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denial

My husband  has been diagnosed with stage four cirrosis  of the liver.  Is it  normal for him to be in denial and irritable ?   he doesnt want to take  the lactalose  and thinks that is what is making him sick.  I am lost with what to do.  Any suggestions will be appreciated
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Avatar universal
Thank you for all the info   I already found him in a comatose state which led to 11 days of hospitilization   I plan on calling his dr tomorrow   he refuses to take more than 2 doses a day and his symptons are getting worse.        
Helpful - 0
1654058 tn?1407159066
It took me weeks to fully accept the diagnosis. I'm g4/s4 buy no HE. Im strict w diet n am in week 22 of triple therapy.
Be patient n keep him going for medical help n testing. Some things can't be rushed, but he should take care of himself.
I hope he gets a good prognosis. It's not a death sentence.
Take care, Karen :)
Helpful - 0
Avatar universal
I think that often people who are in denial are afraid.  More information usually helps to lessen fear.
Advocate1955
Helpful - 0
446474 tn?1446347682
It is not uncommon that patients will deny, evade or blame some other reason for the fact they are ill. We all bring our personalities with us when we are ill. And when our brain is flooded with toxins, the situation only gets worse.

Bill has a lot of good advice for you. I would follow his suggestions. As Bill said, hopefully some of your husband's denial is related to the poisoning of his brain (hepatic encephalopathy= HE) and the confusion, poor judgment, and personality or mood changes that can result.

He needs to learn that hepatic encephalopathy, edema & a bloated abdomen (ascites) and many more symptoms and complications are NOT caused by undigestible synthetic sugar.

Knowing what HE is and its symptoms may be helpful for you, And because the patient is usually unaware of their changed behavior caused by HE, it is important for the caregiver to monitor their condition.
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What is hepatic encephalopathy (HE)?

Hepatic encephalopathy is a potentially reversible disturbance of brain function due to liver (hepatic) failure. The syndrome is characterized by a broad spectrum of neuropsychiatric derangements including personality changes, intellectual impairment, and a depressed level of consciousness, and appears to be the result of neurotoxins that accumulate with liver failure.  Ammonia, which is usually metabolized by the liver, is a critical neurotoxin in the development of hepatic encephalopathy, but other toxins are also involved. The neuropsychiatric manifestations of hepatic encephalopathy are reversible with appropriate medical therapy, but the syndrome is a hallmark of advanced, decompensated liver disease and has an overall poor prognosis. Thus, certain patients with hepatic encephalopathy should be referred for liver transplantation.

What are the symptoms of HE?

Patients suffering hepatic encephalopathy may come to the doctor with a spectrum of symptoms. In mild cases, called minimal hepatic encephalopathy, the patient may have no symptoms but have cognitive deficits revealed by formal neuropsychiatric testing (e.g., number connection tests, etc.). With more advanced hepatic encephalopathy, fatigue, and at least mild deficits of memory, concentration, and coordination may become apparent. At this stage, common complaints by the patient include:

- “I feel like my head is in the clouds.”
- “I’ll walk into a room and forget why I am there.”
- “I am always tired…but I can’t sleep.”
- “I often forget what to say in mid-sentence.”
- “My boss is telling me that my work is slipping.”
- “My handwriting has changed to scribble,”
- “My hands shake so much, I can’t hold my coffee cup without spilling it.”

Nighttime insomnia is a very common and troublesome symptom associated with hepatic encephalopathy. In fact, patients with encephalopathy may ultimately sleep more during the day, with fitful naps, than at night, and this “day-night reversal” is a hallmark of more advanced hepatic encephalopathy. Family and friends frequently notice a deterioration of the patient’s cognitive function as well as a change in the patient’s personality—with frequent irritability, bouts of anger, and loss of social graces. They may also witness firsthand deterioration of the patient’s driving skills (“He would have run off the road if I hadn’t grabbed the wheel!”).

Two of the most common physical (as opposed to subjective) manifestations of hepatic encephalopathy are asterixis and fetor hepaticus. Asterixis is a non-synchronous and coarse tremor– known colloquially as a “liver flap” – that is best elicited by asking the patient to outstretch the hands with straight elbows, wrists cocked at 90 degrees, and fingers spread apart, instructions easily communicated with the command, “Stop traffic!” Although such a tremor is not specific for hepatic encephalopathy (it can also be seen with renal failure and other conditions), it certainly suggests the diagnosis in patients with liver disease. Fetor hepaticus is a musty sweet odor that is usually evident by casually sniffing the patient’s breath.

When symptoms of hepatic encephalopathy progress, the patient may slip into a stupor or even comatose state and be virtually unarousable. Such situations are medical emergencies, and the patient should be brought to medical attention immediately.
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Good luck to you.

Hector
Helpful - 0
87972 tn?1322661239
It’s possible that your husband’s irritability is a product of the condition that the Lactulose was initially prescribed for; hepatic encephalopathy can make patients confused, angry, emotional, unreasonable, etc.

I’d throw this back on his doctor; explain that he’s not being complaint and ask for some help. Of course, in the end it’s up to the patient what he/she chooses; but poor choices might make things difficult for you too.

What can you do to cajole or otherwise get him into compliance for say, ten days or so? That’s probably enough time to clear his thoughts and perhaps he’ll see things differently by then?

Oh, and is he also prescribed rifaximin along with the Lactulose to help manage his encephalopathy? They’re often prescribed in tandem now and can be much more effective in some patients.

Good luck with everything, and welcome to the discussion group,

--Bill

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