ALT/AST - Ultrasound

[Paula319]

I'm a 55yr female w/rheumatoid arthritis.  

I was a moderate drinker for many years(but have quit since enzymes elevated). For my r/a I was on methotrextae, celebrex, plaquinil, darvocet, etc. and many others during my 18 plus yrs with it. I've stopped drinking altogether in February.

Levels were:
Feb 2004  AST 148  Alt 108  Stopped methotrexate
March 20th  AST 137  ALT 106
March 29th AST 145 ALT 89  Stopped all supplements, vitamins
April 19th AST 130 ALT 91  Stopped darvocet
May 10  AST 99  ALT 68

My new rheumy wants to do a ultrasound.  I had more LFT's done today w/my visit and don't know those results yet.  I'm sched for an ultrasound Tues, also wants to do a liver biopsy. Is the liver bx really necessary? I feel it's invasive and thought an ultrasound was enough.  One dr was okay because the enzymes were decreasing and didn't think a bx was needed.  My new rheumy said that this is probably cirrhosis and that mixed with all the meds I've taken is the results.  I said but they're decreasing since I'm not drinking and he said, u can still have normal enzymes and have cirrhosis/liver disease.  I said what happens if it is liver cirrhosis what can I do.  He said "nothing, if caused by your drinking in the past and meds, it is deadly."  I asked "is there anything that can be done for it?...he said no..it's deadly."  

He's ordered hep tests, ultrasound, liver biopsy, kidney test, etc.  bloodwork.

He has scared me to death. Thought liver bx was warranted if enzym levels were 3x normal.   Can anyone help?

[layla]

Sorry your feeling so tired. I know how sometimes you just need to just lay there for a few days and rest. I hope you feel better soon and we hear form you. Have a nice 4th. I hope you see some god fireworks. LL

[Paula319]

Hi all..Thanks for your insight.  My other lab results look okay.  I have gotten copies of it.  ALB Serum is is 3.0 s/b 3.4.  A little on the low side but they weren't concerned...LDL was a little elevated at 141 s/b 129 or lower.  BUN Creat is 13 s/b 15.  Those are the only results that are not in the normal range...everything else normal.  I guess my doctor scared me with the "deadly" death sentence.  Yikes... I'm not scared of the biopsy as much as finding out damage, etc.  I heard methotrexate was toxic but never knew it was this bad.    I am sched for ultrasound on tuesday.  He is also running tests for hep.-

Thank you all...I will keep you all in my prayers too.

Paula    PS I do have Dr Melissa Palmers book on liver disease..anything else on the internet that is very helpful?

[cindee]

Hey I've read a few posts and I am so fatiqued that I've got to  go lay back down. My whole body is aching and I'm too tired to type. I want to wish everybody the best...and I've read a lot of good news in the posts below. Keep up the good news and let's all hang in there. I'll be back as soon as I am feeling better. I love each and everyone of you and my prayers will continue to be with you all. Cindee PS send some prayers my way! Thanks.

[Petey7]

Doctor wants to schedule me for an ultrasound AND to scope for varices. They say that since my original biopsy showed some bridging fibrosis that they like to treat as if a patient has cirrhosis. I am on week 37 of 48, 1A undetectable at 12 weeks. I am wondering if I should have the scope since I am unaware of any treatment if I do have varices other than watching for further developements. I am leary of any more invasive procedures after I have been "burned" several times now with misinformation or just indifference on the part of medical professionals. So, they simple question is, would you have the scope to see IF you had varices? Thank you for any info and all the info I have received here in the past.

[cheriums]

I agree, you should see a hepatologist.  You didn't say what the rest of your lab work looked like, or what other reasons your M.D. gave for thinking you could have cirrhosis.  Liver enzymes alone don't indicate cirrhosis (or not). If you haven't tested positive for chronic viral hepatitis, you could, nonetheless, have another type of hepatitis -- drug induced, inherited,or autoimmune, for example.  A hepatologist can sort it all out with you.  I would suggest you visit the American Liver Foundation's website, and learn what you can to help you understand your lab results (you're getting and keeping copies?), what can and cannot be seen on an ultrasound (not a lot), and why you might need a biopsy.  A biopsy isn't as scarey as you might imagine. One of my coworkers has had compensated cirrhosis for a decade, caused by an inherited condition, and lives a full life -- working, mothering, vacationing just like the rest of us. But without the biopsy, you won't know for sure what shape your liver is in; or, if there is some damage, what FOR SURE is the cause. Hope this is some help.  cheri

[cindee]

Hi and welcome! I "DITTO", rev________ remarks. You will be in my pryers, Cindee

[cuteus]

My friend also has RA and has been on methotrexate and now planiquil. The PDR reccomends regular biopsies for those on metho. It is a very toxic med.
You can have normal enzymes and still have cirrhosis, ultrasounds are not as accurate in determining the damage stage of your liver.
I would suggest a consult with a hepatologist, if you have cirrhosis, you don't want a rheumy treating this.
we are mostly hep c patients here and there are no MDs answering questions. I did have a biopsy and it was no big deal for me. check the post before yours on that subject.
I hope for the best possible outcome for you.