rising ALT level - possible liver disease

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)

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.

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,

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

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
(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)

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.

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

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!

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.

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.

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.

great!!!

now you can sleep well.  Good luck on starting your family..