When my dad found out in 1989 that he had scar tissue on his liver, the doctor told him not to worry. My dad never drank alcohol. The doctor said my father was more likely to die being hit by a car.
On Aug. 21, 2010, my father Irwin died of liver failure.
My father was a kind, gentle man whose greatest goals were to make people laugh and take care of those he loved. He loved funny TV shows, snagging a bargain or sitting outside on a summer afternoon.
My parents were married for 44 years and were true partners, sharing responsibilities and discussing every decision. Their marriage was so special and rare, it was a privilege to witness.
My dad also struggled with his weight almost all his life. Diagnosed with Type 2 diabetes at age 44 in 1989, he found it hard to stick to a healthy diet. While he could see how this affected his blood sugar, he had no idea what he was doing to his liver. Neither did his doctors.
In the '90s, little was known about his condition, non-alcoholic fatty liver disease (NAFLD). Today, doctors know that certain steps can prevent, manage or even reverse liver damage. But what my father didn't know could save your life.
NAFLD is the build-up of excess fat in liver cells. While the cause is unknown, a diet high in calories, saturated fat and sugar overloads your liver, which for some people creates the conditions for NAFLD. This is especially true for people who are overweight. There may also be a genetic link that makes some people more susceptible.
It is estimated that in North America, 20 to 30 per cent of adults have fatty liver disease. With the obesity epidemic, NAFLD will only become more common.
A fatty liver can lead to damage called non-alcoholic steatohepatitis (NASH), which can progress to cirrhosis, or scarring of the liver. With cirrhosis, the liver can't function properly and transplant is the only treatment.
It can take 20 to 30 years for fatty liver to progress to cirrhosis. My dad had his liver enzymes checked regularly and had an annual ultrasound. He was told everything was staying the same.
In 2007, he started having weakness in his knees and swelling in his legs. He couldn't walk very far and climbing steps was difficult. These symptoms were blamed on arthritis and diabetes, while in fact his liver was worsening.
One night in February 2008, my dad was lethargic and incoherent. My parents assumed it was low blood sugar. My dad ate and was back to normal. Or so he thought.
He had actually experienced episodic hepatic encephalopathy, a symptom of cirrhosis. When the liver is damaged, toxins aren't neutralized properly and can build up in the bloodstream. This can cause confusion, agitation and slurred speech.
My dad also started losing weight, but because my parents had joined Weight Watchers, we didn't realize it was another symptom of liver disease.
One day that September, my dad became belligerent and not at all like the man my mom had known for almost 50 years. An ambulance took him to the emergency room and a doctor finally recognized that my father's liver was the problem.
A few days later, a doctor told my parents that without a liver transplant, my dad had two years to live. They decided my dad would beat the odds. And even if he didn't, they would make the most of every moment -- travel to new places and spend more time with family and friends. But my parents never had the chance for many adventures.
By the end of November, my dad had to stop driving. He was on a strict diet, which included no meat and only 1,000 mg of sodium a day. My mom meticulously counted the amount of salt and protein he ate.
My parents would go for drives and my mom would pack sandwiches so they could eat in the car by a nearby lake. But even these outings became too much. My dad had to use his hands to move his legs in and out of the car and climbing the stairs was almost impossible.
Between February and August 2009, my dad made 31 trips to Toronto General Hospital. Many were to see if he was eligible for a liver transplant. My mother, brother and I wanted to get tested to see if any of us were a match as a living donor. We never got that far.
In August, the doctor said my dad's body would not handle the recovery and did not put him on the transplant list. In January 2010, he was admitted to hospital. That weekend, my parents quietly showed me his discharge papers.
They stated that my dad had three to six months to live.
He pretty much never left his room after that. But there was so much laughter there. We watched movies and copious amounts of The Price is Right. My family is known for celebrating every occasion, so we just moved those celebrations into my parents' bedroom.
When my daughter was born on March 7, 2010, I did not expect my dad to visit the hospital. But when my brother and grandmother arrived, I could hear my dad's voice in the hallway. My dad -- who was too proud to use a wheelchair and for whom using stairs was a hardship -- had come to hold his fourth grandchild on the day she was born.
On June 5, 2010, my dad was restless and talking very little. An ambulance took him to the ER, where the palliative doctor recommended he stay in the palliative care wing of the hospital. It was the day before my 34th birthday.
My father stayed there for 10 weeks and his family and friends spent hours in his room reminiscing and laughing. We celebrated Father's Day there, complete with cake and singing grandchildren.
We also each visited alone. We made sure to tell each other all we had to say. I told him what an amazing father and man he was. I told him about all that he had taught me and everything that I would never forget. Other times, we just quietly held hands.
Every day, I wish we had the chance to do that just one more time. By telling my story, I hope to save even one other daughter from needing to have that same wish.
Risk factors:
A large waist circumference, elevated liver enzymes, high triglycerides and high cholesterol could be red flags for NAFLD. If you're at risk, your doctor should check liver enzymes or order an ultrasound or even a biopsy.
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