Liver disorders can be running in the family and one such case is of Neelagandan L, 67, who has been living with the condition of Non-alcoholic fatty liver disease (NAFLD) since 2010. In the last 14 years, despite following a healthy lifestyle, Neelagandan has been going through multiple liver related issues. The family was jolted when a liver biopsy done in 2010 during a regular medical check up diagnosed him with NAFLD, and showed the fatty changes in the liver.

NAFLD diagnosis- A family history of liver conditions

However, the family was able to make quick connections, despite wondering ‘why him’. Both his brothers had succumbed to non-alcoholic fatty liver disease and Neelagandan was thus more vulnerable.

Not just that. In 2019, he once faced acute breathlessness and rushed to a private hospital in Bangalore and was diagnosed with the presence of liver tumor or Hepatocellular carcinoma (HCC), which came as a shocker for his family. He had also faced bleeding in the abdominal cavity.

“My husband is a teetotaller, and doesn’t smoke, or consume alcohol, so it was shocking that he got diagnosed with multiple liver related issues,” says his wife Indira Neelagandan, a retired zoology professor.

“His initial symptoms included bleeding in the abdominal cavity. This was because one of the veins going to his liver was blocked due to the tumor, which caused bleeding”, adds Dr Rajiv Lochan J, lead consultant – HPB and Liver Transplantation Surgery, Manipal Hospital,  Bangalore, who has been treating him.

Diagnosed with Hepatocellular carcinoma

“He was unable to walk properly and experiencing breathlessness, so we immediately rushed to the hospital. The tumor presence came as a shocker”, says his daughter Renuka Neelagandan.

The PET scan revealed the presence of an advanced stage tumor in his liver. He was diagnosed with abnormally high levels of alpha-fetoprotein (AFP), a protein produced by the liver indicating a problem in the liver. The ideal AFP levels must be between 0 ng/mL to 40 ng/mL in adults. Anything beyond 400 ng/mL is suggestive of the presence of liver tumor.

Though his tumor was advanced, it completely melted away with targeted therapy using a tyrosine kinase inhibitor medication, he added.

“HCC is a type of liver cancer that arises from the cells of the liver. It generally occurs when the liver is already damaged, explains Dr Lochan. He adds that Neelagandan is prone to liver conditions due to genetics.

NAFLD progressed to liver cirrhosis

Not just that. In November 2023, Neelagandan’s condition progressed to liver cirrhosis in addition to the existing non-alcoholic fatty liver disease.

Dr Lochan says, “He was diagnosed with fatty liver disease, which led to cirrhosis due to metabolic factors like diabetes or high lipids. Now his liver cirrhosis has advanced, which is why a transplant is being considered as a curative treatment option”.

‘Alcohol not the only cause of all liver issues, blame genes’

Dr Lochan explains that while alcohol is a common cause of liver disease, it is not the only cause. “Even without alcohol consumption, someone can develop fatty liver disease due to metabolic factors like diabetes or high lipids. This fatty liver disease can then progress to cirrhosis of the liver,” he adds.

Treatment and path to recovery

His cancer was not restricted to the liver alone. It gradually spread to his lungs also. Given his condition, chemotherapy was not seen as an option, and he was treated with oral medication. He was prescribed an immunomodulatory drug called Lenalidomide, which he has been taking since 2019. “There has been an improvement in my condition. There is significant improvement in the AFP levels reducing from over 140,000 to 3.8 ng/mL”, says Neelagandan. While he is currently stable and cancer free with no active tumor, he has been advised to go for liver transplantation due to liver cirrhosis for better long-term prognosis.

Neelagandan is also diagnosed with type 2 diabetes and is currently managing with medications.  He also was diagnosed with cardiac ailments in 2023.

Family remained his pillar of strength

Neelangandan recalls that his wife has been very supportive in his treatment and recovery journey.  “She took care of me diligently. Be it following up with a doctor’s appointment or checking my adherence to the medication, she has been my pillar of strength,” says Neelagandan. His family members helped him to stick to the doctor’s advice right from ensuring regular walk to nutritious diet, and monitoring medication intake.

“My son and daughter-in-law, who are both radiologists, rushed back from the UK to India to consult on his case when they saw his PET scan reports”, Neelagandan recalls.

“Having family members who are doctors helped provide medical guidance and support during his treatment”, says Renuka. Though his condition is stable now, he still has NAFLD which is the underlying cause for his doctors recommending liver transplantation”, adds Renuka.

Managing Liver complications through lifestyle changes

Now, he maintains a healthy lifestyle as advised by doctors. “I make sure that I do regular walking, and consume a nutritious diet”, says Neelagandan.

Dr Lochan advises, to keep your liver healthy, you must focus on leading a healthy lifestyle. This includes eating nutritious, protein-rich foods, exercising moderately, and avoiding liver stressors like excessive alcohol, certain medications, and herbal supplements. “Those with a history of liver issues in the family must be more careful,” says Dr Lochan.