May 2, 2006

Yesterday I received a call from Children’s saying that her liver enzyme levels were up at her last blood draw. They draw her blood each time she does Remicade and previous to Remicade about every eight weeks. The methotrexate can cause some irritation in the liver and so they monitor the enzyme level or otherwise called liver function very carefully. Under normal circumstances, these enzymes reside within the cells of the liver. But when the liver is injured, these enzymes are spilled into the blood stream.

This same thing happened one other time and I learned a valuable lesson (or two). The first, don’t’ freak out!! The second, if the blood is drawn to close to the date she receives her Methotrexate it can alter the result of the test. See, the liver has to process the medication and it takes about 3 days for the enzyme level to get back to “normal” after the meds. So, even as late as two almost three days after the injection she could have a “false” reading. That was the case the last time, September of 2004, so it has been quite a while since there has been any issue. So, yesterday after school I picked Sadie up and took her in to have her blood work done again. Today they called to tell me that the levels are still elevated, but had gone down some.

There are two types of test that are the most common. The AST and the ALT both measure the function and both have a “normal” range. AST – between 5 - 40; Sadie’s second testing came in at 59. ALT – between 7 – 56; Sadie’s second testing came in at 117 (first testing well over 200). The ALT is the more precise testing of the two and much to complex to explain here. One thing I will point out though is that these tests are not “rated” of what number comes in. You can have a lower but out of range ALT reading and have a much worse prognosis then someone with an extremely high reading. So, the numbers mean nothing other then the enzymes aren’t contained to where they should be – indicating a problem or irritation.

I was told today to continue Sadie’s medications (she gets Methotrexate today) and we will re-test in a month (specifically at her next Remicade infusion – May 25th). From there, who knows, I guess this is one of those wait-and-see games. I am trying to feel assured that the doctor doesn’t seem particularly worried (otherwise I assume waiting a month wouldn’t be the plan of action). We will be seeing this doctor on the 12th of May and I will discuss this with her more at that time.

That’s the newest news here! We go to Bastyr on Monday and I will talk to them about this issue also and get their feedback and any suggestions.