Sunday, February 28, 2010

Rethinking the Rules of Organ Transplants

Have you ever watched a person die? If death is expected, it can be beautiful. If it's abrupt, it can be deeply disturbing. But if it's predictable and preventable, but is not prevented as a matter of policy, it's torturous.
I'm talking about organ transplantation, or more specifically, patients who need an organ transplant but don't qualify for the surgery. Hundreds, if not thousands, of patients die annually while waiting on the organ transplant list. I suspect many hundreds more die because they never make it to the list in the first place. Given the scarcity of organs available for transplantation and the implications of the surgery itself, transplant centers are incredibly choosy about who the recipients are. They take into account the patient's other medical problems, likelihood to survive the surgery and how desperately the transplant is needed. They also factor in proof of abstinence from alcohol. These criteria may seem straightforward, but enforcing them can lead to some very painful situations.
Take, for example, the case I witnessed of a middle-aged housewife* with four school-aged children who alleviated her daytime boredom by drinking a couple, or eight, vodka tonics. She went to rehab, but too late -- her liver had begun to shut down. Most transplant programs insist that recipients be sober for a minimum of six months. By four months of sobriety, however, her situation was critical; she wouldn't live another month, much less two. Did I mention she had a willing living-related donor ready to go?

Friday, February 26, 2010

10 ingredients to love your liver

I do hate the word "detoxing" I find it soooo misleading... Detoxing the detoxinator. tehehe. There are no quick fixes in your well-being. (Even money, although it would be nice.) So, here are some everyday food choices to keep in mind that Larry has thanked me for... and your liver will too (along with the rest of ya) I got it from a great nutrition site:
>>CLICK HERE<< To go to Suzettes site and see more.

Incorporating Detox Food Into Your Regular Diet

Detox Food: Top 10
Garlic and Onions
Cruciferous Vegetables (broccoli, cauliflower, Brussels, cabbage)
Whole Grains
Green Tea
Legumes (beans), nuts and seeds
Red Grapes

Garlic and Onions

Roast a bulb or two of garlic every week and keep it in the refrigerator to eat straight up or add to your cooking. Mash and spread on bread or add to pasta sauce.

  • Purée fresh garlic, canned garbanzo beans (a good detox food), tahini, olive oil and lemon juice to make quick and easy hummus dip.

  • Sauté steamed spinach, garlic, and fresh lemon juice.

  • My favorite detox food is (red) onions. I prepare a bunch in advance to have on hand for the week. Try this: slice and sauté in nonstick cooking spray over low to medium heat until the onions caramelize. Yummy in omelets, salads and on sandwiches or add to most any vegetable dish.

  • For a quick Mediterranean salad, combine chopped raw onions, tomatoes, cucumber and toasted whole wheat pita bread. Drizzle with lemon juice and olive oil.

  • A classic Italian salad: sliced onions, tomatoes and (organic) mozzarella cheese drizzled with olive oil.

  • Cruciferous Vegetables

    Includes broccoli, cauliflower, Brussels sprouts, cabbage, kale, collards, kohlrabi, bok choy, watercress.
    • Sauté cauliflower or broccoli with garlic, minced ginger and low sodium soy sauce.
    • Snack on cauliflower or broccoli florets dipped in salsa.
    • Roast Brussels spouts...yummy! Another of my favorite detox foods. I never liked Brussels sprouts until I tasted them roasted.
    • Sauté kale with fresh garlic and sprinkle with lemon juice and olive oil.
    • Combine chopped kale, pine nuts and goat cheese with whole grain pasta drizzled with olive oil.
    • Add steamed kale as a topping on homemade pizza.
    • Drizzle cooked collard greens with olive oil and lemon juice.
    • Steam collard greens and serve with black-eyed peas and brown rice (another good detox food).
    Whole Grains
    • Have old fashioned oatmeal for breakfast.
    • Heat up brown rice with milk or soymilk. Add cinnamon, nutmeg, raisins and honey for a quick rice pudding.
    • Look for brown rice sushi rolls.
    • Serve brown rice and beans (also a detox food) rolled up in a whole wheat tortilla with salsa.
    • Use sprouted wheat berries in vegetable and grain salads.
    • Toss chilled cooked hulled barley with chopped vegetables, olive oil and lemon juice to make a quick cold salad.
    • Combine cooked barley with sautéed mushrooms for an easy pilaf.
    Turmeric is an ancient spice, native to Southeast Asia. It has a peppery, warm and bitter flavor and a mild fragrance slightly reminiscent of orange and ginger. It's best known as one of the ingredients used to make curry.
    • Add turmeric to egg white salad to give it a bold yellow one will ever know the yolks are missing.
    • Mix brown rice (a good whole grain) with raisins or cranberries and cashews or pecans (nuts are also top detox foods), seasoned with turmeric and cumin. That's 3 detox foods in one meal!
    • Turmeric is also delicious sprinkled on sauteed apples, steamed cauliflower (good detox), steamed green beans, or sauteed onions (more good detox).
    • For a low-calorie dip, mix turmeric and dried onion with a little plain nonfat yogurt, salt and pepper. Serve with raw cauliflower or broccoli.
    • Turmeric is a great spice to complement recipes that feature lentils, which are a good detox food themselves.
    Strawberries, blueberries, raspberries and blackberries. Eat them straight up, add them to oatmeal, or blend them in fruit smoothies.
    Green Tea
    If you're like most people (including me) you don't love the taste of green tea straight. If that's the case...
    ...good news. You can still incorporate green tea in your diet. Replace water in cooking with green tea whenever you can....particularly in foods that absorb water, like rice, soup, get the idea!
    • Here's one of my favorite meals (but don't hold it against me!). Mix canned sardines (high omega-3) with plain yogurt and sauteed onion. Really, it's great!
    • Toss cubes of cooked eggplant with plain nonfat Greek yogurt (Fage or Trader Joe's are good brands), chopped mint leaves, garlic (detox food) and cayenne.
    • Add chopped cucumber and dill to plain yogurt and use as a dip for raw vegetables, or serve it atop grilled (organic) chicken.
    • Yogurt parfaits: Layer yogurt, berries and lowfat granola in a parfait glass.
    Legumes, nuts and seeds
    Beans, peas, lentils, peanuts, nuts and seeds.
    The nuts and seeds are pretty easy to work in...
    ...sprinkle walnuts, pecans, pumpkin seeds or sunflower seeds on salad or yogurt or snack on them straight up (in small portions).
    Combine cooked lentils and cooked chopped sweet peppers to make a delicious cold salad. Season with your favorite herbs and spices.
    Toss whole wheat pasta with cooked beans or lentils and broccoli florets (detox food). Top with olive oil and garlic.
    Make a bean burrito with canned (rinsed and drained) black beans, salsa, and (organic) cheese wrapped in a whole wheat tortilla.
    Looking for other ways
    to lighten your toxic load?
    Avoid mercury in fish
    Consider organics when possible
    Use this organic produce priority list
    Improve Omega 3/Omega 6 ratio
    Steer clear of food additives
    Limit processed foods
    Drink clean water
    Know where toxins hide
    Don't let label claims mislead you
    Top 10 detox foods

    • Snack on edamame. (without salt)
    • Add soybeans to vegetable stews and soups.
    • Use unsweetened soymilk in place of cow's milk as a beverage, on cereal, and in smoothies.
    • Scramble tofu together with your favorite vegetables and turmeric (remember: a good detox food) to give it a yellow "egg-like" coloring. Serve as is with toast on the side or wrap up in a whole wheat tortilla with beans and salsa.
    Red Grapes
    • Freeze them...they're extra yummy to snack on that way!
    • Slice grapes and add to chicken salad or (canned light) tuna salad.
    • Toss grapes in with salad greens and pecans (nuts are detox foods too).
    With so many good ways to eat the top detox foods, there's hardly room for anything else! Enjoy!

    How Christina Saved 11 Lives - A great donation story

    Thursday, February 25, 2010

    Basics on Cirrhosis

    Larry's not messing around when he tells you this! But just remember that the liver is awesome at regenerating itself!! And there is always hope. We just have to fight and be our own advocate. If you are showing any signs of a overworked liver, please go in and see your doctor. It can only get better if you work at it, there is no miracle speedy liver cleaner and shame on anyone who tries to sell you one!! All you can do is... say it with me now, healthy diet, exercise, moderation, less stress, vitamins/minerals, and for goodness sake, get your yearly check-ups. (Remember, Hep C sufferers to check for Liver Cancer... The percentage is small, but even without cirrhosis, patients are more susceptible)  See post on the 15 Ways to Love your Liver to get the basics... it's a good one, other cirrhosis sickies concur. tehehe. So like I said, this may be repeating, but I liked the way this was written. I am sorry (BAD BLOGGER) because I couldn't tell you for the life of me where I got it. 

    "Many people are walking around with liver
    disease and do not know they even have it.
    The liver can have inflammation inside and
    it can enlarge. This inflammation, if caught
    early on, can be treated and the liver cells
    can heal. IF the inflammation is not
    treated, it can progress to the death of
    the liver cells known as cirrhosis.
    Some people may start to have symptoms
    like the yellowing of the whites of the eyes
    and the skin. This is caused because the
    liver is no longer able to convert a
    substance known as bilirubin into a soluble
    form to be released into the intestines
    with the bile. So instead it goes into
    the blood and can cause a patient to feel
    itchy. Also the patient will start to feel
    very tired since the body is trying to heal
    itself and compensate for the functions
    that the liver once did and can no longer do.
    It all depends on what caused the cirrhosis
    in the first place. If it is caused by a
    bacterial or viral infection...such as Hep
    A,B, could develop a fever, nausea,
    and vomiting. I have to mention here, that
    some patients may not show any signs
    of having cirrhosis until the liver goes into
    liver failure. A few other signs are developing spider like veins on the chest
    and neck, shoulder areas. The skin starts
    to appear thinner and you can see these
    veins...they don't hurt, but if scratched they
    can bleed. Liver patients are known to
    bleed easily because the liver is not making
    the factors needed to help the blood to clot.
    They can also develop red palms and soles
    of the feet...this is caused because of
    hormone changes...the skin may peel off
    like they have had a sunburn. Women
    may have changes in their mentrual cycles
    and men may develop enlargement of their
    breasts and swelling of the scotrum because
    of the changes of certain hormones in their
    When you go into the final stages of
    this disease: they can develop
    encephalopathy (this is mental confusion,
    forgetfulness). They usually need to have
    someone handle their affairs for them.
    This develops from toxins going into the
    blood that liver isn't able to handle anymore
    and it crosses the blood brain barrier and
    goes into the brain. One of these is
    The can develop Ascites and edema:
    Ascites( fluid build up inside the abdominal
    area) which is caused because the liver
    can no longer make a protein known as
    Albumin that normally holds the fluid in
    our vessels and now it leaks out. Edema
    (fluid in the legs and feet) is caused because
    liver patients tend to hold onto sodium in
    their bodies and this holds the fluid inside
    the body also. This can become quite
    uncomfortable for the patient. The fluid
    in the abdomen can keep increasing and
    have to be removed by a procedure known
    as paracentesis. This fluid presses on
    the organs in the abdomen and a patient
    may have difficulty breathing, may not
    feel like eatting cause of the pressure on
    the stomach. It is very hard on the patient.
    The fluid in the leg/feet area, may mean
    they will need a larger size shoe or slipper.
    They try to relieve the fluid in this area
    by elevating the legs. The doctor may
    prescribe diuretics and place them on a
    lower sodium diet. However, the sodium
    level has to be watched closely since it
    needs to stay within a certain range for
    the heart to beat well.
    The patient may also develop
    portal hypertension. As the liver dies,
    the blood doesn't go through the
    liver and backs up into veins that do not
    normally handle this blood flow. They
    can become weak in spots and balloon
    outward. They can also break open and
    internal bleeding may start. These veins
    are known as varicose veins or varies...
    They usually develop in the esophagus,
    rectum and belly button area.

    To have may not even seem
    like you have it till these symptoms start
    to appear. As it advances, it becomes
    more uncomfortable and worse in nature.
    Your body is full of toxins now, the fluid
    keeps building up, your other organs are
    working overtime to try to pick up where
    the liver isn't able anymore, your mental
    ability start to deterate, you don't feel
    like eatting, you are so very tired...but
    your sleeping habits change and you may
    only be able to sleep for short periods of
    time and it might not be at night"

    Healing for children

    I saw the following site and thought it was a great way for children to remember those lost. It is something I hate to think about, but unfortunately being one with health issues, I am reminded regularly that we should always be prepared... even in helping those we are going to leave behind.

    Sunday, February 14, 2010

    Donor evaluation AND surgery risks.

    Larry here just wanted to give some more fun information on living donation, the risks of the evaluation and actual surgery. I know most of it is redundant, but I found the statistics encouraging (in my opinion) tehehe.


    Risks of Living Liver Donor Evaluation
    Some of the possible risks associated with the medical evaluation may include:

    • Mild to severe allergic reaction due to exposure to contrast materials used in abdominal imaging.
    • The discovery of infections or malignancies unknown to the potential donor.
    • Complications from liver biopsy (if needed) range from 0.2% and 1.79%.(7)
    • The discovery of diseases that must be reported to health agencies.
    HLA testing (if performed) could reveal the true identity of family relationships, and create issues that the
    donor or other family members may not wish to be exposed. Test results may require unexpected
    decisions of the donor and medical team.
    • Test results may require the need for additional testing and treatments, which may become the financial responsibility of the donor or donor’s insurance.

    The final decision regarding whether the living liver donor can donate an organ is based upon:
    • The medical test results;
    • The donor’s psychosocial evaluation;
    • Assessment of risk based upon current medical knowledge;
    • Willingness of the donor to proceed after receiving education about the entire donation process; and;
    • Confirmation that the donor is an acceptable candidate based on the medical and psychological

    ((The really fine print))
    Living liver donation involves risk. Most of the medical risks and complications associated with the partial hepatectomy procedure occur in the peri-operative period. These risks are relatively well known and can include:

    • Risks associated with anesthesia;
    • Surgical complications such as liver failure, blood loss, bile leak, blood clots, infection, pain, hernia; and less frequently bile duct stricture(2,3,4,5);
    • Death - the risk of dying from living donor surgery is estimated to be between 0.1%-0.3% and possible as high as 0.5% when donating the right lobe(4)
    • If all complications are considered, from the most minor to the most severe, approximately 1 of every 3 donors will experience a complication based upon multicenter consortium data. The great majority (95%) are considered minor or with no permanent sequelae. (22)

    Recent OPTN data (6) reveal that: five out of 3632 (0.1%)living liver donors were subsequently listed for liver transplant between 4/1/1994 and 11/30/2008. One living donor died after being placed on waiting list, three candidates received deceased donor liver transplants within 4 days after listing, and one candidate was removed from the waiting list due to improved health.

    Saturday, February 13, 2010

    NASH In Children

    Nonalcoholic Steatohepatitis

    Points to Remember

    • Nonalcoholic steatohepatitis (NASH) is fat in the liver, with inflammation and damage.

    • NASH occurs in people who drink little or no alcohol and affects 2 to 5 percent of Americans, especially people who are middle-aged and overweight or obese.

    • NASH can occur in children.

    • People who have NASH may feel well and may not know that they have a liver disease.

    • NASH can lead to cirrhosis, a condition in which the liver is permanently damaged and cannot work properly.

    • Fatigue can occur at any stage of NASH.

    • Weight loss and weakness may begin once the disease is advanced or cirrhosis is present.

    • NASH may be suspected if blood tests show high levels of liver enzymes or if scans show fatty liver.

    • NASH is diagnosed by examining a small piece of the liver taken through a needle, a procedure called biopsy.

    • People who have NASH should reduce their weight, eat a balanced diet, engage in physical activity, and avoid alcohol and unnecessary medications.
    • No specific therapies for NASH exist. Experimental therapies being studied include antioxidants and antidiabetes medications.

    On this page:
    Nonalcoholic steatohepatitis or NASH is a common, often “silent” liver disease. It resembles alcoholic liver disease, but occurs in people who drink little or no alcohol. The major feature in NASH is fat in the liver, along with inflammation and damage. Most people with NASH feel well and are not aware that they have a liver problem. Nevertheless, NASH can be severe and can lead to cirrhosis, in which the liver is permanently damaged and scarred and no longer able to work properly.
    NASH affects 2 to 5 percent of Americans. An additional 10 to 20 percent of Americans have fat in their liver, but no inflammation or liver damage, a condition called “fatty liver.” Although having fat in the liver is not normal, by itself it probably causes little harm or permanent damage. If fat is suspected based on blood test results or scans of the liver, this problem is called nonalcoholic fatty liver disease (NAFLD). If a liver biopsy is performed in this case, it will show that some people have NASH while others have simple fatty liver.
    Both NASH and NAFLD are becoming more common, possibly because of the greater number of Americans with obesity. In the past 10 years, the rate of obesity has doubled in adults and tripled in children. Obesity also contributes to diabetes and high blood cholesterol, which can further complicate the health of someone with NASH. Diabetes and high blood cholesterol are also becoming more common among Americans.
    Illustration of the biliary system including: liver gallbladder, cystic duct, common bile duct, duodenum, pancreatic duct, stomach, pancreas, and common hepatic duct.
    Biliary system.


    NASH is usually first suspected in a person who is found to have elevations in liver tests that are included in routine blood test panels, such as alanine aminotransferase (ALT) or aspartate aminotransferase (AST). When further evaluation shows no apparent reason for liver disease (such as medications, viral hepatitis, or excessive use of alcohol) and when x rays or imaging studies of the liver show fat, NASH is suspected. The only means of proving a diagnosis of NASH and separating it from simple fatty liver is a liver biopsy. For a liver biopsy, a needle is inserted through the skin to remove a small piece of the liver. NASH is diagnosed when examination of the tissue with a microscope shows fat along with inflammation and damage to liver cells. If the tissue shows fat without inflammation and damage, simple fatty liver or NAFLD is diagnosed. An important piece of information learned from the biopsy is whether scar tissue has developed in the liver. Currently, no blood tests or scans can reliably provide this information.
    Illustration of a liver biopsy where a biopsy needle is used to remove a small slender or core of tissue which is in turn looked at under a microscope.
    Liver biopsy.


    NASH is usually a silent disease with few or no symptoms. Patients generally feel well in the early stages and only begin to have symptoms—such as fatigue, weight loss, and weakness—once the disease is more advanced or cirrhosis develops. The progression of NASH can take years, even decades. The process can stop and, in some cases, reverse on its own without specific therapy. Or NASH can slowly worsen, causing scarring or “fibrosis” to appear and accumulate in the liver. As fibrosis worsens, cirrhosis develops; the liver becomes seriously scarred, hardened, and unable to function normally. Not every person with NASH develops cirrhosis, but once serious scarring or cirrhosis is present, few treatments can halt the progression. A person with cirrhosis experiences fluid retention, muscle wasting, bleeding from the intestines, and liver failure. Liver transplantation is the only treatment for advanced cirrhosis with liver failure, and transplantation is increasingly performed in people with NASH. NASH ranks as one of the major causes of cirrhosis in America, behind hepatitis C and alcoholic liver disease.
    Illustration of the stages of liver damage including: normal liver, fatty liver (where deposits of fat cause liver enlargement), liver fibrosis (where scar tissue forms and more liver cell injury occurs), and cirrhosis (where scar tissue makes liver hard and unable to work properly).
    Stages of liver damage.



    Although NASH has become more common, its underlying cause is still not clear. It most often occurs in persons who are middle-aged and overweight or obese. Many patients with NASH have elevated blood lipids, such as cholesterol and triglycerides, and many have diabetes or pre-diabetes, but not every obese person or every patient with diabetes has NASH. Furthermore, some patients with NASH are not obese, do not have diabetes, and have normal blood cholesterol and lipids. NASH can occur without any apparent risk factor and can even occur in children. Thus, NASH is not simply obesity that affects the liver.
    While the underlying reason for the liver injury that causes NASH is not known, several factors are possible candidates:
    • insulin resistance

    • release of toxic inflammatory proteins by fat cells (cytokines)

    • oxidative stress (deterioration of cells) inside liver cells


    Currently, no specific therapies for NASH exist. The most important recommendations given to persons with this disease are to
    • reduce their weight (if obese or overweight)

    • follow a balanced and healthy diet

    • increase physical activity

    • avoid alcohol

    • avoid unnecessary medications
    These are standard recommendations, but they can make a difference. They are also helpful for other conditions, such as heart disease, diabetes, and high cholesterol.
    A major attempt should be made to lower body weight into the healthy range. Weight loss can improve liver tests in patients with NASH and may reverse the disease to some extent. Research at present is focusing on how much weight loss improves the liver in patients with NASH and whether this improvement lasts over a period of time.
    People with NASH often have other medical conditions, such as diabetes, high blood pressure, or elevated cholesterol. These conditions should be treated with medication and adequately controlled; having NASH or elevated liver enzymes should not lead people to avoid treating these other conditions.
    Experimental approaches under evaluation in patients with NASH include antioxidants, such as vitamin E, selenium, and betaine. These medications act by reducing the oxidative stress that appears to increase inside the liver in patients with NASH. Whether these substances actually help treat the disease is not known, but the results of clinical trials should become available in the next few years.
    Another experimental approach to treating NASH is the use of newer antidiabetic medications—even in persons without diabetes. Most patients with NASH have insulin resistance, meaning that the insulin normally present in the bloodstream is less effective for them in controlling blood glucose and fatty acids in the blood than it is for people who do not have NASH. The newer antidiabetic medications make the body more sensitive to insulin and may help reduce liver injury in patients with NASH. Studies of these medications—including metformin, rosiglitazone, and pioglitazone—are being sponsored by the National Institutes of Health and should answer the question of whether these medications are beneficial in NASH.

    Hope through Research

    What is most needed in the management of NASH is more research to better understand the liver injury found in this disease. When the pathways that lead to the injury are fully known, safe and effective means can be developed to reverse these pathways and help patients with NASH. Recent breakthroughs in mapping the human genome and uncovering the individual steps by which insulin and other hormones regulate blood glucose and fat could provide the necessary clues.
    The National Institute of Diabetes and Digestive and Kidney Diseases funds the NASH Clinical Research Network, which comprises eight clinical centers located throughout the United States and a coordinating center at Johns Hopkins University. The NASH network researches the nature and underlying cause of NASH and conducts clinical studies on prevention and treatment. More information on the NASH Clinical Research Network and the locations of the clinical centers are available at