Red palms: How far gone am I?

[jhwrunner]

I am a 43 yr old women with long history of heavy drinking. It's my only vice, but a doozie, isn't it?  (Really, I eat like a saint, don't smoke, and exercise regularly.) I went to my general practitioner (ended up meeting with a new young inexperienced doctor) about 3 months ago, complaining of gastreo-problems and water retention outside of my normal monthly cycle fluctuations.  Also upper right pain, that was pretty severe at the time.  Told the doctor I drink too much & could be liver.  Xrays revealed gas & constipation, and she prescribed OT stuff to clean-out system.  My sytem still is not normal without taking gas-x regularly and occassional Milk of Magnesia or stool softener.  We changed my blood pressure medicine, after which I immediately (within a few days)dropped 5-6 pounds of water weight, which was about the excess I knew I was carrying around.  We did ultrasound (DR thought pain might be gallstones), which revealed alcoholic fatty liver and "possible early stage cirrhosis".  Blood tests were normal for liver function.  Followed up with CT scan of liver, result was "shows no liver damage".  I have since weaned myself off alcohol, except occassional social drink...which I know I must stop 100%...I really am making great progress. HONEST!  Have lost another 12-or-so pounds beyond the initial water weight loss.  I have never been able to lose weight in my life!  I could add up the calories in the wine I'm not drinking and support the weight loss mathmatically, but I'm not convinced that's really the cause.  I don't feel healthy.  I still have some right upper pain, although less severe.  I have significant fatigue. I have the gastreo-something-aint-right.  And most frighting, I have red palms.  I went back to the DR a few weeks ago, and she thought I was a hypocondriac.  She reran blood tests, which were normal.  She had never heard of liver palms, and thought that might be stress related. She thought my pain was possible fractured rib, and definitely muscular-skelatal, not liver. Xray showed nothing. She thinks my weight loss is due to stress.  She obviously is not experienced in liver decease.  I want to see a specialist, but when I looked one up on the internet, they required a referal.  Everything I've found on red palms suggests that it occurs in cirrhosis or advanced liver desease.  Is it possible to have red palms with alcoholic fatty liver that hasn't progressed to Cirrohsis? Will the red palms disappear after I've been off alcohol for awhile, and the liver starts to heal?  Should I see a specialist, or try to relax?  The DR wanted a followup ultrasound after 6 months.  Also, I'm into fitness, and have been in a marathon running group for several years.  We just started up the training for a 2005 fall marathon.  Is that level of exercise OK if I have liver problems?

[Kevin Pho, MD]

Red palms are indeed a sign of liver cirrhosis, amongst many other symptoms like fluid in the belly, prominent veins, yellowing of the eyes, easy bruising etc.  

I would consider obtaining liver function tests at this time.  The ultrasound is normally better at imaging the liver than a CT scan.  Given the history of drinking, you want to definitively rule out cirrhosis.  This diagnosis can only be suggested by imaging studies - for a more definitive diagnosis, a biopsy may be necessary.

I would consider a referral to a liver specialist or GI physician for further evaluation of the liver.  I would advise abstaining from alcohol.

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.

Kevin, M.D.
Medical Weblog:
kevinmd_b

[lizziecee]

I wouldn't worry too much about "red palms" - I have had them since I was in my teens and didn't drink at all until I was 40ish, and then only wine. However, I do have Crohn's (diagnosed when I was 25 yrs old - now 60) so perhaps that has something to do with it. I have monthly liver tests for toxicity to the chemo methotrexate that I take for Crohn's and my levels are normal. I have also just finished chemo and rads for breast cancer and my palms are still as red as they used to be. Just think it is a quirk of nature. Hope yours is too.

[jhwrunner]

Thanks for your input.  I have received referal to GI physician.  I have stopped drinking all together. I know I'll get all my questions answered once I see the specialist, and hopefully get a biopsy for exact diagnosis.  Not sure "they'll" approve that since my bloodwork is normal.  If anyone sees this who has experienced weight loss from early cirrhosis, can you give me an idea how much I might lose?  I've lost about 20, but the first 5 was excess water retention, so probably 15 of body mass.  I keep dropping a pound or two a week, and I am approaching underweight for my build. I'm trying to eat extra healty (not extra fat) calories. I need to maintain some muscle mass for my running program.  Also, none of my clothes fit, even new ones bought this spring, and I can't afford a whole new wardrobe!  Would appreciate any insight from someone with personal experience.  Thanks!

[boogie9903]

Hi.  You really need to get a referal ASAP!  This is a serious illness you are dealing with.  And, you MUST stop drinking.  You say you have cut back quite a bit and only have an occasional drink here and there.  If this is true, why not go all the way and just stop.  Your liver will only get worse everytime you take a drink.  Liver damage caused from drinking is irreversable.  This is something you don't want to live with,  it will kill you. It can affect your kidneys,(just as bad if not worse), and it can lead to pulmonary hypertension. Your calander will be filled with Dr. appoints one after another, with many different specialist. Not fun.  
I don't want to sound like a nag, but I hate for anyone to have to deal with this.  My mother drank heavily for 13 years.  If she would have listened to her PCP 10 years ago when he told her that her enzyme levels were high and she stopped drinking, she wouldn't be dealing with this terrible thing.  She was in and out of the hospital literaly, every other month over 1 years time, she almost died and would have if hadn't stopped drinking and smoking.  It's been two years she's been clean, but the damage had already been done.  She has cihrrosis of the liver, her kidneys are only functioning at 25%, and she has pulmunary hypertension.  She is not a candidate for transplants of the liver, kidneys or lungs because she has each of these conditions.  She has at LEAST 1 doctors appoint each week, and that's on a good week.  
I hate for anyone to go through this, especially if it is 100% avoidable.  
Please see a specialist and please stop drinking.  It's a matter of life or death.

[georgie430]

Hi jh,

I really want to congradulate you for giving up the drink. And if you have had a slip thats ok too.  I dont want to sound like a matyr, I'am also 43 and have had my share of chemical abuse,
and I know I also have done damage to my body.  I know if I didn't clean up my act I would be gone.  Honestly you have to know that in your heart, were not 25 or 33 or even 38 I know as a woman you are concious of your age and health.
  You have ahead start, cause you do take care of yourself!!  I know many people who have cirrohsis from drinking, they aren't
far gone yet, and actually have their lifes back because they are sober!!  It ain't too late, you cant get back the liver cells that you have killed, but you can still live a damm good life, dont look back 5 years from know, in bed or in the hospital and say I should have quit then!!!

[bbqqubxeen]

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