deteriorating motor control

Question

I am trying to save my wife. She is 62, nonsmoker, nondrinker. She is in late stages of NASH(hereditary) but numbers are all good and edema is not out of control. She is, however, experiencing loss of fine motor skills in arms and hands bilaterally, especially upon waking . It gradually improves after waking but is still diminished throughout the day. And her gate and balance have made her where she must be guarded against falls and escorted. On good days she gets along well with cane. She has some sleep apnea but primary physician doubts it is of issue here. Serum ammonia was high but we think it is better now as confusion she was experiencing has improved. Any thoughts as to what this might be?

ceanothus · Accepted Answer

I just noticed this thread and I'm having a bit of trouble figuring out what exactly has been done so far, and what kind of doctor is in charge of your wife's care. Your wife does need to be seen by a hepatologist, and preferably one who is associated with a liver transplant clinic because they are the ones who are the most educated and trained when it comes to the less common problems associated with liver disease. You are on the right track with a low sodium diet, but high protein is a bit dubious. She should definitely be avoiding protein from red meat sources, as these are much harder for a damaged liver to handle, and can result in more toxins in the blood. If the liver is more damaged then the recommendations tend toward avoiding all non-vegetarian protein and eventually toward keeping even vegetable protein intake somewhat reduced. The body does need protein, but with a very damaged liver one has to work a bit more at finding the best kind and the best level. Views on the subject of protein intake are quite variable however. It's best to have a really good doctor do a thorough evaluation and then go with their suggestions. I hope your wife can also have a thorough exam for any other health issues too, as the loss of mobility could be coming from an entirely separate health problem. I'm not a doctor and am not that "up" on what other illnesses could cause her problems, but just thinking about illnesses recently faced by two dear friends of mine, I would be concerned about a possible auto-immune disorder. I have one friend with MS and another with a paraneoplastic disease in which an autoimmune response to a previously undiagnosed cancer has permanently damaged the motor region of her brain. Both are suffering mobility impairments. Neither of those are very common or likely for your wife, but they do point out the importance of full and careful medical exams rather than focusing on the known disease as being the sole source of all new problems. Since she is experiencing some impairment of mobility it might be a good idea to ask for an evaluation by a neurologist. They should be able to sort out whether it is related to the liver disease or some other problem. Good luck!

Dee1956 · Answer

Hi I don't know if this will help but I saw this article while searching for reasons high ammonia occurs

http://www.livestrong.com/article/276710-how-to-detox-ammonia-from-the-body/

Dee1956 · Answer

This might helps, it talks about gait abnormality

http://emedicine.medscape.com/article/1174503-overview

Dee1956 · Answer

Hi, I did a search to try find any reasons for elevated serum, it can be related to kidneys as well as the liver, at least that is what this article says.

http://www.localhealth.com/article/elevated-blood-ammonia-level

Dee1956 · Answer

Before I had to go in to the hospital I was doing searches for food that can cause high ammonia, I am sorry to say I lost track, I will look for more.

The ammonia gets high when the liver can't flush out the toxins in the body, I will look for more information
Take care
D

Dee1956 · Answer

Hi I have been ill and off line, since before Christmas, I hope you had a Merry Christmas, Happy New Year. I hope you have found some answers/help for your wife.

I have been thinking of you
Dee

oldboy51 · Answer

Thank you and Merry Christmas.

oldboy51 · Answer

Thank you and Merry Christmas.

Dee1956 · Answer

Hi you are so nice to be out there searching for help for her.  I would be doing the same thing.  I will try to search for more and get back to you.

Take care
Dee

oldboy51 · Answer

She has been evaluated and over a year on watch list for transplant. Her good albumen and other numbers have the lead specialist unable to explain why she is still having these other issues. She does have hepatic encephalopathy. She has a plethora of doctors I know, but as he husband, I need to be proactive in finding out all I can too.

oldboy51 · Answer

Thanks and you are on target as we have taken many of the steps you have suggested and diet is high protein, low sodium. Lots of yogurt and fruit. Lactulose previously used and excretion working normal other than loss of muscle control. I heard there are other ways that serum ammonia levels can get elevated. Do you know any?

Dee1956 · Answer

So sorry I read this so quickly I see that her ammonia is high.  Please do not assume anything.  He balance problems could be affected by the ammonia.

Also are you seeing a Hepatologist? This is a GI that specializes in the liver.


That is what you need to save your wife, no disrespect you your GP I am sure he/she is good but to save your wife's life you need the big guns.

Has she had a biopsy to see the amount of damage she has? Just curious, not necessary.

I had slightly elevated enzyme levels but was going in to cirrhosis.

I know there are other questions I should be asking and I hope others will come along and ask them.  I have a limited amount of time on the PC due to sciatica.  I will come back.

Dee1956 · Answer

Here is an article I found, it is safe, I have a lot of Security on my PC, thank God for my son :)

http://www.livestrong.com/article/307175-the-nash-diet/

Dee1956 · Answer

Hi I am not a doctor just a patient but is if possible that she has hepatic encephalpathy? There is a cheap remedy called Lactulose, it is prescription and your doctor might want to check her ammonia first.

The problem is that they need to go by symptoms more than level of ammonia as people with high levels can have no symptoms (rares I know) and people with low levels can have bad symptoms.

There is also an antibiotic that can be taken but it is very very expensive.  

First thing I would do is go see the doctor to see if he thinks it could be causing her balanace problem.  Second thing is that I would monitor anything she eats, drinks puts on her skin or in her eyes.

Everything has to pass through the liver.  The liver is having problems processing everything.  You would want her to drink water.  That is all I drink now, In fact I had read in my vitamin book that distilled water is best for people with liver damage.
Then I would stop any fast food, processed lunch meats, tv dinners, red meat, fried food. No sugar at all.

Start her on a vegetable, fruit, chicken and fish diet
Of course this is not all the information available, this is just off the top of my head.

I will try to find more information.
Please keep in touch, there are many many supportive people on the forum all willing and able to help you.  I will look for more

Take care
Dee.

deteriorating motor control

Elevated liver enzymes and elevated lypmphocites

Elevated enzymes

Do you see a pattern?

Doctor says no way I have a liver issue BUT

Elevated liver enzymes and elevated lypmphocites

Elevated enzymes

Do you see a pattern?

Doctor says no way I have a liver issue BUT

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