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more questions about brothers lab test results

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Posted 5/2/2014 4:11 PM (GMT 0)
Ok, so I know that BUN and creatinine are related to kidney function, I know creatinine, Bilirubin and INR give you the MELD score and I know the ALT, AST pertains to the liver function. My question is......what are the most important of those lab numbers that I need to track? His kidneys are doing better, creatinine went down some. But the ALT, AST are going up. I know these lab numbers can fluctuate daily.......I'm just wondering at what point do I get worried that things are getting much worse? If that makes any sense. He was just moved to an LTAC last night so now all new drs and nurses we're dealing with and that's why I keep track of all his labs etc so I know what to ask the Dr's. (yes I DO have control issues) smilewinkgrin
Posted 5/2/2014 10:36 PM (GMT 0)
Hi CC! Because liver disease is so unpredictable, it's just really hard to say when certain lab results mean things are getting worse. It's more a matter of 'trending'. Since lab results can vary day to day, up and down, it's tough to say that just because a person's ALT, AST, GGT, etc. reach a certain level, that it means things are actually getting worse. It's when labs begin to show a consistent 'trend' in the wrong direction - instead of varying up and down, the numbers begin to only increase. That's the best way I can explain it - I sure hope it made sense!

And what you're doing for your brother has little to do with any 'control issues' you may have, in my opinion. You are simply being a loving, caring sister who is being a wonderful advocate for her brother. He is very lucky to have you in his corner. Just keep doing what your doing - talking to the doctors and nurses and asking questions. I was always respectful, but I asked questions about everything - and I questioned anything I wasn't sure of, or I didn't agree with. I never once hesitated in speaking with anyone on Robert's medical team, about anything. I was always very 'well-known' on whatever floor he was on! Lol

Please remember to take care of yourself - stay rested and hydrated! Have a peaceful day, CC.
Posted 5/3/2014 12:49 AM (GMT 0)
Good to know your on the job Cat. You have to be aggressive so no worries with that. Splash nailed it.


Ziff
Posted 5/3/2014 1:26 AM (GMT 0)
Cat, all the numbers are important. Keep a notebook with all the labs and test results they will give you. They tell a story and the next place he goes can catch up by looking through them.

You have the kidney and liver labs correct. The MELD score is calculated using the kidney numbers as a prediction of who will or will not best survive a transplant surgery. Evidently your kidneys have to be in good shape to survive a huge surgery like that. If he every got to that point of eligibility.

The liver function tests give you more of an idea how compensated or decompensated the liver is. If they get really high, well, the worst may be upon you. I don't recall the typical numbers for your brother.

Being there, careing, talking to everyone really helps...it helps your brother to know he is loved and a valuable person. It helps because the docs know patients with positive family support do better in the long run, and it keeps them on their toes because someone is going to come snooping around to be sure everying is going well....if you get my meaning.

Best to you both,

Mama Lama
Posted 5/3/2014 1:16 PM (GMT 0)
Thank you! I don't know what his numbers "typically" are since he was still drinking and not seeing drs until a month ago. I do know what his numbers were each hospital trip he's had over the last 3 years. I do write down all info and keep track of it. How long is considered trending? For instance for the past week his ALT and AST have gone up. His platelets also keep lowering. Here's some of the past weeks lab results (dates at the top):

4/25
MELD 38
Blood pressure better 114/65
BUN 42
Bilirubin 28.6
INR 2.7
Platelets 96
Creatinine 2.27

4/26
MELD 37
Hemoglobin 8.6
Creatinine 2.13
INR 2.7
Platelets 88
BUN 41
Bilirubin 28.2
ALT 37
AST 95

4/27
MELD 34
Bilirubin 18
INR 2.7
Creatinine 1.8
ALT 43
AST 111

4/28
MELD 33
Creatinine 1.73
INR 2.6
Bilirubin 18
Platelets 83
Hemoglobin
1 liter fluid restriction
109/63 blood pressure
Temp 96.6

They didn't do bloodwork on 4/29

4/30
MELD 34
INR 2.7 or 2.8
ALT same
AST same (that's what dr told me no number given)

5/1 he was moved to the LTAC hospital didn't do bloodwork before he left.

5/2
MELD 33
Temp? He's cold 95.9
Blood pressure 118/73
Still on fluid restriction
INR 2.6
Creatinine 1.5
Bilirubin 21.9
Platelets 66
Sodium 135
Calcium 7.7
ALT 62 (norm 7-56)
AST 137 (norm 5-40)
ALP 156 (norm 44-147)
Posted 5/3/2014 1:54 PM (GMT 0)
Good morning, Cat. Not much I can offer you, except supportive hugs. He is holding pretty steady, still very ill with a MELD in the 30's. You are a good Sis. Big Hugs,
Posted 5/3/2014 8:18 PM (GMT 0)
Cat,

I was in your shoes a about 18 months ago....you're doing a great job for your brother.
The others pretty much answered your questions. As far as him being cold, my brother was cold ALL the time, the nature of the beast, and so I bought him an electric blanket. You have to be careful with those if he has any numbness (so he won't get burned).

It's so often a bumpy, unpredictable ride, this ESLD. His numbers aren't trending UP, so just take it day by day and get whatever documentation they want for the alcohol abstinence.

Have a peaceful weekend :)
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