Aa
help
i was just told i have portal hypertension varicis and hep c with high ammonia levels this may be a stupid question but i am in the trucking industry can i still drive for a living
Here is a study on HE and driving skills that you may find interesting...
"The effect of fatigue on driving skills in patients with hepatic encephalopathy."
Bajaj JS, Hafeezullah M, Zadvornova Y, et al.
Am J Gastroenterol. 2009;104:898-905.
Posting Date: April 24, 2009
* Observational study with age- and education-matched controls
Summary of Key Conclusions
* Individuals with minimal hepatic encephalopathy (MHE) demonstrated worsening driving simulator performance over time due to presumed subclinical cognitive changes with concomitant fatigue
* Self-reported driving-associated fatigue higher in individuals with MHE and overt hepatic encephalopathy (OHE) vs cirrhotic individuals with no MHE or controls
- Actual driving-associated fatigue predicted driving simulator collisions
* Driving simulator performance and psychometric testing results similarly impaired between treated patients with OHE and untreated patients with MHE
Main Findings
* Driving performance significantly impaired in cirrhotic patients with OHE and MHE vs cirrhotics with no MHE or controls
- Average speed and length of run not significantly different between any groups
- Driving performance similarly impaired for individuals with OHE and those with MHE
* Only patients with MHE showed statistically significant increase in collisions in second half of driving simulator vs first half (mean: 1.3 vs 0.7 collisions, respectively), indicative of fatigue
- MHE patients also showed statistically significant worsening of speeding violations (mean: 1.2 vs 0.6 violations, respectively) and center crossings (mean: 7.6 vs 4.3 crossings, respectively) in second vs first half
* Psychometric performance of patients with OHE and MHE statistically significantly impaired vs those with no MHE and controls (data not shown for controls)
- Psychometric performance similarly impaired for individuals with OHE vs those with MHE
* Among cirrhotic patients, significant correlations identified between impairment on psychometric tests (for all but block design test and number connection test-B) and driving simulator collisions
* Significantly higher proportions of cirrhotic patients with OHE (27%) and MHE (25%) reported feeling tired after driving on American Medical Association questionnaire compared with cirrhotic patients with no MHE (4%; P = .02) and controls (6%; P = .03)
- All patients who admitted to fatigue on questionnaire had collisions during driving simulator
- No collisions observed in individuals who denied fatigue on questionnaire
I would suggest making sure your Lactulose and Rifaximin are dosed properly so as to minimize any HE you are experiencing. Otherwise what I take away from this study and others is that we cirrhotics with HE are not aware of how badly we are driving plus our reactions speeds will be slowed. Similar to people driving who are high on alcohol or drugs. Not a good thing! We can hurt both ourselves and others without being aware of how impacted our driving skills are.
Hectorsf
"The effect of fatigue on driving skills in patients with hepatic encephalopathy."
Bajaj JS, Hafeezullah M, Zadvornova Y, et al.
Am J Gastroenterol. 2009;104:898-905.
Posting Date: April 24, 2009
* Observational study with age- and education-matched controls
Summary of Key Conclusions
* Individuals with minimal hepatic encephalopathy (MHE) demonstrated worsening driving simulator performance over time due to presumed subclinical cognitive changes with concomitant fatigue
* Self-reported driving-associated fatigue higher in individuals with MHE and overt hepatic encephalopathy (OHE) vs cirrhotic individuals with no MHE or controls
- Actual driving-associated fatigue predicted driving simulator collisions
* Driving simulator performance and psychometric testing results similarly impaired between treated patients with OHE and untreated patients with MHE
Main Findings
* Driving performance significantly impaired in cirrhotic patients with OHE and MHE vs cirrhotics with no MHE or controls
- Average speed and length of run not significantly different between any groups
- Driving performance similarly impaired for individuals with OHE and those with MHE
* Only patients with MHE showed statistically significant increase in collisions in second half of driving simulator vs first half (mean: 1.3 vs 0.7 collisions, respectively), indicative of fatigue
- MHE patients also showed statistically significant worsening of speeding violations (mean: 1.2 vs 0.6 violations, respectively) and center crossings (mean: 7.6 vs 4.3 crossings, respectively) in second vs first half
* Psychometric performance of patients with OHE and MHE statistically significantly impaired vs those with no MHE and controls (data not shown for controls)
- Psychometric performance similarly impaired for individuals with OHE vs those with MHE
* Among cirrhotic patients, significant correlations identified between impairment on psychometric tests (for all but block design test and number connection test-B) and driving simulator collisions
* Significantly higher proportions of cirrhotic patients with OHE (27%) and MHE (25%) reported feeling tired after driving on American Medical Association questionnaire compared with cirrhotic patients with no MHE (4%; P = .02) and controls (6%; P = .03)
- All patients who admitted to fatigue on questionnaire had collisions during driving simulator
- No collisions observed in individuals who denied fatigue on questionnaire
I would suggest making sure your Lactulose and Rifaximin are dosed properly so as to minimize any HE you are experiencing. Otherwise what I take away from this study and others is that we cirrhotics with HE are not aware of how badly we are driving plus our reactions speeds will be slowed. Similar to people driving who are high on alcohol or drugs. Not a good thing! We can hurt both ourselves and others without being aware of how impacted our driving skills are.
Hectorsf
I would echo yodennis' remarks on the encephalopathy and the risk it has on your occupation. Most do not even realize that they are experiencing the changes until a substantial time loss is identified or others around them point it out to them.
The risk for your occupation is the memory loss and severe disorientation, which can also result in high anxiety.
As the condition worsens, it is recommended that folks do not even driving a car to the store.
The risk for your occupation is the memory loss and severe disorientation, which can also result in high anxiety.
As the condition worsens, it is recommended that folks do not even driving a car to the store.
Sorry my friend. As though you weren't living with enough of a question mark. And why do I comment: empathy. I have cirrhosis with grade 2 varices secondary to portal hypertension as well as "high" (as in higher than normal). Indeed they do suggest you suspend driving with encephalopathy However "they" is abstract - Go to google: research, research, research- look up the treatments: Lactulose vs. Xifaxan to decrease the ammonia. And beta blockers vs. banding for the varices which I presume are esophageal. You will get variations of experiences here which are therapeutic relative to your anxiety and directive relative to the facts But go to your Hepatologist with these anxieties because you can manage the effects of cirrhosis. My best. d
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