2nd opinion

Jan 24, 2009

1-22-09      Made an appt. to see a new liver specialist for a 2nd opinion on risks I may face, if I chose to have ANY surgery.  Here is what I know...or understand.  I have liver cirrhosis.  People w/liver cirrhosis can be placed into 3 categories of "risk"...meaning this is the percentage risk of a person decompensating, or going into liver failure, from anesthesia following surgery.  While a normal and healthy person has <1% chance of this occurring, people with liver cirrhosis are placed into these 3 categories of risk.....Stage A = 10% risk;  Stage B = 20%-80%; and Stage C = 90%-100% risk.....following Stage C is the end stage of liver cirrhosis, meaning the person needs a liver transplant.  I am in stage A.

I will need a liver transplant, we just don't know when.  Without surgery I could live a "normal" life for years.  With surgery, I may also live a "normal" life, or better.  However, surgery is something that is considered an irritant to the liver when in cirrhosis... So, the doctor explained the risks and that it was her job to inform me of them.  She said that if I had surgery and did begin to decompensate, or go into liver failure, it could happen as soon as the day following surgery through the next couple weeks.  She said if I made it 4 weeks without decompensating after surgery, I should be OK, but the cirrhosis I have will remain, but most likely improve with weight loss.  Again she said, I will need a liver transplant, we just don't know when.

If I had a liver transplant, I would first require a donor.  The hospital stay following the transplant would be 2 weeks and full recovery would be anywhere from 6-12 mos.  I can hardly think about that and what it means to my job and future.  And I suppose there is no need to worry too much about it since it hasn't happened.  I just try to be realistic in considering what risks are involved in what could be a life changing surgery.

A friend had a good point in saying that if I chose the weight loss surgery, at least I would be more healthy at the time of the liver transplant.  This would be true if the weight loss surgery helped to resolve my comorbidities of :  diabetes, pcos, high blood pressure, and sleep apnea.  The thought of those comorbidities AND being overweight AND liver cirrhosis, overwhelm me.

The liver specialist requested bloodwork and that a CAT scan of my liver be done since apparently some of my recent ultrasound results were limited.  She talked about the fact that I am at high risk for having liver cancer, so a CAT scan would detect any of that.  My sister-in-law died of liver cancer in June 2008.  If I have liver cancer, treatment would begin right away and the consideration of weight loss surgery would be put on hold.  I will schedule the CAT scan this week.  I have to tell myself not to worry about the things that have not yet happened.  Just need to think that I can still help myself.

So, I thought back to the diet I was given in October....1,300calories and 1,600 mg sodium.  I haven't had one day of success on that yet.  I decided that I am going to follow it strictly from now until February 16, when I have an appt with my PCP and bariatric surgeon...February 17 is when I'll meet with the endocrinologist.  If, with this diet and daily exercise, I lose no weight by then, I will most likely opt for the WLS....based on the things I know today.  If I do lose weight, I'll talk to the docs about whether they feel that is a long term diet that will become part of my life.

This is all I can include for now...that I recall.  The liver specialist is sending me a report which I'm sure will allow me to explain more things better.  Until then, I am trying to maintain any sense of hope while I take each day a few hours at a time.

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