how can i convince my primary care dr to let me use vanco? My situation is that I clearly have PSC on MRI’s and I feel liver pain daily but my numbers are normal. I believe that starting early may help save me from a liver transplant.
Thanks for your advice
Tom
You should not be relying on a primary care physician for diagnosing and managing PSC. You need to go to a heptologist connected to a transplant hospital. The heptologist is best suited to diagnose PSC. For my son, the critical elements for the diagnosis were the elevated blood tests, the MRI showing bile duct inflamation and a colonoscopy, which showed Crohn’s. Depending on where you live, some people here can recommend potential heptologists who will prescribe Vanco. Also, on this site is plenty of research information. Put the homework together and present it to your doctor.
Update after 9 months on Vanco (one month on Lupin brand capsules):
ALP: 157 (normal range 35-144)
9 months ago my ALP was 492.
AST: 36 (normal range 10-35)
ALT: 62 (normal range 9-46)
GGT: 173 (normal range 3-95)
I was hoping to have LFTs normalized in 3-6 months, but I’m still cautiously optimistic that Vanco is working. At least general downward trend happened after Vanco started.
Based on the research literature, ALP needs to get lower than 1.5x normal range upper limit (those who achieve that had lower rate of a composite outcome (liver decompensation, liver transplantation, liver related deaths, cholangiocarcinoma) compared to those who did not).
Ulcerative colitis is better than ever (stool looks normal most of the time, never been like in at least in the last 20 years).
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Update after 10 months on Vanco (last 2 months taking Lupin brand):
ALP: 137 (within normal range, finally!)
AST: 37 (normal range 10-35)
ALT: 51 (normal range 9-46)
GGT: 148 (normal range 3-95)
Ulcerative colitis also under control. MRI looked very good.
I think Vancomycin is clearly working here, so I plan to continue with the current approach.
Ted, that’s wonderful news. I’m so glad to hear that your numbers have normalized. I have found with several problems I had in the last three years Now almost 9 years Post Transplant, that I am continuing on 250 mg of vancomycin four times a day to keep my bile ducts inflammation under control. It has made a big difference.
Mark
Update on my situation:
My LFTs are finally normal (about 15 months after starting Vanco). My bilirubin has always been slightly elevated so 1.7 is normal to me.
I think this is a clear proof that Vancomycin works.
ALP: 123 (normal range 35-144)
AST: 27 (normal range 10-35)
ALT: 34 (normal range 9-46)
GGT: 91 (normal range 3-95)
Bilirubin: 1.7 (normal range 0.2-1.2)
I’ll plan to continue with the current dosage (1500mg/day).
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Awesome! Happy for you! Welcome to the vanco club. 
Ted,
These are great lab numbers. I am very thankful you are doing much better. Yes, I am convinced that Vancomycian is a big help in keeping those numbers down. I continue to take it even post-transplant as it keeps the inflammation down in my bile ducts having had some complications with bile duct infections from my Roux-N-Y. Keep us posted and I hope you will continue to do well.
Mark
I do appreciate the postings of the LFT reductions over time. That is interesting data for me, as I’ve recently had an LFT uptick from a combination of a period of use of ineffective vanco (I think) and my rejection episode (in my 12 year since Tx). I’m on a known working brand now, and have been watching the numbers fall, but not as fast at the last times I had been off Vanco and restarted it on LFT uptick. But I am confident it will normalize again.