A whirl wind of doctors appointments.

August 30,2017

We went in to the Gastroenterologist office who is the first step to take when anyone has a issue with their liver.  Lee was diagnosed with stage III liver cirrhosis.

 
We found out that this is called from a condition called NASH Nonalcoholic steatohepatitis. This is caused by fatty liver.  The plan from here was for weight loss, and start on a medication called Lactulose to help combat the symptoms of encephalopathy (on this day he was at a grade 2) that had developed after surgery.  We were also told we shoulf follow up with the Liver team at IMC in Murrey.  
I wanted to add a little education to this blog so it is not just for my personal story but may help others and help our friends and family understand a little more about what is happening in our lives.  

What Are the Stages of Hepatic Encephalopathy?

The severity of HE is judged according to your symptoms. The most commonly used staging scale of Hepatic Encephalopathy is called the West Haven Grading System:

• Grade 0: Minimal HE
  This stage is very hard to detect as changes in your memory, concentration and intellectual functioning are so minimal that they may not be outwardly noticeable, even to you. Coordination can be affected and although subtle, may impact your ability to drive a car. If you recently had poorer performance at work or have committed a number of traffic violations while driving, it would be worth bringing this to the attention of your healthcare provider. You may be referred for special testing, called neuropsychiatric testing, to evaluate your thinking abilities by doing a number of specifically designed tasks with a trained examiner. If your test reveals some deficits, your healthcare provider will likely schedule frequent follow-up visits to closely follow your condition. There are currently no medications approved by the FDA to treat minimal HE.
• Grade 1: Mild HE
  You may have a short attention span, notice mood changes like depression or irritability, and have sleep problems.
• Grade 2: Moderate HE
  You may keep forgetting things, have no energy and exhibit inappropriate behavior. Your speech may be slurred and you can have trouble doing mental tasks such as basic math. Your hands might shake and you can have difficulty writing.
• Grade 3: Severe HE
  You may be confused as to where you are or what day it is and be extremely sleepy, but can still be woken up. You may be unable to do basic mental tasks, feel extremely anxious and act strangely.
• Grade 4: Coma
  The last stage of HE is when the person becomes unconscious and slips into a coma.

Later that same day August 30, 2017 

Follow up with the surgery team.  This appointment went very well Lee healed well from surgery and was told that he did not need any follow up from a surgical standpoint but to keep following up with the liver specialist.   

August 30, 2017

Pulmonology (lung specialist) follow up, while staying over-night in the hospital Lee could not keep his oxygen sats up at night even with his c-pap on that he has worn for years.  So we followed up with the pulmonologist office. He was ordered an over night pulse ox exam and was also given an antibiotic for a cough that had developed and some tessolon pearls. After finishing the test a few days later Lee was ordered to have oxygen set up for over night only, so now he has the c-pap and the oxygen.  

September 4 2017

ER Visit:  Lee was having some increased pain where his liver is and and where is gall bladder was removed so we ended up back in the ER.  Being a nurse can be a blessing and a curse some times my head goes to the worse case scenario and sometimes I don't want to over react If it is nothing.  So with the severe increase of pain that Lee was having I was afraid he was having a bile leak.   They took him to CT to scan his belly and it just showed some fluid build up and some portal hypertension.  No Leak.

Portal hypertension is an increase in the blood pressure within a system of veins called the portal venous system. Veins coming from the stomach, intestine, spleen, and pancreas merge into theportal vein, which then branches into smaller vessels and travels through the liver.

September 7, 2017 Primary care doctor visit.

Because I am a nurse and the first opening at the liver clinic was not until (March 2018 in Lee wanted to be seen in Saint George) November 14 th in Murray, we went to see our primary care doctor to talk about the portal hypertension and to  see about any other treatments that needed to start before our visit to the liver team.  Lee was started on Lasix to help decrease the amount of ascites (the accumulation of fluid in the peritoneal cavity, causing abdominal swelling.) and Metopolol for the portal vein hypertension.  Lee was also referred to a nutritionist, when meeting with them Lee was told a healthy diet and decrease sugar was what was best for him at this point.  

September 9th 2017

EGD done to evaluate for any esophageal varieties. According to the Mayo clinic (portal hypertension) forces the blood to seek other pathways through smaller veins, such as those in the lowest part of the esophagus. These thin-walled veins balloon with the added blood. Sometimes the veins can rupture and bleed. The EGD esophagogastroduodenoscopy is a little camera thy use to look down Lee's throat and at his esophagus.  There were no Varieties found at this time but Lee will have to do this every year. Thank goodness Lee's was clear but this is what they were looking for.  

Next post will be about our visit to the liver team.