Liver and Kidney Treatment Journal / Timeline
   O N E   C I R R H O S I S   P A T I E N T
Birth date: 08/26/50
I created this when the GI said in March of 2011 that he was sending patient Tom to Birmingham for evaluation for transplant listing. That did NOT happen but resulted in TIPS recommendation and ultimate procedure.
Pre-summer redflags: Increased drinking. Sores on head. One growth looked like a huge wart. While on a business trip had an attack of diarrhea walking in a parking lot feeling fine.
Early July symptoms: Heavier drinking through June early July, unusual swollen belly, dark-colored urine, much fatigue, ultimately edema after a business trip via airplane to Cincinnati. Time to take action!
 
July 2010
17                    Last drink
Return from Cinncy       Edema; ascites; jaundice (Didn’t notice. Thought it tan.)
                        (Cancel Vegas trip)
20                    Blood work order         Primary care doctor
22                    Appointment                 Primary care doctor
                        Elevated everything
                        Admitted to hospital
23                    Hepatitis test negative
Enzymes from 170 down to 125
“Cautiously optimistic”
“I believe you got a do over.”
(We have more original notes if needed.)
25                    Referred to GI
28                    Lab / blood work
                                    b/p       110/70
                                    wt        218
                                                prylosec, B1, K, multi, aldacdone 100 mg x2, folate
                                                20 mg lasix x2
                                                Limited to 1 liter of water
                                                1000 mg sodium
30                    Paracentesis    
 
 
August 2010
2                      Appointment                 GI
                                    b/p       100/68
                                    wt        206
                                    restrict liquids 1 ½ liters
9                      Paracentesis                 9 liters 
16                    Appointment                 GI
                                    b/p       104/61
23                    Paracentesis
                        Blood work
27 (Tom to Atlanta: Very thin; cachexia seems to be in full swing)
 
 
September 2010 (tough month for Tom)
1                      Appointment                 GI: Increased diuretics
                                                            Decreased fluids 800 ml
5                      To hospital (AM)          Dr. Tom K. (yuck!)
                                    b/p       85/59
                                    creatinine          3.4?
                                                            Kidneys bad
                                                            Tom ADMITTED
6                      Paracentesis                 Tom very weak / SICK
                                                            Renal group consult (kidneys sensitive to medication)
9                      CAT scan                    
                                    b/p       99/60
10                    Paracentesis                 1 liter; DISCHARGE (no lactulose prescribed)
                                    b/p       102/66
                                    wt        171
                                    Meds   lasix      40 mg every AM
                                                Aldac   25 mg every AM
11                                                        Cloudy day
12                    Ambulance                  RE ADMIT: HIGHLY CONFUSED (HE)
15                                                        DISCHARGED
24                    Paracentesis
30                    Appointment                 GI
                                    b/p       92/66
                                    pul        102
                                    Bilirubin            2
                                    Creatinine         1.2
                        “Your liver is better.”   
 
October 2010
11                    Labs / Blood work       Coughing badly
12                    Paracentesis                 10 liters
26                    Paracentesis                 10 ½ liters
28                    Appointment                 GI: we report irregular bowel movements        
                                    b/p       96/58
                                    pul        90
                                    wt        160
                                    Sodium 123
                                    Bili                   2.4
                                    Creatinine         1
                                    Meds               20 mg lasix
                                                            25 aldactone
                                    MELD             11
 
 
--more--
 
November 2010
2                      Appointment                 Primary care (doctor who first referred to GI)
4                      Appointment                 Surgeon (for hernia)
9                      Paracentesis                
12                    Surgery                        Hernia (right side as a result of ascites)
23                    Paracentesis               (HE) Some confusion; increased Lactulose; by 1:00 PM fine
30                    Appointment                 GI
                                    b/p       110/68
                                    wt        166
                                    pulse    80
                                    potassium 5
                                    sodium 126
                                    creatinine 1.2
                                    INR 1.21
 
December 2010
9                      Paracentesis                
12                                                        Confused day; increased lactulose
13                                                        Wake up clear
21                    Paracentesis                 10 liters
                                                            Some constipation; leave for B-ham
                                                            Mother in hospital / gallbladder
25                    ADMITTED              Confusion 12:01 AM: Tom to Medical Cen. by ambulance
                                                            Ammonia 270; CAT scan ; doctors order lactulose
                                                            By morning: ammonia to 76?
28                    Appointment                 GI (in FL)
                                    b/p       98/64
                                    wt        177
                                    pul        78
                                    diruetics           
aldacdone         50 mg
lasix                  20 mg
 
January 2011
4                      Paracentesis                 10 liters
19                    Paracentesis                 10 liters
25                    GI visit
                                    Sodium 124
                                    Creatinine         1.2 / 1.4
                                    INP                  1.2
                                    Potassium         4.3      
28                    Paracentesis                 9.5 liters
                                    b/p       98/64
                                    wt        177
                        Meds               aldacdone 50 mg
                                                Lastix 20 mg
 
February 2011
Plan was for Tom to have tapping during first week (a week early) because merchandise show begins Mar. 9. Had just had tapping week before.   Tapping scheduled for Monday. Weekend of 5/6 begins feeling sick. Weak. Tired.
7 (Mon)-          Paracentesis                 7 liters
                                                            HE: ambulance to the Medical Center in AM
                                                            Ammonia high enough for high confusion through Tues.
                                                            Kidney infection
                                                            Stay until Wed. Off all diuretics
                                                            Scar tissue developing in abdominal wall b/c of
                                                                        continued paracentesis
18                                                        Blood work
                                                            Plentiful bowel movements
                                                            Dark BMs toward end of weekend. Not sure if
                                                                        where darker color from
21 (Mon)         Paracentesis                 8.5 liters
Tom feels well after. Gradually becomes more tired.
                                                            2 AM Black Stools
                                                            Call to doctor. If shortness of breath, to emergency
                                                            Gets sick to his stomach. Throws up pink mucous 1 AM.
22 (2 AM)                                           No confusion
To hospital via car: “Bleeder” / Varices
                                                b/p 56/34
                                                2 units of blood / some medication to stop bleeding
                                                Blood pressure going up some
Emergency doctor orders helicopter to West Florida Medical Center (goes by ambulance)
25                                            More blood / much saline / ascites going crazy  
Banding of Varices / Discharged                               
 
March 2011
1                      Paracentesis                 11 Liters          
2                      GI Appointment            Discussion of UAB and Liver list
                                    Adds 25 mg. Aldacdone
4                                                          Call from UAB
 
(Week of) 7     Paracentesis                 9 Liters
18                    Paracentesis                 10 ½ liters
                                                            Blood in peritoneal fluid
Doctor reports that it is simply
                                                            a complication  from the “puncture” for the tube.
                                                            But advises to get Tom to the emergency room if
                                                            Tom shows any complications (shortness of breath, etc)
                                                b/p: 96/63. After Par: 99/45
 
Had TIPS end of May. Subsequent edema BUT greatly reduced ascites. Now in Sept. 2011 trying to get his diuretics gauged to reduce all ascites. But life is much more normal.