Cirrhosis

Cirrhosis is an extensive scarring of the liver that is caused by damage to the liver or from a long-term reaction to inflammation over a prolonged time period.  With cirrhosis, the normal tissue of the liver is replaced with fibrotic tissue that has no function, so demands placed on the liver can no longer be met like they once were.  Most often, individuals with cirrhosis will appear with a yellowing of their skin, or jaundice.



There are three types of cirrhosis and their causes/risk factors may include viral hepatitis, use of certain medications or toxic substances, excessive consumption of alcohol, obstruction of the vessels in the liver, other infections, or having an autoimmune disease.  To best promote your health, our team of professionals at Total Home Health will encourage you to remain current on your vaccinations in order to best avoid infections, along with avoiding consumption of alcohol.



Signs and symptoms of cirrhosis may include any of the following:



·      Fatigue, weight loss, abdominal pain.

·      Notably large abdomen from ascites, or the bloating/swelling due to the fluid build-up in the abdomen and legs.

·      Severe itching of the skin.

·      Confusion or difficulty thinking due to the build-up of waste products in the blood stream and brain that the liver is no longer able to get rid of.

·      Personality changes, depression.

·      Altered sleep patterns.

·      Gastrointestinal bleeding, passing of blood in bowel movements.

·      Bruising, nosebleeds, blood noticeable if a person were to vomit.

·      Redness/warmth of the palms of the hands.

·      Spider angiomas (red vascular lesions with branches extending over the nose, cheeks, upper chest and shoulders).

·      Asterixis (coarse tremor characterized by rapid, extension/flexion of the wrists and fingers).

·      Liver breath that will assume a fruity or musty odor.



If you or a loved one notice you are experiencing any of the symptoms as listed above, you may indeed be suffering from cirrhosis and should not hesitate to bring it to the attention of your provider to receive treatment.  There are several laboratory and other diagnostic tests your provider may carry out in order to diagnose you and evaluate how severe your condition has become.



Keep in mind that of the diagnostic procedures, an invasive liver biopsy is the most definitive to diagnose cirrhosis.  A liver biopsy will allow medical professionals to identify the progression and extent of your cirrhosis.  Once diagnosed, your treatment will be composed of anything ranging from lifestyle changes to surgery, including the possibility of a liver transplant.  Complications related to cirrhosis if it is left untreated or if it has progressed to a later stage can be life-threatening.  Complications may include the following:

·      Portal Systemic Encephalopathy (PSE)

-  PSE occurs because those with cirrhosis have a liver that functions poorly and is unable to covert wastes in the body, such as ammonia, to a less toxic form.  Therefore, these wastes build-up and accumulate throughout the bloodstream and even in the brain, which can lead to causing neurological problems.

-  PSE is treated with medications such as the liquid called Lactulose, which if effective will reduce ammonia levels via the bowels when the person has bowel movements.

-  Protein is generally reduced in the diet in the case of PSE because when proteins are broken down in the body, they are turned into ammonia which is what the body needs rid of in this situation.



·      Esophageal Varices

-  These are formed due to portal hypertension, which is elevated blood pressure in the veins that carry blood from the intestines to the liver.

-  Portal hypertension is caused due to impaired blood circulation in the liver, which causes blood to form a new way around to get to where it needs to go (collateral circulation) and the new route of vessels are more fragile and can bleed easily.



·      Acute Graft Rejection after Liver Transplantation

-  Typically will occur 4 to 10 days after surgery.

-  Individuals will experience a fast heart rate, pain in the upper right flank area of the abdomen, and yellowing of the skin.

-  The bone marrow will create cells that will attack the new organ because it does not recognize it.

-  Individuals must expect lifelong therapy with immunosuppressants to avoid rejection and infections.



The professional staff at Total Home Health will make regular visits into your home to continue your care outside of the stressful medical setting.  Our goal in your home will be to promote your health and safety while preventing complications of your cirrhosis by encouraging you to avoid alcohol and follow an appropriate diet…to start.  We will also work in conjunction with all members of your health care team including your physician, dietician, social worker, and more so that you receive the most holistic care as possible for the best outcomes.  Enroll with us today so that we can show you just how much we care about the life you lead!

Chronic Inflammatory Bowel Disease

Chronic inflammatory bowel disease (IBD) includes the conditions of ulcerative colitis, crohn’s disease and diverticulitis.  In order to be classified as chronic IBD a person must have diarrhea (at least up to 20 stools during an acute flare-up), cramping abdominal pain, and exacerbations (flare-ups).  Total Home Health understands how much of a nuisance it can be to continually plan your daily routine around your bowel schedule with IBD in hopes of not going out somewhere and having to run to the bathroom because of multiple episodes of diarrhea.  Allow us to explain the differences in these conditions related to chronic IBD.

·      Ulcerative Colitis

ü  Swelling and inflammation of the rectum and sigmoid colon (the last part of the large intestine that leads to the rectum).

ü  May affect the entire length of the colon.

ü  Bowel obstructions may occur.

ü  Changes in the cells in the mucosa lining of the intestines due to compensating for the inflammation and swelling may lead to colon cancer or insufficient production of the intrinsic factor, which will lead to pernicious anemia…or lack of vitamin B12.

ü  Associated symptoms include:

o   Abdominal pain/cramping, generally in the left lower area of the abdomen

o   Loss of appetite and weight loss

o   Fever

o   Diarrhea – up to 15 to 20 stools per day

o   Mucus, blood or pus can be present in the stool

o   Large abdomen that is tender and/or firm if touched

o   Rectal bleeding

o   High-pitched bowel sounds will be heard if your provider listens    

·      Crohn’s Disease

ü  Inflammation and ulceration of the gastrointestinal tract that can involve the entire gastrointestinal (GI) tract from the mouth the anus.

ü  All layers of the intestine may be involved.

ü  Fistulas are common (abnormal connections between organs).

ü  Vitamin and mineral supplements, including vitamin B12 injections may be necessary.

ü  Associated symptoms include:

o   Abdominal pain/cramping, generally in the right lower area of the abdomen

o   Loss of appetite and weight loss

o   Fever

o   Diarrhea – up to 5 loose stools per day with mucus or pus present

o   Large abdomen that is tender and/or firm if touched

o   High-pitched bowel sounds will be heard if your provider listens

o   Fatty stools may be present and appear light in color, such as white or tan

·      Diverticulitis

ü  Inflammation of the diverticula (pouches that form in the intestine) that frequently occurs in the colon.

ü  Only about 10% of those with diverticula will develop diverticulitis.

ü  Diverticula may bleed and the loss of blood may be either minimal or severe.

ü  Diverticula may also perforate (get holes in them) and lead to other complications.

ü  Associated symptoms include:

o   Abdominal pain in the left lower abdominal area

o   Nausea and vomiting

o   Fever and chills

o   Fast heart rate

Risk factors for these conditions may vary person to person and may include:

·      Genetics

ü  Ulcerative colitis and Crohn’s disease.

·      Culture

ü  Caucasians (ulcerative colitis), Jewish (ulcerative colitis and Crohn’s disease).

·      Gender and age

ü  Incidence of ulcerative colitis peaks during adolescence to young adulthood more often in females, and the incidence peaks during older adulthood more often in males.

ü  Crohn’s disease may be diagnosed at any age.

ü  Diverticulitis occurs more often in older adults and affects males more frequently.

·      Diet

ü  A diet low in fiber may predispose a person to ulcerative colitis and the development of diverticula.

·      Smoking

ü  Smokers have an increased risk of developing Crohn’s disease.

ü  Non-smokers have an increased risk of developing ulcerative colitis.

·      Other factors

ü  Stress, autoimmune issues, and infection.

If you or your loved one suffer from any of the signs and symptoms as listed above on a regular basis, it would be a good idea to approach your doctor for a medical opinion to receive treatment to manage your condition.  There are various diagnostic procedures your provider may perform in order to confirm your diagnosis of a chronic IBD condition including an abdominal x-ray, CT scan, barium enema, and/or a colonoscopy.  Your provider will provide you with more in-depth information about the diagnostic procedures once they are recommended for you.  After you’re diagnosed your treatment plan will be highly individualized for your particular condition and symptoms.  It could include everything from making simple lifestyle changes to surgical procedures depending on the extent to which you are affected.

Total Home Health has a program that is right for you.  Our professionals will accompany you in the comforts of your own home in order to continue your treatment for your chronic IBD condition(s) with the goal of managing your symptoms and preventing flare-ups from frequently occurring.  There are several lifestyle and dietary changes that can be modified that we will encourage you to take part in, so that you may continue to lead a life with less interruptions to run to the bathroom…enroll with us today!

Ear Disorders

Most of what we all know and are aware of is gained through our vision; however, having a well-functioning auditory system is also very important.  If you or a loved one suffers from an ear disorder, it may result in hearing loss and create problems in your everyday routines.  An individual with a significant hearing loss may easily become confused, lose trust in others, and begin to socially isolate themselves from their loved ones and the activities they once loved.

Some conditions of the ear, such as Meniere’s disease, will interfere with balance and coordination.  Other conditions, such as otosclerosis and age-related presbycusis, affect an individual’s ability to give and receive information accurately.  Disorders of the ear can be classified into one of the following categories:

v Conditions affecting the external ear (otitis externa)

v Conditions affecting the middle ear (otitis media)

v Conditions affecting the inner ear (Meniere’s disease, otosclerosis)

v Age-related hearing loss (presbycusis)

v Ear trauma

Total Home Health has a program that will fit into your lifestyle depending upon which type(s) of ear disorder you may suffer from.  Our professionals will diligently work to adapt your care depending upon your specific needs in order to maintain your safety, promote your independence, and allow you to continue to enjoy the things you love to do!  Following are simple descriptions of various ear problems that you may encounter at some point in your life.  Total Home Health believes in promoting your health and preventing complications, so we encourage you to read on to be prepared if you or your loved one experience any of these conditions.

            Otitis Externa

·      Often referred to as “swimmer’s ear” because it occurs more often in hot, humid environments.

·      May result from an allergic response or inflammation or it may occur from infectious organisms, including bacteria or fungi.

·      This may also occur from bacteria present on telephones and hearing aids that proceeds to make itself at home on your ear.

·      In rare cases otitis externa may be caused by a virus which spreads the infection into the adjacent structures of the brain, which may cause meningitis, brain abscesses, and damage to cranial nerves.

·      Treatment of this condition is aimed at relieving pain, inflammation, and swelling.

·      Topical antibiotics and steroids are the treatments of choice.

·      Systemic antibiotics (oral or intravenous) are used in severe cases.

            Otitis Media

·      Infection of the middle ear that occurs more often in younger children because the tubes in their ears are shorter and wider than in adult ears, which allows bacteria to set in more easily and compromises how well their ears drain.

·      Signs and symptoms of this condition include pain, malaise, fever, vomiting and anorexia.

·      An increase in pressure can actually cause the eardrum (tympanic membrane) to rupture.

·      Rupture of the eardrum leads to a relief of pain and fever, but repeated rupture can lead to scarring of the membrane which will eventually result in hearing loss.

·      Allergies can also cause otitis media from contact with hair spray, cosmetics, earrings, earphones and/or hearing aids.

·      Treatment includes use of systemic antibiotics, analgesics for pain, and most likely antihistamines and decongestants to decrease fluid in the middle ear.

·      Antibiotics are continued for 7 to 10 days to ensure what has caused the ear infection has been completely eliminated.

·      If the eardrum continues to bulge out following antibiotics, a small surgical incision is made in the membrane and a tube will be inserted in order to allow continuous drainage of the middle ear.

            Meniere’s disease

·      Disease of the inner ear that includes the symptoms of vertigo (feeling that the room around you is spinning), tinnitus (ringing in the ear), and hearing loss of low tones.

·      Symptoms can come on suddenly and can last from several hours to several days.

·      Exact cause is unknown, but it is associated with allergies and vascular and inflammatory responses that alter fluid balance within the ear.

·      Conservative management is the goal with this condition with the use of antihistamines, antiemetics (to prevent vomiting), diuretics (to control swelling), and vasodilators (to decrease constriction of the vessels).

·      Restricting fluid and salt in the diet is recommended to decrease the amount of fluid that is produced.

·      Quitting smoking is also recommended to improve symptoms by helping to reduce constriction of vessels.

·      Surgical interventions may be used in order to place a shunt to allow the fluids to travel and escape elsewhere.

·      Following any surgery can cause the individual to experience vertigo, nausea and vomiting for several days due to being off balance from alterations in the fluid in the ear(s).

            Otosclerosis

·      Progressive hardening of the bony configuration known as the stapes within the ear that leaves it incapable of moving; it is the most common cause of conductive hearing loss.

·      Symptoms include tinnitus and conduction deafness.

·      Management will involve a procedure called a stapedectomy to remove the diseased stapes bone.

·      Your surgeon will further discuss the risk and benefits of this procedure with you, along with what to expect and report after surgery is over.

            Presbycusis

·      This condition is associated with aging and is a common cause of sensorineural hearing loss (the ability to hear high-frequency, soft sounds).

·      Result of damage to the ganglion cells of the cochlea and decreased blood supply to the inner ear.

·      Deficiencies in vitamins B9 and B12 also may play a role in the development.

·      Sensorineural hearing loss is also related to the use of ototoxic medications and consistent exposure to loud noises.

            Ear Trauma

·      Injury to the tympanic membrane can result in pain, infection and loss of hearing. 

·      Most ear trauma is the result of jabbing injuries that damage the eardrum and inner ear or from blows to the ear that result in extreme pressure changes.

The professionals at Total Home Health are ready to attend to all your needs in the comforts of your own home.  We understand that everyone greatly relies on their hearing and if it is the least bit compromised it can lead to many unwanted emotions and changes in the way you go about your daily life.  Our professionals will instruct you on many ways to adapt your lifestyle to your level of hearing related to your ear disorder.  Plus, we will encourage you and educate you related to different strategies to prevent further complications and help you get back to normal.  Don’t wait any longer because it’s not fair to you to miss out on any of your life that is taking place around you…enroll today!