tips stent

[katienhannah]

Has anyone had the tips stent performed?  My dad has been on iterferon treatment for 4 mos and has gradually had more portal hypertension and has been in need of blood transfusions since July.  For the last 6 weeks we have been getting them weekly w/ a hemoglobin of 4.3.  Last week he was given 4 units of blood on Thurs. and went in for endo on Fri. Doc said he saw alot of blood in the stomach, but my dad did not take prep for colonoscopy.  My mom asked if they could admit him, but Doc said her insurance would not pay for it and so the Doc sent him home.  He continued to bleed all weekend and they told him to come to the office Tues. to check h&h.  Tues. night my dad became very symptomatic with dizziness, low HR, and low BP.  By the time the Drs offfice called on Wed. they said Hemo was 4.8 and he needed to get to hospital asap to get blood and tips procedure or he would be dead in a week.  After 4 units of blood and 2 units FFP (Kindneys also shutting down) they put the tips stent in on Fri.  Drs say his kidneys are doing better, but they are giving him alot of fluids, bilirubin is back up...yellow eyes/skin, lot of swelling in the arms and legs, and super high ammonia levels again despite lactulose and Xifaxin.  I am not sure how much time this will buy him or if he will ever be able to be normal.  He has a hard time talking and gets confused easily and is still losing blood and had 2 more units this morning.  Has anyone had any experience with tips at this end stage of liver cirrhosis?

[katienhannah]

Unfortunatley he continues to bleed despite two more units of blood today.  Docs want to do a scan to see where bleeding is coming from and do an  upper and lower GI, but my dad told them no.  He says he wants to wait and see if the bleeding will stop???? Obviously he is not thinking clearly.  Later today my mom went out to talk to the nurse and she said that they have D/C'd all orders and want to transfer him to Hospice.  My dad honestly has no clue that he is dying and must have the procedure...I can't believe the doc would not tell him the consequences of that decision...death.  My mom has been staying every night with him in the hospital and she has asked to talk to the doc in the morning so she can have him explain the situation to my dad.  Meanwhile he has had so many iv fluids his skin looks as if it will split open at any time, it is really unbelievable all the swelling he has!  Ammonia levels are back down in the 30's so he can speak today, but is too weak/lacks the coordination to feed himself or walk and although his kidneys are working better and his bladder is full he is unable to void??

To answer your question about treating when he is so sick.  I feel like they did not stay on top of things and waited until it was too late to try and help him.  My dad was only seen by the Doc 2 times in the office since we found out about the cirrohsis in April....poor communication and too many docs in the practice in my opinion.  If he was not the only hepatologist in town we would be seeing someone else!!

[Mr Liver]

katie,
I haven't had the TIPS procedure myself so I cannot give you a personal perspective on it. I was just wondering why he is treating when he is so sick ? The reason I ask is that it is known that interferon can cause decompensation in compensated cirrhotics, and worsen decompensation symptoms if the patient is already in ESLD.

I really can't comment on prognosis. At this stage of liver disease it's my personal opinion that you should rely only on the prognosis of the attending doctors.

I do know that restoring kidney function is vital, and I would be encouraged by the fact it has been improving since the procedure. I hope that his improvement in other areas is forthcoming, as well. I have met a few who had similar symptoms as you described who have fully recovered and/or recovered enough to qualify for transplant. I pray that a good outcome is in the future for you and your family.

Regards,
Mr Liver