Monday, October 31, 2016

Liver worries liven things up

Here's an update on C.'s bad blood test results and persistent plague of pressure sores.

Our pediatrician - despite C.'s reaching 21 years I implored him to keep her on - has done another 180. But before convicting him of vacillation, bear in mind that he's a Harvard Med School graduate, an ace diagnostician, and a humble, compassionate human being.

So to recap: he initially blamed C.'s low protein and albumin on the valproic acid of which she gets 1400 mg/day. He then switched to blaming her diet and recommended as a remedy more eggs and dairy. Then last week he switched back to the valproic acid theory. He said his research revealed that every one of C.'s blood abnormalities - and she's had several for quite some time* - could be traced to valproic acid.

He couldn't fathom why C.'s neurologist doesn't agree and guesses it might be because this condition is rare. To confirm his suspicion, he has referred us to a hematologist and an ultrasound of her upper abdomen including liver, gall bladder, bile ducts, porta hepatis, portal vein and spleen.

He's even referring to this possible condition with a very medical name: mild hepatic dysfunction.
Here's the Medscape entry on Drug-Induced Hepatotoxicity:
Updated: Oct 09, 2014
Drugs are an important cause of liver injury. More than 900 drugs, toxins, and herbs have been reported to cause liver injury, and drugs account for 20-40% of all instances of fulminant hepatic failure. Approximately 75% of the idiosyncratic drug reactions result in liver transplantation or death. Drug-induced hepatic injury is the most common reason cited for withdrawal of an approved drug. Physicians must be vigilant in identifying drug-related liver injury because early detection can decrease the severity of hepatotoxicity if the drug is discontinued. The manifestations of drug-induced hepatotoxicity are highly variable, ranging from asymptomatic elevation of liver enzymes to fulminant hepatic failure. Knowledge of the commonly implicated agents and a high index of suspicion are essential in diagnosis.
So while I'm still awaiting the ultrasound scheduled for this Wednesday and an appointment with the hematologist, I feel that we're inching toward a final resolution of this mess.

And, who knows, a reversal of this condition may also herald an improvement in C.'s general functioning. (that old optimism rearing its delusional head again).

As for the pressure sores, they are healing nicely now though they're still around and requiring that time-consuming daily bandaging.

Still haven't organized any at home physiotherapy or occupational therapy or hydrotherapy in C.'s former school's pool. We've begun to collate the names of a few senior, respected ones to contact.
* Abnormally low total protein and Albumin
Abnormally low hemaglobin, Red Blood Cells and Hematocrit
Abnormally high MCV [Mean Corpuscular Volume] ) and MCH [Mean Corpuscular Hemoglobin] Levels are tested as part of a complete blood count test. The MCV test measures the size of the average red blood cell. The MCH test measures the amount of hemoglobin in the average red blood cell.

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