Good Doctors Ask Good Questions
A nurse for more than 30 years, Donna Owens works at Cone Health as interim assistant director of the Cardiac Telemetry floor, 3 East, at The Moses H. Cone Memorial Hospital. She is married to a wonderful guy named Mitch who retired not too long ago after the biotech company where he had worked for 25 years was sold.
Early on, Mitch and Donna spent a lot of their family time at their daughter’s soccer and softball matches. Their daughter Ashley was an accomplished soccer player throughout high school and college. Daughter Joslin played softball throughout high school. Now that the girls are grown and on their own, when she is not working, Donna and Mitch enjoy time connecting with friends, family and members of their church, and relaxing at their lake house.
This year has been a big year for Donna. One daughter moved into a new place in Charlotte. The other daughter moved with her military husband to Germany. And Donna and Mitch spent a week hiking Yellowstone, something she would never have considered doing or been able to do two years earlier. She credits her new vitality and renewed quality of life to having a good primary care doctor – one that took an interest in her and, most importantly, asked good questions. The rest is her story…
John Jenkins, MD
You would think that being in healthcare means you take good care of yourself. But, between taking care of families and taking care of patients, those on the frontlines of healthcare, nurses, too often leave taking care of themselves to the last. Donna is one of those ‘put everyone else first’ nurses.
For Donna, going in to work before 7am is normal. Coming home before dark to walk or exercise rarely happens. As a result, for years, Donna’s knees would ache by the end of the day and gaining weight was something she battled constantly.
Donna has been a patient of Dr. John Jenkins, recently retired from LeBauer HealthCare, for the last eight years. In 2010, Donna went in for her annual check-up. When her labs came back, Dr. Jenkins made note of some elevated liver enzymes. He then spent time with Donna getting information about her lifestyle and family history and referred her to Dr. Malcolm Stark, a LeBauer gastroenterologist, for an ultrasound of her liver.
"A good doctor, like Dr. Jenkins, listens and takes all the time I need for an appointment. If you ask him about something (drug or procedure), he respects the question and gives you research explaining the science behind it before giving you his honest opinion," says Donna.
Liver Disease - A Family Connection
As it happens, a lot is shared in Donna’s family. Brown eyes. Family recipes. And liver disease. Based on Donna’s inquiries, she found out that liver disease had affected 15 members of her family. That is when Donna and her sister put together a plan to help everyone in the family understand more about it.
Elevated liver enzymes are fairly common and can happen anytime. They can be the result of taking everyday pain relievers, like ibuprofen. However, over time and multiple check ups, consistently elevated enzymes might also indicate liver disease, which is often painless in the early stages and ends up a silent killer – often going without discovery until it’s in its end stages.
As part of her family history, Donna told Dr. Jenkins of two uncles who died of liver cancer and of a third that got a liver transplant in 2011. She also told Dr. Jenkins that 25 years earlier, her mother, a non-drinker, was diagnosed with idiopathic liver cirrhosis (liver disease of unknown causes) and her sister had had a liver biopsy a few years earlier that found fatty liver and scarring.
Donna's aunt, Helen Dalton, has seen this family connection first hand. "In 1995, my husband Thomas Dalton went in for gallbladder surgery. Surgeon said he had severe cirrhosis of the liver. Pauline’s death (Donna’s mother) from liver disease, got me thinking there was a family connection," says Helen. "Most people automatically go to alcohol as the cause of liver disease. Alcoholism wasn’t the case for Thomas. We got married in 1971 and he hasn’t had an alcoholic drink in our 44 years. It’s not the cause of my daughter's liver disease either."
After getting a better idea of the family history, Dr. Jenkins sent Donna for a liver biopsy which showed liver inflammation as well as fatty liver and scarring – similar to her sister. Donna was 20 pounds heavier then. Dr. Jenkins also suggested moderate alcohol intake and a testing regimen every six months to keep track of the condition.
Dr. Jenkins believes Donna might have NASH (Nonalcoholic Steatohepatitis). NASH is liver inflammation and damage caused by a buildup of fat in the liver. It is part of a group of conditions called nonalcoholic fatty liver disease. Some think it may be linked to obesity and diabetes. The fact remains, the number of cases is increasing and there is no known cure. The upside is that NASH is slow to progress and might be stabilized through diet and exercise. If unchecked, however, NASH can lead to so much scarring that the liver no longer works, resulting the need for a liver transplant or other serious conditions.
"A-HA moments are found when you are able to put together lab results, the history of a patient and family and the healthiness of their lifestyle. Being an internist is a lot like being Sherlock Holmes – evidence put together to make a meaningful diagnosis," says Jenkins.
Donna’s Journey Back to Health
Donna’s enzymes went up in 2011 and, at her checkup in 2012, they were still high. That is when Dr. Jenkins spent the whole checkup appointment reviewing with Donna information he had downloaded on the benefits of the Paleo Diet. Though no scientific proof had been published, he had seen references to the diet having beneficial anti-inflammatory effects. Since NASH is an inflammatory condition, he figured it couldn’t hurt. He also suggested to Donna that she add more exercise to her schedule and consider adopting the diet as part of a weight management program.
In 2014, one of Donna’s cousins died of liver cancer. At her check-up in 2014, two years after committing to a healthier diet along with exercise, Donna’s liver enzymes were normal.
Today, Donna goes to a liver specialist at the Carolina’s Medical Center for Liver Diseases in Charlotte. She gets regular checkups and keeps to a moderate diet with consistent exercise.
Donna’s Family History Goes National
As a clinician herself, Dr. Jenkins’ questions made Donna curious about other family members and their experience with liver disease. She began to ask questions.
None of Donna’s family are, or ever have been, heavy drinkers. Until Donna’s family shared their experience, there were few, if any, known cases of fatty liver turning into liver cancer. Today, the link is on the verge of discovery, and Donna’s family is at the center of it.
In 2013, Donna’s sister found information on a study at the National Institute of Health (NIH) in which they were looking for a genetic link to NASH. Donna and her sister put together a document that outlined their family tree, including those with and those not known to have liver disease. Then it was off to Bethesda, MD where they met with researchers at NIH to provide them with information on their family history and its connection to liver disease.
Dalton Family Reunion
Later that year, in July 2014, Donna and her sister took their family tree to the Dalton Family Reunion (Donna’s mother’s maiden name) which is held each year along a lake in Virginia. Working with her aunt Helen, Donna got saliva samples as well as signed consent forms to share their information with NIH. The reunion also gave them an opportunity to educate and recommend to every family member that ‘it is important to mention this family history and condition to your doctor.’
Earlier this year, just before the 2015 Dalton Family Reunion, Donna got word that the saliva samples and family history had been reviewed and their family is now one of the largest families participating in this groundbreaking genetic study.