Wednesday, January 14, 2009

Cirrhosis Confirmed

Yesterday was a long day of medical tests and appointments. I started out at the BMT lab at 8am with blood tests and an antibiotic IV of Ceftriaxone, prior to my scheduled endoscopy (EGD) at 9am. My wife had dropped me off at 7:30 am, since I could not drive my self after the EGD. There was a lot of delay and the EGD did not start until about 11:30. Even before they would start they needed to confirm with a family member who would pick me up afterwards. Since I was supposed to see the liver specialist at 11am that was delayed as well.

Anyway the actual endoscopy went ok. The Dr strapped a mouth guard around my head while the nurse administered a sedative through my IV. Before I knew it, I was recovering with a minor throat irritation. The report of the exam highlighted some recent bleeding at the pylorus, between the stomach and duodenum and a hiatus hernia, though neither appeared serious. Some biopsy samples were taken, but need to be tested.

After the EGD, they pushed me in a wheelchair over to the liver Dr at about 12:30. I then saw my BMT Dr at about 3pm. Everyone seemed to be running late, but I got through it all. By the time my son got me home at 4pm, I was hungry and needed to catch up on all my pills.

Because of the bleeding and hernia, I have stopped taking blood thinners (Coumadin and Lovenox) and will double my dose of Protonix for acid reflux. Recent blood tests had indicated that my original blood clotting problems had been "cured" by the BMT anyway.

The most concerting prognosis from the liver biopsy last week was that there is scarring or cirrhosis of the liver most likely due to the iron buildup discovered before or a complication of the GvHD. The analysis of the Ascites fluid showed no infections or evidence of any tumors. Changes in treatment include a new medicine, Spironolactone, to help reduce the fluid retention and stopping of potassium which is not needed with this mew med. We will see if the Ascites returns and if I need additional drainage of the fluid. Since my blood counts are good again, I will restart the phlebotomies tomorrow and continue every two weeks, possibly for another 3 years. My next appoinments with my BMT and liver Drs is scheduled for Feb 10.

Wednesday, January 07, 2009

Liver Biopsy

I had my liver biopsy today as well as paracentesis to relieve the fluid buildup. I started out with a BMT Clinic appointment where I also brought in a 24 hour urine sample that the lab will test. My regular blood counts were normal with my hemoglobin now back up to 14.4. The Dr thought he heard some irregular heart beat and ordered an immediate EKG, but no problems were found. They also monitored my EKG during the biopsy.

It took a total of 5 hours for the procedures including 2 hrs of prep and 2 hrs of monitoring afterward. It was really nothing to fear compared to the many bone marrow biopsies that I have had. They started with a quick ultrasound to decide where to poke the needles and selected both on the right side (where the liver is of course). They drained off 4 liters of fluid which weighs about 8 pounds before getting a couple of liver samples. I had a couple local lidocaine injections to numb the areas where the needles were inserted and had some other IV sedative for the biopsy itself. But I was able to see the needles on the ultrasound screen during the action and mostly felt the one as it entered the liver.

Because of the sedative, my daughter drove me to the appointment and my son picked me up. I am feeling much lighter, easier to breathe and generally a whole lot more comforttable. Hopefully, the other fluid in my legs and around my lungs will also dissapate as well. I should learn more about the testing of the fluid and liver samples next week.