Hungry!

Once again, one of my pictures was creating consternation on my blog, so I had to remove it and now all is well. I have been at the hospital all day waiting for Nick to go for a liver biopsy. Nick was not able to eat anything all night and he did not get called for the test until 4:00PM! All those good eating hours wasted!!! Last night, I was sort of bummed out so I was not up to posting much, but, today I feel better so I will give everyone an update on the latest developments to Nick's never ending story!

First of all, the discharge discussions have been table for the moment. Several medical issues have come up that need to be addressed before Nick can head out the door.

The first is the air in his chest (aka - the pneumomediastinum). The chest CT scan from yesterday did show that the amount of air has gone down, but, the air is still there. Nick continues on the 100% NRB mask to try to force the air to absorb into the tissues (a long gas exchange story that I don't want to explain, nor do I fully understand). The doctors are still looking for the cause of this air. A test was done to check for what is called a tracheo-esophageal fistula. The test was negative, but, I later found out that this test is only able to detect holes greater than or equal to 1cm. That is an awfully big hole! I really don't think Nick has this TEF thingy as he has no other symptoms. However, considering the radiation he received I can imagine that he would be a risk for such a hole.

The second major issue is the continued elevation of Nick's liver enzymes. Despite stopping most of the drugs that could hurt his liver and stopping the IV food, Nick's liver apparently is not happy and wants to crash the GVH party. The doctors are not sure if Nick has GVH of the liver, but, the levels are concerning everyone. Nick is on his immunosuppressant medication called, Prograf, and mega doses of steroids and yet, these levels remain high. At this point, any GVH that Nick has is considered to be chronic GVH based on the number of days post-transplant.
The doctors ordered a LIVER BIOPSY to confirm that it is GVH. If it is GVH, additional medications may have to be added to get the liver enzymes to come down. They do not want to put Nick on these extra meds unless it is confirmed that he has liver GVH. These immunosuppressant meds have so many other side effects, they only want to use them if necessary. If it is NOT GVH, then the doctors will have to figure out what is the cause of this problem.

Nick was wheeled by stretcher to the interventional radiology department. There he had to have his neck numbed up and he also got some sleepy meds in his IV. They then take a big needle and put it in Nick's jugular vein, I will spare you further detail, but, they must thread this catheter down through Nick's vein to get to his liver. Then they put some kind of "grabber" thing down there to pinch off the biopsies of the liver tissues. The biggest risk is bleeding, followed by infection. Nick had to get platelets this morning to bump up his platelet counts for the procedure. He sailed through the procedure (thank goodness, I was worried....surprise!) and now has a new "hole" to add to his collection. I am not sure when we will have the results, but, I am sure it won't be tonight as all the doctors are gone now.

Since Nick's return to his room, he is awake and ready to eat! He ordered himself some dinner and ate heartily! If things go well, we are still hoping that Nick may be able to come home next week sometime. I have been slowly taking things from his room to minimize the load on the actual discharge day. Please keep Nick in your prayers. He is getting stronger. His appetite is improving. His body is fighting the consequences of this cure and most importantly his spirit remains indomitable and unbroken! "Man never made any material as resilient as the human spirit." ~Bern Williams