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  • Odd AST and ALY measurements?

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    Old 08-21-2009, 03:09 PM   #1
    mosspa
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    Question Odd AST and ALY measurements?

    Hello,

    I am a 55 YO Male. I have been (depending on your definition) a relatively heavy drinker (i.e., between 3 and 6 fl oz ethanol/day) for the past 35 years, or so. Over most of that time I had received comprehensive semiannual physicals (one by my civilian GP, one by the VA which I schedule to occur at 6 mo intervals) that included all standard blood work including complete liver panels. Throughout the period my liver enzymes, bilirubin, glucose, minerals, electrolytes, etc) have measured well within the normal range.

    About 3 months ago, I had a Meneire's attack (I have about 1/month). I don't like benzodiazepines all that much and over time I found that I could get some relief from the vertigo and nausea by substituting ethanol for diazepam. Well, I went a bit overboard during that last episode and drank enough ethanol to keep my blood alcohol concentration between 0.7 and 0.9 (I have a breathalyzer) for almost an entire week. Realizing that I went a bit too far, I decided that I would present myself at an emergency room to be assisted through the inevitable de-tox. I ended up being placed in a de-tox/recovery program (6-days). Blood was drawn in the ER, as well as the first 3 days of the program and again on the day of my exit. Not surprisingly, the ER and first day de-tox values for my minerals and AST were out of whack. Oddly, my ALT values never exceeded the normal range even in the ER evaluation. My AST concentrations measured 74 in the ER test (N-Range: 17-59 IU/L), and remained elevated in the draw taken about 12 hrs later (71 IU/L). The following day measured in the high normal range (59 IU/L) and on 3rd day the AST concentration was a reasonable 39 IU/L). The AST concentration was measured at 33 IU/L the day I was released.

    Having scared myself with the whole episode, I discussed the situation with my physician and we decided that we would get good baseline values after 60 days of alcohol abstinence in preparation for him putting me on a testosterone replacement program (my last physical conducted by him detected very low testosterone concentration). Counting the 6 days in the hospital before I saw my doc, I ended up abstaining for a total of 64 days before the 'baseline' blood draw. When I received the results (13 days later after a vacation where I allowed myself a few drinks on most days), both my ALT and AST concentrations measured high [AST 55 (N-Range: 10-35)]; [ALT 71 (N-Range 9-60)]. However, my physician concluded that the values were probably incorrect because many items in the total chemistry panel measured outside normal limits, including minerals, electrolytes, and kidney function items (which have always been well within normal range). There were no events that occurred in the abstinence period that could explain the aberrant results.

    So, that day he drew more blood and another liver panel was performed (this, again, was after my resumption of light-moderate drinking on my vacation). Again both the AST and ALT values came back high AST = 43; ALT = 71 [same lab/same range scale as the post-abstinence values].

    At this point he recommended I be given an ultrasound screening for possible cirrhosis. Of course, it seemed absurd to me that I would all of a sudden develop cirrhosis after 64 days of abstinence followed by 13 days of light-moderate drinking (<1.5 oz absolute alcohol/day max), especially since 35 years of reasonably heavy drinking apparently had not damaged my liver (I had a hemicolonectomy in 2002 during which a manual examination of all my peritoneal organs was conducted. The remarks on the OR report noted that my liver was healthy).

    I had the ultrasound that day and it came back of excellent quality and unremarkable except for a slight increase in liver parenchyma echogenicity but "portal and hepatic veins appeared in normal limits. Duplex Doppler evaluation of the portal and hepatic veins revealed normal color flow and pulse wave Doppler. The gallbladder was visualized and appeared normal. The gallbladder was not thickened. The common bile duct was measured at 4mm, which is normal. The intrahepatic bile ducts were normal. The pancreas was technically difficult to visualize due to prior surgical repair (i.e., my peritoneum hemicolonectomy scar ... comment mine)".

    When I got home that day I scheduled a liver panel with the VA and it was performed 8 days after that last blood test, during which time I continued to drink moderately (<2 oz/day). I received the results 1 week later, during which I continued to drink moderately. Not surprising to me, both my AST and ALT concentrations were found to be well within the normal range [AST - 23 U/L (N-Range 12-50)] [ALT - 23 U/L (N-Range 17-63).

    On the day I received the VA results by mail (exactly one week after the VA draw), but before I picked up the mail, I stopped at the local supermarket which happened to have a blood-test clinic going on in the pharmacy. So, for $40 I decided to have my AST and ALT concentrations measured again. The results were very similar to the VA's from blood obtained 1 week earlier [AST - 26 U/L (N-Range 10-30)] [ALT - 22 (N-Range 10-40)]. The day before that test was my birthday and I consumed a bit more ethanol than I have for the past month (apx 3.5 abs oz) which occurred between 9 PM and 2 AM (the supermarket blood test was conducted about 12 hrs later at about 2 PM the next day).

    One other thing. Because of a detection of a low red blood count in a physical, I have had an inordinate number of blood chemistry/and blood cell evaluations performed over the 2 years by my hematologist n=6 (in addition to the 4 semiannual physical evaluations performed during that time). Although my RBC and hemoglobin concentrations have remained low my liver enzymes always measured well within the normal range (that's 10 tests in the 19 months preceding any of the testing mentioned above!).

    I have an appointment with my doc set for Monday who has been withholding testosterone replacement until he was sure my liver was no longer 'irritated'. My argument is that the lab results he obtained on his re-test were also not accurate, either based on a second faulty test, or because of uncertainties surrounding the statistical probabilities associated with the values being not too far out of the defined normal range, but well within the actual probability distribution that defines TRUE normality (this is based on the assumption that all of these ranges reflect 2 standard deviations around a mean with truncation of the lower tail to reflect an absolute floor value of zero with a 5% probability) . Is this a reasonable assumption on my part?

    I don't believe that my doc is over-testing with a profit motive, but I think he might be operating in CYA (Cover Your A**) mode to defend against a potential lawsuit should I develop some untoward liver problem after the testosterone replacement.

    I'm a Ph.D. neuropharmacologist, BTW.

    Thanks in advance,

    Moss

     
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