Today we visited Dr. Richard’s office. This was a follow-up visit for Roy’s hospitalization in January. It was more of a conversation with his physician’s assistant than an exam because Roy had so recently seen the hepatologist in Dallas. Essentially, his case is now in the hands of Dr. Asrani, his hepatologist in Dallas, and his PCP Dr. Sterling. We will be waiting to see if the new combination of diuretics, potassium, and actigall improve his situation. He cannot drive while on this medication and was dizzy a bit on Tuesday from it. He will have labs again on Monday to check his liver function.
So far, Roy reports that he is feeling incrementally better and he, as always, remains optimistic. He is walking around the house to help move fluid off his body and we will be seeking out some medical-grade compression socks to add to his wardrobe. The PA said that those were the only other thing that might help get the fluid off.
The mix of symptoms/conditions Roy has are all associated – ascites, edema, fatty liver, cholestatic hepatitis, elevated bilirubin, drug-induced allergic rash, itching, jaundice, vanishing left lobe and shrinking right lobe, fibrosis and probable cirrhosis – and add up to liver disease. However, this liver disease hasn’t yet been given a handy title, so we can’t say “Oh, he has stage blah of this condition, so the next step will be…” Knowing the level of damage is not possible without a liver biopsy. Most liver diseases are avoided or addressed with the magic of diet and exercise.
We did schedule a colonoscopy for March (everyone’s favorite procedure!) and the PA will be conferring with Dr. Richards to see if he wants to add an esophagogastroduodenoscopy (more easily called an EGD) which would look at his upper gastrointestinal tract at the same time. Colonoscopy? Yes, Roy put it off and his hepatologist asked that when he did next have one that they do some random biopsies for only reasons he knows, so we scheduled it. It might help in some way with his diagnosis or treatment. Why the possible EGD? One possible result of liver disease especially with fibrosis or cirrhosis can be portal hypertension (elevated blood pressure going into/out of the liver, which can cause “backflow” of blood into other areas). The EGD would allow the doctors to check his esophagus for varices (think varicose veins on the interior) which are one of the complications people can develop with liver disease. We won’t know if this special treat gets added until closer to the colonoscopy appointment.
Generally, people with cirrhosis or fatty liver are told to avoid excess sugar, refined/processed foods, and restaurant foods (lack of control over salt and sugars is the primary reason). Dr. Michael Greger’s How Not to Die chapter on liver diseases suggests that avoiding “alcohol, excess calories, cholesterol, saturated fat, and sugar” are the best bet for avoiding a fatty liver. Liver-protecting foods include oatmeal (and other whole grains) and unsweetened coffee. Lucky us, we just got a little coffeemaker for Christmas (not for this reason, but so we could cut down on take-out coffee cups on weekends). The phytonutrients in cranberries may also help so we will be trying some of Dr. Greger’s “Pink Juice” made from whole cranberries.
Being vegetarian, Roy is already doing one of the things that is suggested for improving liver inflammation – eating vegetable proteins, fruits and vegetables, and whole grains. He’s particularly fond of watermelon at the moment (Thanks, Mary Ann!) and has also been eating blueberries (Thanks, Karen!). Mostly he just has to avoid salt while he’s still on diuretics.
I got some pretty red and orange gerbera daisies for the vase for this week. So far the cats are leaving them alone. Last week’s purple irises were not so lucky – the irises kept getting pulled out of the vase. Don came by and trimmed back the shrubs on our front walk so they won’t be jumping out and tripping visitors like they did last week (Thanks Don!). Roy’s mostly been watching Netflix and listening to podcasts.
Waiting 
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