Dear Dr. Roach: I am 77 years old and recently have been diagnosed with cirrhosis of the liver. I do not drink and never have.
Apparently this has been caused by a buildup of fat. I am now watching everything I eat and have cut out fried foods completely. Is there any hope for me at all? I thought that the liver regenerated itself every so often? I am healthy otherwise.
M.P.
Cirrhosis of the liver is a chronic liver disease where much of the normal liver is replaced by fibrous and scar tissue, along with nodules of regenerating liver cells. Cirrhosis can be caused by many different conditions, including alcohol abuse, but certainly not every case of cirrhosis is caused by alcohol.
The most common causes of cirrhosis in the U.S. and Canada now are hepatitis C, alcohol abuse and fatty liver. All kinds of cirrhosis are worsened by exposure to alcohol, so being a never-drinker is good sign for you.
Non-alcoholic fatty liver disease is commonly, but not always, associated with being overweight, especially extra weight in the abdomen (as opposed to hips and thighs), and with prediabetes or diabetes. However, there are other causes, such as sleep apnea and untreated hypothyroidism.
In obese people, the rate of nonalcoholic fatty liver disease ranges from 50 per cent to 90 per cent. Only about five per cent of people with fatty liver go on to develop cirrhosis. Even a five per cent to 10 per cent loss of body weight can prevent progression, and some medications are showing promise at preventing progression.
Once cirrhosis has set in, it usually isn鈥檛 curable; however, that certainly doesn鈥檛 mean there is no hope. There are many important things that can be done to prevent problems, even in people with cirrhosis.
A few are easy: Get vaccinated against hepatitis A and hepatitis B. These viruses can be very serious to someone with existing liver disease, and are completely preventable with vaccination.
Also, diet is very important. In addition to avoiding all alcohol (which you already have done), people with cirrhosis should avoid undercooked or raw foods, especially seafood like shellfish.
Your doctor will periodically look at your liver to evaluate for precursors of liver cancer, and may recommend medication to prevent bleeding in the esophagus, both of which are complications of cirrhosis.
听
Dear Dr. Roach: Twenty-six years ago, at age 42, I was infected with Gardnerella by my philandering husband. While we were married, I was completely monogamous, and since that time I have been celibate. Eight years ago, I was diagnosed with lichen sclerosis, and three years ago, I had vulvar cancer. I am now in remission, but I would like to know if there is a cause and effect between Gardnerella and cancer.
C.S.
I could not find any link between Gardnerella and vulvar cancer. (Gardnerella is a bacteria that can overgrow in the vagina, causing bacterial vaginosis. Bacterial vaginosis causes pain, itching and discharge, and is treated with antibiotic creams or pills.) However, lichen sclerosis, a chronic inflammatory condition of the skin, does increase the risk of cancer.
Lichen sclerosis most commonly happens in the vagina, but it can occur in other parts of the body, or on the glans penis in men.
The cause of lichen sclerosis is not understood (again, I couldn鈥檛 find any link to Gardnerella). I did find an excellent resource for lichen sclerosis at lichensclerosis.net.
听
Dear Dr. Roach: Can you write about Addison鈥檚 disease?
D.L.
Addison鈥檚 disease is an autoimmune condition where the body destroys the cells in the adrenal gland, which is responsible for making cortisone. Cortisone is important for many of the body鈥檚 functions. Early symptoms of cortisone deficiency are subtle 鈥� fatigue, lightheadedness, low blood pressure. Too-low levels of cortisone can cause an Addisonian crisis 鈥� very low blood pressure, vomiting and diarrhea, fever and confusion are common signs. This needs to be treated with cortisone right away. There are few treatments in medicine as effective as giving cortisone to someone with an Addisonian crisis 鈥� it鈥檚 like watching someone come back to life.
Fortunately, Addison鈥檚 disease is rare. It can be diagnosed with a blood test, or by stimulating the adrenal gland with a hormone (ACTH) to see if cortisol levels in the blood go up. People with this disease need replacement cortisone every day.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible.
