meeting with docs today

NJC said:

Renee,

You, nor his doctors should be throwing in the towel just yet! My wife was in a very similar situation last January after her Isolated Liver Perfusion. Her liver essentially shut down for a few weeks, and her bili was about as high as Carl's. I'm not going to lie to you, but this is a very critical time for him. This is when the experience of his surgical team is going to make or break the situation. I'm assuming they've been giving him FFP, blood, etc. You have to look at more than the bili number because it is the last number to stabilize and start its way back to normal. The most important numbers to show how his liver is functioning are his liver numbers: ALT, AST, INR, PT/PTT, H&H, etc. if those numbers have started to stabilize, or are still elevating but at a decreased rate then hope is not lost. Even if they haven't, his liver may just need a bit more time to recover, and it's important for them to continue supporting his liver with fluids.

My hope is you are at a major teaching facility, rather than a smaller hospital.

Stay strong and keep after his doctors to support his liver properly.

Best of luck,

-Joe

NJC said:

He's doing ok. The only real
He's doing ok. The only real number severly out of whack is his bili which can be caused by a bunch of things, such as inflammation, slower than normal bili excretion from the liver into the intestines, etc. However, with the AST only being slightly elevated I can't see inflammation being a major contributor of his bili still climbing. However, the AlkPhos number would give a good indication of the liver's ability to excrete bilirubin. His Albumin is decreasing because I'm sure he's been soley on fluids, and his INR is only slightly elevated. You can't just look at one number and say, "OMG!" You have to take a look at all of his numbers and have a pretty good understaning as to what they mean and how they relate. I am not a MD, however, I was in the process of trying to go to MED School prior to my wife getting sick. So, I delved into my Med School Systemic Pathology book and read, and read, and read, and was able to apply my background to help keep track of my wife's care.

My wife's AST and ALT were near 2,000. Her INR - ability to clot - was in the high 3's. Her bilirubin peaked around 29 and her blood counts (hemoglobin and hematocrit (HH))I don't recall exactly, but they were concerning. As long as he is managed properly he should come out of it ok. The problem now is trying to manage him while walking that fine line. They have to let his liver try to recover, but they can't keep pumping him full of fluids because of potential kidney and respiratory issues that may arise for doing so. I'd ask the Critical Care doctor to hang some Albumin. They may not want to but you can certainly ask. It may help with his blood pressure, as I'm sure it's been low, thus the fainting spells. However, it's another fluid but I'd certainly ask. All they can say is, "No."

It's going to be a bit longer but I think he's going to be ok! Also, another number to look at are his platelet counts. I'm sure they're low but again, if he's being managed properly and his body can continue to fight he'll be ok.

Best,

-Joe

annalexandria said:

SSD
Just wanted to let you know that the application process is pretty simple, and if you have metastatic disease, you go the head of the line, so to speak. I applied for it last August and was approved by early November. They did both a monthly payment and a year's worth of back pay, so it helped quite a bit. Sending strength and hope your way-Ann