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Hypochondriacyy 02-08-2012 08:55 PM

Please Evaluate my Labs... opinions please
First my history. On and off drinking since I was in my 20s. Im 45 now.
In the early 90s I drank what I considered heavy (2 or 3 nights a week drunk) for maybe 7 years. But I know PLENTY of daily drunks. I NEVER drank to that extreme on a daily basis. Anyway, that was for maybe a 7 year run when I was young and crazy. Afterwords I was just a social drinker, a few cocktails before dinner, very rarely 4 or 5 drinks but only on occasion.
I am a severe hypochondriac with anxiety and panic disorder. So I am at the doctors ALOT! I have had 5 ultrasounds over the last 20 years, maybe 3 times they show fatty liver. My liver enzymes were only really elevated once in my 20s.
2 years ago I go in for a check up, I have mild pain URQ which he thinks is sluggish gallbladder. I get mild pain after a fatty mean or indigestion. He does blood work and AST/ALT elevated by 2 points, so he says its nothing to worry about. I request an ultrasound. The results were:

[B]Moderate to SEVERE fatty Liver! with mild hepatomegely[/B]

Well that scared the bejesus out of me! I never seen severe before in my fatty liver diagnosis and the mild enlargement was not too comforting!

I stop all alcohol completely. And I go on a diet. Im 50 pounds overweight,

Last year I go to recheck with another ultrasound, this time a new doctor because I moved. The results came in NORMAL! I was very happy naturally.
When we read the top part where they detail all the organs etc it did say "Something something conisitent with MILD fatty infiltration of the liver"
My doctor quickly pointed out the the doctor who read the scan didn't even think the fatty liver was significant enough to include it in the conclusion and just wrote "Normal Limits abdominal sonogram"

Being a hypochondriac I still worry about Cirrhosis. I have what I perceive as "signs" for example
1-Pale Finger Nails (but I have had pale fingernails since childhood, and my dad has it too and his liver is fine)
2-Red Palms -they burn sometimes. Have had for a few years. Never worried about it until I started googling.
3- A few spider veins here and there. Not tremendous, but if I look hard I will find them.

Now before I post my most recent blood test results, let me give you one more caveat to ponder. I have been diagnosed with Low Testosterone. Its very common for middle aged men with fat to have this. As a result, my estrogen is a little high. I know high estrogen can be a sign of liver disease, but in my defense, I must say I have had high estrogen all my life. when I was a kid I developed male gynomastia (male breasts) from too much estrogen. So I am hoping that my red palms and spiders are a result of the estrogen imbalance and not a faulty liver. I am currently on Testopel (Testosterone pellets).
I also read online about distended abdominal veins, and if I look carefully at my chest and belly, especially after I work out at the gym I can see a few veins. But I would think the ultrasound done only one year ago would show portal hypertension.

The good news is that since going on Testosterone therapy I have been having blood work almost monthly! Its not a major panel, they do that once a year, but its a basic. As a result of the testosterone therapy, my RBC runs high, which is common for men on T therapy. So I give blood at the Red Cross every 8 weeks. I asked my doctor to do another ultrasound and said no I don't need one. He said "don't look for trouble" -When I pushed him on it he said that "too many of these tests lead to more and more tests then the next thing you know your doing biopsys because of a cyst here and a cyst there. You feel good, you don't need it, your labs are normal"

This is my lab results from 2 weeks ago:
Total Testosterone 905
Free Testosterone 108
Estadiol (Estrogen) 62 -should be under 55
A1C 4.9
Glucose 95
Creatnine 1.0
Bilirubin 1.1
Albumin 4.9
ALT 36
AST 19
Hemoglobin 18.1

My bilirubin does seem to stay in the high range of normal bouncing between .08 and 1.3 over the last year. He said he is not concerned.

I read somewhere that people with Cirrhosis usually will have AST elevated 2 or 3 times the ALT, where as in every other form of liver disease its ALWAYS the ALT that rises. that gives me some hope as my AST is very low compared to my ALT

BillinSD 02-09-2012 08:57 AM

Re: Please Evaluate my Labs... opinions please
From what I have learned about liver disease, cirrhosis is a point where existing liver disease (fatty liver, NASH, alcoholic fibrosis) takes on a life of its own and will progress even when whatever caused the initial disease (alcohol, obesity) has been corrected.

Once your AST is double your ALT, and other confirming diagnoses point to cirrhosis, you're well past the point of living healthy and disease free.

This makes watching for early warnings like palmar erythema, spider veins, and other non-confirming labs very important. These symptoms can help you change your lifestyle and get healthy BEFORE you develop cirrhosis, and find yourself on a road on which you can no longer turn back from.

Hypochondriacyy 02-09-2012 08:59 AM

Re: Please Evaluate my Labs... opinions please
Bill are red plans and spiders early symptoms? I though they came on in advanced disease? If they truly are early then its a good thing. But I thought I read that they presented latter. Can a simple fatty liver or fibrosis with no Cirrhosis cause red palms?

BillinSD 02-09-2012 05:50 PM

Re: Please Evaluate my Labs... opinions please
[QUOTE=Hypochondriacyy;4925152]Bill are red plans and spiders early symptoms? I though they came on in advanced disease? If they truly are early then its a good thing. But I thought I read that they presented latter. Can a simple fatty liver or fibrosis with no Cirrhosis cause red palms?[/QUOTE]

Early, late. or in-between... When you see 'em, it's best not to ignore 'em (in my book at least). When you are younger, you tend to think "oh well, if I get in trouble I'll just go to the doc and he'll have something for me".

As you get older and see the "end of the road" looming in the not so distant future, and realize there really is nothing medicine can do to fix your liver once it's toast, these little signs mean a lot.

I'm not a doctor, and I don't really know what these signs actually mean. All I know is, when I saw them, I changed my behavior real quick.

My ultrasound showed a "mildly echogenic" liver, which could mean fat or fibrosis. There was no sizing of the spleen, liver or portal vein. I don't know if this means they were nominal, or if this just wasn't done.

Labs were normal, but once these show obvious signs of trouble one is often past the point of returning to optimal health.

I'm on the straight and narrow now, and learning all I can about how to keep this old body chuggin' along for another decade or two. The more I've learned about cirrhosis, the more convinced I am that this is something I never want to risk.

Hypochondriacyy 02-09-2012 06:24 PM

Re: Please Evaluate my Labs... opinions please
Bill you and I are a lot alike! I quit drinking 2 years ago, after getting that scare with the liver enlargement. Yea your right, the older you get, the more you value your health.
Im 47, how old are you if you don't mine my asking?

They did measure the size of your liver, thats an automatic with an ultrasound. If they didn't comment, then it was normal. But from my understanding, a normal size spleen is more important, as you probably already know.

One of my "signs" that I have been noticing lately are veins in my abdomen. Im a little over-weight and out of shape. But after reading online that distending abdominal veins are a sign of Cirrhosis, what do I do? I begin to examine my abdomen. I see shades of blue here and there. I can definitely see veins. In th morning I see no veins at all, as the day wears on I see more. After I work out at the gym I see more. There are a couple that seem to be very visible sometimes. Like today I was in the car for 2 hours, when I got home I look at my chest and on the sides I see a couple that are almost raised a little. So now I'm terrified I am developing portal hypertension.
I had an ultrasound exactly one year ago, which hopefully would shave detected PE, but I still worry.
And before that one year again.
The US from 2 years ago was at a major NY hospital and it was a doppler US which shows blood flow, very good at seeing the hepatic tree in the liver.
the on least year was in the Dr.s office on a portable machine, I'm not sure if he used doppler or not on that one :(
Im very tempted to see a different doctor again and try to get another US, just to ease my mind if nothing else. But I hate to start "looking for trouble" so I'm debating that.

Do you plan to repeat any testing?

BillinSD 02-09-2012 09:46 PM

Re: Please Evaluate my Labs... opinions please
I'm 55 (and still alive!)

With regard to the abdominal veins... I always thought the "caput medusae" was part of the end of the road as far as cirrhosis goes. If you google the photos of it, they always show gross acites and patients that look more dead than alive. I should think one would have several years of dealing with major complications before this stage appears.

When it comes to more testing, I've had enough for now. I'm already following the prescription as best I can (no alcohol, healthy diet etc). The only true diagnostic is a biopsy, and I have no desire to be harpooned, only to find out I've got a terminal disease that nothing will fix, in addition to hearing I need to avoid alcohol and eat healthy.

Life is a terminal condition, and if I blow out a blood vessel and bleed out one night, so be it. I'll escape the long slow decline and end stage jollifications. I'm actually feeling quite good now (since I've been dumping iron). Tummy is flat and firm, man-breasts have shrunk to normal, appetite is good, and fatigue is much less of a problem.

Each day of your life dawns but once, and I'm focusing on living for now. If and when I get more symptoms, I'll start thinking about doctors and dying once again.

Hypochondriacyy 02-09-2012 09:59 PM

Re: Please Evaluate my Labs... opinions please
Very good thoughts Bill! Yea makes sense. believe it or not, my urologist said the same thing about a biopsy! I told him I was worried about my bilirubin because it was .01 over the reference range a few weeks ago. He said "you should see my liver enzymes" -So I questioned him, and he told me has had persistently high LFT;s for a number of years. It was at the point that his hepatologist wanted him to have a biopsy. He refused stating that the results of a biopsy will have no significance one way or the other on the outcome. So he would rather just live his life and IF the time should come, he will have a transplant. Coming from an MD, that was inspiring.

Regarding the veins, yes I have seen plenty of picture of Caput Medusa and I don't want to see any more!!! Horrible looking thing.
Thats not what I was referring to though. I certainly don't have that, thank God. If I exercise or sit in the car for a long time, then look into mirror (because I can't see them looking down, on both of my sides I have a couple of veins that feel to raise above the surface of the skin ever so slightly. they are small and hard to see, unless you know where to look. I have had them about 2 years. Funny thing is, in the morning they are completely invisible, at night they are more visible and more blue. I assume this relates to blood pressure. I thought maybe this indicated portal hypertension, but Im think this is unlikely with a negative ultrasound 12 months ago. I think with PE there would me other stuff going on too, but still I worry. I wish I could post a picture here of those veins.
I shoed my doctor and he said he didn't see anything, lol, but it was way too yearly in the day. Blood pressure was probably still low from sleeping

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