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extremely high bilirubin
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extremely high bilirubin

My friend is an alcoholic. He has quit drinking now that he is sick but it may be too late. He just got out of the hospital with cirhosis of the liver. His doctor is sending him to a hepatoligist(sp?) but can't get in until next month. His bilirubin is 20 times the normal range and his doc is saying he may be a candidate for a liver transplant. I do not know what to expect now. I guess I was afraid to ask the doc in front of my friend any serious questions about if he would get better, or if he would die.He also has bad bruising,really bad itching(the doc said that was because of the high bilirubin),weakness,he just starts bleeding from different places.He also has a loss of appetite and is a diabetic.
I just need some answers. My friend won't ask and we have a month till the specialists appointment. Any information would be appreciated. Thanks
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I know this isn't an easy time for you and your friend.  Sorry to hear the bad news.  I have done a lot of research on the liver, which I am sure you are doing now.  The only thing I know for sure is that there is no cure or reversing the damage of liver cirrhosis.  But if the alcohol is the cause of the cirrhosis then if your friend abstains from alcohol it should stop the disease from any further progression.  I'm not a doctor, but thats just what I have gathered from my research regarding liver cirrhosis.  Hope you guys get good news from the hepatologist.  Take care.
Hi Garnet.  I'm so sorry you're going through this.  I think it's wonderful you are trying to help your friend.  It's natural to not want to ask questions of the doc in front of him.  But maybe now you can begin to get a "feel" for what you can ask.  

If you are with your friend or if you're checking on him, or if he has said to you "help me with this", you can speak to the doc (either with him when he goes for his appointment or on his behalf now if he designates you to help him.)  This will require in most cases HIM telling the doctor "I need help with this - this person is going to be the one I want to help me>" (something like that)

I've watched two good friends (one died last year) with alcoholic cirrhosis  (in their 50s), and for the one who died there was no help for him because he would not quit drinking and he was also refusing medical care.  He got down to about 85 lbs in the end, if that, and he died in his apartment.  

My other friend (his drinking buddy) bled out (typical for alcoholic cirrhosis)  a few weeks after our buddy died.  (I don't drink - been in recovery for decades - just thought I'd throw that in :)  Anyhow...he called me and said he was vomiting blood.  I got him to the ER, scared to death while driving there I wouldn't get him there in time.  They saved him in the nick of time.  They transfused him and they "banded" his varices  (varicies are engorged blood vessels caused by cirrhosis, usually in the esophagus that are the source of the bleeding, and "banding" is a procedure that can be done on these "varicies").  My friend pulled through that one, he swore off drinking, began attending AA again, stuck to it for about six months, gained 70 lbs in that time back to his baseline weight, he was clear headed again, felt good, but then he began drinking again last year.  He's now in bad shape again, back down to about 120 (and he should be at least 210).  He's had another scare - enzymes are way up there and his bili is too, and he's stopped drinking again.   It's sad.  He's smart, but he just cannot lay off that booze, even though he knows it's killing him.  

At any rate, between now and the time your friend is seen by the hepatologist, if he thinks (or if you think) he is bleeding somewhere (if he vomits or coughs up blood) he needs to get to the ER immediately (911).  Bleeds can happen quickly with these patients and can be fatal. They can't always been seen, either, because a lot of it happens in the gut.

Also, with cirrhosis your friend could, at some point, become disoriented (confused, very sleepy, and possibly not arousable).  If that happens, he needs to get to the ER immediately.  

I'm not telling you these things to scare you - I'm just telling you what can possibly happen and - if you are trying to keep an eye on him -- some things you can watch for that would mean he needs immediately medical attention (911).  

If you get a chance to speak to his doctor, ask him, too, what you need to know and look out for.  In fact, if your friend gives you the "go ahead", I urge you to call his doc now  (the hep doc he has the appointment with) and ask the nurse or the doc what you need to watch out for with him.

I don't know what his diabetes will do as far as transplant, and that will be something the doc will know.  

If he's considered at some point to be a candidate for a liver transplant, most I know on the TP list have to have a designated "caregiver" living in the home (one who meets the transplant team's criteria).  Also, being alcohol-free, cigarette-free, pot-free, rec-drug free, etc, will be a must with liver TP.

Wishing you all the very best.
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