Concerned about a friend. Hep c, alcohol, ascities

[beatgirl]

Hi gang, may healing come quickly to all.

My friend has had hep c over 30 years. I tried to get him to stop drinking. *Shrug* He has cll( leukemia) and still is abusing alcohol. He has not had any hep c treatment. He recently has been hospitalized repeatedly for ascities. We're not close, anymore. And is not proactive in learning about the disease (s). He also has pins and needles in his feet and uses a cane.

Is this advanced cirrosis( sp) They want to put a shunt to continually drain the stomach fluid. And are starting hep c drugs soon.

How serious is all this? Ty

[Lynn K]

Your friend probably has very advanced liver disease liver cirrhosis.

To put it bluntly if he wants to live he must immediately stop drinking alcohol and any other drugs if he takes them. His doctor has likely told him this.

He likely not in immediate danger of dying but he is very ill. He may need a liver transplant but won’t be allowed to be placed on the transplant list until he has been clean for at least 6 months.

https://www.mayoclinic.org/diseases-conditions/hepatitis-c/expert-answers/hepatitis-c/faq-20058533

“End-stage hepatitis C means the liver has been severely damaged by the hepatitis C virus. The hepatitis C virus slowly damages the liver over many years, often progressing from inflammation to permanent, irreversible scarring (cirrhosis). Often, people have no signs or symptoms of liver disease or have only mild symptoms for years or even decades until they have cirrhosis.

Once you have cirrhosis, treatment focuses on keeping the condition from worsening. It may be possible to stop or slow the damage.

Symptoms of end-stage liver disease may include:

Easy bleeding or bruising
Persistent or recurring yellowing of your skin and eyes (jaundice)
Intense itching
Loss of appetite
Nausea
Swelling due to fluid buildup in your abdomen and legs
Problems with concentration and memory
Cirrhosis usually progresses to the point where the liver loses most or all of its function — liver failure. In addition, people with cirrhosis may develop:

Bleeding of the digestive (gastrointestinal) tract due to enlarged veins in the tube that connects the throat and stomach (esophagus), a condition known as esophageal varices
Brain and nervous system damage due to the buildup of toxins in the bloodstream (hepatic encephalopathy)
Cirrhosis also increases your risk of liver cancer.

The only effective treatment for people with end-stage liver disease is a liver transplant. Chronic hepatitis C virus is the most frequent cause of liver transplantation in the United States. Most people who receive a liver transplant for hepatitis C survive for at least five years after their transplant, but almost always the hepatitis C virus returns.

If you're diagnosed with hepatitis C or end-stage liver disease, see a doctor who specializes in gastrointestinal diseases or liver diseases (hepatologist). Newer, more-effective hepatitis C treatments can eliminate the virus in many people, reducing the risk of end-stage liver disease.“

[Lynn K]

Just wanted to add I am so sorry to hear about your friends health problems. He may be feeling hopeless with all this going on and believe what is the point in trying to change.

I hope for his sake he changes his way of thinking and decides he wants to change. End Stage Liver Disease (ESLD) is not a good diagnosis. He can change his fate if he decides to work for better health.

It is his decision if he wants to continue to drink or if he wants to live.

Best to you both

[beatgirl]

Ty, I have very little contact. Personally, he did me wrong. Lol, but that's neither here nor there. He said the Dr said to quit drinking and they'd start that new hep c drug. He lives on the streets now w a fellow drinker. He's always been robust and sounds robust, but when I heard ascites, I googled.

Tell me, is the pins and needles in his feet, liver related? Sounds like neropathy. So...

I thought he may be in stage 3. But your saying perhaps stage 4?

I know it's speculation. Neither of us no hiis condition. What's the life span? Estimated?

Cll
Poly substance abuse
Hep c
Ascities recurrent


I'm just wondering if he could pass quickly? Ty tc

[Lynn K]

Not sure what you mean by Stage 3 vs 4.

He likely has a fibrosis score of F4 which is cirrhosis. There are two stages of cirrhosis compensated and decompensated. Compensated cirrhosis means your liver has enough function left to still perform its job. Decompensated cirrhosis is when the liver is beginning to fail. The development of ascites especially that requires draining is an sign he has transitioned into decompensated cirrhosis.

For reference I have had cirrhosis from hep c for 10 years now. I don’t drink and was cured of hep c 3 years ago. I am considered compensated and am doing reasonably well althoigh I did develop esogaphageal varicies 6 years ago that needed banding.

It is hard to say how long he can live like this given his circumstances. They often won’t treat hep c in someone who is a drug or alcohol abuser in his case the alcohol at this point is killing him. Why treat him with very expensive meds when he may not even take them correctly and seems unwilling to save his own life this is also why they won’t put him on a transplant list until he stops drinking.

For ascities they normally have you take a diuretic medicine and ask the patient to avoid sodium in their diet. He is to the point he needs to have a shunt from what you said. Some of the ways cirrhosis can kill is the fluid in the abdominal can become infected SBP sudden bacterial peritonitis which can kill. He should have an upper endoscopy to check for varicies. If he has large varicies they can begin to bleed causing the person to have black tarry bloody stools or even vomit what looks like coffee grounds which is partly digested blood. This internal bleeding can also cause sudden death. Another deadly complication of cirrhosis is Hepatic encephalopathy which if untreated can lead to coma and death.

So it is so hard to say as for as the cirrhosis how long until something suddenly happens or if he lingers for years as his liver shuts down and fails. Dying from liver cirrhosis can be a slow lingering death or he can pass quickly. Or he can stop drinking and get on the transplant list after 6 months of sobriety and counseling.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3321494/

“While steatosis is an almost completely benign disease, liver cirrhosis is associated with marked morbidity, mortality and life expectancy shortening. The median survival of patients with advanced cirrhosis is 1-2 years.”

He may not be considered advanced cirrhosis but he is getting close. If he wasn’t drinking healthwise he likely is sick enough to qualify to be on the transplant list is my assumption without knowing more about his condition.

There is something called a MELD score that goes from 6 to 40. Your score has to be about 15 to get in the list with most transplants happening around 30 due to availability of organs. There are about 16,000 on the transplant list and about 6,000 liver transplants done per year. If you knew his lab test results you could find out his MELD score. That would give you a better idea how sick he is.

Read up on alcoholic ESDL it will give you an idea. Or refractory ascities, SBP, esophageal varicies and hepatic encephalopathy  to know more.

[beatgirl]

Ty for all this valuable information. I'm very glad to hear you're doing well!!

I haven't enough contact w him to get more information. But I do hope he stops drinking. He said he would. I d k...

My best!