She had no mental breakdown – her liver was failing


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Landree Sarata believed her declining brain function was a symptom of mental illness. Then she learned that she was suffering from advanced liver disease. Getty Images
  • Hepatic encephalopathy (HE), a disease that causes temporary worsening of brain function in advanced liver disease, is on the increase in young women.
  • This happens when the liver can no longer remove toxins from the blood, resulting in these toxins affecting the brain.
  • Medication as well as lifestyle modifications, such as diet and exercise, can help with HE.

In 2015, Landree Sarata found herself driving to McDonald’s shopping for food for her imaginary car mates. She then drove her “friends” for 3 hours to the Detroit airport.

While it might appear that Sarata was developing a mental disorder, it was actually her failing liver causing neurological symptoms.

“Most people don’t associate brain function with liver function” Dr Howard Franklin, vice president of medical affairs at Pharmaceuticals Salix, Healthline said. “The normal function of the liver is to filter the blood and take toxins that enter the bloodstream through the intestinal tract and eliminate them.”

When liver function is compromised, Franklin says the liver can no longer remove toxins from the blood, and toxins that enter the bloodstream are harmful to the brain.

Turns out that’s what Sarata was going through. However, she only learned of her condition after undergoing surgery.

“I went to have my gallbladder removed, but they couldn’t do the operation because my liver was so bad,” she told Healthline.

After undergoing several tests, Sarata, who was 31 at the time, was diagnosed with cirrhosis and hepatic encephalopathy (HE), a disease that causes temporary worsening of brain function in advanced liver disease.

While her cirrhosis was caused by drinking alcohol, Sarata says she was a social drinker.

“My body just couldn’t take what I put in it. I was someone who had shingles all the time, hives because my immune system was [weak], hypothyroidism, Hashimoto… so when I put alcohol in my body, not even in excess, it reacted so badly that all of a sudden, almost overnight, I got so sick ”Sarata said.

His condition was also unusual for his doctors.

“It was surprising that Landree had this because she is a dynamic young woman. Most people historically associate this type of condition with the elderly, but that is not true and that is changing, ”Franklin said.

He says that over the past 4 or 5 years, there has been a 27 percent increase in the number of young women who have ET.

Dr Jasmohan Bajaj, professor at Virginia Commonwealth University says that HE is an epidemic of cirrhosis and a disease that affects the whole family.

“It cuts across all social strata and tests the physical, financial and emotional health of the patient and their caregivers,” Bajaj told Healthline. “Underlying the development of HE is the development of cirrhosis, which is often caused by alcohol use disorder and obesity. Both of these issues are on the rise in the United States, especially among young people, and are a major challenge that we all need to work on.

Prior to her diagnosis, Sarata felt lethargic, bloated, started to gain weight, and became forgetful, all of which worsened over a period of 3 years after her diagnosis.

Bajaj says HE can cause a range of changes in brain function ranging from a subclinical feeling of “slowing down” to coma.

“All of these steps have their own challenges. Secretive HE can often be experienced by patients as a sensation of slowing down in general and particularly during work and driving and changes in sleep patterns. The overt episodes often present with confusion, not knowing where one is or done and changes in personality, ”Bajaj told Healthline.

Sarata’s symptoms affected her to the point that she could no longer work at her job as a medical representative.

“I couldn’t be responsible enough to get to where I was going. I had to drive a lot, but I got lost all the time. I’ve had a lot of cases where I was supposed to be in a doctor’s office in one city and went to another city instead, ”she said.

Her social life and relationships were also impacted.

The most heartbreaking incident she remembers is her mother being kicked out of her house because she believed she was an intruder posing as her mother.

“When you have an illness like this you can hallucinate and you can’t remember who people are. My mom didn’t know what was going on and neither did I. It was the lowest. I was ashamed because you don’t pass out with the HE attacks, so you relive every moment of what you did, and it’s tormenting because you’re so irrelevant, ”Sarata said.

The fear of interacting caused her to suffer from social anxiety.

“I was paranoid about what was going to happen. I felt isolated and alone because I was dealing with a decaying liver, gallstones and gastroparesis, and then I was also stuck in a mental prison because I couldn’t tell or explain to anyone what I was doing. felt, ”Sarata said.

After the diagnosis, she ended up in the emergency room every month and at one point was in a coma for 13 days with uncontrolled ET.

“My ex-husband found me on the floor foaming in my mouth,” she said.

However, it wasn’t until she suffered internal bleeding that she finally received a drug that controlled her ET.

“I was demobilized [from the hospital and] a case manager came. She asked to see my medication list and she found a missing medication that ended up changing my life, ”Sarata said.

Bajaj says treatment depends on the stage of HE.

Stage 1 is subclinical or covert HE, in which the goal is to improve daily function. Stage 2 corresponds to acute episodes of overt HE, where the goal is to become alert again and to be discharged from the hospital. The last step is to prevent the recurrence of episodes of HE.

“There are treatments available that work on the gut microbiome, such as lactulose and rifaximin, that can be used for this. During the acute phase, the triggers of HE must [be] studied and treated and during recurrence prevention we need to focus on medication adherence and determine if liver transplant is an option, ”Bajaj said.

In addition to medications, Franklin says lifestyle changes, such as diet, exercise, and moderation of fluid intake can also help.

“Once treated, you can maintain a normal lifestyle and delay the symptoms, but it is rare that once the liver becomes cirrhotic it will return to a normal state, so you will still continue with therapy or treatment. other medical care once diagnosed, ”Franklin says.

However, he adds that proper medical care can make all the difference.

“If you look at someone like Landree who was very sick… if you met her on the street today, you wouldn’t know she has liver complications, especially ET. She’s alert, she’s awake, she’s oriented, she’s in conversation – all because she’s under optimized medical treatment, ”he said.

Today Sarata is taking 20 pills a day and her ET is under control. She says she can tell when an HE attack is in progress.

“My legs are weakening and my eyesight is wavering. I can now be reconciled when the HE attacks start, ”she said.

Now that she is feeling better, it is difficult for her to think of the 3 years that she struggled to find treatment.

“I couldn’t be there anymore. I was suicidal, helpless and desperate. When I was diagnosed my prognosis was 3-5 years. Now that I have the right medicine and can live a life again, it’s great to know that no matter what happens to my body in the future with cirrhosis, I know that I will always be clear in it. head and mentally stable to manage. that, ”Sarata said.

She hopes to spend the rest of her life raising awareness about cirrhosis.

“There is a stigma around cirrhosis; everyone thinks you are an alcoholic, but that is not the truth. There are several types of cirrhosis. The more I can tell my story, the more people I can reach and inspire for the best results, ”she said.

Cathy Cassata is a freelance writer specializing in health, mental health and human behavior stories. She has a knack for writing with emotion and connecting with readers in insightful and engaging ways. Read more of his work here.


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