Jerry, I can't answer your med question, but I would think that the liver doc can order an MRI with contrast to see what condition your liver is in. I had a biopsy in '93 when I was diagnosed with hep C and didn't have another until surgery to remove the rt. lobe in '07. They did a bx of the lt. lobe while I was under anesthesia. Mayo has never pushed me for biopsies as they can tell a great deal just from scans.
The cause that those with intolerance have to Imuran is an inability to metabolize it so it builds up to toxic levels... http://en.wikipedia.org/wiki/Thiopurine_methyltransferase There is a blood test they can do for it. That is completely different than how CellCept works and it wouldn't hurt to ask them to at least try it. All the immunosuppressants are 'steroid-sparing' drugs which help wean off the pred, as I'm sure you know. There are a lot of people on the Yahoo group that aren't able to take the Imuran but are fine on the CellCept. A lot of people who flare after the 7.5mg drop to 5mg go much slower the next time around. So when they are at 7.5mg and start weaning from there, once LFT's are normal, they go down 0.5mg at a time. It helps the adrenals kick back in better. How long since your diagnosis and starting pred? I only worry that they are trying to get you off the pred and maintain you on nothing. With your history of flare on the pred, what happens when you are fully off and flare again? It will always be the same cycle as there is such a high relapse rate with this disease. There's also another lady I know of who couldn't take Imuran or CellCept (but at least they had her try) who is on cyclosporine. My hep has also mentioned Tacrolimus (http://en.wikipedia.org/wiki/Tacrolimus) as an option. I think you should insist they try something as your liver will only incur more damage if you get off the pred with no back up.
Please tell them you insist on trying a different immunosuppressant. Now that you have gone back up on the pred is a great time to do it! CellCept works immediately unlike Imuran that takes 2 months to fully kick-in. I don't know about the Tacrolimus or the cyclosporine.
You are your own advocate!
Glad to hear your numbers are better! I hope one of the immunosuppressants will work for you! Good to hear you're going for a bone density check and they are fully checking everything else. I don't think I ever had my vitamin levels checked...maybe I'll ask about that on Thursday when I go for my hep check up. I had bloods drawn today...it's always nerve wracking when an appointment comes up. It'll be good to know what's going on in there. I've been plenty stressed lately and am worried about it causing a flare.
Keep us posted on how your appointment goes.
Imuran (azathioprine) converts to 6MP. There is a test that can be done (blood) to test for deficiencies in TPMT. It's an enzyme needed for safely taking either azathioprine or 6MP. You can request the test and if you had trouble with the Imuran, they should have done it. Personally, I didn't have trouble so they didn't do it but I know many others who have. Aside from those 2 immunosuppressants...there are others. CellCept, Cyclosporine, Tacrolimus. I'd bring all these up to Dr. Schiff...I'm sure he'll bring them up to you being an expert in liver disease...he'll know! When's your appt?
Sounds like your numbers are pretty great..only a few numbers less and you'll definitely be in normal range no matter which lab is running your samples (they all vary for what are 'normal', that's why they usually show the range of their normal beside your values).
I know the pred sucks...on the plus side, once you get on an immunosuppressant (and it's fully on board--I think the others act quickly, I know CellCept does), they'll start to lower your dose. All my crappy side effects started going away when I got down to 10mg which was only 2 drops from where you're at...I had a small stop at 15mg on the way.