Archive for the Patient Category

Nausea and Vomiting

Nausea and vomiting are can be experienced by patients with liver disease and may have many causes. Nausea and vomiting are important symptoms to look after as they can lead to constipation, dehydration and weight loss. Talk to your healthcare provider if you are experiencing nausea and vomiting that is affecting your day to day life. They  may be able to treat the cause of your nausea and vomiting and can provide advice about what to eat to obtain the nutrients your body needs. You may also be referred to a dietitian.

What is nausea?

Nausea is the feeling you get when you think you might throw up. The urge to vomit does not always result in vomiting. Nausea is often described as feeling ‘queasy’ or ‘sick to your stomach.’

What is vomiting?

Vomiting is when you actually throw up, emptying stomach contents through your mouth. Muscles along the wall of your abdomen contract and create movement to bring the contents up.

Risk of Dehydration

A concern with vomiting is the risk of dehydration. Common symptoms of dehydration include:

  • increased thirst
  • dry mouth
  • dry lips
  • decreased urination

What causes nausea and vomiting?

There can be many causes of nausea and vomiting if you have cirrhosis:

  • constipation
  • swelling in your abdomen (ascites)
  • Medications
  • Alcohol and illicit substances
  • infection

Treatment

Typically, at home methods can treat mild nausea caused by liver disease or the side effects of liver disease treatment. If you are struggling with nausea and vomiting, your doctor may be able to prescribe medicines to prevent and treat nausea and vomiting. Be sure to tell your doctor if you continue to have problems after your treatment.

What can I do?

Nausea remedies

You may want to try the following at home treatment tips for nausea. Be sure to consult with your doctor if you are experiencing different or worsening nausea.Maintain good oral hygiene

  • Make sure you drink enough liquids so you don’t get dehydrated. Take a few sips at a time
  • Make sure you are still eating enough good. Try frequent small meals instead of bigger meals
  • Try ginger, such as ginger tea or ginger candy. Real ginger helps to reduce nausea.
  • Avoid greasy, spicy or excessively sweet foods
  • Stay upright for about 1 hour after eating, as this can help with digestion
  • Do not drink alcohol

Vomiting remedies

You may want to try the following at home treatment tips for vomiting. Be sure to consult with your doctor if you are experiencing different or worsening vomiting.

  • Get some rest
  • Try a drink with electrolytes to restores lost fluids and nutrients
  • Gradually drink more clear liquids
  • Avoid solid foods until symptoms pass
  • Eat smaller amounts of food more frequently and adjust timing of meals as necessary. Eat slowly.
  • Do not drink alcohol

Prevent Constipation

  • Take all of your medications (including Lactulose) as prescribed
  • Eat regular meals and snacks through the day to keep food moving through the bowel
  • Drink enough fluid
  • Be as active as possible to help your bowels move

Symptoms to watch for

The symptoms of nausea and vomiting are typical across different diseases and conditions. Be on the watch for these additional symptoms if you are experiencing nausea and/or vomiting and you have cirrhosis:

  • you have signs of dehydration
  • vomiting has lasted longer than 24 hours
  • you have changes in mental alertness (personality change, fatigue, confusion, irritability)
  • you vomit blood or your vomit looks like coffee grounds
  • you develop belly pain

Vomiting Blood

Throwing up blood is a medical emergency. With cirrhosis, a scarred liver has to work hard to filter your blood. The blood that flows from the veins in the esophagus have a hard time moving through the damaged liver. As a result, these veins begin to enlarge. When these blood vessels rupture, throwing up blood occurs. You can lose significant amounts of blood within a short period of time and it is important that you get proper treatment. In addition to vomiting blood other symptoms can be found here: Esophageal Varices

 

Important Resources

References

This material was adapted from content by:

Conservative Kidney Management

My Health Alberta 

Muscle Cramps

A muscle cramp is a strong, painful contraction or tightening of a muscle. Muscle cramps are common in people with cirrhosis and can be very distressing. Cramps can happen for no apparent reason and may last from a few seconds to several minutes.

Causes

The reason why people with cirrhosis get muscle cramps is not well understood. Usually they come on suddenly with no apparent cause, and can be worse at night.

There are also reasons people get muscle cramps that are not related to cirrhosis. Examples of other conditions that can cause muscle cramps are:

  • Restless legs syndrome (irresistible urge to move or shake the legs)
  • Vein diseases of the legs
  • Low hemoglobin
  • Changes in sodium, potassium or magnesium levels in the body

Treatment

Medications

Your doctor or nurse practitioner may prescribe medicines to treat causes like low magnesium.  They may also recommend other medicines. Medicine used to treat cramps can have serious side effects, so it’s not always the right choice for everyone.

Calf Exercises
  • Stretch and massage the affected area
  • If the cramp is in your calf muscle
    • Straighten your leg and lift your foot upwards, bending it all the way so that your toes point towards your shin
    • Walk around on your heels for a few minutes

Self Care Tips:

  • Drink plenty of water and avoid alcohol or caffeine.
  • Eat a healthy diet.
  • Stretch your muscles every day.
  • Deep tissue massage may be helpful.
  • Take a warm shower or bath to relax the muscle. You can also try a using a heating pad over the sore muscle.

Let your healthcare provider know if:

  • you get new muscle cramps.
  • cramps continue even after treatment.
  • cramps are making it hard for you to move.

References:

The information on this page was adapted (with permission) from the references below, by the Cirrhosis Care Alberta project team (physicians, nurse practitioners, registered nurses, registered dietitians, physiotherapists, pharmacists, and patient advisors).

This information is not intended to replace advice from your healthcare team. They know your medical situation best. Always follow your healthcare team’s advice.

References: 

  1. US Department of Veterans Affairs, Veterans Health Administration 
  2. Canadian Liver Foundation
  3. Davison SN on behalf of the Kidney Supportive Care Research Group. Conservative Kidney Management Pathway; Available from: https//:www.CKMcare.com.
  4. My Health Alberta
Last reviewed March 15, 2021

Itching

Itching refers to the unpleasant sensation that causes the need to scratch. The medical term for it is pruritus. Itching can be caused by many conditions, including liver disease. It can be located in a few areas, or be all over the body. For some people, itching can be mildly distracting or irritating. For others, it can be very intense and impact quality of life. Itching related to liver disease is usually worse in the evening and at night, and it doesn’t usually involve a rash or open sores.

Causes

Skin conditions such as allergies, drug reactions and dry skin can cause itchiness. Itching in people with liver disease is usually caused by a build-up of toxins that have not been filtered by the liver. It is more common in some liver diseases (like primary sclerosing cholangitis), than others.

Treatment

Skin Care

Skin care is usually recommended before trying medicine, or along with medicine.

  • Avoid harsh soaps, body washes and bubble baths.
  • Use gentle lightweight skin cleansers (eg. Cerave, Cetaphil- both glycerin based), and only apply to limited areas such as armpits and groin.
  • After a bath or shower, pat your skin dry and apply lotion within two minutes of getting out, while skin is still damp.
  • Use hypoallergenic lotion with ceramides (eg. Cerave) that are free from fragrance and additives. Do not use the moisturizers on areas of broken skin.
  • Apply baby oil to your skin up to three times a week.
 Medications

People with liver disease might be prescribed medicine that decreases the feeling of itching, or that helps get rid of built up toxins.

Self Care Tips:

  • Baths are better than showers (daily in lukewarm water for at least 15 minutes).
  • Keep skin cool by wearing light and cool clothing.
  • Avoid scratching – keep fingernails short, encourage massaging rather than scratching, wear gloves at night.
  • Maintain a humid home environment, especially in the winter.

Let your healthcare provider know if:

  • you develop new itching.
  • your itching is not getting better with treatment.

References:

The information on this page was adapted (with permission) from the references below, by the Cirrhosis Care Alberta project team (physicians, nurse practitioners, registered nurses, registered dietitians, physiotherapists, pharmacists, and patient advisors).

This information is not intended to replace advice from your healthcare team. They know your medical situation best. Always follow your healthcare team’s advice.

References: 

  1. US Department of Veterans Affairs, Veterans Health Administration 
  2. Canadian Liver Foundation
  3. Davison SN on behalf of the Kidney Supportive Care Research Group. Conservative Kidney Management Pathway; Available from: https//:www.CKMcare.com.
  4. Bhalerao A, Mannu GS. Management of pruritus in chronic liver disease. Dermatol Res Pract. 2015;2015:295891. doi: 10.1155/2015/295891. Epub 2015 Mar 10. PMID: 25861254; PMCID: PMC4377431.
Last reviewed March 15, 2021

Breathing Trouble

What is breathing trouble?

Breathing trouble describes discomfort when breathing and feeling as though you can’t get an entire breath. The medical term for shortness of breath is ‘dyspnea.’ It can come on suddenly or over weeks to months. It may occur when walking, climbing stairs, running or sitting still.

Symptoms of shortness of breath

Symptoms of shortness of breath can include:

  • Feeling like you have to work hard to breathe
  • Pain, discomfort or tightness in the chest
  • Fast breathing, heartbeat or both
  • Wheezing
  • Cough
  • Feeling panicked or anxious
  • Feeling lightheaded or even passing out
  • Swelling (edema) of your feet and ankles
  • Feeling breathless in the sitting or standing position and better when lying flat
  • Fingers/feet/lips turning blue (called cyanosis)

What causes shortness of breath?

Heart and lung conditions are common causes of shortness of breath. Your heart and lungs move oxygen throughout your body and remove carbon dioxide. Breathing is regulated by the brain. It is an interaction between chemicals in the blood and in the air that we breathe.

People who have advanced liver disease can have complications that affect the heart and lungs. Breathing problems can occur because you can’t take as big a breath due to:

  • A build-up of fluid in the belly (ascites). This buildup of fluid can compress the lungs and make it difficult to breath or take in deep breaths. The best way to improve your breathing is to get rid of the fluid (paracentesis) and take all medications prescribed by your doctor to manage ascites.
  •  A build-up of fluid between the tissues that line the lung and chest (pleural effusion)
  • A large spleen and liver that pushes the diaphragm up.

Things you can try to prevent and control shortness of breath:

  • Pace yourself
  • Trying not to hold your breath
  • Sit in front of a fan so it blows on your face
  • Sit upright. Using pillows to support your back may help
  • Maintain humidity in your room
  • Sit near an open window
  • Try meditation, mindfulness, or relaxation therapy

What are some relaxation techniques?

Some of your healthcare providers may be able to teach you relaxation techniques or you can learn some on your own. Some techniques include:

  • Progressive muscle relaxation (focus on slowly tensing and then relaxing each muscle group)
  • Visualization (form mental images to take a visual journey to a peaceful, calming place or situation)
  • Music and art therapy

 

Breathing problems and liver disease

Breathing problems can also occur with liver disease from changes in the blood vessels and blood flow in the lungs.

One problem that can develop with liver disease is portal hypertension. Portal hypertension refers to increased pressure in the blood vessel that enters the liver.

Liver disease and portal hypertension can cause problems in the blood vessels of the lungs. One factor that causes problems in the blood vessels of the lungs is the damaged liver’s inability to remove harmful substances from your digestive tract before they enter the rest of your body. These toxins can damage blood vessels in your lungs leading to larger or more narrow vessels. Two different conditions can be seen in the lungs that arise from liver disease:

Hepatopulmonary syndrome

Hepatopulmonary syndrome is a condition where the blood vessels in your lungs become enlarged, leading to low oxygen levels. Symptoms of hepatopulmonary syndrome are mostly caused by low oxygen levels in the blood. You may find yourself experiencing the following signs or symptoms:

■ Becoming short of breath easily

■ Feeling breathless in the sitting or standing position

■ Fingers/feet/lips turning blue (called cyanosis)

Diagnosis

There are three basic features required to make a diagnosis of hepatopulmonary syndrome:

■ low blood oxygen levels

■ enlarged blood vessels in the lungs

■ liver disease

You must have all three features to be diagnosed with hepatopulmonary syndrome. Your healthcare provider will usually order a sample of blood from an artery (arterial blood gas) test to evaluate your blood oxygen levels. Your healthcare provider may also order tests to look for enlarged blood vessels in your lungs.

Treatment

The only definitive treatment for hepatopulmonary syndrome is liver transplant. When liver transplant is not an option, there are limited medical therapies available.

Portopulmonary hypertension

Portopulmonary hypertension is a condition where the blood vessels in your lungs become narrowed, leading to increased blood pressure in the vessels of the lungs which obstructs the flow of blood through the lungs.

Symptoms

You may find yourself experiencing the following signs or symptoms:

■ Becoming short of breath or tired easily

■ Chest pain, which can be mistaken for a heart attack

■ Feel your heart pounding or racing

■ Feel lightheaded or even pass out

■ Swelling (edema) of your feet and ankles.

Diagnosis

The diagnosis of portopulmonary hypertension is made when you have increased lung (pulmonary) pressure and liver disease.

Treatment

Treatment of portopulmonary hypertension depends on the condition of your liver. Therapies can include:

  • medical therapy to widen the pulmonary blood vessels
  • liver transplant

Appetite Loss

Appetite Loss

If you are experiencing appetite loss you may eat less than usual, not feel hungry at all, or feel full after eating only a small amount. Having no appetite can lead to serious complications. These include weight loss, not getting nutrients your body needs, fatigue, and weakness from muscle loss. For those suffering from chronic diseases like cirrhosis, these issues can slow recovery and a decreased quality of life. It is important to talk to your healthcare provider (doctor, nurse practitioner, etc)  if  you lose your appetite. They can help you with making sure you are getting the nutrition you need. Your healthcare provider may also refer you to a dietitian, who are experts in food and nutrition.

Causes of appetite loss

Many different things can cause appetite loss in a person with cirrhosis, including:

  • A change in your metabolism due to your illness, which can also be complicated by different treatments, also known as ‘cachexia.’
  • Changes in metabolism, which is your body’s process of breaking down food and turning it into energy. Such changes can happen with cirrhosis.
  • Ascites, or a buildup of fluid in the belly, which can cause swelling, discomfort, and a feeling of fullness
  • An enlarged liver, which pushes on the stomach and creates a feeling of fullness
  • Medications
  • Surgery or procedures on parts of the gastrointestinal system
  • Side effects of cirrhosis treatments

Managing appetite loss

If possible, the first step in treating appetite loss is to address the cause. Treatment for side effects of cirrhosis treatments such as nausea, pain, or depression may help improve appetite.

Although you may not feel like eating, remember that getting good nutrition and keeping a healthy weight are important parts of your recovery.

Consider the following tips for getting proper nutrition when your appetite is low:

  • Eat smaller, more frequent high calorie meals each day (every 3 -4 hours)
  • Try to not drink a lot of fluids when you are eating so there is more room for food.
  • Determine which times of day you are hungry and eat at those times
  • Eat nutritious snacks that are high in calories and protein. Examples include dried fruits, nuts and nut butters, yogurt, cheese, eggs, cereal, and protein or granola bars.
  • Ask family members or friends to get groceries and prepare food for you when you are too tired to shop or cook. Also consider ordering precooked meals from a meal preparation company, such as Meals on Wheels. Many grocery stores also offer pick-up or delivery services.
  • Try to eat in pleasant surroundings and with family or friends
  • If the smell or taste of food makes you nauseous, eat food that is cold or at room temperature. This will decrease its odor and reduce its taste.
  • Try to reduce your intake of drinks like coffee, tea and water as they can decrease your appetite and do not have much nutrition
  • Sometimes, your health care team may use different interventions including placing feeding tubes. There are different types, see: What to Expect in the ICU

 

 

Health Benefits & Medication Coverage

The provincial and territorial governments are the primary administrators of healthcare and health benefits in Canada. Indigenous Albertans who have treaty status (as defined by the Indian Act) are able to receive health benefits through the Non-Insured Health Benefits (NIHB) program, which is administered federally. All Alberta residents (≥ 3 months of residency) are provided with basic medical coverage under the Alberta Health Care Insurance Plan (AHCIP).

People able to access extended health benefits (drug coverage, dental, ambulance, and optical) through various sources, including employer health benefits, provincial benefits, and federal health benefits (Indigenous peoples with status). Some provincial programs are means-tested (AAHB, ACHB, AISH/IS health benefits), and others base eligibility on other circumstances (Palliative Coverage, Coverage for Seniors). Non-Group Coverage is available for any Alberta resident under age 65 who applies.

Alberta Drug Benefit List

If you receive health benefits coverage through a provincial program (i.e. AISH, Income Support, Seniors Benefits, AAHB/ACHB, Blue Cross Non-Group) you can check the Alberta Drug Benefit List to see if a specific drug/health product is covered.
The Health Benefits Exception Committee reviews requests for drugs, optical, dental, ambulance services or diabetic supplies that are not covered in the optical agreements, dental agreements or drug benefit lists (i.e. restricted benefit). To submit a request for an exception, complete the Request for a Health Benefit Exception form and follow the instructions contained in the form.

Health Benefits Exception Committee

If your request is for drugs or nutritional products that are not covered on the drug benefit lists, your doctor must provide a detailed medical rationale using the Request for Prescription Drugs and Nutritional Products form.

If your request is for optical services that are not covered in the optical agreements, please have your optical services provider (ophthalmologist, optometrist, or optician) complete the Request for Optical Services form.

Health Benefit and Medication Coverage Programs

Alberta Adult Health Benefit (AAHB)

Alberta Health administers AAHB; however, Community and Social Services process enrolment in the program. AAHB is intended as a support to Albertans in low income to ensure they have access to prescription drugs, dental services, optical services, emergency ambulance and diabetic supplies that are essential to health and well-being.

The AAHB program is provided as an extension of health benefits offered through the Community and Income Support and AISH programs, to assist eligible persons leaving the programs to maintain employment.

The AAHB is also available to women during pregnancy and to households with high ongoing prescription drug needs, if their household incomes are within the AAHB qualifying income levels.

AAHB is a means-tested benefit. Eligible applicants may be: pregnant; have high ongoing prescription drug needs; refugee or refugee claimants not otherwise receiving health benefits from any other source; or leaving the Income Support or AISH programs due to excess income. People who would ordinarily not qualify for AAHB based on income, but have high drugs needs may qualify (total annual income – annual drug cost = adjusted income). If you have dependant children under the age of 18 and are low-income, see: Alberta Child Health Benefit for information.

Please note: Eligible applicants must have an annual household I not above qualifying levels. You must have completed your income tax return for the most recent year before applying. If your current annual income is lower than your last reported annual income, contact the Health Benefits Contact Centre.

To apply for AAHB, complete an application, and submit to Health Benefits Contact Centre by fax or mail. For assistance in completing your application, have your physician refer you to a social worker, or contact Alberta Supports.

Important Links

AAHB (All Information) 

AAHB Application

AAHB (What’s Covered)

Alberta Child Health Benefit (ACHB)

The Alberta Child Health Benefit (ACHB) covers children’s health expenses for families with low incomes. This health plan is for children up to 18 years of age. Children who are 18 or 19 years old also qualify, if they are living at home and attending high school. ACHB is a means-tested benefit. The total combined household net income plus non- taxable child support income received must be equal to or less than the applicable qualifying income level.

Please note: To be eligible for the ACHB, you and members of your family must be a low-income resident of Alberta, with an annual income below current threshold levels. You must have a Notice of Assessment (NOA) for the most current tax year in order to apply. If your current annual income is lower than your NOA, contact the Health Benefits Contact Centre for an exception.

To apply for ACHB, complete an application, and submit to Health Benefits Contact Centre by fax or mail. For assistance in completing your application, have your physician refer you to a social worker, or contact Alberta Supports.

Important Links

ACHB (All Information)

ACHB Eligibility

ACHB Application

Alberta Works (i.e. AISH, Income Support)

AISH and Income Support (BFE and ETW subtypes) are eligible to receive similar health benefit coverage provided for by the Alberta Adult Health Benefit (AAHB) and Alberta Child Health Benefit (ACHB) programs. People applying for AISH and Income Support will receive a health benefits card automatically upon the approval of their application.

Recipients of One-Time (Emergency) benefits through Income Support are able to access funds for up to one month of prescription medication, along with other emergency expenses.

Call the 24-hour Emergency Income Support Contact Centre (available 24/7):
Toll free: 1-866-644-5135 TTY toll free: 1-800-232-7215 (ask to speak to Alberta Supports) Fax: 780-422-9681 Email: [email protected] (responses may take 1-3 business days)

Give your pharmacy fax number and contact information to the Alberta Works worker you speak to. The worker will provide your pharmacist with a code valid for 24 hours in order for your prescription to be covered under emergency benefits.

Non-Group Coverage (Alberta Blue Cross)

The Non-Group Coverage program ensures all Albertans have access to an economical supplementary health benefits program. The program provides coverage for a variety of health-related services not covered by the Alberta Health Care Insurance Plan (AHCIP).
Alberta Blue Cross administers Non-Group Coverage on behalf of the Alberta government.

A monthly premium is charged for Non-Group Coverage. If your household income is too high to qualify for AAHB/ACHB, but falls under this threshold, you may be eligible to receive a subsidized premium for Non-Group Coverage.

Please note: This program does not provide travel coverage. If you are planning to travel outside of the province or country, you should purchase travel insurance to cover emergency hospital and medical expenses.

A $50 annual deductible is applied to the total of all eligible health benefit expenses incurred in a benefit year, except for prescription drugs and diabetic supplies. The benefit year runs from July 1 to June 30. When no claim has been made for health benefits in a benefit year, any such expenses incurred during April, May or June that do not exceed $50 may be carried forward into the next benefit year and credited, in whole or in part, toward the deductible in that year.

For prescription drugs, the co-payment is 30% to a maximum of $25. A co-payment is the portion of the prescription cost you pay to your pharmacy when you have your prescription filled. For most prescriptions, you will not pay more than $25 for each prescription. Prescription drugs covered under the plan are listed in the Alberta Drug Benefit List.

Benefits include diabetic supplies, ambulance services, clinical psychological services, home nursing care, prosthetic and orthotic benefits, mastectomy prosthesis, and hospital accommodation (semi-private).

These benefits include an annual maximum, and are subject to a $50 annual deductible (total per annum). Prescription medications are not subject to this deductible (see above).

 

Important Links

Non-Group Coverage (All Information)

Eligibility for Monthly Premium Subsidy 

Non-Group Coverage Application

Coverage for Seniors (Alberta Blue Cross)

Seniors, their spouses/interdependent partners and dependants registered on the same Alberta Health Care Insurance Plan (AHCIP) account receive a premium-free benefit to provide coverage for prescriptions and other health-related services not covered under the AHCIP.

Alberta Blue Cross administers the Coverage for Seniors program and claims. AHCIP manages eligibility and registration.

Please note: This program does not provide travel coverage. If you are planning to travel outside of the province or country, you should purchase travel insurance to cover emergency hospital and medical expenses.

To be eligible for Coverage for Seniors, you must provide proof of being 65 years of age or older. When AHCIP records indicate an Albertan will be turning 65, a package is mailed to the address on their AHCIP file providing information about programs and services for seniors. This package will include a letter asking you to submit proof-of-age documents if required. If you did not receive the package, or have further questions, contact the AHCIP office.

If AHCIP have a proof-of-age document on your AHCIP file, Coverage for Seniors is automatically added to your AHCIP account. If you are unsure if you are already covered, call Health Link (811) with your AHCIP number ready to inquire.

If AHCIP does not have a proof-of-age document on your AHCIP file, you will need to submit a proof-of-age document and a completed Proof-of-Age Declaration form.

Acceptable proof-of-age documents include: birth certificate, old-age pension entitlement form, passport or immigration record, or Canadian citizenship certificate.
Take your proof-of-age document and declaration to an AHCIP authorized registry agent for processing. You can also mail the completed form and a copy (both sides) of the proof-of-age document to the AHCIP office.

Low-income seniors may qualify for additional funding for medical supplies and equipment through SNA-Seniors, including a portion of prescription drug co-payments.

Important Links

Coverage for Seniors (All Information)

Coverage for Seniors Benefit Information

 

Palliative Coverage (Alberta Blue Cross)

The Palliative Coverage Program provides subsidized benefits to Albertans who are diagnosed as palliative and remain in their home or in a hospice where access to publicly funded drugs, diabetic supplies, and ambulance services are not included.

Albertans who are palliative are provided access to supplementary health benefits that provide coverage for health-related services not covered by the Alberta Health Care Insurance Plan (AHCIP) through this program.

Alberta Blue Cross administers the Palliative Coverage program. There are no premiums to pay. The program is open to Albertans registered with the AHCIP and who have been diagnosed as being palliative.

Palliative refers to patients who have been diagnosed by a physician or nurse practitioner as being in the end stage of a terminal illness or disease. Patients are aware of their diagnosis and have made a voluntary informed decision related to resuscitation, and the focus of care is palliation and not treatment aimed at a cure.

Please note: The program excludes patients who live in residences that provide publicly funded drugs, diabetic supplies and ambulance service, including long-term care facilities, acute care hospitals, and psychiatric hospitals.

To apply for the Palliative Coverage Program, download and complete the application form. The application form must be completed and signed by both the affected patient, or guardian, and physician or nurse practitioner.

The patient or guardian will receive written notification from the Ministry of Health regarding acceptance into the program. Alberta Blue Cross will mail an ID card to the patient or guardian.

The physician or nurse practitioner determines the effective date of coverage. This date must not be more than 30 days prior to the date the program office receives the application. The coverage will continue if the patient is diagnosed as being palliative.
This program covers prescription medications, specific laxatives and solutions for hydration therapy are covered if listed in the Alberta Drug Benefit List or Palliative Care Drug Benefit Supplement. You will be responsible for 30% of the cost of the prescription to a maximum of $25 co-payment, and a lifetime maximum of $1,000.

Please note: You may be responsible for additional costs if: your drug is not listed in the Alberta Drug Benefit List; or you want a more expensive brand of drug than the lowest- cost option, maximum allowable cost product, or generic product; or the brand of drug you want costs more than the maximum amount set by the Alberta government for that drug.

 

Important Links

Palliative Coverage (All Information)

Palliative Coverage Application

How to Claim Benefits though Alberta Blue Cross

Non-Insured Health Benefits (NIHB)

The Non-Insured Health Benefits (NIHB) Program of the Department of Indigenous Services Canada provides eligible clients (persons with registered First Nations status and recognized Inuit) with coverage for a range of health benefits, including prescription drugs and over-the-counter medications, dental and vision care, medical supplies and equipment, mental health counselling, and transportation to access health services not available locally.

These benefits complement ACHIP coverage, which includes physician and hospital care, as well as other First Nations-oriented community programs and services. For low-income Albertans with First Nations status, you can access benefits not covered by NIHB through different provincial benefit programs (i.e. AISH, Income Support, AAHB). If you experience difficulty obtaining coverage due to the coordination of these benefits, ask a social worker to assist you.

Benefits include drugs, medical transportation, dental care, medical supplies and equipment, crisis intervention counselling and vision care.

If you require assistance with accessing benefits, have inquiries about coverage, or any other questions, contact your band worker or have a social worker assist you in contacting NIHB.

 

Important Links

NIHB Contact Information

NIHB Client Reimbursement Form

NIHB Eligibility

NIHB Guides

References:

The information on this page was adapted (with permission) from the references below, by the Cirrhosis Care Alberta project team (physicians, nurse practitioners, registered nurses, registered dietitians, physiotherapists, pharmacists, and patient advisors).

This information is not intended to replace advice from your healthcare team. They know your medical situation best. Always follow your healthcare team’s advice.

References: 

    1. US Department of Veterans Affairs, Veterans Health Administration 
    2. Canadian Liver Foundation
    3. Ministry of Community and Social Services Alberta 
    4. Department of Indigenous Services Canada 
Last reviewed March 15, 2021

Medication Safety

Most medicines are processed through the liver and kidneys. So, it’s important to think about safety when you are taking medicine, especially when you have liver or kidney disease.

Know the names of your medicines and what they are used for. Bring a list of them and the doses to appointments with your healthcare team. Without this information, it will be difficult and possibly even unsafe to make changes in your treatment.

Always take your medicine as prescribed and let your health care team know if you are taking over-the-counter or herbal medicines. If you are not sure if something is safe, please ask a member of your healthcare team, like your pharmacist.

Below you can find information for people with cirrhosis, on some common medications.

Non-steroidal Anti-inflammatory Drugs (NSAIDs)

Non-steroidal anti-inflammatory drugs (or NSAIDs) are medicines used to treat pain. Some examples of NSAIDs are ibuprofen, Motrin, Advil, Naproxen and Aleve. You should avoid NSAIDs if you have cirrhosis, especially if you have problems with ascites or fluid build-up. They can cause serious problems with your kidneys and increase your risk of bleeding.

Acetaminophen (Tylenol®)

If you have cirrhosis, you may have been told not to take acetaminophen. But, you actually can as long as you keep the dose to less than 2000 milligrams a day and don’t drink alcohol. You can take up to 4 extra strength acetaminophen in a day, as long as they only have 500mg in each pill. You should always read the medicine label. If you follow these guidelines, acetaminophen is actually safer than most other pain medicines.

Opioids

Narcotics and opioids are usually used to treat pain. Some examples are codeine, morphine and fentanyl. Taking these medicines when you have cirrhosis is complicated, and can be dangerous, and it’s best to avoid them.

Sedatives

Benzodiazepines are a type of medicine used to treat anxiety. Some examples are Ativan or valium. They can make you feel really sleepy if you have cirrhosis. It’s best to avoid them or take them as little as possible. Even over-the-counter medicines like Benadryl, which is used for itching and allergies, or Gravol, for nausea, can cause too much sleepiness. If you need to take these medicines, try taking a lower dose for a limited period of time.

Cold and Flu Medications

Many over the counter medicines for colds and flus contain more than one drug. Some contain NSAIDs, which you shouldn’t take. Others have decongestants and antihistamines that can make you drowsy. Remember to read medication labels so you know what’s in them before you take them.

Herbal Medicines

The small amounts of herbs used in cooking don’t usually cause health problems. But, herbal medicines can be risky, because they contain more concentrated and larger amounts of herbs.

Milk thistle is a common herbal medicine that people with liver disease might be interested in. Studies haven’t proved that it helps the liver, but it’s generally considered safe, although it can have side effects like diarrhea and bloating.

Remember that just because something is “natural” doesn’t mean it’s safe. Most herbal medicines have not been studied in people with cirrhosis, and some have been found to be toxic for the liver.  Also, herbal medicines can interact with other medications you’re taking.

References:

The information on this page was adapted (with permission) from the references below, by the Cirrhosis Care Alberta project team (physicians, nurse practitioners, registered nurses, registered dietitians, physiotherapists, pharmacists, and patient advisors).

This information is not intended to replace advice from your healthcare team. They know your medical situation best. Always follow your healthcare team’s advice.

References: 

  1. US Department of Veterans Affairs, Veterans Health Administration 
  2. Canadian Liver Foundation
Last reviewed March 15, 2021

Alcohol

Anyone with liver disease should NOT drink alcohol. 

Alcohol affects everyone. When a person has a drink, the alcohol is absorbed through the wall of the stomach and intestine into the bloodstream, where it is sent throughout the body. Alcohol affects the brain, heart, muscles and other tissues of the body.

Age, gender, body weight, and genetic factors can all affect the way alcohol is processed by the body. For example, women absorb more alcohol from each drink than men do and tend to be more susceptible to alcohol-related liver damage.

The liver filters and processes everything a person ingests, including alcohol. If the liver is damaged, even small amounts of alcohol can make things worse.

Finding it hard to avoid alcohol?

Cutting down or stopping drinking may be difficult at times. Most people do not cut down or give it up all at once. Just like going on a diet, it is not easy. That’s OK. If you don’t reach your goal the first time, try again. Get support from people who care about you and want to help. Don’t give up!

Drinking Diary 

To keep track of how much you drink, use a drinking diary. Record the number of drinks you have each day. At the end of the month, add up the number of drinks you had each week.

Change Plan

One way to make any kind of change in your behavior is to come up with achange plan.” This exercise has you list the specific goals you would like to achieve, outline the steps and challenges you will meet in reaching those goals, and figure out ways to overcome those challenges.

Helpful Tips
  • Keep no alcohol, or only a small amount at home.
  • If you drink, sip your drink slowly. Take a break of 1 hour between drinks. Drink water or non-alcoholic drinks after a drink with alcohol. Do not drink on an empty stomach! Eat food when you are drinking.
  • If you drink, pick a day or two each week when you will not drink at all. Then, try to stop drinking for 1 week. Think about how you feel physically and emotionally on these days. When you succeed and feel better, you may find it easier to cut down for good.
  • You do not have to drink when other people drink. You do not have to take a drink that is given to you. Practice ways to say no politely. For example, you can tell people you feel better when you drink less. Stay away from people who give you a hard time about not drinking.
  • Watch out for people, places, or times that make you want to drink, even if you do not want to.
  • Stay away from people who drink a lot and avoid bars where you used to go.
  • Plan ahead of time what you will do to avoid drinking when you are tempted.
  • Don’t drink when you are angry or upset or have a bad day. These are habits you need to break if you want to drink less.
  • What would you do instead of drinking? Use the time and money spent on drinking to do something fun with your family or friends. Go out to eat, see a movie, or go for a walk.

References:

The information on this page was adapted (with permission) from the references below, by the Cirrhosis Care Alberta project team (physicians, nurse practitioners, registered nurses, registered dietitians, physiotherapists, pharmacists, and patient advisors).

This information is not intended to replace advice from your healthcare team. They know your medical situation best. Always follow your healthcare team’s advice.

References: 

  1. US Department of Veterans Affairs, Veterans Health Administration 
  2. Canadian Liver Foundation
Last reviewed March 15, 2021