The Right Direction
Ana’s labs from Monday came back this afternoon – her liver enzymes (AST, ALP and GGT) are going down compared with last week. Since those acronyms keep coming up, I’ve decided to define them, really for my own benefit but also in case anyone else is curious (courtesy of WebMD/Wikipedia):
AST = Aspartate Aminotransferase – An enzyme, low levels of AST are normally found in the blood. However, when an organ like the liver is damaged, additional AST is released into the bloodstream. The amount of AST in the blood is directly related to the extent of the tissue damage (it’s not clear to me what “damage” actually means). Normal range for this is 0 – 44 IU/L – Ana’s is 23 (it was 193 on 5/15!)
ALT = Alanine Aminotransferase – An enzyme, ALT is found mainly in the liver, but also in smaller amounts in the kidneys, heart, muscles, and pancreas. Low levels of ALT are normally found in the blood. But when the liver is damaged or diseased, it releases ALT into the bloodstream, which makes ALT levels go up. Most increases in ALT levels are caused by liver damage. Normal range for this is 0-28 IU/L – Ana’s is 101 (It was 277 on 5/15).
GGT = Gamma-glutamyl transpeptidase – An enzyme present in our blood, organs and tissue that rises when there is a problem with bile flow in the liver (I think they all rise when there’s an interruption in bile flow because any kind of liver damage/disease, effects bile flow). Normal value is 5-55 IU/L. Ana’s is 169 (it was 210 on 5/15).
My sense is that all three tests must be done to gauge if there truly is a problem with Ana’s liver. In this case, the “damage” is a result of inflammation due to rejection which causes increased production of all the above enzymes and is a type of marker or red flag for the doctors who then order a biopsy to confirm this.
So, enzymes going down = the right direction! Rejection causes liver inflammation – a result of Ana’s immune system attacking her liver – which is why they pumped her full of steroids. Since her enzymes are going down, Dr. Martinez decreased her prednisone to 40 mg/day (from 60 mg) which is good because she is uncomfortably hungry on such a high dose of prednisone. She won’t need her labs drawn again until Tuesday! (It would’ve been Monday but we figured the lab would be closed for the holiday). Isn’t it funny how you have to put your health on hold whenever there’s a holiday?
Ana went back to school yesterday and is fully in the swing of end-of-year activities at High Meadow. I was really relieved to hear that she didn’t need labs until next week because tomorrow is her school’s dance performance and she’s in three dances. It’s really hard to believe that she was in the hospital on Thursday and Friday…and she’ll be dancing tomorrow night.
She’s loving every minute of the hectic end-of-year stuff. She truly appreciates being caught up in the routines she’s come to know and love. It’s a joy to see her so happy (and the best birthday present I could hope for…my birthday is Saturday).