Ascites

[island woman]

My friend has been under treatment w/ a doctor for end-stage liver failure. This was only diagnosed, as Hep C, 2 months ago. His abdomen has increased in size by 9 inches in the last 4 weeks, he is in severe discomfort and is now experiencing pain in the abdomen. His doctor has prescribed Lasix (sp) and spironolactone diuretics, which are doing No good at all. Due to the abdominal swelling, he is unable to breath, eat or sleep very much at all. His doctor has put off paracentisis twice, telling him that the procedure is not w/o risk. My question is "why would the doctor refuse to do this procedure, when two other emergency room doctors have expressed the need to do so, then when they consult the primary doctor they refuse to do it? What could he possibly be waiting for? And should my friend consult a different doctor? Thank you in advance

[mikeray]

A related discussion, ascites diet was started.

[imkindly]

They usually won't do paracentesis unless the ascites is "tense" and "refractory".

They can tell if it's "tense" by palpating (touching) the abdomen.  If it's tight (huge, doesn't "slosh" or move)....they call that "tense".

"Refractory" means that it's not responding to low sodium and diuretic therapy.

My husband is one of those patients that they would rather not do paracentesis on. (We've been told that if it gets bad enough, they will have to eventually do it in the future. But for now, we're trying to put it off as long as we can.)
The reason they are putting it off in our case is---
1. my husband's platelets are very low (so he could continue to bleed internally if they poke him)
2. my husband has a high risk of infection (he has already had peritonitis (infected ascites fluid) twice)

We were also told that there's the possibility that he might need a TIPS (shunt) procedure done in the future.
(TIPS can get rid of alot of the fluid.)

But again, they are putting that off as long as they can, for the same reasons (risk of bleeding and infections).

I think what it really boils down to, is whether you totally trust your doctor's judgement or not.

For example, I don't trust anything that our local gastroenterologist says!  I really don't.  (If HE were the one that was stalling on doing any procedures, I'd be suspicious.)

But I do trust the liver transplant team at the center we go to. (I trust what the hepatologist there says.) So when they tell me that it's too risky to do (unless we have no other choice later)...I believe them.

Is your friend going to a good center, and dealing with liver specialists?  If he is....they may have good reason to be putting this off.
(But if he isn't-----he should get an appointment with a better doctor, someone whose judgement you trust.)

PS- My husband has Hepatitis C, and has been in liver failure since August 2000.  If I can be of any help, let me know.
My homepage is at  http://groups.msn.com/CirrhosisSupportGroup

[island woman]

Yes, he's a strict vegetarian and has avoided salt & most processed foods for many years. My curiosity is why the doctor wont perform the parasentisis now with all the pain & discomfort he is experiencing. Do they usually wait for certain symptoms to be present before doing this procedure?

[imkindly]

Is he on a low sodium diet?  (Staying under 2000 mg. sodium per day)

Our hepatologist has us doing several things for ascites:
1. low sodium diet
2. Lasix and Spironolactone
3. Keeping track of weight (weigh every morbning and write it down. Any weight gain of 5 pounds or more during a week means to call the doctor so that the dosage of diuretics can be adjusted.)

When those (above) aren't effective, then they consider paracentesis.
Paracentesis is usually 'safe'....but there are some risks involved (infections, internal bleeding).  So it should only be done when the low sodium diet and diuretics aren't effective.

Sodium (salt) makes a big difference in how effective the diuretics are.
Make sure he's on a low sodium diet.  Read labels on anything he eats or drinks (you'd be amazed at how much sodium is hidden in foods and drinks).

Hope this helps.