ALT, AST getting high

[Moeymitt]

I am back again. Nice to see there are still some oldtimers left from this past year. welcome to everyone else. I have used this forum up until June after my second bx in four years.
History: female, dx four y.o/ Geno 1. First bx(2001) stage/grade1, second bx in June stage1 grade 1. In Oct of o4 ast went from 30 to 70 then up to 170 this past spring. Last monday I went for my 6 month check up and ALT was 301, AST 197. yikes!! My doctor all along has been telling me if I decide not to tx that I would most likely live my whole life out with this getting out of hand.. I have had it since 1973.I spent about 6 months here on the forum getting help and support in making my decision not to tx.  Now he said I should start tx. Besides for the RUQ pain, I have no other sx. I am active triathlete who just spent last summer going around the NW doing races and totally forgetting I had hep C. It was great. This last blood work really threw me for a loop. Anyone else have high AST?ALT's? I don't drink or smoke, don't do any drugs and have been on a vit. regimen since dx in 01.

Happy New Year  and good health to all of you.

[Forseegood]

Hi, I know what you mean, it's only in this last year that I've given serious thought to treating...my alts have gone up somewhat and I am getting more symptomatic, one thing that has really had me confused, I get this pain on my bone it feels like, right on top of my breast bone? It's weird, at first I thought it was my heart or something, but it's higher, right on top of the breast plate, between my breasts. (No comments from the peanut gallery...you know who you are! ha ha!) It's things like that that are wierding me out and making me want to take the plunge...my system is starting to put up this big immune response I guess, oh yeah, and fatigue... I was also dx in 01 and still have low liver damage. I am just finishing up some dental work and my doc is looking into some trials at the beginning of the year, but if that doesn't pan out I'm just going with what we got, (kicking and screaming, obviously, ha ha!) I have other issues that have to be looked into and thoroughly tested, like palpitations and anxiety-depression, but if it's doable, I'm going for it. I have also suffered intense migraines and am not looking forward to having those again, but will see....

To me it would be a lot harder if I were like you, with no symptoms and running triathalons, but I guess bloodwork doesn't lie, hope you come to some good decisions for yourself. Maybe we'll be treatment partners? Sorry you got this news, I know exactly how you feel....we'll be okay....

[Upbeat]

Those numbers seem really strange. Have you thought about a retest?  There are a host of reasons for high AST'S that have nothen to do with hep-c. If the numbers are correct I would start looking elseware as those numbers seem to have come on fast.
                                                      Ron

[couldn't think of a nickname]

Money, it is not unusual to have an AST that high when your ALT is that high. Some use the ratio for progression. For example, a 2:1 ratio of ALT/AST is usually seen when disease progression is not extreme, and your biopsies showed that. It is inexact, and controversial, but some do pay attention to the ratio, as does my doc. Mine are about in that range, too. They also went up at about the same rate. They do flucuate over time, so your next test could be different.

Forsee: It is quite possible that (after anything cardiac is ruled out) that you have an inflamation of your sternalis muscle, which is located right in the center of the breast bone. I have had that, as well as pectoral trigger points. If you have them, they can be quite painful to the touch. Obviously, you want to rule out other stuff, but if they are telling you that you are fine, that is very likely what it is.

By the way, something about your migraines: Are they with or without aura? is it in the back of your head?
If they are without aura, and in the back of your head, you likely have excessive neck and shoulder tension, as well as trigger points in your trapezius and levator scapulae muscles.

[Forseegood]

Hi, I think Upbeat makes a good point, there are a few things that could mess with alt readings. Hard exercise for one, if I were you, I'd get them tested at intervals to see if they go down - they might be tweaked by something youre doing, etc. New meds, even vitamin and herbal regimens could do it. That's why I've done a "tried and true" thing on my regimen, to make sure it wasn't messing with these blood readings, took a lot of hard work, ha! Titering up, adding things one by one and testing, etc. If anything, my regimen is very good for my alts because in a brief 2 and half month time I went off it my alts went up considerably, then back down again once I got back on my regimen.

All this testing is laborious I know, so that's why I go to this mobile lab that goes to this Long's Drug Store in my area, I'd imagine they might go to your area or there would be something similar in your area. I have cross checked this place with my normal doctor's labs and there readings have always been about the same so I have faith in them, been going to them for years. Here's the link, like I said, don't know what area you are in. They are reasonably priced, like 25 bucks a throw, and I sure prefer my finger poked then getting a blood draw! (I'm such a baby!)

http://www.westcoasthealthservices.com/index.html

You do seem to be in good shape so if this is just anomalous and not directly from the hep, it might influence your decision making process...hope this helps.....

[Forseegood]

Dude, you are such a find! Not to say that we are medical experts, but this is an excellent way to compare notes and maybe point each other in a good direction or to the proper authorities. Yeah, this has just been happening, and being the Woody Allen neurotic that I am, first thought it might be heart related, but like you said, it's not exactly in the heart area, and I would think the heart pain is more "internal" this seems to be a pain right on that bone you were talking about. It aches when I twist. I talked to this other friend I have with hep and he said he had it too, but of course, could be from something else...but it does seem like it would be an immune response deal because it has to do with inflammation.

What did you do for it if I might ask? Did it just go away on it's own or what? It's really the only pain I have, and it's not horrible. I do get occasional fibromyalgia type pain in my muscles and very occasionally in my joints, but I am 52, with hep c, and in menopause so maybe I'm doing pretty well considering. I just get the occasional palpitation and it goes away pretty quickly. Hate those. As far as the migraines, 10 years ago I got them really, really bad. You know, two or even three days in a fetal position in the dark, couldn't even look at TV or have any light or sound, even nausea. Was getting them weekly at one point, a dark time in my life to be sure... then like two monthly. Now just occasionally, maybe one or two a month. It's mostly a "right eye" pain and in back of the right eye, no light shows thank goodness. Only want those if I paid for a ticket! ha ha! Menopause causes migraines as well. And tx can exascerbate existing conditions, but not always, try to look on the bright side....

And yeah, to be honest, I know many people who get migraines from tx, some really badly, and knowing what they are, I don't relish that happening, at all. And I am allergic to many pain meds, anything morphine based, and that's most of them. I can't do that Imetrix stuff, I can't have anything that speeds me up, so yeah, not in the best position, but I'm trying to see what I can do. Thanks soooo much for your input as always, or anyone else's. Hope youre all having a great holiday, I will to later, ha ha!

[Forseegood]

Just wanted to thank you again for that tip about the "breast bone" thing, once you told me it was an inflammation thing, I did a steam, then ice packed it, and it feels a lot better! Funny, I asked a gp about it, told me it was prob normal aches and pains deal. Like I said, it's so great that we can compare notes here...


Also, have you ever taken glucosamine&chondrointin? Really works for a lot of people too, it's just a simple sugar I think, haven't heard anything bad about it. You just have to make sure you take enough of it, and it is kinda pricey. I think some people don't take enough. My mom said her arthritis in her shoulder was really bothering her, she hadn't taken some for a few weeks, just didn't buy any...and in one day she said her shoulder felt much better after taking it. Really good stuff.

[couldn't think of a nickname]

Glad I was of some help. GP's I don't think take the time or care sometimes to really help things like that. I think many don't really understand the widespread problem they can cause.

I have heard of the supplements you mentioned, and are intrigued by them. What has stopped me from trying it is that everything I have tried has made something worse, except for apple cider vinegar, so I have been reluctant to try it. apple cider vinegar can help arthritis too, by helping to flush out the crystals that form.

[cuteus]

whats wrong with apple cider vinegar? I always liked the taste. when it was a fad to drink it for weight loss, I realized the stuff is not bad at all. ANd that is the supermarket kind!
I can't believe people don't like the taste! I guess my taste buds are odd.

[couldn't think of a nickname]

Thank you so much for the kind words.
I have had my massage therapist work mine, but they may be more reluctant to work that area. Self-massage is taught very well by the Trigger Point Therapy Workbook, though. My PCP did say he thought my muscle inflammation was likely HCV related. It also tends to come and go. If you are noticing it while doing certain movements, then yes, it is probably that muscle. Apple Cider Vinegar has really helped me though, in my opinion.

I get palps (PVC's?) on occasion. They are very annoying. They come and go. They can be from many sources-thyroid function being off, GERD, positional, stress, etc. The esophagus and heart are innervated by the same nerve-the vagus nerve-that is why a stomach disorder can be the cause of those as well (at least from what I read).

The eye pain can also be caused by trigger points-some in the area of the back of the head, near the other muscles I mentioned, and also the SCM (sternocleidomastoid) which is in the neck. I have said many times that this virus can cause inflammation of the muscles for a variety of reasons, and a strong immune response could be part of it. The virus is myotoxic, and toxins remaining in the muscles are basically what trigger points are.

[jmjm530]

High ALT doesn't necessarily correlate with liver damage. Strenuous exercise, diet, herbs, rx drugs, supplements and a host of other things can influence enzyme levels. I know a lot of triathletes judiciously use pain killers and anti-inflammatories which can be a real problem if your liver is compromised.

I would therefore base my decision on whether to treat or not more on liver damage then enzymes or even viral load. If I read your post correctly you were stage 1 in '01 and are still stage 1 as of June. This is minimal liver damage that doesn't appear to be progessing. Therefore as a hard-to-treat geno 1, an approach of watch and wait could make sense, especially in light of better, newer drugs hopefully on the horizon.

In any event, before making any sort of decision I'd examine more closely my diet, including supplements, and perhaps tone down the exercise until my enzymes return back to base level.

-- Jim

[Forseegood]

Boy, you've unwittingly showed me what a hypocrite I can be. I'm always on people to change their diets for the better... that type of sanctimonious BS, and here, I have Apple Cider V. in my cupboard and I can't bring myself to drink it cause I just hate the taste...ha ha ha! But it's New Years resolution time...gonna down that stuff if it kills me! How hard can it be? Just chase it with some cran-ras juice or something! You are not the only one that touts it's medicinal properties, I know other people who benefit from it too. Thanks so much for the heads up on the points, message is yet another expense but well worth it if you find the right person. There are even people like Goofman that go to Extra terristials, takes all kinds!!!!

[couldn't think of a nickname]

If you think that tastes bad, you should taste the kind from the supermarket. I gave some to my mom who is getting over a cold, and she said the pure stuff tastes much better-it is less bitter. If you put it in enough water, I don't think it is so bad, and I hated the supermarket kind when I was a kid. Maybe that's why I don't mind the pure stuff as much now.

Don't feel bad. It sat on my counter for months before I started using it, now I am afraid to miss a day.

[Forseegood]

One more thing I forgot to add that's i've read, it's when your ast goes above the alt that is concerning...

[couldn't think of a nickname]

yes, a higher AST to ALT is often an indicator of progressed disease, and possibly cirrhosis. Platelets might be lower by then as well.

[Forseegood]

Hey you! I wrote you a post a little farther down below!, if you have time...just always appreciate your input! But it's not like youre going to get 86ed from here if you don't! he he he!

[couldn't think of a nickname]

When I was a kid, it really tasted kind of sour. Maybe it was because you expect water to taste like water. My mother says she likes the natural stuff much better, as it is not as bitter, and I think that might be it. When I was a kid, we used Heinz ACV. Now, I like the taste. Since I have never been a huge fan of plain water, I actually like it better LOL!

There may have been 1 other reason why I didn't like it as a kid. My mom MADE me drink it!

[jmjm530]

Apple Cider Vinegar -- especially Bragg's Apple Cider Vinegar with the "Mother" -- has been been touted by many health aficionados  as an all-purpose cure for ailments ranging from arthritis to obesity to hypertension to reflux to weight loss to even premature aging. In fact, Paul Bragg's best-selling book is titled "Apple Cider Vinegar -- Miracle Health System. I'm reading from the cover of the book which I own.

Personally, I have always liked the taste of vinegar and have used in cooking and in salads for years. BTW it's also a great non-toxic cleaning agent for the kitchen and bath.

One of the more popular claims is that Apple Cider Vinegar can cure reflux. I'm not sure of the origin or substantiation of this claim, but all I can say is that it didn't work for me or for most of the folks over at various GERD (chronic reflux) forums I've visited. Just wanted to share that before anyone started pouring it down the hatch who has stomach/digestive/reflux problems. That said, it may work for you.

-- Jim

[couldn't think of a nickname]

I have reflux too, and I also take Prilosec, but it has been better with using both for me. It is supposed to aid in digestion and neutralize stomach acid, which is supposed to reduce reflux. Many take it for weight loss. I actually put on 5 pounds during the first couple of months, which is what I wanted anyway. It is actually probably a better weight regulator more than anything.
Our massage therapist was drinking it straight. More power to her LOL!

[TnHepGuy_]

A continuing spike in LFT's can be an indicator of increased inflamitory activity, which in turn can be an precursor to further histological progression.


Here are a few articles realted to LFT's and histology:

<a href="http://www.hivandhepatitis.com/2003icr/03_assld/docs/pegasys/102703_i.html">Patients with Chronic Hepatitis C and Normal ALT Levels Show Impaired Quality of Life But Significantly Lower Liver Inflammation and Fibrosis Progression Compared to Patients with Elevated ALT</a>

(from the study)

"<i>Patients with chronic hepatitis C and persistently normal ALT levels show significantly lower liver inflammation and fibrosis progression rate per year compared with patients with elevated ALT levels.</i>"


<a href="http://www.hivandhepatitis.com/hep_c/news/2005/ad/102105_a.html">Natural Course of Hepatitis C Virus-infected Patients with Normal ALT and the Effect of Interferon Therapy on Hepatocellular Carcinoma in Those with Elevated ALT</a>

(from the study)

"<i>The progression rate of fibrosis was slower (in patients with persistently normal serum ALT level) than in chronic hepatitis C patients with elevated serum ALT levels.</i>"


<a href="http://www.hivandhepatitis.com/2004icr/ddw2004/docs/0602/060204_c.html">Factors Associated with HCV Stage 3/4 Fibrosis</a>

(from the study)

"<i>Univariate analysis revealed a significant association of 2 X upper limits of normal ALT and AST (i.e. > 80 U/L) ... were significantly associated with stage 3/4 fibrosis.</i>"


<a href="http://www.hivandhepatitis.com/hep_c/news/042803a.html">Progression of Liver Fibrosis in HCV Patients with Normal and Elevated Transaminase</a>

(from the study)

"<i>Anti-HCV patients with PNALT (persistantly normal ALT levels) with an initial fibrosis of F0 or F1 were less likely to develop progression of fibrosis than those with elevated ALT....</i>"



TnHepGuy

[jmjm530]

Thanks for the informative articles.

Regarding a spike in LFT's, I think the key word is "continuing".

In my case, the spike lasted 8 months which was more or less predicted by my hepatologist based on the assumption it was caused by either an herbal formulation, the hepatitis B vaccine, or a combination. Of course I was very worried but he kept telling me they would normalize and it did.

After 8 months, my liver enzymes returned to normal and in fact my viral load eventually dropped from 35 million IU/ml (prior to the spike) to 16,000 IU/ml (a couple of years after the spike.)

Moey, in your case, you really need to look at your lifestyle and see what might have caused the spike. My guess would be your triathlon training as I've also had exercise-induced spikes in the past.

Bottom line, I'd take everything into consideration with your treat or not to treat decision -- but I'd still make your biopsy results primary in that decision. I know you've had a recent one but if your enzymes are still high in six months or so, maybe a fibrosure or fibroscan test would help fill in the gaps before your next biopsy.

-- Jim

[jmjm530]

Curious, did you try the apple cider vinegar before you started taking the Priolosec or only with the Prilosec? Now that I'm on Nexium I have a little vinegar on occasion with a salad but I'm figuring the Nexium is buffering the vinegar somewhat. Also curious how much apple cider vinegar you take daily. I've been up to 2 Nexium a day with only partial success. Hoping things will get better when treatment is over.

-- Jim

[couldn't think of a nickname]

I can't remember which I started first, they may have been around the same time. I take one teaspoon in a full glass of water once daily, but many take it 2 or 3 times per day. My doc suggested once per day, that is how often his wife takes it.
From what I have read, it should work by itself, but when on tx, there are other things going on.

[jmjm530]

CTON said prev: "...but when on tx, there are other things going on"
---------
But ain't that the truth. :)

[couldn't think of a nickname]

Pretending you're playing quarters : )

I use Bragg's ACV, I order it by the quart as it is less than $4. On a salad though, I use balsamic vinegar. I LOVE that vinegar.