Life Support Issues/Cirrhosis

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Question
My boy friend and I live together.He was told he has cirrhosis about 4 months ago. He is still drinking, (1 750 ml bottle of brandy a day) and more on the weekends. He also is diabetic, and has high blood pressure. He is taking meds for both, but continues to drink, and eat whatever he wants. (His diet is very fatty)We have talked and he is aware of the  outcome of things if he continues, butis looking for a home to buy, and acts as if he will be around for the next 20 years. My question is, isn't the meds he is taking actually doing him more harm than good? considering he is drinking even more than when he was diagnosed? Isn't that damaging the liver more, since we need our liver to process medication? He recently is becoming lethargic, sleeps a lot, vomits bile almost daily, sometimes blood comes out, (not a lot)does not have swelling in the legs. I can feel the live hangs down to his hip it is so enlarged. His nose has become HUGE bulb-like, and bumpy, yellow eyes etc. He still holds a job, but feels that because he is still able to function at work, he is still far from "the end" He will not go back to the doctor anymore, so I can no longer tell how his disease is progressing. Can you help me figure out about where in this disease he is at? are we looking at months? years? do ALL cirrhosis patients have the same symptoms? Thank you for your answer in advance, I am going nuts, not sure how to handle all this.

Answer
Sandra,

Your situation sounds very difficult having to watch someone each day choose to destroy their health. It is difficult to say when "the end" will happen. Vomiting blood is a very bad sign because alcoholics develop esophageal varices and because their liver is damaged, their blood does not clot and they can bleed to death. Yellow eyes are an indication of liver damage. Sleeping a lot is an indication of liver disease.  The pills may not be making things worse. He is at risk for a stroke or heart attack without them and poorly controlled diabetes leads to a host of other medical problems.

Knowing how long he will live may be less important than knowing what you will be experiencing in the future with his illness. His alcoholism is running your life. You need to get some support for yourself so that you can make good decisions. Your local Alcoholics Anonymous has group meetings for family members. People who are experiencing the exact same issues that you are. Attending meetings will help you understand what you are in store for and how you are powerless against his disease.

I see a great deal of heartache ahead for you. Most of the patients I have cared for in Hospice care who were alcoholic with end stage disease had multiple trips to the hospital and emergency room.  They had accidents, falls etc. and their put others at risk for injury when they continued to drive.  Even if he does not drink during the day, the alcohol remains in his body for hours after he stops drinking.  These patients can no longer effectively process either food or medications and they develop high ammonia levels which affects their thinking.  They can also develop a form of dementia becoming increasingly confused and requiring 24 hour help at home.   Their medical problems are multiple: pancreatitis, kidney failure, heart failure etc. I have seen some patients who got a bit better and then worse over a period of years. I am sorry to paint such a dire picture.

My intention is to encourage you to get more help and more information so that you can make a better decision about your choices. You are distressed because right now, it seems that his disease is running your life.  

Life Support Issues

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Betsy Murphy

Expertise

My expertise is in end of life care for adults. Identifying when someone is approaching the end of their life. Benefits and burdens of end of life treatments. Managing pain and other symptoms. Providing care for dying patients at home. Advocating for someone who is dying in a hospital or nursing home.

Experience

More than 28 years of experience in hospice care. Currently consulting with hospices to promote access for patients to receive hospice care earlier in the course of their illness. Betsy provides training for hospice marketing staff to effectively work with nursing facilities to help identify eligible patients. She writes Additional Development Request (ADR) letters to Medicare to help hospices get paid for their services and to avoid future claim denials.

Organizations
Hospice and Palliative Nurses Association

Publications
Articles: Clinical Reviews, Advance for Nurses, Nursing Spectrum, Washington Business Woman, www.Ezine.com;www.alz-nca.com.Books: Understanding Medical-Surgical Nursing (FA Davis and Company), Guide to Caregiving in the Final Months of Life (TM Brown publishers).

Education/Credentials
Bachelors of Science in Nursing, additionally trained as a Family Nurse Practitioner and certified as a hospice and palliative care nurse.

Awards and Honors
Outstanding Woman in Loudoun County (VA) by Loudoun County Commission on Women 1997 and 2002.

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