Dear Dr. Roach: I am a 58-year-old man. Two years ago, after a routine physical, my bloodwork came back abnormal for liver function, especially the alkaline phosphatase.
Before this, my bloodwork numbers were normal. Since then, I have had liver ultrasounds, an MRI and even a liver biopsy. They showed slight inflammation of the liver, but nothing major. It just seems the bloodwork numbers are off.
I’m 5 feet 9 and weigh 175 pounds. I’m still very active and in good health except for this liver function number. I have ulcerative colitis, and I’m taking Lialda.
My doctor thinks I have primary sclerosing cholangitis and I’m currently taking ursodiol (Actigall). She does not really know if PSC is what I have, but feels we need to try this.
I have never been a heavy drinker and, in the past two years, I’ve cut back even more on my beer drinking to maybe one or two, twice a week after golf.
I totally stopped drinking for a couple of months, but it made no difference in my blood-test results. I get a full metabolic blood panel every six to eight weeks, but the numbers don’t change much. What can I do?
L.S.
Primary sclerosing cholangitis is a chronic, progressive, inflammatory disease of the liver. It is strongly associated with inflammatory bowel disease, especially ulcerative colitis, and it is more common in men.
The diagnosis usually is made by cholangiogram, which is most often done now via MRI. Liver biopsy is sometimes also necessary. I am concerned that your doctor isn’t sure of the diagnosis. It might be appropriate to get your MRI and liver biopsy reviewed by an expert, since this is a very serious diagnosis and there are other conditions that PSC may be confused with.
PSC typically progresses over 10 to 12 years to severe liver disease. When the liver disease becomes serious, liver transplantation becomes the best treatment option. Although some treatments, especially ursodeoxycholic acid (Actigall), are commonly tried and might reduce the abnormal blood levels, there is no clear evidence that they slow down the progression of the disease. Alcohol may speed up progression, so I would recommend complete cessation.
One additional point is that there are some complications that may occur with PSC, the most worrisome of which is cholangiocarcinoma (cancer of the bile duct). Many experts in PSC recommend periodic screening, although the best method for this is not clear.
There are many educational resources and support groups for PSC. One is at pscpartners.org.
Dear Dr. Roach: A friend from Thailand with prostate cancer treated with radical surgery recently came to the U.S. to be evaluated for an increasing prostate specific antigen level, up to 0.65, and losing weight. The doctors in the U.S. can’t find anything wrong with him. Have you heard of this?
C.P.
A rising PSA level after surgery almost always means recurrence of disease, which can be either in the area of surgery or at distant sites, usually in the bone. Unfortunately, even the most sensitive techniques sometimes cannot find the areas of cancer in the very earliest stages. There are experimental drugs (such as monoclonal antibodies) that can find recurrent disease earlier than standard imaging tests, and it might be worthwhile having your friend look at some ongoing studies. Clinicaltrials.gov is a good place to start.
Dr. Roach Notes: In January, I published a column about a man with hair loss on the front and outside of his legs.
I suggested a few uncommon medical diagnoses, but several readers with a good deal of common sense suggested another possibility — the fabric of his trousers might be rubbing off the hair. A trial of looser-fitting pants, or shorts if one is lucky enough to be able to do so, might answer the question and solve the problem.
I appreciate the readers who take the time to share their experiences and suggestions, either to my email address or by regular mail.
Dr. Roach is unable to answer individual letters, but will incorporate them in the column when possible. Readers can email questions to [email protected]
