Can I assume...

[DD9th]

I've been wondering about something...

Can I assume if my ALT/AST readings get back to normal, (this is after UND reported at 4 weeks, and the ALT/AST dropping a great deal)... if those enzyme readings are in the normal range, can I assume then that I no longer have a disfunctional liver?

My problem is that the doctor did not want to do a biopsy (because I'm g2b and had already decided to do the tx), so I don't have a lot to go on to figure out just how bad (or not) my liver might be.  

[DD9th]

Thanks Bill, that is a very informative site.

[Bill1954]

A good resource to help understand blood values is:

http://www.labtestsonline.org/

Bill

[DD9th]

- very very helpful.  I'll review the other info on my tests  with a bit more of an idea of what I'm looking at/for.

Thank you!

[newleaf09]

I'm sure they will be doing CBC's (complete blood count) on you all the way through TX so they can monitor how the drugs are affecting white and red cell counts.  That's a safety issue and is in your standing orders, I'm sure.

I have copies of almost every blood test done on me.  They tested a lot more than CBC and I just looked all the things on the sheets of results up, to figure out why they were ordering those tests and what it had to do with both monitoring TX and with my liver.  Tests cost money so they would not order if not related.

By my reckoning, the ones directly related to liver function were:
AST & ALT indicate inflammation, something harming the liver.  ALT is produced by liver but AST may be produced by cell damage to heart and muscles, too
Bilirubin - If high, liver is not properly excreting it into bile ducts.
Alkaline phosphatase - bile duct enzyme that's high if bile duct is blocked by scarring
Low platelets can mean liver damage or interferon side effect
Albumin, triglycerides and cholesterol are all made in the liver.  Low may mean liver not making them.

Others may interpret the relationship of these to the liver differently, but these are the things I have been watching especially closely for liver function.  My ALT/AST got back to normal (from 153/108 at day 1 of TX) about 8 weeks after I started TX and stayed that way. 17/26 at EOT and 12/21 at 12 weeks.  I found charting all the numbers a comfort and the numbers told the story of the progress of TX.

[DD9th]

Newleaf09:

You said: "You will have a dysfunctional liver until enough of it heals to carry out it's normal duties.", and that is my question basically.  

If ALT/AST get to normal, does that mean the liver is now functioning normally?  The doctor actually told me initially that I had abnormal liver function.  Are there other things/readings in their tests I should be looking for to help me determine if it is functioning normally?

I'm kind of bummed that the liver doctor doesn't seem to want to do any more tests until I'm done with the tx.  (this he said is due to the UND finding).  I'm sure if I start to have problems and a test is needed, I have a couple of standing orders, but for now, from what I understand, no more tests till March.

[DD9th]

What prompted my primary care doctor to do HIV/HCV test was the high AST/ALT numbers (which really scared me.  I haven't had a drop of liquor since that day.)

Here are the numbers:
Prior to treatment, my ALT was 210 (normal is 0-65)
Prior to treatment, my AST was 143 (normal is 0-37)

I had a few months in between the first tests and when I actually started treatment, and I tried a home-remedy while I was waiting to begin the treatment (h202).  

It did bring the ALT/AST numbers down as well, but they were still high.  Right before I began the treatment, they were at ALT: 187 AST: 95

As I recall (please correct me if I am wrong here), one of the 2 numbers (AST I think) is more related to alcohol being the cause than (HCV???).  

So now, at week 4, my ALT was 89 and my AST is 64.  I'm not there yet, but I feel fairly confident that by the time I'm done with the tx, those numbers will be back within the normal range.

I'm hoping that some day I'll be able to at least have a glass of wine here and there.  I'll never go back to daily after work cocktails.  I just don't want to have to be excluded from social occasional drinks (because it makes me feel like a pariah.)

Like yesterday, at work we just moved from the 4th floor to 6 months temporary digs (while they re-configure and reconstruct our office space).  I am in IT (Information Technology) so my duty was moving everyone's computer, and I really worked my a** off (considering how easily fatigued I am on the tx....) and at the end of it all, there was a social gathering of the rest of the building to welcome us to the new temp space.  

Never has a cold beer been so tempting to me, and I couldn't even join in.  I was hot, tired, and extremely thirsty.  I had a soda (which I usually don't drink soda), and felt somewhat nauseous.  

Needless to say I had some rather black thoughts and an internal pity party.  Thank god it was at the end of the day and I was able to just leave.

[newleaf09]

You will have a dysfunctional liver until enough of it heals to carry out it's normal duties.  The studies that paired biopsies and showed fibrosis regression and healed livers looked at biopsies 4-5 years apart.  It would be hard to say how long it will take you to repair any damage that you may have now.  Don't think anybody knows yet.   At least you know, by lack of virus in your blood and normalizing liver enzymes and other blood values, that you are no longer ADDING damage.  Let the healing begin.

[FlGuy]

What gives you the idea that you had a dysfunctional liver in the first place?  It appears that if you achieve SVR, and there's every reason to believe that you will, that you will always have a mystery inside you.  Since you don't know what your liver condition is and you have no medical reason to find out later, then you won't ever know the before and after. Won't know how bad it was or how good it gets!   Congratulations on the 4 week news, not much longer to go.  Stick with the med schedule.