Pricey Dr. Cocarach: I’m a 65 -year -old man. In my latest semiannual examine, my laboratories confirmed an AST degree of 53 U/L and an ALT degree of 62 U/L. I am nervous about non -alcoholic fatty liver illness. Along with losing a few pounds, is 800 vitamin E probably useful? – HC
ANSWER: Steatotic liver illness related to metabolic dysfunction (MASLD, the latest and most appropriate identify for fatty liver illness) is an more and more frequent reason behind irregular liver operate assessments. However it could actually progress to steatohepatitis (mash), which might trigger fibrosis, irritation and, in the end, liver cirrhosis. Definition illness excludes individuals with heavy alcohol consumption.
In individuals liable to MASLD (those that have chubby or weight problems or have diabetes, hypertension and irregular ldl cholesterol), medical doctors ought to take into account analysis, particularly in individuals with earlier household historical past or excessive liver enzymes. (AST and ALT are liver enzymes that mirror injury to liver cells, known as hepatocytes).
Earlier than beginning a remedy akin to vitamin E, I like to recommend making a agency analysis, which might usually be made excluding different harmful causes, akin to viral hepatitis, iron and copper storage illnesses, celiac illness and fewer frequent liver illnesses akin to major bile casting and antipsin deficiency ALFA-1. That is adopted by ultrasound.
If the illness is confirmed by an ultrasound, most consultants will decide the MASLD stage by means of a non -invasive process known as VCTE. (“Fibroscan” is a recognized model). Individuals who have puree however shouldn’t have typically vitamin E are advisable.
Weight reduction by means of a nutritious diet and common train is the pillar of Masld remedy with out mash. There could also be some advantage of vitamin and even in individuals with out puree, however not all research have demonstrated it.
In my view, it’s extra essential to make sure that you don’t have any different reason behind excessive liver enzymes and make a analysis (and staging if mandatory) of what it’s so that you can begin vitamin E now. Vitamin E will increase the danger of prostate most cancers, so I don’t advocate it in individuals who have a excessive threat attributable to private or household historical past of prostate most cancers.
Pricey Dr. Cocarach: My good friend’s daughter fell thrice in her ball at an early age, and was cracked. Now she is a 25 -year -old lady and stuffed with ache on this space. They’ve advised him that he should dwell with ache, since there’s nothing that may be performed to assist his Coxis space. In your opinion, does this younger lady should dwell with this for the remainder of her life? – WT
ANSWER: The continual ache that has lasted years (and maybe many years) doesn’t have an excellent prognosis, however I do not know what therapies have been examined. The routine remedy for a fracture of the Coxis (Coccix) with persistent ache (coccygodygodinia) contains relaxation and safety of the realm. For refractory signs, an professional in cocygodynia ought to be consulted.
Native steroid and anesthetical injections (nerve blocks) can present lasting aid. Physiotherapy, together with pelvic ground physiotherapy, will be very helpful since ache is just not all the damaged bone and may also have an effect on bladder and gut. Therapeutic massage and bodily manipulation will be helpful.
For an individual just like the daughter of his good friend who has in all probability had these therapies, he would take into account the surgical elimination of the coccyx. My sources level out this as a “final resort”, however some research present that as much as 75% of individuals could have wonderful or good surgical procedure outcomes. Eleven % had problems, and 6% was left with a worst end result after surgical procedure that earlier than.
Dr. Roach regrets that he can’t reply particular person letters, however will incorporate them within the column at any time when potential. Readers can ship questions by e mail to toyourgoodhealth@med.cornell.edu or ship mail to 628 Virginia Dr., Orlando, FL 32803.
(C) 2025 North America Syndicate Inc.