I am a surgical resident on my transplant rotation. The last couple of days have been brutal. I was essentially awake for 48 hours straight by first transplanting a kidney in one patient, then flying on the transplant jet to procure (harvest) a liver from a different state, then flying back and transplanting it in our very sick recipient.
This was the patient's second liver transplant so everything was completely scarred in. It was like someone had poured super-glue in the patient's abdomen. We had to essentially carve the old liver out and had audible bleeding multiple times. Bleeding that sounds like an open garden hose is generally not compatible with life, but we got the patient through the operation with a pulse. From opening the belly to finishing took about 12 hours and there were several times that we thought we were going to have to start CPR as the patient's blood pressure was dangerously low due to blood loss. We transfused 40 units of blood which is around 14 L of volume. Considering the average person has a total circulating volume of about 5 L, 40 units is like replacing their entire blood supply. Three times.
I, and most of my colleagues, don't really get tired operating. In part, it's hard to sleep when you're standing, but you're also so focused on the task at hand that you just forget to be tired. I'll be honest that as a medical student, I definitely fell asleep on my feet at the operating room table, but when you're active, it's tough to pass out. However, most of us crash immediately when we sit down. After closing the abdomen and wheeling the patient up to the intensive care unit, I sat down at a computer to quietly write my operative report and the dense fog of fatigue set in. My eyelids were heavy and blinks lasted seconds. My hands felt weighted and my typing was so slow. I was having significant word finding difficulty too, but was making steady progress.
Then I got to the word "of." Ove? Ov? Av? I said the word out loud slowly. Ooooovvvvvv. Definitely a "v" in there. I think? Ahhhhhvvvv. Fuck, that looks wrong. How do I spell of? I sat for minutes trying different iterations. Colleagues walked by to see how to case went. "Wow, you look beat." "Yeah, it's been a rough call." I considered asking my coresident, but knew that if I did, the word OF would definitely find it's way to my graduation roast. OV, OVE. Fuck. Finally, I thought to read another note and finally found it. OF. Are you kidding me? That's is not how it's pronoun
... keep reading on reddit โก
His name is Oliver
Apologies for mobile. I know, I know "just see a doctor." I'm trying to work myself up to it. I'm also scared that if I tell doctors how much I've drunk in the past and I need a lover transplant, it will effect my chances of getting one. There's apparently some debate that you can't feel your liver, but the location isn't anywhere near my stomach or pancreas and my gallbladder has been removed.
I figured there are enough drinkers here that maybe someone could give me an idea of exactly how much shit I'm in.
I'm a 36 year old woman. (I've had gastric bypass about ten years ago if that matters). I went through maybe 3 years of drinking wine or even vodka every day, all day. I'm now at a point where I binge for three days once every two or three months and otherwise don't drink. When I drink, my liver area usually hurts after for 1-7 days. Last time I binged was about three weeks ago and I'm still getting an off-and - on, dull throbbing at the bottom of my right rib cage most of each day. What are the odds I'm actually dying? I'm scared.
https://www.ncbi.nlm.nih.gov/pubmed/31815184 ; https://www.nature.com/articles/s41538-019-0058-4.pdf
Okuda T1.
Abstract
A low-carbohydrate ketogenic diet (LCKD) promotes the progression of hepatic steatosis in C57BL/6 wild-type mice, but improves the condition in leptin-deficient obese (ob/ob) mice. Here, we show a novel effect of LCKD associated with the conflicting effects on these mice. Gene expression microarray analyses showed that expression of the Vldlr gene, which encodes the very-low-density lipoprotein receptor (VLDLR), was induced in LCKD-fed ob/ob mice. Although the VLDLR is not normally expressed in the liver, the LCKD led to VLDLR expression in both ob/ob and wild-type mice. To clarify this effect on VLDL dynamics, we analyzed the lipid content of serum lipoproteins and found a marked decrease in VLDL-triglycerides only in LCKD-fed wild-type mice. Further analyses suggested that transport of triglycerides via VLDL from the liver to extrahepatic tissues was inhibited by LCKD-induced hepatic VLDLR expression, but rescued under conditions of leptin deficiency.
https://preview.redd.it/puzvlaaho0441.png?width=561&format=png&auto=webp&s=541df9260a2b1c935f5ba072472a5123bbd33c11
http://www.jomes.org/journal/view.html?doi=10.7570/jomes19042
treated 7-week old male C57BL/6 mice with water (control) or one of three different SSBs, carbonated soda (Coca-Colaยฎ), milk-sweetened milk coffee (Maxwellยฎ), or chocolate-added cocoa (Choco-Latteยฎ), for 13 weeks (n=10 in each group). Half of the animals were fed a regular chow diet and the other half a high-fat diet (40% fat). Body composition and biochemical variables were investigated at the end of treatment. Histology of the liver and adipose tissue, as well as molecular signaling related to glucose and lipid metabolism, were also evaluated.
1906-P: Effects of a Carbohydrate-Restricted Diet on Hepatic Lipid Content in Adolescents with Nonalcoholic Fatty Liver Disease
https://diabetes.diabetesjournals.org/content/68/Supplement_1/1906-P
Abstract
Background: NAFLD has emerged as the most common liver disease among adolescents in industrialized countries. Results from trials in adults with NAFLD suggest that reducing CHO intake may deplete liver fat to a greater extent than other dietary approaches, even when there was no difference in weight loss between diet groups. The objective of this study was to determine the effects of a CHO-restricted vs. fat-restricted diet in adolescents with NAFLD on reduction in hepatic lipid and insulin resistance.
Methods: Twenty-three adolescents (age 9-17) with obesity (BMI โฅ85th percentile) and confirmed NAFLD were randomized to a CHO-restricted (<10:25:>65% energy from CHO:protein:fat) or fat-restricted diet (55:25:20) for 8 weeks. Caloric intakes were calculated to be weight maintaining. Participants and one parent attended bi-weekly counselling with a registered dietitian. To encourage compliance, groceries were delivered to participantsโ families during the first 2 weeks of the study. Both diets included minimally processed foods with limited added sugar. Change in hepatic lipid content was measured via MRI, body composition via DXA, and insulin resistance via a fasting blood sample.
Results: After 8 weeks, the CHO-restricted diet group experienced a significant decrease in hepatic lipid content (-6.0ยฑ4.7%, p<0.001), whereas the fat-restricted diet group showed no change. We found significantly greater decreases in insulin resistance (HOMA-IR, -1.2ยฑ5.1, <0.05), abdominal fat mass (-1.7 ยฑ1.1 kg, p<0.01), and body fat mass (-3.1ยฑ4.0 kg, p<0.01) in response to the CHO-restricted vs. fat-restricted diet.
Conclusion: The CHO-restricted diet approach may be markedly beneficial in improving fatty liver, body composition, and insulin resistance in adolescents with NAFLD even in the absence of intentional caloric restriction. Practitioners should consider recommending this diet approach to effectively improve disease course in this patient population.
I've been eating beef liver for years and to me it's one of the best tasting foods out there. What I do differently is I soak it in milk for an hour. If I have time I'll drain the milk after an hour and soak it again with fresh milk. If anyone is having issues with liver this may be something to try. If you're concerned about the milk you can always rinse it off after.
Hello,
My husband has been diagnosed with decompensated cirrhosis of the liver. We do not drink at all. Never have. We get NO help from our doctors...they go months between getting him in for any appointments etc...I am very unhappy with the lack of concern or care. Or even advice. Stay away from sugar...literally that is all they gave us.
My husband LOVES his coke (the soft drink) however he only drinks one once in a while. He does however drink a lot of ginger ale due to feeling queezy all the time. I want to completely ban sugar from the house so I was wondering if there was anyone else out there was this that is working on healing it on their own. Any tips for tummy upset etc. Anyone who has had results with cirrhosis and keto would be great to hear from.
Thank you all in advance.
