Does this sound like Cirrhosis or just Fatty Liver?

[JonBoyOhBoy]

First off, I am a hypochondriac, and I have OCD and GAD. I am at a doctors office every week.

Im 47 and have a history of on again and off again drinking.For about 15 years I drank quite heavily, late 80s early 1990s. Been to doctors for check ups got the usual high liver enzymes etc. Was told I had a fatty liver based on ultrasound.. I stopped drinking in 1998 completely. a couple years latter I have an ultrasound and to my happy surprise my fatty liver was gone!

Then for some weird reason I started again in 2007 and drank for 3 years until 2010. But I wasn't drinking like I did in my 20s. Hell I couldn't. Back in those days I could drink all night, get 4 hours sleep and be good to go. But now in my 40s, 4 pints of beer and I was toast, and felt it the next day.
My last drink was September 21, 2010 after I had a ultrasound. My blood work was almost normal, I don't remember the values but the ALT was elevated by 1 point and the AST 2 points below that. something Like 47/45 I request an abdominal ultrasound with doppler. The report comes back:
"moderate to sever fatty liver with mild hepatomegaly" !
Scared the hell out of me. I never drank again after that. All liver enzymes were normal, spleen normal, no portal hypertension.

About a year ago I got a follow up ultrasound to see how the severe fatty liver was doing. This second ultrasound  was done in the doctors office on a portable machine and sent out to a radiologist to read. I don't recall but I doubt it was was a doppler. I just hope it was accurate :(
One week latter i get the call to come in: I read the conclusions: Untrasound of the abdomen was NORMAL. I jump for joy! Wow in a year fatty liver was gone! I quiz the doctor "are you sure". We look at the report more closely. Up on the top where it describes the findings of each organ, spleen was normal, kidney normal, liver was MILD FATTY INFILTRATION of the liver
The doctor says this is good news though. I went from SEVERE to MILD and there is no mention of enlargement on the second scan. I assume the radiologist didn't think the fatty liver was significant enough to include it in the diagnosis, but merely mention it in the detailed findings above.

Just to throw more confusion into the mix,
I have been diagnosed with low testosterone (not from any liver problem, its been since teenage years) SO I just recently about a year ago began T replacement. I have been having monthly blood work due to the T problem, and with that of course he has been checking my liver. But I just found out, all they really check is AST ALT BILIRUBIN and AlBUMIN. But its been every month because of the low T. Blood all looks normal. My AST and ALT droped to the mid 20s from the high end.The only exception is my Bilirubin which has been bouncing between .08 to 1.3. the doctor says under 1.5 is normal, but I'm jealous of people with .05 totals.

Now that I laid the groundwork, here is my question: being a hypochondriac, I tend to obsess over things. Im constantly checking my abdomen for distended veins and my palms do look red. when I showed my doctor he thought it was more of a carotine red than true palmer erithmer. I have found a few small spider veins here and there. At 48 I am assuming some of these are normal.
After I work out I notice a couple of veins on the sides of my chest and abdomen seem to become more visible, I can almost "feel" one through the skin. I attached a photo. I tried showing the doctor but he said he didn't see anything. Its there, but not all the time.
I am also attaching a copy of my most recent blood test.
I donate a pint of blood every 8 weeks to keep the RBC and Hematocrit in check, the elevated numbers seem to be a side effect of testosterone.I wish I knew the platelets but apparently they don't check that for the purposes of testosterone monitoring.
with high hematocrit and hemoglobin can you have low platelets?

Tomorrow I have an appointment with my gastro doctor. so my question is, do you think I should push them for yet another ultrasound, or should I just monitor with blood testing.  Based on what I told you, does this point to cirrhosis?

Labs January 2012

Total T 905
Free T 108
E2 62
A1C 4.9
Glucose 95
Creatnine 1.0
Bilirubin 1.1
Albumin 4.9
ALT 36
AST 19
Hemoglobin 18.1

[mekla2000]

You should check your GGT level.

[skcylist]

I sympathize with the OCD part.  I tried drinking to alleviate OCD related anxiety and ended up in rehab. More if interested:
OCD (obsessive compulsive disorder)  

SC  February 7, 2005

I probably had it for years without knowing it.  Initially, virtually asymptomatic.  Early signs:  At age 11 or so, I read about a Red Skelton’s son dying of leukemia.  I then worried for years that I was going to die of a similar illness.  Uncomfortable, but bearable.  Worry was intermittent, not constant.  Functioned OK in society.   Later obsessions included fear of being gay, fear of public toilets, fear of killing myself in a plane crash. Garden variety OCD stuff.  Still functioned OK in society, but believe OCD prevented me from getting married.  Maybe a good thing anyway ;-)

OCD dam broke in Feb 2001 when an audit caught me cheating and triggered a cascade of various obsessions.  After roughly 6 months of OCD hell, therapy and medication, I resorted to alcohol after 18 years of sobriety.  This ended Christmas Day 2002 when I seriously considered suicide.

Dec 26, 2002 I asked a friend to drive me to re hab, where I spent the first 4 days on my journey back to sobriety and sanity.  

It’s been a slow, painful journey, but I am nearly back to “normal”.  

I stopped taking meds a few months ago and haven’t felt the need for therapy for months either.  

The things that helped me:

Initially, therapy and meds at least gave me the sense I was tackling the problem.  In the end, I don’t know that either helped all that much with the exception of Klonipin (clonazempam), which took the edge off my anxiety.  A few months ago, I began to wean myself off 1-3 mg a day to zero.  None of the SSRI’s seemed to work for me.  I am skeptical about ERP, as that seemed like nothing more than spending time doing what I was doing all day anyway: obsessing about something fearful.  Eventually, it seems I achieved the same result on my own. The ERP concept is probably correct.  

I also sold my farm which might be claimed to be an avoidance, but on the other hand, relieving stress and subjecting myself to a radical change in lifestyle proved to be helpful.  Breaking an ingrained pattern of living may be therapeutic for an obsessive personality. I am glad I did it.  

I also took up road cycling.  I have for decades been athletic, and exercise and endorphin “highs” are vital to me.  This has kept me busy and physically pumped up.  I find other athlete riders a good group for socializing.  It is a risky sport and it has been therapeutic to take on the risk, rewarding to survive, and willing to accept any outcome.  It makes me confident and positive just putting that down.

Helpful:  Books: Brainlock and From Panic to Power.  Clonazepam if used as prescribed.  Therapy offers insight and possible relief from the problem.  Regular exercise, good diet. Socializing.  Any close friend and confidant who has coped with or vanquished OCD extremely helpful. Possibly a radical change to lifestyle as long as it’s not  blatant “running away” in the vain hope that will cure OCD.  My Jack Russell Terrier has been incredibly therapeutic!  Old Time Radio tapes/TV (any relaxing media) to aid with sleep. Patience and time. Acceptance and surrender.  Sometimes it’s just a matter of holding on as, day by day, by miniscule degree, one gets better.  It’s worth the effort as one begins to enjoy and appreciate life once again.

As I recovered from this late life crisis, I began to let go long held obsessions, fears and “deep, dark secrets”.  I didn’t feel so threatened. Physiologically more relaxed, biological functions even seemed to work better. In the end, this traumatic experience (however exaggerated), has been cathartic and liberating.  

OCD can become a non issue in one’s life.  No matter how hopeless it may seem during a major OCD episode, don’t lose sight of that probability.  

[Paderla Anitha, DNB]

Hello and hope you are doing well.

As your doctor has assured you, the liver function tests are normal. If you are worried about cirrhosis, it can be detected by an ultrasonography, but unlikely because of your normal results.

Hope this helped and do keep us posted.

[JonBoyOhBoy]

I had a visit to my gastro today who assured me I'm fine,n he thinks my problem is more of an anxiety issue then a liver disorder. He ordered a new set of bloods, but he says he's only doing this to appease me, he sees no reason for it. sorry for the neurotic behavior. He was quick to point out that I had 3 ultrasounds in the last 2 years and almost 20 blood tests all relatively normal.