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Author Topic: need expertise  (Read 1514 times)

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Offline wolfter

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need expertise
« on: January 04, 2012, 04:36:10 PM »
I know a few of you understand these lab results with as much clarity as some doctors.  I've been rooting through my 1,000's of papers all dealing with medical issues.  I've mentioned before that I was dianosed with Hep B in the early 90's and have found some documents pertaining to it.  I'm thinking now that they just used these results to arrive at a diagnosis.

AST/SGPT was 879
ALT/SGPT was 1735;   there was a comment indexed to them that reads; Rechecked and STAT broadcasted; Patient results continue to be in panic range.  Previous results were reviewed and called; results printed to floor.

T Bili was 13.83
D Bili was 8.65
GGTP was 147

Since I now know that I didn't have Hep B, can anyone who understands these number hazzard a guess to what was going on?  My doctor won't do so.  I'll eventually let this go, but I lived with this disease for 15 years and didn't even have it. 

Thanks all
Wolfie


Judging someone does not define them, it defines you. 

True peace is not merely the absence of war, it is the presence of justice.

Offline newt

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Re: need expertise
« Reply #1 on: January 04, 2012, 04:54:00 PM »
Okay these are way off the scale. How do you feel?

A retest immediately is in order cos these results look like someone with acute liver damage ie Paracetamol poisoning, but if you are walking, talking and laughing guess this isn't the case.

Hepatitis A would a good starting point, but then they may be someone else's results.

There are other explanations too. Get a retest. Maybe an abdominal ultrasound. If it's serious other biomarkers will also be odd.

A duff liver test on its own means little.

- matt
« Last Edit: January 04, 2012, 04:56:32 PM by newt »
"The object is to be a well patient, not a good patient"

Offline Growler

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Re: need expertise
« Reply #2 on: January 04, 2012, 04:59:28 PM »
Matt I think you missed Wolfie's saying that these are OLD figures (back in the 90's) so there's no need for panic stations.

Now I think it's time for you both to sit back relax with a White Zin and have a laugh.

GROWLER
“If loving someone is putting them in a straitjacket and kicking them down a flight of stairs, then yes, I have loved a few people.”

Offline newt

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Re: need expertise
« Reply #3 on: January 04, 2012, 05:32:29 PM »
Yes, well spotted, I'd set no store by them on their own - matt
"The object is to be a well patient, not a good patient"

Offline wolfter

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Re: need expertise
« Reply #4 on: January 04, 2012, 05:44:24 PM »
It has always bugged me, that's all.  I knew in my heart that I didn't have Hep B, as I was quite aware of how it is contracted and I hadn't been involved in any of those activities.  But I also can't seem to let it go wondering what else was going on and if there's an underlying issue. 

Yeah, I was horribly sick Matt.  I went beyond yellow and was a bright shade of orange.  Dropped down under a 100 pounds and couldn't even ingest water.   That was the days before privacy was a concern, some of my family found out about my AIDS diagnosis that day before I had a chance to inform them.  They didn't expect I was leaving through the front door so I guess they thought it didn't matter. 

Wolfie

Judging someone does not define them, it defines you. 

True peace is not merely the absence of war, it is the presence of justice.

Offline bocker3

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  • You gotta enjoy life......
Re: need expertise
« Reply #5 on: January 04, 2012, 06:24:12 PM »
Hey Wolfie,

One would never make a definitive diagnosis off those numbers -- without doing a Hep panel (at least one would hope not).  Clearly something was going on with your liver at that time.  Your results are amazingly close to mine when I had Hep A (confirmed with a Positive Hep A Surface Antigen, IgM test).
Back in my lab days, we rarely saw numbers like that except in Hepatitis or Cirrohsis.  It's impossible to tell at this point.  Can you tell me again -- how do you know that you didn't have Hep back then (A, B or C)?

Mike
Atripla - Started 12/05
Reyataz/Norvir - Added 6/06
Labs - Pre-Meds
Sep05 T=350/25% VL98,559
Nov05 288/18%  47,564
Current Labs
May2013 691/31% <20

Offline newt

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Re: need expertise
« Reply #6 on: January 04, 2012, 07:14:55 PM »
I'd put money on hepA. It's dead easy to catch. There was an outbreak in London 10 years or so ago traced to salads in a posh restaurant. But there you go, you are well now, yes? Did they not do relevant antibody panels etc? My liver panel was similar, if not quite so sky-high, when I had hepA but not when I had hepB. With hepA I too was, like, guest star in the Simpsons.

But then again, the liver is a mysterious organ, and many things can affect it for a short and extreme while, including some opportunistic infections connected with low CD4 count, some of which have difficult presentations and  may not have been on the physicians' radar liver-wise. << dumb but common a while back and even now

- matt
"The object is to be a well patient, not a good patient"

Offline TonyDewitt

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Re: need expertise
« Reply #7 on: January 04, 2012, 07:49:24 PM »
Matt,

Since we're OT about the various Heps and how to test for and interpret results, how does one know for sure that they have / don't have Hep (A,B,C, etc.)? Is it like HIV in terms of having a window period, antibody tests, RNA tests? Seems like a muddy picture in terms of diagnosis, please fill me in if you can.

Thanks!

Offline buginme2

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Re: need expertise
« Reply #8 on: January 04, 2012, 07:50:55 PM »
I'm convinced HIV itself can cause liver probles (although I'm not sure to that extent).  Prior to me being diagnosed positive, my liver enzymes were elevated.  They tested me for Hep A/B/C and all were negative (plus I was previously vaccinated for hep a and b.  I had an ultra sound and it was discovered my liver was enlarged.  I was referred to a specialist and after a bunch of tests it was discovered I had HIV. 

I have since read that liver disease is major cause of death for HIV positive people (even those who are negative for hepatitis).  So I am convinced of a relationship.
"All I need are some tasty waves, a cool buzz, and I'm fine."

http://www.youtube.com/watch?v=6e0gcEC1TWE

Offline phildinftlaudy

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  • sweet Ann what you think babe...
Re: need expertise
« Reply #9 on: January 04, 2012, 08:04:27 PM »
Those numbers you showed are right around where mine were when I had Hep A in 2001 and was hospitalized for 8 days.... I was extremely sick --- and actually caught it from a salad I ate at a restaurant (I know because two hospitals in the area confirmed that there had been other cases around the same time as mine and a common denominator was salad eaten at this particular restaurant) [oh, and no jokes about it coming from "tossed salad" or tossing salad  ---   ::)     ]

It came on pretty suddenly - high fever, extreme fatigue, pain in abdomen, sore all over, nausea --- it completely had me messed up --- I wouldn't wish it on my worst enemy (alright, maybe I would - but only a mild case ----- I'm trying to be more honest this year)

My bet is it was Hep A --- a test should show if you have antibodies to Hep A which if you haven't been vaccinated would be attributed to having had it before.
Same with the Hep B.
September 13, 2008 - diagnosed +
Labs:
Date    CD4    %   VL     Date  CD4  %   VL
10/08  636    35  510   9/09 473  38 2900  12/4/09 Atripla
12/09  540    30    60   
12/10  740    41  <48   
8/11    667    36  <20  
03/12  1,041  42  <20
05/12  1,241  47  <20
08/12   780    37  <20
11/12   549    35  <20
02/12  1,102  42  <20
11/12   549    35  <20

Offline bocker3

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  • Posts: 3,265
  • You gotta enjoy life......
Re: need expertise
« Reply #10 on: January 04, 2012, 08:13:08 PM »
My bet is it was Hep A --- a test should show if you have antibodies to Hep A which if you haven't been vaccinated would be attributed to having had it before.
Same with the Hep B.

However -- an absence of said antibodies does not mean that you did not have Hep A or B.  Some people have a drop off in antibody titer -- most don't, but some do -- some quickly, some over a longer period.  That is the bitch with this -- it is easy to rule in, if tested -- but not altogether easy to rule out, after the fact. 
I would simply let this go -- your liver seems to have recovered, no?  The likelihood that you will find your answer is slim -- unless you've never had an antibody test -- you could try that and then drop it.

Hugs,
M
Atripla - Started 12/05
Reyataz/Norvir - Added 6/06
Labs - Pre-Meds
Sep05 T=350/25% VL98,559
Nov05 288/18%  47,564
Current Labs
May2013 691/31% <20

Offline wolfter

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Re: need expertise
« Reply #11 on: January 05, 2012, 10:01:06 AM »
However -- an absence of said antibodies does not mean that you did not have Hep A or B.  Some people have a drop off in antibody titer -- most don't, but some do -- some quickly, some over a longer period.  That is the bitch with this -- it is easy to rule in, if tested -- but not altogether easy to rule out, after the fact. 
I would simply let this go -- your liver seems to have recovered, no?  The likelihood that you will find your answer is slim -- unless you've never had an antibody test -- you could try that and then drop it.

Hugs,
M

Is it possible to entirely rid yourself of the virus, leaving no antibody to show a previous infection?  When I switched to my current ID doctor, he ran all the antibody tests and indicated I never had any infection.  I went through the 3 shot procedure to inocculate myself.  I'll eventually drop it, but it has always gnawed at me.  I'm not sure how I've made it this long with the less than stellar medical attention I rec'd.

Wolfie
Judging someone does not define them, it defines you. 

True peace is not merely the absence of war, it is the presence of justice.

Offline newt

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  • the one and original newt
Re: need expertise
« Reply #12 on: January 05, 2012, 05:07:38 PM »
Your body deals with viruses by producing various antibodies. How long these remain depends on you and the virus in question. Sometimes it's a lifetime (effectively) and sometimes less. It really does depend on the individual and the virus in question. Since vaccinations tend to produce weaker antibody responses than the real deal this is why you are advised to top up eg every 5 years, 10 years on many vaccinations.

I had hepA and hepB about 15 years ago.  I still have detectable hepB antibodies but not hepA antibodies. << this is the first year they were too low to equate to "immune" The "fade" is variable then....

- matt
"The object is to be a well patient, not a good patient"

Offline bocker3

  • Member
  • Posts: 3,265
  • You gotta enjoy life......
Re: need expertise
« Reply #13 on: January 05, 2012, 05:32:20 PM »
Wolfie,

Hep A and B tend to be acute diseases and the body rids itself of the virus.  Hep C can go either way.  Given your lab results from back then, I would think the best a doctor could say is that you don't have any antibodies to Hepatitis A,B,C.  To state that you never had Hepatitis is not something that could said with any surety.  Your labs certainly suggest that something was up with the liver -- something that you recovered from.  This certainly puts hepatitis into the realm of possibilities. 
Not sure why you would have results like that and NOT had a Hepatitis work up done, but that is water under the bridge now.  Let it go -- you're healthy now!

Hugs,
Mike
Atripla - Started 12/05
Reyataz/Norvir - Added 6/06
Labs - Pre-Meds
Sep05 T=350/25% VL98,559
Nov05 288/18%  47,564
Current Labs
May2013 691/31% <20

Offline phildinftlaudy

  • Member
  • Posts: 2,950
  • sweet Ann what you think babe...
Re: need expertise
« Reply #14 on: January 05, 2012, 07:48:38 PM »
Because I had recently started a thread about my own "Hep B Chronic - to have or not have that is the question" (or something like that) thread - and this thread deals with some concerns Wolf has.... I thought it appropriate to post the response that I received via email today from my ID doc in regards to my questions about my insurance showing that I had recently been reported via a claim as having Hep B Chronic (see thread for additional background):

From phild's ID doc:

"....We can revisit this with the new set of serologies, but most likely they will just show past infection.  In any case, the backbone of Atripla contains 2 drugs that are active against Hep B, so even if you had it, it would be extremely unlikely to be active at this point.
 
I like proactive patients J
Susanne
 
Susanne Doblecki-Lewis, M.D.
Assistant Professor of Clinical Medicine
Division of Infectious Diseases
 
University of Miami Miller School of Medicine"


I'm pretty sure my issue has to deal with a coding error tied to the labs which were ordered that day for my next round of labs (to occur in March) - which include Hep A, B, C testing. At any rate, we shall see....

And Wolf - I can understand why it would bother you - but as long as your current labs are clear and your liver functions are intact, then I agree that I would let it go - and just continue to be proactive on your current and future medical care - as I am sure you are and appear to be.
 
September 13, 2008 - diagnosed +
Labs:
Date    CD4    %   VL     Date  CD4  %   VL
10/08  636    35  510   9/09 473  38 2900  12/4/09 Atripla
12/09  540    30    60   
12/10  740    41  <48   
8/11    667    36  <20  
03/12  1,041  42  <20
05/12  1,241  47  <20
08/12   780    37  <20
11/12   549    35  <20
02/12  1,102  42  <20
11/12   549    35  <20

Offline wolfter

  • Member
  • Posts: 4,070
Re: need expertise
« Reply #15 on: January 05, 2012, 08:37:16 PM »
I guess I was fortunate that I showed up early for my doctor's appointment because he had a no-show and I got to spend almost an hour with him.  I brought him all the paperwork from that hospital admission.  He agreed to review them if I'd finally let it go. :o  He is still pretty certain that it wasn't Hep B.  His best guess is that it was an active CMV infection, possibly soon after acquiring it.  It could also have been a gallstone that blocked a bile duct while trying to pass.  And there are numerous other things, although less likely, that could have presented with the same numbers.

He also indicates that there's no record of virology tests to indicate the presence of a virus.  He also brought up a good point;  this diagnosis occurred in the ER of a rural hospital 20 years ago.  It was most likely assumed it was Hep B since I was a gay man with AIDS and presented myself with jaundice and elevated numbers. 

Other than that, everything looked great; labs wise.  The we moved on to fun shit, like scheduling my next scope.  I'm not returning to the same surgeon who performed my ass surgery this Spring.  We still have not rec'd a detailed report from him after numerous requests.  So I'm getting a new referral.  Then I had him look at the splinter that has been impaled in the bottom of my foot for a few months now.  Now I have another referral to have a damn plantar wart removed.

Wolfie
Judging someone does not define them, it defines you. 

True peace is not merely the absence of war, it is the presence of justice.

 


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