A Quick Guide to Hepatitis C

hepatitis c

What is hepatitis and HCV?

Hepatitis is a general term for inflammation of the liver. Any number of conditions can cause hepatitis, but one of the more common causes is a viral infection from the hepatitis virus, of which there are three types: A, B, and C. Type A is a short-term infection often caused by consumption of a contaminated food or water source. Type B is also short-term, though chronic hepatitis can evolve from an HBV infection in some cases. This type is spread by blood, semen, or saliva from an infected organism entering the body of an uninfected one – IV drug use, sexual contact, and animal bites can all lead to an infection of Hepatitis B. Vaccinations for both Type A and Type B hepatitis exist.

Hepatitis C is of particular concern because the virus can remain dormant for decades, often failing to manifest symptoms until an infected person’s immune system is compromised by age or a separate medical condition. Untreated, Hep C can lead to cirrhosis, liver cancer, and death. It’s also a factor in the fastest growing cause of cancer-related deaths in America presently, hepatocellular carcinoma (HCC). In fact, HCV is the leading cause of HCC in the western world. There is no vaccine for Hepatitis C.

How is HCV spread?

Hep C isn’t spread by casual contact with a carrier or through a vector (mosquitoes, animals, or contaminated food products). Needle-sharing is presently the most common cause of an HCV infection. Prior to 1992 HCV was spread through blood transfusions, but rigorous screening of blood products has eliminated that concern. In some cases, sexual contact, sharing of contaminated razors, and contact with unsterilized tattoo needles has led to an HCV infection, though these are much less common causes of the disease. Finally, a baby born to a mother with HCV will also carry the HCV virus.

What are the symptoms of hepatitis?

An acute infection of hepatitis C manifests with fever, fatigue, abdominal pain often accompanied by nausea and vomiting, jaundice (a yellow discoloration of the skin and eyes), joint pain, clay-colored stools, and dark urine. Bear in mind, however, that an acute infection from HCV is less likely than a chronic infection, which typically manifests no symptoms and takes years or even decades to cause damage to the liver (in the form of scarring or cancer). Many carriers of HCV will have no reason to suspect they’re infected (and as carriers they can still infect another person with it).

Who should be screened for Hep B and why?

Anyone who’s ever been an IV drug user or shared needles should strongly consider HCV screening. Currently, there’s also a huge push for baby boomers (anyone born between 1945 – 1965) to receive HCV screening because of the risk from contaminated blood products. Moreover, because of the time required for HCV to cause liver damage, baby boomers entering middle age are now at the greatest risk for complications. In fact, baby boomers are five times more likely to have an HCV infection than the general population and may not even know it. Health care workers who’ve been exposed to HCV by needle-stick injury or handling blood products should be screened. Some experts also suggest that incarcerated individuals living in close contact with others should also be screened.

Getting an HCV screen promptly will help anyone with an HCV infection receive care to prevent the potentially serious side-effects of hepatitis.

What’s the procedure for HCV screening? 

The first step in HCV screening is a routine blood test ordered by your primary care provider (PCP). This test is used to determine the presence or absence of an antibody for HCV. However, a reactive antibody test (meaning the antibody is present) only indicates that the person is a carrier. To determine if an active HCV infection is present, a second test for HCV ribonucleic acid (RNA) is done (See: “Screening and Management of Hepatitis C,” American Nurses Association). Both tests are required for a positive diagnosis of HCV, however, because (for reasons we don’t fully understand), 1 in 4 people eliminate the hepatitis C virus on their own – meaning they will have the HCV antibody, but not the active infection. Baby Boomers take note: Medicare covers the cost of the PCP-ordered blood test for anyone born between 1945-1965. 

How is an HCV infection treated?

HCV used to be treated with interferons with limited success. However, since the introduction of a new class of drugs called direct acting antivirals (DAAs) in 2012, the success rate for eliminating HCV is now an impressive 90-95%.  DAAs are given as an oral medication with very few side-effects. Unfortunately, they’re also very expensive and this is a major barrier to treatment.

Summing Up

Hepatitis C is a viral infection of the liver, sometimes leading to an acute set of symptoms but most often developing over decades with little or no obvious symptoms in the carrier. However, this chronic form of hepatitis can lead to serious outcomes later in life – scarring of the liver (cirrhosis), liver or blood cancers (HCC), and death.

Anyone with a history of needle sharing/IV drugs use, Baby Boomers (individuals born between 1945 – 1965), and anyone who received blood clotting products or an organ transplant prior to 1992 should consider being screening for HCV through a routine blood test ordered by their provider.

Remember, no one can diagnosis or treat an illness except a qualified, licensed medical professional like your primary care provider. If you’re concerned about HCV, contact your doctor or APRN and schedule an appointment to discuss your concerns. 

Legal disclaimer: Advice offered on this website is for educational purposes only. The information herein is not intended for use to diagnose, treat, or manage any health conditions or offered as an intent to treat any individuals. ALWAYS consult your primary care provider with questions regarding your health.  

The Incredible Shrinking Pie (and Free Photo of the Day 9/4/16)

Mansfield Hollow, September 2014. Free to use with attribution to Jace Paul and link to this site. 

Hello friends,

Have you ever noticed that working in America is subject to the law of diminishing returns?

Yes, once upon a time you got a lot more for your, well, time. Forget about pensions, which long went the way of the Dodo. Raises are smaller, benefits leaner. We all know the one percent have been squeezing the lower- and middle-classes for every drop of sweat they can get, and the money flowing to the top means less of the pie for the rest of us.

I listen to the nursing staff at work, and they talk of halcyon days when every employee got a mandatory wage increase every six months. They speak of holiday bonuses that became a holiday turkey, then a holiday gift-card, then nothing at all. They remember when working Christmas meant double pay. These days it’s time and half – if you use your personal time and work the holiday at the same time.

The scarcity should unite us against the oligarchy, but instead it inevitably puts us at odds with each other. Morale has been low at work, and I wondered to the charge nurse why the aides and nurses were practically screaming at each other. “We’re always working short,” she said. “People are working eight, even nine days straight to cover the shifts. Every year we’re asked to do more with less.”

We’re all increasingly desperate. Wages are stagnant while cost of living rises. In Connecticut, taxes are raised repeatedly as services are cut – the local court that handles family and DSS matters is closing, the Department of Motor Vehicles is slicing hours yet again, the DEEP was forced to close three state campgrounds. Our local vocational school may close. The hospital lost 1/4th of its staff, and statewide health services are facing a nearly half-billion dollar budget cut.

All this to say the obvious – the working person’s share of the pie is getting smaller. Even the crumbs are running out.

When will we demand change?

Getting It All By Giving It Away (Free Photo!)

Free photo of day! (Attribution: “Photo by Jace Paul, 2016.”)

Hello friends,

Whenever we lose a patient on my unit, I try to take a second to whisper, “Thank you.” No, not “thank you that it wasn’t me,” but rather for that person’s life, witness, gifts, and all they gave to the ones they loved.

Maybe it was the sun shower that hit just as I left work, maybe it was the date I went on last night with a girl that made my heart sing, but today, as I came to a field bursting with black-eyed-susies on my hike, I decided to shout my gratitude out loud. I spread my hands wide, let the wind and butterflies twist around me, and just let my voice speak for the mass of my soul: “Thank you!”

Working in healthcare, I see death often enough that it’s honed my sense of urgency about the whole “carpe diem” thing. Perhaps it’s a shuffling of priorities. So much of my life has been spent in the pursuit of Truth that I have often forgot that other aims are more important. Life presents opportunities for us to be right and kind – but sometimes it gives us a choice to only one or the other. Insecure, unhappy, and overly-educated, I have all too often chosen to be Right and not kind. I’m glad that, in recent years, I have learned to be kind more often.

At an in-service for work today, we took the new hires on a tour of the building. Our wonderful Infection Control/Safety Compliance Officer, Jane, stopped to talk about responding to a combative patient. The question was when it’s right to argue with an angry patient, and when it’s better to avoid an argument. When safety or health is at risk, she said, it’s important to be right. But if these concerns aren’t present, it’s better to be kind. If a dementia patient thinks it’s 1945, let them think it. What good will come of trying to convince otherwise?

“As often as possible, choose to be kind over right,” Jane said to cap the conversation.

A patient in a wheelchair, on leave from long-term care (the unit for people who won’t, most likely, ever be going home) suddenly spoke up.

“That’s very good advice,” she said. “I’ve seen people who spent their lives trying to be right and not kind, and let me tell you…they don’t get many visitors.”

We touch down on this earth and barely find our feet before the ground disappears below us. The sliver of time we occupy in the greater lifetime of our cosmos is such a small space within which to move, to learn, to create. How do we want to use that time?

It’s a question that is never fully answered; or one that dips below the horizon of our awareness as we become focused on the immediate, the logistical, and the mundane. I try to bring it forward each day and use it to stay focused on the things that really matter – those virtues and choices that will mean more meaning, more love, and – yes – more friends and loved ones at our side when time runs out. 

My friends, don’t listen to the pragmatists or cynics. Give away the “stuff” you think you need and become rich with freedom and peace. Love wildly and impulsively. Believe in gods or good people or fields stuffed with flowers.

Say it with me: “Thank you.” 

Depression: Doing It (Mostly) Right


I felt the darkness trying to swallow me around the third week of August.

We all get stressed and a little melancholy from the ups and downs of life, especially when the downs keep coming and the ups are far behind. But some of us know a certain form of sadness, a very consuming despair, quite well. I’ve survived with clinical depression for twenty-five years now – sometimes handling it well, sometimes…not.

For the last two or three years, however, I’ve handled it well. Depression isn’t something you just “get over,” of course. I didn’t become better at managing it spontaneously or through great luck; no, it took a lot of work. Namely: five years with a great cognitive behavioral therapist, group support, and a lot of personal time re-training my mind to react differently to the circumstances that used to send me into the abyss. I know exactly what to do if I start to feel depression coming on, who to engage for support, what to do to stay healthy, how to quash the distorted thoughts that want to damn with self-condemnation and loathing.

This time the noonday demon arrived suddenly and that made restoring balance a little more difficult.

Here’s what I got right (and wrong):

  1. I drank. So I don’t have a lot of friends who are local – much of my socialization is through social media – and I needed friends to go out and see a movie with, or have a pizza and talk to. Lacking this support, I reached for a bottle and got pretty drunk a few nights early on. Not blackout drunk, not vomiting all night drunk, but pretty crapulous, I must say. Drunk on weeknight, or “pulling a Jace” as my friend Lauren calls it – which I find flattering despite myself.
  2. However, I did reach out to family and let them know I was struggling. I talked to a few friends by e-mail and text. They kept in touch and offered support.
  3. I kept on exercising. Hiking is really the foundation of my physical and mental health, and even without a car I found ways to hike when I could. The increased blood flow, oxygenation, and natural endorphins are probably the best cure for depression. Even if I felt awful, I forced myself to put my feet on the ground and move.
  4. I focused on getting plenty of vitamin D in my diet. I continued to eat a good balance of leafy greens (I strongly recommend an organic spring mix with kale and herbs), tomatoes, avocados, fruits with a low glycemic load (cherries, berries, grapefruit, watermelon), and healthy proteins (Greek yogurt).
  5. I stayed in contact with my therapist. He was on vacation, but made time to check in from time to time.
  6. I focused on rewarding tasks. Thankfully, classes started shortly after the depression started. Spending time with future colleagues and amazing friends was a huge boost to my mood. (Shout out: Haley, Taylor, and Lauren – so much love!). Of course, the classes themselves are also a source of happiness. Learning about the anatomy of the body, blood typing, and doing chemistry experiments (especially successfully mastering the math) helped boost my mood considerably.
  7. Used a trick from dialectical behavioral therapy called “opposite of emotion” activities. So instead of putting on sad music and sad movies that edify depression, I put on my favorite upbeat songs and shows that make me laugh like It’s Always Sunny In Philadelphia and Arrested Development.

Within a week I was back on my feet. I’m proud of myself and the hard work I’ve done to get here. Depression is one of those illnesses that, I’m told, are never “cured.” We keep it in remission and, with diligence, hold it at bay. I feel no shame in being a little immodest about what I’ve accomplished over two decades – anyone who’s fought depression and is still standing has the right to be unreservedly proud.

Another important update – On August 24, I received some great news that I was accepted to the UConn CEIN Nursing program, too! Some of you have been following my progress for over a year now and know how important this goal is to me. So I’m extremely grateful for everyone who has encouraged and supported me along this journey.

I’ll be starting in January if I can come up with the considerable tuition. I still have a GoFundMe account for achieving this dream, and if anyone has enjoyed my posts, the photos, or just believes in dream of becoming a nurse and helping others, I would be so thankful if you made a donation. Above is another FREE photo that you can use for any purpose you’d like – put it on your website, your fliers or church bulletins, in a movie, in a book, CD – whatever! All I ask is you credit me and link to this page.

Stay positive, friends – and feel free to share your depression success stories (or challenges) below!

A Mid-Life Renewal

Hello friends,

I’m well into the year in which I will turn 40 years old. Things didn’t quite kick off as expected on my birthday back in September, to be sure. The planned entry into nursing school vaporized when funds didn’t become available in time, and I must sheepishly admit to spending my birthday party lakeside and brooding into a setting sun. It wasn’t an auspicious way to mark what I have hoped would been a renaissance rather than a time of rueful regret.

There are rumors in the press that mid-life crises for my generation (GenX) have been canceled, and that’s just fine with me. I could spend this year looking back and enumerating the errors I’ve made, but that would be upholding a very unhealthy tradition of obsessing over the past. I’m working with just one central premise as I plan for the second half of my stay in the universe:

I’m tired of being weak and defeated.

Last summer, a friend wrote me a very pointed e-mail in which she said that many of my efforts – in business, in art, in romance – have failed because I don’t “project an attitude of success.” At the time, I was incensed. She’s a very successful one-percenter and I saw her remarks as a gross oversimplification of the laws of the universe (and an insensitive classist remark, to boot). It rankled my progressive ideology and activated a series of rationalizations that I now believe are very unhealthy. You know the type: the system is gamed against us, wealthy people fail to grasp the realities of the lower classes, and the universe doesn’t give a damn about our attitude (more on that later). You could say that the excuses arise from a victim mentality. For most of my life, I’ve seen myself as just a passive, immobile fixture of the world. I’ve typically responded to what Richard Dawkins calls the “pitiless indifference” of the cosmos with resignation and apathy. Without a god or any justice in the universe, it seemed like existence was something to endure.

In the preface to my book Eggshells & Entrophy, I shared my envy of a certain type of fortunate soul who isn’t troubled by the hardship or cruelty of the world. They simply “get on with it.” These folks aren’t poets or painters, I said, but people who get things done. “If you want to know the good life,” I said, “don’t ask a priest – observe a plumber.” I felt like I was cursed to ever hold the opposite mindset, rendered impotent and helpless by too much despair over how things ‘ought to be.’ I spent far too much time producing abstract sadness for myself instead of working on concrete satisfaction. I wonder, now, how much of the depression I’ve experienced in my life stemmed from this wrong-headed way of responding to the world. How much heartbreak would I have been spared had I stopped fretting about the capriciousness of life and just got on with living it?

Now, you may be worried that I’m about to launch into some tenuous proposition about the “real” meaning of life and the grand overarching dynamic that drives creation. Not at all. Nothing in my epistemology has changed, and to be quite frank I don’t really see any good coming from dwelling on the grand questions anymore. So many have dedicated their lives to following the seemingly innate drive to discover something “more,” and without success. For me, at least, the solution is to stop pursuing pipe dreams. I’ve spent the better part of the last twenty years looking for answers, a fruitless endeavor that earned me three worthless graduate degrees and an arrested career. While I idled away my time in philosophy, theology, and psychology courses, my more grounded and sensible peers made lucrative careers in business and science. The search for meaning as a vocation really is an exquisite joke. In both assets and answers, it leaves you bankrupt.

I’m starting to think my friend was right (when someone with a seven-figure annual income gives me advice, maybe we ought to listen). It’s embarrassing that, of all the things I’ve learned in some eleven years of post-high school education, I lost a fairly simple lesson from social psychology: that our behavior will change how people view us, behave toward us, feel toward us. Positive thinking doesn’t change the laws of the universe, but it does affect the people in our lives. Projecting strength and assurance makes people feel more confident in us, and their support can increase the probability of achieving certain goals. It creates respect. I’ve always curried favor through self-deprecation and even self-loathing. I’ve found that it generally earns other people’s pity, their concern and compassion, but…respect? No. Why would they believe in someone who doesn’t believe in himself?

I’m also starting to see the benefit of “radical acceptance,” a term that comes from Marsha Linehan and the method dialectical behavioral therapy she developed. In a nutshell, radical acceptance is the frame of mind that stops fighting reality. It acknowledges that good things will happen and bad things will happen, and most of both will be well beyond our control. Our choice comes in how we respond. But I also feel there’s a crucial next step that comes in asking how we can use the present reality to our advantage. So I’ve been asking myself how I can work within the system to achieve my goals instead of worrying endlessly about how unjust the system is.

My mid-life renewal begins on the premise that I will not enjoy the kind of life I want if I continue to de-value or immiserate myself with pervasive despair over the status quo. It means scrapping those interests and aspects of my personality that won’t move me closer to my goals. Of course, philosophy has a place in human experience and, yes, there’s a modicum of satisfaction in occasionally looking up at the stars and wondering why there’s something rather than nothing at all. For those whose joy is found in the search, and for whom other considerations are less concerning, philosophy and theology are enough. My goals, however, are becoming more concrete. I want to make a respectable income. I want to give my daughter more than a basic childhood. I want more pleasurable experiences and fun.

It’s a mid-life renewal. Of course, the sense of mortality at this age is a little bit more keen that it was at twenty, but that awareness is galvanizing. I feel compelled to make the most of my time, not to squander it with worry about the world’s many problems or the apparent meaninglessness of the cosmos. It’s a wonderful feeling to start believing in who I am. It’s pushing me to create a better me, with a new career (now underway), an improved and healthier body, and a personality that attracts people rather than repels them.

I know some of my readers are also approaching my age, and I welcome your thoughts on starting over at mid-life. Please share them in the comments below.

Free Photo of the Day 6/22/14

Nikon D40; 1/40 sec;   f/10;   ISO 200.
Nikon D40; 1/40 sec; f/10; ISO 200.

Hello friends! It’s a beautiful day here in Eastern Connecticut. I’m off to enjoy a picnic and some swimming at a lovely lake in Eastford, but before I go I’m sending out this free photo of the day.

This is a shot of Mashamoquet Brook on a June afternoon in 2010. The sun was shining brightly in a field beyond the brush and I wanted to capture the view from my side of the water. I hope you enjoy it.

If you do, please consider donating to my nursing school fund! (http://www.gofundme.com/8ws7bs) This week I’m aiming to raise $250, a modest sum that will pay for the required Advanced CPR class and books for my microbiology class. Your help would be greatly appreciated.

Have a wonderful day, and stay positive!

Heroin Town


April, 2004. I was living in Willimantic CT in an apartment in a converted municipal building, I had a job at the downtown grocery store. I was about to start a new career as a minister and due to start classes at Andover-Newton Theological School in the fall. I was dating a young singer/guitarist, a wonderful person who was also an aspiring teacher and passionate Quaker.

May, 2014. I’m moving to Willimantic to be closer to a new assignment for work. I’ve applied for a part-time job at the same downtown grocery store to supplement my insufficient income. I’ve been accepted to a community college and hope to start a new career in nursing in the fall. The woman I was dating, now my ex-wife, lives just outside of town; our daughter splits her time 50/50 between the two of us.

Yeah, it’s definitely funny how so much changes and so much stays the same.

I took River to the public park yesterday as we did business in town. The playground was inexplicably placed next to the sewage treatment plant. The ground was littered with beer cans and broken glass, and a homeless man screamed at no one in particular from the nearby woods.

Willimantic was once a thriving mill town that imported immigrants to work in the textile and dye plants. My grandfather, who worked in the mill at 14 and later became the town’s mayor, spoke of the time with great fondness. But the social divisions of that era are still apparent in the town’s layout: high on the hill on the north side of the town are grand Victorian homes, while close to the valley floor and the filthy Willimantic River public housing complexes abound. When the mills closed, the wealthy departed and the immigrants, with no work to do, sank into bitter poverty. Crime and drug use soared to such an extent that even Connecticut’s largest newspaper, The Hartford Courant, dubbed it “Heroin Town.” The final blow to the town’s once vibrant community came when the big-box stores moved in. Main Street, once dotted with locally-owned shops like Nassiff’s, The Victorian Lady, and The Bench Shop is a long stretch of boarded up storefronts and empty windows. No one can compete with Wal-Mart in a town where 56% of the residents are on SNAP or other government assistance – and I say that without judgment; after all, I shop there to save money, too.

I suppose it would be easy to view my return to Heroin Town as a defeat. Yet there are positives. I’ll be minutes from work, and with gas at $4 per gallon in my area that will save me quite a bit of money. I’ll be closer to River and her mother than I ever have been. And best of all, I will be poised to begin this new and exciting chapter of my life. Naturally, I wish I’d known in 2004 that ministry would not be a good fit for me or a sensible career for someone who likes, you know, food, shelter, and the ability to provide basic necessities for his child.

But it’s never too late to begin again. Stay positive, friends.