A hepatologist. in Texas

[Martyann]

My husband has just recently been diagnosed with  compensating stage 4 cirrhosis.   It has been recommended by members  of this forum that he be seen by a  hepatologist.  Because of his age his gastroenterologist has already told us he would not be a candidate for a transplant.  I have learned that there is not a  hepatologist.  in our city. Is anyone familiar with any doctors they could recommend in the Dallas/FW. Houston/or San Antonio area?  SA is the closest but Dallas/FW and Houston have the better hospitals.
Thanks  

[Martyann]

Thanks for the info.  This is all so new to me, I don't even know where to start.  I just want to keep him as healthy as possible as long as possible.  I know one of the goals it to try to get him off some of his pain medication for his back pain so we are looking at alternative pain management.  If we had known of the cirrhosis at the time he was put on the pain meds we would have likely been able to argue another course of treatment but that is water under the bridge now.  Thanks for everyone's input.

[HectorSF]

In case it is not clear.

Hepatologist that treat people with cirrhosis are only found a liver transplant centers. Not in individual practices. They work in teams. There is no one doctor that can treat all the complications of advanced liver disease. That is why patients with advanced cirrhosis can only be diagnosed, treated, managed, and in time get transplanted at liver transplant centers. Without the care of a transplant center in time the patient will die.

Hector

[HectorSF]

'Because of his age his gastroenterologist has already told us he would not be a candidate for a transplant. '

His gastroenterologist is totally ignorant of the basic facts of liver transplantation. Most centers transplant to age 70 normally. Most of us liver transplant patients are in our 50s-60s when we get our transplants.

I would not trust anything that gastro has to say if he is so misinformed about the basics of liver transplant. I would get copies of all my records and never see him again. His opinions are not based on any knowledge.

Gastros are not liver specialist first of all. That he has had only 2 patients over 62 that have had liver transplant means nothing but that he is obviously inexperienced with treating patients with serious liver disease.
My best advice is to drop this doctor before he misleads you further and present his misinformation as truth.

You should get hooked up with Baylor ASAP and they will refer you to a competent local gastro to perform basic test while your husband waits perhaps years for a transplant.
Baylor is one of the best transplant centers in the country.

Baylor All Saints Medical Center -
* has 382 patients between 50-64 Years on their waiting list. ) the majority of all patients waiting for a transplant
* there are 63 patients over the age of 65 patients on the Baylor waiting list.

Luckily your husband has early cirrhosis and may not need a transplant any time soon. Find a competent doctor soon before your husband does decompensates and starts to really suffer. Cirrhosis that is not properly managed can be fatal.

Good luck!
Hector

[Martyann]

His gastro was the one that said that he has had only 2 of his patients over the age of 62 have transplants.  My husband does not drink or smoke the risk factors is weight and blood sugar.  He has not been able to keep his blood sugar under control since all of this started. This has been one of the things we have questions since his symptoms started.   At this point he has not signs of decompensated cirrhosis.  He has his procedure in March to check for varices. This is all so new to me and I am trying to learn as much as possible.  We have had only one appointment with the gastro since the biopsy when we learned of the cirrhosis and so he has not really given us much information or a prognosis.  I expect we will know more after the procedure and the follow up appointment.

[Advocate1955]

Pugdaddy,
Here is the thread where Martyann said her husband is 62 (toward the bottom of the thread):
http://www.medhelp.org/posts/Cirrhosis-of-the-Liver/New-diagnosis-/show/1893744
Advocte1955

[Advocate1955]

I don't know that 65 is a cut off, per se.  I think it just presents a higher risk and patients who are >65 have to be evaluated, like everyone else, to see what other risk factors present (heart problems, etc.) that may disqualify them for a transplant.  I read your other post, and I believe that since you have varices, you do have Cirrhosis.  I'm not the Cirrhosis expert on this forum, but varices is one of the signs of decompensated Cirrhosis so far as I know.  Glad you're seeing a hepatologist in March.
Advocate1955

[pugdaddy]

Dear MartyAnn, I also seem to recall some uncertainty about your husband's age.  It may have been something as simple as a typographical error...but if he's 'only' 62, that alone would not disqualify him.  I have a hard time keeping up with ages myself, even with family members - unless I know for sure when they were born!  Do you know what year he was born? 1950 or 1951 perhaps?

[PaulaAnn]

65?  I have to see what Cleveland Clinic's cutoff is.  Plus I have long time rheumatoid arthritis...  Its not easy...I feel like I am going to heck.  

I see Dr Banes the end of March..so long to wait.  

Its scary....I'm such a mess with worry.  

P

[Advocate1955]

I don't know anything about Texas, but a quick search on the internet came up with Baylor Clinic at Texas Medical Center in Houston; University Transplant Center in San Antonio; Texas Liver Center in Houson, the Liver Institute at Methodist Dallas Medical Center in Dallas; and UT Southwestern Medical Center in Dallas.  The process can be a long one.  It usually starts with finding a transplant hepatologist and making an appointment to be seen.  The transplant hepatologist will review all of your husband's records, so have them sent ahead of time, and then examine him and meet with him.  At that point, the transplant hepatologist will make recommendations.  If he meets the criteria for being listed for a transplant, then the hepatologist will tell him what the next steps are (e.g. usually there are some assessments, tests, and some classes that the prospective transplant patient and caregiver must participate in).  There are some things that will automatically disqualify a patient for a transplant, such as drinking alcohol, using drugs, and smoking.  Obesity is a risk factor that at a certain BMI will exclude a patient as well.  Most transplant centers say 'advanced age' is a factor, but >65 seems to be the age of concern and that is the age listed in the AALD's hand out regarding transplant criteria.  I suggest that you either get your current gastroenterologist to refer you to the transplant center that you pick, or call yourself and make an appointment.  Since it is a lengthy process, the sooner the better.  That way your husband will already be established with the transplant hepatologist and he/she will be monitoring him and caring for him.
Advocate1955

[Advocate1955]

In another post, you said that your husband is 62.  I'm not sure why your husband's gastroenterologist said that at age 62 he is too old for a transplant.  Several other forum members have either had transplants or are waiting for a transplant.  HectorSF is waiting for a transplant right now, and I believe he is the same age as your husband.  A transplant hepatologist would be able to answer this question, but I don't think your husband is too old for a transplant.
Advocate1955