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Thursday, September 10, 2015

Sharing more about me - NASH - Non-alcoholic steato-hepatitis

Selfie - me
I was diagnosed with NASH or fatty liver disease about three years ago now. It's what's called a 'silent' disease. It has no discernible symptoms, but it affects the liver. Badly. It resembles alcoholic liver disease but occurs in people who drink little or no alcohol. Like most or many people, I had the occasional drink - mostly wine. (And occasionally I overindulged, but not often.) After all, the recommendations were that wine, red wines especially, were good for you.

Some people with NASH complain about fatigue, but I never had that. The only symptom I had was high cholesterol - something both my parents also had - but every time they put me on a statin, my liver enzymes would sky-rocket, so they'd take me back off.

The major feature in NASH is fat in the liver, along with inflammation and damage. Most people with NASH feel well and are not aware they have a liver problem. Nevertheless, NASH can be severe and can lead to cirrhosis, in which the liver is permanently damaged and scarred and no longer able to work properly. A liver scan might show fatty liver, a biopsy will confirm it or show cirrhosis.

My family physician recommended a liver specialist, who didn't diagnose NASH, but did charge nearly $3,000 dollars over and above what health insurance covered. YIKES! That was insane. And I felt fine. So, I didn't go back.
(And, in any case, there's no treatment for NASH, except changing your diet, losing weight and avoiding alcohol.)

What I didn't know is that I was developing cirrhosis, an extensive scarring of my liver.
There's no real treatment for that either, except for a very restricted diet - no carbs, none, no bread, rice, or potatoes, only meat, fresh fruits and vegetables, and that's it.
If you suspect fatty liver - especially if you're overweight or have diabetes - you need to lose weight (as hard as that might be) and you need to exercise. You also need to stop taking any over the counter medications - even and especially painkillers like ibuprofen or Tylenol - or only take half doses.

Because of the negative connotations of cirrhosis - mostly commonly associated with alcoholism - many people with NASH don't or won't talk about having it. Given that the American fast food obsession (something I never shared) and diet (heavy on fat and salt) are the primary causes of the disease, that makes it an even more silent disease.

I do have some of the symptoms of cirrhosis, sometimes I feel tired or weak, have loss of appetite, or feel sick to my stomach. Waste materials from food have built up in my blood or brain and caused confusion or difficulty thinking. (Once I couldn't even remember how to brush my teeth or open a bottle of mouthwash.)

Cirrhosis can lead to other serious problems:
You may bruise or bleed easily, or have nosebleeds.
Bloating or swelling may occur as fluid builds up in your legs or abdomen—the area between your chest and hips. Fluid buildup in your legs is called edema; buildup in your abdomen is called ascites.
Medicines, including those you can buy over the counter such as vitamins and herbal supplements, may have a stronger effect on you. Your liver does not break medicines down as quickly as a healthy liver would.
Blood pressure may increase in the vein entering your liver, a condition called portal hypertension.
Enlarged veins, called varices, may develop in your esophagus and stomach. Varices can bleed suddenly, causing you to throw up blood or pass blood in a bowel movement.
Your kidneys may not work properly or may fail. Keeping hydrated is essential. I keep a glass of lemon water or water with me all the time.
Your skin and the whites of your eyes may turn yellow, a condition called jaundice.
You may develop severe itching.
You may develop gallstones. (I no longer have a gall bladder.)

The only real cure for either NASH or cirrhosis is a liver transplant - not exactly a cheap alternative considering both can be managed with diet.

For the moment, I'm managing. Occasionally, I get a little depressed, and sometimes have to deal with the confusion - which makes writing a bit of a challenge.

I wasn't raised to whine, though, so this will probably be the only time I'll mention this.