Lab report

[John Duncan]

Male, age 42 Ht. 5'11" - Wt. 175 Professional occupation, Rx-Flonase 50mcg x 1 daily. No history of cardiac, HBP or cancer in family.  Insurance EXAM lab chemistry showed 235 cholesterol (85 HDL-136 LDL)LDL/HDL ratio 1.6.  The AST (SGOT) = 140 & ALT (SGPT)= 49 concerned the underwriter in combination with cholesterol readings. Applicant states muscle build up, etc. while in serious training for marathon run is cause of irregular liver functions.  Could this be the cause and should training be discontinued? Is hepatitis a possibility due to training?  Or, is there a possible secret of alcohol and/or drugs or harmone use?

[mremeet]

I'm not a doctor, but a doctor was recently here that was commenting on this topic. Apparently extreme exercise can cause liver enzyme elevations for two possible reasons. One is because muscle tissue is torn down during rigorous exercise which in turn releases enzymes from the muscle tissue which mimics liver enzymes (making it falsely appear that liver enzymes are higher than they actually are). Another is a rarer case where a form of temporary hepatitis of the liver can occur by the extreme exertion, although I don't remember exactly why that is. I think high protein diet in conjunction with rigorous exercise was also cited a possible reason for elevated enzymes. Otherwise drugs and alcohol can cause elevations, especially if you combine alcohol with something like Tylenol.

Overall I wouldn't stop exercising, but I would get a hep A, B, C panel and have your doctor look into why they're high (maybe check your protein too). Good luck.

[jmjm530]

ANYTHING is a possiblity including all what you listed. Have "applicant" see a hepatologist (liver specialist) for a workup and further testing if necessary. As Mre said, there are no doctors here. Regarding "muscle buildup", I'm assuming no steroids or other perfomance enhancing substances are being used which could also be yet another cause.

All the best,

-- Jim

[Kalio1]

There are no doctors here, this is a patient to patient forum.

It is true that intensive exercise can cause your ALT to be raised. I would think further investigation is warranted. If the person with these readings is training for a marathon this could be one reason for the elevations. Obviously a doctor would have to look into it further to determine that definitively. Possibly he could be rechecked after his intense training is over?


The enzymes you give are not indicative of alcohol use from what I understand, if heavy alcohol use was the cause the AST would be higher than the ALT from what I have read. Here is a quote from an explaination about understanding ALT/AST:

  "The ratio of the ALT and AST may also provide useful information regarding the extent and cause of liver disease.  Most liver diseases  are characterized by greater ALT elevations than AST elevations.  Two exceptions to this rule exist.  Both cirrhosis and/or alcohol abuse are associated with higher AST levels  than ALT levels, often in a ratio of approximately 2:1."

[mremeet]

Why does everyone say "there are no doctors here", when once in a while there *is* a doctor here?

[Kalio1]

LOL mremeet, looks like we all gave the saame caution. You are right, sometimes there are doctors here.

I think it is just a way to warn people ahead of time so they don't think by mistake they are getting an answer from a doctor.
To do that they have to go to the patient/doctor section Gastroentrology and pay a fee.
hope you aren't feeling too terrible and I hope you and ours have a nice holiday season

[mremeet]

hehe - I was just wonderin' that's all! And I'm doing ok lately, I lowered my riba, currently at 1000mg. I was at 600 and then 800 which gave me a break I needed. My skin still resembles sandpaper with ants incessantly crawling all over it, but otherwise it's nowhere near like it was. Hopefully my skin is slowly, ever so slowly desensitizing from the VX rash.

Anyway thanks for asking, hope you're doing well too.

[jmjm530]

Mre: Why does everyone say "there are no doctors here"
--------------
Haven't you learned by now you can't trust everything you read on the internet :)

[jmjm530]

That may have come off wrong, I wasn't referring to HR but my post :)

[APKhaos]

Great to hear that you are recovering from the rash. Guess you noticed that the highest cause of drop from the trial was rash, at 9%. No question that you were right about that, although there were fewer sufferers than we might have thought. Must be a terrific relief to see that rash finally departing [slowly].

Hope the VL results are good for you too. When do you unblind?
I can't remember if you kept going at reduced dosage or stopped dosing altogether, so maybe the unblinding question is bogus.

[susan400]

85% of the time my AST is higher than my ALT, but both have consistently remained elevated.  My AST never normalized this time during treatment.  On all the other treatments, it did normalize.  I don't drink, and I haven't drank anything for years.  I do walk, practically daily, but it's not really as an aerobic pace, far from it.  I walk for length of time more than for a faster pace. Usually 40-45 min. a day.  I feel too out of breath and dizzy when I try to walk fast and run (forget about it).  I right my exercise bike every other day as well, but there again, not enough to say it's 'aerobically'.  I know it's better for your heart to get your heart rate up, but I can't do it.  

Susan

[Eisbein]

Before tx my ALT was always higher than my AST.
A few weeks into tx the ratio reversed, with the AST being approx 10-14 points higher than the Alt.
I am 10 month SVR, the AST has remained higher than the ALT, but now by only 1-5 points.
My last drink was in 1980, before that I drank twice a year.
I was estimated stage 3 before tx, I reversed to stage 1 according to Fibrospect II.
Not sure why the ALT/AST reversal remained.
My endocrinologist looked up his patients data for me, about 30% have a higher AST, none have to his knowledge liver problems.

Ina

[mremeet]

Hey apk, nice to hear from you, thanks for the encouraging words.

apk quote: "Great to hear that you are recovering from the rash. Guess you noticed that the highest cause of drop from the trial was rash, at 9%. No question that you were right about that, although there were fewer sufferers than we might have thought."

I'm actually wondering about that. When they say 9% discontinued, I was wondering if they meant things got so bad they discontinued from the trial *altogether*, or simply discontinued the VX and carried on with the SOC drugs? Because if it means discontinued from the trial altogether (stopping all drugs), then that means there are almost certainly a good number more who developed a rash, but managed not to stop ALL treatment. In other words, although myself and PDS discontinued the VX early due to a horrible rash, we did not and have not discontinued from the trial itself. We have continued with SOC and are still enrolled in the trial. So I'm wondering if they're including people like PDS and myself in that "9%". I'm thinking they're not including us, but they really don't say. Also, I spoke with our study lab tech who draws our blood. She said "there are four of you all with that bad rash", when referring to us VX participants. I later asked our study nurse the same question (without telling her what the lab tech told me); she denied anyone else had a rash. I think she was lying, probably because they're instructed to keep their mouths shut.

But I guess time will tell what's going on with the rash and how truly frequent/likely it is. Even if it does have a 58 day onset (as claimed by our doctor and as experienced by myself and pds), hopefully a large percentage can still use it and simply stop before that time. That way they can get the excellent benefit of strong and early clearance, and yet still avoid the rash.

"Must be a terrific relief to see that rash finally departing [slowly]."

Yes it's nice to have some relief. Still miserable, but at least it's no longer at "festering leper level".

"Hope the VL results are good for you too. When do you unblind?
I can't remember if you kept going at reduced dosage or stopped dosing altogether, so maybe the unblinding question is bogus."

For me VL's will be pretty touch and go, with the early VX stoppage, the riba interruptions and all the prednisone and solumedrol I took t the same time. But according to the study nurse (whom I don't completely trust), she said that no news is good news. If I had shown a significant viral re-emergence after initially being negative, they would have discontinued me. Which I guess I believe, so we'll see.

I unblind in about 2 weeks. Although part of the unblinding has already been done. The rash was caused by the VX, so it's pretty clear that I wasn't in the control group. The only question now is 24 or 48. In my shoes I think 48 would be the way to go, unfortunately.

But that brings me to a question I have for you. Both myself and PDS thoroughly tasted our VX/placebo pills and then compared notes. Our pills were very bitter and nasty tasting. This really has me confused, and the reason it does is because you've already clearly described your pills as being not bitter and as having a neutral flavor (similar to what you would expect a cellulose placebo to taste like). I don't see how any person with a normally functioning olfactory/taste sense could perceive those pills as having anything but an awful bitter taste to them.

So since you've been unblinded and at this point and definitely without any question know that you were receiving VX, and yet your pills were neutral in taste (and not bitter)??? Something isn't jiving on my end. Either I was wrong and the bitter pills are the placebo and not the VX (certainly a possibility)...but that doesn't make sense because of the horrible rash that not only did I get, but also PDS came down with it. And we both got it at the same point in time in our respective treatment chronologies. Both were described as definitely not being caused by riba and I feel fairly safe in saying it wasn't caused by a cellulose pill.

So it's got me befuddled, it really does. Don't know what to make of it. Any 'idears???

[crsrph]

if you are talking about anabolic steroids then yes they can cause peliosis hepatis and also cause changes in the blood lipids

[mremeet]

The rash was awful, once it set in and fully blossomed it was absolutely intolerable. I was on the very verge of quitting, but with the help of prednisone/solumedrol somehow just hung on because I desperately didn't want to give up what I had gained in the beginning from taking the VX. It won't be out (if ever) for another couple of years, and even if/when it does become available I won't be able to take it because I'm allergic to it now. So that's why I pulled out all the stops to continue...otherwise I woulda QUIT.

Still, I believe the VX will make it and offer good benefit for most. Our doctor said the rash appeared to have an average onset of 58 days from what the vertex study coordinator told him. 58 days is right around where myself and pds got the rash. So even if you were a rash candidate, hopefully you could just discontinue on day 55 or so and avoid all the fun.

[Kalio1]

As I recall you guys described a confluent rash so severe it required steroids and other drugs and you had to stop VX and maybe even lower tx drugs too, I think at least  one of you had a Riba reduction also.

Hopefully they can adjust the length of VX treatment and eliminate this problem. A confluent rash requiring these measures that (it sounds like) you still have some residual effects of is a major stumbling block. Confluent rashes of that magnitude can be quite dangerous.

The fact that it showed up in the same time frame in most ( by no means did all participants even get it) might mean it could clear the virus early (as it has shown it can do) and then stop the VX sooner and bingo, no rash problem.


Are you still coping with the rash now?

[mremeet]

Yep, it was confluent, head to toe and just awful. Everyone that saw me said that I had the worst rash they had ever seen. In my case it was really bad and long lasting because the initial onset of the rash wasn't managed properly. I was on a short taper of prednisone that initially did a great job of arresting the rash. But then I tapered down to 10 mg and the rash resurged with a vengeance. After it resurged, no matter how much prednisone I took after that (even up to 80mg), it would NOT abate. Even after stopping the VX and riba, the rash kept going like a locomotive. I wallowed in that state for about a week waiting for it to subside, but it never did. Finally I went to the ER to try the IV solumedrol, which finally seemed to "turn off" the worst of the rash (along with ongoing prednisone dosing). Since then I had one more lesser "rash relapse" which required me to go back on prednisone for another week and half (starting at 10mg that time). I've also had to lower my riba off and on because of severe itching, and residual "blotchy" rash on my hands, ankles and feet.

PDS had a similar experience, except her initial prednisone taper was much longer than mine which allowed her to keep going while continuing with the VX. I reported to her what happened to me, so she (and our doctor) knew for her to stop the VX early and to be careful with the pred taper at the lower doses approaching 10mg. Her rash came back as she went to 10mg, but she knew from what happened to me to immediately go back up in her pred dosing to stop it before it got out of control. Fortunately she caught it in time and it still responded to the pred. So she didn't quite experience the long drawn out uncontrolled rash episode I had which could only be arrested with solumedrol.

I'm still coping with "a" rash, although it's nothing like it was. I still can't tolerate 1200mg of riba, currently at 1000mg. Unfortunately I can't know if this sensitivity to the riba would have happened to me just on SOC drugs, because I have no previous point of reference/experience with the SOC drugs. But to me it seems as if my skin has been hypersensitized by the VX rash and it is very slowly dampening down over time. Anyway, hoping to be able to keep going on and continue for 48 weeks. Although I can't imagine feeling like this in the summertime when it's hot and humid out. I don't think I could take it, but who knows...maybe by then my skin will have calmed down to the point where I can keep hanging on.

Anyway, like you said, I'm pretty confident that even if you were one of those who would get the "58 day rash", you can stop at day 54 or so and still derive an excellent early clearance benefit. I think the VX still offers great promise for most, including even for me if I had just stopped it before the rash got out of hand. Oh well, guess that's why they call it "research".

[Kalio1]

What special He L L you guys have endured for the benefit of science! I am still confident, even through all the bumps in the road you have dealt with, that you will SVR with flying colors. It seems like this 20 week wait for VL numbers has been about a year long so far to me, I can imagine for you guys it's really really hard to wait on that info. I imagine it will show you as being UND all the way through to now. I want it to work so much. A special thanks to you all who have endured these "special circumstances" in order to soldier through with the trial. I am extremely grateful to you all for participating in the first place and so very sorry you have had so much to endure. Your attitude is just spectacular, I want you in my fox hole when the shooting starts! You guys are good for my morale. If I start to thinking how cruddy I feel I remind myself I didn't have to face that nightmare rash like you guys and it keeps me in line. I am also glad your experience was beneficial in limiting the problem for pds, that's great. Shows how communication can really be a good thing.

I have started adding Oxymatrine 600mg/day for the last 3 months of my SOC for an extra antiviral punch to my tx "cocktail" hope it helps. I'd add Alinia too for good measure if I could get my hands on it. I will find out this week if the doc will comply. The theory is it might get at any
under the radar" virii with additional antivirals and the Interferon will do it's job and keep it from mutating.

theoretically anyway LOL