rising ALT level - possible liver disease

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nhelen79
New Member


Date Joined Jan 2016
Total Posts : 16
   Posted 1/12/2016 1:14 PM (GMT -6)   
hi everyone,
i'm new here. I'm not diagnosed yet but I"m at the starting process to find out what's going on with my liver.
as part of routine blood tests, my ALT level has been rising. Now, the doctor ordered the liver panel test and hep. tests to find out what's going on. I'm not overweight, and i don't drink. I come here by googling, and feel better after reading your stories. I hope I don't have Hep. disease, but right now, it's an unknown. here are my ALT numbers. i took these as part of my complaining feeling fatigue. i don't have pain or jaundice.
How long does it take for Hep. disease to process to end-stage ? i have a 2 years old daughter and beautiful family. I just hope i can survive to see she growing up.

thanks for reading.

normal is 36 UL
1/11/16: 80(U/L)
11/9/15: 43(UL)
8/27/15: 37(UL)
6/01/15:32(UL)
1/9/15:29(UL)
1/11/14:31(UL)

woofer4
Regular Member


Date Joined Jan 2016
Total Posts : 35
   Posted 1/12/2016 4:29 PM (GMT -6)   
Hi nhelen79 and welcome aboard.
It's tough not knowing and having to wait just plain stinks...believe us, we know.

Keep in mind that ALT and AST are best described as coarse markers. Elevations in these enzymes reflect liver inflammation and can include both acute and chronic conditions. (Virtually all disease processes start with inflammation)

You only have one result that's out of whack, but your labs reflect a chronic elevation. Your doc is doing exactly what's indicated, i.e., more tests.

Generally, hep c is a very slow and insidious disease, but there are no rules here. I had hep c for about 37 years without knowing it.
In 1977 I was stuck with a bloody needle from a known hep b patient and unbeknownst to me and my docs, he had hep c as well. (The Hep c virus wasn't isolated and accurately identified until 1989).

Anyway, I was diagnosed and successfully treated for hep c in 2013.
I have remained undetected for 2 1/2 years and my wife of 33 years and my 2 kids...28 & 29...have never been infected.
My hepatologist really didn't find any evidence of liver damage, even after 37 years. There are others where the disease has progressed rapidly, but this is atypical.

I know it's impossible not to obsess about this, but try...the "tunnel vision" and anxiety will only create more stress for you.
Your labs results won't take long. Routine labs and an antibody screen will turn around in a day. The antibody screen will only tell you if you've ever been exposed.
Your doc may have ordered an HCV RT-PCR quantitative. This will actually identify and measure the hep c viral load. This test takes about 3 days for standard labs to result. Most often, this is ordered after the antibody screen result is positive, but he/she may have already ordered it.

You should figure 1-2 additional days for the office to actually receive the fax, a licensed clinician to sign off on the results and eventually for you to get a call.
The folks here are great people with tons of knowledge and first-hand experience. Post back with your results and any questions, problems or if you just need to vent.

Hope this helps
(woofer5...I'm still having to post under an alias)

Post Edited (Hepcsurvivor) : 1/12/2016 3:46:25 PM (GMT-7)


nhelen79
New Member


Date Joined Jan 2016
Total Posts : 16
   Posted 1/12/2016 10:46 PM (GMT 0)   
hi woofer5,
thank you so much for your reply. I've learned a great deal from your post. since it's shown a chronic elevation, look like it's Hep. C right? :( funny thing is i don't even remember how i could have gotten infected. I don't touch other's blood, but again we all have to deal with things when life throw at us.

Yes, this is nerve-wrecking because i feel like i just got hit out of the blue without prior warning. Will try to be strong to deal with whatever the outcome is. I will post my results when it's available. I have Kaisers in Northern California. Their lab results are usually within 24hrs. I've set up a Dr. appt with the GP to go over the result tomorrow.

I'm only 36 years old, female. I will let my husband and daughter tests after my results come in. My daughter had the vaccine for hept., i hope to God that she's not infected with any of these.

thanks again for your kindness.

woofer4
Regular Member


Date Joined Jan 2016
Total Posts : 35
   Posted 1/12/2016 5:00 PM (GMT -6)   
Hi again Helen,

I'm happy to have helped a little.

Looks like hep c at this point? There are no answers right now. All anyone can say is that it could be. Right now, your doc wants to start crossing off the big, bad stuff as do you.

Kaiser P is a great organization, but if the hep c RNA test was ordered, it's still gonna take 3 days or so to run it... :)
You, your daughter and your husband are gonna be just fine.
Hang tough and keep the faith.

themiz
Forum Moderator


Date Joined Feb 2013
Total Posts : 1891
   Posted 1/12/2016 8:21 PM (GMT -6)   
Welcome to the Hep forum. We are a support group of people with liver disease, and those who love them. I am so sorry you are having health problems.

My husband, themister, was diagnosed with cirrhosis and Hep C in 2005. He likely had the virus for decades before he was diagnosed. I am glad to say he has successfully cured the Hep C, but the damage was done to his liver before he even knew he had that nasty virus.

He is now waiting for a liver transplant and has been very ill for several years. Again today, we spent the day at Mayo Clinic. And we will tomorrow. So we take life as it comes, day by day.


Let us know when you get your labs. We are here to support you. The hardest part is often waiting for answers from the specialists, labs and tests. Again, welcome! Big Hugs
themiz-Forum Moderator-Hepatitis
Wife of themister, a fine man living with ESLD. Transplant list-2013

“Out of suffering have emerged the strongest souls; the most massive characters are seared with scars.” Kahlil Gibran

nhelen79
New Member


Date Joined Jan 2016
Total Posts : 16
   Posted 1/13/2016 3:16 PM (GMT -6)   
hi woofer5 and themiz,

thanks again for your support. I couldn't sleep last night, stressing out, but didn't dare to check test results online. I feel lucky though to find this forum and read all the support that everyone giving to each other although we are strangers.

I went to see the doctor this morning. I'm not totally out of the wood yet.
He said that I'm Hep C and A negative. I've been exposed to Hep B virus and have overcome and developed Inmunity. however, he needs to check for Hepatitis B surface antibody. Interestingly, these tests don't post results online.

So I'm still pending that 1 test. If it's positive (Hep B Surface antibody), then I'm out of the wood for now. He would recheck my liver levels in a few months to make sure they are going down. In the mean time, I need to get over my coughing/neck pain and work with a therapist on my anxiety. he said that chronic Hep B even if you have it, you need to monitor and take care so it won't kill you in 10 years or later down the road. however, it's not something you shall lose sleep or your life over it. it's not worth it.


here are my other test results:

ANA: negative
Ferritin: 251ng/mL (MAX is 291) --> it jumped from 112 from June of 2015. I asked him about the current level, he said it's okay. you are a menstruating woman. 251 is not a concern.
ALBUMIN: 4.7g/dl (Max is 5)
Bilirubin: 0.3 mg/dL (Max is 1)
Alkaline Phosphatase: 77 U/L (Max is 117)
AST: 36 U/L (Max: 40)
ALT: 80 U/L (Max: 36)


thanks all,

ppm guy
Veteran Member


Date Joined Apr 2010
Total Posts : 1080
   Posted 1/13/2016 3:48 PM (GMT -6)   
Hi nhelen,
Congrats !!!
if you have immunity, it's gone

ppm guy
Veteran Member


Date Joined Apr 2010
Total Posts : 1080
   Posted 1/13/2016 4:16 PM (GMT -6)   
One more thing , I reread my post.
The surface antibody your waiting for determines immunity.
The core antibodies (hbcab) is the test, that shows , infection resolved.

I also went thru the same scenario. Had hep b, passed it and now have both antibodies

nhelen79
New Member


Date Joined Jan 2016
Total Posts : 16
   Posted 1/13/2016 4:27 PM (GMT -6)   
hi ppm guy,
I don't see the test results for those Hep. tests, so I have no idea what he tested and their names. this is so new to me. thanks for your explanation. Can you please help me with one more question.

I only have one minor concern now. so what I'm waiting for is whether I have immunity or not. The way the Dr. phrased it, I thought that I'm almost out of the wood. So my current situation is that I am Hep B positive, infection resolved, I guess. However, don't know if I have immunity or not, right unless the surface body tests return positive? What if the test result is negative in worst case scenario, does that mean I'm a carrier but not yet active and have no immunity? do I need to take more tests in this case? I'm sorry that I'm a pessimistic person (not good), but I keep on thinking of the worst case scenario.

I'm from Vietnam and the % of people infected are almost 20%. so the Dr. suspected that I got it from my mom, and fought it off when I was young.

nhelen79(Hanh)

woofer4
Regular Member


Date Joined Jan 2016
Total Posts : 35
   Posted 1/13/2016 7:20 PM (GMT -6)   
Hi Helen,

Glad you're on your way to getting some answers...this is good news so far.
With the help of ppm guy, it sounds like you've got a pretty good understanding. This stuff is actually pretty darn confusing and quite complicated.

I suspect you will find yourself in the same boat as ppm guy and myself...
which is a very nice, safe boat to be in wink
(Recall that I have acquired immunity to hep b as a result of that needle stick back in 1977)

My bet is that your results will be:

HBsAg: Negative
(HBsAg = Hep B surface antigen)...[an antigen is a protein or partial
protein from the actual hep b virus]

Anti-HBc total: Positive
(antibodies to the Hep B core antigen...this includes both IgM and IgG...I'll explain below)

Anti-HBc IgM: Negative

Anti-HBs: Positive

These results reflect a patient who has been infected with hep b and who's own healthy immune system fought it off and ultimately conferred immunity to hep b.

Someone who was never infected, but successfully vaccinated will show the above results with the exception of:
Anti-HBc total: Negative

IgM is a immunoglobulin (also called an antibody) seen in the earliest stages of an infection, ie., the acute phase. Symptoms of an acute hep b infection usually appear in 60-90 days or so and this acute phase can last up to 6 months or so. Many patients (myself included) never develop any symptoms at all.

In about 6 months or so, your body will transition from IgM to IgG. This marks the transition from acute to chronic infection, but it's not a clear and definitive timeline.
When in the chronic phase, a lab test may still show IgM, but in a much lower quantity than the acute phase.

Hep c doesn't follow these rules and is highly mutagenic...congrats on not having that bad boy.

I hope this helps to clarify and not make it even more confusing.
This stuff can get crazy with IgG subtypes and various receptor binding, etc., etc., and is way above this old guy's pay grade...lol

It's looking good!
Stay in touch and get some sleep.

woofer5

Post Edited (Hepcsurvivor) : 1/13/2016 6:40:12 PM (GMT-7)


woofer4
Regular Member


Date Joined Jan 2016
Total Posts : 35
   Posted 1/13/2016 7:34 PM (GMT -6)   
I forgot to add that it's also really good news to see that your autoimmune marker...ANA (antinuclear antibody test) is negative. Your doc probably also did an RF (Rheumatoid factor) and sed rate.
These are common tests and just help to rule out other nasty stuff that you want no part of...

ppm guy
Veteran Member


Date Joined Apr 2010
Total Posts : 1080
   Posted 1/13/2016 7:51 PM (GMT -6)   
Sorry about the confusion

I said congrats, because you stated," I was exposed to hep b, overcome it, and have acquired immunity.

That equates to resolved

I'm sure your dr is covering all bases.

nhelen79
New Member


Date Joined Jan 2016
Total Posts : 16
   Posted 1/13/2016 8:25 PM (GMT -6)   
I wish my doctor is as knowledgeable as all of you. First he said that I have overcome the infection and gained immunity. Then later today, on email conversation with him, he wrote this:

Hep B core antibody positive and Hep B surface antigen negative and Hep B surface antibody positive-That tells us that one had been exposed to the virus but overcame it .

From what I understand, what I have are just 2 out of 3:

Hep B core antibody positive and Hep B surface antigen negative

I need to have Hep B surface antibody positive. What would happen if it turns out negative? Does that mean I'm still infected? I asked the same questions and waiting for tommorriw answer.

If I'm clear on all 3, I will go to sleep extra hours as a way to celebrate.

Thanks again everyone. I feel a lot more strong just by talking with everyone .

ppm guy
Veteran Member


Date Joined Apr 2010
Total Posts : 1080
   Posted 1/13/2016 8:57 PM (GMT -6)   
You have cleared. The virus
Those 3 tests are perfect.

Hbsag( surface antigen ) negative means you are now testing negative for hep b.

The 2 anti bodies that are positive, means virus resolved and immunity
Congrats
Barry

nhelen79
New Member


Date Joined Jan 2016
Total Posts : 16
   Posted 1/13/2016 9:38 PM (GMT -6)   
hi Barry,
I'm still waiting for this result Hep B surface antibody to be positive. shall find out by tomorrow.
my only concern is what if "Hep B surface antibody" = negative? :)

woofer4
Regular Member


Date Joined Jan 2016
Total Posts : 35
   Posted 1/13/2016 10:41 PM (GMT -6)   
Hi Helen, hope you're sleeping as I post this.
Like I said, I'm pretty sure your results will spell victory here.
But like you, it's a bit confusing the way your doc presented the results so far.

Were you told the results and just emailed an explanation?...that's what it sounds like. You're correct, to be complete, you need the Hep B surface antibody.
However, given the other 2 lab results, the only two scenarios I can see as far as hep b are...either you've cleared the hep b infection completely or you are still in the process of clearing it...and by that I mean winning the process. I had assumed the HB core antibody was "total" and not just an IgM assay, but now I'm not sure and apparently you weren't given that info.

Anyway, I'm betting you've already won or you're just about to cross the finish line as a winner.
Can't wait to officially celebrate your victory!

nhelen79
New Member


Date Joined Jan 2016
Total Posts : 16
   Posted 1/14/2016 4:09 PM (GMT -6)   
hi woofer5,
I was just told from doctor's explanation. such a bummer that the previous blood is not enough. I need to go back to the lab and do that hep. b surface antibody early test next week since I'm waiting to check on my pregnancy test too (currently trying). Your words are encouraging. I really hope it will be all fine. my doctor also told me that he think it would be positive for hepb surface antibody. I'm still praying :)

by the way, does anyone has good recommendation on Milk Thirstle supplement? I'm thinking of taking it to help my liver. I also will start on a low-iron diet to get my ferratin lower. I don't like it being up to the high end of normal.

thanks all,
Helen

woofer4
Regular Member


Date Joined Jan 2016
Total Posts : 35
   Posted 1/14/2016 4:46 PM (GMT -6)   
Hi Helen,
Boy oh boy, you gotta be sick and tired of the emotional roller coaster.
Yes, I really think you're out-of-the-woods on the hep b, but it'll be great to get the "official" word from your doc.

As I said in my last post, based on the labs so far, I only see two scenarios...either you've completely cleared the virus and now are immune or you're in the process of clearing it and clearly winning the battle. (Recall the IgM assay vs. the total assay [IgM & IgG].

Re: Milk Thistle...I couldn't be a bigger advocate.
Of course, many ppl. are not, including many doctors, etc.
My hepatologist supported my taking MT. It is the only "supplement" that he supports. I still take it and probably will forever.

Sorry, I gotta run, but I'll be happy to share more info with you later on if you like.

woofer5

_____________________________________________

2013 / Diagnosed and successfully treated for hep c geno 1b with Telaprevir, Interferon and Ribavirin...treatment duration 24 weeks.
Retired CRNA (aka nurse anesthetist)...approx 35 years experience in the ER and anesthesia.
Exposure was likely a bloody needle stick from a known hep b patient in 1977. Hep B never progressed to the chronic phase...my own, healthy immune system crushed it.

nhelen79
New Member


Date Joined Jan 2016
Total Posts : 16
   Posted 1/14/2016 7:02 PM (GMT -6)   
thanks Woofer5. please let me know which MT i shall buy? i see too many on amazon ranging from 250mg, 140mg, etc. i asked the doctor and he said multivitimin is enough. he doesn't know about MT.

Hanh

woofer4
Regular Member


Date Joined Jan 2016
Total Posts : 35
   Posted 1/15/2016 1:57 PM (GMT -6)   
Hey Helen,

I have used the this excellent product for 4 years:

"Maximum Milk Thistle" from Natural Wellness.

Although Amazon Prime carries it for $34.95 (90 capsules),
it is actually cheaper when purchased directly from Natural Wellness via their Easy Auto Ship program.
I take 3 capsules a day so every 3 months I pay a total of $82.86...delivered (3 bottles or 270 capsules).

It sounds like you're knowledgable about MT so I'll leave it there.
Hope you're sleeping better.

nhelen79
New Member


Date Joined Jan 2016
Total Posts : 16
   Posted 1/16/2016 2:28 PM (GMT -6)   
Hi Woofer5,
thanks for your detail on MT. i'll look into it.

I would also thanks everyone else for your support. I'm very grateful. the Hep B surface antibody test came back as positive. So the Dr confirmed that I had Hep B immunity.

helen

**David**
Veteran Member


Date Joined Nov 2009
Total Posts : 3708
   Posted 1/16/2016 4:59 PM (GMT -6)   
My hepatologist said it's okay to take milk thistle, but said he doesn't think it helps or hurts. A lot of people think it's not a good thing, as it isn't regulated. I have never taken it and wouldn't. I don't trust meds that aren't known to be effective.
nullum beneficium impunitum...

woofer4
Regular Member


Date Joined Jan 2016
Total Posts : 35
   Posted 1/16/2016 7:16 PM (GMT -6)   
nhelen79 said...
...the Hep B surface antibody test came back as positive. So the Dr confirmed that I had Hep B immunity.

helen

Yippee Ki Yay...You go girl!
Go get a big hug from your husband and daughter.
Sleep tight.

ppm guy
Veteran Member


Date Joined Apr 2010
Total Posts : 1080
   Posted 1/16/2016 7:23 PM (GMT -6)   
great!!!
now you can sleep well.  Good luck on starting your family..

themiz
Forum Moderator


Date Joined Feb 2013
Total Posts : 1891
   Posted 1/16/2016 8:34 PM (GMT -6)   
Wonderful news! Big Hugs
themiz-Forum Moderator-Hepatitis
Wife of themister, a fine man living with ESLD. Transplant list-2013

“Out of suffering have emerged the strongest souls; the most massive characters are seared with scars.” Kahlil Gibran
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