Ascites

[laolover88]

Lovely friend, who drinks like the proverbial fish, has blown up like a barrel and been diagnosed with Ascites. Has anyone any experience of anyone treated for this in Thailand?. Seems you can take diuretics, specifically Spirinolactone and Furosemide and have the fluid drained; he is a bit nervous of that here!

[johnatong]

Acites is a sighn/symptom of a, usually serious, disease process. It is not a "diagnosis" in its own right.

Treatment will depend on the cause.

Distress can sometimes be alleviated by draining the accumulated fluid.

In the case you describe the person has likely got a serious liver disorder.

[Sheryl]

As above. While the fluid can be drained off it will re-accumulate unless it is possible to treat the underlying cause. In a heavy drinking, ascites usually indicates serious liver damage

[laolover88]

Thank you. I am sure liver damage/cirrhosis is the underying problem. Question, then, is what is best for him to do!? Apart from stop drinking. Not hopeful about that! He is 75. Would not like to speculate on the likelihood of morbidity/mortality!

Edited May 14, 2016 by laolover88

[NickJ]

Nervous of Tx , Well this wont end well....If he doesnt get the correct dx and go from there....

Edited May 14, 2016 by NickJ

[johnatong]

I am sure liver damage/cirrhosis is the underying problem. Qestion, then, is what is best for him to do!? Apart from stop drinking.

He should be guided by his medical adviser(s).

If he is distressed by the acites it can easily be drained. It is a very minor procedure.

[tonray]

Too late for him to be nervous. He needs to seek professional help ASAP. The acute condition is a warning. If he does not get immediate treatment for his swollen liver, his life will be short and miserably painful. Even if he does get immediate treatment, it may not help a lot. Once the damage is done he is on the slow path to the death of an organ he cannot live without. Sorry for the bad news but I knew someone in the family with a similar condition. Not a great prognosis.

[DogNo1]

If he continues to drink and damages his liver further he could eventaully end up as one of our condo diver news items. I hope that doesn't happen!

[NancyL]

You and your friend may want to read the Wikipedia article on cirrhosis, especially the section toward the bottom on "Management" and "Palliative Care" https://en.wikipedia.org/wiki/Cirrhosis

At his age and with this condition, he should make sure that he has his affairs in order, with a Final Will and an Advance Health Directive. He should be very direct with his doctor about how he doesn't want any special steps taken to keep him alive (if that's his wish) and how he wants to be keep as comfortable and free from pain as possible. Telling him to stop drinking, if that's been a life-long habit, may not be realistic at this point, but he owes it to the people he loves to get everything in order for them ASAP.

[laolover88]

You and your friend may want to read the Wikipedia article on cirrhosis, especially the section toward the bottom on "Management" and "Palliative Care" https://en.wikipedia.org/wiki/Cirrhosis

At his age and with this condition, he should make sure that he has his affairs in order, with a Final Will and an Advance Health Directive. He should be very direct with his doctor about how he doesn't want any special steps taken to keep him alive (if that's his wish) and how he wants to be keep as comfortable and free from pain as possible. Telling him to stop drinking, if that's been a life-long habit, may not be realistic at this point, but he owes it to the people he loves to get everything in order for them ASAP.

Good advice. Thanks. I think things are in order. Not sure about the Health Directive. He is a Brit not American; and it is still less common there

[johnatong]

You and your friend may want to read the Wikipedia article on cirrhosis, especially the section toward the bottom on "Management" and "Palliative Care" https://en.wikipedia.org/wiki/Cirrhosis

At his age and with this condition, he should make sure that he has his affairs in order, with a Final Will and an Advance Health Directive. He should be very direct with his doctor about how he doesn't want any special steps taken to keep him alive (if that's his wish) and how he wants to be keep as comfortable and free from pain as possible. Telling him to stop drinking, if that's been a life-long habit, may not be realistic at this point, but he owes it to the people he loves to get everything in order for them ASAP.

Good advice. Thanks. I think things are in order. Not sure about the Health Directive. He is a Brit not American; and it is still less common there

Brits are familiar with Advance Directives (Living Wills) although it is something which many ignore .

http://www.nhs.uk/Planners/end-of-life-care/Pages/advance-decision-to-refuse-treatment.aspx

[Sheryl]

Nancy is correct. Thid is basically a terminal situation, especislly if he will not stop drinking.

[arunsakda]

Is organ transplant out of the question or not available due to age and alcoholism?

75 is a pretty decent run but I have seen a few people make Major lifestyle changes succesfully when presented with a harsh diagnosis.

Edited May 16, 2016 by arunsakda

[laolover88]

Update in thanks for your help.

Got the old gentleman to hospital.

Had all the blood and other tests.

Very worryingly low platelet count. AST and ALT levels not particularly abnormal

However turned out he had an umbilical hernia.

Because of age the hospital were not keen on paracentesis.

They have decided to see what they can do with diuretics etc as a start.

Doctor thought the Ascites probably brought on by a particularly heavy night with the bottle.

He's not telling. Of course he was told not to drink a drop. Said to me that at his age he wasn't going down drinking dandelion tea. Obstinate.

Doctor estimated he was at late stage 2 cirrhosis advancing rapidly to 3.

[johnatong]

Update in thanks for your help.

Got the old gentleman to hospital.

Had all the blood and other tests.

Very worryingly low platelet count. AST and ALT levels not particularly abnormal

However turned out he had an umbilical hernia.

Because of age the hospital were not keen on paracentesis.

They have decided to see what they can do with diuretics etc as a start.

Doctor thought the Ascites probably brought on by a particularly heavy night with the bottle.

He's not telling. Of course he was told not to drink a drop. Said to me that at his age he wasn't going down drinking dandelion tea. Obstinate.

Doctor estimated he was at late stage 2 cirrhosis advancing rapidly to 3.

Without wishing to appear unkind the old chap is likely nearing the end of his life and energetic efforts to reduce his alcohol intake are only likely to be met by resistance and nothing really will be gained.

You are clearly a trusted friend so, as difficult as it might be, just try to support your friend to achieve the best from what life remains for him.

Have you been able to broach the topic of end of life care with him?

I think NancyL or Sheryl may have some info/forms which they can send if you make PM contact.