Breathlessness and Elevated Liver Enzymes: A Patient's Journey

Hello, doctor?

Hello Doctor, I apologize for the lengthy message, but I would appreciate your attention.
I have been suffering from cellulitis in my leg since March 5th of this year, which has rendered me completely immobile.
By early April, my weight increased from 80 kg to 100 kg within a month.
From mid to late April, I began experiencing difficulty breathing; my breaths felt weak, and at times, it felt like I couldn't get enough air into my lungs.
When I tried to breathe deeply, it sometimes sounded like snoring or a pig-like wheezing, and my breathing was irregular.
I also have a history of insomnia and am currently taking sleeping pills.
I'm not sure if the breathing issues started at the end of April or if they began after my weight reached 100 kg.
I reported this to my doctor during a follow-up visit, but they only changed my medication.
Sometimes, even after taking the sleeping pills, I wouldn't fall asleep until 7 or 8 AM.
On May 12th, I had a chest X-ray and pulmonary function test arranged by the pulmonology department, both of which were reported as normal.
On May 13th, I had an examination by an ENT specialist, which also came back normal, including an endoscopic examination through my nostrils.
The doctor prescribed a bronchodilator, but I still haven't seen much improvement.
On May 14th, I had blood tests done, and my GPT level was 206, compared to around 100 last year.

Could my breathing difficulties be related to my obesity? Regarding the GPT level of 206, I only remember having a hepatitis B vaccination as a child, and I do not have any known risk factors for fluid-borne infections.
Could this elevated level be due to obesity-related fatty liver combined with long-term medication use? Are there other potential causes for my breathing difficulties and elevated liver enzymes, and what steps can I take to seek assistance and alleviate my symptoms? I apologize for the lengthy inquiry, and thank you, Doctor.

Awei, 30~39 year old female. Ask Date: 2020/05/16

Dr. Ye Qianyu reply Family Medicine

Hello! Regarding your difficulty in breathing and abnormal liver function, these may be related to weight gain.
It is recommended that you reduce caloric intake and engage in moderate exercise (focusing on upper body movements and rolling exercises).
For your breathing issues, you may want to consult a pulmonologist to assess for sleep apnea, and for the abnormal liver function, you should see a gastroenterologist specializing in hepatology.

Reply Date: 2020/05/16

More Info

Dear Patient,
Thank you for sharing your detailed medical history and concerns. It sounds like you are experiencing a complex interplay of symptoms that warrant careful consideration. Let’s break down your situation regarding breathlessness, elevated liver enzymes, and the potential underlying causes.

Breathlessness and Its Causes
Your experience of breathlessness, especially after a significant weight gain, can indeed be linked to obesity. Excess weight can lead to a condition known as obesity hypoventilation syndrome (OHS), where the increased body mass restricts lung expansion, leading to inadequate ventilation and oxygenation. This can manifest as difficulty breathing, particularly when lying down or during physical exertion. Additionally, obesity can contribute to sleep apnea, which may explain your disrupted sleep patterns and the sensation of not being able to breathe deeply.

The fact that your lung function tests and chest X-ray were normal is reassuring, but it does not entirely rule out the possibility of other issues, such as asthma or bronchitis, which may not always show up on standard tests. It’s also worth considering that anxiety can exacerbate feelings of breathlessness, especially if you are experiencing insomnia and stress related to your health.

Elevated Liver Enzymes
Regarding your elevated liver enzymes (GPT 206), there are several potential causes to consider. Given your history of significant weight gain, non-alcoholic fatty liver disease (NAFLD) is a strong possibility. This condition is characterized by the accumulation of fat in the liver, which can lead to inflammation and elevated liver enzymes. Additionally, certain medications, including those used for sleep, can also impact liver function. It’s crucial to review all medications you are taking with your healthcare provider to assess their potential effects on your liver.

Your previous vaccination against hepatitis B provides some protection, but it does not eliminate the risk of liver disease entirely. Other factors, such as diet, alcohol consumption, and metabolic syndrome, could also contribute to your liver enzyme elevation.

Seeking Assistance and Management Strategies
To address your symptoms effectively, I recommend the following steps:
1. Consult a Specialist: Given the complexity of your symptoms, it may be beneficial to see a pulmonologist for your breathing issues and a hepatologist or gastroenterologist for your liver concerns. They can provide targeted evaluations and management plans.

2. Weight Management: Engaging in a structured weight loss program can significantly improve both your respiratory function and liver health. Even modest weight loss (5-10% of your body weight) can lead to improvements in liver enzyme levels and overall health.

3. Lifestyle Modifications: Incorporating regular physical activity, a balanced diet rich in fruits, vegetables, and whole grains, and reducing processed foods and sugars can help manage both your weight and liver health.
4. Medication Review: Discuss with your doctor the medications you are currently taking, especially those for sleep. There may be alternatives that have less impact on your liver.

5. Monitoring and Follow-Up: Regular follow-up appointments to monitor your liver enzymes and overall health are essential. Blood tests can help track changes in your liver function over time.

6. Breathing Techniques: Practicing deep breathing exercises and relaxation techniques can help alleviate feelings of breathlessness and improve your overall respiratory function.

In summary, your symptoms of breathlessness and elevated liver enzymes are interconnected and likely influenced by your recent weight gain and possibly other underlying conditions. A multidisciplinary approach involving specialists in pulmonary and liver health, along with lifestyle modifications, will be crucial in managing your situation effectively. Please do not hesitate to reach out to your healthcare provider for further evaluation and support.

Wishing you the best in your health journey.

Sincerely,
Doctor Q&A Teams

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