end signs of cirrohsis also needs heart valve replacement

[seiver]

My Dad is in end stages it seems of cirrohsis.. he has been in and out of the hospital 3 times in the past few months.  The first time was bleeding internally he was given many transfusions.  He was sent home and 4 weeks later swelled with fluid.  They drained much of this fluid from him and sent him home again.  He was diagnosed also as needing a heart valve replacement.  Two cardiologist at that time told him he was not a candidate for the surgery  (he is 72)... 3 weeks later he seemed to have lost his mind.  He didn't know my brother's name and was almost coma like state.  They seem to have this under control with diratetics.  He is no longer drinking!!!  His primary tells him if his liver counts keep coming back up he will be a candidate for heart valve replacement.  I know this might be rare but has anyone ever heard of this?  I would like to believe that he is on the right road but my family needs to know the truth.

[donnieraye]

You have come to the right forum for support, but I believe if you were to start a new thread for your post you will get some response.  As your post is (added to an old thread) , it may get overlooked by anyone that can help you.  Go to Hepatitic C Community, then click POST A QUESTION, and rewrite your letter there.

My heart goes out to you.

Donnie

[tracymcj]

Well folks sorry for all the saddness! My husband is labled ESLD He never drank. We think he got it in Europe while in the army 30 + yrs ago.
It is so sad to see the love of your life slipping away. He is on all the meds I see everyone talking about. He is a good man. He is so ill now. I'm trying my best not to show him that my heart is breaking! I don't know how I will go on without him? I would love to meet someone who is going though this. Other than my church I don't have much support. Sometimes I feel like I can't go on. If there is anyone out there in the world that would like a friend I would love to hear from you. I'm 46   yrs old I live in TX please onl-y honest good people that honor God! I'm trying to reach out for support. Jeez, my kids are grown I thought this -would be the part of life you get to enjoy. I guess life is just an illusion. My name is Tracy I'm so sad right now. Does anyone know anyone that may bring some hope? 956-227-8816

[daph912]

My dad has this disease and I seriously need some help!!!! He will not go to the doctors.  I know that is his wish, however, I am so struggling with it.  

[Whrose]

surely this post is a pime example of how different perceptions are between people.

it was interesting to revisit it

Sevier.... if you are reading this i send my best to you and your family and hope your dad is doing well and progressing. i can personally relate to how hard it is to live away from your parents when their health is failing. i hope the holiday season blesses your family with peace and calm.

all the information on lactulose and supplements are very important in the stabilization of your dad's liver disease.

the way i read your post i deduced it differently from the others. my open conclusions are based on the scanty medical information you gave about your dad.
72 y/o male
hx alcoholic liver disease/ ESLD ? end stage cirrhosis mentioned
ascites (refractory?)
hepatic encephalopathy
GI bleeding/ site undetermined probable varices
anemia
CHF/ lung disease??? /ASHD??
with resonable certainty i suggest the above list is more lengthly but unknown.

cardiac consultation: not a surgical candidate medical management
PCP state lifestyle changes no drinking medical compliance will improve his health possibily changing his surgical status for hrt valve replacement
heart valve malfunction severity unknown, surgical repair needed

sevier's question?  request for the truth about the possibilty her dad may be well enough for hrt valve surgery with his history. need for truth on how serious this is with his liver problems

my view of the truth considering the above? very serious. working close with cardiac surgeons i can state that the ones i know with would not perform surgery on this gentleman to replace his hrt valve due to his age and preexisting conditions. good medical management may stabilize CHF but more likely  progression of his disease expected, increase risk for pulmonary edema and other cardiomyopathies. quality of life very important in decision making.
cirrhosis ESLD?...stabilize and improvement can be expected with abscence of alcohol and medication compliance.
Bleeding risks/ unable to determine but increase risk factors present

at 72 this gentleman with medical compliance may live a reasonable elder life however care must be suported by close supervision medically and in the home. not knowing any other his health history, my advice for end of life decisions is very important along with family planning/support for supervision of care not only now but for the days ahead considering his age and home situation. typically diet will need to be managed and possibly prepared by others to insure best nutrition. (72y/o may be unable to shop and menu plan for optimal nutrition needs...and in his case a specific diet ratio is important. confusion/ forgetfulness/ disorientation are important risks factors from his liver disease and age and will need close monitoring and will prevent independent living alone in home however may improve somewhat with compliance. an activity intolerance should be expected and activites planned as tolerated and encouraged. depression may be present.

the other recomendations by HR and others important in consideration of his liver disease however your dad's health needs are complex and will be ongoing. decisions for end of life care should be addressed and supported by family and medical providers.

sevier i hope this helped some to your understanding of your dads complex health care needs.
yes i do feel he is on the right road and quitting alcohol will definitely help his liver!
i can not venture to say what his prognosis or future care needs will be but i can guess after >30 years in acute care nursing they will be an important focus to his quality of life in the days ahead.
i would encourage you to spend as much time as you can with him as he is fragile and certainly will need alot of family support and possibilty consideration for placement in a nursing facility if he is unable to live in a home situation meeting is personal and health care needs.

take care + and my best regards.  i am positive that your family may cherish your dad in his elder years and help him live the highest quality of life with comfort and care.
i am sorry your question has other conflicts attached to it. everyone here is passionate about their opinions that may often conflict and get defensive. btw.... HR is a hepatologist and certainly can help supplement your understanding of liver disease from a very knowledgable perspective.

[geterdone]

Should get rid of this one to. Med police, be gone with it.

geterdone

[copyman]

thanks for the kind words. your response is exactly what i expected from a lonely person like you. yes i do have a GED but i also own one of the largest copier dealerships in the midatlantic region so i must know something. God bless you and more importantly the people who have to be around you in person.

PS, if this is your way of developing a commonality with people i would hate to see you trying to alienate them! LOL

[Ginger12521]

Granted, it's just a study done in rats...but, I'm sold. : )

1: Acta Pharmacol Sin. 2007 Nov;28(11):1803-9.Click here to read Links
    N-acetylcysteine attenuates lipopolysaccharide-induced apoptotic liver damage in D-galactosamine-sensitized mice.
    Wang H, Xu DX, Lu JW, Zhao L, Zhang C, Wei W.

    Department of Toxicology, Anhui Medical University, Hefei 230032, China.

    AIM: To investigate the effects of N-acetylcysteine on D-galactosamine (GalN)/ lipopolysaccharide (LPS)-induced apoptotic liver injury in mice. METHODS: When given together with a low dose of LPS, GalN highly sensitizes animals to produce apoptotic liver injury with severe hepatic congestion, resulting in rapid death. In the GalN/LPS model, TNF-alpha is the major mediator leading to apoptotic liver injury. Reactive oxygen species (ROS) are involved in GalN-induced sensitization to TNF-alpha-evoked hepatocyte apoptosis. N-acetylcysteine (NAC) is an antioxidant and a glutathione (GSH) precursor. In this study, we investigated the effects of NAC on LPS-induced apoptotic liver injury in GalN-sensitized mice. RESULTS: Pretreatment with NAC significantly reduced GalN/LPS-induced elevation of serum alanine aminotransferase levels. In parallel, GalN/LPS-induced hepatic necrosis and congestion were obviously improved by NAC. Furthermore, NAC pretreatment significantly alleviated GalN/LPS-induced hepatic apoptosis, measured by the inhibition of hepatic caspase-3 activity and attenuation of DNA laddering. NAC pretreatment had no effect on LPS-evoked nitric oxide production in GalN-sensitized mice. Increases in serum TNF-alpha concentration, which were observed in GalN/LPS-treated mice, were not significantly reduced by NAC. Although NAC pretreatment significantly alleviated LPS-induced hepatic GSH depletion, DL-buthionine-(SR)-sulfoximine, an inhibitor of GSH synthesis, did not influence the protective effect of NAC on GalN/LPS-induced apoptotic liver injury. CONCLUSION: NAC attenuates GalN/LPS-induced apoptotic liver injury via its strong ROS scavenging and anti-apoptotic effects.

    PMID: 17959032 [PubMed - in process]

[Ginger12521]

I would just like to say that HR is right on target.  I can certainly tell he's done his homework!  BTW, I've married to a Rph Pharm D (17 years Hospital experience) who's read most of HR's posts, and he was in total agreement.
Not to wav the pom-poms, but HR knows his stuff. No doubt about it.



Comparison of S-adenosyl-l-methionine (SAMe) and N-acetylcysteine (NAC) protective effects on hepatic damage when administered after acetaminophen overdose.
Terneus MV, Brown JM, Carpenter AB, Valentovic MA.

Department of Pharmacology, Physiology and Toxicology, Marshall University, Joan C. Edwards School of Medicine, One John Marshall Drive, Huntington, WV 25755-9388, USA.

In the clinical setting, antidotes are generally administered after the occurrence of a drug overdose. Therefore, the most pertinent evaluation of any new agent should model human exposure. This study tested whether acetaminophen (APAP) hepatotoxicity was reversed when S-adenosyl-l-methionine (SAMe) was administered after APAP exposure, similar to what occurs in clinical situations. Comparisons were made for potency between SAMe and N-acetylcysteine (NAC), the current treatment for APAP toxicity. Male C57BL/6 mice were fasted overnight and divided into groups: control (VEH), SAMe treated (SAMe), APAP treated (APAP), N-acetylcysteine treated (NAC), SAMe or NAC administered 1h after APAP (SAMe+APAP) and (NAC+APAP), respectively. Mice were injected intraperitoneal (i.p.) with water (VEH) or 250mg/kg APAP (15ml/kg). One hour later, mice were injected (i.p.) with 1.25mmol/kg SAMe (SAMe+APAP) or NAC (NAC+APAP). Hepatotoxicity was evaluated 4h after APAP or VEH treatment. APAP induced centrilobular necrosis, increased liver weight and alanine transaminase (ALT) levels, depressed total hepatic glutathione (GSH), increased protein carbonyls and 4-hydroxynonenal (4-HNE) adducted proteins. Treatment with SAMe 1h after APAP overdose (SAMe+APAP) was hepatoprotective and was comparable to NAC+APAP. Treatment with SAMe or NAC 1h after APAP was sufficient to return total hepatic glutathione (GSH) to levels comparable to the VEH group. Western blot showed reversal of APAP mediated effects in the SAMe+APAP and NAC+APAP groups. In summary, SAMe was protective when given 1h after APAP and was comparable to NAC.

PMID: 18068290 [PubMed - as supplied by publisher]

[lanier]

ditto

[mremeet]

Wow, what a huge wack-o-matic. Sad.

[lanier]

you have no ryme nor reason to attack me on this thread, so I hope you do try with your GED to get me booted.  I responded to the person who was commenting NOT YOU.  I feel very human and I helped more people in my life than you could in three.  I am proud of my service to my country and my profession and when morons like you start barking at me they will NEVER I REPEAT NEVER NOT GET A RESPONSE. GET A JOB try customer service you would be great.

[lanier]

copyman you get yourself some help.  you are pathetic, it is not my place to "help" anyone it is to try and develop a commonality with them, your and uneducated idiot, try to get me booted you cheese brick

[copyman]

get yourself some help. you really sound pathetic. if you have these so called credentials how come i have never read a post where you actually help someone? put your energy into helping others instead of this stuff and you may start to feel human again. keep it up and you will surely be booted from this site. hope you feel better real soon. Happy Holidays!

[lanier]

boy, I am starting to see where your following comes from...you have the "tone" thing down to a science.  thanks for the response that although does not mention my name inside, does out and who knows with this crowd that might call off a few.  lol doubtful but still smiling
this is the first writing from your logon that seems so human.
reagrds
Lanier

[Hepatitis Researcher]

The situation that seiver was describing is one of an alcoholic with advanced cirrhosis, that falls from one of the cirrhotic complications into the next. It was also reported that the father had stopped drinking.

This situation has several red flags:

If he indeed stops drinking his liver can improve substantially.So there is a chance.  But this takes time.

Meanwhile he is in danger to die from one of the cirrhotic complications, before he has reached enough improvement.

He needs to  "bridge " this dangerous time.

He also had ascites and GI bleeding. This Gi bleeding often leads up to encephalopathy, because the blood is converted , partly, by the Gi flora into ammonia.
He actually had this complication.
If he bleeds again and is already on lactulose, then the ammonia production will be supressed and further bouts of encephalopathy can possibly be avoided.

The low glutathione levels in the cirrhotic liver can be best raised by moderate dose NAC. He is likely to reiceive other medications that can tax his livers glutathione levels, like eg tylenol.

His family posted here, in order to possible get some thoughts and ideas that they can forward to his treating doctors.

Goofydad responded with sensitive, intelligent  suggestions, that reflected a good understanding of the very need to bridge until his abstinence will start to stabilize him.

I liked Goofydads quite proper, helpful words, and requoted them, adding the NAC/Vit C idea, which could indeed be lifesaving in this case, to submit of course to his treating docs - that always goes without saying.  Please read the general medhelp disclaimer that refers to that aspect, no need to put it in front of every paragraph.

The scenario described by seiver also had a certain air of urgency about it - for the reasons described above. Preventing life threatening cirrhosis complications until some partial recovery has occured is the key in that situation. Out of compassion for those posting this particular situation I used the words " his doctor should already have prescribed lactulose, it should go in right away". And furthrmore I detailed the dose of NAC/Vit C that would be appropriate for that situation, for his doc to use, who might or might not be as well informed  in liver issues.

The mentioning that lactulose  is OTC in Canada served to point at its harmlessness.

[lanier]

well thank you Sir for responding to me.  Now first I would like to ASK YOU to call all your followers off my BACK.  I respect YOU, I appreciate YOU.  I appreciate anyone who write here NO matter what they put next to their name.  I was NOT mad, I was surprised. I can not justify recommending any supplement nothing to a friend or stranger. I am aware of Hepatic encephalopathy. Asorbic Acid And NAC are not prescriptions.  However, it freaked me out that you were even recommending dosing anything.  I was wrong about the Cananda thin, God I hope forseegood see this I was Wrong.  I am NEVER afraid of being wrong and admiting it.  I am scared of the power you seem to have here and the lack of rapour anyone can have with you if they are asking a question that does not praise you.  You surely see the way these Bloggers seek you out.  I have been told you have credentials, great, so do I, But I would not advise anyone to take a dose of morphine under the tongue any quicker than a supplement.    I understand Lactulose.  I was afraid for I see everyone here worshipping you and this was the first time I read you dosing someone....we know nothing of their diet or have no assessment subjective or objective and well it just goes against the grain.

I am so thankful you responded and thank you for pulling this up.  I guess what you are saying is you would not dose anyone anything other than supplememnts that are in a qauntity that should be harmless and so I say to you hep, I am sorry for worrying that maybe in other threads you go to the next level.
Lanier

[copyman]

no need to even waste your time. i see lanier's other post was deleted and hopefully MH deleted them as well.  hope you realize this is only one troublemaker here and hope gone for good.

[Hepatitis Researcher]

This is the thread that makes lanier so angry. .

How does she know that seiver is female?

Lanier is it the lactulose to prevent further bouts of encephalopathy that make you so mad at this?

Since goofydad, whom I consider a friend, suggested the lactulose first here, why do you not attack both of us?

Do you consider the NAC and Vit C a prescription?

Are you aware that hepatic encephalopathy has a tendency to reoccur spontaneously in the circumstances described? That preventative measures might not be such a bad idea?

[lanier]

your correct on the "recent" before heavy drinker, I missed it.  I also agree that animal protiens are not so good for us.  the encephalopathy ...well if that was the case it has been my experience the client would not be sent home.  and when it comes to being related to the liver it can many times be acompained with jaundice and gastrintestinal bleeding.  I would think even the "worst" practicioner woulod not sent anyone home with edema in their brain.  imminent or not, a blood and spinal fluid test would be needed immediately.  Apparently your in Canada...do you guys send people to the back of the line with edema and jaundice and possible gastrintestinal bleeding...not trying to argue, just pointing out something I have seen with my own eyes in the emergency room here in my state in the USA.  Not trying to make anyone mad at me either, I know I am not always on point and make mistakes.  But when it comes to things I have seen, I often remeber.

As far as giving intake advice that's another thing we never do here and I am really surprised.  Your last sentence kinda covers your "backside" but not really.

Please nobody hate me I am not dissing this person, HR or Goofy dad in any way shape or form

regards
Lanier

[seiver]

Thank you all for your input on my dad and his end stages of cirrohsis.  I have been away from my computer for the holiday.  My dad is now saying he is very itchy??  He definately has the will to live which is a huge plus.  I live 1500 miles away and have been home twice to be with him.  It is very hard for me to not be there everyday.

[GoofyDad]

Bravo Goofydad, you are right on:

Maybe I'm more than just a pretty face, after all!

[scratchinghead]

If the Vitamin C is ripping up your gut (pH of 2.5) then Alacer has a "Supergram II" that has a neutral pH form of C on a time release.

for what that's worth

[Hepatitis Researcher]

Bravo Goofydad, you are right on:

"If the change in alcohol habits was extreme and recent - that would offer some hope that things might improve some. The out-of-mind stuff is probably encephalopathy (correct spelling it is). A diet that restricts animal protien can help. So can a medication called lactulose, and also probiotics.

Diet is a big factor in liver disease, and a very regemented diet might help alot. Low salt, low or no refined sugar, very restricted carbs like pasta and potatoes "

2x600 mg N-acetylcystein Plus 2x 500mg Vit-C  daily are some minimal extra measures to try  The lactulose has to go in right away, his doc should already have prescribed it - it is OTC in Canada and some parts of Europe.

And of course all his meds, since his mind might wander off, should be monitored for compliance by his family members....

[lanier]

Hi dear girl, "it seems" and "end stages" are words many of us here may have toruble with

what kind kind of internal bleeding?

the liver is the most amazing organ in it's sytem, but can also take all the others with it.

I hope your there for him, and if you write things here you must be interested in his welfare.
I wish you good luck and tell you as a health care professional "never say never" he can go on.

I hope he does

Lani