STAGE 4 CIRRHOSIS,GRADE 2 INFLAMMATION,NASH

[TIDEGIRL]

Greetings,
In May a liver biopsy revealed I have Stage 4 Cirrhosis/Grade 2 Inflammation caused by NASH.  My liver is currently "well compensated".  I  was not obese, a drinker or drug user.  In Nov 2008 I had a liver profile done at the insistance of my sister who had discovered she had 2 mutant genes (C282Y and H63D) and wanted me to be tested for them.  I tested negative for the C282Y and HETRZYG for the H63D,  I don't know what that means on the H63D, because the test revealed my ALT/AST both were in the high 180's & that became the focus.  Subsequent testing for Hepatitis C, Wilson's, Hemochromatosis, Autoimmune Hep, showed negative.  Ultrasound and Cat scan showed nothing, but by April the ALT/AST were in the high 300's and climbing.  Hence, the biopsy.
I'm on a 1200 cal 2000 mg. sodium diet.  Other than that, no meds.
My only other diagnosed med problems are osteoporosis and mild Barrett's Esophogeous.
I am in a very stressful job that requires 12-14 hour days/6 days a week. I'm very tired and have been for about a year. The one day off is not lending itself to letting me to gain strength like it used to.

Here are my questions:  (1) Can this job contribute to shortening how long my liver will continue to compensate?
No matter how strict I am with my diet guidelines.   (2) Strictly speaking from an empirical standpoint, what is the average number of years that someone in my condition can honestly expect to go without the liver decompensating?


I have life choices I want to make.  It is my thinking that if I were a drinker, I could just stop drinking.  But, since I have no earthly idea what caused this insidious thing, then it can still be attacking me.  
I'm a realist and if my job is going to cause me to deteriote quicker, well then I need to do something about that.
Right now I am seeking quality of life more so than length, which I suppose we all should.

Can you help me re-group and prioritize, based on what your expertise has shown you.?

[Thomas D Schiano, MD]

heterozygosity for the the HFE gene mutation alone does not convey an increased incidence of liver disease.  the magnitude of the elevation in liver tests is frankly not typical for NASH, so i would look for something else, like celiac disease or drug hepatotoxicity.  You might need to get a second opinion regarding the biopsy interpretation.

People can go many years-decade with cirrhosis and not decompensate although the specter of HCC is always there.  Although there is no direct evidence that stress will accelerate the course of one's liver disease, stress cannot be good for you overall.  it will increase fatigue, etc.  If you could ease soem of your stress at the workplace i think it'd be beneficial for you.

[TIDEGIRL]

Thank you very much for your insight.  It actually fortified what I felt was sensible.
This might also explain why the "Fatty Liver/Nash" did not appear on the CAT or Ultrasound.

Thanks Again,
Tidegirl