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Dr. Young-Mee Lee & Dr. Daniel Pratt
1.) The recommendation is to take Ursodiol with food. Why? Does food increase effectiveness or minimize side effects? If taking with food isn't possible is it OK to take urso with water for one or two doses? What is the difference between Actigall and Ursodial aside from milligrams per tab? Is major depression (which is out of character for the patient) be a side effect of Actigall?
Answer
I don't think that it makes very much difference whether or not you take ursodiol with food. The active ingredient is the same in both drugs. They may be packaged differently. Major depression is not usually a side effect of Actigall.
2.) Would you encourage or discourage a patient of yours with stage 3 PBC from taking Milk Thistle. Please explain your answer.
Answer
There are no data of which I am aware about milk thistle in PBC. Hence I would not encourage anyone with PBC, no matter what stage, to take it. I am not aware of any side effects. Many patients take it on their own because it is sold over the counter. I would rather not have patients take milk thistle but do not feel strongly because it is seems to be safe in the doses taken.
3.) For approximently 3 years I have undiagnosed fevers. Use to be only at night and maybe every three months for a week at a time. The temps at times will go to 105. I have seen numerous doctors about the fevers without any conclusions. Recently the fevers are becoming more frequent and also during the day. Is fever due to PBC or something else going on in the body?
Answer
Fevers are not usually seen in PBC. You should check with your doctor. There is most likely another reason for the fever.
4.) Most doctors tell us that diet plays no role in how PBC may or may not progress. How is this known? Have controlled studies been done?
Answer
There are no data on diet but no reason or even hint of a reason to think that diet plays a role. What kind of diet are you thinking of? There are many different kinds of diet.
5.) Is it normal to feel heavy edema in your abdomen and lower extremities. What can be done to relieve this? Is there anything holistic or home remedies to help relieve the symptoms? I am currently living in Belgium. I would appreciate any info.
Answer
Edema is fluid retention. It usually occurs only in clinically advanced PBC where the serum albumin level is low. I know of no holistic or home remedies and this is usually treated by a physician.
6.) I needed to find out the correct names of the ANA, AMA, & AMST and their purpose in diagnosis. Are there any other tests that may be beneficial to indicate or rule out PBC or any other liver disease?
Answer
AMA is antimitochondrial antibody, positive in about 95% of PBC patients but found in 2% of patients who do not have PBC. ANA is antinuclear antibody, a less specific test. It is positive in patients with all sorts of different diseases and also found in people with no obvious medical problem. I am not sure what AMST is. ASMA is antismooth muscle antibody, present in some patients with chronic hepatitis.
