Coping With Hepatitis

Living with hepatitis can be stressful even if you don’t have any symptoms. There are several types of infectious hepatitis, as well as inflammatory causes of hepatitis.

Because the liver is such an important organ that affects so many aspects of your health, hepatitis has widespread physical effects. Additionally, the emotional effects and uncertainty may be further compounded by the stigma and the fear of infecting others if you have one of the infectious types of hepatitis. Fortunately, there are things you can do to cope with these challenges.

Emotional

Viral hepatitis B and C are highly stigmatized. Rather than viewing it as one would the flu or other community-borne infections, people will often assign blame to those who have been infected.

Much of this is due to the fact that these types of hepatitis are associated with sexual transmission or injecting drug use.

When faced with the prospect of judgment, many people with hepatitis will isolate themselves, fearing disapproval or discrimination. It is an understandable response, but one that can leave you vulnerable to anxiety and depression or keep you from getting the medical care you need.

If you delay medical care until your liver becomes is severely damaged, you may be at risk for cirrhosis or liver cancer. and treatment will be less effective.

While these emotional barriers are very real, there are a number of things you can do to cope with a hepatitis diagnosis.

Educate Yourself

It can be empowering to become a partner in your own care. Learn everything you can about the virus, including its effect on the body, how it is transmitted, and what treatment options are available.

Talk to your healthcare provider about your questions and ask for help in finding accurate information. By doing so, you can correct any misconceptions you have about the disease and answer many of the “what ifs” that may be causing you distress.

What you will learn is that hepatitis is no longer the hopeless disease it once was. There are more effective treatments, and their side effects are far less severe than older treatments.

Learn Acceptance

Receiving a hepatitis diagnosis can leave you feeling shocked, numb, sad, angry, panicked, or guilty. You may even cycle through these emotions as you grapple with what the diagnosis actually means. All of these feelings are perfectly normal.

Rather than trying to “fix” your emotions, remind yourself that coping is not an event; it is a process that takes time. Denial can be a means of coping, essentially buying yourself time until you have the strength to look the disease in the eye.

With that being said, you should never allow gloom to define your condition. Strive to remain positive. Not everyone responds to hepatitis in the same way; some have even used it to make positive changes.

Establish Goals

Even if you are still reeling from the diagnosis, it helps to set goals and targets rather than wondering what’s next? Having some sort of game plan can help dispel the uncertainty you may be feeling and provide you a better sense of control and self-determination.

If you find yourself overwhelmed, ask for a referral to a counselor or social worker who can navigate you through the system and help you identify the family, mental health, financial, and substance abuse treatment services you need.

Try to set up your next medical appointment as you leave each appointment, and set aside time for routine lab tests and follow-ups. The most important thing is to remain linked to care. By stepping out of care, you risk falling out of the system altogether.

It's beneficial to establish a routine that becomes a regular facet of your health, rather than dealing only with symptoms or problems as they come up.

Reduce Stress

Living with hepatitis can be stressful, impacting your physical, mental, and emotional well-being.

Rather than ignoring it, consider mind-body therapies, such as:

• Meditation
• Gentle yoga
• Tai chi
• Progressive muscle relaxation (PMR)
• Guided imagery
• Controlled breathing
• Biofeedback

Exercise can also be a great stress reliever, boosting levels of feel-good hormones. Even taking a leisurely 30-minute walk can help you de-stress by providing you with a change of scenery.

Seek Counseling

Anxiety and depression are common with hepatitis. Even if the danger is not imminent, you may feel anxious and depressed due to your hepatitis diagnosis. Don't suffer these emotions in silence, especially if the feelings are persistent or interfering with your work, relationships, or sleep.

Depression and anxiety can take a toll on your health. They can make you too upset to take your medications or could cause you to use alcohol, sleeping pills, or illicit drugs as a means to cope.

When it comes to managing hepatitis, it is just as important to treat your mental health as your physical health. If you’re feeling anxious or depressed, make an appointment to see your primary care provider or ask for a referral to a therapist. You may benefit from psychotherapy, medication, or both.

If you are misusing alcohol or drugs, it is vital that you seek substance abuse treatment.

Physical

Living with hepatitis is about more than taking care of your liver. The liver affects other organs and it is affected by other organs.

Exercise

Being overweight or obese can lead to a condition called portal hypertension which harms the liver and increases blood pressure, as well as the risk of heart disease.

A healthy weight and blood pressure are essential for protecting the liver. The best place to start is by engaging in routine exercise with a combination of resistance and cardio training. Start slowly and increase incrementally to get lasting benefits.

Consider meeting with a personal trainer or physical therapist who can design an appropriate fitness plan with specific targets and milestones.

Diet and Nutrition

The liver metabolizes everything you eat, so a healthy diet is essential for people living with hepatitis. Protein, which is a vital nutrient, can be especially hard on the liver, so getting this nutrient in your diet has to be planned very carefully.

A healthy diet provides the fuel your body needs, which is especially important to overcome the fatigue that's common in acute and advanced-stage disease.

Here are some of the ways to protect your liver while ensuring proper nutrition:

• Reduce your meat intake: Opt instead for plant-based proteins.
• Reduce your saturated fat intake: Limit your saturated fat intake to no more than 10% of your total daily calories, choosing heart-healthy monounsaturated and polyunsaturated fats.
• Cut back on sugar: Limit your added sugars—including fructose—to less than 10% of total daily calories. Sugars can raise your triglycerides and promote fatty liver disease.
• Eat more whole grains, beans, and vegetables: These foods are rich in dietary fiber and complex carbohydrates needed for good digestion and blood sugar control.
• Drink plenty of water: Your body functions better if it is not dehydrated. About 64 ounces (eight cups) is a reasonable amount of water for most people. Drink more if you’re very active, especially in hot weather.

Avoid fad diets, which rarely work and often deplete you of the nutrients your body needs. Instead, work with a qualified nutritionist or dietitian who can help design a program that is safe, effective, and sustainable.

Sleep

Getting enough rest is important when you have hepatitis. Sleep deprivation causes fatigue, contributes to depression, and diminishes the body’s overall immune response.

While psychological distress is a common cause of insomnia, poor sleep habits (known as sleep hygiene) also contribute.

There are a number of ways to improve your sleep hygiene:

• Limit daytime naps to no more than 30 minutes.
• Avoid nicotine before bedtime.
• Avoid stimulants like caffeine by the afternoon.
• Eat dinner two to three hours before bedtime.
• Avoid electronic devices an hour before sleep.
• Go to bed at the same time every night and wake up at the same time every day.
• Establish a good sleep environment with comfortable temperatures of 60–67 degrees.
• Limit alcohol, and don’t drink close to bedtime.
• Use blackout curtains, eye masks, or earplugs if needed.

Social

Managing hepatitis is a team effort. It helps to have a support network of family and friends to help through the daily challenges of living with hepatitis.

Making Disclosure

The first—and perhaps hardest—step is disclosing your condition to others. It can be especially difficult if you have to make secondary disclosures, namely how you got infected. However tough this may be, it shouldn’t stop you from trying.

One of the challenges of non-disclosure is that forces you to keep your treatment secret. This, in turn, can interfere with your ability to adhere to your medications, resulting in missed doses and an often-inadequate response to treatment. The consequences of skipping treatments are serious.

Lack of privacy and secrecy are frequently cited as reasons for missing doses.

To find the support you need, disclose your status to those you trust and can fully rely on. These will be the people who are less likely to be concerned about how you got hepatitis and more about how to help. Take the time to educate them about hepatitis, and allow them the time to ask questions to help them understand.

Support Groups

You can find support groups online and in person. It often helps to speak with those who have first-hand knowledge of what you are going through, who can share advice and insights, provide emotional support, and lessen the isolation you may be feeling.

You can ask your healthcare provider or social workers for referrals to local support groups, do a community search on Facebook, or find local or online support resources through non-profit organizations like the American Liver Foundation.

Practical

If you have hepatitis, the risk of infecting others and the cost of accessing care can add to your stress. Fortunately, there are practical approaches to both.

Hepatitis Prevention

Of the three most common viruses, hepatitis A is a picornavirus, primarily transmitted by fecal contamination of food. Hepatitis B is a hepadnavirus, mainly transmitted by blood, sexual contact, and breast milk. Hepatitis C is a hepacivirus that can be transmitted through direct blood contact or to the baby during pregnancy.

The guidelines for prevention vary by the viral type and should be shared with anyone who may be at risk of infection:

• With hepatitis A: Avoid unclean food or water and wash your hands thoroughly after using the restroom and coming into contact with a person’s stool and blood or other bodily fluids.
• With hepatitis B: Always use condoms during sex, be cautious about body piercings or tattoos, avoid injecting drugs or sharing needles, and do not share personal care items like razors or toothbrushes.
• With hepatitis C: Avoid sharing needles, direct exposure to blood, shared personal care items, or tattoo/piercing studios that don’t use disposable needles. Condoms should also be used in the unlikely event the virus is passed during sex.

Also, if you have viral hepatitis of any kind, you should take measures to avoid infection with other hepatitis viruses.

Accessing Care

The cost of treatment for all types of hepatitis can run high, especially if you don't have health insurance coverage.

A course of treatment with hepatitis C treatment such as Harvoni (sofosbuvir + ledipasvir) can cost tens of thousands of dollars. Some private insurance companies will only approve these treatments when the liver injury is significant (typically a fibrosis score of 3 to 4). Eligibility requirements for Medicaid and Medicare are less restrictive, but both might deny treatment to those whose liver injury is considered minimal.

This doesn't mean that you should abandon hope of treatment. Most drug manufacturers offer patient assistance programs (PAPs) and co-pay assistance programs (CAPs) which provide low-cost or free hepatitis B and hepatitis C medications to those who qualify.

While the program rules vary, these vital assistance programs can be broadly described as follows:

• PAPs provide treatment to uninsured people who meet eligibility requirements (generally based on your annual income as a multiple of the Federal Poverty Level, or FPL).
• CAPs provide drug co-payment assistance to insured individuals up to a certain annual limit. Annual income eligibility is also based on the FPL.

These programs may not solve all of your problems, especially if you are insured and are denied treatment. CAPs may cover a significant portion of your costs but can still leave you burdened with excessive out-of-pocket expenses.

To learn more about eligibility requirements and which costs are covered, contact the drug manufacturer directly. You can access the free, confidential Partnership for Prescription Assistance program for contract details and program information.