alarming test results

Good morning to all...I am in need of some prayers and some insight as to what might be going on with my liver....I did what I thought was my last labwork ( alt ggt and platelet count ) yesterday morning prior to starting tx......at 7:30 last night my hepat. dr. called and said he was concerned about the results...In August my ALT was 601 ( doc thinks this could have been from steroid tx for tennis elbow )...Oct. ALT was 567 ( day of biopsy )....Nov 4th ALT down to 192 & GGT was 87

Yesterday my ALT "spiked" to 807 & my GGT was up to 202.....He said SOMETHING caused this to go up. He asked me if I had taken another steroid injection. ABSOLUTELY not...I don't drink or do drugs...He ask me about any chemicals I have been around at work or at home....I told him I have been doing some painting at work but it is outside, well vent. 2-3 hrs a day...There are some chemicals at wk. but I rarely come in contact.....He said no more painting and avoid all chem.

He wants me to do another lab next Fri. ( Liver Panel, PT, and CBC )....He really sounded puzzled...I think he said " WE just don't see that kind of ALT Spike over one month " ( 192-807 )....

The only Meds. I've taken since my biopsy is Tylenol.....He said that would not cause this......I was mentally ready to start tx. and now this....Any thoughts or similar exp. is appreciated....God Bless and Thanks

[raining]

Sorry you are in such a worrying position. My ALT also spikes (39 to 520) in a month (I never get the same ALT readings, it jumps around). My doctor has no idea why. I will be very interested if you ever find out the answer. Please e-mail ne if you can ***@****

[AmIDoneYet]

My ALTs have never been very high maybe two to three times higher than normal and have never spiked.  When I was diagnosed with HCV, my doctor told me to avoid Tylenol because it is toxic for the liver.  Someone said even for people with healthy livers, 4 grams of Tylenol a day can be toxic.  That's 8 extra strength Tylenols.

[newtex]

raining...I will be out of town, away from my computer until Monday morning. Hopefully there will be some info to look at then.

G.I.PA...Just wondering what your thoughts are on the way my ALT #s have acted?

I,m going to my daughters soccer playoffs in college station, and I'm determined to leave the " DRAGON THOUGHTS " behind.....GO BAYTOWN SAINTS....God Bless

[GI.PA]

I would agree with your doctors concern. The question always is...Is there something else cooking in the liver?  Some liver disease can be very elusive.

They should be doing (or have done) a full panel looking for other liver issues.  Hep A, Hep B, autoimmune Hep, Wilson's disease, hemochromatosis, Eppstien Barr, celiac sprue, thryoid and the list goes on.  I cant recall if you had a liver biopsy or not.  Certainly if one hasnt been done, this would be a very good reason to be doing one pre-treatment.  If it has been done, a second opinion at a top-notch Hepatology center may be indicated.  You can email me if you want some names.

Remember..Hep C is a disease we look at in "DECADES"...other liver diseae just arent as generous....the waiting game is definatley indicated here.



GI.PA

[AK - Hepper]

When they do a biopsy and they already know you have hep c, do they still look for all signs of other possible liver problems, or do they mainly look at the hep c related issues?

[GI.PA]

They do a series of stains looking for iron, copper, different types of inflammatory cells ect.  We provide the pathologist with some clinical history (hep C, elevated liver numbers, chronic alcohol use) which helps them figure out what we are looking for.  But the bottom line, they do a complete analysis of the liver tissue...most of the time it is what we expect..on occation, there is a suprise.

GI.PA

[TravelGrl]

Dear Erin~
   I am sure you've read my daughters story...I saw you mention that HCV is a decade virus...Well Amanda's doctors feel the same way...but she progressed from a normal biopsy in 1999 to cirrhosis is 2002.  The summer of 1999 she got jaundice and her enzymes shot up into the 800's...ALT AST and GGT.  We had traveled out of the country to Mexico and Bahamas that summer...we also had copper toxicity in our swimming pool that summer...She got sick and jaundice weeks later.  We didn't repeat the biopsy at that time because we had just done one the beginning of that summer..Well we repeated her biopsy last summer 2002 and it showed cirrhosis...They don't understand what is going on.  We tested for other hepatitis viruses including Wilsons and Autoimmune all which were negative.  We are worried sick that something else is going on but can't seem to find anything.  They are saying if she continues to progress at this rate she will need a liver transplant in the near future...Can you suggest anything else that may be going on here.. She is only 15 years old...She dosn't seem sick and her synthetic function of her liver is still pretty good.  We just need to figure out what else is happening...It was also suggested that maybe she has some sort of metabolic toxicity going on...Any suggestions on other tests we can do??? You just dont go from normal biopsy in 1999 to cirrhosis three years later...Looking forward to your response.  Do you know of a "top notch" liver doctor in the tri-state area?  Thank you,,,Jodi

[Sweetlucy]

Hi Everyone

First I want to thank every one for their unselfish support.  I got a copy of my biospy report before I seen the doctor and I wish I had never did that  because I was going nuts because I did not know what it meant. I feel better and about to take my first injection this evening in about 2 hours.  I have taken my firs dose of the Rabivirin and the next does in about and hour prior to my shot.  I have some concern my doctor told me it was okay to take a tylenol say for this shot prior to taking it and then next week take and ibuprofen.  Then I hear that neither oned of them is good for the liver. Tonight I am going to take a tylenol about 1 hour before I inject myself.  I have type 4 and I am very positive that this treatment is going to work.  I was worried about the side effects at first but I have been telling myself I am not going to get all the side effects that I have been told about.  I know that there are some people out there some where who did not have the bad sides.  That is what I have prayed for.

G.I. P - Can you explain to me what TSH is and my test read 1.267, also is a reading of 55 for an AST reading very high or what.  For my Hep C Ab there is a number 2741000 and it says high.  What is this and how high is it to a good or bad.  I forgot these papers when I went to the doctor yesterday called myself being so prepared to ask all these question and did not have my notes.  But from reading some of the posings you made you are very knowledgeable about this stuff.  Any information that you can share with me will be greatly appreciated.

Thank you all for the support because where I live in Aberdeen there is no one I can talk to that I know of.  My family if real good at listening and want to learn more about this stuff
God Bless

[GI.PA]

I have been following your daughters case with dismay.  If your daughter was infected at birth and is 15-16, her progression is rapid and concerning for somehthing yet uncovered going on.

I am sure they have ran a comprehensive workup on her but if she hasnt been to a PEDIATRIC hepatologist, this might be a good place to start.  They are few and far between but may be able to have something else to add even if you had to travel for the evaluation.

I dont have any names of pediatric heps but some good adult ones in the PA/MD area are DR. Riley at Hershey or Dr. AnnaMae Diehl at Hopkins.  I have been out of that area for a few years but they are still there and very good..  You might want to inquire as to where the nearest liver transplant center is..not because she is ready for transplant but because that is where a lot of the good hepatologist are...and it helps to be hooked up at a place who can take this on from start to transplant.

Wish I could be of more help.

Erin

[GI.PA]

The normal range for a TSH is lab dependent but is usually between 0.5-5.5 but the ideal is around 2.0. Labs can vary so ask your doctor about this one.


You AST is minimally elevated which is most likely not clinically significant.

Your Hep C viral load (or PCR) is 2,400,000 something.  This simply confirms you have Hep C.  It is termed "high or abnormal" because normal would be non-detectable (i.e.with out Hep C).  This is actually neither high or low..just in the middle...meaning nothing about progression of the disease.

Tylenol up to 4 extra-strength per 24 hours is even safe in our cirrhosis patients, just never mixed with alcohol.  You doctor may even allow you to take more, or even ibuprofen.

GI.PA

[layla]

I hope everything is going ok for you tonight. Let us know how you did. LL

[TravelGrl]

Thank you for your response.  We are willing to travel anywhere to see "The" best doctor...We're just not sure who that would be.. If it were your daughter where would you go?  We live in NJ, but as I said would go anywhere for a chance to help her...Can you suggest anything?  Also, her last biopsy report suggested some sort of non-specific metabolic toxicity may be happening...What does this mean and is there a special doctor to see for this?  Thank you again for any information or guidance you can suggest. By the way, what is your email address?

Thank you
Jodi

[GI.PA]

Did a little asking around and you might best be served by:

Benjamin Shneider, MD
Fred Suchi, MD
Mount Sainai School of Medicine New York

They have a complete Pediatric Hepatology department.

I hope this helps.

GI.PA

[GwithHepC]

Hi:

You might also want to look into where I am taking my daughter in Manhattan.  It is called <A href="http://www.hepccenter.org/pediatrichepcpatients.php">The Center for the Study of Hepatitis C</A>.  They have a pediatric division specializing in Hep C (The link if it works should take you to that page).

G

[TravelGrl]

Thank you Erin.  I am going to give them a call on Monday.  Maybe they will come up with some answers..Thank you for your help..it is greatly appreciated.  Can you post your emial address and where your practice is located?  I would love to give you a call..Is this possible?  My email address is: ***@****

Jodi

[raining]

In a response to newtex's post you suggested that a whole range of other liver tests be taken as ALT is so high. If there is another liver problem would this show up on a biopsy? I've also been told not to worry so much about my high ALTs as I was told it was the "nature" of the virus and my biopsy showed only mild damage.

Now I am WORRIED.

[raining]

Sorry meant to send this message to you.

In a response to newtex's post you suggested that a whole range of other liver tests be taken as ALT is so high. If there is another liver problem would this show up on a biopsy? I've also been told not to worry so much about my high ALTs as I was told it was the "nature" of the virus and my biopsy showed only mild damage.

Now I am WORRIED.

[raining]

Could a mal-functioning kidney cause ALT to spike?

[TravelGrl]

Thank you   I remember you told me about this some time ago. Is there a certain doctor that you would recommend?  Do they see lots of kids with Hep C?  

How is your daughter doing?  Please e-mail me with details...Hopefully she is doing well.
Jodi

[GI.PA]

Erin Dettrey, PA-C
Gastro Associates of North Texas
1201 Summit Ave #300
Fort Worth, TX 76132
817-335-2487
***@****

[GI.PA]

Yes the biopsy would usually elude to these things.  A combination of careful liver biopsy and a series of lab studies can usualy look for even the most elusive causes of liver disease.  

Severely malfunctioning kidneys (such as one in kidney failure) may cause some liver number abnormalities, but one would be less likely to see a "spike"..more just an elevation over time.  This is usually quickly ruled out by part of the panel of labs they use to monitor the liver (a comprehesive metabolic panel or Chem 12)..We look at the BUN and the Creatnine the most for kidneys.

GI.PA