GIPA Question ALT/AST and other posts

[meandhepc]

I received my AST and ALT counts and they are:

AST   75
ALT  123

they usually are in normal range. A ct scan last week showed I have 3 small benign tumors in my liver and I have relapsed after 13 months of Pegasys and Riba 2 months ago (VL is in low range 400,000),   my question is:  what does the increase in my ast/alt mean? and what's your opinion on my retreating with Pegasys and Riba at this time?

Anyone here that has any advise, please do so.....

Thank You ever SO much

[justhinkn]

Ringading, you just crack me up every time I read your posts!  One thing that's not numb is your sense of humor.  

All I can suggest is that you teach your dogs to dial the nurse's number for help before they come to the point to gnawing your bones for food.  Who knows, you may need them if you can't dial with your numb fingers, toes or other body parts--put them to work!  I don't blame you for not wanting to go into that hospital--you'd probably go in there for numbness and come out (in one way or the other) with the flu or a staph infection and they'd charge you for giving it to you!  Worse yet, you might come out of there with a numb head and a boring sexual encounter (sorry GwithHepC, couldn't resist).

[justhinkn]

I'm not sure how well you get along with your boss or how open-minded he/she is, but you may want to approach your human resource department first and discuss that you're going to be receiving treatment.  They are required by law (I'm assuming you're in the US) to keep this confidential.  Check out what your options are as far as sick time, benefits and your employment rights.  To be protected legally, and not be fired for having to take medical time off, you must report this to them.  As I said before, they must keep it confidential from everyone--your supervisior, the company president, etc.  It's great if you can assure that you'll have decent rapport with your supervisor at treatment time and you two can work something out...but sometimes that's not the case.

I wish I had the list of url's that's posted here often.  "Indiana" and "MajNeni" (I believe) post these for people quite often and will give you a good range of websites for the information you need.  Treatment for HCV differs greatly with the individual so one person's experience with it may not be what you'll experience.  

Just a hint, you may want to try posting your questions again so it'll be closer to the top--you'll probably have to piggyback on another new post unless you're a lucky one that gets first dibs on a new one--the few we have a day are hard to get.  You're in a posting that already has a few questions it in and it's starting to sink to the bottom and may not be seen.  In your new post, you might also want to ask for "Indiana's list of url's" from someone--I think someone will know what I'm talking about.  Good luck!

[GI.PA]

If you are "stage 3" this usually the "fibrosis" (or scarring stages).  This is on the more moderate damage side of things.  The enlarged spleen may just be your anatomy or may represent and elargement that can be associated with early cirrhosis (advanced scarring).  This suggests a damaged liver and treatment to get rid of the Hep C, or improve the liver fibrosis should be considered.

GI.PA

[rsterling]

Sorry to butt in, but :), I'm going to be approaching my boss with my illness and wanting to start treatment after the first of the year.  What I would like to show him is a response containing information on the different side effects of a Pegintron & Riba combo treatment.  I would also like him to be able to read info from those who say the sides were or are few.  I feel that this would be the easiest way to explain as we try to decide the best course in my employment regarding treatment, and to let him read from the experienced what we might expect.

Thank You,  Robin

[willing]

I'm sorry to hear about your relapse. It's a harsh setback and it's bound to  take a while to adjust. Please remember you have lots of company. The most important factor in  planning what to do next is knowing the state of your liver. I'd strongly suggest talking to your Dr. about a biopsy. Ultrasounds/CT scans simply do not have enough resolution to assess cell-level scarring in the liver: several people on this board have reported that their ultrasounds or CTs showed no problems and a later biopsy showed significany fibrosis(scarring). Once you know your bx "stage" you'll be in a better position to decide how important it is to act soon. If it's 3 or 4 you might want to talk to your Dr. about maintenace IFN or antioxidants, otherwise you're probably OK waiting and watching. There isn't much data yet on treatment of combo-tx relapsers : keep an eye on the <a href="http://www.hivandhepatitis.com/hep_c/news/070703a.html">REPEAT</a> trial over the next two years. Your AST/ALT levels are nothing to worry about - they're not that high and remember most people with chronic infection have out-of-range levels. Also, tx could very well have changed the dominant strain with which you're infected, so you should be prepared for changes  (eg different enzyme and VL values, maybe different symptoms). All the best.

[layla]

I had a terrible problem in my neck and arms. A new type of keyboard worked. I also readjusted my work chair a bit higher and now I'm ok. Have a good day.

I'm off to get a a new fax machine. My office manager has been compalining about ours but I didn't realize what a problem it is until I had to get a fax out of the dam thing last night. I wanted to throw it up against the wall but knew then I would never get that fax out. So I resorted to shaking the hell out of the thing and swearing a lot. I think the swearing finally worked. She doesn't swear so I guess I couldnt tell how bad it is. lol LL

[ringading]

good morning all and thank you SO MUCH i was pretty scared for a tough ol gal last night, but don't tell anyone, wouldn'y wanta ruin my reputaion!!!!.numbness is not present when i woke up...10 min. ago....well there is no pain associated with the numbness for me...but that would be something for me to hopefully remember, should it begin....also...interesting about.."carpol tunel"..spelling???/i'm on my 1st latte....yes i have been typing tons lately and my fore arms and hands are elevated some also...i wonder.....i just kept trying to shake them out hoping the feeling would return, it was a tiny bit better by the time i went to bed about 10pm...but still 10 hours of progressive numbness is very strange.....i will mention all this info you've all given me to my wonderful nurse today when she calls....ISN'T THAT AMAZING that she would give out her private number in case of emergency....i just am sure that is above and beyond the call of duty for her. i never wanted to feel the need to take advantage of that number, but glad i had it also VERY GLAD i have all of you...DON'T KNOW WHAT I WOULD HAVE DONE, i imagine if it wasn't for you guys, i could have spent endless hours waiting in docs offices for answers.....SO THANK YOU THANK YOU THANK YOU...WHAT A LIFE SAVING SITE THIS IS.......kimberley

[yuneedtono]

I am a 1A Stage/Grade 3. Now they tell me I have a fatty liver and an enlarged spleen. How serious is an enlarged spleen

[meandhepc]

Hey There,
In answer to your questions:  I am 1B, was undetected at 24 weeks into tx and relapsed 6 weeks after tx. Haven't had a bx, but ultrasound showed smooth liver.... Thanks

[GI.PA]

If you ALT/AST were normal pretreatment, normal during treatment but are abnormal now, this is most likely just the virus in the relapse stage.  Some patients actually have transient elevations from baseline when then relapse.  Your ALT/AST are not suprising, they are consistant with someone with Hep C, relapse or not.

If your ALT/AST were elevated pretreatment, normal during treatment and and elevated now (along with your relapser status) would again be explained by the return of the virus.  It makes no difference relapser or initial infection, the virus inflames the liver and therefore the ALT/AST go up.

Unless there was some reason you recieved sub-optimal dosing during Peg/Rib or Pegasys/Rib treatment for the 13 months (for example you were only on 1/2 dose Peg because of low neutrophils for the most of treatment OR you were only on 400 mg of Rib because of low hemoglobin), I know of absolutely no data to show that retreatment with either Peg brand would result in a sustained viral response.  You will be better served by a Peg-alone maintence regimen (if you have significant fibrosis or cirrhosis) OR waiting for a better/different program to come around (if you have less severe disease).

Hope this helps.

GI.PA

[GwithHepC]

Tallblonde/Ringading:

Now I might not be the brightest person, but about 4/5 times in my life I had my head fall to sleep!  (I've had hep c my whole life.)  It was the strangest feeling.  It felt numb just like when your foot falls to sleep.  In each case I was laying down (and no it wasn't due to a boring sexual encounter.)  I actually got the same tingling/shooting pins and needles sensation you get when the blood starts to circulate again.  I have mentioned this to a doctor who just looked at me funny and said he never heard of it before.  I'm really happy it doesn't happen often because it is truly an unsettling sensation.

Ringading: Have you been typing more than usual?  Perhaps in an an unusual position?  Reason I ask is it sounds sort of like carpal tunnel syndrome.

[ringading]

wow, bizarre is right....and creepy.....i have had this often times at night or as i wake in the morning now that i think about it....where a whole arm is numb..or while watching tv i'll notice one arm tingly and numb but just have always thought it was due to how i was leaning on it or something....but today was the first time it happened in the day this bad....it has now lasted for 8 1/2 hours.....SO CREEPY....well i am somewhat greatly relieve to hear from you that this is not the first time you have heard of this happening....so guess i don't need to worry about droppin dead tonight and my dogs knawing on my remains till they are found eh....sigh of relief girl.....thanks for taking the time to answer this as it WAS scary and weird

[Tallblonde]

According to both GI's I've seen, numbness and tingling is simply one of the symptoms of HCV for some people.  I'm not even on treatment, so it's not related to side effects.  I know that others on this board have talked about having this symptom, so we're definitely not the only two.  Personally, I find it to be really, really creepy.  It happens a lot at night; both my hands will be completely numb at the same time, so it's not a matter of the circulation being cut off or anything.  I just keep reminding myself that it's a minor nuisance and certainly nothing that interfers significantly with my daily activities.  I feel blessed to have such a mild case of HCV, at this point, at least.

Susan

[ringading]

DUH!!!!! just re-read yours and you already answered my question.......peripheral neuropathy......hummmm what IS THAT anyway and is it dangerous or how is it brought on.....

[ringading]

holy **** are you kidding me????OPPS...SORRY have you told your doc or anyone ....what was their reply or explanation for this susan???wow.....just used up one of my..CALL HEP NURSE ANYTIME DAY OR NIGHT CARDS!!!!.and she said as far as she knows it isn't a side, but did say that my hemeglobin had dropped dramatically and with me STILL frikken bleeding 8 days straight like a stuffed .....you know.....could be that...or a small tia...tip....something to do with heart, but asked if i had hyper ventilated or anxiety attack etc...i said no...so she's stumped...ha ha , but you'll like this she did ask if i was feeling afraid being way out here alone...and i said NO WAY....if anything happens someone will surely find my skeletal remains by the spring thaw...said she call and check on me tommorrow, but of course if really scared go to hospital....yah like thats gonna happen, try and explain all this in a second language, my spoken french is great, but i've never had to use any medical terms...hummmm.....guess i could write the words oxogen and nepogeon....whatever that stuuff is on a paper...anyway, thanks for that susan.....i remain....tingly yours...sincerly kimberley

[Tallblonde]

If it's bad....you're not alone.  I've had almost daily episodes of numbness and tingling in my hands and feet for several years now.  Yet I have only a "histologically mild" case of HCV. According to my GI, peripheral neuropathy, as it's called, isn't uncommon.  I don't think you have to worry.

Susan

[Revenire]

I am sorry to hear you relapsed. How long after you stopped tx did you relapse?

You did 13 months of tx? 52 weeks? That IS an achievement!

Let me ask you: Was this your first attempt at tx? Did you have an EVR? What did your biopsy show? Are you a genotype 1? I assume so.

I believe many go on maintenance therapy (a half dose of peginterferon) to ward off any further progression of fibrosis; others retreat. I know of people that treated several times before they adchieved a SVR.

I am not in a position to answer the ALT/AST question other than it shows that you've relapsed.

[ringading]

hi sorry to butt in, i don't have any answer for you....
but....around noon my finger tips became numb on both hands....now it has moved in the last 3 hours to entire hands and now part way up to my elbows....?????//  ISN'T THIS A BAD THING?????...........don't want to go to the dinky country hospital.....anyone know what this might be and if it could be serious....