Decreasing ALT, increasing AST-rejected for insurance

[JimandTerri]

i am a 51 year old self-employed male just rejected for an individual health insurance policy because of results on a lab panel including liver enzymes. However, my personal physician is not concerned about the numbers nor is there any formal diagnosis of anything or any treatment plan. I am researching to see if I need a second opinion and/or a plan to address this.

My ALT in Jan. 04 was 55, AST was 70. 7 months ago in June 03 at my annual physical, ALT was 104, AST 50, biliburin 1.2. AP and other indicators within range. So my ALT has decreased significantly, and may be within some labs normal ranges; But my AST has increased in the same time period. Any thoughts?  

I am 6 ft. 4 inches tall and currently weigh 225 lbs. I have lost 30 lbs over the past 6 months; ny B/P has gone from 148/80 to 122/80; I still have borderline high cholesterol inherited from a parent. (214). I do drink daily, mostly wine and on occasion, a vodka.  

I began taking n-acetyl-L-Cysteine and L-Glutamine this summer after the June test results, although I do not take as much as the recommended dosage. I take about 600 mg n-a-l-c, and 1000 mg L-Glut.

I dug around in old test results: it looks like the first time my AST was out of range was in 2002 at 51. AST was 39 in 1989; 35 in 1994. ALT has been a bit high all along: 51 in 1989, 102 in 2002, 104 in June 2003 and 55 in Jan. 2004. Biliburin was within range until 2002 when it was 1.1. No biliburin in urine. Alk P, Albumin and total protein all within ranges all these years. I do have chronically low, though steady, platelets, around 114.  

I abstained from alcohol 3 days before the labs in January 04. I know understand that I may have needed to abstain longer for any impact on test results.

My 84 year old father has had some heart trouble, and I know that elevated AST can be an indicator of heart issues as well as liver. Do you have any thoughts on what my next steps should be in terms of determining whether there is a problem and figuring out what the problem is? My internist's nurse told me that the dr. didn't get very concerned unless levels were 2-3 times the upper end of the range. I have been in that category for the ALT, and appear to be moving that way in the AST.        

Thank you for your assistance.

[Kevin Pho, MD]

There are many people with benign causes of mildly elevated liver enzymes.  Your doctor is correct in saying that most liver diseases present when the liver enzymes are 2-3 times the upper end of normal.  

As you have mentioned, chronic alcohol use as well as many medications can elevated the liver enzymes.  Other causes that should be evaluated for include hepatitis and anatomical disorders of the liver - like fatty liver.  

I would recommend abstaining from alcohol for several weeks before the repeat liver function tests to ensure it isn't alcohol related.  Other reasonable screening tests would be a hepatitis panel - looking for hepatitis A, B, and C, as well as an abdominal ultrasound looking for any anatomical liver disease.  

If these tests are normal, then serial monitoring of the liver function is recommended.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[Caroline5]

While elevated AST can be from alcohol and abstaining for 3 days is not nearly long enough, it worries me that you have chronically low platelets along with this. This could certainly mean you have cirrhosis. You should have a hepatitis panel done and possibly a liver biopsy as this is an ongoing problem.

[tessa0825]

I just wanted to ask you something about this insurance denial problem...Myself and many others at our place of employment have been going through the same thing...I was wondering if you were recently in a group policy for health ins.?...We were given 5 days notice (Jan. 26th.) that our group health ins. through our employer was being cancelled effective Jan 31st..DUring the next week we met with many ins. representatives trying to obtain affordable private policies...Some of us fell into a gray zone...I was denied coverage through every company imaginable..I have barretts esophagus, hypertension, arthritis,and a systemic collegen vascular disorder....My medication alone is thousands of dollars each month because of weekly injections I take for the sclerosis....Finally, there is a plan called "hippa" that has to offer health insurance to people who are otherwise uninsurable...The problem with the policies is mine was totally non-affordable...The only one I could obtain came with a premium of 996.00 monthly with a 2,500.00 maximun per calendar year for prescription drugs, and such a high deductable it was almost funny.....Mine had a happy ending as I had gotten remarried this last July and with my certificate of coverage stating my plan was cancelled by our employer I was able to go right on my husbands ins. with no lapse of time for pre-existing conditions....Many of my co-workers were not that lucky.....Besides myself, there were also 7 people in my work place diagnosed with cancer in the last year so our insurance company took a big hit and raised our bosses premium to something he couldn't afford....Does make me wonder what might be going on at work that so many of us have gotten so sick in the last couple years but I guess thats beside the point....Anyway, if all else fails, check in to this "hippa" plan....Some people were quoted much lower premiums that what I was quoted.....Also, don't stop at just talking to only one company and one representative....Talk to many of them....Best of luck....Tessa

[yoshi]

insurance companies are getting very cautious in taking on new applicants,they sent you to see doc and you have to show photo id and whatever you said at the doc office is noted and later questioned by the underwriter.
some are known to send inspectors to your family doctor and ask to see your medical file.
if you are healthy?? and do not foresee major illness in the coming years,it may be worthwhile to look into a healthplan with high deductible.
pay for the office visits and medication yourself,just insure for the big one.
of course we dont have the crystal ball.

[tessa0825]

Your right about the high deductable....It is much better to take a policy with a high deductable if your healthy...If your healthy and have no pre-existing conditions you can get policies very reasonable with a higher deductable even if you opt for a plan with a copay and prescription card....The flip side is the people who fall into the gray zone, It's very sad that good people willing to continue working will be sent into disability or to the welfare system just to be able to get medical care.....There should be an alternative other than that or being told to move to Canada!..Tessa