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What else can happen?
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What else can happen?

  My mother had hepatitus (hepatitis) c. She has had it for over 20 years following a blood transfusion.cyrrohsis of the liver.
  She has been to all hospitals, specialists everything, but they have run out of options. there can be no liver transplant or any tips, a new procedure, they tell us it is a matter of time. her encepalothopy is horrible, she can be fine 1 hour just alittle confused and tired and completly delirious the next.
  The doctors have had her in intensive care4 times in the last 4 months each time calling the family in because her liver has almost stopped functioning to prepare us for her passing.
  Each time she seems to get better and pull thru and we all breathe easier, but I don't know how much more I can take of the calling everybody in to say goodbye, it seems like she has died 4 times. I live3 hours from her so this is extremely hard for me. I don't know when it really might be so I go every time, the doctors say its a miracle she has survived this long.
  this time that she went into the hospital her doctors said her liver has almost stopped functioning and her amonia (ammonia) levels were 240 higher than they have ever been. She lives in pain and in confusion, what else can we expect? I know you are not God, but please help me if you can, thanks, Melinda ***@****
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Dear Melinda:
I am extremely touched by you situation and I would like to say something that will help.  It is a situation that I see too often.  
If your mother has hepatitis encephalopathy, her disease must be very advanced.  We do not have good therapy for patients with hepatitis C and liver disease that is that advanced.  Usually, in that situation, we look to do a liver transplant.  I noticed that you said your mother could not receive a transplant and I would be interested in why that is the case.  Hepatitis C is now the leading indication for liver transplant in the U.S.
If she is not a transplant candidate, our goals would be to keep her comfortable and to give her as good a quality of like as possible.  We have some good medications to help control hepatic encephalopathy and they include lactulose and neomycin.  I
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