liver failure

[kittykat70]

My 73 year old mother is presently in hospital after collapsing on Tuesday last week.  She was unconscious until Friday and at first Dr's thought she had suffered massive heart attack or massive stroke.  Her prognosis was not good.  She came around but is still not sure what is reality and what is fiction.  They have since ruled out stroke and heart failure as she has liver failure and had a bleed in her stomach.  She is already at stage 4 Kidney failure and has been for a couple of years and her health has deteriorated the past few months to the point we were expecting something big like this to happen.  5 Years ago she had heart surgery as she has irregular heart beat, metal valve fluid on her lungs.  We have been told if she ended up in hospital she would be finished as being active was the only thing keeping the fluid build up down and once in hospital for any period she would slowly deteriorate.

She is sat in a chair for part of the day but she is very week and drowsy.  They are continuing to do tests but they have not said what her long term prognosis will be.  I want to know what to expect.  She has cirrhosis of the liver end stage and she has never drunk alcohol so I know it is not reversible.  But how well can they control this with medication.  Her blood pressure is very low now but they don't want to increase her fluids anymore as her liver is already under strain and so are the rest of her organs.

What questions should I be asking the Dr's and how long could I expect her to live, best and worst time scales.  I don't know whether to look at nursing homes or if it would be hospices or might we be able to get her home.  Just the unknown is killing me at the moment.  I can deal with anything if I have the facts and I feel I do not know enough about any of this to help understand what will happen.

Any advice welcome.

[kittykat70]

Well here we go again, my mother is back in hospital after a massive nose bleed on Tuesday. She is very confussed and they still have not been able to take the packing out of her nose as the bleed restarts.  We have discovered she has encephalopathy, which is aparently brought on by too much protein in the liver, we know her nose bleed causes this as it goes into her stomach and then gets into her blood stream.  My question this time is about the way this condition works.  In the past she has become unconcious quickly.  This time it has been a larger nose bleed but she is just confussed.  Does this mean she will recover quicker from this episode or is it when her liver starts to catch up on itself that the coma happens?    I thought the bigger the nose bleed the worse the recovery would be.  It has suprised me that she is doing so well.  Am I still to expect problems or is she over the worst?

Any advice welcomed?

Kat xx

[kittykat70]

Thanks for the comments from everyone.

We have discussed machines not being used as she does not want them  We are now about to have her discharged home.  She is still very confussed but they have been able to work out what is wrong.  Her liver becomes over loaded by protien in her body which it can not break down quick enough, these turn to toxins making her confussed, in time her liver packs in making her fall into a coma state for a few days while her liver catches up again.  If she does not move her bowels twice a day this also happens making it impossible to say how long she will last at home.  As soon as she has a nose bleed (Often as she is on Wafrin) or doesnt move her bowels properly she will be back in a coma state and next time her body might not be able to get her well again enough to get home.  There is nothing they can do about this as she has mulitiple organ failure so they are just balancing her body to keep her alive with drugs.  So it will be back home to wait for the next episode to happen.

Thank you all for reading.

kat xx

[merryBe]

I'm really sorry about your mom. It's hard at any age to let a loved one go.
Even harder is how to make the last days count.

Having gone through it this spring it's still fresh on my mind losing my son's gramdma.
The thing is, even though they may hate hospitals, in the end our little gal realized she was being made more comfortable there. It's hard no matter where, but at least they are getting changed, cleaned, and not having to get up to go potty if they are too weak

Unfortunately, medicare would not pay for her to stay in care because the doc did not call it dying...so she ended up with my ex...at home...where she wanted to be, but very poorly cared for..by him.  She ended up sleeping in the recliner, afraid to lay down in bed, because she thought she'd die there...and ended dying in the chair anyway.

I'm not sure how to help you except to say try to make decisions that are in her overall best interest. If everyone could pass on peacefully and surrounded by loved ones it would be ideal, but we don't live in an ideal world where that can always happen.

Did your mom ever express to you how she felt about machines and being hooked up to pumps and such to postpone her passing? Usually at some point thoughts about this get expressed. Remebering back to those conversations may help you to make future calls for her.
If she does have another period where she is lucid and feeling well, it would be a good idea to get her to sign both a "directive to physicians" and give you "medical power of attorney."
my heart goes out to you.
mb

[jdwithhcv]

I feel strange, part of me wants her to let go and loose her fight as she is so unwell and hates being in hospital and part of me wants my mam back but dreading the weeks ahead in hospital recovering
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I understand what you mean and I feel for you.  It's hard to know what to wish for when you are faced with a loved one who is suffering.  I'm facing a similar dilemma, my mother (age 92) is in hospital and her quality of life is questionable, even if they manage to keep her going.

You and your mother are in my thoughts.

jd

[kittykat70]

Have not been back for a while as things changed quickly with my mother.  She came around and within 2 weeks she was back homedoing well.  Now she is back in hospital exactly the same as before.  Because they have had her in this state before they are looking for triggers.  It seems to be that my mother had a nose bleed 2 days before comming ill and that they think her body has had too much protien to deal with and has pushed the liver into failure.  They are hoping she will come around again but there is no normal brain activity but this could be normal for her body at this point as her body has shut down to deal with healling.

I feel strange, part of me wants her to let go and loose her fight as she is so unwell and hates being in hospital and part of me wants my mam back but dreading the weeks ahead in hospital recovering  On top of all this I am going for more tests on tuesday for lumps on my neck that have been there 11 weeks possibly lymphona.

[medicmommy]

Hello..
(((((((((((((((((HUGZ)))))))))))))))))))....This is a rough time...your mother is so medically fragile right now, the docs don't want to say anything...have they started dialysis yet? What are your mother's wishes for long term? Does she desire to be "let go" and have no intervention if her heart should stop, or she should stop breathing?  I know these are hard questions...What the docs aren't saying is that her prognosis (likelihood of complete recovery) is guarded or poor...she has atrial fibrillation...probably congestive heart failure, kidney failure, end stage liver disease..and probably an esophageal varicies bleed (when an enlarged blood vessel that looks like a varicose vein, ruptures)...IF she stabilizes,(and I mean conscious, breathing on her own, able to make her own decisions, and medically unchanging) there are things that can be done to give her back some quality of life..she can have a shunt put in her liver to help the blood circulate through better (it won't improve the filtration, however), she can be put on dialysis to help further clean the blood..But realize, dialysis involves being hooked to a machine for hours 2-3 times per week...every week...The varicies can be "clipped" in a brief surgery...for longer  care, start with a rehabilitation unit (in-hospital if you can get it) and go from there...You may consider hospice services if it looks like she won't recover, and she doesn't wish to be "kept going"..They are wonderful people who make a person's end stage of life much more comfortable....and they are there for the family too...