Hi, it’s Patrik Hutzel from INTENSIVECAREHOTLINE.COM where
we instantly improve the lives for Families of critically ill Patients in Intensive Care, so that you can make informed decisions, have PEACE OF MIND, real power, real control and so that you can influence decision making fast, even if you’re not a doctor or a nurse in Intensive Care!
This is another episode of “YOUR QUESTIONS ANSWERED“ and in last week’s episode I answered another frequently asked question our readers and the question in the last episode was
My mom may need to undergo a liver transplant. Can they take me as a live donor?
You can check
out last week’s question by clicking on the link here.
In this
week’s episode of “YOUR QUESTIONS ANSWERED“, I want to answer the next questions from one my clients Sharon who has her 64 year old mother transferred in the Intensive Care due to severe difficulty in breathing and alteration in mental state.
Ultimately, her mother was diagnosed with liver failure and is on blood pressure medications and may subjected to dialysis due to renal failure.
When we first got into ICU, they told my Mom she was only at the intermediate stage of cirrhosis, but now there are more complications!
“You can also check
out previous 1:1 consulting and advocacy sessions with me and Sharon here.”
PART 1
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PART 6
PART 7
Patrik: For the ammonia, yep. But that’s mainly for the ammonia, okay? I think,
from everything that you are describing, I do believe that bringing up the issue of a liver transplant is urgent, right? So because you still haven’t worked out where do they stand with that issue. They haven’t made a point, really, whether they want to do a liver
transplant. They haven’t really discussed that with you, have they?
Sharon: I think because her body’s in shock. I mean, they did discuss it with us originally. They’re like, “You know, you want to get her on the list sooner than later.” But since she’s been in the ICU, they don’t discuss very much with us, to be honest with you.
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Patrik: Right. So when was the first time they brought up a liver transplant? How long ago was that?
Sharon: Maybe three or four days ago?
Patrik: Right, right. Okay, and the liver transplant and such has never been brought up as a discussion point in the past ever?
Sharon: Ever. No, this is all new to us. And that’s maybe partially my mother’s
fault, because she maybe didn’t even take the steps she needed to, even though she needed to do it. I mean, this has been like- Do you think there’s any chance they can help her?
Patrik: If they didn’t think they could help her, they wouldn’t give blood products, right? If they thought there is no hope, they would sit down with you and say, “Look, we believe there is no hope, and we believe we need to stop treating her.”
Right? That would be the discussion they would have with you if they think this is going nowhere.
Sharon: I mean, it just seems like it’s going in that direction.
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Patrik: It could be. We can’t rule that out. However, she’s only been in ICU now for 24 to 36 hours?
Sharon: Not even.
Patrik: Not even. So it’s very, very early days. Very early days. Patients do —
Sharon: So there’s still a lot they can do,
you think?
Patrik: There is a lot they can do. It also depends now how your mother responds to the treatment, right? So they’re giving the blood products, but then it’s also a question of is this going to be effective or not?
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Sharon: Right, and how soon will they know that?
Patrik: Probably within the next 24 to 48 hours, because they will check the blood. They will check blood results.
Sharon: Right. I mean, yeah. This hasn’t come up before, so this just started
now, kind of thing. And what could precipitate that? Just the liver?
Patrik: Yeah, just the liver. All the coagulation is being done in the liver, right? So that’s usually the first sign of the liver failing, that the coagulation is going off the rails.
Sharon: Right. Well, I mean, hasn’t the liver already failed?
Patrik: Yeah, of course it has, but there could sometimes be a delay in the symptoms.
Sharon: Right, right. I mean, when we first got there, they told her she was only at the intermediate stage of cirrhosis (liver failure)
Patrik: Right, okay.
Sharon: So I don’t know. I mean, we thought that could still be maintained for a while. But now it’s like all this other stuff is going wrong.
Patrik: Who is the main
treating physician? Do you know?
Sharon: It was a liver team, but now they’ve basically washed their hands and handed it over to the ICU.
Patrik: Okay. The liver team will definitely still have some input while she’s in the ICU. They may not necessarily be the treating team, or the main treating team, but they will have some input. There’s no doubt
about it. But you’re probably correct to say that the focus has shifted from the liver team to the ICU team. You’re probably right. I think that at this stage, right? What are you going to do next? Are you going to visit your mom? What’s your next step
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Sharon: I don’t even know what to do with myself. This thing now is- Every day, it’s like a different thing that doesn’t end up being okay, you know? Yesterday it was the blood pressure. Now that’s not really as much of a thing. The day before, it was the lungs. And now that’s not really a
thing. Then it was ARDS (Lung Failure), and that wasn’t a thing. Now it’s this blood thing. Do you think if she hasn’t started bleeding yet, this is a major preventative
measure?
Patrik: It is a preventative measure, whether it’s a major preventative measure is really dependent on how she responds to the blood product, right?
Sharon: ‘Cause they would start her on that urgent. It’s important that they caught that, though.
Patrik: Oh, it’s very
important. It’s very important.
Sharon: So it’s good that they at least caught it, that they can start fixing it.
Patrik: Absolutely. Absolutely.
Sharon: But you’re saying there’s no real fix for it?
Patrik: There is no real fix at this- You see, in ICU, the problem in ICU is just what you’ve experienced in the last 24 hours. Things go wrong. That is the reality of patients being in ICU, and it’s often a matter of keeping patients alive until they get better, right? And that can take time. And watching these, it’s horrible. Watching what you are experiencing now is an absolute nightmare.
Sharon: It’s the worst thing ever in my life. My mom is my best friend.
Patrik: Of course.
Sharon: I can’t even talk to her. If they are able to take the breathing tube or she can stabilize her breathing, will I be able to at least talk to her?
Patrik: Absolutely. But here is the good news, you can talk to her now. Talk to her. I think it’s good if you can talk to her.
Sharon: She won’t talk to me back.
Patrik: No, she’s alive. You should talk to your mom when you’re there. You should.
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Sharon: Is this blood thing going to be eminent? Like could it kill her by tomorrow?
Patrik: Could it be gone by tomorrow, is that what you’re asking?
Sharon: Yeah.
Patrik: It could be, but there’s also the risk that it comes back.
Sharon: No, I mean is this something she could die by tomorrow because of this
blood thing?
Patrik: Unlikely. Unlikely, but you can never rule out. To illustrate this, I mean, anybody in intensive care if they survive, they’ve probably come as close to death as they’ve ever been in their entire lifetime, right?
Sharon: Right. Of course, of course.
Patrik: That should sort of illustrate that. So at this point in time, I still haven’t seen any evidence around them not trying. Every issue that has come out, they’re tackling. They’re-
Sharon: Right. And it feels like they’re tackling it, and it’s very traumatic, and this and that. But then it sort of stabilizes a little. I don’t know. It just seems like, yeah. So that’s at
least good, right? Like the body is still fighting.
Patrik: Absolutely. Absolutely.
Sharon: ‘Cause some people are on ventilators at 100%, right?
Patrik: Correct, correct.
Sharon: So for her to be at 40% isn’t-
Patrik: Pretty average.
Sharon: -that terrible.
Patrik: Pretty average.
Sharon: Okay. Yeah, ’cause they kept telling us she’s really not requiring that much oxygen.
Patrik: It’s going to be, by everything that you are describing, it’s going to be a
waiting game. It’s going to be.
Sharon: Okay. But there’s still a chance?
Patrik: Look, as long as she’s alive, there is hope. There is. It’s going to be a test for you and your family to look at her in this situation, and be very, very patient.
Sharon: Okay. And just let
her body start to fight.
Patrik: Yeah. Fight, and also rest.
Sharon: Right. Are they letting her rest, though? By giving her all the stuff, that’s letting the body rest, right?
Patrik: Especially putting on the ventilator and putting her in an induced coma, it’s letting her body rest. She has enough to fight, that’s with the liver failing and with the kidneys failing. She has enough to fight, despite by focusing on that, you know?
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Sharon: So I have one more question for
you, and then I’ll let you go.
Patrik: Sure.
Sharon: This has been a huge support for me, so, I don’t know how long she’ll be there but I’m sure I’ll want to continue this after seven days. But I- Shoot, I just lost my train of thought. Oh, you had mentioned that sometimes in any patient who’s gone through shock and this organ failure sort of situation,
that there’s a chance the kidneys can come back once the body starts to heal a bit. Is that still a possibility?
Patrik: That is a possibility. Most research suggests that 90% of patients who require hemofiltration in ICU, their kidneys recover. Now, but I can tell you that even if kidneys don’t recover, there’s patients out there, they have ongoing hemofiltration or dialysis, right? And I know I’m saying this almost blatantly. I’m not concerned about the kidneys. I’m really not concerned about the kidneys at this point.
Sharon: Really? They’re so concerned about the kidneys.
Like yesterday it was the kidneys, and her blood pressure. Now it’s the blood. I don’t know what to focus on, you know what I mean?
Patrik: Yeah. And the reason-
Sharon: Is this just the roller coaster that it is?
Patrik: It is a roller coaster.
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Sharon: Or are they just not sure what to focus on? Like shouldn’t they have dealt with this blood issue before?
Patrik: No, no. Because you don’t know when the liver’s failing, it’s an issue that could come up, but you can’t really prevent it. All you can do is manage it now, which is what they’re doing. The reason why I’m not concerned about the kidneys is I have seen patients in ICU on the hemofilter for weeks, and yet patients leave intensive care alive, right? You see, to illustrate this to you, the kidneys-
Sharon: But combined with the liver failure, though.
Patrik: Of course. I’m not dismissing it at all. But what I am saying is the
kidneys can be controlled with hemofiltration, right? So yes, the kidneys are failing, but it can be managed with hemofiltration, right? The liver, at this point in time, cannot be controlled, right? It can only be managed symptomatically. Whereas the
kidneys-
Sharon: So, attacking-
Patrik: The kidneys can be managed with hemofiltration for some time to come.
Sharon: Okay. And then does this blood issue, is this affecting her heart? ‘Cause her heart’s been pretty strong through all of this.
“Thank you very much for being a part of the previous series of 1:1 consulting and advocacy sessions. We hope you will find these new upcoming episodes informative and empowering.
Kind Regards
Patrik
