Im 2011 my liver enzymes and iron levels were three times higher than normal. I was seen by a gastroenterologist in Southaven, MS for two years. Every six months he kept say he was going to do a liver biopsy. After two years nothing was accomplished. I had no energy an no one could find an answer. I stopped going to the gastric doctor after two and a half years. I kept feeling horrible no energy and begin having dizzy spells. I had to go to the emergency room and the doctor said my platelets were low but it’s ok. About a month later I decided to go online and chart my labs. I noticed my platelets has been up and down and dropping lower over the last few years. I printed the charts out and made an appointment with my pcp to ask about my labs and why my platelets are low as well as other labs high and low. She looked over my chart and spoke with another doctor. She came in and said both didn’t like my labs results. She decided to call the West Cancer Clinic and made me an appointment and told me she is going to be surprised at what they find.

A week or so later I went to my appointment at the West Cancer Clinic. The hematologist took labs and ran test and came back into the room later stating he doesn’t think I have luekemia but beloved it is my liver. He called and made an appointment at a gastroenterologist the next day. I went for my visit and he made arrangements for an EGD and colonoscopy the next morning. The test showed esophageal varacies and had to remove three benign polyps from my colon. He stated he was making me an appointment to have a liver biopsy because people with esophageal varacies usually have Cirrohsis of liver. The doctor called me later the same day and stated he had a biopsy scheduled for the following morning.

A personal note about this story. Shelley Walker Myers is a heroine, and her journey through life is both cautionary and inspirational. As patient advocates, we deal with thousands of people who face the future in many different ways, but liver disease is hard because it is not managed well by the medical profession or society in a larger sense. Patients often fight battles that in hindsight they should not have had to and we so admire the human spirit that we often see coping with very difficult life journeys.

My story is long and complicated. In 2009 I went in for a gall bladder surgery and woke up to a team of liver doctors telling me in fact nothing was wrong with my gall bladder but I actually had end stage cirrhosis of the liver and was terminally ill! My meld at this time was 28! It started with my first doctor telling me until I lost the weight I had gained, not realizing why I was so sick, I could not meet with a transplant team! Long story short I lost enough to meet with them and the doctor told me in 2012 “Go home and live out the next five years the best you can”!  I was told fatty liver was the cause of my disease.

When I was sent home to die by my first doctor I gave up on myself for awhile and stopped taking all of my meds even the mental health meds I am on for bipolar disorder! I just didn’t want to prolong the inevitable of dying! Well, HE and its fogginess and my bipolar/depression took over my life and all rationality was out the door! I was around the wrong type of people and ended up facing jail. That’s when I woke up and realized my life was still worth fighting for! Looking back now I feel like it was God stepping in and telling me He was not done with me yet!

My first doctor did nothing to truly help me! I had no idea about my disease or the things I needed to know! After talking to another patient, who I didn't even know, who was also going through it I realized I needed to do the research myself!

Posted by admin with patient permission who wishes to remain anonymous.

PBC stage 3/4 here. Need to be your own advocate and that is so hard to do when you are sick.

I thought I was recovering from flu still months later, took week off from work to just sleep and recoup...that was almost 2 years ago. Haven’t returned to work, cirrhosis due to PBC (diagnosis took at least 2 months). The paperwork for long term disability, filing for SSD (well over a year now, denied and waiting appeal ruling since Sept 2017) and doctor visits, bills...gotta sleep, shower, feed yourself and the kids and the dogs...it’s maddening.

My 80 year old mother does my grocery shopping because it’s too exhausting. The fatigue is incredibly debilitating, the memory loss embarrassing, the patience gone...socializing/volunteering gone...visits with friends you actually do still see? Fake it till ya make it then go home and finally sleep for a few days. Had to downsize & sell home & car...blew through savings in a few months, luckily I have retirement 401k I now dip into. There was no “accident” but life sure did seem to change quickly. Made it to Liver Transplant Center for live donor consideration and they are excited because I am “sick healthy” great candidate - get biopsy and they say we don’t think you have cirrhosis...Maybe stage 3, possibly 2. Can’t say they can rule in or out PBC although the report clearly refers to damage to the bile ducts which pisses off my GI. No further tests needed...Stay on your meds, lose weight blah blah. Bye...throughout all this I sought out neurologists to help explain cognitive issues such as memory loss, speech impairment (15 months of speech therapy-just “graduated” last month). I sought out nutritionists...3 to be exact and they were all different. 😂

Posted anonymously by admin with the patient's agreement

The system is broken. Such a lack of communication between providers. I’m always worried that one Dr might give a medicine to my husband that would further damage his liver (stage 4 NASH cirrhosis). Thankfully our PCP, gastroenterologist, and hepatologist seem to all be good at communicating and seem very knowledgeable of the disease.

It’s when we have to go to the ER or be admitted that’s the problem. We use a local hospital from where he is listed and it’s like every time the ER wants to run every battery of tests known to man and “re-diagnose” him. Example. He had bronchitis a few weeks ago. The PCP’s nurse practitioner saw him. First time we’d ever seen her. He had a 10 lb weight gain in about two weeks so she sent him to the ER to make sure it wasn’t ascites. The ER did two CT’s one of his lungs to rule out clots for the shortness of breath and one of the abdomen to check for ascites fluid. (He had just had an ultrasound as an outpatient 5 days earlier to check for ascites and there was none). Everything came back clear. But the ER Dr was trying to figure out the fluid gain. Finally after 8 hours in the ER I said look, we’ve dealt with this fluid gain and loss like this for two years now. ( I knew my husbands compliance with his meds and diet) he was wheezing, coughing and no other symptoms. I’ve had asthmatic bronchitis off and on my whole life. I know what it’s like. And I’m no Dr, but really? Finally the Dr said, just nothing makes sense. I spoke up and said, could he not just possibly have bronchitis? He was like well yea that is possible. Diagnosed him with bronchitis, gave him an inhaler and cough meds FINALLY. We then got to walk out thru a very crowded standing waiting room only in the height of flu season getting exposed to who knows what.

 
On another note, the transplant team wants to know everything but they don’t want it to help with his care it seems, more to just use the information to monitor the progression of his disease. That’s what we’ve learned anyway. Outside of them receiving info and monitoring him yearly any time we have an issue we use his local pcp or gastroenterologist. His gastroenterologist trained at his liver transplant hepatic Dr. So we’re lucky in that sense but for folks who don’t have good local Drs their care can be mismanaged.

Posted anonymously with permission of the patient

 In October of last year (2017), I went to the ER with what I knew were symptoms for Hepatic Encephalopathy. When the ER doctor asked me why I was there, I told him. He patted my hand and told me, “no...you probably just have a uti. As you get older, they can cause confusion.” I looked him straight in the face and told him, I have cirrhosis. Test for Hepatic Encephalopathy. Thirty minutes later he came back a little paler and told me yes, I tested positive for elevated ammonia and was being admitted to the hospital. Four days and two episodes later, I was finally discharged. 

Doctors don’t listen. They know what they know and won’t change their minds. Incidentally, I did also have a uti. If I hadn’t spoken up I would have been sent home with antibiotics and orders to follow up with my PCP. 

The other thing I have to constantly watch are drugs that are prescribed. It is maddening to realize that my husband and I are constantly on watch even with the doctors we trust. Always the question is “How does that interact with the liver?

A NOTE FROM ADMIN

Drug interaction and liver toxicity are a serious problem for liver disease patients.  They may have been diagnosed by a gastro or hep specialist but they end up in the care of their primary care doc who rarely has training in liver disease and potential liver damage tends not to be top of mind.  Communication between specialties is very limited until a patient is so sick that they are in the care of a transplant team which increases the risk for their disease to progress.

Posted by admin as the patient wishes to remain anonymous.

I was sick over 2 years ago and my husband asked the doctor if it was due to my fatty liver. He was told fatty liver was not going to give me pain and uncontrolled nausea. He asked if I should have another biopsy and was told no not needed. He explained I had two done 6 years prior. Was told not to worry. Fast forward this past summer, I was so ill that I couldn't even keep water down. We went to the ER and was told maybe food poisoning, I had been seen 3 times over 3 weeks for the same issues. I asked the doctor if she was sure my liver was ok ( my dad died of liver disease at 36) was told no it was ok, then I made it to my car and had a phone call from the ER doctor saying after looking back on my labs, my AST and ALT tripled in the past 3 weeks. I went to a new GI and he did a biopsy to then tell me I had full blown cirrhosis. I feel like I probably had had it and was having flares for 2 years but I was just being told not to worry. Now I really trust no one.

This patient story is posted by admin as the writer is afraid to be identified.

When my husband was first diagnosed with ESLD, his GI doctor told him that his liver would repair itself, even though an ultrasound had recently shown scarring of the liver. He prescribed him Xifaxan but his insurance wouldn't cover it because they needed preauthorization. The doctor's office would not follow through with my request to call them. His next visit, the doctor told us that he could do no more for my husband and dismissed him as a patient. He told us that his only option was to go to our local transplant hospital's ER department so that he could start off there to try to get seen by the Hepatologists at the transplant hospital. My husband got in to see them and they told him not to worry about the Xifaxan and, for the next year, he underwent rigorous testing, invasive procedures, counseling, weight loss, teeth extractions, etc...

He got cleared by every doctor that he needed to be cleared by to get on the list. However, since my husband's liver disease was caused by previous alcoholism, he was told that he must complete 3 AA meetings a week. He tried extremely hard to go faithfully. After all he had already done to be considered, why would he want to mess up his chances because of not attending meetings? But, his physical and mental deterioration, made it impossible and he was only able to attend 1 meeting a week. I spoke to the social worker with the transplant team about this concern numerous times and was told that there were no exceptions for no reasons. This ultimately led to my husband's dismissal from being placed on the list. Later, I found out that there were online meetings but was never told of these by the social worker. But the hospital not only decided not to consider him for transplant, they also decided to drop my husband as a patient as well.

This was posted by admin with permission of the writer who wishes to remain anonymous.

My brother, was diagnosed with cirrhosis in 2017. He went to ER on 6/16/17 because of leg pain. It turned out to be sepsis. Over the next few days his abdomen began to distend -- we were told that we had just never seen him lying down before (!!??), as it continued to grow, we were finally told "that's just him" "it's called a beer belly". We asked about a liver consult and we were told that we would need to do that on an outpatient basis -- earliest available appointment when i called was almost 2 months away! Anyway, looong story short. we found out in late august the diagnosis -- when we finally got to the outpatient hepatology appointment -- even though my brother was in-patient in some type of facility from 6/16 - 8/31! he lost 55 lbs, in 6 weeks before they finally gave him his first paracentesis so that he could finally eat! he used to weigh 196, he now weighs 123. it is unfortunate that he was allowed to de-condition all that time, not able to eat or walk -- it set him back so far, right from the beginning simply because they would only focus on his knee!

it took the PCP calling foul on the whole thing and sending him back thru the ER to make them deal with what they should have dealt with weeks prior. also, sadly, He had been to the doctor 3 times for an unexplained rash over the course of a few months prior to this June event with sepsis. if they had actually done any exploration, they may have realized that it was his liver BEFORE it failed. anyway, not to write a book here (because it feels as though one could!), I guess I would just trim it all down to the fact that the medical model seems to dismiss patient's complaints too casually. then the system with the "hospitalists" creates a lack of continuity and opinion when one is in the hospital (6 different doctors in 14 days! -- no wonder they could not observe the change in his abdomen).

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.

posted anonymously by admin

I am going to be taking him to hospital in a little bit to try to get his paracentesis done. If anyone has any pull at that hospital, PLEASE try to help us get him drained today. He needs to be comfortable. He is in so much pain. 

The on-call doctor at this hospital won't call in his team after hours or on the weekend for paracentesis. Even though I called the department this afternoon, and was told otherwise. We are about to head home. They said he can try another hospital or come back Monday. 

The hospitalist called the on-call radiologist and he said that he couldn't call in his team at night or over the weekend. My husband seems to hit some kind of road block everywhere he turns. I told them that he didn't have many days left but they still wouldn't help. It's the same hospital that suggested Hospice. I feel so bad for him. I would do the procedure if I had the needle. We still have the liter bottles used for home drainage but they took out his tube when he went to hospice. If he feels like he's up to another ER trip tomorrow, I'll take him to another hospital.

The Hospice nurse got him an appointment at the hospital to be drained but the earliest appointment they had was the 14th at 2:00 but he can't wait that long so they told me to just go to the ER and Hospice will pay for this one last draining. We just got here and are waiting.

The on-call doctor at this hospital won't call in his team after hours or on the weekend for paracentesis. Even though hospice called the department this afternoon, and was told otherwise. We are about to head home. They said he can try another hospital or come back Monday.

Well, his pain doctor gave him his meds. I asked for the same dose he was on at the hospital because he was doing good once they got on top of his pain. But his doctor told him that those Fentanyl patches are very bad for his liver and he won't prescribe those. He doesn't like the patches either. His pain doctor said that unfortunately, nothing is going to be safe as far as long lasting pain relief with end stage liver disease. So, he still has nothing for long lasting pain relief, only immediate. But, I had to put another patch on him this morning because he was in so much pain and his appointment was the last one of the day. His swelling is progressing and about to the point where he will begin oozing out of his feet. The patch, plus his lack of sleep & restlessness has his hepatic encephalopathy flared up. But he is still fighting. Thank y'all for all your thoughts and prayers.