Post op Fatty liver question, no help from doctors

[HopefullXOXOXO 73]

Day of surgery 5/3/18, a biopsy was done of my liver and it was perfectly normal. No problems. Last year, 6 months post op, I had an abdominal ultrasound and was told I had gallbladder sludge, no mention of fatty liver. 18 months out, another abdominal ultrasound and I got a copy of the results. It shows a fatty liver, unchanged from 1 year ago and GB sludge. The doctor didn't even mention the liver damage to me and when I asked about it was told not to worry, it happens with WLS. I've researched and I've seen it can happen to people who lose a lot of pounds fast. I lost 55 pounds first 7 months (10 of it pre op). since then another 12, for a total of 67 pounds. This just isn't making sense to me. How could I have a normal liver on surgery day, after enjoying whatever foods I liked for years, and now that I'm eating MUCH better, have liver disease??? It's not that I never have fat or sugar (had some yesterday, but not a lot), but if I eat even 1/10th of what I used to, that would shock me. Like a have a bite of something, maybe two bites. Even that's once or twice a month. Does anyone have any ideas about how this happened and what I can do about it? I'd really appreciate hearing from the community on this as my doctor doesn't want to address this. I don't drink ANY alcohol.

Thank You,

Lisa

Edited November 29, 2019 by HopefullXOXOXO

[FluffyChix 17,415]

((hugs)) What advice are your doctors giving you? Have you seen a liver specialist? What stage is your fatty liver?

[HopefullXOXOXO 73]

Wow FluffyChix, you've done great! Very happy for you.

The reason I came here with my question is my doctor (surgeon) doesn't want to deal with this. He says "I'm the surgeon", ask your primary care. My primary care says "I'm not a weight loss specialist, the weight loss center should be helping you with this." The hospital, Mass General in Boston, Ma., for some reason, doesn't have a doctor, other than the surgeon, for me to talk to about this. It's very frustrating. All I was told was to eat low fat and low sugar. I'm already doing that. The only other thing I was told is to stay away from Tylenol and other pain killers. My question: for LIFE? Really? Not realistic.

I'm sorry to say that Mass. General's weight loss program isn't good. At least it hasn't been for me. The surgery itself was done very well and I have no complaints about that at all. All other follow up, like with a nutritionist, etc. was pretty much useless. They didn't give me any information I didn't already have and could have easily found online. The post op support is non existent. I could have been the nutritionist I saw because she did retire about 6 months after my surgery. Her heart just wasn't it in. It's my opinion they should have other doctors who are knowledgeable about WLS to help patients who have problems post op. Maybe it's just me.

Bottom line, I have no idea what stage it is. I just know that's what the ultrasound showed and that my liver enzymes are high. ??? The ultrasound results say:

echogenic liver parenchyma which may be related to underlying liver

disease

Perhaps I should see a liver specialist. I didn't even know there are specialists for the liver. Makes sense.

[RickM 1,747]

I can't speak for your specific case, but in general, the liver is stressed by metabolizing all of that fat that we are losing so quickly - this is why many surgeons advise against consuming any alcohol during that first year or so of rapid weight loss (the liver doesn't need any additional stress from a liver toxin like alcohol). So, liver numbers in blood tests are often abnormal for a while during this loss phase and for some time after; whether that extends to a physical fatty liver diagnosis from an ultrasound, I don't know.

My surgeon is also a liver guy (does transplants in his "spare time") so these things get discussed in general in the support groups, though I never had occasion to talk any specifics with him. It is hard to say if your surgeon is just being casual about it because what he sees is fairly normal, or is something beyond his job description and experience. While they may not have anyone else within the bariatric department who is more knowledgeable, they certainly have a liver disease department there that will have a hepatoligist that you can talk to. The problem is that they may not be that familiar with bariatrics and rapid weight loss so may want to go farther in treatment than is necessary - they may need to get their heads together between the two departments to determine what is really going on.

Good luck...

[HopefullXOXOXO 73]

Thank you Rick. I appreciate this information. I will look into seeing a liver specialist to get to the bottom of this.

[eporter 69]

It sucks that your doctors are just trying to pass the buck. So is it not “official” that you have liver disease? I’d find a new PCP at a different practice and go from there, see if they’ll refer you out to a Hepatologist ( doc that specializes in livers) to get some real answers

[HopefullXOXOXO 73]

Thanks E.P. The only person who mentioned the fatty liver disease was the CNP who ordered the ultrasound and labs to check pain I was having in that area. All this time, I thought it was just the gall bladder. She advised I "lose weight and eat a healthy, low fat, low sugar diet." I had to tell her I had the sleeve surgery 18 months ago. Thank you for the suggestion. I'll take it!

[catwoman7 11,212]

are you sure it's liver disease? It's common for liver enzymes to be high for a year or two after WLS because of the rapid weight loss. Rapid weight loss is really hard on livers. My AST and ALT values were really high for awhile, but by two years out, they were normal. My PCP at the time at first suspected fatty liver disease when she saw those values, but when I reminded her that I'd had WLS, she said it might have been that and if that was the case, they'd eventually normalize, and they did. So - no liver disease. At least not in my case.

P.S. edited to add that I didn't have an ultrasound, though - it was just a blood test. But yes - high liver enzyme values until about two years out.

Edited November 29, 2019 by catwoman7

[BoredCW 35]

So that explains why i have discomfort sometimes in the upper right side of my abdomen. @HopefullXOXOXO thanks for posting about this.

[SabP 5]

So that explains why i have discomfort sometimes in the upper right side of my abdomen. @HopefullXOXOXO thanks for posting about this.

This happened to my mom a few years backs. She'd had an infection that required several rounds of antibiotics, she's Diabetic, not in the best health, but not taking insulin, or severely obese. And all of a sudden her liver enzymes were up, her scans showed it to be fatty and enlarged.
She's always been a teatotaler, so the Dr. looked a bit closer. Figured out the combo of meds led to the liver problem, which many varieties can do this. Put her on a Liver detox/cleanse, sorry I can't recall what exactly but I had to take a liver cleanse before my sleave surgery.
(Rather than take meds, I used 'Green' and started a month early, with my delighted Dr.s approval. I put the pics in, I got them at Amazon, great prices with subribe and save.)
As for the Gallbladder, sorry to say, but sometimes they just go bad. Mine went bad suddenly, well maybe not. I ignore pain really well. So, my first symptom was puking everything even Water, followed by an er visit, cuz 48 hrs without liquid while puking equals baddd. 7 days later, my GB was removed, it was "ugly".
Since then I have encountered many people with similar stories. If you manage to keep it, have some pineapple with every meal, and avoid iceberg lettuce. In fact, go for the greens that are thicker, like fresh spinach, butter lettuce, baby hearts of romaine... These things are true for if you lose it as well.
Sorry if I sound bossy, but I want to save you pain.
Speaking of, moist heat or a heating pad on low will help with your gallbladder pain.
Unfortunately, you may find even if you get to keep you GB, that some meats won't sit well anymore. And it is different for everone.
I take Papaya enzymes to help out. Most use pineapple enzymes, I'm allergic. It might be enough to keep you GB, don't know.
But, the cleanse and enzymes can't hurt.
And seeing a Neurologist that is a diagnostician or at least is willing to be put in charge of all you meds and drs to make sure that they aren't working against each other.
That's who we had for my mom, as soon as the levels came back off, our primary sent her over to the neuro we worked with as a central hub.
I hope this has helped in some small way.  

Sent from my SM-G975U1 using BariatricPal mobile app

[JessLess 1,163]

@HopefullXOXOXO, since your program is being pretty useless, you may want to call mine at Newton Wellesley and ask for referrals. My surgeon is in my profile. I hope they can help you!

[Frustr8 7,886]

And another reason for Right Subcostal pain is Jejuneal ulcerations, many, myself included, retain just enough acidic gastric juices to wreak havoc on your small intestine, be it duodenal or jejuneal, I Will carry carry scarring the remainder of my missbegotten LIFE and be at risk for (gasp) stricture, stenosis and torsion, and I have a gastroenterologist sworn paperwork on THAT!

[HopefullXOXOXO 73]

I really can't thank everyone enough for your responses! Very grateful to have some concrete things to look into. One of the thoughts I've had is that I've used Unjury brand Protein Bars and powers as well as their Vitamins on a daily basis since the surgery and want to look into this as well. You never know....

[catwoman7 11,212]

4 hours ago, HopefullXOXOXO said:

I really can't thank everyone enough for your responses! Very grateful to have some concrete things to look into. One of the thoughts I've had is that I've used Unjury brand Protein Bars and powers as well as their Vitamins on a daily basis since the surgery and want to look into this as well. You never know....

I'm not sure what exactly you mean by this, but Unjury is one of the best brands on the market. It's supposedly used a lot in hospitals.

[HopefullXOXOXO 73]

It's the only product I've had daily since the surgery and I never had it before the surgery, so I thought it might be worth looking into. I've been using it all along because I know it's a top rated product and used by hospitals. It was really just another thought I had, that's all.