My dad has esld...alcoholic cirrhosis

I'm not sure, my mom gave me his test results over the phone and that is all the tests they did. The doctor did state we can make an account on their website and find out all his test results, I'm going to try and do that.

Ziff I'm not sure if he is in renal failure or not! He had an appt with his gp yesterday and those were his lab reports. He is on LASIX I think, I have to ask mom. I'm just wondering with those lab results what do they mean.

His stomach only is retaining fluid. Otherwise he is like a skeleton.

Thanks ziff!!!!!!!!

Hey S&S! There is something wrong with that creatinine level - there must be a missing decimal point. Normal creatinine levels for an adult male is 0.6-1.2mg/dL. So I'm guessing that maybe it's supposed to be '1.58mg/dL'. Now, here's the thing about the urine albumin. Albumin is a protein that is in the blood and healthy kidneys do not allow albumin to pass into the urine. If it's found in the urine, it means that there is some kind of damage to the kidneys. A result under 30 is ok. And the less albumin found, the better. Hope that helps.

(I'm sure his doctor checked his GFR also. It's an important test, especially if there is urine albumin present - it shows how well the kidneys are filtering.)

Post Edited (Splashdancer) : 6/12/2014 8:49:35 PM (GMT-6)

It is obvious that your Dad can not make decisions for himself in his current state of mind. He certainly would not be allowed to sign a contract or enter into any type of legal agreement. That being said, there MUST be something available in your jurisdiction that would allow your Mom to legally make all of his medical decisions. I'm sorry, but I think the time has come for her to do this. This is one more of the awful things we are sometimes faced with as caregivers. His current situation may very well be due to H.E., but the bottom line is he may never think 'it's time' to go to the hospital. I understand that the ambulance won't take him against his will and you'll need to wait until he's in a coma for them to take him. However, the next coma may just be the one he won't awaken from - it's Russian Roulette. I honestly am not trying to scare you and I apologize for being so blunt - but something has to be done to get your Dad the help he desperately needs. Time is not on his side.

I'm really sorry that you're going through this.

S&S -

It's only a guess on my part since data is sparse, primarily due to your dad, but are you sure he isn't still drinking? I know this is something that's hard to assess at home without actually seeing it for yourself. His insisting that your mom go to work and then his condition appearing to have become noticeable worse, hmm? Also, the increase of HE and the yellow stool would tend to indicate alcoholic hepatitis super-imposed within a cirrhotic liver, a bad combination which further inhibits the bile flow, etc. Lactulose isn't a cure but it will certainly mitigate things.

As Splashdancer has noted, the creatinine value (Cr) appears to be missing a decimal point and the reason I was interested in the units (just to be sure). A Cr level of 1.5 or higher can be a indication of something called hepatorenal syndrome (HRS) but he would also have to be suffering with a high level of portal hypertension (PHT). The ascites would indicate that he has the PHT but if his arterial BP has been showing signs of hypotension (below 90/60), then the PHT will be very advanced and HRS a likely possibility. I know the "local" hypertension and "systemic" hypotension seem counter to each other but that's liver disease at it's best, confusing.

You really do need to get specialized medical attention for him, as hard as it is for you, a GP will not do. If not for him, then for yourself and your mother. Good luck amd I hope things turn in your favor soon.

Definitely characteristic of HE. The pooping all over the place can be a good thing in the fact he is getting rid of toxins. It can and likely will get worse before it gets better. We can live without food longer than we can without water, He'll get dehydrated.

Go to the police department explain the situation. Have his medical records handy in the event they want to see them. Put them on notice and make sure a report is filed. Tell them he is posing harm to your mom and himself and he needs medical attention but refuses. alert his doctor to the nature of the problem and see if he'd sign a statement saying dad is not in his right state of mind due to disease. Now you have all the bases covered when the EMT's and police show up to get him.

You may want to remove your mom from the residence before they get there. She can tell dad she's got to go shopping. He'll likely throw a fit and the anger will be directed at her, not good. Better you than her, She is likely already in overload. You can't afford her to cave in under his pressure. Once he is hospitalized immediately make arrangements for his release to a Nursing home institution of your standard. This is the best and only chance I can see of him getting through this.


Ziff

Wow, you guys are amazing.....I can't explain the gratitude I have for all of your input. Today is a changed day, I guess that comes with esld. I actually stayed all day with my dad, my mom was at work and asked me to go there to make sure he takes his medicine etc. 2 days ago he slept through his alarm and missed his doses of lactalose that is why this all happened and yes his creatinine is 1.58....sorry if I mixed that up.

I spoke to my mom about getting him to sign all medical over to her and we are going to do that, she said he would let us.

My day with dad today, got there he was sleeping when I walked in, he woke up. We talked for hours!!!!!!!!! Lots I couldn't understand, but I asked him to repeat everything so I knew what he was saying. He was coming out of the confused state today, it was much better than the last 3 days. Mom and I changed his hours of lactalose so we MAKE SURE he doesn't miss ever! Yes, it is possible he may be starting hepatorenal syndrome and I need to talk to my mom about that tonight and come up with a game plan. I gave dad his Father's Day gift early, a pair of sweats, shorts and a soft t shirt, he loved them all and insisted on trying them on, after about 4 trips to the bathroom (which I was happy he was going to the bathroom). We talked about rehab, transplant, how much we care, love him and how my mom takes such amazing care of him. We talked about his hospital trips, which I'm shocked that he talked to me about that. I find that his mind is going a million miles a minute, always asking me to do something on his phone, go make yourself something to eat, can you go to the store for me, I'm not sure why, but he does seem a bit restless I guess. He didn't want to sleep, he wanted to be with me and talk, this was by far my favorite day ever with him. I was so scared to go there, but it am so happy I did. He did have a bit of a bleeding nose while I was there, which kind of shocked me because I've never seen his nose bleed before, it wasn't a lot just a bit on a piece of toilet paper :( he is now saying he wants to go through rehab, I'm hoping he can make it until then. He seemed ok today, but very very weak, eyes open then close kind of spaced out a bit, but not too bad, I've seen him in every state possible from normal to coma. He is so thin with his hard hard big belly, I helped him try his pants and shorts on. When my mom got home, he started to get agitated a bit, just snappy at both of us, which he was super nice to me all day. I said mom give him another dose of lactalose if you think, she knows when to give it to him now, with everything we have been through, she knows the signs.

I was so upset and mad last night, I do feel a bit better today, because it was my best day with him and I actually didn't feel scared, i felt comfortable sitting there and talking with him about fishing.

I don't know how long my dad has, no one does, today was an amazing day and like ziff says, only god knows.

Maybe someone else knows differently but aldactone and lasix are both rough on the kidney. I don't know of any more diuretics that are effective as those two. Aldactone I believe doesn't rob you of potassium. I'm no doctor but I do know they have to balance the diuretics with his particular situation. No diuretics equals fluid retention so there isn't much of a option at this point.

Probably shouldn't mention it but something similar to a colostomy bag can be set up to constantly drain the fluid. I was told about this when they realized I wasn't responding to diuretics. Problem is this is asking for trouble. Infection from a open wound and a person with a compromised immune system ain't good. It's also temporary (couple months max) so it doesn't solve the issue. Not really a option at all.

TIPS was mt only hope to survive and live a reasonable life until transplant. Same principle as colostomy but it done internally. It relieves the fluid build up by allowing it to flow through a shunt installed into my liver. The fluid is drained into my bladder and I urinate to get rid of it like anyone else. My MELD was 16 at the time and I was very sick. MELD could have stayed that way for along time and I was getting physically sicker by the day. I went through paracentesis 2 times a week for months on end, I was dying slowly with no hope of transplant. Sometimes you just have to roll the dice. I did and the TIPS paid off. Trouble is that I had to deal with fluid issues until sobriety terms had been met. No major surgery until I met my commitment.


Ziff

The fact that you sat down with your dad and really communicated, could be the beginning of you and your mother taking over his medical and legal decisions. With HE, he isn't always making the right choices. You did good...

Once a week blood monitoring should be sufficient until you get in to see someone that specializes in the liver, hopefully you get a great hep July 3! Btw, if you know, what are his dosages for lasix/aldactone? Be sure to watch his creatinine levels for any large jumps. Also, again if possible, pay attention to whether or not he's having trouble urinating ... decreased volume or simply doesn't go.