Tuesday, July 31, 2012
A Roller-Coaster Day
The first thing this morning, Angela was being combative to the point of needing restraints. Her doctor saw that and ordered a psych consult. She had no interest in breakfast or morning medications. But by lunch, she was ready to eat some fruit and a protein shake, and by dinnertime she was her old self, mentally, eating a good meal and taking her Lactulose, the only way - to my understanding - that the extra ammonia can be cleared from her system. She got a shower this evening, even though her mental state had reverted a bit, and with a lot of coaxing took another Lactulose dose. She was sleeping when I left. If she will let them, they will draw blood around 4:00 tomorrow morning to check how the ammonia is doing. It is great that her caregivers are there with her, too. Overall, I would say that today was a small step in the right direction. I thank God and pray that this trend will continue, if it is His plan for her.
Two Good Years
I note that the last entry here was over two years ago. Angela has been quite healthy during this time. Her liver has not returned to normal and, in fact, she has been jaundiced to one degree or another and has continued to have elevated liver enzymes during this time, but she has been able to do the things that make life good for her.
In the last few months, she has started retaining more fluid and, as always, has been very resistant to increasing her diuretics. But she was well enough to visit us about a month ago for our family reunion and celebration of Mom & Dad's 60th anniversary. She thoroughly enjoyed seeing everyone and we all enjoyed her. She did appear more frail than before, but was able to walk a little and play croquet.
Last week, she went to the ER for hip pain, but they looked at how much edema she had and focused mainly on that. She was admitted and some tests were done. Friday morning she told the doctor that she wanted to go home instead of to a nursing home as had been recommended, so she was released home. By that evening, she was becoming irrational, with very strange behavior, some of it outside, obvious to neighbors. Her caregivers took the necessary steps to have her readmitted to the hospital, and she has not been herself since then. Her brain is being attacked by her deteriorating liver, primarily by the increasing ammonia concentration in her blood which prevents her from thinking rationally. She was also given an anti-anxiety drug, Ativan, which gives her a bad reaction. Then, yesterday, she stopped responding at all and looked like she was trying to bite her tongue off. Some of the nursing staff thought she might be having a seizure, but it turned out to be a high CO2 concentration in her blood. She has had this before, and it usually clears up with the use of a BiPAP machine, and she was immediately placed on that. By this morning, she was talking a lot. Unfortunately, if you listened to more than four or five words, you would realize that they made no sense. She spent her day between this state and sleeping.
This afternoon, we were finally able to see her primary-care doctor instead of the on-call physician. She said that Angela's liver has really gone downhill and her heart has enlarged even more. She said that Angela may recover from this episode, but does not have a good long-term prognosis and as her liver fails, her mental status probably will very from good to bad.
I see two possible scenarios:
1) Her liver is failing. There is really nothing that can prevent this; slowing it down is the best we can hope for, or
2) Her BiPAP mask has not been fitting and worn properly, causing her to have less oxygen in her blood than she should have. This causes stress on her heart, which then enlarges, and on her liver.
If it is #1, there isn't much that can be done. If it is #2, we can make sure her equipment is working properly and hope that this will lessen the strain on her heart and liver, allowing some degree of healing. In either case, she is taking at the hospital, and will continue when she is released, a medicine, Lactulose, which removes the ammonia from her blood and gets it into the digestive tract for elimination.
I don't plan to update this blog daily but will post whenever there is any major change. Mike flies home Wednesday, but I plan to stay as long as necessary. Again, thank you each for your prayers.
In the last few months, she has started retaining more fluid and, as always, has been very resistant to increasing her diuretics. But she was well enough to visit us about a month ago for our family reunion and celebration of Mom & Dad's 60th anniversary. She thoroughly enjoyed seeing everyone and we all enjoyed her. She did appear more frail than before, but was able to walk a little and play croquet.
Last week, she went to the ER for hip pain, but they looked at how much edema she had and focused mainly on that. She was admitted and some tests were done. Friday morning she told the doctor that she wanted to go home instead of to a nursing home as had been recommended, so she was released home. By that evening, she was becoming irrational, with very strange behavior, some of it outside, obvious to neighbors. Her caregivers took the necessary steps to have her readmitted to the hospital, and she has not been herself since then. Her brain is being attacked by her deteriorating liver, primarily by the increasing ammonia concentration in her blood which prevents her from thinking rationally. She was also given an anti-anxiety drug, Ativan, which gives her a bad reaction. Then, yesterday, she stopped responding at all and looked like she was trying to bite her tongue off. Some of the nursing staff thought she might be having a seizure, but it turned out to be a high CO2 concentration in her blood. She has had this before, and it usually clears up with the use of a BiPAP machine, and she was immediately placed on that. By this morning, she was talking a lot. Unfortunately, if you listened to more than four or five words, you would realize that they made no sense. She spent her day between this state and sleeping.
This afternoon, we were finally able to see her primary-care doctor instead of the on-call physician. She said that Angela's liver has really gone downhill and her heart has enlarged even more. She said that Angela may recover from this episode, but does not have a good long-term prognosis and as her liver fails, her mental status probably will very from good to bad.
I see two possible scenarios:
1) Her liver is failing. There is really nothing that can prevent this; slowing it down is the best we can hope for, or
2) Her BiPAP mask has not been fitting and worn properly, causing her to have less oxygen in her blood than she should have. This causes stress on her heart, which then enlarges, and on her liver.
If it is #1, there isn't much that can be done. If it is #2, we can make sure her equipment is working properly and hope that this will lessen the strain on her heart and liver, allowing some degree of healing. In either case, she is taking at the hospital, and will continue when she is released, a medicine, Lactulose, which removes the ammonia from her blood and gets it into the digestive tract for elimination.
I don't plan to update this blog daily but will post whenever there is any major change. Mike flies home Wednesday, but I plan to stay as long as necessary. Again, thank you each for your prayers.
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