The Voice Mail

It has been a few days since I saw Dr. Patel and had not heard anything about the CT or lab work he ordered. I always listen to my voice mails first thing in the morning, before I took a lunch, and before I go home. When I got back from lunch that afternoon, there it was sitting on top of my desk, like it was the "king of the hill". The voice mail light on my phone was blinking as if it was telling me "you knew the doctor would be calling today". I don't know why but it seemed to saying "listen to my message if you dare". As I came out of my daze I pushed the blinking button, keyed in my password, and selected item number one. It went something like this. "Hi Mr. Jones, this is Dr. Patel's nurse and you need to go to the pharmacy and pick up a prescription I just called in. Also, Dr. Patel would like to see you first thing in the morning. If you could get here around 8:00 am that would be great. Have a nice day".

Latulose is a liquid sugar that taste so bad I had to rename it to gagulose. Three table spoon three times a day. The next morning when I asked the nurse what she was trying to do to me she just said pretty nasty stuff isn't it. I responded, that's an understatement. She tookt me in an examining room and after a while Dr. Patel came in smiling saying Mr. Jones how are you feeling today. I said kind of strange now that you mention it. He said my ammonia level was elevated to 98 and it should be 29-40. That is why you are tired, confused, and forgetful. We need to get it down quickly, that is why I prescribed the latulose to help with the constipation. You have to have three bowel movements a day. Not one, not two, but three a day. The only way you can remove the ammonia in your blood stream is by bowel movements. He said my CT showed that my liver was shrinking and my spleen was enlarged. You also have portal hypertension and mild encephalopathy. That's what I like about Dr. Patel; straight to the point . He explained that encephalopathy is when too much ammonia is in your blood stream and it has a physiological effect on your brain because the ammonia causes it to swell. He said take the latulose and take a week off work. Your meld score is 14. I want to see you in two weeks.

Link for information on encephalopathy from cirrhosis

http://www.webmd.com/hw-popup/encephalopathy-from-cirrhosis