Author Topic: Should I be concerned? (Read 17840 times)

drummerman · « **on:** October 21, 2015, 08:21:54 pm »

Finally got a hard copy of my EOT labs. Course I knew I was UND.

But my AST and ALT both went up

at 9 weeks my AST was 16. At EOT it is 18

9 weeks ALT was 11. At EOT it is 14.

Before tx AST/ALT were all over the place usually in the 80-100 range.

The only other thing I noticed was my Monocytes are still high at 1.1

What would a normal AST and ALT be? I think I remember reading that a reading of 0 is a normal healthy liver.

I also think I remember reading that an AST higher that ALT indicated possible cirrhosis.

Any thoughts/opinions/info/links etc. would be appreciated!

dm

dragonslayer · « **Reply #1 on:** October 21, 2015, 09:53:01 pm »

DM, I wouldnt even give those numbers another thought! Those 'increases' are so insignificant in size you should just forget about them... Statistically, theyre essentially identical to their precursors..

Youre fine!

Scoutdoy · « **Reply #2 on:** October 22, 2015, 12:19:03 am »

Dm, don't stress on your numbers. I am no doc but any kind of factors can make those numbers go up and down. I think that is why there is a "normal" range. Which your beautiful numbers fall into. Your gonna do great. Take a few Tylenol for a headache and test your numbers the next day...they would probably raise a little...or get a cold. Your virus free...enjoy it!

Go Royals
Scout

gnatcatcher · « **Reply #3 on:** October 22, 2015, 03:22:08 am »

dm, your hard copy may list a "reference range" or "range" (either term meaning "normal range" at that particular laboratory) for each test you took. If not, the report may mark abnormal results in some way (boldface or underline or "HI" or "LOW" alongside anything abnormal or a separate column for abnormal). If you look at my stats, you'll see that I had tests at two different labs, which is why I specified the reference range (normal range) of each result.

At any rate, dragonslayer and Scout are right that small changes like yours are insignificant.

drummerman · « **Reply #4 on:** October 22, 2015, 06:51:17 am »

Thanks Gnatcatcher,Scoutdoy, Dragonslayer!

Calming down a little now!

dm

Butterflykisses · « **Reply #5 on:** October 22, 2015, 03:12:51 pm »

DM, You Got This!

Congratulations on your EOT Lab results of UND. We can drive ourselves a little crazy at times, relax and enjoy your good news.

Had my labs drawn yesterday, will post eot results when available. I too am Trying to Relax a little bit, lol.

Best,
Butterfly

drummerman · « **Reply #6 on:** October 22, 2015, 03:58:12 pm »

Quote from: Butterflykisses on October 22, 2015, 03:12:51 pm

DM, You Got This!

Congratulations on your EOT Lab results of UND. We can drive ourselves a little crazy at times, relax and enjoy your good news.

Had my labs drawn yesterday, will post eot results when available. I too am Trying to Relax a little bit, lol.

Best,
Butterfly

Thanks BFK!

I'm sure your EOT will be UND!

dm

Philadelphia · « **Reply #7 on:** October 22, 2015, 05:00:42 pm »

My ALT was up by one at my EOT test. I immediately put on my worrying face, but decided it was a very small increase, probably due to something I did/ate/didn't do - and ignored it. I think when people's numbers go up due to relapse they skyrocket.

I'm not going to say you've got it till SVR12 because I am by nature a cautious beast, but I will say your numbers are looking good.

drummerman · « **Reply #8 on:** October 22, 2015, 05:08:08 pm »

thanks philly,

I tend to stress out over these things.

dm

Philadelphia · « **Reply #9 on:** October 22, 2015, 05:11:05 pm »

Me too. All. The. Time. I stressed when I saw my alt had gone up one. But I had people to talk me down, which is what we naturally cautious people need.

Bree · « **Reply #10 on:** October 22, 2015, 05:45:53 pm »

DM, your labs are right on!

My platelets went down (which are low to begin with) from 115 to 134 back to 115.... even though everything else looked good, including UND results (the object of the exercise!). My doc not concerned (he never is) but he does know his stuff, ... I asked my nurse practitioner friend (bless her wisdom and her honesty)... she said don't worry about it.

I saw my doctor this week, he didn't want to to do more lab work until 24 weeks, I told him we had to do it at 12 for my sanity if nothing else. He's an EOT and 24 weeks lab work kind of guy. We had already agreed to do it at 12 weeks, guess he forgot. He said you'll still have to do it 24 weeks, I said no problem. After some back and forth, he said I won't quibble and ordered it. He doesn't make it easy I tell ya! I'm persistent, that's how I got the treatment in the first place!

drummerman · « **Reply #11 on:** October 22, 2015, 08:03:58 pm »

Quote from: Bree on October 22, 2015, 05:45:53 pm

DM, your labs are right on!

I saw my doctor this week, he didn't want to to do more lab work until 24 weeks, I told him we had to do it at 12 for my sanity if nothing else. He's an EOT and 24 weeks lab work kind of guy. We had already agreed to do it at 12 weeks, guess he forgot. He said you'll still have to do it 24 weeks, I said no problem. After some back and forth, he said I won't quibble and ordered it. He doesn't make it easy I tell ya! I'm persistent, that's how I got the treatment in the first place!

Thanks Bree!

My doc did the exact same thing!! He said "we'll do a 24 week test" and I said, "everything I read about Viekira says labs should be done at 12 weeks" He said "ok , we'll do 12 weeks and 24 weeks."
Totally agreeable. I think he is not used to the new tx. Docs usually hate to be wrong. Fortunately both my docs go along with anything I say. I don't know if thats good or bad

!

dm

Bree · « **Reply #12 on:** October 22, 2015, 08:17:53 pm »

Quote from: drummerman on October 22, 2015, 08:03:58 pm

Thanks Bree!

My doc did the exact same thing!! He said "we'll do a 24 week test" and I said, "everything I read about Viekira says labs should be done at 12 weeks" He said "ok , we'll do 12 weeks and 24 weeks."
Totally agreeable. I think he is not used to the new tx. Docs usually hate to be wrong. Fortunately both my docs go along with anything I say. I don't know if thats good or bad !

dm

I think for Harvoni EOT and 24 is the protocol. Not sure. I said I wanted it before Christmas and he said after the last test which was 10/5 (because he ordered the wrong test initially) and so I had to remind him of that and 12 weeks post is Dec. 21... which I hated to do because of his ego... that's when he said he wouldn't quibble. His nurse is fabulous... he is a very strange doctor who generally needs to be right...I'm almost done so there! And, if he didn't order it, my internist, a shining star, would have. I am persistent when it comes to this .... I care about my life and my emotional well-being.

I think part of my lesson here is to not let this specialist upset me. I spend way too much energy and time being upset with him. My friends called me on it... "Walks like a duck, don't expect it to be a cuddly dog!" I'll get my emotional fix somewhere else... I know... the forums is one place!

drummerman · « **Reply #13 on:** October 22, 2015, 08:42:14 pm »

Quote from: Bree on October 22, 2015, 08:17:53 pm

I think for Harvoni EOT and 24 is the protocol. Not sure. I said I wanted it before Christmas and he said after the last test which was 10/5 (because he ordered the wrong test initially) and so I had to remind him of that and 12 weeks post is Dec. 21... which I hated to do because of his ego... that's when he said he wouldn't quibble. His nurse is fabulous... he is a very strange doctor who generally needs to be right...I'm almost done so there! And, if he didn't order it, my internist, a shining star, would have. I am persistent when it comes to this .... I care about my life and my emotional well-being.

I think part of my lesson here is to not let this specialist upset me. I spend way too much energy and time being upset with him. My friends called me on it... "Walks like a duck, don't expect it to be a cuddly dog!" I'll get my emotional fix somewhere else... I know... the forums is one place!

hmmm... maybe I just assumed Viekira needed a 12 week lab. Not sure about haroni. Does anyone know when you should have labs after EOT on viekira?? I mean what is medically required, not what you may or may not have done.

thanks,
dm

Lynn K · « **Reply #14 on:** October 22, 2015, 11:24:54 pm »

Per the AASLD American Association for the Study of Liver Disease HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C Recommendations for Monitoring Patients Who Are Starting HCV Treatment, Are On Treatment, Or Have Completed Therapy

http://www.hcvguidelines.org/full-report/monitoring-box-summary-recommendations-monitoring-patients-who-are-starting-hcv

"Recommended monitoring during antiviral therapy.

Clinic visits or telephone contact are recommended as clinically indicated during treatment to ensure medication adherence and to monitor for adverse events and potential drug-drug interactions with newly prescribed medications.

Complete blood count (CBC), creatinine level, calculated glomerular filtration rate (GFR), and hepatic function panel are recommended after 4 weeks of treatment and as clinically indicated. Thyroid-stimulating hormone (TSH) is recommended every 12 weeks for patients receiving IFN. More frequent assessment for drug-related toxic effects (eg, CBC for patients receiving RBV) is recommended as clinically indicated.

Any 10-fold increase in alanine aminotransferase (ALT) activity at week 4 should prompt discontinuation of therapy. Any increase in ALT of less than 10-fold at week 4 and accompanied by any weakness, nausea, vomiting, jaundice, or increased bilirubin, alkaline phosphatase, or international normalized ratio should also prompt discontinuation of therapy. Asymptomatic increases in ALT of less than 10-fold elevated at week 4 should be closely monitored and repeated at week 6 and week 8. If levels remain persistently elevated, consideration should be given to discontinuation of therapy.

Rating: Class I, Level B

Quantitative HCV viral load testing is recommended after 4 weeks of therapy and at 12 weeks following completion of therapy. Antiviral drug therapy should NOT be interrupted or discontinued if HCV RNA levels are not performed or available during treatment.

Quantitative HCV viral load testing can be considered at the end of treatment and 24 weeks or longer following the completion of therapy."

So to reiterate what was said above:

"Quantitative HCV viral load testing is recommended ..... and at 12 weeks following completion of therapy."

So the AASLD recommends a 12 week EOT test

and also
"Quantitative HCV viral load testing can be considered at the end of treatment and 24 weeks or longer following the completion of therapy."

and says if you want to you can consider adding a 24 or longer post treatment test but that would be an extra test.

These comments are not related to whether treatment was with Harvoni or Viekira Pak

The medically recommended test is 12 weeks post. All other tests are extra credit is how I am interpreting the AASLD recommendations.

Best to all
Lynn

Bree · « **Reply #15 on:** October 22, 2015, 11:56:18 pm »

Thanks Lynn, that is very helpful!

sapphire101 · « **Reply #16 on:** October 23, 2015, 12:40:52 am »

DM and Bree you are both fine.
All of us go a bit neurotic over lab point changes and we can lose sight of the big picture while worrying about these tiny numbers.
My globulin was up on my last lab and I buried myself in internet research all about nothing and I won't get those hours back.
I feel that all the many years of stress and worry about Hep C conditions us to react like this.
But your numbers are good.

12 week versus 24 week SVR check.
Lynn has the facts, 12 weeks is the recommendation and even so, many of our practitioners have their own logic or possibly are just as conditioned to worry as we are and feel they must re-check.

My doc drew the 12 week and also insisted on the 24 week. Even though I knew in my head the odds were on my side I still had that heart pounding gut wrenching moment of getting the lab results...again.
I vow to move forward now and quit doubting and trust the results.

My best to all of you- your turn for SVR is coming soon!

Lynn K · « **Reply #17 on:** October 23, 2015, 01:26:46 am »

DM

If you look at my signature you will see my ALT and AST also increased a little post-treatment but per lab corps scale they are normal range (ALT <33 AST 0-40) so nothing to see there. When I relapsed last year both were up AST was still barely normal but ALT was 56

I would not sweat a small increase that is just statistical variation aka noise.

As long as in normal range and maybe even a little high as other things can cause elevations in ALT and AST you will be fine.

Good luck everyone
Lynn

Bree · « **Reply #18 on:** October 23, 2015, 01:36:20 am »

Thanks Sapphire ~ you nailed it. I like your slogan, Stop worrying and start living. And, that's what I'm doing.

My doctor doesn't over test, if anything, he tests less than most. Whatever, the truth is my needs are getting met and then some. I'm making sure of it. I worried much less about Hep C because it was out of my control until I found out there was a cure... then I got my hopes up and became obsessed with getting it and the end result of curing it. Worthy cause, but there needs to be an end point.

I walked 4 miles with my friend today. That's 4 days in a row. I could have never done that before. It is clear to me that my life and my health has definitely shifted. I'm grateful every day. Thanks for reminding me!

drummerman · « **Reply #19 on:** October 23, 2015, 07:09:36 am »

Thanks Lynn,

very helpful!

dm

Morphin · « **Reply #20 on:** October 23, 2015, 07:12:17 am »

Adding my experience, hopefully this will ease some nervousness.

I'm heading out of state for the winter to the SW (live in Minnesnowdah). Leaving next week, so had my labs at 8 weeks after eot. My gastro doc was totally fine with this and felt confident that this would provide a good enough gauge toward the treatment effectiveness until I return in time for the 24 week test.

She"s awesome, so, if she is not worried, neither am I. Going to enjoy my winter migration as if cured pending final word.

Also did labs yesterday, so waiting on final results, but ALT and AST are in normal range They are slightly higher, as with Drummerman and others, but nothing like before TX.

I view these labs similar to my HIV labs. There is always some variation in the numbers, but the end result is the same: undetectable.

Sending calm and patience your way. Something tells me all will be right in the end!

Peace!

Scoutdoy · « **Reply #21 on:** October 23, 2015, 10:10:38 am »

Dm....I just got my EOT test results a few minutes ago!!!!!

NOt DETECTED!!!!!! AST 15 ALT 9

Today is a good day!!

Go Royals
Scout

drummerman · « **Reply #22 on:** October 23, 2015, 10:54:51 am »

Quote from: Morphin on October 23, 2015, 07:12:17 am

Sending calm and patience your way. Something tells me all will be right in the end!

Peace!

ThanksMorphin!

drummerman · « **Reply #23 on:** October 23, 2015, 10:56:06 am »

Quote from: Scoutdoy on October 23, 2015, 10:10:38 am

Dm....I just got my EOT test results a few minutes ago!!!!!

NOt DETECTED!!!!!! AST 15 ALT 9

Today is a good day!!

Go Royals
Scout

Great numbers Scout! Congrats!

gnatcatcher · « **Reply #24 on:** October 23, 2015, 11:13:54 am »

Quote from: Scoutdoy on October 23, 2015, 10:10:38 am

Dm....I just got my EOT test results a few minutes ago!!!!!
NOt DETECTED!!!!!! AST 15 ALT 9
Today is a good day!!
Go Royals
Scout

Fantastic! Scout, your AST and ALT numbers are outstanding -- are they for sale?

Scoutdoy · « **Reply #25 on:** October 23, 2015, 12:20:43 pm »

Not for sale gnat,,,all mine! I don't know if anyone else experienced this but during treatment my appetite kind of got suppressed a bit .....this last week I have made up for it ....I am eating like a pig and enjoying every minute of it
.

Scout

slats1056 · « **Reply #26 on:** October 23, 2015, 01:00:20 pm »

Scout, I was always hungry just didn't feel like eating , so I lost 10 lbs. Tx. EOT I am ready to eat the refrigerator at any given time. Trying to lose another 10-15 lbs. by year end, so trying to resist the urge to munch all day long. Bring more fruit and trail mix and less cookies and donuts to snack on at work. Trying not to become The Incredible Bulk! LOL

Bree · « **Reply #27 on:** October 23, 2015, 04:00:37 pm »

Quote from: Scoutdoy on October 23, 2015, 10:10:38 am

Dm....I just got my EOT test results a few minutes ago!!!!!

NOt DETECTED!!!!!! AST 15 ALT 9

Today is a good day!!

Go Royals
Scout

Congrats Scout!!! That's great news!

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Author Topic: Should I be concerned? (Read 17840 times)