Imagine the liver?

It is a wonderful time to be a liver specialist. The number of treatments available to our patients is at an all time high and the attention now being placed on liver disease is well deserved.

When one thinks of the liver, there are few pretty images that appear. If you play word association, you might encounter the following:

flower?spring, music?emotion, smile?happiness,
sun?warmth, heart?love, kidney?bean, liver?onions.

What a grotesque image and smell! Liver and onions. When I tell people "I take care of people with problems with their liver" they are somewhat grossed out at the thought of doing that. Other organs have had the pleasure of better public relations with the American citizens. The heart is synonymous with love and Valentine's Day, the kidney has its bean, and the lungs have Christmas Seals. Who would ever support children on street corners selling "Liver Seals" or "chocolate shaped livers"? How many volunteers would you expect to come out for the "Jaundice 10K Race"? While I say this all in jest, it is true that the liver has a bad rap.

Education

One mission I have is to elevate the status of the liver to be a more visible organ, and for it to carry a bit more public respect. The only way to accomplish this is through large-scale public education. The Texas Liver Coalition is proud to advance liver education to both the lay and professional communities. In discussions I have with patients and their families, someone invariably says, "I never knew the liver was so important. If I knew that, I would have taken better care of it!" The public is fully aware of high blood pressure and the complications that develop, as well as the perils of high cholesterol, smoking, obesity, and diabetes. Few know what the liver does, let alone where it is located in the human body.

Hepatitis C

A great deal of public attention has been given to liver disease as a result of hepatitis C. Hepatitis C is a blood-borne viral infection that specifically targets the liver. One of the many problems with hepatitis C is that it may be present without a single clue that the virus is present. It may become obvious that someone is infected only after serious liver damage has occurred and treatment may not be a viable option. Currently, it is estimated that 1.9% of the adult population is infected with hepatitis C - nearly twice the number compared to those infected with the AIDS virus, HIV. The risk factors for hepatitis C includes prior blood transfusions, intravenous or intranasal drug use, tattoos and body piercing, sexual promiscuity, and accidental needle exposures. A single risk factor, regardless of how well you feel, warrants you to be tested. Hepatitis C certainly has been, and will continue to be, a catalyst for attention to the liver.

Alcohol

Another issue that needs greater public attention is the affect of alcohol on the liver. Alcohol is a potent toxin to the liver. The majority of cases of cirrhosis are due to excessive alcohol use. There is a misnomer that only "alcoholics" develop cirrhosis and liver disease. Most are unclear what exactly defines an "alcoholic", and this can be the topic of a future article. There are some that feel only "hard liquor" leads to liver disease. Beer really has no effect on the liver. NOT TRUE! Beer is as potent as wine or hard spirits when it comes to the liver and the damage it can inflict. As for women, they are not created equal to men. Women have reduced amounts of an enzyme in the stomach that acts as the first line to break down alcohol to less toxic compounds. As a result, less alcohol is required to raise blood alcohol levels, and cause damage to the liver. Many women try to drink with their male buddies in an effort to keep up with them. This can be a fatal mistake.

Organ Donation and Transplant

Organ donation and liver transplantation is also in the news, and for all of the good the news articles provide regarding public awareness and education, some of the finer points can be taken in error, leading to misconceptions. The central problem all of us in the transplant community face is the ever increasing numbers of individuals in need of livers for transplantation, and the lack of suitable donor organs that are available. Across the country, approximately 20% of the patients awaiting liver transplants die while on the list waiting. This is an unacceptable high figure. When a family is faced with the possibility that their loved one may die without a transplant, all of a sudden there is an outcry as to why more isn't done to get more organs donated. I wonder if these individuals would have voluntarily signed an organ donor card and discussed their wishes regarding organ donation if they were not faced with a life and death situation? The regulations concerning organ and tissue donation could certainly be revised to foster increased donation. For now, everyone needs to discuss their intentions with their family and loved ones, and by doing so, we may be able to reduce the number of deaths while waiting.

The Internet

There is an ever-increasing number of liver related web sites on the Internet. This is both good and bad. The good is that there is growing interest in the diseases of the liver. Maybe now, more Americans will know where the liver really is! On a daily basis, patients come to the office with sheets of downloaded information regarding their own liver ailment. This too is encouraging. At times, I get the feeling we would rather research out the new freezer we are going to buy at Sears on Saturday than the new treatments available for a complex disorder you were recently diagnosed with. Three cheers for the downloaders! On the down side, there is a lot of misinformation available on the web, and this may steer patients away from proper care. Too bad. For the most part, liver disease is chronic, leading to a lifelong illness. This leads to despair. There are those individuals who prey on the ill and desperate with a quick fix for an insoluble problem. Who would not try treatment X if it might control my fatigue? At $50, it's a bargain. Many claims of success are untested and outright scams. Buyers beware. The other problem I have with the Internet is that patients look to it as their primary source of information. Call me old fashioned, but I believe your physician should still be the ultimate answer guy or gal. Many patients tell me their prior physician just "could not answer my questions." This leads to frustration and isolation. The Internet fills in the gaps in the education that should be provided by the physician. In this day of managed care, less time is devoted to speaking with the patients and listening to their fears and concerns. Unfortunately, the Internet has become the invisible doctor, answering the questions our patients have. It is OK to surf the net for questions. Double-check your findings with your physician.

And so, I do hope that someday soon a young kid may knock on your door selling the latest version of liver shaped chocolates, and you'll buy a dozen or so and have a smile on your face, knowing we all may know a bit more about the most important organ of them all, the liver!