Partner worries of future with children Disease can exist without alcohol use

Dear Amy: My boyfriend of eight years has raised perfectly awful children.

They lack basic kindness and empathy.

I have raised two children of my own who volunteer, assist with nonprofit organizations, and are wonderful and caring individuals.

We mainly spend time around my family; his children are in college.

We don’t spend any time with his daughter. She won’t accept that he is even dating me, and his boys are very selfish and self-centered.

Their behavior leads my daughters to question why I would stay

We don’t live together, and I try to distance myself from much interaction.

My boyfriend and I are in our 50s and have been working toward a combined life for some time. His kids cause me to question our future.

I would like to know how to reconcile these differences. — Worried

Dear Worried: Overall, your judgment reveals a lack of empathy toward a set of young people who may be hurting.

If you have been in this man’s life for eight years, and his kids are in college, then the two of you have had plenty of time to try to influence these young people.

Many college-age people go through a self-centered jerky phase. It is possible that these young adults are still maturing, and may actually grow and change.

However, the person at the center of this maelstrom is your boyfriend — not his kids. For whatever reason (probably many different reasons), he has not been an effective and positive influence.

When you think about your future, take these last eight years and then lay another two decades or so out in front of you. You will be facing a lot of rejection, a lot of frustration and the burden of your own harsh judgment. That’s a lot to manage.

Dear Dr. Roach: I am a normal-weight female, age 71, who is very active. I take no medications and have never had an alcoholic drink in my life. My liver tests were abnormal (AST 58, ALT 71), and my doctor found moderate strands of fat in my liver.

What is the difference between high liver enzymes and fatty liver disease? Has my liver been damaged beyond healing? I am prediabetic. — C.D.

AST and ALT are enzymes made by the liver. There is supposed to be a small amount in the blood, but high levels of these liver enzymes indicate there’s been damage to the liver cells. There are many, many causes, but an increasing one is “fatty liver.”

A thorough work-up should be performed looking for these other causes.

If there is evidence of inflammation in the liver, then the correct term is NASH, nonalcoholic steatohepatitis. Cirrhosis develops in people with fibrosis, and fatty liver is set to become the most common cause of cirrhosis in North America.

A FibroScan is helpful but not perfect. The definitive test for NASH remains a liver biopsy, but many experts feel that a biopsy is not necessary if a person meets certain specific criteria. You have several good criteria in your favor: Your weight is normal, you don’t use alcohol, and you don’t have diabetes — yet. Further, although your AST and ALT are elevated, they are not beyond the limit of twice the normal value.

As long as the damage is not extensive, the liver has a remarkable ability to heal itself. Abstaining from alcohol and managing weight if overweight are both of highest importance.

Medications are not a big part of treatment for fatty liver.

I make sure all patients with any kind of liver disease are vaccinated for hepatitis A and B, since these diseases can be deadly in people with any chronic liver problem.