Saying Goodbye to The Hepatitis Comics

It is with mixed emotions that I have decided to retire The Hepatitis Comics. I created this blog in October 2009 after learning about cancer bloggers who poked humor at aspects of their disease. For more than four years I’ve been laughing at my hepatic self, cracking jaundiced jokes and trying to soften the impact of living with liver disease.

What I did not anticipate is that one day my hepatitis C would be cured. That day is here, and naturally, I am overjoyed. However, I feel I’ve lost my prop. It borders on bad taste to make hepatitis C jokes when you don’t have it. Fortunately, hepatitis C treatment didn’t change my hair color, so I will continue to collect and tell blonde jokes. (Brunettes who tell blonde jokes are just jealous.)

Please follow me on my regular blog, LucindaPorterRN, where I will occasionally lob some liver levity. Thank you for reading The Hepatitis Comics. May you too, be free from hepatitis C, but still full of humor.  

A Post-Thanksgiving Liver Prayer

Thank you, liver, for not complaining once about the turkey, stuffing, gravy, sweet potatoes, and cranberry sauce. I know it would have been better if I had eaten more green beans, but if I had, there would not have been room for extra stuffing. I appreciate all the work you did to help me digest that extra rich food, and although I am grateful, I do have one request. Would you talk to my gall bladder and ask it not to complain so much! A little team work would have made Thanksgiving much more enjoyable. 

A Prayer to My Gall Bladder

A Prayer to My Gall Bladder

I have a Thanksgiving request

I need for you to digest;

dear pouch beneath my liver

I need your help as I eat that sliver

of pie, turkey and extra gravy

and perhaps some stuffing savory;

Break down the fat from all that food

and please, oh please, don’t wreck my mood;

Tiny, bag of green bile,

please continue to work awhile

as I eat a second helping or a third,

spare me, from antacids and attacks of GERD.

Unfortunate Hepatic Typos

A spelling mistake can change the meaning of words, so watch that spellchecker feature... 

• Hepatologist vs herpetologist – Depending on whether you need help with your liver or your snake, be sure you know which specialist to consult
• Hepatitis vs helpatitis – Hepatitis is inflammation of the liver; helpatitis is when all hell breaks loose in the liver
• Gall bladder vs gull bladder – A gall bladder condition needs a physician, a gull bladder problem needs a veterinarian or an ornithologist
• Liver vs lover – You don’t want to lose either. One you can’t live without; the other doesn’t complain
• Pepsi vs hep C – Neither is good for you, but one isn’t contagious 

Liver Trivia

All vertebrates have a liver.  Technically you might not be able to call someone “lily-livered” if they are spineless – check for the presence of a liver first. Don’t call them gutless until you are sure they have a digestive tract. Or just stick with “coward.”

The liver regenerates. This means that your liver is making new cells. I don’t know why that feature was overlooked on my face. It seems entirely reasonable that a new liver would like to have matching eyelids.

A mere quarter of a liver can grow to a full size liver, a process known as compensatory growth. If all organs could do this, then things might have been better for John Wayne Bobbitt if Lorena had left 25% of John’s famous lost member intact.

The liver does not have any nerve endings. This means you could get stabbed in the liver and your liver would not complain about it while you are dying.

Humans cannot live without a liver, so no liver, no liver.

The liver is not trivial.

The Liver Meeting

The Liver Meeting starts today, an annual event sponsored by the American Association for the Study of Liver Diseases (AASLD). Picture a huge convention hall, with presentations from morning to night—all focused on the liver. Speakers hone their liver jokes, capturing the audience’s attention with attention-grabbing opening lines such as, “Two livers walked in a bar…” or “Did you hear the one about the liver that…” Naturally, if you aren’t a hepatologist, you might not think liver jokes are funny.  A herpetologist accidentally attended the Liver Meeting and didn’t get a single joke. 

Halloween at the Hepatitis Comics

In honor of Halloween, I found something ghoulish and liver-related— hepatoscopy. Practiced by the Babylonians, hepatoscopy is an occult ritual which uses a sheep liver in order to look into the future. A priest divided a liver into into sections, with each section representing a particular deity. The priest then interpreted the "signs" of the liver in order to divine a course of action.

There is a biblical reference to this practice, “For the king of Babylon will stop at the fork in the road, at the junction of the two roads to seek an omen; He will cast lots with arrows, he will consult with his idols, he will examine the liver.” – Ezekiel 21:21.

It is a good thing the king of Babylon didn’t pick up that fork in the road…

What are you doing for Halloween? I am watching my neighbor’s livestock to be sure the sheep don’t go missing. 

Laughing with Hepatitis C

The average child laughs around 400 times every day. Contrast this with the average adult who laughs approximately 25 times a day. This fact makes me want to either cry, read Dave Barry or watch Carol Burnett reruns.  For me, laughter is the backbone of physical, emotional and spiritual health. Humor is the thread that keeps me from unraveling. I find ways to inject appropriate humor into nearly everything.

The potential health benefits of laughter are well- researched. However, if you need data to tell you to laugh more, you are in deep trouble. However, for you die-hard data devourers, at the end of this post there are some links so you can dig for details.

For those of you who appreciate laughter, you may be delighted to learn that there is a practice called Laughter Yoga. Originating in India, Laughter Yoga is the practice of laughing as a discipline rather than merely for pleasure. Dr. Madan and Madhuri Kataria developed Laughter Yoga about ten years ago and now there are laughter clubs worldwide. Training is available for anyone interested in becoming a certified Laughter Yoga instructor.

The Laughter Yoga website takes laughter very seriously. So much so, that the following warning is given: “Too much of a good thing can become a bad thing. You cannot laugh too little, but you can laugh too much and put your body into destress (sic).” I assume that this is a typo or translation error and the author meant distress rather than destress. Heck, to de-stress is the main reason why I laugh. Also, I have a hard time believing the statement that one can laugh too much.

The Laughter Yoga caution goes on to say that, too much laughter can actually be dangerous, especially for older people (geezers like me). Well, this may seem closed-minded, but I cannot imagine getting through the geezer years without laughing a lot. Between the loss of eyesight, hearing, brain, keys, stamina, waistline, and sex, I am hanging onto laughter as if it is a life preserver. Besides, death by laughter sounds like a great way to go.

I think that humor helps me cope with all of life’s challenges, particularly hepatitis C. This disease was not a laughing matter when I was first diagnosed, but over time, it has provided some amusing moments. This is particularly true when I am in a hepatitis C group with others who live with this virus. Laughing with others is a communal act. It is like sharing an intimate moment or a fine meal. Laughter lifts the spirits and for a brief time suspends the hard edge of reality. It reminds us that we are all in the same boat.

Now let’s get laughing…This YouTube clip of John Cleese doing Laughter Yoga will get you started.

For Data Die-hards:

How Laughter Works

Helpguide

Laughter Yoga

Hepatitis C: A Matter of Perspective

When describing their experiences of treatment for chronic hepatitis C viral infection, patients commonly use analogies. hepatitis C and its treatment can be challenging. It is interesting and sometimes amusing to see how patients portray their various encounters. Humor can be a powerful coping mechanism. Here are a few of my favorite images:

• “I just tell myself that I am in a rented body. I will upgrade it when I am done with hepatitis C treatment.”
• “It is like menopause, complete with irritability and hot flashes. I love watching men on treatment. I hope it gives them sympathy for menopausal women.”
• “It’s like being at high altitudes, except the view isn’t as good.”
• “My body has been snatched by aliens, except in this case, the aliens are interferon and ribavirin. 
• “Treatment is the easiest weight loss program I have ever been on. I don’t even think of food.”
• “Every once in awhile, I lose my temper or say something inappropriate. It is amazing how words just pop out of my mouth that I never would have said before. At first I chastised myself about it. Now I just tell myself that I have interferon-induced Tourette’s syndrome. Thank goodness it is temporary”
• “HCV treatment feels like a preview of old age.”

In addition to these descriptions, patients sometimes reveal stories about themselves. It is not uncommon for patients to lose their cars. Once I got into the wrong vehicle and the car wasn’t even the same color or make as mine. One poor fellow thought he had taken his sunglasses off and realized that he had actually taken his dentures out. He did this in public. The only time I ever ran out of gas was during treatment. I had placed a post-it on my dashboard, reminding me to buy gas. Unfortunately, the note covered my gas gauge and I did not see the low fuel-warning indicator. What can one do but laugh!

Unliverish Humor

This week, the Hepatitis Comics is providing a break from its usual galling humor, but offering some genuinely funny jokes by other people.

A patient sees his doctor: "Doc, I can't stop singing 'The Green, Green Grass of Home." "That sounds like Tom Jones Syndrome." says the doctor. The patient asks, "Is it common?"  "Well, It's Not Unusual." 

Two cows are standing next to each other in a field. Daisy says to Dolly, I was artificially inseminated this morning. "I don't believe you," says Dolly.
"It's true; no bull," exclaims Daisy.

Two antennas met on a roof, fell in love, and got married. The ceremony wasn't much, but the reception was excellent. 

My liver is groaning. 

If Shakespeare Had Hepatitis C, Part 2

If Shakespeare Had Hepatitis C

In Hamlet, Shakespeare wrote, “Brevity is the soul of wit.” Here at the Hepatitis Comics, I believe in beating a dead joke. So this week, I continue with another installment of “If Shakespeare Had Hepatitis C.” Here are quotes the Bard might have written if his humor was jaundiced…

Out, damned hepatitis C out, I say!
("Out, damned spot! out, I say!" - Macbeth)

To treat, or not to treat: that is the question.
("To be, or not to be: that is the question." - Hamlet)

Neither a borrower nor a lender be; but donate your liver and other organs upon death.
("Neither a borrower nor a lender be; For loan oft loses both itself and friend, and borrowing dulls the edge of husbandry." - Hamlet)

The liver doth protest too much, methinks.
(“The lady doth protest too much, methinks” - Hamlet)

This above all: to thine’s own liver be true.
(“This above all: to thine own self be true.” - Hamlet)

Friends, Romans, countrymen, lend me your livers.
("Friends, Romans, countrymen, lend me your ears; I come to bury Caesar, not to praise him". – Julius Caesar)

If Shakespeare Had Hepatitis C

If Shakespeare had hepatitis C, he might have written plays with the following titles:

If Shakespeare Had Hepatitis C

• Romeo and Jaundice
• As You Liver It 
• The Comedy of Livers 
• Love's Livers Lost 
• The Hepatologist of Venice 
• A Midsummer Night's Biopsy
• Much Ado About Hepatitis 
• Taming of the Gall Bladder
• Two Gastroenterologists of Verona 
• Ascites and Cirrhosis
• King Liver
• All's Well That Ends with a Sustained Virolgic Response 

Tasteless Hepatitis C Humor

From time to time, hepatitis C is the subject of tasteless jokes. Many comedians have joked about it, and inevitably it makes the news. Those who live with this disease are often offended by careless quips about hepatitis C. There is an entire facebook page devoted to stopping jokes about hepatitis C.

Hepatitis C jokes are usually tasteless and disturbing, because often they foster misinformation and continue to stigmatize. Even worse, the jokes aren’t funny. Granted, a joke made by someone who lives with hepatitis C is more likely to be appropriate. 

Hepatitis C: A Touchy Subject

All this is to explain a cartoon by Rich Tennant (The 5th Wave). The caption reads, “Once again Ronald felt people were avoiding him because he had hepatitis C.” Ronald is pictured at a cocktail party, wearing a tutu. He is holding a leash that is attached to a turkey. Because of copyright laws, I can’t publish it, but I provided a link to this hepatitis C comic.

Tasteless? Perhaps. Funny? Yes. 

Hepatitis C's Day in Court

This year I participated in a twelve-week clinical trial for hepatitis C. My stats when I began: I had hepatitis C for 25 years; genotype 1a, viral load greater than 8 million, and stage 2 fibrosis.

This was my third hepatitis C treatment. The first was interferon monotherapy in 1997. I did not respond and stopped after three months. The second was 48 weeks of peginterferon and ribavirin in 2003. I relapsed in the post-treatment stage. This time I underwent 12 weeks of triple therapy with Gilead’s sofosbuvir (formerly GS-7977), ledipasvir (formerly GS-5885), and ribavirin.

Hepatitis C's Day in Court

Although this was much easier than the two prior hepatitis C treatments, it was not without challenges. The rash and headache were easy to deal with. Sleep was impossible without the aid of modern chemistry. I was fatigued, my head was cloudy. Apparently, I was a neurotic mess during treatment.  I thought I was moderately together, but my husband would testify in court that I was “difficult to be around.”  Fortunately, I didn’t do anything illegal that would force him to testify in court.

The recovery period was swift and nearly immediately noticeable. Unlike peginterferon’s tedious aftermath of two-steps forward, one-step back, I felt better every day. At my 12-week follow-up visit, I remained free of hepatitis C. I have a 98% chance of remaining this way until the official 24-week post-treatment date in November.

Perhaps I am being overconfident, but 98% sounds like darn good odds to me. The real question is, if I am cured of hepatitis C, will I have material for The Hepatitis Comics? I am sure I will continue to do and say ridiculous things, but without hepatitis C to take the blame, will I be reduced to dumb blonde jokes? The Blonditis Comics just doesn’t have much of a ring to it…

Light Hepatainment

Amusing his Liver

Although these are not liver-related jokes, we know that humor is good for the liver. These jokes appear in my email inbox from time-to-time and I hope they make your hepatocytes chuckle.

• When you get a bladder infection, urine trouble.
• What does a clock do when it's hungry? It goes back four seconds.
• I wondered why the baseball was getting bigger. Then it hit me!
• Broken pencils are pointless.
• I tried to catch some fog. I mist.
• I used to be a banker, but then I lost interest.
• I dropped out of communism class because of lousy Marx.
• A dyslexic man walks into a bra.
• I didn't like my beard at first. Then it grew on me.
• Did you hear about the cross-eyed teacher who lost her job because she couldn't control her pupils?
• I got a job at a bakery because I kneaded dough.
• I did a theatrical performance about puns. It was a play on words.

A Silly Liver Riddle

Question:
What do you call someone who thinks he or she has hepatitis C, but doesn’t?

Answer:  A hepachondriac

Mid-liver Crisis

Image courtesy of artur84/FreeDigitalPhotos.net

Tomorrow is my 60th birthday and I am having a midlife crisis.  I am failing as a hepatic comic. Comedy Central isn’t knocking at my door. I have not been invited to any late-night talk shows.  I thought by now I would have replaced Letterman with my own show, The Liverman show.

I am running out of liver-related material and may be forced to blog about the esophagus.  Oprah where are you when I need you?

Hepatitis Camp Song

Summer makes me think of camp. I loved sitting around the campfire, singing Kumbaya and Row, Row, Row Your Boat. I have modernized one of the songs, making it relevant to those with hepatitis C. Warning: This is highly irreverent and tragic.

Where Have All the Livers Gone  (sung to Where Have All the Flowers Gone - apologies to Pete Seeger)

Where have all the livers gone, long time passing?
Where have all the livers gone, long time ago?
Where have all the livers gone?
Hep C patients have picked them everyone.
Oh, when will they ever live?
Oh, when will they ever live?

Where have all the Hep C patients gone, long time passing?
Where have all the Hep C patients gone, long time ago?
Where have all the Hep C patients gone?
Gone for livers everyone.
Oh, when will they ever live?
Oh, when will they ever live?

Tickling the Liver Cells

Image courtesy of FrameAngel/FreeDigitalPhotos.net

The following medical humor is not related to hepatitis C or the liver, but hope it makes you feel better. This story is purported to be true.

A woman brought her baby in to see the doctor, and he determined right away the baby had an earache. He wrote a prescription for ear drops  In the directions he wrote, "Put two drops in right ear every four hours" and he abbreviated "right" as an R with a circle around it. Several days passed, and the woman returned with her baby, complaining that the baby still had an earache, and his little behind was getting really greasy with all those drops of oil. The doctor looked at the bottle of ear drops and sure enough, the pharmacist had typed the following instructions on the label: "Put two drops in R ear every four hours." 

World Hepatitis Day

July 28th is World Hepatitis Day. I wonder what rituals would emerge if this was an official holiday. I can just see it – red, blue, and yellow decorations along with trees festooned with miniature glass livers. People might play liverball and then eat liver and onions. After their big meal, they might watch the movie with the all time greatest liver line, Silence of the Lambs, where Hannibal Lector said that he ate a victim’s liver served with “some fava beans and a nice chianti.”

Feliz Hepitad Everyone 

Searching for Liver Trees

I saw many trees on my vacation, but not one biliary tree. Here is what I was looking for:

I guess I couldn’t see the liver for the trees.

And speaking of trees, I have been to Braintree but never to Livertree. 

Hepatitis C Greeting Cards

Image courtesy of gubgib/FreeDigitalPhotos.net      

I think we need special greeting cards for hepatitis C patients, and I have some ideas.

Cards for people who are on hepatitis C treatment, or are about to start:

• “Wishing you luck on your hepatitis C treatment. May you avoid all side effects, except the weight loss one.”
• “Don't worry about losing your hair. Once you've lost your eyesight, you won't notice.”
• “There is a bright side to hepatitis C, but I can't remember what it is.”
• “Look at the positive side of hepatitis C treatment—now you will be able to blame everything on the medications.”
• “Has hepatitis C left you feeling blue? That is better than being yellow.”
• “Is your liver down in the dumps? Hope you get well soon.”

A Christmas card for someone with hepatitis C: “Hope Santa brings you a shiny new liver for Christmas."

A New Year’s card for someone with hepatitis C: “Auld Liver Syne”

Attention Hallmark: You saw it here first. 

True Story to Amuse the Liver

Image courtesy of winnond/FreeDigitalPhotos.net

The following medical humor is not related to hepatitis C or the liver, but hope it makes you feel better.

A new, young MD doing his residency in OB was quite embarrassed performing female pelvic exams. To cover his embarrassment he had unconsciously formed a habit of whistling softly.

The middle aged lady upon whom he was performing this exam suddenly burst out laughing and further embarrassed him. He looked up from his work and sheepishly said, "I'm sorry. Was I tickling you?"

She replied, "No doctor, but the song you were whistling was 'I wish I was an Oscar Meyer Wiener."—Physician won't admit his name

Summer Reading for those with Hepatitis C

Image courtesy of Gualberto107/FreeDigitalPhotos.net

There are quite a few books about hepatitis C, but none for pleasure reading. Here are some books on my summer reading list, especially designed for the hepatitis C patient. I call this genre, liverature.

• A Liver Grows in Brooklyn
• The Gall of the Wild
• Gone with the Liver
• Deliverance
• The World According to Gall
• Heplet

More Hepatitis C Drug Names

Last week’s post generated more potential names for hepatitis C drugs. Thank you readers, especially to my dragon slaying partner and favorite nurse, GM.

Dead C (my favorite)

CeCleared

Cesponder

Hepinpast

C-Funeral

C-You-Later

Lost at C

Naming Hepatitis C Drugs

I have a fairly good memory for remembering the names of drugs. The hepatitis C drugs have been easy, because there are basically 4 generic names: peginterferon, ribavirin, boceprevir, and telaprevir. However, my foggy brain is trying to figure out how to remember the names of the drugs that are in clinical trials. They all end in “vir.” Here are some examples:

• simeprevir
• faldaprevir  
• sofosbuvir
• ledipasvir
• daclatasvir 
• samatasvir
• asunaprevir 

These are just a few. Then there are drugs with numbers, and combinations of drugs, such as medivir (combined simeprevir and samatasvir ). So, I propose that we make things easier for our hepatitis C brains by coming up with memorable names. Here are suggestions:

• HepC Killer
• HepC-B-Gone
• Sayonara HepC
• HepC Relief
• ByeBye HepC
• Liver Renew
• Dynomite HepC

Image courtesy of pixtawan/FreeDigitalPhotos.net

What are your suggestions?

Medical Humor to Tickle the Liver

The following entries appeared in Rockingham Hospital medical records. Although these are funny, if you think about it, it’s horrifying. The first one is liver-related.

• The lab test indicated abnormal lover function.
• Healthy appearing decrepit 69-year old male, mentally alert but forgetful. 
• Patient had waffles for breakfast and anorexia for lunch
• She is numb from her toes down.
• While in ER, she was examined, x-rated and sent home.
• The skin was moist and dry.
• Occasional, constant infrequent headaches.
• Patient was alert and unresponsive.
• Rectal examination revealed a normal size thyroid.
• She stated that she had been constipated for most of her life, until she got a divorce.
• I saw your patient today, who is still under our car for physical therapy.
• Both breasts are equal and reactive to light and accommodation.
• The patient refused autopsy.
• Skin: somewhat pale but present.
• Large brown stool ambulating in the hall.
• Patient has two teenage children, but no other abnormalities.

Ten Rules for Hepatitis C Treatment

I was moody and short-tempered during all three of my hepatitis C treatments. Here are my tongue-in-cheek rules for how to manage anger during while taking hepatitis C medications.

1. Set up a tent in your backyard, local park, or anywhere at least 300 yards away from you. Banish anyone who doesn’t agree with you to live there, until they admit that you are right. I call it a ribavirin hut. If I am mad, you go to the ribavirin hut. After all, I am the one suffering here, so why should I give up my comfortable bed?
2. Do not get a new computer or new operating system during this time. Avoid Window 8. Apple users—go ahead and feel smug and superior.
3. Never call customer service while on hepatitis C treatment. It won’t be pretty.
4. Keep hammers and other weapons a minimum of 50 feet from all computers, phones, and people.
5. Do not watch the news. Let’s face it, news is a downer.
6. Carry earplugs with you at all times to block out unwanted sounds, such as barking dogs, whining neighbors, and elevator music.
7. Do not sign any contracts while on hepatitis C treatment. 
8. If you are a gun owner, give your guns to a trusted friend until your treatment is over; someone who lives far away. I am serious about this.
9. Practice restraint of pen and tongue. Remember you still want to have friends when treatment is over.
10. Be prepared to apologize later. You may think your anger is justified, but unfortunately, you probably were in a state of altered consciousness, and perhaps over-reactive. Forgive yourself.  

    

    Image courtesy of Stuart Miles /FreeDigitalPhotos.net

Admiring the Liver through a Kaleidoscope

“At the height of laughter, the universe is flung into a kaleidoscope of new possibilities.” – Jean Houston

I love this quote. It prompted me to imagine looking at a liver through a kaleidoscope. All that bile, blood, lymph fluid, hormones, liver cells, and so on. I imagine it like the play/movie Joseph and the Amazing Technicolor Dreamcoat. Which leads me to an idea for a movie—Lucinda and the Amazing Hepatic-color DreamLiver.

Perhaps I should have just stopped at the quote. Sometimes my imagination closely resembles the features of certain psychiatric diagnoses. Sigh. Liver comedians are frequently misunderstood. 

Another Hepatitis C Jingle

I’ve been singing hep C songs all week, and here is my newest one. Sing it to the tune of “I’m a Little Teapot”

I’m a little liver, big and stout

Here is my lobe, here is my duct 

When I get all liquored up, hear me shout 

Just leave out the booze, and I won’t crap out!

I’m a clever organ, yes it’s true 

Here’s an example of what I can do 

I can change my cells from bad to good 

Just leave out the booze, and I won’t crap out!

 Image courtesy of gubgib /FreeDigitalPhotos.net

Come Alive, You’re in the Hep C Generation

If I were going to imagine a theme song for my blog, I’d rewrite an old Pepsi commercial aired in the 1960’s—Come Alive, You’re in the Pepsi Generation. I would change the words to Come Alive, You’re in the Hep C Generation. This jingle was at its height when many Baby Boomers were first contracting hepatitis C. The commercial targeted young, “hip” consumers, so the irony is not lost on me that I chose this song.

Image courtesy of piyato /FreeDigitalPhotos.net

Something liberating happens to me when I substitute Hep C for Pepsi. Perhaps the light tone of the music offsets the heaviness of this potentially life-threatening disease. Or, it is the notion that we can “come alive” despite living with this virus that now kills more people every year than HIV does. Or is it the sheer irreverence of imaging that Come Alive, You’re in the Hep C Generation could be the battle cry for today’s Baby Boomers…

To watch the original commercial, visit You Tube

Hepatitis Awareness Month

May is Hepatitis Awareness Month, and this is the second annual observation of this event. I was thinking about what “Hepatitis Awareness Month” means, and although I am sure the goal is to increase the public’s awareness, it did occur to me that Hepatitis Awareness Month could have other implications.

First, it could mean to make hepatitis more aware. I can see me lecturing my hepatitis C, “Keep your eyes open; watch where you are going. Hey be careful, you are damaging my liver. For goodness sake, use some contraception, you are multiplying too fast”

Second, it could mean that the month is dedicated to hepatitis awareness, but the rest of the year gets a break. “Hey, no need to watch what I eat in June, since hepatitis awareness was so last month.” Not true, of course.

All joking aside, 75% of those who have hepatitis C are completely unaware of the fact that they harbor a harmful, potentially deadly virus. Please help participate in Hepatitis Awareness Month, and make your efforts a yearlong commitment.

For more information, see the Centers for Disease Control and Prevention.

April Fool's Column

Here is a reprint of my April 2013 column appearing in the HCV Advocate:

It's April, the month that has my favorite unrecognized holiday—April Fool's Day. Long-time HCV Advocate readers know that April is when I let loose my hepatic humor and jaundiced jokes. April is when Alan Franciscus rolls his eyes and wonders if Dave Barry might be available to write future columns.

Pondering my April column, I wondered if I had run out of humorous things to say about hepatitis. I might be forced to make gall bladder jokes. However, I got a big break: Stanford informed me that I qualified for an interferon-free hepatitis C clinical trial. I felt like I hit the lottery. Let's face it, nothing is more hilarious than me on hepatitis C treatment.

I told my colleagues at The Advocate and naturally, they were all happy for me. However, I noticed little hints of concern. One person mentioned that she'd be sure to double check my work. Someone else asked me to look at a project before I went "gaga" from the medication. I assume he meant lose my mind, rather than start wearing Lady Gaga outfits. I've never looked good wearing meat.

These are my dear friends and humor is as much a part of our work together as hepatitis C advocacy is. They all have or have had hepatitis C. They know me, this disease, and the rigor of treatment. More importantly, they know what to say and not to say to someone who has hepatitis C. Unfortunately, unless you have hepatitis C, and most especially if you have been through treatment, it is hard to know what to say to someone with this disease.

This month, I present my "Ten Things Not to Say to Someone with Hepatitis C" and "Ten Things to Say to Someone with Hepatitis C" lists. In the spirit of full disclaimer, ribavirin is setting in, so if I sound caustic, it is because I am.

Let's start with ten things not to say to someone with hepatitis C, especially if they are going through treatment: 

1. "That is a really nasty looking rash." Yes, we get nasty looking rashes, but we are hoping it doesn't look as bad to you as it does to us. Pretend you don't notice it.
2. "Should I call 911?" Sometimes we look and act as if we are on death's door. We may get light-headed or have shortness of breath after walking up a flight of stairs. However, we are more resilient than you think we are. However, if we have chest pain, call 911.
3. "Your problem is that you aren't a positive thinker. If you change your attitude, you would feel better." Excuse me, but I am positive. I am positive that if you knew what I was feeling, you wouldn't say such a stupid thing.
4. "Try this herbal drink—Liver Detox—I know people who cured hepatitis C with this stuff." I appreciate your concern, and I wish that there were a miracle cure. However, don't you think that if Liver Detox worked, that venture capitalists would have bought the company by now?
5. "If you just got some exercise, you would feel better." This is probably true, but I don't want to hear this unless it comes from other patients. 
6. "You are so lucky that you can take time off from work and stay in bed all day." Would you like to switch places?
7. "Are you losing your hair?" No, I am simplifying my life by trying to get rid of some of excess hair. 
8. "My (insert relative) had hepatitis C, and he/she was cured by a psychic healer." This may or may not be true, but in either case, it isn't helpful. We all make our own choices about how to manage hepatitis C. My choice is to try antiviral drugs. I am not sure what your intention is when you tell me that a relative chose another path, but it feels like you may be criticizing my choice. 
9. "You must be feeling better, otherwise you wouldn't be here." Sometimes we push ourselves. We don't feel better, but we are sick and tired of feeling sick and tired, so we force ourselves to show up for work, social events, and other activities. Don't assume that because we do these things we are feeling good.
10. "You look really good." We feel awful and when you say that, are you suggesting that we are lying about our health? If you want to cheer me up, it is best not to say anything about how I look. 

Ten things to say to someone with hepatitis C, especially if they are going through treatment:

I imagine this is hard. How can I support you?" Many patients may not have a direct answer for this, but we like to be asked this question.

1. "You look better than I thought you would, but looks can be deceiving. How are you feeling?" Feeling unwell is complicated. We want to look attractive, but not look so good that you can't tell that we are sick. By phrasing the question this way, it allows us to tell you how we are feeling and soothes our need to look attractive.  
2. "I'd love to bring lunch over, but only if you feel up to it. If we get together, promise me you won't clean the house. I will only stay 30 minutes." This is concrete. The patient is off the hook, you will provide the food, and you set a short time limit on the commitment.
3. "When I am at the store, may I pick up some groceries for you?" This tells me that you aren't going out of your way, and makes it easier for me to accept the offer.
4.  "Do you want to talk about how you are doing, or would you rather we talk about something else?" Sometimes we feel ignored when no one asks how we are doing, but sometimes we'd rather be distracted by talking about other things.
5. "I made some extra soup. I'd like to bring it by later. If you don't want it now, you can always freeze it." It's hard to say "no" when it's put this way.
6. "Just emailing to let you know that I am thinking about you and I hope your treatment goes well. No need to reply." It feels good to be thought about without having to answer an email.
7. "I am free on Thursday. How about I come by to help with the laundry or run some errands." We are proud, and often reluctant to accept help. Stated this way, I might accept the offer.
8. "You are amazing." We feel so bad, that we forget this simple truth. Anyone who has hepatitis C or goes through its treatment is amazing.
9. "Do you want to hear a great joke?" This won't work for everyone, but it is a surefire way to make me feel better.

This is the third time I've gone through treatment, and I know it is hard on family and friends. They don't know what to say, so I try to be patient. My patience is running thin, so I just might give them these lists. 

When Poetry meets Organ Donation

What a quandary: between National Donate Life Month and National Poetry month, I am not sure which to write about in the Hepatitis Comics. Here is something about both topics:

Poet Maya Angelou wrote, "Life loves the liver of it." She sure can turn a hepatic phrase. Or is it an hepatic phrase? Any English majors out there?

"England has no Kidney Bank, but it does have a Liverpool."

 Image courtesy of Christian Southworth/ FreeDigitalPhotos.net

Just Paid My Taxes

Taxes hurt my liver, so I needed a joke to make it feel better:

  A man walks into a store followed by his ten-year-old son.  His son is spinning a quarter in the air and catching it between his teeth.  While walking through the store someone bumps into the boy and the coin goes straight into his mouth and lodges in his throat.  He immediately starts choking and going blue in the face.  His dad starts panicking and shouts and screams for help.
    A middle-aged, fairly unnoticeable man in a gray suit is sitting at the snack bar in the store reading his newspaper and sipping a cup of coffee.  At the sound of the commotion, he looks up, puts his coffee down, neatly folds his newspaper and places it on the counter. He gets up from his seat and makes his unhurried way towards the boy.   When he reaches the boy, the man carefully takes hold of the boy's testicles and squeezes, gently but firmly.
    After a few seconds the boy convulses violently and coughs up the quarter, which the man catches in his free hand.  Releasing the boy, the man hands the coin to the father and walks back to his seat at the snack bar without saying a word.
    As soon as the dad makes sure that his son is OK, he rushes over to the man and starts  thanking him saying, "I've never seen anybody do anything like that before.  It was fantastic! Are you a doctor?"
    "Oh, good Heavens, no," the man replies, "I work for the Internal Revenue Service."

 Image courtesy of renjith krishnan / FreeDigitalPhotos.net 

When A Hepatitis Comic Takes a Vacation

Photo credit: Wolfgang @ Northern Lights Resort

Last month I went to the Yukon to see the aurora borealis. I went dog sledding and snow shoeing, proving that I can do quite a bit despite being on treatment for hepatitis C.

Here is a tasteless joke to honor my Canadian adventure:
"Two Eskimos sitting in a kayak were chilly, so they lit a fire in the craft. Unsurprisingly it sank, proving once again that you can't have your kayak and heat it too."

I hope readers will forgive me, since this has nothing to do with hepatitis or the liver. I am on hepatitis C treatment, and hoping you will tolerate me through the process. 

The Liver Bunny

Image courtesy of supakitmod/FreeDigitalPhotos.net

It is Easter, and the Liver Bunny brought me chocolate livers, cirrhotic eggs, and yellow marshmallow poops (or was it peeps?).   I wonder what the other good children got today... 

Medical Humor

I am both horrified and amused by the following medical notes written in the Rockingham Hospital Records:

1. Examination of genitalia reveals that he is circus sized.

2. The patient has no previous history of suicides .

3. Patient has left white blood cells at another hospital.

4. Patient's medical history has been remarkably insignificant with only 11 kgs weight gain in the past three days. (11 kgs is about 24 pounds) 

5. She has no rigors or shaking chills, but her husband states she was very hot in bed last night.

6. Patient has chest pain if she lies on her left side for over a year.

7. On the second day the knee was better, and on the third day it disappeared.

8. The patient is tearful and crying constantly. She also appears to be depressed.

9. The patient has been depressed since she began seeing me in 1993.

10. Discharge status: Alive but without my permission.

An Irish Small Tale

We have all heard of Leprechauns, the wee folk of Ireland so famously apparent on St. Paddy's Day. However, few have heard about the Leprechauns' yellow cousins, Heprechauns. These are even rarer than Leprechauns, and if you see one, let me know. 

Image courtesy of digitalart/FreeDigitalPhotos.net

Just What the Doctor Ordered

Here are some true medical records dictated by physicians. These are from a column written by Richard Lederer, Ph.D. for the Journal of Court Reporting and have been reprinted at several Internet sites and magazines. They aren't liver-specific, but humor is always good for the liver.

• By the time he was admitted, his rapid heart had stopped, and he was feeling better.
• On the second day the knee was better and on the third day it had completely disappeared.
• She has had no rigors or shaking chills, but her husband states she was very hot in bed last night.
• The patient is tearful and crying constantly. She also appears to be depressed.



Image courtesy of Idea go/ FreeDigitalPhotos.net

• The patient will need disposition, and therefore we will get Dr. Blank to dispose of him.

Hepatic Hiatuses

I am thinking about a vacation. Where does a liver humorist go when she is trying to get out of town? Here are some suggestions:

• Liverpool (in England)
• Liverton (also in England)
• Livermore, CA

I'll probably choose Liverpool because I like to swim. When I run out of liver locations, I'll visit Braintree in Massachusetts. Perhaps I'll come back smarter.

Image courtesy of John Kasawa/FreeDigitalPhotos.net

The Academy Awards for Liver Movies

Image courtesy of Su Sfondo Rosso/FreeDigitalPhotos.net

This year's Oscar Nominations for Best Liver Picture are:

• Liver of Pi – A movie about a man's search for a new liver
• Lincoln's Liver – A movie about a President's liver
• Les Miserable – A movie about the hard times of livers that survive alcohol and foie gras  
• Silver Livers Playbook  - A movie about the livers of silver miners

 See you at the Oscars!

The Perfect Birthday Gift

Image courtesy of ammer/FreeDigitalPhotos.net

This President's Day weekend celebrates the birthdays of Washington and Lincoln. Although I miss not having two separate holidays like we did when I was a kid, I like the idea of combining two birthdays into one. One birthday means one birthday present.

So many of the celebrations I've been to recently have been Baby Boomer birthdays. I've discovered the perfect birthday gift for that Baby Boomer in your life—offer to pay for hepatitis C screening. If the test comes out negative, next year you can buy them a bottle of champagne. If the test is positive, how about a model of the liver?

A Valentine for Liver Lovers

Courtesy of Ed Porter

Before Cupid Took Archery Lessons

Happy Valentine's Day

The Super Bowl is All about the Liver

Image courtesy of digitalart/ FreeDigitalPhotos.net

According to an article in the Smithsonian, guacamole is the official Super Bowl food. Since avocados may be beneficial to the liver, I want to make the argument that Super Bowl Sunday is a liver holiday. The football is the perfect icon for the liver (the average liver is about the size of a liver) and the liver is sort of the shape and color of a football. Granted, the liver would be a lousy substitute for a football, since it weighs 3 pounds and is not very aerodynamic.

So this Super Bowl, think about your liver as that football is making its way down the field. Enjoy the guacamole, skip the beer, and don't forget to get in a little exercise before the game.

Liver Trivia or Triver Livia

Things I think about:

Did you know that every vertebrate has a liver? This means that if you have a backbone, then you have a liver. So, when someone says, "He has no backbone," meaning that the person doesn't have courage to stand up for themselves, then they can also say, "He has no liver,"  since if you don't have a backbone, you don't have a liver either.

Vertebrates include fish, amphibians, reptiles, birds, mammals, primates, rodents and marsupials. 

• Do marsupial livers have pouches?
• Are fish livers buoyant?
• Do bird livers have wings?
• How do rodent livers deal with that horrible diet?
• If a reptile eats a rodent, does that mean the snake's liver has to deal with whatever the rodent's liver was processing?

Image courtesy of rajcreationzs / FreeDigitalPhotos.net

Queen of What?

It's official—I have reached the pinnacle of my success. C.D. Mazoff, PhD declared that I am the Queen of Hepatic Hilarity. He even sent me a virtual crown.

Here is the background story. While writing an article about the recent Partner's Study for the HCV Advocate, Dr. Mazoff ask my husband and I for some statistical analysis of the data. (Click here to read the article.)

This is my reply: "If HCV (hepatitis C)  risk is ~1 per 190,000 sexual contacts, then you would have to have sex 6.5 times a day for 80 years, and assuming that you were an early-starter at age 10, you would be having sex until age 90. I think this is way more than Magic Johnson had sex. 

• Your odds are 10x greater of getting murdered in the U.S. 18,000 to 1 
• Odds are greater that you would die in an explosion: 1 in 107,787 
• 100 x greater of dying from any kind of injury during the next year: 1 in 1,820"

"Dr. Mazoff wrote,  "PS: don’t blame me; remember this is from the Queen of Hepatic Hilarity!"

I wear this crown with pride. The jaundiced color goes well with my hair. 

Liver Games

Alan Franciscus, the director of the Hepatitis C Support Project invented Hepardy – a liver-related version of Jeopardy. he and I play it at all the hepatitis C trainings and it is quite fun. Now there is a game show on the HCV Advocate website, so anyone can test their knowledge about hepatitis C and related issues.

Click here to play. Have fun!

Image courtesy of Stuart Miles/ FreeDigitalPhotos.net

Liver TLA's

Have you ever noticed how often we use three-letter acronyms, especially in medicine. I am referring to  abbreviations, such as DOA (dead on arrival) or the FDA (Food and Drug Administration).  My husband calls these TLAs. He is an engineer, and for years we attended his company's holiday party. After I started working at Stanford, we were invited to a party. My husband said, "Oh great, a whole bunch of new TLAs to learn."

Texting has caused a blossoming of TLAs, which can sometimes cause confusion. For instance, LOL means either laugh out loud or lots of love, so you have to be really careful using LOL or you may ruin a romantic moment.

TLAs are wonderful shortcuts for those that know the code. But for those who don't, TLAs can cut off communication. With liver disease, some TLAs are essential. ALT is much easier to say than Alanine Aminotransferase or AFP for Alpha Fetoprotein.

With liver disease, there are 2 and 4-letter acronyms. HE means hepatic encephalopathy, DILI means drug-induced liver injury. I love the expression DILI.. Although I had it once and NEVER want to have it again, it might be fun to call in sick because, "My DILI is acting up."

Now that you know what DILI is, you are smarter, but you will sound silly.