Liver Function is down

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MoobyDoo
Regular Member


Date Joined Sep 2009
Total Posts : 212
   Posted 1/9/2010 3:17 PM (GMT -7)   
Recent bloodwork from my daughter shows that her status is not getting better, but a bit worse.  Liver function has dropped. Dumb question - why/how does Crohn's affect liver function?  Looks like we are headed for another colonoscopy. This will be her second one (last one in March.) She's only 9! Grrrrrrrr.

  • Becoming undone
    Veteran Member


    Date Joined Jul 2007
    Total Posts : 927
       Posted 1/9/2010 5:47 PM (GMT -7)   
    There are a few reasons...some meds may have a hepatic effect (most likely cause)...also, some of that autoimmunity may also arise in other systems (MS, Lupus, Sorgen's just to name a few)...like me, I DO have PSC (primary sclerosing colangitis) which does seem to be related to IBDs...I know it can be frustrating, having so much to deal with...I'm not sure why they would consider a colonoscopy for abnormal LFTs though...they would more do an upper gi scope (inserted via mouth). Anyone else have any ideas?
    "The earth laughs in flowers"


    njmom
    Veteran Member


    Date Joined Apr 2006
    Total Posts : 1884
       Posted 1/9/2010 5:52 PM (GMT -7)   
    My guess is it is the meds. What is she on?
     
    Daughter (22) Dx'd Crohn's 3/06. Misdiagnosed for two years, including by top pediatric Crohn's specialist as stress. No symptoms for the past two years. Recent colonoscopy shows stricture gone but still two spots of inflammation in TI. Used LDN to taper off Entocort. Was on Entocort since April 06. Never had D. 4.5 mg LDN, SCD multivit, homemade yogurt, 5000IU vit D3, 500 mg calcium, 27 mg iron, monthly B12 shots, daily oral B12 1000. SCD diet modified to include potatoes and rice. 


    MoobyDoo
    Regular Member


    Date Joined Sep 2009
    Total Posts : 212
       Posted 1/9/2010 9:24 PM (GMT -7)   
    Thanks for replying. She is currently on Pentasa and Entecort. 

  • Nanners
    Elite Member


    Date Joined Apr 2005
    Total Posts : 14995
       Posted 1/10/2010 8:51 AM (GMT -7)   
    I'm with njmom, I think its more than likely her meds and agree why would she need another cscope for liver issues?
    Gail*Nanners* Co-Moderator for Crohns Disease & Anxiety/Panic
    Crohn's Disease for over 34 years. Currently on Asacol, Prilosec, Estrace, Prinivil, Diltiazem, Percoset prn for pain, Zofran, Phenergan, Probiotics, Calcium, Vit D, and Xanax prn. Resections in 2002 & 2005. Also diagnosed w/ Fibromyalgia, Osteoarthritis, & Anxiety. Currently my Crohns is in remission, but my joints are going crazy!
    *Every tomorrow has two handles.  We can take hold of it by the handle of anxiety, or by the handle of faith"*

    MoobyDoo
    Regular Member


    Date Joined Sep 2009
    Total Posts : 212
       Posted 1/10/2010 2:01 PM (GMT -7)   
    Well other indicators are off as well.  
    LOW are:  biliruben, LYMPHS, MCV, creatinine, albumin, alkaline phosphatase, ALT
    HIGH are: SEGS, AB SEGS
     
    Not to mention she is pale and continues to lose weight, not gain.
     
    I know nothing about bloodwork of course, but according to her GI Doc all these markers indicate that her disease is in an active state and has her Doc concerned. Last time when bloodwork was not perfect (but not as bad as this time) he wanted to do another endo/colo but I held him off in leiu of trying entecort for her.  I know he will tell us he needs to scope when we see him on Tuesday. She is soooooo scared and depressed about this.
     
     

  • teddybearweiser
    Veteran Member


    Date Joined Oct 2004
    Total Posts : 3042
       Posted 1/10/2010 2:08 PM (GMT -7)   
    Hi MoobyDoo, My prayers are with you and your daughter. Sorry she is not feeling well.
    Hi, I am teddybearweiser, I am a male.
    I was diagnosed with crohns disease when i was admitted to the hospital

    in 1992, in Jan of 1993 I was back in the hospital for surgery for my crohns. I had part of my right colon resectioned with ilecolonstomy.

    My GI doctor has me on and Humira. B-12 injection once a month.
    Also diagnosed with Rheumatoid Arthritis.


    1025
    New Member


    Date Joined Aug 2006
    Total Posts : 8
       Posted 1/11/2010 11:37 AM (GMT -7)   
    try her to take some probiotic yogurt (activia) to rebalance her bacteria. you have to start looking at her diet. try eliminating as much sugar as possible. more fruits and veggies. i have found that being careful with diet is key to managing symptoms. i currently take fish oil and green tea. no meds. i've had crohn's 28 years and never felt better.
     
    the trick is everyone is different. there is no one way of controlling symptoms. you have to find what works for you. i didn't start trying improving my diet until a few years ago and it does take years to change a basic habit such as what you eat.
     
    the drug therapy comes with its own problems, such as liver problems. this helps to motivate be in being vigilant on my diet.
     
    good luck 

    MoobyDoo
    Regular Member


    Date Joined Sep 2009
    Total Posts : 212
       Posted 1/11/2010 2:28 PM (GMT -7)   
    Thanks 1025. I like the natural/diet idea, and you are definitely right about the sugar... whenever she eats things like cakes, cookies, candy she inevitably winds up with tummy pain. We even tried a sugar free cookie (today!) and she is now having tummy discomfort. Sheesh.  We have given her lots of probiotics over the past 9 months consistently. Right now she takes Align and a custom blend probiotic daily.  No luck yet.  Still having symptoms.


  • njmom
    Veteran Member


    Date Joined Apr 2006
    Total Posts : 1884
       Posted 1/11/2010 7:05 PM (GMT -7)   
    Hi MoobyDoo,
     
    You might want to check out www.labtestsonline.org to help interpret the tests.
     
    What struck me is the liver indicators like ALP were low, because often liver disease is associated with higher levels. Also, mono and other issues can cause higher levels.   The following link interprets low and high ALP, and says low ALP can be due to a zinc deficiency: http://www.labtestsonline.org/understanding/analytes/alp/test.html
     
    If your daughter has symptoms, the disease must be active. Pentasa isn't very strong, and Entocort, if it works, is useful mainly for patients who have Crohn's concentrated in the terminal ileum. There is no evidence Entocort can cause mucosal healing, so it is only a placeholder until a more effective med/diet can be used...by this, I mean, if it works, ENtocort can be used to bring a disease to near-remission, giving you time to explore more permanent options for meds/diet.
     
    The inflammation probably is interfering with absorption of nutrients, which could include zinc (many Crohn's patients are low in zinc) and a lot of the indicators do go along with inflammation. Anything is possible with a med, but as an example, in the unlikely event pentasa interfered with ALP, it would probably increase, not decrease ALP. 
     
    Now that I know more, I suspect the primary culprit is inflammation. The meds are either not working or are not effective enough. You have every right to simply ask the doc why it is necessary to do a colonoscopy, when it can be safely assumed the disease is active. Why not simply introduce a new med and then see whether the bloodwork improves?
     
    Sounds like you have been left guessing and there's no need to wonder why -- the doc needs to explain more. 
     
     
     
    Daughter (22) Dx'd Crohn's 3/06. Misdiagnosed for two years, including by top pediatric Crohn's specialist as stress. No symptoms for the past two years. Recent colonoscopy shows stricture gone but still two spots of inflammation in TI. Used LDN to taper off Entocort. Was on Entocort since April 06. Never had D. 4.5 mg LDN, SCD multivit, homemade yogurt, 5000IU vit D3, 500 mg calcium, 27 mg iron, monthly B12 shots, daily oral B12 1000. SCD diet modified to include potatoes and rice. 


    MoobyDoo
    Regular Member


    Date Joined Sep 2009
    Total Posts : 212
       Posted 1/11/2010 8:31 PM (GMT -7)   
    NJMom, thanks for sharing what you know.  I will def. check out the site you mentioned.  As for the doc, I really like this guy. He has colitis himself and so we know he stays abreast of current treatments and he's not opposed to biomed either as he has her on Forvia, probiotics, calcium & omegas that he feels may be preventive and proactive. 
     
    Last time we saw him her labs were off too, although not this much.  He wanted to scope then (September) because when he first scoped her in March her Crohn's was mainly in the terminal ileum. Since he is still seeing inflammation he said he wanted to go back in and look to see if the inflammation has spread to other areas in order to determine what medicine would be best to try next.  It sounded reasonable, but we wanted to avoid that for her since she's only 9 and so we opted to try the Entecort for a while instead. She saw some quick moderate improvement, but it hasn't lasted. Tonight she was having stabbing pains in her mid-abdomen and crying (after she ate grapes which have never bothered her before?). So awful to see. Then the pain passes and she seems fine. So weird. So we have an appt. with him first thing tomorrow morning. He is gonna bring up 6mp and Remicade as options, and probably more prednisone (she was on this last spring). He's not a great fan of 6mp...last thing he mentioned to me is that even short term use can increase one's lifetime cancer risk ?!  So he's leaning toward Remicade. But have you read the warnings all over the Remicade website? OMG. Scary stuff.  So hard to know what to do...
     
     

  • njmom
    Veteran Member


    Date Joined Apr 2006
    Total Posts : 1884
       Posted 1/11/2010 9:27 PM (GMT -7)   
    It's great that the doc is keeping up with probiotics, etc. You didn't mention CRP and ESR tests, key markers of inflammation, so I assume those are high, too?
     
    Yes, they are scarey, which is why my daughter is trying other things....LDN and modified SCD diet, right now.
     
    If considering 6mp, it might make sense to have TPMT labs done to find out whether your daughter has enough TPMT activity to deal with the 6 mp. There are two different tests: one checks the gene, and the other checks the level of TPMT activity. My daughter's doc opted, without letting her decide for herself, to have her tested for the gene. So we now know she has the necessary gene. However, what we DONT know is does she have ENOUGH TMPT activity because there's another test, that measures the activity. So it seems to me the one that measures activity is best - if there is no activity then the gene can be presumed to be absent.  
     
    I hope she feels better soon...when my daughter had a stricture we peeled everything, even the seeds off strawberries. So it might seem odd, but perhaps peeled grapes? 
     
    Maybe the doc wants to check for a stricture, which could cause cramping that feels like stabbing pain - because the opening is too narrow for the food to go through. So grape skins, for instance, could cause problems.

    MoobyDoo
    Regular Member


    Date Joined Sep 2009
    Total Posts : 212
       Posted 1/11/2010 9:47 PM (GMT -7)   
    Okay sorry but since we are new to Crohn's here I'm going to have to dumb it down a bit...okay a lot. WHAT is a stricture vs. a fistula??? Have heard these terms used on this site often. Thanks.

  • Nanners
    Elite Member


    Date Joined Apr 2005
    Total Posts : 14995
       Posted 1/12/2010 7:52 AM (GMT -7)   
    MoobyDoo I have to agree with njmom here, if I ate those grapes with the peel on I would be in a world of hurt too (and I am in remission), so do peel them in the future. The one question you asked above I can answer is what is a stricture. A stricture is a narrowing of the intestines caused by either inflammation or scar tissue. A fistula is a tract that grows between the intestines and another organ. For example a woman might get a fistula from her intestines to her her vagina. Hope that helps a little.
    Gail*Nanners* Co-Moderator for Crohns Disease & Anxiety/Panic
    Crohn's Disease for over 34 years. Currently on Asacol, Prilosec, Estrace, Prinivil, Diltiazem, Percoset prn for pain, Zofran, Phenergan, Probiotics, Calcium, Vit D, and Xanax prn. Resections in 2002 & 2005. Also diagnosed w/ Fibromyalgia, Osteoarthritis, & Anxiety. Currently my Crohns is in remission, but my joints are going crazy!
    *Every tomorrow has two handles.  We can take hold of it by the handle of anxiety, or by the handle of faith"*

    riesasmom
    Regular Member


    Date Joined Dec 2009
    Total Posts : 44
       Posted 1/12/2010 8:26 AM (GMT -7)   
    Hi MoobyDo, I know how difficult it is to see your daughter suffer this way. May I suggest you look into the (SCD) Specific Carbohydrate diet. It is no grains, no processed sugar, no lactose, no yeast. It is very difficult in the beginning, but over time it gets easier. There are also many recipe websites. My 14 year old crohns daughter has had great success with it. Last year, she gained 12 lbs and grew 2 inches in 4 months when beginning the diet. Her doc also suggested Remicade, but I wanted to try everything else possible first before going that route. Many people find, as did we, that doctors are reluctant to reccommend any such diet, even though many many people are helped by it. Its worth a try , or at least look into it.  Hope she feels better soon. Diana
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