excrutiating liver pain at night due to long term alcohol use?

[revil 2]

I have burning excrutiating level 8-9 pain in liver that keeps me up all night.I feel fine during day(but fatigued).I have cosistantly been a cocktail hour girl for 20 years(3-5 nightly that is )and have easily stopped since this has started. I eat well. I exersize alot.I drink lots of water.I do yoga. I dance. My urin,skin all of that is excelent. I look super healthy and normally feel that way.Have I just abused my liver and its saying stop drinking befor its too late?I am worried that its too late.Will my liver heal? Any insights would be greatly apreciated.I, the non worrier, am very worried. Thank you so much. Blessings and healing to you.

[antman]

Hi friends,
  I too am having sharp pain in my upper right side about 2.5 in. right of center, diectly below my ribs.It started around 3 weeks ago. I saw my excellent GE Dr. on Friday. He took blood and is setting up and ultra sound. I've had 2 biopsys.The last one last year, stage 1. I only recently stopped heavy drinking. It was easier than I thought, because the thought of drinking poison does not appeal to me.I asked the DR. what causes liver pain. He told me enlargement.However, he did not feel enlagement with his hands. So, now I wait till the tests come in and see. I appreciate the positive re-enforcement I get here concerning drinking. Do I miss it? Sometimes, but it passes quickly when I think of beating my liver up. Also, the Dr. said it could easily be the gall bladder. In fact, a family friend just had his removed. He had what sounded like identical symptoms as mine. Sharp pain, that waxes and wanes. I've been drinking lots of water, and it seems to help. I'll report back with my test results. Take care friends.
Scott

[wkwithit]

Some Docs may have great credentials and they may know their stuff...but it doesn't mean they will tell the patient. Here's a perfect example. Since I'm a Diabetes Educator, I saw the correlation between insulin resistance and Hep C long ago.  Since there is recent data that says insulin resistance lowers SVR and increases liver damage, I decided to find out whether doctors are actually 1.Treating insulin resistance. 2. Telling the patients about it. 3. Advising the use of any measures that will decrease insulin resistance.

I sent my questions to a list serve..made up of doctors and Nurse Practitioners that treat Hepatitis C.  Here's my email and the response I got...(I have listed my sources at the end).
Silvia

Key words:1.mitochondria--the power plant of the cell.
2. glitazones--diabetes meds like Avandia that decrease insulin resistance but may increase triglycerides increasing cardiac risk.
----------------------------------------------------
Care & Counsel IV: Helping Patients Stay
the Course on Treatment for Hepatitis C
Listserve
E-mail: ***@****
Web: www.projectsinknowledge.com/cc3/
-----------------------------------------------------
Silvia Hinojosa-Price, RN, asks:

I have several questions related to the subject of insulin resistance.

Based on the information about insulin resistance lowering SVR, I would like to know how many of you test for insulin resistance and use insulin sensitizers even though the patient may not be diagnosed as a diabetic yet--just insulin resistant.  If so, what are you using, and have you seen any toxic effects from glitazones?

Since the HCV damages the mitochondria by a process of oxidative stress and the same may be true for insulin resistance, are you recommending anti-oxidants and if so, what amount?

Since aerobic exercise helps produce more mitochondria and a high- protein diet boosts the benefit of exercise, possibly decreasing insulin resistance, are you recommending compensated patients do this and if so, how much protein?

As a diabetes educator, I find the subject of insulin resistance
fascinating. Thank you for your input.

________________________________________________________________

RESPONSES TO DATE (9/15/05):

The issue of metabolic syndrome in patients infected with HCV is quite interesting. It seems that HCV patients with components of metabolic syndrome (diabetes mellitus, central obesity, insulin resistance) can have more advanced liver disease as well as lower response to antiviral therapy.  The exact mechanism of this interaction is not well known but could involve insulin resistance (IR), adipokines (adiponectin, leptin), cytokines, and associated oxidative stress.

Despite this interesting data, I don't routinely check HCV patients  for IR.  However, assessing IR in patients with nonalcoholic disease (NAFLD), a fasting serum glucose and serum insulin can provide an easy method to calculate HOMA (HOMA >2.2=IR).

Although theoretically it makes sense to use medications/ strategies to improve IR and oxidative stress, there are currently no convincing data that these treatment strategies (including amount of protein intake) improve outcomes in patients with HCV.

However, for overweight HCV patients, I do recommend gradual weight loss.

Zobair Younossi, M.D., M.P.H.
Director, Center for Liver Diseases
Medical Director, Liver Transplant Program
INOVA Fairfax Hospital
Annandale, VA



Sources:
Insulin resistance impairs sustained response rate to peginterferon plus ribavirin in chronic hepatitis C patients.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15765399&query_hl=1

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15765399&query_hl=1

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14976002&dopt=Citation

Is oxidative stress the pathogenic mechanism underlying insulin resistance, diabetes, and cardiovascular disease? The common soil hypothesis revisited.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14976002&dopt=Citation

Liver steatosis is an independent risk factor for treatment failure in patients with chronic hepatitis C.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15674091&dopt=Citation
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15674091&dopt=Citation

Protein-rich diet boosts benefit of exercise.
http://www.eurekalert.org/pub_releases/2005-08/epr_pdb082505.php

[PasoPerson]

As an alcoholic and drug addict who's been straight and sober since 1979, I can relate to what you are saying.  I have to tell you the single best piece of advice I received when I first sobered up ...

"You become like what you are around."

The good news is that you do not have to be a recluse.  All you have to do is change those you associate with.  There are many activities and groups where alcohol is not even present.  Find them, attend them, change your buddies.  I did, and I have NEVER looked back.  I am SO GLAD to be able to remember if I had a good time yesterday, remember when I drove home, etc.

God delivered me from these addictions, and He also saw fit to deliver me into the hands of a great church family.  Lots of activities for both marrieds and singles.  And to this day, I have to tell you I have not had a 'BORING' moment.

If you get really bored, though, just let me know.  Got plenty of things to do around our farm to keep you busy!  LOL

God bless you and keep you.  Make the effort, He will do the rest for you.

Carolyn

[Forseegood]

Hope I didn't sound too reprimanding, I work on a deadline and I'm often stressed when I write (not a good thing.) There is absolutely no shame in any of this, researchers have been coming up with more and more info on all of this, through pet scans, mri's, other testing procedures...that addiction and substance abuse is not just necessarily learned at home (although  that certainly adds to the mix) but is a brain chemistry issue as well.

It doesn't necessarily denote a weakness or "bad character" and so on, we come from a Calvanistic society that is pretty judgemental in my opinion. They wouldn't judge a diabetic. Yet... Who needs judgemental people anyway? You don't have to be a recluse, I'm sure there are many in your community that share your concerns about not "socializing" in a boozy environment. Please, go out and find them. Your life is precious and you don't want to jeaprodize it by drinking with this disease. Also, if you prefer, counseling, whatever it takes. You'll find these people are just people like anybody else, they  are not cult members, ha ha! IMHO, it's much more courageous to go out and seek help then sit around in your own juices while not coming to terms with your problems. Much love to you. Good luck!!!!

[NYgirl]

As an ex heavy drinker (since like 17 I am now 40) (stopped at diagnosis completely) I can completely relate how hard it can be.

The thing that works best for me when tempted is to take out this picture i got in a book on what Stage 2 looks like compared to even Stage 1.  Then I just tell myself wow do I want to go onwards from there?  Once I look at what this virus has done to my liver (and the drinking too) I can then pretty much forget about drinking.

I guess what I'm trying to say is: once I saw what it looks like it became REAL what damage was being done.

If you can find a picture on Stages...and take it out and look at it when you are tempted it might help you too.

I just know I want these critters out of me big time and my liver to heal.  

I know there is no magic words to be given but...hang in there.  We have to beat this thing at all costs...and that includes drinking.

PS I found that the Paxill the doctor gave me helps as well.  INstead of a drink at night I just take my little pill and consider it the same thing (even though it's NOT the addict in me can pretend).

:)

[hep62pj]

yea drinking while having this is just pretty stupid, I know, I am trying so hard to just stop completely, but the only way I have found to do that is just stay away from everyone and become a recluse...and that is just too depressing...I thought since I quit easily when I found out about this I didnt need any help, but maybe I am wrong...but I should know better, I have been a drinker since I was 10 and got this from iv drugs so yea I have a bit of a history with addictive behavior.

But I am trying real hard not to give up or give in...

[Forseegood]

Ha! An internist who first diagnosed me w/ the virus told me that I had about 3 years before I'd need a transplant. With perfect labs no less. Definitely not the brightest bulb on the tree. You'd think that some of these guys wouldn't throw a diagnosis out like that without a lot of careful thought. But then, there are some really good docs out there too, thank God.

I'm just grateful that we can avail ourselves of these boards, really grateful, even though we don't always agree. If not, I would have had to believe that chucklehead a lot longer than I did...because the minute I got home I researched my labs on the internet, and asked hep c board members what they thought...and they told me he was nuts. Whew!

[bluepeng]

I agree with you and I understand your reaction to my earlier post. I've read similar posts and have questioned the advice put forth.    But, as you said, everybody is different.   I think we have all met doctors that we have either dumped or scratched our heads on the way out of the office.  We have a nice advantage on this board because we hear about *everything*.  I don't think there is a doctor on the planet that could digest the range of information available just in this forum.  
As for a doctor that says that you should be asymptomatic until  end stage .. that's BS as you called it.  We know better.  
It's too bad more of them didn't hang out here because they'd understand a lot more about their patients .. but maybe some do.

Peng.

[revil 2]

Thanx for that - I am the same I have stopped consuming any alcohol - I feel like at 44  more of a buzz to be 'sober' in the evening than not - It's been effortles also for me to stop. How long has it been for you?

What got you to the liver tests?were you having symptoms?

i am going to self heal through diet etc and than go have a check up in a month or so.

Thanx for sharing.Be well.

[Forseegood]

Hi, I don't know that we are in any kind of disagreement, maybe he was talking in generalities but if you talked about the specifics that I mentioned, he might modify his statements. I can't account for some of the things I've heard docs say.

I'm no Harvard educated person of Science, that is true, but when I went to one particular Ivy league educated doctor with all the sheepskin and chairmenships and accolades and mentions you could shake a stick at; he still told me that people like me, who biopsy at a stage 1, do not exhibit symptoms of hep c. That the only people who exhibit symptoms associated with hepatitis C are people who are cirrhotic or in ESLD. I took issue with this, because I actually "feel" the symptoms we were speaking about. He told me they are probably due to some other etiology... I told him I didn't doubt some other things were going on, but I really think my hepatitis is maybe exaserbating other things and/or presenting on it's own as well, all I knew is that I had these hep "flare-ups that were messed up". He told me this is patently untrue. I've had the benefit of these boards, and I've spoken to many, many people with hep c that are in low stages of biopsy and they tell me they have symptoms as well. Either we are all wrong or he's wrong, at least on this one account. I think the latter and I can't account for it though I have my theories. To me all of this stuff is too much of a mixed bad for most generalizations. Various doctors have been wrong about various things before, it's not unheard of. They are human just like us, and they can't all bat 1000 all the time, they might be wrong on some things. My own view.

I think it was Jim? or someone said that he had gone to a conference where a very, very prominent doctor was speaking, and this doc said he really listened to his patients and that he really did not know all the answers to this, they were just finding out things. My present doc is more like that, he rarely speaks in broad generalizations re this disease.

[GreatBird]

Maybe it's your gall bladder. I've never had gall bladder pain, but I've heard it can be excruciating. If it is your gall bladder, you also want to be very careful about eating food with high fat content.

[GoofyDad]

For years I've had a bit of on and off vague discomfort floating about in the general abdominal area. My GI didn't attribute this to the liver, but I'm beginning to question that assessment. In the past 6 months or so, it's become progressivley more frequent and more defined to the area just under (not so much behind as lower than) the right rib cage. And a bit behind too, I guess. It's rarely present in the AM, but there most nights at bedtime.

My new hepotologist attributes this to the liver, but doesn't seem to place much weight on it, "Oh yeah, they can be tender sometimes...". I didn't ask him & now I'm wondering (finally a question...) whether this is likely indicative of stepped-up inflamation & damage activity. As I'm about to start tx, the issue is largely academic, but the presence of the sensation is starting to creep me out. Oh yeah, June biopsy puts me at advanced fibrosis transitioning to cirrhosis.

Thanks for any comments on similar experiences, etc.

Goofy

[NYgirl]

Even if you don't have hep c I would think being a heavy drinker (and yes I was one too until I found out about this disease and then it's like a miracle...all of a sudden your liver is EVERYTHING you want to protect and all of a sudden I was able to just STOP) I wonder if you have hepatitis (inflammation) and could you have fibrosis or something going on in there from the drinking (probably).

you really need to find a good doctor and have some tests done.

I had NO idea that I was a Grade2/Stage2 until I had my biopsy. In fact i was pretty sure my liver was just FINE.  

I attribute a lot of the fibrosis to the drinking. Don't know honestly if that is true...but I am SURE if I was NOT drinking my liver would be MUCH MUCH better off- disease or not.

I hope you find some help at least for peace of mind.

[bluepeng]

Well, all I can say is that anybody who graduated from Harvard summa *** laude in biology, and then graduated from Harvard Medical school, professorships, concentration in liver disease and so on and so on has more experience than probably you or I ever will.  He sees (and has seen) scores of alcoholics and addicts each month ... for years.  I imagine he has some empirical data on the topic.  I'd say I'd take his word for it.  He's entitled to make "generalizations" if he likes -- he's earned that right.  As for him downplaying the pain in my side, I think it's a psychological ploy on his part.  Why feed into the fear?  Incidentally, I took the Cellular and Molecular bilogy course at Harvard Extension ... absolutely brutal.

Peng.

[Forseegood]

Hi, this is what I can't understand and I hear these type of statements from patients all the time, my doc told me this and that. We pay them for their expertise on these matters. How can your doc definitively say that drinking 4 beers a day would do far, far less damage than having hep C? Firstly, who is he talking about? Maybe that would be the case with Bill and Sue, but not Mary and John. There are so, so many variables in human health, making sweeping generalizations like this is just plain silly. Alcohol not only affects the liver, it affects many other organs and systems. Maybe Sue has a genetic predisposition to heart and liver problems that no one knows about, and that amount of alcohol would indeed affect her health worse than John, who has hep c but doesn't drink alcohol, and John has a very mild case of hep that hasn't done much damage to his body at all. There are many people like that. People point out that the people who are not suffering a lot of symptoms from the TX do not post, well the same could probably be said for people who don't suffer a lot of damage from the hep itself as well.

And it would depend on how you drink the beers. If you had 6 small meals a day, with all the nutrients you needed, and you drank a beer in the afternoon, then one at 6:00pm then another at 9:00 pm, then yeah, the beers probably wouldn't do "much" harm to you, (again, depends) if you had good overall health besides. This is the way many Europeans drink, I lived there for a few years. But if youre sitting at a bar pounding down one beer after another...this is a shock to the system...and it can indeed do plenty of harm, over the long term, even if it's just beer. And as I said earlier, it's been proven in study after study that women can't metabolize alcohol as well as men. One drink to them is like two to us because it takes longer to leave our systems. And you have to factor in hormonal issues for many women as well.

As has been pointed out here over and over, our own lifestyles may play a part in our overall opinions of these matters...I'm going out on a limb here...but I'd almost bet that your doc likes to tip a few himself. This is not unheard of in the medical profession, not by any means.  

And in any case, we all know people who have been badly, badly affected by drinking w/ this disease, at least I know I do.

Oh and that liver pain thing. I got to a point where I almost used that as a barometer in keeping a hepatologist, if he/she told me definitively that there is "no way" that we can feel pain  there (another one of those things where thousands and thousands of hep c patients report this, and they outrighly dismiss it? The "mass hysteria" thing) then I just headed to the parking lot. Did you know that the only way some of them started to give credence to this is when docs with hep c themselves started to report it? I read that in a medical peer review site. No, we're not all nuts.

[bluepeng]

It's funny.  My hepatologist is a pretty caring and knowldgeable guy.  When I mention liver pain, he usually downplays this. He's not the only doc who has done this .. it's like they hear it ALL THE TIME.  He knows all my stats, my 2 biopsies, etc.  He just says that "some people feel it more than others".   He also mentioned my thin  frame which may make me more prone to noticing it.  I only feel my liver when I take a medication.   I've had 1/2 drink over the course of a year .. about 3 weeks ago.  I felt my liver after that drink .. maybe it was in my  head.   Trying to comfort myself a year ago I asked my doc if my liver with hepatitis C was better off than somebody who drank consistently.  He has an immediate answer: NO.  He said I could probably consume 4 beers a day with few liver related issues for many, many years.   Hepatitis C was a whole different story.  Alcohol gives you fatty liver, but you have to *reallly* drink from what I hear.   If anybody has heard contraryy, let me know.  

I hope everyone here is well,

Peng.

[Forseegood]

Hi, guess youre answering most of your own questions. My mom always says, "don't borrow trouble", you might not be as bad off as you might imagine. Having said that, don't take that for granted. I hope you have set up appts w/ doctors, hepatalogists, etc for all the testing and evalution you need. You didn't mention if you thought you had hepatitis C? by all means get tested for that. You might already know that women do not process alcohol as well as men do due to body fat, etc, so a lot of alcohol is much less forgiving to our constitutions. Your drinking is much more than moderate. If you need to stop drinking altogether (not everyone can just "scale back") and you find you can't do it on your own, please avail yourself of all the help that's out there.

With all the other things you do for your health - it will mean almost nothing unless you have a  well functioning liver. One of the wonderful things about our bodies is that they will, most times, give us indications as to what's wrong; but it's up to us to help out after that. Good luck to you.

[hep62pj]

Your post sounds like me...what stage/grade and type are you?

I am stage 2/grade 2, unknown type, I was a fairly heavy drinker for over 30 years and I too stopped pretty easily when I found out I had this over a year ago...I treated and it did not work I have been off treatment since this past March, and since then I have started drinking again a little bit, and sometimes more than a little bit...I am healthy as can be every other way than the hep, not overweight, I eat right, exercise, etc.  I also feel fine most of the time but I do have pain in my right side and my lower back once in a while and it seems more so if I have been drinking...

As for your pain it sounds much more extreme than what I am feeling, on a 1-10 scale, my pain is more like a 1 or a 2 and pretty intermittant...

Are you on treatment?  I would definetly see a doc if the pain is that bad...you need to get a biopsy if you have not had one to see how bad off your liver is...I have heard that the liver can heal itself once the hep is gone and if you stay away from liver damaging foods & drink - even if you are stage 4.  

I take milk thistle everyday, dont know if it is helping any but it cant hurt...

[jmjm530]

Best thing is to have it checked out by a good internist. Your pain may have nothing to do with your liver. None of here are doctors and in any event the symptons are too vague to comment on without an examination. I'd have it checked out right away.

-- Jim

[revil 2]

Thank you so much for great information! - I realy apreciate your words and your sharing - you be well too -

[Forseegood]

One thing I forgot to say...please tell the doc about your drinking habits if he neglects to ask about them. Be sure and at least get tested for the hep c, they don't always do that either. The more info you give them the better they can diagnose. And always keep copies of your records. Let us know how you are doing. Be well.

[Forseegood]

Hi, first of all, none of us are docs, we just play one on Hep C, just kiddin. I know a little about alcohol induced hepatitis (hepatitis means liver inflammation) and alcoholic liver disease, my younger sister almost died of it and I'm a researcher by nature, a lot of people on this board are... You can't get hep c from drinking, it's a blood borne disease and you have to exchange blood with an infected person to get it. Hep C is a different kind of hepatitis, hopefully you don't have it... That's the kind we deal with on this board. You really can't know much until you've been properly evaluated and checked out.

If I were you, and I'm not you but if I were, I'd quit drinking lickity split and get to a doc as soon as possible, preferably a gastro guy or a hepatologist. Many times internists don't pick up on the same codes. You know more than I do what your habits are, etc. but that amount of alcohol over the long term "can" be harmful to many people. With any luck - it'll just be a wake-up call to you and you can give your liver a rest to recoup and regroup, it's the only organ that we have that can do that. That's got to be our credo to heal, we have to "love our livers!" Hope this helps. Try to be calm until you know something one way or another.

[revil 2]

Thank you

[revil 2]

Thank you so much for your wise words - My liver is talking to me - Time to stop piosoning the miracle organ - no I do not have hep c - Do you know if liver acts up at night?