by Dr. Joe Galati on 08/10/2016
Probably the most common question I am asked, is regarding a special diet to follow if you have liver problems. Here is an updated answer to these questions.
The simple diet is “no”…nothing special, but this does not mean you eat what you want.
Generally speaking, if you have liver disease, you want to do the following:
- Limit daily sodium (salt) intake to 2,000 mg per day or less.
- Don’t eat anything in a box, can, or bag.
- Don’t eat processed foods.
- Eat lots of fresh fruits and vegetables
- Eat fresh lean meat and fish.
- If it doesn’t rot, don’t eat it.
- Drink more coffee-2-4 cups of brewed coffee per day.
- Avoid alcohol (bonus answer)
View the recent video outlining these suggestions in more detail.
by Dr. Joe Galati on 07/17/2016
I am happy to announce that we have three research studies for those suffering from fatty liver disease.
If interested, please call our research staff at the following numbers:
Liver Specialists of Texas Main Number: 713-794-0700
On-Line form: CLICK HERE to send our team at Liver Specialists of Texas a message regarding your interest in the research studies.
Kindly tell them you are interested in the FATTY LIVER RESEARCH STUDIES.
Details of the studies are posted below.
A Multicenter, Randomized, Double-Blind, Placebo Controlled Phase III Study to Evaluate the Efficacy and Safety of Elafibranor in Patients with Non Alcoholic Steatohepatitis (NASH) and Fibrosis.
A Multicenter, Randomized, Double-Blind, Placebo-Controlled, Phase 2b Clinical Trial Evaluating Emricasan, An Orally-Active Pan-Caspase Inhibitor, in Patients with Biopsy-Confirmed Nonalcoholic Steatohepatitis (NASH).
A Multicenter, Randomized, Double-Blind, Placebo-Controlled, 2-Part, 12 Week Study to Assess Safety, Tolerability, and Efficacy of LJN452 , in Patients Nonalcoholic Steatohepatitis (NASH).
Each of the three studies have slightly different inclusion criteria, and this will be determined by our research staff to see which study you would best be selected for.
For all of the three research studies, once accepted in the study, all of your medical care related to the study will be free of charge to you. This will include clinic visits, laboratory tests, specific scans, and liver biopsy if needed. All study medicines will be supplied to you. After the study is completed, you will be followed afterwards for an additional several months. Each study will also provide patients with a stipend for each visit that is required. Specific details will be explained is the study documents you will receive if selected.
Here is a short video explaining fatty liver disease in more detail.
Dr. Joe Galati
by Dr. Joe Galati on 07/10/2016
Cirrhosis is a slowly progressing disease in which healthy liver tissue is replaced with scar tissue, thereby preventing the liver from functioning properly. This scar tissue blocks the flow of blood through the liver and slows the processing of nutrients, drugs, hormones and naturally produced toxins.
According to the National Institutes of Health, cirrhosis is the 12th leading cause of death by disease, Fatty liver, Hepatitis C and alcohol abuse are the most common causes of cirrhosis of the liver in the U.S. Patients need to be aware of the complications of cirrhosis. The top three ones are:
- Variceal bleeding. Variceal bleeding is caused by portal hypertension. This is an increase in the pressure within the portal vein (the blood vessel that carries blood from the digestive organs to the liver). This increase in pressure is caused by resistance to blood flow through the liver as a result of cirrhosis. Increased pressure in the portal vein causes other veins in the body to enlarge (varices), such as those in the esophagus and stomach, to bypass the blockage. These varices can bleed easily, causing patients to present to hospitals either vomitting blood or dark stools. Portal hypertension also leads to extra fluid buildup in a person’s abdomen ( ascites) and( or) lower legs/feet( pedal edema). Prompt medical attention should be sought from a liver specialist for both variceal bleeding and fluid accumulation.
- Hepatic encephalopathy (confused thinking). Toxins produced in our intestines are normally detoxified by the liver, but once cirrhosis occurs, the liver cannot detoxify as well. Toxins get into the bloodstream and can cause confusion, changes in behavior, and even coma. Laxatives such as lactulose are used to speed their removal from the intestines.
- Liver cancer. There is about a 5-6% annual incidence of liver cancer in patients with cirrhosis from any cause. Usually it occurs without any symptoms at all. Liver cancer is picked up by periodic surveillance typically using ultrasound. Various modalities can be used to treat these cancers, including evaluation for liver transplantation.
by Dr. Joe Galati on 07/10/2016
Dr. Rashid Khan, in this BLOG entry, discusses the three reasons NOT to ignore heartburn symptoms.
For most Americans, heartburn is an occasional problem. Sixty million people get it at least once a month. But for the 20 million people who have a chronic form of heartburn known as gastroesophageal reflux disease (GERD), untreated symptoms can lead to a variety of health complications.
Here are three reasons why you shouldn’t ignore signs of GERD.
In GERD, stomach acid flows back into the esophagus, the tube that connects the throat to the stomach. Over time, this causes irritation of the lining of the esophagus, known as esophagitis.
If esophagitis is longstanding, scar tissue can narrow the esophagus. Called a stricture, this can make it hard or painful to swallow. Large pieces of food can get stuck as well as there being risk for choking.
If left untreated, constant acid reflux can cause precancerous changes in cells, a condition known as Barrett’s esophagus. This condition may not have any symptoms, but a doctor can diagnose it by performing an endoscopy. A small group of people with Barrett’s esophagus develop esophageal cancer, which is often deadly.
Finally, a subset of patients with GERD symptoms may actually have underlying heart disease i.e. angina. Women and the elderly, particularly, may not present with the typical crushing chest pain that we all hear about. Prompt evaluation by a cardiologist in certain cases is highly recommended.
by Dr. Joe Galati on 07/05/2016
While walking through my local supermarket this weekend, I strolled by the Pop-Tarts aisle to see what was happening in this section. Over the years, I’ve made fun of Pop-Tarts, not only because of their total lack of nutritional value, but because of the important place they have taken on the breakfast tables across America since 1964. So many individuals, especially parents, in an effort to get their kids up out of bed, hair combed, and dressed for school or other morning activities in a timely fashion, slap down a Pop-Tarts, as a quick and easy breakfast. This requires absolutely minimal thought our planning for this activity. For many, it is mission accomplished; Little Johnny and Mary have had breakfast, and are scooted out the door.
What parents should be saying to themselves, as well as anyone else who’s eating a Pop-Tarts, is basically that they’ve eaten a sugar-filled breakfast, with effectively no nutritional value, setting these kids up (and yourself) for hunger soon afterwards, and further bad eating habits for rest of the day, and possibly rest of their lives.
Breakfast is the most important meal of the day, and sadly, Pop-Tarts are doing nothing to help this along. With the ever-growing problem of childhood obesity, we have to stop for a minute and take stock of what we’re feeding kids for breakfast. This has been a passion of mine for over 20 years.
What struck me during this stroll down the Pop-Tarts aisle was a rather eye-catching advertisement that was out in plain sight. It caught my attention, and I photographed it here. Essentially, the message is that a combination of a Pop-Tarts with a glass of fat free milk is the perfect way to start a breakfast off, and none of us should feel guilty feeding our kids such a crappy meal. This is marketing 101 at its finest. Any parent or consumer walking down the aisle, looking at this sign, is granted license to buy Pop-Tarts, and serve them to their kids and family. This subliminal message tells you, “hey it’s OK to feed little Johnny and Mary Pop-Tarts”. Adding a little bit of milk makes whatever reservations you have about Pop-Tarts vanish.
Unfortunately, falling into this advertising trap does nothing for us as individuals, or collectively as an obese nation. I swung back through the fresh produce section, and saw no such advertisement helping to steer consumers to buy fresh fruits and vegetables, eggs, or other unprocessed forms of proteins to be served at breakfast table across America. It just isn’t any fun to eat a scrambled egg, a small bowl of fresh blueberries, with a quarter of an avocado. A small cup of unsweetened yogurt would also be an excellent addition to this power breakfast for your 10-year-old.
So before everyone e-mails me back saying that I am out of line, please take personal stock of how much time and effort you invest personally in crafting meals for yourselves and your families. Cooking real food, which is unprocessed, and thus nutritious for you, takes time. Time to plan the meals, shop, and cook them. And yes, cooking fresh meals at home is messy. In all of my years of practicing medicine, it is far more messy, and far much more of a pain in the butt to suffer the consequences of obesity, diabetes, cardiovascular disease, and cancer.
You make the choice. Pop-Tarts in the morning, or hemodialysis? Misery is optional.
by Dr. Joe Galati on 07/04/2016
Dr. Rashid Khan adds additional information to better understanding fatty liver disease.
As a follow up to my last blog entry on fatty liver disease a few months ago, I thought I would highlight three common questions patients with this condition ask.
1. “Doctor, I don’t drink any alcohol, how can I get fatty liver, I thought that was something you get if you drink?”
A common misconception amongst patients I frequently encounter. It used to be thought that fatty liver disease was usually caused by excessive alcohol intake. However, it now recognized that obesity and diabetes could cause fatty liver. As obesity and diabetes have become more common, so has fatty liver disease.
2. “Does it cause any complications?”
Never ceases to amaze me that most if not all patients with fatty liver in my office do not seem to know the risk of progression to cirrhosis. They seemed genuinely surprised when I mention this fact. Further ,fatty liver disease may add to the already high risk of heart disease if you are obese or have diabetes.
3. “What is the treatment?”
The best treatment is weight loss. Weight loss has a very direct effect: As people lose weight, the fatty liver becomes less fatty.There’s been some research into using diabetes drugs and vitamin E to treat fatty liver disease But there’s not enough evidence yet to recommend them in every patient.
For an appointment, and further information on fatty liver disease, call us at 713-794-0700 and visit our website www.texasliver.com.
by Dr. Joe Galati on 06/27/2016
Coby Tyner has submitted another excellent essay on exploring ways to improve the patient experience at the physicians office. This time he focuses on the financial responsibility aspect of patient care. Dr. Joe Galati
I have learned a lot over the years as a healthcare administrator. And while I am not a billing expert, I do consider myself a good consumer of healthcare.
There are times that I field concerns from patients regarding bills they receive. The concerns can range anywhere from the amount of the bill itself, to why the proper insurance was not used in the submission of the original claim (and all points in between).
Now it’s true, mistakes can and do happen in the billing and collecting process. Every practice and every third party biller seeks opportunities to improve with internal processes and to minimize human errors. To complicate issues, insurance companies can often confuse patients on covered services and what’s actually required prior to receiving those services.
But there’s still hope for patients… Often times, patients can be better informed consumers of healthcare. When it comes to selecting an insurance plan that works for them and their family, covered services, and the amounts they will be required to pay (as defined by their insurance plans), they should be fully informed before the process even starts.
So let’s get down to the nitty gritty of the matter. Questions the patient should ask could include: What insurance plan fits the needs of my family? How much is the co-pay for office visits? How much is the deductible? Why should I choose a PPO plan over an HMO plan (or vice versa)? When do I need a referral? Is a pre-authorization required for procedures? Who could I talk to if I have a questions about a bill?
The takeaway from all of this is straightforward: If patients want to avoid unexpected and undesirable surprises, they should consider researching what will be required when they visit their care provider’s office – this can be done through researching the plan and asking questions to the insurance carrier they’ve chosen. The plan the patient chooses will directly drive the amounts they will be expected to pay. Also, they should actively work with their care provider’s office staff to get a clear picture on financial obligations for the practice itself (such as Co-Pays, Procedure Costs, Deductible Amounts, etc). I’d suggest working closely with the person that verifies benefits in their care provider’s office or reaching out to the practice administrator to point them in the right direction.
As a patient advocate, I want each and every patient to have a great experience when they visit their care provider; especially at Liver Specialists of Texas. Billing is an important part of the overall experience and I encourage all patients to be better consumers of healthcare – it starts with first knowing the expectations from the beginning.
by Dr. Joe Galati on 05/29/2016
Coby Tyner, MBA, CMPE, is the Practice Administrator for Liver Specialists of Texas. In his guest blog entry, he discusses his thoughts on the patient experience we all strive for, and hope to deliver for our patients.
It occurred to me that healthcare is changing more than most people actually realize. With Meaningful Use requirements, the Affordable Care Act, changes with CMS policies, Insurance Benefit Coordination and much more, it doesn’t surprise me that many medical practices struggle with communicating changes with many of their patients.
One way to address questions, avoid confusion, and make the patient feel like someone is actively listening is for medical practices to focus on the patient experience. The Beyrl Institute defines the patient experience as “the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care.” Maybe this definition sounds a bit fancy but it makes sense right? So, what does that definition really mean? Simply put, every time a physician, advance practice provider or a member of the staff has ANY interaction with a patient, it should be memorable to the patient in a positive and informative way. The goal at the end of the day is to have the patient reflect positively about their experience while being cared for by all members of the medical team.
So, where does the experience start? The answer is at the beginning when the patient first calls the office or makes contact. Areas in which to focus could include, is the phone answered with a “smiling voice?” Are staff members nice and friendly and do they answer questions about the appointment, insurance requirements, and location of the office (remember, this should all be done with a smiling voice)? When the patient comes to the office, are they greeted with a smile and are staff members prepared to provide excellent service? Does the staff ensure the patient is coordinated quickly and avoid long waiting times in the lobby? Are the care providers actively listening and ready to provide quality care – all without making the patient feel rushed or discounting the patients concerns as relevant? Are billing and collection efforts done in a timely fashion and are patients able to get quick responses to their questions about a bill? Are prescription orders coordinated and filled timely? And the list goes on and on.
Bottom line, with every question previously asked, there is a direct opportunity for the member of the medical staff to impact what the patient is thinking and if the patient will remember the experience as positive. So remember, from how soon a patient can be seen to coordinating billing questions and all points in-between, focusing on the patient experience can be used to answer questions, develop long term relationships and give patients peace of mind – all while making them feel right at home. And that should be the goal of every medical practice… Just my 2 dollars.
by Dr. Joe Galati on 03/08/2016
Fatty liver disease is everywhere. Dr. Galati outlines a basic review of the information you need to know about fatty liver disease, and the treatment options available to you.
For a consultation if you have fatty liver disease, contact his office at 713-794-0700, or visit the practice website. For a second opinion, please fill out these forms and return to Liver Specialists of Texas.
- The MELD Score and Liver Transplant: An Update for Patients 02/02/2011
- Waiting for a Liver Transplant: My MELD Score is Low-Now What? 06/14/2012
- Telaprevir and FDA Approval: The Race is On for New Hepatitis C Drugs 02/28/2011
- Liver Specialists of Texas Showcase-Open House Video 09/20/2016
- Is There a Special Diet for Liver Disease Patients? 08/10/2016
- Research Studies for Fatty Liver Disease Announced: Liver Specialists of Texas-UPDATED 07/17/2016
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