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27 July 2018 @ 09:44 am
I've modified my diet as much as possible to reduce inflammation, can't tolerate the level of Vit E suggested below but can tolerate 200 IU with food. I still have pain in the vicinity of my liver nearly every day, sometimes severe, and the area of my spleen sometimes has pain and is always tender. (When I went in to Urgent Care last summer with bladder infection symptoms the doc noticed tenderness in both areas. I should note that it had been years since I received a thorough abdominal exam like that. How many things could be caught earlier if doctors weren't afraid to touch fat patients or didn't convince themselves our fat is in the way so it's useless? We still feel pain and tenderness when examined and that tells you something!)

The referral to nutrition mentioned below is useless to me since Medicare (and therefore my secondary insurance) doesn't pay for individual consult. I may pay for one myself at some point, but basically I'm treating this as a stricter version of a heart healthy diet crossed with a modified diabetic diet with the hope of reducing inflammation generally. For my sanity I am not making weight loss a goal though some modest weight loss has resulted.

Gastroenterologist regarding trans-jugular liver biopsy results:

"As discussed on the phone, you have NASH (non-alcoholic steatohepatitis) which is inflammation of your liver from fat cells. There was a little bit of scarring (fibrosis, stage II) but good news is that there is not cirrhosis (complete scarring). Of course, we are trying to prevent cirrhosis so that would entail weight loss in a slow and steady manner. I have referred you to nutrition.
Also, vitamin E supplementation at 800 international units per day may decrease the inflammation and hopefully decrease fibrosis but that needs more studies to prove the latter."

Most recent liver panel:

Total Protein 6.8 g/dL 6.4 - 8.2 g/dL
Albumin 3.2 g/dL 3.2 - 4.7 g/dL
Total Bilirubin 0.4 mg/dL <1.1 mg/dL
Direct Bilirubin 0.1 mg/dL 0.0 - 0.30 mg/dL
Alkaline Phosphatase 131 U/L 26 - 137 U/L
AST 15 U/L 0 - 37 U/L
ALT 18 U/L 0 - 60 U/L

Last C-reactive protein test was 2015

C-Reactive Protein 40.2 mg/L

Recent cardiac cath showed no new blockages so that's great news! Even if nuclear scan showed a lowered ejection fraction.
From her obituary:

“Her brief time diagnosed with inoperable cancer gave her mere days to live... A final message Ellen wanted to share was about the fat shaming she endured from the medical profession. Over the past few years of feeling unwell she sought out medical intervention and no one offered any support or suggestions beyond weight loss. Ellen's dying wish was that women of size make her death matter by advocating strongly for their health and not accepting that fat is the only relevant health issue.”


And then her death is added to statistics that fat people die earlier etc. Let's see what the statistics would show if we ever get comparable health care to that of thinner people. I'm not saying fat doesn't adversely affect my health--just that unbiased health care would improve the situation and not add deadly insult to injury. (Though without fat bias I wouldn't have spent my teens and twenties on a series of diets that also had a negative effect on my health.)

It's difficult enough to deal with illness without second guessing my health care.
The same doc who spent a long time trying to talk me into gastric bypass surgery also brushed off my mention of abdominal pain as a likely symptom of my depression. (Note that I have had depression off and on for decades so I'm likely to know what the symptoms I typically suffer are.)

It turned out to be liver disease.

I wonder if it's worth it to give him any more feedback in the hopes he won't dismiss another woman's symptoms or not. Or if I have the energy.