nikki - RE: Re: ascites/paracentesis

[Guest guest]

Hi Nikki,

Forgot to mention before, I do have some ascites but take large doses of

diuretics - spironolactone and butemide which helps to prevent it and leg

swelling from getting too bad.

I used to be just on the spiro but recently I have been getting very swollen

legs and an increase in belly size so now I am on two drugs which have

certainly made me feel me comfortable, (and keeping me exercising by trips

upstairs! :¬(

Love Barbara (UK)

[Guest guest]

nikki wrote, " I had an ERCP done on Friday (30th) and ever since then, I

have had swelling in my abdomen. ...I had to get up because it was so

uncomfortable to lay there. The swelling seems to be the worse in the

evening... My ankles seem to be a little puffy... If a person does develope

these things, what do the docs usually do about it, if anything? " <--

nikki, the short answer to your query would be that the doctors will make

note of it, until it becomes a quality of life issue.

now for the long answer: if it has been determined that ascites is present,

then a paracentesis (tapping of the ascites/fluid) is performed, sometimes

to determine the cause, but usually at end-stage (prior to transplantation)

for comfort/quality of life.

during the course of years of jim's local overall hepatology care, his

doctor always palpated his liver area (this would make jim a bit sore the

next day or two), and checked for ascites by tap-tap-tapping him and

listening for a dull *thud* (i eventually got good at doing this, too... i

became able to discern where jim's pockets of fluid were hiding from the

differences in thudding sounds) and then the doctor would feel his abdomen

for a shifting wave. sometimes, jim would be asked to roll over, from one

side to his other, to have this done. and always, his doctor would check

jim's feet, pressing his fingers in here and there and making note of any

edema.

nikki, my husband jim was eventually transplanted december 7, 2001 (after

18+ years of UC/PSC history), and his only paracentesis removed 2.5 liters

of fluid -- roughly 5 pounds of ascites (oops -- correction -- an ER doctor

unsuccessfully attempted paracentesis a few weeks before around the time of

a hospitalization for cholangitis).

when jim was tapped (gee whiz, that makes him sound like some kind of

swollen maple tree, doesn't it?), i asked the resident (the on-site expert

in tapping, that is) what his " personal best " was -- he answered 11-12

liters of fluid in one attempt! a week later, at the transplant center, i

asked this question again -- and an intern puffed his chest up in pride as

he answered " my personal best? 13 liters in one attempt. " i can't even

BEGIN to fathom how awful that person must have felt before their tapping...

but before you're inclined to worry, remember: not everyone gets such

extreme, extreme ascites.

jim felt miserable in those last weeks before his transplant, but in typical

fashion the poor guy wouldn't listen to me (coaxing and urging him to have a

paracentesis done). finally, when he could stand it no longer, he did go...

and he felt immediate relief halfway through that first liter bottle.

the parancentesis involves using a thin needle to withdraw fluid from the

abdomen. jim had a topical anesthetic prior to a numbing injection...

before the paracentesis needle was inserted... so jim's pain/discomfort was

kept to an absolute minimum (and the trade-off was that he felt immensely

better!).

you do need to know, though, that it is just a stop-gap measure... many

end-stagers get an abdominal tapping WEEKLY, while they await their

transplants. we were assured when jim got his tapping that all that fluid

would come right back in a weeks' time -- and it sure as shoot-howdy did.

anyway, if the doctors so choose, the fluid upon removal can be tested for

different factors to determine the cause of ascites, e.g., bacteria cultures

and white blood cell counts (used to determine the presence of infection.)

in jim's case, his living donor surgery, with our son as donor, was already

scheduled for seven days away... obviously his fluids were not tested.

personally, i think it would be rare for someone with such end-stage

cirrhosis to have their ascites fluid tested... but depending on someone's

circumstances, their doctors may want to check, say, a patient's protein

levels. low levels of protein in the fluid, plus a low white blood cell

count, would suggest that cirrhosis is the cause of the ascites.

well, to that, i say " du-uh! " ;-)

....but the *appearance* of the tapped fluid certainly CAN be helpful in

determining problems. for instance, a cloudy fluid plus a high white blood

cell count could mean that an infection is present... and bloody fluid could

suggest -- repeat, suggest -- the presence of a tumor.

in jim's case, there was this nice, pale, gatorade-green color present --

which told the doctors that jim's fluid was sharing space with his bile.

jim was no paracentesis wuss... but, rather, he truly was resistant to my

various suggestions. however, now that he's been-there-done-that, he would

say to anyone wondering whether or not they should try to get (temporary)

relief from a tapping ...to DO IT! his smile on the way home from the

hospital was nearly ear to ear, he felt sooooooooo much better.

love,

maureen & jim