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--- I was shocked at the " do you ever feel like jumping off of a

bridge " question. What the doctor was trying to get at was my quality

of life and where my head was with it all. He said they don't like to

do a transplant in stage one liver damage, but if your quality of life

is so bad - itching, not sleeping, thoughts of suicide then they would

consider stepping thing up. As far as Rifampin, my liver specialist

does not like that drug because it give false readings for the ALK

PHOS. and so she says it would be too hard to tell if it's the drug

raising the levels or my bil ducts getting worse. Sheesh!! So for now

I am stuck with the Colostyramine(sp) or Questran as it is also called.

Afer my colon surgery last may and the slow recovery that i've had.

I'm nervous as hell to step any other surgery up. My friends and

family all tell me they think I'm amazing because I really do manage to

stay the same happy, upbeat person I've always been. Only my husband

who is my rock gets to see me fall apart when things get too hard to

handle and I want to scream and cry. When I do have my mini breakdowns

as I call them, it's such a release of frustration. And with that I

can put my feelings of doom and sadness for the things I'm afraid my

husband and I may miss out on together. So much of my sadness is for my

wonderful husband who is having to go through this with me and he feels

so helpless. Wow! I wasn't planing on writing all of that and now

I've had a cry sitting here all by myself and somehow feel I may be

able to sleep now. Weird and cleansing. So sorry for all of that.

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I have to jump in here and say that if the Hepatologist is concerned that Rifampin is going to make your Alk Phos elevate, it is a simple matter of doing the labs to track this and watch the trend of the LFT's. All docs had the same concern. Rifampin can elevate your LFT's but that is not always the case. A lot of patients do fine while taking Rifampin, evidence the fact that it can be used in the treatment of TB. Some patients do indeed get elevated LFT's from the Rifampin but in that case they are really elevated, usually right away.

I would really try and revisit that with your doc only because it has the potential to make your quality of life so much better. AND I would shy away from having a Tx just to improve my quality of life. I wanted to get as much mileage out of my own liver as I could before swapping it.

Ali

BE A LIVE DONOR AND AN ORGAN AND TISSUE DONORAli Lingerfelt-Tait180 Blackberry Inn Rd.Weaverville, N.C. 28787www.Livertx-PSC this a site that deals with Transplant issues for PSCers.also - www. a support group for folks with PSC and their familiesWho's never won? Biggest Grammy Award surprises of all time on AOL Music.

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A & J M wrote:

>

> At least 4 people have offered for me (most related by marriage, one

> friend). It's been 8 years now, with no indication it will be needed

> (knock on wood). I hope that trend continues.

>

That's similar to what happened to me. I had several people offer to be

donors, but I wasn't sick enough to need it. Then when I did get sick

enough, I jumped to the top of the list pretty quickly and got my

transplant, so the traditional system worked well for me.

athan

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athan,

Do you feel that the people who offered

would really have given you half of their liver? It is easy enough to offer,

but doing it is a different matter.

Regards,

Chaim Boermeester, Israel

From:

[mailto: ] On

Behalf Of athan

Sent: Monday, February 11, 2008

12:42

To:

Subject: Re: Re:

Live Liver Transplant

A & J M wrote:

>

> At least 4 people have offered for me (most related by marriage, one

> friend). It's been 8 years now, with no indication it will be needed

> (knock on wood). I hope that trend continues.

>

That's similar to what happened to me. I had several people offer to be

donors, but I wasn't sick enough to need it. Then when I did get sick

enough, I jumped to the top of the list pretty quickly and got my

transplant, so the traditional system worked well for me.

athan

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Chaim Boermeester wrote:

>

> athan,

>

>

>

> Do you feel that the people who offered would really have given you

> half of their liver? It is easy enough to offer, but doing it is a

> different matter.

>

Some of them would have. I think some of them wouldn't have worked out

due to their health though, so I'm not sure if a live donor would have

actually ended up being a real option for me even if I had pursued it.

athan

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>

> ... He said they don't like to

> do a transplant in stage one liver damage, but if your quality of life

> is so bad - itching, not sleeping, thoughts of suicide then they would

> consider stepping thing up. As far as Rifampin, my liver specialist

> does not like that drug because it give false readings for the ALK

> PHOS. and so she says it would be too hard to tell if it's the drug

> raising the levels or my bil ducts getting worse.

So the transplant team is considering a tx based on your quality of

life (QOL) but the hep won't consider rifampin to improve it because

your test results may be influenced by the rifampin! I think that is a

weak excuse for not treating you. My questions to her would be - What

action would you take with my treatment if my Alk Phos changed? If

none, why is it so important to keep my medications unchanged? If you

expect a change in Alk Phos when I start rifampin, why can't we

monitor that change and use that as the new reference level?

I would put your QOL ahead of making it easy to track changes in Alk

Phos, which while they do indicate bile duct activity are not critical

indicators of liver function.

Tim R

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BE A LIVE DONOR AND AN ORGAN AND TISSUE DONORAli Lingerfelt-Tait180 Blackberry Inn Rd.Weaverville, N.C. 28787www.Livertx-PSC this a site that deals with Transplant issues for PSCers.also - www. a support group for folks with PSC and their familiesThe year's hottest artists on the red carpet at the Grammy Awards. AOL Music takes you there.

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Good for you! It's hard to remember sometimes that we have power in this situation as well.

Good luck with your doc.

Ali

BE A LIVE DONOR AND AN ORGAN AND TISSUE DONORAli Lingerfelt-Tait180 Blackberry Inn Rd.Weaverville, N.C. 28787www.Livertx-PSC this a site that deals with Transplant issues for PSCers.also - www. a support group for folks with PSC and their familiesThe year's hottest artists on the red carpet at the Grammy Awards. AOL Music takes you there.

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Dear Liz,

When I said I wanted to get as much out of my liver before I swapped it, I meant' that Tx with a live donor is not something to undertake lightly. I waited until I could wait no more. Your doc has a great point about not waiting until you are debilitated with Liver disease. For me, it just worked out that as I was going downhill, the chance for Simon to donate to me became a reality.

It sounds like you had some of the same issues I did. The fatigue is real however. That's the liver not working as well as it used to. Have you had any issues with HE(Hepatic encephalopothy) I didn't realize until after the Tx how bad it was for me. But as I didn't burn the house down or wreck the car, it's all good.

Ali

BE A LIVE DONOR AND AN ORGAN AND TISSUE DONORAli Lingerfelt-Tait180 Blackberry Inn Rd.Weaverville, N.C. 28787www.Livertx-PSC this a site that deals with Transplant issues for PSCers.also - www. a support group for folks with PSC and their familiesThe year's hottest artists on the red carpet at the Grammy Awards. AOL Music takes you there.

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Ali,

The Dr. from the transplant team and I both decided my quality of life

did not warrent a transplant at this time. He said you really only want

to transplant when your life is at risk, not just when you are really

uncomfortable... I was happy with that.

As far as the Rimafin, that will be part of our discussion again for

sure.

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Tim,

Thanks for your input, I have printed your response to refer to when I

see my Hep. again. Ali and Tim you both have given me great arguements

to help me in my discussion with the Dr.

The transplant team Doctor recommends I try the Rimafin and he has

several others to try as well. It's my Hepatologist who is the sticky

one. I asked her to get back in contact with the transplant team Dr.

and make my life easier.

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>

> > I wanted to get as much

> mileage out of my own liver as I could before swapping it.

>

> Ali

Hi -

I'm reading these posts with much curiousity. I have just been

listed in December with a MELD of 16 (not too terribly high) and am

eligible for transplant at Columbia-Presbyterian in NY (they

transplant starting at MELD 15). The Chief surgeon recommends I get

my transplant (if a live donor is eligible) sooner rather than later

as I would recover much better in a somewhat " healthy " state. But

then I've read in the past that other doctors want their patients to

get the most out of their liver and wait until absolutely necessary.

I feel pretty good. I'm still working full time and get tired, but

not sure if it's from the " daily grind " of life in general or actual

fatigue from PSC; however, it's not debilitating. My only symptoms

are jaundice, mild ascites, and occasional abdominal pain.

Just wondering what other PSCer's docs say.

Liz (CT)

>

> >

>

> **************Biggest Grammy Award surprises of all time on AOL

Music.

> (http://music.aol.com/grammys/pictures/never-won-a-grammy?

NCID=aolcmp003000000025

> 48)

>

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You know Liz, I felt the same way. I didn't want it until I needed it but I on the other hand I didn't want to be really ill when I had it either.

You sound like you are in a good space right now. Just keep working it.

Ali

BE A LIVE DONOR AND AN ORGAN AND TISSUE DONORAli Lingerfelt-Tait180 Blackberry Inn Rd.Weaverville, N.C. 28787www.Livertx-PSC this a site that deals with Transplant issues for PSCers.also - www. a support group for folks with PSC and their familiesThe year's hottest artists on the red carpet at the Grammy Awards. AOL Music takes you there.

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> Have you had any

> issues with HE(Hepatic encephalopothy) I didn't realize until after

the Tx how

> bad it was for me. But as I didn't burn the house down or wreck the

car, it's

> all good.

>

> Ali

>

>

Ali - thanks for your reply. No, I haven't had any HE issues (thank

goodness), just the symptoms I mentioned along with itching. My

husband is pushing me to get the transplant (as long as I have a

qualified donor) asap, but I'm obviously terrified of having the

surgery! I told him " I don't want to get too sick to get it, but I

want to be sick enough to want and be ready for the surgery " and so

far I feel ok. But, he doesn't get it. I cry when I get an ERCP for

goodness sake, b/c I'm such a wimp and scared. Can you imagine when

it's time for transplant!

anyway, I'm so happy for you that you are doing so well. I'm really

going to miss being at the conference in FL - the one in PITT was

terrific and this one coming up sounds fantastic! I wish you the

best with your continued " new " life!

Liz (CT)

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Liz,

My doctor says if a live donor is available she will not let me get too

sick before transplant. Sounds like there is a fine line of being sick

enough and not too sick.

Karyn

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