Liver function tests abnormal

[DianaCox]

Well damn. Had my annual labs, and the numbers are back up.

Date ..... AST (0-40) ... ALT (0-32) Comments
1/9/17 .. 136 ............... 162 ........... Initial appointment

1/27/17 . 126 .............. 274 ........... Recheck

2/20/17 .. 74 ............... 145 ........... After stopping Vit A, D, K1, K2

5/18/17 .. 48 ............... 184 ........... After resuming ½ dose of Vit A, D, K1, K2

8/10/17 . 237 ............. 249 .......... Still taking 1/2 doses of vites.​

My D was 90.7; my A was 75 (both near but not at the top of the range (D: 100; A: 82).

I've sent the results to my liver doctor. I suspect a liver biopsy is in my future.

 

[Munchkin]

That will be no fun at all!

 

[DSRIGGS]

Well my friend, unfortunately I do agree that a biopsy is probably advised at this point. You should have done it the easy way and just had surgery on your gut and had it biopsied then.

 

[hilary1617]

@DianaCox best wishes - hoping the liver numbers can be reversed while still maintaining sufficient vitamin levels.

 

[DianaCox]

OK, just got back from the liver doc. His opinion is that I'm having mild progression of my previously diagnosed mild fatty liver disease (diagnosed in the liver biopsy during my DS 14 years ago), probably fibrotic disease. He's not overly concerned - yet.

We discussed doing diagnostic tests, including liver biopsy and fibroscan (the latter is not invasive), and whether there was any treatment decision that would be influenced by the results, and he said no. So not for now.

However, he wants to refer me to a local liver research center at Good Samaritan Hospital Liver Center, where they are doing clinical trials on new therapies for liver fibrosis, and in particular they have access to a newly approved drug that has not yet been marketed. Dr. Google and I think it's this: https://en.m.wikipedia.org/wiki/Obeticholic_acid @DSRIGGS

The referral is likely to take a while; in the meantime, he prescribed the following:

• Start taking Vitamin E - does anyone have a source for dry form?
• Start taking fish oil - again, what is recommended for DSers?
• Lose weight - I've regained about 8 lbs in the last 2-3 mo since the unfortunate discovery that Sugar Smacks (now called Honey Smacks) are still sold (my childhood favorite cereal that my mother wouldn't buy - I stopped buying it about 3 weeks ago) - the doctor said even a mild weight increase can adversely affect liver enzymes in this setting - and/or increase my reflux by increasing pressure on my small hiatal hernia - and that may also explain my increased frequency of nausea lately that I of course have assumed is from jaundice.
• Get labs redone in 3 mo and come back for recheck.

So, I'm not dying yet, and need to do what I should be doing - lose weight, eat fewer carbs.

And he said I could continue to have an occasional drink. Not a lot of course, but I can't drink much without getting an alcohol flush, so I like a half a jigger of gin in a tall glass of tonic water (by the way, diet tonic water is delicious).

I'm going to try to lose 15 lbs, or whatever it takes to get myself to 159. Hah.

 

[Ever Changing]

I've bee taking this dry E

https://www.amazon.com/gp/product/B003O1OCH4/ref=oh_aui_search_detailpage?ie=UTF8&th=1

I'm only 2 months out, so I haven't had lab tests yet.

 

[Larra]

Did he also recommend avoiding Tylenol?

 

[DianaCox]

Did he also recommend avoiding Tylenol?

Yes - fortunately I never take it, except on the rare occasion that I take a codeine (haven't had one in probably a year or more).

 

[Spiky Bugger]

Did he also recommend avoiding Tylenol?

Any ideas on non-NSAID, non-"Tylenol" pain relief?

I've never found Tylenol to provide much pain relief, and I cannot take NSAIDs...so I'm part of the army of senior citizens loaded on Vicodin/Norco...which means I get way more acetaminophen with my hydrocodone than I want or appreciate. While I have developed a tolerance for my drugs, I'm not dependent on/addicted to it...so far.

IOW, while almost every day starts with one Norco, and some days--"barometer bunion" type days when arthritis makes itself known--require a second dose, I almost never use the max prescribed number of four 10mg in one day. My one-month Rx for 120 tabs* always lasts OVER two months, sometimes three. And I NEVER "need" a Norco the way I "needed" a Valium...because "it's time for another one," or because "I don't feel right" without one. We could set a clock by when I needed my next fix of Valium...not so with Norco.

So I am far more worried about the acetaminophen part than the opioid part.

Any liver-saving suggestions, especially for those among us who may have started with liver issues?




*The relatively large "allowance" is because if there is an Interstitial Cystitis flare or an escaping kidney stone, I do use tbe max amount...or even graduate to oral dilaudid. Luckily, I haven't needed that much help in a while, but Wednesday night/2:00 am on Thursday-- second night post-op on the mystery I had removed from my knee--when
I tearfully awakened Mr. Sue to pamper me with ice packs, I might have gone there. Poor Me!

 

[Spiky Bugger]

OK, just got back from the liver doc. His opinion is that I'm having mild progression of my previously diagnosed mild fatty liver disease (diagnosed in the liver biopsy during my DS 14 years ago), probably fibrotic disease. He's not overly concerned - yet.

We discussed doing diagnostic tests, including liver biopsy and fibroscan (the latter is not invasive), and whether there was any treatment decision that would be influenced by the results, and he said no. So not for now.

However, he wants to refer me to a local liver research center at Good Samaritan Hospital Liver Center, where they are doing clinical trials on new therapies for liver fibrosis, and in particular they have access to a newly approved drug that has not yet been marketed. Dr. Google and I think it's this: https://en.m.wikipedia.org/wiki/Obeticholic_acid @DSRIGGS

The referral is likely to take a while; in the meantime, he prescribed the following:

• Start taking Vitamin E - does anyone have a source for dry form?
• Start taking fish oil - again, what is recommended for DSers?
• Lose weight - I've regained about 8 lbs in the last 2-3 mo since the unfortunate discovery that Sugar Smacks (now called Honey Smacks) are still sold (my childhood favorite cereal that my mother wouldn't buy - I stopped buying it about 3 weeks ago) - the doctor said even a mild weight increase can adversely affect liver enzymes in this setting - and/or increase my reflux by increasing pressure on my small hiatal hernia - and that may also explain my increased frequency of nausea lately that I of course have assumed is from jaundice.
• Get labs redone in 3 mo and come back for recheck.

So, I'm not dying yet, and need to do what I should be doing - lose weight, eat fewer carbs.

And he said I could continue to have an occasional drink. Not a lot of course, but I can't drink much without getting an alcohol flush, so I like a half a jigger of gin in a tall glass of tonic water (by the way, diet tonic water is delicious).

I'm going to try to lose 15 lbs, or whatever it takes to get myself to 159. Hah.

And you, my favorite oenophiliac...I dunno. You and Queen Elizabeth! (And the four-drinks-every-day rumor about her has been declared false, so you are probably safe, too!) You are one of those classy broads who knows and appreciates tbe difference between stuff like cordials and apéritifs, and which to drink before a meal, and Dubonnet! When the hell do we drink Dubonnet? You know these things...and you buy good wine. So...just in case...

While you are losing those 15 pounds...consider temporary Prohibition. Your liver may love you more and stick around longer.

 

[DianaCox]

Most of my alcohol consumption these days is a flavoring amount (1/2 oz or so) of gin in a tall class of diet tonic water and lime. And that's about 2-3 times/week.

I'm not much of a wine or beer drinker anymore - my face and neck sweat when I drink, which is not pleasant. Most of my alcohol consumption occurs in late afternoon and not with a meal.

 

[Spiky Bugger]

Most of my alcohol consumption these days is a flavoring amount (1/2 oz or so) of gin in a tall class of diet tonic water and lime. And that's about 2-3 times/week.

I'm not much of a wine or beer drinker anymore - my face and neck sweat when I drink, which is not pleasant. Most of my alcohol consumption occurs in late afternoon and not with a meal.

I so want to go there. I don't drink alcohol on top of meds...and I've been on a lot of meds.

I want to sit at that restaurant we went to in Huntington Beach and watch the ocean whilst I consume a mojito. And later, I want some sturdy red wine.

 

[Clematis]

Fearing kidney damage from all my kidney stones, my PCP switched me from Meloxicam (prescription NSAID) for arthritis which I loved to Trama-dol which I hate and won't take. It's a quasi opioid. It makes me nauseous and narcoleptic -- I respond to it similarly as I do to Comodol (British version of Tylenol with Codeine which they gave me for kidney stones saying, "this probably won't help much"). Oddly, I don't have the same reaction to Percocet which is stronger. Since I really do need morphine or Percocet when a stone acts up and since Trama-dol would show up in a tox screen at an ER as an opioid, I fear I would be written off as a drug seeker and left to scream through a stone. Or they wouldn't give me morphine for risk of an overdose. I take nothing for arthritis now unless it is really bad in which case I do take ibuprofen. Or a glass or two of wine -- which results in next day inflammation and worse arthritis. Oh well.

Perhaps Trama-dol will work for you... but I don't think it is as strong as Norco. But you could always take two.

There is no hyphen in Trama-dol but it's a fucking "banned" word. (Fuck is, of course, perfectly acceptable.)

 

[southernlady]

There is no hyphen in Trama-dol but it's a fucking "banned" word. (Fuck is, of course, perfectly acceptable.)

That's because spammers love to link to prescription meds so to keep them away, we banned the most used prescription med words. They don't care about words like fuck!

 

[DSRIGGS]

OK, just got back from the liver doc. His opinion is that I'm having mild progression of my previously diagnosed mild fatty liver disease (diagnosed in the liver biopsy during my DS 14 years ago), probably fibrotic disease. He's not overly concerned - yet.

We discussed doing diagnostic tests, including liver biopsy and fibroscan (the latter is not invasive), and whether there was any treatment decision that would be influenced by the results, and he said no. So not for now.

However, he wants to refer me to a local liver research center at Good Samaritan Hospital Liver Center, where they are doing clinical trials on new therapies for liver fibrosis, and in particular they have access to a newly approved drug that has not yet been marketed. Dr. Google and I think it's this: https://en.m.wikipedia.org/wiki/Obeticholic_acid @DSRIGGS

The referral is likely to take a while; in the meantime, he prescribed the following:

• Start taking Vitamin E - does anyone have a source for dry form?
• Start taking fish oil - again, what is recommended for DSers?
• Lose weight - I've regained about 8 lbs in the last 2-3 mo since the unfortunate discovery that Sugar Smacks (now called Honey Smacks) are still sold (my childhood favorite cereal that my mother wouldn't buy - I stopped buying it about 3 weeks ago) - the doctor said even a mild weight increase can adversely affect liver enzymes in this setting - and/or increase my reflux by increasing pressure on my small hiatal hernia - and that may also explain my increased frequency of nausea lately that I of course have assumed is from jaundice.
• Get labs redone in 3 mo and come back for recheck.

So, I'm not dying yet, and need to do what I should be doing - lose weight, eat fewer carbs.

And he said I could continue to have an occasional drink. Not a lot of course, but I can't drink much without getting an alcohol flush, so I like a half a jigger of gin in a tall glass of tonic water (by the way, diet tonic water is delicious).

I'm going to try to lose 15 lbs, or whatever it takes to get myself to 159. Hah.

I take 1,200 mg of Now Foods Dry E. I've never done fish oil.

Even though I have stage 3 Liver Disease my function is good. According to my GI who is a liver specialist, my bridging is a serious structural defect that won't reverse but it shouldn't worsen unless I really abuse it. He told I am fine to take Norco for my chronic pain but just watch the labs. He said I shouldn't drink though, but I am not much of a drinker anymore so not a huge deal. I will admit that on Dianna's last Saturday I drank a bucket of wine but that was the first in a year or so.

Hopefully

Hopefully you can stop your progression as well.