated with interferon didn't get cured and it was a difficult thing.

So you know, some people may be a little hesitant to go back and get treated but the medications today very, very, very, very tolerable.

>> So if somebody has gone through treatment for hepatitis C and you haven't had that conversation with your health care provider and you aren't sure if you've been treated and cured, well, you know you've been treated but if you aren't sure that you've been cured then you would want to get in contact with your health care provider and ask them to run that test and they'll know what test it is.

>> Good, good.

Now the treatments that are provided, not everybody is going to be tolerant of some of those.

>> So what if for instance, a pill that they have now would make me ill?

>> Are there other alternatives ?

>> Are there there some other medications I could take to help balance that out?

You know, because if you've got something that's going to help treat hepatitis C but that treatment is going to make me feel feel ill. >> What other alternatives do you have?

That's one of the obstacles that I hear from folks often is you know, I was not really ready to do that again.

I wasn't ready to put myself in that position and then it's really rewarding to be able to prescribe those medications for folks and then they say that to me, you know, this was not as bad.

This was actually I didn't realize I was taking a pill and I I that's that's another reason why I'm very excited about this because so many people can tolerate this in I think I've had about two people in the last you know since twenty fifteen that actually had to stop the medications due to side effects are pretty good odds.

>> Yeah.

And you deal with a lot of people so I guess those are really good.

Yeah the telephone number is 866- (969) 27 two zero get those questions.

>> And regarding hepatitis C we've got about five minutes left in the program so plenty of time maybe to answer a couple of questions or call right now if you can.

>> So how can we prevent getting hepatitis or let's start with hepatitis in general and then hepatitis C?

>> Yeah.

So vaccinations for hepatitis A and B everybody could get those those are available widely now why would you want to get one of those?

>> Yeah, because of the job you have if you work for the health care sector then you're you're going to probably be required to have that vaccine before you and start working right.

As you know in your field hepatitis A we think more of like Travelers' but we also see hepatitis C outbreaks here in the United States too.

I don't think this 2015 2016 was the last outbreak of hepatitis A we saw here in county health department was very involved and did a great job of getting folks vaccinated who might have had some exposures if you have hepatitis C for instance and you end up getting covid, what what can you expect what is that going to do any extra damage to your liver?

I mean how how did those two diseases work together?

And I'm sure you've seen some cases like that.

>> Yeah, depending on the type of hepatitis you don't expect those to really cause a robust, you know, life threatening situation like like maybe it might sound because I have I've seen many folks that have hepatitis C and many people have had covered and just because we have hepatitis C doesn't mean that are covered infections going to be worse.

>> OK, what about the the Hyde hygenic formalities if you will?

>> I'm trying to find the right mix of words to prevent hepatitis C I mean are we talking a lot of handwashing don't kiss anybody you know.

Well you know what kind of things can we do to prevent from getting hepatitis a sense of is kind of out there right now.

>> Yeah.

So just a just a few things would be for hepatitis A handwashing.

Absolutely.

But in terms of hepatitis B and C you know we we can we can kiss our loved ones, we can hug them, we can use the same bathrooms, we can drink after them even we'll get other things if we do that.

But we have there's no risk of transmission of hepatitis B or C through casual contact or even some intimate contact.

One thing I would want to stress that for for those who actually might be injecting drugs there's a syringe exchange program in Allen County and that's one important way because that's where the the majority of the new infections are coming from through intravenous drug use and Allen County has really stepped up to provide that service.

Well, in earlier you were a little bit hesitant to talk about that the drug usage.

But I mean it's obviously a fact and that's one of the reasons why we're sitting here talking about it right now and that's the reason why it has become so prevalent.

>> Yeah, yeah.

>> So hey, it's facts I know we've got to lay it out there and that's what this show is all about.

>> So just if you have hepatitis what should be the well if you have the symptoms of hepatitis what what should be going through your mind and what should you be doing right away if you have late stages of cirrhosis which would be like hepatitis gone to you've had it for years decades from now you may experience jaundice yellowing of your eyes and skin.

You may experience some swelling of your abdomen.

It's not the kind of swelling you feel after a big meal but this is the kind of swelling that actually impedes your breathing and it can cause you to feel like you just can't get a deep breath because it's painful.

>> Well there's fluid in it puts pressure on the lungs and so you just can't catch your breath but you don't want to get to that point where it's like you wake up one morning oh my gosh, my eyes and skin are yellow.

So what other symptoms should you be looking out for ?

We talked about this a little at the beginning of the show but I think since we've got a minute left we should talk about this when when is the when does that red light go off or is I better get this checked out before.

>> Yeah.

That particular thing happens.

>> This is the scary part of hepatitis because we can live for decades and decades and have no idea and that's again if we get to those later stages where we have those symptoms we just described then we're talking getting connected with the liver transplant team and things of that nature that doesn't happen overnight.

So I don't want people saying oh my gosh, I have hepatitis C, I need to get this taken care of this minute.

>> That's why I brought this up.

Yeah.

Thank you for doing that.

Yeah.

I don't want to freak out.

I just want to be able to control it.

Yeah yeah.

>> Taken care of .

Yeah because you know it can be twenty thirty years that someone's been living with this just unawares and then you know maybe their their liver tests are off at their at their general practitioner or his office and they aren't sure it could be a medication they're taking but then they run the tests and lo and behold it's positive they can get in touch with that health care provider and then they would refer them to somebody who can get the treatmet going and it's actually very accessible for folks.

So I want to make sure that that comes through loud and clear.

Insurances are covering the medications very well in we can get most folks cured again about ninety five to ninety nine percent of folks.

>> I'm so glad you came on tonight and talked about this.

>> It has been some questions wavering out there for me about this as well and I'm sure that we answerd many for our viewers tonight.

>> That's exactly why we're here and we thank you very much for being here tonight.

Oh, thank you so much.

All right.

Please come back again.

We'll talk more about infectious diseases when you return.

So that's great.

In the meantime, you return next week, Tuesday night seven thirty from your HealthLine and Good night.

Good