Hepatic Encephalopathy - that explains a LOT! | yosoyrosa's Blog

The countdown continued to the next TACE with what seemed like a normal week, except that my husband couldn't sleep, complaining of night cramps and head pressure.  Well, after a week of lying in bed, then getting up to help build out the closet organizers I had bought could most certainly bring on cramps.  My research before on his night cramps had shown that they often occurred in athletes after overexertion, where blood chemical balance gets out of whack.  Little did I know how blood chemical balance was exactly the problem, and whenever the kidney or liver isn't able to filter properly, the doctors order extra blood tests to monitor the balance of different enzymes, cells and elements that make up our river of life.

Friday morning my honey wasn't at all normal, and I had decided to work from home.  He complained he'd not been able to sleep all night, the 2nd in a row.  He repeated phrases, like "I'm sick" and often wouldn't answer a direct question, but would stare at his hands as if he couldn't wake up.  As I peeked in the living room between conference calls, I realized he wasn't there, and searching though the house I found him in a corner leaning on the bar half asleep.  I realized he'd not taken the blood pressure pill and gave it to him.  He tried to take his own blood pressure, but he was shaking and I could see his heartbeat through his shirt.  Holding his hands, they kept clutching and letting go of my fingers but when asked to squeeze the strength was even.  Push against me I asked again and again as I looked for signs of stroke, his eyes were dilating normally and within minutes he seemed to be coming back to normal.  

Several times I suggested we go to the doctor, telling him that the hospital could do some tests quickly.  He assured me "I'm fine" and I agreed to wait a bit.  I finished up on a couple more things for work, when I checked again to find him wandering in circles saying "Oh God", pause, then mumble "Oh God" again.  He went in the bathroom, closed the door, then came out, went into our bathroom, came out, then headed in my office.  I asked "where are you going" and he yelled back "To the Bathroom", so I quickly steered him in the right direction.  After that, I was able to get him to agree to Urgent Care, as that's where Dr. B his primary physician has an office.  

I was able to get him cleaned up, and he reluctantly let me dress him but kept looking at his PJs.  At one point, I had him look directly at me, his face totally slack and eyes half shut, a bit of drool coming from his mouth.  "Up" I said "time to go" and off he went to his desk, grabbing some paperwork.  I told him they weren't needed, but he wouldn't let go, I tried to pull them away and he said "No" like an upset toddler.  As I went back for his truck keys, he kept pulling on the front door, swearing each time it wouldn't open, and I was thankful that he couldn't work the lock at that moment I was ready to exit the house.  

Once in the truck, I had to buckle him in.  We started backing up when I realized he was pulling at the door handle while we were moving but the auto-lock wouldn't allow the door to open.  I opened the window for him, and stopped to let a worker at the neighbor's house know we were on our way back to the doctor, with my hubby sitting in the passenger seat, smiling and finally managed to say the word "hi".  

Once we got to urgent care, I requested an ammonia test and his primary, both as quickly as possible.  When the doctor came in, she quickly agreed in the assessment - his body wasn't filtering out ammonia fast enough, so his brain was basically swimming in bacteria byproducts.  They did the blood tests requested along with a full CBC, prescribing Lactulose.

Lactulose is a pretty brutal laxative, used with liver patients as it helps quickly remove any proteins from the intestine & colon before bacteria can assist with the digestion.  It was absolutely amazing, within 2 bowel movements and 4 hours later, it was like I had my husband back from the brain dead.  The doctor called and confirmed the findings, faxing over the bloodwork and test results.  Normal levels of ammonia are between 19 and 35, where my honey has tested at 52 and 59 over the past year.  This day, it was 149, wow.

We contacted the hepatologist at the university, and he agreed that the diet for now is low protein, and to take the lactulose daily, increasing the dosage as necessary to achieve 2 - 4 loose bowel movements per day to help the body's waste elimination process.  He's asked to meet with us on Wednesday, since the TACE procedure is on Friday.  Everyone wants to make sure this next treatment is a success. 

The good doctor also recommended an article I found very helpful, which can be found by searching the words hepatic, ammonia and knol in google, or by using the link http://knol.google.com/k/tim-davern/hepatic-encephalopathy/4ptrsx4j4vcq/4#. 

Speaking of sleep, I know its getting late and time for me to log off, there's much to do tomorrow.