And is the kind of detail that would (probably) be captured in a patient intake versus Dr. InterWebs, M.D. or casual exchange with physicians on a message board.
I can’t wait until people start using chatbots en masse as a stand-in primary care physician. The number of newly discovered maladies, syndromes, and treatments that generative AI will ‘hallucinate’ will fill volumes of medical journals with false and misleading information.
Stranger
IANAD, but with those liver function test numbers, I have to ask (which does NOT mean that you have to answer, particularly publicly) … that weight loss you talked about.
How’d you do that? Diet? Exercise? Specifics of either or each?
And – more importantly – were you taking anything to aid in this weight loss endeavor – legal or otherwise, prescribed or not?
Are you/were you taking anything before you felt ill – apart from anything you may have been doing in order to lose weight?
Drug-Induced Liver Injuries aren’t all that uncommon. Prescription medicines can cause them. OTC meds and nutritional supplements and intoxicants can cause them, too.
Boy. You’ve had a rough couple years, medically, haven’t you? I hope it’s all smoother sailing from here on out!
My thermometer is brand new just a week ago from Amazon. I matched it against an instant read kitchen thermometer using hot liquid (about 100F) and they matched. within .1 degrees.
I did it the old fashioned way: diet and exercise.
Diet: I practiced intermittent fasting. I’d take my first meal at 7-8 PM, then another before bed. My total calories would be 1100-1800 per day, though sometimes I’d just skip a meal and eat just 300-500 that day. I’d either eat packaged food with calories clearly labeled, or I’d use a gram scale to measure calories, e.g. flank steak is 190 cals/100g, so I’d eat that with roasted veggies or salad (low cal dressing, ginger miso sesame). Maybe a small snack like dried fruit or pretzels (the commercial Bavarian style are 40 cals/pretzel) or something or crackers or something.
Exercise: I started out slow on an exercise bike, 2-3 hours a day at low resistance and eventually 5 hours a day at highish resistance in 1 hour sets. Later I added abs, 20x3 ab types per set, up to 15 sets/day, so 300 x 3 abs. I’d add maybe 150 pushups/day.
This all happened in 11 weeks. I’m looking at my weight loss spreadsheet now, everything went on that spreadsheet.
As an appetite suppressant while fasting, and to keep hydrated, I’d drink 6-8 cans of unflavored or flavored sparkling water daily, which is more than my hematologist recommend daily to avoid blood clots, but seems fine.
No. I’ve taken the same cocktail of low dose Seroquel + Gabapentin for like 15 years for chronic insomnia (and in fact I’m talking to my shrink this afternoon), plus 2 blood pressure meds. I take nothing else. Oh, wait: low dose Tadalafil because had a radical prostatectomy.
A Zen koan (parable) that you might find interesting:
"A monk asked Tozan, “How can we escape the cold and heat?” Tozan replied, “Why not go where there is no cold and heat?” “Is there such a place?” the monk asked. Tozan commented, “When cold, be thoroughly cold; when hot, be hot through and through.”
My translation: “It’s all in your mind, Grasshopper. Get some self-control.”
Perhaps the most perfect poster name and response/parable.
Did @squeegee address this post about nicotine and low body temperature?
I didn’t in the thread. I thought it was a very interesting post/paper by @PastTense, and thanks to them and v sorry for not acknowledging.
FWIW, I’ve taken steps to drastically reduce my nicotine load: I’ve switched from 4mg back to 2mg gums, and started keeping a log in my kitchen next to where I keep my gum. The log keeps me honest: “shit, it’s only been 30 minutes, dammit” so I back off for 30 more minutes or more (which is tough when drinking coffee in the AM). My goal is 12 pieces of 2mg or fewer per day, where I was just jamming like 35 pieces of 4mg/day during intense weight reduction. Reaching my goal would be (counts on fingers) 1/8th of my previous nicotine consumption. So far today I’ve consumed 14 pieces, but there’s 3ish hours before bed, so probably 17 pieces today. It’s a process.
Also: on Monday this week (today is Thursday, I was at urgent care this last Sunday) my chills vanished almost entirely. No explanation, but my hunch is my core body temp adjusting maybe? to less body fat after losing 18% of my weight. 
I’ve also restarted my exercise routine after taking a victory lap for 3ish weeks. It seems like stopping intense exercise is when everything went to shit. I’m not going nuts and I’m eating normally – no intermittent fasting, normal calories, I eat whatever I want – but I did 2 hours on the bike today, probably the same tomorrow.
Sounds like you’re on the right path, or at least a better path. 
I found this abstract that says rapid weight loss can cause liver damage.
Seeing the GP today.
So the GP today was much more sanguine about those liver numbers. Basically yellow alert, not red alert.
He sees the rapid weight loss (33 lbs in 11 weeks) as a very large contributing factor in the numbers we’re seeing, that that can be very hard on a liver and pancreas. Basically the liver can only process so much fat per day/week, so going too fast is a problem, possibly a big one. He threw out a recommended maximum loss lbs/month (I don’t recall his figure), and I’d blown the doors off that.
He said my drinking habits over years are a big thing, even if moderate but continuous (3ish drinks a day), but this sudden huge leap combined with the dieting/exercise makes a whole lot of sense as a combination for why the numbers are so nuts at the moment.
The connection with excessive nicotine usage (140mg/day vs 40mg recommended) is much more tenuous, but could also have been a factor. Nicotine is metabolized in multiple places in the body (liver, kidneys, etc) but when one of these locations gets stressed the others try to take up the slack and things can go sideways as a system.
He said the ALT/AST numbers are in the “definitely concerning, we need to get on this, stat” rather than than the UC doctor’s much more concentrated, “oh shit you’re screwed” reaction. These are def not good numbers, but they’re not utterly dire.
He said to get these numbers down I do need to cut out drinking, but it’s okay to do it gradually to avoid other side effects. He recommends cutting out one drink a week until I’m down to nothing, and we’ll watch the numbers throughout that time. We’ll revisit monthly and if the numbers don’t improve we’ll escalate and figure out why.
He said my chills ending this week were very very likely the weight loss - I couldn’t maintain core temperature because I’d f’d with my body’s fat ratio (I think he said “fat ratio”, this was a dense conversation) so hard. If so, this would gradually ease (narrator: it has).
Anyway, I feel very reassured by this conversation and feel like we have a plan and am feeling much more optimistic. I’m going to celebrate with a beer!
*No I’m not.
It seems like you have a very good doctor there. It sounds like a good plan to me. Just stick to it, especially tapering off the alcohol. If you find you can’t taper off, there are lots of mutual support groups out there that can help with that.
Thought of this thread when @Velocity noted their feeling cold wondering about it relating to exercise!
Any update, @squeegee?
My chills went away in post 22. I’m meeting with my GP on Jan 26th. I assume he’ll order liver tests before that. So no, no update, but thanks for asking.
I wasn’t been a good boy re drinking in December. I went to Thailand in December, and all of Thailand is a great big bar/red light district. I’ve cut back since and am quit last week.
New numbers: ALT/AST liver numbers are totally back to normal.
AST: 13 (normal 0-37) was 683
ALT: 18 (normal 0-60) was 383
So I guess it was totally the super-quick weight loss that messed these up and inevitably they returned to normal, though I’m sure quitting drinking helped some. I’m anemic, so I’ll wait to hear from the doc about that.
Thanks for the update!
Could also have been the kind of rapidly resolving viral hepatitis we see in kids (again in a kid I’d have been suspecting a mono hepatitis).
Glad better and the cutting down alcohol was still good to do!