Slightly elevated ALT/AST: talk me off the cliff
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I am no expert but it sounds like those numbers are so borderline that they should be okay. The focus should be that they went down for the most part. Let us know when you hear from the dr. and breathe!0
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how is ast and alt numbers associated with cancer? I saw a dr today for my joint pain I’ve been having. I got results back. Ithink my levels we’re both around 50. Did yr dr say yr ast and alt levels were concerning?
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Are you still taking Aromasin? If so, your drug may affect liver!
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no I haven’t taken drugs. Only surgery.
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what about antibiotic or anything? Or a cold? Susan
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Jonsgirl, I dont remember 50 being really off the normal mark....What is in normal range,? Sounds maybe just slightly elevated. Was dr concerned, oncologist, at all? If he's not saying anything then you are most likely okay.
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claireinaz, not to trivialize any concerns you have but it seems like those numbers are only slightly elevated. Anything can change it a little bit. One time I took extra vitamin supplements and mine were off. They went back to normal. I totally get the anxiety and then with all the US is going through, it makes it tough for people like me too to cope with anxiety. At least you have a plan for when this gets back to normal. That is awesome! Keep busy if you can. JCP
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Hi all, yes, I am still on Aromasin and wonder if (since I've been on some kind of anti-hormonal since 2012, beginning with Tamoxifen-8 years on anti-hormonals) it is finally taking a toll on my liver. If so, I'm going to have a conversation with my doc about stopping it. I've already done the research that claims that anything longer than ten years offers no more protection against recurrence, anyway. So I'm close to ending anyway.
Thank you, jcp and perigrine lady, for reminding me that the #s are dropping and that only one is borderline (.2 above); the bilirubin seems to be "what I do" from time to time. But the liver thing was troubling since they've been great for years: so why now go haywire? Why didn't it correct to normal levels in a month? You know.
I have not been sick or had a cold, but I do seem to have developed slight allergies to spring pollen. Not sure if that would be enough to "stick" my ALT in the still borderline high range.
I did find that ALT can remain elevated for 7 days after vigorous exercise and boy did I ever hike my *ss off at altitude last week. The problem is that vigorous exercise is the only way I can relieve my tremendous anxiety right now.
Right now I feel like I'm trying to hit a moving target--why didn't my ALT drop the way the others dropped?
I did find an ALT/AST calculator and my ratio is normal with these new #s--.77 (.8 is normal, 1.0 or above points to problems).
I just hope my MO will tell me he's happy with the lab results and to come see him in 5 months. I have no idea when he will call. I also have my annual physical coming up June 22 with my PCP, and I'm going to talk to her about all this too. She's local and I have a fairly good relationship with her.
I love all of you!
Claire
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jonsgirl,
I think that MOs look at all the values for liver tests-ALP, bilirubin, globulin, albumin, protein, if they suspect liver cancer. I think. I hope someone who knows more will weigh in. 50 is just a tad above normal range, and if you use the Mayo clinic ranges for liver values in blood tests, you seem to be normal. But my lab uses lower values, and that gives me red flags (and gray hair). Here's the link to Mayo ranges that gave me some hope.
https://www.mayoclinic.org/tests-procedures/liver-function-tests/about/pac-20394595
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Claire, I also wonder about long term effects of the antihormonals. I am on my second month long break from Anastrozole to see if it is affecting my blood pressure and heart issues. The oncologist suggested a 3 month break but I am not comfortable with that since I have a high BCI. One year of Tamoxifen and almost 4 years of Anastrozole and I imagine the lack of estrogen could have a toll on various parts of our systems. Let us know how it goes on the 22nd and keep hiking!0
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Thank you both for your responses. I will follow up with a dr. Ievels are just a little off....no worries. Thank you. I wish you the best too Claire.
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Here's this: "Aromatase Inhibitors and Newly Developed Non-alcoholic Fatty Liver Disease"
https://pubmed.ncbi.nlm.nih.gov/30679317/
My MO originally wanted me to get an US to see if I was developing it. I have no idea now whether, because my values have dropped, whether he will go forward. Playing the waiting game.
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https://pubmed.ncbi.nlm.nih.gov/23358971/?dopt=Abs...
Here is a study that compared Arimidex vs Aromasin and their SEs.
I think getting US is a good idea! I am originally from Eastern Europe, and our doctors usually recommend short courses of liver supplements for people who are taking pills on a regular basis. Sometimes it is easier to prevent health problems.
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Claire, I'm so sorry you are stressing (I'm also having some issues, so I totally get the anxiety). Can you redo the labs again in 4 weeks? If the trend is lower, it might alleviate your stress. If I had to guess, I think the AI is starting to take a toll. Our bodies can only handle so much medication and some are more sensitive than others. Perhaps stopping the AI for a month or two and redoing the labs...if they are normal, then you can guarantee it is the AIs. If your wanted to finish the 10 years, the values you have are certainly not going to hurt your liver. Keep monitoring and get off the AIs if the numbers start climbing.
I don't know that an ultrasound will be definitive but certainly may alleviate or confirm your fears. At this point, I have to think it's the AI.
Thanks for keeping us posted!
Have you tried the milk thistle?
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Hi Wallycat and all-
It could be the AI-or the gargantuan amount of exercise I did the week before the test, which (research says) can temporarily elevate ALT levels. Since everything else dropped with the re-test-even the ALT did (except that I wound up with a B+ instead of an A since I was still .2 above upper limits of normal) I have to think that the original test results were due to overindulgence and perhaps the toll that AIs take on our bodies. Ten years might be a stretch for me, although I know why 10 years on aromasin was rx'd for me: + nodes, and an ILC dx. ILC has a higher tendency to recur at later years-well beyond five, often beyond 10.
Anyway. I am not afraid of an US, and didn't mean to imply that. What I am perplexed? anxious? about is that my ALT didn't drop into normal ranges after a month of clean eating and no alcohol at all. It dropped but much more slowly than I hoped or thought. Exercise? AI? Hard to tell at this point.
I am also not afraid of fatty liver disease brought on by aromasin. FLD can almost always be reversed if you remove the problem causing it (like booze or medications), and I will stop the AI earlier than my MO wants because it is causing FLD, if I even have FLD. BTW, I made this point earlier in this thread, but it is not just tamoxifen anymore that causes liver problems for us over time, hate to say. All AIs carry potential to cause serious liver problems for us especially the longer you take them and I'm at 8 years now. I will stop the AI if it is contributing to any FLD.
I want that ALT to drop into normal levels. But I also don't want to be over-tested or followed or have an unnecessary test when labs don't merit it. I know the balance between unnecessary testing just "because we can" and the needless anxiety that causes and a merited test that will solve a problem. My MO is 3 hours away, one way, and right I feel like I'll have to call him and let him know my labs were re-done before he will call me at all, even though he ordered the re-test. I just think he kind of forgets about me at times. I do have an appt with my GP in 10 days and I'm going to get her take on all this then.
Maybe she will want to take over this liver enzyme thing; at least she is local and probably sees as much or more of this kind of thing than my MO even does.
Claire in AZ
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Wallycat,
I take a lipotropic complex that my naturopath rx'ed long ago, and it has milk thistle in it. It's a liver support supplement. I also added folic acid to my supplement list, which is supposed to help support the liver. Interestingly there seemed to be some good research out there that taking one aspirin a day protects livers too; I've been doing that for years since it also increases protection from b.c. recurrence.
Claire
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Claire,
There's a difference between unnecessary tests and tests that will offer quality of life. So even if you do not need the test in theory, if it resolves this massive anxiety, it is worth having done.
I just wanted to say that "decimal point" out of range values rarely set an alarm for doctors. They get concerned when it is noticeably elevated or below normal. For instance, my DH had a PSA of 10,000+ ...the doctor noticed. I've had labs out of range by 4 points and she said we'll watch and wait.
Please let us know what your doc thinks.
AIs have a lot of benefits but also some dangers so it is always a balance. Again, if you decide you need the 10 year protection, taking a 2 month vaca from them may let you see if that is the cause in your liver and you can always go back for the remaining 2 years for peace of mind.
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Hi
You are barely out of normal range. If you could accept that your test results were actually pretty positive then maybe that would help you relax.
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Hi all,
Here's the official update (my oncologist just phoned). He thinks my ALT was still slightly elevated because of the intensity of the exercise I did the week before the test.
As for the slight bilirubin elevation, he said it was likely because of Gilbert's syndrome. I told him historically my bili has already tended right at ULN or just above and that my PCP also mentioned Gilbert's, so that was fine with him.
He said my enzymes are "headed in the right direction" so he's not talking NAFLD anymore. He said he "thinks I'm fine", which was good to hear. The entire conversation took barely 2 minutes--I had to squeeze in my few questions and comments--he simply didn't really seem to want to spend much time on the phone with me at all. I suppose that is a good thing since he does not at all seem worried about me or my condition. I'm sure he has many other patients that are sick and need more of his energy.
However, he also wants to send me a lab request to get re-tested in 2 months "or so". (!) So I will take charge of that when it happens. I might stretch it to 3 months to get tested, simply because right now I am very aware of the unnecessary stress and anxiety caused by over-monitoring one slightly elevated value. I don't know why he didn't just ask me to make an appt for a regular face to face check up with a regular CBC, since a month ago when we talked he wanted me to come see him in four months for a physical exam anyway :O
I have my regular annual physical scheduled this Monday with my PCP. I like her, she knows me, and I'm going to share all this with her. (But I'm getting weary of doctors and lab results.)
Claire in AZ
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I'm hopeful you can decompress a bit with your info.
For myself, I have found that my oncologist tries to be non-alarmist. I'm on a watch and see as well and she talks about 6 month or one year labs. From listening to her, and watching my DH, I have gleaned that anything wrong with us or anything right with us is always a possibility and the nuances of labs don't really confirm or deny anything until things get really out of range one way or the other. Most oncologists see so much stuff that the small (and sometimes incidental) findings simply don't fret them.
Keep us updated. Maybe take it easier with the exercise...too much of anything is not good for us...moderation in all things, including moderation, eh?
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Thanks for the update, Claire. I think you can relax for a bit and check again in three months. My oncologist spent maybe 5 minutes with me last visit. I think if it does not directly relate to breast cancer, they don’t really want to hear about it. My impression of my dr. anyhow. Keep exercising. That is the best medicine!0
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Exercise is great for us...again...moderation in all things.
From the exercise guru that helped me fall in love with running: https://www.texasmonthly.com/articles/walk-dont-ru...
There were similar studies that Jim Fixx (the father of jogging) started noticing a lot of his friends who did marathons and heavy running---so many started developing unexplained cancers.....
I still sometimes wonder if my 15 mile days of running could have contributed to breast cancer. I was fit, BMI of 19, but exercised and exercised. I loved it....Now I can appreciate I need to do it ...to a point.
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Wallycat, that's a great article. Thanks for sharing it. I'm sure a large percentage of women here wonder if their lack of exercise caused their breast cancer, not 15 mile days of running!
Claire, I hope all these results have you backed far away from any cliffs, and once you get past your PCP appointment, you can take a rest from doctors for awhile! That's the part of invasive cancer that changes you forever and that people who haven't been touched by it just can't understand: it's a systemic disease and if it were only so simple that you are treated and you go on your merry way. People will ask me, " Are you cured?" I sure wish I could know. Of course I don't say that. I tell them there's no evidence of disease as if I'm hopeful I might be able to help educate them. Ha!
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The article posted is 25 years old since then study after study shows that exercise reduces the risk of many kinds of cancer and reduces the risk of recurrence of breast cancer. You can see these studies right here on breastcancer.org
Don't fear monger. And no running doesn't cause cancer. Anecdotes are not evidence.
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Current studies show the same thing. Too many free radicals increase risk of cancer. Excessive exercise lowers immune systems temporarily. My goal isn't to fear monger and I'm sorry you took it that way. My reason for posting is that it sounded like Claire is exercising to where she thinks her labs are showing her body is not appreciating it...and that those can be real and honest things.
Please read the article..it does NOT say to not exercise...it says EXCESSIVE.
And it isn't just immune and cancer, https://www.webmd.com/fitness-exercise/news/201206...
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Hi all, I exercised ONCE recently to the point of thinking that it might (operative word is might here) have skewed my results .2 above normal. My enzyme ratio is normal. There is no way of knowing for sure if that is true. It’s a theory, which is conjecture at this point.
Somehow this thread has taken a turn to a debate about intense exercise and a link to cancer, instead of my original concern about a slightly elevated lab test.
I have no plans to stop, or back away from, my exercise routine at this point. It’s the only thing saving me from the anxiety (which causes stress, which negatively affects immune systems) of having to go back to university teaching in six weeks and the fear of exposure to covid that I will risk, and my ongoing cancer induced PTSD.
I believe the articles linked about athletes and cancer compared rates to elite athletes. I’m nowhere near that.
Peace out.
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Claire, you asked for help and I hope that is how you are taking the comments. I'm glad you are not "fear mongered" from science. You wanted answers to what it "might" be and you are correct; all of the comments are conjecture specific to you.
When people say they exercise too much or eat too much or drink too much...that is a meaningless statement unless one can compare it to something else.
I'm so happy you understand that exercise is important and that no one is suggesting for you to stop.May your next set of labs be perfect.
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Wallycat, when threads stray away from the original problem, it can sometimes be helpful to the OP and sometimes not. A debate about the negatives of intense exercise between two members wasn't so helpful in this case since my only concern was a slightly elevated liver enzyme. However, I never took your post as fear-mongering. It might have been slightly off topic, but nothing more.
Claire in AZ
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Claire, I'm just glad you are in a better place. I'm sorry if I misread your request...you seemed to want justification that the lab changed due to a day or two of intense exercise and I was trying to corroborate it for you....the fact the other poster imagined I said to stop exercising was odd, but this is a forum and we are all entitled to our thoughts so long as we are polite.
Stay safe---not sure where those Arizona fires are in relation to you but hope they can contain it.
As you say...peace out.
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hi Claireinaz,
After much research about alcohol and recurrence, I asked my oncologist (he is young and a professor at the local UC) where the research was on alcohol, and he told me that there was no conclusive evidence that alcohol after diagnosis caused recurrence, so I was ok to have my daily glass of wine! He did tell me that a healthy diet and daily exercise was more important than abstaining from alcohol. So don’t beat yourself up. There could be tons of reasons for those numbers. If you do find a study or your Oncologist shares a study about alcohol causing recurrence , please share it.
Take care.
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