wondering

Hi - I know I probably shouldn't have done this but I have been reading about cirrhosis and alcoholic liver disease and now I am wondering if I have damaged my liver with my drinking habits. Based on what I have read, drinking moderate amounts regularly can be as bad if not worse when it comes to liver damage than drinking a lot, especially for women.

Over the past 20 years, I have had my share of binge experiences at parties, regular glasses of wine (1 or 2) in the evenings, and in recent years, I might have one cocktail 3-5 times per week. I also have taken a lot of NSAIDs over the years.

When I had my acute hepatitis episode last year, I had just finished taking a course of strong antibiotics for an infection and wasn't drinking at all. I didn't have a drink for several months, but once my LFTs were normal for a while, I returned to having a glass of wine or a cocktail once in a while, mostly on weekends, and less than before.

In recent years, in general I've noticed I have a lower tolerance for alcohol. I try to drink a lot of water with any alcohol, and I just reach saturation very quickly; sometimes I can't even finish a second glass of wine because I just "feel bad". And there is usually pain in my right side after I've had drinks several days in a row. I can just feel my body wanting a break, even if it is after just one glass of wine for a few consecutive days with dinner.

Over the holidays, just before my last episode of pain, GI problems, elevated ALT/AST, severe exhaustion, and even some strange episodes of talking nonsense out loud in my sleep, I had been drinking much more than usual for more days than usual and I was taking a lot of NSAIDs during the day for pain. I've cut out both now and don't plan to use either ever again, but I'm worried I've already done a lot of damage. In my most recent liver panel, my albumin was low and I've been losing weight.

Should I insist on a biopsy? I've had the CT and Ultrasound which didn't show anything. Maybe what I thought was AIH because of elevated ANA is actually a result of my own stupidity. I had a lot of misconceptions about cirrhosis and alcoholism.

Sorry to be such a worry wart. I go for more blood tests next week, but it seems like normal LFTs don't necessarily mean everything is ok with cirrhosis?? Do I just have to wait and hope for the best?

Thanks for reading. hana

Hana,

Please don't listen to speculations of how much MAY be necessary to cause problems.  Everyone is different...period.  Women are more sensitive to alcohol because they have less alcohol dehydrogenase which enables the body to break down alcohol to less toxic compounds.  You say you were on an antibiotic when you had your first bout of hepatitis...more than likely drug-induced hepatitis.  That can clear up on it's own (as it did).  However, that would make you more susceptible to liver problems from toxins.  So continuing to drink and take NSAIDs puts you more at risk for future bouts of acute hepatitis (liver inflammation).  Drug-induced hepatitis can lead to AIH.  Your ANA are slightly elevated but you also have some other issues that may be cleared up with the Rheumy.  Since some docs have speculated that it may end up being AIH, get a referral to a hepatologist.  Have the biopsy and know for sure what the heck is going on.  If you don't have cirrhosis (and I have heard your LFTs can be normal and still have cirrhosis since the LFTs indicate inflammation not scarring---so maybe no active inflammation at this time), then you can put it behind you and be very careful about the drugs you put in your body (OTC or alcohol).

See a hepatologist and don't listen to anyone trying to lessen your worries with breaking down exactly how many "units" of alcohol you drink.  You are more sensitive, you've had issues, find out what's going on.

David,

Acute hepatitis doesn't mean you have any kind of viral or other chronic hepatitis.  It just means that something happened to cause your liver to be inflamed.  The word hepatitis simply means inflammation of the liver.  It can be caused by some herbal remedies, some prescription meds, alcohol, etc.  It is usually termed "drug-induced hepatitis" or "acute hepatitis" as once the offending substance is stopped, the liver heals and goes back to normal and may never have a problem again.  Because Hana seems to have this happen at different times, the 1st after her treatment with an antibiotic, and then again...each time her liver healed without medication...I agree it's best to not have any alcohol as it is one of the worst toxins you can expose your liver to...no matter how much you drink.

Hana, I agree with others who say not to drink any amount of alcohol at all...and only take an NSAID if you absolutely have to.  They are hard on the kidneys, also.  Listen to Dany.  She knows what she's talking about.  It's possible you've caused some harm to your liver by past behavior; however, you can stop the damage in its tracks and even reverse it, by doing the right things.  Your possible ANA is another issue entirely, but I feel sure, regarding that, a hepatologist would tell you that drinking or taking NSAIDs is not a good idea.

Hugs,

Connie

Hana,

I know I brought this up before but I don't remember the answer...did they test you for CMV (cytomegalovirus)?

Also, even if you have some cirrhosis, which I honestly doubt...it can be stopped.  It can't be reversed but as long as no more distress is put on the liver and you don't have another bout of acute hepatitis, you'll likely be fine.

You are correct, not all docs are created/educated equally.  Find one that you are comfortable with, is thorough and takes everything into account and doesn't have a superiority complex about sending you to the appropriate specialist.  If you do indeed have an autoimmune issue, some can be tricky to solve...and in the end, even though it's your liver that initially said "hey pay attention", it may not be AIH but a different one altogether!    Or it could just be that you need to keep on your healthier living and avoid the things that some are able to take for granted and imbibe in!

I'll be interested to hear what all your levels are next week!!

Yep hana ur right sorry....and at least a biopsy may give some further info..

hana,

Hugs! Others know much, much more than I do.

You have said a couple times that "it just doesn't feel right when you drink." Does that mean you have physical pain? Have you mentioned that to your doctor? If not, maybe you should?

Sorry, hana.

Thanks Connie for tidying up the place :) , and to all for the understanding and support. I value this as a place where I can ask questions, share experience and learn from others. I am surprised when I see the sparring, but communication is always tricky under these circumstances, when folks aren't feeling well or have been through the ringer or are worried or frustrated. Having it all be mediated by a computer doesn't help I'm sure. But I really appreciate this forum.

Dany, the docs are pretty inconsistent sometimes. I was told low doses of tylenol were better than NSAIDs since I have had so much GI irritation. Seems like something like bufferin would be good too. For now, though, my doctor is encouraging me to just suck up any pain so we can do the LFT again in a couple of weeks. At this point, I too would kind of like to know what I'm dealing with. I need to find a doc who does the transjugular biopsy -- and a lot of them :) -- because I cannot go the needle route either due to adhesions and other prev med issues. That will be the next project if only I had some energy.

Philosophy, I haven't mentioned my seeming alcohol sensitivity and definitely should. I start to get pain on my right side after a day or two of drinking relatively small amounts, I just feel "full" like I cannot tolerate any more of anything. It's hard to explain - instead of making me feel good, one more sip of alcohol just makes me feel bad, like it is irritating my GI system. It's been going on for a while I think because I've been aware of drinking very slowly when I do have a glass of anything.

Today I'm suffering with major lower back pain, headache, feel weak, last night I had bad sore throat and felt like I had a low fever. I'm achy and just feeling bad. My right side is sore. I'm waiting for those elusive good days and wish I knew what to do to make one happen now. hana

Technically, Tylenol is just a pain reliever.  True it isn't a steroidal but the actual NSAIDs work on the COX enzyme pathway.  Tylenol doesn't so it is neither.  That's why it is OK to have both Tylenol and Advil at the same time if you are allowed pain relief and need extra help after one doesn't work well.

In any case, liver patients should try to avoid any of them. Aspirin is considered safe but only if you are in a remissive state and your liver is functioning well.  Otherwise, a distressed liver affects clotting ability so taking aspirin (a blood thinner) would be bad.  Since pain is a stress on the body, if you are having pain and you are a liver patient, it is best to check with your hepatologist so they can advise on pain relief and so they know what you are taking if something does change in your LFT levels.

I had a transjugular biopsy since I had lost my ability to clot when my liver was failing.  I had 4 bags of plasma prior to the procedure...you wouldn't need that.  I had no problems with the biopsy and you don't have to lay still for 4 hrs like to percutaneous route.  I did spend the night in the hospital because I was sick but I'm sure that wouldn't be the case either.  However, they only offer it to patients who can't have the "regular" percutaneous one...which sounds like maybe you could get it that way.