For the Love of Science & Medicine I

[dinoiii]

Originally presented 1/11/05

Oftentimes, I am accused of thinking about the two aforementioned topics maybe too much, but both truly are enjoyable and allow me to employ not only knowledge learned into a true life scenario but incorporate ideas from both of my favorite hobbies.

I am offering in this post an opportunity for you guys to see why I love it so much and see how our shared hobby of bodybuilding and supplementation meets the clinical setting.

Last Friday, I was posed with a colleague who was taking a methylated compound. The trick was he needed his Hepatitis B series 6-month booster and was concerned that potentially elevated LFTs would be a problem with entrance of this recombinant vaccination into his body and the immune response that would follow. I dealt with it accordingly.

So, if it were you guys who were in my position, what advice would you have given my friend with the liver working overtime? I will let you guys tear away at response for a few days before I tell you what I did. I think this is good topic for discussion. Let me hear those armchair scientists/doctors make decisions affecting this guys potential well-being.

[dinoiii]

Bottom Line of the Case...

Recap: Colleague was on M1T/MOHN stack. Suffered a needle stick injury in the hospital from Hep B patient and was still not given his 6-month booster (although it was time for the shot - roughly 6-mos time had passed and he was planning on having the booster done in a week).

Initial Workup: included immediate lab work to verify LFTs and creatine kinase. We had results in < 2hrs. showing elevations in AST (significant) and CK (significant). Elevations in ALT was not significant, but had risen and GGT was essentially nil which is actually more likely elevated in alcohol patients.

Interpretation: AST + CK significant elevations potentially due to methylated compounds, but his pre-cycle labs which were done indicated that these enzymes were more chronically elevated (the rationale for which has yet TBD). ALT slightly risen due to potential viral scenario (but really this would be rare to get an elevated reading this quick if that were the case). GGT absent essentially ruled out alcohol abuse.

Plan: Glutathione IV infusion. Concurrent introduction of recombinant vaccination (which is more likely to undergo post-translational modification so antibodies to HBV core and surface antigens would need to be monitored).

Today (1/19/05): LFTs still significantly elevated. I have a feeling it has nothing to do with the methylated compounds. + HBVAbs which implies immunity to virus is likely successful - no antigens (surface, core, e) were present. Will monitor at 1 month.





D_