What more can they do for hepatic encephalopathy. My relative is on rifaxim twice a day and lactose 3 times a day but still has symptoms. Some days are better than others. Sadly he can’t have a liver transplant as he has cancer and has been told he has months there for want to make sure that he has the best quality of life as possible. His Dr is saying he not to bad yet but he very wobbly on his feet and worried about him falling..
Can you take rifaxim 3 times a day? What else can should the dr be doing.
Any help would be great.
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Albw
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I'm sorry, but l can't really add anymore to what l wrote in reply to your first post.
Certain food types can bring on an HE episode in some people. Try and avoid high protein foods, such as, red meats, eggs, chicken, dairy products, etc.
So sorry to hear about this situation for you and of course your relative.
Whilst there is often some flexibility in increasing lactulose pushing up Rifaximin does need a drs involvement. Trying both maybe all that's needed.
In addition, reducing certain types of meat protein has been shown to help some patients.
*Remember it is absolutely crucial that protein stays in the diet of any cirrhosis patient*
So we are talking about adding dairy and plant based protein rather than just eating meat protein. Discussing this adjustment with a dietician is important.
As a side note, L-ornithine-aspartate is also thought to lower blood ammonia concentrations in some people with HE and is a promising third treatment option. Again this should only be explored with a Dr's approval and prescription.
Hopefully, simply increasing their current medication will prove effective.
I’m glad you mentioned plant based proteins as I think they are often forgotten. I saw a dietitian only once for 5 minutes and the booklet I was given only mentioned tofu and baked beans in the plant protein spectrum but focused on meat and eggs.
I have only had glimpses of HE so I understand it’s not comparable to the situation being discussed here, but I stopped meat during those times and switched to plant proteins instead and it resolved.
I wouldn't go making any big diet changes until you have your appointment - the Mediterranean Diet is useful in Non Alcohol Related Fatty Liver Disease but in end stage/stage 4 at transplant assessement stage it may not be an appropriate diet. When you go to t/p assessment you will see a liver specialist dietician who will assess your needs and advise on the most appropriate diet (often loads of carbs and loads of protein needed when someone has a really struggling liver - my hubby was put on what we called 'weight watchers in reverse' by liver transplant team).
Katie
Also eating more fruit and drinking more water will help remove the toxins.
As chrisw740 has mentioned the Liver Specialist prescribed LoLa for my husband and it made a difference, so this might be worth discussing withthe specialists. My husband was also given enemas.I hope you can raise these possible additions with your relatives Consultants to help to easy your relatives symptoms. 🤗
Sorry to hear this, he best way to keep symptoms at bay is to empty the bowels at least 3 times a day. If the lactulous isn't achieving this then ask for some enemas to be prescribed, this really kept me on a more even keel. It's all about keeping the toxins out of the brain. My thoughts are with you and your family member.
My hubby had he may last year so scary not knowing what he was doing etc was in hospital for 5 days sedated for 3, he had a few enima’s which cleared out the toxins which I think causes it, he had a brain scan which showed no damage, however not really been the same since, he is with it but kinda slower than he was, he stayed on Rifaxin twice a day also lactolose , and if he gets constipated he has a home enigma to clear it, good luck x
Hi, you’ve had lots of good advice re HE already so I just wanted to chip in on palliative care. Has your relative had a palliative care referral? The GP can make one and I found that it opened doors to community nurses who recommended different laxatives, occupational health who provided aids in the home to help with wobbliness and getting in and out of bed etc and hospice who could talk about difficult stuff. It definitely improved Mums quality of life and provided support for me. Having a realitive looking out for them is so valuable too
I myself suffered hepatic encephalopathy for seventeen years prior to eventually getting my transplant 3years ago, I used to be on that regime as well but I was also on Laxido and fibrogel both help you go to the toilet better and I know for a lot of people drinking 2litres of water a day really helps the concept is the more bowel movement's you have the more toxins you get rid of, it doesn't by any means cure the encephalopathy but like you said you can have reasonable good days although be wary of knowing were all the public toilets are if you are out and about as I found out you can very embarrassing accidents I hope this is of some help its not pretty I went into a coma twice thank god for a loving partner who got to know the signs as I didn't for the first few years, anyway good luck
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Hepatic encephalopathy
Hepatic encephalopathy 
Hepatic encephalopathy 
