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Questions About Chest Pain And Liver Enzymes


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#1 kiwimum03

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Posted 07 January 2007 - 10:27 PM

Hi everyone,
I went and saw my general practitioner this morning to find out what liver enzymes were raised and it was my Alk Phos 111 Units (normal 40-100) and my GGT 75 Units (normal 0-50),
so not too high, but enough for her to tell me to stop the Plaquenil.

she is unsure whether it is the Plaquenil that disturbed my liver, or that going off my Cholesterol tablets has caused my fatty liver to play up again.
I only have a very mild fatty liver, and was told at the time that it shouldn't cause pain, but my goodness I have been having so much liver pain.

Back in June my Alk Phos was 114 units and my GGT was 57, then by August they were back to normal after I had been on the liver cleansing diet and my cholesterol was back to normal too, so I don't really know what is going on. Its all very confusing, I kind of want another ultrasound to check to see if my fatty liver has gotten worse or something else is going on, but she didn't see the need.

I have to phone my rheumatologist next week when he is back and discuss all of this with him, as I am just unsure where I am at now.

The other problem I am having is chest pain.

I have had it on and off for a week, its just a sharp pain, usually pretty mild every now and then, and I am pretty sure it is muscular because it can be worse when I move.
It seems to be right over my heart area.
But today I have had it all day long, it only stopped about 4 times a day for half and hour each time before hurting again, and the pain is very uncomfortable.

She listened to my heart and chest and said it was fine, and then felt my chest and said it seemed like it was over the 4th rib down on the lefthand side, and she suspects I may have inflammation or friction, but she wasn't really willing to give me any more help than that.

Can this pain be arthritis?

My father had ischemic heart disease so of course I wanted to make sure my heart was fine first.

The other thing she gave me were some artificial tears......what a blessing! and some more Gaviscon for my acid, as I have been throwing up again in the evenings with food sitting in my throat.

Aside from the chest and liver pain I have been having very sore ribs, and she seemed to think that was esophegal (sp?) related. I see the ENT doctor on the 25th for my Tinnitus, so she said to speak to him then about it.

I wish I could sort out what is wrong with me, I am sorry I keep bothering you all with my questions, but I thank you all for your lovely answers.

Hugs,
Irene

#2 Elehos

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Posted 08 January 2007 - 03:41 AM

Hi Irene,

I'd definitely keep track of your heart, but a lot of the chest and rib pain you're mentioning sounds very familiar. My ribs have been extremely painful at times for about 8 years, and there are days that the slightest move will make it worse. At this point it affects most of my rib cage, and I refer to it as "The Resident Boa." There are sharp pains that sometimes end up with severe muscle spasms that makes breathing almost impossible, but I don't know if that's similar to what happens to you. The esophageal spasms can sometimes feel like a heart attack, so it wouldn't surprise me if that's what's going on with you, but keep track of symptoms to be sure.

As for the liver, my enzyme levels have always come back in the normal range, but there certainly has been pain and visible inflammation both there and in the spleen, so I do sympathize with you! It could be a combo of going off your cholesterol meds and the effect of the Plaquenil, but only your doctor can really determine what's going on. If the pain gets worse though, I'd request an ultrasound! I hope you can find something to help this pain soon!

Best wishes to you,
Elehos

#3 Heidi

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Posted 08 January 2007 - 05:17 AM

Hi Irene,

I get the rib cage pain alot and my rheumatologist said it was chest wall rheumatism (not that I know exactly what that is....I think it is inflammation of the chondroital joint). I take celebrex to help with all of my joint pain and my rib cage (as is all of my joint pain) so much worse when I stop taking it. Are you on any type of NSAID? You might want to ask about that. I do hope you can get some relief soon.

Warm wishes,
Heidi

#4 Sweet

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Posted 08 January 2007 - 06:06 AM

Hi Irene,

Oh hon, sounds like you are having a rough go of it right now, I'm so sorry.

I haven't had any experience with rib pain, but what I wanted to suggest was an EKG. I'm surprised she didn't do one. You can't tell much just from listening to someone heart other than a regular beat, but it doesn't tell you what KIND of beat. For instance you could be having PVC's, (premature ventricular contractions) etc. I would contact your doctor and ask for a more in depth look at that aspect. Especially since you have family history of heart disease. Now I certainly am not a doctor, but I am a nurse, and feel this may warrant more testing.

I think this is the second post I've seen about liver testing being related to Plaquenil. I need to do more research on this, because I've been on it for 7 years and my doctor has never mentioned that connection to me. The only side effect he's ever told me about or been concerned about is my eye exam. I would venture to say your liver tests were high due to your cholesterol lowering agent.

Please don't ever feel you are bothering anyone here, that is what this forum is all about! Support!
Warm and gentle hugs,

Pamela
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International Scleroderma Network (ISN)

#5 kiwimum03

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Posted 08 January 2007 - 10:25 AM

Thanks for the replies, Elehos, Heidi and Pam,

I am thinking I will request another ultrasound of my liver, my father also died of Cirrhosis, from his fatty liver not being pick up early on (and being on loads of meds for years), so of course that freaks me out, he was also a bad diabetic and had horrendous osteoarthritis......poor man.

I am very much like my father in physical and some medical appearances. As my mother has watched me over the last few months with my pain and swelling, she said it was just like watching my father get sick all over again. My poor mother, but she is such a blessing, she used to be a nurse and looked after my dad for 20yrs before he died 2 years ago, its only because of her he lasted that long.

Okay, off the beaten track, sorry....

I was also wondering if it could be Costochondritis (sp?), someone else mentioned it to me, and I looked it up and that seemed plausible.

Heidi, I am taking ibuprofen 800mgs 1-3 times a day. I find it does help a little with the swelling , but not too much with the pain.
And I can't find any medication which will take away that muscle burning tight pain, that you get that makes you feel like you have been working out for hours.

I have always had a very touchy stomach, and was hesitant about anti-flams as they always upset me, but I don't really know what else to take, so I just keep taking the antacids to counteract it all.

The other thing lately........is on the roof of my mouth I have a red sore about the size of a pea, but a bit more oval. It is flat, but quite painful and red, I have had it for a week, and totally forgot to mention it to my doctor. Of course I am thinking that perhaps it is from the Plaquenil, as I got it when I started on that.
But it is the least of my worries.

Today, my hands are very puffy and tight, it hurts, so I am going to stop typing,

thanks again for the replies.

Big hugs,
Irene

#6 sadie20

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Posted 08 January 2007 - 04:07 PM

Each of our bodies are so different..Regarding elevated enzymes, mine have been elevated since this "seige" started in Sept. Both Imuran and Cellcept caused them to almost triple, although I was told these drugs were not the cause. in both cases, I convinced my doctors(1st time the rheumatologist and the 2nd time the liver specialist) to allow me to go without the drugs and redraw them. I'm unclear at this time what the next step is. Tomorrow, I have to pick up my liver biopsy slides and take them to the liver pathologist..the liver doctor thinks I have autoimmune hep in addition to systemic sclero. As for the chest pain, I too agree with sweet that you need to have it checked out from a cardiology standpoint first . I also have the rib/chest discomfort which is mild to pretty awful, but anti-inflammatories do help.

#7 kiwimum03

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Posted 08 January 2007 - 10:02 PM

Thanks Sadie for sharing your liver experience with me, all the best for the liver specialist, I do hope that you don't have autoimmune Hep.

I am only taking ibuprofen at the moment (I quit the Plaquenil last week), and my doctor told me to go back to a fat free diet to see if any of this helps. I guess if they enzymes stay up then they will look into it further.

I agree my heart needs more looking into. I do have an issue with my heart. I can't remember the name of it right now, but everytime I have a chest x-ray, it shows up that one side looks slightly larger, but I do have scoliosis too, so that always alters my x-rays a little.

I saw a cardiologist 16yrs ago, when I was 15, so I do think it is time for another visit.

all the best,
hugs,
Irene

#8 Dee

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Posted 09 January 2007 - 07:27 PM

Irene, I'm so sorry you are suffering, but glad you are asking questions. I'll just add my two cents.



Yes, I think you should definitely have your heart checked. Also the esophagus/GERD can really produce different kinds of chest pain: spasms, soreness, burning, etc. It can mimic a heart attack. It takes a doctor to differentiate. My husband and I both have severe esophageal problems.



I would definitely mention the elevated liver enzymes to your rheumatologist. She may want you to see a gastroenterologist to rule out autoimmune liver disease such as PBC/primary billary cirrhosis or AH/autoimmune hepatitis. They are treated differently, so I would suggest a gastro liver specialist. The PBC has nothing to do with alcohol, it is an autoimmune disease somtimes associated with scleroderma. I've had two liver biopsies and my doctors still can't quite agree. I've been treated for both.



I've taken Plaquenil for several years and it has given me back my life. I've had no side effects at all--just good results. The only side effect I've heard of is related to the eyes and that is very rare. Just get regular check-ups.



It sounds to me that you are really aware of your body and family history. That is good. Just get everything checked-out so you can have peace of mind.



This is the right place to share your concerns and get great support and info!



Many blessings,



Dee

#9 WestCoast1

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Posted 10 January 2007 - 11:23 AM

Dee~
I have to agree with you about the Plaquanil. It was a life saver for me as well. Unfortunatly, my liver enzimes are up also. We are not sure why...just that it is Autoimmune stuff and I need further testing. I would hate to hear that Plaquenil was the culprate and have to discontinue using it.

Irene~
i hope that you are able to let us know what you find out about all of this...your rib pain and your elevated enzymes! feel better soon...
*WestCoast*

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#10 kiwimum03

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Posted 12 January 2007 - 11:08 PM

Hi Dee and Erin for your messages,

I am totally gutted that I had to stop the Plaquenil, as it sounds like it can work really well, and I am so pleased for you both that you had so much success with it!

I know it takes a while to work, so having to stop it after only 2 weeks, doesn't give me any indication of if it would have worked for me.
I am counting down until Monday when I can speak to my rheumatologist and see if we can sort out if it was the Plaquenil that caused the liver upset, as I am still not convinced.

I do have to admitt that since stopping the Plaquenil my liver pain has eased somewhat, but I do still get it on and off. But I was getting it a few months ago when my liver enzymes were normal, so I think there is definately a bit of research to do there.

I am 'trying' to fight my fatigue and joint pain, but this last week has been a doozy, ###### I am so tired of feeling tired.

take care,
Hugs,
Irene

#11 kiwimum03

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Posted 14 January 2007 - 10:21 PM

Just a little quick update.

Rheumy phoned me back today to say go back on the Plaquenil. He didn't feel it should affect my liver, and also my enzymes were raised a few months ago before I was even on it, so he wasn't worried.

I took it at about 1pm today and by 3pm I noticed a slightly odd rash on the tops of both of my hands. It is very mild, and a little itchy, so I do hope it is not a reaction, as I didn't have a rash last time I took it.

I go back to my general practitioner tomorrow as I told her my chest pain has continued and she wants to run more tests........thank goodness.

Thats all for now,
Hugs,
Irene

#12 Sweet

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Posted 15 January 2007 - 05:25 AM

Hi Irene,

Thank you so much for the update, I was just thinking about your yesterday. I am glad you are going back on the plaquenil. Also very glad the doctor is looking into your heart related issues.

Keep us posted.
Warm and gentle hugs,

Pamela
ISN Support Specialist
International Scleroderma Network (ISN)

#13 LisaBulman

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Posted 16 January 2007 - 02:44 AM

Hi Irene,
Great news about going back on planquenil! Let us know what happens at the doctor today!

Hugs,
Lisa
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#14 laurie906

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Posted 16 January 2007 - 05:55 AM

Irene,

I am a new member with a new diagnosis of Sclero. Your description of muscle pain to the point of burning (like you have been working out for hours) sounds very familiar. I had this reaction as a side effect of prednisone. I could track it to this med as it was the only one I was on at the time. I also expirienced a racing heart. If I sat still I was fine, but if I walked down the hall my heart went racing and if I tried to fold laundry my arms felt like I just couldn't lift them one more time. The fatigue moved to my legs also. I was on 10 mg of prednisone, we backed off to 5 mg and after a week the symptoms went away.

After a month we raised the dosage to 7.5mg and I seem to be tolerating that level without the side effects. Everything is a balance. I did loose some ROM in my hands when we backed off the higher level of prednisone but am willing to work with that to eliminate the symptoms.

I know it's completly exhausting to keep reviewing and bringing things up with the doctors but keep at it. I am the annal accountant so my doctor is getting used to me bringing my folder with lists and reminders. Even the small stuff like your mouth sore you should push to follow up on. Sometimes fixing the small stuff can ease your day.

Keep at it! B)
Laurie
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#15 kiwimum03

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Posted 18 January 2007 - 09:25 PM

Thanks Pam, Lisa and Laurie for your encouragement.

Again the doctor checked my chest and said it was fine, but she honestly didn't do much more than she did last time, as my pain has now gone.

Surprisingly my bloodpressure has reached a normal level for the first time in 7 years, it usually runs at 135-40/90-95 and now its 120/70, I am very shocked, and wonder if the Plaquenil is bringing it down?

Laurie, I am glad someone can understand the burning muscle pain, ugh, it wears you down doesn't it?
Unfortunately mine is not related to any meds I am taking as I have had it every couple of weeks for a few months now, long before I started on medication.

My general practitioner was very interested in the red spot on the roof of my mouth though.
She couldn't figure out what it was, and said it wasn't an ulcer. Its quite red, and has gotten quite big, about the size of my thumb nail......I don't know, I wonder if it is some sort of bleed?

thanks again for all your encouragement.
Off to bed, the fatigue is getting worse daily.

Hugs,
Irene