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Anthony Bray, MD
Anthony Bray, MD, Doctor
Category: Health
Satisfied Customers: 10337
Experience:  14 years as clinician in the field of Family Practice
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I will try to be as brief as possible.In August 2012 (~9 mos

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I will try to be as brief as possible.In August 2012 (~9 mos ago) I had an ultrasound done that showed my liver had echogenic characteristics/ 'compatible with fatty liver'.Prior to this ultrasound in the years of 2010-2011 I had 6 ultrasounds andXXXXXscans (for acute appendicitis) at which time did NOT reveal the fatty liver, so I am assuming it was NOT present until August 2012. To give you the background at the time of the ultrasound I was 232 lbs, high cholesterol/high triglycerides, and pre-diabetic. However, all other bloodwork was absolutely normal (liver enzymes, and other hepatatic labwork). Since August I have lost 35 pounds (now 196 pounds) and still trying, I am trying to exercise as much as I can, I do not drink (was an occasional social drinker) and have started a cholesterol med that has lowered both my LDL's and triglycerides. My sugar has gone down as well. I take omeprozole (GERD), Prozac (20mg for GAD), Prevastatin (40mg for cholesterol), and Zyrtec (10mg as needed for allergies). I also take Vitamin E, Calcium with vitamin D, and a liver support supplement. I have cut out most white starchy carbs, fried foods, high fat foods, sodas, beef, and junk food. I need to lose at least 50 more pounds and I intend on doing it. This is my question... I am still worried that I am not doing what I need to do to reverse this condition. I see my PCP every 3 mos, have labwork done at same time, and follow her advice as best as I can. She said there is no need for a follow-up ultrasound nor to see a specialist. The mild discomfort I feel at times on my right side she has no worries about, yet I do. It may be muscular in nature because I have back issues, but I am concerned it is my liver inflamed. I am doing everything I can to be proactive about this condition, but it is a slow process and I am concerned that I, or my doctor, may be overlooking something. If you could address my concerns with your advice I would be very appreciative.

Anthony Bray MD : Hello !!
Anthony Bray MD : The fact that you have NO ABNORMALITY of your liver enzymes would be very reassuring with regard to your situation....
Anthony Bray MD : Often with fatty liver disease we will see mild inflammation with a low grade rise in the liver enzymes...
Anthony Bray MD : You are doing the right steps to correct this trend...
Anthony Bray MD : Fatty liver will be associated with excess fat storage in the liver ....
Anthony Bray MD : This has a strong correlation with high triglycerides....
Customer: That's reassuring.
Anthony Bray MD : Your proactive steps to lose weight and avoid fat in your diet are helpful to this condition....
Customer: The discomfort I experience is at times below the ribs but predominantly in line with my belly button to the right. It forms almost the letter 'L' if that makes sense?
Anthony Bray MD : I would think that a close review of prior ultrasounds should reflect gradual change of the density of the liver .... I think it was a subjective review by the last radiologist that made the judgment call..
Customer: And my lower back has been an issue fir years and now is affecting predominantly the right side lower back. Muscoskeletal in nature perhaps?
Anthony Bray MD : This is a very gradual process however .... Your ultrasound would not be expected to change rapidly over time but very slowly( improvement or worsening either way...)
Customer: Meaning maybe if someone else read it they may have interpreted it differently?
Anthony Bray MD : I think a follow up ultrasound in 2 years would be reasonable... I would advise recheck of cholesterol and liver enzymes at 6 months to one year....
Anthony Bray MD : Right... I think a close review of your past ultrasounds would show gradual change in liver density.... This had not developed overnight....
Customer: I appreciate your advice. I get bloodwork every three months since I was diagnosed last august. My cholesterol has gone down as have my triglycerides. Could excess fat in the middle cause this discomfort?
Anthony Bray MD : It is possible that this may be related yes.... You might have abdominal fat and could have physical enlargement of the liver as well that COULD be related to discomfort BUT the abdominal discomfort is not now related to inflation of the liver tissue itself since the liver enzymes are normal ...
Anthony Bray MD : Your improvement in weight and in your cholesterol should correspond to improvement in the fatty liver change as well....
Customer: Xould u explain physical enlargement of the liver?
Anthony Bray MD : yes>>> fat storage causes the liver to enlarge... The volume if the liver increases...it takes up more space...
Anthony Bray MD : of the liver ...correcting typo above...
Anthony Bray MD : just as losing weight causes you to have a smaller waistline it affects the size if your liver too...
Anthony Bray MD : of...
Anthony Bray MD : I hope this is helpful for you! Let me know if you have further questions!
Customer: Ok makes sense. So at this point continue with diet and exercise? Supplements and meds ok to take? Any other recommendations? Specific dietary regulations? Repeat ultrasound in a year or so?
Customer: It will also take several years to reverse this?
Anthony Bray MD : Yes , exactly.... Continue your current MEDS ... I don't know all your supplements?? I favor vitamins and antioxidants....milk thistle is favorable liver health...
Anthony Bray MD : I would agree that ultrasound in 1 to 2 years would be feasi
Anthony Bray MD : reasonable....(spellcheck program driving me crazy today!!)
Customer: I take calcium with d, e, and livergenix which has milk thistle as well as other liver healthy herbs/vitamins
Customer: So even though I have lost 35 pounds I still have a ways to go to rid myself of this condition? It may take a while for my liver yo decrease in size... As I lose more fat, it will too?
Anthony Bray MD : Yes that sounds fine! (Just avoid super- high doses of A, D, E and vitamin K---these are safe for liver in normal doses but extreme high doses of these four can be toxic to liver)
Anthony Bray MD : Yes the liver far storage will correspond to weight but factors specific to your metabolism may have led to excess liver fat storage. Your tendency to have high triglycerides would fit with this...
Anthony Bray MD : If this continued as a problem( I don't think that it will) then the use of a bike acid sequestrant may be helpful...
Customer: And tris are directly related yo diet and exercise?
Customer: What is a bike acid sequestrant?
Anthony Bray MD : These are another class of cholesterol medication that works to bind fats in the GI tract and reduces absorption of fats to the liver...
Anthony Bray MD : this class includes Welchol , Colestipol, Questran...
Customer: You have been extremely helpful. Thank you so much!
Anthony Bray MD : You are very welcome!
Anthony Bray MD : let me know if you should have further questions! I will be happy to get back with you !
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