David's Way to Health and Fitness

Non-Alcoholic Fatty Liver Disease

David Yochim
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How much abuse do you find acceptable?

Do you find it reprehensible when the innocent among us are abused?

I am sure you do.

How much abuse do you find acceptable for yourself?

I would hope that you do not find abuse of any sort to be acceptable for yourself, yet, people accept it everyday by actually abusing their own body’s through food and drink.

Our liver quietly takes this abuse with no complaints, and then one day it rebels against what we are doing to it. Like an individual, once the liver has had enough, it is very often permanently damaged for the remainder of our lives. It cannot take anymore of the beatings we dole out to it.

Non-Alcoholic Fatty Liver Disease!

(NAFLD)

You might be the most sober individual person you know and mistakenly believe that your liver is at little to no risk from your habits and lifestyle. Yet, you could not be more mistaken my friends. NAFLD is becoming increasingly common around the world, especially in Western nations. In the United States, it is the most common form of chronic liver disease, affecting about one-quarter of the population.

One quarter of our population is roughly 82,500,000 people who have this preventable disease!

Some individuals with NAFLD can develop nonalcoholic steatohepatitis, referred to as NASH,  which is a very aggressive form of fatty liver disease that results in liver inflammation and may progress to advanced scarring (cirrhosis) and liver failure. This damage is really no different than the damage experienced by alcoholics through heavy alcohol use. You better be thinking about issues like this as you are stuffing foods of little to no nutritional value down your throats. A good part of that tummy you are building may be your liver and not typical belly fat.

Being as NAFLD usually causes no signs and symptoms, you are likely to have a false sense of comfort that your health is good despite carrying a little extra weight. Quite often, as this disease is progressing you might only feel fatigued with possible pain or discomfort in your upper right abdomen.

Life is grand until…

Your diseased liver which has been quietly taking it’s abuse and has now progressed to nonalcoholic steatohepatitis (NASH) and advanced scarring (cirrhosis). Symptoms include:

Abdominal swelling (ascites) 

Ascites occurs when fluid accumulates in the abdomen. This buildup occurs between two membrane layers that together make up the peritoneum, a smooth sac that contains the body’s organs. Ascites is often painful and typically causes a person to feel:

Enlarged blood vessels just beneath the skin’s surface

Enlarged spleen 

Your spleen is extremely important in your body’s fight against infection because it’s the source of two types of white blood cells: B cells and T cells. White blood cells protect your body from bacteria and infections. The spleen is usually about the size of your fist, but when enlarged, it can become much bigger. It is not uncommon that some people with an enlarged spleen will experience no symptoms. If you are experiencing symptoms, you will experience a feeling of pain or discomfort in the upper left side of abdomen, where the spleen is located. It is possible you might also begin feeling full after only consuming  small amounts of food. This is a result when the spleen has become enlarged to the point that it actually presses on your stomach. If your spleen starts to press on other organs, it can start to affect the blood flow to the spleen. This could cause your spleen to not be able to filter your blood properly. If your spleen becomes too big, it can start to remove too many red blood cells from your blood. Not having enough red blood cells can lead to a condition called anemia.

Red palms

Yellowing of the skin and eyes (jaundice)

Jaundice can occur when the liver can no longer work to efficiently process red blood cells as they break down. It’s normal in healthy newborns and usually clears on its own. At other ages, it may signal infection or liver disease.

NAFLD and NASH are both linked to the following:

These combined health problems are known to promote the deposit of fat in the liver. For some people, this excess fat acts as a toxin to liver cells, causing liver inflammation and NASH, which may lead to a buildup of scar tissue in the liver. Risk factors include:

My personal experience as a caretaker of one with a diseased liver.

Most people will often assume they can just go about life eating and drinking whatever they please and that it is no business of anyone else as long as they are working and paying their bills for themselves.  This would be true, unless the individual arrives to a point where they can no longer work and pay their own bills. It becomes the business of others when an individual can no longer take care of their basic needs for living, when they can no longer cook or clean for themselves, when they require assistance with bathing and personal hygiene, when they need assistance just to get dressed, or to change their clothing after soiling themselves.

As many of my long time readers and subscribers already know, I was a caretaker for my terminally ill brother in law, who was also my best friend, who passed away from liver disease just last February. A few weeks before Howard passed away, he asked me if I could write about some of his experience with liver disease in order to help others. This was something I was already doing in regards to my beautiful wife and her battle with breast cancer on my No Hill For a Climber Series.  Naturally, I told Howard I would, but this is still quite a painful subject for me to address, it brings tears to my eyes writing this.

Howard’s end stage liver disease and cancer had multiple causes including the use of alcohol. Nevertheless,  the end result of liver disease from any cause ends with the same results – sickness and death. We took him in one year before he passed away and kept him in our loving care until 3 days prior to his death when he was checked into palliative care at KU Medical Center in Kansas City where he passed away peacefully in his sleep with Loraine and I at his bedside.

Being a caretaker, even for a loved one can become a challenge, yet this is a labor of love I am glad we were able to provide for Howard. We expected the obvious tasks such as cleaning and cooking for him, doing his laundry and so forth. But there was a lot more to learn and experience through that year of caretaking. One of the first things that struck me was how our downstairs bathroom had begun to always have a sour odor to it, even hours after it had been used. This odor is just a part of the territory with liver disease. It is one I had to get used to as there were times when I had to help Howard with cleaning up after he had had bowel movements since he was not always capable of this task which is not even a thought for most of us. He was on a strong laxative called Lactulose which is  used to reduce the amount of ammonia in the blood of patients with liver disease, hence the odor. One side effect of Lactulose is the sudden urge to defecate with explosive diarrhea. Lactulose is a horrible necessity for one suffering from liver disease in order to assist with their ability to remember, along with their ability to think and reason.

As a result of severe liver disease, you develop Hepatic encephalopathy which is a decline in brain function, it causes a form of dementia. With end stage liver disease, your liver can no longer adequately remove toxins from your blood. This causes a buildup of toxins in your bloodstream, which can lead to brain damage. When you have reached this stage, you are going to have to rely on others for your care, whether it be from loved ones in their home, or strangers in a nursing home. Think about this as you are going about your merry way cramming food and drink down your throat which you know to have zero nutritional value for your health. It does get this serious.

The maddening part of being a caretaker for one with end stage liver disease who is taking lactulose to rid their body of ammonia and other toxins is not so much with helping them with their personal hygiene. No, the maddening part is their mental state will always keep you off balance. You never know for sure who or what you are going to be dealing with. Sometimes Howard was the mature rational man, my best friend, who I had known all my life. Then other times, he was like a rebellious teenager, then maybe a five year old, and sometimes he would just sit and mumble about God knows what. He would be unintelligible almost daily for a few hours. His mental state was all dependent on if he was taking his lactulose as prescribed, which he did not always do. Sometimes, because of the hepatic encephalopathy he would simply forget, then other times he would not take it because he needed a break from unexpected, explosive diarrhea. It was maybe 10 to 12 feet from his chair to the toilet, yet sometimes the distance might as well have been 1000 to 1200 feet from the toilet. Friends, this is a miserable condition to find yourself in.

Symptoms and signs of moderate hepatic encephalopathy may include:

Symptoms of severe hepatic encephalopathy, which Howard had, are:

My friends, taking care of your liver is no joking matter.

Wednesday, February 19th 2020, Howard turned as jaundiced as the picture of the gentleman above. We knew he had taken a turn for the worse.

Friday, February 21st 2020, I took Howard to his final appointment with his doctor. It was at this appointment his doctor informed him he could do nothing further for him. The doctor advised Howard that palliative care through Hospice should now be considered. The staff set up a room at KU Medical Center for Howard and I took him there where Loraine and their other brother met us. While waiting on the room to be cleaned, we had lunch in the hospital cafeteria, while making small talk. I do not know if it was fear, wishful thinking, or the hepatic encephalopathy that had Howard hopeful they were going to figure out how to get him better by next week. This was right after his doctor had told him how he would peacefully slip off to sleep to never awaken again.

Howard had his favorite foods in that cafeteria, which turned out to be his last meal of pizza, a cheeseburger and fries, a Coke and a chocolate dessert. We then went up to his prepared room where we sat and visited until Howard drifted off to sleep. Other than for a moment when he got sick during that night, Howard never woke up again. Sunday, as Loraine and I sat next to his bed, I watched as my best friend, a man I loved with all my heart, took his last breath and passed peacefully on.

Howard, with tears in my eyes, I pray this is the story you wanted told in order to help others. I love and miss you my brother. Until we meet again…

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