One of the most difficult challenges of advancing liver disease is when it can no longer manage the ammonia in the blood well.  Ammonia is poisonous to the brain and mimics dementia in many ways.  It can be subtle but it is a challenge for a patient and everyone around.  Some are able to keep a sense of humor for a time.  A friend gave me permission to tell her story here, anonymously of course, as an example of how a bit of ammonia can disrupt your day.

I suppose it's not a bad day when you are headed out the door with your purse and pants and shoes even had my car keys! Just forgot I needed a bra and a shirt. I inhaled a big amount of lactulose after that. Thankful I didn't go out but it's time to get a babysitter for me I think.

Most patient stories are about getting lost, driving and having accidents, or conflict with caregivers.  The great difficulty is that the personality changes are often destructive and the poor patient is a blameless victim but is the center of drama or conflict as a result of a medical problem.  Something to keep in mind when you see an apparently deranged person on the street.  

It is a failure of our system that so many liver patients are destroyed financially by this disease and end up in desperate situations and are uncared for.

Well, a story of disease that had a chuckle in it has turned a bit preachy so I'll stop but HE is one of the challenges our patients deal with that is not typically understood when mild.