Driving with minimal HE: real world consequences?

[Guest guest]

Am J Gastroenterol. 2007 Sep

Driving with minimal hepatic encephalopathy: real world consequences?

Munoz SJ.

Albert Einstein Medical Center, Philadelphia, Pennsylvania

Mounting evidence suggests that minimal hepatic encephalopathy of

cirrhosis may compromise driving performance. A study now reveals that

patients with minimal hepatic encephalopathy had a greater

self-reported frequency of motor vehicle accidents and traffic

violations. There are still numerous issues to be resolved before this

increasingly recognized variant of hepatic encephalopathy can be

firmly linked to hazardous driving. Minimal hepatic encephalopathy

affects a substantial proportion of patients with otherwise

well-compensated cirrhosis, and because therapies are effective in

reversing this type of encephalopathy, its role in motor vehicle

accidents deserves further attention.

PMID: 17727431 [PubMed - in process]

[Guest guest]

....

> Mounting evidence suggests that minimal hepatic encephalopathy of

> cirrhosis may compromise driving performance.

Has anyone else been asked to restrict their driving due to minimal

hepatic encephalopathy? Prior to my recent transplants I was. In most

areas of the US such a restriction greatly hinders mobility and

activity. I am concerned that reports such as this one may cause an

overreaction to the problem of driving while sick, imposing

restrictions that are not justified by the increased risk of accidents.

Tim R

[Guest guest]

>> Has anyone else been asked to restrict their driving due to minimal

hepatic encephalopathy?

The reason I sent this study in today, was because it's something

we're going to have to deal with. Ken's ammonia level today was back

up to 88. Not overly high, but not normal either. Dr asked Ken

several questions, including spelling his last name backwards. It's

quite possible Ken will suffer from HE off and on. We live in a rural

area, without the ability to drive, as things look now, he'll have to

live with us. Certainly not something he wants to do. But what choice

will we have? We all want him to drive as long as he's able. Hopefully

the doctor will agree. I see your point Tim, it's something we should

all think about.

With love, Barb in Texas

[Guest guest]

>

> Has anyone else been asked to restrict their driving due to minimal

> hepatic encephalopathy?

------------------------------

Well, no one **asked** me to restrict or cease my driving, but I had

the good sense to know that I was not sufficiently compos mentis to

drive!!! I stopped driving about November 2003, yet wasn't

diagnosed with HE until 2005. However, I did still have enough brain

left to know that if I couldn't figure out what to do when a car was

coming at me as I pulled out from a stop sign, then I shouldn't be

behind the wheel!! I was endangering myself and others. A few months

after that was when I couldn't figure out how to write a check. Now

.... trust me on this one, folks ... anytime a woman can't figure out

how to write a check, something's waaaaaay wrong! LOL!!

It was only after from Missouri and Deb in Virginia posted

their HE experiences (around Nov. 2005) that we realized what was

affecting me. We told the dr., he immediately ordered an ammonia

level, and it was quite elevated, confirming the HE diagnosis.

Fortunately, after more than a year of being on the Xifaxan, my

husband and I have felt I'm stable enough to drive around town (NOT on

highways or interstates, no way, no how!) and I very carefully got

back behind the wheel about a month ago. My confidence is returning

very slowly, and if there's the slightest doubt in my mind, I don't

hesitate to step away from the car! But it is mighty nice to once

again be able to run to the post office or the drugstore or something,

and not feel completely shut-in any longer.

Xifaxan is my miracle drug. I literally couldn't live without it!!

Regards,

Carolyn B. in SC

[Guest guest]

>

> we're going to have to deal with. Ken's ammonia level today was back

> up to 88. Not overly high, but not normal either. Dr asked Ken

> several questions, including spelling his last name backwards. It's

> quite possible Ken will suffer from HE off and on.

------------------

Barb -- See if you can't push for Xifaxan!!! You'll have to be ready

to fight the insurance company to get it (mine was willing to give me

3 days worth, but no more. We had raise to get it!!

The bit about spelling the name backwards got me. I sat here and

tried and tried and couldn't figure out how to spell my name

backwards!!! The Xifaxan doesn't put you completely back to normal

(as if no HE), but it does about 85% of the job which is -- at this

point anyway -- sufficient to live a more or less normal kind of life.

Many thanks for sending the study in!!

Regards,

Carolyn B. in SC

[Guest guest]

I think that if you realize you have a problem you are beyond the

point of minimal hepatic encephalopathy. The paper discusses the

increased accidents and traffic violations experienced by those with

cirrhosis who thought they were OK and had no overt evidence of

encephalopathy. What should be done about them? Should we treat them

like teenage drivers, who think they are very competent, but have

higher accident rates anyway, and let them drive as much as they want?

Or like those impaired by alcohol, and forbid them from driving? And

since encephalopathy is not a black and white condition, at what point

should one stop driving? Is there an easy test (reaction time?) that

could be used to determine a go / no go condition? Without some sort

of guidelines as to when driving restriction is appropriate I think

too many doctors will err on the side of caution and restrict driving

for cirrhotic patients.

Tim R

[Guest guest]

>

> I think that if you realize you have a problem you are beyond the

> point of minimal hepatic encephalopathy. ...... And

> since encephalopathy is not a black and white condition, at what point

> should one stop driving? Is there an easy test (reaction time?) that

> could be used to determine a go / no go condition? Without some sort

> of guidelines as to when driving restriction is appropriate I think

> too many doctors will err on the side of caution and restrict driving

> for cirrhotic patients.

Point well taken! My concern stems (naturally) from my own

experiences. My drs., family and friends were all (except for my

hubby) very surprised when I gave up driving. My GI dr. -- who sees

me every 4-6 weeks -- was stunned that we thought I had HE (and we

gave him all the things we based it on), until he checked for

asterixis (very present!!) and the ammonia level came back so high.

In other words, THEY ... the doctors ... all thought I was minimal

when I thought I was well around the bend! The trouble was ... no one

had checked for any signs or symptoms of HE. It was entirely due to

what and Deb (God bless 'em!!!) posted in this forum that

opened our eyes to what was really happening.

That's one of the problems with this stinkin' disease -- unless you're

jaundiced you tend to look so dadblasted healthy that no one believes

anything is wrong.

I guess what I'm saying is --- what is the precise definition of

" Minimal " ????

Regards,

Carolyn B. in SC

[Guest guest]

And that is the real issue, and I applaud you for stating it.

The problem is being able to recognize you are endangering others, whether from HE, age, intoxication, prescription meds or just plain ineptness. We went through this with my FIL a couple of years ago (macular degeneration). Fortunately, he had the living daylights scared out of him instead of an accident, like my grandfather.

Driving is not a right, it's a privilege. Of course, this is easy for me to say now, but it may not be later. The loss of freedom is devastating, especially in rural areas.

But how would you feel if you caused a fatal accident?

Sorry about the soapbox speech - the Europeans have a much more sensible view of driving than we do. In many countries, you lose your license to drive for DWI - permanently (and I know it's not the same thing). In Norway, if they knew I was driving, my relatives served NA beer - wasn't even asked. For celebrations, they rented a minibus or had a friend drive a minibus. It's not a macho thing - it's just plain sensible to ask for help. Even though I feel perfectly capable to drive after a colonosopy, I never have.

Arne

________________________________

....I was endangering myself and others...