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Lisa
@techi

Posts: 303
Joined: Jun 18, 2017

Gastroenterologist/ hepatologist

Posted by @techi, Nov 8, 2017

I want to know what’s the difference between a gastroenterologist and hepatologist because just recently l went to a new gasterentogist he was one of the partners of my previous one and l thought l was seeing him for my elevated ammonia and so l told him l didn’t know my levels if they were high or low or if they can fluctuate at different times. He told me your levels are normal. I can tell by looking and hearing you. Your not confused and your not jaundice but l told him l am bloated and gaining weight. Which l know could be ascites. I showed him that the Mayo Clinic vascular medicine doctor said my TIP surgery was done incorrectly and l had an appointment with the gastroenterologist there but l also found out looking at my appointment again that the gastroenterologist l am to see is also a hepatologist. No w l don’t know the difference? Since when l went to my previous gasterentogist did everything in the begin. Is the hepatologist to continue to follow up with you in case it runs in to more complications with TIP procedure since it was done incorrectly. Does anyone know? I looked it up but it really doesn’t explain that. But next week is when l had out to the Mayo clinic. I guess l will find out but l would like to know before l see the doctors. I am nor afraid, just want to know if anyone knows the difference?

REPLY

Hello Lisa, @techi

Here is some information from Mayo’s website about the two different specialists you mentioned, https://www.mayoclinic.org/departments-centers/gastroenterology-hepatology. I am also going to invite @contentandwell and @rosemarya as they have posted about high ammonia levels and also had liver problems. They might be able to share about their situations.

Teresa

@hopeful33250

Hello Lisa, @techi

Here is some information from Mayo’s website about the two different specialists you mentioned, https://www.mayoclinic.org/departments-centers/gastroenterology-hepatology. I am also going to invite @contentandwell and @rosemarya as they have posted about high ammonia levels and also had liver problems. They might be able to share about their situations.

Teresa

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@hopeful33250 and @techi hi, i’m A bit late in joining in due to other, unrelated problems I am currently dealing with. I believe hepatologists are gastroenterologists with a further speciality. My hepatologist is part of the Gastrenology department.

Ammonia levels do not stay constantly high. Mine varied a lot, most days I was fine and functioned normally, I never got jaundiced at all, ever! Then I would have an HE episode and my level would be very high. The rest of the time I lived a normal life. If your doctor assumed because you looked and functioned fine on that day that you did not have an ammonia problem he is obviously not a specialist in these problems. My PCP also did not pick up on what my problem was because that was beyond his experience. He had me going to for a neurologist because he thought my HE episodes were a neurological problem and a hematologist because my platelet counts were low. The neurologist finally put the pieces together and had an ammonia test done when I was in the hospital from an HE episode.
I hope things go well on your appointment. Let us know what that doctor says.
JK

Thanks, @contentandwell, I knew that you were highly experienced in the matter of high ammonia levels and you could answer the question well. How is your knee surgery healing?

Teresa

@hopeful33250

Hello Lisa, @techi

Here is some information from Mayo’s website about the two different specialists you mentioned, https://www.mayoclinic.org/departments-centers/gastroenterology-hepatology. I am also going to invite @contentandwell and @rosemarya as they have posted about high ammonia levels and also had liver problems. They might be able to share about their situations.

Teresa

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Thank you so much joy because you know l felt the Lord tell me something was just not right. And at first l was believing my doctors but the couldn’t come up with any answers but l was mentally deranged and l would pass out and sometimes l could remember and sometimes l couldn’t. Then this pass Jan when l fell out they said l hallicuated and when l got to the hospital and they did my lab the next thing they did was have the psychiatrist come to see me and the weird thing was they never told me any results of my lab. I found out they never ran a test on my ammonia level. I asked them but they were a little reluctance and said fine. It was strange my husband couldn’t believe it. Then the er doctor called me 2 days later and said l had a uti and she would call in something in for me. So when l came to the Mayo clinic the internal meds doctor was great and she said you don’t have any mental problems. When l saw the neurologist there she told me l have been a neurologist for along time and so l know about neurological issues. So I had a lot of test ran which l was happy l did. Everything for the most part came back normal. And when l saw the vascular meds doctor he just verified it wasn’t me so l have an appointment tomorrow with a gastroenterologist/hepatologist and also one the following week at the Mayo Clinic so that’s why l wanted to know if it fluctuates because when l just fell out l thought it was because it was high and when l went to the hospital it was ok. Also l been having a lot of bloating but the doctors here says that normal which l never had this much bloating. I’ve gained a lot of weigh since l last was at the Mayo in Sept. So that’s not good at all and l am starting to have chest pain which l haven’t had maybe over a year ago. So l will see what he says tomorrow. Have you had some of these symptoms? Well thank you for answering my questions this is all something new to me.

@hopeful33250

Thanks, @contentandwell, I knew that you were highly experienced in the matter of high ammonia levels and you could answer the question well. How is your knee surgery healing?

Teresa

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@hopeful33250 Teresa, my knee surgery is not doing well at all. I am in incredible pain 24/7. I get some relief from taking the narcotic but I do not want to become dependent on them so I put off until the pain is unbearable. I have two different types, one is obviously not as much of a threat when it comes to addiction because they can FAX the prescription to the pharmacy. The other needs a paper scrip that they send to me to get filled. It’s that one that I really hold off on. I managed to get through to about 3:30 today before I took it. It really does help to dull the pain. It is wearing off now but my goal is if to get through the rest of the night without taking another. My PT felt my physical progress was pretty good but he was concerned about my level of pain. I’ve had him two times before so he knows I am not a wimp and usually very resilient. I think they are concerned at the ortho’s office too since they booked me into Thursday. I can’t drive until I am off the narcotics but I have no desire to go out of the house or anything. If I don’t keep my leg up it hurts more. The pain has taken my appetite away so I am losing weight too, more than I want to at this point.
I will let you know how things turn out after I see the doctor. I wish I could see him before then but he’s out of the country. I know I am not going to be in good shape for my daughter’s wedding ceremony this month and her reception next month. I am really upset at myself about that. If I had any indication that I might not be I would have put the surgery off but they assured me that by then I would be great.
JK

@hopeful33250

Hello Lisa, @techi

Here is some information from Mayo’s website about the two different specialists you mentioned, https://www.mayoclinic.org/departments-centers/gastroenterology-hepatology. I am also going to invite @contentandwell and @rosemarya as they have posted about high ammonia levels and also had liver problems. They might be able to share about their situations.

Teresa

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@techi When a doctor tells you something, like mental problems, it’s so scary. The PCP I had at the time of my first HE episode called me and told me ON THE PHONE that she thought I had Alzheimer’s! I went to the neurologist and he basically laughed at the inaccuracy of her diagnosis. I also happened to have an appointment with my endo who I had been going to for a couple of years and he too laughed at it! When, a year and a half later, they finally figured out that I had cirrhosis and that the confusion episodes were HE it was a relief despite not being a great diagnosis. I had a transplant in September 2016 and every day I get up and thank God that those days are over. It was scary living each day worrying that I might have an HE episode that day. Overall I really did not have that many but they were so scary that they really effected me.
I did have bloating in my feet (edema) but did not have ascites (belly) until about a month and a half before my transplant. I never had chest problems, nor have I heard of anyone who has, so that may be unrelated.
Will be looking forward to hearing how things proceed, please keep us posted. Knowing what is wrong is just such a huge relief.
JK

@hopeful33250

Thanks, @contentandwell, I knew that you were highly experienced in the matter of high ammonia levels and you could answer the question well. How is your knee surgery healing?

Teresa

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@contentandwell, I’m so sorry to hear about your knee pain. I hope you can make it to your daughter’s wedding and reception. Is it possible that taking the pain medications on a regular basis, keeping a constant level in your system, will allow your pain to be relieved enough that you can attend the wedding and enjoy this special time? I’m sure you can withdraw when the reception is over. Just a thought. I know that when the pain is unbearable before you take the medications, it is more difficult to get it under control.

I certainly hope they figure out what is causing this level of pain. I appreciate all the responses you give people on various Connect areas. Your experiences are so very helpful. Thanks, Gail B

@hopeful33250

Thanks, @contentandwell, I knew that you were highly experienced in the matter of high ammonia levels and you could answer the question well. How is your knee surgery healing?

Teresa

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@contentandwell

I am so sorry that you are having so much pain. As I recall, you had knee surgery previously and you did OK. I hope that the doctor is able to come up with a reason for the pain and plan to take care of it before your daughter’s wedding.

Take it easy on yourself – there is no way you could have known that is experience would be so difficult to recover from.

Praying for you and hoping for the best!

Teresa

I concur with gailb; taking your pain medicine when it has reached an unbearable level makes it much less effective. I have had chronic pancreatitis for 11 years and the primary symptom is excruciating pain. I do best when I take an extended release narcotic, so there is always a little in my system and then I have some fast acting for breakthrough pain. The level of my opiate usage has fluctuated from moderately high levels to almost none in reaction to my pancreas flares. I have read in various studies and been told by docs that if I am only taking what is necessary for my pain and not for any kind of euphoria, then you are not experiencing addiction. Dependence is a different matter and that is when your body gets used to having the drug and if you stop, you will have withdrawal symptoms. I can tell you they are not much fun, but with support and medical guidance, it can be done with minimal problems. Happens to me every time I move lower on my narcotics, but again, it is manageable and I have an addictive personality or genetic predisposition.

@hopeful33250

Thanks, @contentandwell, I knew that you were highly experienced in the matter of high ammonia levels and you could answer the question well. How is your knee surgery healing?

Teresa

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@contentandwell, I am sorry to learn that you are experiencing this sort of pain. I hope that the issue can be resolved for you.
Are you keeping your Transplant team informed of this situation? If you have not done so, I encourage you to do it. They need to know what is going on so they can an eye on that beautiful liver.
Rosemary

@hopeful33250

Hello Lisa, @techi

Here is some information from Mayo’s website about the two different specialists you mentioned, https://www.mayoclinic.org/departments-centers/gastroenterology-hepatology. I am also going to invite @contentandwell and @rosemarya as they have posted about high ammonia levels and also had liver problems. They might be able to share about their situations.

Teresa

Jump to this post

I just went to my new hepatologist and he explained everything about my portal vein. He told me that if there is no blood flowing out from the right portal vein that’s suppose to flow from the vein to the liver then it’s ok until you start bleeding. He told me sometimes that happens to people but that doesn’t mean there’s a problem. He wanted to get my films from the Mayo clinic to see what problems the doctor sees. He said he only has the records but he needs to see the film’s and if there is a problem l can get the procedure done at the Mayo Clinic or he can do it. He also said you are the patient and we want the best for you. I really enjoyed his response so l am praying weather l should cancel my appointment for next week. What do you think? I know l have to make the final decison but after all the misdiagnosed I’ve been through its hard to decide.

@hopeful33250

Hello Lisa, @techi

Here is some information from Mayo’s website about the two different specialists you mentioned, https://www.mayoclinic.org/departments-centers/gastroenterology-hepatology. I am also going to invite @contentandwell and @rosemarya as they have posted about high ammonia levels and also had liver problems. They might be able to share about their situations.

Teresa

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@techy, Thank you for the uplifting update! I am happy for you that you are getting some answers.
Your new doctor sounds fabulous, too. I believe that you have hit the jackpot: He explained everything, and he wants the best for you, the patient.
I do not have the expertise, or qualifications to provide any direction about whether to keep or cancel next week appointment. I think that that is best left up to your current gastroenterologist/hepatologist and the Mayo doctor to decide.

Lisa, keep in touch.

Prayers and hugs are attached to this message!
Rosemary

@hopeful33250

Thanks, @contentandwell, I knew that you were highly experienced in the matter of high ammonia levels and you could answer the question well. How is your knee surgery healing?

Teresa

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@hopeful33250 things are very gradually improving. I spoke to the nurse at the beginning of the week and she told me to increase my narcotics, which I then did. That has helped. Today I saw the doctor and he thinks I am doing too much, causing the pain. My physical recovery is good, range of motion is better than typical, and that whole thing is good, it’s just the pain. Of course that is complicated by my having to be careful of what I take due to being post-transplant. No ibuprofen, just acetaminophen, max 2000 mg a day.
So life goes on. I think I will manage at my daughter’s events if iI take the max allowable meds. Of course I am very anxious to get off of them so I can have my independence back. My husband has been very good but shopping with him is no fun, he’s very impatient.
I did lose weight because I was in so much pain that I had no appetite but now I have gained a few back.
JK

@hopeful33250

Thanks, @contentandwell, I knew that you were highly experienced in the matter of high ammonia levels and you could answer the question well. How is your knee surgery healing?

Teresa

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@gailb Thank you Gail for your words of encouragement. I really was getting very discouraged because I usually bounce back so well. I really do not think I have been doing too much but then I am not the doctor. Whatever.
I would not miss my daughter’s events no matter how much pain I was in. I thought I may end up in a wheel chair there but I think I will manage OK, with max pain relief. The ortho definitely too seems a bit surprised by what I am going through because he wants to see me again in two weeks. That’s fine but it’s generally five hours round trip of driving for. 20 minute appointment!! That’s due to very heavy traffic. With no traffic it would be just about an hour, but I don’t think I will ever trust a doctor in my area again for anything serious.
A little aside about my daughter — as you may recall her ceremony is here on November 25, thankfully I arranged for a caterer. I generally enjoy doing food prep. The reception is in NYC on December 9. She HAS NOT YET BOUGHT A DRESS FOR EITHER EVENT!!! Crazy. She is fortunate in being petite so almost everything looks good on her.
JK

@hopeful33250

Thanks, @contentandwell, I knew that you were highly experienced in the matter of high ammonia levels and you could answer the question well. How is your knee surgery healing?

Teresa

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@hopeful33250 Thanks Teresa. As I mentioned previously the doctor thinks I am doing too much. He says I am healed enough to return to the pool but only for about 15 minutes at a time. It’s just not worth that for me. It’s about 20 – 25 minutes round trip, and getting in an out of a bathing suit, plus having to have my husband drive me makes it not worth it. For now I will just try to be active at home. He is a huge advocate of pool exercises though. I will hold off on reinstating my memebership until just before Christmas probably. My son made a last minute decision to come home and he always enjoys going there with me. We do head in different directions, he goes to the heavy duty gym, I go to the one for wimps,
JK

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