About Dr. Joe Galati

Dr. Joe Galati is a Liver Specialist practicing in Houston, Texas. His practice, Liver Specialists of Texas is dedicated to the care of patients with all facets of liver disease.
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31 Days of Wellness: Starting 2016 on the Right Step

31 Days of Wellness: Starting 2016 on the Right Step

Each January, I do my best to post 30 daily entries, allowing all of our readers to get a daily dose of inspiration to start off the new

year. While the vast majority of New Years resolutions are “health related”, the majority fail by months end. The reason for this high failure rate is simple-people don’t change habits easily. These resolutions require some sort of change in a person’s daily routine. Weight loss, eating better, spending more time exercising, cutting back on alcohol use are common themes each year, yet the difficulty in changing entrenched behaviors is what makes all of this so hard. So why should we even talk about this? My feeling is that while the failure rate is high, there are those that are able to make the changes needed to improve their health. I remain optimistic that there are those of you that have finally seen the light, and make the bold steps to change for the right reasons.

For today, let me leave you with this message (and challenge):

IMG_4379Make plans to try one new vegetable each week. Pretty simple. With the vegetable you select, try various recipes until you find one you like. Get feedback from your family and those you eat with. You may have to experiment until you get it right.

One of my favorite websites for learning about vegetables and fruits is Worlds Healthiest Foods. Use this site as a starting point to fine new foods to try.

 

Happy 2016.

Let me know what you think. Share these daily entries with those you care about.

Cheers,

Joe Galati, M.D.

 

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Top Five Facts about Primary Biliary Cirrhosis (PBC)

Background

Primary biliary cirrhosis, a disease of the bile ducts, has been around for a long time. More recently, there has been a movement to change the name to primary biliary cholangitis. The presence of the word cirrhosis in the name is both misleading, and a cause of concern for patient’s that have it. Not all patients with PBC have cirrhosis. Cholangitis, which is inflammation of the bile ducts, seems to be a more representative term to use. At Liver Specialists of Texas, we have extensive experience in treating those patients with PBC.

PBC is considered an autoimmune disease, that affects the bile ducts of the liver. It is progressive in nature, and can lead to further destruction of liver tissue and the eventual development of cirrhosis. Generally, it is a slowly progressive disease, and is in most cases, progression is judged in decades rather than years. In your liver, bile ducts are the extensive system of tubes draining bile from your liver to your gallbladder and intestines. With PBC you develop damage to the bile ducts, the bile has a tendency to get trapped in the liver, causing damage. What causes PBC is really not fully understood at this time. It is not contagious, nor is it caused by alcohol. Most of us feel that primary biliary cholangitis is inherited, as we see it occasionally cluster and family’s.

Top Five Facts

  1. Primary biliary cholangitis typically affects young white female.
  2. To make the diagnosis of PBC, the lab test for the antimitochondrial antibody is positive and the majority of cases, about 95%.
  3. Fatigue is the most common symptom of PBC, no nonspecific, occurs in approximately 78% of the cases.
  4. UDCA is the only FDA approved medication for the treatment of primary biliary cholangitis.
  5. Patients with primary biliary cholangitis can present with a number of systemic complaints and complications throughout the body including:
    1. Pruritus ( itching) occurring in 20-70% of patients
    2. Elevated cholesterol
    3. Vitamin D deficiency
    4. Osteoporosis in approximately 30% of individuals
    5. Sicca syndrome (dry eyes and/or mouth)
    6. Raynaud’s phenomenon

For more information on PBC, or if you would like a consultation, feel free to contact us, and we would be more than happy to evaluate you.

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Top Five Symptoms of Hepatic Encephalopathy

Top Five Symptoms of Hepatic Encephalopathy

Hepatic Encephalopathy

Hepatic Encephalopathy

Hepatic encephalopathy, seen in advanced liver disease and cirrhosis, results in a number of neuro-psychiatric symptoms, that cover a wide spectrum of manifestations. Being aware of the clinical presentations are important for both the patient and their caretaker, as well as healthcare professionals involved in their care. These include:

 

 

  1. Personality changes.
  2. Changes in sleep-wake cycles, associated with excessive daytime somnolence and nighttime insomnia.
  3. Disorientation to person, place and time.
  4. Development of inappropriate behavior, associated with confusion.
  5. Coma.

Individuals with hepatic encephalopathy have serious live problems, and should be considered for liver transplant evaluation.  All of us at Liver Specialists of Texas are experienced to care for these complex patient needs.

 

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Survey of the Public’s Perception of Liver Transplant and Alcoholics

Our team is very interested to learn about the public’s perception regarding alcoholism and the availability of liver transplantation. For the past 25 years, most programs have been hesitant to transplant alcoholics because of the concern for drinking after successful transplant. Without getting into the details of survival after transplant for those with alcohol related liver disease, the perception from the general public is that for many, alcoholics should be judged differently than non-alcoholic patients. This survey is a first attempt to better understand the thought process of the non-medically trained public.

Below is the link to our survey. We appreciate your participation.

Take Our Survey Now!

Joseph S. Galati, M.D.

Brandi McCall, RN
Nurse Practitioner

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Top Five Reasons to Evaluate Nonalcoholic Fatty Liver Disease (NAFLD)

Dr. Rashid Khan adds this blog entry further reviewing important issues related to nonalcoholic fatty liver disease (NAFLD)

I few weeks ago I wrote on this topic as guest editor on Dr Joe Galati’s blog. We talked about some basic concepts surrounding Nonalcoholic Fatty Liver Disease (NAFLD). To recap, this condition involves fat accumulation in the liver of non drinkers. I mentioned the importance of prompt evaluation, necessary investigations and potential therapies. Here I once again write about this common condition, afflicting close to 100 million Americans, highlighting five reasons why NAFLD needs to be taken seriously.

  1. The most relevant reason from a liver doctor’s perspective is the potential transformation of fatty liver disease to liver cirrhosis. Fatty liver is generally benign, but the development of cirrhosis becomes a game changer.
  2. Along with the potential risk of cirrhosis, comes the added risk of developing liver cancer. Studies have shown that this risk is even present in the absence of cirrhosis, though small.
  3. Cardiovascular disease( CVD) is one of the most common medical conditions in the US and globally. NAFLD and CVD go hand in hand. Usually both exist in many patients. Fatty liver is known to be an independent predictor of CVD.
  4. Type II diabetes is another very common medical condition . Numerous studies have shown the propensity of diabetic patients to develop fatty liver . This association is bi directional, meaning some patients with fatty liver will go on to develope diabetes.
  5. Finally, I will mention chronic kidney disease( CKD), another disease afflicting millions of Americans in this day and age. While the association of NAFLD and CKD may not be as robust as with CVD and diabetes, nevertheless it all comes back to the metabolic syndrome entity, which involves dangerous plaque build up in the blood vessels throughout the body.

 

Here at Liver Specialists of Texas, it is our sincere hope that fatty liver disease is recognized and evaluated in its earliest stages. Our practice is specifically geared towards the management of these patients, as well as other liver diseases, and we will be more than happy to see you in our offices.

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AASLD Liver Meeting 2015

AASLD Liver Meeting 2015

LiverMtg-logo

 

 

For the next several days, liver disease experts from around the world will be in San Francisco learning and sharing the latest developments in liver disease at the annual Liver Meeting.

Today, the one-day postgraduate course covered common clinical conditions, including non-alcoholic fatty liver disease, hepatitis C, liver cancer/hepatocellular carcinoma, and complications of cirrhosis, including volume overload/ascites, malnutrition, and hepatic encephalopathy.

More updates will be posted through the meeting.

Dr. Joe Galati

Liver Meeting 2015

 

 

 

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How Old is Too Old for Liver Transplant?

How Old is Too Old for Liver Transplant?

imagesIs there an upper age at which liver transplant is not performed?

Read the following article to learn more.

Dr. Joe Galati

 

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Nonalcoholic Fatty Liver Disease: What You Need to Know? Dr. Rashid Khan Explains

Nonalcoholic Fatty Liver Disease: What You Need to Know? Dr. Rashid Khan Explains

Dr. Rashid Khan, Hepatologist at Liver Specialists of Texas, guest edited this blog entry on Fatty Liver Disease.


Obesity and Fatty Liver Disease

Obesity and Fatty Liver

In my 9 years of medical practice, it still does not cease to amaze me, that the public as well as the general physician’s perspective on fatty liver disease could be so wrong.

Every day of the week I see at least 10 patients with fatty liver, who have been told by their family physician that fatty liver is “no big deal”, and it is nothing to worry about. I tell them it is “ absolutely something to worry about”. Let me explain why.

Nonalcoholic fatty liver disease is a condition where there is fat accumulation in the liver of people who drink little or no alcohol.This condition is very common and generally causes no signs or symptoms, and generally no complications. Most people feel “OK” with this condition.

A wide range of diseases and conditions can increase your risk of nonalcoholic fatty liver disease, including: gastric bypass surgery, high cholesterol, high levels of triglycerides in the blood, metabolic syndrome, polycystic ovary syndrome, sleep apnea, diabetes, hypothyroidism, and of course, obesity.

In some people with fatty liver, the fat that accumulates can cause inflammation and scarring in the liver. This form of nonalcoholic fatty liver disease is called nonalcoholic steatohepatitis, commonly called NASH. In its most severe form, fatty liver can progress to liver cirrhosis (scarring), liver failure, and even liver cancer. About 20% of patients with fatty liver disease related steatohepatitis can progress to liver cirrhosis, so the risk is not trivial. In these such cases, liver transplant is discussed, and may be the only option to survive.

Evaluation of fatty liver begins with simple blood tests to assess liver function. These blood tests are the ALT, AST, bilirubin, and possibly alkaline phosphatase.

Unfortunately, many times these liver tests are elevated, and ignored by both physician and patient. These elevated (and abnormal) liver tests may be the first indication that trouble is brewing in the liver. This is almost always followed by some sort of liver imaging test, such as an ultrasound, CT scan or MRI of the liver and abdomen. If I suspect a more advanced stage of fatty liver disease, I will recommend we perform a liver biopsy, a procedure that involves removing a small sample of tissue from the liver, and examining it under a microscope to look for signs of inflammation and scarring.

Unfortunately, despite extensive research in this field, no single standard and targeted therapy exists for fatty liver disease in 2015. In other words , no medication is currently the perfectly effective treatment for fatty liver disease. Almost always my patient will ask me , “Hey Doc, what pill can I take to fix this problem? And I reply there is none.

So we typically work to reduce the risk factors that have caused the fatty liver disease which are well known as I have eluded to above. If the patient is obese, we ask them to lose weight. Weight loss can be tough in the modern day lifestyle, but a committed approach involving caloric reduction and increasing physical activity usually works. Patients with diabetes and or high cholesterol are placed on medications to better control these disorders of their metabolism.

No alternative medicine treatments are proven to cure nonalcoholic fatty liver disease. The use of herbs, and many other widely available over the counter supplements not only don’t work, but can be dangerous. Some studies have shown that natural substances such as Vitamin E and coffee may help to reduce the damage caused by inflammation. However, more research is needed, and patients should discuss the use of these substances with their liver specialist.

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Our Staff is Key to Our Success: A New Paradigm in Medical Office Staff

Our Staff is Key to Our Success: A New Paradigm in Medical Office Staff

Dr. Joe Galati and Dr. Rashid Khan with The Millennials of Liver Specialists of Texas

Dr. Joe Galati and Dr. Rashid Khan with The Millennials of Liver Specialists of Texas

Our practice specializes in the care of those with all facets of diseases of the liver and digestive tract. Liver disease patients, as a whole, are sicker than most. The proper functioning of the liver is vital to a persons overall state of wellness. Chronic liver disease, in the form of viral hepatitis (such as hepatitis B and hepatitis C), autoimmune hepatitis, fatty liver related to obesity and metabolic syndrome, hereditary disorders such as Wilson’s disease (excess copper), hereditary hemochromatosis (iron overload state), Primary Biliary Cirrhosis, Sclerosing Cholangitis, alcoholic liver disease, cirrhosis, and portal hypertension are all multi-organ conditions, and lead to progressive organ failure, and the potential for premature death. While this is a mouthful, the truth is that liver disease is no laughing matter, and needs to be taken very seriously. Liver patients are demanding. They require a lot of care, education about their condition and the required care, and most importantly, compassion. Facing the spectre of a life threatening illness is stressful for all involved.

Caring for this group of patients requires that I surround myself by the most capable staff possible. We have been making use of mid-level providers (both Physician Assistants and Nurse Practitioners) to implement the medical and surgical care plans designed for them. It would be impossible for me to provide the care we do without their assistance. The mid-levels at Liver Specialists of Texas are superb professionals, well trained, intuitive, patient centered, and in-tune with the emotional state of the patient and their family.

Staff Outing with the Houston Astros

Staff Outing with the Houston Astros

Over the past 2 months, we have hired 5 new staff members, all recent college graduates from Duke University and University of Texas-Austin. These five young ladies have degrees in Psychology/Human Development, Nutrition, Evolutionary Anthropology, Cultural Anthropology, with minors in Spanish, and Music. Academically brilliant, they have aspirations for Medical School, and one a Doctorate in Psychology. The positions they hold within the office include Medical Assistants, Scheduling, Patient Education and Public Outreach, and Front Desk/Reception. All of them are woefully overqualified for these positions. Seeking a two-year break from their educational plan, they are looking for real-world experience, to better prepare them for the next way station in their life-journey.

Hiring this caliber of staff is eye opening for me, rest of the staff, and our patients. Their academic training allows them to grasp new concepts faster, making them quick learners. They have the capacity to think outside the proverbial box, and contribute to the operations of the practice like I have never seen before. They have a keen grasp of new technology and social media, are well versed in teamwork, and have an eagerness to learn and take on new tasks. Coming from the rigorous academic challenges of Duke and UT-Austin, their brains are hard-wired differently than other applicants that I interviewed for their positions. Somewhat older individuals, having completed their formal education decades earlier, the applicants I met with had no real desire to advance themselves, challenge the status quo, or cultivate their creative juices for the betterment of the patients we serve and care for.

The Staff of Liver Specialists of Texas

The Staff of Liver Specialists of Texas

Millennials by birth, they are being exposed to an environment run by Baby Boomers. We have had to enlighten them to maximizing the positive features of their generation (civic mindedness,multitaskers, connectivity, tech-savvy, and passion), and work on certain less favorable features such as reduced attention spans, obsessing with the online world, constant use of their cellphone, and the need for immediate gratification.

My desire to have the most capable staff available for these complex cases has come closer to reality with the addition of the five recent college graduates. Working side-by-side with our established staff has allowed for continued mentoring. In the medical office staff/clinic environment, it is unheard of to have such overly competent staff. With what we have all experienced in just a few short months, I will never be able to return to the norms of the standard office environment. Once this group graduates to bigger and better opportunities, I hope to develop a pipeline of future employees from Duke University and University of Texas, allowing our patients to be cared for by a group of overqualified, passionate, forward-thinking, quick learning, twenty something year old staff.

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Latest News on Hepatitis C Cures

For tonight’s broadcast of Your Health First, Dr. Rashid Khan joins me to discuss the latest news on fatty liver disease, and the new therapies for hepatitis C, which results in a cure rate of over 95% of the cases. You can listed to the audio from the three segments here.

 

Dr. Rashid Khan and Dr. Joe Galati Discuss Liver Disease: Part 1 by Your Health First Radio on Mixcloud

Dr. Rashid Khan and Dr. Galati Discuss Fatty Liver Disease: Your Health First Part II by Your Health First Radio on Mixcloud

Hepatitis C: Dr. Rashid Khan and Dr. Joe Galati Discuss-Your Health First Interview Part III by Your Health First Radio on Mixcloud

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