What to do next?

[Bass12]

New to the forum. Was a steady drinker (now abstain) since my late teens now in 50’s. Went to Dr about 6 months ago (after ignoring early signs) with bloating, itching, IBS, skin rash. nausea, soon followed. Had LFT tests which were ok. Then had other symptoms of liver disease particularly weight loss, sweats, anxiety, abdomen pain, increasing fatigue, general illness - had further blood tests, ultrasound and CT which where all ok. So Dr has decided its anxiety related even if my body telling me otherwise as symptoms still getting worse - now have puffy eyes after salty meals &, increasingly tired, muscle cramps after walking only short distance, bad diarrhoea. But anxiety meds working so feel much better in head. So certain something not right. I’m convinced it is liver issue but Dr is telling me because of tests/scans being ok it can’t be and despite me saying symptoms getting worse and sending in evidence. Dr won’t do any thing more, other than telling me to focus on my head. I’ve resigned myself now to waiting till symptoms deteriorate further and symptoms become obvious. Even the times I do think it’s in my head - as I think surely tests/scans I’ve had would have showed up I I had liver disease /Dr telling me I don’t, as soon as I try and do a walk, which I’m increasing struggle to do or start to feel sick I’m brought back to certainty I have liver disease. Feel exhausted by whole process and no idea what to do next as did think about going private by Dr won’t refer me. Any advice welcome?

[Jaygee87]

Unfortunately it sounds like you are suffering with health anxiety. You're so sure you're ill now that nothing any one can say will change your mind. I understand because I suffer myself with it and have for another 5 years, but unfortunately I do actually have a bad liver. If you've had scans and a CT and bloods are fine then I would say there is no further action on this. Even I haven't had a CT scan and I've got a diagnosed liver condition. I dont think the hospital will do much more for you on this subject in all honesty.

Could it be IBS? This could be causing the GERD and bad stomach etc. Some of these symptoms could be related to a whole host of issues, and dont directly mean anything liver related.

[Richard-Allen]

Hello Bass, and welcome.

I always find it hard to accept when some doctors just arn't prepared to go that extra mile to help someone.

When a person goes to the doctors with a certain unknown condition, a doctor should carry out a series of test to arrive at a diagnosis. To achieve this, they have to go into a Sherlock Holmes type mode. By ruling out what it’s not, normally what is left is the correct diagnosis.

A basic blood liver function test will only provide a doctor with a simple snapshot of how the liver is performing at that particular moment in time. It won’t tell if there’s any scarring or if the liver is enlarged. To find out more, the doctor should have examined you. By lying down on a couch, and feeling around the liver area, there are a few simple little tests they can do. Firstly, by feeling around the left ribcage (their left, your right), a normal liver will protrude just below the ribcage. Here they use the three-finger rule. If the liver is just one finger width below the ribcage this is normal. If it extends by two or even three fingers below the ribcage this may indicate that the liver has become enlarged.

At the same time, the doctor should carry out a simple sound test. This is where they place two fingers on the tummy and tap these fingers to get a sound. The sound that is made should be a sort of echo sound. However, if the sound over the liver area is more of a dull thud, then this could be a sign that further investigation is needed. These are just two very basic tests, which could warrant further tests be carried out.

I’m not sure whereabouts in the world you are but in the UK, there is another more reliable blood test a doctor can order up. This is called an ELF test (Enhanced liver fibrosis) this test can show up if the liver has reached the fibrosis stage, or even show up the fatty liver stage. This test alone should give you peace of mind, even if the results are alright.

Finally, I would add that a person can have liver cirrhosis and still show a normal liver function blood test. In my opinion, some doctors tend to rely too much upon the liver function test. However, if the CT scans are all clear, I think Jaygee87 might be right.

Please don’t take this the wrong way, but we humans can be psychosomatic at times, “I think therefore I am” here we can trick ourselves into believing that something is wrong, and in doing so, we can begin to feel pain in an area we think is damaged.

Tell your doctor you would like to have an ELF test carried out, if for no other reason than to give you peace of mind.

Good Luck, and good health

Richard

[Bass12 in reply to Richard-Allen]

Thanks Richard great advice and I did ask about the ELF and unfortunately not done in our part of the country but they did do physical examination. Which was ok. Just have to hope Dr right as I have had health anxiety before and recovered pretty quick on meds I took. This time being taking stronger meds for longer and certainly helped the anxiety (feel great in that respect) but physical symptoms still getting worse. IBS is certainly another possibility and Dr though might be that originally but never suffered from it before.

[JJgut]

If your bloods and imagine studies were clear, and your doctor is convinced that your liver is fine, odds are your liver is fine. If you really wanted to, you could see a gastroenterologist or hepatologist (if you can go directly to a specialist per the laws in your country), but they will likely look at your images and bloods and come to the same conclusion as your doctor did.

If you don't mind my asking, how much did you drink between your teens and 50s?

[Bass12 in reply to JJgut]

Thanks JJ gut. I’m Think you need Dr to refer but can check and as scientist can see why Dr come to that view but feeling increasing rough. And varied but plenty when young 3 or 4 pints during week then 6-7 pints regularly up to my 30’s. The cut down a bit but more a wine /social drinker but still probably double recommended limit.! With heavier lads weekends etc thrown in.

[JJgut in reply to Bass12]

If you need your GP to refer you, then there's a good chance they will decline to do so, as they seem satisfied with the results.

I know that "pints" have a different meaning in the USA vs. UK, but it doesn't sound like you were drinking alcoholically at any point in time. In fact, in the USA, 6-7 pints is considered moderate drinking, and 3-4 is definitely considered a safe level for those who do not have liver disease. I am not advocating drinking 6-7 pints per week, but that quantity doesn't scream "you should get checked for liver disease".

[Bass12 in reply to JJgut]

Thanks Richard. Yes certainty wouldn’t say I’ve drunk as much as many but does seem bit of a lottery who gets liver disease and who doesn’t and I’ve certainly drunk well over guidelines limits. As an aside I did have v rare side effects to one of the anxiety meds they put me on where my muscles locked up which my Dr had never seen But was getting increasing weakness/fatigue well before I was put on that particular medication. Now back on Citalopram but at higher dose than I was put on originally.

[Coco513]

Is it possible you could have Auto-Immune Hepatitis? - sometimes a biopsy is necessary to confirm if the blood tests don’t pick it up.

[Worriesalot]

Same here except I haven’t had scan cos doc won’t send me. I have really bad constipation, unusual for me. These blood tests should be reassuring but on here some say different.

[Mikeeee2]

Hi there, I have the same problem I did my blood test and had slightly elevated enzymes but doctors told me it’s tiny so they won’t worry and the rest is looking great. Since then I have been drinking at night and been haven’t touched it since last 50 days. I had chronic diarrhoea and they did a stool test so it was C diff and IBS. My doctor told the pain and aches and diarrhoea are due to IBS and anxiety and when you are continually checking your hands, eyes, palm and feeling your body you might find something and it will trigger your health anxiety further. I went to my GP and told him I think I have Cirrhosis and he did some checking and stuff and told me it’s health anxiety again as i had those sort of episode before . I keep checking symptoms like 100 or more times a day you automatically feel there’s something wrong. I only feel better when I’m out for a 5k. So my advice is meditate and try to figure out what’s causing it I mean is it something from childhood or go through a diary, join a gym or for a run and at last try counselling it really helps.