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1475202 tn?1536270977

Cirrhosis and Statins

AGE: 41
Alcoholic cirrhosis diagnosed nearly 4 years ago/maintains sobriety
MELD: 12
Symptoms of decompensated cirrhosis include: Grade 3 non-bleeding Varices and Hepatic Encephalopathy “controlled”.

CT Scan shows: Atherosclerotic disease including mild renal scarring

Calcium score test was ran- results: 570- high risk category and coronary arterial age in years is 85.

Lipid panel, results are as follows:
CHOLESTEROL BLOOD TL: 136 mg/dL (<=199)
TRIGLYCERIDES BLOOD: 60 mg/dL (=41)    
LDL CHOLESTEROL CALC: 87 mg/dL (1-129)
TC:HDL: 3.7  

EKG and Stress Echo: NORMAL FINDINGS.

Questions: Does it seem fitting to begin treating atherosclerosis with a statin “Lipitor” per the suggestion of my cardiologist. I have expressed my concerns regarding the use of the statin and would like to try diet and exercise first. Does this seem feasible? This past February my lipid panel showed tl. Chol: 156. One month ago I began a low-fat diet and since achieving 136 tl chol but this specialist keeps pushing the statin and avoiding any of my questions via email communications setup with the TP center I go to. Anyone else using a Statin?

I appreciate your reply.

Randy
17 Responses
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446474 tn?1446347682
COMMUNITY LEADER
Hi Randy.

"Symptoms of decompensated cirrhosis include: Grade 3 non-bleeding Varices and Hepatic Encephalopathy “controlled”."

FYI: Non-bleeding varices and controlled HE are signs of compensated cirrhosis not decompensated cirrhosis.

The symptoms of decompensated cirrhosis can be serious and life-threatening, but many of them can be successfully managed. Signs of decompensation are... Ascites and edema which are usually the first complications of decompensation. Bleeding varices. HE stupor, hand flapping and coma. Bruising and bleeding caused by coagulation problems. Gynecomastia, enlarged breasts in males. Jaundice and itching. Infections. Severe weight loss.
Not all patients will experience all of these complications.

I can't comment of statins as I have no experince with them.

In general...
For anyone having cirrhosis they should consult with their hepatologist before treating any other health issue as it could complicate maintaining the health of the liver. Medicines that are benign in a healthy person could be dangerous for a cirrhotic to take.

Good luck!

Hector
Helpful - 0
1475202 tn?1536270977
COMMUNITY LEADER
Thanks for your response and the FYI Hector.

I have researched and spoke to my Hepatologist to learn that the use of statins to control cholesterol (cause apparently I have a problem with built-up plaque even with CHO TL. 136 –hereditary I think) in the setting of cirrhosis should be determined safe on a case by case basis. There are pros and cons, pros being that they do a good job at lower your cholesterol and some studies have indicated they can even aid in the reduction of portal hypertension. Cons are these drugs metabolize in the liver having the potential to further advance liver disease just as many other drugs do. Anyone taking a statin that has liver disease should have routine labs coordinated by their Hepatologist.

Though receiving the approval from my Hepatologist to begin taking a statin the decision has weighed heavily on my mind. In my circumstance my liver can safely recover from a certain amount of damage caused from processing the drug according to my Hepatologist, and in the event of a major coronary episode dead myocardium (heart tissue) cannot be brought back. I still feel it’s not worth the risk at this point so  I have opted not to take the advice of the cardio specialist and make things simpler. Diet and exercise was never suggested  by either doctor and yet it brings the most benefit to my cardiovascular disease and liver health. Sure were told to do it after diagnosis and some of us do but some of us don’t. The labs keep coming back consistent and that’s that. In my opinion this should have been the first question/suggestion from either doctor. The cardio specialist has agreed that it is safe to try it my way for the next couple of months at which point we will retest. Goal being to get my cholesterol down to 100.

I wanted to use this as an example of why it is so important to stay as actively involved in our treatment decisions. Our doctors try hard to do their best but I know more about my past medical history and it is easy to forget to mention day to day behavior or even thinking it’s not relevant whereas if they could see these things treatment may be more than obvious. Ever leave the doctor’s thinking why didn’t I think to mention…

Randy
Helpful - 0
446474 tn?1446347682
COMMUNITY LEADER
I agree that being involved in your own treatment can make a world of difference. Besides it is us that this is happening to, nobody else. We must do what we think is right for ourselves. Only we can decide what risks we want to take. As you said there is no all good or all bad choices. It is always a balancing act. Pros vs cons. We must weight the odds and factor them into our own belief system. What is "right" for one person may not be "right" for someone else.

Good luck to you!
Howie
Helpful - 0
317787 tn?1473358451
Hi I agree with you. I would want to try diet and exercise before taking a statin.
The same thing happened to me when I was dx with diabetes. Instead of   having me change my diet I was put on medication right away.
I think what happens is that doctors do not think we can change so they put us on medication

My Mom was diagnosed with blockage in her heart during a stress test.  She opted not to get any further testing, angioplasty, and went to Duke U to live while they put her on the "Rice Diet"  Between that diet and a book by Dean Ornish, my Mom was able to get rid of the blockage.

Most people will not change their diet.  Many will have open heart surgery and continue to eat   processed meats, subs, pizza, butter etc.

I think you are doing the best thing for you.  If it turns out you can't change your diet and increase your exercise then you can revisit the statins.

Take care
Helpful - 0
Avatar universal
I would seriously try to cut all gluten type grains and increase mid chain fatty acids to your diet and excersise.....first. Why load your compromised liver with more drugs if you don't have to.  Check out this blog re the role of mid chain fatty acids in the diet required to balance LDL & HDL ...ultimately your stage of cirrhosis will dictate the amount of protein/ fats you can process but the nutrional science is again pointing to a diet devoid of detsructive grains and focused on fish,poultry,meat & veggies as being the most balanced approach to human body & mental health.

http://hopefulgeranium.blogspot.com.au/

http://www.forbes.com/fdc/welcome_mjx.shtml






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1475202 tn?1536270977
COMMUNITY LEADER
Thank you everyone for your replies. This post hardly seems fitting in this community but read on and I promise to tie it to the original.

Alcoholism runs in the family and at a pretty young age I just joined the rest of them. I built towards a good career but in my spare time I was drinking quite heavily. This pattern continued for more than 20 years and for the last couple of years before I quit if I was awake I was drinking, sadly I didn't know who I was without it. Nearly four years ago I was diagnosed with cirrhosis. I tapered my consumption to zero in less than a week and never touched it since nor will I ever again. Since then life is absolutely wonderful, I can't believe what I was missing. Today I know very well who I am and that has restored my confidence for the first time in years. So I am very thankful for today and every tomorrow. I understand very well what making life changes are all about, for me changing my diet will prove easy in comparison. I'm feeling excited about my next lipid panel in hopes of encouraging my cardio specialist to be more open to suggesting simpler more effective treatment technics since we're not all the same. Medication should only be prescribed as a last resort especially to cirrhotic patients.

Randy
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Avatar universal
I thought you might like to look at these 2 articles.

Statins Are Associated With a Reduced Risk of Hepatocellular Cancer

See:    http://www.natap.org/2013/HBV/021913_01.htm


Statins may protect cirrhotic patients from infection

See:   http://www.healio.com/hepatology/cirrhosis-liver-failure/news/online/%7B8e73b7db-38f5-45ba-b1ea-bf4ef8ba631f%7D/statins-may-protect-cirrhotic-patients-from-infection

Mike
Helpful - 0
1475202 tn?1536270977
COMMUNITY LEADER
Thanks Mike, I will be sure to take a look. It seems there could be some benefits to taking a statin depending on a persons liver health. In my mind the risk for me just doesn't yet seem worth taking although I'm glad to learn all I can if this is the route I end up taking.

As Dee mentioned above " If it turns out you can't change your diet and increase your exercise then you can revisit the statins".

I hope you are doing well Michael!

Randy
Helpful - 0
317787 tn?1473358451
Hi my husband was just diagnosed with high cholesterol and high triglycerides, we are trying diet. I found an article that said that grapes, salmon, spinach,beans, fresh fruit, and olive oil can help.

We are trying juicing one meal a day, it isn't bad, not bad at all.

I was shocked that I could put some kale, spinach, an apple, banana in a  nutri bullet and it would taste good.

Good luck

Mike, thank you for the good news about statins, I appreciate
Helpful - 0
1475202 tn?1536270977
COMMUNITY LEADER
UPDATE:

TL. Cholesterol- 131 so yay it dropped 5 more points.
AST- 31
ALT- 29

These are the lowest I have seen in many years! Should be happy about that but then bilirubin usually 2.3 or less just jumps up to a 3.0 now giving me a MELD of 14. INR has been climbing over the past 6 months from a consistent 1.1 to a 1.3.

I figure no big deal on the INR and maybe just a testing error on the bilirubin? Does anyone else have a different idea?

So anyway: It has been nearly four years since diagnosis (cirrhosis) and coming to terms I was unable to work anymore. During this time I have been able to stay actively involved with the build of our new home along with many other “online” functions. I feel pretty good most days though my memory and being able to focus my attention can be a challenge. Grade three varices also put my health at risk but so does getting hit by a bus. Haha! Bouts with HE though nothing serious enough to be hospitalized are sometimes a problem.

An opportunity to return to work as a broadcast engineer has presented itself and I’m excited to take it. I'm fortunate to be covered under my wife's insurance policy. So that's no problem. As always money is the problem but from my understanding I can try it for 9 months and make as much money as I can before any action will be taken. I will continue to receive my full monthly allowance for those 9 months. After which point I will lose my allowance but if at any point my disability proves to be a problem I can have my benefits reinstated immediately providing that I am still considered disabled. I plan to stick with this for the long haul but 60months/5yrs of having this option available sure gives me the security I need. My cirrhosis will never get better that's a fact, it can only get worse proving my disability more than before. For my circumstances work would provide me with not only a lot better income but physical exercise and challenges that exercise my mind. Interaction with others besides over the computer would be healthy too. The only question is how do I know if I can do it if I don’t try? SSA would have me believe I have nothing to lose by trying, I’m willing to take their word for it. The benefit far outweighs the risk in my mind.

Randy
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Avatar universal
I empathize with your situation and I know this decision is not an easy one.
I think you're smart to try to work.
I don't accept your statement that "My cirrhosis will never get better that's a fact..." I am a perennial optimist and I'm going to stay that way.

Good luck my Friend.

Mike
Helpful - 0
1475202 tn?1536270977
COMMUNITY LEADER
Mike you are a good man and you know I have always been grateful for your kindness and respective input.

“I don't accept your statement that "My cirrhosis will never get better that's a fact..." I am a perennial optimist and I'm going to stay that way.”

So then can cirrhosis be reversed? I know we can better manage our symptoms and control what we ingest and in return these things allow our liver to work easier giving us the illusion the cirrhotic portion of the liver is healing because liver function is getting better. Hence allowing the liver to better compensate. I have been a smoker for many years and my diet has not been so great either, a few months ago I changed my diet and stopped smoking cigarettes, I see the impact of this in my AST/ALT. Lowest it’s been in years, but this doesn’t mean my cirrhosis (scarring of the liver) has gotten any better. I have improved my chance of survival though, but my liver will remain as cirrhotic as it’s ever been. Making these lifestyle changes for some can determine the difference in transplant or not/life or death. Relieving the burden from the healthier potion of my liver is the only way to improve liver function allowing it to better compensate for the permanently damaged areas. If I started smoking again and my lab test got worse does that mean my cirrhosis advanced or simply my liver cannot compensate as well as it does now?

Staying positive is so important because it gives us the motivation we need to make lifestyle changes that are in many cases necessary to increase our survival. Just like anyone else strong mind and strong body will give you advantages, diminishing health or not.

I wish you well my friend,

Randy
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Avatar universal
So then can cirrhosis be reversed?

I have several articles that state that cirrhosis can regress. All of my articles focus on Hepatitis C and suggest that when a patient achieves Sustained Viral Responder status (SVR or "cure") that the liver histology does improve - even in cirrhotic patients - a stage or two. I recollect seeing similar results in cirrhotic patients with different underlying diseases but I don't have any of those articles on hand. I think that if HCV patients' histology can improve once the offending agent is removed (Hep C) then that should also translate to patients with different offending agents - such as alcohol, in your case? I know for quite a long time the standard line was that cirrhosis can never improve or regress but that axiom has, in my opinion, been debunked. And, moreover I see no upside to believing that your liver can not become healthier. You're doing all that you can do to help yourself get better and rejecting all the negativity and embracing a positive attitude cannot put you at any greater risk. I gotta run but that is the crux of the matter.
As always Randy I wish you the best.
Mike
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Avatar universal
I should not have said that after SVR the histology does improve. That is not true with all patients. But it can improve and does in a significant number of patients.
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4670047 tn?1375730401
Great post as always Mike!!!

Just really like your upbeat attitude Randy! Good luck to you buddy!!!!!

Kitty
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317787 tn?1473358451
Hi I was just passing by,thought I would stop in.  This is a great thread with lots of good information.  I am hoping my diet will improve my cholesterol.  My doctor has given me a chance to reduce it with diet.  If not then I have Mike's great information concerning statins.  You guys are the best!
Thank you
Dee
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1475202 tn?1536270977
COMMUNITY LEADER
Mike I had decided not to respond to your last post since I decided this debating issue is better left alone for those that want to believe liver disease can regress from decompensated to compensated. This gives people hope and inspires them. A new comment was made to an old thread about an hour ago and so I now find it relevant to link the two threads together.

http://www.medhelp.org/posts/Cirrhosis-of-the-Liver/Can-a-decompensated-liver-become-compensated/show/1983952
--------------------------------------------------------
SO now I will address the rest of your statement: “And, moreover I see no upside to believing that your liver can not become healthier. You're doing all that you can do to help yourself get better and rejecting all the negativity and embracing a positive attitude cannot put you at any greater risk.”

I maintain a positive attitude almost daily, embracing each day gladly and gratefully accepting the challenge to get the most from it as I possibly can but at times I need to face facts. Accepting the idea that liver transplant may someday become necessary is something every cirrhotic individual should consider. Consider the idea so that you can prepare your mental and physical status:

Mental: Adjusting to the idea of having a donor liver is not easy for some nor is accepting the complexity of the surgery but also learning all that you can about cirrhosis and how to care for yourself before and after TP.

Physical: Keeping your body strong and as healthy as possible, transplant surgery for anyone with heart disease, diabetes, high BMI and so on will only complicate an already difficult procedure.

These are facts we must face since no one can say with any certainty that transplant will not be required. In my four years living with cirrhosis I have been told transplant will be required in 5 years then in 10 years then possibly not at all and yesterday at the TP center from my hepatologist 10 years and my MELD is only a 12!  There are so many pieces of information on the internet one disputing the other, but in the end cirrhosis needs to treated as a progressive disease but then again this is just My opinion (another piece of information on the internet!).

Randy

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