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Liver Disease Linked to Obesity Epidemic

  • August 1, 2005
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Maggie Rodgers was shocked to find she could have such a serious disease and so few symptoms.

Rodgers, 57, of East St. Louis, Ill., had a liver transplant Feb. 12, 2004, at Barnes-Jewish Hospital. She had been suffering from non-alcoholic steatohepatitis (NASH), also known as fatty liver disease. NASH had slowly destroyed her liver, but until a few months before her transplant, Rodgers didn''t feel bad.

Doctors say NASH has risen dramatically in the last five years to become the most common liver disease in the US, a rise they link to the increase in obesity. Some studies have shown that 20-40 percent of grossly overweight people develop NASH.

However, doctors note, not all overweight people have NASH and not all people with fatty liver disease are overweight. Some doctors suspect NASH may be related to changes in the immune system or diabetes, as well as obesity. But they do know that more people are acquiring NASH and for many of them, like Rodgers, it becomes life threatening.

A long-time administrative assistant to the director of the Southern Illinois University East St. Louis campus, Rodgers had decided to retire about two years ago. She wanted to enjoy life with her husband of 37 years, James. Though she had been heavy all her life, she always had been active, she said.

During routine bloodwork, her doctor found that Rodgers'' liver enzymes were high. But Rodgers didn''t feel bad, and all her other tests showed her to be healthy.

About six months later, Rodgers started to feel tired frequently. A short walk would wear her out. Occasionally, she''d be overcome with malaise and nausea. Then, her stomach, which had always been flat, started to bulge.

"I just couldn''t put my finger on it," she said. She thought perhaps knee replacement surgery had "made me lazy."

Rodgers'' primary care doctor referred her to Dr. Mauricio Lisker-Melman, Washington University School of Medicine liver specialist at Barnes-Jewish Hospital. The liver program at Barnes-Jewish is consistently ranked as one of the top programs in the country because it offers treatments, including liver transplant and cutting edge medical and radiologic treatment, for a wide range of liver diseases ranging from liver cancer and hepatitis to NASH.

Dr. Lisker ran a battery of tests, suspecting that either Rodgers'' own immune system was attacking her liver or that she had NASH. Dr. Lisker and his team later determined that Rodgers indeed had NASH. But the diagnosis wasn''t as important to Rodgers as was the news they gave her about the future - she would eventually need a liver transplant to survive.

As her liver began to shut down, Rodgers'' symptoms worsened. Her nausea was overwhelming.

"I was surviving on club soda and lemon," she said.

She grew weaker, she couldn''t sleep and she developed ascites, a condition in which fluid accumulates in the abdomen. She was having six to seven liters of fluid drained from her belly several times a months.

"I''d have two or three good days out of the months after the fluid was drawn," Rodgers said. "But it wouldn''t last long. My abdomen would fill right back up."

Her swollen belly and liver pressed on her diaphragm, making it difficult to breathe. Rodgers soon needed to be on oxygen.

In October 2003, she was evaluated for transplant. After extensive testing and "a lot of prayer", Rodgers was added to the transplant waiting list in December. Her transplant coordinator Suzanne Tiller, RN, became her lifeline, monitoring Rodger''s health, answer her questions and offering reassurance.

Rodgers also credits her husband''s loving care with helping her survive the wait. James Rodgers took over cleaning and cooking duties after coming home from work.

"He was just so instrumental in the process," Rodgers said. "I think he was even more determined than I was to get me well."

On Feb. 12, 2004, Rodgers got the phone call she had been waiting for-a liver was available. Ironically, she had been at Barnes-Jewish in the morning for a doctor''s appointment. She didn''t mind the extra trip, though.

Dr. Will Chapman, surgical director of abdominal transplant, and Dr. Surendra Shenoy performed the transplant operation. The donor liver began working well, as soon as it was implanted in Rodger''s body.

After about one week in the hospital, Rodgers returned home. Other than a short episode of rejection soon after the transplant, her recovery has gone well.

"I am thankful to be alive and thankful every day for my donor," Rodgers said. "One of the good things that has come out of this is that my whole family know the importance of organ donors and want to be organ donors themselves."

Another result of the transplant is that Rodgers has started an exercise program, to healthily regain some of the weight she lost during her illness and to keep off excess weight and keep her new liver healthy and help her celebrate her second chance at life and the new life of her first grandchild.

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