The liver is an organ in the body that is essential for detoxing the blood, production of bile, certain proteins for blood plasma, cholesterol to help carry fats through the body, regulating blood clotting, and many others. It is the largest solid organ (2nd largest in the body, to the skin) and located in the right upper quadrant of the abdomen, under the ribcage.

Liver failure and liver disease are two different things. Liver disease refers to any condition that causes inflammation and/or damage to your liver. Liver disease affects the overall function of the liver. Liver failure is when your liver has lost some to all of its functionality. Liver failure often occurs from the damage caused by liver disease.

One amazing fact about this organ is that it can repair and even regenerate itself, if the damage is caught early enough! Many people with liver disease do not look or feel sick, even though their liver is becoming damaged. At a certain point, the liver damage becomes irreversible and can lead to liver failure, cancer, or death.

Common Causes of Liver Disease

• Viruses, such as Hepatitis A, B
• Genetics
• Certain autoimmune diseases
• Excessive alcohol consumption
• Poor diet/obesity
• Reactions or overuse of certain medications, street drugs, or other chemicals, such as acetaminophen, certain antibiotics, or certain herbal supplements

Symptoms of Acute Liver Failure

• Feeling unwell
• Fatigue
• Nausea or vomiting
• Abdominal pain and/or swelling
• Jaundice- yellowing of the skin and eyes
• Confusion or disorientation

Symptoms of Chronic Liver Failure

Early symptoms

• Fatigue
• Appetite loss
• Nausea or vomiting
• Abdominal discomfort and/or pain

Advanced symptoms

• Jaundice
• Easily bruised or bleeding
• Confusion or disorientation
• Edema, buildup of fluid in abdomen, arms, or legs
• Dark urine
• Severe skin itching

Stages of Liver Failure

Damage from liver failure can occur in several stages. Each stage increasingly affects the liver’s ability to function. Just like we previously said, “Liver failure is when your liver has lost some to all of its functionality. Liver failure often occurs from the damage caused by liver disease.”

Inflammation
In the early stages of liver failure, inflammation occurs. This means your liver becomes enlarged and/or inflamed (“a localized physical condition in which part of the body becomes reddened, swollen, hot, and often painful, especially as a reaction to injury or infection”). Many people with inflammation don’t experience symptoms. However, if the inflammation continues, permanent damage occurs. Inflammation can be hard to detect since there are usually no symptoms.

Fibrosis
If no treatment is sought when you are diagnosed with liver inflammation, the liver may begin to scar over. Excessive buildup of scar tissue on the liver is called liver fibrosis. If left untreated over time, the excess scar tissue replaces the healthy, normal liver tissue. As scar tissue replaces normal tissue, this greatly impacts the function of the liver. The buildup of scar tissue can even reduce or stop blood flow through the river. Fibrosis can be difficult to detect because of the lack of symptoms. If a patient with liver fibrosis seeks medical attention and treatment, there is a possibility the liver can heal.

Cirrhosis
Cirrhosis is a late-stage scarring of the liver. This late-stage fibrosis can be caused by excessive alcohol consumption or certain conditions/diseases. Many people begin to notice symptoms once cirrhosis has began. Without treatment, it can worsen and damage can be irreversible. As a result, the liver may stop properly working or may stop functioning at all. Treatment may be able to stop or delay liver damage, you cannot reverse damage caused by cirrhosis.

End-Stage Liver Disease
When a person reaches end-stage liver disease (ESLD), the liver’s function has deteriorated so much that the person requires a liver transplant. Some physicians may refer to this as chronic liver failure. With ESLD, some people may develop ascites (the accumulation of fluid in the abdominal cavity which causes abdominal swelling) and the development of ascites has an average life expectancy of 6 months or less , if it doesn’t respond to treatment.

Palliative and Hospice care can greatly benefit those with liver disease and/or failure. Both work to improve quality of life however with hospice care, the patient is no longer seeking curative treatment and/or a liver transplant. Call St. Anthony’s Hospice or Palliative Care at (270) 826-2326 or make an online referral to see how either program can benefit you or a loved one.

Sources found here, here, and here. Definitions linked on term above. Photo sources here and here.

Heart failure, sometimes known as congestive heart failure or CHF, is a chronic condition in which the heart doesn’t pump blood as well as it should. It can occur if the heart cannot pump blood or fill the chambers adequately. Certain conditions such as coronary artery disease or hypertension, will gradually leave your heart too weak or stiff to fill and pump as it should.

Not all cardiac conditions that lead to heart failure can be reversed. However, some treatments can improve the signs and symptoms of heart failure, which will help you live longer. Some lifestyle changes like regular exercise, reducing sodium in your diet, managing stress, and maintaining a healthy weight can improve heart health and quality of life. One way to prevent heart failure is to prevent and control conditions that directly lead to heart failure. These conditions include but are not limited to coronary artery disease, hypertension, diabetes, or obesity.

Symptoms of Heart Failure

You should see your doctor or call 9-1-1 if you think you are experiencing a heart attack. Please see your doctor to be checked for heart failure if you experience any of the following symptoms.

• Shortness of breath, aka dyspnea, when exercising or lying down
• Fatigue
• Weakness
• Swelling (aka edema) in your legs, ankle, and feet
• Rapid/irregular heartbeat
• Reduced ability to exercise
• Persistent cough or wheeze with white or pink colored phlegm
• Increase in urination at night
• Abdominal swelling (ascites)
• Rapid weight gain due to fluid retention
• Lack of appetite
• Nausea
• Difficulty concentrating/decreased alertness
• Sudden, severe shortness of breath and coughing up pink, foamy mucus
• Chest pain, if your heart failure is caused by a heart attack

Stages of Heart Failure

There are four stages of heart failure 1, 2, 3, or 4. As heart failure progresses through the stages, a person’s survival rate for 5+ years decreases.

Stage 1 
Those in stage 1 do not yet have issues with the pumping function of their heart. However, they do have a high risk of developing heart failure due to presence of related conditions like those listed above. People in stage 1 don’t have issues with the structure of their heart or how their heart works. It is rare to experience symptoms in this stage of heart failure. But a person may have symptoms related to other cardiac conditions.

Stage 2
Those in stage 2 of heart failure begin to have a reduced pumping function from the heart. This can lead to an enlarged left ventricle. The left ventricle pumps the blood rich in oxygen through the aortic valve and into the rest of the body. This area builds up while trying to overcompensate for the reduction in pumping function. An enlarged left ventricle can also result from previous heart attack(s). Some people in stage 2 remain asymptomatic.

Stage 3 
In stage 3, people will begin to show some of the symptoms above. Most are currently undergoing treatment either before or during stage 3.  The symptoms usually appear in this stage due to problems with the pumping chamber of the heart (or left ventricle). The patient may benefit from a referral to palliative care for enhanced symptom management.

Stage 4 
People in stage 4 have advanced heart failure and exhibit symptoms even when at rest. This stage is severe and may require advanced, specialized treatment or hospice care, depending on the patient’s treatment plan.

Check out our previous post on how palliative care can benefit patients with heart failure here. 

If you or a loved one is in need of St. Anthony’s Palliative or Hospice Care, please call us at (270) 826-2326 or make an online referral. 

Sources found here and here.

For over 10 years, the day after Tax Day is National Healthcare Decisions Day. After getting your taxes filed, it’s usually a good idea to discuss the wishes of your family. From April 2020-April 2021, these decisions have looked a little different and the way we have been living has been really changed. How many Americans look at advance directives has taken more of a profound meaning.

With the impacts of COVID-19, you never know what is going to happen. Remember last January and February before COVID became so widespread? We all had plans for 2020; some awesome resolutions, weddings, graduations, proms, homecomings, big birthday parties, vacations, and so much more. Then COVID hit and hit hard. All plans came to a screeching halt. Stay at home orders were invoked, along with mask mandates. Unfortunately, many Americans contracted COVID and some never recovered and passed away. Many of those people passed away without advance directives in place, which left family members trying to honor wishes that were not communicated.

Having advance directives is certainly not a new idea, but COVID did force everyone to look at what they want at the end of life and talk about their wishes with loved ones. There are huge benefits to the patient and family by having advance directives in place prior to hospitalization. These can include peace of mind for the patient because they know they will get their wishes honored and peace of mind for the family knowing they don’t have to guess or worry in this stressful time. After a loved one becomes chronically ill or unable to speak, these advance directives will come in handy! Your wishes will be crystal clear to medical professionals and loved ones.

St. Anthony’s Hospice and Palliative care helps patients get their wishes in order! Not only do we have copies of the 5 Wishes booklet to help you get started (for free), we can also help witness and notarize your documents, as well as help you get in contact with an estate attorney to draft the documents for you. We also honor end of life wishes by allowing the patient to be at home and ensuring all patients will have the highest quality of life and are able to die with dignity.

Call us today at (270) 826-2326 or make an online referral to see how hospice or palliative care can help you.

Chronic Kidney Disease (or CKD) refers to lasting kidney damage that progressively worsens over time and all 5 stages of kidney damage. These stages range from very mild (stage 1) to complete kidney failure (stage 5) The stages of CKD are based on the kidney’s ability to filter waste and extra fluid from the bloodstream. In the early stages, a person’s kidneys can still filter waste but in the later stages, your kidneys will have to work harder to get rid of waste or may not be able to do so at all. Over 30million people in the United States are living with CKD. How your physician measures your kidney function is by the estimated glomerular filtration rate (or eGFR). The eGFR is a number based on your creatinine levels, which is a waste product in your blood.

While anyone can be diagnosed with CKD, some risk factors that increase your risk include:
1. Diabetes
2. High Blood Pressure
3. Heart Disease
4. Family History of CKD
5. Being African American, Hispanic, Native American, or Asian
6. Being over 60 years old

Understanding the different stages of CKD can help a patient be more educated on the disease process and make appropriate healthcare decisions. We wanted to help you learn more about this disease.

Stage 1
In stage 1 CKD, you have mild kidney damage and an eGFR of 90 or greater. Most of the time, this means your kidneys are healthy and functioning well but you do have other signs of kidney damage. These signs of kidney damage can include protein in your urine or actual physical damage to your kidneys. Some ways to slow the progression of CKD if you are in stage 1 include:
– Controlling your blood sugar if you are diabetic
– Control your blood pressure
– Maintain a healthy diet
– Don’t smoke/vape or use smokeless tobacco
– Strive for 30 minutes of exercise at least 5 days per week
– Maintain a healthy weight
– Talk to your doctor about medications or vitamins to help protect your kidney function
– Get an appointment with a kidney doctor, or nephrologist, even though you have a primary care provider

Stage 2
In stage 2 CKD, you have mild kidney damage an eGFR between 60%-89%. Most of the time, this means your kidneys are healthy and functioning well but you do have other signs of kidney damage. These signs of kidney damage can include protein in your urine or actual physical damage to your kidneys.

Some ways to slow the progression of CKD if you are in stage 2 include:
– Controlling your blood sugar if you are diabetic
– Control your blood pressure
– Maintain a healthy diet
– Don’t smoke/vape or use smokeless tobacco
– Strive for 30 minutes of exercise at least 5 days per week
– Maintain a healthy weight
– Talk to your doctor about medications or vitamins to help protect your kidney function
– Get an appointment with a kidney doctor, or nephrologist, even though you have a primary care provider

Stage 3
Stage 3 is split into 2 stages, Stage 3a and Stage 3b. In Stage 3a, you have an eGFR between 45%-59%. In Stage 3b means you have an eGFR between 30%-44%. This means there is some damage to your kidneys and they are not functioning as well as they should be.

Many people do not exhibit symptoms in Stage 3, but if you are exhibiting symptoms they can be:
– Swelling in the hands and/or feet
– Back pain
– Urinating more or less than normal

Also in Stage 3, a person is more likely to start having health complications as waste builds up in your body. These can include:
– High blood pressure
– Anemia, or a low number of red blood cells
– Bone disease related to hyperphosphatemia or high levels of phosphorus in the blood

To prevent Stage 3 CKD from progressing, you can:
– Control your blood sugar if diabetic
– Control your blood pressure
– Don’t smoke/vape or use smokeless tobacco
– Eat a healthy diet and meet with a dietitian
– Exercise for at least 30 minutes, 5 days per week
– Get to and maintain a healthy weight
– Visit a nephrologist in addition to your primary care provider
– Ask your physician about medications to control your blood pressure and those to improve kidney function

Stage 4
Stage 4 CKD means you have an eGFR between 15%-29%. This means your kidneys are moderately to severely damaged and not working as well as they should. Stage 4 is the last stage before kidney failure and should be taken very seriously. Stage 4 is where palliative care can benefit the patient!

Many people begin to exhibit symptoms in Stage 4, which can include:
– Swelling in the hands and/or feet
– Back pain
– Urinating more or less than normal

Also in Stage 4, you will likely have health complications as waste builds up in your body. These can include:
– High blood pressure
– Anemia, or a low number of red blood cells
– Bone disease related to hyperphosphatemia or high levels of phosphorus in the blood

To prevent your Stage 4 CKD from progressing to complete kidney failure, you should:
– Regularly see your nephrologist
– Meet with a dietitian to help with your healthy diet
– Regularly take blood pressure medications as prescribed by your doctor

In Stage 4 it is time to begin talking with your nephrologist about the starting dialysis or preparing for a kidney transplant.

Stage 5
Stage 5 CKD means you have an eGFR less than 15%. This means your kidneys are either getting very close to failure or they have completely failed. If your kidneys fail, waste will build up in your blood which makes you very ill. Stage 5 is where hospice or palliative can help!

Some of the symptoms of kidney failure include:
– Itching
– Muscle Cramps
– Nausea & vomiting
– Not feeling hungry
– Swollen hands and feet
– Back pain
– Urinating more or less than normal
– Trouble breathing
– Insomnia (or trouble sleeping)

Once your kidneys have failed, kidney transplantation or dialysis are your treatment options. However, should you choose quality of life, hospice can help! If you choose quality of life in tandem with your treatment, palliative care can help! A kidney transplant is when a donor kidney is taken and transplanted into your body. If you can find a living donor, you may be able to plan for a kidney transplant and palliative care earlier. Dialysis assists your body in removing excess water and waste from the blood when your kidneys can no longer do it themselves. Palliative care can be used in conjunction with a kidney transplant and/or dialysis.

Palliative Care and Chronic Kidney Disease
When a patient is facing late-stage kidney disease (stage 4 or 5), St. Anthony’s Palliative Care team can help to manage symptoms and bridge the gap between the patient and their physician/nephrologist by providing an extra set of eyes and ears in the home. Palliative care can also help the patient access additional resources and support in the community.

Our palliative care team helps patients match their care plan to their personal goals as the patient explores options from transplant to dialysis to comfort care only.

To learn more about St. Anthony’s Hospice or Palliative Care, please call us at (270) 826-2326 or make a referral online.

Resources for this article found here.