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Spiked Enzymes - 10 times normal
For the last 4 years, my AST and ALT have been normal or very close to normal. On May 9, 2008: ALT 59; AST 60.
Yesterday, 8/4/08: ALT 630; AST 449. My Platelets are 223 (Normal), Albumin 4.5 (Normal), Total Protein 7.9 (Normal). My Doctor wants me to have blood drawn again tomorrow morning. That does not even seem possible! I have no symptoms, like fatigue, jaundice, etc. My Urine has been slightly dark, and my stool light in color.
I'm Type 2B, responded at 12 weeks then relapsed........4 years ago. I haven't treated since. Viral Load was about 2 million, 10 months ago. I did not tolerate treatment very well and would love to avoid it.
Any ideas from all you experienced folks?
Steve
Yesterday, 8/4/08: ALT 630; AST 449. My Platelets are 223 (Normal), Albumin 4.5 (Normal), Total Protein 7.9 (Normal). My Doctor wants me to have blood drawn again tomorrow morning. That does not even seem possible! I have no symptoms, like fatigue, jaundice, etc. My Urine has been slightly dark, and my stool light in color.
I'm Type 2B, responded at 12 weeks then relapsed........4 years ago. I haven't treated since. Viral Load was about 2 million, 10 months ago. I did not tolerate treatment very well and would love to avoid it.
Any ideas from all you experienced folks?
Steve
One week later, after stopping Doxicycline, Protonix and Alcohol, AST dropped from 449 to 248, ALT dropped from 630 to 321. I also increased the amount of distilled water I drank. Billirubin was 1.1 and did not change, but that's only .1 over the range.
Much Happier,
Steve
Much Happier,
Steve
St Jude Mechanical Aortic Valve........Graffite with a Polyester cuff.
I've had at lease 2 MRI's, one was full abdominal, & 2 CT scans. No problems. However, thanks for the heads up. I'll talk to the Doctor before.
Steve
I've had at lease 2 MRI's, one was full abdominal, & 2 CT scans. No problems. However, thanks for the heads up. I'll talk to the Doctor before.
Steve
"I'll do the Fibroscan as soon as I am able"
You need to check with your cardiologist before getting a Fibroscan.
People who can not have MRI's can not have fibroscans because of the
metal in your body (It depends on which heart valve you have)
With my cardiac implant I can not have either an MRI or Fibroscan.
It'd be best to check with your doc.
Good luck....
enigma
You need to check with your cardiologist before getting a Fibroscan.
People who can not have MRI's can not have fibroscans because of the
metal in your body (It depends on which heart valve you have)
With my cardiac implant I can not have either an MRI or Fibroscan.
It'd be best to check with your doc.
Good luck....
enigma
My family physician is in Farmerville, and his name is Doctor Unkel.......and that's no sh__. The onlt thing in Downsville is the post office.......very rural. I have a place on Lake Bayou D'Arbonne, an 18,000 acre lake north of Downsville.
In Monroe, there's no Hepatologist, but there is a Doctor that bills himself as an "Infectious Disease Specialist.' Maybe I'll call him.
Jim: I Goggled Protonix, Liver and there were multiple articles that warned of a Liver Side Effect. Most just said to be careful of the dosage.......................of course, everything has that!
In Monroe, there's no Hepatologist, but there is a Doctor that bills himself as an "Infectious Disease Specialist.' Maybe I'll call him.
Jim: I Goggled Protonix, Liver and there were multiple articles that warned of a Liver Side Effect. Most just said to be careful of the dosage.......................of course, everything has that!
......"(That's me folks). I called my Gastro, and guess what, he took me off the Protonix. I think I need a new Doctor."
It doesn’t seem there would be a whole lot of Doc’s to choose from in Downsville. Do you have to drive all the way to Monroe?
I lived in Spencer when I was in the 6th grade and if my memory is correct, it had 1 small country store and the Jamboree Hall. That was the whole town. I still have some family (Thomas’s) that live there.
It doesn’t seem there would be a whole lot of Doc’s to choose from in Downsville. Do you have to drive all the way to Monroe?
I lived in Spencer when I was in the 6th grade and if my memory is correct, it had 1 small country store and the Jamboree Hall. That was the whole town. I still have some family (Thomas’s) that live there.
I have no idea what herbs I was taking, rather I put faith in a recommendation of a friend in a practioner (probably unlicensed) of TCM. A mistake I will not make again -- the part about not knowing what I was injesting. FWIW the herbs were mixed from in a raw stalk form and I was then given instructions on how to brew a tea from them.
As to "Protonix", I wouldn't fire a Gastro over that -- I'd just fire a Gastro because he's not a Hepatologist :) -- because regardless what the package insert says, PPI's like Protonix, Nexium, etc. are generally very safe for most people to take regardless of liver damage. Not to say it may have caused your flare, and in fact you may never know.
As to future bloodwork, as mentioned, it took my enzymes at least six months to return to normal so don't necessarily expect them to spike downward after a week.
-- Jim
As to "Protonix", I wouldn't fire a Gastro over that -- I'd just fire a Gastro because he's not a Hepatologist :) -- because regardless what the package insert says, PPI's like Protonix, Nexium, etc. are generally very safe for most people to take regardless of liver damage. Not to say it may have caused your flare, and in fact you may never know.
As to future bloodwork, as mentioned, it took my enzymes at least six months to return to normal so don't necessarily expect them to spike downward after a week.
-- Jim
Tallahassee also suggested I look into prescriptions and such.............I have been taking Protonix for two weeks before my blood test, and that was the only change in my routine. LO AND BEHOLD, IT HAS AN EFFECT ON LIVER ENZYMES! It tends to elevate them in folks with liver disease......(That's me folks). I called my Gastro, and guess what, he took me off the Protonix. I think I need a new Doctor.
I'll do the Fibroscan as soon as I am able. In the meantime, I wait a week, without the Protonix, and do the blood work again.
Many thanks for all the suggestions, and especially for taking the time to calm me down.
Jim, was that Herb LIV 52?
Steve
I'll do the Fibroscan as soon as I am able. In the meantime, I wait a week, without the Protonix, and do the blood work again.
Many thanks for all the suggestions, and especially for taking the time to calm me down.
Jim, was that Herb LIV 52?
Steve
One more thing -- I had planned on treating within a month or so (biopsy said between stage 3 and stage 4) but we decided that best to hold off until the enzymes returned to normal. I have no idea if this was the correct move but frankly I always looked for ANY reason to put off treating and that gave me one :) Ending up treating a couple of years later with a pre-tx viral load of 1.5 million. Am now SVR 2 years.
Probably should mention that you might do an inventory of any potential recent insults to your liver such as new nutritional supplements, herbs, rx medications, vaccines, excessive exercise, even envirormental toxins like cleaning fluids, paint thinner etc, etc. Perhaps you and your doc will find something that may have caused the enzymes to spike.
At face value, I don't share the degree of concern some have shown re your spiked enzymes.
2-3 years before I started treating, my enzymes were either slightly elevated or high-normal, depending on diet. Then one week, I felt fatigued and had blood drawn only to find a similar spike as yours. Like yourself I was freaked out to say the least, but when I saw my liver specialist he seemed less concerned, but did liken the spiked enzymes to an acute reaction.
Stepping back a little, I had started some Chinese Herbs and also gotten a Hep B booster injection the week before the blood was drawn showing spiked enzymes. Our conclusion was that the cause was either the herbs, the Hep B injection, or a combination of both. In any event, the doc told me not to be overly concerned and that the enzymes should return to normal in a few months. He did not equate it with advancing liver damage at all. He was correct, it took 6-7 months, but my enzymes did return to normal.
Moreover, and I didn't do enough viral load tests to be definititive, it appears that the spikes and the resulting acute reaction may have significantly lowered my viral load -- from over 30 million to around 100,000. Again, I'm speculating here, but the underlying rationale is that the acute reaction caused my immune system to ramp on and try and get rid of the virus. Sort of like what might happen in a real acute stage right after initial infection. And while I never got to UND, the lowered viral load probably helped my eventual treatment, as low pre-tx viral load is a positive predictor of SVR.
Certainly not trying to say your spiked enzymes are a positive development, and I also don't want to infer you have a guaranteed silver lining, but did want to relate how my spiked enzyme story played out.
Hopefully, you're treating with a liver specialist (hepatologist) who has seen large numbers of patients. They would tend to put things like this in a better perspective so as neither to over or underreact.
As to your actual liver damage, if biopsy is contraindicated,you might look into some of the non-evasive techniques like Fibroscan, which may or may not still be in FDA trial, but which several doctors might have access to. Two in particular are Dr. Afdhal in Boston and Dr. Eugene Schiff in Miami. Also, a good clinician, should be able to give you some idea based on blood values, size of spleen and physical examination.
All the best,
-- Jim
2-3 years before I started treating, my enzymes were either slightly elevated or high-normal, depending on diet. Then one week, I felt fatigued and had blood drawn only to find a similar spike as yours. Like yourself I was freaked out to say the least, but when I saw my liver specialist he seemed less concerned, but did liken the spiked enzymes to an acute reaction.
Stepping back a little, I had started some Chinese Herbs and also gotten a Hep B booster injection the week before the blood was drawn showing spiked enzymes. Our conclusion was that the cause was either the herbs, the Hep B injection, or a combination of both. In any event, the doc told me not to be overly concerned and that the enzymes should return to normal in a few months. He did not equate it with advancing liver damage at all. He was correct, it took 6-7 months, but my enzymes did return to normal.
Moreover, and I didn't do enough viral load tests to be definititive, it appears that the spikes and the resulting acute reaction may have significantly lowered my viral load -- from over 30 million to around 100,000. Again, I'm speculating here, but the underlying rationale is that the acute reaction caused my immune system to ramp on and try and get rid of the virus. Sort of like what might happen in a real acute stage right after initial infection. And while I never got to UND, the lowered viral load probably helped my eventual treatment, as low pre-tx viral load is a positive predictor of SVR.
Certainly not trying to say your spiked enzymes are a positive development, and I also don't want to infer you have a guaranteed silver lining, but did want to relate how my spiked enzyme story played out.
Hopefully, you're treating with a liver specialist (hepatologist) who has seen large numbers of patients. They would tend to put things like this in a better perspective so as neither to over or underreact.
As to your actual liver damage, if biopsy is contraindicated,you might look into some of the non-evasive techniques like Fibroscan, which may or may not still be in FDA trial, but which several doctors might have access to. Two in particular are Dr. Afdhal in Boston and Dr. Eugene Schiff in Miami. Also, a good clinician, should be able to give you some idea based on blood values, size of spleen and physical examination.
All the best,
-- Jim
Steve,
I don't know anything about heart valve things (heck took me long enough to figure this disease out) can you get a fibrosure or fibroscan one of those things? I don't think they are 'as' accurate but it would maybe give you something to judge with. Ultrasound doesn't tell you anything except look for tumors - I had no idea when they said my ultrasound was perfect that I already had stage 3 damage.......in fact I couldn't figure out WHY I needed the biopsy.
I don't know much about the fibro tests but the other guys in here certainly do and can probably advise you on that?
I don't know anything about heart valve things (heck took me long enough to figure this disease out) can you get a fibrosure or fibroscan one of those things? I don't think they are 'as' accurate but it would maybe give you something to judge with. Ultrasound doesn't tell you anything except look for tumors - I had no idea when they said my ultrasound was perfect that I already had stage 3 damage.......in fact I couldn't figure out WHY I needed the biopsy.
I don't know much about the fibro tests but the other guys in here certainly do and can probably advise you on that?
What kind of anticoagulants and for how long?
Check all mediaction what you take for a possible side effect on liver.
Be well
Check all mediaction what you take for a possible side effect on liver.
Be well
Biopsy is out due to a Mechanical Heart Valve, I'm on anticoagulants........risk is too great. I've had an Ultrasound and a CT Scan recently. Both showed no enlargement or abnormalities.
I sure would like to wait for the better treatments!!!!!
I sure would like to wait for the better treatments!!!!!
If i was you (and that's the only advice I can give) and wanted to avoid treatment at all costs I'd go for the biopsy and hope that you have a nice low stage and can skip the whole thing and move on to trying to find out if anything else can be causing the liver damage. You're numbers aren't just ten times higher - mine were in the 200s and that was considered so...so yours are vastly higher and being that high probably aren't from medication or anything I"d imagine.
As a geno2 they don't normally give biopsies (stupid it would really come in handy for you to know where you were four years ago versus now) but maybe if you start there and also continue trying to find out why the enzymes spiked (even though it seems like it's your liver and the hep maybe just maybe it's something else???)
I am trying to be positive for you. I don't ever want to treat again but if I had to I would - you just have to do what you have to sometimes in life, thats the nature of the beast I suppose.
Good luck Steve.
As a geno2 they don't normally give biopsies (stupid it would really come in handy for you to know where you were four years ago versus now) but maybe if you start there and also continue trying to find out why the enzymes spiked (even though it seems like it's your liver and the hep maybe just maybe it's something else???)
I am trying to be positive for you. I don't ever want to treat again but if I had to I would - you just have to do what you have to sometimes in life, thats the nature of the beast I suppose.
Good luck Steve.
Bottom line first-you require a biopsy!
The spike in your transamines is indicitive of inflammation but could be caused by medication or numerous other factors.
I see from your profile that you are 69 years of age so close monitoring is critical.
Have you had a biopsy previously?
When?
What did the report say?
The doctor may also want an abdominal ultrasound.
Dark urine and pale stool is consistent with chronic hep C infection although if the urine has become dark recently it's another reason for some detailed diagnostics.
The spike in your transamines is indicitive of inflammation but could be caused by medication or numerous other factors.
I see from your profile that you are 69 years of age so close monitoring is critical.
Have you had a biopsy previously?
When?
What did the report say?
The doctor may also want an abdominal ultrasound.
Dark urine and pale stool is consistent with chronic hep C infection although if the urine has become dark recently it's another reason for some detailed diagnostics.
Steve,
I'm sure you know this from treating before, but those spikes indicate you have some serious inflammation going on in your liver. Although ALT and AST are not indicators of how much liver damage you have, they are showing you have injured liver cells because they are the end result that leaks out into the blood. ALT is a more specific indicator of liver inflammaton than AST. Dark urine and light stools are definetely signs of liver problems as well.
People with fairly normal enzyme levels can still have significant liver damage. I would recommend you talk with your doctor about this. I don't know if you had a biopsy done previously but knowing the extent of liver damage is always helpful in determining whether tx should be considered. Liver disease progresses at it's own pace, sometimes quickly and sometimes not. I know you would like to avoid treatment but keep in mind there will be new and improved drugs out in a couple of years with much better odds of attaining SVR and hopefully a shorter tx time. It would be very beneficial if you knew exactly what the health of you liver is so that you can gauge whether to re-treat or wait for better drugs. No alcohol - it's bad news.
Trin
I'm sure you know this from treating before, but those spikes indicate you have some serious inflammation going on in your liver. Although ALT and AST are not indicators of how much liver damage you have, they are showing you have injured liver cells because they are the end result that leaks out into the blood. ALT is a more specific indicator of liver inflammaton than AST. Dark urine and light stools are definetely signs of liver problems as well.
People with fairly normal enzyme levels can still have significant liver damage. I would recommend you talk with your doctor about this. I don't know if you had a biopsy done previously but knowing the extent of liver damage is always helpful in determining whether tx should be considered. Liver disease progresses at it's own pace, sometimes quickly and sometimes not. I know you would like to avoid treatment but keep in mind there will be new and improved drugs out in a couple of years with much better odds of attaining SVR and hopefully a shorter tx time. It would be very beneficial if you knew exactly what the health of you liver is so that you can gauge whether to re-treat or wait for better drugs. No alcohol - it's bad news.
Trin
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