31 point rise in ALT over weeks

[sillygirl1122]

Hi Everyone,

We've been watching my ALT and AST since last February when they came back high....106 LT and 63 AST. I was found to have fatty liver via ultrasound and to eat a liver healthy diet, stay active and exercise. For the entire year of 2014, the levels slowly came down to normal, as did my weight (60 pounds). I now weigh 132 pounds at 5ft 5 inches. My bmi is 22. I was SO hoping for a healthy and worry-free 2015 after a melanoma scare, a radical hysterectomy, a traumatic brain injury and all of this liver stuff. I didn't have a biopsy, as my doctor didn't want me to because she didn't think it was needed, as it can be dangerous and my elevations slowly went down throughout the year.

In November, my ALT was 24 and my AST was 21. Now, all of a sudden 9 weeks later, my ast is still totally normal and my alt is 55....one point below the upper limit.

During November and December, I didn't exercise as much as I should have, spent a lot of time in the house spending time with my family as they were all home from school/work and although I didn't eat horribly, I ate plenty of processed foods, cookies, crackers, etc.... that I shouldn't have. About 11 days prior to my blood being drawn, I took 3/400 doses of Ibuprofen for a headache. Also, the week before I went in a couple of weeks ago, I exercised (FAST walk on the treadmill) from 1 to 2 hours each day. I did this up until about 6 days before my appt.

The medications I take are:

Prevastatin 40 mg/day for high cholesterol, which is perfect now

Ambien 12.5 mg ER for sleep

Zanax 4 mg day (I confess I took much more of it the prior week to my blood being drawn...especially the couple of days before my appointment.

Hydroxyzine for excema 100 mg at night for itching (dosage was increased in December, but I am actually going to go off of this and just continue to use topical creams....so, one less drug in my body.) That will bring me down to 4 medications.

Luvox 200mg a day for Generalized Anxiety Disorder, Panic Attacks and Depression.

I am a recovering alcoholic and have been completely sober for almost 8 years. For 7 of those eight years, until 2014, my enzymes have always been TOTALLY normal. Could this be a factor? My GP didn't think so.

I am wondering if my crummy eating/exercise habits and gaining 8 pounds during those two months, could have jumped my ALT up 31 points?

I know I've posted before, and I apologize for asking a lot of the same questions, but I'm not getting any answers. My doctor told me that since my AST and ALT have been normal since last July, that there is no reason to test my enzymes anymore in the future and that even though my 55 alt is one point below the lower limit....there is absolutely NO reason to worry or even follow, despite the 31 point jump.

What do you all think? I'm so scared.

Thanks for being patient with me!

Robin

[Avux99]

Hi. My advice:

1.Ditch all/most of the oral meds if at all possible. Eg instead of meds for cholesterol concentrate on avoiding saturated fat in the diet and regular exercise. If your Liver is under the cosh, the less meds it has to process can only be better for it.

Eg if you are on meds for anxiety and sleep try to address the causes of the anxiety instead of rushing to pop meds. If other health issues are the actual cause of the anxiety but you are well enough to exercise...go out for a run/bike ride to burn off that nervous energy instead of popping those pills.

2. Eat as sensibly as you can, all of the time if possible. Sure, you're human so will probably still have the odd indulgence (and this has psychological benefits) but 99% of the time, eat well.

3. Develop a more sensible, consistent approach to exercise: instead of binge exercising, then periods of doing nothing. Eg 30 mins moderate exercise every day is better than 2 hours at full tilt once a week.

All IMHO of course

Do all that for 6 months then get the bloods done again

[sillygirl1122 in reply to Avux99]

One more thing.....I do not have diabetes. I checked my blood sugar this morning and it was 85. I check it periodically. Since I started losing weight last Feb/March, it has come down from 110. My bp is usually around 100/70. It's always been low. My midsection is now right around 35 inches and am now in the area of 22 bmi, weighing 132 pounds at 5 feet 5 inches. Not too bad for a 43 year old geezer! I hope that all of these things are in my favor!

[sillygirl1122 in reply to sillygirl1122]

Also, cholesterol good at 174. HDL getting higher and almost at 50 (it was at 32) and LDL going lower with each measurement. Hope that gives you more of a snapshot of my overall health. BTW.....how long does it take for NASH (if that's what I have), to turn into cirrhosis? Is it a good sign that all of these things are good? Am I at an increased risk of liver cancer, or is that only once you have cirrhosis? This has really turned my life upside down and I have been devastated ever since my original diagnosis of "NASH" by my doctor, with no biopsy, even though my elevations came down pretty quickly. There's still some idea that my initial reaction was from a medication that I started 2 weeks before my liver enzymes went up. They started immediately coming back down as soon as I quit the medication. Although we've had this jump, they are still in range. I just want to see my girls grow up, go to college, get married and have kids. I figure if I could have 15 to 20 years left, I'd be good. After that, they can take care of themselves. This is the place where my anxiety takes me. ALL THE TIME. I do see a counselor once a week. Doing everything I can to lessen the anxiety. Getting this ultrasound behind me will hopefully ease my mind. I'm just scared that it's going to come back even worse than before. It seems to me that if this would be the case, my enzymes would be much higher than they are.

[sillygirl1122 in reply to sillygirl1122]

Triglycerides at 64.

[margaretkirkman]

Hi,

I note you are taking statins for high colesterol. Are you aware that these can, in some cases, irritate or even damage liver? BNF/NICE prescribing guidelines advise GPs should regularly monitor for signs of hepatic impairment, as well as doing 6 monthly liver and lung function tests?

I appreciate this doesn't answer your queries, but knowledge is power.

Maggie K.

[Keren in reply to margaretkirkman]

Ironically, statins can also be used as a therapy for fatty liver - my husband has been put on them and his ALT has dropped back into normal range. See ncbi.nlm.nih.gov/pmc/articl...

[sillygirl1122 in reply to Keren]

Thanks for sharing, Karen! :o) Interesting read!

[sillygirl1122 in reply to margaretkirkman]

Yes, Maggie. I've been taking 40 mg. of Prevastatin for 6 years and have never had any enzyme problems. They have monitored them consistently through the time that I've been on the medication. Prevastatin has brought my triglycerides down from the 300s to the 60s. I'd say that this is definitely a great thing, as I've read that elevated triglycerides can definitely injure your liver.

[Stupidliver]

Hi robin it's me again. Wow you really worry. It's not a big deal that your ALT is 55 even if it's up 31 pts.Ibuprofen and fatty diet will affect it a bit. Anti-depressants by themselves do not affect ALT unless they cause you weight gain.Ibuprofen will have an acute reaction in the way that your ALT will rise Immediately and then fall within probably 2-3 days maybe a little longer.Above normal ALT in itself signifies liver inflammation.your drinking 8 yrs ago will not impact this.More info is needed. How is your AST,ALP and other liver indicators ?? My ALT recently was 28.six weeks before that it was 90 and three months before it was 38 and before that it was always high going back last 2 yrs. ALT tells you what is happening now (last 2-3 days) and not what happened 8 yrs ago or what is going to happen next week.You will never know for sure how your liver is unless you get a positive result on a biopsy. you can go to 10 different doctors and they will tell you same general things and a lot of grey .It's a combination of ALL liver indicators that paint a good picture of what is happening.it is typical for final stage cirrhosis patients to have normal ALT and AST only because they are few surviving liver cells to leak enzymes into the bloodstream.however their liver (true)FUNCTION tests will tell the story. These people will have an increased prothrombin time,high bilirubin and low albumin.If you were at this stage you can bet you would know it.early cirrhosis usually has no symptoms or maybe just mild fatigue.

Do this: go on you tube and type in "liver tests:use and interpretation".you will see a lecture video 38:13 min long. this video with slides is a lecture to medical students. The lecturer is a Gastrointerologist who is the head of the Gastrointerology teaching the department at university of Michigan. This lecture is a GOLD MINE of information on the meaning of liver test results.She (Dr Rebecca van dyke)explains everything so clearly and is the biggest source of my knowledge.Watch and listen carefully and you will learn so much.She explains clearly on how to differentiate between chronic or cute,cholostatic or hepatocellular and how it affects liver function.It would help if you had a copy of all your blood work. Trust me, watch the video and many questions will be answered and others raised.once again the video is on you tube called "liver tests:use and interpretation".a gold mine of info!!

[Stupidliver in reply to Stupidliver]

Another thing is don't do so much strenuous exercise.5 days a week moderate exercise is better than going all out. Go on the treadmill for a quick pace walk but don't over do it. Strenuous exercise may raise your AST because AST is also found in muscle cells so it's not as specific to liver as ALT.The breakdown and reassemble of amino acids in proteins can raise the AST.This is a normal reaction.If I lift weights today and get all sore my AST will rise tomorrow for sure.you can still have the occasional cookie. Remember the body still needs fat.the important thing is to keep it to a minimum. More fruits, veggies and lean meats such as fish and chicken.Anti depressants normally don't impact liver enzymes much unless they cause you to gain weight. Painkillers such as all common meds can raise enzymes counts.Remember when you gain weight it's everywhere including your liver and that's the main reason for elevated liver enzymes.fat in liver causes congestion and inflammation and this will cause cell injury and they will leak enzymes into the bloodstream.Your doctor SHOULD do blood work again in 3-6 months. iT appears that she is not overly concerned which is a good sign.the most concerning thing you've shared is your high AST and ALT back in February but they've come down so it appears you have no or insignificant damage. Take care of yourself.do the simple things. Avoid alcohol or very little,consistent good diet and MODERATE exercise for now is the best advice to follow.dont go nuts on the treadmill because you don't need to. do the right things and you will be fine.i know you worry and trust me I do too mostly because I can't get a specific answer from any doctor. They simply don't know exactly because there is no way to know.once again the only proof positive way to know is a biopsy showing that there is scarring. otherwise it's an educated guess with varying accuracy.you could ask for a Fibroscan which is very reliable for no fibrosis to cirrhosis but less reliable for moderate fibrosis. If you get a score of lower than 6 you can go home and celebrate with a beer. Last year I had 3.6 and recently 5.8.doc says that's normal but the score sheet says it's borderline mild fibrosis. I went home and celebrated with 10 beers. Idiot.playing with Fire .

[sillygirl1122 in reply to Stupidliver]

stupidliver, please tell me you are kidding about going home and celebrating with 10 beers. We're all trying to get better here.....don't be.....we.......stupid! I love having you here and want you to be around for a long time! Take care of yourself and thank you so much for ALL of the helpful advice you've given me! And yes, I am SUCH a worrier. I am literally sick to my stomach right now as I have a follow-up liver ultrasound tomorrow. My doctor told me to expect some fat to be there since 10 months ago, the result was moderate to severe fatty infiltration of the liver and that it can take quite awhile for it to go away. Thanks for always supporting me! Robin

[sillygirl1122 in reply to Stupidliver]

Watched the video and it was very interesting. Thanks for sharing! Robin

[Bolly]

I second Avux99

[sillygirl1122]

Thanks so much for your answers....both of you! All of my other numbers are perfectly normal and always have been. Nothing ever high except for the ALT and AST. Have a follow-up liver ultrasound tomorrow and I am terrified! Certainly, after losing 60 pounds, at least some of the fast has lessened. I'm working on being more consistent on the treadmill.....30 minutes in the morning and 30 minutes in the afternoon. Also, was given a tip to try to keep carbs low....mainly the simple ones. I've been working on that. Here's a tip for all of us: I learned that instead of salad dressing on my spinach, I use garlic hummus. It's loaded with garlic, olive oil and chick peas. Low in carbs and fat, but very yummy! Eat fish at least 4 nights a week with lots of vegies. Please keep me in your prayers tomorrow as I have my ultrasound. I should know the results on Tuesday and I will post them as soon as I can. I appreciate all of your support......to all of you! You keep me pushing through the anxiety during the difficult times. That means the world to me! Robin