A Not-so-happy New Year

By early December 2013, my spirits had hit a low... not just because of health issues, but also because my husband was laid off from his job. Fortunately, he received a generous severance package and we were optimistic and hopeful about his ability to find work. Nonetheless, it was very stressful.

With a lot of planning and steady effort, we had a nice Christmas. My kids were home from college and we especially enjoyed spending time with them and seeing their friends. It was nice to relax a bit because I felt very tired from the all of the holiday prep.

However, I felt even more tired after Christmas and began sleeping nearly all day. And then I began to have trouble talking: I couldn't think of the right words to say, or if I did, I couldn't speak them. And some of the things I said didn't make sense, which was frustrating because my thoughts were pretty logical - or so I thought. It was alarming to watch my decline. My biggest fear: Was this situation permanent?

My husband talked to my transplant coordinator at least once a day. Lactulose was prescribed, but not in enough quantities to make a difference. On the evening of Jan. 3rd, we ended up in the ER of a local hospital and, long story short, I was admitted and spent six days there flushing the excess ammonia from my body.

Turns out that I was experiencing an episode of hepatic encephalopathy because of too much ammonia in my system. My brain didn't work as it should, or as it usually does, and the only way to eradicate the ammonia is by excreting it via bowel movements. That's what the lactulose does - it's a syrupy, sickly sweet liquid that stimulates one's bowels. Finding a balanced dosage is done by trial and error, and what a freakin' mess that was!

It seems that 2014 is a year of challenges, because there has been plenty to be concerned about since January. And I'll tell you more about that in my next post...

Photo courtesy of Andrej Troha

Years After My Liver Transplant, Am I Simply Waiting to Die?

I wrote this on November 18, 2013, but never got around to posting it. So much has happened over the past month - things I want to share on my blog for other liver transplant patients and people who have Hepatitis C - that I believe it's worthwhile to post this now.

On December 3, 2006, I had a liver transplant that saved my life. Afterward, I was exceedingly grateful. Because of the transplant I knew I’d be able to continue to raise my children through the tough high school and early college years, and hopefully enjoy that ride with my husband, Gene.

In general, I’m an optimist: I embrace life with gusto, cherishing moments, loving family and friends, and laughing and learning along the journey.

But I now realize I no longer live my life this way. Instead of making plans for the future, I have spent the last seven years trying to survive an unending onslaught of procedures, treatments and bad news about how Hep C is wreaking havoc on my new liver. It's been exhausting, frustrating and depressing.

Instead of living it up, I've been waiting to die.

I had this "ah ha!" moment over the weekend and was shocked. I consider myself to be an optimist, a "the glass is half-full" person. I'm so fortunate to have had this transplant. When did my spirit break? 


Photo by Julia Freeman-Woolpert

Seven Years After My Liver Transplant, What Lies Ahead?

In spite of my recent blog whines (apologies), I'm still amazed at the miracle of modern medicine. At the beginning of December I'll celebrate seven years with my transplanted liver. SEVEN! I would never have imagined that this liver, which vexed me with so many complications for several years after my transplant, would prove to be strong enough to last this long. Granted, I have cirrhosis now (curses, Hepatitis C!) yet I've survived longer than I expected and I'm incredibly grateful to be here.

That said, do I have seven more years here on Earth? I doubt it, but there is little information for patients like me who are still alive many years after transplant. Furthermore, I want information that addresses Hepatitis C and cirrhosis in my transplanted liver.

For me, not knowing what to expect is torture. I'd like to know if I'll experience the same physical symptoms I had prior to my transplant. Also, I'm curious about my MELD score, which has been fairly consistent for the past two years. Will it slowly increase? How much longer will I live - I don't want an exact answer to this question but a general estimate would be helpful.

I'll continue to search for information and will share it in this blog.

Photo courtesy of Bayek, London, UK

Good Grief! It's Only Cataract Surgery.

In a few hours my husband will take me to a local Ophthamology Surgery Center and my doctor will remove the cataract in my right eye that has grown and now affects my vision. The procedure sounds relatively simple, they're giving me enough sedation that I won't flip out when the doc cuts into my eye and considering the myriad other procedures and surgeries I've had, the surgery and recovery should be a breeze.

That said, I've had several brief episodes today where I was on the verge of tears about the surgery. Why? There seems to be no logical reason. It's such a minor procedure. I compare it to the challenge that faces one of my best friends from high school who recently learned that she has breast cancer. THAT'S worth crying over.

I believe I'm experiencing medical exhaustion. Hmm... does such a thing exist? I dread the whole pre-op process, IV stick, answering the same questions every doc asks, etc. I've done more than a lifetime's worth of this nonsense and just feel so overwhelmed and tired of it all.

Now that I've had a little pity party, it's time for me to put on my big-girl knickers and deal with the challenge in front of me. Thank you for letting me whine. The next post will be more useful and relevant - promise!

Photo courtesy of Lauri Koski

Life, Death and Liver Disease

One month ago today, my mother died from liver disease, which her doctor said was non-alcoholic fatty liver disease.  Her death wasn't a shock since she'd been suffering for a number of years, but I was surprised at how quickly her condition deteriorated. My mother and I haven't been close for many years, but her death leaves me feeling sad, depressed and very mortal.

I've been terribly negligent about keeping this blog updated. Here's where I stand in my journey:  I describe myself as being on "maintenance" status with my transplant center. By this, I mean that I'm not a candidate for any available treatments, so I have blood tests every three months and we track my MELD score. For the past few tests, my MELD score has remained constant - 12 - which is pretty good (relatively speaking). My next set of labs will be drawn in about two weeks.

There's much more to share, but I'm too blue to write about all of it now. Before I go, a quick shout-out to Beaux and his successful transplant. I'm encouraged to read about every bit of progress there is. To those of you awaiting transplant, may you find peace in your trial. And to those who have had transplants and are struggling to achieve a "normal" life, please know that awaits. Normal will be different, but it will feel oh, so good!

I'm Qualified to be a Doctor Now, Right?

In my last post I wrote about how uncomfortable I was approaching my GI doc regarding his colleague's diagnosis, which I believed was wrong (I saw the colleague because my doc was out of the office). The problem I was experiencing wasn't critical, so this was no life-threatening matter, but I wanted to see what could be done to treat it because I was so uncomfortable.

The other doc said I needed to undergo a four-hour (and I'm sure, pretty expensive) procedure to confirm his diagnosis. But I didn't think his diagnosis was on-point and wasn't willing to spend the money on the procedure. Still, I was concerned about not following doctor's orders.

I saw my doc when he returned to the office and he concurred that I didn't need to undergo the procedure because the presumed diagnosis didn't seem exactly right. Ha! So there - I could be a doctor!  

Crowing aside, I'm dismayed at my reaction - after all this time and all my experiences with healthcare professionals over the past six years, I'd like to think that I would be more comfortable and confident when asserting my opinion, even when it isn't the same as the doctor's. But I wasn't. How can I be a good self-advocate in light of this realization? It gives me much food for thought.

Photo by Sasha Dunaevski

 

Well, This is Another Fine Mess...

What's a gal to do? I received a diagnosis last month that I believe is wrong and I'm uncertain about how to handle the situation.

Here's the scoop: Had an appointment today with my gastroenterologist, who was unexpectedly out of the office. Rather than reschedule, I agreed to see one of his colleagues (my symptoms had been plaguing me for weeks and I hoped I could get them resolved this week). This doc was unfamiliar with my medical issues - and there are plenty of them - and I believe he did what he thought was best given the circumstances. But I believe his diagnosis was off the mark and I'm not inclined to follow his directions.

I was very uncomfortable about addressing my concerns with my doctor, with whom I had a follow-up appointment 10 days later. But a friend helped me frame it up, suggesting that I point out the complications of my situation and ask for my doctor's perspective. A much more graceful approach than I can sometimes imagine.

Fingers crossed. Let's see how this goes.

Have You Been Tested for Hepatitis C?

Last month the Centers for Disease Control and Prevention (CDC) proclaimed May 19, 2012 as the first ever National Hepatitis Testing Day and proposed that every US baby boomer (people born between 1945 and 1965) be test for Hepatitis C. Why this unusual mandate? Because the CDC says that two million, or one in 30, baby boomers are infected with the Hepatitis C virus. This group accounts for more than 75 percent of US adults living with the virus. 

Testing is critical because most people aren't aware that they're infected with Hepatitis C, which can damage the liver for years with few perceptible symptoms. According to the news release, “Identifying these hidden infections early will allow more baby boomers to receive care and treatment, before they develop life-threatening liver disease,” said Kevin Fenton, M.D., director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and Tuberculosis Prevention.


The release goes on to state:

"Current CDC guidelines call for testing only individuals with certain known risk factors for hepatitis C infection. But studies find that many baby boomers do not perceive themselves to be at risk and are not being tested.

CDC estimates one-time hepatitis C testing of baby boomers could identify more than 800,000 additional people with hepatitis C, prevent the costly consequences of liver cancer and other chronic liver diseases and save more than 120,000 lives."

I hope this proposal is approved. I wish that circumstances were different before I developed cirrhosis and needed a transplant. Trust me... no matter how terrible the treatment might be, a transplant is harder. MUCH harder.

Photo by Wojciech Wolak

Beaux Had His Transplant!

After blogging long enough, I imagine that we'd all stumble upon (or be stumbled upon) people who share something in common with us, the reason our blogs exist in the first place. At least, that's how it's been for me.

One of the people whom I've become especially attached to is Beaux, a father, husband and name on a liver transplant waiting list until March 8th this year, when he finally had a transplant. Beaux is an inspiration to me, the way he persevered through myriad difficult symptoms caused by cirrhosis. His angel of a wife, Lo, blogged for a while after his transplant and kept those of us in cyberland updated about his progress.

But I'm worried. The last post on his blog, from Lo, was April 23. At that point docs thought he might have CMV.

Beaux, I'm praying for you, Lo and your daughters. I'm worried and would love a quick little "All's OK" or "Things suck."

I hope anyone who stumbles upon my blog will join me in sending good wishes and healing prayers to Beaux and his family.

Thanks.

A Simple Tip for Easier Access to Veins that Just Don't Cooperate

In the years since I started this blog I've posted more than once about how difficult it is to find a good vein in my arms for drawing blood or running an IV. (Usually I'm complaining about nurses or lab techs who won't listen to me and end up sticking me several times, without success - grrrr.)

Recently, a really wonderful lab tech suggested that I run hot water over my hands for a minute or two before she attempted the draw and, Eureka!, it worked like a charm. For every draw since then I've used the hot water technique and it's made the experience SO much better.

Yesterday I had a CT scan with contrast and we ran into the same issue - my two good veins weren't an option for several reasons and the veins on the back of my hand were tiny and rolling. Then I remembered the hot water trick and BAM!, the vein worked. The only downside was that they didn't warn me how the contrast was going to burn in my vein going across my hand and over my wrist. I literally yelled, "Oh, shit!" Frankly, they were lucky I didn't drop the f-bomb (I have a terrible potty mouth). Lord, I hate it when I'm not told to expect something in advance. No matter how bad it's going to be, just tell me or I'm going to hate you and never trust you again.

I digress. This post is to recommend the hot water trick for people like me, who have crappy veins and suffer because of it. I hope this works as well for you as it has for me!

Photo by William Stadler

Hepatitis C and Baby Boomers

Hepatitis C has made headlines recently, following the release of a study by the Centers for Disease Control and Prevention (CDC) that, among other things, revealed that one of every 33 baby boomers (people born between 1945 and 1965) is living with hep C. Furthermore, research reported in the Annals of Internal Medicine showed that three-fourths of the approximately 15,000 people who died from hep C in 2007 were between the ages of 45 and 64.

These findings and more were reported in an article in The Wall Street Journal, Hepatitis C deaths up, baby boomers most at risk. Some of the notable items in the story include the following:

"Deaths from liver-destroying hepatitis C are on the rise... "

"About 3.2 million Americans are estimated to have chronic hepatitis C, but at least half of them may not know it."

"In fact, in 2007 there were 15,000 deaths related to hepatitis C, higher than previous estimates — and surpassing the nearly 13,000 deaths caused by the better-known AIDS virus."

The CDC is deliberating "... whether to change testing guidelines to recommend that anyone born between 1945 and 1965 get a one-time screening."

I hope hep C screening becomes more widely adopted. By the time I experienced symptoms caused by hep C, my only option was a liver transplant. Discovering the disease early and getting treatment using one of the promising new, more effective drug regimens could save many lives.

Photo by Vangelis Thomaidis

New Year, New Opportunity?

Wow! It's been nearly two months since I last posted on this blog. The chaos of the holidays have kept me busy, but now they are over and there's lots of news to share.

The biggest change for me in the past 60 days is that my doc switched my immunosuppressant from Prograf to Gengraf. The docs at my transplant center are going to try one of the new Hepatitis C treatments on a small group of transplanted patients and those patients must take Gengraf. I'm one of the people being offered the chance to try the treatment, which creates a dilemma for me. A year or two ago I probably would have jumped at this opportunity, but now that I feel better I'm very reluctant to go back to feeling unwell all the time, which is almost certain to happen on the drug regimen. And because my liver has become cirrhotic, I'm not confident it will work.

So what's the right road to take? For now I've adopted a wait-and-see approach. Because it takes just four weeks to know if the meds are effective, I want to observe what happens to some of the transplant patients who take them. If it's successful, I might give it a go. Regardless of the outcome, I'm very grateful to have this choice.

In the meantime I'm trying to determine if I can handle the Gengraf side effects. The acne (ugh! face and back!) and hair growth (face and who knows where) aren't pleasant, but they fall into the "inconvenient" category. Leg cramps, night sweats, upset stomach, etc. - these are a bigger issue.

The year is off to a good start and 2012 promises to be as much of a roller coaster as ever. Here's wishing you and yours peace, grace and health.

Photo courtesy of michaelaw

Organ Transplant Recipients Twice as Likely to Develop Cancer, At Increased Risk of Developing 32 Types of Cancer

A study of more than 175,000 transplant recipients reveals their significantly increased risk of developing cancer, according to a study by the National Cancer Institute (NCI), part of the National Institutes of Health, that was published in the November 2, 2011 issue of the Journal of the American Medical Association.

A news release issued by NCI stated, "Organ transplant recipients in the United States have a high risk of developing 32 different types of cancer, according to a new study of transplant recipients which fully describes the range of malignancies that occur."

Researchers discovered that the most common cancers among transplant recipients were non-Hodgkin lymphoma, lung cancer, liver cancer and kidney cancer. Of particular interest to me was the following finding:

The risk of liver cancer was elevated only among liver recipients. Studies of cancer show, in this group, the occurrence of liver cancer can be partly attributed to recurrent hepatitis B or C infection in the transplanted liver, or to diabetes mellitus, which is also common among transplant recipients.

Organ transplants save lives, but there are numerous risks and challenges: Hypertension, diabetes (I was taking medication for these conditions almost immediately after my transplant), skin cancer (and 31 other types of cancer, according to this study), and much more. It's a lot to take on and for me, well worth it. But there's no denying organ transplants aren't for the faint of heart.

Photo by Johany López

The Effect of Cirrhosis on the Brain

Several months prior to my transplant I began experiencing "brain fog," or hepatic encephalopathy, which the US National Library of Medicine defines as, "... a worsening of brain function that occurs when the liver is no longer able to remove toxic substances in the blood." Among the symptoms are change in sleep patterns, mild confusion, forgetfulness, mental fogginess, personality or mood changes, and poor concentration. Symptoms may become severe and life-threatening.

What is the lasting impact of hepatic encephalopathy on the brain? Doctors in Spain and Italy conducted preliminary research on this topic in a study published in the September 2011 issue of Journal of Hepatology. Researchers used advanced magnetic resonance imaging and Voxed based Morphometry analysis to assess brain tissue density of 51 healthy subjects and 48 patients with cirrhosis.

The researchers reported the following results:

Patients with cirrhosis presented decreased brain density in many areas of the grey and white matter. The extension and size of the affected areas were greater in patients with alcoholic cirrhosis than in those with post-hepatitic cirrhosis and correlated directly with the degree of liver failure and cerebral dysfunction (as estimated by neuropsychological tests and the antecedent of overt hepatic encephalopathy). Twelve additional patients with cirrhosis who underwent liver transplantation were explored after a median time of 11 months (7–50 months) after liver transplant... Compared to healthy subjects, liver transplant patients showed areas of reduced brain density in both grey and white matter.

The doctors concluded, "... the loss of brain tissue density is common in cirrhosis, progresses during the course of the disease, is greater in patients with history of hepatic encephalopathy, and persists after liver transplantation."

This study isn't definitive, given the small sample size, yet should lead to further research. Nonetheless, it's troubling information for those of us with cirrhosis. At the same time, it explains a lot. When I become forgetful, I don't just have to use my usual excuses - advancing age, menopause - and can simply blame it on liver disease.

Image courtesy of The New York Public Library. www.nypl.org

Whew! My Lab Results Improve

Last week it was time to have blood work done again and I'm SO pleased to say that, for the most part, the numbers look much better. My MELD score, which was 9 two months ago and 12 last month, dropped to 8. What a relief!

My AFP test rose from 106 to 137, but I'm still not worried at this point. It would have to rise to the 400 to 500+ before I start wringing my hands.

My heptologist, a fabulous doctor, called me personally to tell me the results and discuss what's next. First, I'm going to take metformin again to help control my blood sugar. And in a month or so, I'll probably switch from prograf to cyclosporine. This change will make it possible for me to take one of the new Hep C meds, if they become available to transplant patients. I'm not sure whether I'll want to take the meds, but I'll ponder that matter if and when the opportunity arises.

In the meantime the docs will monitor my MELD score and AFP test results, and I'll be on the lookout for any signs of ascites (edema), varices (esophageal bleeding) and encephalopathy (I refer to it as "liver dementia"), which are indications of advanced cirrhosis. Mostly, though, I will enjoy this world and the people in it.

What I Wouldn't Give for a Good Night's Sleep...

Chamomile tea, a nice warm bath, counting sheep - when it comes to sleep, you name it, I've tried it. But insomnia still dogs me, as it has since I was diagnosed with end-stage liver disease and told that I needed a transplant. While everyone else slumbers, I'm awake and watching TV, tired but unable to sleep. Often, it isn't until 5 or 6 a.m. that I doze off, not restfully, feeling uncomfortable about all the things I'm missing as I sleep the day away... and then the cycle repeats itself.

I've come to learn that I'm not alone. A PubMed article, "Role of Sleep Disturbance in Chronic Hepatitis C Infection," posted on the National Center for Biotechnology Information, U.S. National Library of Medicine website, reveals the following:

Chronic infection with the hepatitis C virus (CHC) is associated with physical and mental symptoms including fatigue and depression that adversely affect quality of life. A related complaint, sleep disturbance, has received little attention in the literature, with the exception of sleep changes noted in cirrhosis and end-stage liver disease. We present an overview of studies indicating sleep problems in patients with CHC, with about 60% to 65% of individuals reporting such complaints. Evidence suggests that impairments in sleep quality exist independent of antiviral therapy with interferon-α and prior to advanced stages of liver disease. Further investigation of sleep disturbance in CHC patients with a mild stage of liver disease may provide important information on disease course as well as allow additional opportunities for patient support.

Unfortunately, there is no "cure" for insomnia; experts stress the importance of working with your doctor to find a solution. A Guide to Hepatitis C, Treatment Side Effect Management, is a fact sheet on the HCV Advocate website that offers basic suggestions to address insomnia, including the following:

• Make eight hours of sleep a regular habit. Sleeping less during the week and trying to catch up on the weekend doesn’t work

• Try to go to bed at the same time every night

• If you have a clock that is always lit, turn it so you can’t see the time

• Exercise every day

• If you nap, keep it short and early in the day

• Try reading before bedtime, but use a low-watt bulb

• Do not eat during the few hours before bedtime, but don’t go to bed hungry. If you eat something, choose food that is light and nutritious. Avoid spicy or greasy foods

• Take a hot bath before retiring

• If you feel you need to worry, tell yourself that you will only worry in the daytime. Make your bedroom a fret-free zone. Learn relaxation techniques to reduce stress and worrying

• Listen to relaxation tapes before retiring

• Do not lay awake in bed for more than 20 to 30 minutes. Get up, do something boring for a little while, and then go back to bed

• Your bed is for sleep and sex. If you are not doing either of these, stay out of bed

Hopefully, some of these tips will help. Here's wishing Sweet Dreams for us all.

Photo by Philippe Ramakers

What You Should Know About Liver Cancer

Hepatocellular carcinoma, or liver cancer, is something that's crossed my mind - wondering if I might ever have it - but I've never sought information about it, until now, that is. The US Department of Veterans Affair website offers information about liver cancer, including this list of "Things to know about liver cancer:"

* Liver cancer can cause death in a person with cirrhosis.

* Patients with cirrhosis resulting from any cause, including hepatitis C, hepatitis B, and alcohol use, have a greater risk of developing liver cancer.

* Liver cancer is one of the most common cancers in the world, especially in Asia and Africa, and it is becoming increasingly common in the United States.

* Biopsy refers to extracting a small sample of tissue with a hollow needle and testing it for liver cancer. A biopsy is sometimes needed to make a diagnosis, but imaging and blood tests can usually determine whether liver cancer is present. Biopsies of liver masses can be difficult to perform and there are some risks involved.

* Liver cancer can be treated if it is detected early, but the treatment is very specialized. Patients should discuss the details thoroughly with their health care providers.

* One excellent treatment for early-stage liver cancer is a liver transplant. This is a complicated form of treatment, because a patient first needs to be a good candidate for a liver transplant, then be evaluated at a liver transplant center and placed on a waiting list, and finally, be well enough to undergo a transplant when a donated liver becomes available.

According to the U.S. National Library of Medicine, which is overseen by the National Institutes of Health, "The (prognosis for liver cancer) is poor, because only 10 - 20% of hepatocellular carcinomas can be removed completely using surgery. If the cancer cannot be completely removed, the disease is usually fatal within 3 - 6 months. However, survival can vary, and occasionally people will survive much longer than 6 months."

Photo by Andrew Richards

Liver Cancer? Hepatitis C and the Alpha-Fetoprotein (AFP) Blood Test

In my August 12, 2011 post about the results of my recent blood tests, I mentioned the alarmingly elevated level of a new blood test that my doc ordered - the Alpha-Fetoprotein (AFP) test - which is an indicator of liver cancer. When I heard "AFP" I thought of a blood test I took when I was pregnant with both of my children. I've learned that the tests are one and the same.

According to an article from Gastroenterol that was cited on HCV Advocate’s hepatitis blog:

Alfa-fetoprotein (AFP) is a blood test that is used widely to detect abnormalities that may be an indication of the presence of certain types of cancers... In viral hepatitis it is a test used to indicate liver cancer... In people with chronic hepatitis C most providers will generally start monitoring for liver cancer using the AFP test and liver imaging once someone has developed severe fibrosis or cirrhosis.

As I continued my search for information about the AFP test, liver cancer and how to interpret AFP test results for people like me who have Hepatitis C and a cirrhotic liver, I found a web page about hepatic tumors written by D. Montgomery Bissell, MD, for Gastroenterology students at the University of California, San Francisco. He stated the following:

As a surveillance tool, AFP is readily available and inexpensive but has many limitations. Its specificity is poor, particularly in patients with chronic hepatitis C, in whom the value often exceeds normal (in the 5-100 range, presumably on the basis of regenerative activity). False negative results are not infrequent, which is the reason for including basic imaging in routine HCC surveillance. The utility of AFP is largely two-fold: (1) A progressively rising value has much greater specificity than a single test and requires a search for HCC; (2) AFP >500 is assumed to reflect HCC even if imaging is negative, and qualifies for transplant listing. Also, a very high AFP (>1000) suggests vascular invasion and metastasis.

Given this information, my AFP test result of 106, when the normal range is about 0 - 8, isn't something I need to be concerned about today. If the level continues to rise... well, we'll cross that bridge if we ever get to it.

Photo by Franco Giovanella, www.fotolog.net/giovanella

Tackling the Itch: A Medication That Worked and the Skin Products That Helped Most

For many weeks I've been vexed by severe itching. The condition is called pruritis and it's caused by my poorly functioning liver. The two meds I tried so far didn't work, so my doc prescribed a third: Cholestryramine. At last, we found something that works! What a relief. Few things are more uncomfortable than incessant itching and I'm very grateful for relief.

Note: Mark left a comment on my June 24, 2011 blog post, recommending Cholestyramine. You were right - thank you for your suggestion!

Pruritis is a condition that isn't alleviated by topical treatments. Calamine lotion and products like it are ineffective. Nonetheless, I kept my skin well moisturized - why run the risk of dry skin itch compounding the existing pruritis, right?

Here are the moisturizing products that I've been using, all of which I highly recommend:

Skin Free makes my favorite skin care products. They're super-rich without being oily. The body balm is a great all-over moisturizer that I usually apply in the shower before toweling dry after bathing. And the butter stick is the best smelling moisturizer I've ever used.

My every-day, all-day-long lotion is made by Gold Bond. Obviously, Gold Bond isn't just for just for jock itch. I use the Ultimate Healing Skin Therapy Lotion. As the company states, this lotion has "... aloe to heal dry, problem skin." It's the thickest lotion I've ever used and while it costs more than other brands, to me it's well worth the money.

Lastly, I recommend Eucerin. I first used the Original Moisturizing Creme in the hospital after my liver transplant, when it was given to me by docs. I was told to put it on my lips, which were scraped and terribly scabbed by tape used to hold tubes in place. It was very healing and I'm happy to say that my lips are as good as new.

My Blood Test Results Don't Make Sense

At the beginning of the week I had blood drawn and today I received a copy of the results. Some of the numbers were alarming and others had me shaking my head in disbelief.

The good news - most of the tests in my hepatic function panel (ALT, AST, GGT, etc.) are better than they've been in ages. Seriously? My liver is cirrhotic, but on paper, these tests indicate that it's doing fairly well (for me, that is - it's all relative).

Other results aren't so wonderful. My MELD score has increased to 12, a jump of three points in five weeks. The docs are chalking it up to an elevation in bilirubin and don't seem too concerned. I'm praying that it's not a trend.

Additionally, my doc is running more tests now, one of which is AFP serum (it indicates the presence liver tumors). The normal range is 0 - 8.3 and mine is 106.2. ONE ZERO SIX POINT TWO. Holy crap! My doc believes the number is elevated because of my aggressive Hep C, not because I have a tumor. Six weeks ago I had two CT scans and neither showed a tumor, which is a good sign. But I'd be lying if I didn't admit that I nearly fell off of my chair when I saw that result. I'm grateful that it had been explained to me before I saw the results.

Up next: More blood work in three weeks and an endoscopy (where a scope is run down my esophagus). And I'm not certain what else, but I'll keep you posted.

Photo by Heidi Marasigan