The liver

Well, another liver complication. As I have mentioned in one of previous Blog;s - my mother-in-law was detected with primary-liver-cancer. In fact, she succumbed to it.

Now, my father-in-law has been diagnosed with maybe Cirrhosis of the liver. Now, how the heck did this happen - well - who knows. But it did. I will add more information here .... but for now,

Some questions to be asked from the doctor

1. Is Dad's cretin levels high?
2. Dad's urea level is supposed to be higher than normal. So, how's the kidney & is/was there any detection of internal bleeding?
3. We should perform daily massage the hands & legs to induce motion and improve blood circulation through the limbs.
4. The lungs should also be exercised, using the ball blow apparatus.

Now, prevention and cure for the future.

Based on all I have read, The best treatment (ongoing) for Daddy is not medications or anything else ...... but diet and exercise. He should be a complete vegetarian diet (no animal protein).

• Low fat
• Low iron
• Low protein
• Low sodium diet

While, Daddy is not diagnosed with Diabeties - he is still recommended to eat a Diabetic Diet. The prime reason is because the insulin absorption is supposed to be reduced.

Some foods good are

• Always have a breakfast in the morning, a small one. Preferably cereal (corn/oats etc.) with low fat milk. Avoid "iron enhanced" cereals.
• Limit your total calorie intake to be less than 20% from fats. This means no fried foods and no fast foods.
• The liver has to work hard to push the iron from the body. For this reason, Daddy should not have high iron foods. Here are some low iron (or good iron) foods -- { Spinach, whole grains (wheat, barley etc.), soy products, beans and lentils (have 'good' iron), brocolli).
• Onions garlic and egg yolks (only upto 2-3 a month) are sulfur-containing compounds that are one of the primary types of molecules used to help the liver detoxify a wide range of prescription medications, pesticides, and other types of environmental toxins.

Some web links

Liver Function Tests	http://www.naturalvigor.com/labtests.html
Alternative hope for Cirrhosis victims	http://www.naturalvigor.com/livralcomplexingredients.html
Diet	http://www.naturalvigor.com/diethiv.html
Nonalcoholic Steatohepatitis	http://digestive.niddk.nih.gov/ddiseases/pubs/nash/
Snippets from a book about liver disease.
Search for Clinical Trials	http://www.clinicaltrials.gov/ct2/home and http://www.clinicaltrials.gov/ct2/results?term=Cirrhosis
What foods help support the liver	http://www.whfoods.com/genpage.php?tname=fightdz&dbid=15#discussion
Nutrition and Cirrhosis	http://www.hepcnet.net/nutritionandcirhossis.html
Nutritional Advice	http://www.liverdisease.com/nutritionalguidelines.html
An excellent - complete article about long term care for Cirrhosis	http://www.postgradmed.com/issues/2001/03_01/habib.htm

Visiting Australia and US from India

My Mom is visiting Australia from India

Well, my Mom is planning to make a trip to Australia. Now, I did not know that getting a Visitor's Visa for Australia was such a pita, well at least IMHO. There was first the application with all the information and loads of paperwork (financial info etc.) for her and my brother in Australia. Then there was the "medical examination" (to be performed by "specific doctor's" only). This meant, she had to forgo an entire day, to visit the doctor. After the doctor completed the tests, then she was required to get the travel insurance. Now, remember, all this with the looming uncertainty that she may not even get the Visa. So, anyway - now she has to go another set of medical tests, or the benefit of the medical insurance companies. And then finally, she gets approval for her Visa. Sending the passport to get stamped (She is in Mumbai, India and the Australian Consulate is in Delhi) - means another 5-7 business days. And, you have to get the tickets, before you submit the passport. Finally, they would only give her a 3 month Visa ..... I shudder to think if she has to go through all this again, the next time .....

Well, anyway - all's well that end's well (I guess). So, she has her passport on the way to get stamped, she has her tickets. Unfortunately, Air India does not fly to Australia (I was surprised to learn about it ... I would have thought AI goes to most major countries ...... or do they not consider Australia to be a major country :) ). The reason I was checking out AI, was primarily for language help on the plane. Well, my Mom know English. Hell, she helped me in my studies when I was young. But, when you do not speak it all the time, then you tend to take time understanding it .. especially with all the various accents. The hope was, with AI, she would be able to communicate more easily with the staff, especially when she has to fill the landing/customs card (or the Passenger Incoming Card, as known in Australia). For most other flights, the crew departing from India may have one or more members who would understand Hindi .... but on the second leg, that is where there could be issues. But, well - currently no India airline (AI, Jet Airways) flies to Australia from India.

So, Singapore airlines it is. In order to make life a little easy for her, we decided to make a checklist of items for her.

1. Of course her Passport (with the Visa stamp) and tickets. These should be in a zipper pouch, with three compartments (one for the passports, one for the tickets, and one for all the papers she would get in the airport ... boarding cards, baggage stubs etc.).
2. I found a copy of the Australia Incoming Passenger card that she has to fill, on the web (
   http://www.evisastoaustralia.com/section06/customs.pdf). We would prefill this for her, with all the relevant details, so that she can simply copy the information across (or maybe ask a fellow passenger to help her).
3. Medicines. She has to take her regular medicines from India. While most of them would be found in Australia too ... it is a good idea to continue the same brands as much as possible, especially when on a trip. She is planning to go for few months - so the recommendation is to put about 2 weeks worth in her carry on, while the rest can go in the check in. We know what can happen with check in luggage.
4. We plan to make sure her seats are preassigned and she gets an aisle seat. It would make it easier for her to get up and stretch her feet during the flight.
5. And, while she is decently mobile, considering her age, we still plan to request for wheel chair access. This will ensure that she is fine, in case she has to rush for absolutely any reason, like when reaching the connecting flight. One problem I know with wheel chair access, is that she would be the last ones to be taken off the plan. Sometimes, after a long flight - you just want to get off. But still, the benefits would out weigh these minor inconveniences.

Well, more when I learn how her flight experience was.

Nexavar not easily available..

Well, so they come up with a so-called "miracle drug", they price it extremely high ( while I have not been able to get accurate prices, since it is not available anywhere) - approx $2500-$4000 for a months dosage (2 pills a day), but it cannot be obtained anywhere either.

Well, in my case, the problem is compounded by the fact that the patient is not here in the US, and not covered by a US insurance company. Obviously, now - there is no company which would consider insuring her. So, I read on one site that in order to procure the drug, I could try asking the Nexavar Reach program (866-883-3177) or Bayer (800-288-8371). I am going to give both of them a call tomorrow, to see what can be done.

Some rays of hope ...

Like anybody else in the similar situation, I refuse to believe that there is nothing out there, which can extend the life (without loss of quality - since I do not believe in life on support with machines .... but that would be another discussion). So, I decided to check out some options. Here are some

• Sorafenib, marketed as Nexavar by Bayer.
  This is a medication, approved by FDA in 2005, and EU in 2006, which has been showing some promise. Here are some sites with information about this drug
  
• http://en.wikipedia.org/wiki/Sorafenib
• http://www.nexavar.com/
• http://www.drugs.com/nexavar.html
• http://www.drugs.com/pro/nexavar.html
• http://www.fda.gov/cder/drug/InfoSheets/patient/sorafenibPIS.htm
• http://www.eurekalert.org/pub_releases/2007-02/gg-nst021107.php
• http://www.medscape.com/viewarticle/558023
  
• Tian Xian, a herbal supplement aimed to control, inhibit and destroy cancer cells.
  Well, now obviously we come to a "slippery slope". There are "testimonials" of the effectiveness of this supplement - but no "scientific study".
  
  However, as one of the doctor's put it (caution - he was not talking about Tian Xian, but alternative medicines in general) - when I asked him whether I should look into alternative medicines (I may be para phrasing a bit, since I was not taking notes at the time) - 'Well, he had come across a patient, who was given a couple months to live, after being diagnosed with Cancer (do not remember which specific cancer he had told me). The person went to his village in India, and started taking medication from a local Vaidya, and was still alive and well after 1.5 years. A little investigation showed that the Vaidya was giving him arsenic in some form, which was found later (in western medicine research) as being an effective treatment. However, for every one case like this, there are dozen's, where the non-traditional medicine has no (or sometimes even negative) effects. So, caution is prudent, you can do some reasearch and try various options, especially given the terminal nature of the disease.'
  
  Some sites for Tian Xian


• http://www.tianxian.com/
• http://www.cancerhelp.org.uk/help/default.asp?page=5059
• http://www.cancer-tian-xian.com/
• http://www.healthrecipes.com/tian_xian.htm

• Raw food diet.
  Another acquaintance, who also had cancer, had gone into a very strict raw food diet. The logic here was to absorb as little impurities as possible, and cause as little stress on the immune system as possible. For him, it definitely had a profound effect (in regards the reduction in growth and spread of the tumor), to the extend that even the doctor's were surprised. However, the regimen was definitely not a very easy one to follow.
  
  Some sites that provide information regarding this regimen.
  
  
  
  • http://www.arnoldsway.com/
  • http://mail.rawfoods.com/email/scripts/loginuser.pl

Well, this is where I would love to get some comments and input from the wider audience, since I am sure there are other options out there .... it is just a matter of knowing which ones.

What the Doctor's say ...

Here is what the doctor's say (I am trying not to add my personal comments to this),

1. The cancer has advanced to a level, that there are no options available to cure the cancer 100% (as as one doctor put it, there is no treatment which can be considered as a home run).
2. All the doctors have given a fixed time period for her survival. This time is different, ranging from 8-10 weeks, to 6 months. Some of the reasons for the "shorter" time are
• The fact she has Diabetes complicates the matter, in case she gets any infection.
• Three months back (in May 2007), her blood sugar had gone dangerously low (about 30). As a part of follow-up tests, she had a CT scan (I need to investigate if it was done with a dye or not. And, also if it was a plain oversight, since nobody was looking for it.), which did not show up the liver tumor. So, this means the current tumor has grown to this size, in 3 months.
  
  Some reasons for the "longer" time are
• The fact that she is not exhibiting any "severe symptoms" (such as fluid in the abdomen).
  
  I am hoping I can add more to this second list.
  
3. All doctors have ruled against surgically removal of the tumor (since it has spread), and Chemotherapy (on grounds of the limited current life expectancy and the very limited addition after Chemo, and the side affects of the same). The doctors are simply suggesting we take "Palliative measures", which as I understand mean, just treat her symptoms (pain, nausea etc.) as and when they appear.

I should add one important item here, which I have missed before. I am located in NJ, USA, while she is located in Mumbai (Bombay), India. This means, while I am getting all her medical records, I am not able to see her first hand. And family members, who are as close to her as I am, are right there by her side.

Some background

Some background about the person, who has been diagnosed. She is 69 years old, has been diagnosed for Diabetes for about 4 years, and also underwent a triple bypass surgery 2 years back.

A lump near her chest, was the reason for taking her to the doctor for diagnosis, and Cancer was detected. Her recent CT scan of Abdomen and Pelvis states

"Ultrafast CT scan of the Abdomen and Pelvis reveals neoplastic lesion in the left lobe of the liver. This lesion measures 18.07x15.72 cms. Satellite nodule is noted in the caudate lobe. Thrombosis is noted in a left portal vein. Multiple enlarged lymphnodes are noted in the para-cardiac, celiac, para-aortic and supra-pancreatic regions. The largest lymphnode measures 5/34x5/80x4.22 cms. Enhancing nodules are noted in the left paramedian anterior abdominal wall, largest measuring 3.94 x 1.33 x 1.39 cms. Minimal free fluid is noted."