Patients and Caregivers Support

I Have A Fatty Liver And I Seldom Drink, What Should I Do?

DON’T PANIC! Nonalcoholic Fatty Liver is usually benign, but not always. It is estimated that only about 20% of those with fatty liver will advance to the next stage of the disease (Nonalcoholic Steatohepatitis, or NASH). Just be aware and take action. Stop it from getting worse. Monitor your situation through regular bloodwork. The liver is a forgiving organ; it is the only organ that can regenerate itself. Fatty liver disease can be reversed through lifestyle changes. Without action, though, it can lead to serious liver disease such as cirrhosis and as the scarring gets worse a transplant may be needed.

WHAT LIFESTYLE CHANGES DO I NEED TO MAKE?

Increase aerobic and resistance exercise; shoot for about 150 minutes of exercise per week. Walking is a good start. The best first step, though, is to change your diet and lose weight. Studies have shown that a 10% reduction in body weight is the single most important action in reversing fatty liver. That’s a tough goal to achieve, but any weight loss will help. There are a lot of diet systems around, many with mixed reviews. Keep it simple; something you can stick with. It is always a good idea to first just cut the “CRAP”.

• C = Carbonated beverages
• R = Refined sugars
• A = Artificial flavorings and alcohol
• P = Processed foods

Another tip; when you visit your supermarket, avoid the aisles and stick to the walls; that’s where the healthy foods are. Try some form of the Mediterranean Diet. There is no single definition of that diet, but all the variations have a common theme and are heavily focused on fruits, vegetables and whole grains. Choose a version and stick to its principles. Harvard’s “Healthy Eating Plate”, is also a good guide. Lose weight slowly, no more than four pounds per week, as fast weight loss could damage the liver. No starvation diets.

SHOULD I SEE A SPECIALIST?

It is usually not necessary unless your liver begins to swell and healthy tissue is destroyed. There is one recently approved drug (Rezdiffra by Madrigal Pharmaceuticals) for those with advanced fibrosis and others are in development. Mostly, though, it’s all about lifestyle change and treating your underlying symptoms, such as diabetes. If your liver gets progressively worse, as indicated by regular bloodwork or imaging, then you see should see a specialist, usually a hepatologist.

I’m A Caregiver For A Liver Patient. What Can I Expect?

caregivers play an important and often underappreciated role in the liver disease process. They are the unsung heroes. Many people, even including family members, are often unaware of the burden absorbed by a caregiver.

The caregiver plays many roles, which may vary based on the severity of the liver disease including:

• Lifestyle Monitor. Anyone diagnosed with fatty liver disease SHOULD change their lifestyle, including both diet and exercise. The patient will need encouragement to adopt and maintain lifestyle changes. The caregiver is likely to get plenty of pushback from the patient and should not take it personally.
• Meal Planner and Chef. It will become increasingly important to maintain a liver-healthy diet. The caregiver and the patient should take a fresh look at meal preparation and seek diet guidance.
• Medical Liaison. It’s always a good idea for the caregiver to accompany the patient to doctor’s appointments. There is often just too much information for one person to absorb. It helps for two people to attend and compare notes afterwards. Eventually, it may fall to the caregiver to arrange and keep track of medical appointments.
• Gatekeeper. As the disease progresses, the caregiver will increasingly need to shield the patient from unhealthy situations and exposure to germs in social occasions and other large gatherings. This extends beyond germ avoidance as the patient sometimes may not be in a frame of mind conducive to interacting with others.
• Emotional Rock. As the disease progresses, the patient is likely to experience plenty of emotional ups and downs. Someone must provide the support to help the patient through this roller coaster ride. If it becomes a major problem, professional help should be sought. But on a daily and hourly basis, it is the caregiver who provides much-needed support. This may be the most difficult role because the caregiver is often going through the same ups and downs. It takes a team.
• Driver. There could reach a point, typically later in the disease progression, where the patient develops a “foggy brain” and may be unable to drive. You will be the family chauffeur.
• Decision Maker. A foggy brain may also affect the decision-making abilities of the patient. The caregiver must “step up” and perform these financial, health and household duties as well.

There are risks in being a caregiver. Probably the biggest is the threat to your own health. So much time may be spent worrying about the patient that the caregiver’s own physical and emotional needs often go unattended. Don’t let this happen to you!!

Attend to your own needs, including medical appointments, and recognize that you will need a periodic break. Find someone, a family member or a good friend, to give you a break from time to you time. You will need it. Don’t hesitate to vent. Find someone who will just listen. Also, forget about staying on schedule. You will continually be at the mercy of the patient’s health and emotional needs, which often change unexpectedly. If it seems overwhelming, the National Alliance for Caregivers (www.caregiving.org) might be helpful.