liver function test

[steelcraft]

i have just received a letter from casa requiring further information in relation to alcohol consumption. I have been asked to take a blood test for carbohydrate-deficient transferrin, full blood count and liver function tests. no doubt someone out there has been asked to do the same. Any advice or information would be greatly appricated as i dont want to loose the class one for obvious resons. look forward to hearing from you

[mad_jock]

I know of a couple of folk that have had it due to folk reporting some concerns.

Basically they take a blood sample and have a look at various chemicals and they can tell if you are kicking the arse out of the bottle.

If you are a heavy drinker and then think bollocks I will stop drinking because I have a test coming up it actually makes it worse. This is because the liver once you stop abusing it starts to heal and it dumps all its toxins stored in it to deal with processing the booze. Its these toxins that they are picking up.

It takes something like 9 months to a year tea total for things to start sorting themselves out if you have passed the point of damage being done.

O and the out come was that one saw the writting on the wall went to AA and took their sponsor person (I think thats what you call them) with them to the AME. They all had a bit of a heart to heart, medical was suspended for a month for fatigue and the last time I saw him it was 2 years off the booze.

The other had thier medical pulled as apparently they could tell he had been drinking 2 bootles of red a day for years. And he could never convince them that he had sorted things out.

[Agaricus bisporus]

If you are a heavy drinker and then think bollocks I will stop drinking because I have a test coming up it actually makes it worse. This is because the liver once you stop abusing it starts to heal and it dumps all its toxins stored in it to deal with processing the booze. Its these toxins that they are picking up.

What utter, unmitigated, inaccurate and unscientific twaddle that entire post is. Toxins my arse! What the hell are "toxins"? Where do people get these daft ideas from? Books on homeopathy and crystals? Why would the liver store toxins? It is there to get rid of them! You don't have a clue pal. Not a firkin clue.

The internet will fill you in on the details of this test which is looking at Transferrin, a plasma protien associated with Iron transfer in blood and bone that responds to steady and substantial alcohol consumption. A few/several weeks of abstinence will reduce it markedly (Jock's 9 months is total bolleaux too) but it is a good indicator of recent activity.If you can't stay off the sauce it just won't come down much. It is quoted as having a half life of 14-17days which must make consumption even a month or few ago apparent, and also contradicts the little gem of misinformation in the post above about it getting worse for a while after stopping. If it does, medical sites on the net seem unaware of it...

It cannot diagnose alcoholism which is a clinical diagnosis that takes much more than a blood test and the analysys of many different liver-function parameters even within that.

But don't take my word for it, I'm not a doctor. The medical description of this process is available on the net - and this is not the right place to go believeing the tabloid tattle of the uninformed on such a potentially serious matter. It is so easy to find out the facts.

[Loose rivets]

Oh, fcuk! Now Jock's going to be really mad.:p

[mad_jock]

Nah I am not, its what I had been told by the bloke that is still flying.

He got tested every 3 months and his levels apparently took a year to get into normal band. I might have the wrong term with toxins, enzymes would be proberly better. 300 rings a bell with his liver function test and he had a fatty liver what ever that is.

I am sure ginger will be along soon to give us the real data.

[homonculus]

I am more interested in why casa sent the letter!

I didnt know they had spies around, so why pick on an individual? why should they suspect someone?

[gingernut]

I am sure ginger will be along soon to give us the real data.

Sorry folk's, make a rule about posting medical stuff after the third glass of Pinot :)

[steelcraft]

I just dont understand. Just turned 40, BMI is well with in limits, lung capacity etc etc all well with in the range for my age. Eat well etc etc enjoy a beer like most and get this letter. And they want reply to my request for someone from CASA to dicuss it with me.
They have extended my medical until the new results so I will wait and see.

[mad_jock]

Someone will have been **** stirring.

[R8TED THRUST]

I had a similar warning on my last medical.
I took a week off any alcohol consumption, and
took milk thistle pills. They are herbal and
assist in rejuvenating ones liver. A week later was
well in limits.

[Loose rivets]

I . . . erm, hesitate to ask, but . . . erm, is there a similar natural product for alcohol damaged brains?

[gingernut]

Blood tests can sometimes identify an underlying alcohol problem, but there are problems with sensitivity (the ability of the test to pick up a problem and not miss any cases) and specificity (the ability to get it right without falsely identifying those who haven't got the problem).

The ideal test would have high sensitivity (doesn't miss any cases) and high specificity (doesn't falsely pick up cases.) Most tests don't have either so we have to use them with caution.

Doctors (and nurses) love performing tests, it makes them look scientific, but in the real world it can often confuse the issues, rather than add to the picture.

In your case, I suspect that the docs will be looking at a constellation of tests to try and focus on the underlying problem. Traditionally the Gamma GT (GGT) test was seen as a marker of alcohol use, but problems with specificity limits it's use (gamma GT (GGT) and alcohol - General Practice Notebook (http://gpnotebook.com/simplepage.cfm?ID=x20090313123734749131)) so I think they'll be looking at things including liver enzymes and the size of your red blood cells (MCV) which is part of your full blood count (FBC).

Technically you could argue the toss. You could argue that the biggest p*sshead in Manchester are within normal parameters, whilst the guy who has the odd glass too many have results outside what's classed as "normal." (I see this every day :-) )

It does sound like a warning shot has been fired across the bow.

It'd be interesting to explore the journey that has brought you to this point.....you'll find some understanding ears here:)

Now, forgive me if I fail to reply tonight, a rather cold glass of Pinot awaits.

[homonculus]

I agree Gingernut - why are people getting these letters unless of course they are admitting to excessive alcohol intake? I am unaware of other examples of the medical department responding to tittle tattle from other pilots, and AMEs on the whole dont make wild assumptions that people are on the binge unless they turn up to medicals half cut

Can we have some more information from anyone?

[osmosis]

I sometimes wonder about the practical validity of some of these scientific tests. I seem to recall an Australian policeman who finished in the top ten of the Hawaiin Ironman in recent times yet failed the BMI test in his annual medical for employment. Scientific tests ain't everything yet we are governed by them; doesn't make a lot of sense to me.

[mutt]

If you are a heavy drinker and then think bollocks I will stop drinking because I have a test coming up it actually makes it worse. This is because the liver once you stop abusing it starts to heal and it dumps all its toxins stored in it to deal with processing the booze. We recently had a new hire do a pre-employment medical, he was initially told that his readings were high, then a week later he was told that because his liver had responded so rapidly to his not drinking, that this indicated he was an excessive drinker. His employment offer was rescinded.

Mutt

[C-change]

When they take blood for your medical they look for a GCT count (enzyme). Normal is considered less than 50. Mine has been as high as 180 over the years but all else was fine. First reaction from the Dr was that I drank too much. Didn't touch a drop for a 3 month period with weekly blood tests but GCT stayed high (150-180). Went to gastroenterologist, did ultrasound and said I had "Fatty Liver". In short, diet was way too high in saturated fats and very little exercise. Went on low fat diet and had to get lazy arse moving again, as well as little or no alchol and within 6 months back under 50 again. Been managing it like that for last 15 yrs. Gets hard at Christmas time. :ok:



Fatty liver, also known as fatty liver disease (FLD), is a reversible condition where large vacuoles (http://en.wikipedia.org/wiki/Vacuole) of triglyceride (http://en.wikipedia.org/wiki/Triglyceride) fat accumulate in liver cells (http://en.wikipedia.org/wiki/Hepatocyte) via the process of steatosis (http://en.wikipedia.org/wiki/Steatosis) (i.e. abnormal retention of lipids within a cell). Despite having multiple causes, fatty liver can be considered a single disease (http://en.wikipedia.org/wiki/Disease) that occurs worldwide in those with excessive alcohol (http://en.wikipedia.org/wiki/Alcohol) intake and those who are obese (with or without effects of insulin resistance (http://en.wikipedia.org/wiki/Insulin_resistance)). The condition is also associated with other diseases that influence fat metabolism (http://en.wikipedia.org/wiki/Metabolism).[1] (http://en.wikipedia.org/wiki/Fatty_liver#cite_note-reddy-0) Morphologically it is difficult to distinguish alcoholic FLD from non alcoholic FLD and both show micro-vesicular (http://en.wikipedia.org/wiki/Vesicle_(biology)) and macrovesicular fatty changes at different stages.

[dlx_xlb]

Steelcraft.

Yes I had a very similar thing happen to me.. However mine was much worse
In addition to the blood tests, CDT cost money I had to provide a psychiatric report.

They request it if you score too highly on their AUDIT and FAST tests..

No real advice I can give people out there, but just to stop drinking in the interim.. Advice given to me by my dame aswell... I was a binge drinker at the time and didn't drink for two weeks and my results came came reasonably normal besides my GGT which was a little elevated. Possibly due to fats

[sherburn2LA]

what do you think the motivation behind liver function tests is anyway ?

Is it possible for liver damage to cause sudden incapacitation or are they using this as a proxy for heavy drinking inferring you may take the controls while inebriated or hungover or both ?

[Capetonian]

Basically they take a blood sample and have a look at various chemicals and they can tell if you are kicking the arse out of the bottle.

No they can't.

First of all they need to appreciate the difference between being a heavy drinker and being an alcoholic. Both are problems, but for different reasons and in different ways.

As mentioned, one of the so-called identifiers for heavy drinking is Gamma GT. The 'norms' for an adult male are anywhere between 8 and 70 IU/L (International units/litre) depending on whom you ask and in what country. Mine is consistently around 100, has been as high as 200, and I have always been a very light drinker, in fact my doctor says that by some standards I am almost teetotal, probably consuming about 5 units a week. I know people who drink that at lunchtime and then double it in an evening, consistently and one of my friends who drinks more every lunchtime than I do in a week, has a Gamma GT of 24.

[Agaricus bisporus]

I am almost teetotal

Brilliant!

Reminds me of a girl I once knew who used to claim she was "almost a virgin..."

[afhelipilot]

I would treat this as a just normal new procedure nothing personal.. Yesterday, I spoke to my BA retired uncle, and indeed CASA letter should not be treated as something personal. You will not lose anything for sure. Did you have any liver pains lately? For instance, long persistent “ silent “ liver pains they are the worst. By silent means they appear from time to time, causing you a pain and walking difficulties? I have these kinds of pains since a year. Already had sent a fax to a m hospital and uncle will confirm it with them definitely, however, my pains are being associated with a crash shock, and at latter due to others involved in making funs and who are registered at a police. Happens. Do not worry, even if you drunk a little bit, it won’t affect you at all, men always used to drink, while we do not drink. Do not bother yourself with it at all, for sure you will not lose anything. Do not suspect CASA for anything at all .

[corsair]

Well this thread has made me paranoid. I have a liver test in a couple of weeks. I had one before since I'd just started on Lipitor for high cholesterol. The result was a polite letter suggesting I cut back on my alcohol consumption. I laughed it off because I had just arrived back from from a very pleasant holiday with lots of nice wine in my system.

The problem is that that Doc is an AME and he might pick up the phone to talk to the Doctor in the Aeromedical centre if he thinks there's a problem. I don't want a similar letter to that of the OP!

So it's off the sauce for me, which is no hardship really as I actually don't have an alcohol problem.

[cavortingcheetah]

Six weeks complete abstinence before a liver function test.

[steelcraft]

received the results back and all well with in limits and they give me my medical with no restrictions.

[cavortingcheetah]

Just wait until they cotton on to metallic ions.

[corsair]

Well I have a test on Friday morning. I had few drinks last week and only half a glass of white last night. By any standard that is below moderate drinking. So the result will be interesting compared to previous results.

[DX Wombat]

I still drink moderately - about 20 units a weekReg.6, either you are deluding yourself or somebody has been misleading you. 20 units is not moderate, it borders on the safe limit for men of 21 units and exceeds the limit for women by quite a large margin. Alcohol recommended safe limits, units/week. (I still drink moderately - about 20 units a week)
Steelcraft, that's excellent news. :)

[gingernut]

I'm still unclear as to why LFT's are tested in pilots? The tests are neither specific or sensitive.

Testing for those on a statin is just about acceptable, at 1, 3 and 12 months, (and then never again),but, again, the science behind this is limited.

What really worries me about using this test is that it may result in a fit, healthy, (undrinking) pilot being stigmatised, whilst the hardened drinker is missed, due to the over reliance on snake oil medicine. Have the authorities created another "EEG" test?

[sherburn2LA]

20 units is not moderate, it borders on the safe limit for men of 21 units and exceeds the limit for women by quite a large margin. Alcohol recommended safe limits, units/week.
funny man - the Royal College of Physicians admit they just made these numbers up on the basis of no evidence at all. In NZ the limits are more than twice as high and they are not exactly dropping dead in the streets. The WHO says below 35 units is low risk . Even supposing anybody tells the truth about how much they are drinking to any studies that are done.

[cavortingcheetah]

I'm sure I've read somewhere, perhaps hidden amongst the musings of Robert Louis Stevenson, that anyone who feels the need to discuss their own alcohol consumption is either a schizophrenic or an addict.

[Cameronian]

Hi sherburn2LA! Where did you get that dit about the Royal College? It's not often that such a body will put its reputation on the line with an admission like that - it would be a refreshing change if it is so.

[gingernut]

I expect The Royal College would have used a phrase such as "the evidence is less than robust," rather than, "we made it up."

Although it probably amounts to the same thing.

Interestingly though, if we look at mortality rates for chronic diseases, the lines are generally pointing down, in some cases quite spectacturely. Probably as a result of all the good work done in primary care (!), much more probable as a result of better educated kids coming through the ranks, people smoking less etc.

The exception for the line direction though, is death through liver disease.:ouch:

[Cameronian]

There is (I have had to edit this to change the verb from "was" because that seemed unfair...) a certain popular musician (no names, no pack drill) whose interview appeared on the BBC website today who admitted to previously unheard of, by me anyway, consumption with explosive consequences.

I wonder if you saw the report, gingernut.

[homonculus]

The story I was told Gingernut was that it was 5 pm at the Royal College of Physicians and the great and good had spent all day with the civil servants drafting a policy on alcohol. The doctors were keen to get to the bar but the civil servants refused to close the meeting until a safe limit had been agreed. In desperation the doctors pulled figures from the ether and disappeared to the bar

I suspect it has validity. Certainly the recommendations are rubbish with some people able to drink much more but others getting problems with lower levels.

Alcohol is the only vice that will prolong your life - if you drink regularly in moderation you will statistically have a greater life expectancy than if you are tee total. But equally drunks in city centres at 11pm and elsewhere cause massive harm and cost to society. As this posting shows it also causes anxiety in otherwise normal people. The debate is rather political - alcohol abuse does kill but whether the increase in incidence is as much as reported or merely reflects more accurate reporting is another debate

[mad_jock]

consumption with explosive consequences.

You have obviously not had a night out on cornish cider.

You think everything is normal and there is a very small fart brewing then bang the mother of all wet farts comes out. Strange thing was the pub even had spare pairs of trackie bottoms behind the bar for such accidents.

Thankfully I wasn't the first to be hit and went for a tatical before the fart

[gingernut]

Great story homonculus.:)

Alcohol is the only vice that will prolong your life - if you drink regularly in moderation you will statistically have a greater life expectancy than if you are tee total. But equally drunks in city centres at 11pm and elsewhere cause massive harm and cost to society. Interesting statistic, but as ever, there are lies, damn lies, and...........
(Do the tea totallers die young because there are other factors in their life which are responsible, eg chronic disease, reading Watchtower, being boring etc).

Of course, we'll be revealling more patients with elevated LFT's as we're monitoring more and more patients-('cos we're sticking more on statins.)

Still not convinced using them as a screening tool is useful. And why oh why are we measuring GGT's.:ugh:

As for Cornish Cider....me and Adam, Watergate Bay, circa 2005 http://www.youtube.com/watch?v=FTw2tDA7bVw&feature=plcp&context=C38e1199UDOEgsToPDskJnfv44J1gPdGRuXhDQtkD9

[britboy2]

Guys I need your help, I had a problem with the sauce im CC not FD and went to rehab, been tee total for coming up 2 months.
Had a company blood test 2 weeks to prove im off the sauce and it came back with hight liver Enzymes reading .

I HAVE NOT HAD A DRINK !

The company Dr has said I am still drinking and has grounded me ???? where do I stand ?

Saying that no test were taken before i went into rehab so they have no way of telling how high my readings were before.

[mad_jock]

Well it according to my sources they should expect it to go up intially then drop down over a year but more learned people on here seem to think thats pish.

I would call there bluff and say you are more than happy to have a breathalizer with you and take a test infront of the Captain before every duty or for that matter when ever they want.

[britboy2]

Thanks for that I have offered to do that but they say a breatlizer will only show ive not been drinking in the last 24 hours.
The Company Dr at Gatwick is very well know for being useless, So im off to see a Diffrent one on Monday but still grounded:ooh:

[mad_jock]

Might be worth speaking to one of the CAA doctors then.

I know CC don't have much to do with them but they are actually pretty friendly and good and want to help.

They also have the joker in the pack telling a company AME that they are talking ****e.

As a none medic it would seem sensible to me that your body will be under going a period of stablisation after removing a constant input of booze.

The AA might also be a good point of contact to get references showing that whats happening is normal.

[gingernut]

which enzyme was raised?

[britboy2]

I cant rember the name but ive asked to see the results so ill let you know when I do.

I'm going to see a different company Dr on Monday so fingers crossed this one has some common sense.

He also has a problem with the GP giving me zopoclone even though the old company Dr said it was ok as long as it was 12 hours before work so he grounded me for that as well.

In our SEP Manual it says they are ok for cabin crew just again not 12 hours before work.

Im going to call the CAA to double check on Monday.

I'm not the first person to question this Dr a lot of CC are unhappy with the help or lack of it they have received.
Had the results on his desk for 2 weeks and forgot about them until my manager chased it up.
I've been back at work 2 weeks now grounded again:{

On the bright side I have the Alan Carr book to read how to control your Alcohol witch I was told to read before I stopped, because you get no withdrawal systems from stopping heavy drinking it all in your head and its in the book:ugh::ugh:.
Didn't take his advice on that saw a GP and had a medical detox in rehab.
Sorry to go on but im so angry!

[gingernut]

Oh dear, poor advice. Stopping suddenly can, and often is, a killer.

[gingernut]

Of course, 2 dry days a week in Manchester, can be difficult... Drinkers should have two 'dry' days a week, say MPs - Telegraph (http://www.telegraph.co.uk/health/healthnews/9000827/Drinkers-should-have-two-dry-days-a-week-say-MPs.html)

More bo**ocks from well intentioned health facists.

[che ci dò che ci dò!]

Dear all,

for the first time in my life, following some routine tests, they've found my transaminases too high. I've gone through all kind of exams (blood work, epatitis markers, US, MR, etc) and they all came back normal (I'm not a drinker either). Does any of you have any idea on what are the JAA class 1 limits for SGPT SGOT?

Thanks

[homonculus]

No

But if you have no symptoms and all other tests are normal you have no diagnosis, no pathology, merely a rogue test so although you have to declare it shouldnt matter as you are not ill and present no risk of incapacitation

I wish people ie doctors would stop wasting money and frightening people by doing silly tests.