Anyone who has encountered me on this forum will know that I have suffered from health anxiety for most of my adult life, and that I have been suffering from from all over the body itching for the past couple of months which I feared could be due to either cirrhosis or liver cancer even though I had no other symptoms at all of either disease.
I recently had a series of blood tests at my GP surgery, and although they all returned as being ‘clear’ with no further action being required, I was given an appointment with my doctor today for a fuller discussion and explanation of the results.
My doctor told me that the tests were very extensive, and were a ‘full blood count’ and included tests for liver function, kidney function, iron levels, B12 levels, diabetes, platelets, ALT, ALPs, tumour markers, inflammation markers and various other things, and said they were just about as extensive as they could be.
The doctor said I should be assured by these as if there had been anything at all ‘sinister’ going on it would have presented as a pretty obvious imbalance in my system, but when the results were viewed as a whole as well as individually, there was absolutely nothing of concern at all.
This would all be fine, but on looking at the website for the NHS - which I trust implicitly - I read that it’s possible for these tests to be not quite as reliable as I hoped, and I find this very quite confusing as whilst I know I should be reassured by what the doctor says, I have also chanced across the following which has become a real ‘spanner in the works’ of finding any peace of mind.
The NHS quote lists some of the various benefits of these LFT’s but only after first suggesting - to my mind - that they might actually be fairly unreliable, which obviously makes me worry all over again.
I’d be very grateful to hear your views on this as it’s presenting as a real ‘spanner in the works’ of what should have been a good day.
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Kellan38
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I’d say I have a pretty good diet. I eat fresh fruit and have vegetables every day, and take various vitamin supplements. I exercise every day, and have recently restarted jogging. I’m a non-smoker, and have cut my alcohol intake right down to around just 3 pints a week. I only drink beer, and don’t bother with wine or spirits.
All that said, the problems could well be down to something in my diet, but I’m struggling to identify it if it is…
As regards ant medications; I’ve tried a cream prescribed by my doctor, and whilst this helps a little bit, I don’t find it a pleasant sensation to be greased up every night, so I only really use when the itching is really bad!
May I ask you, please, among all the very extensive blood tests, was the determination of the level of bile acids in the blood recommended? They are usually recommended to be determined on an empty stomach, and then after a meal. My doctor recommended checking this when I got mild itching, but all my LFT tests were normal. Definitely what else I would try to do in the fight against itching would be to refuse even beer since given a minimal amount of alcohol, it can continue to damage the liver.
I’m not sure whether the level of bile acids in my blood were tested, but as I’m planning to speak to my named GP to discuss the matter further, I’ll certainly make this part of our discussions.
As regards my alcohol intake; it’s over. I’ve suffered so much anguish in the past two months that it’s not even worth drinking at a ‘moderate’ level if it does this to me. If I ever recover from all this, I won’t risk anything that can possibly put me in this horrible position again.
You're very fortunate. Listen to your doctor. It seems like you have a good doctor, who has run all possible tests, analysed the results in the correct context, and taken the time to explain them to you. You can't ask for anymore, truly.
Yes, you do have a point in that LFTs do not always indicate a liver problem, and a hepatologist is best placed to advise on them. Patients with cirrhosis and bleeding esophageal varices, to name but some, can have normal (ish) LFTs. The most common LFTs assess liver damage but are not always able to assess hepatic function.
However, before making a very large leap of faith in assuming you have a liver problem - and I do think it is a large leap of faith if you have no other symptoms and are not knowingly living a lifestyle which puts you at risk of a liver problem or have a family history) - I would push the GP to advise on what is causing this pruritis (itching) first. It can have a number of causes from infections, your environment, and host of others (including stress).
If you are really concerned (and happy to spend some money if you want peace of mind), find a private hepatologist, re-run the bloods with them and get a fibroscan. Speak to a nurse at the BLT.
Thank you for your very reasoned comments, Harting. I’ll re-read them a few times, and as I am still quite concerned about the itching, I’ll try to come to some kind of a decision as to what to do next.
HiThe British Liver Trust tour the country with a mobile Fibro scanning device each year if you're really concerned (check out their website for dates (also posted below for you). Really good advice in general. Well worth a visit.
March:
Cardiff: Monday 13th March - Outside Capitol Shopping Centre, Queen Street/Churchill Way, CF10 2HQ
It doesn’t look like these come anywhere very near to my home just outside Leeds, but I’d be interested in paying a visit if I could somehow get to another site elsewhere.
Whilst your GP appears to have taken some time to try and reassure you about your liver health, maybe a separate appointment about your health anxiety would be beneficial.
I had a look on the NHS website for what it explains for liver function tests. It doesn't mention anything there about the validity of those tests. However, I note it does link you to the lab tests online website for further info on what those tests mean. I'm guessing therefore that its there where you have read about when LFTs may not be so reliable. I take it you have latched on to the following statement on that page, "... conversely, normal results can be found in patients with serious liver disease".
Of course reading this in isolation could give you less confidence in your results, particularly if you are looking for anything that confirms your fears or assumptions. Dont worry, everyone does that. Its called "confirmation bias" where we focus on the thing that confirms our theories but give less weight to, or even completely ignore the usually much greater and more overwhelming evidence that goes against it. Its how politicians and conspiracy theorists, crank therapists and snake oil salesmen try to sway public opinions.
This is why its important to always fully read a document, or even better lots of documents from different sources, to get an accurate and well rounded viewpoint. Doing this will give you the consensus of the majority view and weed out the outlying crank views. This is also what doctors do when they both do lots of tests and by their many years of experience that gives them an understanding from those thousands of medical papers published every year, helpfully collated and turned into guidelines for them by those clever folks at NICE.
I've gone off on a bit of a tangent so will get back to the point. Yes, in some very rare cases of serious liver disease, there can be times when the traditional liver function tests may not give a significantly elevated result or may even give normal results. The reason for this is that the liver is so damaged that there are insufficient healthy cells left to damage that give off the enzymes being detected. In those cases though, your doctor can physically see the changes in peoples appearance and fragility and also they can easily feel the vastly reduced size of the liver. There may also be times where a disease or substance does not constantly attack the liver. In those cases too, the traditional LFTs may appear normal at times.
Now we get to the crux of it. In both those situations, other tests carried out, which you have had done, can help diagnose whether or not there is significant liver damage. Even with the standard LFTs showing normal, with significant liver damage, it is highly unlikely that none of the others would be abnormal too. These, taken with the symptoms described by the patient together with the doctors own examinations would be sufficient to rule out or in the possibility of significant liver disease.
So with all the tests you've had done, and the statements your doctor has made, you should be reassured that your itching or other concerns you have is not a symptom of liver disease.
Thank you so much for taking the time and the trouble to send me such an excellent reply.
I’ve copied your reply in full, and and as it answers so many questions for me - including being a perfect explanation of my original query that formed the basis of my post - that I’ll use it as a reference if I ever might be struggling in future.
I can’t thank you enough for what you’ve given me in your post. My mood was a low as I could remember a little earlier this afternoon, but you lifted me right back up again, and I can only offer my sincere thanks for that.
I totally understand your anxiety about this but you really must trust your GP. If you want a second opinion, ask for it. Change your GP if you feel that you aren't getting the service you deserve. To be honest without knowing you I'd say you need some assistance in dealing with the underlying health anxiety. Look at your lifestyle, do you drink to excess? Do you generally take care of yourself, including eating all the right things? If you were seriously ill then trust me the doctor would know and refer you. Please don't pay to go private, there's really no need.
I hope that you get the appropriate help that you need.
I think I’d say my lifestyle is actually quite good.
I’m 67, and whilst I’ve been a very regular drinker in the past - and heavy at various times - I’ve just about completely stopped, and I drink tea and coffee and various juices in the evening now instead.
I take vitamin supplements every day, eat lots of fruit and veg, but have next to no processed food at all. I have increased my water intake, exercise by walking every day, and have recently returned to jogging in a further attempt to ‘boost’ what I consider to be a fairly healthy lifestyle.
I’m not sure I can do a whole lot more than I’m already doing, but I’m willing to consider anything if it helps.
I’m trying to deal with the health anxiety as best I can, and my GP referred me for some counselling. The arrangements for this are already quite well advanced, and the actual counselling is set to commence within the next 2 weeks.
To be fair, I really can’t complain about the service from my GP’s and they’ve done as much as I could reasonably have expected from them in the space of 2 or 3 weeks, especially as I hear of some many other people at other practices waiting weeks for an appointment.
I wouldn't say you had anything to worry about liver wise, in fact it sounds like you are healther that most!! I suppose as we get older the little niggles get a bit more uncomfortable than we'd like and maybe you've had a few things going on at once which has thrown you into an anxious state. It's perfectly understandable. I hope the counselling is beneficial to you and wish you all the best.
When you say you have all over itch, can you describe it ? Itch can be caused by anxiety not only liver disease and when your doctor has done a thorough look into your bloods and ruled it out then it’s time to move on and look at other causes.
I suffer with severe itch caused by liver disease and was one of my first symptoms but at the time I dismissed it until I went to gp when I felt really poorly. My point is ,it was only one of a list of symptoms and my bloods were extremely high.
The itch is ‘spikey’ or ‘needle like’ and feels like that caused by anxiety when it presents on my arms and body, but feels like tiny insects under my skin when it happens in a ‘belt’ around my waist area.
I have no other symptoms than that, and have cut my drinking of alcohol down from around 12 pints per week to no more than 3 now, and intend to take this down to no home drinking at all with no more than two pints whenever I go out, which is only 3 times a month at most,
I helped run a Covid forum for 2 years where people suffering from Health Anxiety were very frequent visitors. Sometimes their anxiety had caused them to have crippling inability to go out, to function, and in fact one gentleman was eventually sectioned.
As you are aware, your Health Anxiety gives you concerns which are disproportionate, perhaps even gross exaggerations, to the real risks to your health. Where you have qualified physicians who have given you extensive testing, it is important that you address square on that this habit of second-guessing them on forums like this is you directly feeding your health anxiety compulsive behaviour. Your risk is not your liver, it is your health anxiety and you need not to bring queries like this to specialist forums where people are in fact dealing with real life threatening conditions.
I have a great deal of sympathy for people suffering from Health Anxiety. It is a terrible thing. However, you also have to manage your compulsion and not post on forums like this or you are merely feeding your compulsive behaviour habit. Part of becoming happier and better balanced is to not do the very thing you've done here.
I take your point entirely, and I apologise for taking up time that should been used on helping other people.
I’m going to try to stop posting about problems of my own on here, and I apologise to anyone who reads this who might have been wearied by my now repetitious posts.
Thank you again for being so frank and honest with me, and take care.
I can understand your anxiety Graham and feel for you . In my opinion it’s good to reach out and speak with others , it helps with reassuring you which most of the replies have done . I feel you were feeling better earlier but it only takes one person to knock you down . You have every right to post on a public forum and we have not been wearied with your post . You are asking for help and advice and where better to come . Don’t let one person put you off and please don’t sit and bottle things up because of this . I wish you well and hope this itching stops soon , keep us updated and take care
HiI am in similar situation to you normal LFT results but other evidence of liver damage. Echogenecity on an US showing steatosis and also elevated fibroscan 10.8 down to 9.8 and cap 346 down to 308.
The NICE advice last time I checked was for GPs not to rely simply on LFTs the recommendation is to use an ELF test. It took my GP a year to do this, may I suggest you contact the BLT nurses, then access the NICE page that is relevant.
My GP does not accept texts or emails from patients but simply hand write a note explaining the NICE advice for an ELF test to be the useful diagnostic test of liver damage, showing the relevant URL.
My understanding is that the ELF test is an algorithm of 3 measures of enzymes in the blood. The ELF has been cross referenced with biopsy results and found to be a reliable.
My ELF was 10.8 the cut off was 10.5 my ELF was high enough for a referral to a liver consultant and fibroscan, US, MRI, CT and CT with dye.
These were all reassuring to a degree.
As regards the itching, it caused me concern, having had venesection and my ferritin reduce from 500 to 317 the itching has gone. It was the excess iron I think. Have you had your serum ferritin checked? I also had high heamocrit and haemoglibin which can cause itching.
The central issue is that itching alone is not conclusive.
The last point is mental health, I suffer from extreme health anxiety. I attempted suicide twice and ended up being sectioned and spending some time in a secure institution.
The existence of Dr Google and underlying anxiety can lead, as it did in my case to severe pshychosis.
Seek advice from BLT tell your GP and make sure it is on your notes so every healthcare professional you meet understands the circumstances.
For me the point at which I became more resilient to health anxiety happened when some of the symptoms that I had googled and worried about disappeared.
My poohs became darker having been clay coloured, my pee became crystal clear having been the colour of newkie brown. The red palms disappeared, the red soles on my feet disappeared.
I had a serious gallbladder abscess and liver abcess that hospitalised me.
As a result dye was put through my blood and I could watch it flowing through my portal, which was the correct diameter, there was no evidence of varices as the dye would have been diverted down other blood vessels.
That convinced me that my condition was not life threatening.
If you want to pm me feel free to, I am not a Doctor but my experience is that the mental health reaction to the perceieved condition can actually be more life threatening than the actual condition you have.
We all die of something, my perception is that far, far more people die with a dodgy liver than from it.
There was much to consider there, and I’ll be reading through your post again to try to see if any of your experiences might also apply to me.
Again, it was kind of you to write so much and to detail your own experiences in such a thorough way, and I’m really grateful to you for your willingness to do that.
I hope people don’t mind me posting again after I said I’d stay away, but I wondered if anyone could offer me a little bit of general advice.
I received a copy of my recent blood test results today, and although I was told last week that they were fine, and that no further action was required, there were a couple of results that, to me, seemed slightly worrying.
These were:
Mean cell haemoglobin level (XE2pb), which was listed as ‘Above range’ with a reading of 32.5pg (27.0 -32.0) Above high reference limit.
and
Serum alanine aminotransferase level (XaLJx), which was listed as ‘Above range’ at 42 iuL(<40.0) Above high reference level.
Do we have anyone out there who might be able to advise me on these, please?
I would have queried them at my GP’s but I wasn’t a copy at the time of my appointment last week otherwise I would have done.
Thank you in advance for any advice that anyone is able to give me.
There is nothing to be concerned about there - 0.5 over on Haemoglobin, 2 points over on ALT. Doctors are only going to get concerned if your figures are 3 to 4 times over the upper limit of normal. Such figures can change day in day out and at such a low amoutn over it's neither here nor there. Some labs have different reference ranges up to 56 can be considered normal for ALT in some lab ranges. ALT is also not exclusive to the liver, it can be raised with exercise, when fighting any kind of common bug.
If you were here saying they were into the 100's or 1000's you might be concerned, a 0.5 or a 2 point elevation is neither here nor there.
Hi GrahamB8. Not sure if I have read your post correctly, but It sounds to me as though you have nothing to worry about with all those favourable bloods, especially if you have no symptoms of anything, and assuming you had no pre-existing issues. I had itching problems, and I’m going through all kinds of tests at the moment. It became quite obvious early on that there was an issue. But it seems that the skin is a coincidence. The NHS has protocols in place now which are triggered by certain test results. Life’s too short to worry about things that haven’t yet occurred. I felt it very helpful to see a dermatologist.
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