I better work on my Goodbye Cruel Forum post...

No advice from me, just sending good thoughts your way.  (((hugs)))

Even though most of us have never met in the 3-D world, you have many here who care. 

I'm so sorry that you are having such a hard time right now Shari, like others said you've been through so much and sometimes it just gets tiring to always be going through something and feel like you aren't getting a break (been there, done that).  I don't really have a lot of advice for you, and what I tell you might seem silly, so take it with a grain of salt, it is said with the best of intentions, but like others said, stress can cause all kinds of things to happen to our bodies.  Just last night on The Biggest Loser Bob was saying how he's seen people gain weight purely from stress alone and one of the gals who just came back into the house and was stressed from all the changes and being thrown into the game gained 5 pounds on the scale last night.  It's not real weight, but discouraging and scary all the same. 

I don't have any advice for you on the liver that hasn't already been said, just that I'm sorry your having to worry about something else.  I hope that things get better very soon.  

That is alarming.  Go to an internal medicine doc.  They can help you with your liver.  Elevated enymes are a sign of liver stress.  Your levels are not terrible...yet.  So intervne now.  How frustrating!  After I had a terrible bout of mono in the 1990's my liver enzymes weren't normal for 5 years.  Make sure you don't have mono.  And take care, my dear.  Feel free to use me as your whipping girl.  I'd be pissed as hell, too.

Shari,

Have you googled this enzyme stuff?  I understand your frustration with your doctors.  I went five years undiagnosed with a thyroid tumor before I actually diagnosed myself by doing some web reasearch.  See if you can get any clarity from a little web research on your symptoms and then go back to your doctor and have another discussion and hopefully get some more testing done.  In the meantime, I hope things improve on all fronts.

I'm sorry, Shari.  Do you still use protein supplements?  These are often made of low grade protein and can cause liver issues.  My husband was taking them to help him build muscle a few years ago, and he had a routine physical including a blood draw at work that found his liver enzymes to be elevated.  Because he had lost weight and bulked up since his last physical, the doc asked if he was using any protein supplements.  Joe cut them out immediately, and a few weeks later, his liver enzymes had returned to normal.    I'm hoping this is the case with you, too.

Also, elevated amylase (one of the liver enzymes) can be an indicator of intestinal blockage.  That could explain why you've gained 6 lbs in a short period of time (if you're blocked, stool can't pass and backs up) and the elevated liver enzymes.  So you may want to ask your surgeon to perform a barium swallow and/or barium enema and/or a sitz marker study and/or any other test which would show him if there is a blockage somewhere.

I hope it is something minor, Shari.  Please keep us posted on your progress.
Amy

I supplement rather infrequently-- the vast majority of my protein is from food.

New gastro doc, says, "EH, they can be up for any reason, means nothing" but doesn't understand my history doesn't allow me to shrug off **** like that, since the same response from several docs before nearly killed me.

I fear the blockage-- had all the signs of a partial one for a couple weeks-- now the ghost poop, the enzymes, the weight-- I am thinking I am headed for yet more blockage issues. ****

a woman from Quix who doesn't post much anymore also had liver problems. she used to post a lot of NASH articles. I will copy and paste a couple from pub med that she posted.

the point that she is always making is that without a biopsy, none of us know if we have NASH and more of us probably have it than realize it.

If nothing else it gives you ammo to make your pcp or surgeon take you seriously. I pray it is not your liver.

i worry for you. you CAN only take so much. take care, judi

Semin Liver Dis. 2008 Nov;28(4):407-26. Epub 2008 Oct 27.Related Articles
Role of Fatty acids in the pathogenesis of obesity and Fatty liver: impact of bariatric surgery.

Verna EC, Berk PD.

Department of Medicine, Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York.

Nonalcoholic fatty liver disease (NAFLD) spans a spectrum from simple steatosis to nonalcoholic steatohepatitis (NASH) to cirrhosis.

Simple steatosis is the substrate upon which the more serious entities in the spectrum develop; it is the first "hit" in the multistep pathogenesis of NASH, which is considered the hepatic manifestation of the metabolic syndrome.

Demonstration of the existence of regulatable fatty acid transport mechanisms has contributed to clarifying the role of fatty acid disposition in obesity, the various components of NAFLD, and the metabolic syndrome.

Hepatic steatosis is closely linked to obesity. This linkage is based on the fact that obesity results in marked enlargement of the intraabdominal visceral fat depots.

The eventual development of insulin resistance leads to continuous lipolysis within these depots, releasing fatty acids into the portal circulation, where they are rapidly translocated to the liver and reassembled into triglycerides.

Reactive oxygen species, generated in the liver from oxidation of fatty acids, are precipitating factors in the cascade of events leading from simple steatosis to NASH.

Dysregulation of fatty acid disposition, with ectopic lipid accumulation in other tissues, is a major contributing factor to other components of the metabolic syndrome.


Bariatric surgery is an effective treatment for severe obesity, but its role in the management of the various forms of fatty liver disease is unclear. Our review of the literature that includes both initial and follow-up liver biopsies suggests that most obese patients with simple steatosis and NASH who undergo bariatric surgery will achieve improvement in hepatic histology, but that occasional patients, especially those who lose weight very rapidly, may show worsening of either fibrosis or steatohepatitis.

PMID: 18956297 [PubMed - in process] __________________


Curr Opin Clin Nutr Metab Care. 2008 May;11(3):267-74

The impact of bariatric surgery on nonalcoholic fatty liver disease.

de Freitas AC, Campos AC, Coelho JC.

Department of Surgery, Federal University of Parana, Curitiba, Brazil.

PURPOSE OF REVIEW: To analyze the effects of bariatric surgery on nonalcoholic fatty liver disease by reviewing the most important and recent studies.

RECENT FINDINGS: The prevalence of obesity has increased dramatically over the last decades. Comorbidities related to obesity, such as nonalcoholic fatty liver disease are also increasing. Nonalcoholic fatty liver disease is a progressive disease with potential evolution to liver cirrhosis and hepatocellular carcinoma. Overweight patients who have nonalcoholic fatty liver disease should be considered for a weight loss program; however, long-term result with dietary interventions and drug therapy has been disappointing. Bariatric surgery is effective in promoting long-term weight loss in morbidly obese patients with control of comorbidities, especially those associated with the metabolic syndrome. On the basis of the early experience with extensive intestinal bypass, it was believed that rapid weight loss could cause liver damage. In contrast, recent prospective and retrospective observational studies and case series have demonstrated that bariatric surgery is well tolerated and is associated with nonalcoholic fatty liver disease regression in a significant number of patients.

SUMMARY: There is good level of evidence that bariatric surgery is associated with nonalcoholic fatty liver disease regression in morbidly obese patients.

1) alcohol abstenance is critical for liver recovery or inhibition of cirrhosis and liver cancer.

2) Fructose has been associated with progression of liver disease in those with fatty livers. (Your gut becomes a still)

3) smoking does as much damage to the liver as alcohol.

4) in combination with viral hepatitis, and the above factors, progression to cirrhosis of the liver has been seen in less than 10 years.

5) transplant is the only remaining treatment, except those who drink alcohol or smoke do not qualify for the transplant list.

ok, that one is depressing as hell

***********************************************************************


Obes Surg. 2008 Mar 12 [Epub ahead of print]Related Articles, Links
Metabolic Syndrome Is Related to Nonalcoholic Steatohepatitis in Severely Obese Subjects.

Huang HL, Lin WY, Lee LT, Wang HH, Lee WJ, Huang KC.

Department of Family Medicine, National Taiwan University Hospital, 7 Chung-Shan, South Road, Taipei, Taiwan, 100.

BACKGROUND: Metabolic syndrome (MetS) and nonalcoholic fatty liver disease (NAFLD), ranging from simple steatosis to steatohepatitis (NASH), have become important health issues in obese subjects. In this study, we investigated the relationship between MetS and NASH in severely obese subjects.

METHODS: A total of 111 non-alcoholic obese patients who underwent laparoscopic bariatric surgery (BMI 45.4 +/- 5.7 kg/m(2)) were enrolled from February to September 2004 in a referral center in North Taiwan. MetS and its individual components were defined using the American Heart Association/National Heart, Lung, and Blood Institute criteria. Based on liver biopsy during surgery, subjects were classified into either having NASH or not. The relationship among NASH, adiponectin, insulin resistance, MetS and its individual components was examined using a multivariate logistic regression analysis.

RESULTS: The prevalence of NASH and MetS in these subjects was 79.3% and 68.5%, respectively. Using a multivariate logistic regression analysis with NASH as the outcome variable, odds ratio (OR) of NASH for subjects with MetS versus without MetS was 2.96 (95% CI = 1.14-7.68) adjusted for age, gender, and BMI. Also, high blood pressure (OR = 2.97, 1.31-6.73) and high fasting glucose (OR = 2.94, 1.13-7.67) were independently associated with NASH after adjustment for age, gender, and BMI. Insulin resistance measured as HOMA-IR and serum adiponectin level were not significantly different between the NASH and non-NASH group.

CONCLUSION: MetS and NASH were common in severely obese Taiwanese adults. Presence of MetS, high blood pressure, and high fasting glucose was independently related to increased risk of NASH.The underlying mechanism deserves to be explored in the future.

PMID: 18335290 [PubMed - as supplied by publisher]public domaine
 

Well hell.. I thought this was an April Fools day post until I started reading :-(

you can ***** at me if it makes you feel better... I have broad shoulders, I can be the whipping boy.

Seriously though... sending you good vibes

Learned something new today.  My poop changes color directly related to what I eat.  I thought the pale was food related.  However, I am diabetic so it is and always has been liver/pancreas related.  I have had elevated liver enzymes since I was eleven years old.  Every doctor along the way says hmmmmmmmmmmmm.  So far, I am still kicking.

Stress is the real culprit.  Do every vitamin, calorie, food plan, exercise and well being check correctly and stress can still kill you.  Eliminate it.  Even if weapons are involved.

I can preach a good sermon.  It sounds like I am being all Sunshine and rainbows, but I am not and I know the path.  I had to say NO.  FUCK NO.  And lives were threatened.  I informed all of them who left it to me, dumped it on me and assumed I would be the massive clean up as I always had been that the STOP SIGN was up.  I didn't speak to, hear a story, buy a birthday card, Christmas gift or acknowledge a phone call for a year.  I let the "family" know I was merely married to their relative and they could contact him for any and all.

It took awhile but they learned. I was not doing it any longer.  I stuck by my guns until the the assumptions actually stopped.  

  I have slowly accepted some of those responsibilities back into my life but it is now knowingly my choice that allows it.  I always thought I was being put upon when in fact, I allowed it.

I am a public school middle school teacher. Blocking out the needs of others isn't really possible, although I appreciate the sentiment. Thanks!