When we are diagnosed with F4 MASH (cirrhosis) we are often told that it is irreversible and the medical strategy is to just manage symptoms. To be clear, there is a point of no return when a person is simply too ill to mount a defense, but before that the sense of hopelessness driven by the usual statement of "there is nothing we can do" is not useful.
I recently had a hernia repaired and, though it sounds odd, I welcomed the chance to get a look at my liver. I had gallbladder surgery in 2010 and the doc took this picture which led to him telling my wife that I had cirrhosis and only a few years to live.
That is an ugly image and certainly doesn't suggest a good outcome. We did, however, get good advice at the time and we took it seriously. That led to me not being dead, which I'm thankful for. The image below is from last week. Not the smooth look of a young liver, but clearly not what my surgeon predicted 15 years ago when he saw it.
When you look at my liver today, it is clear that it has been abused. It has been battered and bruised, but I am nearly 83. I will admit that, like most people, I never thought a single time about my liver until that surgery when I was 67. One of the highlights of this medical journey was a few years ago when my hepatologist said that he figured something other than my liver would kill me one day.
The point of this message is that medicine is too pessimistic about the chance for people with an F4 diagnosis to recover. They always say that once the scarring happens nothing can be done. The message to patients should be that scar resolution is a slow process but if the inflammation and constant abuse of the liver is stopped it can improve. The liver really wants to repair itself. The liver is like the skin, both can regenerate. We all have had cuts that have faded over the years. The liver will never become new again, but over time some percentage of that scarring can be reabsorbed if you don't continually re-injure the tissue.
The thing about scar tissue is that it is a complex process. It is collagen which you might think of as a somewhat like a polymer. It is a complex mix of cells and other materials with a scaffolding of collagen fibers. Collagen fibers go through a process as they mature and when fully zipped into their final triple helical form, those fibers are very robust. Before that, the body can reabsorb them more easily and can clear away the other cells and material in the developing scar. If you take away the continuing insults and provide a supportive environment for the remaining liver cells, they will seek ways to continue to do their job for you.
We are seeking drugs that will speed up these processes and perhaps one day even directly attack the scar tissue, but even with drug support, it will be key to develop personal habits which support liver health. That always starts with diet. If you would like to know how we think about that subject, try this link
This highlights the importance of early detection and screening. Cirrhosis is a preventable disease. We encourage everyone to speak to their doctors about liver health.
Getting physicians to be more proactive about liver disease is one of our current campaigns. To that end, we need patient information. I know you may have taken this survey before and we thank you, but if you have, it is important that you do it again. Our goal is to track the changes in patient care over time. We need to know how it is going for you over time. The changes are important. How is treatment changing, are new therapies being prescribed, are patients being educated? These are just a few of the questions we are trying to answer.
We can't press the system to do better if we can't show them data that change is needed, so please join us by clicking the link and take the survey.
THE 2025 STATE OF STEATOTIC CARE SURVEY
If you would like to read the report from last year, here is a link to that one.
The State of Care 2024 Lay Report
Or you might find the poster presented at the 2024 conference for the American Association for Study of Liver Disease interesting.
Poster Presentation at AASLD Conference
On another subject:
Many people don't know what services are available to them in their local area. Finding those local resources in their local zip code is often a challenge. We are developing a tool to help with that. Just click on the link below: enter your local zip-code in the form: to explore the services available to you in your area.
