Cirrhosis and ascites and wasted muscle mass

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caro829
New Member


Date Joined Oct 2010
Total Posts : 3
   Posted 10/17/2010 8:50 AM (GMT -6)   
Hello everyone! I am a 80 year old male who was diagnosed with cirrhosis in November 2009,
Ascites was my first problem and then the dreaded ammonia level. I was in the hospital in Jan, Feb, March and April with very high ammonia levels. Each time I went in my stay was 3 to 4 days. I finally have the ammonia and ascites somewhat under control. My protein daily intake is about 40 grams a day and that has controlled my ammonia level greatly. However I still have the ascites drained every 3 to 4 weeks. They take off 5 to 6 liters each time.
 
I'm sharing my problems with this forum hoping I can contribute and I will get ideas from others about how they have controlled their problems as well.
My muscle mass has wasted away pretty much although I walk good and also drive for short trips i,e., Food Lion etc.
 
Although I've had a rough year I seem to be feeling much better and also feel stronger. Anyone who will share their cirrhosis condition with me would be greatly appreciated.
 
Although I am 80 years old, my health is great except for cirrhosis.
Looking forward to hear from you.
 
Bob in Virginia.

arneeb
Veteran Member


Date Joined Nov 2009
Total Posts : 2308
   Posted 10/17/2010 10:07 AM (GMT -6)   
Hi Bob... welcome to the Forum... and many of us will share their experiences with you... I have been a caretaker myself... and I commend you for your positive attitude... do you have a support person??? I hope you do... well others will chime in.. welcome to the Forum... Sandi
There is no pit so deep that He is not deeper still... Corrie Ten Boom

pscwife
Regular Member


Date Joined Dec 2008
Total Posts : 302
   Posted 10/17/2010 10:14 AM (GMT -6)   
Bob,

If you are who you say you are, all I can say is WOW! Forgive my skepticism, but this is the Internet after all. For a man of your generation to even surf the net is incredible let alone given what you’ve been through. I’m very impressed!

I’m sorry you are going through these experiences. Ascites is very difficult to manage. Draining the fluid can also compromise your body’s level of albumin (protein) vital to maintaining muscle mass. Are you receiving IV albumin in conjunction with your fluid drains?

From what source are you getting your protein? Nutritional shake, meat, beans and/or nuts? It sounds like you’ve really got a handle on your condition. Kudos!

Penny

caro829
New Member


Date Joined Oct 2010
Total Posts : 3
   Posted 10/17/2010 11:30 AM (GMT -6)   
Hi Penny
 
Yes I am real! I've been using the computer and the internet for several years, it's my only form of amusement since I lay down a lot because of lost muscle mass. Before I was diagnosed with cirrhosis I weighed 210 lbs, now my weight after removal of fluid is about 170..
 
I was an avid golfer up until I was diagnosed with this horrible disease and that was October 2009..
 
They do give albumin by IV when the fluid is removed, my protein is limited to 40 grams a day and I have no problem doing that with eggs, chicken and other food.
 
My ammonia level is under control because of  the control of protein.
 
I would like to do something to stop the sacites build up.. I see here that some people have practically no ascites anymore.
 
Help!  Bob

hep93
Elite Member


Date Joined Jul 2005
Total Posts : 12014
   Posted 10/17/2010 1:13 PM (GMT -6)   

Hi, Bob, and welcome to the forum!  There is a lot of information about liver disease in the folder at the top of the page entitled Hepatitis Resources.  You might want to check it out.  I have hep C, cirrhosis, and am a liver cancer survivor.   Regarding protein, it's best to stay away from animal protein as much as possible, as that is the most difficult for the liver to process.  Try soy products, such as edamame (soy beans) in the shell or shelled, to use in stir fries.  You will find them in frozen foods.  Cheese and eggs in moderation are also good.  Fish, of course.

I think everyone with liver disease has a battle with ascites and edema at some point.  I did when I had liver cancer.  My feet and calves had 3+ pitting edema and my stomach was horribly swollen.  They finally got it under control with diuretics.  I also had drainage bags for weeks following abdominal surgeries.

I'm sure you will be an inspiration to others here and will also learn a lot.

Hugs,

Connie


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

pscwife
Regular Member


Date Joined Dec 2008
Total Posts : 302
   Posted 10/17/2010 2:36 PM (GMT -6)   
Bob,

I’m certain you’ve research the causes of Ascites as it relates to cirrhosis. The scaring of the liver restricts blood flow through the liver via the portal vein. This results in portal vein hypertension. Sodium restriction is very important because sodium provides the means by which plasma fluid passes through the tissues and vessels. When the blood flow is backed-up in the liver, plasma (fluid) leaks out of the lining of the liver and blood vessels and collects in the abdominal cavity and lower extremities.

Harvey was prescribed metoprolol twice a day to reduce the portal vein pressure. He was also prescribed two diuretics, spironolactone (Aldactone) to block salt retention in the body and furosemide (Lasix) to aide the kidneys in expelling excess water and salts from the body. This regiment did help, but only to reduce the volume of Ascites. I don’t know of any treatment that will eliminate Ascites in the case of cirrhosis.

Harvey’s liver was only the size of a grapefruit at the time of transplant. Cirrhosis scars and shrinks the liver. His portal vein pressure resulted in esophageal varices (bursting blood vessels in the esophagus). This was a very dangerous condition. Another dangerous condition that developed was an abdominal aortic aneurysm. His aneurysm is being monitored. They will not address it until it is 5cm in diameter. Given that he underwent a liver transplant and the portal vein pressure is no longer an issue, his aneurysm may cease to expand.

The liver is an incredible organ and a brilliant chemist. When it is not functioning correctly, the chemical balances in your body are thrown off resulting in a wealth of complications. Modern science cannot duplicate the chemical functions of a healthy liver. The use of diuretics is a necessity in treating Ascites but finding the proper balance is key. If the dose is too high, encephalopathy increases as does the risk of kidney damage. You should routinely monitor your blood pressure because if you are too dry, it can drop to a dangerously low level. Electrolyte and potassium levels (balance) in the body are also affected by diuretics. Calcium and magnesium in a 2 to 1 ratio can stabilize potassium levels. However, consult your hepatologist or pharmacist prior to taking any vitamin/herbal supplements to avoid drug interactions.

Having hearing issues? Ringing in the ear or the stopped-up sensation is common with liver disease. Vertigo (dizziness) is also an issue. The inner ear is fluid filled. An imbalance of inner ear fluid will cause these issues.

It seems you are darned if you do and darned if you don’t, but don’t give up. Record your weight and vitals regularly. You will learn what works best for you. I wish you luck and success in battling your symptoms.

I hope this information is helpful to you.

Sincerely,

Penny

hep93
Elite Member


Date Joined Jul 2005
Total Posts : 12014
   Posted 10/17/2010 3:34 PM (GMT -6)   

Penny, it is my understanding that Aldactone taken with Lasix prevents the lowering of potassium that is caused by Lasix alone.  Of course, it is also a mild diuretic.  Perhaps the liver cancer caused my ascites and edema flare.  After being on diuretics for about 2 years, I noticed my BUN and creatinine creeping up, I reduced my diuretics to twice a week, which my hep doc approved.  When I stop taking them altogether, I do have some slight swelling in my fingers and abdomen and slight edema in my feet.

I also want to add beans to the list as a source of protein.

Hugs,

Connie


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

pscwife
Regular Member


Date Joined Dec 2008
Total Posts : 302
   Posted 10/17/2010 4:37 PM (GMT -6)   
Connie,

Harvey was prescribed potassium in conjunction with the diuretics before his liver transplant. It was in liquid form because he was unable to take the “horse” pills. It has a horrible taste. Lactulose is delicious compared to Potassium. It was a constant battle to maintain Harvey’s potassium levels. I didn’t learn about the calcium/magnesium combo until after his transplant. But there may be good reason for this.

Some antacids containing magnesium can cause drug interactions. So it is logical to assume that a magnesium supplement would do the same. This is why it is so important to check with a doctor or pharmacist prior to taking any supplements. What may seem harmless can affect a prescribed medication. Consider grapefruit juice for example. It renders cholesterol lowering drugs useless. Other interactions can be very dangerous and actually increase the potency of prescribed medication.

I prefer discussing interactions with a pharmacist. If I get the all clear, they I run it past the doctor.

Penny

**David**
Veteran Member


Date Joined Nov 2009
Total Posts : 3261
   Posted 10/17/2010 8:06 PM (GMT -6)   
Most of the other transplant patients I've spoken to had greatly enlarged livers, when they were removed. Mine was. I always thought of my failing liver as looking like a Raisinet. When I told my surgeon, he laughed and said mine was a third larger than it should have been. A transplant forum I'm on has pictures of an old tired liver and a new one about to be transplanted. The new one is half the size of the old old one. Sometimes the old liver is small, but that seems to be less common.
"No good deed goes unpunished."

hep93
Elite Member


Date Joined Jul 2005
Total Posts : 12014
   Posted 10/17/2010 9:05 PM (GMT -6)   

Penny, I couldn't take the potassium "horse pills" either.  That's when they decided to put me on Aldactone.  Lasix and Aldactone seem to work for me.  I have an up-to-date Mosby's Nursing Drug Reference and always look up interactions in that.

David, I don't know how large my rt. lobe was when it was removed, but the surgeon said it was completely dead (from the chemoembolization and TheraSphere) and would NOT regenerate.  I am living fine on the left lobe.

Hugs,

Connie


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

pscwife
Regular Member


Date Joined Dec 2008
Total Posts : 302
   Posted 10/18/2010 5:07 AM (GMT -6)   

 

David,

 

The size of the liver depends on the affliction and progression of the disease.  For example, with NASH (fatty liver disease), the liver will be enlarged with fat.  With cirrhosis, the liver will initially swell.  As the disease progresses and the amount of scar tissue in the liver increases, the liver will actually shrink.

 

Harvey was nearly a dead man when he received his transplant.  The surgeons were amazed he was alive considering what was left of his liver.

 

Penny


**David**
Veteran Member


Date Joined Nov 2009
Total Posts : 3261
   Posted 10/18/2010 7:45 AM (GMT -6)   
I had cirrhosis, not NASH. I'd guess that in Connies case, the two procedures to shrink the tumors zapped the right lobe of your liver.
"No good deed goes unpunished."

hep93
Elite Member


Date Joined Jul 2005
Total Posts : 12014
   Posted 10/18/2010 1:23 PM (GMT -6)   

David, you're correct.  Due to the size of the tumor (12 cm x 11.5 cm), it took up the entire right lobe and metastasized into the inferior vena cava.  The treatment shrunk the tumor and the metastasized part, but there was no viable tissue remaining, either.

Hugs,

Connie


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