I like to have some advice. My mother is a Diabetic that has Heart Failure, Cirrhosis of Liver, and Alzheimer's. Her heart doctor said she got Heart Failure due to having Lymphoma about 15 years ago when she was treated with Chemo. Her Lymphoma has been cured. My mother has never been a drinker or done any type of drugs. She was a housewife who raised 6 kids and for the first 10 years took care of 2 of her grandchildren. My mother got Cirrhosis just last year. She had been drained about 6 times. Her Liver doctor gave her 20 mg tablets of Furosemide to take once a day. She was taking it every day, since the last 3 weeks the hospital has not given them to her and the skilled nursing facility did not give them to her either. Right now she is taking Carvedilol 12.5 MG was to be twice a day pill, but in the hospital they are not always giving it to her. She carvedilol pill because her heart was not beating right on one side. She was also taking memantine ER 28 mg and the hospital stopped giving it to her, as they said it cannot be crushed. Only when her sugar goes over 200 they give her an insulin shot, as they do not give pills. My mother has a wound on her tail bone back in Jan 2018 when going to ER and they made her sit in a chair for 2 days. The nurses in ER never moved my mother and just kept her in a chair; at that time they said she had pneumonia. Since the time she been being treated for it. Back in April 2018 the wound doctor cut into her wound and said it was infected, which she was taken to the hospital to clean it out. She had the bone infected and the wound has not closed up. I was told it takes a long time. She is on some strong meds in her picc. The last 3 weeks I have not been caring for her as the 1st week in the hospital then transferred to a skill nursing facility for one week. Then I had to take her out, since they were not caring for her wound right and not giving proper skin care. My mother got fungus in arm pits and genitals area. Shingles on back and they only changed her wet to dry dressing once a day. They were to change it 2 times a day. They messed up her hand and I could go on what was wrong with the facility. I took her back to the hospital and they said they were going to treat her wound, her shingles, and fungus. All the blisters are gone from her back and the fungus is almost gone from her genitals and arm pits. The entire time almost all three weeks IV fluids given to her that made her skin stretch out and her feet always swell you could not see here ankles, stomach stuck out, and sac in eyes sticking out the sides. My mother does not eat or drink on her own. She will call out for water and food she has been like this for about 6 months. Due to her wound she did not walk and every time in the hospital did not eat their food. One needed to be at her side to give her water as at times she drank a lot and other times just little sips. The last 3 weeks she did not want to eat, so I liquify the food. I got her to drink it . In her drinks she had at least 60 grams of protein a day. At times I gave half her food in the morning and the other half in evening. She still at times eats cookie with dark cholate.

Now being swelled so much fluid went to one of her lungs and I think this is due to not giving her Furosemide pill. The hospital drained her thoracic area twice. And she still has some fluid. They say it will continue to fill up again. I am not sure. They are saying I should put her away to die. At times the last 2 days I have seen her awake and asking for help. She stops complaining once I get the nurse to move her. I feel they are keeping her on her back more. At home I turned her more on her side. I was told before they would not give her furosemide as the fluid would go and her blood pressure would go down and the fact she was not drinking. She was drinking when I visited every day. I just think the nurse asked her and maybe she said no. They did not come back and ask later. I had to ask my mother several times before she wanted water. As a few nurses said she drank a lot of water. If I gave her meal that was liquefied at 18 ounces she would not drink or eat for several hours. The nurses complain she is not eating. I keep telling them she is drinking her food. All the times my mother been in and out of the hospital she has lost some weight and is only about 100 pounds now. Today the first time the doctor gave her iv med of furosemide of 40 mg twice a day. The nurse I talked to acts like there is no hope. I see a lot of urine coming out her catheter. Now some of the swelling out her feet and legs. What do you think? Is the fluid in her one lung area because they gave her so much fluid for 3 weeks without giving her water pill (furosemide). Her liver doctor had previously said the Cirrhosis was not bad. Last month 2.5 fluid oz removed from her middle. The month before 2.7 fluid oz removed. The last three days mother at times seemed to be ok. She has been sleeping.

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Thank you for your reply. My mother die yesterday Aug 9. On Aug 8th she was screaming in pain until 3:30pm. I asked the nurse to give her something for the pain. They said no, as her blood pressure would go down. I want to take her home and they said she is not stable. They said I could transfer her to Hospice of the Valley and they afterwards be transferred home. Once she was in Hospice they gave her something for pain and she never woke up. Her mouth was very dry inside from the oxygen I went to clean it (dry mouth moisture product they had at hospice.) and her lungs stopped. Her heart stopped afterwards.
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Very sorry your mother and you are going through this horrible situation. It is a mortal battle and she is truly blessed to have you as her advocate.
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Tired123 Aug 2018
Thanks for for replying. Yesterday she died, as she never woke up. The last day in the hospital she was screaming in pain from in the morning to 3:30pm. The nurses said they could not give her anything for pain. They talked to me about sending her to Hospice of the Valley to handle her pain and afterwards she could come home once she was stable. She was transferred at 3:30pm and never appear to wake up. The next morning they said she was icy cold in arm and said she was in the process of dying. By 1:44pm she was gone. Her mouth was so dry from not eating or drinking the last 3 days before, since the hospital said that fluids may be going to her lung. Her mouth was drying inside. I tried to clean her mouth and she closed it briefly and then opened it. She stopped breathing within a couple of minutes her heart stopped. Now I just feel a part of me is gone. She was the most important part of my life. She was my mother and my best friend. We did everything together.
These are my opinions and experiences as a nurse and they are not meant to be used as medical advise.

I'm not sure why the doctor would order both the Carvedilol and the Mermantine (Namenda) because they both should not be given with severe liver disease (Cirrhosis).

Your mom has multiple diseases that often interfere with and exacerbate each other. She is a very sick woman.

The problem with diuretics ("water pills" such as Furosemide) is, while they pull out the excess fluid from your body, they also wash out Potassium, depleting your supply sometimes to a dangerous level. Too little potassium can cause cardiac dysrhythmias (uneven heart beats). Your mom already has heart failure, so I can see why they are hesitant to give too many diuretics.

Usually, as the liver has less and less ability to function, an accumulation of fluid gathers in the abdomen (ascites), making the tummy puffy. A parcentesis (or abdominal tap) is the procedure to drain it. This condition does not get better. The person will have to have continual taps to drain the fluid or have a catheter put in so that the fluid can be drained as needed. Massive doses of diuretics is not the answer.
If your figures on the amounts of fluid pulled out are correct, she has had very little fluid pulled out (75 ml). I've seen a couple of liters (around 2 quarts or 2000 ml.) of fluid or more taken off at once.

"Cirrhosis is the most common cause of abdominal fluid buildup that requires a diagnostic abdominal tap. Since cirrhosis is irreversible, treatment for this condition concentrates on preventing further liver damage. Ascites in such cases is often a sign that liver failure is imminent. Depending on your condition, you may require multiple abdominal taps in the future if fluid continues to build up in your abdominal cavity. According to the American College of Gastroenterology, people with liver disease who develop ascites have a 30 and 40 percent chance of surviving five years. At this point, a liver transplant is necessary."

The fact that your mom has a Picc line (a percutaneous indwelling central catheter) (like a big IV line that can be used for a long time) testifies that your mom needs long term medications. Does she suffer from jaundice (yellow skin from liver failure) also? What about shortness of breath? Often there will be so much fluid that it restricts the breathing. Pulling the fluid out will make breathing easier (until it builds up again).

Your mother's condition is complicated by diabetes and is one of the many reasons the bedsores (decubitus ulcers) aren't healing. Diabetes restricts the blood flow, making it harder to get nutrients to the wound. Also, prolonged pressure in one area stops the blood flow, making the ulcer worse. Poor nutrition is also a factor.

If you make her any liquid drinks, please make sure they have no salt or bouillon cubes in them. Salt holds fluid in the body. You also should check with her doctor before giving her a high protein diet, as it may be too hard on her liver.

Often Hepatitis B or C can cause liver damage (since you said she didn't drink alcohol). Is she being treated for hepatitis?

Because it sounds like your mother isn't mobile (walking around), she is at more risk for pneumonia than a person who gets up and moves around. If she can follow commands, have her medical staff get her an incentive spirometer (a plastic breathing machine with either balls or a baffle to show how deeply you are breathing). She should be using this many times a day to keep her lungs clear. Because of the abdominal fluid buildup, the immobility and probably having to eat and drink while lying in bed, she should always be fed while sitting at at least a 60 degree angle, better a 90 degree angle if possible to prevent aspiration (inhaling) of the food and fluids, since that can cause aspiration pneumonia).

I'm so sorry your mom is so ill. Never be afraid to ask the doctor questions. Enjoy your mom now.
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Tired123 Aug 2018
my mother does not have hepatitis. Just today they mentioned my mother's blood pressure is low. Her normal blood pressure is usually around 90/55 or when upset around 105/60 range. We told them this is her normal range and found out they did not want to give her heart medication because it was in this range. I am not sure if the problems got worst because they would not give her heart medication. Her previous heart doctor said she needed the heart medication to make her heart beat correctly. Just 2 days ago the doctor at the hospital then double the dosage of water pill to 40 twice a day by IV. As before it was 20. They had added a drain to her lung this morning. They taken her to another floor in the hospital to take care of her. They plan to discharge her maybe within 2 days.
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