Hello everyone, I am 29 y/o male and I have been reading this forum for some time. Since I was about 18 I have binge drank almost once or twice a week (on Friday / Sat. Nights). I kept up this bad behavior until a few weeks ago when I started getting nauseous pretty regularly ( I never got nauseous before), had dizzy spells where I felt like I was going to pass out, have been getting this wierd taste coming from my nose / back of throat, mild abdominal pain, odd looking stools (malformed, multicolored light / dark brown), indigestion, etc..
I had a blood test back in April (when this all began) that came back normal except for anion gap (low). I had another blood test when my symptoms did not subside, and it came back with high bilirubin total (1.4 with an upper limit of 1.0 in american units). I went back to my gastroenterologist and pushed him to do an ultrasound and he also did a full hepatic panel and the hepatic panel came back normal except for direct bilirubin (.23 with an upper limit of .2). They have already done the ultrasound and I have to wait quite a bit of time before the doctor returns for him to read it. In the meantime, I am freaking out that I might have advanced liver disease from my foolish drinking.
I have been trying to read the ultrasound myself and have had a little success I believe. The reason I am scared now is because when I look at the images of the liver I cannot see any clear hepatic veins (dark channels) in the images. In images that I reference on the internet, I can see clear representations of these veins and how they are 'supposed' to look. My question is - should you always be able to see these veins on an ultrasound of the abdomen (including the liver)? Is there different angles that they could have taken where it doesnt include these channels? What are strong signs on an ultrasound that can indicate healthy or damaged liver tissue? I would appreciate any input here as I am extremely scared and time is against me right now with this doctor. I have already quit drinking cold turkey (it was never really that I had to drink - more that, when I start drinking I do not have a limit.) This is a reason I am kicking myself too.
Many of my family and friends are telling me that it is all in my head which is bothering me because I know my history of abusing alcohol and NOW I know the risks that I have done all of this research. Please comment. Thanks!
Justin
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Unearth1y
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1) Normal blood tests are good. That's a good sign. Bilirubin is a little bit high but if there are no other liver tests out of whack it's a good thing and may not mean all that much. Many people have higher bilirubin as a matter of course. It can be their version of normal. Also blood tests are not looking at a static system so they vary a lot from day to day and hour to hour.
2) The liver is a remarkable organ and has the ability to repair itself and to regenerate. Even if you have caused damage to your liver (scarring which is called fibrosis), once the cause of the fibrosis is removed the liver has a remarkable ability to repair itself. So obviously no more drinking.
3) One thing that may have happened is fatty liver. This is often the case with alcohol and poor diet/lack of exercise. If you were getting it because of lifestyle then it would advance quicker with the alcohol. If left too long then the fat damages the liver and causes fibrosis. So not only stop drinking but switch to a healthy diet and get some exercise. Lose weight if you need to but gradually - too quickly will add fat to the liver.
Fatty liver generally reverses itself quite quickly once causes of fat infiltration are removed.
4) Fibrosis is graded according to the amount of scarring of the liver. The final stage of fibrosis where the entire liver is scarred is called cirrhosis. It used to be thought cirrhosis was irreversible but in fact recent studies have shown that even cirrhosis may be reversible in the earliest stages.
5) Even without taking regeneration and repair into account a person can live quite well with only a small part of the liver working.
6) The treatment for alcoholic liver damage is to advise you to stop drinking, eat healthily, get exercise and rely on the liver's repair ability - so effectively you should start this now yourself. Doctors will monitor for complications and treat them as necessary as long as they can.
7) Stop Googling. You'll drive yourself insane. There's a lot of information out there and it's hard without training to understand it properly in its context. We've all been there which is why it's better to talk to your doctors and then people who have some experience with the situation.
8) Don't ask people to try to assess your description of your ultrasound. It's a bad idea and it won't help you, if you've stopped drinking and are eating healthily and exercising you've effectively already started the recommended treatment plan anyway. Let a doctor review it and tell you what it says.
I hope that's a reasonable starting point. Try not to worry too much just yet, just stop drinking and start getting healthy and wait for information. You may well not have any or much damage at all and might have caught it in time, but if not you're in the fortunate position that you can prevent further damage and allow the liver to recover.
Cheers.
PS - What you've described doesn't sound like you're instantly about to drop from advanced liver disease. You've got a bit of time for your doctors to do tests and get results. Just make sure no more alcohol.
I am what I would consider to be in pretty good physical shape. I have recently lost ~15 lbs (I think some is due to this stress that I am facing), but I currently weigh 175 at a height of 5'9" with 17.7 % B.F. and 44 % muscle. The reason I am concerned is because on some of these drinking bouts I have been out of control - and as i stated I cannot see these veins on the ultrasound. I am hoping that the ultrasound tech might have just missed them or something.
I know it is unusual to be sick at this early of an age (and especially if I havent drank on a daily basis). There is not enough information about binge drinking out there however and to what degree its effect is on damaging the liver (just that you should not exceed normal recommended limits). This bout has made me want to inform more students on college campuses about the dangers of drinking as this is where my really strong drinking began.
Perhaps if you had some comments on my labs?
My ALT and AST have been normal , although on the most recent test, the AST was below the normal range by one point.
I wish I could take solace in my numbers, but I have heard that with cirrhosis or later stage liver disease the ALT / AST are not reliable indicators and that Bilirubin is a good measure of function. Do you have any comments on how reliable some of these measurements are? Thank you.
Thanks for that - it was only the Alk number I was curious about but actually the rest help - normals ranges vary from test to test.
Those are good numbers. I really don't think you're helping yourself with reading around on the net. Not that it's not useful, it is, but it's very complicated and intricate and it will take you a while to get a feel for what the results actually indicate - by which time you'll have driven yourself out of your mind with worry.
So;
1) The numbers are good. None of those numbers are going to cause a doctor to hit panic stations - or even be all that concerned.
2) All the numbers have meaning - it's completely wrong to discount AST and ALT and focus only on Bilirubin. As I said earlier a large proportion of the population have a harmless condition where their bilirubin is permanently above normal and one momentary snapshot of a complex working system and then taking one very slightly increased number out of context isn't going to help you. In fact the AST/ALT numbers are extremely important. Yours are normal. Those numbers are indicating that your liver is carrying out its functions well. They're not speculative.
The bilirubin number you have cited is also normal - the very slight increase in direct bilirubin doesn't seem significant to me - and that's the only basis bloodwise on which you think you may have a significant problem.
You may well have fatty liver. That's a normal result of drinking. You're not going to get very far trying to interpret your own ultrasound - it's a specialised job.
As I said, regardless of what you look up or find out you're going to be relying on your own body to do the repairs. Do consider diet and exercise in the mix. A lot of liver disease in the US is caused by poor diet and lack of exercise causing fatty liver eventually turning to fibrosis.
Also, since you last had a drink your liver should have been hard at work maintaining itself. It's not static so remember you will be recovering as you write - assuming there is enough damage to recover from.
There is a lot of experience on this forum so do use the search function and read around. Others will also chime in if they can add anything. In that respect the quality of answers I've found here has generally been better than out on the net as it's based on real peoples' experiences through the entire cycle of suspicion, testing, diagnosis and (if necessary) treatment.
Thank you for the great answers and support. Now that I am sober I am really starting to enjoy different things in life. Sad I had to waste my 20s drinking. Thanks again and I hope anyone else who has anything to add will.
Millions all over the uk drink every weekend for most of their lives without issues.
You might be better off not trying to read too much into the ultrasound pictures that you arent trained to understand. Sorry to sound blunt, but you are going to make yourself sick with anxiety.
I drank a couple of times a week for 15+ years and all scans and bloods,including a FIbroscan have been clear. The Liver does not just turn Fibrotic the second Alcohol hits it.
Short sharp binges are more likely to cause Gastritis and other digestive problems before serious damage to the Liver in most cases. It very much sounds like Gastritis that you are suffering from. Take it as a warning that you are getting older and your body is starting to dislike the binges.
If you are really worried then go for a Fibroscan, its a very good test and will give some numbers to work with.
My binges were pretty hefty though, sometimes drinking the entire day (from 8 am to 8 pm)...
What is bothering me is the fact that I have not had any sickness like this ever before - and I keep noticing more and more symptoms. Today I have a swollen parotid gland in the right side of my face - which I am again attributing to liver issues.
I asked the radiologist if they offer fibroscan when I went in for the ultrasound. They do not (I am not sure if fibroscan is just a UK thing as I live in the US).
Mister X You are to be commended for your understanding of the issues and your time that you spend assisting so may people with concerns and queries. As ever your offer sound advice, on behalf of all the PBC-ers out there Thank you for your considered replies.
One question from me, PBC, liver transplant 1 year ago, I understand possibility of having PBC back again, do you concur? have any idea how many do? and any time scales for it to recur? (just interested not worrying!)
Hi again. I spoke with my gastro today (his nurse) and she told me that the ultrasound was negative and there were "no abnormalities". I should be happy on this finding but because I am still having sumptoms (indigestion, nausea, unwell feeling, etc) and I have recently had swelling of both of my parotid (salival) glands on my face I am having a hard time feeling 'safe'. I have pain where these glands Are located and taste salt of saliva flow is stimulated. I also asked her if the docs said anything about the elevated bilirubin direct also anf she she kind of shrugged it off saying "they do not feel it is significant at this time."
I have a few questions. First, how reliable is an ultrasound finding of no abnormalities to say I am "out of the woods?" Second, do you know much about the swollen parotid symptom? Thanks a lot for your help.
Hi again. I spoke with my gastro today (his nurse) and she told me that the ultrasound was negative and there were "no abnormalities". I should be happy on this finding but because I am still having sumptoms (indigestion, nausea, unwell feeling, etc) and I have recently had swelling of both of my parotid (salival) glands on my face I am having a hard time feeling 'safe'. I have pain where these glands Are located and taste salt of saliva flow is stimulated. I also asked her if the docs said anything about the elevated bilirubin direct also anf she she kind of shrugged it off saying "they do not feel it is significant at this time."
I have a few questions. First, how reliable is an ultrasound finding of no abnormalities to say I am "out of the woods?" Second, do you know much about the swollen parotid symptom? Thanks a lot for your help.
Not aware of the swollen gland being a symptom of a liver problem per se - and I can't work out a direct link with that gland and the operation of the liver.
The problem you have is that in people with advanced liver disease, because the liver performs so many processes it can impact on a vast array of functions - directly and indirectly - so you will (possibly) come across all sorts of things being linked to advanced liver disease. Pretty easy when someone has end-stage liver disease to assume that something swollen is related because by then the liver failure is affecting systemic body chemistry - BUT - they will have had all the usual complications first - i.e. indications in blood results, jaundice, ascites, oedema, encephalopathy etc etc.
There is no evidence you have any liver damage.
There are a load of obvious symptoms. None of which you have.
There are indications in blood tests. None of which you have.
There are indications in scans. None of which you have.
An ultrasound is a perfectly reasonable scan in these circumstances. It's supportive of all the other evidence so the clear result is no surprise.
You have what amounts to a pretty emphatic diagnosis I think. For peace of mind you may want to schedule a confirmatory blood test in a few weeks to see if things remain normal the longer you're off the alcohol and eating healthily. Other than that it's time to get on with your life.
What are the obvious symptoms? Because the nausea, tired/dizziness/abdominal pain i have i thought were common symptoms. Also, several resources state that someone with liver issues will have increased problems with salivary glands because the fat-filtering ability of the liver is hindered- so it causes these ducts to be plugged and then it results in inflammation and pain /irritation. It is just pretty wierd this popped up during this whole scare because I have never had this occur ever before.
Thank you for all your comments as it has really helped. I think it us just the direct bilirubin reading thats keeping me hooked. From what I understand it has to be sometjing with liver / gallbladder/ this area of the body. Again, you have been a great resource and I really appreciate it.
If you've had all the tests and nobody is concerned then I agree with your family. It sounds more like a case of anxiety! You've had all the tests, you've had an ultrasound and the professionals aren't worried. I've had plenty of ultrasounds, probably in the region of 50 or so. How on earth did you get to take the images home with you? Why would you think you can diagnose yourself with them? It takes years of training?
If I were you I'd get to the GP and explain your anxiety. No one here will convince you you're not ill if the Dr's haven't already.
All I did was ask for a copy at the radiologist! I am becoming more and more concerned as I keep having symptoms pop up. Today I have a swollen parotid gland on my face.
The professionals have not told me anything yet, as the doctor has been out of the office and has not had a chance to get back with me regarding the ultrasound - so I am stuck in this hell of waiting along with all of my symptoms. I have been assuming the worst.
The odds are in your favour, I have read about a 28 year old dying of Cirrhosis, but at his height he was on 3 bottles of vodka a day! Another one was 22 but he started drinking at 12 and again 3 bottles of vodka a day, years of needing half a bottle just to get out of bed. These guys are on a whole different level than most here and were constantly drunk for a decade or more. Along as you have 3,4,5 days free a week you can drink reasonably heavy and be fine, not advisable of course. People having weekend beers generally don't get serious Liver issues.
The Liver is pretty tough, most would be able to drink more than 21 units a week without issues for life. According to a Hep doctor from southhampton hospital most of his cirrhosis patients had been drinking 150+ units a week for 10 years, some it takes alot longer. Thats more than 2 bottles of wine a day for 10 years.
I think you will come out of this OK, its your wake up call, youthful binging is starting to have a negative impact on your health. You need a good year off and give your body a good health kick with good foods, then you can think about your relationship with alcohol.
Thank you for the reply. I never 'needed' a drink to do anything, but once I started with beers it would then progress to shots, mixed drinks, etc. The only reason that I am scared is because I know that I pushed it quite a bit some nights - sometimes probably a total of 12 - 15+ drinks. I would wake up the next morning and still have the taste of alcohol on my breath and think to myself man I need to stop doing this - but then came the next Friday night and it was back to the races.
I realize that the people that have died at these young ages are on a whole different level - drinking every single day and excessive amounts. I am hoping that the fact I didnt drink every single day is on my side and that I get this second chance to rebound. I am ready to marry my girlfriend of a long time and have kids and settle down. I already told her the 'party is over' and the 'club is closed'... meaning I will never have another drink again and I pinky promised her. She is terrified for the results as well.
I for sure went past 21 units... (this is only like 7 beers?). I would have like 5 beers and then some shots and then some mixed drinks. When I am drinking it is like it doesnt even phase me I can continue to drink, chug beers, take shots, and still hold a normal conversation without slurring. I would drink for sometimes 8+ hours straight and people would still think I was sober. This is my downfall. Sometimes I wish it would have just made me throwup or I couldnt tolerate it so well so that it would deter me from drinking. It was always a 'cool' thing in college .. "O man he can drink so much , awesome!" While I was chugging beers or liquor straight from the bottle. It is so engrained in society it is sickening. Little did I know while I was getting cheers from my classmates the danger that lurked beneath the surface.
I walked into the doctors feeling like crap after a binge at 38 years old and had my first Liver tests. I know what you are feeling now, I was terrified.
Your drinking, as I have said its much like nearly everyone I know and have ever known. You are starting to see what I started to see, that drinkers should atleast be getting some blood tests and having large breaks. The alcohol industry/culture needs a good kick up the arse, just the other day I was surrounded on all sides by alcohol in a grocery store ffs. Cut price deals being thrown at you everywhere! Don't feel guilty about having fun at the weekend, you were unaware and young.
There is a risk of about 0.2% of cirrhosis in sticking to the 21 units a week, at 40 units its about 0.8%, yes the chances seem scary when experts say drinking 40 units times's the risk 4 fold. This sounds scary but, 0.8% risk is pretty small. Only 10-20% of full time alcoholics develop cirrhosis. As I have said the numbers are on your side.
I do know of a guy in work at 30 years old has got early cirrhosis, but he was popping all kinds of pills and drinking hugely.
Its sounds like you could have Gastritis and maybe even H.Pylori which can take along time to resolve and leave you feeling like crap.
Hang in there, Im sure you will be fine and carry on with your life in confidence that you aren't about to die.
I bet the hardest thing about this disease is the fact that it could have been prevented had individuals drank less. It was within our control. The truth is, I do not know if I can really claim that I was "unaware" - my grandfather died (at an old age) from cirrhosis. However, this happened when I was in my late teens and at this age I had not really started drinking too much and always thought it was because he had done it for so long.
I am a Chemical Engineer, so I have a pretty scientific background. I regret when my grandfather died not going online and reading up and doing research on alcoholic liver disease. I think that maybe if I had taken the time and done my research early on then I would have been more responsible with my drinking. I have always been someone who needs to learn the hard way, and then regret seems to take control of me. I am here still wondering and wishing I would have done things differently in my past (especially now concerning my drinking). I also had joked about this several times with my friends that "im not going to make it past forty", and stupid comments like that - knowing how heavily I was drinking. Now I look back and am disgusted with my behavior and pray and hope that I get this second chance. I have a strong will so I can stop myself from drinking... not another sip - ever. I am thankful that I have the will to do it and am sympathetic for individuals who dont.
Alcohol is a terrible thing and I believe it should be made illegal. Not only does it cause many deaths from health, but add in car crashes, crimes, etc. and you have a very convincing case. I used to smoke marijuana quite a bit and do not believe it is as harmful as alcohol, and I do not think there is any evidence that it has killed people (like alcoholic liver disease). Society however does not allow it and in a way pushes people towards alcoholism. Big alcohol is making huge profits all while making people sick. It is a huge issue especially on college campuses now. I used to be able to go to a bar and they would have $.10 mixed drinks. Im talking strong mixed drinks too. Then the other bar the next night would have $5 all you can drink beer. And the list goes on and on. It is a big problem with this age group - to the point that I say most college students these days are coming out of school as alcoholics.
And once college ends it did not stop either. With me, or my friends. Something needs to be done about this and I have thought that I might start a non profit to educate students about these dangers. Thanks for reading and replying!
Its great that you are an engineer, I am a software engineer myself and you will soon see that doctors generally don't miss serious Liver disease when looking for it. Hopefully soon you will have confidence that you likely don't have end stage Liver disease.
Remember F1 and F2 Fibrosis will heal over time, so even if you do have some damage it doesn't mean its what we all fear, progressive scarring aka Cirrhosis.
You could have something called Gilberts syndrome, which is harmless and will explain the Billirubin. Also as I have said short sharp binges can cause some other digestive issues, its possible your pancreas is starting to complain, could be your intestines, stomach. Pretty much anything that gets irritated in the digestion system can cause Billirubin to jump up a bit because it is slowing the flow of bile out of the Liver.
Its not just the Liver alcohol affects, some people can get chronic pancreatitis where it slowly dies and kills you over 5 years or so. In short any serious illness caused by alcohol is pretty grim really.
What amazes me about alcohol is that we have all heard of the 21 units a week, but I don't know anyone who actually knows what alcohol does to the body. fatty liver, alcoholic hepatitis, cirrhosis. Hardly any drinkers I know have every heard of these things. The drinks industry certainly doesn't advertise this and it ANGERS me.
I always considered myself pretty healthy, cycling, good food etc, alot of water in my diet and enjoyed a beer session once or twice a week. I didnt think it was an issue at all, I loved it. Now I know differently and Im trying to warn others, long breaks and annual tests should be advised for people who drink.
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