My ALT is not Cooperating!

We decided to get the blood tests yesterday in preparation for my consultation in my hub. We wanted to get my next month’s supply of my meds because the long holidays are coming next week and it maybe hard for me to schedule an appointment. Also, I can show the results of these lab exams to Dr.T when she comes back on Thursday. Good thing, on Sundays, there were no more lines in the hospital so in just 15 minutes I’m done.

Early today, we decided to get the results. Shocking was my ALT. It was 328! This is more that 5X increase from the normal level. Tag and I freaked out and called our doctor friend and asked if we need to see my GI doctor. She said I have to see him ASAP. I then scheduled for an appointment. Dr.T is still in Boston so my doctor friend orchestrated everything. She contacted another ID that I can see today too for an opinion. I guess this is an emergency move.

We saw Dr. R in his clinic and showed him the result of my blood work. I made him a table with all the data of my previous and present blood tests for easy comparison. I also gave him some literature on the three medicines that I am taking. He said the efavirenz is causing the increase! He recommended that I should stop taking the meds and he wants to know from my ID if it will be continued or not. Else, he wants another set of blood work after a week. He said to give him an update that day. 

He then checked me physically and palpated my liver. He said everything is normal. I have a good appetite and I am gaining weight which made him more happy. He said I have good skin color (not yellowish) and that my eyes are normal. Overall, I am still healthy despite my ALT being high.Whew. We left his clinic and I wasn’t even charged. My friend doctor is friends with him that’s why. Before we left, the secretary told us that our friend doctor had arranged for an appointment with another ID doctor in the afternoon. Leaving the hospital, we decided to eat in Bubba Gump Shrimp in G3, Makati. After lunch, we decided to go back to to the hospital so we can be there early. Tag dropped me at the condo for me to get my iPad since we will be waiting for 2 hours for my scheduled appointment.

We came back to the hospital and went to Dr. Saniel’s office. She is a “pillar” to the ID Society and was the Chairman of the UP-PGH IDS where SAGIP is. While I was signing her patient form, Dr. Saniel came out and told us that she is very busy that afternoon but she can accommodate us at that time. Wow. Nice to have doctor friends in the hospital! She then evaluated me and said that she would talk to her fellows about my medicines but definitely, the efavirenz is the culprit. She told me that she would call me by the following day but I should skip the efavirenz that night. She assured me that one night is ok to skip. It got me worried. 

We then came home and after two hours, Dr. Saniel said that SAGIP knows my situation already and my doctor there will change my meds the following morning and to stop taking the efavirenz. 

The following day, Tag and I went to SAGIP and met Dr. R. She explained to me the new medicine and that is already the second line. OMG. I just smiled of course, but inside I’m already worried. I was given Lopinavir and Ritonavir tablets. Upon reading the literature, these meds are protease inhibitors, really the second line. Once I start taking them, I can’t go back anymore to the 2nd line.

I then asked my friend doctor for her opinion. She said come back to the hospital and get another ALT test and we will decide from there. Back in the hospital, after blood was drawn from me, we decided to go and see Dr. R, GI for his opinion. My new ALT was 311. Still high. Upon reading the literature of my new meds, he said that the meds that SAGIP gave me was even worse for my liver and should not be given to patients with already high ALT! Talking to him like a friend, I said I have a deadline to make because I already skipped my efavirenz the other night so I have to decide if I’m going back to efavirenz or take my new meds. I told him that while waiting for a “real” decision, I might as well stick first to efavirenz. Dr. R agreed with me and said we will do a close monitoring of my ALT, to take it again after 2 days.

We were kinda worried but since this was a bad day, we decided to celebrate. We had an early dinner in Texas Roadhouse and just forgot about my condition. At home, my doctor friend texted me and said she was able to talk to Dr. Ditangco who sees patients also in the hospital. She is really the HIV expert and is the Head of the HIV department in RITM. Dr. Ditangco advised my doctor friend that I should stick to my original meds and will see me after two days in the hospital. My doctor friend said she will accompany and introduce us to Dr. Ditangco personally.

For now, I am back to efavirenz. I don’t know what will happen tomorrow with my check up with Dr. Ditangco or how will my ALT test go. What I know is I’m still positive about this despite of all the struggles me and Tag are experiencing now. 

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