Alkaline Phosphotase

[Sondra Elmore]

Hello.  I'm 16 weeks postpartum from a pregnancy with mild preeclampsia.  At 2 weeks postpartum all liver and kidney function tests were normal, my alkaline phosphotase was 130 (150 being the cutoff for normal)  In Dec. after a repeat test my Alk. Phos. was up to 161 - doctor wants to repeat the test in 4 weeks.  The test in December was not fasting, but my GP says that's fine.  What could this test indicate?  I have no specific symptoms (some minor dry skin, itching, mild bowel changes since c-section surgery) and all other tests including a cardiac echo were normal. Please let me know what this could be.

[cuteus]

you did not metion what your drs did to help with the weakness, Did they give you Procrit? those falls could have been caused by the dizziness anemia can bring, and they might have contributed to your back problems. Falls, time, and normal changes in our bodies, coupled with the effects of the medications can all be contributors to spinal degenerative changes.
"Low back pain resulting from degenerative disease of the lumbosacral spine is a major cause of morbidity, disability and lost productivity. Up to 90 percent of the U.S. population may have significant low back pain at some point.1 In 1984, it was estimated that over 5 million persons were incapacitated as a result of lower back pain."
The blessed back pain has become part of our lives.  

our immune reaction to hcv,  causes inflammation in the liver and other parts of our bodies, it seems. Plus the inflammatory property of external interferon in some folks, might be too much and it irritates existing conditions and accelerate others. We all are speculating and guessing, as no one really knows what is at work.
I have a friend who developed Carpal syndrome that went away after tx, I had it before, during and after tx, as well as the herniated discs. At least my bone density test was good. I hope you find the proper mix of medications and interventions to alleviate your most troubling symptoms.

[Mister beagle bailey]

The dr. told me to take maalox but not till 2 hours before or 2 hours after riba, he said that's safe.  I should have posted that, but forgot to.  

               BB

[jmjm530]

You can take antacids on treatment, but if you don't want to compromise ribavirin absorption, you have to allow a window (2-3 hours?) between the riba and the antacids -- probably err on adding time if they contain aluminum or magnesium which I believe drugs like Gaviscon might. Similar precautions should also be taken with flax (and possibly similar products like Metamuscil) as they also can interfere with drug absorption.

Depending on your symptons, a better choice than antacids might be prescption PPI's such as Nexium, Priolosec, etc, or a class of drugs called histamine receptor antagonists such as Zantac which can now be found OTC. Both these drug classes can be taken with riba with no problems as they operate on a different principle than antacids.  They are also generally considered more effective for serious reflux or GERD.

-- Jim

[nyhepc]

thanks for all your comments. word is i will get a call on monday and find out what's happening.  i did try to make my point  but she was very firm..i think because the 40000 procrit never worked and the iron was so high. but maybe....she did mention the wbc's.  the neup lasts me 3 days only, was taking it twice a week and was sure to get labs on 6th day. last week, lab was on 7th day.  as a matter of fact, when i switched to this doc, we discussed just that. i agree with you all, my numbers are better than some.  had a pcr in feb..undetectable.
will give them til lunchtime monday, then will start bugging them.
of course the thought is always there to just continue onward, but that's probably not a good idea, lol.  could have PCP intervene, he knows me better. for pete's sake, i've been working!!! how bad can it be?

[NYgirl]

I googled it and it makes sense it DOES affect the ability of the Ribavirin to be absorbed and work apparently. Mr. BBB I think this would also mean Maalox as well - check with the doctor.

Some precipitant drugs bind with object drugs in the stomach or the intestine and inhibit their ability to be absorbed into your bloodstream. For example, if you take the antibiotic ciprofloxacin with most antacids, the combination will dramatically reduce the amount of antibiotic getting into your bloodstream.

If you are taking ribavirin capsules, tell your doctor if you are taking antacids. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.

This includes antacids containing aluminum or magnesium or products that contain simethicone. Patients with hiv infection taking stavudine or zidovudine should talk with their doctor or pharmacist before using ribavirin. The effectiveness of these medicines against hiv may be reduced when given with ribavirin.


Ribavirin + Antacids. The UK makers of ribavirin note that there was a minor 14% decrease in the AUC of ribavirin when it was given with an antacid ...

Antacid. The bioavailability of ribavirin 600 mg was decreased by co-administration with an antacid containing magnesium, aluminium and methicone; ...

That all came from a bunch of different sources and I could probably print up another 100 of them but it's enough to show why we CANT take them.

[friole]

lorrie - not again.  I just don't see that your bloodwork is all that bad.  My WBC stays about 1.5, my ANC about .6. Now my hgb is higher - about 11.5 and so is the hct -- but still, it does seem that you should push to complete the 9 more weeks.  Perhaps the high iron levels are the cause of the stop and I don't know much about hemocromatosis except that it is a iron buildup.  I agree with Goof and Jim to try to get a consult with other doctors as soon as you can.   Good luck   (you had a PCR in December didn't you - what is the vl)    kathy

bob -- on you CBC look for "NE#" - this how absolute neutrophils are stated on my CBC.  "NE%" is the percent that the neutrophils are of the total white blood cells.

[wonderingwhen]

Thanks for the explanation, now I know! I like you love ice cream it has always been part of my daily ritual. I guess I will just have to start eating more. Just started week 25 last night and I fortunately have not lost any weight. Appetite has been good. Again thanks to you and all who make this forum great. I learn so much here.

[NYgirl]

Sorry I didn't get back to you I hadn't been back on line yet.

I don't know exactly WHY we aren't supposed to take the antacids but I know we are not. That is why I became and ice cream addict - it helped since I couldn't take the Tums anymore and I find during treatment my stomach is always feeling real ageda (don't know how to spell that exactly LOL).

I probably should try and look it up and find out but I guess whatever is in them might counteract something in our meds. I never asked the doctor why I just wrote it down on my pads of notes when I started.

I hope you are feeling better. Remember ice cream...in all it's billions of flavors and colors - is a very fun way to replace the antacids hee hee.  Plus...if you are like some of us who have lost too much weight - it helps with that (that's my good excuse)

Of course Rocker doesn't like using so many dairy products and has advised me to use low fat and yogurt...they help too.

[jmjm530]

I don't know about your iron levels, but the rest of those numbers look OK.

If it were me, I'd start calling around Monday for an emergency appointment with another hepatologist at one of the larger teaching hospitals in your area.

Meanwhile, why don't you email your numbers, including your Iron and Ferritin levels , over to Dr. Dieterich at
http://www.thebody.com/Forums/AIDS/Hepatitis/  

Bottom line, the longer you stay off the treatment drugs, the less chance you have at eventual success.

-- Jim

[Mister beagle bailey]

Goof--- Thanks, that's what I thought but wasn't sure.  I see mine are within range.

Wondering---I don't think it would contribute to your sx's. But I think it can interfere with how the riba works.  But check the paper work and I'm sure someone will come on who has the asnwer.  Let me know if you find out.

Bob

[wonderingwhen]

thanks, I will read the paper work and see if I can find it. I see the Dr. next week and will ask. Like I said I have been using it, hope it hasn't contributed to the sides.

[GoofyDad]

In simple terms, ANC is another measurement of White Blood Cells, or WBC. Generally, I think WBC above 1.5 or so is in the comfort zone.

[Mister beagle bailey]

You said you take neupogen for low ANC:  I can't find it on my blood test, What is it and what's considered low?
Thanks,

Bob

[nyhepc]

thanks for your comments...i don't seem to be stressed about this (unusual for me)...it's just 1 more cog in the wheel. hope they don't start talking phelebotmies just yet...with my H_H so low, will have no blood left!!!!!
hope everyone has a good weekend
lorrie

[Mister beagle bailey]

Good morning,

I read the same thing in the paper work that comes with the meds. My doc said I can have maalox,the brain fog sets in and now I can't remember why we can't  have the other antacids.  Guess another riba day is here.

         Beagle

[Mister beagle bailey]

My HGB is at 8.7 and holding.  Tues. I'll find out if it went up any and if they need to increase the procrit again, I hope they don't need to yet as I'm leaving NY where I'm treating to go home to Fl. for 6 days.  Tomorrow is # 10 for me with 14 to go.  How much procrit were you on?  Just wondering why they pulled you off, all they had to do was take a pint of blood from you to prevent iron over load.
I have Thalassemia anemia, it runs in families.  The norm for my HGB is around 11.0 but I can't take iron because it will turn to iron over load yet the procrit is fine to have.
What will the Dr. do now?

            Beagle

[jmjm530]

I'm approaching week 54 of treatment and plan to stop relatively soon. In fact, if my psoriasis and upper respiratory symptons start acting up much more, this could be my last week -- I'm sort of playing it by ear.

I hope things work out for you and that you'll soon be able to retutn to your job. It must be wonderful to have a profession where you are able to impact people's lives on a daily basis.

The only time I've "lived" in Indiana was for 12-hour period in the back seat of a car during the Indy 500 Race when I was a teenager :)

All the best,

-- Jim

[jmjm530]

Last sentence in first paragraph more accurately should have read: "I'm sort of playing it by ear, nose and throat." :)

[GoofyDad]

In answer to Bailey's questions:

I'm a 3a, stage 4. I initially planned to go 48, but when I cleared at week 4 and the shorter tx data was coming out, we revisited that call. We decided that as long as tx wasn't being too hard on me, I should go 6 months. When that time came close, we decided to call 6 mos 26 weeks, rather than 24 for a little more cush.

I'm on procrit for anemia and Neupogen for low ANC. Those drugs allowed my to stay at full dose, where I wouldn't have otherwise.

[GoofyDad]

One more comment, if you're interested. My blookwork looks about like yours, and this is my best month in a while. I continue on full dose tx - actually I did drop one riba pill last week, to 1,000 for 163 lbs. My iron is abot twice normal range and my feritin is so high I don't want to bother looking it up. Based on my experience, I don't see why you can't finish up your 24 weeks if you feel up to it. I'm on wk 24/26 and taking Neupogen and Procrit. Maybe you can push for a consult ASAP so you don't miss many doses.

[Mister beagle bailey]

snook--- Congratulations! on getting the position you wanted. You must feel great and free now that this is behind you and you didn't have to lie. This is a lesson for all of us here on how to apply for a job and how to answer the question if you ever had Hep C.

Great news,

     Bob

[Mister beagle bailey]

This brain fog is getting bad.  You said 24/26 weeks:

Are you treating for 26 weeks because your a 2? And you said you were on both procrit and neupogen, Why both and how did it help you?


       Bob

[Mister beagle bailey]

I live near Orlando and went through 2 Drs. here before getting on a plane and going to NY for treatment.  The Dr. in NY has been my families GI specialist for years and I also knew he was one of the best Hep Drs. in the country.  I'm really glad I made that choice, if I didn't the Drs. down here would have pulled me off the meds by now.  As it stands now after tomorrow I'll have 14 shots to go.  

I hope every thing works out for you, and you'll be able to return to work soon.

                Bob

[GoofyDad]

My iron and feritin are very high - as a result of tx. My docs aren't worried at all - say we'll look again in a few months, after tx. I'm on 60,000 procrit weekly. Your situation may be quite different, but thought this might give perspetive.