00:00
Now, let's look at our
lifetime treatment goals
because remember the prognosis
for this is very good
if you get treatment.
00:06
So we've got two goals.
00:08
Get rid of the copper that's
accumulated and the second,
stop you from accumulating
more copper in the future.
00:15
That's it.
00:16
That's what we have to do.
00:18
Remove the copper
that's accumulated
and then prevent copper
from accumulating.
00:23
So you see why early diagnosis
is life-changing for people
and that's our role as nurses,
we're part of the team that
puts that all together.
00:33
Now, you might be interested in
how do we get rid of the copper
that's accumulated. Right?
That seems kind of weird.
00:39
Well, we use these
drugs called chelator.
00:42
Now chelator are chemical compounds
and they react with metal ions,
and then they make a stable
water soluble complex.
00:51
I'm sorry,
but I just think that is so cool.
00:54
You can give them these drugs
it reacts with metal ions,
and now it's stable
and its water soluble.
01:01
Well now that its water
soluble I can just simply what?
Pee it out.
01:06
That is the bomb.
01:08
You got a body full of copper.
01:10
We give you these medications,
they combined,
now it becomes water soluble and
you wash that extra copper
right out of their body.
01:19
Now some examples
are D-penicillamine
or the secondary
one is trientine.
01:25
Don't really worry about
the names right now.
01:28
There's a lot of other
drugs you have to know
but you do need to know
what a chelator is,
that chemical compound it
reacts with metal ions,
if forms stable,
that's important,
so it'll stick around long
enough that you can pee it out
in a water-soluble complex.
01:45
So how do we get rid of
the copper that they have?
You give them the
chelator drugs.
01:50
Now, how do we stop future
copper accumulation?
Will we continue to
give them chelator
but at one-third of the dose we
gave them on the initial round.
02:00
We keep the standing chelator for
the rest of their life because
those pathways don't
start working again.
02:05
They just don't
instantly redevelop.
02:08
So they're going to need chelator
for the rest of their life.
02:10
They can also take zinc salts
and zinc salts will prevent their
bodies from absorbing copper.
02:17
The last part is
everyone's least favorite.
02:21
They can maintain
a low copper diet.
02:25
Well, I'm going to introduce
you to the food that have copper
but anytime you start
messing with people diet,
it is real personal, right?
You're getting up
in their business.
02:36
So that takes a lot of patient.
02:39
I mean you being patient
that takes you being very
patient with your clients
and helping them understand
what these foods are
and helping them find
recipes and ideas
and how they can still
eat foods they enjoy
and limit themselves in the
copper that they take in.
02:57
Why do we do all this?
Because if we can help them
stick to in a treatment plan,
they have an
excellent prognosis.
03:04
Without treatment it's fatal,
Wilson's disease is fatal.
03:08
Most of the patients
would die from cirrhosis
or acute liver failure if
they didn't receive treatment,
so that's why you and I can make a
phenomenal difference in patients life
as we talk to them,
as we gather information,
and then as we help them follow
the best treatment
in their daily life.
03:28
So here we go,
we're getting personal.
03:30
These are foods that
are high in Copper
and you'll see them
appear on your screen.
03:35
Shellfish,
nuts,
Say it isn't so chocolate,
mushrooms and organ meats.
03:47
Now that's a pretty wide range.
03:49
So we're going to have to
walk them through this.
03:53
I would collaborate
with a dietitian
and we've got several meal
plans out there for patients
but work together with the team
to help a patient stick
to this low copper diet
because in the beginning
it's extremely restrictive
like zero, none of this.
04:10
Then as it's gotten
under control,
we can gradually We
add levels of copper
that are acceptable to that
patients copper levels.
04:18
So when you're first diagnosed with
Wilson's, it's a super strict diet.
04:22
There's just no
margin for error.
04:24
Afterwards, chelator have kicked
in, we've got things under control,
then you'll work with the
physician and the dietitian
to find out what's the appropriate
level of foods with copper
for each individual patient.
04:36
Now I don't even like
talking about this
but this is the
worst case scenario.
04:40
If we weren't able to get
treatment to them quick enough
and they end up needing
a liver transplant.
04:45
Because if we weren't able
to address the liver failure
didn't respond to
the drug therapy.
04:51
They may need to have
just the organ replaced.
04:54
So during that time while
they're waiting for an organ,
they might have plasmapheresis,
they might have an
exchange transfusion,
try and filter that
blood or dialysis.
05:04
We're just trying to do everything we
can to bring that copper level down
while they're waiting
for an organ transplant.
05:11
Now the good news.
05:12
This is kind of a dark scenario,
but this is a good news
if they are able to get a
transplant then they don't need
any further treatment
for Wilson's disease.
05:21
Now I'll have to stay on
immunosuppressive treatment for the liver,
but they don't need any more
treatment for Wilson's disease.
05:27
So that's a bright spot in
a pretty tough solution.