Blood Tests
 

So, after my last Bloods showed elevated Serum Alkaline Phosphatase and Serum ALT levels, an Ultrasound showed I had NASH.

Now, with deeper tests, it is found my Inflammatory Markers are elevated. My GP gave no explanation except to request another test in a month, but my usual GP asked whether my Oncologist was checking on me regularly.

Should I be concerned?

Most of the time, I don't worry about things until I am told it is time to worry when it comes to medical/health issues. I did say "most" of the time. I just figure that worrying isn't going to change anything and if there was nothing to worry about, then I wasted a lot of time and energy worrying for nothing. It is also my way of coping and denial is my first choice until I am ready to cope.

All that being said, I have inflammatory markers frequently and have never been diagnosed with any type of cancer as of yet. I would be more concerned about being asked by your GP if your oncologist is still following you and checking on you.

Inflammatory markers is a vague statement and could be anything or nothing of concern.

I just got some blood results and for the FIRST time in over 30 years, my white blood cell count is actually within the normal range. Yes, my WBC count has been elevated for years and years.

I have also been told many times about having inflammatory markers.

I seem to worry more about what they (doctors) are going to do to me than the conditions that may present. I was very apprehensive about my eye doctor appt. today but it was the fear of what he might "do" during the appt. today.

If I sound like a "chicken", you got the right picture, especially when it comes to eye docs. I don't like anything near my eyes and they come at me with all kinds of machines, instruments, drops, etc. They poke and prod my eyes like a squishing ball.

See, I got so rattled today that I can't even respond properly to your post, Dave. I am going off topic.

NO, I don't think you need to be concerned (yet) but I do think you need to follow-up and get more information from your GP. Can you get him to be more specific and detailed?

PS I am scheduled for an eye surgery in 3 weeks. Not sure if I will show up. :) Already thinking about cancelling and it hasn't been 12 hours since I scheduled it.

Dave, I would not be unduly concerned.

Elevated serum levels of AP and ALT can be a marker of liver disease.

This fits with the ultra-sound and NASH diagnosis.

NASH usually has an inflammatory component which could explain the elevated inflammatory marker levels.

There is some general information about NASH here; http://www.niddk.nih.gov/health-info...ges/facts.aspx .

Hi Dave,

I'm a medical writer, which means I see lab results from thousands of clinical trials patients. There so many reasons that you can have elevated ALP or ALT levels that you shouldn't necessarily worry.

One of the more common causes of NASH is metabolic syndrome. How are your glucose, cholesterol, and triglyceride numbers?

Concern
 

Hi Dave,

I think "concern" is normal, all things considered. You are a very reasonable guy and you will likely temper your concern with reason. :winky:

I am saddened tonight about your having to even think about possibly dealing with more of anything medical. :hug:

You are a strong man, on many levels. I believe you can cope with whatever you decide you want to take on. My concern isn't about your ability to endure. My concern is more about the many ongoing challenges and how these challenges may affect your quality of life and your everyday sense of joy.

You aren't these conditions and you are very skilled at transcending these immense physical challenges. :)

Even so, you deserve a break.

I am praying for your healing. :hug:

Warmly,
DejaVu

Hi madisongrrl,

HbA1c is 44 mmol/mol, down greatly in 8 weeks.

I do not have my cholesterol or triglyceride numbers for this year, all I was told was that they were in range. Last year

Serum cholesterol 4.1 mmol/L. HDL Ratio 3.7
Serum triglycerides 1.9 mmol/L

Over here, NASH is called stage 2 steatosis, and I have been put in this category because I am symptomatic - pain under ribs (no Gall Bladder, had a tumour)


Dave.

Just phoned Drs.

Cholesterol/HDL ratio 3.8
No Triglycerides test taken.

Thanks everyone,

When you have had 2 rare Cancers, the mention of Oncologists gets you worked up a little. Perhaps it is all coming from the damage from my latest falls.

I will try not to worry for a month - until my next tests.

Dave.

I hope things work out for you Dave.

Liver functions can elevate from viruses. Simple ones and the usual hepatitis ones.

Mild elevations are usually not considered important. But when my son had Mono, his were really high. It took six months for them to come down.

Some drugs may do this too... so your doctor should evaluate all your medications.

NASH is very common in this country. I've seen stats estimating it at 30% of people here. As you proceed with your new lifestyle changes in diet, you may see that regress some.

Me, that does not worry until a brick wall falls on me, would be freaked out about the mention of "is your oncologist following you" if I had your past history of 2 rare cancers.

I count my blessings that I have all sorts of "chronic" illnesses that kill you very slowly over LONG time frames, or have no fatality involvement at all, just pain. Maybe that is why I don't worry so much about the illness as I do about the "treatments and testing" for various conditions.

Inflammatory markers does NOT necessarily take you down the road of looking for cancer. All sorts of benign things will cause inflammation in the body and possibly show in blood work.

When you have diabetes, you can have all sorts of lab values affected.

Hope your next labs will be less concerning to you.

Hope

Hi Dave,

I guess I could try and look it up, but I am being lazy and asking you to translate your values to United States numbers so I can understand what they are in "my" head.

What is the corresponding US value for your 44 A1C?
Serum cholesterol?
Serum triglycerides?

OK, showed my stupidity, but I need help in translating values to what I know.

Hopeless,
Is this any help?

http://www.onlineconversion.com/cholesterol.htm

Yes, Lara, a big help. Thanks. Converted them. So nice of you to provide it.

Do you have a link to convert the hemoglobin A1C of 44 to US ?

Hopeless

Hey Hopeless,

My A1c has fallen from 7.1 to 6.4 in 8 weeks.

I do not know how to, or what, the others convert to over there. Why don't you all go Metric, like the rest of the World?:D

Dave.

Why don't you all go Metric, like the rest of the World?:D Because we have super smart people like YOU, that know both. I let you act as my brain. Mine is too small. :)

THAT is fabulous. Super SUPER good. GREAT job, Dave. VERY impressive.

Can I come eat all my meals at YOUR house? My next appt. with endocrinologist is tomorrow.

I've been asking that for years Dave. ;)

MrsD,

I am clear of the usual infections like Hepatitis and I know the problems leading to the state my liver is in are more and more common. The stage I am at is estimated at 2-5% of the population. Still a huge number, but concerning when it is YOUR liver at risk of further damage.

I do expect it is being taxed by the quantity of meds I have to take, I have gotten rid of the statins, maybe the Tramadol will be changed Monday.

By coincidence, my quarterly Oncologist check up came through the mail this morning, it's in just over a fortnight so I will bring up my liver and Bloods there.

Dave.

We USA people have to be different.

We have a guy in Congress that is pushing for us to change. The US is meant to be taken both ways, as United States and as a plural pronoun.

Was that clever? Guess not. I guess comedian is not in my future career. :winky:

I don't think this old dog is ready to learn that new trick, converting to metric.

I'm surprised your doc didn't test your triglycerides again. Here in the U.S, a typical reference range for this lab test would be <150 mg/dL (~<1.7 mmol/L) would be considered normal. However, we have studies showing that you really want your numbers to be <100 mg/dL (~<1.1 mmol/L). Doctors and dietitians who are more on the pointy end of the stick will tell you this.

http://circ.ahajournals.org/content/...60726.full.pdf

Whatever you are doing, keep doing it! More whole foods, more green vegetables, less refined carbs....sometimes it only takes small changes to get the ball rolling.

Hi Dave

Well you beat me all round on the cholesterol tests - your diet is obviously working - well done. I'm too embarrassed to post my numbers - the only good thing I can say is they've come down a little from last year. Got to keep minimizing those steroids.

Hope you get some answers soon re your liver tests and that it's something manageable. Some of my liver numbers came back borderline low recently - Albumin & Total Protein - GP doesn't seem concerned - so wait another 3 mths and see if they've improved.

All the best for your onc. appt. Sending lots of positive vibes your way.

My diet of around 1200cals a day, no junk and watching carb intake for my Diabetes is still taking 1.5-2lbs off per week. Hard to stick to with the Mirtazapine and Metoclopramide, but it is going well.

This is the biggest beneficial change in my life since I quit drinking 26 years ago.

Roughly halfway to target weight!

Dave.

You are such an inspiration to so many. Outstanding job.

Gotta Love Determined Dave!
 

YES! I agree so very much! :D

Dave, the two meds you mention are also difficult to contend with when dieting. I have a couple of those types of meds, as well. :(

I deeply respect your determination! :D

You are an inspiration, as Hopeless has expressed so well.

You bring me much JOY! :D

:hug:
With Gratitude,

DejaVu

Dave, I had a chat to one of my medical colleagues about this.

His comment was that what you are doing (eating in a healthy way, losing weight in a sustainable way) is very highly recommended for people with NASH.

Keep it up - as others have said, your determination is an inspiration to many people here :).

I had an appt with my GP on Monday regarding my repeated Blood Tests. My Liver Function numbers are shooting up, out of control (no numbers, just shown on graph).

She says they are the numbers of a heavy drinker - I quit 25 years ago - and that none of my meds are liver toxic or can explain this. Nor can my positive change in lifestyle and weight loss.

She has booked me in for a CT Scan of liver and pancreas as I have already suffered 2 rare cancers. I do not know how I would face another. My father died of liver cancer just slightly older than I am now after spread from colorectal cancer.

The alternative, she said, is becoming increasingly ill from liver disease. With this, I will be referred to a Liver Specialist.

Within 6 months of quitting smoking I was diagnosed with colorectal cancer. Now, 5 months after quitting junk food and sorting out my A1c and weight, I have to deal with this mess. It is no wonder I am spiralling deeper into Depression every day.

Dave.

Dave, this is alarming, I agree.

There are reports of Mirtazepine causing liver damage...Are you
still taking it?

http://livertox.nih.gov/Mirtazapine.htm

Yes MrsD, I'm still on Mirtazapine. I will go and read up on that.

Dave.

This link is to Drugcite.com

They are upgrading the site and only have archival data available.
This is the link to mirtazepine as of 2013:

https://web.archive.org/web/20130811...?q=MIRTAZAPINE

It is in the bottom list, which you have to expand. These are from FDA reports showing 1.81% reported liver toxicity.

While this is low, keep in mind that you use lots of medications and that may be contributory to the liver.

Also other things can be happening too. So get all the tests
your doctor orders, and it there is no indication of an organic
cause, consider the drug, then.

Awful news
 

Oh, Dave, this is awful news. I know this is very common in diabetics, but you mentioned that the doc thinks the diabetes is not responsible for the continued elevation.

Let us hope that your scan will came back with good news. You will be in my prayers and thoughts.

How soon will you be having your scan? I know sometimes the wheels in medicine turn very slowly.

Is there a possibility of a lab error? I recently had some labs that came back very bad and had them repeated since there was no explanation for them. When the 2nd labs were done (by a different lab), they came back normal. That made me wonder how many of the other labs that were drawn at the same time were valid since one of them was REALLY off a tremendous amount.

Labs are not perfect and errors DO sometimes occur.

I can certainly understand your feeling of despair and depression. It would worry me and weigh heavily on my mind if I were in your shoes. But for the moment, until the scan is done, let us try to think positive and consider the possibility of a lab error.

Please keep us updated as we keep you in our prayers and thoughts. We are here for you.

Hey Hope,

Just waiting for the scan appt to drop through the door, have no idea of wait time.

This is the third retest, all showing accelerating increases in numbers, so there is no chance of Lab error this time around.

Dave.

Hi Dave,

Hope the scan will happen soon and that it turns out to be something that can be fixed easily. I know with your history, your first thoughts would go to a very bad potential diagnosis and prognosis, but I am sure there are other possible reasons that may explain the continued elevations.

I do not want to think the worst so I am going to hold hope for you, even if you find that difficult to do for yourself right now.

Some say, "Plan for the worst, and wish for the best." So, I am going to be one to WISH for the BEST.

PLEASE someone, give me a magic wand to wave over English Dave. He can use some GOOD news and some healing.

I am going to have to search for some good news so I can share it with you. Never give up hope for good news.

I would give you some of my liver for a transplant but I have the same condition from my diabetes so I am not sure that will be of any help to you.

Thank you so much, Hope. Your words are very much appreciated.

I have decided, after reading up on Mirtazapine, that - until I have definitive answers from tests - I will assume that a combination of that med and changes in my liver from losing weight may be the cause of these results.

What else can I do, worry myself sicker about potential illnesses? Better to be deluded for a while, eh?

Dave.

Dave, your courage and determination in dealing with everything that life has thrown at you is an inspiration to me.

I am thinking of you and hope that the tests shed some helpful light on what is going on.

Thank you, kiwi.

Dave.

Dave

Keep up that fighting spirit - reassure yourself that what's going on with your liver will be dealt with in the best way possible.

When you're feeling depressed think of your friends here at NT and lean on us for support and comfort (and the occasional bad joke).

Sending hugs northwards :hug: :hug:

bluesfan

... and from me too. We're always here for you Dave.

:grouphug:

Thank you bluesfan and Lara for your support.

(Probably) Psychosomatically, the pains that had receded have returned. It doesn't help that I have cheated on my diet these past 2 days and eaten a few of my Christmas weakness - mince pies:D - so I am feeling nauseated.

I have to be dragged out this evening to have an MRI on my cervical spine again for the numbness and referred pain in my right arm/hand, and the pain in my neck. Have to fight through traffic for the Guy Fawkes bonfire/fireworks Celebrations on the way back as it is the 5th November. He was the Conspirator who almost blew up Parliament. Do we celebrate the attempt, or that he failed? Sometimes we wonder.

Dave.

The MRI was 40 minutes of excruciating neck and arm pain, despite being doped up with all my meds. I truly thought I was not going to make it through this time, they had to keep asking me to try not to shake from the pain, even though the images were good. More than 5 hours later and the pain has not subsided even after more Tramadol, Ketamine and Arcoxia.

Just a wait of 2 weeks for the images to reach my GP and about 5 weeks before I see a damned Neuro:(

Dave.

I'm so sorry about your pain Dave and also sorry that it's such a long time to wait now for results.

I hope your pain subsides a little and that you can get some sleep eventually tonight. [guessing you're up in the middle of the night]

One good thing is that the Mri is done as hard as it was for you.

you take care there

Oh Dave,

I can't stand to hear you are feeling nauseated from the mince pies because I am ready to box up a bunch of junk food and send it to you overnight. Obviously your body is in complete rebellion at the healthy changes you are trying to make. ;)

But seriously, I am so sorry you are going through so much. It is hard enough having one system giving you trouble, but to have more than that to worry you at once is just unfair. It would be impossible for anyone not to feel anxious with unfavorable lab results and the history of what you have gone through.

I don't know how it works there, but here in the states you can bypass waiting for results by signing a release for the imaging center and having them give the radiology report right to you. I have done this more than once not wanting to fret over the time it takes to forward the report and get in for the next appointment.

I hope you recover soon from your MRI ordeal. Holding still for those can be a real problem when the position makes you uncomfortable. I remember being surprised at how much discomfort I had in my foot when getting those. I am glad it is over and pray you get good information out of it.

We are all thinking of you and sending love. Rest well my friend and know you are held in the deepest affection here.
:circlelove:

Yes, Lara, I was up most of the night with the increased pain. Too much to even be able to distract myself by logging on here:( Then came the now customary Cluster Headache this morning.

Littlepaw, your mothering instinct really comes to the fore towards everyone here. A Care Package is a lovely thought! I have laid off the mince pies, my Ex picked up strawberries, grapes and a triple chocolate cookie (fresh baked) for me while we were out yesterday, so that makes up my afternoon snack today.

Here, Radiographers are not allowed to give out information on scans. It has to come from the Dr or Specialist who orders it. That is to avoid Law Suits and confusion and to ensure proper interpretation of results. Stupid really as the Radiographers often know more than the Drs.

Dave.