DEAR DR. DONOHUE: I had a diagnosis of “fatty infiltration of the liver” on a CT scan done for another problem. I was surprised and upset by this. Recently I had another CT scan, and the report made no mention of fatty liver. Would you discuss the implications of fatty liver and its treatment? – C.R.

ANSWER: Because we live in the era of scans, fatty liver is becoming a common diagnosis. It can be a harbinger of bad things to come, but it’s not always.

The most common cause of fat infiltrating the liver is alcohol. That doesn’t apply to you (I’m assuming you don’t drink). The fatty infiltration you speak of is called NAFLD – nonalcoholic fatty liver disease. In some people, NAFLD incites liver inflammation. When it does, its name becomes NASH — nonalcoholic steatohepatitis. (“Steato” is the Greek for “fat,” and “hepatitis” signifies liver inflammation.) NASH has the potential to progress to liver cirrhosis – a scarred, shrunken, nonfunctioning liver.

Which NAFLD patients will become NASH patients and which NASH patients will develop cirrhosis are questions difficult to answer. A rise in liver enzymes can be an indication that problems lie ahead. A liver biopsy provides the conclusive information. Who needs such a biopsy is another question difficult to answer. So much of this is new that there are no universally accepted ground rules to guide people.

Many times, the dilemma can be solved by having people adopt changes in their lives. If obese – and most patients with the problem are – they must lose weight. That might be the only thing needed to clear the liver of fat. Complete avoidance of alcohol is most important, even when alcohol is not the cause. Some doctors believe that vitamin E can encourage fat loss from the liver.

A word about diabetes is in order. Diabetics are susceptible to developing fatty livers. Maintaining strict control of diabetes can usually reverse fatty liver or prevent it from ever happening.

DEAR DR. DONOHUE: I am 56 and started taking daily aspirin a couple of years ago to prevent a heart attack and stroke. I was always getting black-and-blue marks without remembering being bumped. I stopped taking aspirin, and the black-and-blue marks left. I decided to give aspirin another try. Within days, I had large bruises again. My theory is that my blood must be thin enough without aspirin. What do you think? – E.P.

ANSWER: If a person has had a heart attack, taking aspirin lowers the risk of having a second one. That has been proven. For people who never have had a heart attack, the wisdom of taking aspirin to prevent one (or a stroke) is less persuasive. If a person has high blood pressure or diabetes, smokes or has a family history replete with heart attacks, then a daily aspirin would be a good idea.

What dose of aspirin did you take? If you took a full-strength aspirin (325 mg), you could try a low-dose aspirin (81 mg) to see if it would not cause bruising.

Your theory about your blood being thin enough is interesting, but I don’t think it is true. No one has that kind of blood. You might be quite sensitive to aspirin’s action, as some people are. That’s another good reason to take only a low dose of it.

Since you are under a doctor’s care (as you said in another part of your letter), check with him. If he feels you are at high risk of a heart attack or stroke, he might prescribe a different drug to keep you from forming clots within your arteries. Plavix is an example. It too can cause bleeding, but there is no way to predict that other than by giving it a try.

DEAR DR. DONOHUE: Please let me know if salt and sugar are necessary or good for anything. Do they have the slightest benefits for the body? – I.P.

ANSWER: We cannot live without salt. It keeps blood pressure from dropping and helps nerves fire and muscles contract. Our problem is we eat too much of it.

Sugar is not a demon. In every teaspoon of it are 15 calories. Furthermore, it makes food palatable. There is something to be said for the pleasure sugar gives to eating.

DEAR DR. DONOHUE: My lab results came back, and the only abnormality was high hemoglobin. My doctor says it’s high because I smoke. Did he say that just to get me to stop smoking? A friend who is a nurse says this can mean trouble. What is the significance of having a high hemoglobin level? – R.R.

ANSWER: Every red blood cell contains a large protein called hemoglobin. You can think of it as the red blood cell’s hand. It grabs oxygen as blood courses through the lungs, and it releases oxygen when blood reaches a part of the body in need of it.

A hemoglobin count is pretty much the same as a red blood cell count. A low hemoglobin count indicates an anemia; a high count – too many red blood cells – can indicate trouble brewing.

The significance of an elevated hemoglobin depends on a patient’s symptoms, what other lab tests show, and what the doctor finds when examining the patient.

Your nurse friend must be thinking about polycythemia (POL-ee-sigh-THEME-ee-uh), a condition where the bone marrow turns out too many red blood cells (and white blood cells and blood platelets). I am positive your doctor would not have dismissed your count as being due only to cigarette smoking if there was other evidence indicating the possibility of polycythemia. Untreated, it is a menace to health, because it leads to clot formation within arteries, and that can result in a heart attack or stroke. It can also, paradoxically, lead to major blood loss from bleeding.

Cigarette smoking can elevate the hemoglobin level. Smokers fill their lungs with carbon monoxide, which sticks to the hemoglobin of red blood cells more avidly than oxygen does. Smokers, therefore, live in a constant state of oxygen deficit. In an attempt to compensate for the lack of oxygen, the bone marrow turns out large numbers of red blood cells – the hemoglobin count rises.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

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