Bob Massie

I haven’t written for two months because we have been involved in a long series of tests – a kind of slow motion medical detective story – to get to the bottom of why some of my numbers had deteriorated and others had not improved as rapidly as doctors had hoped.   I have been in and out of the hospital for various procedures – and a few dozen blood draws — that didn’t seem worth writing about until I had something solid to report.

First, the good news.  Many of the numbers have improved.   My bilirubin (the stuff that makes your skin yellow) has dropped from an alarming 15 down to a much more acceptable range of 3, and as a result I no longer have the slightly yellowish-gray tinge of many liver patients.   Also, the other numbers that indicate the likelihood of rejection of the liver have been in good shape, as have my kidney functions.

One number – the measurement for alkaline phosphatase – was unusually high.  Alkaline phosphatase is an enzyme made in the liver; when its levels rise that can be an indication that something – a bile duct, a vein – is blocked, resulting in unacceptable stress on and possible damage to the liver.

After reviewing these findings, the doctors at Mass General ordered a liver biopsy.   This is where you are admitted to the hospital for a day; they locate your liver through your abdomen with ultrasound; numb your skin with Lidocaine; and insert a long, thin needle between your ribs into your abdominal cavity and then straight into the liver.   The needle has a small capture device on the end which snatches a little sliver of liver tissue – a core sample the size of a tiny worm.   I had this done a month or so ago.

The two results from this test showed something strange.  The first sample showed that the liver was under general stress from the hepatitis, but nothing too worrisome.  The second sample, however, seemed to confirm the hypothesis of a blockage of some kind.

Now, with this new information, they ordered another test – this time a detailed study of the veins and arteries in my liver through an MRI.  So back I went to the hospital to be loaded like a torpedo down a submarine tube for an hour or two.   I have done this enough times so that I have developed a bit of claustrophobia, for which I take a mild sedative.   It doesn’t help the sense of confinement that the MRI test is very loud; you are not just in a torpedo tube, but a tube on which it sounds like people are pounding with variously sized sledge hammers.

The results of that test showed what the doctors had suspected: there was a constriction in my right hepatic vein which was probably causing a number of symptoms including the residual swelling of the abdomen (ascites) and the elevated alkaline phosphatase.  The extraordinary detective work by Dr. Chung, Dr. Mazhar, and their colleagues had been confirmed.

But what to do about it?  The answer came after another two week interval, when I went in to the hospital last week for a three day, two night stay.    The solution suggested by Mass General and supported by Emory was to do an angioplasty of the liver.   This means putting me under conscious sedation, inserting a catheter through my jugular vein and down through my neck and body into my liver, measuring the difference in pressure on the two sides of the constricted site, and then using a small balloon to stretch the restriction to a wider diameter, thus allowing more blood to flow through.

I had that procedure done on Thursday, December 3.   It was scheduled for 11:00 AM and took place at 5:00, a fairly long delay given that I had not been allowed to eat or drink anything since the night before.   As usual, I required a bit more sedation than usual because the first few doses made me more talkative rather than less.   The doctors, using a phalanx of flat screen TVs, a hovering X-ray machine, and carefully timed contrast solution, were able to thread the balloon right through the center of constriction.   When they started, the pressure in my heart was 7 and the pressure in my liver was 14, a “gradient” of 7.   After they had stretched out the restriction (twice), the gradient had been reduced to 2-3.   Thus, in theory, more blood could now escape from the liver, lowering the pressure inside the organ and helping me along.

I say, “in theory” because we won’t know until we see what happens to the various blood levels.   The widened restriction should remain open – it is not particularly elastic and when stretched, it stays stretched (like leather).   I should start feeling somewhat better.

But given that I am literally on 20 medications – some to prevent infection and rejection, some to address the side effects of the other medications – I am still not completely at the top of my game.   It doesn’t help that we are skidding into winter and that I have picked up a couple of sniffling colds here and there.

However, it is still true that as I approach the five month anniversary of the transplant (on Thursday the 10^th), I am continuing to improve slowly each week, and for that I am grateful.