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Palmar Erythema and Liver Symptom Sequence

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Old 05-06-2011, 06:41 PM   #16
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Re: Palmar Erythema and Liver Symptom Sequence

Fluid Wave test.

When I have just eaten - my abdomen is more taught than when I have not eaten.
In the morning, my abdomen protrudes less when lying down - and if I tap it on top it does seem wobbly. Wheras after eating a lot - it is taught and seems bloated - thus it doesnt wobble.

I have tried to examine myself for shifting dullness - but I am inconclusive on that because I do not understand ***exactly*** the sound I am listening for.

I tried taking dandelion - because I am too worried about the truth - to see if I could cause diuresis? but could not. I took a lot until I got to the point where I was 4x the max dose on the bottle. Nothing happened.

If it had - and I had lost weight and girth rapidly - then I would have been forced through knowledge to go to the doctors and get the ball to my death rolling.

Its dreadful living like this - but I do honestly think that if I went and got a prognosis < 3 yrs it would kill me.

I guess I am trying to string myself along.. Im confused at the end of the day.

I would - with my own limited knowledge - say I am borderline decompensated - or rather - if I have ascites, just now decompensated.

Last edited by Redpalms; 05-06-2011 at 06:45 PM.

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Old 05-06-2011, 06:50 PM   #17
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Re: Palmar Erythema and Liver Symptom Sequence

I have been thinking some more now.

Around 1 year before I stopped drinking - the skin on my forehead between my eyebrows started to become flakey and red. I used hydrocortizone cream and that would clear it up - but it always came back a week or two later.

This went on for about 20 months - but 4 months ago - it cleared up and has not come back.

I also suffered terrible dry scalp aswell with dandruff falling off and visible flaking round my hairline. This has also eased somewhat over the last 4 months.

I also have a dry mouth quite a lot. Especially at night in bed.

My night vision - I have not noticed anything problematic in that area.

I have never exfoliated properly - this is something I will look into - although Im wary of curing the spots but not the cause if its liver related.

Last edited by Redpalms; 05-06-2011 at 06:53 PM.

Old 05-06-2011, 07:52 PM   #18
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Re: Palmar Erythema and Liver Symptom Sequence

Our NHS system here will likely treat me like an insect as this was done of my own accord. (Although I debate in my favour as I thought this only happened to 75 year olds in the gutter with a bottle in a brown paper bag) and it never once entered my head that a 40 year old could die of drinking problems.
I found out a guy died mid 40s who was a friend of the family. My hair stood on end on my back. Because I knew then that I was in danger. My first reaction when I heard he had died of "drinking" (I knew no detail) was that he had committed suicide - died of alcohol poisoning (acute rather than chronic which of course I knew nothing of at the time either.
So looking into it - I noticed things like lists of symptoms - Palmar Erythema being a noticable one. I looked at my hands and almost died on the spot - there it was.
The previous day was my last boozed up evening/night.

Since then - I have learned what I know - not scientific by a long shot - but the basics.

As you say - my symptoms appear to be textbook along with the cause itself.

Having been on here with you tonight - I have some serious thinking to do about the future. In essence - you have diagnosed me - being as you are medically educated. You have in fact pretty much given me a prognosis - as I know enough to read stats from the right websites online. These would be inline with MELD scores and Child-Pugh scores - given symptoms at various levels. Whilst I dont know my LFT's or Prothrombin time and a few others - I think its really safe to say that I am on the scale - and the cirrhosis will likely progress.

I have often wondered whether they are more geared towards viral Hep though - with the liver still under attack - rather than a liver no longer under insult.

Youve explained for the first time how cirrhosis can progress of its own accord. I think its pretty much at that stage when ascites is present from what I read - and also - before ascites is present.

You are a good bloke for listening to me - non-judgemental (at least not revealing)

For that - I thank you deeply.

It is almost 4am now here - day/night reversal is another symptom Im told - and here we are!

What is needed now is action on my part. Whether I am ready to face up to this yet is unclear - but a step towards my doctor is looking more imminent by the day.

I do sympathise with the US patients. I have read a lot of horror stories. I am under the impression (maybe wrongly) that Obama is sorting that out?

For now - I must go and lie down and think hard.

I will try and get some pics of my symptoms for you - a case study

Although with the way society is - and your field of training - I suspect I will be one of a many many people you see in this mess over the coming years.

Catch you later and thanks again.

Old 05-07-2011, 08:30 AM   #19
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Re: Palmar Erythema and Liver Symptom Sequence

RP? the one thing that i just DO highly doubt in your particular situation AND the mere fact that you DID indeed quit drinking, is that you would be treated anything less than the human being you are. you simply DO need help here that ONLY an educated GI or hepatologist can give you right now. i am glad, soo glad that it appears to have decided its time to simply see the doc and get some testing done? and a huge congrats on your sobriety year, that IS a huge huge deal and more than likly IS the main reason that things have not progressed to the point they easily could be at this point too, so give yourself a huge pat on the back for that.

luckily, you have gotten some really great advice from DD here thru this. i am not too certain as why i have only gotten one mail sent to my inbox with this many responses tho. but i am here only becasue i DO truely care about you, your condition and what this does and can do to a persons family. you HAVE made some really good solid choices for yourself RP, but getting that ball rolling with simple baseline testing is critical for alot of reasons. everyones disease processes do NOT always play out in the very same ways since there just are so many different variables involved. so some things that you feel may be really bad, may not be as bad as you might think, and some things you will just find out as you go.

simply obtaining that very basic labwork done on you along with a needed UA to check for any traces of actual ketones since you are now mentioning friuty breath? are needed. they can also check your portal vein flow velocity by actually doing one simple doppler ultrasound. trust me, that doppler, which is just a small kind of flat wand that is simply run over the over the outter abdominal, sides and partial back(by the tech) at various angles really SHOWS all vascular flow including not just P vein flow velocity based upon among other things, color changes with that doppler system(its kinda like watching the weather channel), but also the overall texture of your liver/scarring, and how your actual blie duct flow is, size of your liver too among other needed info. it would also allow checking of all other organs in your upper GI too just to see if anything else is also involved, or more responsible for particular symptoms not directly related to the actual liver. i get one of these every single year to help monitor my own liver and kidney diseae. alot of info in one very simple non invasive test.

once they have done the very basics that will at least allow them to know the basic function levels you still have and how much critical bloodflow is also still going thru the very needed P vein, then they will more than likely want to that liver biopsy. while it does sound kinda scarey, it truely is not that bad and allows much more detailed info on the more 'inner cells' and how impacted "they' just are too. how those cells simply 'look' under a microscope will give them a ton of good info on YOUR particular liver disease process. and they DO numb you up really well before they do this too and also if you need or want, they can use along with the lidocaine for numbing, a combo of what is usually fentanyl and versed to help ease any other pain and help relax you too. my son has had five at this point, with that inital one done when he was first admitted since they assumed before all testing was done that he was going to be an immediate 'placed on the list' candidate, he wasn't at that point since there just were certain things they could actually still do for him. despite him already having a completely closed of P vein(he was vomiting blood VERY heavily from that then) upon US and being done to only about 20% of his overall liver function ,and NO jandice yet either which just totally freaked me out. if you are NOT at all seing anything in your stolls that appear to look almost exactly like coffee grounds or are not vomiting up any blood and are feeling faiurly clear headed as well(tho high blood sugars can also kae a person feel 'off' too), chances are that your own P vien has NOT yuet closed itself off and is still clearing the ammonia that is done when any blood merely passes threu that P vein. that would be a huge indicator for P vien compromise. using lactulose now just to keep things moving would NOT actually be a bad idea either. you WILL be placed on this liquid med if that P vein DOES close off from scarring tho. its just very needed at that point to get that backed up ammonia thru the intestines where the longer it sits there, the more ammonia gests absorbed even thru the intestinal walls, and then of course attaches to the brain cells. but hopefully you are not there yet. but simply reducing, as dd mentioned, your overall protien intake ESP when it comes to red meats which DO contain and create a much higher level of protien/ammonia down the road would really be a good idea too.

what concerns me the most right now is your mentioning of the fruity breath? as DD mentioned, this can be impacting how well the pancreas is also working along with the livers job too when ANY liver disease is also present. you just DO need to have your blood sugars tested to see where they are too. if your BS is way too high, it also would place you at very high risk of going into a ketoacidosis or whats usually called a diabetic coma(this just IS the more common cause, hence the name)? at that point, you would really NOT even have the ability to say no, do not take me to the hospital. that choice gets taken out of YOUR hands anytime you become unresponsive and not able to tell what YOU want done. then you would also risk having a siezure and brain cell damage too. it all really depends upon how high the overall BS is at the time. overly high BSs/fruity breath are just not to be taken lightly either. they very much can do their own levels of real damage if not appropriatly treated within a certain timeframe. you just seriously DO NEED that blood sugar checked along with everything else, and the sooner the better RP. the bigger problem when you wait to even find out just where you are at with ANY level of liver disease is it does start to really impact the other GI organs too. so you just DO seriously need to make up your mind to go to your doc and get this all started hon. your kids DO deserve to have their father around for as long as they possibly can. and you are NOT any 'less' in anyones eyes becasue you succumbed to something that DOES affect billions of people when they are usually trying to 'cope' that results in alcoholism. you did something, you found out you have a liver problem and quit the toxin from even being reintroduced into your system. now you just need to make the appropriate choices to give yourself back to your family RP. what you did was admirable(and the absolute BEST possible thing you even could have done considering) and most certainly is nothing to be ashamed of. now if you simply did nothing and did NOT FIGHT back for at least your kids sake, that would be the bigger tradgedy in all this. you OWE them YOU.

i KNOW you have been in and out of denial over this and were hoping there was some possible way of changing things be doing anything that you could at home. but you realistically NEED the ongoing testing and expertise of the specialists right now to get your baseline estabilised, and that critical GGT that shows them you have not been doing any alcohol consumption either. this just realistically should have been done wayy before now so 'they" already were aware of your sobriety date. but doing this now would still take care of that part and document it. its just critical to have that sobriety established in this type of situation, the sooner the better.

just one other thing i needed to mention to you is reguarding what if any potential OTC type pain relievers to take? while that particular choice should really be up to your doc and him knowing where your particular labs are. taking a small amount of tylenol is not a seriously 'bad thing' like you may think compared to what can happen with ibuprofen or any other types of NSAIDS that also tend to thin out blood as well. when NAPQI actually even gets generated, its ONLY when a needed chemical that is in the liver called 'glutithione' gets too depleted. THEN you have a toxic situation, but ONLY if no glut is availiable? the thing is, that same exact chemical is what also metabolized ALL of the alcohol you consumed as well? this is the biggest reason there is finally a big warning about taking tylenol along with alcohol. once that glut is gone its gone til it has time to actually replenish itself with NO toxins being introduced for like 24 hours, but that is when the NAPQI gets created. it simply will not metabolize anymore alcolho which goes to the brain and can create alcohol poisoning and pretty severe liver damage all in and of itself. but with NSAIDS, and ONLY becasue you really have NO CLUE as of yet just how your blood is clotting, taking anything that may thin it even more, esp if you end up with a ruptured varice,can really create much worse overall bleeding than if you had not taken it? thats what i see as a potential issue here.

we were told when even my son being down at the 20% of liver function left, that in THAT type of situation, its simply 'safer' to use a smaller amount of tylenol and NO NSAID type pain relievers. but this DOES need to come from your doc ONLY really once he knows where your overall labs are at and more importanly what is still being generated in your liver as enzymes/chemicals along with of course clot time. there ARE also a few narcotic pain meds out there like roxicodone(it is basically like percocet without any tylenol? just 'plain' oxycodone) that also can be used that would NOT include any tylenol or any NSAID what so ever too. these types of narcotics are simply used more for chronic pain patients which i am unfortuently one of too, becasue we HAVE to take soo much of this crap on a daily basis. but these types of meds can also be very beneficial for you too if actually needed. there are also 'long acting' narcotics out there too that you only have to actually take like two or three times per day. but like i said, getting all of your labs done and levels/functions known right now, is really critical.

as much as certain things may 'sound' like specific conditions with symptoms, there realitically is no true way for anyone to fully dx anyone with anything over the net(just good educated guesses til certain things are known). there is just not enough real solid info availiable that your doc can obtain. and also seeing what the patient is acting like, looks like,and esp palpating that abdomen also IS part of the overall exam as well.

i just truely hope you can do this much sooner vs later, esp with the latest newer symptom. that just HAS to be checked out asap before something else happens that will take the doc decision right out of your hands RP. we just want you to have the best possible life here with what you are dealing with. and for your kids to NOT lose their father either. i lost mine just a few years ago and i am 50. it still absolutely killed me inside since it was soo sudden and unexpected too. just DO what you now KNOW are the main things needed for your best interest and health, K? good luck RP, and DO please keep us posted. we DO care about you or we would not be here or so concerned. just please keep THAT in mind too? marcia
3-22-01,herniated C-6-7
11-20-01,placement of hardware for failed fusion
9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

Old 05-07-2011, 11:22 AM   #20
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Re: Palmar Erythema and Liver Symptom Sequence

Hi Marcia, Thankyou for your post - I will try and give you some info.

My breathing doesnt have the fruity smell it appears to be my sweat - in the night. Its the top of the quilt which has the odour - some days - some days not.

So things maybe not so bad ......yet?

The pills - for years I took ASPIRIN daily (an NSAID) - I took it for a neck injury - the pain comes and goes with it. I would take a lot - upto 1800mg per day. This would be mixed with alcohol - naturally I dont know if this has made things worse. Do you know if this makes it worse? I take NOTHING now - and havent for around 6 months. Not one single pill.

I will have to check whether we can do portal vein flow and pressure with non-invasive technology here - I havent heard of that before. It sounds impressive.

My GGT levels wont change now if I went to the doctor. Lets say I was still drinking and I got my GGT then next month it would be less if I stopped on the first test. So now if I go - it will be a fixed number from hereon in - SURELY this can prove I stopped to them. But I can see they wont know for sure how long. Well I know anyway - its a year on May 15th.

I know I should go.

I really want a way to kick myself in the rear side so that I can be forced into it. If I could get my weight to fall by 6 lbs in 10 days then that really would proove to me that I have ascites and that scares me to death.

I was saying to ddfreedom last night that I had put weight on since xmas. But I mentioned stone as my unit of measurement.

So to clarify - I would like to know if this sounds like ascites.

At christmas last year my weight dropped from 180lbs to 171lbs in a week - it is now 182Lbs
So an 11Lbs increase in four months.

Well - my abdomen is where it all seems to be - I look pregnant. But I have put on SOME subcutaneous fat aswell - I can tell.

To me that weight change could be anything - but - the sudden drop at xmas really bothers me A LOT.

Now that I have reached that 182lbs I am worried again. BUT I read things about people with ascites and my own weight gain is very very slow it would seem. So maybe its not ascites?

This is why I am so desperate to prove myself WRONG. I want to prove to myself that I have it - and I HAVE TO GO - NO QUESTIONS ASKED - GO.

How can I prove it? Is there a natural diuretic? Shall I get my hands on the potassium sparing pills online and give it a week.

If my abdomen shrank - I would shoot to my doctor right now - because then with the facts in hand - there is NO DENIAL.

I know im a joke. I dont want pity - I think I just want logical facts for myself to kick me into gear. It just the way Ive always been - like the dentist - forget the checkups and go when the pain is too bad. Must be a gene or something

Old 09-11-2011, 06:25 AM   #21
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Re: Palmar Erythema and Liver Symptom Sequence

Hi All,

Its 4 days short of 1 year and 4 months now since I stopped booze 100%

I have to say the following for the record.

My Palmar Erythema is still there and it is worse - its deeper pink more frequently and also more prominent on the bumps at the base of my fingers aswell - which it wasnt really a year ago.

I dont think ive got ascites - I think I have just gained fat through a fatty diet and reaching 42.

The skin on my forehead used to be red/flaky itchy between my eyebrows this cleared up about 6 months ago and stayed clear for about 6 months but is coming back again.

My fingernails seem fine and there is no clubbing.

I have no new Tangliastes but the old ones are still there.

I am tired a lot and it takes ages for me to come round in the morning - about 3 hours before I am awake and "normal" feeling.

I lose sugar and get the shakes about once a month.

I dont feel sick anymore - well maybe once every two months or so - but thats because I am hungry really and have missed meals due to laziness. It used to be almost every other day I felt sick.

Still have spotty upper arms.

My diet is atrocious - I eat grilled lamb and pork chops/ribs with fries and onion rings and chilli sauce every day. In large amounts aswell.

So is my liver holding out? I do not know. I just wish I hadnt been a drunk for 10 years.

Dont do it. I have no idea if I have varices - for all I know they could be there and ready to burst at any moment.

Last edited by Redpalms; 09-11-2011 at 06:34 AM.

Old 09-11-2011, 09:45 AM   #22
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Re: Palmar Erythema and Liver Symptom Sequence

Hi RP, I found your thread a few months ago when I was looking into some distressing symptoms I was having that I fear are drinking/liver related. I can relate to so much you are going through, almost like a mirror image of myself.

My first symptom was a change in body odor I would get from supplements I was taking. I would take vitamin E, and a strange odor would appear on my bedding and clothes. Other supplements I had never had a problem with would cause similar odors.

On further investigation, I found the telltale red spots on my chest and a few faint spiders lurking about . My palms were clear until I stopped drinking and my blood pressure shot up for a while. Now I've got those lovely little pink areas you described so well below my little fingers near the wrist.

Thanks to your posts and the responses given, I think I've caught on to the danger I was in and made the necessary changes in my life to halt a serious decline in my health. Thanks so much for relating so well exactly what was going on.

A few things I have found in my own research you may find helpful.

Coffee has shown some remarkable anti-fibrotic properties for the liver... If you google around on coffee and cirrhosis, you will find studies describing the remarkable protective properties coffee has in preventing cirrhosis in drinking populations. Each cup of coffee drank daily (long term) reduced the chance of cirrhosis in drinkers by 20%, with up to an 80% reduction in cirrhosis at 4 cups per day. Coffee won't dissolve fibrosis you already have, but it may halt or slow the progression of fibrosis yet to come.

Coffee drinkers with liver disease / cirrhosis have also been found to have a much lower rate of liver cancer which is a common problem in liver disease than those who don't drink coffee.

A fellow in Germany (Olav A Gressner) believes he has found a metabolite of caffeine called "paraxanthine" is responsible for the remarkable anti-fibrotic effect of coffee, but his research on this has been questioned. The fact remains though, coffee has some magical effects on liver health and its all good.

Freshly brewed coffee from freshly ground beans is probably best, and decaffeinated coffee may not work (if you believe Gressner). Also, you should always use paper coffee filters rather than a French press or wire screen as paper filters effectively remove "cafestol" and "kahweol" from the coffee, and these "diterpenes" have been found to raise liver enzymes in some people. Filter your coffee through paper filters and this possible issue is solved.

Also... Eggs, specifically lecithin (aka Phosphatidylcholine) found in egg yokes has shown remarkable properties in liver health, both in preventing liver disease, and helping regain function in livers compromised by disease. Google around on: Lecithin and Liver and Lecithin and Cirrhosis for more info on this. You'll get the most benefit from eggs if the yoke is a bit runny... Sunny side up, over easy, or soft boiled, so don't cook them to death. There is a small risk of salmonella when eating undercooked eggs, but the reward from the magical stuff in egg yokes may well be worth this risk. Cirrhosis scares me a lot more than sunny side up eggs!

Finally... I've been reading a lot about fats and oils and the liver. It seems the liver is at odds with the heart when it comes to fats and oils. Hearts may like polyunsaturated vegetable oils and margarine, but it seems livers prefer saturated fats and real butter. One researcher even damaged his lab rat's livers by feeding them alcohol and polyunsaturated fats (fish oil), and then reversed the liver damage by changing their diet to saturated fats (palm oil), even while they were still getting fed alcohol.

The liver is Grand Central Station for all fats and oils in the body and it seems polyunsaturated fats oxidize at the drop of a hat (lipid peroxidation), creating oceans of free radicals that damage the liver. Heart disease is bad, but I'm more worried about my liver, so I just say NO to foods labeled "heart healthy" as these often contain polyunsaturated fats and oils that appear to be the liver's nemesis. Google: "Dietary Saturated Fatty Acids: A Novel Treatment for Alcoholic Liver Disease" (without quotes) for more on this.

We can't turn back the clock and un-do what we've done to our bodies, but it seems to me our best hope is to slow/stop the progression of disease. Let's do our homework and see what else we can find.

Again, thanks so much for posting your symptoms and findings. Together perhaps we'll see a few more decades of good health.

Best of Luck to You!

Old 09-12-2011, 10:38 PM   #23
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Re: Palmar Erythema and Liver Symptom Sequence

Hi Again RP... A few more thoughts for you to ponder.

Regarding your fears of only a few more years left. From what I've learned, the life expectancy of someone with Child Pugh A disease is 15 to 20 years, not around 5. That may mean at least 10 or more fairly good years, with perhaps some diuretics or lactulose as needed, and able to work at least part time. 10 years is a long time, and plenty of time to worry about the next 10. I wouldn't start worrying about a transplant just yet.

We should also consider these numbers include those with Hepatitis-C, and perhaps some alcoholics who continue to drink, and decline due to the ongoing insult to their livers. I should think a drinker who really can stop for good while at Child Pugh A should have the best chance to make it longer than anyone else with this disease.

Regarding your current fear of ascites... Again, just from what I've read, as long as it is not progressive; mild transient or cyclical ascites is not a sign of decompensation, but simply a normal part of the disease. Before you go trying to find some potassium sparing diuretics on the black market (as you mentioned above), you might ask your doctor about a kinder, gentler diuretic like coffee / caffeine. Besides drying you out a bit, this just might also slow down any fibrosis that is occurring as current research seems to indicate.

If one has had problems with caffeine in the past, one could consider humans are known to develop a tolerance to caffeine rather quickly. One might start out with black tea and move on to coffee after a week or so on the tea. I know my stepfather drinks coffee all day and brags he can have a couple of cups in the evening and still sleep. I've read dietary recommendations for people with liver disease and most doctors are OK with moderate amounts of caffeine for patients with mild to moderate disease, still, it is always best to talk with your own doctor before one takes caffeine or any other substance or supplement. It is also smart to start out slow with anything one might try.

I am NOT a doctor, by the way, so take my thoughts with a grain of salt, and do your own research (and talk with your doctor!) before you try anything like this.

An interesting side note... Caffeine is metabolized by the liver, and there is actually a liver function test called the "caffeine clearance test" that indicates how much liver function one has left. This test involves taking a measured dose of caffeine and measuring the metabolites in the urine and saliva for a few hours, but I've actually done a home version of this test myself. I took my resting pulse (count the number of beats in 6 seconds and multiply by 10) and record it. Then I had a cup of coffee (or two?) till I get a mild case of the jitters and take my pulse again. It is higher now.

I keep taking my pulse every 30 minutes and see how long it takes to return to normal. If my liver is "clearing" the caffeine out of my blood in 2 to 4 hours, this is a good sign. 4 to 6 (or 8) hours, perhaps not so good. I always rest in a chair for at least 5 minutes before taking my pulse. Even walking into the bathroom and back will raise it for a few minutes and the "resting pulse" is the number I want. Smoking will scue the results down a bit (speed clearance)... Nicotine is metabolized in the liver too, and this will raise ones metabolism rate for caffeine as well. Smoking will also raise ones pulse and foul up the results, so no smoking during the test. I cleared 2 cups in about 3 hours, so not bad. I do smoke a pipe though, so perhaps I got bad results.

Another interesting tidbit... After reading a small ocean of data about hepatic encephalopathy, I found an interesting clue to the earliest sign of this condition. Its a speech artifact called "stymie"... When a word is on the "tip of your tongue" but you have difficulty getting it out or saying the word you're thinking of.

When I quit drinking, my brain seemed scrambled for a couple of months, and I thought "oh my god, I've got it", but as I got on an even keel a few months down the road, my stymie vanished.

Just thought you might find this interesting.

Hope you're doing well.

Old 09-13-2011, 03:31 PM   #24
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Re: Palmar Erythema and Liver Symptom Sequence

Hi BillinSD

Thanks for your input - I REALLY appreciate it.

I think from my communication with Freedom and a whole lot of other reading I have done - its clear I have cirrhosis and also its clear that I cannot go to my doctor unless something like an internal bleed or ascites gets the better of me. Fatigue may also cause the push required if it gets much worse.

So here I am with the primary objectives of staving of the visit to the doctor by attempting to manage my symptoms before they start - and to lessen the effects of those I have.

BillinSD (Bill?)

Yes - I would give myself a CP score of around 5 to 7 (So either A or very early B) allowing for no HE and No or Mild Ascites. The blood scores - I am assuming would fall into the same column rating. So for instance - my logic is that if I had terrible ascites, I would also have less than 28 albumin. Whilst I know this is an assumption - I have noticed that people with way out blood scores on various tests are also suffering the later symptoms and are typically already on a regime of Lactulose, Beta Blockers and Spironalctone (sp?) to control the HE, Varices and Ascites respectively.

I know I am dancing with death here by self-diagnosing my position - it is my choice though. Well - if we were to discuss the psycology of my reasoning for not going to the doctors - we would probably find it is not my choice - but beyond my mental capacity and out of my own control - thats how hard I find it!!! Hey ho - we cant all be perfect

Then we have the only thing which can be done at this stage would be beta blockers for blood pressure. I have my own blood pressure machine and my level is normal - so I couldnt take it down much anyway safely????
I contemplate the folks with burst varices being of the higher natural blood pressure levels and also being further gone with other symptoms such as HE and Ascites already present.

Dancing with the reaper again :/

The hands have gone redder recently as I said - I speculate that this could be the effects of long terms exposure to elevated hormone levels as opposed to a rise in the actual levels in the blood - deep down in my head though - I suspect most strongly that the levels have risen recently due to a decrease in liver function. I would like to know the level of decrease in function which has caused the level of increase in the hormone. Like - has a decrease in my liver function of .0001% caused my hands to go redder? If so - I would not worry - but my head tells me ive lost another 1% liver function in the last 8 months. Pure speculation.

So I like the idea of coffee - I drink at least 4 cups per day already - just out of choice. I work from home so I can drink it as required. I think I will increase my intake though - not by cups - but I will be increasing the strength of each drink. I will be doing this on the basis of trying to increase protection against fibrosis - and I may lose some weight (if I am carrying fluid). I will let you know how I get on.

Your test of metabolizing the caffeine - I can relate to that - but with alcohol. In the few months before I quit the booze - (I would always have 10 cans (about 9 pints) during an evening) - my wife noticed that it was affecting me faster - by about the 3rd can. Normally I would slur slightly after 5 or 6 cans - but in the last three months - I was slurring slightly at around 3 cans. I put this directly down to a decreased rate of alcohol metabolism. Of course - at the time I thought nothing of it - I didnt have a clue about alcohol, metabolism, liver disease - the most I worried about was losing a few million brain cells - which given everyone elses drinking habits - it would appear that those didnt seem to matter.

I can start on the eggs right away. I went into them a while back (hard boilded) as I was told they were good for protien and albumin levels. But because I felt ok - I lapsed into a dreadful diet of self punishment almost - chops chips and onion rings with chili as I mentioned. This stopped yesterday with a light meat and potatoe pie and chips - and today a lasagne.

So tomorrow I will buy in the eggs and cook lightly.

I looked up the index and found (of all things) rice crispies had a high index -Orange Juice? I found this to be middle of the road in the index I looked at.

Ok - thanks to you guys I have something to attack here. The goal is as follows :-

To increase liver function (Eggs - more veg and fruit)

To look after liver (Coffee - less Polyunsaturated Fat)

To thwart fatigue (Rice Crispies - plus above)

I do hope with increased function I would see some lessening of the reds of my hands.

The doctor visit will happen eventually - but I NEEEEEED to try better myself first before going. Ive been shocking on the diet front for months now. So its time I changed that. The booze is stopped - 1 year 4 months now - it isnt an issue thankfully - it is simply impossible for me to have a drink. My brain is as stubborn on that one as it is on the not letting me go to the doctors front!!!!!

BillinSD I didnt get the stymie - just the tiredness - especially in the morning for around 2 to 3 hours. Sometimes all day at the moment.

I will come back here and let you know how im getting on - I also would really appreciate BillinSD and DDFreedom keep feeding me this invaluable information.

Thanks enormously.

Last edited by Administrator; 12-09-2011 at 12:50 PM.

Old 09-13-2011, 11:02 PM   #25
Join Date: Aug 2011
Location: California
Posts: 341
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Re: Palmar Erythema and Liver Symptom Sequence

Hi Again RP. A wee bit more of my "invaluable information" for you...

Have you looked at the possibility of Hemochromatosis??? A genetic condition common in "Caucasians of Western European descent", where iron is absorbed at a high rate in the gut and builds up and damages the liver?

Symptoms are often seen in "men between the ages of 30 and 50" and present as classic liver fibrosis symptoms. The liver symptoms are usually accompanied by joint pain and "bronzing" (darkening) of the skin.

Treatment is simple, but absolutely essential... They simply drain some blood from a vein in your arm (like in blood donation) until your iron levels return to normal and the damage stops. The test for hemochromatosis is equally easy... A blood test for "ferritin" and free iron.

You poured down the pints pretty good there for a few years, yet it is unusual for so much damage to occur so quickly at your age provided you were eating. I suppose the pain meds could have contributed, but you must realize how unusual it is to experience this much damage so early, and hemochromatosis would explain this quite well.

Aside from genetic hemochromatosis, there is also "secondary hemochromatosis" which can be caused by alcoholism! Some homework for you... Look up: "alcohol and iron overload in the liver" (without the quotes). You should find iron overload, (particularly in the liver!) is a common problem with chronic alcohol consumption. Once you develop iron overload, it can remain for years, even after you quit drinking.

Iron is a VERY powerful pro-oxidant, and can pre-dispose liver damage whenever it is high. I've even seen opinions the reason women tend to outlive men is due to the fact that they lose iron through menstruation and therefore have less oxidative stress on their bodies over their lifetimes. Studies have also shown blood donors enjoy better health because of their donations.

Speaking of blood donors... Donation is the easiest way to dump excess iron from your body. You are supposed to be in good health to donate blood, so I don't know if they would take you. Fair warning... The needle they use is quite large! About the size of a pencil lead, but it really doesn't hurt much more than the smaller needles they use to draw blood for testing. It takes about 10 minutes for them to draw half a liter, and it would take several donations (every other month) to draw down your iron levels. Still, if you've got alcohol related iron overload in your liver, this could add years to your life. If you've got hemochromatosis, this is the only way to save your life!

I've been a blood donor for 20 years, and I've noticed I seem to feel better in the weeks after I've donated. Perhaps this is why I also could drink for 35 years before I ran into trouble!

I don't see why you can't just go see your doc and tell him you've been feeling tired and just want a check-up. If you haven't been drinking in over a year your enzymes shouldn't be embarrassingly high. Ferritin and free iron are not normally included in basic blood work so you would need to ask for these. You could tell him you found a relative who had hemochromatosis and want to rule this out as a reason for your fatigue. Albumin may also be something he may not order unless you ask for it. A CBC (complete blood count including platelets) and liver panel is also essential.

As your "drinking enzymes" are normal now, but your iron levels may very well be high, you might be able to blame the whole thing on this "mysterious iron overload" and save face. One thing is for sure... If you've got iron overload, either from hemochromatosis, or drinking, and it goes untreated, your health will most likely continue to decline.

In my humble opinion, the "Holy Grail" of cirrhosis survival is to stop or slow down new fibrosis generation on as many fronts as possible... Anti-fibrotics (coffee/caffeine), avoiding pro-oxidants (alcohol and polyunsaturated fats and oils), lecithin from egg yokes (liver health and regeneration), and, if you do your research, I think you'll agree dumping some iron may also help.

There's simply got to be a way to get your labs done. Now that you're sober, I don't see what difference it makes when your doc finds out you are sick. Sooner or later, he will. Just tell him you haven't a clue what's going on and you'd like some tests. I'd bite the bullet and get 'er done!

Best Wishes,

Last edited by Administrator; 12-09-2011 at 12:50 PM.

Old 12-08-2011, 05:47 PM   #26
Join Date: Aug 2011
Location: California
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Re: Palmar Erythema and Liver Symptom Sequence

Hi Redpalms (and fellow followers!). Some news we can use on the issue of alcoholic liver disease, and how iron can affect its development and resolution.

I've been restricting iron (no red meat!), donating blood (4 units since June), and blocking absorption of dietary iron with black tea (tannin in black tea blocks iron absorption). I am now feeling much better. Palmer erythema is fading, the ache in my side is nearly gone, and my "body odor issues" have resolved.

Incredible finds researching iron and liver disease... Google: "Role of iron in alcoholic liver disease" and "Liver iron is predictive of death in alcoholic cirrhosis" for more on this.

In looking into how excess iron gets into the liver of drinkers, and how to get it out, I came across: "HEPCIDIN" as the recently discovered (2000) master hormone of iron regulation. Hepcidin has two functions.. When low, it allows dietary iron to be absorbed from food in the GI tract, and transported into (or out of) cells; mostly liver cells, as this is where excess iron is stored. When hepcidin is high, it locks iron inside the GI tract so it is not absorbed, and also locks iron inside liver cells to prevent excess iron from damaging the body.

Hepcidin has been documented in several studies to be artificially lowered by alcohol consumption, so with chronic alcohol consumption, excess iron that is not needed is absorbed in the GI tract and stored in the liver until enough iron accumulates to cause disease. When alcoholics get sick and stop drinking, hepcidin levels rise, locking this excess iron in the liver where it continues to cause damage and development of fibrosis for years, until it is either slowly dissipated, or cirrhosis develops.

Inflammation (and infection) causes hepcidin levels to go through the roof, totally locking up iron transport so tightly, that even with a liver full of iron anemia can develop in advanced disease states. This is called: "The Anemia of Chronic Disease" or "The Anemia of Inflammatory Response". This is why cirrhosis patients are often anemic and fatigued even though their livers are full of iron. It is therefore imperative to treat iron overload before liver disease progresses too far.

Sobriety, combined with an iron restricted diet (no read meat!) will greatly speed iron removal from the liver, as hepcidin levels fall when the body needs iron to build red blood cells. With hepcidin levels down again, and no dietary iron in the GI tract, stored iron is removed from the liver.

This de-ironing of the liver can be greatly accelerated through "therapeutic phlebotomy" or blood donation, as substantial blood loss causes hepcidin levels to drop like a rock for a week or so, opening the floodgates of iron transport. If dietary iron is restricted during this time, the body will raid its toxic treasure of iron in the liver in order to replace the lost blood. Each blood donation draws off over 200mg of iron in only 10 minutes!

The gurus of hepatology are already researching this new treatment for alcoholic liver disease and hepatitis C, (it has been used for hemochromatosis for decades) but don't expect your local GP to be hip to this information.

Do your homework and learn all you can about iron overload in alcoholic liver disease... If you are healthy enough for blood donation, and can live without red meat every day (or have an ice tea with your burger!), better health may be achieved with very little effort.

If you are under a doctors care, seek out and print the valid studies you find on this for your doctor's enlightenment. It may be 10 years before this information becomes common knowledge and established protocol for treatment of early to mid-stage alcoholic liver disease.

Last edited by BillinSD; 12-08-2011 at 05:52 PM. Reason: addition

Old 02-09-2012, 06:54 AM   #27
Join Date: Feb 2012
Location: New york, NY
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Re: Palmar Erythema and Liver Symptom Sequence

Originally Posted by BillinSD View Post
Hi Again RP... A few more thoughts for you to ponder.

Regarding your fears of only a few more years left. From what I've learned, the life expectancy of someone with Child Pugh A disease is 15 to 20 years,
Hope you're doing well.
I just want to point out, Child Pugh A would include all NORMAL people too, because if you look at the chart for Child Pugh A, it has no minimum values. The only way to assign a Child Pugh A score is with positive confirmation of disease to begin with, which he has not had
We can't diagnose people based on red palms and body odor, because if we assumed that everyone with spiders and red palms had cirrhosis then half the people on the planet would have Child Pugh A.
Child Pugh A classification is reserved for positive confirmed cases of Cirrhosis

Old 02-09-2012, 07:50 AM   #28
Join Date: Feb 2012
Location: New york, NY
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Re: Palmar Erythema and Liver Symptom Sequence

Hi Bill;
I was reading your post about Iron. Very good stuff. I also donate a pint of blood every 8 weeks to the Red Cross. Sometimes I do it in 6 week intervals (although your not supposed to).
I just did my 3rd donation and I also feel better. Forget about liver disease for a moment, I read a study that suggested that men who donate blood regularly live longer then men who do not. Apparently there are numerous health benefits to blood letting.
Mind you, I am on anabolic steroids (Testosterone) for low T. A common disease amount middle aged fattys, and drinkers. One of the sides of testosterone is elevated RBG and Hematocrit and Hemoglobin. which is why I have to donate blood.

I didn't mean to come off abrasive in the post above, but we really need to put this in perspective. RedPalms already has himself on a transplant list for gods sake, and he hasn't even been to a doctor. Those mild vague symptoms CAN be liver disease and they can be a million other things. Lots of people have spider veins, Spider nevi, red palms etc. There is no way in hell he can conclude cirrhosis based on this. As an alcoholic my self (and please don't take this the wrong way), I can recognize alcoholic behavior when I see it. We alcoholics deal with a lot of guilt issues over our past and the things we have done. There is a huge psychological component here.

Like I said above, Every single person on the planet is a 5 on the Child Pugh score, because it has no minimum values because its reserved for confirmed cases of disease only. It really shouldn't even be discussed here in the context of someone who has not even had a simple blood test.

Bill may I ask you: I know you said you had blood work and it was normal. Have you had an ultrasound?
Were there any abnormalities?

Old 02-09-2012, 08:32 AM   #29
Join Date: Feb 2012
Location: New york, NY
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Re: Palmar Erythema and Liver Symptom Sequence

Just to add to my post: This fact about the Child Pugh should be pointed out because what will happen is anyone who happens to read these posts via google, thinking they have liver disease because their palms arrear red, will immediately run to the Child Pugh calculator and score a 5 and think they have some terminal disease. At leas thats what I would do, but I'm a hypochondriac

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