Obese patients and ultrasound

[Liberty82]

Hi, I have a bmi of 36 and carry a lot of my weight around my middle. My recent ultrasound came back as normal however it did say 'Liver appears normal' not liver IS normal and it did say that the images are somewhat compromised by my bmi. My lfts are also normal but I'm having a huge host of symptoms that seem to point to my liver and they have been reduced a fair bit since cutting out alcohol and certain pain meds. If I take anything my liver doesn't like them they are back with a vengeance. I'm in the process of reducing my bmi and am hoping to attend the British liver roadshow in May, my last trip they couldn't get a clear picture due to my bmi. Would it be likely something has been missed? The scan was with a sonographer who refers you on of anything abnormal looking is seen so I haven't been referred on. She said my liver didn't even appear fatty which contradicted what the fibroscan said, they said they couldn't get a clear reading but there did appear to be some fat but everything they 'thought' looked OK but I suppose what else could they say before sending me on my way. I'm currently going to the gym and swimming 4 times a week and I'm on the 5.2 diet so I'm hoping my bmi will have reduced a fair bit by May. Any thoughts or experiences would be greatly appreciated x

[Kev12564]

Hi Liberty82, you don’t sound that different from me, from 18 months ago. Before I go on, keep with the weight loss program for a few weeks and then see.

My BMI was 32, I was sedentary and whilst I ate healthily, I drank loads (70+ units) a week. I still don’t understand the visceral fat rating, but mine was estimated at 13, which is not healthy at all. It was hardly surprising I had aches and pains from a mild fatty liver* and also acid reflux.

I cut down (now stopped) alcohol. I went to the gym “only” three times a week, but importantly I had a personal trainer once every week or two who not only devised training plans, but he pushed me. I never knew gym/cardio sessions were that brutal, but it taught me that was how I needed to train.

A massive side effect/benefit of all this was I started to equate alcohol calories in terms of exercise. Ten minutes running on a treadmill would have been 150 calories. Yikes! That’s one glass of wine!

My diet wasn’t so bad, but I did cut down and kept a very accurate food diary which I showed to a dietitian. You won’t like this, but she dismissed the 5:2 diet outright. If it works for you, great, but I think cutting down and accurately recording calories of absolutely everything worked for me.

Again, to keep to 2000 calories a day meant I had to cut something out. That’s a normal intake for a male but physically impossible with two or three alcoholic drinks a day.

So, cutting down the booze and exercising properly, the weight dropped off at a ridiculous rate. We’re talking 1kg a week for three months. Then it plateaued a bit, but my BMI by then was 28 and I was 12Kg down. More importantly, the aches and pains and acid reflux were gone.

As of today, my BMI is 26. I mentioned cutting down alcohol, which I did, but I was still on 40 units a week and had to admit defeat - I was alcohol dependent - and stop altogether. You need to think about this. If you can genuinely moderate your drinking and not have cravings, lucky you. If not, the only (and easiest) way is to stop.

Your BMI is high as you know, but you should see weight loss fairly quickly. Save your alcohol money as you’ll need new clothes at an alarming rate. If you’re not losing weight, it’s too much food/booze and/or not enough exercise or enough intensity.

* I mentioned fatty liver. A general abdomen ultrasound showed this during a routine health check three months ago. I wasn’t surprised in the slightest after drinking excessively for years. I bet it will take months or years to recover, but the aches and pains are gone. It really takes a drastic lifestyle change.

And not just the booze. I had a three-week holiday and whilst I kept up my running, I skipped the weights. The amount of muscle/power I’d lost in just three weeks was shocking. This gym thing is ongoing long after you’ve reached an ideal weight. Keep at it and I reckon your aches and pains will disappear.

[Liberty82]

Thanks so much for your reply, congratulations on turning your life around, I'm sure you feel great for it!

I've been working out with a personal trainer too, it's so intense and he really pushes me beyond anything I thought physically possible lol. I see him 3 times a week and then swim 50 lengths once a week, my weight loss was initially great, I lost 7lbs in the first 2 weeks, but then a family tragedy happened and I missed the gym for a month and like you say I couldn't believe the difference when I went back, I was nearly strangled by my first rep on the barbell! I've struggled to get back into clean eating since then so although my trainer doesn't agree with the 5.2 either, it's working for me at the moment and I lose weight at a slow rate anyway as I have have hypothyroidism.

In the past 2 years I've barely drank but I was a heavy drinker in my 20s and early thirties. I'm addicted to codeine, which obviously put strain on my liver but the issues I've been having the past 18 months came about when I had a toothache and foolishly for a number of days I took more pain medication than I should have exceeded (paracetomol). Then I started getting pains in my upper right quadrant, and around to my back, gastro issues, sweating when I take any alcohol (even one beer), or take paracetamol and the heat seems to come from where my liver is, oily stools, irregular periods which have been regular my whole life and its not hormonal as my hormones have been checked (I'm 36), when I last had alcohol 2 months ago I had severe itching the next night and when I took an amitriptyline tablet to help me sleep 4 weeks ago the itching was terrible again the next night and I've since read amitriptyline isn't recommended for patients with liver disease. This was a different kind of itch, it was under the skin, it felt like burning and crawling. The sweating was bad after the amitriptyline too, it's only just calmed down now after 4 weeks but the other night I was kept awake by having sweats and chills. Since everything coincided with taking too many paracetamol, it seems to point right to my liver. Although so far I'm glad test results have come back normal it does worry me that my weight was obstructing the sonographer from getting a clear picture of my liver. She did say my liver sat high and I thought this meant it was enlarged but she said it didn't appear to be. I suppose the only thing I can do is continue eating as well as I can and keeping up with the excersising. It's just being stuck in limbo not really knowing what's going on inside my body.

Thank you so much for your reply x

[Kev12564]

You’re welcome, although I’d jumped the gun a lot as it sounds like you have quite an exercise plan sorted. Losing 7lbs was a great start and as for swimming 50 lengths, you must have a great technique as I can barely manage 4 ☹️ But has the weight loss slowed or stopped? Isn’t hypothyroidism controllable by medicine? Sounds like booze isn’t a factor, so with the exercise that’s my area of “expertise” all used up. 😀

I’d certainly keep up the training as excess weight and visceral fat in particular can’t help.

[Liberty82]

I got back to the gym and during my time off my eating clean had gone out the window. I've really struggled to get back on track but I do try to eat a lot of protein. Since starting the 5.2 3 weeks ago I've lost 6 lbs so I'll just continue it for a bit and then just try and go back to a normal diet where I'm eating clean.

My hypothyroidism was always subclinical and that was only an issue when trying to get pregnant or maintaining pregnancy, but when I had my hormones checked recently I got a letter in the post with a prescription from my gp telling me I was no longer subclinical and that I must take my medication.

I'm sure I have a lot of visceral fat. How did you have yours checked? I'm sure I'd be horrified at my number. Thanks for your reply. I suppose I'll just try to continue what I'm doing. My symptoms like the RUQ pain, sweating and itching have stopped now since I've stayed away from alcohol or certain meds although it's taken weeks for it to calm down. It's scary so I hope to get to the bottom of it soon x

[Kev12564 in reply to Liberty82]

So much for my dismissing the 5:2 diet 😀 Six pounds in 3 weeks is great. As you probably know, the “experts” recommend 2lb a week as a maximum healthy weight loss.

I wouldn’t get too worried on visceral fat figures. It will come down if you keep up the weight loss. Electronic scales very roughly measure body fat and visceral fat. A one-off reading isn’t useful, but weekly or even monthly readings will show a trend.

[Liberty82 in reply to Kev12564]

Thanks x

[GrittyReads]

From my experience of being thoroughly checked out - for the autoimmune liver condition 'PBC' - I was told that ultrasounds do not show damage to the liver on a small scale (and especially not at a micro-level, which is where PBC starts … as I imagine is the case for most early-stage liver issues). Ultrasounds do not show scarring of the liver unless it is at an extreme level - or so my 'Leading Hepatologist Professor' told me. He said ultrasounds are used (more) to rule out other large issues (eg cysts/growths/gall bladder/main bile duct/stones etc). The fact that the ultrasound does not show any damage does not mean that your Medic can presume that all is okay, there should be more tests until they get an answer, if you do have cause for concern.

Don't let them brush you off , ask for a second opinion if necessary.

[Liberty82 in reply to GrittyReads]

Thanks for your reply. I think I'll just continue to push to get answers x