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Seven Days

Wednesday, Dec. 27
Electric companies dependent on TVA power say they're worried by the agency's decision not to pay down its debt as quickly as planned. TVA officials promise they'll still be providing power "at or below market price" by 2007. And what is "market price" for the biggest utility company in the Southeast? Uh, whatever it says it is.

Thursday, Dec. 28
Census figures show Tennessee grew by 16.7 percent in the past decade. So, is that actual people, or just waistlines?
Gov. Don Sundquist says he might recommend increased auto taxes, sin taxes, or a state property tax to help make up next year's expected budget deficit. Other options: If you drive a car, he'll tax the street. If you try to walk, he'll tax your feet. If you try to sit, he'll tax your seat.

Friday, Dec. 29
Now That's What We Call Vision!: Knoxville officials back off plans to condemn the Holiday Inn on Henley Street as part of downtown redevelopment projects. Despite ramming the condemnation down City Council's throats last summer and arbitrarily earmarking $13 million in the convention center budget, Mayor Victor Ashe says he can't estimate how much it would cost after all.

Sunday, Dec. 31
Auld acquaintances are forgot.

Monday, Jan. 1
Nit-pickers the world over struggle to find a new purpose in life now that they can no longer commandeer conversations by explaining why it really isn't the 21st century yet.
The Vols lose to Kansas State. Just wait 'til next year! Oh, wait, it is next year...

Knoxville Found

(Click photo for larger image)

What is this? Every week in "Knoxville Found," we'll print the photo of a local curiosity. If you're the first person to correctly identify this oddity, you'll win a special prize plucked from the desk of the editor (keep in mind that the editor hasn't cleaned his desk in five years). E-mail your guesses, or send 'em to "Knoxville Found" c/o Metro Pulse, 505 Market St., Suite 300, Knoxville, TN 37902.

Last Week's Photo:
Why do adults persist in thinking children are amused and comforted by clowns? They're scary! You'd think all those horror movies would have taught us that by now. Anyway, this particular scary clown head adorns the top of a swing set in the Fourth and Gill neighborhood park on Eleanor Street. Thanks to all who sent in correct answers. Due to technological glitches too embarrassing to go into right now, we won't be able to declare a winner until next week. So just sit tight and enjoy the final weeks of a Bush-free America.

Meet Your City
A calendar of upcoming public meetings you should attend

KNOX COUNTY COMMISSION
THURSDAY, JAN. 4
10 A.M.
CITY COUNTY BUILDING
400 MAIN STREET
Commission is expected to vote on the urban growth compromise plan—already approved by City Council—at a called meeting on Thursday morning.

KNOXVILLE CITY COUNCIL
TUESDAY, JAN. 9
7 P.M.
CITY COUNTY BUILDING
400 MAIN STREET
As usual, Council's agenda wasn't available at press time. Check the city's website on Friday afternoons before scheduled meetings for the latest agenda.

METROPOLITAN PLANNING COMMISSION
THURSDAY, JAN. 11
1:30 P.M.
CITY COUNTY BUILDING
400 MAIN STREET
Same as City Council: no info available. Check MPC's website before the meeting.

A New Epidemic?

Hepatitis C can strike decades after exposure, and it can be deadly.

Though the spread of HIV is still perceived as America's number one viral threat, hepatitis C is actually the most common blood-borne infection. The sheer number of hepatitis C (hep-C) patients in the United States has necessitated an all-out effort to combat the disease and find new treatments. Though it's hard to pinpoint the exact number of cases, physicians and health care officials in Knoxville say the disease is prevalent locally.

With approximately 3.9 million Americans carrying the virus, fighting hep-C has become a top priority for health agencies. The most insidious thing about the virus is that it can go undetected for long periods of time—as much as 20 years. Patients diagnosed with it usually fall between the ages of 30 and 50, and the infection is often a result of risky behaviors that have long since ceased.

The hepatitis C virus is transferred similarly to HIV. Hep-C is usually spread through sharing dirty needles (60 percent of hep-C sufferers have used I.V. drugs), sexual contact, blood transfusions and surgery. There is little risk of hep-C infections from blood transfusions today because all donated blood is screened. But doctors say anyone who received a transfusion before 1992 should be tested.

As with many hep-C patients, "Richard" (a pseudonym) went through a wild era earlier in life. His litany of risky behaviors included unprotected sex with multiple partners, numerous tattoos and a morphine habit that lasted for a couple of years

"You know, it's a possibility I got it through using I.V. drugs," he says. "In the past, tattoo parlors weren't regulated, and I could have gotten it that way. There's a lot of ways you can get it, and the jury's still out on how I got mine.

"I'm also on lithium, and they have to do blood work for that. The hepatitis popped up when they did a lithium level test. I hadn't shot dope or nothin' in like years—and I'd had lots of these tests, like all the time. That's why I don't think I got it bangin' dope."

Those infected with hep-C can carry the virus without any ill effect for decades. And the latency period makes the disease difficult to track. Once diagnosed, it's also hard to decide whether to classify the disease as acute or chronic.

"Acute means you're sick with it now, while chronic means you got it a long time ago and you've kept it," says Jan Fowler, public relations representative for the Knox County Health Department. "People still don't know—when they report it—if it's acute or chronic."

Making a distinction between acute and chronic cases may be a moot point for those who must track the virus. And Tennessee's rigid guidelines for reporting the disease are often confusing.

"We don't really report the total number of people who are infected," says Frank Bristo, epidemiologist for the East Tennessee Regional Health Department. "We only report on acute hepatitis. And a lot of times it's very difficult to determine the difference between chronic and acute. A lot of folks have no idea when they contracted it—they could have been asymptomatic for quite a long time. We don't know if they've had it for three months or three years. So you can take the data with a grain of salt.

"To me, the most important number is the number of people who are actually infected as opposed to the supposedly 'new' patients," Bristo says. "There probably aren't near as many new cases now as there are people who were infected a long time back. I mean, there are people who got blood transfusions before 1992 who are at risk. So there's a big push to get all those folks tested."

Available statistics on the spread of hep-C are sometimes contradictory. While the Tennessee State Health Department reports a total of 918 actual reported cases from 1996 to 1999 (with only 49 in Knox County), the Centers For Disease Control national estimate of a 1.8 percent infection rate suggests that more than 36,000 people may be infected in East Tennessee. Clearly, there is a spate of undiagnosed infections yet to be revealed.

As the virus runs rampant in certain populations, some are calling it an epidemic. State epidemiologist Dr. William Moore says that's a matter of semantics. "The term epidemic, very liberally applied, can mean more cases than you might expect in a given period of time," he says. "And I don't know that we're actually having more cases in Tennessee at this time."

While the CDC is only accepting figures on cases deemed acute, Moore is trying a different tack in tracking the disease. "I'm accepting all the cases that are not clearly within the CDC case definition of acute cases as prevalence cases," says Moore. "In an effort to try to determine the number of cases in Tennessee, we have done some spot checks."

Mary Little, program director for DRD (Drug Research & Development) in Knoxville is no stranger to the devastating effects of the virus. DRD operates a methadone clinic for drug addicts (usually addicted to opiate derivatives such as heroin, morphine and dilaudid) in the area. And hep-C is a growing concern for both current and former addicts.

"I know the problem is worse than what people think and much worse than we would like to see," says Little. "A lot of I.V. drug users—they don't get tested until we force them to. I'd say probably 30 percent of our population is hep-C positive.

"Right now we're doing in-house testing for hep-C," Little continues. "It's not mandatory, and it's not part of our rules and regulations. But most of the patients do want to be tested and we have labs come in and do that on-site, just like we do with HIV testing."

"Drug use has been a major factor since we've been screening the blood banks in 1992," agrees epidemiologist Moore. "The majority of cases that we're seeing today are almost all related to I.V. drug use."

Hep-C seems custom designed for spreading among addicts. "People who use intravenous drugs are going to shooting galleries, they're using unsterilized drug paraphernalia and are exposed repeatedly to a population that has a high [hep-C] prevalence," says Moore.

Moore says that though health care workers, policemen and fire fighters are supposedly at higher risk, studies done on those groups have revealed no higher infection rates than in the general population. There are no proven cases of transmission from tattooing either.

Hep-C usually manifests itself through liver damage, abdominal pain, loss of appetite and jaundice. Again, the addict population is at increased risk because extended drug and alcohol toxicity punishes the liver. Addicts can often piggyback several viruses onto their weary bodies, including HIV, hep-C and hep-B. When the liver becomes so damaged that it is at 10 to 20 percent of its power, hep-C symptoms become apparent. By then, the disease has already wreaked its havoc.

Treatment for those infected with the disease is a long, hard road. Patients often must receive chemotherapy treatment with interferon, a radioactive isotope, for six months to a year. And like cancer patients, hep-C sufferers can have high remission rates, even after the battery of interferon and drug therapy. If the disease has proceeded to a point where the liver is severely damaged, healing of the liver tissue is not possible.

"You have to keep in mind that even with combined drug therapy, the remission rate is about 70 percent," says Moore. "So long-term success in treatment probably occurs in only 40 to 50 percent of those who complete a course of treatment.

"And treatment with that combination of drugs is an absolute nightmare. A whole lot of patients will never even finish a course of treatment. For example, there was a patient who was infected with both hep-C and HIV in a prison system. He consulted with his doctor, found out what the side effects were and said, 'You know, I'm gonna die of AIDS a hell of a lot sooner than I'll die of hepatitis-C. And I'm not gonna put up with that crap.'"

Physical side effects aren't the only hurdles for those going through the treatment gauntlet. The medication oftentimes brings on depression. So keeping patients motivated is a goal for health care providers.

"We refer the patients to counseling and to support groups," says Gary Shell, a nurse practitioner employed by Knoxville-based gastroenterologist Dr. Jeffrey Crist. "Sometimes you can accomplish a lot with a five-minute pep talk in the office. I think that just projecting a little bit of genuine care will accomplish a lot."

Shell says hep-C patients can have relatively normal lives while in treatment. "I encourage people to work," he says. "I discourage going on disability. It seems to me that the people who do not have the victim mentality end up doing better."

Richard assaults his disease with combination therapy: chemotherapy through interferon injections, a drug called rebetol taken orally, celexa for the accompanying depression, and homeopathic treatments (echinacea for the immune system and thyllicin for the liver). The interferon injections are especially tough.

"Once you've taken the interferon shot, it feels kind of like there's lava going through your arms and legs," Richard says. "You get a real bad headache and it makes you nauseous.

"The side effects vary, 'cause I know other people who have different things. You may notice that my speech is—it's kind of hard for me to complete sentences some times. The doctors call it mental confusion but I just call it all kinds of drugs in your system."

The treatment is very taxing physically, and that's not all. Richard reports a monthly expense of around $2,000 to combat the disease, and his health insurance won't cover the cost.

"When you're on interferon, you don't get to feeling normal until your treatment's through," says Richard. "You do your shots like right when you're going to bed 'cause you don't want to feel it. But it lingers anyway. I feel weird even when I have a break from it. It's like having the flu 24-7.

"But people who come off it say you feel great when it's over," Richard continues. "I know people who have gone through this and gotten off of the treatment, and they say it's like all of a sudden, hey, I'm a person again."

—John Sewell