Best Treatment for HBv

[jcm60]

I am 53 years old last month I have went for preventive health check up and based on the report findings the followings noted; SGOT 83 IU/L ,SGPT 200 IU/L , Doctor recmended me to see the Gastro.consultant , the gastro.consultant advised me to go for others test the result are as follows: Anti-dsDNA 16.6 IU/ml. , HBsAg test value 9520(Reactive) ,HCV,IgG test value 0.12 ( non Reactive) ,Anti Nuclear Antibody ( ANA) 0.12 , Immunoglobulin IgA 279 mg/dl , Tissue Transglutaminase antibody IgA 0.40 U/mL , Anti Mitochondrial Antibody , Serum 0.26 UL/ml , ASMA 2.70 U/mL , LKM Antibody 0.02 U/ml , Hepatitis B envelope Antibody test value (Ab) 43.0 ( Reactive) , Hapatitis Be Antigen ( HBeAg) 0.15 ( Non reactive),AFP 4.38ng/ml  , HBV DNA Quantitative,Real Time PCR 5156250 IU/ml. Based on this the Doctor advised me for the treatment  Tab.Entavir 0.5 mg one daily. Here i went for second opinion with Lever specialist consultant and he advised me to go for Fibroscan which the result is 5.91 Kpa ( Negative for fibrosis).Now the lever specialist advised for Viraferon Peg 80 mg once in a week and monitor CBC & S creatin every 15 days.I have not started the treatment yet as I am going out of India for 1.5 months as Doctor told me that this treatment will be given under there supervision , please suggest which treatment is suitable under these report.Also with vaccine this problem will be solved and how long i have to take this treatment.

[stef2011]

there is only a disease that i know of making so much calcium despite low vitd3 levels and this also justify pth kinetics so different to others.your kidneys were eliminating so much calcium despite normal vit d levels and high pth

please check here about this disease
https://en.wikipedia.org/wiki/Sarcoidosis

if there is sarcoidosis it is not possible to take vit d supplements, i am not expert about this disease at all so you should check with your endo

with low vit d now and high pth you are still well above normal calcium in urine.this is not normal and not possible, i think we have sarcoidosis here of some degree
On 15/6/2015: Calcium 24 hours Urine : 375 mg/day ( Ref.Range 100 - 300)

[jcm60]

Hi Stef

I have done some test , please review & let me know your opinion:


Vitamin D,25 Hydroxy:
- on 8 Nov.2013 : Vitamin D , 25 - Hydroxy ,Serum ( CLIA ) 41.05 nmol/L.
- on 22 June 2014Vitd25oh :18.22 ng/ml.
- on 24/8/2014 : 51 ng/ml.
- on 8 Nov.2014 : 51.2 ng/ml.
- on 5 Feb.2015 : 157.55 nmol/L ( Sufficient range 75-250 nmol/L )
- on 7 march 2015 : 164.50 nmol/L (CLIA method) Range 75-250 sufficient)
- on 3 April 2015: 174.12 nmol/L ( CLIA method - Ref.renge 75-250 sufficient )
- on 1 May 2015 : 65.2 ng/ml
- On 13/6/2015: 41.1ng/ml

PTH ( Parathyroid Hormone) Intact, Serum :
- on 5 Feb.2015 : 73 pg/mL ( Ref.Interval 14 - 72 )
-on 7 March 2015: 86.60 pg/mL ( CLIA method Ref.range 14-72 )
-on 3 April 2015: 73.60 pg/mL.
- On 1 May 2015: 83.80 pg/mL.
-On 13/6/15: 63.45 pg/ml.

Calcium, Serum:

- on 23 Feb.2015: 10.60 mg/dL ( Ref.range 8.8 - 10.60)
-on 7 March 2015: 10.50 mg/dL .
-on 3 April 2015: 10.50 mg/dL.
- on 1 may 2015: 11.20 mg/dL.    
-On 10 may 2015: 9.6mg/dl.      
-On 13/6/2015 : 9.8 mg/dl.

Phosphorus,Serum:
- on 23 Feb.2015: 2.00 mg/dL. ( Ref.Range 2.40-4.40)
- on 7 March 2015: 2.20 mg/dL.
- on 3 April 2015 : 2.40 mg/dL.
- On 1 may 2015: 2.30 mg/dL.
On 10 may 2015: 4.9 mg/dl.
-On 13/6/2015: 2.4 mg/dl ( LOW)

S.Creatinine:
-On  10 May 2015: S.creatinine : 1.4 mg/dl.
-On 13/6/2015: S.creatinine : 1.09 mg/dl (HIGH)


24 Hours urine : test date - 10 May 2015.

- Total urine volume 3500 ml.
- urine creatinine 1.36 g ( normal range Male 1.1 -3.0 mg/24 hrs.)
- urine calcium : 1335.0 mg ( normal range 25-300 mg/24hrs.)
- urine calcium :  1.33g  - (on average calcium intake 500-800 mg/24 hrs.)
- urine phophorus : 1.22 g ( normal range 0.3 - 1.3g/24/24hrs.

On 15/6/2015: Calcium 24 hours Urine : 375 mg/day ( Ref.Range 100 - 300)
Phosphorus ,24 hours urine 825 mg/day ( Ref range 400 -1300)
Total urine volume 5000 ml/day ( Ref.range 800 - 1800)

HBsAg Quantitative:

- on 28 Jan. 2014:  : 7767.68 IU/mL.
- on - 1 May 2014:  6812.40 IU/m
- 9 August 2014: 3585 IU/ml.
8-  Nov.2014: 4633 IU/ml
- 20 Feb.2015 : 5174 IU/ml.
- 13/6/2015: 5431 IU/ml



L.F.T.-

- 28 Jan.2014
SGOT / AST 48 U/L.
SGPT / ALT - 106 U/L.
ALK . Phosphatase - 139 U/L.

L.F.T.-
-  27/4/2014-
SGOT / AST 40 U/L.
SGPT / ALT  65 U/L.
Alkaline Phosphatase ( ALP ) 143 U/L.

L.F.T :
9 August 2014:

Serum billrubin total ( Jendrassik- Grof) 0.8 mg/dl ,
Serum Billrubin direct ( Jendrassik - Grof) 0.1 mg/dl,
Serum Billirubin Indirect 0.70 mg/dl ,
AST/SGOT ( kinetic-Henry) 10 IU/L  ,
ALT / SGPT ( kinetic-Henry) 26 IU/L ,
Serum Alkaline Phosphatase ( Kinetic) 110 IU/L ,
GGT 22 IU/L , S.total Protein ( Bluret) 7.3g/dl ,
S.Albumin 4.1 g/dL ,
S.Globulin 3.20g/dL ,
A\G Ratio 1.28.

L.F.T
- on 8 Nov.2014:
Serum Biluirubin indirect 0.50 mg/dl ,
AST/SGPT ( kinetic - Henry) 24 IU/L. ,
ALT/SGPT ( Kinetic Henry) 34 IU/L. ,
Serum Alkaline Phosphatase ( Kinetic) 136 * High  IU/L. ,
GGT 17 IU/L. ,
S.total protein 7.8 g/dl. ,
S.Albumin 4.1 g/dl. ,
S.Globulin 3.70*High g/dl ,
A\G Ratio 1.11* Low.

LFT: On 25Jan.2015:
SGOT/AST:  12.8IU/L ( Ref.range 0.0 -37.0)
SGPT/ALT : 24.7 IU/L ( Ref.range 0-41 )

LFT : On 20 Fe.2015:
ALT : 26 IU/L ( Ref.Range 10-40)
Serum Alkaline Phosphatase 112* High IU/L ( Ref.Range 32-92)
GGT : 21 IU/L ( Ref.Range 7- 64)

LFT On 13/6/2015:
ALT 32 IU/L.
AST 19 IU/L.
Serum Alkaline Phosphatase 104 IU/L ( HIGH)
A|G ratio 1.34 (LOW)
GGT 17 IU/L.

FibroScan:
On 26 Dec.2014 : 4.7.
On 9 August 2014 : 4.9.
On 13/6/2015: 3.5 E ( kpa)
on 13/6/2015: CAP ( dbm) Median 270 , IQR 21.


Last 45 days i am not taking Vitamin D3 as Dr.Endocrinology have suggested to give break for D3 , now the Vitamin value is coming down as well as PTH also reduced with the previous one. So its mean when I stopped D3 both the values 25 hydroxy and PTH reduced .
I am planning to start Vitamin D3 , please suggest.

Result for HBV DNA is awaited will share once the report comes.
Looking forward your expert advice..

[jcm60]

Thank you , Yes I have stopped taking Vit.D3 for 1 month , I will redo all the test after 1 month & then decide based on report.
Any suggestion related to 24 hours urine test report ?

[stef2011]

reduce vitamin d intake and lets see if calcium goes down in serum and urine, your situation is very unusual

[jcm60]

Hi Stef

Hope you doing good , I have done serum & 24 hours urine test, & scan please find the report:
Serum: Test  Dated 10 May 2015
-S.calcium: 9.6 mg/dl.
- S.phosphorus : 4.9 mg/dl.
- s. creatinine : 1.4 mg/dl.
- Albumin : 3.45 gm%.

24 Hours urine : test date - 10 May 2015.

- Total urine volume 3500 ml.
- urine creatinine 1.36 g ( normal range Male 1.1 -3.0 mg/24 hrs.)
- urine calcium : 1335.0 mg ( normal range 25-300 mg/24hrs.)
- urine calcium :  1.33g  - (on average calcium intake 500-800 mg/24 hrs.)
- urine phophorus : 1.22 g ( normal range 0.3 - 1.3g/24/24hrs.

Beside these test I did Scan , X-ray ete.
Report date 4 May 2015: Examination performed: 10 min Iso time static image were acquired at 10 minutes and 2 hours following intravenous injection of 20 mCi of 99m Tc. Sets MIBI.
Findings: Initial images reveal physiological tracer accumulation in the third gland and submandibular salivary glands , normal washout of tracer is seen from the thyroid in delayed image acquired at 2 hours.
No other abnormal area of tracer accumulation is seen anywhere else in the neck or mediastinum.
Impression: No scan evidence of parathyroid adenoma seen .

X-rays: Both hands AP : No bone injury noted.
X-rays Skull lat: No bone noted.

This time I have changed the Lab. I noted the S.calcium level dropped, below are the previous test.
24 hours urine test did first time please give your opinion.
I met with two Doctor on different timing to 100% sure on the parathyroid result but as per this report there is no problem.
Both doctor asking to repeat test after 1 month as there is no medicine started .
Looking forward your comments,
Thank you,



Vitamin D,25 Hydroxy:
- on 8 Nov.2013 : Vitamin D , 25 - Hydroxy ,Serum ( CLIA ) 41.05 nmol/L.
- on 22 June 2014Vitd25oh :18.22 ng/ml.
- on 24/8/2014 : 51 ng/ml.
- on 8 Nov.2014 : 51.2 ng/ml.
- on 5 Feb.2015 : 157.55 nmol/L ( Sufficient range 75-250 nmol/L )
- on 7 march 2015 : 164.50 nmol/L (CLIA method) Range 75-250 sufficient)
- on 3 April 2015: 174.12 nmol/L ( CLIA method - Ref.renge 75-250 sufficient )
- on 1 May 2015 : 65.2 ng/ml

PTH ( Parathyroid Hormone) Intact, Serum :
- on 5 Feb.2015 : 73 pg/mL ( Ref.Interval 14 - 72 )
-on 7 March 2015: 86.60 pg/mL ( CLIA method Ref.range 14-72 )
-on 3 April 2015: 73.60 pg/mL.
- On 1 May 2015: 83.80 pg/mL.

Calcium, Serum:

- on 23 Feb.2015: 10.60 mg/dL ( Ref.range 8.8 - 10.60)
-on 7 March 2015: 10.50 mg/dL .
-on 3 April 2015: 10.50 mg/dL.
- on 1 may 2015: 11.20 mg/dL.

Phosphorus,Serum:
- on 23 Feb.2015: 2.00 mg/dL. ( Ref.Range 2.40-4.40)
- on 7 March 2015: 2.20 mg/dL.
- on 3 April 2015 : 2.40 mg/dL.
- On 1 may 2015: 2.30 mg/dL.

First time I did the test for Calcium , Ionized , Serum : 1.24 nmmol/L. ( Reference range is 1.16-1.32) don't know much of this test , please let me have your comments.

My question is the value of Calcium ,Serum is on out of reference range mean on high side and the PTH is also not coming down , the vitamin D,25  serum also almost same as one month before. Please let me have your comments on it.
Last one month I have severe pain on my upper back just behind chest. Don't understand the reason.

I met with Doctor Endocrinologist and he suggested to go for Parathyroid scan which i  am doing on 4 May 2015 , this test is slighlty expensive @USD 140/

I am still taking Vitamin D3 & Vitamin k2 mk7 , let me know should I continue Vitamin D3 or stop for some time.
I am taking 3 litres water with 0 calcium on it.

Looking forward your suggestion / comments.

Others test like qHbsag , HBV DNA and kidney test , LFT will be done next week as a routine six monthly.

Thank you,

[jcm60]

Hi stef

Doctor suggested to give some break for Vit.D3 and continue with Vit.k2mk7.
After the parathyroid scan we will suggest further.