Novel treatment for cirrhosis-caused distended abdomen

DEAR DR. DONOHUE: I am writing this for my husband. About five years ago, he was diagnosed with hemochromatosis. The iron damaged his liver and pancreas. He is not a candidate for a liver transplant. In this past year, he has developed fluid in his abdomen, and for many months now, 5 liters (about 5 quarts) of fluid have to be removed weekly. The doctors suggest the TIPS procedure. What do you know of it? -- B.S.

ANSWER: Hemochromatosis is a genetic illness that causes the body to lose control over the amount of iron it absorbs. It absorbs too much. Iron deposits in the liver and pancreas and other organs. In time, the liver becomes scarred -- cirrhosis. A severely scarred liver keeps blood from the abdominal organs from passing through it on its return to the heart. Blood backs up, and abdominal blood vessels leak prodigious amounts of fluid into the abdomen. The fluid buildup is called ascites (ah- SITE-ease).

The swollen abdomen is most uncomfortable and can hinder breathing.

TIPS is a way of dealing with ascites when medicines are no longer effective. It is not an operation. A thin tube, about the size of a strand of spaghetti, is passed through the jugular vein in the neck to the main liver vein. On the tip of the tube is a stent, a device that keeps a blood vessel propped open, very similar to the stents that keep heart arteries opened. The stent opens up the liver vein, and blood can once again course back to the heart. This stops fluid from leaking into the abdomen and bloating it.

If my doctors told me I needed this procedure, I would go for it.

"TIPS" stands for "transjugular intrahepatic portosystemic shunt."

DEAR DR. DONOHUE: You wrote that grapefruit can increase the blood concentration of Lipitor. What does that mean? -- E.C.

ANSWER: Grapefruit and grapefruit juice interact with a few medicines. They inactivate an enzyme that normally breaks those medicines down. As a result, the blood level of these drugs rises and could potentially rise to dangerous levels. This rarely happens.

All the same, people who take a medicine sensitive to this effect of grapefruit shouldn't eat it or drink its juice. A pharmacist can tell you if your medicine is on the list. Most medicines are not.

.Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall. com. 2006 North America Syndicate Inc. All Rights Reserved