Progress of Chirrosis

[Val68]

I'm writing this post because I'm extremely worried about my husband's condition. He was diagnosed with cirrhosis about a year ago. He was throwing up blood and had bloody stools for a month or so before this episode. He stayed in the hospital for a few days, got some plasma and the bleeding was fixed. Doctors told him o stop drinking immediately. He has been an alcoholic for about 25-30 years. He is 59. He does not care about his condition and keeps drinking up to this day. Every day I can see his decline mentally and physically. He had 1-2 episodes when he did not recognize me and had no idea where he was. His legs are swollen in spite of water pills. he sleeps all the time, is tired every day, his muscles are hurting, he is irritable and angry all the time. his stomach is huge and his skin is yellow. He does not want me to go to the doctor with him and does not share what they tell him. I don't know any of his lab results. What is the progression I should expect at this point? Do I need to be ready for the worst any time soon? Please any advice and input will be greatly appreciated!

[Dee1956]

Hey there! Your English is very good, you have given Val some very important advice, everyone has

Good luck Val
Please keep in touch

I think Alanon helped my Mom very well when my Dad was drinking

[NT77]

Another thing came back from memory, and I may lack English words to make it sound nicer, so I apologize in advance.

If you've decided to take care about him, it is imperative that you now make ALL the decisions regarding his life, not him. Don't treat him like he's an innocent sick child, fulfilling all his wishes. If he decides to keep drinking, it's you that's gonna bear most of the pain, not him. He'll eventually just fall into hepatic coma never to wake up. Pain is felt only by those watching...

I made that mistake few years ago with my father. It soon evolved into "I dont want this, I dont want that"... We couldn't even roll him over on the bed to wash his back because his legs hurt so much... But when the nurse came few days later with a strict and professional attitude, she easily rolled him over all by herself, and he complained zero...

And don't worry about making a wrong decision, because any single decision he makes will surely be worse. Your first decision should be to throw all the alcohol out of the house, make it physically inaccessible.

Yeah, blood picture doesn't look bad. Color of the urine (when diuretics are not in effect) is perhaps even more important. Once it starts to get lighter, you're on a good track.

Good luck, and just so you know: your determination is inspiring.

[Dee1956]

I am so sorry for what you are going through.  While protein is important red meat is very hard on the liver and body.
Everyone above has given you excellent advice
I just wanted you to know that there are many people here willing to help.  You are not alone.
It is difficult for you because you don't really know what the doctor is saying.

I think that the fluid and the pain is being caused by the livers inability to release the fluids.

I had awful pain in my ankles at one point.  I had  a rash from feet to knees, bleeding under the skin, swelling of the ankles and legs and it felt as if my ankles were broken. I had a extra heptaic manifestation called cyroglobulinemia.
Everything that we eat, drink, put on our body, even in our eyes has to be processed through the liver.
When the liver is not working right then it really taxes the liver to process even more.
If you could get your husband to drink water to help flush his system that might help.  I am not a doctor but I remember a friend of mine had cirrhosis the swollen leg and stomach and her doctor told her she was dehydrated.  It was very counter intuitive
Hang in there, try to go to the Hepatologist with him..
Tell him you don't want him to leave you before his time.

I would try to get his ammonia checked.  If he is suffering from Hepatic Encephalitis then  he is not thinking right and really needs the support of his doctor, friends and family.

Take care, keep in touch
Dee

[rpooo]

Your husband does have some very serious complications that needs to be addressed by his hepatologist so I am glad you have him set up with an appointment. If he begins to use alcohol again his cirrhosis will continue to advance rapidly. At this point it is up to him which way it goes, with a MELD of 10 he can surely stop any further advancement and make a good recovery, comfortably living the rest of his life sober. I hope the best for you both.

Randy

[Val68]

Thanks for all this information. It made me feel much better reading that the lab results are not as bad as I thought.  My husband acts he is in a real bad shape though. It is just hard to see how in the last couple of years he went downhill so fast. Seeing him not be able to walk because of pain and swollen legs, being confused and extremely irritable, and not being able to do simple task due to being tired and exhausted makes me feel really sad for him and is hard on all of us. I'm praying he stays sober so his condition won't get much worse.

[rpooo]

Good morning Val,

The best I can tell you from looking at his labs:
Kidney function is normal
Liver is still irritated (likely from drinking)
Over-all liver function is pretty good considering cirrhosis
MELD= 10

The Model of Enstage Liver Disease or MELD score.
The Model for End-Stage Liver Disease (MELD) score has been in use since February 2002. It is used to measure a patient's risk of dying from chronic liver failure over a 90 day period from the day it was measured. It is used to determine the order and urgency of patients waiting for a liver transplant. The "MELD score" is a number scale. The range is from 6 (less ill) to 40 (gravely ill). The number is calculated using the following laboratory tests:
• Total Bilirubin: a measure of how well the liver clears certain body wastes.
• INR (International Normalized Ratio or previously known as the prothrombin time): a measures the liver’s ability to make blood clotting factors.
• Creatinine: a measure of kidney function. Severe liver failure often results in kidney failure.

In interpreting the MELD Score in hospitalized patients, the 3 month mortality is:
• 40 or more — 71.3% mortality
• 30–39 — 52.6% mortality
• 20–29 — 19.6% mortality
• 10–19 — 6.0% mortality
• <9 — 1.9% mortality

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Everything we ingest kills liver cells but this is okay because the liver has an amazing ability to heal itself but when we abuse alcohol over several years massive amount of cells are being destroyed and the liver cannot keep up so scar tissue begins to form. This is called fibrosis and in more severe cases such as your husbands, cirrhosis. The idea is to remove the cause to stop further progression this is why maintaining his sobriety for the rest of his life is so important. A carefully planned diet is also important, low sodium, low fat and avoiding red meats are important. There are many other sources of protein besides red meat. This type of is very much necessary for the health of his liver and to treat symptoms of cirrhosis. Tuna, chicken and salmon are excellent. Lots of green leafy vegetables and fruits. Foods that are high in antioxidants will also assist his liver in removing toxins, berries are an excellent source. All medications should be approved by your liver specialist, especially pain medication such as Tylenol or aspirin. You should also seek the approval of your liver specialist for any medical treatment that does not involve your Hepatologist.

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Hepatic encephalopathy is a condition affecting your brain due to liver disease. One of the functions of the liver is to clean blood coming from the gastrointestinal system. The gastrointestinal system includes your stomach and the intestines. Blood from the gastrointestinal system often contains ammonia and toxins made by intestinal bacteria (germs). Normally, the blood is cleaned in the liver by turning these harmful substances into less harmful products. The clean blood then goes to the lungs to get oxygen before going to the heart. The heart then pumps the blood to all parts of the body, including the brain.
With this condition, there may be a problem in the blood flow into the liver. This happens when blood does not easily go into the liver because of liver disease. When blood cannot flow into the liver, it uses other blood vessels to return to the heart. This then leaves the blood uncleaned of harmful substances, including ammonia. The function of the liver to convert ammonia in blood may also be decreased in liver disease. Ammonia and other harmful substances may go into the brain and damage brain cells. This may affect many of the brain's important functions that could cause even more problems to your body. Early treatment is needed to reverse the damaging effects of this condition and restore proper brain function

Medication to treat hepatic encephalopathy (HE) are Lactulose (as Dee mentioned), Xifaxin and Rifaximin. A prescription is required to obtain any of these drugs.
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Ascites is excess fluid in your lower abdomen. Symptoms of ascites include:
• Rapid weight gain and swelling
• Swollen abdomen
• Shortness of breath
• Stretch marks and bulging veins on the abdomen
• Nausea
• A feeling of fullness after eating little food

Ascites treatment usually combines medicines with changes to your eating and drinking habits. Other treatments are used if your ascites does not improve or if the condition that caused the ascites is getting worse.

Diuretics and antibiotic medications.
Sodium and liquid restrictions.
• Procedures and surgeries:
o Paracentesis: Your caregiver drains the fluid out of your abdomen through a needle. You will receive numbing medicine before the procedure. Paracentesis can quickly remove quarts of fluid. Paracentesis may be repeated if the ascites does not respond to other treatments.


Dehydration is a common side effect of taking diuretics. His dosage may need to be reduced. Signs include dizziness, extreme thirst, excessive dryness of the mouth, decreased urine output, dark-colored urine, or constipation. If these symptoms occur, don't assume you need more fluids, call your doctor. Your husband’s kidney function looks good.
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Thousands of lives depend on receiving organs and tissues for transplant, but there is a severe and chronic shortage of donor organs. Every year, more than 1,500 people die waiting for a donated liver to become available.
How many people are waiting for liver transplants?
Currently, about 17,000 adults and children have been medically approved for liver transplants and are waiting for donated livers to become available. The waiting list grows every year.
From reading your posts I think that as long as he maintains his sobriety he can avoid a liver transplant. Candidates for liver transplant must have documented six months of sobriety before being added to the list. Four years ago I was diagnosed with alcoholic cirrhosis, though living with liver disease isn’t always easy life has never been better. I spent more than twenty years abusing alcohol. I’ll take my sobriety and cirrhosis any day over going back to living every day in that drunken haze that really isn’t living at all. In a strange kind of way my diagnosis was a blessing.

I wish you and your husband the best,

Randy