Liver function tests abnormal

[DianaCox]

OK, time to update.

Went to the PCP for the follow-up appointment on Friday the 27th. We decided to do another blood draw - and I got the results and they were a bit concerning - in less than 3 weeks, my ALT had gone up another 112 units (although AST stayed about the same).

ALT (SGPT)
0-32 IU/L
274 Above High Normal (was 162 on 1/9)

AST (SGOT)
0-40 IU/L
126 Above High Normal (was 136 1/9)

So, I made an appointment to see a liver specialist, which happened today. I should note that the specialist is with a GI/Liver group, and I also needed to discuss some GI issues - I have GERD and three times this week, I have awakened in the middle of the night and barfed acid and then mostly dry-heaved, despite taking 2 Protonix/day. My PCP in CA had suggested five months ago that I should see a GI doc and maybe get another EGD, as it was happening occasionally back then - but 3x in a week is MORE than a little annoying (especially being the barfophobe that I am, waking up and trying to mentally overcome the feelings of needing to puke, and usually failing, is very disturbing).

So, we discussed a variety of things, and came up with this plan:

• He wants me to stop taking my vitamin A and D for a week and retest
  • My vit D3 level (taking 10 50K IU caps/week) is 100.0, with normal range 30.0-100.0
  • My vit A level (taking 3 25K IU caps/week) is 81, with normal range 26-82
• As it happens, I haven't taken my tiny Adderall prescription for the last three days, and I was thinking about stopping taking it altogether (turns out to be a bigger PITA here in AZ to get refills, and I'm not sure I need it anymore anyway)
  • He wants me to stop taking it too
• I'm going to do a trial of Dexalent once a day, before dinner, instead of Protonix, twice a day (which I've been taking after breakfast and just before bed, which he said was not the optimal way to take it - should be an hour BEFORE food, not after)
• And he's going to run some tests for various vital hepatitis types (I know I don't have HepC, or at least I didn't a couple of years ago), and some odd autoimmune diseases, when I get the bloodwork done in a week or so.

He also reassured me that it is likely not much of anything, just a reflection of my mild steatohepatitis/fatty liver which was caused by years of obesity, and which didn't get better when I lost weight - plus getting older. Great :eyeroll:

If things get worse, he'll do a fibroscan and maybe liver biopsy. I do NOT want to have to have the biopsy, that's for sure.

Next up (in a while - I need to deal with this first) is making an appointment with a nephrologist for the kidney cyst.

 

[DSRIGGS]

I am sorry hear that your levels jumped again, Diana. It sounds like the GI (that is my liver specialist as well) has you on a prudent path. You are kind of of the other side of the coin from me. My liver is hardened with the bridging fibrosis but my function is excellent. Let's hope things reverse and get back to normal for you.

Waking up to that acid in your mouth and if like me when it happens,up into the nose through my throat, is horrible. Hopefully the dexilant works for you. Cameron was on that one for a little while but it did nothing for him and that is why he got the Nissen Fundoplication. That being said, I know a few others from whom Dexilant works quite well.

Your A and D levels leave me envious.

Best wishes for you with the Dexilant and the liver regimen.

 

[DianaCox]

"Your A and D levels leave me envious." - Unless of course, it's too much of a good thing.

Thank goodness, it does not come up my nose - that would be even more awful. At 3 am, there's essentially nothing in my stomach - just the spit I've been swallowing in the minutes before, as when I get nauseated, my mouth starts to water uncontrollably. My stomach empties quite efficiently, especially at night, so I usually eat something right before bed - last night, I had a yoghurt to "top off" and coat my stomach, and I got sick anyway.

Anyway, this is not fun - but I have to keep reminding myself that (1) it's probably NOT related to my DS (unless I'm ODing on vitamins), and (2) if I had not had the DS, I would possibly have been dead from something else by now anyway. And (3) my mother, who is almost 85 and was SMO most of her life, is not dead yet, nor is my almost 86 year old father, and among her many ailments and his small handful, liver issues are not involved. And I never drank much, and was a piker compared to most of my generation when it comes to taking drugs.

So this CANNOT be anything.

 

[DSRIGGS]

Yeah my envy of the A and D levels is that you should be able to get the A down quickly and D as well but just backing off your dosage a little.

I rarely get the full reflux anymore and like you I empty quick. In fact I often eat something around midnight to 2 and go back to bed.

You have a lots of positives on your side so I am sure you will get this one figured out and everything back in relative order soon so you can grow to be an old lady.

 

[aaa]

Glad to hear you are in a specialist's hands.

Interesting what you said re: perhaps taking too much of some vitamins. I've found that is a truism (at least for me).

 

[Larra]

Sounds like a good plan. Did you ask the GI guy whether or not it's a good idea to eat something before going to bed? Many docs recommend against that for someone with reflux. Just a thought.

 

[DianaCox]

I didn't ask, but for me at least, my reflux/nausea is worse if I don't have something mild on my stomach before bed. Often, I have Rice Chex with milk, for example. But when I barf a few hours later, there is nothing in my stomach - just spit and maybe a little acid. Mostly spit, because when I start getting nauseous, my salivary glands go into overdrive, and I've usually swallowed a lot of spit before I barf.

 

[Clematis]

Yuk. I sympathize with the nighttime regurgitation. It's not just unpleasant, but its frightening as one feels one is asphyxiating. Per my doc, I no longer eat after 8p and sleep elevated on a bed wedge -- it helps me.

Don't fret about the kidney cysts. I have them. They're very common and of no importance. They're one of those things that no one would know about unless one has an X-ray/ultrasound for something else. (In my case, kidney stones.)

 

[DianaCox]

Thanks for the encouraging comments - please know that I'm not TERRIBLY concerned - just sharing this part of the journey, in case other end up on the same path. I still don't know what is causing the problem, or if it's just something to live with because of my age and long history of obesity. If it is excess vitamin A and/or D (which I doubt, because I'm at the top of normal, and nowhere NEAR toxic levels), that's an easy fix. If it is something else, I'll deal with it.

I'm also not very concerned about the kidney cyst - except for the possibility that it has a stone in it that I don't know about. A couple of years ago, there was a little blood in my urine, and they did a CT scan and cystoscopy, and didn't find anything, but an occult stone might explain it.

 

[Larra]

I've never heard of a kidney stone inside a cyst, though I suppose you never know. And 90% of kidney stones show up on x-rays, and benign kidney cysts are very common, so that's probably all it is.

 

[DianaCox]

This is what I was referring to:

"The left kidney measures 10.2 x 5.2 x 5.9 cm. There is several peripelvic renal cysts, largest measuring 1. 7 x 0.9 x 1.5 cm size which has a 5 mm echogenic peripheral focus, perhaps a nonshadowing calcification."

I was wondering if this could be a stone.

 

[Spiky Bugger]

I didn't ask, but for me at least, my reflux/nausea is worse if I don't have something mild on my stomach before bed. Often, I have Rice Chex with milk, for example. But when I barf a few hours later, there is nothing in my stomach - just spit and maybe a little acid. Mostly spit, because when I start getting nauseous, my salivary glands go into overdrive, and I've usually swallowed a lot of spit before I barf.

Sounds like what some of us went through with the band. Body "detects" a blockage/obstruction (courtesy of the band) and tells brain. Brain says, "Oh...I can fix that...I'll just send a metric shit tonne of mucousy saliva to ease that on through." That, of course, ADDS to the problem.

So, in a restaurant, a spoon of soup, another spoon, suddenly saliva...and I was dashing for the restroom because the course was already set in stone.

Hope you can get it fixed soon.

 

[DianaCox]

This is just straight up being nauseous for no discernible reason. Sometimes I can will it away, but most of the time I fight it for agonizing minutes till I barf and dry heave.

 

[OldBroad]

Have you ever had any success sucking on a tiny piece of candied ginger or chewing on a bit of pickled ginger when you are suddenly nauseated? It sometimes works for me when I get a rare wave of nausea.

Regarding reflux, I only seem to have that problem when I eat right before I go to bed. I try not to be that dumb, but I sometimes forget late at night and pay for it half an hour later when I wake up choking and gagging. When that happens, I'm up for another hour nibbling on a Tums and slowly sipping water until everything settles back down.

 

[DianaCox]

Nothing can go in my mouth once the nausea starts - massive salivation happens. And I am more likely to get sick if I DON'T eat right before bed. I don't think it's actually reflux - it's something else. My stomach is EMPTY when I get nauseous.