HopefullXOXOXO

It sounds like your in the Boston area. You have one of the top Liver specialist in the USA at Lahey Clinic Dr. Roger Jenkins. He has been voted top in his field by Specialists in his field . He has his own wing at Lahey. Above all he is the sweetest physician you will ever met. He has managed me for over 12 years and I'm still healthy. As a FYI Brigham and Women in Boston gave me 3 months to live with metastatic Pancreatic Cancer from IPMN. He was a second opinion I went to and never left. Good luck

Do you have anyone looking into your gallbladder issues??? I had severe pains for awhile ,long story short I actually ended up having gall stones blocking my liver. I started turning yellow. If your having color problems you may need to just go to an er. They will get you the doctors you need. Without having to wait to see one.

Under abdominal sonography (ultrasound) it tells you the stage (grade) of your fatty liver.. mine was grade 1, my surgeon said not to worry about it.. My father has both sludge , small stones and fatty liver grade 1; so far he's been doing good..
Fatty liver grade 1 is nothing.. so try to ask them for the grade of ur fatty liver..
If your biopsy is good then your all set and it's not cuz of liver failure or something. Your liver enzymes must hit 2ice a normal or around 500+ to say something around hepatobiliary tract might be wrong..
Your symptoms could be cuz of ur GB and not the liver..
Hang in there hope you feel better soon and hear some great news
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I've been going to Mass. General for many years and have always had wonderful care there. So I've been very surprised by the weight loss center. Like I said though, the nutritionist who led the support group after surgery, retired last year and I think her heart just wasn't in it. I do think the weight loss center should have doctors available for after care. I've told this to several people at MGH. I really appreciate all the responses and now feel like I'll be able to get somewhere. I do have to take some responsibility though since I didn't even know there are doctors that specialize in liver disease. Now that I know what to ask for, I hope I'll get the answers I'm looking for.

Azin,
I don't know the grade of liver disease. I'll be sure to ask this question as I wasn't even aware there are grades.
I was not given the meds for GB because surgeon said there are a lot of side effects and didn't recommend it. I do have pain under my ribs on the right side. I've also had GB "attacks", where I get shooting pain up into my chest and in my back. I get nauseous but haven't vomited, yet. I'm more worried about my liver since you can live without a GB, can't live without a liver. A few people have commented on my color being off too. My liver was fine through biopsy day of surgery and now I'm told it's "fatty liver disease". Trying to figure out why so I can do something about it.

Hello Lisa, how are you doing?

first, what is the grade of your fatty liver?
Garde 1 doesn't even count my dear.. grade 2 is also mild..

Did you take medication for your GB during your wl? I have no stones but I receive ursodeoxycholic acid once a day as prophylaxis..

Also my dear do you have any pain in your upper right side of tummy? Or even the upper middle part?
Do you vomit or have GB stone symptoms?
If not, it doesn't matter at all.. no worries hon

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And another reason for Right Subcostal pain is Jejuneal ulcerations, many, myself included, retain just enough acidic gastric juices to wreak havoc on your small intestine, be it duodenal or jejuneal, I Will carry carry scarring the remainder of my missbegotten LIFE and be at risk for (gasp) stricture, stenosis and torsion, and I have a gastroenterologist sworn paperwork on THAT!

@HopefullXOXOXO, since your program is being pretty useless, you may want to call mine at Newton Wellesley and ask for referrals. My surgeon is in my profile. I hope they can help you!

This happened to my mom a few years backs. She'd had an infection that required several rounds of antibiotics, she's Diabetic, not in the best health, but not taking insulin, or severely obese. And all of a sudden her liver enzymes were up, her scans showed it to be fatty and enlarged.
She's always been a teatotaler, so the Dr. looked a bit closer. Figured out the combo of meds led to the liver problem, which many varieties can do this. Put her on a Liver detox/cleanse, sorry I can't recall what exactly but I had to take a liver cleanse before my sleave surgery.
(Rather than take meds, I used 'Green' and started a month early, with my delighted Dr.s approval. I put the pics in, I got them at Amazon, great prices with subribe and save.)
As for the Gallbladder, sorry to say, but sometimes they just go bad. Mine went bad suddenly, well maybe not. I ignore pain really well. So, my first symptom was puking everything even Water, followed by an er visit, cuz 48 hrs without liquid while puking equals baddd. 7 days later, my GB was removed, it was "ugly".
Since then I have encountered many people with similar stories. If you manage to keep it, have some pineapple with every meal, and avoid iceberg lettuce. In fact, go for the greens that are thicker, like fresh spinach, butter lettuce, baby hearts of romaine... These things are true for if you lose it as well.
Sorry if I sound bossy, but I want to save you pain.
Speaking of, moist heat or a heating pad on low will help with your gallbladder pain.
Unfortunately, you may find even if you get to keep you GB, that some meats won't sit well anymore. And it is different for everone.
I take Papaya enzymes to help out. Most use pineapple enzymes, I'm allergic. It might be enough to keep you GB, don't know.
But, the cleanse and enzymes can't hurt.
And seeing a Neurologist that is a diagnostician or at least is willing to be put in charge of all you meds and drs to make sure that they aren't working against each other.
That's who we had for my mom, as soon as the levels came back off, our primary sent her over to the neuro we worked with as a central hub.
I hope this has helped in some small way.  

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are you sure it's liver disease? It's common for liver enzymes to be high for a year or two after WLS because of the rapid weight loss. Rapid weight loss is really hard on livers. My AST and ALT values were really high for awhile, but by two years out, they were normal. My PCP at the time at first suspected fatty liver disease when she saw those values, but when I reminded her that I'd had WLS, she said it might have been that and if that was the case, they'd eventually normalize, and they did. So - no liver disease. At least not in my case.

P.S. edited to add that I didn't have an ultrasound, though - it was just a blood test. But yes - high liver enzyme values until about two years out.

Thanks E.P. The only person who mentioned the fatty liver disease was the CNP who ordered the ultrasound and labs to check pain I was having in that area. All this time, I thought it was just the gall bladder. She advised I "lose weight and eat a healthy, low fat, low sugar diet." I had to tell her I had the sleeve surgery 18 months ago. Thank you for the suggestion. I'll take it!

It sucks that your doctors are just trying to pass the buck. So is it not “official” that you have liver disease? I’d find a new PCP at a different practice and go from there, see if they’ll refer you out to a Hepatologist ( doc that specializes in livers) to get some real answers

I can't speak for your specific case, but in general, the liver is stressed by metabolizing all of that fat that we are losing so quickly - this is why many surgeons advise against consuming any alcohol during that first year or so of rapid weight loss (the liver doesn't need any additional stress from a liver toxin like alcohol). So, liver numbers in blood tests are often abnormal for a while during this loss phase and for some time after; whether that extends to a physical fatty liver diagnosis from an ultrasound, I don't know.
My surgeon is also a liver guy (does transplants in his "spare time") so these things get discussed in general in the support groups, though I never had occasion to talk any specifics with him. It is hard to say if your surgeon is just being casual about it because what he sees is fairly normal, or is something beyond his job description and experience. While they may not have anyone else within the bariatric department who is more knowledgeable, they certainly have a liver disease department there that will have a hepatoligist that you can talk to. The problem is that they may not be that familiar with bariatrics and rapid weight loss so may want to go farther in treatment than is necessary - they may need to get their heads together between the two departments to determine what is really going on.
Good luck...

((hugs)) What advice are your doctors giving you? Have you seen a liver specialist? What stage is your fatty liver?

Yeah, MGH is one of the top hospitals. I was very surprised they weren’t being more helpful.

Hey there...I just looked at the Massachuesetts General Hospital website and they have 8 gastroenterologists/internists that specialize in non alcoholic liver disease. I would ask your PCP and surgeon for an ASAP referral because something is up and you need answers sooner than later. If you are not getting anywhere with them, contact the patient advocate at the hospital and ask them (nicely😃) for help at getting you seen by a specialist. Stay away from the tylenol for sure until you know what is going on. You need your liver to live so please get on the phone ASAP and start the process.
I had my sleeve the day before you did and my liver enzymes were very slightly elevated at the time of surgery which my surgeon said was common with morbid obesity. He said my liver look "perfect" at the time of surgery and when I had the labs checked again at 6 months and i8 months out the enzymes were completely normal. Good luck and please be your own advocate.

I really can't thank everyone enough for your responses! Very grateful to have some concrete things to look into. One of the thoughts I've had is that I've used Unjury brand Protein Bars and powers as well as their Vitamins on a daily basis since the surgery and want to look into this as well. You never know....

Wow FluffyChix, you've done great! Very happy for you.
The reason I came here with my question is my doctor (surgeon) doesn't want to deal with this. He says "I'm the surgeon", ask your primary care. My primary care says "I'm not a weight loss specialist, the weight loss center should be helping you with this." The hospital, Mass General in Boston, Ma., for some reason, doesn't have a doctor, other than the surgeon, for me to talk to about this. It's very frustrating. All I was told was to eat low fat and low sugar. I'm already doing that. The only other thing I was told is to stay away from Tylenol and other pain killers. My question: for LIFE? Really? Not realistic.
I'm sorry to say that Mass. General's weight loss program isn't good. At least it hasn't been for me. The surgery itself was done very well and I have no complaints about that at all. All other follow up, like with a nutritionist, etc. was pretty much useless. They didn't give me any information I didn't already have and could have easily found online. The post op support is non existent. I could have been the nutritionist I saw because she did retire about 6 months after my surgery. Her heart just wasn't it in. It's my opinion they should have other doctors who are knowledgeable about WLS to help patients who have problems post op. Maybe it's just me.
Bottom line, I have no idea what stage it is. I just know that's what the ultrasound showed and that my liver enzymes are high. ??? The ultrasound results say:
echogenic liver parenchyma which may be related to underlying liver
disease
Perhaps I should see a liver specialist. I didn't even know there are specialists for the liver. Makes sense.

Thanks E.P. The only person who mentioned the fatty liver disease was the CNP who ordered the ultrasound and labs to check pain I was having in that area. All this time, I thought it was just the gall bladder. She advised I "lose weight and eat a healthy, low fat, low sugar diet." I had to tell her I had the sleeve surgery 18 months ago. Thank you for the suggestion. I'll take it!

Thank you Rick. I appreciate this information. I will look into seeing a liver specialist to get to the bottom of this.

Wow FluffyChix, you've done great! Very happy for you.
The reason I came here with my question is my doctor (surgeon) doesn't want to deal with this. He says "I'm the surgeon", ask your primary care. My primary care says "I'm not a weight loss specialist, the weight loss center should be helping you with this." The hospital, Mass General in Boston, Ma., for some reason, doesn't have a doctor, other than the surgeon, for me to talk to about this. It's very frustrating. All I was told was to eat low fat and low sugar. I'm already doing that. The only other thing I was told is to stay away from Tylenol and other pain killers. My question: for LIFE? Really? Not realistic.
I'm sorry to say that Mass. General's weight loss program isn't good. At least it hasn't been for me. The surgery itself was done very well and I have no complaints about that at all. All other follow up, like with a nutritionist, etc. was pretty much useless. They didn't give me any information I didn't already have and could have easily found online. The post op support is non existent. I could have been the nutritionist I saw because she did retire about 6 months after my surgery. Her heart just wasn't it in. It's my opinion they should have other doctors who are knowledgeable about WLS to help patients who have problems post op. Maybe it's just me.
Bottom line, I have no idea what stage it is. I just know that's what the ultrasound showed and that my liver enzymes are high. ??? The ultrasound results say:
echogenic liver parenchyma which may be related to underlying liver
disease
Perhaps I should see a liver specialist. I didn't even know there are specialists for the liver. Makes sense.

Taoz- I'm very proud of you and VERY happy for you! I hope you feel as good as you look!

I was sleeved 5/3/18 at 235 pounds, 65 years old. I mention the age because I was capable of doing much more exercise, even just ten years ago. I'm now 171 pounds. The first 40 pounds came off in the first 3 1/2 months. Since then it's been slow for me, but still going down. I'm following the eating plan and doing "silver sneakers aerobics" 2 times a week. My doctor told me ahead of the surgery that a post menopausal woman's metabolism is slow. I know it would be faster if I could do more exercise but I also have chronic fatigue syndrome, which is why I got the surgery to begin with. If I could have lost this weight the old fashioned way, I would have. I'd done it many times before. I had hope for more energy after the surgery and have had a few really good days, but nothing consistent. The best news for me is that whatever I have to do is MUCH easier for me now. Hoping with summer coming to get out more and walk more. The only thing that happened to me that was concerning since the surgery is I had some pain/tenderness in my right abdomen and it turned out to be gallbladder sludge. I still don't understand why I have this since if people get it after surgery it's usually because they lost a lot of weight really fast. By Sept '18 my weight loss had already slowed quite a bit and it wasn't until just before Christmas I began having the symptoms. Had the ultrasound just before Christmas. Then, not knowing yet what it was, I did treat myself Christmas Eve, Christmas Day & New Year's Eve. On N.Y.'s day, I had a stabbing pain that radiated up into my chest and around my back. It was scary. Doctor told me the next day it was cuz of the GB. Since then, I've been very good about low fat again and learned my lesson. I do still have the tenderness from time to time, but nothing like NY's day. Other than that, I've been great. I'm very happy I did this.

Thanks so much for responding. I've done research online and have read both what you wrote above and what 2bsmaller18 wrote. From what I can tell, if I had stones and regular attacks, I should be planning my surgery asap. Everything I've read about just sludge and a few irregular pains (not having full blown attacks) says to wait and watch. I also read there are medications that can help but my surgeon only mentioned the surgery. Of course, he's a surgeon, that's what they do! So I really appreciate your input. For me, with what I've experience SO FAR, surgery seems extreme. Certainly if it gets worse, I'll do what I have to do. I'm mostly concerned because my husband and I have a much awaited trip to Hawaii in 10 days, with my new 175# figure. My husband thought of cancelling the trip so I could have the surgery but I think I'll eat very low fat, as I was doing before the holidays, and worry about this after we get back. Hopefully this will be ok. Thanks again!

Thanks so much for responding. I've done research online and have read both what you wrote above and what 2bsmaller18 wrote. From what I can tell, if I had stones and regular attacks, I should be planning my surgery asap. Everything I've read about just sludge and a few irregular pains (not having full blown attacks) says to wait and watch. I also read there are medications that can help but my surgeon only mentioned the surgery. Of course, he's a surgeon, that's what they do! So I really appreciate your input. For me, with what I've experience SO FAR, surgery seems extreme. Certainly if it gets worse, I'll do what I have to do. I'm mostly concerned because my husband and I have a much awaited trip to Hawaii in 10 days, with my new 175# figure. My husband thought of cancelling the trip so I could have the surgery but I think I'll eat very low fat, as I was doing before the holidays, and worry about this after we get back. Hopefully this will be ok. Thanks again!