DEAR DR. DONOHUE: My doctor says I have a fatty liver. I’ve never heard of this. What causes it? How is it cured? – K.P.

ANSWER:
Alcohol is the biggest cause of fat infiltrating the liver. Since you didn’t mention alcohol use, you fit into the large category called nonalcoholic fatty liver disease. It’s one of North America’s most common liver ailments. Overweight people are subject to getting it. High blood levels of triglycerides (fats) are another cause. Diabetes leads to it. The metabolic syndrome – a combination of high blood pressure, high blood triglycerides, insulin insensitivity and a large waistline – accounts for many with a fatty liver. Then there are people for whom a definite cause is never found.

Often fatty livers are discovered when a scan or ultrasound is obtained for a totally unrelated reason. If the liver has fat but there are no signs of liver cell destruction, the condition has a good prognosis.

Weight loss, when indicated, almost always draws fat out of the liver. High blood triglycerides are lowered with a low-fat diet and with medicines when diet alone doesn’t bring them down, and that depletes the liver’s fat. Insulin insensitivity and diabetes are controlled by diet and medicines, another way to de-fat the liver.

A rise in liver enzymes indicates liver cell damage due to the fat, and that is a more dangerous process called steatohepatitis – “steato” being “fat,” and “hepatitis” being “liver inflammation.” This can evolve into cirrhosis. A serious effort must be made to rid the liver of fat. All the above measures have to be taken in earnest.

Alcohol is banned for both conditions.

Sometimes a liver biopsy must be taken to ascertain the extent of the process and to see if cirrhosis has occurred. The biopsy can also help discover other liver conditions that raise liver enzymes.

DEAR DR. DONOHUE: I am very disappointed in you. One year ago, when my son died of nonalcoholic cirrhosis, I asked you if it was fatal unless one gets a liver transplant. You never answered me. A still heartbroken and grieving mother. – G.D.

ANSWER:
I am terribly sorry to hear of your son’s death, and I apologize for not answering your question sooner. I’ll do so now.

Cirrhosis is a liver filled with scar tissue, and it cannot perform the many functions that keep the body alive. The normal liver synthesizes proteins, fats and sugars. It makes blood factors responsible for clot formation when a blood vessel breaks. It manufactures bile for fat digestion. It metabolizes drugs. It alters many cell waste products and readies them for excretion.

All of these functions are necessary for life. However, if cirrhosis is not extensive and if the liver can continue some of its necessary duties, life is possible. If cirrhosis is extensive, then a liver transplant is the treatment that saves life. Cirrhosis accounts for 25,000 deaths a year in the U.S., is the fifth leading cause of death in people between the ages of 45 and 54 and the 12th leading overall cause of death for all ages.

Alcohol accounts for many cirrhosis cases, but far from all. Hepatitis, fatty liver with inflammation, inherited liver diseases, heart failure and an attack on the liver by the body’s own immune system can all give rise to cirrhosis.

DEAR DR. DONOHUE: For several years, I have enjoyed a full glass of fresh-squeezed orange juice before a light breakfast.

My question is this: I take vitamins before breakfast. Does the acid of orange juice affect or negate the action of vitamins? – D.H.

ANSWER:
I do exactly as you do. As far as I know, we’re getting the full benefit of vitamins. I don’t plan on changing. I don’t believe you have to either.

DEAR DR. DONOHUE: Can you get postpolio syndrome without having had polio? I have many of the symptoms of it, but I never had polio to my knowledge. – J.K.

ANSWER:
Are you putting me on? Of course you cannot get postpolio syndrome without having had polio.

DEAR DR. DONOHUE: I have a brother who has been confined to a bed. He uses a contraption to get out of bed and into a wheelchair. He was recently diagnosed as having a bamboo spine. I’ve never heard of it. What is this disorder? – B.S.

ANSWER:
Bamboo spine describes the X-ray appearance of the backbone in the illness called ankylosing (ANG-kuh-LOW-sing) spondylitis (SPAWN-duh-LIE-tiss). It a special kind of arthritis that principally affects the spine and is more prevalent than you would guess. It strikes men more than women, and its peak age of onset is 24.

Its first symptom is often buttock pain that moves from one side to the other and sometimes shoots down the backs of the legs. Then low-back pain sets in. Activity lessens pain, and rest increases it. Stiffness and pain inch their way up the backbone and can reach to the top of the neck. At that point, people are generally immobile, unable to bend over or turn their heads.

This arthritis can strike other joints – hips, shoulders and knees. Joints are not the only targets of AS. The eyes can become inflamed, and the heart’s aortic valve can leak.

The HLA-B27 gene is found in nearly all patients. First-degree relatives (parents, brothers, sisters and children) of a victim are at risk of coming down with it.

Your brother must not have sought help early on, or his case must be extreme. Not many are as incapacitated by it as he is. Physical therapy is a must. It helps preserve spine mobility.

A number of medicines are used for control of this condition. Many find relief with standard anti-inflammatory medicines. Pamidronate, a medicine used for osteoporosis, has also been found effective for AS; so have two newer drugs, infliximab and etanercept.

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. Readers may also order health newsletters from www.rbmamall.com


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