Is my liver going to rot and fall out my ass?

May 14, 2008 6:48 AM

I've been pooing water for nearly 3 months now. My liver tests came back a month ago with the GGT being extremely high. I take a lot of prescription meds, and before the shitting-water problem was a heavy drinker. I've stopped drinking completely for several weeks now, but have yet to notice much of a change. I'm seeing the doctor again soon. What should I be thinking about/asking?

I'll try to be as brief as possible. I know YANAD or YANMD. I'm seeking good questions to ask at an upcoming follow up appt with my doctor. Here's the story. On 2/22 I had a gallbladder attack, my first. After spending most of the day in the hospital, I discovered the next day that I was having serious intestinal issues. I assumed it was a flu as I had been in the hospital at the height of flu season. I was basically shitting water. And it continued. And continued. On 3/22 I got my gall bladder out. I still had serious intestinal issues and had cut my food and drink intake to BRAT (bananas rice apples toast) and electrolyte powder and water. My doctors didn't seem particularly concerned and after the surgery sort of waved the problem off as adjustment to the lack of gall bladder, even tho the problem had been occurring for a month beforehand. Fast forward a month, they tested me for C.Diff, which came back negative, then kind of threw up their hands again and offered me no answers other than the possibility of giving me a bile binding powder or something like that, despite the fact that I was adamant that the problem had existed before the surgery. So I was pretty ticked at my GP, and elected to switch doctors. When I told my new doctor that I was going up to 2 dozen times a day, he immediately agreed that it wasn't likely to be related to the lack of gall bladder and ordered a large series of tests. What came back was kind of scary. My liver function tests were not normal. The two beginning with A's (AST and ALP I think?) were fine, but the GGT was 305 (normal is less than 50). FYI everything else appeared normal and I tested negative for celiac, although I have cut out wheat, dairy, and caffeine as well as alcohol from my diet. He said there was no indication that my liver was actually damaged but the GGT indicated that it was seriously irritated with me.
Now I'll admit to being a rather heavy drinker in addition to being on a lot of medication. However, honestly, my alcohol intake was greatly reduced after my gall bladder attack. However, during that period, I was still taking the following medications at various times or continuously -- Celexa 40mg/day, Benicar, Adderall 20-30 mg/day, Klonopin 0-5 mg/day, Trazodone 0-100 mg/day, Seroquel 0-100 mg/day (either Trazodone or Seroquel but never both at the same time on any given night), Oxycodone some days, lots of Immodium Advanced, Mucinex, Advair, prednisone, and Zithromyacin. The last four were prescribed by my previous doc in the 2 weeks running up to the surgery because I had a bad cold/possible sinus infection in addition to the intestinal issues.
SO once I got the LFT's back, my doc said quit drinking completely for 6 weeks and within 3 weeks, he said, I should see a good reduction in the intestinal issues. Well I did quit drinking completely which has not been easy but definitely better than my liver rotting and falling out of my ass. And I haven't seen much improvement. My med intake has decreased, though I took pain killers for about 2 weeks post surgery, so that I am now on 40 of Celexa, 20 of Adderall, 0-3 mg of Klonopin, and 0-100 of either Trazodone or Seroquel depending on the time of night I am able to take it to sleep. Also he prescribed Lomotil (lonox) for the diarrhea, which I have been taking occasionally.
So...what does the hive mind think...what questions do i need to ask him next time i see him (next week)? Can the high GGT be related to the combo of drugs and alcohol, or is it just the alcohol, even though my intake was greatly reduced in the 2 months prior to the test? Can I expect the level to drop back to normal ever? Will I ever be able to drink, even just occasionally? Is it a sign of liver toxicity because of the combo of celexa and alcohol? What else am I not thinking about? I get so frozen when I'm in the office i forget to ask questions and I would really like to make a list and seem like I know something about it. TIA.

posted by Soulbee to health (14 comments total)

Almost no Mefite is going to know these medical abbreviations, or appropriate diagnoses, medical treatments, and effects of medicines for what you're dealing with. This is a situation where the terminology in this question is thick enough that it'd be immoral for a non-medical professional to even venture an opinion.
posted by WCityMike at 7:39 AM on May 14 [2 favorites]

Did they do a stool sample with a culture? I know you said they tested for C. diff, but you may have a parasite. I had Giardia for nearly a month (primarily because I was travelling and couldn't see my doctor) and it was, at its height, a whole bunch of water shitting (once every hour or two). However, I was otherwise healthy (so long as I kept my fluids up), and was not taking anything even remotely near your level of medication. And I had my gall bladder (still do, thanks). Have you been to a GI specialist?
posted by Xoder at 7:47 AM on May 14

On post-comment remorse, I agree with WCityMike. And would like to re-iterate the need for you to see a Gastro-Intestinal specialist.
posted by Xoder at 7:48 AM on May 14

WCityMike, the OP doesn't seem to be asking us for answers to those questions, or to even speculate on her diagnosis or medical treatment. She is asking us to help her add to her list of questions, the above being ones she's already come up with. I don't think there is anything immoral about people suggesting additional questions for her to ask her doctor.
posted by necessitas at 7:51 AM on May 14

There are several doctors who read askmefi. But thirding go see a gastroenterologist ASAP.
posted by arimathea at 8:08 AM on May 14

Questions:

Is my high GGT caused by the alcohol and the meds combined? Is there a certain med in my list of meds that interacts with alchohol to cause higher liver toxicity? Are there interactions b/w the meds on my list that cause liver toxicity?

Is my diarrhea connected to my liver problems? Is it connected to my meds? Is it both?

Are my liver problems and intestinal problems two seperate and unrelated problems?

How does the gall bladder attack fit into this scenario or is it also a seperate, unrelated problem? Did illness of my gall bladder and the eventual removal of my gall bladder cause my intestinal problems?

Is my immune system involved with the intestinal problems?


Please make sure, if you haven't already, you give your GP and/ specialists a complete list of the meds you have taken/ are taking on a regular basis since the onset of symptoms.
posted by InstantSanitizer at 8:16 AM on May 14

These are kind of obvious, but a lot of times people don't think to ask them. There's a tendency to just stick your arm out so they can draw blood, and not ask what they're looking for or how certain they might be. So, ask your doctor these questions, and write down the answers so you can google them later. Ask him to slow down his explanation if necessary so you can write all the relevant info down - a quick comment like "Sorry, I'm trying to stay really informed about this because it's kind of freaking me out" should placate him if he seems impatient. Maybe you could even ask if it's ok to use a voice recorder. Questions:

- What are your theories on what could be causing this?
- How do we/you test those theories?
- Can I reduce or eliminate any of these medications I'm currently on?
- What do I need to do to treat these symptoms and avoid getting worse, while we figure out what the trouble is?

Also, bring a written (typed) copy of your question here, cleaned up a bit and formatted in bullet points (and keep a dated copy for yourself). Give it to your doctor at the beginning of your appointments. "Here's a list of my medications and dosages. Here's a timeline of my symptoms and treatments. Here are the treatments I've tried, and the results that did or did not occur." Just like any other person, a doctor may process things better when he reads them than when he hears them. And in case he has some a-ha moment 3 hours after you leave the office, he'll have the relevant info laid out for him to double check. The process of writing it all out will help keep it more clear in your own head, too. It's easy right now to feel like you'll remember the order of when things happened, what you tried, etc. but if this is still going on a month from now your memory will get fuzzy.
posted by vytae at 8:27 AM on May 14

As a laboratorian I'll just chip in with that GGT is a near-worthless test. It is completely non-specific and has limited value for working up any type of differential diagnosis. Transaminases (AST/ALT) have far greater value. Go see a gastroenterologist.
posted by i_am_a_Jedi at 8:50 AM on May 14

When I saw the question on the front page, my thought was giardia, but Xoder beat me to it. (Basically, have you been swimming in any lakes?) Best to get checked out to be sure, either way.

You should get a colonoscopy to rule out Crohn's or ulcerative colitis (or bowel cancer).

Most of all, though, you need to sit down with a doctor (maybe doctors, plural) and have a frank discussion about ALL of the drugs you are on and your alcohol consumption. It is unfortunately not uncommon that people don't disclose all of their drug-taking (and I'm talking something as simple as a tylenol, here) to their doctors, and can get cross-prescribed things that will make them very, very ill. Things that, when mixed, can kill them.
posted by phunniemee at 9:00 AM on May 14

I agree that you should write out the sequence of events you describe above and bring it with you to help you explain clearly what has happened so far.

Good for you for planning out your questions in advance. It's easy to get flustered and forget to ask all the things that you wanted to know.

You've been on a lot of meds and had a major surgical procedure...it may take some time for the doc to straighten it all out. Try not to get frustrated! And ask your GP whether he thinks you should be seeing a gastroenterologist?

Also very much seconding necessitas.
posted by desuetude at 9:05 AM on May 14

thanks for the advice. my docs have very specific med lists, i've been extremely careful with that, straight down to the odd here-n-there tylenol, 2 stool samples were taken, i think parasites were rules out, in any case i haven't been swimming in any lakes or traveling anywhere in ages and ages and ages (years). i am seeing docs, and if my doc doesn't have some answers for me next week, i'll see a gastroenterologist...i just appreciate the guidance on questions i might not have thought of. thanks.
posted by Soulbee at 11:10 AM on May 14

I can't offer advice in place of a doctor, but I do recommend that you *not* soley consult with one doctor. If your insurance policy can cover it, get second opinions...try to find another very knowledgeable gastrointerologist in your area.

I personally have been dealing with an illness that has been very hard to diagnose, and am finding that by branching out to different doctors, you'll get very different views and opinions on what is happening....it's made me lose some faith in our healthcare system, but at the same time it's taught me to be persistant about my health.
posted by samsara at 11:17 AM on May 14

One thing to try, which won't hurt you while you wait for your doc visit-eat some yogurt with live culture.
posted by konolia at 1:24 PM on May 14

You definitely, definitely need to see a gastroenterologist.

Few primary physicians do very well with the workup of what is now chronic diarrhea. My suspicion is that if the only thing wrong with your liver tests was a GGT of 300, and all the other enzymes, clotting tests and protein levels were normal, the liver may be a bit of a red herring and freaking out about the GGT is probably premature though it might warrant regular monitoring. That could be from alcohol, medications, or just plain old non-alcoholic fatty liver disease which tons of people have without even knowing it. There are diseases that both affect liver enzymes as well as cause diarrhea, just so you know, however diarrhea as a symptom of liver disease itself most often occurs when the liver is doing so poorly that you develop problems with bile metabolism (this is usually the case at the point of cirrhosis).

Getting to the bottom, forgive me, of your diarrhea issue will probably depend less on the questions you ask and more on how well-trained and experienced your gastroenterologist is at dealing with these types of symptoms. I suppose it would be useful to ask if the stool tests you previously had were sufficient (I suspect they probably weren't), whether you would benefit from any imaging tests of the abdomen, and whether you might need endoscopy and/or colonoscopy. For your own sanity, ask if the gastroenterologist thinks the liver enzymes have much any relation to your diarrhea, or if your liver is going to poop out any time soon (I suspect not).

Out of curiosity, with so many bowel movements a day, do things improve if you stop eating entirely? Do you find that you sleep soundly without having to wake up to use the restroom? And have you noticed any changes in the color of your stool?
posted by drpynchon at 1:49 PM on May 14