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Something's up with my liver

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Posted 1/18/2012 7:44 PM (GMT 0)
PBP, let us know the results of the ultrasound and your blood work results.

Hugs,
Connie
Posted 1/19/2012 1:28 AM (GMT 0)
Yup she was really good. She asked me if there were any other things I wanted her to test for! I'm feeling quite a lot better today, so perhaps it was just a viral thing that's going to pass! Hopefully anyway!!
Posted 1/23/2012 6:44 AM (GMT 0)
Just an update, blood tests were negative for CMV, hepatitis A/B/C. I'm having an ultrasound tomorrow. My liver function tests were improving and now they're going back up again. So I've got no answers and still feeling terrible =[
Posted 1/23/2012 1:58 PM (GMT 0)
You've got some answers. You know that you don't have CMV, Hep A,B, or C. Sorry you're feeling terrible.
Posted 1/23/2012 3:46 PM (GMT 0)
PBP, it's great that you don't have CMV or viral hepatitis. Did she test for autoimmune hepatitis and primary biliary cholangitis (PBC?)

Hugs,
Connie
Posted 1/24/2012 12:04 AM (GMT 0)
I was really hoping it was going to be Hepatitis A, that way I'd be feeling better soon!

I haven't been tested for autoimmune hepatitis or the other one. The latest theory is medication induced hepatitis. None of the medication I'm on is high risk for this though. I'm stopping the Mobic and seeing if that's what's causing it.

Thanks everyone.
Posted 1/24/2012 1:23 AM (GMT 0)
PBP, are you taking any herbal meds? They can also raise liver enzymes, though shouldn't make you feel bad.

Hugs,
Connie
Posted 1/24/2012 1:49 AM (GMT 0)
I use to take fish oil, but only for a month or so and stopped about 3 months ago. I took Evening Primrose Oil for a week about 5 weeks ago. I took a little bit of vitamin C for 2-3 days while I had a cold about a week and a half ago. Apart from that, nothing. The ultrasound was extremely painful when she pushed in to try and see my liver. The sonographer said there was nothing major that she could see wrong with my liver but wanted the doctor to look. I'm thinking it might be the NSAIDs that I'm taking for my joints so I'm going to try and do without them and see if that makes any difference. Thanks again.
Posted 1/24/2012 3:26 AM (GMT 0)
PBP, vit. C and fish oil aren't herbals. I'd stay away from evening primrose, though. As for NSAIDs, you could be right. Try acetaminophen (Tylenol) instead, up to 1200 mg a day. That's what I'm allowed.

Hugs,
Connie
Posted 1/24/2012 3:32 AM (GMT 0)
Sorry I just thought I'd mention all the alternative things I've tried. Currently I'm just taking Plaquenil and cutting out everything else (except anti-nauseas). I thought Tylenol/Panadol was hard on the liver too? My GP told me "not to over do it" on the Panadol, I've just been taking it when I'm at my worst. I'm unsure if the medication could really be the culprit because my LFTs were up before I started Meloxicam and Plaquenil, but I was on other NSAIDs (Celebrex, Diclofenac, Naproxen and Brufen- not all at the same time!) before the Meloxicam. I guess it's just a process of elimination. Thanks for your support!
Posted 1/24/2012 4:31 AM (GMT 0)
PBP,

I think it's great that you're sorting through it.  If it is drug-induced hepatitis, then finding the culprit is crucial and working around that so your other health issues don't suffer.  If you can't sort it out and your LFTs continue to rise, I'd ask about having a biopsy.

Tylenol is bad for your liver but if you stay below that max allowed amount then it should be fine...or ibuprofen (Advil).  Just be sure you speak to the doc and see which is their preference as they should know everything you are taking.

Posted 1/24/2012 4:51 AM (GMT 0)
It's a slow process! We just rung and left a message for my GP to ask if she could please test for autoimmune hepatitis like she said she would if my Hep A/B/C/CMV etc all came back normal. So hopefully I'll hear from her tomorrow about that. The ultrasound was pretty painful around my liver and I'm feeling pretty bruised now.

I'm hopeful it is a drug induced hepatitis, but I'm worried that might mean I can never take an NSAIDs again especially because they've been a pretty big part of treating my arthritis. None of my medications are highly likely to cause drug induced hepatitis either, three rheumatologists have said it's not medication!

I haven't been taking more than the recommended dose for any of my medications or paracetamol or mobic.

Thanks.
Posted 1/24/2012 4:47 PM (GMT 0)
Acetaminophen/Tylenol is not an NSAID, which is why it is allowed. But even with that, you can't take much. Ibuprofen is said to be the worst offender. I do think, as a process of elimination, it is best for you to eliminate everything you can for awhile to see if your enzymes go down.

I don't know how those three rheumatologists can state that it's not drug induced without a biopsy.

Hugs,
Connie
Posted 1/25/2012 2:59 AM (GMT 0)
I was taking Tylenol every 4-6 hours when I was feeling my worst, my GP said that it was fine to take it as long as I wasn't exceeding the recommended dose.

That's odd that you say Ibuprofen is the worst offender. I got in contact with Pharmacology and Toxicology at the hospital here and emailed a professor in hepatotoxicty. This was her email about taking ibuprofen-

"Has she tried nurofen? It is the brand name for ibuprofen so any brand will do. It just has to have ibuprofen as the active ingredient. If you buy it in the supermarket the package will say to take 2 pills that are 200 mg each. However, the dose for arthritis is 800 mg (4 pills) every 8 hours or 3 pills every 6 hours which ever is easier to remember and keep on schedule. Ibuprofen won't harm the liver but some people get stomach ulcers (about 5-10% who try it)."

Note the last line.


I sent her a list of my medication. This was her reply-

"Of all the medications listed Meloxicam is the only one with the potential to cause liver problems. So it is completely possible that her liver issues are related to her using Meloxicam. "


She told me it was fine to stop taking Meloxicam and take Ibuprofen instead.

At the moment I've just stopped Meloxicam (and my joints are sore!) and haven't taken Ibuprofen. I just want to give it a week without NSAIDs to see if that's what causing it. I'm also starting university tomorrow so I'd like to be feeling well. I can put up with the joints over the nausea.

Thank you again.
Posted 1/25/2012 3:12 AM (GMT 0)
That's very odd since Mayo absolutely said no ibuprofen. I had been taking prescription strength, 800 mg tablets, but they don't even want me to take OTC ibuprofen of 200 mg each...only acetominophen/Tylenol or Rx Lortab (up to 4 a day, but not to take a combination of both that would equal more than 2000 mg/day.

This is from the first article I read when I Googled NSAIDs and liver damage:

"NSAIDs are safe when used properly and as prescribed by doctors; however, patients with cirrhosis and advanced liver disease should avoid NSAIDs since they can worsen liver function (and cause kidney failure as well)."

Perhaps this "no NSAIDs" edict for me is due to my hepatitis C, which already has my liver enzymes and viral load very high with the new liver. They want to protect my liver as much as possible. Acetaminophen is not an NSAID.

Hugs,
Connie
Posted 1/25/2012 3:30 AM (GMT 0)
I thought it was very odd because I can find more online about Ibuprofen causing drug induced hepatitis than I can about Meloxicam. I spoke to my Mother and she said "I'd trust a professor in pharmacology and toxicology who specialises in the liver over what you read online". I'm still not sure. I had the prescription strength 800mg stuff too. I was on less than the maximum dose of Meloxicam a day. So I don't know what to do! At the moment I think I'll just try and stay off all NSAIDs and see how I go. I've got topical NSAID gel which I've been rubbing on my knees and shoulders. Perhaps different things apply because you have Hepatitis C, I don't know, but I'm extremely confused!!
Posted 1/25/2012 3:45 AM (GMT 0)
well Mike was told not to take Ibuprofen... He had Hep C and ESLD.. better to be safe than sorry... Sandia
Posted 1/25/2012 2:39 PM (GMT 0)
My hepatologist had told me, when 1st diagnosed to use Ibuprofen for pain relief. Once I started taking a different med for another issue, Ibuprofen was contraindicated so my hep said it was OK to use Tylenol as needed. Aspirin is OK too but you have to worry about your stomach. I find the Excedrin that has 250mg acetaminophen/Tylenol + 250mg aspirin + 65mg caffeine to be helpful when I have a migraine coming on. Ibuprofen is primarily metabolised by the kidneys. That's why there is no talk of 'Black box' warnings for it for liver toxicity like there is with acetaminophen/Tylenol.

Hep C and cirrhosis do have different processing issues.
Posted 1/25/2012 3:07 PM (GMT 0)
I've been to several hepatologists, had a liver transplant and spoken to PAs and nurse/practitioners about over counter meds. All have said the only thing. I can take (and hopefully not much) is Tylenol.
Posted 1/26/2012 3:45 AM (GMT 0)
Well the professor replied again and she said Ibuprofen would be fine. I'm still unsure so I'm going to go without NSAIDs for as long as I can. I've had a few days in the past 6 weeks where I just start to feel a bit better for a few days and then I get worse again. If I go back on Ibuprofen and feel worse, then I won't know if it's the NSAIDs or just having a good few days.

Thanks everyone.
Posted 2/10/2012 4:32 AM (GMT 0)
Sorry to bring up an old post, but I thought I'd just give a little update.

My ultrasound showed everything normal. I came off Meloxicam like the professor said and within 3 days I felt a lot better. My GP wanted my blood tests reordered last week. I was expecting everything to be fine, but they were worse than they've ever been! My ALT was 192, my AST and GGT were elevated and my ALK Phosphate (I think) was low, I couldn't get the exact numbers though. My GP said she wasn't happy with where things are at and she wants me to have them retested on Monday and see her on Wednesday. So I have NO idea what to make of this! I was expecting things to be all normal. So I think it's time to see a specialist now.
Posted 2/10/2012 6:25 AM (GMT 0)
Princess, alk phos = alkaline phosphatase.

Your ALT is higher than mine and I have chronic hep C. It would be in your best interest to see a hepatologist, but I know you said there is only one and he's too far from you. Can you see a GI doc who specializes in liver disease? You really need to get a biopsy to determine just what is going on.

Thanks for the update and please continue to keep us posted.

Hugs,
Connie
Posted 2/10/2012 6:49 AM (GMT 0)
Thanks Connie. My GP said she's "not happy where things are at" so I guess I'll find out more on Wednesday. It's just pretty shocking and annoying because I am feeling better! Yet my blood tests say things are getting worse! I'm going to push to see a specialist this time, I think it's gone on long enough now. There are some GI doctors here and they say they specialise in gastroenterology and general hepatology. I think that's my best bet from here. Thanks again.
Posted 2/10/2012 11:29 AM (GMT 0)
Quick question, why are you on Doxycycline, Plaquenil and Mobic? I hate bringing this up on non lyme forums but it there the possibility of lyme? Lyme can be the cause of both elevated liver function tests and positive ANA/ENA profiles. Hugh
Posted 2/10/2012 5:25 PM (GMT 0)
PBP,

Definitely push to see a specialist.  If there isn't a hepatologist then, at minimum, see a GI doc.  It is very possible that it started as drug-induced hepatits but, as I've said, if you are predisposed to autoimmune disease, it can become AIH.  A biopsy will help with a definitive diagnosis but there are antibody tests they can do as well.  There is also PBC (primary biliary cirrhosis) and PSC (primary sclerosing cholangitis) to look into.  Don't discount other viruses or infections as Hugh mentioned Lyme's disease.  It sounds like you have a proactive GP so that's awesome!

I hope Wednesday goes well!

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