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Exercise for cirrhosis of the liver
My wife has cirrhosis of the liver due to alcohol abuse. She is no longer drinking and is getting better. We got a scare when she started talking gibberish and just seemed out there; that's when we went to the Dr. and found out she has cirrhosis. 1 month later she started throwing up blood. We got that taken care of and now she is on the road to recovery (I hope). Anyway, she finally agreed to go to the gym with me, but I want to do it right. I read a book called "Hepatitus C cured" and how the author started training for a marathon and turns out that training helped drive certain enzymes into the liver that helped it along the way (I know she does not have Hep C, but the cirrhosis they both have in commom is what I am thinking about). I believe however that that book was written before HIIT traing wwas very popular, so my question is:
Which is best to help my wife recover as much as popular?
Which is best to help my wife recover as much as popular?
Hector,
Thank you for your detailed reply. I would like to clarify a few things however. I am not a huge fan of the western medicine train of thought (believe me I am 100% american, raised in Oregon and am quite honored and lucky to have what we have; including medice), western medicine seems to concentrate on "drugging up the symptoms" and not helping the body do what it is designed to do; and that is heal itself, that is in short what our bodies do 24 hrs. a day.
I am looking for answers on what is best to do, outside of the hospital,along with the medication. I have listened to Dr.s tell us no protein, no this no that, don't move around rest rest rest. Rubbish! No protein! So even if we survive the cirrhosis we die from our body eating itself to death! How about no animal proteins! What is wrong with vegetable proteins....Nothing, perfectly fine! But they do not tell you that. Lay in bed all day! Are you kidding me! That would kill me right there! You have to get you muscles working, you have to get your body going; take it easy, start slow, yes. But dont just lay in bed, fight off depression and wait for the inevitable.
The mental and spiritual part of this is just as (if not more) important than the physical part.
I di not just read an article on the internet. I read a book about a man who has been through this and come out on top. I have gone to forums (Like this one) and talked to people (Like your self), I have done research and know for a fact that the Dr.s generally just prescribe medicines and talk to you about taking it easy, they have already decided you time is limited.
I need to know what we can do, not just lay around.
Now, all that being said; we are seeing the Dr. we are going to see a liver specialist. I WILL NOT deny my wife access to healthcare, but I/we need more than what they are telling us, I know there is much more by talking to people such as your self (and thank you again by the way).
I know she can be exercising (not weights), maybe some walking, bike riding, rowing etc.
Given what you say about the varices, perhaps then the lower intensity, longer duration training would be best.
Your thoughts?!
Thank you for your detailed reply. I would like to clarify a few things however. I am not a huge fan of the western medicine train of thought (believe me I am 100% american, raised in Oregon and am quite honored and lucky to have what we have; including medice), western medicine seems to concentrate on "drugging up the symptoms" and not helping the body do what it is designed to do; and that is heal itself, that is in short what our bodies do 24 hrs. a day.
I am looking for answers on what is best to do, outside of the hospital,along with the medication. I have listened to Dr.s tell us no protein, no this no that, don't move around rest rest rest. Rubbish! No protein! So even if we survive the cirrhosis we die from our body eating itself to death! How about no animal proteins! What is wrong with vegetable proteins....Nothing, perfectly fine! But they do not tell you that. Lay in bed all day! Are you kidding me! That would kill me right there! You have to get you muscles working, you have to get your body going; take it easy, start slow, yes. But dont just lay in bed, fight off depression and wait for the inevitable.
The mental and spiritual part of this is just as (if not more) important than the physical part.
I di not just read an article on the internet. I read a book about a man who has been through this and come out on top. I have gone to forums (Like this one) and talked to people (Like your self), I have done research and know for a fact that the Dr.s generally just prescribe medicines and talk to you about taking it easy, they have already decided you time is limited.
I need to know what we can do, not just lay around.
Now, all that being said; we are seeing the Dr. we are going to see a liver specialist. I WILL NOT deny my wife access to healthcare, but I/we need more than what they are telling us, I know there is much more by talking to people such as your self (and thank you again by the way).
I know she can be exercising (not weights), maybe some walking, bike riding, rowing etc.
Given what you say about the varices, perhaps then the lower intensity, longer duration training would be best.
Your thoughts?!
COMMUNITY LEADER
Your wife needs to see a liver specialist (a hepatologist) before making any changes in her lifestyle and needs to have her liver disease accessed. Only when she has had a full evaluation of her liver disease (cirrhosis) can a medical doctor advice her what is helpful and what is harmful.
I person with cirrhosis of the liver is very ill and should not be advised by anyone other than a liver specialist on how to manage their health.
For example you said your wife had vomited blood. This is caused by varices (enlarged veins usually in the esophagus bursting). This is a sign of advanced cirrhosis. A person which portal hypertension which causes the veins to burst must avoid certain types of exercises that increase blood pressure. Certain exercises can cause these veins to burst again. A person that has has a pervious bleed is more likely to have future bleeding episodes. Variceal bleeding can be FATAL! If the blood loss is so great that a patient can go into shock. This can lead to death.
Esophageal varices are abnormal, enlarged veins in the lower part of the esophagus ( the tube that connects the throat and stomach). Esophageal varices develop when normal blood flow to the liver is obstructed by scar tissue in the liver or a clot. Seeking a way around the blockages, blood flows into smaller blood vessels that are not designed to carry large volumes of blood. The vessels may leak blood or even rupture, causing life-threatening bleeding. Anyone with cirrhosis and portal hypertension should be taking a nonselective β-blockers such as Propanolol and Nadolol lower portal pressure by dropping the heart rate and thus the blood pressure. A hepatologist would assess the amount of portal hypertension, look for other varices throughout the GI track and monitor them and if needed perform banding to prevent future bleeding.
Whether your wife liver disease has gone to far to recover even though she has stopped drinking can only be determines by a hepatologist at a liver transplant center. There is a point where the liver is too damaged to repair itself. It is important to have her liver disease monitored on a regular bases so see if it is improving or time or not. Also since your wife has had cirrhosis she needs to have surveillance for liver cancer every 6 or 12 months. Liver cancer can be fatal if not caught early.
"now she is on the road to recovery (I hope)"
Unfortunately once a person has had advanced cirrhosis health issues related to the liver and other body systems don't just go away. A person who has vomited blood and had hepatic encephalopathy (she started talking gibberish and just seemed out there) has had very serious liver disease. Things that a normal healthy person can do can not always be done by someone with cirrhosis. A simple over the counter pain med such a aspirin or any NSAID can cause serious health issues such as internal bleeding and kidney failure. While she may look okay on the outside doesn't mean she is healthy. Just like people with cancer can look normal and healthy until they reach stage 4 cancer.
For someone with cirrhosis who has had a previous bleeding episode there is a potential risks of bleeding during strenuous exercise. For example lifting heavy weights.
Your wife should be under the care of a hepatologist at a liver transplant center ASAP. They are the only ones who can assess her current condition and manage her liver disease. SInce you are in Fremont and I am here in San Francisco there are 3 transplant centers in the Bay Area. Stamford, CPMC and UCSF in San Francisco. Since I have been treated at UCSF and just had a liver transplant 3 weeks ago there I would recommend your wife seeing someone there. Her gastroenterologist can give her a referral to UCSF so she can be seen there.
Remember advanced cirrhosis is a very serious life-threatening illness. Without proper care it can be fatal. Unfortunately I have know more than my share of people with cirrhosis who waited to long to get proper care or did not take care of themselves, as all cirrhotics must who are no longer with us. Please don't think risk your wife life based on some articles you read on the Internet. Help her get the best medical care she can. There are other people in other parts of the country that don't have access to the care we have here in the Bay Area. Take advantage of what we have here in this part of the country. Serious illness such as cirrhosis needs proper care and monitoring to have the best outcome.
A few things every cirrhotic should know and that a hepatologist would tell them.
Medications (over‐the‐counter and prescribed by other physicians)
Patients with cirrhosis should avoid pain medications called “non‐steroidal anti‐inflammatories (NSAIDS). These include over‐the‐counter medications such as ibuprofen (Motrin, Advil), naprosyn (Aleve), as well as some prescription medications. Ask your doctor if any of your medications are NSAIDS.
For mild to moderate aches and pains, it is safe to use Tylenol (acetaminophen) at doses of 2,000 mg/day or less (no more than 6 regular strength or no more than 4 extra strength each day AND no more than 20 regular strength or no more than 15 extra strength each week). Some cold medicines and prescription pain medicines contain acetaminophen, so read the labels and make sure you don’t take too much by mistake.
Most other prescription medications are safe for the liver. You are not at
increased risk of side effects just because you have cirrhosis.
Surgery
Surgery can be quite risky in patients with cirrhosis. If you are consideringhaving any type of surgery, please be sure to ask your hepatologist (UM liver specialist) if this is safe for you. If there are any concerns, please ask your surgeon to talk to your hepatologist.
Hospitalizations
It is very important for us to keep track of any hospitalizations you have.
Please call your liver transplant center if you are admitted to an outside hospital.
Screening for liver cancer
People with cirrhosis are at increased risk for liver cancer. All patients withcirrhosis should have an ultrasound and blood test called an AFP blood test every 6 months.
Although these tests are not perfect, they can often detect the tumor
when it is small before people develop symptoms. If the ultrasound or AFP is abnormal the next step is MRI or CT scan.
Vaccination
If you have never been vaccinated against hepatitis A or B, we will check to see if you are immune (already have protection). If not, we will recommend vaccination, which can be arranged to be done near your home. The
schedule is shots at 0, 1, and 6 months.
The yearly influenza vaccination (flu shot) is also recommended. It is important that you receive the inactivated vaccine (injection), not the live form
(nasal drop).
To be seen at UCSF...
To schedule your first appointment at the UCSF Gastroenterology and Liver Clinic, please fax the following information to (415) 353-2407:
* A referral letter, including your current diagnosis, from your primary care doctor or specialist.
* All related doctor's notes, and lab and test results.
* Copy of your insurance card (front and back).
The center accepts most health insurance plans. Some insurance plans won't cover the full amount and you will be responsible for the remainder.
* Call your insurance representative to confirm eligibility, benefits, co-pay and deductible amounts.
* Copy of authorization from insurance, if required.
* Your contact information, including mailing address and phone numbers.
If you have any questions, please call the clinic at (415) 353-2318.
Good luck to the both of you!
Hector
I person with cirrhosis of the liver is very ill and should not be advised by anyone other than a liver specialist on how to manage their health.
For example you said your wife had vomited blood. This is caused by varices (enlarged veins usually in the esophagus bursting). This is a sign of advanced cirrhosis. A person which portal hypertension which causes the veins to burst must avoid certain types of exercises that increase blood pressure. Certain exercises can cause these veins to burst again. A person that has has a pervious bleed is more likely to have future bleeding episodes. Variceal bleeding can be FATAL! If the blood loss is so great that a patient can go into shock. This can lead to death.
Esophageal varices are abnormal, enlarged veins in the lower part of the esophagus ( the tube that connects the throat and stomach). Esophageal varices develop when normal blood flow to the liver is obstructed by scar tissue in the liver or a clot. Seeking a way around the blockages, blood flows into smaller blood vessels that are not designed to carry large volumes of blood. The vessels may leak blood or even rupture, causing life-threatening bleeding. Anyone with cirrhosis and portal hypertension should be taking a nonselective β-blockers such as Propanolol and Nadolol lower portal pressure by dropping the heart rate and thus the blood pressure. A hepatologist would assess the amount of portal hypertension, look for other varices throughout the GI track and monitor them and if needed perform banding to prevent future bleeding.
Whether your wife liver disease has gone to far to recover even though she has stopped drinking can only be determines by a hepatologist at a liver transplant center. There is a point where the liver is too damaged to repair itself. It is important to have her liver disease monitored on a regular bases so see if it is improving or time or not. Also since your wife has had cirrhosis she needs to have surveillance for liver cancer every 6 or 12 months. Liver cancer can be fatal if not caught early.
"now she is on the road to recovery (I hope)"
Unfortunately once a person has had advanced cirrhosis health issues related to the liver and other body systems don't just go away. A person who has vomited blood and had hepatic encephalopathy (she started talking gibberish and just seemed out there) has had very serious liver disease. Things that a normal healthy person can do can not always be done by someone with cirrhosis. A simple over the counter pain med such a aspirin or any NSAID can cause serious health issues such as internal bleeding and kidney failure. While she may look okay on the outside doesn't mean she is healthy. Just like people with cancer can look normal and healthy until they reach stage 4 cancer.
For someone with cirrhosis who has had a previous bleeding episode there is a potential risks of bleeding during strenuous exercise. For example lifting heavy weights.
Your wife should be under the care of a hepatologist at a liver transplant center ASAP. They are the only ones who can assess her current condition and manage her liver disease. SInce you are in Fremont and I am here in San Francisco there are 3 transplant centers in the Bay Area. Stamford, CPMC and UCSF in San Francisco. Since I have been treated at UCSF and just had a liver transplant 3 weeks ago there I would recommend your wife seeing someone there. Her gastroenterologist can give her a referral to UCSF so she can be seen there.
Remember advanced cirrhosis is a very serious life-threatening illness. Without proper care it can be fatal. Unfortunately I have know more than my share of people with cirrhosis who waited to long to get proper care or did not take care of themselves, as all cirrhotics must who are no longer with us. Please don't think risk your wife life based on some articles you read on the Internet. Help her get the best medical care she can. There are other people in other parts of the country that don't have access to the care we have here in the Bay Area. Take advantage of what we have here in this part of the country. Serious illness such as cirrhosis needs proper care and monitoring to have the best outcome.
A few things every cirrhotic should know and that a hepatologist would tell them.
Medications (over‐the‐counter and prescribed by other physicians)
Patients with cirrhosis should avoid pain medications called “non‐steroidal anti‐inflammatories (NSAIDS). These include over‐the‐counter medications such as ibuprofen (Motrin, Advil), naprosyn (Aleve), as well as some prescription medications. Ask your doctor if any of your medications are NSAIDS.
For mild to moderate aches and pains, it is safe to use Tylenol (acetaminophen) at doses of 2,000 mg/day or less (no more than 6 regular strength or no more than 4 extra strength each day AND no more than 20 regular strength or no more than 15 extra strength each week). Some cold medicines and prescription pain medicines contain acetaminophen, so read the labels and make sure you don’t take too much by mistake.
Most other prescription medications are safe for the liver. You are not at
increased risk of side effects just because you have cirrhosis.
Surgery
Surgery can be quite risky in patients with cirrhosis. If you are consideringhaving any type of surgery, please be sure to ask your hepatologist (UM liver specialist) if this is safe for you. If there are any concerns, please ask your surgeon to talk to your hepatologist.
Hospitalizations
It is very important for us to keep track of any hospitalizations you have.
Please call your liver transplant center if you are admitted to an outside hospital.
Screening for liver cancer
People with cirrhosis are at increased risk for liver cancer. All patients withcirrhosis should have an ultrasound and blood test called an AFP blood test every 6 months.
Although these tests are not perfect, they can often detect the tumor
when it is small before people develop symptoms. If the ultrasound or AFP is abnormal the next step is MRI or CT scan.
Vaccination
If you have never been vaccinated against hepatitis A or B, we will check to see if you are immune (already have protection). If not, we will recommend vaccination, which can be arranged to be done near your home. The
schedule is shots at 0, 1, and 6 months.
The yearly influenza vaccination (flu shot) is also recommended. It is important that you receive the inactivated vaccine (injection), not the live form
(nasal drop).
To be seen at UCSF...
To schedule your first appointment at the UCSF Gastroenterology and Liver Clinic, please fax the following information to (415) 353-2407:
* A referral letter, including your current diagnosis, from your primary care doctor or specialist.
* All related doctor's notes, and lab and test results.
* Copy of your insurance card (front and back).
The center accepts most health insurance plans. Some insurance plans won't cover the full amount and you will be responsible for the remainder.
* Call your insurance representative to confirm eligibility, benefits, co-pay and deductible amounts.
* Copy of authorization from insurance, if required.
* Your contact information, including mailing address and phone numbers.
If you have any questions, please call the clinic at (415) 353-2318.
Good luck to the both of you!
Hector
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No hepatologist would tell a patient who has cirrhosis…no protein, lay in bed, rest, rest, rest, etc. Those recommendation will only make the patient more ill. Their job is to keep the patient as healthy as possible, for as long as possible and try to stop the cause of the liver disease if possible or when the time comes help the patient get a liver transplant so they can continuing living.
I am not talking about something I have read or heard about but something I’ve been living for the last 6 years and the only reason I am still living is because of my hepatologist and transplant center. I had a liver transplant only 3 ½ weeks ago after fighting cirrhosis for 6 years and liver cancer for 2 ½ years. Without the transplant center’s staff there is no question I would not be alive now. I am speaking from personal experience and I have all scars to prove it. I had my 54 surgical staples removed last week. It don’t mean I know all the answers or anything so foolish but I have learned the hard way what it takes to survive advanced liver disease and cancer. It isn’t easy or nice and will probably the toughest thing you will ever face BUT it is doable. I am living proof of how a person can be saved even against the odds. Myself and many of my friends are still alive because some very generous person donated their liver upon their death to us. I am 61 years old and I have a 36 year old female liver inside of me that allows be to live and type this letter. All I am trying to say is I don’t want your wife to have to suffer what we have been through if possible. That is all I am trying to say based on what I myself know and the hundreds of transplant patients I have meet in the last 4 years of my life.
I think the mental and spiritual part of us is equally important. In fact I believe the toughest part is not the physical pain but the mental anguish of dealing with death on a daily basis. I have my support groups and therapists that have been invaluable in getting me mentally prepared either to die or get through this in one piece. I actually found a lot about myself and if a strange way have found facing death the most enlightening experience of my life. But I didn’t volunteer for it. None of us do. But I figured I may as well learn from what I had to go through so I could see it as something that could be good as well as bad.
I am not sure what you have read but I can tell you from my experience and my friends our doctors tried in every way to save our lives. I have a very close relationship with my hepatologist. We have been working together for over 6 years now. She knows me and I know her. We have been through it all. Only 2 months ago she told me that I didn’t have much time left to live because of my cancer so she said her goal was to get me to transplant someway somehow. So she advocated for me so the hospital would try an experimental treatment on my cancer. She got me the treatment and amazingly it worked. I got a transplant 1 ½ weeks later. I had untreatable liver cancer yet they were able to get it under control enough so that I could get a transplant and be alive today. What can I say? My life was literally in the hands of others. I couldn’t save myself. They never said we give up because the odds were about 1 in 100 that I would make it this far. I knew all the doctors who were trying to save my life. And we went through the failures together. They also gave me hope because they keep on trying their best to help me even though my case was unique and they never saw anyone with my situation before. And this is a transplant center that has done over 3,000 liver transplants.
What can you do? A lot. Please try to hear what I am saying. If I could help your wife I would but only a hepatologist can along with all of the liver team of doctors that are involved in the care of a person with advanced cirrhosis. They will tell her the best diet, the best way to stay as healthy as possible including exercise, medications that can prevent life threatening complications of advanced cirrhosis, so many things that I could never say. Advanced liver disease is a very complicated illness. But we can learn about it and how we can best live with it. That is what hepatologists do. They can also answer all your questions so you understand what is happening to a person’s body and mind as they live with the disease.
Yes, the lower intensity, longer duration training would be best. I did yoga and life LIGHT dumbbells for as long as I could before transplant because the healthier you are going into transplant usually the quicker your recovery. The low impact exercise keeps the blood pressure from rising, which is a problem with cirrhosis and portal hypertension. If I couldn’t do anything else some days I could always walk even if it was just to the door. Exercising helps BOTH our mental health and bodies. Laying around can lead to depression and our bodies muscles atrophy very quickly if not used. Ask anyone who has ever been in a hospital. In fact the first thing you do after your transplant is start walking with a walker ASAP. They get you up and out of bed a day or two after you get out of ICU. You can never go wrong walking. Most of us are limited by our fatigue rather than our muscles themselves. Also it is very important to try to life even day as fully as we can when we have any ailment. We are not our disease. We are still us and we need to try to be as normal as we can be for our own mental well being. We must stay positive and hopeful as we can. Every day is precious. Make the best of it. Every day we are alive is a victory if we choose to look at it that way. Never, never, never give up, as Churchill said.
If there is any way I can help you and your wife let me know. I have helped others in the US get seen at liver transplant center and some people even listed for transplant. At first it all seems overwhelming but it is all doable just take it one step at a time and it can be done. I am no different than anyone. I learned from others and found my way to be here today. And that I am so very grateful for.
All the best.
Howie