Lost in Virginia

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MaxP
New Member


Date Joined Nov 2009
Total Posts : 1
   Posted 11/24/2009 9:49 PM (GMT -7)   
A dear friend of mine, Cindy, has been diagnosed with cirrhosis and is in the hospital for the second time. She has no relationship with her family and her landlord (also her friend) and I have been doing our best to help out in a desperate situation. She has lost her apartment and all of her clients and is staying at her landlord/friend's house. Cindy is an alcoholic - we've tried talking with her about it for several years to no avail. She is still in denial and hiding information. We are trying to get a better handle on her prognosis so that we can help plan for next steps - we don't know if we should be looking for a hospice or a residential alcohol treatment facility. We don't have access to her doctors and she thinks she's going to be all better in a few weeks (clearly not the case.)

Her Admitting Diagnosis from her 1st hospital stay was: alcoholic liver cirrhosis, hyponatremia, macrocytic anemia, portal hypertensive gastropathy and Ascites. She was 'hospitalized for the following conditions': End organ damage: the liver has fibrosis which led to accumulation of fluid in the abdomen. (all that from one of her discharge papers)

She was given oxycodone (is this something you normally give an alcoholic?) esomeprazole, folic acid, furosemide, spironolactone, thiamin and a multi-vitimin.

Her abdomen is swollen to the point of apx 8 months pregnancy equivalent in size, her muscles in her arms are wasted, her legs and feet are horribly swollen. Rather than loose weight daily on the restricted diet and diuretics, she gained 7 lbs it the 2.5 weeks she was out. Not sure what I'm asking here...? Given this info, is there any way I can tell what to expect moving forward? Can I assume the doctors have assigned her a MELD score or do you have to ask them to do that? Any ideas on how to get some info out of doctors/nurses when there is no family, the patient is in denial but not suicidal or homicidal enough be judged incompetent? Any advice much appreciated. - Max

hep93
Elite Member


Date Joined Jul 2005
Total Posts : 12014
   Posted 11/24/2009 11:06 PM (GMT -7)   

Max, welcome to the forum.  You are in a tough situation, since you are not family nor do you have Power of Attorney or Medical Advocacy.  Since HIPAA regulations went into effect, the medical profession has become almost paranoid about releasing information to ANYONE.  She would have to give express permission to nursing staff and doctors to allow you to get info.  That said, I suggest you read through some of the older posts here, specifically those related to alcoholism.  You will learn a lot.  In addition, there is more detailed information in the folder at the top of the forum page titled Hepatitis Resources, which will let you know what to expect.

If she continues drinking, she will accelerate her liver disease and her demise.   Since she is in denial, there doesn't seem to be much hope of her stopping anytime soon.  If she doesn't want to stop, she will continue to drink until it become physically impossible for her to do so.  That is the harsh reality.  You can talk to her and she may "yes" you to death, but if she doesn't really want to stop drinking it won't mean a thing.  I can tell you this as both the daughter of an alcoholic who died an alcoholic, and as a sober one myself with 23 yrs. of sobriety, thanks to AA.

Furthermore, she will not even be eligible for transplant evaluation until she has been sober for a length of time (usually at least 6 mos.) in AA or alcohol counseling, which has to be documented.  A MELD score is usually calculated during evaluation for a transplant.  However, there is an online calculator if you know certain info to plug in:  http://www.unos.org/resources/MeldPeldCalculator.asp?index=98

If the diuretics and low-sodium diet don't work to reduce fluid retention, they may drain her abdomen (paracentesis.)  Sometimes a TIPS procedure is also done (basically a stent is placed to reroute fluid from the abdomen.)

Her landlord/friend can do his part by refusing to supply her with alcohol (not saying that he has been, but simply that she may ask him to get her some, especially when she is discharged.)
 
As to your question of whether an alcoholic should be given oxycodone, a person who is in recovery should not be given any potentially addicting drugs, but if she is in pain and isn't drinking at the moment in the hospital, then I could see how the doctors would be okay with it.
 
I know this isn't very hopeful, but perhaps it will help you in some way.
 
Hugs,
Connie



hep93
Forum moderator - Hepatitis
 
"But that was yesterday, and I was a different person then."
Lewis Carroll, Alice in Wonderland


arneeb
Veteran Member


Date Joined Nov 2009
Total Posts : 2350
   Posted 11/25/2009 2:40 AM (GMT -7)   
Max, How wonderful that she has you ..... you have obtained an immense amount of information... not much you can do in this situation other than what you are doing... other people can tell you about your questions... I just wanted to give you an attaboy!!!! supporting a person in this situation and loving them is so difficult... my prayers are with you ....
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