Cruisin with the Real"s

Cruisin with the Real"s
Joe and Nancy Grand Cayman 10-07

Loma Linda Medical Center

Loma Linda Medical Center
Where the magic happens........

Saturday, March 15, 2008

Something to chew on.....

I am having a wonderful productive day but in taking a break this came through one of my support groups...for those that want to know more about the symptoms and progression of cirrhosis.............................................................

This woman is extremely knowledgeable and explains things well. The group is encouraging her to write a book...

The following are also things I have to look forward to if my liver comes later than sooner..................................

When someone is in the end stages of this disease: their mind will not be clear as it normally would. This is because of the liver not being able to handle toxins like it once did. The liver usually converts the by product of proteins that are used in the body,which is ammonia, to a substance known as urea. In which case the kidney picks up this urea and disposes of it in the urine.However, because of liver cell doesn't get converted to urea and stay in the blood and goes pass the blood brain barrier and into the brain. This is what causes the mental confusion and unclear thinking. This condition has a name, known as encephalopathy. The doctor may prescribe a drug known as lactalose to help bind this ammonia in the intestines and remove it so it won't build up in the blood.

When the liver is damaged, the blood doesn't flow through it as it once did. The blood has to go back to the heart someway.This blood from the abdominal area usually goes through the liver through the Portal Vein. However, it cannot do this well anymore and will back up into vessels that normally doesn't handle this blood. This causes pressure to build up in the Portal vein known as Portal Hypertension. The vessels, now, that the blood is backed up into can have weak areas in them cause they are small and can balloon outward and break open. The areas these weak spots are usually found is mostly in the esophagus but can also be found in the rectum or belly button area. That means that if a patient every coughs up blood in is considered an emergency situation cause they could very easily be bleeding internally. This can look like coffee grounds or like purple or red color blood depending on how much oxygen is in it.

Another thing that can occur with the development of fluid in the legs and feet and also the abdomen. The fluid that develops in the legs and feet is different than what is in the abdomen. This fluid is known as edema. This is caused because cirrhosis patient have a high level of sodium retained in their body. Sodium tends to hold fluid in the body. Many patients are placed on a "lower sodium diet" and may be given a diuretic also. The diuretic isn't given so much to remove the fluid as it is to lower the sodium. The doctor will look at the patients individual blood work and then inform the patient how much sodium they are allowed to have through their diet. However, this has to be watched closes as the sodium is one of the elements that helps the heart beat in rhythm. Also, the patient should be told how much fluid would be acceptable to take in. The doctor has to balance this with his directions, as a patient...even though they are retaining fluids in the body...can become dehydrated.It is very difficult to explain but it is true. The other type of fluid build up is usually in the abdominal area....this is known as "Ascites". The liver makes a protein, known as albumin,that not only transport substances in the also is what holds fluid in our vessels. The liver is no longer able to make a sufficient amount of this protein now, so the fluid seeps out and collects in the abdomen and can keep building up.If the patient becomes uncomfortable because of this, since the fluid tends to put pressure on abdominal organs like the stomach and up against the diaphragm..making it difficult to breath...they can do a simple procedure to remove this fluid by inserting a needle in the abdomen and then sliding a tube over it that is connected to a vacuumed bag or bottle that will gently (because of the vacuum) pull the fluid slowly out of the abdomen. They will test this for infections and other things. This fluid will tend to build up again because the albumin is still not being made enough and will have to be removed again.

I mentioned that because of this fluid, the patient may not feel like eating. It is very important for the patient to have nourishment to help their body keep its strength. Sometimes it is best to feed little meals all day long than one large one.Something like a bowl of fresh fruit, pudding, soup, a sandwich.This helps keep their digestive system working well and doesn't cause them alot of discomfort. If they don't want to eat anything at is best to ask the doctor about supplement like Ensure or other products that may be used that they can drink. The doctor should recommend which ones will be okay as they sometimes contain items the patient may not have. For example...some people are not allowed alot of potassium and these products tend to be very high in them.

The patient will becomes more tired as time goes on. Their sleep patterns may change. They should be allowed to sleep whenever they need to. They may get to the point where they may sleep 10 minute sand be up a half an hour or more. Any sleep they get is beneficial.

I forgot to mention something about the fluid in the legs and feet.They may need a larger size slipper and shoe. It is good to elevate the legs just slightly higher than the chest, on a pillow,when they are lying down. Do not massage the legs. When they are swelled like that, it is easy for a blood clot to develop.Massaging the legs can release a blood clot there and move it into an area, like the heart and lung, and become fatal. The patient will develop little spider like veins on the neck,chest and shoulder areas. These are not harmful to the patient.If they are scratched, they may bleed....just apply pressure to the area for about a minute to see if the bleeding will stop.

The liver will not be able now to make the factors needed to help the blood to clot. The patient may bruise easily and develop blood bruises under their skin. If they are cut, it may take awhile for the blood to clot. It is best to remove items that they might trip on or stumble around. Area rugs are one of the main things...a nightlight or low light in the room can also help.

The palms of the hands and feet can turn a red/pink color.Usually, patients should use a cream like eucerin...that doesn't have scent to it. I

t is also best, for now, to keep people who may be sick away from the patient. This would include very young children.The reason for this is that the patient is very weak and having something else, like a cold, flu, or childhood illnesses, can weaken them more or cause them to use medications that can be harmful to them at this time. The liver processes most medications and since it is now not able to do this...the medications have to be adjusted according to how far the patient is in this disease. Any medications, whether over the counter,herbs, herbal teas, vitamins, minerals, or those prescribed by other doctors should be told to the Liver specialist. Also,it would be could to give him the list of call doctors and their addresses and phone numbers that the patient has contact with...this includes dentists and eye doctors.

Here are a few of cirrhosis sites that may be of help to you.

I want to give you an idea of words you might see on this site and what they mean.

Hepatitis is inflammation of the liver cells.Cirrhosis is scarring of the liver which leads to death of the liver cells.

If a work starts with Hepata or Hepato...this means the liver

Jaundice is the yellowing of the whites of the eyes, mucus membranes and the skin caused by bilirubin.

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