Posted 10/25/2008 5:26 AM (GMT -6)
Most hepatologists are pretty good, though I did get one really bad horrible one. Because the procedures they do in some forms of liver disease can kill a person, they have to be really good. Not saying you need those things. Heck, I don't need them. Just know they have to be really good. The fatty liver causing your raise in liver enzymes is called steatohepatitis and I strongly disagree with your PCP. Any consistent elevation in your liver enzymes needs to be evaluated by at least a GI, if not a hepatologist. I prefer hepatologists. I have known people having to get liver transplants because they were not treated properly for steatohepatitis. It may take a while for one's liver to get bad, but it will as long as the enzymes keep rising, even if they go up and down, and steatohepatitis, which is more severe than fatty liver because your liver enzymes are elevated, indicating inflammation, will cause one to become very obese and pregnant looking, develop worse neuropathy, and possibly full-blown diabetes.
Basically, your pcp doesn't know what is wrong with your liver, is not qualified to review and diagnose properly from bloodwork and a liver ultrasound--which is required to diagnose fatty liver. Also, with the hep B antibodies, you remain a risk to your family and those you are close to should you have blood to blood contact. Just because the hepB virus is not active at the time of your last test doesn't mean that it can't come out of remission, especially on immunosuppressants and steroids for lupus. In fact, you might google viral hepatitis and lupus and you will see that lupus can be a consequence or occur with viral hepatitis commonly.
The possibility that you have two liver diseases and elevated enzymes would send me running to a hepatologist. Doctors did not take my steatohepatitis seriously, called it "fatty liver" and told me to exercise for twelve years before a good hepatologist did the right thing and put me on glucophage, an approved treatment for steatohepatitis. I am now being seen four times a year at a transplant center because the disease progressed as far as it possibly could before becoming End Stage Liver disease--which means you are terminal--dying. Most of my docs agree I will likely die of liver disease.
Some things you can look forward to dying of liver disease:
Stinking bad because your liver can no longer process toxins and you can't wear deodorant or perfume because the chemicals will put you into liver failure and kill you
Lots of gas, loud and embarassing
Lots of water weight, causing you to look odd
Very bad skin and nail changes that are permanent
Huge blood vessels showing through your skin
Yellow tint, pigment changes, lots of red patches, liver spots, even open sores
Lots of very serious GI problems
Restrictions on food, moving to soft diet, liquid diet, very low sodium, potassium, sugar
Severe, severe fatigue
Inability to take many meds, especially pain meds, though you are in pain
Inability to tolerate surgeries due to anesthesia, no pain meds during procedures
Spinal and joint problems
Dementia--sometimes severe--severe mood changes
Itching, really bad sometimes
This is just a partial list, but it is bad enough. This stuff happens over years in some cases. You might not even notice you are having some problems until they get bad and you have irreversible damage.
I'm trying to help you so you don't end up like me. I've been told I'm dying, slowly, but the next five years will be critical for me to try to turn things around. If something bad happens, called "oxidative stress", I progress to cirrhosis and could get very sick very fast. It's funny a benign drug like glucophage can help so many people avoid death and my doc told me there may be a possibility of reversalin some cases, but it is not likely for me because I have other diseases. Please, learn from my misfortune and find a good hepatologist and don't give up until they fully diagnose and TREAT with medication your condition(s). I don't mean to sound harsh, I just care and I'm in your same boat, with HCV antibodies and steatohepatitis (fatty liver with inflammation--the most severe form of fatty liver disease). There is no way a pcp should be trying to manage this.
--Sometimes I think the surest sign that intelligent life exists elsewhere in the universe is that none of it has tried to contact us. Bill Watterson (1958-) cartoonist "Calvin and Hobbes"
Ills--Sjogrens-Lupus-like AI Disease, Hashis, Vitiligo, spinal stenosis/fusion with plate, salivary/lymphectomies, Diabetes, NAFLD, COPD, RLS, neuropathy, trigonitis, hystero, diffuse brain atrophy, GI nightmare
Meds--Plaquenil, Evoxac, Metformin, Synthroid, HCTZ, Estradiol patch, Prosed, Detrol, Klonopin, Ultram, Vicodin, Restasis, Albuterol, steroid injections and pred prn