You Say Drunk, I Say Muscle-Bound

by Chris Battle, survivor on June 11, 2011

Note: This article is cross posted from The Kidney Cancer Chronicles.

So I’ve been reading a lot of online medical journals to find information about elevated enzymes in the liver and how they can be used to diagnose liver disease, such as hepatitis. I don’t pretend to be a doctor, but I am married to one. Well, kind of. Dena has a medical degree from Google University, and she was also presented with a “Medical Degree in a Box” from our friend Karen Hanretty. I think this certainly qualifies her as a medical authority and, by extension and all rights of marriage, qualifies me to filter and interpret the vast amounts of confusing and often inaccurate information to be found online.

So here is my initial conclusion: I am a hopeless drunk with a liver as scarred and crusted as a greasy cheeseburger. At least that appears to be what all the scientific literature says. (Not to mention two insightful older gentlemen at a Betty Ford-type clinic near Portland who offered helpful advice about binge drinking and cirrhosis.)

As I noted in my last post, my aspartate amino transaminase is at 254, whereas the low range of normal AST (as those of us in the medical business call it) is 0 and the high is 37; my alanine amino transaminase (ALT) registers at 91, with a low of 0 and a high of 40. Each of these enzymes tend to leak into the bloodstream when damage occurs to certain organs, with both enzymes being particularly associated with the liver. Thus high levels of AST or ALT are warning flags in lab results, suggesting liver disease or organ damage.

There is something known as the “AST-ALT ratio,” which is often used to distinguish between alcohol-related liver damage and damage related to other causes, such as viral hepatitis. An AST-ALT ratio of less than 1 is evidently more often associated with non-alcoholic liver damage. Think of it this as the Shirley Temple of liver disease. An AST-ALT ratio of 2.0 or higher is suggestive of liver damage resulting from severe alcoholism. Think of this as the W.C. Fields of liver disease. (Which brings immediately to mind Mr. Fields’ famous comment that once, during prohibition, he was forced to live for days on nothing but food and water.)

My ratio is 2.7.

So there you have it. I’m a drunk. Bloodwork doesn’t lie. I think this is unfair, as my wife gets to come home each night and have a nice glass of cabernet with dinner while I drink water. And who gets cirrhosis? And who knew you could get hammered on bottled water? I will have to cut back at the office.

Seriously, since I don’t drink that much anymore … something seems off about these numbers to me. Perhaps the enzyme spikes are being prompted by something other than autoimmune hepatitis brought on by the MDX-1106.

ALT is fairly exclusive to the liver; AST, however, is not. It can also indicate other forms of organ trauma in other areas of the body including the heart, kidneys and skeletal muscle. While ALT and AST combined are strong indicators of liver damage, AST levels alone can rise due to reasons other than the liver. For example, muscle damage. And it just so happens that, for the first time since my nephrectomy more than two years ago, I recently began serious strength training. And was sore for four days immediately leading up to the blood test, due to the muscle damage from the weightlifting. According to WebMD – and I think we can all agree that WebMD is an incontestable medical authority – AST levels are at the highest immediately after an injury. Additionally, one of the sites I reviewed recommended avoiding strenuous exercise prior to the liver panel blood test, as it might impact the reading of the enzyme levels.

So to review: I work out a few days prior to getting Thursday’s bloodwork, and the labs come back with high amino enzymes. Muscle damage from weightlifting, which literally tears the muscles, results in the leakage of AST into the bloodstream. Voila, case solved.

This doesn’t really explain the high ALT levels, but the ALT levels weren’t as ridiculously high as the AST levels. You can have some variance without getting hysterical, it would seem. Who knows, maybe I’m delusional. But delusions have their value: You say DTs, I say good times. You say autoimmune hepatitis, I say muscle damage.

Of course, this is all irrelevant speculation. Until we get the results back from Monday’s blood test, we really can’t know anything. However, Dena and I have all weekend to sit around and stress and wonder (again) about whether we’re getting kicked off this trial – exactly what Fabulous Alice told us not to do – and so we either (1) starting drinking like fiends, as we might as well get the benefits of cirrhosis and disfigured livers, or (2) do some research and come up with a different hypothesis from the more ominous potentiality of autoimmune hepatitis. And since I had to sit around and read these language-challenged medical journals all weekend to come up with this hypothesis, I figure I should make you suffer with me by writing this post. Moreover, I want to stake my claim now so that when the numbers show up Monday as having dropped back to more normal ranges, I shall proclaim myself a medical genius.

Or a drunk.

Or maybe just buff.

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