Week 4 #'s: UND but still with high liver enzyme? How come?

[aiuta]

Dear Forum Friends,

I hope you're having a good day.  Did shot #5 in stomach Saturday night and so far the symptoms are more bearable than when I injected in the thigh.  Maybe it's because I have more fatty tissue on my stomach than my thigh.  Don't know why, but since I had been feeling so down and out, I'll take tbe reprieve, even if it's temporary.  

I got my Wk 4 results. The viral load came back undetectable, down from 140 when I began tx on 7/15 (that down from 3,143,000 in late April).  I got the illness in mid-March 2006.  
I AM WORRIED BECAUSE I STILL HAVE A HIGH ALT LEVEL. The GOT has returned to it's norm of 15 or 17, but the ALT has been hovering out between 58 and 62 for the last two months.  I have years of tests where both these numbers consistently fell between 10-20.  

Did any of you still have high liver enzymes when you were at undetectable?  Is it possible that my liver enzyme has been permenantly affected and will never return to normal?  Does this mean I had serious liver damage?  They did NOT do a biopsy on me, since I am acute, but they DID do an ultrasound, which revealed no problems.  Every once in a while I'll still feel pain under my lower right ribs and I wonder if this is because of liver damage.  What do you know about this?  What about my somewhat high for THE norm, but definitely high for MY norm ALT?  

Thank you so much for your posts and for your responses.  
YOU GUYS ROCK, ROLL AND BOOGIE and I ALWAYS look forward to reading the forum and to seeing how you are doing.  
  
God bless to you all,
Aiuta (the Acuta)

[aiuta]

Thanks for comments Susan, jmjm and friole.  By the way, the test the came back as UND was sensitive to 10.  Gotta go back to work.  Have a great day.  -Aiuta

[susan400]

I used to have both my ALT and AST go normal when I treated. However, this time, my AST stayed above normal and never came down into normal range.  My ALT dropped really low.  I don't know that the liver enzymes are that worrisome unless that start getting really high.  I don't get that concerned about it until it starts getting up around 100 and above.  My Dr.'s don't seem to get too bothered about it at this point until that get up there.  Used to, they'd get all upset by it when they were around 60. But, now that they know I've been chronic with this Hep thing and have treated all these times w/o clearing, they just are like, 'that's to be expected' type of way of thinking.  Because there's really nothing else I can do about it.  I'm a long way off from having to worry about life/death/transplant issues.  I'm just enjoying not being on treatment right now.  Even with the post treatment issues.  Try to think positivity.  I know that it's hard to do that when you're on treatment. The meds mess with our heads.  Hey, I made a rhyme! MEDS MESS WITH OUR HEADS.....   ain't that the truth.  I'm being silly.  Well, take care of yourself and God Bless.  Susan

[friole]

Such excellent news.  Do you know the sensitivity level of the test given?  My ALT and AST went up during treatment too - I don't think it is of major concern.
frijole

[jmjm530]

aiuta: I need to CHILL and just appreciate that this is UND.
------------------------
Just as a reality check, the question you asked is a very logical and important one that many have asked before, and most in your position would be concerned about. I was also concerned when my enzymes spiked a little -- in my case after treatment -- and so posted here as well as called my doctor.

Not that anyone has suggested otherwise, but please feel free to ask any question on your mind regarding your treatment, no matter whether you think it's focusing on a "negative" or not.

No studies that I'm aware of that the stomach or thigh are better areas to inject. Personally, I always went with the area that had the most fat and that tended to give me the least amount of injection area irritation as well as side effects -- especially when I injected the "helper" drug Procrit. My NP as well as other recommend to rotate the injection sites.

Here is a good diagram: http://janis7hepc.com/treatment_help.htm#h

Good luck with your treatment.

-- Jim
The area is to avoid is the waistline and the belly button area.

[GoofyDad]

MIne were high at week 4 too, and I was unD as well. By the next test at 8 weeks they had settled down. Then they rose again way down the road. Whatever. Try not to worry - you're doing fine.

[cuteus]

that is great news! you are on your way to a cure!  I am glad you decided to treat and not wait to see if your body got rid of it by itself. It does not happen in 80% of people and why chance it when the cure rate is high with tx in the acute stage?
excellent!

I did both the tummy and the thigh, and since I felt no reaction from the tummy shot, freaked out that it might not been absorbed, so I went back to the thighs and stayed there for the shots. I also felt less discomfort from the shot.
take care

[Mister beagle bailey]

Being UND at 4 weeks is great but it takes time to get you #'s down, give it some time.  Your on your way.

Beagle

[aiuta]

Thanks for your comment, Mister Beagle Bailey.  We must have posted at the same time, and that's why I hadn't seen your note when I wrote my previous comment.  -Aiuta

[aiuta]

Dear Jmjmc530, AK - Hepper, Amommy, Snookmeister, Goofydad and Cuteus,  

Thanks for your comments.  They helped me very much, especially to feel like this situation isn't so drastic.  AK - Hepper, you are absolutely right: I need to CHILL and just appreciate that this is UND.  I forgot to mention that these meds have put me into a major "mixed" depressive episode (I have been treated for bipolar for the past 8 years), so that could help explain why, rather than celebrate the current VL victory, I choose to remain focused on the "negative" fact of the still elevated ALT.  

Regarding the tummy and the thigh, Cuteus, thank you for what you said, because it's exactly how I feel: I'm beginning to freak because I haven't been having symptoms this week: "Does this mean it's not working?" I ask.  Are there any studies on thigh versus tummy that you have seen?  Again, perhaps I should chill BEFORE MAKING ANY MAJOR DECISIONS about this or anything else right now-- especially with my probably at 1/3 capacity brain and body that are undergoing Interferon/Ribaviron tx as well as suffering from PTSD as a result of a recent trauma, a mixed depressive episode induced by the Int/Riba, and simultaneously attempting to adjust to a serious mind cocktail (Int/Riba plus 1200mg of Lithium, 60 of Prozac and clonapin PRN since initiating tx, as well the Vicaden they now want to give me for my migraines that have come on since tx (I'm waiting to meet with the psychiatrist to see what he says, because my inkling is no for this one, but if you guys have any thoughts or experience with Vicaden, they are always appreciated).  

Thanks again, everyone.  As always, I feel better after sharing with you and receiving your feedback.  I'm only sorry you are meeting me at such a difficult moment of my life.  Five months ago, before I even knew what Hep C was, I was a much happier, more stable girl.  Of course, had none of this happened, I never would have met you guys or the other fine specimens/characters I've met since it all occurred.  Thank you again for your service, understanding and kindness.  

-Aiuta  

[Mister beagle bailey]

Being UND at 4 weeks is great but it takes time to get you #'s down, give it some time.  Your on your way.

Beagle

[Snookmiester]

My ALT's elevated while on tx, and did not normalize until the discontiuation of tx.. Dr. Cecil commented about it at www.hcvinprison.org
Look for the thread started by me about a year ago.. It is very common.
I am now 11months post tx, and still undetecable.. Don't let it worry you, as I've already done the worrying for you on this matter. I even went to 3 different Dr's for opinions, ending up in the hands of Schiff who also said it was common, and seen particularly more with patients using Pegasys..

[amommy]

Hi there!
Just wanted to let you know that my liver enzymes actually went up while on tx and did not normalize until my LFT's done at 4 weeks post.  They were higher than they have ever been while on the drugs, and as of 3 months post, I am still clear!  So, it very well might just be the drugs.  Hang in there! I thought for sure it meant the meds weren't working, but in fact that doesn't seem to be the case!  Good luck. :)

[AK - Hepper]

Wow, you need to step back and take a breath and calm down a little. :-) You say you got the disease in March of this year and you're worried about liver damage? It doesn't happen that fast.
Your viral load was 140 when you started treatment? You body may have been spontaneously killing the disease without any help from interferon, that happens in about 10 percent of patients.

My enzymes only got down to normal after about 9 months on tx and I was undetectable at 24 weeks. I DID relapse afterwards, though.

Undetectable at 4 weeks is fantastic news, you should be celebrating that, not worrying about your enzyme levels. Lots of factors can make them rise, your body may be taking a while to get used to the medicine. They aren't even really all that high, anyway. Mine was over 200 at one point, lots of people go way higher than that, even.

Good luck to you, you are doing great!!!

[jmjm530]

We've had several people here with elevated ALT's who still cleared the virus. It could be a number of things including the treatment drugs themselves. As long as you stay non-detecible, the enzymes will most probably return to normal later in treatment or after treatment is over. Being non-detectible at week 4 is very promising. That, combined with the fact you're treating a relatively acute infection should give you excellent odds of a successful outcome.

I also had better results injecting in the abdomen and the drug absorption seemed more "even", probably because as you suggest there's more fat in that area for some of us.

All the best.

-- Jim