Is edema the same thing as ascites?

[dlr2007]

My first post was confusing I think- that is basically my question. I'm very anxious because if edema+ascites, my husband has gone from being *possinly* stage 3 or cirrhotic to decompensated cirrhosis- quite a difference. Thanks for any answers.
-Dee

[copyman]

I do not think they are the same, edema can be water build up anywhere on the body where ascites pertains to the belly. Why keep guessing? have him get a biopsy or at least a non-invasive test like a fibroSCAN or at last resort a fibroSURE bloodtest. The fibroSCAN is only available at a few locations in the US. If my ankles were swollen I would run to get a biopsy because that is usually the first sign when the liver is getting cirrhotic and I would want to know. Best of luck

[dlr2007]

Thank you for your reply- you have always given me excellent advice before and it's good to hear from you again. I hope everything is going well for you.
My husband scored a 67 on FibroSpect II, but I think it was off due to his platelets being  normal from pleurisy (his platelets usually hover at around 100 but the inflammation bumped them up to 160). They were unable to do a bx because they couldn't start an IV line- it has just been one thing after another. I finally convinced my husband that his platelets are low, albumin is dropping to 3.5, and it's time to treat before it's too late. That should have been the doctor's job, but oh well...
  So the swollen ankles are more of a first sign of cirrhosis than a symptom of decompensation? That's good, then! I just have this fear that something will go wrong and he will be unable to start tx- like his platelets getting too low or some other complication... it's so frustrating just watching time tick away... hopefully December will be the start of tx though. Thank you for wishing me luck, and for the advice!
-Dee

[copyman]

Why not start tx sooner? I see you live in Mass, can you get to Boston and have a fibroSCAN done? there is one at Dr Afdhals office. Or better yet if you can treat at his office your husband will be with one of the best HCV docs in the world. Bottom line is that swollen ankles is serious and you need to move fast now! If your husbands doc does not seem concerned about the swollen ankles then you need to get a different doc ASAP !!! best of luck

[fretboard]

Swollen ankles are one thing, and like I said in my other post.  You don't have to be cirrhotic to have swollen ankles, if there were swollen ankles plus ascites, then that would be definite trouble.  Another thing to consider is for your husband to schedule another biopsy, they had trouble locating a vein on me as well, but they finally did.  Maybe a doctor will need to be on hand to use a port, so a sub-clavian or femer vein may be another option to locate a vein.  I've had different modes of access to veins used in the past surgeries, there is always the juggler vein,  although I'm sure they would want to stay away from that.  I hope I spelled that right.  Another couple of problems that I see for concern are the pleurisy and the fact that he's a diabetic.  A biopsy is very important and considered to be the golden standard to dx how much damage there is to the liver.  One last thing I wanted to mention was that swollen ankles seems to be a more common sx with recovering addicts, but your husband has other issues as well, any other reason could result in swollen ankles.  Another thing is his age, he is the same age as I am.  Good luck and God Bless  

[dlr2007]

Copyman,
I would LOVE to go to a really good doctor for my hubby- the problem is he has MassHealth insurance and I'm not sure if the really wellknown hepatologists take that. I could look into it however. Also, my husband would probably b*tch about going to Boston- one thing, well the major thing, that drives me INSANE is that he just doesn't get that his life is in danger here! If we wait til his platelets get too low for tx- then we have lost that HUGE hope just because he wasted time dragging his feet. I'm just so upset about it. I'm gonna try to get him to read these posts and maybe he'll believe me. Meanwhile, I'm looking up Dr Adphal to see if he accepts MassHealth. If not, at least we should go to a hepatologist. My husband (Rick) just has so many issues tht tx is going to take a very competent and attentive doctor. Otherwise, he'll get pulled off tx cuz of sides or low platelets and go into the "there's nothing left to do for me" mode :(... Thanks for your advice, I really appreciate it.

Fretboard,
I mentioned the jugular vein as an option- unfortunately my hubby turned white and the doctor said "guess not!". He could've at least TRIED to convince my husband... I think a biopsy would really tell us where we stand, and hopefully get my husband (Rick) to take this more seriously. He has been putting off tx for the entire 4 years that I've known him- and between his falling platelets and albumin, the diabetes and now the ankles, something tells me things are going south with his liver. Very frightening.
  Oh yeah- I Googled the exact definition of what Rick has and it is "pitting edema". When you press your finger on his ankle, the imprint remains for a few seconds. Is that what you have? Or is there another kind of "just plain swollen ankles"? Sorry for my lack of knowledge. Any btw, I hope everything is going well for you. It seems that many people on this board are in their 50's- it's a popular age ;) . God bless you also- have a good day. I'm off to work!

[copyman]

Like fret points out there are other reasons for swollen ankles but having HCV and swollen ankles would bring much concern to me. I have personally only met 2 people in my life with swollen ankles and both had cirrhosis. Of course later on they developed ascites but this was the first sign. I think if you can get him to see a hepatologist then your hubby with get the hard core facts and WAKE him up. Hepatitis C has a strange way of sneaking up on you and sometimes it is to late to treat. Then the only option left is to get on a transplant list and wait . Not to alarm you but most die on the list waiting because there aren't enough livers. Sorry to be so blunt but it is the truth.

PS, you commented about many people on this forum being in their 50's. One of the reasons for this is many of the baby boomers did some "stupid" things in their youth and hepatitis C "usually" takes decades to show symptoms. 45-55 yrs old seems to be a poplar age range.  

[MIBunny55]

Hi there, I have some questions re: transplants. I was (in the recent past) of the understanding that they were having good luck with partial/liver transplants and some were even donated by a family member or loved one.  Then include the harvested livers and I hoped there was more options for us who may need a transplant.  Don't have all my numbers handy but I was Dx'ed with Hep C in 1993, did first tx in 99-00, second was 02-03.  Did each for 6 months with unbearable sides on the most recent.  Following that I fell hard. Stepped into some old behaviors and beat the **** out of my liver for almost 5 years.  Recent labs show much more deteroration.  I do have cirrhosis and ascites, Dr says the ascites are from the water leeching from my blood vessels due to low rbc. In early July I looked as if I was 9 months pregnant, not fat but huge from water weight.  Been playing musical water pills ever since - gives me abdominal pain.  Plus due to some calcium problem I also have gallstones. The never-ending litany of health problems I started in by doing those "stupid" things in my youth.

[copyman]

Hey MIB, sorry you are having a tough time. I did not mean to sound so discourging about transplants but I was trying to get a point across to the husband that was reluctant to treat. You are correct and there have been advancements with transplants and even though things are looking hopefull they have a long way to go. I think the living transplants can only be done in certain patients. It is a major operation for both doner & patient. I hope you are on the list as it sounds like you are far along. Are you seeing a hepatologist? hope you feel better soon.

[Mr Liver]

Edema can be caused by various situations as noted by others. For many with advanced fibrosis/cirrhosis it can be the symptom of a failing liver. Not everyone will experience this symptom, so it is necessary to rule out/in the cause as soon as practical. Left unattended it can become painful and debilitating, regardless of the origin. Edema when seen in someone with liver disease can be the result of the failure of the liver to produce enough albumin.This in turn causes fluid to leak from the vessels into the surrounding tissues. If the cause of the edema is indeed liver-related it may be a sign of decompensation .There are methods and meds to control edema and even eliminate it. I would discuss this with his doctor. Best of luck,
Mr Liver

[Dayzdreamer]

My first post was confusing I think- that is basically my question. I'm very anxious because if edema and ascites, my husband has gone from being *possibly* stage 3 or cirrhotic to decompensate cirrhosis- quite a difference. Thanks for any answers.
-Dee

I may repeat some of the advice given already but to give you an idea of the stages it is hard not to. Decompensated cirrhosis is end stage liver disease. If your husband hasn’t had a biopsy how has the doctor diagnosed him with stage 3 cirrhosis? My GI wouldn’t do a biopsy because it may cause more problems from bleeding and I had enough of the symptoms to be end stage at the least stage 4 but he said more than likely end stage. I also had a CT scan.  I can not be put on treatment as it is too dangerous with my condition. I have the acites (ascites) and the edema and portal hypertension in the esophagus... My liver is also not producing enough albumin. I get my stomach drained once a month and have to have the albumin because my liver is not producing it. Mrliver explains well why the fluid builds up.

If he is pressing on the legs and then indention shows that is edema not just swelling of the legs. It isn’t uncommon for those with hep c to have some swelling of the legs. Many get a bit larger mid drift. This is due to the liver not functioning properly. At some point if you have the virus long enough you will see some of these symptoms as the hep c are causing damage to the liver slowly. That is one good thing hep c works slowly unless you drink a lot of alcohol.

The doctor can put him diuretics to help with the fluid gain. They make a big difference. He should get plenty of rest and make sure his feet are raised up when possible. Definitely do a low sodium diet. Sodium makes the fluid gain worse.

If your husband can do treatment sooner is better.  If he clears the virus and your husband does not have a decompensate liver it will stop the hep c from causing further damage. He still may have to have a liver transplant in time depending on the damage to the liver. I would take notes from all the advice here and have questions ready for you doctor next visit. Good luck and I pray he doesn’t have the decompensated liver.
dlr

[HCA]

A trans jugular biopsy is safer than a needle biopsy in advanced cases as there is little risk of bleeding.He should go for it.They can do a wedge pressure test at the same time to measure portal hyper tension.
What genotype is he?
The odds of anti viral-treatment working if he has decompemsated are not very encouraging.