Good News and Huh? Kind of News

[peleroja]

I just heard from the transplant coordinator at Kaiser.  UCLA wants me to go on a 9 month treatment because my TB skin test is always positive (no problem).  They also said they want a BMI of less than 40 (down from the 35 I was originally told, and since I'm almost there, that's the good news).  The huh? kind of news is they want a GI consult because I have "cirrhotic transformation."  Huh??  Anyone know what that is?  I see the doc tomorrow, but I wondered if anyone could give me a heads up cuz Webmd didn't tell me a thing.

[IUNurse]

cirrhotic transformation....the first word I would relate to cirrhosis which relates to liver.  A problem with your liver?  Just a guess...

[Chris]

I found this, not the greatest thing, but this is what the doctor wants to make sure it is not.


Changes in renal kaliuretic function in the dynamics of hepatic cirrhotic transformation]
 
[My paper] A V Pozdniakov, Ia D Finkinshteĭn, G D Mysh
During formation of hepatic cirrhosis in animals, excessive potassium loss has been found to depend on the increased loading of a nephron by its cation at its early stage and on abnormally changed tubular processes at late stages.
Mesh-terms: Animals; Dogs; English Abstract; Kidney :: metabolism; Liver Cirrhosis, Experimental :: metabolism; Liver Cirrhosis, Experimental :: urine; Potassium :: urine;
http://lib.bioinfo.pl/pmid:8183619

and

http://www.ncbi.nlm.nih.gov/pubmed/9102280

[Immunogenic hyperthyroidism with hyperdynamic heart failure and early cirrhotic transformation of the liver][Article in German]


Fischer MR, Spes CH, Huss R, Gärtner R.
Medizinische Klinik, Klinikum Innenstadt, Ludwig-Maximilians-Universität München.

HISTORY AND CLINICAL FINDINGS: A 58-year-old woman was admitted because of jaundice, ascites and marked oedema. For three years she had suffered from nervousness, decreasing fitness and weight loss, which had been assumed as due to chronic alcoholism. Liver biopsy revealed extensive fibrosis, in part with early cirrhotic transformation. This was followed by cardiac failure with atrial fibrillation (ventricular rate 140/min) and marked pleural effusions. The thyroid was diffusely enlarged and there were signs of exophthalmos. INVESTIGATIONS: Bilirubin concentration was 3 mg/dl, lactate dehydrogenase activity was 310 U/l, cholesterase 1.3 kU/l and the prothrombin test was 21%. The TSH level was 0.01 microU/ml while the free thyroxine level was 4.7 ng/dl and that of free triiodothyronine 13.5 pg/ml. Chest radiograph revealed cardiomegaly, bilateral peripheral pulmonary congestion and pleural effusions to midfield. Right heart catheterization excluded pulmonary hypertension; cardiac output was 10l/min. The thyroid was enlarged on ultrasound and diffusely echopoor, as in immune thyroid disease. TREATMENT AND COURSE: Cardiac failure regressed and thyroid function normalized within ten days on propranolol, 4 x 40 mg and thiamazole 3 x 40 mg daily intravenously. Subtotal thyroidectomy was performed three weeks later with subsequent thyroid hormone substitution. Liver functions were normal six months later and ultrasound showed no signs of cirrhotic change and the ascites had resolved. CONCLUSION: Hyperthyroidism is frequently associated with changes in liver functions. In extreme cases, high-output cardiac failure may occur, with liver congestion and clinical as well as histological changes like those in liver cirrhosis.

[rose1999]

Just wanted to wish you luck and hope that things turn out OK.

[carla13]

Hi, i just wanted to let you know I'll be thinking of you. Post and let us know how it went!

xx

[peleroja]

Doncha just love it when docs don't talk to one another?  All my doc said was there was some concern over the way my liver looked on the ultrasound and the transplant team wants me to see a GI.  She didn't say it was a problem, just a "concern."  As for the TB skin test, my neph wants me to see an infectious diseases doctor, as she's concerned about my doing some kind of prophalaxis for 9 months.  However, the liver has to come first, so as soon as I get an appointment and know anything I'll let you know.  Oh, yeah, about the BMI.  I weighed 210 at the doc's today and a BMI of 40 is 204, so I'm pretty close!

[jbeany]

6 pounds - that's a reasonable goal!

[G-Ma]

You are very near goal...down hill to that number.  Good for you.

[Chris]

Idiot docs!
They have all this technology, mail service, walking distance,  and a land line to to communicate and they don't do it. Yet heavan forbid we are late for our appointment so they can make us wait an hour to see them for less than 10 minutes.
Doctors just need a swift  in the