DEAR DR. DONOHUE: I am a very healthy 34-year-old woman. Recently I went in for my annual exam and had routine blood work done. Everything was normal except for two liver enzyme tests that were elevated. The SGOT was 47, and the SGPT was 79. My doctor wants the liver tests repeated in four months and told me not to worry.

What do these numbers mean? Can bodybuilding or a few diet soft drinks affect the liver? – N.A.

ANSWER:
What to do for people who are in the pink of health but have abnormal lab results is a challenge faced by every doctor just about every day.

Enzymes are foremen within all body cells that keep cell machinery running at optimum speed. When cells are injured or die, they release their enzymes, and blood levels rise. The kind of enzyme found indicates which body organ is involved (sometimes).

In many labs, the upper limit of normal for SGOT (also known as AST) is 30. For SGPT (also known as ALT), it is 35 for women and 40 for men. Your numbers are not sky-high. Concern grows when the SGOT and SGPT are three times the normal value.

About one-quarter of symptomless adults are found to have elevations such as yours. Of that number, one-third become normal in a matter of months. A repeat test, therefore, is the first step in evaluating liver enzyme elevations. Your doctor is playing by the rule book.

If the enzyme values do not drop to normal, further pursuit of the abnormalities is justified. A large percentage of people who have elevated liver enzymes are overweight, and fat invasion of the liver is the reason why the tests are high. Weight loss can bring the numbers down.

Neither bodybuilding nor a few diet drinks explain the rise of liver enzymes.

DEAR DR. DONOHUE: You have frequently written about Lyme disease, but I have not seen you discuss another tick-transmitted disease: ehrlichiosis. Because of a delay in identifying this infection, I became very ill, and recovery time was weeks. During my infection, death could have occurred. Thanks to a vigilant doctor, I am still around. – V.P.

ANSWER:
I haven’t mentioned ehrlichiosis (er-LICK-ee-OH-suss) because you are the first person to ask about it.

It is an infection caused by bacteria transmitted to humans by way of tick bites. It features severe headache, abdominal pain, fever, enlarged lymph nodes and often a rash. It’s a little like Rocky Mountain spotted fever.

The diagnosis is often delayed because the illness is uncommon and not thought of. Between 1986 and 1997, a little more than 1,000 cases were documented in the United States – about 100 cases a year.

Most of the time, treatment with doxycycline, a tetracycline antibiotic, puts a prompt end to the illness. Fatigue, however, can linger much longer.

In a few cases, the course is stormy and can end in death.

The public does not need to panic. This is not another new illness like mad cow disease. It has only recently been reported in humans, but the illness was long known to be an animal illness. Human illness in the past was misdiagnosed.

DEAR DR. DONOHUE: My son has been married for a year, but the marriage has not been consummated. My son told me this in confidence. His wife’s very tough hymen prevents intercourse. Can you suggest a remedy? – H.K.

ANSWER:
The remedy is simple. A doctor can solve the problem with a scalpel and with little fuss or pain. This is a matter that should be corrected immediately. If your daughter-in-law is too shy to see a doctor, offer to accompany her and to stay with her during the procedure.

DEAR DR. DONOHUE: I have one kidney stone that doctors tell me should never bother me. They told me to drink lots of water. I drink eight cups of water a day and four cups of coffee. I am 61 and am worried that my kidneys will wear out from drinking so much fluid. Should I be concerned? – C.S.

ANSWER:
You have nothing to worry about. Your kidneys, and mine, and everyone’s can handle that amount of fluid without batting an eye. Stone formers do need to drink at least eight 8-ounce glasses of water a day. The rest of us do not require so much.

DEAR DR. DONOHUE: My husband, 42, comes from a family where heart attacks at a young age are common. His dad and his uncle both died of one in their 40s. I would like to know what to do if my husband should have one. Don’t use my name. My husband would kill me if he knew I wrote to you. – Anon.

ANSWER:
Mum’s the word. I gave you maximum anonymity — no initials.

Your question is a good one for all readers. What transpires in the early minutes of a heart attack often means the difference between life and death.

The starting point is knowing heart attack symptoms. Chest pain is the hallmark symptom. Some describe it as a squeezing pressure on the lower left side of the chest. Others have a buzzing sensation in the throat. The pain can spread down the arms, especially the left, or radiate to the neck or jaw. Not infrequently there is no pain, and then you must rely on signs.

One sign is pallor. Another is sudden sweating on the face.

People often complain of nausea, and they might vomit. Many heart attacks are dismissed as indigestion. People sometimes say they feel like they are on the brink of fainting.

Even if you are not sure that a person is having a heart attack, act as though one is happening. Give the victim an aspirin and instruct him or her to chew and swallow it, so long as there is no aspirin allergy. If you have nitroglycerin around, the kind you put under the tongue, fetch it and give it to the stricken person.

Such simple steps save thousands of lives annually.

Don’t forget to call 911. That should be the first step.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.


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