Hi all! I haven't posted in quite a while. It's been a bit hectic here. My Mom went through surgery and radiation, and beat cancer's butt for the 2nd time! :)
My question is about a MELD score. How can the score decrease as the patient gets progressively worse? My ex-husband is in the hospital again, this time with a high ammonia level and severe anemia. He quit drinking last August, and has gone through the fluid in the belly (ongoing issue), has bands in his esophogus. The doc got him all cleaned out overnight, but his ammonia level only dropped 3 points. It is still very high (149). We got the lab results this morning and checked his MELD score. According to it, he is at a 12. That confuses me, as we are watching him get worse. Can someone explain it to me?
Ammonia levels aren't taken into consideration when figuring out meld scores.
I hope you know your husband should be on a low to no, salt diet and not eat any red meat. Red meat contributes to the ammonia buildup and salt ( sodium) contributes to the ascites, fluid build up. Read labels. Feed him food as fresh and freshly prepared and as organic as possible.
People who liver disease has gone too far (extensive scaring and portal hypertension will continue to progress over time until the liver fails. In order to stay alive the person will need a liver transplant before that happens.
Meld score go up and down just like every blood level does and people feel sicker of less ill at different times with early cirrhosis. In order to be put on the waiting list for transplant at most US transplant centers, a person needs a MELD score of 15 to get listed. Then it depends on the transplant centers location as to how high their MELD score must be to get a transplant. In NYC, San Francisco and LA people will need a MELD score in the 30s to get a transplant. With a MELD score of 30 something a person will usually be very ill and in the med to upper 30 may need to be hospitalized. Patients are often on the waiting list for years before getting a transplant because livers are a rationed resource. Every day on average 18 people die waiting for an organ that isn't available because people do not choose to sign up as organ donors.
HE is early cirrhosis is manageable in the vast majority of cases. Is he being treated at a transplant center? If not, that is why his HE is not being managed properly. Only doctors at a transplant hospital know how to manage HE. Get him cared for at the nearest transplant center now as things are only going to get worse over the years to come. When HE becomes advanced as the liver becomes more damaged HE can be life-threatening. People go into comas and die or they can have irreversible brain damage.
Yes, many think ammonia levels should be part of the MELD score, but it's not. So this means your ex, with a score of 12, has decent bilirubin levels, his kidneys are all right, and his blood clots quickly enough. I hope he is taking Lactulose for the ammonia. That, and a good diet with no red meat and lots of leafy greens will bring the ammonia down. Always keep salt intake as close to 1000 mg as possible. No processed or fast foods. Use salt only at the end, when cooking. Try new foods.
All the very Best to you both.
Tink... Notes of hope... I was on a liver transplant list, in Tampa Florida, for 3 years starting in 2008 with a MELD score ranging from 18-26. As it turned out the doctors did a great job managing my illness until my liver decided to just "become better". I did not need a transplant and my MELD score is now a 5... unbelievable but true. I lost 100lbs, was in a wheel chair, could not write, my ammonia levels were also high and had to have many Paracentesis to treat the ascites (abdominal fluids). We had discussed the TIPS procedure but I was not ready for that. KEEP POSITIVE THINKING and my mother always said to pray for help from my angels, they were only waiting for me to ask.... it didn't hurt! Good luck, there is still the possibility of a great recovery. I was one of the lucky and grateful ones.
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